Objectives To describe the epidemiological and clinical characteristics and outcome of hospitalized children with COVID-19 during the initial phase of the pandemic. Methods This was a cross-sectional descriptive study conducted at the dedicated COVID-19 hospital of a tertiary care referral center in North India. Consecutive children aged 14 y or younger who tested positive for SARS-CoV-2 by RT-PCR from nasopharyngeal swab between 1 April 2020 and 15 July 2020 were included. Results Of 31 children with median (IQR) age of 33 (9-96) mo, 9 (29%) were infants. About 74% (n = 23) had history of household contact. Comorbidities were noted in 6 (19%) children. More than half (58%) were asymptomatic. Of 13 symptomatic children, median (IQR) duration of symptoms was 2 (1-5.5) d. Fever (32%) was most common followed by cough (19%), rapid breathing (13%), diarrhea (10%) and vomiting (10%). Severe [n = 4, 13%] and critical [n = 1, 3%] illnesses were noted more commonly in infants with comorbidities. Three (10%) children required PICU admission and invasive ventilation; one died. Median (IQR) length of hospital stay was 15 (11-20) d. Follow up RT-PCR before discharge was performed in 17 children and the median (IQR) duration to RT-PCR negativity was 16 (12-19) d. Conclusions In the early pandemic, most children with COVID-19 had a household contact and presented with asymptomatic or mild illness. Severe and critical illness were observed in young infants and those with comorbidities.
Background: Dengue infection occurs among more than 50 million annually. In India, the case fatality rate is up to 3-5%. Early diagnosis is crucial to the clinical care. However the currently recommended diagnostic tests by WHO is costly, time consuming, labor and technologically demanding which may not be available in the resource limited set up where the large burden of dengue related illness occur.This study evaluated the role of immunochromatographic method based rapid diagnostic test kits (RDT) and costeffectiveness for the diagnosis of acute dengue infection.Methods & Materials: 281 adult patients presenting to Christian Medical College, Vellore, India with community acquired acute febrile illness between September 2012 to February 2013 were recruited for the study. The patients with other proven etiology were used as negative control. 132 cases of dengue and 149 cases of non-dengue infection were enrolled. The RDTs tested from 4 manufacturers were Panbio, SD, J.Mitra and Reckon. SPSS version 16.0.1 was used for statistical analysis.Results: Performance of the RDTs based on IgM: The sensitivity, specificity, PPV and NPV of Panbio, SD, Reckon and J.Mitra. The inter-rater kappa agreement between Panbio with SD duo of 0.54 was found to be moderate. Performance of the RDTs based on NS1 detection:The sensitivity, specificity, PPV and NPV of the SD, Reckon, and J.Mitra. The inter-rater kappa agreement between SD with Reckon of 0.79 was found to be best and substantial.Combination of RDTs: the best sensitivity of 99.2% was achieved by testing Panbio and SD in parallel. The best specificity of 99.9% and 100% respectively was obtained when Reckon with Panbio or SD was performed in series.None of the RDTs could not adequately differentiate between acute primary and secondary dengue. Conclusion:In the region of high dengue endemicity, Panbio RDT alone is highly sensitive, cost effective (∼13.6 USD), easier to perform and shorter turnover time makes it a test of choice in resource limited set up during an outbreak season.
Polyarteritis nodosa (PAN) is a medium vessel vasculitis with necrotising vascular changes along with multisystemic involvement. Due to variable initial presentations, diagnosis of systemic PAN in children requires a comprehensive work up. In addition, systemic PAN needs an aggressive therapy. Mycophenolate mofetil is an emerging newer alternative for the treatment of PAN. We report a case of childhood systemic PAN who initially presented with subtle signs like reduced sensation over lateral foot, non-deforming arthritis and multiform rashes. After comprehensive aetiological work up, nerve biopsy and supporting evidence clinched the diagnosis. Vasculitis in children presenting with benign subtle signs is sometimes a diagnostic challenge to clinicians. Our case highlights the importance of lateral thinking while dealing with non-specific multisystemic signs. Evidence of successful treatment of PAN with mycophenolate mofetil is gradually being built up. It is also described to result lower relapse and increased treatment free survival rate.
Polyautoimmunity or multiple autoimmune syndrome (MAIS) is increasingly being recognized in pediatric clinical practice, often in conjunction with systemic lupus erythematosus (SLE). Besides multi-organ autoimmunity, children with SLE are often at a higher risk of developing infections including tuberculosis. The tendency to develop infections and multiple autoimmune diseases in childhood SLE often occurs in the absence of monogenic primary immunodeficiency disease. Conversely, children with inborn errors of immunity, of which selective IgA deficiency (sIgAD) is the most common, may develop recurrent infections and autoimmune disorders including SLE. Herein, we report a child with MAIS (including SLE) and sIgAD who developed drug-resistant tuberculosis, which was managed successfully with second-line antitubercular drug therapy. To the best of our knowledge, this combination of rare findings has not been reported previously in the pediatric literature. Although a majority of patients with sIgAD are either asymptomatic or have mild infections/autoimmunity, the index child had a myriad of infectious illnesses and multi-organ autoimmunity.Our case highlights the prudence of thoroughly evaluating children with SLE for other autoimmune diseases and vice versa. Given the higher probability of inherited disorders, including early complement deficiencies and monogenic interferonopathies, in childhood SLE compared with adult SLE, it may be prudent to perform a basic immunological workup (for example, immunoglobulin levels, 50% hemolytic complement) in such patients. A more extensive immunological and genetic evaluation (including next-generation sequencing) may also be required in the presence of unusual clinical or laboratory features, a positive family history, or a complicated clinical course.
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