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Monthly Newsletter Vol. 12,December 2016
Merry
Christmas
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
1. Monthly Meetings
2. President’s Message
3. Pediatric Endocrine Update - 26 Feb 2017
4. HEPATICON 2017
5. Article on Awareness and Education is the Key to Prevention of
Neurodevelopmental Damage in Children.
6. Article on Drug Resistant Tuberculosis In Children-worsening Scenario
with Grave Implications :
7. Life Skills - Centre For People In Need Of Special Care
2 ,9 ,16 ,23 , 30 , Dec. Friday Clinical Meetingsnd th th thth
1 Dec. Thursday : North West Mumbai Pediatric Meetingst
1 ,8 ,15 ,22 , 29 Dec. Thursday : Postgraduate Grand Roundst th th th th
th
1
2-3
4
5-6
7-9
10-12
13
PRESIDENT’S MESSAGE
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
2
Respected Seniors and dear members of IAP Mumbai,
Compliments of the Season!
As the year draws to an end, it is time to thank all of you for a great year for IAP Mumbai!
We had two National Conferences, one on Pediatric Intensive Care and the other on
Developmental Pediatrics- both of which were outstanding events! With a participation of
about 800 delegates each in spite of being hardly a month away from each other speaks
volumes of the high esteem the country holds Mumbai's Academic programs in!
Needless to say, thanks to the relentless efforts put in by the Organising Committees and the
whole hearted support of all members of IAP Mumbai!
We had a theme of "Taking IAP Mumbai to the Community" for the year. Following i n this
theme, IAP Mumbai launched two visionary programs.
The first program is
PAALAK- PArenting with Love And Kindness -
a program devised by Dr Y K Amdekar and Dr Rajesh Chokhani which is a highly interactive
program with parents. This program is carried out free of charge to the parents or schools.
The program trains parents on how to recognise common emergencies and how to deal with
common behavioural problems to empower them to take effective action. We conducted 10
such highly success sessions across the city. The program is put up on the IAP Mumbai
website for all to see. We are conducting a National Training of Trainers workshop wherein
pediatricians will be able to conduct this program free of charge for parents all across the
country.
The other program is the Preventive Pediatrics Program. Convened by Dr Raju
Khubchandani, IAP Mumbai got some of its best and most experienced pediatricians to
brainstorm on common preventive strategies. These will be made into 4 short films (about 5
minutes each) in a lively animated self- explanatory format that will be released on social
media- again free for everyone to download and view. These could be dubbed in all
languages for a wider reach. This will empower parents and children to adopt simple healthy
and safe practices that will prevent most diseases and disorders prevalent in the community.
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
3
Along the year IAP Mumbai conducted numerous programs. Almost all the National
Programs were implemented with aplomb. In fact the Teenage Day and the World Breast
Feeding Week celebrations won the First and the Second Prize respectively at the Annual
Central IAP Awards.
Thanks to the efforts of all the members, IAP Mumbai has won the Best City Award which will
be presented during the Award Ceremony at
PEDICON 2016! We request all of you to be present to receive the award on behalf of IAP
Mumbai!
I would like to place on record my gratitude to all of you, especially the Trustees, the
Executive Board, the Office Bearers, the Research and Academic Affairs Council and to Dr
Sushant Mane, Honorable Secretary and Dr Bela Verma, Honourable Treasurer and to our
office assistants Mr Nilesh Pote and Mr Vinod Bodwade.
Wish all of you a very happy and prosperous New Year!
May IAP Mumbai continue to serve the community and our fraternity and carry on the great
work of our predecessors!
Respectfully,
Dr Samir Dalwai,
President IAP Mumbai.
4
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
Interactive Case Based and Panel discussions on Pediatric Endocrinology
Date: 26th February 2017
Venue- Kohinoor hall, Opposite Siddhivinayak Temple, Prabhadevi Mumbai
Indian Academy of Pediatrics Mumbai BranchInvites for Pediatric Endocrinology Update 2017
Organising Chairperson
-
Dr Samir Dalwai
Organizing Team
-
Dr Bela Verma, Dr Sushant Mane
Dr Barkha Chawala
Organising Secretary
-
Dr Prashant Patil
International Faculty:
Dr Senthil Senniappan MD FRCPCH MSc(Diab) PhD
Consultant Paediatric Endocrinologist
Alder Hey Children’s Hospital
& Hon Senior Lecturer
University of Liverpool
United Kingdom (UK)
National Faculty:
Dr. Vaman Khadilkar
MD,DNB, MRCP(UK), DCH(London)
Pediatric & Adolescent Endocrinologist,
Jehangir Hospital, Pune & Bombay Hospital, Mumbai
Head, Division of Pediatric Endocrinology,
Bharati Vidyapeeth Medical College, Pune
Dr Hemchand K Prasad
MD (Ped), PDCC (Ped endo)
Fellow Ped Endocrinology (ESPE)(Birmingham children hospital, UK)
Fellow ped diabetes (ISPAD) (Washington university, St Louis USA)
Senior Consultant and Head of Department Department of Pediatric Endocrinology and Diabetes Mehta Childrens hospital, Chennai
Dr Prashant Patil
MD (Ped), PDCC (Ped
endo)
Fellow Pediatric Endocrinology (ESPE)(Alder Hey children hospital, UK)
Consultant Pediatric Endocrinologist Zen Hospital Chembur Mumbai
For Registration Contact-
IAP MUMBAI 02224045803 OR Ashok Theurkar -9594415903
MMC credit hours APPLIED
Registration Free But Compulsory!No spot registration!!!
PEDIATRIC ENDOCRINE UPDATE - 26 Feb 2017th
5
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
Children's Liver Foundation and
Indian Academy of Pediatrics, Mumbai
Invite you to
HEPATICON 2017Single theme meeting on
Wilson Disease – Bench to the BedsideMarch 25th
2017, Nehru Center, Worli, Mumbai
Endorsed by
Indian National Association for Study of the Liver
Movement Disorder Society of India
MMC Credit hours applied for
Case based discussions and Talks on…
· Genetics of Wilson disease –
is there a role in clinical
practice?
· Diagnostic challenges
· Neurological spectrum and management
· Psychiatric problems
· Wilson disease beyond liver and the brain…
· Histopathology – how accurate is it?
· Speech and Developmental issues
· Therapy and monitoring
· How important is diet?
· Management beyond drugs…
· Pediatric and Adult Wilson disease - Is there a difference?
· Role of liver transplantation
HEPATICON 2017
6
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
HEPATICON 2017
Organising Secretary: Aabha Nagral
Organizing Team: Priya Malde,
Simpy Raj, Samir Dalwai, Pettarusp Wadia,
Bela Verma, Sushant Mane, Barkha Chawla, Smita Sawant, Ajay Jhaveri,
Kritika Malhotra, Fazal Nabi
NATIONAL FACULTY
Seema Alam ILBS, Delhi
C E Eapen CMC, Vellore
Prashanth L K NIMHANS, Bengaluru
John Mathai PSGISMR, Coimbatore
Ujjal Podar SGPGI, Lucknow
Anupam Sibal Apollo Hospital, Delhi
B R Thapa PGI, Chandigarh
Ashish Bavdekar KEM
Hospital, Pune
Harshad Devarbhavi St. John’s Hospital, Bengaluru
Arnab Gupta University of Calcutta, Kolkata
Banumathi Ramakrishna SIMS, Chennai
Srinivas Sankaranarayanan Apollo Hospital, Chennai
N Shivashankar NIMHANS, Bengaluru
S K Yachha SGPGI, Lucknow
Registration fees:
Upto 28th Feb 2017
PG student: Rs. 2000
Delegates: Rs. 3000
1st – 20th March 2017
PG student: Rs. 2500
Delegates: Rs. 3500
Spot Registration: Rs. 5000
Children’s Liver Foundation
Saraswat Bank, Prabhadevi, Mumbai
A/C No: 022200102715348
IFSC code: SRCB0000022
Cheque to be issued in favour of
“Children’s Liver Foundation”
CHILDREN’S LIVER FOUNDATION
O-18 Nav Bhavna, Veer Savarkar Marg, Prabhadevi 400025
Follow us on facebook and www.childrenliverindia.org
Write to: [email protected]
For further details sms/call Priya 9224791366 Simpy 7875042461
Online Net Banking payment details
7
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
Awareness and Education is the Key to Prevention of Neurodevelopmental Damage in Children.
Dr. Bela Verma, Dr. Upasana Ghosh, Dr. Prachi Aatmapoojary, Dr. Umesh N.Dept of Pediatrics, GGMC and Sir. J.J.Hopsital, Mumbai.
Ÿ Two cases presented here highlight the need for awareness about Abusive Head Trauma ( Shaken
Baby Syndrome ) and Varicella Associated Arterial Ischemic Infarct (AIS ) , as two among many
preventable causes of neurodevelopmental damage in children.
CASE 1 : “ Fragile Brain Handle with Care “ • An eleven month old boy was brought in status epilepticus.
• The presence of bilateral retinal haemorrhages and generalised cerebral atrophy
indicating ischemia revealed on imaging tests lead to the diagnosis of Shaken Baby
Syndrome ( SBS ) / Abusive Head Trauma ( AHT) .
• The child was referred with history of fever and vomiting (nonprojectile and
nonbilious) and recurrent generalized tonic-clonic convulsions since 5-7 days which were
followed by drowsiness.
• On detailed history , a relative had held the baby's neck and chin and shook him
vigorously in an attempt to stop the seizure. Following this event there were multiple
episodes of seizures after which the child was comatose. There was no history of head
trauma or recent vaccination.
• Lumbar puncture report was normal.
• CT brain – diffuse lesions in bilateral cerebral hemispheres with thinning of sulci,
cisternae and ventricles indicative of global ischemia.
• Birth and developmental history – normal.
• Fundus – bilateral retinal hemorrhages.
• GCS – E2V1M2 ,decerebrate rigidity +.
• EEG – generalised slowing.
• The MRI showed generalized cerebral atrophy with little amount of white matter in
the frontoparietal region mostly due to an ischemic insult.
• At the time of discharge Child had blindness spasticity and regression of milestones.
MRI showing generalised cerebral atrophy mainly in bilateral frontal region due to global ischemia.
DISCUSSION :• SBS was first described by Caffey in 1972 as “whiplash baby syndrome”, and acceleration-deceleration stress is
known to be the cause of the injury. AHT and SBS are forms of nonaccidental inflicted injury to infants often due
to violent shaking, impact to the head or a combination of both.
• About 18–25% of babies who are shaken and hospitalized, die. As many as 80% of survivors have significant lifelong
brain injuries.
• Abusive head trauma is a devastating and potentially lethal form of infant physical abuse with a grim outcome. It
typically results in death or significant lifelong brain injuries in survivors. These injury mechanisms can result in head
trauma, including subdural hematoma, diffuse axonal injury, cerebral edema, retinal hemorrhages and sometimes
fractures of the long bones or ribs with little or no external evidence of trauma.
8
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
CONCLUSION :
• The incidence is reported to be 20 to 30 cases per 100,000 children less than one year of age with a case fatality rate
exceeding 20% and significant disability for about two-thirds of the survivors.
• Yet to our knowledge there are only 4 reported cases of SBS in India.
CONCLUSION :
• Overt effects of repeated shaking , if unrecognised , can lead to motor dysfunction, sensory compromise or cognitive
losses resulting in mental retardation, learning difficulties and behavioural problems later in life.
CONCLUSION :
REFERENCES :
1. Barr RG. Preventing abusive head trauma resulting from a failure of normal interaction between infants and their
caregivers. ProcNatlAcadSci U S A. 2012 Oct 16;109Suppl 2:17294-301. doi: 10.1073/pnas.1121267109. Epub 2012
Oct 8.Review. PubMed PMID: 23045677; PubMed Central PMCID: PMC3477395.
2. Albert DM, Blanchard JW, Knox BL. Ensuring appropriate expert testimony for cases involving the "shaken baby".
JAMA. 2012 Jul 4;308(1):39-40. doi:10.1001/jama.2012.6763. PubMed PMID: 22760288; PubMed Central PMCID:
PMC3660987.
3. Cox LA. The shaken baby syndrome: diagnosis using CT and MRI. Radiol Technol. 1996;67:513–520.
4. Lee Y, Lee KS, Hwang DH, Lee IJ, Kim HB, Lee JY. MR imaging of shaken baby syndrome manifested as chronic
subdural hematoma. Korean J Radiol. 2001Jul-Sep;2(3):171-4. PubMed PMID: 11752989; PubMed Central
PMCID: PMC2718116.
5. Catherine Adamsbaum, SophieGrabar NathalieMejean, Caroline Rey-Salmon, Abusive Head Trauma: Judicial
Admissions Highlight Violent and Repetitive Shaking. PEDIATRICS Vol. 126 No. 3 September 1, 2010 pp. 546 -555
(doi: 10.1542/peds.2009-3647)
6. Ray M, Ghosh D, Malhi P, Khandelwal N, Singhi PD. Shaken baby syndromemasquerading as apparent life
threatening event. Indian J Pediatr. 2005Jan;72(1):85. PubMed PMID: 15684458.
7. Jose B, Sankhyan N, Arya R, Kabra M, Gulati S, Azad RV. Inflicted neuro-traumain infancy. Indian J Pediatr.
2010 Mar;77(3):318-20. doi:10.1007/s12098-009-0310-z.Epub 2010 Jan 20. PubMed PMID: 20091362.
8. ArunBabu T, Venkatesh C, Mahadevan S. Shaken baby syndrome. Indian J Pediatr.2009 Sep;76(9):954-5. doi: 10.
1007/s12098-009-0192-0. Epub 2009 Nov 4. PubMedPMID: 19904512.
9. Ray M, Ghosh D, Malhi P, Khandelwal N, Singhi PD. Shaken baby syndromemasquerading as apparent life
threatening event. Indian J Pediatr. 2005Jan;72(1):85. PubMed PMID: 15684458.
CASE 2 : POST VARICELLA ISCHEMIC STROKE :• Eight year old girl had sudden onset right sided weakness with inability to speak since 5 days.
• There was history of having chicken pox infection 2 - ½ months ago.
• Coagulation profile, homocysteine levels- normal.
• Lipid profile- normal, sickling test – negative.
• MT – 5 mm
• CXR – Normal , GLA & gene expert – negative .
• HIV – negative.
• CSF varicella zoster IgG antibody – 28.2 U/ml.
• Serum varicella zoster IgG antibody – 114.52 U/ml.
• CBC, LFT, RFT, CSF ( R) – WNL.
• MRI brain and MRA showed acute infarct in left basal ganglia and luminal narrowing of M2 segment of left
middle cerebral artery.
DISCUSSION :
• Diagnosis of VZ Vasculopathy should be suspected in patients with recent history of herpes zoster or varicella who
present with transient ischemic attack, ischemic or hemorrhagic stroke or altered mental status.
• The diagnosis should also be considered in patients with stroke of unknown origin, particularly among HIV and
immunocompromised patients.
• The absence of rash should not deter the clinician from pursuing a diagnostic evaluation for VZV vasculopathy since
37 % of patients may not have rash. ( Nagel et al 2008 ).
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
9
• Confirmatory diagnosis of VZV vasculopathy is made by the presence of VZV- DNA or anti VZV antibody in CSF.
• Reduced serum /CSF ration of anti- VZV-IgG confirms intrathecal synthesis of anti VZV IgG.
• The association between ischemic stroke in childhood (AIS ) and infection with varicella zoster virus is significant ,
both cerebrovascular disease and thrombotic mechanisms appear to be implicated.
• Thus detection of anti- VZV IgG has higher sensitivity than detection of VZV- DNA in CSF , most likely due to the
protracted nature of the disease
CONCLUSION :
• Varicella associated AIS accounts for nearly 1/3rd of Childhood AIS , including two fold increase in recurrent AIS
and TIA.
• Residual stroke as a disability is a significant complication of chicken pox, may add weight to the arguments for
immunising children against varicella zoster vaccine
(also passive prophylaxis with VZIG ).
• Primary Prevention of Varicella is an important consideration and likely to have long term clinical impact of
immunisation in future.
Enlarged image of MRI showing narrowing of Left middle cerebral artery.
REFERENCES :
1. Rand Askalan, Suzzane Laughlin et al, Chickenpox and Stroke in childhood : A study of frequency and Causation,
American Heart Association, 2001, 32: 1257-1262.
2. Stephen E. Straus, Jeffery M. Ostrove et al, Varicella Zoster Virus Infections, Ann Intern Med, 1988,108 (2) :
221 – 237.
3. V. Ganesan, FJ Kirkham,Mechanism of ischemic stroke after chickenpox, Archive sof Diseases in Childhood 1997,
76, 522 – 525.
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Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
Dr. Bela Verma, Dr. Nita Sutay, Dr. Sushant Mane, Dr Shyam , Dr Archana Rai,
Dept of Pediatric , GGMC and Sir. J.J.Group of Hospitals, Mumbai.
DRUG RESISTANT TUBERCULOSIS IN CHILDREN-WORSENING SCENARIO WITH GRAVE IMPLICATIONS :
ABSTRACT:Tuberculosis is a major contributor to the under five morbidity and mortality.
The goal of the Worldwide TB Scientific Community to “ Eliminate TB by 2050” seems like a distant dream.
MDR-TB is being seen increasingly amongst paediatric age group. Childhood TB reflects ongoing infection.
Children are worst affected when the adult epidemic is poorly controlled.
The present study highlights the clinical profile of 16 drug resistant tuberculosis children. Of the , 16 patients12(75%) were confirmed DR-TB (all cases confirmed by Gene Xpert or culture) ,4(25%) were DR-TB suspects.
There were 4 patients less than 2 years of age with youngest being 2 months old. Thirteen (81%) were severely
malnourished. Nine(56%) children had received treatment for TB in the past (3 relapse, 5 treatment failure,
1defaulter). Disseminated TB was found among 8 (50%) of children at diagnosis. There was history of close TB
contact in 8(50%) children, 3 of these were less than 2 years of age .
Children under 5 years and over 10 years of age formed the high risk group. Past history of TB, malnutrition and
contact with TB cases are important risk factors for drug resistant tuberculosis infection in children.
We are currently seeing the “ TIP OF THE ICEBERG” and the bulk of the cases are ' BELOW THE RADAR
SCREEN'.
High degree of suspicion, risk stratification, recognising disease diversity, up-scaling TB control and prevention,
engaging Health Care Programmes to develop 'Integrated Family and Community Centered Strategies' are urgently
needed.
RESULTS:
Parameters
N=number
Cough
Fever
Malnourished
TB relapse
Treatment Failure
H/o contact
Only PTB
Disseminated TB
TB lymphadenopathy
Abdominal TB
CNS TB
TB Osteomyelitis
HIV positive
Received BCG
AFB positive in gl/sputum/tissue
Gene xpert positive
<2 yr
4
4(100%)
3(75%)
3(75%)
-
-
3(75%)
3(75%)
1(25%)
-
-
1(25%)
-
-
4(100%)
3(75%)
3(75%)
3-9yr
4
2(50%)
3(75%)
3(75%)
1(25%)
1(25%)
3(75%)
-
1(25%)
3(75%)
-
1(25%)
-
-
4(100%)
1(25%)
1(25%)
10-19 yr
8
0
5(62%)
7(87%)
2(25%)
3(37%)
2(25%)
1(12%)
1(12%)
6(75%)
3(38%)
1(12%)
1(12%)
3(37%)
6(75%)
4(50%)
1(25%)
Total
16
11(68%)
11(68%)
13(81%)
3(19%)
4(25%)
8(50%)
4(25%)
3(19%)
9(56%)
3(19%)
3(19%)
1(6%)
3(19%)
14(87%)
8(50%)
5(31%)
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Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
Of the 16 patients,
1. Twelve (75%) were confirmed DR-TB (all cases confirmed by Gene Xpert or culture) ,4(25%) were DR-TB
suspects.
2. There were 4 patients less than 2 years of age with youngest being 3 months old.
3. Nine (56%) Children had been treated for TB in the past out of which 3(19%) were relapse, 4(25%) were treatment
failure,2(12%) were defaulters.
4. Thirteen (81%) children were malnourished, indicating malnourishment to be an important risk factor for drug
resistant tuberculosis.
5. Three (75%) children of less than 2 years had TB contact indicating the probable source of infection in this young
age group to be adults, predominantly parents.
6. Pulmonary TB- 4(25%) ,disseminated TB -3(19%), abdominal TB -3(19%), CNS TB- 3(19%) and TB
lymphadenopathy were seen in 9(56%) .
7. Fever(68%) and cough(68%) were the 2 most common symptom in children with drug resistant tuberculosis.
8. Acid fast Bacilli was isolated only in 8(50%) children, indicating it to be a fair marker of diagnosis of tuberculosis
in children.
9. 14(87%) children had previously received BCG vaccination.
50% 50% MALE
FEMALE
25
7587
<2 years 3-9 years 10-19 years
Malnourished(%)
Malnourished(%)
GRAPH2 : Distribution of malnourishment in various age groups :
GRAPH 1 : Gender distribution :
GRAPH 3 : Past history of TB(Treatment failure, Relapse, Defaulter) :
0
25
37
0
25 25
0
25
12
<2 years 3-9 years 10-19 years
Pe
rcen
tage
Age
TREATMENT FAILURE(%)TB RELAPSE(%)
DEFAULTER(%)
GRAPH4: Distribution of types of Drug resistance TB :
75
0
12
25 25
12
0
75 75
25
25
20
0 0
38
<2 years 3-9 years 10-19 years
Pe
rcen
tage
Age
only PTB Disseminated TB TB lympahdenopathy
CNS TB Abdominal TB
12
Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016
• India, the world's second most populous country, accounts for a quarter of the world's annual incidence of TB.
• Every year around two million people develop TB in India and 300,000 die of TB.1
• Drug resistant TB includes Mono resistance, Poly resistance, MDR TB, XDR TB .
• Monoresistant TB refers to resistance to any first line ATT.
• Rifampicin resistant TB refers to resistance to R. However, resistance to R should be treated as MDR TB.
• The term rifampicin-resistant TB (RR-TB) refers to TB strains which are eligible for treatment with MDR-TB
regimens (conventional or shorter) as standard first-line regimens can no longer be used.2
• MDR TB refers to resistance to at least H & R.
• XDR TB refers to MDR TB along with resistance to any fluoroquinolone/second line injectable drugs.
• High relapse rates have been reported in India from various sites, approximately 11-13%.1
• INH Resistance is 11% in untreated TB patients and 37% in previously treated cases and the prevalence of HIV
co-infection is 5%.1
Who is a presumed case of DR TB?3
• Defaulter: received ATT >/= 1 month from any source & not taken ATT consecutively for >2m and has active disease
( clinical or bacteriological).
• Recurrent TB/Relapse: Child who was declared cured or treatment was completed and now has a (clinical or
bacteriological) evidence of recurrence.
• Treatment after failure: A case who after 12 weeks of compliant IP fails to have bacteriological conversion to negative
status or fails to respond clinically / or deteriorates.
For MDR TB diagnosis
• Microbiological confirmation should always be done.
• DST/LPA/CBNAAT is advised.
• Make all efforts to get clinical samples.e.g. sputum, BAL, tissue biopsy, CSF, CT/USG guided biopsies.
• Diagnosis of drug resistant TB in the absence of bacteriological diagnosis must be thoroughly reviewed as it may
often be untenable.
• In a DR TB suspect, if all other alternative causes for symptoms have been ruled out but there is no microbiological
confirmation - bacteriologically negative, clinically diagnosed MDR TB can be considered.
DISCUSSION :
CONCLUSIONS :
• Fever(68%) and cough(68%) were the most common symptoms in children <2 years of age, with drug resistant
tuberculosis.
• Thirteen (81%) children were malnourished, indicating malnutrition to be an important risk factor for drug
resistant tuberculosis.
• Eight (50%) had TB Contact.
• Nine (56%) Children had been treated for TB previously.
• We should have a high index of suspicion of DR TB ,provided the case fulfills the criteria described above.
• In certain cases, where DR TB can't be proved bacteriologically, with evidence of clinical deterioration (all other
causes ruled out),child must not be barred from starting MDR drugs.
• Compliance should be maintained strictly to prevent emergence of further DR TB strains.
REFERENCES :
1.Standards of TB Care in India,2014.
2.Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis.
(WHO/HTM/TB/2014.11) [Internet]. Geneva, World Health Organization. 2014.
3.Management of Tuberculosis in Children; Basic Training Module, Based on Indian Academy of Pediatrics-RNTCP
Consensus Guidelines 2015.
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Indian Academy of Pediatrics, Mumbai, Monthly Newsletter, Vol. 12, December 2016