Publications by authors named "S Elilarasi"

5 Publications

  • Page 1 of 1

Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2.

Indian J Pediatr 2021 Nov 24. Epub 2021 Nov 24.

Department of Pediatric Cardiology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India.

Objectives: To know the clinical presentation and outcome of children with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV- 2 (PIMS-TS) at a pediatric tertiary care center in Chennai.

Methods: Clinical and biochemical parameters of 65 children with PIMS-TS treated between July and October 2020 were studied. All children had their COVID RT-PCR and IgG COVID antibodies tests done.

Results: Mean age of the study group was 5.65 ± 3.68 y. Fever with red eyes, rash, vomiting, abdominal pain, and shock were common presenting features. Sixty percent of the study group had Kawasaki/incomplete Kawasaki features. Sixty-seven percent of the study group had coronary dilatation, 41% presented with shock, and 25% had left ventricular dysfunction. Coronary aneurysms were documented in 58% of the study group (z score more than 2.5). Respiratory presentation with pneumonia was seen in 10%. Four children presented with acute abdomen. Acute kidney injury, acute liver failure, hemolysis, pancytopenia, macrophage activation syndrome, encephalopathy, and multiorgan dysfunction syndrome (MODS) were other features. Forty-three percent required noninvasive oxygen support and 15.4% required mechanical ventilation. Intravenous immunoglobulin (73.8%) and methylprednisolone (49.8%) were used for therapy. Mortality in the study was 6%, which was due to MODS.

Conclusions: Acute febrile illness with mucocutaneous and gastrointestinal manifestations should have PIMS-TS as a possible differential diagnosis and needs evaluation with inflammatory markers and SARS-CoV-2 antibodies.
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http://dx.doi.org/10.1007/s12098-021-03954-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611247PMC
November 2021

Plasma chemokines as immune biomarkers for diagnosis of pediatric tuberculosis.

BMC Infect Dis 2021 Oct 11;21(1):1055. Epub 2021 Oct 11.

International Center for Excellence in Research, National Institute for Research in Tuberculosis , Chennai, India.

Background: Diagnosing tuberculosis (TB) in children is challenging due to paucibacillary disease, and lack of ability for microbiologic confirmation. Hence, we measured the plasma chemokines as biomarkers for diagnosis of pediatric tuberculosis.

Methods: We conducted a prospective case control study using children with confirmed, unconfirmed and unlikely TB. Multiplex assay was performed to examine the plasma CC and CXC levels of chemokines.

Results: Baseline levels of CCL1, CCL3, CXCL1, CXCL2 and CXCL10 were significantly higher in active TB (confirmed TB and unconfirmed TB) in comparison to unlikely TB children. Receiver operating characteristics curve analysis revealed that CCL1, CXCL1 and CXCL10 could act as biomarkers distinguishing confirmed or unconfirmed TB from unlikely TB with the sensitivity and specificity of more than 80%. In addition, combiROC exhibited more than 90% sensitivity and specificity in distinguishing confirmed and unconfirmed TB from unlikely TB. Finally, classification and regression tree models also offered more than 90% sensitivity and specificity for CCL1 with a cutoff value of 28 pg/ml, which clearly classify active TB from unlikely TB. The levels of CCL1, CXCL1, CXCL2 and CXCL10 exhibited a significant reduction following anti-TB treatment.

Conclusion: Thus, a baseline chemokine signature of CCL1/CXCL1/CXCL10 could serve as an accurate biomarker for the diagnosis of pediatric tuberculosis.
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http://dx.doi.org/10.1186/s12879-021-06749-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504024PMC
October 2021

Discovery and Validation of a Three-Cytokine Plasma Signature as a Biomarker for Diagnosis of Pediatric Tuberculosis.

Front Immunol 2021 16;12:653898. Epub 2021 Apr 16.

National Institutes of Health, National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India.

Pediatric TB poses challenge in diagnosis due to the paucibacillary nature of the disease. We conducted a prospective diagnostic study to identify immune biomarkers of pediatric TB and controls (discovery cohort) and obtained a separate "validation" cohort of confirmed cases of pediatric TB and controls. Multiplex ELISA was performed to examine the plasma levels of cytokines. Discovery and validation cohorts revealed that baseline plasma levels of IFNγ, TNFα, IL-2, and IL-17A were significantly higher in active TB (confirmed TB and unconfirmed TB) in comparison to unlikely TB children. Receiver operating characteristics (ROC) curve analysis revealed that IFNγ, IL-2, TNFα, and IL-17A (in the discovery cohort) and TNFα and IL-17A (in the validation cohort) could act as biomarkers distinguishing confirmed or unconfirmed TB from unlikely TB with the sensitivity and specificity of more than 90%. In the discovery cohort, cytokines levels were significantly diminished following anti-tuberculosis treatment. In both the cohorts, combiROC models offered 100% sensitivity and 98% to 100% specificity for a three-cytokine signature of TNFα, IL-2, and IL-17A, which can distinguish confirmed or unconfirmed TB children from unlikely TB. Thus, a baseline cytokine signature of TNFα, IL-2, and IL-17A could serve as an accurate biomarker for the diagnosis of pediatric tuberculosis.
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http://dx.doi.org/10.3389/fimmu.2021.653898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085486PMC
September 2021

Tuberculosis preventive treatment should be considered for all household contacts of pulmonary tuberculosis patients in India.

PLoS One 2020 29;15(7):e0236743. Epub 2020 Jul 29.

Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.

The World Health Organization (WHO) recently changed its guidance for tuberculosis (TB) preventive treatment (TPT) recommending TPT for all pulmonary TB (PTB) exposed household contacts (HHC) to prevent incident TB disease (iTBD), regardless of TB infection (TBI) status. However, this recommendation was conditional as the strength of evidence was not strong. We assessed risk factors for iTBD in recently-exposed adult and pediatric Indian HHC, to determine which HHC subgroups might benefit most from TPT. We prospectively enrolled consenting HHC of adult PTB patients in Pune and Chennai, India. They underwent clinical, microbiologic and radiologic screening for TB disease (TBD) and TBI, at enrollment, 4-6, 12 and 24 months. TBI testing was performed by tuberculin skin test (TST) and Quantiferon®- Gold-in-Tube (QGIT) assay. HHC without baseline TBD were followed for development of iTBI and iTBD. Using mixed-effect Poisson regression, we assessed baseline characteristics including TBI status, and incident TBI (iTBI) using several TST and/or QGIT cut-offs, as potential risk factors for iTBD. Of 1051 HHC enrolled, 42 (4%) with baseline TBD and 12 (1%) with no baseline TBI test available, were excluded. Of the remaining 997 HHC, 707 (71%) had baseline TBI (TST #x2265; 5 mm or QGIT #x2265; 0.35 IU/ml). Overall, 20 HHC (2%) developed iTBD (12 cases/1000 person-years, 95%CI: 8-19). HIV infection (aIRR = 29.08, 95% CI: 2.38-355.77, p = 0.01) and undernutrition (aIRR = 6.16, 95% CI: 1.89-20.03, p = 0.003) were independently associated with iTBD. iTBD was not associated with age, diabetes mellitus, smoking, alcohol, and baseline TBI, or iTBI, regardless of TST (#x2265; 5 mm, #x2265; 10 mm, #x2265; 6 mm increase) or QGIT (#x2265; 0.35 IU/ml, #x2265; 0.7 IU/ml) cut-offs. Given the high overall risk of iTBD among recently exposed HHCs, and the lack of association between TBI status and iTBD, our findings support the new WHO recommendation to offer TPT to all HHC of PTB patients residing in a high TB burden country such as India, and do not suggest any benefit of TBI testing at baseline or during follow-up to risk stratify recently-exposed HHC for TPT.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236743PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390377PMC
September 2020

Adult Form of Scimitar Syndrome Presenting as Severe Pulmonary Hypertension in a Child.

Indian Pediatr 2015 Oct;52(10):889-90

Department of Pulmonology, Institute of Child Health and Hospital for Children; and *Department of Pediatric Cardiac Surgery, Apollo Childrens Hospital; Chennai, India. Correspondence to: Dr Sivasambo Kalpana, Department of Pulmonology, Institute of Child Health and Hospital for Children, Halls road, Egmore, Chennai.

Background: Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies; the adult form is not usually is associated with pulmonary hypertension.

Case Characteristics: 6-year-old girl with recurrent episodes of cough and breathlessness, along with features of right heart enlargement. Computed tomography angiogram revealed right pulmonary veins draining into inferior vena cava with dextroposition of heart.

Outcome: Successfully managed with surgical correction.

Message: Scimitar syndrome should be considered in any child with unexplained pulmonary hypertension and dextroposed heart.
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http://dx.doi.org/10.1007/s13312-015-0738-3DOI Listing
October 2015
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