Scrub typhus is an emerging acute undifferentiated febrile illness (AUFI) among children, particularly in rural West Bengal. Due to the lack of gold standard diagnostic tests, and lack of awareness among healthcare personnel, it leads to delay in diagnosis and specic treatment which leads to several complications and even death. In this perspective, with the hope to know better, this study was done to evaluate clinical features, complications, laboratory proles and outcome of scrub typhus in the paediatric population. AIMS AND OBJECTIVES:To study clinical features, complications, laboratory proles and outcomes of scrub typhus in children. MATERIALANDMETHODS:Thisretrospective studywas conducted in theDepartment ofPaediatrics ofBankuraSammilaniMedicalCollege and Hospital(BSMCH),Bankura,India.Data of 75 childrenwhowere found to be IgMpositive toOrientia tsutsugamushi, aged onemonth to 12 yearswere collectedfromthe case registermaintainedinourunitfromJune2020toAugust2021andwere analysedbyEpiInfo,version3.5.1,software. RESULTS: Fever was the most common presenting symptoms seen in 100% (n=75) of cases. Other common signs and symptoms were vomiting (n=22,29.3%), pain abdomen (n=15,20%), cough(n=22,29.3%), myalgia (n=12,16%), headache (n=12,16%), convulsions (n=8,10.7%), pallor (n=25,33.3%), facial pufness (n=28,37.3%), oedema (n=12,16%), eschar (n=20,26.7%), hepatomegaly (n=45,60%) and splenomegaly (n=42,56%). Among laboratory parameters, anaemia (n=72,96%), leucocytosis (n=31,41.3%), thrombocytopenia (n=43,57.3%), raised alanine aminotransferase (n=49,65.3%), aspartate aminotransferase (n=46,61.3%) and hypoalbuminemia (n=31,41.3%) were observed. Meningoencephalitis was present in 10.7% (n=8) of cases. CONCLUSION: A high index of suspicion and abnormal laboratory ndings will help physicians in the timely diagnosis of scrub typhus and initiate anti-scrub treatment early, thereby preventing complications and minimising fatality.

Introduction: Nephrotic syndrome, being one of the common glomerular diseases in the paediatric population, is characterised by massive proteinuria and has a negative impact on thyroid function, necessitating investigation. Aim: To assess the status of thyroid function in nephrotic syndrome in the paediatric age group. Materials and Methods: This descriptive cross-sectional study was carried out at Bankura Sammilani Medical College and Hospital (BSMCH) in Bankura, West Bengal, India. The study included 100 children of both sexes aged one to eightyear-old who had nephrotic syndrome, either newly diagnosed or relapsed, and who were either hospitalised to the paediatric department or visited an outpatient department between April 2020 and September 2021. Thyroid hormone profiles, as well as other relevant investigations, were estimated in all children. Data was analysed using the Epi-Info (version 3.5.1) software. Results: Out of 100 children, 64% were males and the rest, 36%, were females. The mean age of presentation was 4.31±1.90 years. A 62% of them had a higher serum level of Thyroid Stimulating Hormone (TSH). Low levels of thyroxine (T4) and triiodothyronine (T3) were observed in 56% and 54% of cases, respectively. The serum albumin and serum TSH levels showed a significant negative correlation (r=-0.249, p=0.013). While T3 had a significant positive correlation (r=0.221, p=0.027), serum levels of T4 had a positive correlation (r=0.187) but turned out to be statistically insignificant (p=0.063). Conclusion: It was found that 62% of the children having nephrotic syndrome also had increased levels of TSH. Serum T4 and T3 levels were low in 54% and 56% of the study population, respectively, necessitating further investigation.

ConclusionIn a country like India, especially in rural and resource limited areas, where IgM ELISA might not be available easily at hand, it is pertinent to have a high index of suspicion for scrub typhus and more so in the endemic regions. The predominant clinical signs like hepatosplenomegaly, lymphadenopathy or the characteristic finding of eschar along with raised ALT,AST and decreased platelets can prompt the treating physicians to initiate the treatment early, thus preventing severe morbidity and mortality.

A female child hailing from South Asia, India presented with pallor, multiple petechiae and ecchymosis. Based on the clinical picture and demography, the differentials considered were pancytopenia of nutritional origin, acute leukaemia, autoimmune and infective aetiologies. After ruling these out by respective tests, a literature review was done which revealed the possibility of filariasis especially in a patient with eosinophilia which was present in our case. A repeat peripheral blood smear study with a nocturnally drawn sample revealed multiple microfilariae and a diagnosis of filariasis was made. The patient was treated with triple drug therapy of diethylcarbamazine (6 mg/kg), ivermectin (6 µg/kg) and albendazole (400 mg) administered as a single dose. Subsequent haemograms showed improved cell counts. This along with a previous handful of case reports emphasises filariasis as one of the differentials of pancytopenia and should be kept in mind while evaluating for the same, especially in the endemic areas.

Nicolau syndrome is a rare complication of intramuscular injections caused by various drugs that present with intense pain and induration at the injection site. It is characterized by local aseptic skin necrosis and rarely, muscle necrosis on the injection site. It has rarely been reported to occur after intramuscular injections of anti-inammatory drugs, corticosteroids, local anesthetics, penicillin and interferon. Our literature review revealed no cases of Nicolau syndrome following intravenous (IV) clindamycin injections. Herein, we report a case of Nicolau syndrome that occurred after IV clindamycin injection in the left forearm of a 1.5-year child, that was notable because of the uniqueness of the syndrome coupled with the fact that it has not previously been reported after intravenous clindamycin injection.