Category Archives: infectious diseases

Urinary infection in children: what need to be done?

uti

  Definition of urinary tract infection (UTI) is  growth of significant number of organisms of single species  in urine sample along with Symptoms. ( First aid for urinary pain in children. )

Types of UTI and common symptoms

Simple UTI: mild fever, irritable, Pain during urination, increased frequency and urgency

Complicated UTI: High grade fever, vomiting, stomache, dehydration and toxic looking child

Symptoms present less often are: heamturia, voiding issues, bed wetting , failure to thrive may also be present

 

Risk factors:    Girl child , poor hygiene, Vesicoureteral reflux (VUR), Voiding dysfunction, obstruction in urinary tract

Urine collection: mid stream clean catch sample gives most accurate report in home settings

Urine routine , microscopy s/o UTI: pus cells in urine sample, along with positive nitrate and leucocyte esterase .

Gold standard test is urine culture.. as its report takes aroung 48 hours to come, we can start antibiotics after sending urine sample for culture in consultation with doctor and wait for culture report for further plan of action.

Treatment:

Plenty of fluids, oral antibiotics and other supportive care as advised by your doctor

Plan of action as per age ( preferably in consultation with pediatric nephrologist)

  • Less than 1 years: Ultrasound, MCU and DMSA scan
  • 1-5 years of age: ultrasound and DMSA, ( if DMSA is abnormal than MCU to be done)
  • More than 5 years: Ultrasound only ( if abnormal  further work up)

In high risk cases ,we might need prophylaxis to prevent repeated episode of urinary infection.

Whenever in doubt consult pediatric nephrologists

Regards

Dr Rahul Varma

Hand washing in children can save life

Hand washing

 

HandsHygiene_Logo_1 1

Hand washing can save many lives. It prevents spread of infections and decrease incidence of illnesses which in turn leads to increase productivity.

hand washing

Five simple and effective steps are

  • Wet
  • Lather
  • Scrub for 20 seconds
  • Rinse
  • Dry

It helps prevent spread of germs and prevent sickness.

hand-washing-2

When to wash hands:

  • Before and after eating food
  • After using washroom/changing diapers
  • Coughing, sneezing, blowing of nose
  • Handling garbage
  • Playing with pets
  • Taking care of sick person at home
  • Coming back after long day at office (especially before greeting small children)

 

What If there is no water and soap??

Use hand sanitizer. These are alcohol based sanitizers; they quickly reduce microbes significantly. But washing hand with soap and water is the best option.

hand 2  hand

Hand washing is like vaccination, it prevents spread of infection. More important it is, if you have a small baby at home.

hand-washing-and-infection-control-school-presentation-1200021766683692-2-thumbnail-4

Regards

Dr Rahul Varma

“Healthy Kids, Happy Family”

First Aid for Urinary Pain in kids

home page UTI 

Pain, irritation or excessive crying while passing urine should not be ignored as it could be sign of urinary tract infection. If urinary infection spreads it can cause damage to kidney in children. Other causes of Pain during urination could be local injury, stones (which are small masses of minerals).

UTI (urinary tract infection) is the most common cause of pain during passage of urine.

What are the common sign and symptoms of UTI? :

  • Increased frequency of urine i.e Urgency
  • Burning sensation while passing urine
  • Blood in urine
  • Lower back pain
  • Fever
  • Vomiting
  • Poor appetite

 UTI 2

What can be done at home? :

  • Do not panic
  • Give one dose of Ibuprofen to make child comfortable
  • Encourage child to drink lots of water and other fluids, like juices (some say cranberry juice is best).
  • Call your child doctor (if child is not able to pass urine or having severe pain not responding to medication).
  • Follow your doctor’s advice
  • Do not give Antibiotics without consulting your doctor and without sending sample for Urine routine and microscopy.

 watch for temp in UTI

How to prevent Urinary Infection? :

  • Change diapers frequently. Soiled diaper to be removed right away.
  • Encourage child to go to bathroom at regular interval. Prevent child from holding urine for long.
  • Avoid perfumed soaps. Wash genital area with mild soap and water.
  • Wipe potty from front to back (especially in girls). This will avoid contact of soiled potty particle to come in contact with urinary and genital area.
  • Adolescent kids to be screened for sexually transmitted diseases.

  Urinary-Tract-Infection

Feel free to discuss with your child specialist regarding any queries regarding your child’s Health or contact Us at MAYA CLINIC.

Regards

Dr Rahul varma

Rotavirus vaccine: should we give to children?

Did you know? Rotavirus vaccines combat the leading cause of deadly diarrhoea among children.

Around the world, these vaccines keep kids happy, healthy and out of hospital!

 

https://www.facebook.com/GAVI/photos/a.126742141406.129029.92572781406/10153294291846407/?type=1&theater

 

There is significant reduction in cases of Diarrheal disease since the induction of rotavirus vaccine in National Immunization schedule of many countries.

Hopefully soon we too have this Vaccine in Govt. of India Vaccination schedule UIP (Universal immunization Programme).

Once the vaccine is built indigenously then it will lead to sharp reducing in pricing of this vaccine in private sector too.

 

Regards

Dr Rahul Varma

“Healthy kids, Happy Family”

Fever in Kids: Not to panic

fever 2 

My child is having fever: what should I do?

Fever or high temperature is often the biggest concern for parents. There are various Myths about fever in every society. Remember Fever is just a symptom, not a disease. It’s a way of body to fight off Infection. Various organisms like bacteria; virus etc cannot survive and replicate themselves in high body temperature.

Here I am listing 6 important facts about fever which we should all know. Many of them might be just opposite of what your parents or grandparents think. Aim of this post is to create awareness and decrease parental anxiety rather than to discredit grandparents.

  fever in kids

These facts do not hold true for small children less than 3 months of age. Any newborn or small child with fever should be dealt with seriously and visit to pediatrician is a must.

  1. High grade fever like 104F does not mean you have to visit Emergency Department immediately: Yes you read it write, not even 104F. Fever only means that our immune system is fighting it out against these pathogenic organisms/attackers. As I told you before Fever is a symptom of illness rather than a disease.
  1. Intensity of fever does not always correspond with severity of Illness. Many a time simple viral illnesses can have high fever up to 104F whereas many serious illnesses might have mild fever. Every child reacts differently to fever. So instead of looking at the actual value of fever we should be looking at other signs of serious illness. Watch for general activity of child, their hydration level and urine output. If in doubt discuss with your child specialist.
  1. Sometimes Fever might not touch baseline: We have to look at comfort level of child rather the numerical value on thermometer. It is absolutely fine if body temperature does not reach baseline and your child is actively playing around. Goal of given anti-fever medications (like paracetamol, ibuprofen etc) is to make your child comfortable and feel better.
  1. Incorrect dose: Many parents are giving wrong doses to the child, or some might deliberately give only half the dose. Remember appropriate dose is a must, discuss with your pediatrician regarding right dose as per the weight of your child. For example dose of paracetamol is 10-15 mg /kg/dose.
  1. Brain damage: Every normal person’s brain has an internal thermostat that will prevent body temperature to go beyond limits to cause brain damage. Some children might have febrile seizures; but even they are benign and do not causes brain damage. It is only when hyperthermia or heat stroke occur that it will lead to brain damage. These cases are very rare and occur only in special circumstance. In normal child who has fever due to illness will not cause brain damage (unless until the cause of illness is itself brain infection like meningitis or encephalitis).
  2. Not antibiotics; only anti-fever (antipyretic) medicines like paracetamol are needed.Antibiotics as the name suggest are “Anti-biotic” means against bacteria; needed only when bacterial infection is confirmed and most of the common illnesses in children are viral. Viral infections are self limiting which settles down with time.  We should avoid indiscriminate you of antibiotics in every case of fever.

If you are coming to the pediatrician’s office because your child has a fever, and baby is uncomfortable, please give your child a fever-reducing medication prior to coming to the office. You do not have to wait until the doctor “sees them with a fever.” A comfortable child is much easier to examine. And a good exam will often determine the cause of the fever, allowing for accurate treatment.

fever

Interesting anecdote from past regarding fever:

Concern about childhood fevers is long-standing in our history. Fever superstitions and ancient fever remedies are ribboned throughout all cultures. For example, Romans would trim the fingernails of those affected with fever. Using wax to attach the fingernail clippings to a neighbor’s front door was thought to transmit the fever to that household. Note: Do not have ancient Romans as neighbors. And, even today, we see lots of elders using their different unique methods to get fever down.

Regards

Dr Rahul Varma

“Healthy Kids, Happy Family”

Precautions we need to take in Dengue Season; Danger signs to watch out for?

During rainy season ,please take plenty of Fluids ,fruits and watch for danger signs like Decrease oral intake, decrease urine output and bleeding from any site (including skin rashes).

In case of any danger signs contact your doctor as soon as possible and get yourself checked.
Donot Take Pain killers or Aspirin for fever. Take Simple paracetamol formulation like Crocin for fever.

Now even on Day 1 of fever Dengue can be diagnosed by blood Tests from reputed labs like SRL etc. (9711040458 contact number of Indirapuram SRL for early reports and home collection)

 

Read on to know in detail regarding Dengue fever.

 

Dengue Fever

  dengue-fever heading

Dengue Fever as we all know spread from bite of an infected Mosquito. It has 4 serotypes. It can cause very severe life threatening illness; however most cases are milder in nature.

Huge number of cases has been reported worldwide (50-100 million cases every year worldwide).

mosquito_0

Dengue virus is transmitted by Aedea Mosquito. It bites during day time only. Outbreaks can occur at anytime, however rainy season with high humidity increases changes of transmission.

Symptoms:

Occurs after 4-10 days of mosquito bite and symptoms can last from 2 to 7 days usually.

2_1 

High grade Fever associated with atleast 2 of the below mentioned features should raise suspicion of Dengue Fever:

  • Headaches
  • Body ache.  esp pain behind eyes
  • Joint Pain, bone pain, Muscular pains
  • Nausea, vomiting
  • Rashes (usually extensive red colored all over body)
  • Itching

rash 2 rash

Most crucial Phase of Dengue illness occurs once fever subsides; i.e. at deffervescence of Fever as most of the complications arises at this time. At this time platelet counts start decreasing along with rise in Hematocrit values. 3rdspace losing occurs, so it is very important to prevent dehydration and let your child have PLENTY OF FLUIDS.

 dengue-diagram

Severe Cases (also called dengue hemorrhagic fever):

Special attention needs to be given to these warning signs as it could lead to severe dengue:

  • Severe abdominal pain
  • Persistent vomiting
  • Bleeding from any site eg gums, blood in vomiting etc
  • Rapid breathing
  • Fatigue/ restlessness
  • Altered sensorium

 download

Treatment:

  • At present no vaccine is available.
  • No specific medication for dengue fever.
  • Mainstay of treatment is supportive
  • Patients should seek medical advice, rest and drink plenty of fluids.
  •  Paracetamol (Crocin) is the drug of choice for Fever. Other medications like aspirin or ibuprofen should be avoided as it increases the risk of bleeding.
  • Vital Monitoring along with blood test to have a look at Hematocrit along with platelet count.
  • Platelet transfusion in some cases

Infection with one strain will provide life-time protection only against that particular strain. However, it is still possible to become infected by other strains and develop into severe dengue. Usually re-infection cases are severe.

With proper medical care and early recognition, case-fatality rates are below 1%.

  sintomas-dengue-prevencion

What should be done by Patients and Relatives?

  • If you suspect you have dengue you first need to avoid panic and consult a doctor soon.
  • Drink plenty of fluids, watch for urine output & watch for bleeding from any site.
  • For diagnosis, your doctor will
    • Evaluate your signs and symptoms
    • Test your blood for evidence of a dengue virus using NS1 Antigen or serology test (IgG& IgM).

 know_about_dengue_10

How Dengue is spread:

  • Bite from infected mosquito (Aedes aegypti)
  • Day time biting by this mosquito (esp early morning & evening)
  • Does not spread by contact

 prevent 2

Mosquitoes  breading Ground:

  • Clear water in nearby areas esp water filled containers etc.
  • Rest Indoors in dark areas like closet, under beds, behind curtain etc.

   prevent 

Preventive measures:

  • Source reduction: eliminate mosquitoe’s egg laying sites.  Examples of the following habitats are listed:
  • Indoor, Ant traps, Flower vases and saucers
  • Water storage tank (domestic drinking water, bathroom, etc…)
  • Plastic containers, Bottles, Outdoor, Discarded bottles and tins
  • Discarded tyres, Artificial containers, Tree holes, potholes, construction sites, Drums for collecting rainwater
  • Shells, husks, pods from trees, Leaf axils of various plants
  • Community participation is the key to dengue prevention. As every household aims to reduce vector density, the transmission rate will decrease or maybe even stop.
  • Protecting yourself from mosquito bites: It can be done by using
    • Long-sleeved clothing and mosquito repellents are the most viable options.
    • Window and door screens, air conditioning reduces the risk of mosquitoes coming into contact with the household members.
    • Mosquito nets (and/or insecticide-treated nets) will also provide additional protection to people sleeping during the day, or protect against other mosquitoes which can bite at night (such as malaria).
    • Household insecticides aerosols, mosquito coils or other insecticide vaporizers maybe also reduce biting activity.

 outbreak

 

 

Feel free to contact your doctor for detail or contact us at MAYA CLINIC.

Regards

Dr Rahul Varma

dengue fever danger signs in dengue fever precautions in dengue maya clinic dr rahul varma

Chikungunya Fever: Not a life threatening illness but extremely painful condition

mayaclinic.in-chikungunya

Chikungunya Fever:

Not a life threatening illness but extremely painful condition with bone pain so severe; which you might have never felt ever in life previously.

chikungunya-fever-symptoms

  •   Symptoms begin 3-7 days after mosquito bite. It is caused by day biting mosquito aedes ageptyi (same one which causes Dengue).
  •  Abrupt onset of high fever and severe joint pain (hands, feet, ankle, wrist, back etc)
  •  Across all age groups
  •  other features may include: headache, myalgias, conjunctivitis, weakness, maculopapular rash.
  • Most patients feel better within a week but some may feel the joint pain for months.
  • Lab test: Normal except for lymphopenia (low WBC or TLC)
  • Diagnostic test: (only after 5-7 days of illnes) ELISA based IgM for Chikungunya.

 sick_with_chikv_denv_zika

Treatment:

  • No specific treatment.
  • Adequate Rest
  • Plenty of fluids
  • Paracetamol . NSAIDS like Ibugesic and meftal etc ,should only be given after Dengue has been ruled out. (as NSAIDS increases chances of bleeding).
  • Prevent mosquito bite and breeding of mosquito around your surroundings.
  • Avoid self medications , it can be dangerous.

 transmission chikungunya chikungunya mosquitos

Death due to Chikungunya is rare.

  • It is not contagious i.e. it does not spread by touching or in close contact. (It happens in the family and close relatives because all are living in same environment where mosquito is breeding.)
  • Remember it spreads in clean water. (So do not blame poor and unhygienic conditions around you for everything).

  chikungunya_1

 

Regards

Dr Rahul Varma

home scabies

Scabies in Children

home scabies

Summary:

Scabies is commonly seen skin lesions across globe and across all age groups. It leads to severe itching. It can happen across all socio economic status; but mostly seen in people living in crowded area. It spreads by skin to skin contact. Treatment has to be given simultaneously to all the family members to eliminate this disease.

What is it?

Scabies is caused due to tiny mites called Sarcoptes Scabiei. These mites burrow into the skin and lay eggs there.

 

microscopic scabies picture

Symptoms/signs: Sever itching (which can be worse at night), red rashes, sometimes wavy raised red lines can be seen where mites might have burrowed. Scratching of skin due to itching can lead to superimposed bacterial infection (eg Impetigo).

Which body part is involved: It affects hands and feet most commonly (especially the web between fingers), genitals etc. In kids even scalp, palms and soles can be involved. Practically speaking any body part can be involved.

scabies-mite-EM

How long will it take for symptoms to develop?  It can take 4- 6 weeks after infection for symptoms to develop; but in people who have had this disease previously, it can develop within few days too.

25_06.tif  symptoms

Cause: It is contagious; spread from one to another via skin contact of infected person. It is commonly seen in crowded settings like in families, child care centers, schools, hostels etc.

Treatment:  Take opinion of Dermatologist (in kids child specialist can also help). Follow the instructions properly to avoid recurrence of illness.

  • Cream or Lotions need to be applied to skin all over body below the neck (in kids it can be applied even on head and face as per the instructions).
  • Cream need to be left over skin overnight (8-12 hours); after that it can be washed off.
  • After applying the cream, don’t wash your own hands — scabies mites love the area between the fingers!
  • Wash all the cloths, bed sheets etc with warm water and soap (to kill all the mites)
  • Sometimes oral medicines might be prescribed by your skin specialist.
  • Scabies is very contagious and re infection in same person or other family member can occur; so it is very important for all the family members to take treatment simultaneously on the same date.
  • Anti allergic medicines to prevent itching will also be given and sometimes antibiotics might be given to treat bacterial infection, if any.
  • If the treatment is effective, there should be no new rashes or burrows after 24 to 48 hours.

life cycle of scabies    Scabies_life_cycle 2

Medicines which can be given as per need by doctor:

Anti scabies: 5% permethrin cream (most common), 1% Lindane lotion, 25% benzyl benzoate lotion etc.

Antihistamine: to control itching

Antibiotics: to clear the bacterial infection

Steroid based cream: to ease the redness, swelling and itch; if needed.

treatment

Preventions:  Avoid direct physical contact with person infected with scabies. Wash cloths, sheets and towels with warm water and soap if any of the family member or close person has been recently treated for scabies. Vaccum clean the home if needed. Treatment should be given to all family members to prevent the spread of infection.

 dd

 

We can stop scabies if we follow regular hygienic measures and get treated on time.

Regards

Dr Rahul Varma

 

Kawasaki disease

Slide1

Kawasaki disease is a leading cause of acquired heart disease in children, but with effective treatment, only a small percentage of children have lasting damage.

Kawasaki Disease is also called as “Mucocutaneous lymph node syndrome” as it affects lymph nodes, skin, mucus membranes inside mouth, nose and throat. It causes inflammation of medium sized arteries wall in body; involvement of coronaries (blood supply to heart) being most dangerous.

KD awareness

Symptoms and Signs:

Various Symptoms are

Fever > 5days, along with characteristic features like

  • Rashes all over the body
  • Redness of the eyes (specially involvement of white area of eye ball) without discharge
  • Redness of tongue (strawberry tongue), red and congested throat along with red, dry, cracked lips.
  • Swelling of neck, Lymph nodes enlargement of neck ( one sided > both sided)
  • Redness of palms and soles (erythema) along with swelling

symptoms of Kawasaki disease

Other nonspecific features like Irritability, vomiting, diarrhea, pain abdomen, joint pain, jaundice can also be there.

Typical feature of “Peeling of skin on hands and feet” occurs in 2nd to 3rd week of illness.

peeling of skin

Cause of disease: Unknown but it is more common in boys in less than 5 years of age and seen more common in Asian. As the name suggest it is most commonly seen in Japanese or Korean but it is also seen in Indian population.

Treating Kawasaki disease within 10 days of its onset may greatly reduce the chances of lasting damage.

Most severe complications is damage to your child’s heart. Inflammation of the coronary arteries can lead to weakening and bulging of the artery wall (aneurysm). Aneurysms increase the risk of blood clots forming and blocking the artery, which could lead to a heart attack or cause life-threatening internal bleeding.

KD sign

Diagnosis:

Kawasaki disease can look similar to other common childhood viral and bacterial illnesses. No specific test, diagnosis is on clinical basis and test are done to support the diagnosis and rule out other illnesses with similar features like Measles, Steven Johnson syndrome, Juvenile rheumatoid arthritis, other viral illnesses.

Tests:

  • Blood test: CBC, CRP, ESR, to look for elevated neutrophils and other inflammatory markers, relative anemia, low albumin, raised bilirubin and liver enzymes, dyselectrolemia etc.
  • Urine test: may show few pus cells (sterile pyuria)
  • ECHO: to look for dilatation of coronary arteries and other suggestive features.

 

Treatment:

To reduce the risk of complications, your child’s doctor will want to begin treatment for Kawasaki disease as soon as possible after the appearance of signs and symptoms, preferably while your child still has a fever. The goals of initial treatment are to lower fever and inflammation and prevent heart damage.

  • IVIG (Gamma globulin). 2mg/kg over 10-12 hours should be given when diagnosis is made. Mostly given between 5- 7 days and within 10 days. It can lower the risk of coronary artery problems.
  • High doses of aspirin may help treat inflammation. Aspirin can also decrease pain and joint inflammation, as well as reduce the fever. Kawasaki treatment is a rare exception to the rule against aspirin use in children.
  • Important to give Flu shot to prevent flu infection as child is on aspirin.
  • Pediatric Cardiologist opinion should be taken.

Within 2 days significant improvement is seen in fever.

Untreated cases can lead to more serious complications, such as aneurysm

  KD image

To summaries:

summary of KD

Regards

Dr Rahul Varma

Fever, chills, headache during rainy Season? It could be Leptospirosis!

 

 Fever, chills, headache during rainy Season? It could be Leptospirosis!

 02-leptospirosis2

Leptospirosis is most common zoonotic (Spreading from animals) disease worldwide. It is still widely overlooked and under reported.

Without treatment, Leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death.

It spreads via urine of infected animals which can get into water and soil and survive there for weeks.

 Leptospira_interrogans_strain_RGA_01

Animal which commonly causes this disease are cattles, rodents, dogs, horses, pigs etc. Animals might be asymptomatic and continue to excrete the bacteria into environment.

EID_Leptospirosis_AcsB_1

It Spread to Human via

  • contact with urine (or other body fluids except saliva) from infected animals
  •  Ingestion of contaminated food or water
  • Direct contact over cut or wound (eg splash of infected water over eyes, nose or broken skin & mucus membrane)

 

Symptoms

Leptospirosis has a wide range of symptoms which could be similar to other illness as well. But common ones are:

leptospirosis

  • High fever, with or without chills
  • Headache
  • Muscle aches, body ache
  • Vomiting
  • Jaundice (yellow skin and eyes)
  • Red eyes
  • Abdominal Pain, Diarrhea
  • Rash

Incubation period ranges from2 days to 4 weeks. Can occur in 2 phases: 1st with acute febrile illness followed by more severe involving multi organ dysfunction “Weil’s Disease”

 model_lepto

Who is at Risk?

  • Occupational hazard eg farmers, mine workers, sewer workers, slaughterhouse workers, veterinarians and animal caretakers
  • Recreational hazard eg swimming in contaminated water , camping outdoor sports. More common in tropical and temperate climate
  • Incidence of Leptospirosis infection among urban children appears to be increasing.

 lepto-infection

How to diagnose?

It is completely curable if diagnosed early and treatment started on time.

Consult your doctor immediately. Doctor will order few tests which may include dark field microscopy, Culture, leptospirosis Serolgy (IgG& IgM) and PCR.

How to manage?

Avoid self medication

Leptospirosis is treated with antibiotics, such as doxycycline or penicillin, which should be given early in the course of the disease. It should be taken only after consulting doctor, in appropriate doses and for proper duration.

Intravenous antibiotics may be required for persons with more severe symptoms.

 1

How we can prevent it?

  • Clean Water (boiled, RO )
  • Protective gears: while swimming
  • Protective clothing or footwear
  • Cover your would properly and avoid contact with contaminated water, taking shower in monsoon rain, going to river banks
  • Take care of pets. Consult vet doc
  • Clean your home regularly of rats and other animals

For further reading click on the link below

http://www.searo.who.int/entity/emerging_diseases/topics/Communicable_Diseases_Surveillance_and_response_CDS_leptospirosis-Fact_Sheet.pdf?ua=1

Feel free to discuss with your doctor or call us at MAYA CLINIC. we will be happy to respond back.

Regards

Dr Rahul Varma