Rachita Sarangi

Detection of metallo β-lactamase producing Klebsiella pneumoniae in a neonatal septicemia

Abstract A 10-day old preterm neonate, appropriate for the date, was admitted for lethargy and feeding intolerance. By culturing its blood, the antibiogram of the causative bacterium was ascertained by both Kirby-Bauer disc diffusion method and the Vitek2 system. Due clinical steps were taken for survival of the baby. The baby was suffering from septicemia. The causative bacterium was Klebsiella pneumoniae (K. pneumoniae). The isolated strain was found resistant to a total of 17 antibiotics; the strain was positive for extended spectrum β-lactamase production and resistant to two carbapenems, imipenem and meropenem. The baby could not survive. The baby was infected with an appalling strain of K. pneumoniae with a capacity to produce metallo β-lactamase overriding carbapenems, which is found to present in the state of Odisha, India.

Prevalence of multidrug resistant uropathogenic bacteria in pediatric patients of a tertiary care hospital in eastern India.

Today, because systemic infections such as urinary tract infection (UTI) affect even pediatric patients, antibiotic resistant bacteria have become a constant clinical challenge. In the present study, a total of 1054 urine samples were collected from pediatric patients over 18 months. From these samples, 510 isolates of pathogenic bacteria were collected using HiCrome UTI agar. Antibiotic sensitivity tests of isolates were performed using the Kirby-Bauer method. Two Gram-positive bacteria (Enterococcus faecalis and Staphylococcus aureus) and 7 Gram-negative bacteria (Citrobacter freundii, Enterobacter aerogenes, Escherichia coli, Klebsiella oxytoca, K. pneumoniae, Proteus vulgaris and Pseudomonas aeruginosa) were isolated. Antibiograms of isolated bacteria were ascertained using antibiotics of 4 classes: aminoglycosides, β-lactams, fluoroquinolones and 2 stand-alones (co-trimoxazole and nitrofurantoin). Based on percent values of antibiotic resistance, isolated bacteria were (in decreasing order of number of isolated isolates): E. coli (109)>S. aureus (65)>E. faecalis (82)>E. aerogenes (64)>C. freundii (41)>P. aeruginosa (32)>K. pneumoniae (45)>K. oxytoca (50)>P. vulgaris (22). Surveillance results show that MDR isolates of 9 pathogenic bacteria were prevalent in the environment around the hospital. Thus, revisions to the antimicrobial stewardship program in this area of the country are required to increase clinician confidence in empiric therapy, which is often used for UTI cases.

Neurocysticercosis masquerading psychotic disorder: A case report

Abstract Psychotic manifestations are uncommon in neurocysticercosis. This article describes a ten year girl presented with manic–psychotic manifestation for which she was under treatment with antipsychotics for eight months. Eventually she developed generalized tonic clonic seizure and CT scan of brain revealed small isodense right posterior parietal lesion of 5 mm size with perifocal edema. CECT revealed intense nodular post contrast enhancement. This highlights the possible misdiagnosis of a case of neurocysticercosis as an organic psychotic disorder so it should be considered as a differential diagnosis in patients with neurological as well as psychiatric manifestations in endemic area like India.

Thrombocytosis in children: Clinico-hematological profile from a single centre in Eastern India

BACKGROUND AND OBJECTIVE: Thrombocytosis is not an uncommon finding in hemograms of children with an incidence of 6%–15% among hospitalized children. This study aims to determine the etiology of thrombocytosis and analyze various platelet parameters in children attending our hospital. MATERIALS AND METHODS: A prospective observational study was carried out in a tertiary care center in Odisha, in eastern part of India, for 6 months from July 2016 to December 2016. All children of age group 1–14 years of age attending pediatrics and other pediatric super specialty outdoors and/or admitted to indoors and whose complete blood counts (CBC) were done were included in the study. The CBC parameters such as hemoglobin, red blood cell indices, and platelet indices (platelet distribution width [PDW], mean platelet volume [MPV], platelet large cell ratio [P-LCR]) were noted. RESULTS: Out of 2500 hemograms done in pediatrics age group, 272 (10.8%) patients showed thrombocytosis. About 99.6% of cases were of secondary thrombocytosis. Only one case of primary thrombocytosis was encountered. The most common cause of secondary thrombocytosis was infection (39.5%) alone followed by iron deficiency anemia (14.1%). With increasing platelet counts, a decrease in MPV, P-LCR, and PDW was noted which was statistically significant (P < 0.05). CONCLUSION: Thrombocytosis is not rare (10.8%) in children. Secondary thrombocytosis is common and predominatly attributed to infection.

Acute intravascular hemolysis following accidental ingestion of naphthalene: A rare case report

Naphthalene toxicity, an unusual form of poisoning, is often missed as a probable diagnosis for acute onset of intravascular hemolysis in children. It has an unpredictable clinical course and proper management in children relies heavily on high index of clinical suspicion. We report a rare case of naphthalene toxicity in a 1½-year-old child who presented with acute onset of intravascular hemolysis following accidental ingestion of a single mothball. She was put on supportive therapy. We have reported the present case to highlight the spectrum of acute symptoms that a single accidental ingestion of a moth ball can cause. The idiosyncrasy of the chemical toxicity and the myriad of symptoms that it can cause has to be kept in mind to impart timely and right treatment to save precious human lives.