Correlation of SARS-CoV-2 Serology and Clinical Phenotype Amongst Hospitalised Children in a Tertiary Children's Hospital in India.

INTRODUCTION: Children usually present with minimal or no symptoms of COVID-19 infection. Antibody responses to SARS-CoV-2 in children from low- and middle-income countries (LMIC) have not been well described. We describe the prevalence of anti-SARS-CoV-2 antibodies and clinical phenotype of seropositive children admitted to a tertiary children's hospital in South India. METHODS: To determine the seropositivity and describe the clinical characteristics of COVID-19 infection amongst hospitalised children, we performed a prospective clinical data collection and blood sampling of children admitted to Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India over 4 months of the COVID-19 pandemic. In seropositive children, we compared antibody titres between children with and without PIMS-TS. RESULTS: Of 463 children, 91 (19.6%) were seropositive. The median (range) age of seropositive children was 5 years (1 month-17 years). Clinical presentation was consistent with Paediatric inflammatory multisystem syndrome associated or related with SARS-CoV-2 infection (PIMS-TS) in 48% (44/91) of seropositive children. The median (range) antibody titre was 54.8 (11.1-170.9) AU/ml among all seropositive children. The median antibody titre among the children with PIMS-TS (60.3 AU/mL) was significantly (p = 0.01) higher when compared to the children without PIMS-TS (54.8 AU/mL). CONCLUSION: We describe the antibody responses to SARS-CoV-2 amongst hospitalised children in a LMIC tertiary children's hospital. Almost half of the seropositive children had PIMS-TS. Antibody levels may be helpful in the diagnosis and disease stratification of PIMS-TS. LAY SUMMARY: Children usually present with minimal or no symptoms of COVID-19 infection. However, Multisystem Inflammatory Syndrome in Children (MIS-C) or Paediatric inflammatory multisystem syndrome associated or related with SARS-CoV-2 infection (PIMS-TS) has emerged as a distinctive paediatric illness related to SARS-CoV-2. Recently, antibody testing for SARS-CoV-2 is being used increasingly as a diagnostic test for PIMS-TS. However, data on the antibody responses to SARS-CoV-2 in children are sparse. We, therefore, attempted to identify the seropositivity and describe the clinical spectrum of COVID-19 infection amongst infants and children getting hospitalised in a children's hospital in south India. Nearly one-fifth of the hospitalised children tested serology positive over 4 months. Antibody levels in children with PIMS-TS were significantly higher in comparison to the other two groups (acute COVID-19 infection and children without PIMS-TS). Results from our study suggest that all children are at risk of COVID-19 infection though they may present with mild illness or no symptoms. We also observed that antibody testing may have a possible role in diagnosis of PIMS-TS.

Rapid antigen diagnostic testing for the diagnosis of group A beta-haemolytic streptococci pharyngitis.

Background: It is difficult to make a diagnosis of group A beta-haemolytic streptococci (GABHS) pharyngitis solely on clinical findings. The McIssac scoring system has been recommended as a reliable clinical tool for diagnosis. The rapid antigen detection test (RADT) has been shown to considerably increase the number of patients who are appropriately treated for streptococcal pharyngitis, compared with the use of traditional throat cultures. It also reduces the time to start treatment. We evaluated the diagnostic utility of RADT in comparison with throat swab culture. Methods: Using the McIssac scoring system, RADT and throat swab cultures in those with a McIssac score of 3 or more, we evaluated 165 children (aged 2-15 years) with a clinical diagnosis of pharyngitis. Results: GABHS pharyngitis was confirmed in 41 (24.8%) by throat swab culture and RADT was positive in 39(23.6%). Only in 2 (4.9%) children, RADT was negative but throat swab was positive. The sensitivity of RADT was 89.7% and specificity was 98.4% with a positive predictive value of 94.6%, negative predictive value of 96.9% and diagnostic accuracy of 96.4%. Conclusion: RADT performed was observed to have high sensitivity and sensitivity for the diagnosis of GABHS pharyngitis in contrast to an earlier report from India. Our observations suggest that using RADT as a point-of-care test is reliable and cost-effective and needs to be propagated in Indian settings where facilities for throat swab culture are not routinely available and also because clinical diagnosis based on scoring systems are comparatively less reliable.

Epidemiological and Clinical Profile of Pediatric Inflammatory Multisystem Syndrome - Temporally Associated with SARS-CoV-2 (PIMS-TS) in Indian Children.

Background: We describe the demographic, clinical and labo-ratory findings along with the treatment and outcomes among children meeting the case definition of Pediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2 (PIMS-TS). METHODS: We analyzed the clinical and laboratory findings of children who presented with PIMS-TS during an 8-week period from May 4, 2020 to July 8, 2020. RESULTS: We report 19 children with a median age of 6 year (IQR: 13 months-16 years), who met the case definition of PIMS-TS. All of them presented with fever. Multi organ involvement (79%), mucocutaneous involvement (74%), cardiovascular symptoms (63%) and gastrointestinal symptoms (42%) were the other features. Elevated levels of C-reactive protein was found in all of them and the majority of them had evidence of coagulopathy; intensive care admissions were needed in 12 (63%) and vasoactive medications were given to 6 (31.5%) children. There were no deaths. CONCLUSION: Children with PIMS-TS present with a wide range of signs and symptoms. Fewer children in this series had coronary artery abnormalities, and there was a low incidence of RT-PCR positivity with high presence of SARS-CoV-2 antibodies.

Extended-spectrum Beta-lactamase-producing Community-acquired Urinary Tract Infections in Children: Chart Review of Risk Factors.

BACKGROUND: Community acquired urinary tract infections (CA-UTI) caused by extended spectrum beta lactamase (ESBL) producing organisms is on the rise throughout the world. There are known risk factors such as age <1 year, children on uroprophylaxis, recurrent UTI, recent antibiotic usage etc which can predict the occurrence of these ESBL producers. OBJECTIVES: To correlate known risk factors with occurrence of ESBL UTI and antibiotic susceptibility of uropathogens isolated. MATERIALS AND METHODS: Clinical and microbiological data were collected from 100 children 1month to 12 years with CA-UTI. The risk factors were compared in the ESBL and non-ESBL group and analysed. RESULTS AND CONCLUSION: The antimicrobial sensitivity pattern in our study showed increased resistance to cephalosporins, cotrimoxazole, fluoroquinolones and amoxicillin-clavulanic acid which are frequently used in the treatment of UTI, with most isolates being sensitive to aminoglycosides, piperacillin-tazobactam and carbapenems. Statistical analysis did not identify any significant risk factor that predisposes to ESBL UTI.

Chromhidrosis--colored sweat in a toddler.

BACKGROUND: Chromhidrosis means production of coloured sweat. CASE CHARACTERISTICS: A toddler who presented with colored sweat was diagnosed to have chromhidrosis based on skin biopsy. No treatment was attempted considering the young age. OUTCOME: Parents were counselled about the benign nature of this disorder. MESSAGE: Identification of causes of colored sweat requires appropriate investigations.

Correlation of Childhood Obesity and Related Insulin Resistance with Leptin and Retinol Binding Protein 4.

OBJECTIVES: To study the correlation of obesity with various metabolic parameters and correlation between insulin resistance and leptin and retinol binding protein 4 (RBP4) levels. METHODS: This is a cross sectional study in a tertiary care children's hospital wherein 98 obese children were included and their metabolic parameters analysed with regards to insulin resistance and RBP4 levels. RESULTS: Leptin levels were abnormal for all children and high RBP4 levels were observed in 69.6 %. There was no significant association between insulin resistance and RBP4 levels (p 0.8). CONCLUSIONS: RBP4, the sole retinol transporter in blood, secreted from adipocytes and liver has been implicated in insulin resistance. The index study however, did not show a significant positive association.

Gamma interferon receptor defect presenting as recurrent tuberculosis.

Failure of response to therapy in childhood tuberculosis may be due to resistance, paradoxical response or immunodeficiency. Interferon-γ (IFNγ) plays a major role during host defense against Mycobacterium tuberculosis (Mtb). An 8-y-old boy presented with fever, hepatosplenomegaly and parotid abscess. He had been earlier treated for BCG adenitis in infancy and at 5 y for TB osteomyelitis of iliac bone and recovered. Investigations confirmed disseminated Mycobacterium Avium Intracellulare infection. He was investigated for immunodeficiency because of recurrent mycobacterial disease and a partial defect of γ-interferon receptor was identified. He required a 2 y course of therapy with a 7 drug regimen and recovered. The authors report this case because of its rarity and to highlight the need to consider γ-interferon receptor defect in the presence of recurrent tuberculosis (TB) and also review the options for therapy.

Vitamin D deficiency in childhood-a review of current guidelines on diagnosis and management.

Vitamin D deficiency has emerged as a significant public health problem throughout the world. Even in the Indian context,it has been reported to be present in majority of children in spite of wide availability of sunlight. Recent guidelines have defined vitamin D status as severe deficiency, deficiency, sufficiency and risk for toxicity as 25(OH)D levels <5, <15, >20 and >50ng/mL, respectively.The manifestations of deficiency may vary from hypocalcemic seizures, tetany in infancy and adolescence to florid rickets in toddlers. Treatment is necessary for all individuals with deficiency whether symptomatic or not and consists of vitamin D supplementation as Stoss therapy or daily or weekly oral regimens with equal efficacy and safety, combined with calcium supplements. Routine supplementation starting from newborn period is being increasingly endorsed by various international organizations. Prevention by sensible sunlight exposure, food fortification and routine supplementation are the currently available options for tackling this nutritional deficiency.

Dengue viral infection in children: a perspective.

Dengue is a vector-borne viral infection of global importance. Several pathogenetic mechanisms such as immune enhancement and selection pressure have been proposed and febrile, critical and recovery phases have been identified. A new classification proposed by WHO has recently been introduced where definitions have been changed to 'probable dengue', 'dengue with warning signs' and 'severe dengue'. The majority of dengue viral infections are self-limiting, but complications have high morbidity and mortality. The diagnosis of dengue viral infection is essentially clinical, although confirmation requires laboratory tests including serology, NS1 antigen detection, PCR and viral cultures. There are no specific anti-dengue drugs and treatment is basically supportive and consists of early recognition of complications and appropriate fluid therapy. A number of candidate vaccines are under development.

Factors associated with delay in diagnosis of Kawasaki disease in India.

A retrospective analysis was carried out to identify factors associated with delay in diagnosis of Kawasaki disease in a tertiary care pediatric hospital setting in Chennai, India. Over a period of 2 years, a total of 37 cases were studied. The cases were divided into Early Diagnosis Group (EDG) and Delayed Diagnosis Group (DDG) with the cut-off for early diagnosis being ten days. A greater proportion of cases in the EDG presented primarily to our institution (P=0.004). In the DDG group greater number of cases had received medical attention from practicing pediatricians prior to referral. There was greater interval in onset of individual symptoms in the DDG group. There was no difference between the two groups with regard to age, gender, total blood counts, CRP, liver enzymes, urine analysis or serum albumin values. Platelet counts were higher in the DDG compared to the EDG (P=0.004).Coronary abnormalities were more common in the DDG (P=0.05). Our findings suggest that children presenting primarily to a tertiary care centre with symptoms of Kawasaki disease are more likely to be associated with early diagnosis and delay in onset of neck swelling or oral lesions may be associated with delayed diagnosis. There is a need for creating more awareness about Kawasaki disease among practicing pediatricians in India.

Correlation of nasal smear eosinophilia with class of allergic rhinitis.

We correlated the grade of nasal smear eosinophilia with severity of allergic rhinitis, in 50 children in a cross sectional study conducted at a tertiary care referral hospital, between August 2007 to July 2009. The grade of nasal smear eosinophilia correlated well with increasing severity of allergic rhinitis (P<0.001)(r=0.83).