Archives of Pediatric Infectious Diseases
Volume:5 Issue: 4, Oct 2017

Context: Fungal keratitis is an uncommon infection with high morbidity in pediatric patients. Trauma is the most common risk factor for infection in children. Thus, rapid diagnosis should be made by scoring clinical features and mycological examination. This review discusses the management of fungal keratitis in pediatric patients.
Evidence Acquisition: In this narrative review, the most recently published data on pediatric fungal keratitis, respective prominent signs and symptoms, etiologic agents, diagnosis and treatment of this infection have been reviewed.
Laboratory methods such as investigation of smear by potassium hydroxide and staining and cultural and molecular methods can be helpful in the diagnosis. Treatment of this infection with improved outcome is challenging. Medical therapy (topical and systemic treatments) is the first choice of treatment, but early surgical intervention and removal of the infected tissues are critical for effective cure. Lack of response to these therapies requires corneal transplantation. Unfortunately, loss of useful vision rate was found in patients even with treatment by antifungal agents.
The signs and symptoms of fungal keratitis are similar to those of other microbial keratitis. Use of diagnostic methods and early treatment are helpful for recovery in infected pediatric patients.

Status of maternal education has a direct association with the incidence of childhood mortality. Despite many collected data about maternal education in developing countries, similar studies in transitional countries are low.
The overall aim of this study was to define the relationship between maternal education and a variety of health parameters in families with young children.
In this study, 1112 families were enrolled. Data relevant to the factors linked with health parameters was collected through face-to-face interviews with parents. The infants aged 6 - 24 months were brought to the out-patient clinics of Taleghani and Mofid children teaching hospitals, Tehran, Iran, for vaccinations, checkups, or minor childhood illnesses. According to level of education, the mothers were divided to two groups: those who had received formal education for at least nine years (group A) and those with less than nine years of education (group B).
The rate of single child (68.33%, P = 0.000) and cesarean delivery (61.53%, P = 0.000) was significantly higher in educated mothers (> 9 years). Conversely, frequency of low birth weight infant (9.1%, P = 0.021) and hospitalization after the neonatal period (15.4%, P = 0.024), in families with low maternal education, was significantly increased. Overall, 28.9% of children were exposed to second-hand smoke (SHS), which in all cases, fathers were responsible for the exposure (P = 0.00). Maternal education was significantly associated with infants’ exposure to SHS from their smoking fathers.
Our findings revealed the significant effect of maternal education on health parameters and indicated that low maternal education may increase the risk of mortality in infants.

Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to most antibiotics and can transfer resistance to other bacteria, which is a significant problems among hospitalized children with MRSA infections.
The aim of this study was to detect blaOXA-1 and blaDHA-1 AmpC β-lactamase-producing MRSA in hospitals.
In this descriptive study, 21 MRSA samples isolated from healthcare providers’ nostrils and 35 samples isolated from clinical cases, obtained between August 2012 and July 2013, were examined. Antimicrobial susceptibility testing was performed using agar disc diffusion (i.e., the Kirby-Bauer method). Polymerase chain reaction (PCR) approaches were used to examine MRSA molecularly for blaOXA-1 and blaDHA-1 AmpC β-lactamase genes.
From the 56 MRSA samples, the highest antibiotic resistance was to penicillin (92.29%) and ceftazidime (82.98%). All isolates were sensitive to linezolid and vancomycin. Only one clinical MRSA sample carried both blaOXA-1 and blaDHA-1 AmpC β-lactamase-encoding genes
Improper consumption of antibiotics and environmental factors play important roles in the emergence and spread of antibiotic-resistant MRSA. Thus, the significance of the isolates from this study was that they were assayed for the presence of resistant genes, such as blaOXA-1 and blaDHA-1 AmpC β-lactamase, in healthcare worker and patient samples, and decolonized to reduce transmission of antibiotic-resistant microorganisms in hospitals.

The increasing emergence of resistance among clinical isolates of Klebsiella pneumoniae (K. pneumoniae) has limited the therapeutic options used to treat infections caused by these bacteria.
The aim of this study was the molecular detection of quinolone resistance genes acrA, acrB, qepA, and aac(6’)-Ib-cr in K. pneumoniae strains isolated from hospitalized patients in selected hospitals in Tehran during 2013 - 2014.
One hundred and seventeen strains of K. pneumoniae were isolated between August 2013 and March 2014 from hospitalized patients in Taleghani hospital, Mofid children’s hospital, and Imam Hossein hospital in Tehran. Antimicrobial susceptibility tests were performed using disk diffusion and broth microdilution methods based on CLSI guidelines. The identification of the genes that encode efflux pumps acrA, acrB, qepA, and aac(6’)-Ib-cr was done using the PCR technique.
Antimicrobial susceptibility tests showed that colistin and tigecycline had the best effect against clinical isolates of K. pneumoniae. The PCR assay detected the acrA and acrB genes in 110 (94%) and 102 (87%) isolates, respectively. Additionally, the qepA and aac(6’)-Ib-cr genes were detected in 5 (4%) and 100 (85%) isolates, respectively.
The prevalence of the acrA, acrB, qepA, and aac(6’)-Ib-cr genes in K. pneumoniae, which causes resistance to fluoroquinolones, in this study is cause for concern. Based on our results, accurate identification of resistant Gram-negative bacteria such as K. pneumoniae and detection of its susceptibility to common antibiotics could lead to proper treatment and control of resistant nosocomial infections.

Respiratory tract diseases in children are one of the two leading causes of death worldwide and Mycoplasma pneumonia is the most important etiologic agent of respiratory tract infections.
This study aimed at determining the seroprevalence of Mycoplasma pneumoniae specific IgM and IgG antibodies in asymptomatic 5- to 6-year-old children in Tehran, Iran.
This cross sectional study was conducted during summer season of year 2010 in Tehran, North of Iran. Overall, 291 children were enrolled in the study in a sequential method. Blood samples were obtained from each child and the serum was separated and stored frozen at -70°C for later antibody assay. Detection of IgM and IgG antibodies against M. pneumoniae was performed using commercial qualitative Enzyme Linked Immunosorbent Assay (ELISA) kits.
Of the 291 participants in the present study, 156 (53.6%) were female and 135 (46.4%) were male. Overall, 73 (25.1%) serum samples had positive results for M. pneumoniae specific IgG. The frequency of positivity and mean of titers for M. pneumoniae specific IgG antibody among males and females was 31 (23%), 17.4 ± 5.5 U/mL (95% CI 16.77 - 18.03) (ranged from 12.2 to 33 U/mL), and 42 (26.9%); 17.1 ± 4.4 U/mL (95% CI 16.6 - 17.6) (ranged from 12 to 28 U/mL), respectively. Moreover, all tested serum samples for M. pneumoniae-specific IgM were negative.
In summary, our findings present the frequency of recent and previous exposure to M. pneumoniae infection among asymptomatic children aged from 5 to 6 years old in our region. Moreover, findings of such surveillance studies could provide useful insight to compare our situation with others.

Although primary varicella zoster virus (VZV) infection (chicken pox) is a mild childhood disease, it can cause severe infection with complications in adults. As the disease is preventable by effective vaccination, it is important to determine the level of immunity to VZV in every region to implement proper vaccination strategies.
The aim of this study was to investigate the seroprevalence of VZV infection in adolescents living in different provinces of Iran.
In a cross-sectional multicentre study, serum samples from 2315 students, aged 10 - 18 years, were examined for VZV antibodies (IgM/IgG). Students were selected by multistage cluster sampling during a national surveillance program.
Prevalence of VZV antibodies was statistically different in various provinces of Iran (P = 0.001); it ranged from 82.4% in Isfahan, Center of Iran, to 98.5% in Mazandaran, North of the country. The VZV seroprevalence was not significantly different by gender, except for Khuzestan, South of Iran, where antibodies were much more prevalent in girls (92.7%) than in boys (78.3%, P = 0.004). Seroprevalence was not significantly different according to the living area (urban/rural).
VZV seroprevalence is different in various provinces of Iran; the susceptibility of adult population to VZV infection is suggested to be high in Ardabil, Isfahan, and Kermanshah; and low in Kerman and Mazandaran. Therefore, different strategies should be implemented in each province to protect high-risk adults from severe varicella infection.

Escherichia coli is the most common cause of urinary tract infections. Different studies have been reported that acquisition of drug resistance mechanism may be related to loss of virulent factors. In this study, we investigated the correlation of antibiotic resistance and ESBLs production with presence of hlyA and cnf1 virulence genes.
During June 2014 to March 2015, 250 Escherichia coli isolates were collected from different patients with urinary tract infections in Kerman, Iran. Disk diffusion method was used for determination of antibiotic susceptibility profile and combined disk method was used for detection of ESBLs producing isolates. The hlyA and cnf1 genes were detected by PCR method.
In total, 44.8% of isolates were considered as extended spectrum beta-lactamases (ESBLs) producing by combined disk method. hlyA and cnf1 genes were detected in 28.8% and 29.2% of isolates, respectively. Statistical analysis revealed significant correlations between susceptibility to NA, CIP, CTX, CAZ, PIT antibiotics with hlyA and cnf1 positive isolates and also significant correlation observed between ESBLs negative isolates with hlyA positive isolates (P value Acquire of antibiotic resistance mechanism may lead to loss of virulence factor.

Notwithstanding the current advances in the drug discovery and the pharmaceutical biotechnology, the bacterial infectious diseases are still one of the biggest health concerns worldwide. Also, the new therapeutic methods are urgently required due to the increasing resistance to antimicrobial agents.
The current study aimed at investigating the synergic effect of eucalyptus leaf oil and silver nanoparticles (Ag NPs) on Escherichia coli H7:O157, Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA), Salmonella enterica, and Bacillus subtilis.
The current experimental study was performed in Islamic Azad University, Iran. The disc diffusion method, well diffusion method, and broth dilution assay were used in the current study.
Results showed that none of the drugs affected the bacteria by disk diffusion method. In broth dilution method, E. coli O157:H7, E. coli, MRSA, and S. enterica showed the same susceptibility and B. subtilis showed more susceptibility to the combined agents.
The current study showed the synergic effect of Ag NPs 1.5 ppm plus eucalyptus leaf oil on the growth inhibition of E. coli O157:H7, E. coli, MRSA, S. enteric, and B. subtilis. The combined drug showed more efficiency; lower dose of each medicine in the combinatory form decreased the toxicity in the treatment of infections caused by these bacteria.

Primary immunodeficiency disorders comprise a heterogeneous group of diseases in which there is a defect in the development or function of the immune system. Clinical presentation of these disorders is highly variable. The aim of this study was to determine the frequency and type of primary immunodeficiency disorders, diagnostic delay, common pathogenic microorganisms, and infectious complications in patients, admitted to Mofid Children’s hospital in the past decade (2004 - 2014).
The data of patients with a diagnosis of primary immunodeficiency disorder, admitted to Mofid Children’s hospital from 2004 to 2014, were reviewed. The frequency, diagnostic delay, pathogenic microorganisms, and their sequelae were determined.
In 32 patients (20 males and 12 females) admitted to Mofid hospital in the past decade, chronic granulomatous disease was the most frequent primary immunodeficiency disorder (22%). Other immunodeficiency disorders in these patients included X-linked agammaglobulinemia, hyper IgM syndrome, common variable immunodeficiency, severe combined immunodeficiency, ataxia-telangiectasia syndrome, transient hypogammaglobulinemia of infancy, leukocyte adhesion deficiency, and Kostmann syndrome. The mean age at onset of these disorders was 15 months, and the mean delay in diagnosis was 20 months. Pneumonia was the most common infectious manifestation (53%), and Acinetobacter was the most common isolated microorganism.
Diagnostic delay is a major concern in patients with primary immunodeficiency disorders. Ethnic and geographical differences may significantly influence the frequency and presentation of these disorders. Therefore, local epidemiological data are always necessary and useful in the management of primary immunodeficiency disorders.

Septicemia is an important cause of acute kidney injury (AKI) in neonates admitted to neonatal intensive care units. The aim of this study was to identify the predictive factors for AKI in neonates with culture-proven septicemia.
Medical records of 138 newborns with septicemia were evaluated in 2 groups with (n, 65) and without (n, 73) AKI.
The mean age at diagnosis of AKI was 11.31 ± 9.92 days. AKI was more common in neonates with lower gestational age, birth weight, age, blood pressure, platelet count, and serum pH at admission. Moreover, AKI was associated with an increased incidence of intubation at birth, inotrope treatment, shock, disseminated intravascular coagulation (DIC), mechanical ventilation, and morality. Gestational age, initial serum pH, and DIC were the only independent predictors of AKI in the multivariate analysis. In addition, serum pH at admission was the most accurate laboratory marker for the prediction of AKI with 83% sensitivity and 60% specificity.
Monitoring of renal function is highly recommended in low-birth-weight infants with severe septicemia.

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.
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.
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.
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.
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.

Methicillin resistant Staphylococcus aureus (MRSA) are one of the most common and important pathogens, accounting for diverse nosocomial and community-acquired infections. The serious concern about these bacteria is the development of antibiotic resistance.
The present study was conducted to investigate the frequency of MRSA strains, their epidemiological and molecular relationships and antibiotic susceptibility patterns of isolated strains from university teaching hospitals of Tabriz, Northwestern Iran (during years 2014 and 2015).
A total of 215 non-repetitive clinical isolates of S. aureus were identified using standard methods. The MRSA isolates were detected by the combination of phenotypic and genotypic methods. The presence of pvl gene and SCCmec types was determined by PCR and multiplex PCR, respectively. The MRSA isolates, in which the presence of mecA gene had been confirmed by PCR, were subjected to Rep-PCR analysis. Resistance to antibacterial agents was determined by disk diffusion, screening agar, and E-test methods.
All S. aureus isolates were positive for nuc gene and 87 (40.5%) of them revealed the presence of mecA gene, confirming them as MRSA. All isolates were found to be sensitive to linezolid and vancomycin. However, a reduced sensitivity of 3 MRSA isolates to vancomycin was observed (MIC = 6 μg/mL). SCCmec type III was the most prevalent (79.31%), followed by type IVd (13.80%) and type I (6.90%). The PVL occurrence was detected in 33 (15.35%) S. aureus isolates. The MRSA isolates could be divided to 2 main clusters, indicating the possible clonal relatedness of MRSA isolates.
The MRSA isolates with SCCmec type III were the predominant MRSA strains in this area. The majority of MRSA isolates were MDR. Linezolid and vancomycin were found as suitable antibiotics for the treatment of MRSA. The results of typing methods indicated possible clonal relatedness among MRSA isolates. Therefore, routine infection control surveillance is necessary for the prevention of epidemic emergence.

There are several reports of recurrent infections in patients with organic acidemia. Almost all studies on the immune system of these patients have investigated the immune system in the acidotic phase of the disease. In the present study, the phagocytic component of the immune system was evaluated in patients with organic acidemia.
After exclusion of patients in the acidotic phase of the disease, 31 patients with organic acidemia were included in the study. All patients completed the written informed consents, and the study was approved by the ethics committee of Mofid Children’s hospital. Information including age, sex, type of organic acidemia, and history of hospitalization due to infection was recorded. Screening tests of phagocytic component of the immune system, including total and differential white blood cell (WBC) count and nitroblue tetrazolium (NBT) test, were performed for all the patients.
The prevalence of neutropenia was high among patients (22.6%); it was even more frequent in patients younger than 3 years (42.6%). On the other hand, in most patients (93.5%), neutrophils showed normal function on the NBT test.
Neutropenia in the nonacidotic phase of organic acidemia can be the cause of recurrent infections in these patients. It can be independent of bone marrow suppression, caused by reduced production of these cells as a result of reduced pH in the acidotic phase of the disease.

Hepatitis B Virus (HBV) infection remains a public health and health care issue in Iran. Since the data on its outbreak is required for effectual policies, this epidemiological study was performed on population from Neyshabur, where there has been no former epidemiological information.
This study aimed at investigating the epidemiology of hepatitis B surface antigen among subjects from Neyshabur, from year 2011 to 2015.
The researchers established this study from data collected from a surveillance system. Screening tests were carried out by the Chemioluminsance method. Age, gender, referral year and month were the investigated variables. Data were analyzed by the SPSS-20 software.
The prevalence of HBsAg in Neyshabur was 4.11%. In the age group of more than 40 years (1.87%) and females (2.2%) had significantly (P Hepatitis B Virus (HBV) infection rate was seemingly high in Neyshabur, even higher than other parts of Iran. An immunization program should be continued progressively for high-risk areas, especially the Neyshabur city of Iran.