Case-based Reviews in PEDIATRIC INFECTIOUS DISEASES
Case-based Reviews in PEDIATRIC INFECTIOUS DISEASES
Editors
Ajay Kalra MD DCH MNAMS FIAP
Erstwhile Professor Department of Pediatrics SN Medical College
Agra, Uttar Pradesh, India
Vipin M Vashishtha MD FIAP
Director and Consultant Pediatrician Mangla Hospital and Research Center
Bijnor, Uttar Pradesh, India
Forewords
YK Amdekar
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Case-based Reviews in Pediatric Infectious Diseases
First Edition: 2021
9789352706730
Printed at
- AJ Chitkara MD FIAP
- Director and Head
- Department of Pediatrics
- Max Superspecialty Hospital
- New Delhi, India
- Ajay Gaur MD PhD FIAP FICMCH Dip FW Child Dev Cert IYCF (UK)
- Professor and Head
- Department of Pediatrics
- GR Medical College
- Gwalior, Madhya Pradesh, India
- Ajay Kalra MD DCH MNAMS FIAP
- Erstwhile Professor
- Department of Pediatrics
- SN Medical College
- Agra, Uttar Pradesh, India
- AK Patwari MD DCH
- Professor and Head
- Department of Pediatrics
- Hamdard Institute of Medical Sciences and Research
- New Delhi, India
- Alka Agrawal MD FIAP
- Professor and Head
- Department of Pediatrics
- Santosh Medical College
- Ghaziabad, Uttar Pradesh, India
- Amit Agarwal MD (Ped) FIPNA FISPN
- Consultant Pediatric Nephrologist
- Madhukar Rainbow Children Hospital
- New Delhi, India
- Ankita Bhandari MBBS DCH
- Senior Resident (NICU)
- Department of Pediatrics
- DY Patil Medical College
- Navi Mumbai, Maharashtra, India
- Anupam Sachdeva MD
- Incharge
- Pediatric Hemato-Oncology Unit
- Department of Pediatrics
- Center of Child Health
- Sir Ganga Ram Hospital
- New Delhi, India
- Arun Shah MD DCH FRCP (London) FIAP FNNF FIAMS
- Consultant Pediatrician
- Head
- Department of Pediatrics
- Prasad Hospital
- Muzaffarpur, Bihar, India
- Ashok Banga MD
- Director and Consultant
- Department of Pediatrics
- Chirayu and Astha Hospitals
- Gwalior, Madhya Pradesh, India
- Atul Kulkarni MD
- Assistant Professor
- Venkatesh Hospital
- Ashwini Rural Medical College,
- Hospital and Research Centre
- Solapur, Maharashtra, India
- Bharat Mehra MBBS MD (Pediatrics)
- Associate Consultant
- Department of Pediatrics
- Max Superspecialty Hospital
- New Delhi, India
- Fellowship in Pediatric Emergency and
- Critical Care (SGRH)
- Dhanya Dharmapalan MBBS MD
- Consultant in Pediatric Infectious Diseases
- Apollo Hospitals
- Navi Mumbai, Maharashtra, India
- Dipti Agarwal MD MAMS
- Associate Professor
- Department of Pediatrics
- Dr Ram Manohar Lohia Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Kheya Ghosh Uttam DCH DNB FIAP
- Associate Professor and NICU-In-Charge
- Institute of Child Health
- Kolkata, West Bengal, India
- Mallar Mukherjee MD
- Assistant Professor
- Institute of Child Health
- Kolkata, West Bengal, India
- Monjori Mitra DCH DNB
- Associate Professor
- Institute of Child Health
- Kolkata, West Bengal, India
- Nimisha Arora MD (Pediatrics)
- Assistant Professor
- Department of Pediatrics
- Santosh Medical College
- Ghaziabad, Uttar Pradesh, India
- Pallavi Gahlowt MD
- Assistant Professor
- Department of Community Medicine
- DY Patil Medical College
- Navi Mumbai, Maharashtra, India
- Prabhas Prasun Giri MD MRCPCH (UK)
- Associate Professor
- Institute of Child Health
- Kolkata, West Bengal, India
- Prakash Petchimuthu MD
- Senior Resident
- Department of Pediatrics
- GR Medical College
- Gwalior, Madhya Pradesh, India
- Pranjali Saxena MD
- Assistant Professor
- Department of Pediatrics and Neonatology
- Era's Lucknow Medical College and Hospital
- Lucknow, Uttar Pradesh, India
- RK Sabharwal MD DM (Neurology)
- Chief
- Division of Pediatric Neurology and Epilepsy
- Institute of Child Health
- Sir Ganga Ram Hospital
- New Delhi, India
- Rajesh Rai MD
- Head
- Department of Pediatrics and Neonatology
- DY Patil Medical College
- Navi Mumbai, Maharashtra, India
- (Col) Rekha Mittal MD
- Additional Director Pediatric Neurology
- Madhukar Rainbow Children's Hospital
- New Delhi, India
- Ridhimaa Jain MBBS DCH DNB
- Senior Resident
- Department of Pediatrics Child Development Center
- Maulana Azad Medical College
- New Delhi, India
- Rohit Bannerji MD
- Assistant Professor
- Institute of Child Health
- Kolkata, West Bengal, India
- Sanjay Verma MD
- Professor (Pediatrics)
- Infectious Disease Unit
- Department of Pediatrics
- Advanced Pediatric Centre (APC)
- Postgraduate Institute of Medical Education and Research (PGIMER)
- Chandigarh, India
- Shrish Bhatnagar MD (Ped) SR (Ped Gastro, SGPGIMS) MIAP MISG
- Professor and Head
- Department of Pediatrics
- Era's Lucknow Medical College and Hospital
- Lucknow, Uttar Pradesh, India
- Vikram Hirekerur MD
- Associate Professor
- Ashwini Rural Medical College, Hospital and Research Centre
- Solapur, Maharashtra, India
- Vimlesh Soni
- Assistant Professor
- Department of Pediatrics
- Maharishi Markandeshwar Institute of Medical Sciences and Research
- Ambala, Haryana, India
- Vineet Saxena MD FIAP
- Head
- Department of Pediatrics and Neonatology
- Anand Hospital
- Meerut, Uttar Pradesh, India
- Vinod Gunasekaran MD FNB FIAP
- Consultant and Head
- Pediatric Hemato-Oncology Unit
- Kauvery Hospital
- Trichy, Tamil Nadu, India
- Vipin M Vashishtha MD FIAP
- Director and Consultant Pediatrician
- Mangla Hospital and Research Center
- Bijnor, Uttar Pradesh, India
- Vivek Saxena MD
- Consultant Pediatrician
- Vatsalya Hospital
- Kanpur, Uttar Pradesh, India
- Yashwant Rao MD
- Professor and Head
- Department of Pediatrics
- GSVM Medical College
- Kanpur, Uttar Pradesh, India
- YK Amdekar MD
- Erstwhile Professor of Pediatrics
- Grant Medical College and JJ Group of Hospitals, Mumbai
- Consultant Pediatrician
- Jaslok and Breach Candy Hospital Mumbai, Maharashtra, India
- President of IAP (1995)
I am happy to write a foreword to Case-based Reviews in Pediatric Infectious Diseases. Choice of infectious diseases is most apt as not only infectious diseases from major part of pediatric practice but they often pose challenges in terms of diagnosis and rational treatment. Case-based learning helps to develop skills for analytical thinking and reflective judgment by reading discussion on real-life situations faced in practice. Reviews offer insight into a thought process of arriving at a probable diagnosis, choosing appropriate tests and instituting rational treatment. This book is different than a textbook in that it combines basic knowledge and analytical skills that together pave the way for rational practice. Readers would identify similar situations that they may have faced in office practice and compare author's views with their own. In effect, it becomes an interactive self-learning exercise. It is the best way of continuing medical education.
Clinical medicine presents with different types of challenges and this book deals with all of them with representative case scenarios. Patient usually reports to a pediatrician with symptoms that must be properly analyzed with detailed history and focussed physical examination to arrive at a probable diagnosis. Broad diagnosis such as pneumonia is often possible but specific etiology is not easy to judge and needs rational thinking. Even when specific etiological diagnosis is made, complications may prove a hurdle in successful outcome. Non-specific physical findings such as hepatosplenomegaly may indicate an infectious disease that demands rational consideration because it may as well be a non-infectious disease. Positive infection-specific antibodies may indicate recent or old infection, carrier state or even cross-reacting antibodies to another infection, and hence interpretation of such tests need caution. Imaging modalities denote pathology more than etiology as in case of ring enhancing lesion on CT brain scan that may suggest tuberculosis, cysticercosis or transient disappearing benign lesion. Such are the challenges of infectious diseases and reader will find in this book, all such practical issues presented with case-based discussions. Immunization is the integral part of prevention of infectious diseases and is rightly addressed in this book.
It is an irony that every sick child is presumed to be suffering from infection and unfortunately prescribed an antibiotic at the first contact. Abuse of antibiotics have thus led to increasing drug resistance. It is possible to make reasonably correct decisions about presence or absence of infection and whether infection is bacterial or otherwise. With varied types of case-scenarios, I am sure, reader will be stimulated to think rationally that will pave the way for ideal clinical practice. It is time that we all join this crusade against infections and I wish every reader gets sensitized after studying this excellent book.
YK Amdekar MD
Erstwhile Professor of Pediatrics
Grant Medical College and JJ Group of Hospitals, Mumbai
Consultant Pediatrician
Jaslok and Breach Candy Hospital
Mumbai, Maharashtra, India
President of IAP (1995)
Preface
Come fever and the first thing that strikes our mind is Infection!! Which indeed, is the case most of the times. Yet infections may not always be associated with fever (as happens in congenitally acquired infections) and not all fevers are due to infections. There can be no better way to bring out these fine nuances than by studying the case-based scenarios, which is what this book intends to do.
The most essential part of a student's instruction is obtained ….not in the lecture-room, but at the bedside.
–Oliver Wendell Holmes
The authors have unfolded the mystery behind each case, step by step, working on them as if they were detectives.
Methods of physicians are like those of a detective, one seeking to explain a disease, other a crime.
–Anonymous
We have purposely placed these case studies randomly and have not grouped them under any class, so that the readers have an element of surprise and wonder whether it is a case of infection or a mimic.
Observation is not merely the power of seeing, looking or matching. It should evolve and proceed through a carefully directed analytic exercise to shed new light, provide meaningful insight, propose creative solutions or arrive at novel conclusions.
–Sir William Osler
We hope the readers will find this collection interesting and of help in evolving the art of rationally analyzing the cases in hand.
Ajay Kalra
Vipin M Vashishtha
Acknowledgments
We are thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy), Ms Pooja Bhandari (Production Head), Dr Rajul Jain (Development Editor) and entire team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving the go-ahead at the very beginning and helping us in every way possible to bring out this book.