Archives of Pediatric Infectious Diseases

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 454
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    Analysis of Clinical and Radiologic Parameters in Children Diagnosed with COVID-19 Infection at Admission and Discharge
    (Brieflands, 2024-07-31) Hanieh Sadeghi Koupaei; Shiva Nazari; Shahnaz Armin; Vahide Zeinali
    Background: Recognizing risk factors for poor prognosis among COVID-19 patients is crucial, especially given the absence of standardized treatments and medications. Objectives: In the present study, our aim was to survey changes in clinical parameters in children diagnosed with COVID-19 infection from admission to discharge. Methods: The present retrospective cross-sectional study focused on children with COVID-19 infection. All demographic data and clinical information of patients were extracted upon admission and at discharge from the hospital. Data analysis utilized the Mann-Whitney U test and Fisher exact test. Multivariable regression modeling was employed to identify factors predicting the probability and duration of hospitalization in ICUs for children with COVID-19. Results: Elevated levels of ESR, CRP, creatinine, and ferritin were found in 51.7%, 67.4%, 69.3%, and 53.6% of patients upon admission. Moreover, 98.2% and 38.3% of patients had high levels of ALP and AST. Platelet (PLT) and neutrophil levels were higher at discharge compared to admission (P < 0.001), while creatinine levels were lower at admission than at discharge (P < 0.001). Patients admitted to ICUs exhibited significantly higher levels of pulse rate (P < 0.001), respiratory rate (P < 0.001), mean corpuscular volume (MCV) (P = 0.01), red cell distribution width (RDW) (P = 0.002), prothrombin time (PT) (P = 0.006), and ESR (P = 0.04). Conclusions: Pulse rate, respiratory rate, MCV, RDW, PT, ESR, and oxygen saturation (SPO2) percentage can be used to predict the severity of COVID-19 disease. However, further studies are needed to determine the prognosis and severity of COVID-19 infection in children.
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    Kawasaki Disease Triggered by Septic Arthritis: A Case Report
    (Brieflands, 2024-03-04) Khosro Rahmani; Ehsan - Goudarzi; Fateme - Yousefimoghaddam; Vadood Javadi; Reza Shiari; Mehrnoush Hassas Yeganeh
    We present the case of a 6.5-year-old boy who presented to our center with complaints of pain in both hip joints that had started 10 days prior to admission. Following the diagnosis and treatment of septic arthritis, he developed a fever that did not respond to antibiotics. Subsequently, he was diagnosed with Kawasaki disease triggered by septic arthritis.
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    Clinical Characteristics, Laboratory Features, and Outcomes of 151 Pediatric Patients with COVID-19 and MIS-C: A Single-center Study in the Northwest of Iran
    (Brieflands, 2023-05-07) Mahmoud Samadi; Mahboobeh Azadi; Amir Saeed; Akbar Molaei; Shahram Abdoli Oskouie; Shamsi Ghaffari; Ahmad Jamei Khosroshahi; Sara Kaveh
    Background: To date, multiple outbreaks of coronavirus disease 2019 (COVID-19) have been reported. Moreover, a wide spectrum of multiple organ involvements has been reported. Objectives: This study aimed to describe and compare the clinical characteristics, laboratory features, and outcomes of pediatric patients with COVID-19 and Multisystem Inflammatory Syndrome of Children (MIS-C). Methods: This cohort retrospective study was performed on patients under 18 years admitted with a diagnosis of COVID-19 and MIS-C in a pediatric referral center in the northwest of Iran from March 2020 to June 2021. This study included the data obtained from three time points, including on admission, 1 week, and 3 months after admission. Results: In this study, 151 patients with a mean age of 5.3 ± 4.1 years were enrolled, out of whom 51.7% and 48.3% were in COVID-19 and MIS-C groups, respectively. Fever was observed in 64.9% of the patients. In the third-month follow-up, there was no abnormality in the neurologic, respiratory, or gastrointestinal systems. For most patients with cardiovascular involvement, normal ventricular and valvar function, and coronary arteries were obtained in follow-up. Approximately one-third of the subjects were admitted to the pediatric intensive care unit (PICU). Neonates, those with cardiac involvement and underlying disease, were at a higher risk for PICU admission (P < 0.001). Moreover, six patients died. Conclusions: Although irreversible post-COVID-19 organ involvement is uncommon among pediatric patients, routine and preplanned follow-up programs play an important role in achieving satisfactory outcomes.
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    Antibiotic Resistance Patterns of Uropathogenic Causes of Urinary Tract Infections in < 3-Year-Old Children: A Single-Center Cross-Sectional Study
    (Brieflands, 2023-07-31) Houman Hashemian; Ziba Vazifedoost Saleh; Masoomeh Afzalipoor; Alireza Jafari
    Background: Urinary tract infections (UTIs) are among the most common childhood infections and can lead to serious complications, such as hypertension and renal failure, if not diagnosed and treated promptly. The prompt initiation of appropriate empiric therapy in children with upper UTIs requires the identification of causative bacteria and their antibiotic resistance patterns. Objectives: The aim of this study was to investigate the frequency and patterns of antibiotic resistance among uropathogenic bacteria causing UTIs in children under 3 years of age admitted to the 17th Shahrivar Hospital in Rasht, Iran. Methods: A total of 259 children diagnosed with UTIs from 2014 to 2020 were admitted to our hospital and included in the study. The age, sex, clinical symptoms, urine analysis results, urine culture findings, and antibiogram of the patients were documented in a questionnaire. The data were then analyzed in SPSS software version 21. Results: The mean age of the children was 4.9 ± 2.7 months. Boys comprised 53.3% of the patients. Escherichia coli was the most frequent cause of UTIs in the children (56.4%), followed by Klebsiella (33.2%). The highest resistance was related to cephalothin (77.1 %), cephalexin (77.1 %), ampicillin (78.8 %), and amoxicillin (100 %). Conclusions: The most common uropathogenic bacterium causing UTIs in young children was E. coli, which showed sensitivity to ciprofloxacin, amikacin, gentamicin, nitrofurantoin, imipenem, ceftriaxone, and nalidixic acid. Accordingly, it is advisable to use aminoglycosides as the drugs of choice to treat UTIs in children under the age of 3 years. In the case of any contraindication, third-generation cephalosporins are recommended for empirical treatment, and if there is no response to these treatments within 48 to 72 hours, ciprofloxacin can be considered.
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    Comparison of Antiphospholipid Antibody Levels in Children with and Without COVID-19
    (Brieflands, 2023-10-31) Salimeh Noorbakhsh; Fahimeh Ehsanipour; Behnam Sobouti; Behzad Haghighi Aski; Mohammad Faranoush; Ashraf Mousavi; Amir Ghadipasha; Zahra Sadr
    Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the recent pandemic. According to published reports, respiratory symptoms, such as pneumonia and inflammatory conditions, are common in this disease. Objectives: The current study aimed to investigate the level of antiphospholipid (aPL) antibodies in children with and without coronavirus disease 2019 (COVID-19). Methods: This descriptive-analytic cross-sectional study was conducted on patients under 16 years of age with and without COVID-19 admitted to Ali Asghar Hospital between December 2021 and February 2022. Patient information was collected by the researcher in a checklist. The checklist included demographic information, clinical findings, and information on laboratory and ultrasound results. Results: In this study, 99 patients were evaluated in three groups: control (without COVID-19), moderate, and severe. The means (standard deviation [SD]) of C-reactive protein (CRP) and D-dimer were significantly higher in the severe group. The Pearson correlation coefficient test was used to examine the relationship between aPL and anticardiolipin (aCL) antibodies with laboratory results. The only significant and direct relationship was observed between aCL antibody and D-dimer. Conclusions: Increased CRP and D-dimer in children with COVID-19 are associated with the severe form of this serious disease. However, there was no significant association between the severity of the disease and the levels of aCL and aPL antibodies and anti-beta 2-glycoprotein I antibodies (aβ2GPI) in children.
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    Primary Carrier Status and Alteration in the Colonization of the Extended-Spectrum β-Lactamase Producing Enterobacteriaceae Among Children in Pediatric Intensive Care Unit During the Hospital Stay
    (Brieflands, 2023-07-31) Shiva Ahmadipour Sereshkeh; Siavosh Salmanzadeh Ahrabi; Azam Khosroabadi; Roxana Mansour Ghanaiee; Abdollah Karimi; Masoud Alebouyeh
    Background: Widespread and inappropriate use of antibiotics has led to an increase in antibiotic-resistant bacteria worldwide. Extended-spectrum β-lactamases (ESBLs) are among the most important resistance mechanisms in members of Enterobacteriaceae, which can pose a threat to patients. Objectives: This study aimed to investigate the carrier status and alteration in the fecal transmission of ESBL-producing Enterobacteriaceae (ESBL-E) on admission and during the hospital stay, as well as its correlation with the usage of antibiotics among children in a pediatric intensive care unit (PICU). Molecular typing between the primary and secondary isolates was done to detect the homotypic clonal strains. Methods: Demographic and medical data of PICU children were collected, and the carrier status of ESBL-E was investigated in pairs of their rectal swab samples at the admission and discharge time. Detection of ESBL phenotype and antimicrobial susceptibility to 12 antibiotics were performed by double-disk synergy and disc diffusion methods, respectively. Polymerase chain reaction for detection of blaTEM, blaSHVblaPER, blaCTX-M, and blaVEB genes was performed using specific primers. The phylogenetic relations were analyzed by the enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) method. Results: Extended-spectrum β-lactamase-producing Enterobacteriaceae was detected in 48% of the samples at admission and 42% at discharge time. The highest frequency of resistance was observed in cephazolin, amoxicillin-clavulanic acid, and ampicillin. Children with a history of meropenem administration showed a significantly higher frequency of meropenem resistance Enterobacteriaceae in their samples. Moreover, the administration of metronidazole increased the isolation of ESBL-Escherichia species in hospitalized children. The most common gene associated with the ESBL phenotype was blaCTX-M, while blaPER and blaVEB were not detected in the ESBL-E isolates. The phylogenetic analysis did not confirm the occurrence of the cross-transmission of ESBL-E in the patients during hospitalization. Conclusions: Our results showed a high frequency of ESBL-E in the feces of children upon admission to the PICU, which did not change significantly during the hospital stay. Although the prescription of metronidazole showed an association with the enrichment of ESBL-E due to observed diversity in the molecular types and resistance phenotypes of the isolates, the community seems to be the primary source of ESBL-E transmission in children. Further investigations are needed to understand the role of hospital stay in the colonization and enrichment of ESBL-E in the intestinal tract of children and their association with infections during the medical interventions in the PICU.
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    Comparison of Clindamycin with Other Anti-staphylococcal Antibiotics for the Treatment of Pediatric Staphylococcal Skin-Scaled Syndrome
    (Brieflands, 2023-07-31) Houman Hashemian; Majid Asgharzadeh; Seyed Lida Baghaei; Seyyedeh Azade Hoseini Nouri
    Background: Staphylococcal scalded skin syndrome (4S) is caused by Staphylococcus aureus exfoliative toxin and is characterized by the separation of the surface layers of skin. Given the existence of conflicting treatment strategies and differences in antibiotic resistance patterns, this study aimed to compare the effectiveness of clindamycin, clindamycin with another anti-staph agent, and antibiotic regimen without clindamycin in the management of pediatric 4S. Objectives: To compare the effectiveness of different treatment strategies in the management of pediatric 4S. Methods: In this cross-sectional study, children with 4S (based on the final documented clinical diagnosis) admitted to the 17th-Shahrivar Hospital of Rasht, Iran, from 2005 to 2021 were enrolled. Exclusion criteria comprised being a neonate, having chronic skin diseases or immunodeficiencies, and incomplete data files. The variables gathered included age, sex, type of antibiotic received, time of fever cessation (if fever existed), recovery time, duration of hospitalization, and complications. The data were entered into SPSS v.24 software and analyzed. Results: This study was conducted on 73 patients with the final diagnosis of 4S. The mean age of the patients was 17.70 ± 15.85 months, and 47.9% of them experienced fever during hospitalization. The mean duration of hospital stay was 6.52 ± 1.90 days. Also, the average duration of recovery in these children was 4.90 ± 1.73 days. There were no differences in terms of sex (P-value = 0.245), age (P-value = 0.383), and duration of fever (P-value = 0.568) between the three groups receiving different antibiotic regimens. Meanwhile, the durations of recovery (P-value = 0.018) and hospitalization (P-value = 0.020) were significantly longer in children who did not receive clindamycin. Moreover, the duration of hospitalization was significantly shorter in the patients who received clindamycin alone compared to those treated with clindamycin plus another antibiotic (P-value = 0.044). There was no significant difference in the occurrence of disease/drug complications between the three groups, and the most common complication in all patients was scaling. Conclusions: Clindamycin (alone or in combination with other anti-staphylococcal agents) could shorten the recovery period, and hospital stay in children with 4S. Besides, it did not have any adverse impact on the occurrence of complications. The patients who received clindamycin alone had a shorter hospital stay than patients who were treated with clindamycin plus another antibiotic. Considering the lower complications, lower costs, and shorter length of hospital stay associated with monotherapy, we recommend using clindamycin alone for treating 4S patients.
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    Fever and Dehydration as the First COVID-19 Presentation in a 2-Months Old Boy in Northeast of Iran
    (Brieflands, 2020-08-22) Mahsa Besharat; Pooya Bahari Khorram
    Introduction: After the worldwide pandemic of coronavirus 19 disease (COVID-19), pediatric involvement has been seen as case reports with various initial symptoms. Case Presentation: Here, we report a 2-months old boy with severe dehydration, fever, and electrolyte imbalance with lung involvement compatible with COVID-19 in the Northeast of Iran (North Khorasan). Conclusions: Pediatric case reports in COVID-19 are limited, and it seems that the disease has a milder course compared to the adult patients, but the range of the clinical features is wide.
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    Nosocomial Infection in an Iranian Neonatal Intensive Care Unit: Hospital Epidemiology and Risk Factors
    (Brieflands, 2020-05-11) Farhad Choobdar; Zahra Vahedi; Nastaran Khosravi; Nasrin Khalesi; Asma Javid; Soraya Shojaee
    Background: Hospital-acquired infection is one of the main concerns in Neonatal Intensive Care Units (NICUs), leading to increased mortality, hospital stay, and costs. Objectives: This study aimed to investigate the risk factors of hospital-acquired infection in NICUs. Methods: A descriptive, cross-sectional, prospective study was conducted in the NICU of Ali Asghar Children Hospital for one year. All admitted newborns were sampled on a simple basis. The criteria for the diagnosis of hospital-acquired infection were based on the definitions of the CDC and the NNIS system. Risk factors such as days of fully catheters usage, nurse-to-patient ratio, history of surgery, prematurity, and mechanical ventilation were considered as variables. The data collection tools consisted of a patient information questionnaire, the monthly report of the hospital infection control committee based on the NNIS system, a daily schedule of all risk factors for each infant, and the monthly nurse-to-patient ratio in the NICU. The STATA software was used for data analysis. Results: In our study, 654 newborns were enrolled. The rate of hospital-acquired infections was 13.5%. Moreover, 80.7% of the cases exhibited sepsis (72.7% diagnosed based on clinical findings and 8% based on positive blood culture). Statistical analysis showed 9% pneumonia cases, 8% surgical site infection cases, and 2.3% urinary tract infection cases. The average time to the occurrence of hospital-acquired infection was 13.5 days after admission. All risk factors were significantly higher in the infected group than in the control group (P = 0.0001). Furthermore, surgical interventions were significantly more in the infected group than in the non-infected group (34.1% vs. 6.7%, respectively, P = 0.0001). The prevalence rates in different weight ranges (less than 1000 g, 1001 to 1500 g, 1501 to 2500, and above 2501 g) were 2.6%, 6.9%, 21.4%, and 69.1%, respectively, in the infected group, which were significantly different from those of the non-infected group (P = 0.0001). The most common etiologic microorganism was Acinetobacter baumannii. Conclusions: Factors such as surgery, the presence of a central venous catheter, and the increased length of hospital stay significantly increased the hospital-acquired infections. Reducing invasive procedures, maintenance of full catheters, and providing optimal nursing care can help control hospital-acquired infections.
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    Epidemiological Aspects and Main Determinants of Prognosis in Children with Acinetobacter Infections Admitted to Intensive Care Units at Aliasghar Children's Hospital, Tehran, Iran
    (Brieflands, 2018-10-31) Alireza Nateghian; Hanieh Radkhah; Niyosha Masalegooyan; Masoumeh Moradkhani; Masoumeh Miradi
    Background: There is not enough information about the prevalence of Acinetobacter infection as well as its risk factors, especially in neonatal intensive care units. The present research aimed at conducting a five-year study on Acinetobacter infection and its main factors in neonatal and pediatric intensive care units in Iran. Methods: This cross-sectional survey was conducted on 89 children with positive culture for hospital-acquired Acinetobacter, admitted to intensive care units of Aliasghar Children's Hospital in Tehran, between 2010 and 2015. Besides, 97 patients with similar baseline characteristics without Acinetobacter positivity were enrolled as the control group. Epidemiological information and clinical data were collected by reviewing the hospital recorded files. Results: In the group with positive Acinetobacter culture, complete and partial improvement was observed in 62.9% and 11.2%, respectively, while 25.8% died due to treatment failure. In this regard, complete and partial improvement in the control group was revealed in 85.6% and 11.3% with an overall death rate of 3.1%, indicating significantly higher failure rate in the case group (P = 0.001). To determine the main factors for in-hospital death, all variables with a significant association with positive culture in univariate analysis (considering P < 0.2) were entered in a backward multivariable logistic regression model. In this regard, venous access (OR = 7.80, 95% CI: 1.06 to 57.19, P = 0.043), carbapenem use (OR = 27.03, 95% CI: 1.93 to 377.780, P = 0.014), and ampicillin use (OR = 0.12, 95% CI: 0.019 to 0.739, P = 0.022) were shown as the main determinants for Acinetobacter-related death. Conclusions: Although the study was not a prognostic study and determination of the main determinants of prognosis in children with Acinetobacter infections was not possible yet it seems that the mortality rate due to Acinetobacter infection in the population was about 25.8% in the global range reported in the literature. The main factors for Acinetobacter infection-related death are central venous catheters related to TPN, carbapenem use, and ampicillin use.
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    SARS Coronavirus 2, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome in Children: A Review on Epidemiology, Clinical Presentation, and Diagnosis
    (Brieflands, 2020-09-19) Seyed Ahmad Tabatabaii; Pegah Soltani; Ghamartaj Khanbabaee; Deepak Sharma; Rohollah Valizadeh; Nazanin Farahbakhsh; Marjan Tariverdi; Matin Pourghasem; Ebrahim Tabiei
    Context: Coronavirus Disease 2019 (COVID-19) pandemic has caused irreparable damage to society. The pediatric population may be asymptomatic but has positive viral nucleic acid test results and plays an important role in spreading the infection in populations. However, there is a substantial information gap on the epidemiology, pathology, and clinical presentations of COVID-19 in pediatric patients. Evidence Acquisition: English research articles published before April 18, 2020, were reviewed to understand the clinical characteristics of SARS coronavirus 2, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome in children. The WHO (https://www.who. int/) and CDC (Centers for Disease Control and Prevention, https://www.cdc.gov/) websites were also reviewed to find eligible studies, besides articles extracted from PubMed, Scopus, and Google Scholar. Results: In comparison with SARS and MERS, COVID-19 seems to have wider clinical symptoms and routes of transmission. Multisystem inflammatory syndrome is a unique clinical feature of this novel virus. The low prevalence of COVID-19 in children may be due to lower contacts or incomplete identification rather than resistance to the virus. Conclusions: As this virus is novel, we believe that lessons learned from SARS and MERS outbreaks are very valuable in handling the current pandemic. The aim of this paper was to provide the updated summary of clinical manifestation, diagnostic, molecular, and genetic aspects of the novel coronavirus in comparison with SARS and MERS coronaviruses in children.
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    Evaluation of Viral (HHV6, Adenovirus, HSV1, Enterovirus) and Bacterial Infection in Children with Febrile Convulsion by Serum PCR and Blood Culture Mofid Children’s Hospital , 2016 - 2017
    (Brieflands, 2018-10-31) Abdollah Karimi; Mohammad Sakhavi; Negin Nahanmoghaddam; Farideh Shiva; Leila Azimi; Mehdi Shirdust; Shahnaz Armin; Ahmad Reza Shamshiri
    Background: Febrile seizures (FS) are common in young children. Viral infections that result in high fever are frequent etiologic agents that lead to febrile seizures. Human Herpesvirus 6 (HHV6), Influenza virus, adenovirus, and enterovirus have been named as the most common viruses causing high fevers in young children. Although bacterial infections have rarely been found as causative agents, many children with febrile seizures are treated with empiric antibiotics. Objectives: To determine the epidemiology of the viral (HHV6, Adenovirus, HSV1, Enterovirus) and bacterial infection in children presenting with febrile seizures. Methods: In a descriptive study, data was collected from 93 children, 3 months to 5 years of age, hospitalized with febrile seizures between September 2016 and April 2017. Relevant information was documented on a previously designed questionnaire. Blood samples were collected for culture, Serum 16S rRNA for bacteria, and PCR assay for 4 viruses (HHV6, adenovirus, enterovirus and HSV), in addition to routine investigations. Results: Of the 93 patients, serum PCR results were negative for 73 patients (78.49%) and 15 (16.13%) were positive for viruses (11 for HHV6 and 4 for Adenovirus). Serum 16S rRNA for bacteria was detected in 5 cases and blood culture was positive in 4 cases. Conclusions: Findings of this study indicate a significant prevalence of viruses and a very low rate of bacterial infection in children with febrile seizures, thus, negating the use of empirical antibiotic therapy.
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    Clinical Profile and Predictors of Outcome for Pediatric Scrub Typhus at a Tertiary Care Hospital
    (Brieflands, 2020-09-26) Kiruthika Muthukrishnan; Shruthi Tarikere; Rajakumar Padur Sivaraman; Shuba Sankaranarayanan; Krithika Prabaharan; Balaji Thiruvengadam Kothandam
    Background: Scrub typhus is an important cause of acute undifferentiated fever. It is currently one of the most covert re-emerging infections and the most common rickettsial infection caused by Orientia tsutsugamushi. Untreated cases can have mortality rates as high as 30-35%. Objectives: This study was done to study demographical data, clinical profile, and predictors of outcome for scrub typhus in children who were admitted to our institution, a tertiary care hospital in south India. Methods: In this retrospective study, children diagnosed with scrub typhus based on IgM enzyme-linked immunosorbent assay (ELISA), between January 2012 and June 2019 were included. Detailed history, clinical examination findings, laboratory profile, complications, and outcome were analyzed. Results: A total of 120 patients were identified, of whom 84 (42 males- and 42 females) cases satisfied the inclusion criteria and were analyzed. About 80 (95%) cases had a complete recovery, whereas 4 patients (5%) died of multiple complications. Hypotension, hypoxia, altered sensorium, hypoalbuminemia, elevated liver enzymes, azotemia, and deranged coagulation on admission were considered as poor predictors of outcome for scrub typhus. Conclusions: Pediatric scrub typhus is a common infection and should be suspected in cases with fever for more than 5 days and non-specific signs and symptoms. Early detection and timely management lead to a higher recovery rate. Hypotension, hypoxia, azotemia, altered sensorium, and bleeding manifestations on admission were associated with unfavorable outcomes.
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    An Algorithmic Approach to Management of COVID-19 Associated Multisystem Inflammatory Syndrome in Children
    (Brieflands, 2021-01-03) Roxana Mansour Ghanaie; Abdollah Karimi; Zahra Pourmoghaddas; Shahnaz Armin; Seyed Alireza Fahimzad; Fatemeh Fallah; Katayoun Tayeri; Mohammad Reza Sabri; Hamid Rahimi; Ali Akbar Zeinaloo; Seyedeh Mahsan Hoseinialfatemi; Vahid Ziaee; Reza Shiari; Bahador Mirrahimi; Ali Saffaei; Sedigheh Rafiei Tabatabaei
    This article does not have an abstract.
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    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.
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    Contribution of gyrA and qnrA genes in Ciprofloxacin Resistant Ecsherichia coli Isolates from Patients with Urinary Tract Infections of Imam Khomeini Hospital of Tehran
    (Brieflands, 2018-10-31) Zahra Zahedi; Mojdeh Hakemi Vala; Fatemeh Bagheri Bejestani
    Background: Resistance to ciprofloxacin as the most common antibiotic for the treatment of urinary tract infections (UTIs) is increasing. In this study, the role of gyrA and qnrA genes among ciprofloxacin resistant Escherichia coli (E. coli) isolates from UTIs was evaluated. Methods: During September to March 2014, urine samples were collected from patients with UTIs of Imam Khomaini hospital of Tehran. Bacterial identification was done based on standard tests. The antibiotic sensitivity test was performed based on the clinical and laboratory standards institute (CLSI) 2014 protocol and minimal inhibitory concentration (MIC) of ciprofloxacin was determined by E-test strips. DNA was extracted by the boiling method and assessment of gyrA (DNA gyrase (type II topoisomerase)) and qnrA genes was done by the polymerase chain reaction (PCR). Further sequencing was done for PCR confirmation and blasting. Results: All isolates were susceptible to carbapenems (100%) and 98.7% were susceptible to nitrofrontain. The highest resistance was towards piperacillin 85%, ampicillin 83.8%, sulfamethoxazole trimethoprim (SXT) 78.7%, ciprofloxacin 77.5%, and 75% tetracycline. Around 80% of the E. coli isolates were identified as multi drug resistant (MDR). All isolates with MIC of ≥ 4 μg/mL for ciprofloxacin were the candidates for DNA extraction, PCR, and sequencing. The gyrA and qnrA genes were detected in 100% and 39% of isolates, respectively. Mutations were found in the sequence analysis, yet the mean full change was related to change of serine to leucine at position 83 (S 83 L). Conclusions: Finally, contribution of both mutated chromosomal gyrA genes and plasmidic qnrA resistance genes in some of the high ciprofloxacin resistant bacterial strains was found in this study, besides the overuse of antibiotics, which can increase the emergence of resistant strains.
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    Posaconazole-Induced Acute Pancreatitis: A Rare Side Effect in a Child with Chronic Granulomatous Disease
    (Brieflands, 2020-07-12) Marjan Tariverdi; Sedigheh Rafiei Tabatabaei; Ali Saffaei; Ladan Ayazkhoo; Bahador Mirrahimi
    Introduction: Pancreatitis is an inflammatory disease of the pancreas. Drug-induced pancreatitis is an important cause of pancreatitis. There are two pathological types of acute pancreatitis, including pancreatic edema with a mild course and pancreatic necrosis with a poor prognosis. Some agents can induce pancreatitis, but so far, posaconazole-induced pancreatitis in children has been not reported. Here, we describe the case of a child with acute pancreatitis who received posaconazole. Case Presentation: A 10-year-old girl with a three-year history of chronic granulomatous disease (CGD) was admitted to hospital due to epigastric pain, nausea, vomiting, loss of appetite, and fever for the last four days. The pain was persistent and prominent in the periumbilical area. The patient was on lifelong antifungal prophylaxis for her illness. On abdominal sonography, the head of the pancreas was inflated, which can indicate pancreatitis. All the medications were discontinued at the time of admission, and along with sufficient hydration, acetaminophen was administered for the patient’s pain. One, three, and twelve months after discharge, the patient was visited for follow-up with no signs of stomach discomfort, and the lab data was within the normal limits. CGD is a rare disease in which the phagocytes fail to produce hydrogen peroxide. Such patients are prone to bacterial and fungal infections. Conclusions: In conclusion, this is the second case of posaconazole-induced pancreatitis and the first case in children; thus, we recommend that physicians should be aware of the signs of pancreatitis in high-risk individuals like immunocompromised pediatric population.
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    Renal Hydatid Cyst or a Simple Cyst? Report of a Rare Case
    (Brieflands, 2018-08-14) Fariba Jahangiri; Shirin Sayyahfar; Elham Zarei; Rozita Hoseini; Seyed Javad Nasiri
    Hydatid disease is a parasitic infection mainly caused by Echinococcus granulosus and is endemic in many parts of the world. Although hydatid disease can be found anywhere in the human body, the liver and lungs are the most commonly involved organs. Urinary tract involvement has been seen in about 2% - 4% of the cases; however, the isolated renal cyst is extremely rare. Here, we report a 5-year-old boy with an isolated huge renal hydatid cyst with no scolices or hooklets in aspirated fluid mimicking a simple renal cyst. The clinicians and radiologists should consider hydatid disease in the differential diagnosis of cystic lesions found in any part of the body especially in endemic countries since earlier diagnosis is crucial for appropriate treatment.
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    Antibiotic Prescribing Pattern in Neonates of Seventeen Iranian Hospitals
    (Brieflands, 2017-10-31) Alireza Fahimzad; Zahra Eydian; Abdollah Karimi; Farideh Shiva; Shahnaz Armin; Roxana Mansour Ghanaei; Fatemeh Fallah; Sedigheh Rafiei Tabatabaei; Fariba Shirvani; Mohammad Rahbar; Shirin Sayyahfar; Manijeh Kahbazi; Aliakbar Rahbarimanesh; Reza Arjmand; Anahita Sanaei Dashti; Babak Abdinia; Masomeh Abedini; Hossein Hidari; Keyghobad Ghadiri; Aminsadat Sharif; Elham Shafighi Shahri; Zeynab Shariat; Ali Nejadian; Mona Moshayedi; Samaneh Fatholahpoor; Hamid Alizadeh; Reza Entezari Heravi
    Background: The association between the use of antibiotics and bacterial resistance has obviously been established and it seems to be a significant problem for public health. It is clear that irrational use and high rates of antibiotic prescription are associated with increased bacterial resistance. As antibiotics are the class of drugs commonly prescribed in neonatal and Neonatal Intensive Care Unit (NICU) wards, neonates are at high risk of opportunistic or nosocomial infections due to prolonged hospitalization and immunosuppressed condition. Objectives: It is essential for antibiotic prescription patterns to be evaluated periodically for rational use. Therefore, the present study was carried out to identify the prescribing patterns of antibiotics in neonatal and NICU wards of 17 different Iranian hospitals. Methods: The study was done during 1 calendar week between January and February 2014. All in-patients admitted to the NICU and neonatal units of 17 Hospitals in 15 Iranian cities were included. Relevant data of all neonates receiving an antibiotic at 8 am on the day of the study was collected by trained members of the study team; age of the patients, type and number of administered antibiotics, route of administration, underlying disease, and indication for use were documented. Results: The total number of neonatal in-patients was 366 on the day of the study. Mean age of infants was 9.2 ± 3.9 days, with 54.4% being male. Overall, 264 patients (72.1%) were being given one or more antimicrobials; the proportion of patients receiving antibiotics ranged from 21.4% to 100% in different neonatal units. Most frequent antibiotics used were ampicillin (25.6%), vancomycin (16.4%), amikacin (10.6%), and cefotaxime (9.74%). Parenteral route was used in 255 cases, (96.6%); 110 (41.7%) antibiotic courses were prescribed for community-acquired infections, 29 (11 %) for hospital-acquired infections, 42 (15.9 %) for pre- or post-operative prophylaxis, and 83 (31.4 %) for medical prophylaxis. Empirical antibiotics were administered to 255 newborns (96.6 %); 96.2% of patients received combination therapy. Conclusions: High use of empirical and prophylactic antibiotics, overuse of vancomycin and third generation cephalosporins are of concern and contrary to recommended therapies. Therefore, guidelines for the use of antibiotics in neonates are required and a larger number of studies are needed.