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Atypical Infections: Pediatricians Perspective

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Dr S Balasubramanian, Chennai    16 January 2018

  1. Atypical presentation of typical infectious diseases is more common than the typical presentation of an infection caused Mycoplasma is a notorious atypical pathogen with protean extrapulmonary manifestations. There is no gold standard for diagnosis of mycoplasma infection.
  2. Chlamydia and Legionella are other so-called atypical pathogens causing pneumonia.
  3. The term atypical pneumonia will soon become obsolete.
  4. Atypical mycobacterial infections are severe in immunodeficient individuals, but can be troublesome in others also.
  5. Majority of scrub typhus present with eschar. It is more common in male children (in the age group of 1-5 years). This could be because male children might be exposed to outdoor play or may be used to sleep scantily dressed. Adding doxycycline on clinical grounds today is justified and rational.
  6. Majority of eschars occur in areas which may not be routinely examined in children with fever (perineal, inguinal, gluteal region). Search for eschar all over the body.
  7. Melioidosis – Melioidosis is an infectious disease caused by a Gram-negative bacterium, Burkholderia pseudomallei. It is endemic in southeast Asia and northern Australia. Sporadic cases in India have been reported from Kerala, Karnataka, Tamil Nadu, Maharashtra. Modes of transmission are cutaneous inoculation, inhalation (during heavy rains), ingestion, sexual transmission, near-drowning, amniotic fluid contamination, laboratory acquired. Management involves initial parenteral eradication therapy followed by oral maintenance therapy.
  8. Brucellosis mimics TB, malignancies and SOJIA. It is difficult to confirm and requires prolonged antibiotic course. Imaging, HPE and serological tests often give clues.

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