Background and objectiveUrinary tract infection (UTI) is one of the common causes of febrile illness in young children. Vitamin D influences the levels of endogenous cathelicidin, an antimicrobial peptide, which improves bladder wall immunity and prevents UTIs. In light of this, we conducted this study to determine the association between vitamin D deficiency and UTIs in children and to identify whether vitamin D deficiency is one of the risk factors for UTIs. Materials and methodsThis was a case-control study of children aged between one to five years. Eighty-two children with the first episode of febrile culture-proven UTI as cases and 82 healthy children as a control group were included in this study. The sera were analyzed for 25-hydroxy vitamin D levels and classified as vitamin-D deficient if their level was below 30 ng/mL. Descriptive statistics were presented as numbers and percentages. Continuous data were expressed as means and standard deviations (SD). Pearson's chi-square test was used to test the significance of the differences in variables between the two groups. Multiple logistic regression equation methods were used to predict the relationship between the dependent and independent variables. ResultsThe mean age of the study and the control group was 2.36 ±1.42 years and 2.57 ±1.26 years, respectively. The mean serum 25-hydroxy vitamin D levels in the patients and controls were 24.27 ±9.70 ng/mL and 31.97 ±10.7 ng/mL (p<0.001), respectively. Vitamin D deficiency was present in 34 (41.5%) patients and 10 (2.2%) in the control group (p<0.001). ConclusionBased on our findings, vitamin D deficiency might be one of the risk factors for UTIs in children. Vitamin D deficiency is significantly associated with febrile UTIs in children between one to five years of age.

Background: Scrub typhus, a zoonosis caused by bacteria Orientia tsutsugamushi is associated with varying clinical features and significant mortality due to complication in view of ineffective treatment. Objectives: This study was undertaken to identify the factors for predicting severity in scrub typhus. Methods: This retrospective study was conducted at a tertiary care teaching hospital between January 2015 to October 2016. All children younger than 18 years of age admitted with a history of fever for more than seven days and positive IgM ELISA for scrub typhus were included in the study. Cases of "severe scrub typhus" were identified based on criteria from published pediatric studies. A total of 235 patients tested positive for scrub typhus, out of which 39 patients were in the severe scrub group and 196 in the nonsevere group. Reports were analyzed for the predictors of severity of scrub typhus in both groups. Results: Using multivariate analysis, the factors for predicting severity in scrub typhus were hemoglobin < 10 g/L (OR = 2.8, CI = 1.40 to 5.72), platelet < 150 000 cells/mm 3 (OR = 2.54, CI = 1.21 to 5.30), albumin < 2.5 g/d (OR = 3.18, CI = 1.42 to 7.11), SGOT > 5 fold rise (OR = 49.7, CI = 13.49 to 183.17), prolongation of PT (P value = 0.03), and altered sensorium (P value = 0.016) were correlated with severe disease. Conclusions: We conclude that altered sensorium, anemia, thrombocytopenia, elevated transaminases, hypoalbuminemia, and prolongation of prothrombin time to be predictors of severity of illness in scrub typhus.

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Fig. 1. Child presented with silvery hair and patchy areas of skin hypopigmentation. Fig. 2. Peripheral smear showing giant intracellular granules (arrow).

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Kikuchi-Fujimoto disease (KFD), also called histiocytic-necrotizing lymphadenitis is a rare, idiopathic and self-limiting cause of lymphadenitis. Clinical presentation of KFD closely resembles nodal tuberculosis (TB). Here we present a case of an adolescent female whose diagnosis of KFD was made despite being misled in the course. A 15-year-old female, previously treated for tuberculous lymphadenitis was brought with complaints of fever for 1 month. Various possibilities considered were TB reactivation, autoimmune disorders, lymphoma. Lymph node biopsy for gene Xpert showed TB bacilli detected but low with no RIF resistance. Despite anti tuberculous treatment initiation, there was no improvement in the clinical condition. Histopathology of cervical node showed features of Kikuchi lymphadenitis. Literature search revealed that gene Xpert can detect the intact DNA of Mycobacterium tuberculosis even years after the previous treatment. On stopping anti tuberculosis therapy (ATT) and starting IV steroid, she started improving dramatically. KFD should always be kept as a differential diagnosis in any individual with fever and lymphadenopathy. Diagnosis can be misled in any patient based on gene Xpert reports alone which often turns out to be positive if there is past history of TB as gene Xpert detects DNA from non-intact cells suggesting that dead bacilli contribute to the false positivity.