Acute glomerulonephritis: an unusual manifestation of Plasmodium vivax malaria.

Long considered a benign infection, Plasmodium vivax is now increasingly recognised as a cause of severe and fatal malaria. Various atypical presentations of vivax malaria have been reported. This report highlights the occurrence of acute glomerulonephritis in a 7-year-old girl who presented with fever and vomiting. Peripheral smear examination demonstrated ring forms of P. vivax. OptiMAL test was positive for P. vivax and negative for Plasmodium falciparum. She was managed with antimalarial and antihypertensive drugs and made an uneventful recovery.

Infective endocarditis in a child masquerading as vasculitis: case report.

Since both vasculitis syndromes and infective endocarditis may present with multi-system involvement, they can pose a diagnostic dilemma. A 10-year-old boy was admitted with multi-system disease secondary to embolic complications of infective endocarditis. Echocardiography demonstrated mitral valve prolapse and moderate mitral regurgitation with vegetations on the anterior and posterior mitral leaflet. Despite supportive treatment, his general condition deteriorated and he died 3 days after admission.

Clinical manifestations of dengue and leptospirosis in children in Mumbai: an observational study.

OBJECTIVES: The aim of this study was to determine the causes of acute febrile illness in children presenting to our hospital following an extremely heavy rainfall event in the city of Mumbai in 2005. The clinical and laboratory manifestations of leptospirosis and dengue together with their outcomes are also described. METHODS: This was an observational study conducted from 26 July to 30 November 2005. The diagnosis of leptospirosis was confirmed by a positive enzyme-linked immunosorbent assay (ELISA) test. The diagnosis of dengue was confirmed by a positive immunoglobulin (IgM) antibody capture ELISA test. Clinical features of patients with and without leptospirosis, respectively, and with and without dengue, respectively, were analysed. RESULTS: A total of 602 patients (age range 1 month to 12 years) admitted to our hospital for acute febrile illness with no obvious focus of infection were enrolled in the study. Of these, 30 had malaria, 11 had enteric fever and seven had mixed infections. Twenty-seven patients had leptospirosis. Three clinical features were significantly associated with leptospirosis: flood water contact, myalgia and conjunctival suffusion. Eighty-one children had dengue. All patients responded well to the treatment and were released to go home. Four clinical features were significantly associated with dengue, namely, giddiness, abdominal pain, rash and bleeding manifestations. CONCLUSIONS: Based on this review of the clinical and laboratory features of dengue fever and leptospirosis, we conclude that following the heavy rainfall event on 26 July 2005, there was a concurrent outbreak of leptospirosis and dengue among children presenting to our hospital.

Transient quadriparesis after electric shock in a child: case report.

Electric shock injuries are commonly encountered by emergency physicians. Various systemic complications owing to electric shock injury have been described. It is important to maintain raised awareness of these different complications to ensure that they are recognised and treated early. We describe a rare case of transient quadriparesis following electric shock in a 10-year-old boy.

Staphylococcal toxic shock syndrome presenting as acute respiratory distress and cor pulmonale.

We describe a 7-year-old boy with staphylococcal toxic shock syndrome who presented with acute respiratory distress and cor pulmonale. We wish to highlight this unusual presentation as the diagnosis of toxic shock syndrome depends chiefly on a high degree of clinical suspicion. Early diagnosis and prompt institution of appropriate therapy will significantly reduce morbidity and mortality.

Cerebral salt wasting syndrome following neurosurgical intervention in tuberculous meningitis.

Cerebral salt wasting is characterized by inappropriate natriuresis and volume contraction in the presence of cerebral pathology. Diagnosis can be difficult and therapy is challenging. We report two children with tuberculous meningitis and hydrocephalus who developed cerebral salt wasting following neurosurgical intervention. The first patient was managed with rigorous salt and water replacement whereas the second patient required the addition of fludrocortisone for control of salt-wasting.

Efficacy and safety of phlogenzym--a protease formulation, in sepsis in children.

BACKGROUND: Infections are a major cause of hospitalisation wherein the host mounts an inflammatory response against the infecting agent. Administration of proteolytic enzymes could regulate the host's immune system and help early recovery from sepsis. OBJECTIVE: To test the efficacy and safety of an oral enzyme formulation, Phlogenzym (Mucos Pharma GmbH, Geretsried, Germany; constituents of each enteric-coated tablet were bromelain 90 mg, trypsin 48 mg, rutin 100 mg) as adjuvant therapy in treatment of sepsis in children. SUBJECTS AND METHODS: Double-blind, randomised, controlled phase III study at a tertiary care centre wherein 60 eligible children aged one month to 12 years with sepsis were randomised to receive either phlogenzym (n=30; 17 boys) or placebo (n=30; 22 boys) tablets (1 tablet/10 kg body weight up to maximum six tablets a day in two or three divided doses for 14-21 days) along with appropriate antibiotics and supportive treatment. RESULTS: Median time taken for fever to subside was three days (range 1-12; 95% CI--1.14 to 7.14) in the phlogenzym group vs four days (range 1-18; 95% CI--3.52 to 11.52) in the placebo group (p < 0.05); haemodynamic support was needed for two days (range 1-3; 95% CI--0.84 to 3.16) in the phlogenzym group but three days (range 1-8; 95% CI--0.76 to 5.24) in the placebo group (p < 0.05). The modified Glasgow coma scale score normalized in three days (range 1-14; 95% CI--4.62 to 9.62) in the phlogenzym group vs 5.5 days (range 1-18; 95% CI--2.52 to 13.52) in the placebo group (p > 0.05). Oral feeds could be started in four days (range 1-15; 95% CI--1.74 to 9.74) in the phlogenzym group vs five days (range 1-11; 95% CI--1.26 to 11.26) in the placebo group (p > 0.05). Two patients died in the placebo group. CONCLUSION: Phlogenzym is effective as an adjuvant with antibiotics and supportive treatment for early improvement of pediatric patients with sepsis.

Vitamin a status of pregnant women and effect of post partum vitamin a supplementation.

OBJECTIVE: To assess the Vitamin A status of pregnant women in their third trimester using maternal serum retinol levels as the indicator; and (ii) To assess the impact of postpartum Vitamin A supplementation on the Vitamin A status of exclusively breastfed infants. DESIGN: Prospective randomized single blind controlled study. SETTING: Teaching Hospital. SUBJECTS: 109 apparently healthy primi and second gravida women registered at the antenatal clinic were included in the study and followed up for three months postpartum. Serum retinol levels of pregnant mothers in their third trimester (35-37 weeks) and cord blood levels after delivery were estimated. Mothers were then assigned to two groups. The experimental group included 53 mothers who received a single dose of 2 lakh units of Vitamin A orally. The control group had 56 mothers who did not receive Vitamin A. Mothers and infants were followed up for three months. The serum retinol of infants and the breast milk retinol levels were estimated at the end of three months and the results were compared. The growth of the infants was also monitored. RESULTS: Subclinical Vitamin A deficiency was seen in 29.67% of pregnant women. At the end of three months, 69.6% of mothers in the control group had breast milk retinol levels below 30 mg/dl, as opposed to 36.1% in the experimental group. Forty five per cent of infants in the control group had subclinical vitamin A deficiency compared to none in the experimental group. There was no difference in the growth of infants in the two groups. However, the infant serum and the breast milk retinol levels were significantly higher in the supplemented group. CONCLUSION: There is a high prevalence of inapparent Vitamin A deficiency (29.7%) in pregnant women in their third trimester from lower socio-economic strata. Postpartum Vitamin A supplementation had a beneficial impact on the infant serum retional and the breast milk retinol level but no effect on infant growth.