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Background Microbiological diagnosis of pediatric tuberculosis (TB) using conventional microbiological techniques has been challenging due to paucibacillary nature of the disease. Molecular methods using cartridge-based tests like Xpert, have immensely improved diagnosis. A novel next-generation cartridge test, Xpert Ultra, incorporates two additional molecular targets and claims to have much lower detection limit. We attempted to compare the two techniques in presumptive pediatric TB patients. Objectives The aim of this study was to compare the diagnostic performance of Xpert MTB/Rif Ultra with Xpert MTB/Rif for the detection of pediatric TB. Study design This is an observational comparative analytical study. Methods Children under 15 years of age with presumptive TB were enrolled. Appropriate specimens were obtained (sputum, induced sputum or gastric aspirate for suspected pulmonary TB, cerebrospinal fluid for suspected tubercular meningitis and pleural fluid for suspected tubercular pleural effusion), subjected to smear microscopy, mycobacterial culture, Xpert and Xpert ultra tests and other appropriate diagnostic investigations. Results Out of 130 enrolled patients, 70 were diagnosed with TB using a composite reference standard (CRS). The overall sensitivity of Xpert was 64.29% [95% confidence interval (CI) 51.93–75.93%] and that of Xpert Ultra was 80% (95% CI 68.73–88.61%) with 100% overall specificity for both. The sensitivity of Xpert and Xpert Ultra in pulmonary specimens (n  = 112) was 66.67% and 79.37% and in extrapulmonary specimens (n  = 18) was 42.86% and 85.71%, respectively. Conclusion Our study found Ultra to be more sensitive than Xpert for the detection of Mycobacterium tuberculosis in children. Our findings support the use of Xpert Ultra as initial rapid molecular diagnostic test in children under evaluation for TB. [ABSTRACT FROM AUTHOR]

Introduction: Background: Acute febrile thrombocytopenia is a commonly encountered entity in hospitalized patients. The usual etiology in tropical countries is an infection, though the common etiological agents will vary depending upon the region and season. Accurate and early diagnosis, though challenging at times, is important as timely institution of appropriate treatment may be life-saving. This study was planned to evaluate the clinical and etiological profile of pediatric patients admitted with acute febrile thrombocytopenia and to assess their complications and outcome. Patients and Methods: A retrospective study of hospital records of 118 patients with acute febrile thrombocytopenia was carried out. Their clinical findings, investigations and outcome were recorded and analyzed. Observations: An etiological diagnosis could be made in 81% patients. The most common etiology was scrub typhus (44%) followed by dengue fever (11%). Lower platelet counts were associated with a higher risk of complications like shock, acute kidney injury, encephalopathy and bleeding manifestations. Of all enrolled patients, 108 recovered and were discharged while 7 patients died and 3 left against medical advice. Conclusion: Infectious illnesses are commonest causes of acute febrile thrombocytopenia. Knowing the common etiological profile in a particular region and season will help in timely institution of appropriate empiric therapy to reduce morbidity and mortality from the condition. [ABSTRACT FROM AUTHOR]

Various biomarkers have been studied for predicting etiology and outcome in status epilepticus (SE); cerebrospinal fluid (CSF) total tau (t-tau) protein levels is foremost among them. Only handful of studies are available regarding role of t-tau in childhood SE. This prospective study was conducted in a tertiary care center of Northern India in children 6 months −12 years of age. The Cases were patients with convulsive status epilepticus (CSE) whereas Controls were patients without SE and normal CSF. The t-tau levels were done in CSF of both the groups. The outcome was assessed by GOS-E Peds score. A total of 50 (62% males) cases and 15 (67% males) controls were enrolled in the study. SE was generalized in 78% cases whereas 14% had refractory SE. Most common etiology of CSE was acute symptomatic (52%), followed by prolonged febrile seizure (24%), remote symptomatic group (14%), unknown etiology (8%) and progressive disorder (2%). Case fatality rate was 10%. Poor outcome was seen in 30% cases. Median (IQR) CSF t-tau levels was significantly lower 2.6 × 103 (0.5–9.4 × 103) pg/ml in cases vs 10.6 × 103 (6.0–14.2 × 103) pg/ml in controls (p = 0.004). There was no significant correlation seen between type, duration, etiology and response to antiepileptic drugs of SE with CSF t-tau levels. Also, no significant correlation of poor sensorium, outcome of SE and critical care needs with CSF t-tau levels was noted. CSF t-tau is not a useful diagnostic or prognostic biomarker in pediatric SE. [ABSTRACT FROM AUTHOR]

Background: Vitamin B12 deficiency causes serious neurologic problems among infants. However, its neuroradiologic correlate is still largely obscure. Methodology: This prospective study was conducted on patients aged 6 months to 2 years. All children with proven vitamin B12 deficiency were planned to undergo magnetic resonance imaging (MRI) and magnetic resonance spectroscopy of the brain. Results: A total of 35 patients (63% female) were enrolled. Twenty-six (74%) patients had significant findings on brain MRI scan, commonest of which were thinning of corpus callosum and prominence of extra-axial spaces in 28.6% children, cerebral atrophy in 17%, and diffuse symmetrical hyperintensity of white matter in 5.7% patients. Using logistic regression, it was found that odds of abnormal neuroimaging findings were higher in children below 12 months, in females, and in patients with developmental regression, but none of them were statistically significant. Conclusion: Most of the infants with vitamin B12 deficiency have abnormal neuroimaging findings. [ABSTRACT FROM AUTHOR]

Acute disseminated encephalomyelitis (ADEM) is a post-infectious, autoimmune, demyelinating neurological illness, usually attributed to infection with viruses. We describe a case of ADEM occurring in a child with Leptospira–Brucella co-infection. The 12-year-old girl developed a biphasic febrile illness with encephalopathy. On evaluation, she was found to have serological evidence of Brucella and Leptospira infections. Persistence of neurological symptoms after initiating treatment for the co-infection led us to do a magnetic resonance imaging scan of the brain which showed typical findings suggestive of ADEM. Patient responded appropriately to treatment of ADEM with glucocorticoids. The high prevalence of these zoonotic infections in developing countries, and the risk that these may lead to ADEM highlights the importance of detailed evaluation of such cases for proper treatment and better outcomes. [ABSTRACT FROM AUTHOR]

Byline: Suresh. Angurana, Shivani. Randev, Vishal. Guglani A 1½-year old exclusively breast-fed male child belonging to lower socio-economical status (SES) presented with regression of milestones since 3 months and abnormal [...]

Byline: Suresh. Angurana, Vishal. Guglani Sir, We read with interest the recently published research article titled, “Correlation of Serum Vitamin D Level with Mortality in Patients with Sepsis” by Vipul [...]

Byline: Abhimanyu. Tiwari, Vishal. Guglani, Kana. Jat Background: There is a lack of consensus regarding second-line therapy in children with acute asthma who fail to the standard therapy. Ketamine had [...]