Archives of Pediatric Infectious Diseases
Volume:6 Issue: 3, Jul 2018

Escherichia coli is the main cause of urinary tract infection regardless of age. If it harbors shiga toxin, hemolytic uremic syndrome may occur. The aim of this study was to determine the incidence and prevalence of Shiga Toxin producing E. coli (STEC), as a cause of urinary tract infection in Iran.
Major medical search engines, Iranian scientific search engines, and Iranian databases for thesis were searched for relevant English or Persian keywords for urinary tract infection, shiga-toxin Escherichia coli, and hemolytic uremic syndrome in Iran, which were published between 1985 and 2017. The study was followed by the PRISMA statement. Point prevalence and proportion were calculated by random effect and I2 for heterogeneity and expressed as 95% confidence intervals. MedCalc version 15 and SPSS IBM were used for statistical analysis.
A total of six articles with 1,111 positive E. coli urine cultures met all the inclusion criteria and were eligible for the final analysis. All studies had a cross-sectional design. The qualities of two studies were poor with low to moderate risk of bias. Considering 32 samples reported as positive for STEC, the pooled prevalence for E. coli associated UTI was 3.46% (95% CI, 0.89 to 7.65, I2 = 86%). The study was heterogeneous for publication bias.
This review indicated that STEC constituted some percentage of uropathogenic E. coli that required to be considered during culture processing and longer clinical follow up of the patients for the occurrence of STEC-related morbidity.

Vesicourethral reflux is the reverse flow of urine from the bladder to the ureter and then to kidneys. 30% to 40% of children are infected with urinary tract infections disease, and recenthly, one of the most common urinary tract infections has become Extended - Spectrum Beta - Lactamases (ESBL) Escherichia coli isolates.
The aim of this was to investigate the correlation between extended Extended Spectrum Beta Lactamase Escherichia coli isolates and reflux nephropathy disease in children.
This was a case - cotrol study conducted on 200 children with or without reflux nephropathy referred to the pediatric clinic. The researchers selected two groups of children; 100 children with reflux nephropathy and 100 healthy children. Urinary tract infection was tested by urine culture and antibiogram. Correlation of reflux nephropathy and ESBL Escherichia coli infection were analyzed by the SPSS program.
Infected children with Extended Spectrum Beta Lactamase E. coli infection compared with healthy children, were more influenced by reflux nephropathy. Overall, 53% of case and 9% of control group had infection of ESBL Escherichia coli.
Reflux nephropathy can be controlled by prevention of these types of infections.

This study describes the antibiotic resistance pattern in patients with Acinetobacter bacteremia and investigates the factors leading to extensively drug resistance (XDR) and mortality.
This descriptive analytical study was conducted in patients with Acinetobacter bacteremia between February 2014 and February 2015. The microorganisms were identified with conventional bacteriological methods and then, following the clinical and laboratory standards institute (CLSI) recommendations, susceptibility testing was performed on all isolates. Moreover, we used electronic records to extract the patients’ data and analyzed them using Chi-square test or Fisher’s exact test and T-Test.
Among the influencing factors, the severity of clinical symptoms at the time of admission, longer duration of hospitalization especially in the ICU, and use of invasive devices such as ventilator had a significant relationship with the occurrence of resistance and mortality in the patients. In addition, the central venous catheterization and history of drug resistance such as XDR were associated with mortality.
Given the increasing prevalence of XDR Acinetobacter strains causing resistant nosocomial infection, especially in immunocompromised patients, it is necessary to reduce the risk factors leading to drug resistance and mortality. Furthermore, early administration of empiric antibiotic therapy can have a good effect on the outcomes.

Acute respiratory infection plays a major role in hospitalization of children worldwide and viruses are one of the most important causative pathogens of acute respiratory tract infections (ARTIs). Human metapneumovirus (hMPV) is a respiratory pathogen responsible for ARTIs in infants and children around the world. The epidemiology of hMPV in the northeast of Iran is poorly described. This study aims to evaluate the prevalence and molecular types of hMPV in children under the age of 12 along with clinical relevance in northeast Iran.
In this cross sectional study, from autumn 2015 to spring 2016 (nine months), 150 nasopharyngeal swabs were collected from children with ARTI and were evaluated for the presence of hMPV by reverse transcriptase-polymerase chain reaction (RT-PCR) technique; after that hMPV typing on positive samples was performed using PCR method.
Among the 150 patients that were included the study, 31 (20.6%) were positive for the hMPV genome. We also found that 96.8% (n = 30 cases) of positive cases belonged to genotype A; whereas no B genotype was detected. One of our hMPV isolates was non typable (3.2%).
This study, for the first time, reports the existence of Human metapneumovirus virus in children with respiratory symptoms in northeastern Iran. We have also shown that the genotype A is the predominant circulating type among our patients.

Brain Abscess (BA) is an uncommon intracranial suppurative infectious disease, especially in children. Its treatment involves surgery and prolonged antibiotics courses.
The current study aimed at describing the clinical characteristics of children with BA, treated at the central Tunisian region health center.
A retrospective study, lasting 19 years (1995 to 2014), was conducted in four Tunisia pediatric departments of the central region. Forty-one children having radiological abnormalities suggestive of BA and confirmed operative lesions were included. Mycobacterial, parasitic or fungal abscesses were excluded. Medical records were analyzed for age, gender, presenting symptoms, predisposing factors, imaging, microbiology findings, treatment, and outcome.
The mean age was 4.9 years (range: 4 days to 16 years). The most common clinical presentations were increased intracranial pressure symptoms (87%). Brain Abscess was diagnosed in 95.1% on the basis of cranial imaging. The majority of abscesses were supratentorial (92.6%). The most frequent etiology was contiguous infections of the skull (63.4%). No predisposing factor was found in 17%. Intravenous antibiotics were given in all cases with surgical drainage in 63.4%, causative organisms were identified in 53.7%; gram positive cocci in 21.9%, and gram negative cocci in 9.7%. The mortality rate was 24.3%. Age of less than two years was the only statistically significant identified prognostic factor.
The current study confirmed the severity of this pathology and underlined the importance of early diagnosis and management.

Backgound: The aims of this study were to evaluate the antimicrobial properties and synergistic effects of nano-titanium dioxide (TiO2), nano- zinc oxide (ZnO) and two synthetic peptides (mastoparan-B, indolicidin) against drug-resistant strains of Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii.
From March to August 2015, a total of 30 (10 each) isolates of the above bacteria were recovered from patients in the ICU of two referral hospitals in Kerman, Iran. The sizes and purities of nano-TiO2, nano-ZnO were determined by scanning electron microscope (SEM) and X-ray diffraction (XRD). Similarly, mass spectroscopy and HPLC were used for checking the genunity of the peptides. Antibiotic sensitivity was determined by agar disk diffusion assay. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) activities of nanometals and synthetic peptides were assessed by CLSI broth microdilution test. Similarly, checkerboard and time-kill curve analysis were performed to determine the synergistic activities of these compounds.
Mastoparan-B had potent toxicity to all isolates with an average MIC 4 ± 0.2 mg/L, while TiO2-NP had lowest antimicrobial activity with MIC range 1280 ≥ ± 0.2 mg/L (P. aeruginosa growth was not inhibited by TiO2 and ZnO NPs). The bactericidal activity against the isolates in descending order was mastoparan-B, indolicidin, nano ZnO, and nano TiO2, respectively. Further investigation on synergism using fractional inhibitory concentration index (FIC) revealed that, nano-TiO2 and nano-ZnO combination had an additive effect (FIC = 0.95 ± 0.1) on A. baumannii and K. pneumoniae strains, whereas, P. aeruginosa isolates were indifferent to this combination (FIC ≥ 2 ± 0.2). In contrast, mastoparan-B and indolicidin combination displayed broad synergistic effect (FIC = 0.5 ± 0.1) on all the isolates and caused rapid killing of the organisms within 4 h of incubation.
Our results showed that the combination of mastoparan-B and indolicidin peptides is a suitable candidate for substitution of the antibiotics for topical treatment of infections caused by drug- resistant bacteria. to determine the incidence and prevalence of Shiga Toxin producing E. coli (STEC), as a cause of urinary tract infection in Iran.

This work aimed to study the detection and genotyping of rotavirus, enteric adenovirus, and astrovirus in Egyptian hospitalized children below five years old, associated with non-bacterial diarrhea. In total, 119 fecal samples were obtained from the target population, admitted to Abu El-reesh hospital in Cairo, Egypt. Based on the findings, the detection rate of at least one viral infection was 36.7% in children below five years old, whereas, the overall detection rate of rotavirus, adenovirus, and coinfection was 31%, 6.7%, and 0.8%, respectively. No astrovirus infection was observed. Spring was the peak season for rotavirus and enteric adenovirus. The findings showed that higher rates of rotavirus (78%) and enteric adenovirus (100%) were identified in children less than two years of age. The dominant genotypes were G1P [8] (29.7%), G3P [8] (27%), and G1P [4] (18.9%) for rotaviruses and genotype 41 for enteric adenoviruses. Uncommon genotypes G1P [6] and G9P [8] were also detected in five (13.5%) and four (10.8%) samples, respectively. The present findings indicated that the high incidence of rotavirus and adenovirus in children below two years old. Thus, highlighting the necessity of vaccine development to reduce the incidence of acute viral gastroenteritis in Egypt.

The aim of the present study was to investigate biofilm formation among Methicillin-resistant Staphylococcus aureus (MRSA) isolated from children referring to a pediatric hospital in Tehran.
In total, 98 MRSA isolates were collected from children referring to a pediatric hospital during 2014 - 2015. All the isolates were confirmed to be MRSA using PCR amplification of the mecA gene. The antibiotic susceptibility patterns of the isolates were determined using the Kirby-Bauer disk-diffusion and E-test methods. In order to assess the ability of biofilm formation among the isolates, Congo red agar (CRA) and Microtiter Plate (Mtp) methods were used.
All the isolates were found to be susceptible to linezolid and vancomycin and, likewise, the majority was susceptible to minocycline and rifampicin. CRA and Mtp methods showed that 81.6% and 63.3% of the MRSA isolates, respectively, were biofilm producers.
The early identification of S. aureus and detection of biofilm formation by the Mtp method are essential steps towards the prevention of the most serious nosocomial infections.

Actinomycosis is an unusual infection, which usually appears in the thoracic, cervicofacial, and abdominal areas. Renal actinomycosis is rare and has not yet been reported in children.
An 8-year-old boy presented with a fever, weight loss, and flank pain two weeks after a sore throat. As the imaging studies were in favor of the malignant tumor of the right kidney, he underwent right radical nephrectomy. Pathologic study revealed Xanthogranulomatous pyelonephritis and actinomyces bacterial colonies.
Renal actinomycosis is difficult to diagnose due to its non-specific clinical findings and near similarity to other inflammatory and tumoral conditions. Early diagnosis is important for medical treatment and decrease of un-necessary surgery. Using auxiliary diagnostic methods can be helpful in this aspect. Percutaneous core needle biopsy or fine needle aspiration possesses higher accuracy and specificity in comparison with other methods.

Hydatid disease is a zoonotic parasitic infection that affects humans in many parts of the world, including Iran. It is caused by the larval stage of a tapeworm called Echinococcus. Human is an intermediate host infected accidentally by the ingestion of eggs excreted in the feces of dogs. This infection most commonly involves the liver and lung. Other site localizations are rare including kidney that is seen in 2% to 4% of cases.
Here we report a 9-year-old boy with kidney involvement in a village near Poldasht city, West Azerbaijan, Iran, admitted on Jan 2013. He referred to our hospital with a left upper quadrant (LUQ) mass without any other symptoms, which was discovered by his mother accidentally. Sonography and CT scan with and without contrast revealed large hypodense fluid containing a mass arising from the left kidney that stretched renal parenchyma. Surgery consult was done and radical nephrectomy with left adrenalectomy and retroperitoneal lymphadenectomy due to the suspicion of malignancy was performed. In addition to surgery, he received the first dose of chemotherapy for Wilms tumor and after the pathologic report, albendazole started for him. A definitive presurgery diagnosis is not always possible by radiographic evidence. Therefore, the hydatid disease should be in the differential diagnosis of renal mass. Only surgery and pathologic findings can confirm the diagnosis. In our case, due to the lack of a definitive radiologic evidence for hydatid diagnosis, we did not start albendazole presurgery and albendazole started and continued for six months after the pathologic report confirmed the hydatid disease.
We recommend that albendazole starts in endemic areas for abdominal masses with a non-definitive diagnosis.