Macrophage activation syndrome (MAS) is a potentially fatal complication of systemic inflammatory disorders first reported by Boone in 1976. In 1985, Hadchouel et al described this condition in seven patients with systemic juvenile idiopathic arthritis (sJIA). In 1992, the term "macrophage activation syndrome" was coined and Stephan et al were the first to use it in relation to juvenile arthritis. Since then, MAS has been widely described in rheumatic diseases, especially sJIA. However, it is being increasingly reported in association with systemic lupus erythematosus (SLE), Kawasaki disease (KD) and periodic fever syndromes. 1-3 Macrophage activation syndrome is characterized by uncontrolled activation and proliferation of T cells and macrophages, leading to a storm of inflammatory cytokines. Although the incidence of MAS remains unestablished, reports show that clinically overt MAS

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Background: Over the last few decades there has been a change in the trend of antibiotic sensitivity of Salmonella typhi from being sensitive to first line drugs like chloramphenicol, ampicillin and cotrimoxazole to developing multi-drug resistance. Most strains are presently sensitive to third generation cephalosporins and azithromycin but are developing resistance against fluoroquinolones. Objectives: To determine the culture positivity and antibiotic sensitivity pattern of Salmonella typhi. Method: This retrospective study was conducted at the Institute of Child Health, Kolkata from July 2014 to December 2020. Nine hundred and twenty children aged 1-10 years were included in the study, all with fever for more than 5 days. These children were suspected to have typhoid fever clinically i.e., with history, suggestive physical examination and after excluding other common febrile illnesses with routine blood test as per hospital protocol. Blood culture was done to confirm the diagnosis of typhoid fever, determine the proportion of blood culture positive cases and to find out the antibiotic susceptibility of Salmonella typhi in our hospital set up. Children were included in the study irrespective of prior antibiotic treatment. Results: Of the 920 children, 55% were male and 45% were female; 15% cases were between 1-2 years of age and 85% were between 2-10 years of age; 53% cases were culture positive. In our study S. typhi was fully sensitive to ampicillin, chloramphenicol, cefixime, ceftriaxone and azithromycin. It was highly sensitive to cotrimoxazole. It was highly resistant to ciprofloxacin and nalidixic acid Conclusions: There was complete sensitivity of Salmonella typhi to third generation cephalosporins and azithromycin. It was also sensitive to older, less commonly used antibiotics like chloramphenicol, cotrimoxazole and ampicillin. There was increased resistance to fluroquinolones. Sri Lanka Journal of Child Health, 2023: 52(2): 169-174

Langerhans cell histiocytosis (LCH) is the most common of the histiocytic disorders and occurs when the body accumulates too many CD1a/ CD 207 positive Langerhans cells, a subset of the histiocytes in certain parts of the body where they can form tumors or damage organs. LCH is not a very common diagnosis in the pediatric age group. More than two-thirds of cases have the single-system disease with bones or skin as the commonly involved sites. Here, we present a 4-year-old child who had acute abdominal pain as chief complaint and etiological workup eventually led to a diagnosis of gastric LCH without affection of any other organ system. To the best of our knowledge, this is the first report of a unifocal gastric LCH in a child.

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