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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Severe Bone Marrow Suppression and kidney Injury Due to Multisystem Inflammatory Syndrome in Children: A Case Report
(Brieflands, 2024-12-15) Sayed Yousef Mojtahedi; Maryam Ghodsi; Elham Shahgholi; Paniz Pourpashang
Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of COVID-19, and bone marrow suppression is an exceedingly rare manifestation of MIS-C. This report presents a 10-year-old boy with periorbital ecchymosis, lethargy, and a history of fever and cough, who was diagnosed with MIS-C accompanied by severe bone marrow suppression. Case Presentation: A 10-year-old boy was referred to our hospital with complaints of ecchymosis around the eyelids, especially the upper eyelids, and lethargy. He also reported a history of cough, fever, and bone pain over the past 10 days. Although fever and cough had subsided, the patient remained lethargic. Laboratory studies were performed, and a complete blood count (CBC) revealed severe bone marrow suppression. Additional tests showed markedly elevated urea and creatinine levels, severe hyperphosphatemia, and severe hyperuricemia, indicating renal failure. Given the laboratory findings and his lethargic condition, the patient was hospitalized and underwent hemodialysis. Blood products, including packed red cells and platelet units, were transfused following hematology consultation. Further laboratory tests ruled out rheumatological conditions, with all rheumatological tests reported as normal. However, Interleukin-6 (IL-6) and fibrinogen levels were significantly elevated, and the COVID-19 PCR test was positive. Based on these findings, the diagnosis of MIS-C was established. Treatment with remdesivir and methylprednisolone pulse therapy was initiated. Other potential infectious causes of bone marrow suppression, such as leishmaniasis, were excluded due to normal test results and a normal CBC performed one week prior to the onset of clinical symptoms. Following the completion of treatment, the hematological and nephrological complications resolved, and the patient was discharged in good condition. He remains under regular follow-up. Conclusions: Multisystem inflammatory syndrome in children can lead to bone marrow suppression, and a combination of remdesivir and methylprednisolone appears to be an effective treatment for managing this condition.
Clinical Characteristics and Outcomes of COVID-19 in Pediatric Cancer Patients: A Retrospective Cohort Study
(Brieflands, 2024-12-11) Sara Badiepour; Sharareh Kamfar; Samin Alavi; Shahnaz Armin; Reza Taherian
Background: The impact of COVID-19 on pediatric cancer patients remains a critical area of investigation. Objectives: This study aimed to compare the clinical characteristics and outcomes of COVID-19 in children with and without malignancies. Methods: A retrospective cohort study was conducted at Mofid Children's Hospital in Tehran, Iran, from July 2020 to December 2022. The study included 210 children with confirmed SARS-CoV-2 infection: 105 with malignancies (case group) and 105 without malignancies (control group). Clinical presentations, laboratory parameters, imaging findings, and outcomes were analyzed. Results: Conclusions: Pediatric cancer patients with COVID-19 exhibited more severe symptoms and distinct laboratory and imaging findings compared to non-cancer patients. While mortality rates were similar, the trend toward higher risk in the malignancy group highlights the need for specialized management strategies for this vulnerable population.
Evaluation of Neonatal and Maternal Outcomes in Pregnant Women with COVID-19 in Southern Iran: A Case-Control Study
(Brieflands, 2024-12-06) Marzieh Davoodi; Hamide Barzegar; Reza Bahrami; Khadijeh Najib
Background: Pregnant women and their fetuses are considered high-risk populations during pandemics, including coronavirus disease 2019 (COVID-19). Objectives: This study aims to evaluate maternal and neonatal outcomes among pregnant women infected with COVID-19. Methods: This descriptive, analytical, retrospective case-control study included COVID-19-infected pregnant women referred to hospitals affiliated with Shiraz University of Medical Sciences in southern Iran from March 2021 to March 2022. Data were collected using a pre-designed checklist covering demographic information and maternal and neonatal outcomes. Analyses were performed using SPSS version 25, with the significance level set at P < 0.05. Results: Significant differences were observed in maternal and neonatal outcomes for variables such as vaginal bleeding, fetal distress, premature birth, intrauterine death, ICU admission, low birth weight, and NICU admission (P < 0.05). Although neonatal transient tachypnea and pneumonia were more than twice as common in infants of COVID-19-infected mothers compared to controls, these findings were not statistically significant (P > 0.05). Similarly, abnormal lung X-rays, thrombocytopenia, and positive CRP were slightly more frequent in infants born to COVID-19-infected mothers, but these differences did not reach statistical significance (P > 0.05). Conclusions
Evaluation of Heath Care Commitment with Prevention and Infectious Control Protocols in Mofid Children Hospital, IRAN
(Brieflands, 2024-12-02) Raheleh Razmara; Shahnaz Armin; Sepideh Mirzayi; Leila Azimi; Abdollah Karimi
Background: The dedication of healthcare teams to adhering to protocols for the use of personal protective equipment (PPE), maintaining vaccination coverage among healthcare workers (HCWs), and ensuring environmental health are crucial elements in managing hospital-acquired infections. Objectives: This study aimed to evaluate adherence to PPE use, vaccination history, hand hygiene protocols, and environmental health practices in a tertiary children's hospital in Iran. Methods: This cross-sectional study evaluated compliance with PPE use, vaccination history among doctors, nurses, and hospital staff, adherence to strict hygiene practices, patient isolation protocols, and environmental health measures based on an Iranian Health Ministry query. Data collection was conducted over three months, from May to August 2023. Results: During the study, 285 staff members were assessed for compliance with hand hygiene protocols. Nurses demonstrated the highest level of compliance, reaching 51%. The highest compliance with hand hygiene protocols at the five designated moments was approximately 79%, with the transplantation and hemodialysis wards achieving the highest rates. Nurses also showed the most positive vaccination records. Personal protective equipment was used correctly in various wards, with an overall compliance rate of 79%. Conclusions: This study revealed that compliance with health protocols in different parts of the hospital was suboptimal and required significant improvement.
Identification of Viral Causes in Cerebrospinal Fluid of Patients Under Investigation for Central Nervous System Infections During the COVID-19 Epidemic: A Cross-Sectional Study
(Brieflands, 2024-11-29) Nasrin Aliabadi; Nahid Heydari Marandi; Gholamreza Pouladfar; Seyedeh Sedigheh Hamzavi; Marzieh Hosseini; Rosemina Bahrololoom; Marzieh Jamalidoust; Mazyar Ziyaeyan
Background: Although viral etiology of central nervous system (CNS) infections such as meningitis and encephalitis are investigated widely worldwide, it remains to be declared under the COVID-19 pandemic. Objectives: The focus of this study was to examine the etiology of viral CNS infections in patients hospitalized in a single referral hospital during the outbreak in Iran. Methods: We retrospectively collected the cerebrospinal fluid (CSF) samples and reviewed the medical records of patients hospitalized with suspected viral CNS infection in Shiraz, a large city in southern Iran, from April 2021 to May 2022. One hundred sixty-six CSF samples were tested primarily for detection of HSV-1 and -2 and retrospectively analyzed by primers polymerase chain reaction (PCR) targeted to coronavirus 2 (SARS-COV-2), human herpesviruses1 to 6 (HHV-1 to 6), polyomaviruses JC, and enteroviruses (EV). Results: Of the total CSF samples analyzed by PCR, 22 (13.3%) were positive for only one viral pathogen, and just one (0.6%) sample was detected with multiple viruses (HSV-1 and CMV). The SARS-COV-2 (6 cases) was the second most common viral etiology just after Herpes simplex virus-1 (HSV-1) 6.6% (11 cases). Other detected viruses were CMV for 1.8% (3 cases), VZV for 1.2% (2 cases), and JC for 0.6% (1 case) of the cases. Conclusions: This study highlights the prevalence of viral pathogens in CSF samples from patients with suspected meningitis at Namazi Teaching Hospital. Notably, HSV-1 was the most common virus detected, followed by SARS-CoV-2. These findings underscore the importance of viral testing in the diagnosis and management of meningitis.
Disseminated Bacille Calmette-Guérin Vaccine-Induced Disease in a Sample of Iranian Children: A Longitudinal Case-Series Study
(Brieflands, 2024-11-20) Hamid Rahimi Hajiabadi; Gelareh Kiani; Sayed Nassereddin Mostafavi Esfahani; Monir Sadat Emadoleslami; Tooba Momen; Zahra Pourmoghaddas
Background: Approximately a quarter-million Iranian newborns receive the Bacille Calmette-Guérin (BCG) vaccine annually. However, in immunodeficient infants, this vaccine can lead to disseminated BCG disease (DBD). Objectives: This study aims to determine the clinical presentation, comorbidities, underlying immunodeficiency, and prognosis of DBD in a group of Iranian children. Methods: In a longitudinal case-series study, data were collected from the files of infants and children diagnosed with DBD from 2005 to 2017. Immunodeficiency screening was conducted for each patient. For children with normal immunodeficiency screening results, further testing for Mendelian susceptibility to mycobacterial diseases (MSMD) was performed. Detection of DBD in children was achieved by evaluating gastric lavage and bone marrow aspiration samples for mycobacterium. Results: Most of the 22 patients were immunocompromised, with the following distribution: 31.8% had severe combined immunodeficiency (SCID), 45.5% had MSMD (specifically IL-12Rβ1 deficiency), one patient (4.5%) had Wiskott-Aldrich syndrome (WAS), and the remaining 18.1% had unknown immunodeficiency types. Most patients with MSMD were successfully treated and did not show relapse during the follow-up period, even after discontinuing anti-tuberculosis (TB) medications. Conclusions: Due to the similarity of its manifestations to sepsis, diagnosing systemic infections caused by the BCG vaccine in children requires a high level of clinical suspicion and appropriate diagnostic measures, such as mycobacterial culture, biochemical speciation, or polymerase chain reaction (PCR). These diagnostic steps should be taken promptly in cases of DBD, with concurrent treatment using anti-tuberculosis drugs and, if possible, targeted therapies for underlying immunodeficiency.
Schaaf-Yang Syndrome Presenting with Prolonged Hyperthermia in a Child: A Case Report
(Brieflands, 2024-11-12) Pooya Poormehr; Arya Behzadi; Nazanin Farahbakhsh; Amir Reza Bahadori
Introduction: Schaaf-Yang syndrome (SYS) is a rare autosomal dominant disorder, first identified in 2013, resulting from mutations in the paternal allele of the MAGEL2 gene. Schaaf-Yang syndrome exhibits clinical features similar to those of Prader-Willi syndrome (PWS), including hypotonia, joint contractures, developmental delay, and intellectual disability. However, SYS is also characterized by unique manifestations, such as recurrent hyperthermia, feeding difficulties, respiratory distress, and seizures. This case report describes the first SYS case identified in Iran. Case Presentation: A one-year-old female, born to consanguineous parents, presented with recurrent episodes of hyperthermia, respiratory distress, and seizures since the neonatal period. Despite initial empirical treatment with broad-spectrum antibiotics for suspected infections, her symptoms persisted. Physical examination revealed hypotonia, camptodactyly, and hand contractures. Genetic testing confirmed SYS with a MAGEL2 gene mutation (c.1923dupC, p.V643Gfs*70) and probable pathogenic variants in ASPM and KIF7. The hyperthermia was attributed to hypothalamic dysfunction, a hallmark of SYS, rather than an infectious cause. The patient remains under follow-up without specific pharmacological intervention. Conclusions: This case emphasizes the importance of considering SYS in patients presenting with unexplained fever, seizures, and neurodevelopmental delays. Early genetic testing is crucial for diagnosing SYS and differentiating it from conditions such as PWS or infection-related disorders. Timely diagnosis can improve management strategies and help reduce the risk of lasting neurological impairments associated with this genetic disorder.
Successful Treatment of Carbapenem-Resistant Klebsiella pneumoniae Meningitis with Combination Therapy of Meropenem and Amikacin
(Brieflands, 2023-04-30) Eman Hamza; Shahinda Rezk; Hassan Eshra; Heba Selim; Mohamed Samir Turkey
Introduction: The widespread use of carbapenems increased the prevalence of carbapenem-resistant Enterobacteriaceae with subsequent increases in mortality due to extremely limited treatment options. Following neurosurgical procedures, carbapenem-resistant Klebsiella pneumoniae (CRKP) is the main cause of central nervous system (CNS) infections. The optimal antimicrobial treatment of such infections has not yet been defined. Case Presentation: We present a 4-month-old boy with an extra-ventricular drain-related CNS infection with CRKP. Although meropenem minimum inhibitory concentration (MIC) for the bacterial isolate was ≥ 16 mg/L and it harbored blaNDM, blaVIM, and blaOXA-48-like carbapenemase genes, this infection was effectively treated with a combination therapy of intravenous (IV) double dose extended infusion of meropenem in addition to amikacin. Conclusions: This successful treatment regimen for CRKP-causing meningitis may pave the way to manage severe CNS infections with extensive-drug-resistant bacteria in infants and children without inserting an external drain or intra-thecal antibiotic administration.
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.
Detection of pbp2b Gene and Antimicrobial Susceptibility Pattern of Streptococcus Pneumoniae Isolates in Tehran Hospitals, Iran
(Brieflands, 2017-01-01) Sedigheh Rafiei Tabatabaei; Mohammad Rahbar; Ali Nazari Alam; Fatemeh Fallah; Ali Hashemi; Masoud Yousefi; Hamidreza Houri; Abdollah Karimi
Background: Streptococcus pneumoniae is the major cause associated with otitis, sinusitis, bronchitis, and pneumonia, as well as an outstanding cause of meningitis, bacteremia, and many other infections. Throughout the world, an increase in antibiotic resistance S.pneumoniae has become a serious problem in the recent years in many different countries. Penicillin resistance in S. pneumoniae cause of altered on the penicillin target position, the penicillin-binding proteins (PBPs). Objectives: In the present study, we describe the prevalence and antimicrobial susceptibility pattern and identification of the pbp2b gene of S. pneumoniae isolates at specimens of several general hospitals in Tehran, the capital of Iran. Methods: A total of 73 S. pneumoniae were obtained from various clinical specimens from hospitals in Tehran from September 2012 to July 2015. Antibiotic susceptibility of isolates was determined by the broth microdilution method. The genes pbp2b in penicillin-resistant streptococcus pneumoniae (PRSP) were detected using polymerase chain reaction (PCR). Results: In total, 73 isolates were collected and diagnosed as S. pneumoniae. Isolates were susceptible to ofloxacin 95.9%, vancomycin 93%, penicillin 78%, trimethoprim-sulfamethoxazole 61.6%, ceftriaxone 53.5%, meropenem 52%, cefotaxime 46.5%, and erythromycin 8.2%. Of the 15 PRSP isolates, the pbp2b gene was identified in 12 (80%). In 1 penicillin-intermediate S. pneumoniae isolate the pbp2b was detected. Conclusions: These results in comparison with same studies in other parts of the world showed us an increase in resistant S. pneumoniae isolates to conventional drugs in the treatment of the acute infections caused by this bacteria. In the present study, PRSP possess the pbp2b gene were the most frequently found, which means they have a high level of resistance of S. pneumoniae. For decreasing the mortality and morbidity of patients, it is suggested to determine the antibiotic susceptibility pattern of the isolates in each hospital for doing necessary medical interventions.
Hepatitis B and C Infections Among Pediatric Patients with Sickle Cell Disease at a Tertiary Hospital in Nigeria
(Brieflands, 2020-06-20) Adefunke Olarinre Babatola; Oladele Simeon Olatunya; Ayodeji Opeyemi Faboya; Temitope Olumuyiwa Ojo; Segun Tolorunju Kayode; Akinwumi Kolawole Komolafe; Oyeku Akibu Oyelami; Oladimeji Akande Ajayi
Background: The frequent use of blood products for patients with sickle cell disease (SCD) may put them at risk of being infected with hepatitis virus infections, especially if such blood products are not properly screened. Hepatitis B and C infections (HBV and HCV, respectively) may result in cirrhosis and liver cell cancer. Objectives: This study determined the prevalence of HBV and HCV infections among pediatric patients with sickle cell disease in comparison with matched controls at the Ekiti State University Teaching Hospitals (EKSUTH), Ado-Ekiti. Methods: This was a descriptive cross-sectional study that comprised of 116 patients with SCD and their aged and sex-matched controls who were referred to the pediatric clinics at EKSUTH. The hemoglobin (Hb) genotypes of the participants were confirmed by Hb electrophoresis and high-performance liquid chromatography (HPLC), Biorad, USA Variant II, using the Beta thalassemia short program. Moreover, HBV and HCV antigens were assessed by the Enzyme-linked Immunosorbent Assay method (Kits were manufactured by Biotech Laboratories USA). Results: The mean ages of the patients with SCD and controls were 8.35 ± 4.50 and 8.92 ± 3.25 years, respectively. The seroprevalence of HBV infection among the children with sickle cell disease and controls was 1% each (P =1.00). The seroprevalence of hepatitis C virus infection was 0% among the two groups. Most (98.3%) of the patients with SCD and controls were fully vaccinated against HBV infection. The two children (100%) that were seropositive for hepatitis B were never vaccinated against HBV infection. Conclusions: The seroprevalence of HBV infection is low among patients with SCD and controls. This may be due to the protective effect of high hepatitis B vaccination rate and high quality of care among our study population.
A Case Report of Pediatric Kawasaki Disease and COVID-19 Association
(Brieflands, 2021-10-31) Soroosh Salehabadi; Shima Shekari; Shiva Shadani; Mohammad Shoja
Introduction: As COVID-19 spreads rapidly all over the world and nations struggle to control it, the novel presentations of SARS-CoV-2 infection and its possible triggering role for other diseases in pediatrics concern clinicians in frontlines. Case Presentation: We describe a 10-year-old child diagnosed with COVID-19 infection and concurrent Kawasaki disease. He presented with prolonged fever and conjunctivitis. His initial echocardiogram showed coronary artery dilation in RCA. He was treated with IVIG and aspirin as per guidelines and discharged 48 hours after the completion of IVIG and diminishing fever. His follow-up echocardiogram showed improvement in a two weeks’ interval while he was quarantined in the meantime and showed no respiratory complications. Conclusions: In conclusion, we think that there might be a correlation between COVID-19 infection and hyperinflammatory conditions, like Kawasaki disease. Further investigations are needed to enlighten the complications caused by COVID-19 infection, especially in pediatrics. In addition, we emphasize follow-up visits (in person or long-distance) in pediatrics presenting with inflammatory symptoms.
Investigating Ventriculoperitoneal Shunt Infections, Characteristics and Microbiology in Pediatric Patients with Hydrocephalus: A Single-Center Experience in Tehran, Iran
(Brieflands, 2024-10-31) Seyed Ali Mousavi Nejad; Ali Shafieefar; Hassan Pourmoshtagh
Background: This study investigates the epidemiology of ventriculoperitoneal (VP) shunt infections in pediatric patients with hydrocephalus, using data from 39 cases admitted to Loghman Hakim Hospital over a five-year period. Methods: This study was a case series involving a retrospective analysis of medical records, with a focus on demographic characteristics, etiological factors, and clinical outcomes. Statistical analyses were performed to explore associations between VP shunt infections and various variables. Results: The study identified a significant association between VP shunt infections and the presence of fever (P < 0.05) as well as the number of white blood cells (WBCs) in cerebrospinal fluid (CSF) obtained from the VP shunt (P < 0.01). This association may be explained by the release of cytokines during VP shunt infections, which can lead to the development of fever. Additionally, the stimulation of the immune system in response to the infection may cause an influx of WBCs into the CSF surrounding the VP shunt. Conclusions: This investigation offers valuable insights into the complex dynamics of VP shunt infections in pediatric patients with hydrocephalus. The observed associations between infection, fever, and WBC count enhance our understanding of the immunological responses triggered by VP shunt infections. These findings highlight the need for further research to elucidate these pathways, which could inform targeted interventions in the clinical management of VP shunt infections in pediatric populations.
Utility of Available Methods for Diagnosing SARS-CoV-2 in Clinical Samples
(Brieflands, 2020-07-31) Armin Shirvani; Leila Azimi; Roxana Mansour Ghanaie; Masoud Alebouyeh; Fatemeh Fallah; Sedigheh Rafiei Tabatabaei; Maryam Rajabnejad; Shahnaz Armin; Seyed Alireza Fahimzad; Fariba Shirvani; Saeid Maham; Abdollah Karimi
The laboratory diagnosis of SARS-CoV-2 should be done to confirm coronavirus disease 2019 (COVID-19) in suspected patients. Although several diagnostic methods have been developed in this regard, their accuracy for clinical application is not very clear yet. To compare the diagnostic value of laboratory tests for the detection of COVID-19 infection, this study provides an upcoming review of the newly developed detection methods. Sensitivity, specificity, detection limit, and turn-around-time of these methods are compared and challenges for their application in clinical settings are reviewed. PubMed and Google Scholar web sites were used for the systematic search until April 9, 2020 to identify the published studies based on the following keywords: “Detection”, “Coronavirus 2019”, “SARS-CoV-2”, and “Sensitivity”. Out of 526 results, a total of 54 articles, including 46 studies on detection methods, were considered eligible for the review. The results showed that most of the proposed tests focused on molecular methods, while immunological and point-of-care tests were investigated in 13 studies. There were also a few commercial automated methods for the qualitative detection of SARS-CoV-2 in clinical samples, most of which are not examined in the current review, as no data about their sensitivity and specificity were presented. Although the assessment of publication biases showed that 64% sensitivity and nearly 100% specificity for RT-PCR are close to reality, most of the related reports for serological methods are not valid and further studies are needed to confirm their utility in clinical settings. Moreover, the RT-PCR test alone cannot act as a gold standard because of bias in measurements. Therefore, antibody tests and other proposed methods could be used as supplementary diagnostic tests to improve RT-PCR accuracy. Although clinical findings are invaluable, in many cases, they can provide more valuable supportive data than serological tests.
Childhood Tuberculosis in Kermanshah, Iran, During 10 Years
(Brieflands, 2013-10-01) Keyghobad Ghadiri; Farid Najafi; Bahram Solimani; Mansour Rezaei; Mandana Afsharian; Reza Akramipour; Aliasghar Alipour; Elham Shobiri
Background:: Tuberculosis in children still remains as one of the main causes of morbidity and mortality throughout the world. Objectives:: The aim of this study was to evaluate the epidemiological aspects of childhood tuberculosis in Kermanshah, Iran. Patients and Methods:: Medical records of all 150 patients aged 0-18 in Kermanshah district who were diagnosed according to WHO criteria for 10 years were retrospectively reviewed. As well as presenting demographic and clinical aspects of patients, we calculated notification rate. Results:: 35% of cases were male and 65% were female. Of total 150 tuberculosis cases, 56% were pulmonary and 44% were extra pulmonary. The most common symptoms were fever and cough. About 16% were asymptomatic. About 17% of patients had adult pulmonary tuberculosis in their families. The mean of the number of people living in a family (5.5) was similar in both pulmonary and extra pulmonary types. Except for year 2002, for all years the notification rate in girls was higher than that in boys. Over 10 years of study, the notification rate was 3.75/100,000 with no significant trend. Conclusions:: Based on our results, rate of diagnosis seemed under the expected range, in particular in children under 5. Therefore, we recommend that authorities come up with programs that aim at raising awareness about the importance of diagnosis of pediatric tuberculosis.
Effects of COVID-19 Pandemic on the Frequency of Complicated Appendicitis in Pediatric Populations
(Brieflands, 2023-01-31) Leily Mohajerzadeh; Manoochehr Ebrahimian; Mehdi Sarafi; Gholamreza Ebrahimisaraj; Sedigheh Rafiei Tabatabaei; Seyed Mahmood Noorbakhsh; Ali Kaveh; Hossein Taheri; Leila Azimi; Masoud Alebouyeh
Background: The clinical course of acute appendicitis, one of the most common diseases needing surgical intervention in children, was affected by the coronavirus disease 2019 (COVID-19) pandemic. The global fear and panic about the outbreak and governmental decisions on lockdowns and restrictions led to an increasing number of complicated forms of appendicitis. Objectives: This study aimed to compare different aspects of appendicitis and its complications between the pre-pandemic and pandemic periods. Methods: In a retrospective cross-sectional analytical study, we enrolled all patients with a diagnosis of acute appendicitis for two consecutive years. Only children under 14 years of age were included in the study. The patients were divided into two groups based on the time of disease presentation, the pre-pandemic and pandemic periods. Demographic features, as well as clinical, laboratory, and imaging findings, were compared between the two groups. Results: Out of 369 patients included in the study, 173 were placed in the pre-pandemic group. There was no significant change in the incidence of appendicitis between the two periods (P = 0.232). However, the incidence of complicated appendicitis increased remarkably during the pandemic (27% vs. 11%, P < 0.001). No substantial differences were found in parameters like age, sex, laboratory findings, and the length of hospital stay between the two groups (P > 0.005). The patients who tested positive for COVID-19 had a significantly higher hospitalization duration (P < 0.001). Conclusions: Our results suggested that the rate of complicated appendicitis was substantially higher during the pandemic compared to the pre-pandemic time. Also, the proportion of midline laparotomy was significantly higher after the outbreak. These findings suggested that delays in care provision during the COVID-19 outbreak could have probably contributed to the rise in the incidence of complicated appendicitis in children.
High Prevalence of Metallo-beta-lactamase Producing Acinetobacter baumannii Isolated From Two Hospitals of Tehran, Iran
(Brieflands, 2014-07-01) Maryam Noori; Abdollah Karimi; Fatemeh Fallah; Ali Hashemi; Shadi Alimehr; Hossein Goudarzi; Shadi Aghamohammad
Background:: Metallo-beta-lactamase (MBL)-producing Acinetobacter baumannii is a growing therapeutic concern, worldwide. Objectives:: The aim of this study was to determine the frequency of SPM and IMP type genes among A. baumannii isolates from hospitalized patients in Loghman Hakim and Milad hospitals, Tehran-Iran from 2012 to 2013. Patients and Methods:: This study was conducted on 108 A. baumannii isolates collected from two hospitals in Tehran, Iran. Antibiotic susceptibility tests were performed by Kirby-Bauer disc diffusion and Broth microdilution methods according to clinical Results:: The resistance of A. baumannii isolates against tested antibiotics were as follow: 108 (100%) to cefotaxime, 103 (95.4%) to ceftazidime, 99 (91.7%) to meropenem, 99 (91.7%) to imipenem, 44 (40.7%) to gentamicin, 87 (80.6%) to amikacin, 100 (92.6%) to ciprofloxacin, 105 (95.7%) to cefepime, 105 (97.2%) to piperacillin, 103 (95.4%) to piperacillin/tazobactam, 106 (98.1%) to ampicillin/sulbactam, 106 (98.1%) to co-trimoxazole, 87 (80.6%) to tetracycline and 1 (1.8%) to colistin. Using combined disk diffusion test, it was found that out of 99 imipenem non-susceptible A. baumannii strains, 86 (86.86%) were MBL producers. The prevalence of IMP-1 gene among metallo-beta-lactamase-producing A. baumannii isolates was 3 of 86 (3.48%). Conclusions:: The prevalence of metallo-beta-lactamase-producing A. baumannii strains detected in this study is of great concern and highlights the need of infection control measures including antibacterial management and prompt identification of beta-lactamase-producing isolates.
The Validity of a Scoring System in Predicting Intravenous Immunoglobulin Treatment Failure in Children With Kawasaki Disease
(Brieflands, 2016-01-01) Alireza Nateghian; Roya Isa Tafreshi; Arezoo Najari; Atefeh Vaezi
Background: Between 10 and 20% of children with Kawasaki disease (KD) will not respond to intravenous immunoglobulin (IVIG) treatment, and are prone to coronary abnormalities. A variety of predicting scoring systems, including the Kobayashi system, have been proposed, but have not yet been evaluated using Iranian patients. Objectives: To evaluate the Kobayashi scoring system with regard to predicting response to IVIG treatment in Iranian children. Patients and Methods: All patients who received a final diagnosis of KD at Aliasghar children’s hospital between 1982 and 2013, and who met the inclusion criteria, were enrolled in this retrospective cohort study. We excluded patients with missing data, abnormal echocardiographic finding on admission, late admission, atypical or afebrile cases, and those who had received an insufficient amount of IVIG. We compared demographic and echocardiographic data before IVIG, and within 7 days of treatment, as well as C reactive protein (CRP), sodium, aspartate aminotransferase, platelet levels, neutrophil percentage, age of patients, and duration of fever before IVIG administration, in treatment responders and non-responders. Results: Of the 141 cases, 97 patients met the criteria and were enrolled. Of these, 19 (19.6%) did not respond to IVIG. A total of 61.8% of patients were male, and the mean patient age was 36.9 months (SD = 32.1 months). Echocardiographic evaluation revealed early coronary involvement in 15.3% of patients, and coronary abnormalities were diagnosed in 10% of patients within the first 10 days of presentation and concurrent with their IVIG treatment. A between-groups comparison of quantitative CRP, absolute neutrophil count, and platelet count showed that platelet count alone was significantly higher in nonresponders (P = 0.04). With regard to items of Kobayashi scoring system, data were present for just 41 cases, but a significant difference between the two groups was shown, with the treatment-refractory group having a significantly higher score (P = 0.002). Receiver-operating characteristic curve analysis revealed that the optimum cut-off point for our population would be 2, which makes the sensitivity of the test equal to 75%, with a specificity of 60%. Conclusions: This preliminary study showed that patients with KD and a high Kobayashi score are at greater risk of being unresponsive to IVIG treatment. Further studies, preferably multicenter evaluations, are required in order to understand the exact application of various scoring systems in the management of people with KD in Iran.
Implementation and Assessment of the Use of Real-Time PCR in Routine Diagnosis for Bordetella pertussis Detection in Brazil
(Brieflands, 2014-04-01) Daniela Leite; Roberta Morozetti Blanco; Leyva Cecilia Vieira de Melo; Cleiton Eduardo Fiorio; Luciano Moura Martins; Tania Mara Ibelli Vaz; Sueli Aparecida Fernandes; Claudio Tavares Sacchi
Background:: Bordetella pertussis is the causative agent of pertussis. In Brazil, laboratory diagnosis of pertussis is based on the culture. In 2010, was standardized the Real-Time PCR TaqMan® in routine diagnosis. Objectives:: The aim of this study was to evaluate the impact achieved with the introduction of RT-PCR for the routine diagnosis of pertussis and to compare with the results obtained from culture. Patients and Methods:: 4,697 samples of nasopharyngeal secretions collected from suspected pertussis cases and/or contacts were analyzed for RT-PCR and culture, from January 2008 until the end of December 2011. Results:: According to the results obtained from the samples 6.9% were culture/RT-PCR positive, 14.8% were positive only for RT-PCR and 0.2% only for culture. Negative samples for both techniques was 3,622 (77.1%) and 1.0% were inconclusive for RT-PCR. Conclusions:: The implementation of RT-PCR in routine diagnosis resulted in an increase in laboratory confirmation by almost three times. The RT-PCR assay does not intend to replace the culture technique, but to promote an improvement in the diagnosis of pertussis.
Serum Zinc Levels in Children 1 - 59 Months of Age with Pneumonia: A Single-Center Surveillance in India from 2014 to 2016
(Brieflands, 2020-04-18) Jayashree Rajasekaran; Sangeetha Geminiganesan; Dinesh Kumar Jayapalan; Ramachandran Padmanaban; Vaishnavi Saminathan
Objectives: This study aimed to estimate serum zinc levels in children with pneumonia according to the WHO criteria and compare them with age-, sex-, and nutrition-matched controls. Methods: The study was carried out in a pediatric tertiary care hospital from September 2014 to July 2016 after obtaining approval from the Institutional Ethics Committee. Children between 1 to 59 months of age admitted with pneumonia according to the WHO criteria were included as the case group (n = 50) and other non-pneumonia cases as the control group (n = 50). Various etiologies were analyzed, such as pneumonia, severe pneumonia, bronchiolitis, and viral infection-associated wheezing based on clinical and X-ray findings. Blood samples were collected for zinc estimation in both case and control groups. All children were investigated and treated as per our unit protocol for the particular condition. Results: Serum zinc level was significantly low in the case group (n- 31; 62%) compared to the control group (n- 9; 18%). The mean zinc level in the case group was 60.36 ± 29.23, and that of the control group was 80.54 ± 25.70, with a significant P value of 0.001. Conclusions: Serum zinc levels were significantly lower in children with pneumonia when compared to their age-, sex-, and nutrition-matched controls.

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