Long-Term Morbidity and Functional Outcome of Japanese Encephalitis in Children: A Prospective Cohort Study.

OBJECTIVE: To describe the long term morbidity and functional outcome of Japanese encephalitis in children. METHODS: Laboratory-confirmed Japanese encephalitis cases were enrolled in the study from January, 2016 to September, 2017 and surviving cases were prospectively followed up for 2.5 years to document various morbidities. Outcome was functionally graded at discharge and during follow-up using Liverpool outcome score. RESULTS: Out of 56 children enrolled, 10 (17.9%) died during hospital stay; severe sequelae was observed in 17 (30.4%) at discharge. At the end of study, among 37 children under follow-up, 23 (62.2%) recovered fully, 2 (5.4%) showed minor sequelae, 3 (8.1%) had moderate sequelae, and 9 (24.3%) were left with severe sequelae. Common long term morbidities were abnormal behavior (n=10, 27%), post encephalitic epilepsy (n=8, 21.6%), poor scholastic performance (n=8, 21.6%) and residual motor deficit (n=7, 18.9%). Improvement of morbidities was noted mostly within initial 1 year of follow-up. CONCLUSION: More than half of the Japanese encephalitis survivors recovered fully, most within the first year after discharge.

Multiorgan dysfunction syndrome in sepsis: Is macrophage activation syndrome secondary to infection?

OBJECTIVE: To assess macrophage activation syndrome (MAS) in septic shock leading to multiorgan dysfunction syndrome (MODS). METHODS: A prospective observational study was conducted at a tertiary care hospital to evaluate the MAS criteria in different stages of sepsis. Children aged 6 months to 12 years in different stages of septic shock were recruited. The Paediatric Rheumatology International Trials Organisation Collaborative Initiative (PRINTO) criteria of MAS were applied initially at the stage of septic shock and subsequently at the stage of MODS (MODS cohort) or following recovery from septic shock without going through MODS (non-MODS cohort). RESULTS: A total of 127 subjects were studied, with 53 comprising the MODS cohort and the rest 74 the non-MODS cohort. At the initial assessment, a comparable proportion of subjects in the MODS and non-MODS groups satisfied the MAS criteria (20.75% and 25.68%, respectively; p=0.529). However, by the time of progression to MODS, 81.13% of the subjects satisfied the MAS criteria in the MODS group, whereas only 16.18% subjects in the non-MODS group continued to satisfy the MAS criteria (p<0.001). Thus, there was a definite increase in the proportion of subjects showing MAS by the time they progressed to multiorgan dysfunction (p<0.001). In contrast, the proportion declined significantly (25.68% to 16.18%; p=0.008) in the subjects who had recovered. CONCLUSION: The findings bear out the hypothesis that MODS in sepsis is a reflection of MAS secondary to sepsis. However, studies in larger cohorts are needed to validate these findings and explore the therapeutic implications.

Hamartoma of Palatine Tonsil: A Rare Case.

Hamartomas are disorganized but benign masses composed of cells indigenous to the involved site. They have been reported in almost all organs but are rare in the head and neck region, especially the pharynx. We describe the case of a six-month-old male infant who presented with acute respiratory symptoms due to a pedunculated polypoid mass arising from his left palatine tonsil. He underwent a tonsillectomy and removal of the polyp after initial stabilization. Histopathological examination showed features consistent with hamartoma. The child had an uneventful recovery and follow-up after one year showed no evidence of recurrence. Our case highlights that rare benign lesions like hamartoma originating in the oral cavity, even in infants, can have such an acute presentation and should be considered in differential diagnosis.

Delayed Cutaneous Findings of Hand, Foot, and Mouth Disease.

OBJECTIVE: To describe various delayed cutaneous findings associated with hand, foot, and mouth disease (HFMD). METHODS: Patients presenting with clinical features of HFMD were followed-up prospectively for a period of 3 months for the occurrence of delayed cutaneous manifestations. RESULTS: Out of 68 patients on regular follow-up, 23 (33.8 %) showed different types of skin and nail changes following HFMD. Nineteen showed features of onychomadesis, 9 developed nail discoloration, and Beaus line was noted in 5 patients. Cutaneous desquamation was seen in 7 patients. Spontaneous re-growth of nails occurred in all cases within 12 weeks follow-up. Skin desquamation subsided by 2-4 weeks. CONCLUSION: Delayed cutaneous findings following HFMD are common.

Nephritic syndrome following multiple bee stings: a late hypersensitivity reaction.

Most hypersensitivity reactions to insect stings are immediate, ranging from transient local reactions of little medical consequence to fatal anaphylaxis. Rarely, some patients have delayed reactions after a period of apparent normality which manifest as systemic features which can be life-threatening. A 3-year-old boy was attacked by a swarm of bees, estimated to be about 200 in number. There was an immediate cutaneous reaction which was treated at a local hospital. After 9 days, he presented with oliguria, dark-coloured urine, pedal oedema, hypertension and acute kidney injury (AKI). He was managed conservatively with fluid restriction, control of blood pressure and peritoneal dialysis, and renal function returned to normal gradually over the following 9 days. The delayed-onset AKI and other laboratory abnormalities suggested a immune-mediated type III hypersensitivity reaction leading to renal insufficiency. After improvement of initial hypersensitivity reactions, patients with bee stings should be followed up in order to detect any late-onset complications which might be life-threatening.

Universal acquired melanosis in siblings.

Generalized pigmentation in a child may be seen in a variety of disorders which can be clinically differentiated. Accuracy of diagnosis can be increased by classifications based on both clinical and histological findings. The authors report a case of siblings in whom hyperpigmentation started at age of about 6 mo and was progressing. Histology of skin revealed shortening and blunting of rete ridges with presence of melanocytes in stratum basal layer. This is a rare type of hypermelanosis and termed as universal acquired melanosis or carbon baby syndrome. This is a rare presentation and first case report in siblings.