Regional lymphadenopathy is a marker of hidden or developing eschar. Total count and differential count should be interpreted on the background of the duration of fever. Since IgM ELISA, which is diagnostic of scrub typhus may not be widely available, any febrile child coming from rural area with hepatosplenomegaly, pallor, eschar, generalised / regional lymphadenopathy, anemia, leucocytosis, thrombocytopenia and increased Aspartate transaminase (AST) /Alanine aminotransferase (ALT) should be started on empirical Doxycycline or Azithromycin in order to prevent life threatening complications secondary to delay in therapy.

Background: Breast milk, the first natural food for a new-born, provides all the energy and essential nutrients an infant requires for the first 6 months of life. The NHFS -4 survey shows only 45.5% of children are exclusively breastfed (EBF) in Puducherry. This study aims at assessing the socio-demographic characteristics associated with exclusive breastfeeding in a tertiary hospital in Puducherry and identify the barriers in the promotion of exclusive breastfeeding.Methods: Community-based cross-sectional study at a tertiary hospital in Puducherry. Sample size: 115 mothers of 6 months to 2-year-old children, born term gestation with a birth weight of >2.5 kg, attending the Paediatric OPD. Questionnaire-based study comprising of socio-demographic and parameters pertaining to exclusive breast-feeding.Results: Only 44.3% of the mothers have exclusively breastfed in the first 6 months. Shorter duration of spacing between births and caesarean section had significant negative association with exclusive breast-feeding. Most of the mothers received postnatal counselling on breast-feeding (94%) of which 58% were by health care personnel. Despite that, only a sixth (19%) of them were well versed with proper breastfeeding techniques. Poor secretion (45.3%), sore/inverted nipple (23.5%) amounted to the most common of the barriers. Among working mothers, 42.9% attributed their jobs as the cause for early weaning.Conclusions: The prevalence of exclusive breastfeeding is still low even among a literate study group. There were no significant association with socio-demographic factors found, but lacunae were identified. A more objective post-natal counselling to mothers involving their caregivers may improve the current scenario.