Tuberculomas are usually infratentorial in children, and supratentorial lesions predominate in adults. We present a 4-year-old girl with multiple seizures, papilloedema and brisk reflexes. On investigation, she was found to have a large left parafalcine tuberculoma. She was treated with antitubercular treatment (ATT) and steroids. The child improved, seizures stopped and the papilloedema gradually disappeared. Follow-up magnetic resonance imaging brain after 8 months showed a mild reduction in the size of the lesion. Child is on regular follow-up.

Opsoclonus–myoclonus–ataxia (OMA) syndrome typically presents with chaotic eye movements and myoclonus with some patients exhibiting ataxia and behavioural disturbances. The pathogenesis may be inflammatory with an infectious or paraneoplastic trigger. We present a 13-year-old HIV-infected girl who was initially started on highly active antiretroviral therapy (HAART) in March 2013 with a CD4 count of 79 cells/cumm. Initially, the patient did not comply with treatment, resulting in a CD4+ count of 77 cells/mm3 in November 2015 and prompting a new HAART scheme comprising lamivudine, tenofovir and ritonavir-boosted atazanavir. Shortly after starting this scheme, she developed OMA syndrome in January 2016. She was treated with intravenous immunoglobulin and methylprednisolone followed by oral steroids along with oral clonazepam and gradually recovered. We suggest immune reconstitution inflammatory syndrome as a possible aetiology of OMA in HIV-infected children.

Postnatal lactational counseling leads to higher weight gain, and lesser chances of mixed feeding in the neonatal period.

Typhoid fever is endemic in developing countries like India. An increasing prevalence of resistance to cephalosporins and fluoroquinolones by Salmonella isolates is seen. We present an 8-month-old boy with invasive Salmonella typhi disease. Blood culture showed S. typhi sensitive to ampicillin–sulbactam and cotrimoxazole but resistant to fluoroquinolones and third-generation cephalosporins. Cerebrospinal fluid examination revealed an aseptic meningitic picture. He was treated with intravenous meropenem and azithromycin following which his condition improved. This case highlights the need for improvement in environment sanitation and hygiene combined with early vaccination against typhoid fever and antimicrobial stewardship to help reduce the emerging resistance to cephalosporins and fluoroquinolones.

Introduction: As children are usually infected by an adult with pulmonary tuberculosis (TB), childhood TB reflects transmission of Mycobacterium tuberculosis within a community Objective: To study clinical profile and outcome of children with TB from 0 to 12 years of age in a tertiary care hospital in Mumbai, India. Method: A prospective observational descriptive study of 30 children with TB was conducted over 18 months at a tertiary general hospital in Mumbai and followed up till recovery. Results: Out of the 30 children with TB, 3 (10%) were below the age of 1 year, 8 (26.6%) were aged 1-5 years and 19 (63.3%) were above 5 years of age. Male to female ratio was 1:1.3. Extrapulmonary TB was more common (63.3%) than pulmonary TB (36.6%). Twenty (66.6%) children had a history of previous adult contact with TB, 29 (96.6%) were vaccinated with BCG and 10 (33.3%) were malnourished. Common clinical features were cough (53.3%), fever (46.6%), weight loss (46.6%) and lymphadenopathy (33.3%). Anaemia and raised ESR were seen in 46.6% and 73.3% respectively. All 30 children were non-reactive for the HIV antibody test. Tuberculin sensitivity test was positive in 16 out of 30 children (53.3%). Drug-resistant TB was seen in 2 (6.6%) children. All 30 cases (100%) recovered completely with their primary regimen. Conclusions: In this study, extra-pulmonary TB was found in 63.3% of children. TST positivity (>10mm) was found in only 53.3% of children with TB. Complete resolution of symptoms was seen in _________________________________________ 1

Methicillin resistant Staphylococcus aureus (MRSA) meningitis is rarely known to occur in children. We report an 11-year-old girl with fever, headache and vomiting, right hemiparesis with left-sided upper motor neuron facial nerve palsy and bladder incontinence. On investigation, she was found to have MRSA meningitis with an acute left thalamo-corpuscular infarct. She was treated with vancomycin, linezolid and rifampicin. She recovered successfully with residual right-sided lower limb monoparesis. MRSA meningitis is rare but can occur in children.

We present a case of a 17-year-old boy with X-linked agammaglobulinemia who had mild disease when initially infected with SARS-CoV-2 but after recovering from acute infection developed fevers and a raised erythrocyte sedimentation rate that persisted for several weeks without any ongoing respiratory symptoms. Multiple nasopharyngeal swabs were found to be negative for SARS-CoV-2 during the febrile period, but typical changes of COVID-19 on high resolution CT chest scan led to the detection of SARS-CoV-2 on RT-PCR in a sample from a bronchoalveolar lavage. His fevers completely resolved after a 5-day course of remdesivir.

Cholestasis can occur in newborns due to infections. However, the manifestations of the underlying infections usually dominate the presentation. We present a 2-month-old infant who presented with jaundice and no fever or signs of systemic illness. Liver biopsy was suggestive of cholangitis. He was subsequently detected to have urinary tract infection with Klebsiella pneumoniae. The child was treated with appropriate antibiotics for 2 weeks following which the cholestasis resolved. Thus, neonatal cholestasis due to infections can also occur in the post-neonatal period without clinical manifestations of an underlying infection.