Macrophage activation syndrome (MAS) is a potentially fatal complication of systemic inflammatory disorders first reported by Boone in 1976. In 1985, Hadchouel et al described this condition in seven patients with systemic juvenile idiopathic arthritis (sJIA). In 1992, the term "macrophage activation syndrome" was coined and Stephan et al were the first to use it in relation to juvenile arthritis. Since then, MAS has been widely described in rheumatic diseases, especially sJIA. However, it is being increasingly reported in association with systemic lupus erythematosus (SLE), Kawasaki disease (KD) and periodic fever syndromes. 1-3 Macrophage activation syndrome is characterized by uncontrolled activation and proliferation of T cells and macrophages, leading to a storm of inflammatory cytokines. Although the incidence of MAS remains unestablished, reports show that clinically overt MAS

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Multisystem inflammatory syndrome in children (MIS-C) is notorious for its cardiac involvement. We present a single center data of 71 children, of which 57.7% had myocarditis and 26.8% had coronary artery aneurysms. 45.1% required intensive care support and 29.6% needed inotropes -91.5% received IVIG. All patients responded to therapy with no mortality.

Introduction Neonatal sepsis is a major cause of morbidity and mortality with a higher burden from the low- and middle-income countries. The coronavirus disease 2019 (Covid 19) pandemic has impacted healthcare in various ways including healthcare-associated infections (HAI). The objective of the present study was to determine changes in organism profile and incidence rates of HAI in neonates admitted to the index hospital during the pandemic and compared it with the data from the pre-pandemic period. Materials and methods The study design was a retrospective, observational analysis of data from neonates with culture-positive sepsis, in a tertiary care children’s hospital, between January 2018 and December 2021. Pre-Covid (January 2018 to December 2019) and Covid period data (January 2020 to December 2021) were analyzed for the significance of change. Results The prevalence of culture-positive sepsis, in pre-Covid and Covid periods, was 19.55% [95% confidence interval (95% CI) 17.13–21.52)] and 18.36% (CI 16.05–20.74), respectively. HAI rates/1000 patient days increased slightly during the Covid pandemic [7.2% (95% CI 6.98–10.08) to 9.8% (95% CI 9.78–13.67)] mainly due to an increase in fungal HAI (26% pre- vs. 41.5% Covid period). However, the proportion of Gram-negative (GN) infections fell significantly (70.5% vs. 48.6%) during the same period. In the pre-Covid period, Klebsiella followed by Burkholderia cepacia, Acinetobacter spp and Pseudomonas, were the major HAI isolates. During the Covid period, there was a decline in these isolates and Burkholderia spp was not detected. All fungal isolates were Candida species. The case fatality ratio (CFR) from HAI decreased significantly from 38% to 15.45%, mainly due to a decrease in GN HAI. Conclusion During Covid pandemic, there was a significant decline in GN HAI and CFR from HAI, due to improved compliance with infection control measures in the neonatal intensive care unit (NICU). At the same time, there was a rise in the fungal HAI, possibly because of a higher proportion of premature, and sick neonates with longer hospital stay and more invasive procedures. Consolidations of gains in infection control and restriction of invasive procedures could help to minimize HAI in NICUs.

Pediatric cardiac tumors are rare and usually benign. An infectious etiology like tuberculosis invading myocardium and presenting as infiltrative mass is extremely rare. We present a case of a 15 month old girl with clinical feature of cardiac failure who had infiltrative multiple myocardial masses in echocardiogram. Advanced cardiac imaging by Cardiac Magnetic resonance imaging (MRI) helped in tissue delineation. Therapeutic trial of anti-tubercular drugs in view clinical suspicion of Tuberculosis resulted in complete remission of symptom and disappearance of the cardiac mass.