Hemophagocytic Lymphohistiocytosis Secondary to Dengue Fever in a Pediatric Patient: A Case Report.

Dengue fever, an arboviral illness, exhibits a broad range of symptoms, ranging from flu-like symptoms to serious hemorrhagic complications. Hemophagocytic lymphohistiocytosis (HLH) is an uncommon pathological state caused by excessive activation of the immune system, culminating in organ dysfunction. HLH can be primary or secondary, with infection being the most common cause. The association between dengue fever and dengue-induced HLH is becoming widely acknowledged as a lethal complication. We present the case of a two-year-old male child referred for the management of dengue infection. The patient's condition failed to ameliorate despite appropriate treatment. On further investigation, he was diagnosed with HLH. Following the initiation of steroid therapy, the patient demonstrated gradual improvement with normalization of laboratory parameters. Differentiating between HLH and severe dengue hemorrhagic fever poses a significant challenge, emphasizing the importance of prompt diagnosis for favorable outcomes. Early identification and commencement of corticosteroid therapy are imperative for successful management.

Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India.

In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.