Background: Dengue fever is endemic to most parts of India and the clinical recognition of progression to severe dengue may become difficult in the absence of classical findings. Early recognition of shock or hemorrhage and appropriate management with fluids prevents morbidity/mortality to a great extent. In this study, we attempted to evolve a simple hematological prognostic marker for prediction of severe dengue.Methods: This retrospective descriptive study of 67 children was conducted in the Paediatric Department of a Government Medical College. The case records of all the patients with a diagnosis of dengue fever and Severe Dengue were analysed using a preset proforma. Besides the demographic and clinical findings a detailed analysis and comparison of hematological profile was done between cases of dengue fever and severe dengue. The data obtained was analysed statistically in order to arrive at a hematological marker to predict severe dengue. Results: Study population consisted of 67 children with 44 children with dengue fever,12 with DSS and 11 cases with DHF. Detailed analysis of hematological profile of severe dengue showed striking neutrophilia and monocytosis besides thrombocytopenia. Neutrophilia was seen in 78% and monocytosis was prevalent in 91% of cases of severe dengue. Monocytosis with thrombocytopenia was consistently seen during shock/hemorrhage. During recovery the fall of monocytes was accompanied by simultaneous increase in platelets in this group. This inverse relation was found to be statistically significant (p <0.05) Such a significant inverse correlation was not seen in dengue fever group (p >0.05).Conclusions: Monocytosis and neutophilia are consistent features of dengue fever. There is an inverse correlation of monocytosis with thrombocytopenia in severe dengue during shock/hemorrhage which recovers on clinical improvement. Thus monocytosis with thrombocytopenia can be used as a prognostic marker to predict severe dengue.

Aim?This study aims to compare the effectiveness of oral azithromycin and intravenous ceftriaxone in the treatment of uncomplicated enteric fever in children aged between 2 and 12 years. Methods?This prospective randomized open-labeled study was conducted in the Department of Pediatrics in a medical college of South India. A total of 126 children with proven enteric fever were randomized into two treatment groups. One group received oral azithromycin (20 mg/kg/d) and the other group received parenteral ceftriaxone (75 mg/kg/d), both of which were given for a duration of 7 days. The study population was observed for fever defervescence, duration of hospital stay, and relapse. Results?The mean time for fever defervescence was 3.68???2.109 and 4.08???1.903 days in the azithromycin group and the ceftriaxone group, respectively. The mean duration of hospital stay was 7.35???2.604 days in the azithromycin group and 9.44???0.249 days in the ceftriaxone group. In the azithromycin group three children had treatment failure and had to crossover to ceftriaxone group. Among the four treatment failures in the ceftriaxone group, two cases relapsed within 4-week follow-up period. There was no relapse in the azithromycin group. Conclusion?Oral azithromycin is as effective as intravenous ceftriaxone in treating uncomplicated typhoid fever in children with respect to fever defervescence, duration of hospital stay, and relapse.

A 9-year-old girl presented with failure to thrive, chronic mucopurulent nasal discharge, recurrent skin pustules and recurrent episodes of purulent ear discharge since 2 years of age. She had coarse facial features with extensive eczema, multiple pyoderma scars, florid dental caries, retained primary dentition, hypermobile joints and a woody induration of the vulva. Autosomal dominant hyper-IgE syndrome was suspected and confirmed by very high serum IgE levels. Vulval biopsy revealed a premalignant condition. STAT 3 mutation, which is usually responsible for this condition, was not found in our case, indicating an as yet unidentified mutation. The child also had unusual features like the total absence of clinical and radiological features of pneumonia. The premalignant change in the vulva was also unusual since vulval carcinoma has not been reported so far in children with this disorder. This child will require a close follow-up to look for malignant transformation.