Two cases of enteric fever in infants from the same orphanage are reported. Case 1 was a 6-day-old neonate who was possibly vertically infected from her mother. Case 2 was a 3-month-old infant who was likely infected by the index case within the orphanage. Both infants grew Salmonella group C1, suggesting horizontal transmission. This is the first report of an enteric fever outbreak among infants in an orphanage setting. Barriers to breastfeeding in rural Rajasthan included mothers needing to work in fields, leading to early supplementation that reduced exclusive breastfeeding. Cultural practices like delayed breastfeeding and prelacteal feeds also hindered optimal breastfeeding.
Two cases of enteric fever in infants from the same orphanage are reported. Case 1 was a 6-day-old neonate who was possibly vertically infected from her mother. Case 2 was a 3-month-old infant who was likely infected by the index case within the orphanage. Both infants grew Salmonella group C1, suggesting horizontal transmission. This is the first report of an enteric fever outbreak among infants in an orphanage setting. Barriers to breastfeeding in rural Rajasthan included mothers needing to work in fields, leading to early supplementation that reduced exclusive breastfeeding. Cultural practices like delayed breastfeeding and prelacteal feeds also hindered optimal breastfeeding.
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Two cases of enteric fever in infants from the same orphanage are reported. Case 1 was a 6-day-old neonate who was possibly vertically infected from her mother. Case 2 was a 3-month-old infant who was likely infected by the index case within the orphanage. Both infants grew Salmonella group C1, suggesting horizontal transmission. This is the first report of an enteric fever outbreak among infants in an orphanage setting. Barriers to breastfeeding in rural Rajasthan included mothers needing to work in fields, leading to early supplementation that reduced exclusive breastfeeding. Cultural practices like delayed breastfeeding and prelacteal feeds also hindered optimal breastfeeding.
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Enteric Fever in Infancy. Two Cases in an Orphanage Out Break
Enteric fever is infrequent under three years of age1. It is is needed in areas where Enteric fever is common. The first even rarer under one year of age. We here discuss two cases case we have reported probably got the infection vertically, of Enteric fever, one in a six days old neonate, and the other from the mother. The baby was abandoned to the orphanage in a three months old infant. They were infected within one and the mother could not be traced. Vertical transmission of month of each other, from the same orphanage. Both had the typhoid has been reported previously3. She had stayed in the same Salmonella group C1 organism, suggesting horizontal orphanage for a week before being admitted with us in the transmission within the orphanage. This is arguably the first hospital. We suspect, the second case inthe orphanage may such report of salmonella infection in infancy in an orphanage have contacted the disease from the index case, either directly or through a carrier. Both of our cases cultured the same strain Case 1 : A six days old female neonate with a cyanotic heart of Salmonella. This suggests the index case who spent the disease (VSD, absent pulmonary valve, PDA with bi-directional first week of it’s life in the orphanage may have spread the shunt and right sided failure) was brought from an orphanage infection to the second case. Measures to prevent further with two days history of respiratory distress, fever and loose spread in orphanage including meticulous hand washing by mucod stools. Blood culture grew Salmonella group C1. She the carriers probably prevented further spread. To our was started on Cefotaxime and Amikacin as per the sensitivity knowledge this is the first report of Enteric fever outbreak in report. Her fever responded to the treatment but she died ten infancy from an orphanage setting. days after admission, due to intractable heart failure. References Case 2 : Another female infant three months old was admitted 1. Sinha A, Sazawal S, Kumar R, Sood S, Reddaiah VP, Singh from the same orphanage one month after the first case. This B et al. Typhoid fever in children aged less than five years. patient was admitted to our ICU in shock with seizures, Lancet 1999; 354 : 734-37. pneumonia and respiratory arrest. The infant was put on a 2. Pandey KK, Srinivasan S, Mahadevan S, Nalini P, Rao RS. ventilator and started on Cefotaxime and Amikacin for sepsis. Typhoid fever below five years. Indian Pediatrics 1990; 27: On the third day of admission, blood culture report showed 153-56. growth of Salmonella group C1. She was given full course of 3. Chin KC, Simmonds, Tarlow MJ. Neonatal typhoid fever. Arch antibiotics for fourteen days and was discharged in a Dis Child 1986;61:1228-30. satisfactory condition. Discussion Mohit Sahni, Shubhangi Bedi* Department of Pediatrics and * Microbiology, Enteric fever in infancy is known to present with shock and St. Stephen’s Hospital, Tis Hazari, India distress2 but Salmonella infection is not often considered, E-mail : mohitsahnil23@rediffmail.com because of the rarity of the condition. A high index of suspicion
Bottlenecks to Breast Feeding in Rural Rajasthan
In Tonk district of Rajasthan, 699 mother’s of 0-3 year old Mothers of this rural area had to go to fields to work as children were surveyed for KAP about breast feeding on a agricultural labourers and thus their children had to be pre-tested questionnaire. supplemented by top milk early in life. Due to poverty, in many The mothers often believed that their milk was not sufficient cases, top milk was not available at home and mothers usually for their infants and made addition of top milk in their diet, fed the children breast mlk supplemented with inadequate which disminished the intensity of breast feeding, there by quantity of complementary foods for economic reasons. 60% directly predisposing mothers to the risk of pregnancy as the of the population has been found following par tial period of lactational amenorrhea got shortened due to reduction breastfeeding for more than 24 months, and a significant of breastfeeding and its replacement by bottle feeding. proportion of male children in comparison to their female counterparts got breastfeeding for this duration. In rural areas, feeding was started only after a ritual performed on the third day after childbirth. A common belief was that There was a common belief in this rural area that the first only after second-third day, mother was capable of secreting milk (colostrum) has some unusual ocnstituents in it, which sufficient quantity of milk to feed the baby. Such practice could be hazardous for the newborn infant and the breast made the mother more vulnerable to postpartum haemorrhage. needs to be squeezed free of this. Thus the baby was put to An account of this practice in the study area can be estimated the breast only after 3 days and most of the times, first feed as 60% of the population started breast feeding their children to the infant had been other than breast milk. from 2nd to 3rd day. However initiation of breast feeding after 3rd day was particularly high in low socio-economic class To mitigate the hunger of newborn child for 3-5 days, prelecteal and the same within 0-12 hours was maximum among upper feed was a very common practice in this area. However, giving socio-economic class. this to the child was the responsibility and prerogative of 155 Enteric Fever in Infancy, Bottlenecks to Breast Feeding
Association of Birth During The Covid-19 Pandemic With Neurodevelopmental Status at 8 Months in Infants With and Without in Utero Exposure To Maternal SARS-CoV-2 Infection