Archives of Pediatric Infectious Diseases
Volume:9 Issue: 1, Jan 2021

 Identifying etiologic factors contributing to Wilms tumor (WT) is necessary for its prevention and treatment. Oncogenic viruses cause nearly 20% of all human cancers. Although trials on preventing virus-caused cancers are complex and difficult, but they are not impossible to conduct. Human Cytomegalovirus (HCMV) and human herpes virus-6 (HHV6) can cause different types of cancers.

 The current study aimed to investigate whether HCMV and HHV6-DNA are present in patients with WT. This is the first study of this kind in Iran.

 This study was performed on patients with kidney disorders who were referring to Mofid Pediatrics Hospital, Tehran (Iran), during 2010-16. In total, 98 kidney samples (49 patients with WT and 49 normal kidneys (autopsy) and kidneys with benign noninfectious lesions) were investigated to identify HCMV and HHV6-DNA. Qualitative Polymerase Chain reaction (PCR) method and nested polymerase chain reaction (nested-PCR) technique were used to identify HCMV and HHV6, respectively.

 No significant difference was found between WT patients and controls concerning the HCMV or HHV6.

 Based on the findings, it can be concluded that there is no association between these viruses and WT.

 Pneumonia remains one of the leading causes of childhood mortality and morbidity in developing countries. Studies showed that zinc supplementation can prevent pneumonia, but its therapeutic effectiveness has not been determined definitively.

 This study evaluated the effect of zinc supplementation as adjuvant treatment on children with severe pneumonia admitted to 17th Shahrivar Training Hospital in Rasht, Iran.

 In this double-blind placebo-controlled clinical trial, 120 children aged two to 60 months hospitalized for pneumonia were randomly divided into 2 groups of size 60 each. The first group received zinc sulfate (20 mg daily for children twelve months of age or older and 10 mg daily for children younger than 12 months), and the second group received a placebo for seven days. All patients received standard antibiotic treatment for pneumonia. The children were daily evaluated, and recovery time for fever and tachypnea (as primary outcomes) and duration of hospitalization and mortality rate (as secondary outcomes) were compared between the two groups.

 The mean age of patients was 14.1 months ± 13.9. The youngest and oldest patients were aged 2 and 60 months, respectively. No significant difference in age and sex distribution was found between the two groups. The zinc receiving group experienced a considerably shorter time of fever (2.1 days vs. 2.84 days, P < 0.05) and tachypnea (1.75 days versus 2.1 days, P = 0.011). There was no significant difference in the duration of admission between the two groups (P = 0.728), and no cases of death occurred in either group.

 This study showed that adjuvant treatment with zinc in children aged 2 to 60 months with severe pneumonia accelerates recovery from pneumonia. Further studies are needed to investigate the effects of administering zinc as adjunctive therapy for pneumonia in other age groups.

 Varicella-Zoster Virus (VZV) infection in children with different malignancies on chemotherapy has become an alarming problem. There are insufficient data about VZV seroprevalence among patients in Iran.

 The current study was conducted to assess the seroprevalence of VZV serum IgG antibodies in children with malignancies on chemotherapy.

 The current single-center cross-sectional study was conducted from January 2018 to December 2019 at Mofid children’s hospital, Tehran, Iran. Five milliliters of blood samples were collected from the patients. Serum samples were then tested in duplicate for the IgG antibody against VZV using Varicella-Zoster ELISA IgG/IgM kit.

 A total of 54 children with different malignancies were included. Overall, 24 and 30 serum samples were collected from females and males, respectively. The children were five months to 15-years-old with a mean age of 5.5 years. The overall seroprevalence of VZV IgG in the children was 21.1% (n = 13/54). Of patients with positive VZV IgG antibody, 9 (69.2%) were male, and four (30.8%) were female. Besides, Acute Lymphocytic Leukemia (ALL) with 61.1% (n = 33/54) was the most common underlying malignancy among these patients. The prevalence of anti-VZV IgG antibodies was 21.2% (n = 7/33) in the group of children with ALL. The highest seroprevalence of the VZV IgG antibody was seen in 11 to 15-year-old children (n = 3/7; 42.9%). The prevalence rates of IgG antibodies against VZV among children aged 0-2 years, 3-5 years, and 6-10 years were 28.6%, 25.9%, and 7.7%, respectively.

 The results showed that children with different malignancies on chemotherapy are quite susceptible to chickenpox infection. It is suggested that a safe and effective live attenuated varicella vaccine in line with the WHO recommendations be incorporated into Iran’s national immunization program for children with various malignancies.

 Leptin is a hormone that plays an important role in human health against infections. Some studies have reported that leptin acts as a reactant phase marker in some infectious diseases. The role of leptin in febrile urinary tract infection (UTI) has not been adequately evaluated.

 This study was conducted to determine the role of serum leptin in febrile UTI in children.

 Thirty-nine febrile UTI patients were compared with 40 healthy children for the serum leptin level. Serum leptin was measured by the enzyme-linked immunosorbent assay method. The results were compared between the groups.

 Median (IQR) of serum leptin in the case and control groups was 2 ng/mL and 0.6 ng/mL, respectively. A significant difference was observed between the groups in the serum leptin level (P = 0.001). No significant difference was observed between cystitis and acute pyelonephritis patients in the serum leptin level. The correlation analysis showed no significant association between the serum leptin level and acute-phase reactant markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (r = -0.13 and P = 0.41; r = -0.15 and P = 0.36, respectively).

 The present study showed that although serum leptin increases in febrile UTI, this increase is not correlated with C-reactive protein and erythrocyte sedimentation rate. Also, this marker cannot discriminate between cystitis and acute pyelonephritis.

 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%.

 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.

 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.

 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.

 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.

 After the worldwide pandemic of coronavirus 19 disease (COVID-19), pediatric involvement has been seen as case reports with various initial symptoms.

 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).

 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.
 

The first case of Kawasaki-like disease in children infected with COVID-19 was reported in a preprint case report. In the present case series, three pediatric probable cases with COVID-19, who presented signs and symptoms of Kawasaki-like syndrome, and their three-month follow-up are provided.

Information about renal involvement in pediatric patients with COVID-19 is limited, and there is not enough data about renal and urinary tract involvement in children infected with this novel virus.

This study aimed to determine the spectrum of kidney diseases in pediatric patients with COVID-19, admitted to a tertiary children’s hospital.

This cross-sectional study was conducted on 71 pediatric patients with COVID-19 infection. Diagnosis of COVID-19 was established based on the guidelines by the IranianMinistry of Health. The patients’ demographic characteristics, clinical symptoms, laboratory results, and renal ultrasonography findings were extracted from the hospital medical records.

On admission, 10% of patients had oliguria, 7.7% had edema, and 3% had hypertension. The first urinalysis indicated proteinuria, leukocyturia, and hematuria in 46%, 24%, and 23% of the patients, respectively. Overall, 40.7% of the patients showed some degree of renal involvement. During hospitalization, acute kidney injury (AKI) occurred in 34.5% of the patients. Based on the pediatric risk, injury, failure, loss of kidney function, and end-stage kidney disease (pRIFLE) classification, stage I (risk group) was found in 20% of patients, stage II (injury group) in 25% of patients, and stage III (failure group) in 55% of patients with AKI. The total mortality rate was estimated at 12.67%, and the incidence of in-hospital death was 30% in pediatric patients with severe COVID-19 infection associated with AKI.

The prevalence of AKI was high in patients with COVID-19 infection hospitalized in our tertiary hospital. We also found that a decrease in renal function was associated with a higher risk of mortality. Overall, early detection of AKI and effective treatment may help reduce mortality in patients with COVID-19.

In the era of the SARS-CoV-2 virus pandemic, new scoring systems need to be developed to estimate the risk of COVID19 complications aiding in the accurate prognosis. Improved scoring systems by combining multiple variables allow clinicians to optimize the allocation of limited medical resources for the best clinical outcomes.

Published articles were selected that assessed the relationship between clinical, para-clinical, demographics, comorbidities, and outcomes of COVID-19 patients in a systematic review to develop a novel scoring system.

In this study, by summarizing the results of 97 studies and the experiences of experts, prognostic factors were determined and divided into four groups: Age, clinical symptoms, co-morbidities, and tests. Twenty-three published articles met the selection criteria and were included in this study. Accordingly, by the opinion of experts, prognostic factors were categorized into four main groups: Age, clinical symptoms, co-morbidities, and specific test results.

This novel scoring model helps physicians to early identify critical COVID-19 patients and optimize patient management based on recent comprehensive data of the most significant predictive factors.