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Rituximab (RTX) is approved for treating CD20-positive B-cell malignancies, including non-Hodgkin lymphoma, when used alongside chemotherapy. It has the potential to interact with and alter the host immune system, putting patients at a heightened risk of infection. Therefore, the use of RTX necessitates a meticulous assessment of infectious risks based on the latest evidence.

We conducted a prospective investigation into infectious complications and mortality among children undergoing RTX treatment over the observation period of the study.

In this observational cohort study, we included 61 pediatric patients treated with RTX for malignancy and immune thrombocytopenic purpura (ITP), as well as 122 cancer patients who had never received RTX (the unexposed group). These patients were prospectively monitored for febrile neutropenia (FN), bloodstream infection (BSI), invasive fungal infection (IFI), and mortality. All infectious complications were documented starting from the initial dose of RTX and continuing for at least six months following the last dose. Logistic regression and Cox regression analyses, with consideration for the proportional hazards assumption, were utilized to evaluate the impact of covariates on mortality and infection-related outcomes.

Infectious complications were observed in 52.5% of children treated with RTX. These complications were notably more prevalent in children with malignancy compared to those with chronic ITP (89.5% versus 10.5%, respectively). RTX was found to be associated with an increased likelihood of mortality in children with malignancy (OR [95% CI]: 1.54 [0.41, 5.69]). According to Cox regression analysis, RTX was linked to a higher risk of IFIs, death, FN events, and BSIs over a 36-month observation period (4.33 [1.21, 15.52], 3.26 [1.008, 10.59], 1.68 [0.83, 3.41], and 1.59 [0.27, 9.17], respectively). The total dose of RTX administered was also associated with adverse patient outcomes, with the odds of infectious events and death increasing in the second, third, and fourth quartiles of the total RTX dose administered. Furthermore, the estimated one-year and two-year survival rates for cancer patients treated with RTX were 77% and 58%, respectively.

RTX treatment, when used concurrently with immunosuppressive chemotherapy for hematologic malignancies in children, showed additive and dose-dependent effects on clinical outcomes.

 Acute promyelocytic leukemia (APL) is a type of aggressive acute myeloid leukemia (AML), characterized by the presence of abnormal promyelocytes in the bone marrow and bloodstream. The abnormal promyelocytes found in APL can lead to severe complications such as bleeding and blood clot formation.

 A 7-year-old boy diagnosed with APL encountered a unique occurrence of isolated molecular relapse following a recent episode of SARS-CoV-2 infection while undergoing routine monitoring for treatment response. The relapse was confirmed by the detection of the PML/RARalpha gene abnormality in both the peripheral blood and bone marrow samples. Notably, during relapse, the boy displayed symptoms indicative of a cerebral ischemic stroke; however, effective management was achieved through the administration of low molecular weight heparin (LMWH) and corticosteroids. Subsequently, the patient underwent an allogenic bone marrow transplantation. Of note, throughout an 18-month period of close monitoring, no complications were reported.

 The detection of the PML-RARA transcript in peripheral blood can serve as a valuable tool for detecting isolated molecular relapse in pediatric APL. In cases where patients are undergoing immunosuppressive chemotherapy, the presence of neurological signs and symptoms may be the sole indicator of APL relapse, and it can be thoroughly investigated through the use of MRI with or without diffusion-weighted imaging (DWI). The administration of LMWH is a safe treatment strategy until D-dimer levels return to normal. It has been observed that COVID-19, as seen with other respiratory viruses, may potentially contribute to the relapse of pediatric APL, highlighting its significance in disease progression.

In many hospitals, the rapid response team (RRT) is specialized in monitoring critical symptoms and timely intervention. The purpose of this study is to investigate the impact of RRT implantation (including reducing cardiorespiratory resuscitation and intubation rate) in adult patients admitted to Namazi Hospital in Shiraz.

This cross-sectional study was conducted in Shiraz Namazi Hospital on 15,448 patients over 18 years of age hospitalized in the emergency room and selected internal wards from April 2019 to January 2022. This study was divided into three periods. The trend of clinical outcomes (cardio-respiratory resuscitation and intubation) in the first and third periods (before and after the RRT implementation) was analyzed using Joinpoint Regression analysis.

The mean monthly cardiorespiratory resuscitation showed a significant decrease (p-value < 0.001) in the third period in the emergency department. Also, the mean intubation rate decreased by 10 units (p-value: 0.1). According to the results of Joinpoint Regression Analysis, the monthly percentage changes (MPC) of cardiorespiratory resuscitation in the emergency department before the establishment of RRT had a positive upward slope of 7.4%, while after the implementation of RRT, MPC was 2.9% with a negative slope.

Implementing the rapid response team can reduce cardiorespiratory resuscitation and intubation rate by screening at-risk patients with warning signs, using trained staff and early intervention, and indirectly reducing the complications caused by cardiac arrest.

This systematic review and meta-analysis aimed to compare coronavirus disease 2019 (COVID-19) (Wuhan strain) features in children and adults during the initial pandemic phase.

Until June 4, 2020, a systematic search was conducted on the EMBASE, PubMed, Web of Science, Google Scholar, and Scopus to find and collect studies based on available data among adults and children. The heterogeneity of the studies was assessed using I2 statistics and chi-square testing. The random-effect model was used to pool the effect sizes due to inter-study heterogeneity (chi-square P-value 0.1 and I2 >50%).

Fever (65.73%), cough (53.78%), expectoration (37.9%), gastrointestinal symptoms (37.01%), headache (23.41%), shortness of breath (21.65%), and myalgia (20.79%) were the most common symptoms reported in children, according to the pooled estimation analysis. Arthralgia (Effect estimate (ES): adults = 2.15, children = 17.94) and headache (ES: adults = 9.22, children = 23.41) were significantly observed higher in children (P-value = 0.019). Adult patients had a higher rate of abnormal computer tomography (CT)-scan findings, while most children had a normal study. Adults had significantly higher rates of comorbidities, whereas children had significantly higher rates of asthma (ES: 17.94% vs 8.85%; P-value = 0.026) and malignancy (‎ES: 10.36‎% vs ‎5.47‎‎%; P-value = 0.045‎). During initial pandemic phase, hydroxychloroquine (ES: 66.21% vs ‎‎29.01%; P-value = 0.001) and antibiotics (ES: 77.86% vs 38.01%; P-value = 0.001) ‎were used much more frequently in adult patients. Adults used much more antibiotics than children. Nonetheless, antibiotics were given to around 40% of the children studied. ‎

Although children were afflicted less than adults in the early stages of the pandemic and had lower mortality, clinical and radiological findings, as well as prognostic factors, did not differ significantly between adults and children. However, with the advent of novel variants, clinical signs and symptoms, complications, and outcomes changed in children significantly.

Taurolidine is active against a wide variety of micro organisms, including bacteria and fungi. Mucormycosis is one of the life-threatening opportunistic fungal infections, especially in immunocompromised patients. Currently, the emergence of Mucormycosis during the COVID-19 pandemic raises public health concerns regarding untoward morbidity and mortality among SARS-CoV-2 patients. It is well-known that delayed and inappropriate antifungal therapy leads to increased morbidity and mortality. This study aimed to investigate the in-vitro antifungal activity of taurolidine to evaluate its effects against clinical isolates of Mucorales.

This study included previously collected clinical Mucorales isolates. The minimum in vitro inhibitory concentration (MIC) of amphotericin B, caspofungin, voriconazole, posaconazole, and itraconazole was determined using the broth microdilution method.

All clinical isolates showed full sensitivity to amphotericin B. Posaconazole MIC range from 8 μg/mL to 0.032 μg/mL. The MIC range of voriconazole and caspofungin were determined to be 2-8 µg/mL and 0.5-16 µg/mL, respectively. Growth of the isolates was entirely inhibited in 1000 µg/mL concentration of taurolidine. In microscopic observations, morphological effects on hyphal growth were observed at 500 µg/mL concentration.

In conclusion, this is an updated experience of using taurolidine against Mucorales. However, our in-vitro findings need to be confirmed in well-designed clinical trials aimed at treating invasive Mucormycosis infections.

It has been believed that infants are at a lower risk for the severe symptoms and complications that arise from COVID-19. This report represents details on a newborn with sepsis that has been diagnosed with COVID-19 and, unfortunately, did not survive.

The case was a 1-day-old female newborn, admitted to the surgical intensive care unit in Namazee Hospital, Shiraz, Iran, for a bladder exstrophy operation. She gradually started to deteriorate on the fourth day after the surgery, diagnosed with sepsis based on the results of her blood culture. Progressively, her vital signs and blood tests fell within normal ranges after being treated with broad-spectrum antibiotics. Without any fever, the neonate became severely irritable on the 16th day after her birth and hospitalization. Considering lymphopenia, high CRP, and abnormal chest x-ray, pharyngeal swab sampled for COVID 19. The newborn died from multi-organ failure on the 18th day of life. Reverse transcription-polymerase chain reaction (RT-PCR) confirmed the COVID 19 infection in the dead newborn. The parents’ pharyngeal sample, however, was negative for COVID 19.

Growing awareness of sepsis as a risk factor for the severity of the COVID-19 infection in the neonatal period can be a form of knowledge for physicians to begin early treatment and reduce odds of mortality in this group of patients.

Mutations in herpes simplex virus Thymidine kinase (TK, UL23) and DNA polymerase (pol, UL30) genes may confer resistance to acyclovir (ACV). Phenotypic resistancemust be determined along with genotypic resistance to achieve complete acyclovir susceptibility.

The present study aimed to characterize HSV-1 clinical isolates from outpatients and organ transplant recipients in terms of phenotypic ACV resistance. Moreover, genotypic resistance to ACV was assessed through sequencing the viral TK and pol genes amplified from virus-infected cell DNA.

Twenty-six HSV-1 clinical isolates collected between 2016 and 2019 were examined for drug susceptibility. The samples were collected from eyes, oropharyngeal, facial, and other skin parts of immunocompetent and immunocompromised individuals. Phenotypic susceptibility was determined by using three different concentrations of ACV. The results were expressed based on the ability of ACV in reducing viral plaques by 50%. Genotyping was carried out by polymerase chain reaction and sequencing of TK and pol genes.

All the strains were characterized as sensitive at 0.01 and 0.05µg.ml-1 concentrations to ACV. Seventy percent inhibition was observed at ≥ 0.1 µg.mL-1 of ACV for three isolates (two from patients who received transplants and one from an outpatient). Nine natural polymorphisms were detected in the TK gene and 31 in the Pol gene. Furthermore, four susceptible-associated mutations in the DNA pol gene were analyzed. A substitution was encoded in the conserved region of the pol Exo III motif (M553L), and nine amino acid substitutions in TK were detected. The phylogenetic analysis of partial genome sequences revealed high diversity in the TK and pol genes of HSV-1.

A higher number of mutations were observed in patients who received transplants and underwent long-term treatment compared with outpatients. The high genetic variability of HSV-1 TK and DNA pol was not associated with phenotypic resistance.

Skin rashes, mostly seen in children and adolescents, are considered among the most common side effects of azole antifungals. Although therapeutic concentrations of voriconazole (VCZ) have been documented for infected skin, there is no evidence specifying whether specific dermatologic side effects could predict high VCZ serum concentration, especially in high-risk leukemic children.

Herein, we report a unique skin side effect of VCZ in a 5-year-old boy with T-cell acute lymphoblastic leukemia (ALL) referred to Amir Medical Oncology Center in Shiraz, Iran. The patient experienced erythroderma and macular rashes shortly after VCZ consumption, leading to generalized exfoliative skin rashes. Concurrent to these skin manifestations, VCZ serum concentration reached the supratherapeutic levels despite the recommended VCZ doses. As a result, VCZ was withheld, and the patient was treated with caspofungin. The lesions were resolved gradually within 2 weeks, and the patient successfully completed his treatment course with caspofungin.

The unique case presented in this study emphasizes the need for a high index of suspicion for VCZ toxicity in any patient with atypical dermatologic manifestations, especially generalized exfoliative skin rashes. Based on this report, VCZ supratherapeutic concentration could be predicted early in the course of treatment. Additional therapeutic dose monitoring should be considered to establish a confirmatory diagnosis. It is required to further investigate the toxic effect of high VCZ concentration on the skin epithelium.

SARS-CoV-2 infection is spreading worldwide, and due to multi-organ involvement, it could mimic other well-known diseases.

Herein, we describe the case of a pediatric patient with acute promyelocytic leukemia (APL), who developed severe respiratory illness with diffuse pulmonary involvement after consuming all-transretinoic acid during the COVID-19 pandemic.

All-transretinoic acid syndrome is a very similar condition to COVID-19 both in clinical presentations and radiologic findings; thus, the treatment of such patients may be challenging.

Clostridioides (Clostridium) difficile infection as a healthcare-associated infection can cause life-threatening infectious diarrhea in hospitalized patients. The aim of this study was to investigate the toxin profiles and antimicrobial resistance patterns of C. difficile isolates obtained from hospitalized patients in Shiraz, Iran. This study was performed on 45 toxigenic C. difficile isolates. Determination of toxin profiles was done using polymerase chain reaction method. Antimicrobial susceptibility to vancomycin, metronidazole, clindamycin, tetracycline, moxifloxacin, and chloramphenicol was determined by the agar dilution method. The genes encoding antibiotic resistance were detected by the standard procedures. The most frequent toxin profile was tcdA+, tcdB+, cdtAˉ, cdtBˉ (82.2%), and only one isolate harboured all toxin associated genes (tcdA+, tcdB+, cdtA+, cdtB+) (2.2%). The genes encoding CDT (binary toxin) were also found in six (13.3%) isolates. Resistance to tetracycline, clindamycin and moxifloxacin was observed in 66.7%, 60% and 42.2% of the isolates, respectively. None of the strains showed resistance to other antibiotics. The distribution of the ermB gene (the gene encoding resistance to clindamycin) was 57.8% and the tetM and tetW genes (the genes encoding resistance to tetracycline) were found in 62.2% and 13.3% of the isolates, respectively. The substitutions Thr82 to Ile in GyrA and Asp426 to Asn in GyrB were seen in moxifloxacin resistant isolates. Our data contributes to the present understanding of virulence and resistance traits amongst the isolates. Infection control strategies should be implemented carefully in order to curb the dissemination of C. difficile strains in hospital.

Acute lymphoblastic leukemia (ALL) has various clinical manifestations due to bone marrow or extra medullary involvement. Osteomyelitis may occur as the first presentation or relapsing sign of ALL. Multifocal osteomyelitis in non-neutropenic children with ALL is rare.
This study reported on an 8-year-old male with ALL during the maintenance phase of his treatment, who presented fever and generalized body pain. Bone scan showed multiple bones involvement and biopsy was in favor of osteomyelitis.
Multifocal osteomyelitis should be kept in mind as a possible diagnosis in patients with leukemia, who are presented with prolonged fever.

Critically ill children at the intensive care unit frequently develop hospital-acquired pneumonia (HAP). Human herpes viruses (HHVs), primarily or by reactivation may cause bronchopneumonitis in mechanically ventilated patients. The exact prevalence and role of HHVs in morbidity and mortality of pediatric patients undergoing mechanical ventilation is unclear. The current study was conducted to evaluate the prevalence of 5 Herpes viruses by polymerase chain reaction (PCR) method in bronchoalveolar lavage (BAL) samples in critically ill children at a pediatric intensive care unit (PICU).
Overall, 140 bronchoalveolar lavage samples from 83 mechanically ventilated cases were studied. Samples were taken via the mini-BAL technique. Samples were analyzed by qualitative PCR for detection of herpes simplex virus type 1 and 2 (HSV1/HSV2), human herpes virus type 6 and 7 (HHV6/HHV7), Ebstein-Barr virus (EBV), and cytomegalovirus (CMV).
Out of 83 cases, 53% (44) were male and 47% (39) were female. The mean age was 29.12 ± 33.67 months (32.53 months in males and 25.29 months in females). The estimated prevalence of HSV1, HHV6, HHV7, EBV, and CMV were 2.4%, 13.2%, 2.4%, 7.2%, and 2.4%, respectively.
Molecular study of BAL specimens and investigation of HHVs may be the first step in the evaluation of the possible role of these viruses in the development of viral pneumonia during VAP. The current results are useful for guiding other well-designed studies for correlation of viral load and clinical outcome in ill ventilated children. The Modified protected BAL may be of use as a safe modality in critically ill ventilated pediatric patients for investigation of possible viral (and also bacterial and fungal) infections. Local study of high-risk patients at the PICU and estimation of the true prevalence of HHVs infection may assist in finding the exact role of HHVs in mortality and morbidity of critically ill patients.

Context: Universal immunization against Bordetella pertussis has partially controlled the burden of the disease and its transmission. However, according to recent data, the epidemiology of this vaccine-preventable disease has changed. Now, younger infants, adolescents, and adults are at greater risk of infection. This article has studied the interaction between the various factors involved in the changing epidemiology of pertussis and the major obstacles faced by the current strategies in its prevention.
Evidence Acquisition: In this narrative review, the most recently published sources of information on pertussis control measures, consisting of textbooks and articles, have been reviewed. We focused on the more recent data about the changing epidemiology or pertussis in Scopus through the use of the MeSH-term words [pertussis] or [whooping cough] and [epidemiology] or [outbreak] or [resurgence], but our search was not restricted to this particular strategy; we also tried to find all of the most recent available data in the general field through other means.
Primary and booster doses of the pertussis vaccine seem to partially control transmission of the disease, but despite the different preventive strategies available, pertussis continues to cause mortality and morbidity among high-risk groups.
Adding booster doses of acellular pertussis vaccine to the current national immunization practices with whole-cell vaccines for young adults and pregnant women seems to be a good option for controlling mortality and morbidity among high-risk groups such as very young infants.

Management of cold-associated cough is a challenging aspect of supportive care for the common cold for pediatricians and parents worldwide. Herbal compounds have traditionally been used for the treatment of cold-related cough. Among these compounds, Zataria multiflora (ZM) has been found to be effective for cough relief.
The aim of this study is to compare a thyme mixture with diphenhydramine in the treatment of cold-related cough in a double-blind, randomized, clinical trial.
Patients and A total of 52 pediatric patients (2 - 12 years old) with common colds were included in the study. The patients were randomly divided into two treatment groups: one group received diphenhydramine compound and the other received ZM syrup, each for five days. The severity of cold-related symptoms and the efficacy of each drug were determined seven days later by asking the parents to complete a prepared questionnaire. sedation, sleepiness, a four-point scale of cough status, and a two-point scale of consumption convenience were also evaluated in these questionnaires.
Our results showed that sedation and sleepiness occurred in 30.8% and 19.2% of the patients in the diphenhydramine and ZM groups, respectively (P = 0.54). Also, 65.4% and 84.6% of the patients in the diphenhydramine and ZM groups, respectively, reported convenient usage (P = 0.10). The patients who received ZM syrup had significantly better outcomes (P = 0.036).
Herbal compounds, such as ZM mixtures, are acceptably efficacious in cough relief with fewer adverse effects than chemical compounds in the treatment of cold-related cough, especially in infants and younger children.

Context: Leishmania is a pathogen that infects mononuclear phagocytes in which they establish chronic intracellular parasitism and survive for the infected person’s lifetime. Untreated cases of visceral leishmaniasis (VL) could cause death within two years. Along with known complications of VL, co-infection of Leishmania with human immunodeficiency virus (HIV) is becoming more frequent, with important clinical, diagnostic, chemotherapeutic, epidemiologic, and economic implications. This review attempts to provide updated information about diagnosis and treatment of VL.
Evidence Acquisition: In this narrative review, recent published sources of information on leishmaniasis consisting of books and articles have been reviewed. This review focuses on VL.
The outcome of infection depends on the host, the Leishmania species, and co-morbidities or co-infections. Disease manifestation may range from asymptomatic carrier to fatal disease. The development of a sensitive and rapid antigen detection test for relapse detection and also for cure remains an important aspect in diagnosis.
Development of novel drugs and diagnostic tests has allowed us to better manage VL. Although leishmaniasis is one of the oldest known parasitic infectious diseases, increasing prevalence of VL among specific populations, recent reports of disease reactivation and flare-up in clinically asymptomatic patients after the onset of immunosuppressive therapy, the risk of disease acquisition by tourists in endemic areas (e.g., the Mediterranean eara), and difficulties in prevention and controlling disease (i.e., given the diversity and distribution of vectors and reservoirs), leishmaniasis has again attracted researchers’ attention. Concerning reports of treatment failure and drug resistance are also new challenges in management of this parasitic disease in endemic areas.

There are increasing reports of serious adverse events of bacillus Calmette-Guerin (BCG) vaccination in infants with unrecognized primary immunodeficiency disorders (PIDs) in our country. Among these adverse events skin manifestations occur less frequently and are less noticed.. We report on an 11-months-old boy with prolonged fever and diffuse hyper pigmented subcutaneous nodules. Due to lymphopenia, oral thrush and severe adverse reaction to BCG vaccination, the possibility of primary immunodeficiency was considered for him and immunological investigations were done.. Subcutaneous nodules in the absence of a local reaction at the site of BCG vaccination may be the sole manifestation of disseminated BCG disease..

Capillaria hepatica (Calodium hepaticum) is a parasite that cause very rare but life threatening infection in human beings.. The current paper reports a case of Capillaria hepatica infection in a four-year-old boy which presented with fever, hepatomegaly, peripheral eosinophilia, and noticeable weight loss. The diagnosis was made on the histological finding of degenerated nematode in the liver. He improved clinically by corticosteroid and albendazole therapy.. Capillaria hepatica should be considered in differential diagnoses in any child with fever, hepatomegaly, eosinophilia and hyperglobulinemia..

Urinary Tract Infections (UTIs) are of the most common bacterial diseases worldwide. We investigate the antibiotic susceptibility patterns of Escherichia coli (E. coli) strains isolated from pediatric patients with community acquired urinary tract infection (UTI) to find a clinical guidance for choosing a right empirical antibiotic in these patients. In this cross sectional study, 100 urine specimens which were positive for E. coli had been investigated for antibiotics susceptibility pattern. The susceptibility to Co-trimoxazol (25µg), Amikacin (30µg), Ceftriaxone (30µg), Nalidixic Acid (30µg), Cefixime (5µg), and Nitrofurantoin (300µg) tested with Disk diffusion agar and MIC determined with the E-test. Mean age of patients was 38 Months. Girls had greater proportion than boys (74 versus 26%). In Disk diffusion method, 26% of the isolates were susceptible to cotrimoxazole. Susceptibility to amikacin, ceftriaxone, nitrofurantoin, nalidixic acid and cefixime was 94%, 66%, 97%, 62% and 52%, respectively. By E-Test method and according to CLSI criteria susceptibility for co-trimoxazol, amikacin, ceftriaxone and nalidixic acid was 37%, 97%, 67% and 50%, respectively. The highest percentage of agreement between Disk diffusion and E-Test method was found for amikacin (96%) and the lowest percentage for co-trimoxazole (89%). Treatment failure, prolonged or repeated hospitalization, increased costs of care, and increased mortality are some consequence of bacterial resistance in UTIs. Misuse of antibiotics in each geographic location directly affects antibiotic resistance pattern. In the treatment of UTI, proper selection of antimicrobial agents should be relevant to the bacterial susceptibility testing surveillance. According to our results, amikacin as an injectable drug and nitrofurantoin as an oral agent could be used as a drug of choice in our region for children with UTIs.

Kikuchi-Fujimoto disease (KFD) is an uncommon idiopathic self-limited cause of lymphadenitis that most commonly presents with cervical lymphadenopathy with or without systemic signs and symptom, which is also called histiocytic necrotizing lymphadenitis (1-6). Although infection and autoimmune etiology have been suggested, the cause of KFD is unknown. Several features that support a role for an infectious cause include the generally self-limited courses and association with symptoms similar to upper respiratory tract infection. Many viral infections have been proposed including cytomegalovirus, varicella zoster virus, human herpes virus, Epstein-Barr virus, parainfluenza virus, parvovirus B19, paramyxovirus, Yersinia enterocolitica, and Toxoplasma gondii. In a Korean study on 147 patients presenting at an outpatient clinic, KFD (34.7%) and tuberculous (TB) adenitis (22.4%) were the most common causes of cervical adenitis (7-14).. We presented a case of TB lymphadenitis in association with celiac disease that mimicked KFD in a young child.. Celiac disease, also known as gluten-sensitive enteropathy and nontropical sprue, is an autoimmune disease with chronic inflammation of small intestine, which is associated with increased risk of TB infection. TB lymphadenitis can mimic KFD. Therefore, in each case of unusual lymphadenitis, TB should be considered and if it is associated with failure to thrive, celiac disease should be suspected..

Bacillus Calmette-Guérin (BCG) vaccine, a live attenuated Mycobacterium bovis strain, is administrated to all newborn infants in endemic regions according to the current World Health Organization (WHO) recommendation.. We report a 10-month-boy who was a known case of severe combined immunodeficiency (SCID) admitted with multi-focal fusiform painful swelling in his hands. He had undergone bone marrow transplantation 7 weeks before admission. Multidisciplinary management was done to treat this rare post-transplant occurrence of Bacillus Calmette-Guérin complication.. BCG vaccination administrated routinely in Iran, given that of no screening program for primary immune deficiency currently achieved in our country, exact attention to reschedule of immunization programs in suspicious newborn (with primary immune deficiency) always is necessary and is one of the most effective strategy to prevent BCG complication..

Bacillus Calmette-Guérin (BCG) vaccine, a live attenuated Mycobacterium bovis strain, is administrated to all newborn infants in endemic regions according to the current World Health Organization (WHO) recommendation.. We report a 10-month-boy who was a known case of severe combined immunodeficiency (SCID) admitted with multi-focal fusiform painful swelling in his hands. He had undergone bone marrow transplantation 7 weeks before admission. Multidisciplinary management was done to treat this rare post-transplant occurrence of Bacillus Calmette-Guérin complication.. BCG vaccination administrated routinely in Iran, given that of no screening program for primary immune deficiency currently achieved in our country, exact attention to reschedule of immunization programs in suspicious newborn (with primary immune deficiency) always is necessary and is one of the most effective strategy to prevent BCG complication..

Pertussis is a highly communicable, vaccine-preventable respiratory disease; which may circulate even in populations with high vaccination coverage. Although frequent, but it is often underestimated as a cause of prolonged cough illness in both children and adults. Without boosting, the protection of the childhood vaccination would be minimal after 10 years. The need for adult booster vaccination depends on the national epidemiology.. The aim of this study was to evaluate the seroepidemiological incidence of Pertussis in fresh college students in four majors..Patients and In a cross sectional multicenter study, blood samples were obtained from 1617 junior students of four universities. None had received Pertussis booster vaccine in the preceding 10 years. Serum immunoglobulin G (IgG) antibody for Pertussis toxin antigen was measured. Some social and demographic determinants including age, sex and number of family members were recorded.. The mean age of participants was 19.64 ± 2.1 years; positive anti Pertussis toxin IgG levels (by cut point of 94 U/mL) was detected in 31.6%. Positivity rate was associated with sex but not with age or residential area.. Pertussis continues to challenge medical and public health professionals. Recent reports of increases in the prevalence and incidence may be because of the limited time of protection of childhood vaccination. Our study can serve as one of the scarce population-based reports from developing countries. A universal cut point should be determined for diagnosis of seropositivity, and a booster of a cellular vaccine is recommended in adolescence..