Leptospirosis Complicated by Secondary Hemophagocytic Lymphohistiocytosis in a Child: A Rare Association

<div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d89213e99"> <!-- named anchor --> </a> <h5 class="section-title" id="d89213e100">Aims and background</h5> <p dir="auto" id="d89213e102">Leptospirosis is caused by spirochetes of the genus <i>Leptospira</i>. In most patients, it is a very mild illness. However, some patients develop complications due to the involvement of multiple organ systems. Hemophagocytic lymphohistiocytosis (HLH) is characterized by prolonged fever, hepatosplenomegaly and cytopenias, hyperferritinemia and hypertriglyceridemia, hypofibrinogenemia, and hemophagocytosis in lymphoreticular system. It may occur primarily as a result of some genetic predisposition or secondarily associated with certain infections, autoimmune, and malignant conditions [secondary hemophagocytic lymphohistiocytosis (sHLH)]. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d89213e107"> <!-- named anchor --> </a> <h5 class="section-title" id="d89213e108">Case description</h5> <p dir="auto" id="d89213e110">We report a 9-year-old girl with secondary HLH associated with Leptospira infection treated successfully with appropriate antibiotics and intravenous immunoglobulin. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d89213e112"> <!-- named anchor --> </a> <h5 class="section-title" id="d89213e113">Conclusion</h5> <p dir="auto" id="d89213e115">Progressive cytopenia associated with deteriorating clinical condition with recurrence or nonabatement of fever should lead the clinician to suspect sHLH. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d89213e117"> <!-- named anchor --> </a> <h5 class="section-title" id="d89213e118">Clinical significance</h5> <p dir="auto" id="d89213e120">Leptospirosis precipitating HLH has rarely been reported.</p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d89213e122"> <!-- named anchor --> </a> <h5 class="section-title" id="d89213e123">How to cite this article</h5> <p dir="auto" id="d89213e125">Nandi M, Bera S. Leptospirosis Complicated by Secondary Hemophagocytic Lymphohistiocytosis in a Child: A Rare Association. Pediatr Inf Dis 2025;7(1):27–29. </p> </div>

Etiology of Prolonged Fever in Children Using a Protocol-based Approach from a Tertiary-level Hospital in India: A Descriptive Study

<div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d83591e129"> <!-- named anchor --> </a> <h5 class="section-title" id="d83591e130">Background</h5> <p dir="auto" id="d83591e132">Prolonged fever contributes significantly as a health problem, and the etiology remains a diagnostic challenge in clinical practice, determined by factors including age-group, ethnicity, season, or geographic location. Using a structured approach for evaluation is useful. The aim of this study was to determine the etiology of prolonged fever in children using a modified four-stage protocol. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d83591e134"> <!-- named anchor --> </a> <h5 class="section-title" id="d83591e135">Objectives</h5> <p dir="auto" id="d83591e137">The primary objective was to determine the broad etiology of prolonged fever in children using a protocol-based approach. The secondary objective was to correlate common demographic and clinical parameters with the four etiological categories: infections, immune disorders, malignancy, and therapeutic trial or undetermined etiology. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d83591e139"> <!-- named anchor --> </a> <h5 class="section-title" id="d83591e140">Materials and methods</h5> <p dir="auto" id="d83591e142">A cross-sectional descriptive study design was used. Children aged 2 months to 18 years admitted with fever >7 days’ duration were recruited with consent. Baseline details and the modified four-stage protocol were used to identify the etiology of prolonged fever. Descriptive statistical analysis was done using SPSS 13. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d83591e144"> <!-- named anchor --> </a> <h5 class="section-title" id="d83591e145">Results</h5> <p dir="auto" id="d83591e147">90 children, aged 3 months to 16 years (mean 6.3, SD 4.6), 60% male, with prolonged fever were included. Etiology was identified in 69 (76.7%) children, and infections were the commonest cause (51.1%), followed by inflammatory disorders (15.6%) and malignancy (10%). Rickettsial infection was the commonest (19.6%). Using the modified four-stage protocol, 33 children (36.7%) were identified in stage 1, 10 (11.1%) in stage 2, 21 (23.3%) in stage 3, and 26 (28.9%) remained undetermined or responded to therapeutic trial in stage 4. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d83591e149"> <!-- named anchor --> </a> <h5 class="section-title" id="d83591e150">Conclusion</h5> <p dir="auto" id="d83591e152">Infectious disease remains the most common etiology of prolonged fever in children, with anemia present across etiological groups. Relevant history, demographic information, symptoms, clinical examination, and baseline investigations are most important for diagnosis. Using a structured approach ensures judicious use of invasive and expensive investigations during evaluation. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d83591e154"> <!-- named anchor --> </a> <h5 class="section-title" id="d83591e155">How to cite this article</h5> <p dir="auto" id="d83591e157">Lewin M, Mary T, K S. Etiology of Prolonged Fever in Children Using a Protocol-based Approach from a Tertiary-level Hospital in India: A Descriptive Study. Pediatr Inf Dis 2025;7(2):54–58. </p> </div>

A Rare Presentation of Intestinal Tuberculosis with Transverse Colon Perforation in an Infant

<p xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" dir="auto" id="d89774e128">To report a case of a 1-year-old female with intestinal tuberculosis (TB) causing transverse colon perforation and peritonitis. </p><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d89774e130"> <!-- named anchor --> </a> <h5 class="section-title" id="d89774e131">How to cite this article</h5> <p dir="auto" id="d89774e133">Mundada S, Shah NB, Solunke V, <i>et al.</i> A Rare Presentation of Intestinal Tuberculosis with Transverse Colon Perforation in an Infant. Pediatr Inf Dis 2025;7(1):25–26. </p> </div>

Pediatric Pulse: Advancing Neonatal and Child Health

<p>With respect to UN SDG03,<strong> Pediatric Pulse: Advancing Neonatal and Child Health </strong>theme covers three journals of Jaypee Brothers Publishing: <em>"Pediatric Infectious Disease (PID), Annals of Pediatric Gastroenterology and Hepatology ISPGHAN (APGH) & Newborn."</em></p>

Epidemiology and Clinical Outcome of Common Multi-drug Resistant Gram-negative Bacterial Infections in a Network of Hospitals in India (IMPRES): A Multicenter Intensive Care Unit-based Prospective Clinical Study

<div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d902396e561"> <!-- named anchor --> </a> <h5 class="section-title" id="d902396e562">Background and aims</h5> <p dir="auto" id="d902396e564">India witnessed the exponential rise of antibiotic resistance due to the high burden of communicable disease. The Indian Council of Medical Research reported <i>Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii</i>, and <i>Klebsiella pneumoniae</i> (PEAK organisms) as the most common gram-negative isolates, constituting 65.5% of total isolates. The present study aimed to observe the demographics and clinical outcomes of patients infected with these four common gram-negative bacteria in ICUs across India. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d902396e572"> <!-- named anchor --> </a> <h5 class="section-title" id="d902396e573">Patients and methods</h5> <p dir="auto" id="d902396e575">This prospective multicentric observational study was conducted in ICUs of 19 hospitals across India. The data collected for each patient included: demography, diagnosis, disease severity score, site of infection, PEAK organism, risk factors for multidrug resistance, antibiotic sensitivity, resistance pattern, total ventilator days, and 28-day mortality. Subgroup analysis of 28-day mortality was done for community-acquired vs hospital-acquired infection, appropriate empirical antibiotic, Carbapenem- and Colistin-resistant infections. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d902396e577"> <!-- named anchor --> </a> <h5 class="section-title" id="d902396e578">Results</h5> <p dir="auto" id="d902396e580">A total of 936 patients were included in the analysis. Resistance to Cephalosporin, Fluroquinolones, Piperacillin Tazobactam, Carbapenem, Aminoglycosides, and Colistin was observed in 84, 68, 55, 47, 37, and 4.2% of patients, respectively. The 28-day crude mortality rate was 23.5%, which was higher in the subgroup with isolates resistant to empiric antibiotics compared to those with sensitive isolates (29.6 vs 21.4%, <i>p</i> > 0.05). Moreover, 32 and 27% mortality rates were observed in patients who were infected with Carbapenem-resistant and Colistin-resistant PEAK organisms, respectively. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d902396e585"> <!-- named anchor --> </a> <h5 class="section-title" id="d902396e586">Conclusion</h5> <p dir="auto" id="d902396e588">The present study observed a high prevalence of antibiotic resistance in Indian ICUs, contributing to a crude mortality rate of 23.5%. Patients with Carbapenem and Colistin resistance may exhibit higher 28-day crude mortality. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d902396e590"> <!-- named anchor --> </a> <h5 class="section-title" id="d902396e591">How to cite this article</h5> <p dir="auto" id="d902396e593">Das SK, Joshi Z, Govil D, Shah MS, Jakaraddi GN, Sinha S, <i>et al</i>. Epidemiology and Clinical Outcome of Common Multi-drug Resistant Gram-negative Bacterial Infections in a Network of Hospitals in India (IMPRES): A Multicenter Intensive Care Unit-based Prospective Clinical Study. Indian J Crit Care Med 2025;29(6):504–509. </p> <p dir="auto" id="d902396e598">CTRI identifier: CTRI/2023/01/049121.</p> </div>

Clinical Profile, Intensive Care Needs, and Outcome of Children with Adenoviral Pneumonia: A Retrospective Study from a Tertiary Care Hospital in North India

<div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d874711e210"> <!-- named anchor --> </a> <h5 class="section-title" id="d874711e211">Background and aims</h5> <p dir="auto" id="d874711e213">Adenoviral pneumonia is a significant cause of morbidity and mortality among children. There is limited data about the clinical profile, intensive care needs, and outcomes of children with adenoviral pneumonia from resource-limited settings. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d874711e215"> <!-- named anchor --> </a> <h5 class="section-title" id="d874711e216">Patients and methods</h5> <p dir="auto" id="d874711e218">This retrospective study was conducted in the pediatric emergency room (PER) and pediatric intensive care unit (PICU) of a tertiary care hospital in North India over a period of a period of 2 years (July 2022 to June 2024). The data collection included demographic and clinical features, laboratory investigations, complications, treatment, intensive care needs, and outcomes. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d874711e220"> <!-- named anchor --> </a> <h5 class="section-title" id="d874711e221">Results</h5> <p dir="auto" id="d874711e223">Eighty-five children were enrolled, majority were <1 year of age and males (71.7% each). All presented with fever and respiratory symptoms. The common complications were acute respiratory distress syndrome (ARDS) (47%), multiple organ dysfunction syndrome (MODS) (26%), shock (25%), and encephalopathy (25%). PICU admission was needed in 46% of children. The intensive care needs included invasive mechanical ventilation (48%), CPAP (39%), HFNC (9%), vasoactive drugs (25%), IVIG (8%), RRT (6%), and cidofovir (5%). The duration of ER, PICU, and hospital stay was 48 (24–96) hours, 7 (4–14) days, and 9 (5–18) days, respectively. The mortality rate was 22%. On multivariate analysis, the independent predictors of mortality were low admission pH, myocardial dysfunction, acute kidney (AKI), ARDS, shock, encephalopathy, MODS, and healthcare-associated infection (HCAI). </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d874711e225"> <!-- named anchor --> </a> <h5 class="section-title" id="d874711e226">Conclusion</h5> <p dir="auto" id="d874711e228">Infants constituted the largest group of patients requiring admission for adenoviral infection to pediatric emergency in a tertiary care center. Common complications were ARDS, shock, MODS, and encephalopathy. Nearly half required PICU admission for organ support. The mortality rate was 22%; and low admission pH, myocardial dysfunction, AKI, ARDS, shock, encephalopathy, MODS, and HCAI were independent predictors of mortality. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d874711e230"> <!-- named anchor --> </a> <h5 class="section-title" id="d874711e231">How to cite this article</h5> <p dir="auto" id="d874711e233">Vyasam S, Jayaram J, Sarkar S, Angurana SK, Raj S, Bora I, <i>et al</i>. Clinical Profile, Intensive Care Needs, and Outcome of Children with Adenoviral Pneumonia: A Retrospective Study from a Tertiary Care Hospital in North India. Indian J Crit Care Med 2025;29(7):586–591. </p> </div>

Glycemic Variability and Outcomes in Sepsis: There's No Smoke without Fire!

Jaypee UN SDG 03

<p>Jaypee Brothers Medical Publisher's SDG 03 Collection is an impressive initiative that consolidates valuable healthcare knowledge. It compiles journal articles from key sub-collections: "Preventive and Emergency Medicine Insights," "Maternal and Women's Health Advocacy," and "Pediatric Pulse: Advancing Neonatal and Child Health." </p>

Development and Validation of a Neurological Outcome Prediction Score for Children Requiring Mechanical Ventilation: The NOPS-VC Score

<div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e158"> <!-- named anchor --> </a> <h5 class="section-title" id="d880065e159">Background and aims</h5> <p dir="auto" id="d880065e161">Currently, no validated scoring system exists to predict neurological outcomes in mechanically ventilated children. We aimed to develop and validate such a score in this population. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e163"> <!-- named anchor --> </a> <h5 class="section-title" id="d880065e164">Patients and methods</h5> <p dir="auto" id="d880065e166">We developed the NOPS-VC score, comprising eight items. Each parameter is rated on a Likert scale, where a minimum score of 1 indicates no significant risk, and a maximum score of 3 represents the highest risk for poor neurological outcomes. The face and content validity of the score were assessed using the content validity index (CVI) and content validity ratio. Neurological outcomes were determined at discharge and at 6 months of follow-up. Construct validity was assessed by correlating the NOPS-VC score with the Pediatric Cerebral Performance Category score, functional status scale (FSS), intelligence quotient (IQ), Vineland Adaptive Behavior Scale, gross motor function measure (GMFM), child behavior checklist, and pediatric quality of life inventory. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e168"> <!-- named anchor --> </a> <h5 class="section-title" id="d880065e169">Results</h5> <p dir="auto" id="d880065e171">Among 170 participants, 87 had good functional outcomes. The scale-level content validity index (S-CVI/UA) was 0.95, and S-CVI/Ave was 0.9, indicating excellent content validity. The one-factor model demonstrated a good fit, with all item loadings exceeding 0.7 [Tucker–Lewis index (TLI) = 0.95, comparative fit index (CFI) = 0.96, root mean squared error of approximation (RMSEA) = 0.067 (0.059–0.074)]. The area under the receiver operating characteristic (ROC) curve for the maximum and baseline NOPS-VC scores was 0.92 and 0.91, respectively. The optimal cutoff value for both scores was 18, with sensitivity/specificity of 82/97% for the maximum score and 80/97% for the baseline score. Construct validity showed strong correlations ( <i>r</i> ≥ 0.70) with all parameters. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e176"> <!-- named anchor --> </a> <h5 class="section-title" id="d880065e177">Conclusion</h5> <p dir="auto" id="d880065e179">The NOPS-VC score, when applied at the initiation of mechanical ventilation in critically ill children, demonstrates strong validity in predicting neurological outcomes at 6 months, with an optimal cutoff value of 18. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e181"> <!-- named anchor --> </a> <h5 class="section-title" id="d880065e182">How to cite this article</h5> <p dir="auto" id="d880065e184">Tomar A, Panda PK, Elwadhi A, Tiwari LK, Sharawat IK. Development and Validation of a Neurological Outcome Prediction Score for Children Requiring Mechanical Ventilation: The NOPS-VC Score. Indian J Crit Care Med 2025;29(7):578–585. </p> </div>

Validation of Global Definition of Acute Respiratory Distress Syndrome in COVID-19 Patients: A Retrospective Study

<div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e180"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e181">Background and aims</h5> <p dir="auto" id="d893418e183">A recent acute respiratory distress syndrome (ARDS) definition included patients receiving high-flow nasal oxygen (HFNO) when fulfilling the oxygenation and radiological criteria of ARDS Berlin definition. However, outcome of patients treated may be better than those who fulfilled the corresponding class of Berlin definition. This study was aimed to compare the survival between patients fulfilling Berlin definition and patients managed by HFNO initially. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e185"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e186">Patients and methods</h5> <p dir="auto" id="d893418e188">Patients fulfilling the World Health Organization case definition of severe or critical COVID-19 infection requiring HFNO (at least 30 L/minute of flow), noninvasive ventilation (NIV) (at least a positive end-expiratory pressure (PEEP) of 5 cm H ₂O), or invasive mechanical ventilation (at least a PEEP of 5 cm H ₂O) were included in this study provided they fulfilled oxygenation and radiological criteria of ARDS as per Berlin definition. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e196"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e197">Results</h5> <p dir="auto" id="d893418e199">All-cause hospital mortality rate in patients who fulfilled Berlin definition ( <i>n</i> = 193) was 47.6% (mild ARDS), 64.9% (moderate ARDS), and 67.9% (severe ARDS) ( <i>p</i> = 0.23). Multivariable survival analysis reported that hazard of death was higher in patients who fulfilled Berlin definition as opposed to those who were initially managed by HFNO (adjusted hazard ratio (95% confidence interval) 1.68 (1.15–2.45), <i>p</i> = 0.007) after adjustment for age, Charlson comorbidity index, and baseline PaO ₂/FiO ₂ ratio. Multiple pairwise comparison reported that hazard of death was lower in patients with moderate ARDS requiring HFNO as compared with the moderate ARDS patients as per Berlin definition ( <i>p</i> = 0.024). However, no difference was observed in patients of mild ( <i>p</i> = 0.39) and severe ARDS ( <i>p</i> = 0.24). </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e226"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e227">Conclusion</h5> <p dir="auto" id="d893418e229">We have found a statistically significant higher survival in ARDS patients managed by HFNO in the first 24 hours after intensive care unit (ICU) admission when compared with the patients receiving NIV or invasive mechanical ventilation. So, we conclude that outcome of patients fulfilling the global definition of ARDS is largely different from those who fulfilled Berlin definition. Hence, prospective multicentric validation is required before its bedside use. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e231"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e232">How to cite this article</h5> <p dir="auto" id="d893418e234">Maitra S, Baidya DK, Ray BR, Kayina CA, Haritha D, Nair PR, <i>et al</i>. Validation of Global Definition of Acute Respiratory Distress Syndrome in COVID-19 Patients: A Retrospective Study. Indian J Crit Care Med 2025;29(7):556–561. </p> </div>