Mycoplasma pneumoniae is a significant pathogen responsible for respiratory infections in older children. Aim of study: Study of the varied pulmonary manifestations of Mycoplasma pneumoniae pneumonia (MPP) in older children, focusing on macrolide-resistant Mycoplasma pneumoniae (MRMP) and refractory Mycoplasma pneumoniae pneumonia (RMPP). Materials and methods: All children below 18 years, admitted between July 15, 2024 and January 15, 2025, with MPP were studied. MPP was diagnosed in children with typical symptomatology, blood counts, and Mycoplasma polymerase chain reaction (PCR) and/or significant Mycoplasma immunoglobulin M (IgM) positivity. Data was collected from the electronic medical records of our hospital. Results: Forty-two children with a mean age of 8 years ± SD 2.7 years (range from 3 to 13 years); 20 girls and the rest boys, were admitted with MPP during the 6 months to the four pediatric units of our hospital. Mean total count was 7,793 ± SD 5.294/mm3; and mean quantitative C-reactive protein (CRP) was 91.15 ± SD 115.06 mg/L; in the eight cases where lactate dehydrogenase (LDH) was done, the mean value was 914 ± SD 457 (all eight had MRMP), and four were direct Coombs test (DCT) positive. Five were both serology and respiratory panel PCR positive, 16 were QIASTAT respiratory panel PCR positive and 21 were Mycoplasma IgM positive. Twenty-three presented with bronchopneumonia or consolidation, 15 had pneumonia with exudative pleural effusion without loculation; four being moderate to massive pleural effusion, requiring intercostal drainage. Two children developed pneumothorax; one was a child with spinal muscular atrophy. A 12-year-old with Mycoplasma pneumonia postinfectious bronchiolitis obliterans (PIBO) responded to high-dose pulse methylprednisolone and intravenous immunoglobulin (IVIG). A 12-year-old who required multiple interventions, including extracorporeal membrane oxygenation (ECMO), diagnosed as RMPP, was the only child in this cohort who expired. All children received first-line macrolide initially (azithromycin, in all except three who received clarithromycin), and 26 children (62%) who continued to have fever and respiratory symptoms after 72 hours of first-line macrolide were considered to have MRMP and were administered intravenous (IV) levofloxacin for the rest of therapy. Four children required mechanical ventilation, while seven recovered with noninvasive ventilation (NIV), and one child required ECMO. All children except the child who expired recovered fully without sequelae. Conclusion: Though classically, Mycoplasma pneumonia is called walking pneumonia, during outbreaks, as in this case series, severe respiratory manifestations could require hospitalization for treatment of various complications with appropriate regimens. Diagnosis of MPP, MRMP, and RMPP in resource-poor settings, where not all confirmatory tests are possible to perform due to financial constraints, is discussed.
Background: Preterm birth (PTB) is a prominent cause of neonatal mortality and accounts for around 1 million neonatal deaths annually. Preterm infants are more prone to infections in the 1 year of life, and many of these infections can be prevented by timely vaccinations. Appropriate and timely vaccination is the need of the hour for preterm infants, which can substantially reduce the associated morbidity and mortality. This review highlights preterm immunization practices in India, current recommendations, and the utility of hexavalent vaccines for preterm infants. Methodology: An expert panel advisory board meeting of pediatricians from all over India was conducted, followed by the collation of their clinical insights. A thorough literature search was performed using specific key terms and relevant articles. Results: PTBs are a significant health challenge, with an estimated 13.4 million cases globally. PTB is the primary cause of neonatal mortality in most parts of the world, including India, and is responsible for around 1 million deaths annually. Preterm infants are immunocompromised hosts and are more likely to contract infections in the 1 year of life. Many of these infections can be prevented to a significant extent by timely vaccinations. However, certain barriers, such as concerns among healthcare professionals regarding the effectiveness and safety of vaccines, parental beliefs, and socioeconomic status, can delay preterm immunization. The gaps created by these barriers can be bridged by creating awareness regarding the need, safety, and effectiveness of available vaccines. Hexavalent acellular vaccines are combination vaccines that are safe, effective, immunogenic, and well tolerated in preterm infants, as validated by scientific evidence. Conclusion: The burden of morbidity and mortality due to vaccine-preventable diseases in neonates born preterm can be combated by timely immunization and by following the current clinical practice recommendations. Hexavalent vaccines can protect preterm infants from six vaccine-preventable diseases, and their safety and effectiveness are well established.
Neonatal urinary tract infections (UTI) classically present with fever in the setting of other nonspecific symptoms like poor feeding and lethargy, and are most associated with pathogens such as Escherichia coli, Enterococcus, or Klebsiella species. We present a rare presentation of a UTI in a neonate presenting with encrusted cystitis and pyelitis, which was later found to be caused by Corynebacterium tuberculostearicum. This case highlights the clinical significance and pathogenicity of C. tuberculostearicum, as it is notoriously difficult to identify with conventional biochemical methods and is typically multidrug resistant.
Introduction: Previous research has pointed toward a rise in immunization hesitancy and the negative effects it has on pediatric immunization status. The coronavirus disease 2019 (COVID-19) pandemic was a catalyst for this spread of misinformation, which is illustrated in reports from the Centers for Disease Control and Prevention (CDC) indicating a decrease in immunization coverage during the COVID-19 period. This study assessed the immunization status of children at age 20 months prior to, during, and after the COVID-19 pandemic in Hawaii. Methods: We collected the immunization history of patients within an accountable care organization (ACO) in Hawaii. Patients' date of birth encompassed the pre-COVID, COVID, and post-COVID periods. Immunization status was determined using a point system where one point was assigned for each completed routine childhood immunization by the age of 20 months. Further analysis was run on the relationship between insurance category (commercial, Medicaid, no insurance) and primary language (English, non-English, not known) on immunization status. Results: The point totals for the 20,843 patients across pre-COVID (12,795 patients), COVID (5,203 patients), and post-COVID (2,845 patients) time periods were analyzed. Linear regression showed—r = 0.02, R-squared = 0.0004, p = 0.0047, indicating that immunization rates increased slightly over the three time periods. Both insurance category and primary language immunization rates demonstrated significant results in terms of COVID. Conclusion: Our study indicates the successful maintenance and slight improvement in high immunization rates in the ACO primary care practices despite vaccine misinformation during the COVID-19 pandemic. Clinical significance: This study demonstrates the ability to maintain pediatric immunization rates despite rising levels of immunization hesitancy.
Background: Enteric fever remains a significant cause of morbidity among children in India, particularly in resource-limited, hilly regions with poor access to clean water and sanitation. Diagnostic challenges and increasing antimicrobial resistance complicate timely management. In remote regions like Kumaon in Uttarakhand, tertiary care centers often serve as the only referral point, emphasizing the need to understand local disease patterns, complications, and diagnostic limitations. Aims and materials and methods: This prospective observational study was conducted at a tertiary care center in the Almora region of Uttarakhand. Pediatric patients diagnosed clinically with enteric fever were included. Diagnosis was primarily based on Widal test results and clinical presentation, as Typhidot was not routinely available and only performed externally in a few cases. Blood cultures were sent where feasible, though positivity was limited, likely due to 45% of patients receiving antibiotics before admission. Data on clinical presentation, laboratory findings, geographic distribution, and complications were recorded and analyzed. Conclusion and significance: Enteric fever continues to burden the pediatric population in hilly regions, with diagnostic limitations due to prior antibiotic use and unavailability of advanced testing. The study emphasizes high index of clinical suspicion, as well as need for improved diagnostic infrastructure and antibiotic stewardship in resource-limited settings. Public health interventions, including awareness regarding early care-seeking, safe antibiotic use, hygiene practices, and vaccination, are critical to reduce disease burden and prevent complications in such underserved regions.
Background: Entamoeba histolytica cysts inside the liver on microscopic examination. Clinical description: We reported a case of type I amebic liver abscess (ALA) in a 3-year-old girl who presented with fever, bloody diarrhea, and right hypochondriac pain. Management and outcome: Ultrasonography (USG) and computer tomography (CT) scan revealed two collections, one in the right lobe and the second in the left lobe of the liver. Pigtail catheter drainage was done, and intravenous (IV) metronidazole was started. Serological tests for the detection of E. histolytica immunoglobulin G (IgG) antibodies were positive. Conclusion: Our case was unique in being found to be infected with cysts inside the liver on microscopic examination.
Background: Candida auris is an emerging species of the genus Candida, responsible for outbreaks in healthcare settings worldwide. It is a multidrug-resistant fungal pathogen that quickly colonizes surfaces in hospitals and intensive care units (ICUs) and causes repeated infections. This report describes a case of C. auris fungemia in a tertiary care hospital in Central Delhi, India. Case description: The patient was a 5-month-old male child from Prayagraj, where he had undergone surgery (arthrotomy) for septic arthritis and had been admitted to the ICU. He developed a urinary tract infection (UTI) as a secondary complication due to suspected pyonephrosis or vesicoureteral reflux. The patient had multiple underlying risk factors and also tested positive for COVID-19. Candidemia with sepsis was detected after prolonged hospitalization. C. auris was isolated and confirmed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) and VITEK 2 (bioMérieux), from blood, CSF, and urine samples, and the patient recovered after treatment with Caspofungin. Conclusion: Candida auris is a new multidrug-resistant pathogenic Candida sp. that is of concern for clinicians and microbiologists because of its propensity to cause outbreaks and pose a major challenge during the management of the infection. The nosocomial spread can be controlled through proper disinfection, spreading awareness, early detection, and appropriate antifungal susceptibility-guided treatment.
Introduction: Inflammatory bowel disease (IBD) is associated with a rising incidence. The cornerstone of treatment relies on immunosuppressive/biological drugs. These medications carry an increased risk of infections, which can be mitigated through vaccination. Our objective was to characterize the vaccination status of pediatric patients with IBD undergoing treatment. Materials and methods: An observational and retrospective analysis of clinical processes for patients diagnosed with IBD followed at a tertiary hospital from April 2010 to April 2023, under treatment in May 2024. Results: Ninety-nine individuals were included, 62 (63%) were female, and a median age of 13 years (IQR 11–15). Sixty-nine (70%) had Crohn's disease (CD), 21 (21%) had ulcerative colitis (UC), and 9 (9%) had indeterminate colitis. At the time of the study, 48 (48%) with immunomodulators, and 53 (53%) with biological drugs. Regarding vaccination status, in 95 (96%), the National Immunization Plan (NIP) was up to date at diagnosis (100% at the start of treatment). At the time of the study, 74% had received the conjugate pneumococcal vaccine, 69% the influenza vaccine, 64% the polysaccharide pneumococcal vaccine, and the hepatitis A vaccine, 63% the SARS-CoV-2 vaccine, 61% the booster dose of the hepatitis B vaccine, 54% the varicella vaccine, 11% the meningococcal A, C, W, Y vaccine, and 6% the human papillomavirus (HPV) vaccine. Conclusion: Preventing opportunistic infections is essential in patients with IBD. Despite good vaccination coverage in this sample, which is significantly higher than reported in the literature, there remains considerable room for improvement, particularly for non-NIP vaccines.
Hepatitis A is a common cause of acute viral hepatitis (AVH), which can often lead to alterations in lipid metabolism. We present a case of a 4-year-old boy with acute hepatitis A, who had elevated serum cholesterol, hypertriglyceridemia, and decreased high-density lipoprotein (HDL), along with typical presentation of acute hepatitis A. The deranged serum lipid profile (elevated cholesterol, hypertriglyceridemia, low HDL) resolved within 30 days of presentation, reflecting the transient elevation associated with the disease.
Antibiotic audit is an essential element of a hospital antibiotic stewardship program. We report an audit done in one unit of our hospital, in which we analyzed the cases admitted in the month of July 2024 with fever, that were treated without antibiotics. Out of 77 children admitted during the month, 41 were admitted with fever and 30 of these children were treated without antibiotics. The children who were managed without antibiotics were 28 with viral illnesses, five of whom had been started on antibiotics elsewhere, and two others who had multiple antibiotic courses before admission to our hospital were evaluated after stopping antibiotics. One child was diagnosed as systemic-onset juvenile idiopathic arthritis (SOJIA), and the other was a case of Kawasaki disease. How to cite this article: Unni JC, Sunu R, Irshad M. Audit of Children Admitted to a Quaternary Hospital in South India with Fever Who Did Not Receive Antibiotics throughout Hospital Stay. Pediatr Inf Dis 2025;7(4):115–117.
