Archives of Pediatric Infectious Diseases
Volume:4 Issue: 1, Jan 2016

Brucellosis symptoms are nonspecific; the most common complaints include fever, sweats, anorexia, headache, malaise, and arthralgia. Hematological manifestations of active brucellosis vary from mild anemia and leukopenia to thrombocytopenia and rarely pancytopenia.. We report on an eight-year-old boy who presented epistaxis and gum bleeding. The physical examination revealed petechiae, purpura, ecchymosis, and cervical while inguinal lymphadenopathy and splenomegaly were noted. Brucella agglutinin titer was positive. After five days of specific therapy for brucellosis, fever was controlled, clinical signs and symptoms were improved and platelet count was dramatically increased.. Sever thrombocytopenia and bleeding may be the presentation of brucellosis..

Adherence to hand hygiene (HH) by health care professional (HCP) is crucial to prevent nosocomial infections; adequate knowledge and a positive attitude are needed for optimal compliance.. The current study aimed to assess the knowledge and the attitudes of the HCPs regarding HH.. Questionnaires were distributed to HCPs in two university affiliated hospitals. After completion, members of the study team analyzed the collected data.. Two-hundred fifty-five personnel completed the questionnaires; 143 (56.1%) physicians and 112 (43.9%) nursing personnel. Hands of health care personnel were named as the major source of transmission of infection and hand washing as the most effective way to prevent transmission by 88.6% and 94.5% of participants respectively. Hand washing was recognized as HH by 81.6% of the HCP, alcohol hand rubs by 64.3% and disposable gloves by 23.9%. Reasons to perform HH included prevention of nosocomial infection by 85.1% along with self-protection by 64.3%; 25.9% had received formal training. Lack of knowledge, poor accessibility to alcohol hand rubs and concerns about skin damage were regarded as barriers to HH by 71.4%, 54.1% and 41.2% of participants, respectively. Suggestions for improving compliance to hand hygiene: continued education, 67.1%; increasing number/accessibility to hand rubs, 63.5%; putting up posters 54.5% and camera control, 15.7%.. The findings indicate that hand hygiene should be included in the formal curriculum, continuous education and supervision are necessary to ensure compliance..

Lupus vulgaris (LV) is one type of cutaneous Tuberculosis (TB) but a rare complication of (BCG) vaccination.. We report a 13-month-old boy with trisomy 9 who developed LV on his right arm with extension to anterior part of the chest one month after BCG vaccination. Culture and Gram stain was negative for mycobacteria. The diagnosis was confirmed by clinical and histopathological correlation and eventually Mycobacterium bovis was detected in tissues using the Polymerase Chain Reaction (PCR) method. The patient was treated with isoniazid, rifampin and ethambutol. Two months after drug therapy, marked improvement was developed.. Post immunization LV is a rare complication of the BCG vaccine and should be considered by any physician. Lupus vulgaris is a paucibacillary form of TB. Therefore, acid fast bacilli are not detected in most cases. The PCR is a useful method for confirmation of the diagnosis of LV..

Cat scratch disease (CSD) is an infectious disease caused by the Gram-negative rod Bartonella henselae (BH). It usually leads to subacute loco-regional lymphadenitis occasionally associated with fever. In most of the cases, it resolves spontaneously within 4 - 6 weeks. However, CSD has also been associated with other atypical presentations.. We reported a series of seven children with unusual symptoms of CSD. In particular, we described the case of a child with ptosis, miosis and enophtalmy, suggesting Horner syndrome, associated with cervical lymphadenitis. Cat scratch was mentioned in only one patient, while four of them mentioned a recent contact with cats. We reviewed and discussed the incidence of these atypical presentations of CSD as well as the therapeutic approaches recommended and the available diagnostic tools.. This paper highlighted the need to exclude CSD in children with unexplained symptoms such as prolonged fever, hepatosplenic lesion and osteomyelitis..

Dysentery accounts for a significant proportion of morbidity and mortality cases, especially in children with diarrhea in developing countries. Shigellosis remains a public health problem in Iran.. The objectives of this study were to investigate the presence and the frequency of Shigella spp. among children younger than 10 years with diarrhea and to determine the antimicrobial resistance patterns of these isolates in Tehran, Iran..Patients and This cross-sectional study was conducted in two pediatric hospitals in Tehran, from October, 2013 to October, 2014. Nine hundred and thirty-eight (n = 938) stool samples were collected (one stool per patient) from children less than 10 years of age. The stools were primarily cultured on MacConkey agar and xylose lysine deoxycholate (XLD). (Selenite-F broth is also used as an enrichment medium for the isolation of Shigella spp.) All of the isolates were confirmed as Shigella species by biochemical and serological tests. Molecular confirmation of Shigella isolates was determined by polymerase chain reaction (PCR) using specific primers for the ipaH gene. The antibiotic susceptibility of the Shigella isolates was tested using the Kirby-Bauer disc-diffusion method.. Amongst 938 stool samples, 36 were Shigella spp. S. sonnei (61.1%, n = 22), which was the most common, followed by S. flexneri (27.8%, n = 10), S. boydii (8.3%, n = 3), and S. dysenteriae (2.8%, n = 1). Furthermore, most Shigella isolates showed resistance to amoxicillin (83.3%), tetracycline (61.1%), and co-trimoxazole (83.3%). No resistance was found against ciprofloxacin and imipenem. This study showed that S. sonnei is currently the predominant species in Tehran, Iran.. Because resistance to antibiotics changes constantly, Shigella strains should be under surveillance in order to monitor local susceptibility and subsequently formulate policies for the use of antimicrobial drugs..

Human head lice infestations caused by Pediculus capitis are a common health problem in school aged children in many parts of the globe. Its transmission occurs directly, mostly by head to head contact, and causes scalp itching. This insect is not known to be the vector of any human disease.. This descriptive-analytical study was conducted in order to determine the prevalence of pediculosis, as well as some effective treatments, among pupils in the primary schools of Glogah county in the Mazandaran province of Iran, during the 2009-2010 school year.. A total of three-hundred students in the first through fifth grades in boys’ and girls’ primary schools were selected via multistage, systematic, cluster, random sampling in the urban and rural areas of Glogah county. They were examined for live lice or nits by experienced educators, while a questionnaire was used to record data on the demographic features and other related information of each student. These data were compared using a chi square analysis (SPSS software), and a P value of less than 0.05 was considered to be significant.. Based on a total of 300 pupils, 17 of them (5.7%) were infested with Pediculus capitis. The prevalence rate was 6.8% in the boys and 4.8% in the girls, while the rate of infestation was 7.7% in the urban areas and 3.4% in the villages. Those children between 9 and 10 years old showed the highest prevalence rate (7.4%). There was a significant association between pediculosis and a prior infestation, number of comb uses per day, frequency of hair washing (per week), having a hygiene teacher, sharing common instruments, health care of the children, children living with parents, knowledge of pediculosis, and the spacing of the children in each class.. The results showed that the prevalence of pediculosis among the Glogah county primary school students was less than the average percentages observed in other students inside and outside of Iran..

Context: Respiratory tract infections (RTIs) affect children all over the world and are associated with significant morbidity and mortality. RTIs are usually triggered by viruses, though bacterial infections are also common.. Children are particularly susceptible to RTIs due to the relative immaturity of their immune systems, and genetic factors (such as family history of atopy) and/or environmental factors (such as exposure to pollution and pathogens) also render certain populations more vulnerable to infection. Furthermore, RTIs tend to be recurrent and can result in multiple infections per year. The management of recurrent RTIs poses a tremendous challenge for physicians, who have a limited armamentarium with which to alleviate patients’ symptoms, treat their disease, and prevent recurrences.. Though antibiotics are rarely indicated, they are often still used to treat RTIs. The resulting increase in bacterial resistance, the lack of treatment efficacy, and drug-related side effects all underscore the need for alternative strategies to manage recurrent RTIs. This article uses a typical pediatric case study to review central issues in the diagnosis and management of recurrent RTIs in children, with an emphasis on the role of immunomodulation as a preventive strategy..

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.. To evaluate the Kobayashi scoring system with regard to predicting response to IVIG treatment in Iranian children..Patients and 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.. 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%.. 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..

Some studies have reported an association between Helicobacter pylori (H. pylori) colonization and the occurrence of asthma or other allergies. However, data are inconsistent, and few studies have been performed in children.. The current study aimed to investigate H. pylori seropositivity in children with and without asthma..Patients and This cross-sectional study was performed with 208 children aged 5- to 12-years-old (104 asthmatic subjects in the case group and 104 healthy individuals in the control group) who had been referred to the pediatric clinic of Amir Kabir hospital in Arak, Iran. H. pylori seropositivity was compared between the two groups according to the serum level of immunoglobulin G (IgG) antibody against the H. pylori cytotoxin-associated gene A (CagA) protein, which was measured using the enzyme-linked immunosorbent assay (ELISA).. The H. pylori serology test was positive in 13 (12.5%) asthmatic subjects and 18 (17.3%) healthy subjects. This difference was not significant (P = 0.54). Duration of asthma in the serology-positive children (3.61 ± 1.5 years) was significantly higher than that of the serology-negative children (2.16 ± 1.33 years) (P = 0.0001). No significant correlations were found between H. pylori seropositivity and age (P = 0.95), gender (P = 0.7), severity of asthma (P = 0.54), control of the asthma (P = 0.23), or pulmonary function test (PFT) results (P = 0.23).. The results showed no association between childhood asthma and H. pylori seropositivity. However, due to the lack of studies, especially in children, and controversial results of the clinical studies, further studies are recommended..