فهرست مطالب

Archives of Pediatric Infectious Diseases - Volume:7 Issue: 1, Jan 2019

Archives of Pediatric Infectious Diseases
Volume:7 Issue: 1, Jan 2019

  • تاریخ انتشار: 1397/11/03
  • تعداد عناوین: 8
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  • Paniz Fathi , Elham Pourbaktyaran*, Erfan Tasdighi , Nasrin Esfandiar , Maryam Kazemi Aghdam Page 1
    Introduction
    Hyperoxaluria is a common abnormal finding in patients with nephrolithiasis, especially in children in contrary to adults. Overall, it is a rare disorder with the four main types of primary, enteric, dietary and idiopathic. The disorder is characterized by overproduction of oxalate that leads to nephrocalcinosis and eventual development of end-stage renal failure.
    Case Presentation
    We report the case of a 2-year-old boy presented with multiple episodes of seizure, gastrointestinal bleeding, loss of consciousness and rise in blood urea nitrogen (BUN) and creatinine (Cr). He underwent imaging study and lumbar puncture with the suspicion of encephalitis. With more history-taking, we understood that he was previously under treatment for nephrocalcinosis. Finally, he underwent dialysis and the level of consciousness improved. His diagnosis was confirmed by renal biopsy and establishing the existence of extensive tubular and interstitial crystal deposition in his kidneys.
    Conclusions
    The case illustrates the need for the early diagnosis of this disorder to prevent systemic oxalosis that affects many organs resulting in severe morbidity and mortality and raising the suspicion of primary hyperoxaluria in childhood progressive renal failure with massive nephrocalcinosis, especially if accompanied by a positive family history. In these cases, complications should be explained to increase drug compliance.
    Keywords: Hyperoxaluria, Oxalosis, Nephrocalcinosis
  • Anahita Sanaei Dashti , Mohammad Rahim Kadivar , Azita Tabatabai , Farid Zand*, Solmaz Salami , Samaneh Ezadpanah , Fariba Shirvani , Kimia Seifi , Nooshin Zarei Page 2
    Background
    The risk of healthcare-associated infections (HAIs) in the developing countries can be up to 20 times greater than the developed countries.
    Objectives
    As the prevalence of HAIs varies even in different wards of a hospital, this study aimed to estimate the prevalence of HAIs in pediatric wards and to compare it with the whole hospital.
    Methods
    This cross-sectional study was conducted in Nemazee Teaching Hospital in Shiraz. We used registered data that was reported monthly during a one-year period (March 20, 2016 to March 20, 2017). Statistical analysis was performed using SPSS software.
    Results
    The average prevalence of HAIs in pediatric wards was 7.77%, while it was 11.38% for the whole hospital. The most prevalent HAIs in the whole hospital and in pediatric wards were urinary tract and blood stream infections, respectively. The mean rate of HAIs was significantly different between various pediatric wards (F = 29.50, P = 0.0001) and all wards of the hospital (F = 27.16, P = 0.0001) (P < 0.05). Investigation of the prevalence of HAIs in the critical, medical, and surgical wards showed the highest prevalence in the critical care ward (13.22% in pediatric wards vs. 17.45% in the whole hospital). Acinetobacter was the most common microorganism causing HAIs in the whole hospital.
    Conclusions
    Considering the prevalence of urinary tract infections in the whole hospital and blood stream infections in pediatric wards, preventive strategies to reduce the infections should be adopted. The high prevalence of HAIs in critical care wards even in pediatric wards compared to medical and surgical wards indicates the importance of interventions in such wards, especially for children with a weak immune system.
    Keywords: Healthcare-Associated Infections, Nosocomial Infections, Prevalence, Pediatric Wards, Nemazee Hospital, Critical Ward
  • Zahra Pourmoghaddas , Narges Ansari*, Bahar Dehghan , Fatemeh Famori , Hosein Saneian Page 3
    Objectives
    The aim of this study was to evaluate endothelial dysfunction in pediatric patients with Helicobacter pylori infection.
    Methods
    In a cross sectional study, 50 children between six and twelve years old were evaluated for Helicobacter pylori infection by a histopathologic specimen. C-reactive protein (CRP) and Interleukin -12 of all subjects was checked. Endothelial dysfunction was evaluated by echocardiography of brachial artery and through measuring flow mediated dilatation (FMD).
    Results
    Mean of FMD level was significantly higher in children with H. pylori infection (P value: 0.04). Interlukin-12 (IL-12) was higher in children with H. pylori infection (P value: 0.04). Linear regression showed a positive association of Helicobacter pylori infection and endothelial dysfunction (beta = 0.3, P value = 0.08).
    Conclusions
    Children with Helicobacter pylori infection have more endothelial dysfunction independent of IL-12.
    Keywords: Child, Endothelial Dysfunction, Helicobacter pylori
  • Marjan Sabzevari , Mehdi Tavalla *, Molouk Beiromvand Page 4
    Background
    Accurate and effective diagnosis of Toxoplasma gondii (T. gondii) infection can make a significant contribution to the control and prevention of the infection, especially in high-risk individuals. Today, polymerase chain reaction (PCR) is frequently applied for the detection of the infection.
    Objectives
    The aim of this study was to evaluate the frequency and genotyping of T. gondii in blood and CSF samples of children with immunodeficiency.
    Methods
    In the current descriptive cross-sectional study, a total of 170 blood samples and 170 cerebrospinal fluid (CSF) samples were randomly taken from 170 children with immunodeficiency. Firstly, the samples were evaluated using the polymerase chain reaction (PCR) method by targeting the RE gene, and then, positive samples were examined by the nested-PCR method, based on the SAG2 genomic target. For genotyping, PCR-restriction fragment length polymorphism (RFLP) assay was by the Hha I and Sau3A I restriction endonucleases.
    Results
    From 340 samples, 23 (seven blood samples and 16 CSF samples) were detected positive by the PCR method. Of 16 CSF samples, all cases were found positive by the nested-PCR method, while all blood samples were negative. After genotyping CSF samples, T. gondii type II was found in 15 samples and one sample was a mix of both types II and III.
    Conclusions
    The findings indicated that the RE target can be considered as a sensitive method for the diagnosis of toxoplasmosis in the CSF samples, especially in children with immunodeficiency. In addition, this study showed that genotype II was the prevailing genotype in the patients.
    Keywords: RE Gene, SAG2 Locus, Toxoplasma gondii, Polymorphism, CSF, Iran
  • Dina M. Hassan , Reham H. A. Yousef , Walaa A. Abu Elhamed , Aliaa A. Ali , Lamiaa A. Madkour * Page 5
    Background
    Being the culprit in 9% - 13% of neonatal bloodstream infections (BSIs), candidemia has been escalating to worrisome levels in the past few decades. While C. albicans has traditionally been the most common isolate, non-albicans Candida spp. are currently gaining a foothold.
    Objectives
    We endeavored to investigate the epidemiological features of neonatal candidemia with special emphasis on non-albicans candidemia. Hence, we evaluated the incidence, risk factors, antifungal susceptibility, and case fatality rate of candidemia patients in the NICU.
    Methods
    Blood samples were collected from 1296 neonates admitted to the NICU of a tertiary care hospital. Then, only neonates with positive blood cultures were enrolled. Incidence and risk factors of albicans and non-albicans candidemia were evaluated. The E-test was employed to determine the minimum inhibitory concentrations of fluconazole, itraconazole, voriconazole, amphotericin B, and caspofungin.
    Results
    Out of 214 neonates with BSI, candidemia afflicted 32 neonates (15%). The predominant isolate was C. tropicalis (43.8%), followed by C. albicans (25%). Both antibiotic use and antifungal prophylaxis were contributing factors (P values of 0.02 and < 0.01, respectively). Susceptibility testing revealed that 87.5% of the retrieved Candida isolates were sensitive to amphotericin B, 81.25% to fluconazole, 75% to voriconazole, and 62.5% to itraconazole while 48.75% were sensitive to caspofungin.
    Conclusions
    Neonatal candidemia often carries an ominous prognosis. The worldwide progressive shift towards non-albicans candidemia necessitates regular surveillance and monitoring of laboratory data. An epidemiological knowledge is critical in terms of preemptive management that should encompass disciplined infection control practices and a restrictive policy for antibiotic and antifungal prophylaxis.
    Keywords: Candidemia, C. tropicalis, Neonates, NICU, Non-albicans Candida
  • Fariba Shirvani , Reza Arjmand*, Mehri Golami , Esfandiar Najafi Tavana , Samira Saee Rad , Kumars Pourrostami , Omid Safari , Saeed Nikkhah , Mostafa Qorbani , Nasrin Elahimehr , Ehsan Zahmatkesh , Kimia Seifi Page 6
    Background
    The administration of Haemophilus influenzae type b (Hib) conjugate vaccine led to a decrease of over 90% in the prevalence of severe Hib diseases in the countries with universal coverage vaccine. After addition of Hib vaccine to the national vaccination program and since no study has yet investigated this subject.
    Objectives
    The current study aimed at investigating the serologic response and assessing oropharyngeal colonization with Hib after the last dose of vaccine.
    Methods
    A total of 500 blood and oropharyngeal samples were collected from one-year-old children referred to Karaj health care centers, Iran. Demographic information and risk factors of the children were collected. Oropharyngeal and blood samples were transferred to the laboratory to determine antibody titer by the enzyme-linked immunosorbent assay (ELISA) technique, culture testing, and polymerase chain reaction (PCR).
    Results
    In the current study, 11.8% of children (95% confidence interval (CI): 8.97 - 14.63) had an anti-Hib IgG titer of ≥ 5 µg/mL. Geometric mean titer (GMT) of vaccine antibody was 6.92 µg/mL (95% CI: 6.76 - 7.08); 9% of oropharyngeal culture results were positive for H. influaenzae (non-type b) and 8.2% were confirmed by PCR. Prevalence of oropheryngeal Hib colonization was 0.02%. There was no significant correlation between the titer of H. influaenzae antibody and positive culture of H. influaenzae and the other studied variables (P > 0.05).
    Conclusions
    In Iran, similar to most countries, pentavalent vaccine in national vaccination program decreased the prevalence of Hib colonization. Prevalence of Hib colonization is an important factor in invasive diseases incidence. It is suggested that further studies asses the prevalence of invasive Hib diseases after national vaccination.
    Keywords: Childhood, Haemophilus influenzae Type b, Vaccination
  • Saleh Khoshnood , Nader Pestehchian , Seyed Hossein Hejazi , Abdollah Rafiei , Ali Soleimani , Mahmoud Ahmadi , Zahra Jabalameli , Mohammad Ali Mohaghegh* Page 7
    Background
    Human toxocariasis is caused by Toxocara canis and cati, which are the main ascarids of dogs and cats, respectively. Most infected humans are asymptomatic and our understanding of human disease burden is limited by lack of epidemiological studies and insufficient clinical awareness.
    Objectives
    There is no precise report on the seroprevalence of toxocariasis in Ilam children. Therefore, this study found an opportunity to investigate this subject.
    Methods
    In this cross-sectional study, 300 sera of children aged between 2 to 15 years old were collected during March 2016 to February 2017 in urban and rural areas. Demographic variables were filled for each person in accordance with risk factors along with sampling. Some hematological parameters were measured. The sera were examined for anti Toxocara canis and cati antibodies, according to the ELISA kit protocol.
    Results
    Among a total of 300 serum samples, 35 (11.7%) were positive for anti-Toxocara IgG. The infection rates were 5.3% and 6.3% in female and male, respectively. There was no significant relationship between gender and Toxocara infection rates (P = 0.59). A total of 26 (17.3%) of the 150 rural children, and nine (6.0%) of the 150 urban children were positive. There was a significant relationship between place of living with ELISA tests results (P = 0.004). Hematologic parameters showed a significant increase in the numbers of peripheral eosinophil in the sample of patients whose sera were positive (P = 0.037).
    Conclusions
    High prevalence of toxocariasis among Ilam children in the west of Iran can be considered as a public health problem. The evaluating infection control programs in dog and cats are necessary for controlling the disease in this region.
    Keywords: Toxocara, Seroprevalence, Children, Iran
  • Reza Saeidi , Hossein Akhavan , Jalil Tavakkolafshari , Abbas Shapouri, Moghaddam * Page 8
    Background
    A double-blind, placebo-controlled randomized trial was designed to investigate the effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on the prognosis of preterm infants with early onset neonatal sepsis (EONS).
    Methods
    Fifty preterm infants were selected from the neonatal intensive care unit (NICU) of Qaem Hospital, Mashhad, Iran in 2011. They were randomized to rhG-CSF (intervention group, n = 25) or identical placebo (control group, n = 25) for 3 days. The following blood parameters were measured: White blood cells count (WBC), absolute neutrophil count (ANC), serum level of high-sensitivity C-reactive protein (hs-CRP), and the ratio of immature to total neutrophils. In addition, the mortality rate, adverse effects, and duration of hospital stay were evaluated as clinical parameters.
    Results
    At baseline, both groups were not significantly different (P > 0.05) except for the hs-CRP level (P = 0.024) and hypoglycemia (P = 0.001). Compared with the controls, significant improvements were only observed in WBC (P = 0.001) and ANC (P = 0.010) of the intervention group. The mean difference in the WBC, ANC, hs-CRP level, and the ratio of immature to total neutrophils between the baseline and 3-day post-treatment values was higher in the controls than the intervention group. More than 90% of the patients exposed to either rhG-CSF or placebo hospitalized for over 72 hours and no significant difference was found between them (P = 0.946). In each group, a decease was recorded (4.0%) during the hospitalization.
    Conclusions
    The rhG-CSF administration could effectively improve WBC and ANC. No significant changes were observed in mortality rate, adverse effects, and hospital stay after the treatment.
    Keywords: Recombinant Human Granulocyte Colony Stimulating Factor, Early Onset Neonatal Sepsis, Preterm Infants, Randomized Controlled Trial