Background: Scrub typhus is relatively less common among infants but found to have a mentionable association with multiple organ dysfunction and turbulent course. The aim of this study was to delineate the clinicolaboratory profile of infantile scrub typhus, complication, course of illness, and responsiveness to therapy. Subjects and Methods: This retrospective observational study was undertaken in two tertiary care pediatric teaching centers in eastern India among infants with diagnosis of scrub typhus. Clinical features, especially pattern of organ dysfunction, laboratory findings with emphasis on hyperferritinemia, and treatment schedules with responsiveness to therapy, were analyzed retrospectively. Results: A total of 272 cases of scrub typhus had been admitted during the study period. Among them, 17 kids (6.25%) were infants. All of them presented with lethargy and poor feeding as a common complaint along with seizures and respiratory distress. Seven out of 17 (41%) were identified early. Fifteen (88%) were critically ill and required pediatric intensive care unit admission, out of which 13 (76.4%) patients were put on ventilator support. Thirteen (76.4%) of them developed hyperferritinemia with multi-organ dysfunction syndrome (MODS) and required additional immunotherapy. Sixteen of them recovered completely without any sequelae. Severe complications such as acute respiratory distress syndrome and MODS were significantly high (P = 0.001 and 0.004, respectively) and hospital stay was longer (P-0.04) in infants in comparison to older children. Conclusion: We conclude that infantile scrub typhus, though not very common, should be considered an important differential in infants presenting with an acute febrile illness with hyperferritinemia and MODS. Infants with scrub typhus can have a more stormy disease course compared to their older counterparts.

Introduction: Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 caused significant health concerns worldwide. In our center, we had encountered the first wave of MIS-C from June 2020 to January 2021, whereas the second wave surged up from April 2021 to August 2021. In this study, we have done a comparative analysis of different phenotypes of MIS-C seen during these two waves. Subjects and Methods: This was a single-center observational study where the children fulfilled the WHO criteria for MIS-C were included in the study. Clinical and laboratory findings, course of the illness, treatment, and outcome were noted down, and the patients were followed up. Depending on the presentations, cases were classified in four different phenotypes (Type 1: MIS-C overlapping with acute COVID-19, Type 2: MIS-C with shock/MIS-C with multiple organ dysfunction syndrome (MODS), Type 3: MIS-C Kawasaki disease phenotype, Type 4: Mild MIS-C/Febrile inflammatory state), and a comparative analysis of these phenotypes in the two waves was done. Results: There were 86 cases in 7 months during the first wave, whereas 102 cases in 5-month duration during the second wave. The clinical manifestations and laboratory findings were compared, type 2 phenotypes increased in proportion requiring more pediatric intensive care unit admissions. Mortality was seen during the 2nd wave which was absent in our cohort during the first wave. Conclusions: MIS-C typically showed a spectrum of disease manifestations starting from a mild febrile inflammatory state to full-blown MODS. Early phenotypic differentiation and targeted immunomodulatory therapy depending on the phenotype had shown to be useful.

No abstract

No abstract