Archives of Pediatric Infectious Diseases

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In Collaboration with Pediatric Infections Research Center, Research Institute for Children’s Health, SBMU

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Archives Of Pediatric Infectious Disease is a clinical journal which is informative to all practitioners like pediatric infectious disease specialists and internists. This authoritative clinical journal was founded by Professor Abdollah Karimi in 2012. The Journal context is devoted to the particular compilation of the latest worldwide and interdisciplinary approach and findings including original manuscripts, meta-analyses and reviews, health economic papers, debates and consensus statements of clinical relevance to pediatric disease field, especially infectious diseases. In addition, consensus evidential reports not only highlight the new observations, original research and results accompanied by innovative treatments and all the other relevant topics but also include highlighting disease mechanisms or important clinical observations and letters on articles published in the journal.

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Now showing 1 - 20 of 478

Molecular Characterization of Staphylococcus epidermidis Isolates Collected From an Intensive Care Unit
(Brieflands, 2017-04-01) Amirmorteza Ebrahimzadeh Namvar; Seyed Asghar Havaei; Leila Azimi; Abdolaziz Rastegar Lari; Ramazan Rajabnia
Background: Staphylococcus epidermidis is known as the most significant cause of nosocomial infections. Moreover, bloodstream infection is one of the noticeable and common infections in many wards of health care units, especially in intensive care units (ICU) and neonatal intensive care units (NICU). It has been proved that the mecA gene is the principal cause of methicillin resistance in Staphylococcus epidermidis strains. Also, mecA and other genes are located on staphylococcal cassette chromosome mec (SCCmec). Objectives: The aim of this study was investigating the genotypic characteristics of methicillin resistant Staphylococcus epidermidis (MRSE) strains isolated from hospitalized patients at the intensive care unit. Methods: A total of 121 isolates were recovered from bloodstream infections of ICU hospitalized patients in Al-Zahra hospital (Isfahan, Iran). Overall, fifty-three isolates belonged to S. epidermidis. Antibiotic susceptibility Test, determination of mecA gene, SCCmec types, Pulse Field Gel Electrophoresis (PFGE) and Multi-Locus Sequence Typing (MLST) methods were carried out as the preferential techniques. Results: In accordance to our study, 43.4% of isolates were resistant to cefoxitin, while the mecA gene was found in 25 (47.2%) isolates by the PCR method. In addition, various SCCmec types were detected from MRSE strains by using multiplex polymerase chain reaction (PCR). Furthermore, a total of 16 different pulsotypes were identified with PFGE typing via GelCompar II analysis. It is notable that the most prevalent ST type was ST2. Conclusions: Recognizing the source of infection is essential for monitoring the dissemination of infections, therefore this important issue is not acquired without various typing methods.
New Advances in Diagnosis of Latent Tuberculosis Infection: A Review Article
(Brieflands, 2015-01-01) Masoud Mardani; Zahra Abtahian
Context: It has been estimated that one-third of the world’s population are suffering from latent tuberculosis infection (LTBI). In order to control tuberculosis in high-risk groups proper diagnosis and treatment is essential. Evidence Acquisition: Useless and expensive tests such as unfocused population-based tests can lead to futile and unnecessary treatments. Targeted screening approaches and individualization of LTBI treatment protocols must be a priority. Results: Diagnostic methods with immune based tests such as the tuberculin skin test (TST) or interferon gamma release assays (IGRA) can accurately detect LTBI. However, interferon-gamma release assays have higher specificity than TST in Bacille Camette-Gurin (BCG)-vaccinated populations; both tests are precise to identify latent tuberculosis. However, it is of great concern that both tests have insignificant roles in predicting risk of progression to active tuberculosis. Conclusions: Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for the comparison of these tests.
Comparison Between Pulmonary and Extrapulmonary Tuberculosis in Adolescents
(Brieflands, 2017-07-31) Ferial Lotfian; Golnaz lotfian; Mohammad Reza Bolursaz; Payam Tabarsi; Aliakbar Velayati
Background: Tuberculosis (TB) is a main health problem worldwide. Despite the high incidence of TB in adolescents, studies mainly focus on the risk factors of TB in adults. Objectives: The current study aimed at comparing the demographic, clinical, and microbiological characteristics of extrapulmonary TB (EPTB) and pulmonary TB (PTB) in adolescents. Methods: The current retrospective study compared 30 EPTB and 113 PTB cases, aged 10 to 18 years, admitted to Masih Daneshvari Medical center, Tehran, Iran, from March 2006 to March 2011. Results: The mean age of the patients with PTB and EPTB were 15.4 ± 2.3 and 16.1 ± 1.7 years, respectively. Sixteen (53%) and 74 (65.5%) of the patients with EPTB and PTB, respectively, were female. Multivariate logistic regression analysis showed that contact with adult patients with TB (odds ratios (OR): 0.07; 95% confidence intervals (CI): 0.009 - 0.58) and smear positivity (OR: 0.062; 95% CI: 0.005 - 0.80) were associated with PTB, while having a fever (OR: 21.49; 95% CI: 1.35 - 339.96) was associated with EPTB. Conclusions: The current study findings in adolescent patients confirmed the quiet onset of EPTB with a lower rate of bacteriologic diagnosis and source detection rate. New strategies are required to improve the early diagnosis and prevention of EPTB in adolescents.
Impact of Helicobacter pylori Eradication in Children with Acute Immune Thrombocytopenia: A Randomized Controlled Study
(Brieflands, 2019-10-31) Aziz Eghbali; Vahid Reza Siavashan; Bahador Bagheri; Roghyae Rahimi Afzal
Background: At present, some evidence supports the role of Helicobacter pylori eradication in treating childhood immune thrombocytopenia (ITP). Objectives: This study was designed to investigate the association between H. pylori eradication and platelet count in children with acute ITP. Methods: Thirty children with a diagnosis of acute ITP and H. pylori infection were studied. This randomized and controlled study was done in Amir-Kabir Hospital, Arak, Iran. Patients were randomly allocated 1:1 to standard ITP and H. pylori treatments or standard ITP treatment. For 6 months, studied subjects had monthly follow-ups. Results: The mean ± standard deviation (SD) age was 11 years with a majority of females (67.9 % vs. 32.1 %). The mean platelet count was 16.93 ± 10.1 (109/L) in the ITP and H. pylori therapy group, and15.0 ± 3.8 (109/L) in the ITP therapy group at the baseline. After 1 week of treatment, mean platelet counts increased to 136.5 ± 55.20 and 124.0 ± 45.70 in the two groups, respectively (109/L). The differences between the two groups were not statistically significant at other time intervals. Children that received ITP and H. pylori therapies had a higher rate of gastrointestinal symptoms (P < 0.01). Conclusions: Our findings suggest that H. pylori eradication did not significantly affect the platelet count compared to standard ITP therapy in children with acute ITP.
Diabetic Foot Infections: Antibiotic Susceptibility Patterns and Determination of Antibiotic Cross-Resistance in Clinical Isolates of Enterococcus Species During 2012 - 2014 in Shiraz, Iran
(Brieflands, 2017-04-01) Mojtaba Anvarinejad; Gholamreza Pouladfar; Aziz Japoni; Shahram Bolandparvaz; Zeinab Satiary; Jalal Mardaneh
Background: Diabetic foot infections (DFIs) are an increasingly common public health problem and are associated with mortality and morbidity. The incidence of Enterococci in DFIs, a leading cause of hospital admission in Iran, has been increasing, possibly due to previous antibiotic use. Objectives: The aims of this study were 1) isolation of bacteria from diabetic patients with foot ulceration, 2) characterization of the isolated bacteria, 3) confirmation of Enterococci and their genus, 4) determination of the susceptibility profile of the isolates, and 5) survey of the cross-resistance among Enterococcus spp. Methods: A total of 86 diabetic patients with foot ulceration were investigated during 2012 - 2014 in Nemazee hospital (Shiraz, Iran). Swabs were collected from diabetic ulcers. For the isolation of bacteria, microbiological media were used. Colonies were further characterized using various biochemical tests (e.g., catalase test, oxidase reaction, growth on bile esculine [BE] agar, growth in the presence of 6.5% NaCl, growth at 45°C, motility, pyrrolidonyl arylamidase [PYR], yellow pigment, arginine dihydrolase [ADH], and sugars fermentation). Antibiotic susceptibility testing was done by standard disc diffusion method, according to the CLSI protocols. Detection of vancomycin-resistant Enterococcus (VRE) was performed by BHI agar screen plate. Results: In the current study, a total of 86 diabetic patients were investigated. Enterococcus spp. were isolated from 34 (39.5%) patients consisting of 20 males (59%) and 14 females (41%). Twenty-five (73.5%) patients received antibiotic treatment on admission. Fifty (44.1%) cases had random blood sugar ranging between 130 - 300, and 19 (55.9%) had blood sugar of 300 - 450. Of the 34 patients, 15 (44.1%) had type 1 diabetes and 19 (55.9%) had type 2 diabetes. Enterococcus faecalis was the most common isolated Enterococcus spp. (50%). Linezolid was the most effective antibiotic against Enterococcus isolates, and ciprofloxacin was the least effective. Conclusions: Our data showed that resistance to vancomycin among Enterococcus spp. isolates is emerging. Knowledge of the causative microorganisms in DFIs and their antibiotic susceptibility profiles is essential for proper treatment and infection eradication.
Efficacy of Ascorbic Acid Supplementation in Relief of Symptoms Due to Febrile Upper Urinary Tract Infection in Children, a Clinical Trial and Hospital Based Study
(Brieflands, 2018-10-31) Parsa Yousefichaijan; Ali Ahmad Goudarzi; Masoud Rezagholizamenjany; Manijeh Kahbazi; Mohammad Rafeie; Ali Arjmand Shabestari; Fakhreddin Shariatmadari; Hassan Taherahmadi
Background: Urinary tract infections (UTIs) as a urological disorder occur in 1% - 3% of females and 1% of males. This disease can induce severe complications such as pyelonephritis. Objectives: The current study aimed to evaluating the efficacy of vitamin C supplementation on UTI in children. Methods: The current clinical trial study was conducted on 152 female children with UTI admitted to Amir-Kabir hospital, Arak, Iran. The cases were randomly divided, based on blocked groups, into two treatment and control groups (76 patients in any group). The subjects were matched in terms of age, gender, and clinical signs and symptoms. The control group received only routine treatment of UTI, while the treatment group, in addition to the routine treatment received oral vitamin C supplementation tablet, for a 14-day period. Results: Dysuria, urine incontinence, fever, urinary urgency, and dribbling occurred significantly earlier in vitamin C supplemented individuals than the control ones, while abdominal pain, dimercaptosuccinic acid (DMSA) scan, and recurrent UTI were not different between the two groups. Conclusions: Vitamin C supplementation can control the symptoms of urinary tract infections, including fever, dysuria, urinary urgency, and dribbling urine.
Candida Colonization in Low Birth Weight and Very Low Birth Weight Infants in a Neonatal Intensive Care Unit
(Brieflands, 2015-10-01) Mehran Noori Sanami; Mitra Radfar; Fariba Shirvani; Mahmood Nabavi; Latif Gachkar
Background: Candida colonization is a major risk factor for invasive candidiasis in premature infants in the neonatal intensive care unit (NICU). Objectives: The purpose of this study was to determine the rate, risk factors, and sources of colonization in low birth weight (LBW) and very low birth weight (VLBW) infants in an NICU. Patients and Methods: All cases were classified in to 1 of 2 groups: LBW and VLBW. A questionnaire that collected demographic data was completed for each case. Swabs were obtained from the ear, umbilicus, and rectum, as well as catheters, tracheal tubes, and nasogastric tubes. Samples were cultured on Sabouraud dextrose agar. The data were analyzed using SPSS software. A P value < 0.05 was considered significant. Results: A total of 102 cases were examined in this study. The mean weight of the infants was 1720 ± 474 gr (range 850 - 2500 gr). Positive Candida cultures were isolated in 19 (31.7%) cases in the LBW group and 20 (47.6%) cases in the VLBW group. In addition, 36 (35.3%) cases showed signs of sepsis. The mortality rate was 1.7% (n = 1). The umbilicus and rectum were the most common sites for Candida colonization in both groups. The analysis also indicated that the duration of hospitalization, prolonged use of corticosteroids, central venous catheters, total parenteral nutrition, and mechanical ventilation were associated with candidiasis infection in VLBW infants while prolonged use of corticosteroids and central venous catheters were major risk factors associated with candidiasis infection in LBW infants. Conclusions: These results show that maturity and birth weight are related to a decrease in the risk of developing a candidiasis infection.
Evaluation of the Virulence Features and Antibiotic Resistance Patterns of Pathogenic Pseudomonas aeruginosa Strains Isolated from Hospitalized Patients in Gonabad, Iran
(Brieflands, 2017-07-31) Alireza Mohammadzadeh; Jalal Mardaneh; Reza Ahmadi; Javad Adabi
Background: Pseudomonas aeruginosa is a ubiquitous microorganism, which is present in diverse environmental niches and is seldom a member of normal human microbiota community. P. aeruginosa is an increasingly problematic drug-resistant bacterium in today’s world. In fact, we are now faced with growing clones of pandrug-resistant P. aeruginosa in hospital settings. Objectives: The aim of the present study was to examine the antibiotic resistance patterns and presence of nan1 and int1 virulence genes (encoding neuraminidase and class 1 integrons, respectively) in clinical P. aeruginosa isolates and to analyze the measured values with regard to hospital wards, specimens, and antibiotic resistance of the strains. Methods: In this cross sectional study, strains recovered consecutively from different samples of hospitalized patients between 2014 and 2016 in Gonabad, Iran, were tested. Culture of specimens was performed on common bacteriological culture media. The isolates were recognized as P. aeroginosa, based on morphological and biochemical tests. The isolates, identified as presumptive P. aeruginosa, were further confirmed by species-specific polymerase chain reaction (PCR) to detect exoA gene. All the isolates were tested for their antimicrobial susceptibility patterns, using the standard guidelines issued by the clinical and laboratory standards institute (CLSI). Genes encoding the virulence factors (nan1 and int1) were investigated by PCR using specific primers. Results: Overall, 95 P. aeruginosa isolates were studied during the study period. The isolates were recovered from 30 (31.6%) males and 65 (68.4%) females. In total, 34 (35.5%) infected patients were in the age group of 30 - 44 years. There were 24 (25.3%) patients hospitalized in the intensive care unit (ICU). A total of 31 (32.6%) strains were isolated from the blood. Colistin was the most effective antibiotic against the isolates, and ticarcillin was the least effective antimicrobial agent. Based on the findings, 21.1% of the P. aeroginosa strains were resistant to the quinolone class of antimicrobial agents. Also, ceftazidime resistance was detected in the isolates (10.5%). Based on the results, 5.26% of the tested isolates were co-resistant to ceftazidime, amikacin, and piperacillin/tazobactam. Among 95 P. aeroginosa isolates on which PCR assay was performed, 44.2% had the nan1 gene. Conclusions: Selection of the most effective anti-Pseudomonal drug (including in vitro test and report) is a decision best made by each clinical microbiology laboratory in consultation with the infectious diseases practitioners and pharmacologists, as well as therapeutic and hospital infection control committees. The guidelines for each bacterium include antibiotics of confirmed effectiveness, which show acceptable results in antibiotic susceptibility tests.
Relationship Between Cerebrospinal Fluid and Catarrh According to Avicenna
(Brieflands, 2016-10-01) Rasool Choopani; Shahpar Kaveh; Saeed Sadr; Sohrab Dehghan; Narges Kaveh; Mahmoud Mosaddegh
Context: A postnasal drip (PND) or catarrh refers to the drainage of secretions from the paranasal sinuses or nose into the posterior nasal space and the oropharynx. A history of pharyngeal or postnasal mucus build-up may be at odds with the lack of other physical findings and the absence of systematic clinical data. The physiological basis and suitable treatments for PND have been insufficiently recorded in the medical literature. However, Iranian traditional medicine (ITM), which has a history of thousands of years, has discussed in detail the causes, origins, complications, and treatment of catarrh. Communication and cooperation between conventional and traditional medicine can lead to positive steps in solving the ambiguities related to catarrh. The present paper examines the origin of catarrh according to Avicenna and compares it with that described in conventional medicine. Evidence Acquisition: In this study, we examined a major resource of ITM, the Qanoon fi al-teb (The Canon of medicine), by Avicenna and the writings of prominent ancient scholars and physicians on the origins of catarrh. PubMed and Google scholar were also searched for information on PND and catarrh, and they were compared with the catarrh in ITM. Results: Physicians of ITM believe that the main substance in catarrh is discharged from the brain and that it is a connection between the brain and nasopharyngeal space. New scientific findings also confirm the relationship between cerebrospinal fluid (CSF) and catarrh, in common with that described by Avicenna thousands of years ago. Conclusions: Catarrh is a serious condition and requires more investigation. It is hoped that a joint study of conventional and traditional medicine can elucidate different aspects of catarrh.
Role of Vitamin D [25(OH) D] Deficiency in Development of Pneumonia in Children
(Brieflands, 2017-07-31) Houman Hashemian; Abtin Heidarzadeh
Background: Pneumonia is a leading cause of children’s morbidity and mortality worldwide. Some studies have reported that vitamin D deficiency is associated with an increased incidence of lower respiratory illness requiring hospitalization. Objectives: Due to the weather conditions of Guilan province, Iran, in this study, we aimed at determining the relationship between serum level of vitamin D and developing pneumonia in children who were hospitalized due to pneumonia. Methods: In this case-control study, children aged 3 months to 5 years admitted in 17 Shahrivar hospital of Rasht, Iran, with pneumonia were compared with healthy children of the same age as the control group. Serum levels of vitamin D in both groups were measured by chemiluminescence method. Results: In this study, 40 children aged 3 months to 5 years with pneumonia (19 males and 21 females) and 40 healthy children of the same age (22 males and 18 females) were studied. The mean serum levels of vitamin D in the group with pneumonia and the control group was 26.16 ± 15.2 ng/mL and 30.45 ± 15.69 ng/mL, respectively. The difference between the 2 groups was not significant (t test, P value = 0.218). However, this difference was significant in the age group of 24 to 60 months (t test, P value = 0.015). Conclusions: In this study, a significant relationship was observed between children’s vitamin D serum levels and development of pneumonia, only at the age of 24 to 60 months, although high prevalence of vitamin D deficiency in healthy children (control group) must be considered. The difference in the serum vitamin D levels of children with pneumonia and healthy children in the age group of 24 to 60 months suggest the need for preventive measures of vitamin D deficiency after infancy period.
Molecular Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae Strains Isolated from Children with Urinary Tract Infections
(Brieflands, 2017-04-01) Reza Ranjbar; Hamed Memariani; Rahim Sorouri
Background: Uropathogenic Escherichia coli (UPEC) and Klebsiella pneumoniae (K. pneumoniae) are major pathogens which cause urinary tract infections (UTI) in pediatric patients. The presence of extended-spectrum β-lactamases (ESBLs) in these pathogens may further exacerbate infections and hamper successful treatment. Objectives: We undertook a study to investigate the prevalence of ESBL genetic indicators among K. pneumoniae strains isolated from pediatric patients in Tehran, Iran. Moreover, genotyping of blaCTX-M-15-positive isolates was determined through repetitive extragenic palindromic sequence polymerase chain reactions (REP-PCR). Methods: A total of 76 non-duplicate K. pneumoniae isolates were collected from outpatients admitted with UTIs at the pediatric nephrology wards of two hospitals in Tehran, Iran. The antibacterial susceptibility of K. pneumoniae isolates was determined by the disk diffusion method. The isolates were examined phenotypically and genotypically for ESBL production using the combined-disk method and PCR, respectively. The blaCTX-M-positive isolates were subjected to minimal inhibitory concentration (MIC) testing for ceftazidime and cefotaxime. The clonal relationships of blaCTX-M-15-positive isolates were determined through REP-PCR. Results: The highest rates of antibiotic resistance were obtained for ampicillin (92.1%), followed by ceftazidime (40.8%), cefotaxime (40.8%), and aztreonam (39.5%). However, only one isolate (1.3%) was resistant to imipenem. Among the ESBL-positive isolates, blaCTX-M(64.5%) was the most prevalent gene, followed by blaSHV (54.8%) and blaTEM (41.9%). Of 20 blaCTX-M-carrying isolates, 14 isolates showed MICs of 256 μg/mL against cefotaxime. The other six isolates had MICs of 512 μg/mL. However, 16 out of 20 blaCTX-M-carrying isolates exhibited MICs of 128 μg/mL against ceftazidime. The other four K. pneumoniae isolates showed MICs of 256 μg/mL. Of 17 blaCTX-M-15-positive K. pneumoniae isolates, 16 distinct REP-PCR patterns (genotypes) were obtained. Conclusions: The frequency of blaCTX-Mamong K. pneumoniae isolates was at an alarming rate, indicating that more efforts should be undertaken to track and monitor the spread of K. pneumoniae that produce CTX-M β-lactamases.
The Prevalence of Human Metapneumovirus and Respiratory Syncytial Virus and Coinfection With Both in Hospitalized Children With Acute Respiratory Infection in South of Iran
(Brieflands, 2015-07-01) Afagh Moattari; Soheila Aleyasin; Amir Emami; Mahzad Fyruzi; Neda Pirbonyeh
Background: Viral infections are the most frequent causes of morbidity and mortality due to respiratory dysfunction worldwide, especially in children under five years of age. Several studies have reported the association of human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) with acute respiratory infection. Objectives: The present study aimed to investigate the prevalence of hMPV, RSV, and their coinfection in children with respiratory symptoms hospitalized in Shiraz City, Fars Province, Iran. The study also attempted to determine the association between asthma and wheezing with hMPV, RSV, and coinfection with both in studied children. Patients and Methods: The study included 280 younger than five years old children with non-influenza infection that were hospitalized for respiratory infection from 2011 to 2013. Nasopharyngeal swabs were collected from patients and tested for RSV and hMPV with reverse transcriptase polymerase chain reaction. Results: The hMPV and RSV were detected in 44 (15.7%) and 84 (30.0%) samples, respectively. Coinfection with both viruses was found in ten patients (3.57%). The incidence of hMPV and RSV infections were observed in children younger than one year old. Infections occurred predominantly from October to April. The most common clinical symptoms were bronchiolitis, wheezing, and cough. Conclusions: Infection with hMPV and RSV are most frequent infections among pediatric patients with respiratory tract symptoms. Coinfection with these viruses may exacerbate the clinical symptoms and increase hospitalization rates, especially in children younger than one year old.
Treatment Outcomes of Adolescents With Drug-Resistant Tuberculosis in Resource-Constrained Settings
(Brieflands, 2015-10-01) Vicente Ausina; Carlos Rodrigo
This article does not have an abstract.
Co-infection of Leishmania and Tuberculosis
(Brieflands, 2014-01-01) Abdollah Karimi; Ali Amanati; Roxana Mansour Ghanaie; Leily Mohajerzadeh
Co-infection of tuberculosis and leishmaniasis has been reported previously in patients with altered immune response due to primary or secondary immunodeficiency. These intracellular pathogens have a unique interaction in the host immune response and their development depends on impaired cell-mediated immunity. A case of chronic non-healing cutaneous ulcer with chronic fistulating soft-tissue mass is presented here which co-infected with tuberculosis and leishmaniasis, interestingly in an otherwise healthy young female.
Detection of Respiratory Syncytial Virus in Hospitalized Children With Acute Lower Respiratory Tract Infections, Using RT PCR in Ahvaz, Iran
(Brieflands, 2013-10-01) Roya Nikfar; Ahmad Shamsizadeh; Manoochehr Makvandi; Arash Khoshghalb
Background:: Acute respiratory tract infections (ARTIs) play a major role in hospitalizations of children, and Respiratory syncytial virus (RSV) is well recognized as the most important pathogen causing ARTI. Objectives:: This study aimed to evaluate the epidemiological and clinical patterns of RSV infection in children hospitalized for lower ARTI in Ahvaz, Iran. Patient and Methods:: Respiratory specimens collected from 100 children with lower ARTI from October 2008 until the end of April 2009, were screened for RSV using reverse transcription-polymerase chain reaction (RT-PCR). Results:: During the study period, 9 children had a positive result for RSV infection. The median age of these patients was 10 months. Bronchiolitis was the clinical diagnosis of patients with RSV infections. All of these patients were less than 24 months. Cough (77.7%) and chest wall retraction (100%) were the leading symptoms and signs respectively. Conclusions:: This study indicates that RSV is a substantial cause of respiratory tract infection in infants less than 2 years old. RT-PCR offers a rapid method for detection of RSV in hospitalized children with LRTI.
Disseminated Bacille Calmette-Guérin Infection in Immunodeficient Infants: Report of Two Cases
(Brieflands, 2017-04-30) Ahmed Ben Hadj Hassine; Manel Marzouk; Hichem Bargui; Miniar Tfifha; Mohamed Dhaou; Jalel Boukadida
Introduction: The Bacille Calmette-Guérin (BCG), a live attenuated Mycobacterium bovis vaccine, is administered to all the newborns in Tunisia in order to prevent Tuberculosis (TB). Complications of this vaccine are uncommon. However, it poses a risk for children with unknown immunodeficiency. Case Presentation: We report on disseminated BCG disease in two infants, respectively, with severe combined immunodeficiency and human immunodeficiency virus (HIV). Evolution was fatal for both, despite adequate anti-tuberculosis treatment. Conclusions: Molecular methods are available to respond to the urgent need for rapid and specific diagnosis of local/regional or systemic BCG disease, using available commercial kits GenoType® MTBC and GenoType® MTBDRplus. These tests allow prevention of inoculation of live vaccines such as BCG among the next siblings until appropriate screening tests exclude primary or secondary immunodeficiency syndromes.
COVID-19 Related Multi-System Inflammatory Syndrome in Children (MIS-C): A Systematic Review
(Brieflands, 2024-07-31) Sharareh Kamfar; Vahide Zeinali; Fariba Alaei; Nazanin Farahbakhsh; Shahrzad Tabatabaee; Asieh Mosallanejad
Context: Multisystem inflammatory syndrome in children (MIS-C) is a severe condition associated with SARS-CoV-2. The underlying reasons why some children develop MIS-C remain unclear. Objectives: To review and summarize the existing evidence about the epidemiological and clinical characteristics, laboratory findings, therapeutic management, and outcomes of patients with COVID-19-related MIS-C. Methods: This systematic review followed PRISMA guidelines. We searched PubMed and Google Scholar for studies on COVID-19 and MIS-C. Out of the 2026 research articles generated from our initial search on PubMed and Google Scholar on 20 December 2022, 44 met the inclusion criteria and were included in the review. Data on demographics, clinical features, laboratory findings, treatment, and outcomes were extracted. Results: The median age of 7297 MIS-C patients was 8.6 years, with 59.2% being male. The most common symptoms were fever (98.7%), rash (55.2%), and conjunctivitis (52.8%). Obesity (27.1%) was the most prevalent comorbidity. Fifty percent of patients were admitted to pediatric intensive care; 631 received inotropes, and 374 required mechanical ventilation. Over 80% received IV immunoglobulin, and 77% received corticosteroids. Abnormal echocardiograms occurred in 77.5% of cases, with coronary artery aneurysms present in 18.5%. Most patients recovered, with a reported mortality rate of 1.7%. Conclusion: Despite the limitations, our systematic review provides valuable insights into the characteristics and management of MIS-C based on existing global literature. While a large number of patients required intensive care and various therapeutic interventions, favorable short-term outcomes were demonstrated in the majority of patients, with notably low mortality rates.
Genetic Variability and Integron Occurrence in Methicillin Resistant Staphylococcus aureus Strains Recovered from Patients with Urinary Tract Infection
(Brieflands, 2019-04-16) Mehdi Goudarzi; Anis Mohammadi; Hossein Goudarzi; Maryam Fazeli; Fattaneh Sabzehali
Background: Treatment for infections caused by Methicillin-Resistant Staphylococcus aureus (S. aureus) is one of the main concerns of public health. Objectives: The aim of this study was to investigate the prevalence of toxin, enterotoxin, and resistant encoding genes and analyze the distribution of different SCCmec types. The prevalence of integron was also determined in S. aureus isolates obtained from patients with urinary tract infections (UTIs). Methods: In the present study, 126 MRSA isolates obtained from patients with UTI were examined for susceptibility to antimicrobial agents. Genes encoding integrase, resistance, toxin, and SEs were detected by the polymerase chain reaction (PCR) screening. The SCCmec types were determined using the multiplex PCR. Integrase positive strains were evaluated for determination of integron classes using PCR-restriction fragment length polymorphism assay. Results: From 126 MRSA isolates studied, 107 isolates (84.9%) were multi-drug resistant. The most prevalent genes in isolates under study was aac (6΄)-Ie/aph (2˝) (50%) followed by tet (M) (47.6%), msr (A) (38.1%), aph (3΄)-IIIa (25.4%), erm (A) (23%), ant (4΄)-Ia (16.7%), erm (B) (14.3%), msr (B) (9.5%), and erm (C) (7.1%). Staphylococcal enterotoxins sea, sec, see, sed, seg, seb, and sei were detected in 27%, 20.6%, 16.7%, 14.3%, 11.1%, 7.1%, and 5.6% of the isolates, respectively. The results revealed that 126 MRSA isolates fell in the SCCmec type III (37.3%), SCCmec type I (23%), SCCmec type II (14.3%), SCCmec type IV (13.5%), and SCCmec type V (11.9%). Class 1 and 2 integrons were commonly found in 34.1% and 14.3% of the isolates, respectively. Seven isolates (5.6%) were observed to carry class 1 and 2 integrons, simultaneously. Conclusions: The current findings showed that identification and screening of integrons and SCCmec elements as reservoirs that should be considered for various resistance genes to consume proper antibiotic and perform a systematic surveillance.
The Value of Renal Scintigraphy With DMSA for Assessing Vesicoureteral Reflux in Children With Suspected Urinary Tract Infection
(Brieflands, 2012-10-02) Fariba Shirvani; Mostafa Sharifian; Masoumeh Mohkam
Background: Renal scintigraphy with technetium 99m labeled dimercaptosuccinic acid (99mTc-DMSA) is a traditional imaging technique commonly used to detect renal scar in patients with probable vesicoureteral reflux (VUR) and/or urinary tract infection (UTIs). We determined whether normal results of DMSA renal scan obviate the need for voiding cystourethrography (VCUG) in evaluating children with UTIs. Materials and Methods: We observed medical records from June 2006 to April 2007 retrospectively of 208 children admitted with community acquired UTIs to Mofid children hospital (Tehran, IR/Iran) a teaching hospital in Tehran in which their age was between 2-120 months. The association between DMSA renal scan results and VCUG findings performed 48 hours and 1 month after the diagnosis was evaluated. To examine the accuracy of abnormal DMSA results in predicting VUR, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and negative and positive likelihood ratio (LRs) were calculated. Results: VUR was seen in 14.0% of renal units with normal results of DMSA and 17.3% of renal units with abnormal DMSA findings. High grade VUR (grade IIIV) was seen in 18 (7.1%) of the abnormal findings of DMSA group and in (2.8%) 1 of the normal DMSA results group (P = 0.56). In the group with previous UTI (n = 68), the sensitivity and NPV of abnormalities on DMSA renal scan for detecting the presence of VUR (grade IIIV) were 100%, and100%, respectively. In the group without evidence of previous UTI, the sensitivity and NPV of abnormalities on DMSA renal scan for detecting the presence of VUR (grade IIIV) were 93% and 97%, respectively. Totally the sensitivity and NPV of abnormalities on DMSA renal scan to detect the presence of VUR (grade IIIV) were 94% and 97%, respectively. Conclusions: As a screening test, DMSA renal scan is a high sensitive technique to assess VUR (grade IIIV) in children with UTI.
IL-17 Producing T cells as Predictors of Primary Immunodeficiencies in Patients with Candida Infections
(Brieflands, 2022-05-19) Mehrdad Amirmoeini; Zahra Chavoshzadeh; Arezou Rahimi; Mohammad Nabavi; Seyed Alireza Mahdaviani; Shahnaz Armin; Sepideh Darougar; Mehrnaz Mesdaghi
Background: IL-17 producing T cells are a distinct subset of CD4+ T cells, which are recognized to have an essential role in protection against certain fungi and extracellular pathogens. Objectives: This study aims to evaluate the number of IL-17 producing T cells as a predictor of primary immunodeficiency disorders in patients with Candida infections and low numbers of IL-17 producing T cells. Methods: Seven newly diagnosed patients with documented Candida infections aged between 4 and 35 years were included in this study. Before establishing the diagnosis of chronic mucocutaneous candidiasis, a thorough immunodeficiency workup, including complete blood count, serum Ig levels and antibody responses, flow-cytometry evaluation, and LTT, was completed for all the patients, and other immunodeficiency disorders, including combined and phagocytic deficiencies, were ruled out. Then, IL-17 producing T cells were detected using antiCD3 and anti-IL-17 antibodies through flow-cytometry evaluation. Results: The IL-17 producing T cells significantly decreased in the peripheral blood of patients with PID and candida infections. A P-value of less than 0.05 was considered statistically significant. Conclusions: To conclude, in cases of recurrent candida infections, initial assessment of IL-17 producing T cells may act as a predictor of an underlying primary immunodeficiency. In patients with low counts of IL-17 producing T cells, selecting a targeted panel of genetic tests may become more helpful in the detection of certain immunodeficiency disorders than performing whole-exome sequence analysis.

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