Neonatal hepatitis with acute liver failure due to varied etiology including various infections is reported in the past. Scrub typhus as a cause of neonatal hepatitis has rarely been reported in literature. A high index of clinical suspicion is required for early diagnosis and timely treatment. Severity and prognosis of the disease varies widely because several different strains of Orientia tsutsugamushi exist with different virulence. Delayed diagnosis can result in complication and significant morbidity and mortality. Here, we report three cases of neonatal hepatitis with acute liver failure caused by scrub typhus to increase awareness.

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Scrub typhus is the most common rickettsial infection in India. A neonate with suspected late-onset sepsis/late hemorrhagic disease of newborn and scrotal cellulitis was finally diagnosed as scrub typhus. The samples of blood and urine were sent and azithromycin was started empirically awaiting the reports. The baby improved with resolution of fever and increased oral acceptance and thrombocytopenia resolved. In any newborn presenting with fever, eschar, and positive family history, besides other common diagnoses like sepsis, scrub typhus should also be suspected as a differential diagnosis, especially in endemic countries. Prompt diagnosis and early initiation of treatment will reduce mortality and morbidity of newborns with scrub typhus.

PurposeTo study whether breastfeeding and breastfeeding status during gluten introduction influences the age at diagnosis of celiac disease (CD). In addition to study, whether the timing of gluten introduction influences the age at diagnosis of CD.MethodsIt was a hospital based observational study. Total 198 patients diagnosed with CD as per modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition (2012) criteria, aged between 6 months to 6 years were included. Detail history taken with special emphasis on breastfeeding and age of gluten introduction. Standard statistical methods used to analyze the data.ResultsMean±standard deviation age of onset and diagnosis of CD in breastfed cases was 2.81±1.42 years and 3.68 ±1.55 years respectively as compared to 1.84±1.36 years and 2.70±1.65 years respectively in not breastfed cases (p<0.05). Those who had continued breastfeeding during gluten introduction and of longer duration had significantly delayed onset of disease. The age at onset of CD was under one year in 40.42% of the cases, who had started gluten before 6 months of age compared to only 12.58% of those who had started gluten later (p<0.001). The proposed statistical model showed that two variables, i.e., breast feeding status during gluten introduction and age at gluten introduction positively influencing the age at diagnosis of CD.ConclusionDelayed gluten introduction to infant's diet along with continuing breastfeeding, delays symptomatic CD. However, it is not clear from our study that these infant feeding practices provide permanent protection against the disease or merely delays the symptoms.

Background: Hepatitis is a major health problem in both developing and developed countries, with various infective and non-infective causes. Aim: This study aims to estimate the proportion of hepatitis A and E as a causative agent in children presenting with acute hepatitis and to study their clinical and biochemical parameters. Materials and Methods: The present study was conducted on all children attending or admitted with clinical features of acute hepatitis defined as hepatomegaly, fever >38°C, malaise, dark urine, and/or jaundice. All children included were clinically examined and relevant investigations were sent. All the data were entered in a structured pro forma and statistical analysis was done. Results: A total of 254 patients were studied. Hepatitis A virus (HAV) was the most common with 95.08% of cases and occurred in the age group of ?5 years. Hepatitis E virus (HEV) was more common in ?10 years age group and was observed in 13.11% of cases. Common prodromal symptoms in hepatitis patients were fever, anorexia, vomiting, and abdominal pain, observed in 82.5%, 32.5%, 55.5%, and 50.5% of cases, respectively, with no significant difference between HAV and HEV. In liver biochemistry, there was no significant difference in serum bilirubin, serum glutamic oxaloacetic transaminase, and serum glutamate pyruvate transaminase values between HAV and HEV. Conclusion: There are no significant differences in both enterically-transmitted hepatitis viruses and the only way to differentiate between them is by serological tests.