RESUMO
Background: Liver abscess continues to be a major cause of morbidity in developing countries. There is no gold standard for management; it has to be tailor made for each child depending on availability of resources. We aimed to study clinical features, laboratory parameters, treatment, and outcome of children with liver abscess in resource-limited settings. Materials and Methods: This is a retrospective observational cohort study of children less than 16 years admitted in pediatric ward with diagnosis of liver abscess during 4 years duration (2016-2019). Demographic data, clinical features, laboratory, ultrasonographic (USG) and microbiological findings, management, and outcome were documented. For descriptive analysis, mean ± standard deviation/median with interquartile range, percentages were used and for testing association, Chi-square test and independent t-test were used. P value <0.05 was considered significant. Results: The mean age of children was 8.4 ± 4.4 years (19- 7 male and 11 female). Fever with chills was the most common symptom (19, 100%), followed by right upper quadrant pain (18, 89.5%), vomiting (7, 36.8%), and pleural effusion (6, 31.6%). Of the 19 children, 26.3% (5) were moderately undernourished and 63.2% (12) severely undernourished. Among the laboratory parameters, leukocytosis (16, 84.2%), anemia (19, 100%), and raised C Reactive protein (CRP) (19, 100%) were seen. Liver abscess on USG was solitary in 14 (73.7%), multiple in five (26.3%), in the right lobe in 14 (73.7%), and left in five (26.3%) with average volume of 104.5 ± 79.2 cc. Blood culture was positive in 22.2% (4/19) with growth of Staphylococcus in 10.4% (2), Pseudomonas in 5.2% (1), and Escherichia coli in 5.2% (1). Pus culture was positive in one (1/8, 12.5%) showing Pseudomonas. Half (9/19) of children were managed on only antibiotics and the other half (10/19) were managed by USG-guided aspiration on two to three occasions along with antibiotics successfully with no mortality. Conclusion: High index of suspicion in children with fever, right upper abdomen pain, positive CRP, and anemia should prompt an urgent USG. Liver abscess can be successfully managed by intravenous antibiotics and USG-guided aspiration in larger abscess, with no mortality. However, in case of signs of impending perforation, surgical management should be considered.
RESUMO
All over the world, children and adults are severely affected by acute gastroenteritis, caused by one of the emerging enteric pathogens, rotavirus C (RVC). At present, no extensive surveillance program is running for RVC in India, and its prevalence is largely unknown except cases of local outbreaks. Here, we intended to detect the presence of RVC in diarrheic children visiting or admitted to hospitals in Haldwani (state of Uttarakhand, India), a city located in the foothills of the Himalayas. During 2010-2013, we screened 119 samples for RVC by an RVC VP6 gene-specific RT-PCR. Of these, 38 (31.93%) were found positive, which is higher than the incidence rates reported so far from India. The phylogenetic analysis of the derived nucleotide sequences from one of the human RVC (HuRVC) isolates, designated as HuRVC/H28/2013/India, showed that the study isolate belongs to genotype I2, P2 and E2 for RVC structural genes 6 and 4 (VP6, and VP4) and non-structural gene 4 (NSP4), respectively. Furthermore, the VP6 gene of HuRVC/H28/2013/India shows the highest similarity to a recently-reported human-like porcine RVC (PoRVC/ASM140/2013/India, KT932963) from India suggesting zoonotic transmission. We also report a full-length NSP4 gene sequence of human RVC from India. Under the One-health platforms there is a need to launch combined human and animal RVC surveillance programs for a better understanding of the epidemiology of RVC infections and for implementing control strategies.Reoviridae, possess 11 double-stranded segments of RNA that encode six structural viral proteins (VP1, VP2, VP3, VP4, VP6, VP7) and five/six non-structural proteins (NSP1-NSP5/6) [7]. Based on the antigenic properties of the major inner capsid protein (VP6), RVs are subdivided into eight well-characterized species (A-H) and two putative species viz. I and J [8-10]. Humans and other mammalian species are affected by species A, B, C and H rotaviruses and birds by species D, F and G, and species E has been reported exclusively in pigs [7,8,11-17]. The newly-proposed species I is reported in dogs [18] and cats [19], whereas species J is found in bats [10].
RESUMO
The seasonal outbreaks of human rotavirus (RV) infection occur every winter. Most patients are diagnosed clinically by a rapid latex agglutination detection kit or polymerase chain reaction assays for RV from stool samples, but some problems have been reported on the specificity and sensitivity of such rapid detection assays. To ratify these issues, a sensitive, specific, simple, and rapid nucleic acid based diagnostic method is expected to be introduced and the reverse transcription loop-mediated isothermal amplification (RT-LAMP) was developed to detect the RV in human stool samples by incubation at 60 °C for 1 h and amplification was confirmed by electrophoretic laddering, restriction enzyme digestion, and hydroxynapthol blue discoloration. The assay established in this study was found to detect only the RVs and no cross-reaction with other viruses, demonstrating its high specificity. By using serial samples dilution as template, the detection limit of LAMP was 10 times more than that of PCR. The results showed the potential clinical feasibility of RT-LAMP as a useful diagnostic tool for the detection of RV with high sensitivity in comparison to conventional RT-PCR.