to evaluate the epidemiology, clinical profile and outcome of serologically confirmed scrub typhus and spotted fever cases among children admitted to a tertiary care hospital in Bangalore.Methods & Materials: Hospitalized children aged <18 years, with clinical features suggestive of rickettsial disease were included prospectively between January 2010 to October 2012. Routine laboratory tests including Weil-Felix test was performed on all children. Specific ELISA was done to detect IgM and/or IgG antibodies for confirmation of scrub typhus and spotted fever.Results: Of 103 children with clinical features suggestive of rickettsial illness, ELISA test confirmed 53 cases for scrub typhus, 23 cases for spotted fever group and 14 with both scrub typhus and spotted fever mixed infection. The mean age was 7.3 (±3.9) years and 44 (71.0%) were male. Majority of cases were from neighboring districts of Karnataka (50%), Andhra Pradesh (32.3%) and Tamil Nadu (17.7%). There was a clear seasonal trend; 53% of cases were seen soon after the rainy season during the months of August to November. Common clinical features included fever (100%) with average duration of 11 days, nausea and vomiting (44%) and rash (36%); eschar was rare. Anemia (63%), thrombocytopenia (52%), leukocytosis (51%) and elevated hepatic transaminases (61%) were also seen. Compared to the ELISA test, Weil-Felix test (OX-K titer of ≥1:80) had sensitivity and specificity of 88.7% and 43.9%, and positive and negative predictive value of 70.5% and 72%, respectively. Treatment with chloramphenicol or doxycycline was given to the majority of the children. Complications were seen in 42% (13% had multiple complications), and included meningoencephalitis (28%), shock (10%), retinal vasculitis (10%) and purpura fulminans (7%); all recovered with no deaths.Conclusion: These findings suggest that the burden of rickettsial infection among children in India is high, with a substantially high complication rate. Rickettsial specific ELISA tests can help in early diagnosis and early institution of appropriate treatment that may prevent life-threatening complications.

Background: Viral infection with Herpes Simplex Virus (HSV) is one of the most common opportunistic infections in seropositive patients of Human Immunodeficiency Virus (HIV). Studies have confirmed that genital herpes caused by HSV-2 has been associated with two-to threefold increased risk of HIV acquisition.Objective: To determine the seroprevalence of HSV-2 in HIV-positive patients.Materials and Methods: A prospective, cross-sectional study was conducted from July 2012 to January 2013 and HIV-positive patients were enrolled into the study after obtaining written informed consent. Demographic characteristics were recorded and serology test was performed using HSV-2 IgG ELISA test kit (Calbiotech, USA). Results were analyzed using w 2 -test.Results: Among 273 HIV-positive patients, 67% were men, 33% were women, and 1 transgender with an average age of 38.8 years. Overall, 50% of HIV-positive patients had HSV-2 IgG antibodies. Seroprevalence of HSV-2 among HIV-positive men and women was 47% and 57%, respectively. The highest HSV-2 seropositivity was detected in the age group of 36-45 years. w 2 -Analysis showed a statistically significant association between HSV-2 and HIV infection (w 2 = 55.900, p = 0.0076). The median CD4 counts estimated in 100 patients were 563.50 cells/mm 3 . No significant difference was observed in the CD4 counts of those with or without HSV-2.Conclusion: HSV-2 prevalence was higher in HIV-positive women than in men. The implementation of continuous interventions for sexually transmitted infections and HIV will bring down the prevalence and spread of both HSV-2 and HIV infection.

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