Bhupesh Jain

Abstract

Scrub typhus is known to cause local and systemic vasculitic response in almost all the systems of the body. Scrub typhus very rarely presents itself with CNS manifestations. In central nervous system it most commonly causes meningitis and encephalitis although several other atypical presentations have been documented. Cerebellar ataxia, which is the lack of coordination, has a number of causes none of which are as uncommon or unheard of as Scrub Typhus. We report a case of a 15 years old child presenting with fever and isolated acute cerebellitis. Scrub Typhus was diagnosed by serum IgM ELISA. Patient showed rapid response to doxycycline therapy.   Keywords: Scrub typhus, Orientia tsutsugamushi, Rickettsia, MRI Brain, Cerebellitis

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Abstract

Introduction: Acute Undifferentiated Febrile Illness (AUFI) is a common cause of patients seeking healthcare in India. Appropriate diagnosis is essential for proper management of children, since failure to identify the nature of the causative pathogen results in increased morbidity and mortality due to diseases either being untreated or treated with inappropriate antimicrobials, Also there is waste of medicines and increased resistance to antimicrobials, which has a major public health threat worldwide. Aims and Objectives: To study clinical profile of children admitted with AUFI and to find out common causes of AUFI in Children (2 months to 18 years of age) and their seasonal trends. Materials and Methods: A prospective study was carried out over 200 children of age 2 months to 18 months admitted in Balchikitsalaya MBGH Hospital with Acute Undifferentiated Febrile Illness of less than 7 days duration over a period of 12 months from November 2021 to October 2022. Results : Majority of the patients were in the age group of 10-15 years (32.5%). Out of 200 AUFI patients, majority had undifferentiated illness (53%) followed by Malaria (16.5%), UTI (12.5%), Dengue(11%), Scrub Typhus(5%) and Enteric Fever(2.5%). Higher incidence of AUFI was seen from August to November. Conclusion: More than 50% cases of Acute Febrile Illness were due to Undifferentiated Illnesses, hence it can be concluded that provided the cause of undifferentiated illness is found, the irrational use of antibiotics and antimalarial should be prevented.   Keywords: Acute undifferentiated febrile illness, Fever with short duration, Fever without focus

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Abstract

Background: Seizure is defined as abnormal paroxysmal neuronal discharge, which is clinically manifested by motor, sensory, autonomic or behavioral disturbances. Seizures are common in pediatrics age group and occur in 10% of children. Less than 1/3of seizures in children are caused by epilepsy. The objective of the study was to determine the clinical and etiological profile of new onset unprovoked seizure in children aged between 2 month to 18 years. Materials and Methods: A hospital based prospective single centre study at RNT Medical College, Udaipur. 111 patients admitted in Balchikitsalya with new onset unprovoked seizures during one year. Results: Out of 111 patients with new onset unprovoked seizures, majority of patients were between 1-5 years of age with male predominance. In which most common diagnosis was seizure disorder in 78 pts (70.2%) [Generalised 76 pts (97.4%) > Focal 2 pts (2.6%)] followed by 13.5% hypocalcemic seizure, 8.1% hypoglycemic seizure. Other diagnosis was tuberous sclerosis (2.7%), white matter changes (1.8%), adrenoleukodystrophy (0.9%), arachnoid cyst (0.9%), tuberculoma (0.9%) and HIE changes (0.9%). EEG abnormality was seen in 46% of patients. Hyponatremia (36%) was significantly associated with abnormal EEG changes. MRI was done in 38.7% of the patients, out of which, abnormality was seen in only 8.6% of the children. Conclusions: Seizure is mainly diagnosed clinically and EEG can be normal in many patients. First episode of unprovoked seizure was common in age group of 1-5 years. EEG and Neuroimaging is useful for better diagnosis, treatment can be started on clinical diagnosis.   Keywords: Unprovoked seizure, EEG, MRI

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