The CREATE-ECLA Randomized Controlled TrialThe CREATE-ECLA Trial Group Investigators* See also pp 427 and 489.

BACKGROUND: Rheumatic fever and rheumatic heart disease continue to be an important public health problem in developing countries. Doppler echocardiography is now widely used for early detection and recurrence of clinical evident carditis (CC) and silent (subclinical) carditis (SC). In this present study, we performed Doppler echocardiography in ARF children clinically diagnosed by the Jones criteria in order to compare its effectiveness in detecting single/multi-valvular lesions over clinical evaluation alone and they were followed with repeat examinations over a period of 6 months. METHODS: A total of 57 consecutive patients diagnosed with acute rheumatic fever were included in the study. The patients without clinical evidence but with echocardiographic findings of carditis were diagnosed as having subclinical carditis. RESULTS: Acute rheumatic fever was diagnosed in 57 patients, and 38 of these had carditis. Among the 38 clinically 25(65.8%) patients were detected to have cardiac lesion. Echocardiography showed thirteen (34.2%) more patients were affected with carditis. The prevalence of SC was 13(22.8%) among these 57 patients. 51patients were followed up for 6months, and 11 of those had SC. CONCLUSION: It is suggested that Doppler echocardiography be performed in all patients with suspected acute rheumatic fever for early detection of SC. Echocardiography should be used as a diagnostic criterion in order not to miss a diagnosis of SC.

Elizabethkingia meningoseptica are Gram-negative rod bacteria that are commonly found in the environment. The bacteria have also been associated with nosocomial infections, having been isolated on contaminated medical equipment, especially in neonatal wards. Rapid diagnosis and early institution of appropriate therapy for prolonged period are essential for the management of such infections. Here, we report a case of bacteremia due to E. meningoseptica in a neonate who was presented with respiratory distress and seizure episodes. A diagnosis of bacterial meningitis was made based on clinical findings and examination of cerebrospinal fluid. The baby was treated with antibiotics and other supportive measures, that helped to improve the condition. During follow-up, the baby showed developmental delay with hydrocephalus. E. meningoseptica can cause severe infection, with high risk of mortality and neurological sequelae in neonates. Intensive care and multidisciplinary interventions are crucial for the case management. Awareness among clinicians along with correct diagnosis in microbiology laboratory is required to minimize the fatal outcome associated with this infection.