Ptosis without Ophthalmoplegia in Acute Motor Axonal Neuropathy Variant of Guillain-Barré Syndrome in Children: A Case Series

Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in children. The clinical variants include Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP), Acute Motor Sensory Axonal Neuropathy (AMSAN), Acute Motor Axonal Neuropathy (AMAN) and Miller-Fisher syndrome. Cranial nerve involvement can occur in approximately 50% of patients with GBS, but it is rarely reported in the AMAN variant. Ptosis as a presenting symptom is extremely rare in the AMAN variant. Autonomic dysfunction is also rarely reported in the AMAN variant. In the present case series, authors hereby, report five children (3 males, 2 females, aged 4-11 years) diagnosed with the AMAN variant of GBS, who presented with early onset of ptosis and rapid progression of flaccid weakness. Autonomic dysfunction, in the form of tachycardia, hypertension and excessive diaphoresis, was a prominent feature in four of the cases. The average time to reach the nadir of weakness was 4.2 days and the average duration of hospital stay was 58 days. The average GBS disability score at discharge was four. Nerve conduction studies were suggestive of the AMAN variant of GBS in all five cases. All children were treated with Intravenous Immunoglobulin (IVIg) and all required mechanical ventilation, with an average duration of 35.8 days. All five cases presented in a short period of three months, from November 2022 to February 2023

Factors contributing to the non-identification of bacterial meningitis in febrile infants: A case series study

Non-identification of serious bacterial infection (SBI) in febrile infants is a common occurrence in clinical practice, culminating in catastrophic presentations. Six infants who initially presented to the clinician with fever without a focus, and were lately diagnosed with bacterial meningitis were analyzed for clinician-related factors contributing to the non-identification of meningitis. In a febrile neonate and a febrile young infant, lack of comprehensive evaluation was contributing to the non-identification of SBI; in four infants above the age of 3 months, meningitis was missed in spite of clinicians practicing treatment guidelines. Inadequate symptom characterization in two febrile infants and inappropriate interpretation of hemogram in three febrile infants also contributed to the non-identification of meningitis. Except for one, all infants developed complications. We conclude that the characterization of clinical features of SBI-like meningitis, interpretation of lab data, and adherence to the treatment guidelines are crucial in the management of an infant presenting as fever without a focus

Visceral Leishmaniasis in Kerala: An Emerging Disease

Leishmaniasis though endemic to certain parts of India is rare in the state of Kerala. Though cutaneous forms of the disease have been reported from a few pockets in Kerala the Visceral form is rare. We report the clinico-epidemiological profile of two cases of visceral leishmaniasis reported from Malappuram district in Kerala. The public health interventions instituted following the confirmation of diagnosis has also been mentioned