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Gayathri 5 year old gir l from palakkad woke up at 7AM as usual. Her usual style on waking up was to sit on the steps in front of her house for a while. Yesterday, while on sitting and enjoying these moments she called out her mother as she thought something bit her from the small gaps of the stone steps. Both parents were workers staying in a thatched house with mud bricks and the steps in front was  made of broken stones having enough holes in between. Her mother searched for a while for anything in the gaps,but she failed to see anything.This happened at 7 AM. As she could nt find anything she thought it must be some insect sting. But, Gradually the pain worsened and she became drowsy within one hour  She was still responding to calls at that time She was taken to Palakkad General hospital. As per records she was noticed to be drowsy, very low heart rate 38 per minute .breathing weak. GRBS tested on arrival was 111 mg/dl In view of bite history and her vitals were di

11 year old girl child was bought with complaints of Head ache and vomiting    4 days Fever                                  2 days Seizures today while on transport to our hospital She was normal child going to schoo l.No past history of significant illness. At the time of admission in PICU Airway was normal,shallow respiration Pulse was good volume,regular 58/mt Blood Pressure above 95th centile  EMV score  8 Temperature 100/mt. After stabilizing measures detailed history was taken No history of skin rashes, or bleeds.  No history of fall/trauma, No history of ear discharge. No history of contact with tuberculosis ,  No history of cough, fever or recent weight loss  History of travel outside state from school . History of taking bath in swimming pool Discussion Previously normal child 11 years presenting with fever altered sensorium possibility of 'encephalitic syndromes' was considered. This is s vague diagnosis which includes many entit