ABSTRACT
OBJECTIVE: To determine the case fatality rate and factors for death in community acquired pneumonia among children aged 1 month to 59 months admitted in a referral Hospital. DESIGN: Hospital based retrospective study. SETTING: Institute of Child Health and Hospital for Children, Chennai. PATIENTS: Case records of children aged 1 month to 59 months of age with pneumonia (clinically diagnosed pneumonia, radiologically diagnosed pneumonia, and clinically and radiologically diagnosed pneumonia), from January 2006 to December 2008. Outcome measures Case fatality rate (CFR) was calculated. Risk factors for mortality analyzed were young age of 1 to 6 months old, female sex, wheeze, respiratory rate >70/min, chest indrawing, altered level of consciousness, convulsions, shock, associated heart disease, recent measles, weight for age <-2 Z score and need for assisted ventilation. The association of risk factors to mortality was arrived at for all three categories of pneumonia cases separately. RESULTS: Case fatality rate was 8.2% (95% CI: 7.37- 8.99%). There was no significant difference in the CFR among the three study groups. Need for assisted ventilation alone was found to be an independent risk factor for mortality in children with pneumonia among all the study groups. Other risk factors like young age, weight for age <-2 Z score, altered level of consciousness, and congenital heart disease were also observed among these groups. CONCLUSION: Among 1 month to 59 months old hospitalized children with pneumonia, CFR was 8.2%. Need for assisted ventilation was a significant risk factor associated with mortality.
Subject(s)
Community-Acquired Infections/mortality , Pneumonia, Bacterial/mortality , Child, Preschool , Community-Acquired Infections/diagnosis , Community-Acquired Infections/physiopathology , Female , Hospitalization , Humans , India/epidemiology , Infant , Male , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/physiopathology , Referral and Consultation , Risk Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To study the clinical profile and outcome of scrub typhus cases admitted in an urban referral centre. METHODS: This descriptive study describes the clinical profile of 67 children with scrub typhus, who were admitted in an urban referral centre(ICH & HC,Chennai) during the period between October 2010 and March 2011.The diagnosis was confirmed by IgM ELISA. RESULTS: All children presented with fever. Eschar and rash were present in 46% and 35% cases, respectively. Cough, vomiting, altered sensorium and oliguria were present in 73%,59%,58% and 43%, respectively. Hepatosplenomegaly and pallor were the commonest findings encountered in more than 80% children. Other findings were edema, lymphadenopathy and icterus.Thrombocytopenia, elevated liver enzymes and leukocytosis were seen in 77%, 64% and 49% cases, respectively. Pleural effusion, ascites, shock and respiratory failure were seen in 61%, 47%,45%,34% cases, respectively. Acute renal failure, hepatic failure, multiorgan dysfunction syndrome (MODS), meningoencephalitis and acute respiratory distress syndrome(ARDS) were seen in 10%,10%,7%,6% and 4% cases, respectively. Doxycycline and azithromycin were the antibiotics used. The overall mortality rate was 11.94%. Causes of death were shock, ARDS, acute renal failure(ARF), MODS and disseminated intravascular coagulation(DIVC). CONCLUSIONS: When a child presents with acute febrile illness, maculopapular or erythematous rash, hepatosplenomegaly, lymphadenopathy, thrombocytopenia and features suggestive of capillary leak, diagnosis of Scrub typhus must be considered and the child should be started on empirical therapy with doxycycline or azithromycin which is life saving.
