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Pediatric and Infectious Disease
Dr Tanu has pursued MD Paediatrics from prestigious institute of AIIMS and MSc in Tropical and Infectious Disease from London School of Hygiene and Tropical Medicine-UK
She has previously worked as Consultant Pediatrics and Infectious Disease at Hinduja Hospital, Mumbai for duration of six years.
As a general paediatrician, she runs a well baby clinic, provides immunization services and treats routine day-to-day illnesses. She is an expert in management of common childhood infections such as malaria, dengue, typhoid, tuberculosis, urinary tract infections etc and has been involved in developing national guidelines for these illnesses.
Apart from this, she has expertise in management of antibiotic Resistant Infections, Multi Drug Resistant Tuberculosis, Hospital Acquired Infections, HIV, Immunodeficiencies, Fever of Unknown Origin and Exotic Infections in both adults and children.
She also runs a travel clinic at the hospital, which provides comprehensive services to both outbound and inbound travellers including vaccination.
She is one of the core members of the infection control committee of the hospital and integrally involved in running the infection control program.
Disease | No. of Cases Treated | International Success Rate | KDAH Success Rate |
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MDR Tuberculosis in children | >50 | 80% | 99% |
XDR tuberculosis in a 16 year old boy
A 16 year old boy presented with fever and cough for 1 month duration. The CT was suggestive of pulmonary tuberculosis with a pleural effusion. Culture samples confirmed the presence of mycobacterium tuberculosis, which was resistant to all first line drugs, quinolones and even 2nd line injectable agents. The child was started on a 2nd line drug regime with quinolones, aminoglycosides, QPAS, clofazimine and linezolid, coamoxiclav, clarithromycin and he improved. 4 months later he developed thrombocytopenia so linezolid was withdrawn. Three months later he developed tubercular meningitis. He was admitted to the hospital and treatment continued with the same drugs and meropenem and amoxiclav was added. He did not improve and then again linezolid was restarted. He developed peripheral neuropathy that was managed with coenzyme Q and drugs were continued. Effort was made t procure bedaquiline which failed. Injectable capreomycin was also started. After about 6 months he started to improve and 18 months later treatment was stopped. He is asymptomatic over the past 6 months. The predicted mortality of XDR tubercular meningitis is in excess of 80% and it was gratifying to save this child
Severe mycobacterium abscessus infection following liposuction
A 23 year old model developed multiple skin abscesses soon after liposuction surgery. She presented to another hospital where was advised radical debridement surgery for her entire back and thighs which would have been associated with very high mortality and morbidity. She took discharge from that hospital and presented to us. Here we sent her pus samples for analysis and detected infection due to mycobacterium abscessus. She was managed conservatively with repeated incision, drainage, and antibiotics including clarithromycin, linezolid and amikacin. She finally recovered after 6 months with very small residual scars and has resumed her modelling career. Mycobacterium abscessus is a rapidly growing mycobacteria that is associated with laparoscopic and cosmetic surgeries and can be managed conservatively with the right combination of antibiotics.
Unusual cause of Aseptic Meningitis in a 5-month-old infant
A 5-month-old infant presented with history of fever for 10 days. She was investigated on day 5 of fever and due to associated irritability a CSF analysis was done which showed around 100 cells predominantly lymphocytes. She was treated with IV ceftriaxone but her fever persisted and antibiotics were upgraded to piperacillin tazobactam. Fever persisted and the WBC and platelets kept rising and she was referred to us. At the time of presentation, she was extremely irritable but there were no other findings. In view of high WBC and platelet counts and high CRP and mild elevation of AST and ALT and also aseptic meningitis, Kawasaki disease was suspected and a 2D ECHO was done. It showed coronary artery aneurysms and the baby was treated with IVIG following which the fever subsided and the aneurysms have lessened over the past few years. Kawasaki disease a medium vessel vasculitis is an unusual cause of fever in children. Infants are unique that they may have none of the tell tale signs such as red lips and tongue and rash. If the diagnosis is delayed there is a 20% risk of coronary artery aneurysms with associated risks of myocardial infarction in later life. Use of IVIG in the first 10 days cuts down this risk to around 1%
Why babies are not small adults?
A 4-month-old infant had history of fever with no focus. A CBC showed high WBC count with predominant polymorphs. His CSR, urine routine and USG abdomen was normal. He was prescribed coamoxiclav with which the fever resolved. Three days later a repeat CBC showed a count of 36,000. The baby presented to the ER of our hospital and was admitted. On history taking, it revealed that the baby was finding it difficult to suck on the breast and lost neck control. An urgent MRI was done which showed a large retropharyngeal abscess that was impinging the airway for which urgent surgical drainage done. Retropharyngeal abscess is one of the occult sites of infection in infants and children along with brain abscess/ sinusitis, osteomyelitis etc. Diagnosis is delayed since the infant cannot localise the infection and are unable to communicate. This makes pediatric practice so challenging and different from adult medicine
Are we in Africa?
A 6-week-old baby presented from a small village near Amreli with fever for 10 days duration. A CBC was done and the PS showed trypomastigotes .This was shocking since trypanosomiasis is unheard of in India unlike Africa where it is fairly common and known as sleeping sickness. The parasite was sent for identification to a higher centre, which identified it, is Trypanosoma lewisi, an animal trypanosome. Review of literature revealed scattered cases in India due to close contact between animals and humans. The baby probably acquired it from contaminated rat excreta which is known to contain this trypanosomes. Since the baby was well and treatment is very toxic, treatment was deferred and the baby recovered spontaneously.
This was followed 1 year later by another case in an adult this time. He was a 48 year old African male residing in Lusaka, Zambia presenting with a progressive neurodegenerative disorder. He came to Kokilaben for neuro rehabilitation. Review of MRI was suggestive of trypanosomiasis. During an acute worsening event, PS for trypomastigotes was sent which was positive. Antimony based treatment was procured from Africa but the patient died. It was indeed surprising that the diagnosis of a disease endemic to Africa was not made there and made here. With increasing international travel and medical tourism it is important to be aware of world wide epidemiology of infectious diseases.
No. | Journal Code | Department | Type | Download | |
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1 | 408 | Centre for Children | International | - | |
Publication/Talk Title : Conjugate Vaccines For Enteric Fever Journal Published : Journal Of Infection In Developing Countries |
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2 | 388 | Centre for Children | National | - | |
Publication/Talk Title : Rickettsial Infections Journal Published : Advances In Pediatrics |
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3 | 387 | Centre for Children | National | - | |
Publication/Talk Title : Infectious Diseases Journal Published : Ghai’s Essential Pediatrics |
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4 | 386 | Centre for Children | National | - | |
Publication/Talk Title : Mycoplasma Infections: Treatment And Prognosis In Pediatrics Journal Published : Treatment And Prognosis In Pediatrics |
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5 | 385 | Centre for Children | National | - | |
Publication/Talk Title : Sepsis And Septic Shock In Children Journal Published : Textbook Of Pediatric Infectious Diseases |
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6 | 384 | Centre for Children | National | - | |
Publication/Talk Title : Immunodeficiency Disorders Journal Published : IAP Textbook Of Pediatrics |
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7 | 383 | Centre for Children | National | - | |
Publication/Talk Title : Rational Antimicrobial Practice In Pediatrics Journal Published : Post graduate text book Of Pediatrics |
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8 | 382 | Centre for Children | National | - | |
Publication/Talk Title : FAQ’s In Sepsis And Septic Shock Journal Published : IAP Text Book On FAQ’s In Pediatric Infectious Disease |
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9 | 381 | Centre for Children | National | - | |
Publication/Talk Title : General Recommendations On Vaccines Journal Published : IAP Text Book On Vaccines |
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10 | 380 | Centre for Children | National | - | |
Publication/Talk Title : Mycoplasma Journal Published : Post Graduate Text Book Of Pediatrics |
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11 | 282 | Centre for Children | National | - | |
Publication/Talk Title : Hand Hygiene Journal Published : Journal Of The Indian Academy Of Pediatrics |
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12 | 280 | Centre for Children | National | - | |
Publication/Talk Title : Impact Of A Multidimensional Strategy To Reduce Ventilator-Associated Pneumonia In Neonatal Intensive Care Units In 10 Developing Countries Journal Published : Infect Control Hosp Epidemiol |
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13 | 277 | Centre for Children | National | - | |
Publication/Talk Title : Delayed Diagnosis Of Infective Endocarditis In A Child With A Normal Heart Journal Published : Indian Journal Of Pediatrics |
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14 | 276 | Centre for Children | National | - | |
Publication/Talk Title : The Outcome Of Treating ESBL Infections With Carbapenem Vs Non Carbapenem Antimicrobials Journal Published : Journal Of The Association Of Physicians Of India |
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15 | 275 | Centre for Children | National | - | |
Publication/Talk Title : Tuberculosis: How Long To Treat Journal Published : Pediatric Infectious Diseases Journal |
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16 | 274 | Centre for Children | National | - | |
Publication/Talk Title : Urine Analysis And Urine Culture Journal Published : Pediatric Infectious Diseases Journal |
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17 | 273 | Centre for Children | National | - | |
Publication/Talk Title : Symposium On Infections Old And New Journal Published : Indian Journal Of Pediatrics |
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18 | 272 | Centre for Children | National | - | |
Publication/Talk Title : Blood Cultures Revisited Journal Published : Pediatric Infectious Diseases Journal |
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19 | 271 | Centre for Children | National | - | |
Publication/Talk Title : How Good Is Compliance With Surgical Antibiotic Prophylaxis Guidelines In A Tertiary Care Private Hospital In India? A Prospective Study Journal Published : Indian Journal Of Surgery |
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20 | 270 | Centre for Children | National | - | |
Publication/Talk Title : Enteric fever Journal Published : Pediatric Infectious Diseases Journal |
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21 | 269 | Centre for Children | National | - | |
Publication/Talk Title : Alleviation Of Pain Associated With Immunization Injections Journal Published : Indian Pediatrics |
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22 | 268 | Centre for Children | National | - | |
Publication/Talk Title : A 1.5 Year Old With Recurrent Fever Journal Published : Pediatric Infectious Diseases Journal |
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23 | 267 | Centre for Children | National | - | |
Publication/Talk Title : TB or Not TB Journal Published : Pediatric Infectious Diseases Journal |
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24 | 266 | Centre for Children | National | - | |
Publication/Talk Title : Management Of Drug-Resistant TB With Individualised DST-The Way Forward? Journal Published : Journal Of Association Of Physicians Of India |
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25 | 256 | Centre for Children | National | - | |
Publication/Talk Title : Mal-Absorptive Bariatric Procedure Causing Keshan’s Disease Journal Published : Journal Of Advances In Obesity, Weight Management & Control |
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26 | 196 | Centre for Children | International | - | |
Publication/Talk Title : Socioeconomic Impact On Device-Associated Infections In Limited-Resource Neonatal Intensive Care Units: Findings Of The INICC Journal Published : International Nosocomial Infection Control Consortium |
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27 | 195 | Centre for Children | International | - | |
Publication/Talk Title : Injection Practices In India Journal Published : WHO South-East Asia Journal Of Public Health |
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28 | 194 | Centre for Children | International | - | |
Publication/Talk Title : International Nosocomial Infection Control Consortium (INICC) Report, Data Summary Of 36 Countries, 2004-2009. Journal Published : American Journal Of Infection Control |
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29 | 193 | Centre for Children | International | - | |
Publication/Talk Title : International Nosocomial Infection Control Consortium (INICC) Report, Data Summary Of 30 Countries, 2005-2010 Journal Published : Infect Control Hosp Epidemiol. |
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30 | 192 | Centre for Children | International | - | |
Publication/Talk Title : Impact Of An International Nosocomial Infection Control Consortium Multidimensional Approach On Central Line-Associated Bloodstream Infection Rates In Adult Intensive Care Units In Eight Cities In India Journal Published : International Journal Of Infectious Disease |
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31 | 191 | Centre for Children | International | - | |
Publication/Talk Title : The Worldwide Antibiotic Resistance And Prescribing In European Children (ARPEC) Point Prevalence Survey: Developing Hospital-Quality Indicators Of Antibiotic Prescribing For Children Journal Published : Journal Of Antimicrobial Chemotherapy |
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32 | 174 | Centre for Children | International | - | |
Publication/Talk Title : Parkinsonism In Human African Trypanosomiasis: Clinical Course, Imaging Findings And Treatment-Related Challenges Journal Published : International Congress Of Parkinson's Disease And Movement Disorders |
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33 | 158 | Centre for Children | International | - | |
Publication/Talk Title : A 4-Year Prospective Study To Determine The Incidence And Microbial Etiology Of Surgical Site Infections At A Private Tertiary Care Hospital In Mumbai, India Journal Published : American Journal Of Infection Control |
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34 | 98 | Centre for Children | National | Download | |
Publication/Talk Title : Outbreak of Burkholderia Cepacia Complex Bacteremia in a Chemotherapy Day Care Unit Due to Intrinsic Contamination of an Antiemetic Drug Journal Published : Indian Journal of Medical Microbiology |
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35 | 86 | Centre for Children | National | Download | |
Publication/Talk Title : Pioneers in Infection Prevention-Part 1 Journal Published : Journal of the Association of Physicians of India |
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36 | 81 | Centre for Children | National | Download | |
Publication/Talk Title : Pioneers in Infection Prevention-Part 2 Journal Published : Journal of the Association of Physicians of India |
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37 | 80 | Centre for Children | National | Download | |
Publication/Talk Title : Pioneers in Parasitology Journal Published : Journal of the Association of Physicians of India |
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38 | 78 | Centre for Children | National | Download | |
Publication/Talk Title : Pioneers in Vaccinology Journal Published : Journal of the Association of Physicians of India |
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39 | 65 | Centre for Children | National | Download | |
Publication/Talk Title : The Microbial Etiology and Antimicrobial Susceptibility of Bloodstream Infections in Patients with Cancer at a Private Tertiary Care Hospital in Mumbai,India Journal Published : Indian Journal of Cancer |