fariba shirvani

 Nocardia is a catalase-positive and gram-positive bacillus. This organism causes skin, lung, and brain infections more frequently in immunocompromised hosts.

 We report a 10-year-old child with a history of lymphoma relapse undergoing chemotherapy several times. There was no improvement after a dental abscess, outpatient surgery, and oral antibiotics. The child was hospitalized with trismus and respiratory distress. In the CT scan, periodontitis and masticatory abscess were reported.

 The culture results showed Nocardia otitidiscaviarum resistant to experimental antibiotics such as sulfonamides. Clinical symptoms improved with surgical intervention and appropriate antibiotics. The child is in good condition and is currently receiving treatment for the primary illness.

 Nocardia should be considered in patients with infectious complications following malignancy or other immunocompromised conditions, as failure to correct diagnosis results in inadequate response.

Congenital cytomegalovirus (cCMV) is the most common intrauterine viral infection, affecting up to 2.5% of live births worldwide; it is also the most common non-hereditary cause of sensorineural hearing loss (SNHL) in infants.

This study aimed to evaluate the frequency of cCMV and the incidence of sensorineural hearing loss at a large referral hospital in Tehran.

In our cross-sectional study, all infants born between March 2019 and April 2020 (one year) at Mahdiyeh Obstetrics and Gynecology Hospital were enrolled in the present study, and their urine samples were collected forCMVPCR in the first 2 days of life. PCR test results divided these infants into two groups, with and without congenital cytomegalovirus infection. For both groups, the otoacoustic emission screening test (OAE) was performed at birth and one month of age; the auditory brain response test (ABR) was then performed for infants with hearing impairment.

Urine samples of 859 were collected for cytomegalovirus PCR testing; 70.3% of specimens were from male infants. Neonatal urine samples were tested for the presence of cytomegalovirus by PCR; 847 of the specimens (98.6%) were negative, and 12 (1.4%) were positive for cytomegalovirus, CI: (95%). The prevalence of congenital cytomegalovirus infection was 1.18% in girls and 1.49% in boys, revealing no significant difference between the two groups. All infants with congenital cytomegalovirus infection were full-term, between 38 and 42 weeks of gestational age. The first OAE test was impaired in 4 cases (33%) with congenital cytomegalovirus infection.

In our study, congenital CMV infection prevalence was 1.4%. We recommend hearing screening tests (OAE and AABR) be performed for all neonates. If impaired, the infant should also be evaluated for cCMV infection in addition to auditory follow-up. It is recommended that this study be continued in a multicenter manner with a larger number of samples and a longer period to fully evaluate the prevalence of complications in cCMV.

The global spread of the coronavirus since 2019 has caused significant concern.

In this study, we aimed to investigate the clinical manifestations and laboratory findings of children infected with the alpha, beta, delta, and omicron strains.

We included all patients who were referred to Mofid Children's Hospital during the peak of the alpha strain in November 2020, the beta strain in April 2021, the delta strain in August 2021, and the omicron strain in February 2022, corresponding to the national peaks of four SARS-CoV-2 variants of concern (VOC). All patients had a positive nasopharyngeal PCR test and were admitted to the emergency ward. We analyzed the collected data using SPSS software.

A total of 649 patients were included in this survey, of whom 58.1% were male. The most and least frequent clinical manifestations were fever and skin presentation, respectively. The mean white blood cell count (WBC) was 8423.9 ± 5427.3. The mean values for C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 30.14 ± 20.07 and 38 ± 22.6, respectively. There was no significant association between coronavirus type, age, and gender. Gastroenteritis, urinary tract infection, and croup showed a statistically significant positive correlation with delta, beta, and omicron (P-values of < 0.003, 0.000, and 0.000, respectively). Cough was more frequent in patients infected with alpha and beta subtypes, while lymphocyte counts were elevated in patients suffering from delta, omicron, and alpha. C-reactive protein and ESR levels were significantly increased in patients with delta infection, and in patients with omicron infection, CRP levels were significantly elevated.

Our study revealed that the different strains of COVID-19, corresponding to the World Health Organization (WHO) peak of VOCs, can cause variable clinical symptoms in children. These findings could be helpful in the diagnosis of COVID-19.

 The spread of resistant bacteria has caused serious concern worldwide. The spread of multidrug-resistant (MDR) and extensive drug-resistant (XDR) limits the choice of antibiotics, making available antibiotics less effective.

 This study aimed to investigate resistance patterns to seven global threatening organisms announced by the Centers for Disease Control and Prevention (CDC) for one year in Iran, called ESKAPE bacteria (Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.).

 Clinical isolates were collected from 10 selective hospitals in nine provinces. Antibiotic susceptibility testing was performed according to the Clinical and Laboratory Standards Institute for each bacterium.

 A total of 5522 bacterial species were considered, of which 30% were ESKAPE. Multidrug-resistant A. baumannii and Staphylococcus aureus methicillin-resistant Staphylococcus aureus (MRSA) were the most identified in Gram-negative and -positive bacteria, with the frequency of 44% and 39%, respectively. The remaining bacteria, including E. coli, K. pneumoniae, Enterobacter spp. P. aeruginosa, and Enterococcus spp., had the frequency of 30%, 32%, 21%, 20%, and 22%, respectively.

 The determined patterns for the antibiotic resistance of the ESKAPE bacteria can help determine antibiotic stewardship. Also, the high rates of the ESKAPE bacteria in Iran could be alarming for healthcare centers not to misuse broad-spectrum antibiotics.

COVID-19 and influenza coinfection may increase mortality and morbidity during the COVID-19 pandemic. Recognizing the differences and similarities between COVID-19 and influenza helps us diagnose and treat these 2 diseases. Accordingly, we aimed to compare virologic, clinical, paraclinical, and radiological features and prophylactic and therapeutic management of SARS-CoV-2 and influenza infections. We also provided an algorithmic approach to the diagnosis and treatment of SARS-CoV-2 and influenza coinfection in children.

Electronic databases, including Cochrane Collaboration, PubMed, Google Scholar, and EMBASE, were searched for the articles published in English language using the following keywords: “influenza virus,” “SARS-CoV-2 virus,” “COVID-19,” “comparison,” “coinfection,” “management,” “treatment,” “antiviral therapy,” “vaccines,” “children,” and “adults.” Boolean operations (AND and OR) were used to refine the search. No date limitation was applied.

SARS-CoV-2 and influenza are both RNA viruses with different receptors. The reproductive rate of SARS-CoV-2 is higher than influenza. Patients with SARS-CoV-2 infection, particularly adults, have higher rates of anosmia/ageusia. Organ involvement occurs more frequently in COVID-19 cases, and multisystem inflammatory syndrome in children (MIS-C) occurs especially in children. Disease severity, excessive immune response, and mortality are higher in SARS-CoV-2. Radiological peripheral lesions and ground-glass appearance are characteristic of COVID-19 infection. It is important to rule out influenza and SARS-CoV-2 infection in patients with respiratory problems during the pandemic. Timely prescription of currently available antiviral drugs is essential.

Treatment of patients suspected of having a coinfection is determined by the patient’s condition and polymerase chain reaction (PCR) evaluation.

Necrotizing pneumonia (NP) is a rare complication of community-acquired pneumonia, which occurs in patients with viral pneumonia such as influenza and secondary bacterial infection. We present a five-year-old boy with cough and dyspnea and low SpO2, who was admitted to PICU. He was intubated, and two-sided chest tubes were placed because of pleural effusion. Nasopharyngeal RT-PCR for H1N1 was positive. Subcutaneous and mediastinal emphysema and a large pneumatocele developed concomitantly, and the patient underwent three times percutaneous aspiration of pneumatocele under anesthesia and CT scan guide without surgery. The size of the pneumatocele decreased, and the patient was extubated. After one month of admission, he was discharged in good condition and no pulmonary sequela.

SARS-CoV2 (COVID-19) is a serious and global infection that has spread to numerous countries, including Iran. Pneumothorax may occur in cases of COVID-19 as a consequence of lung parenchymal damage, which can disrupt the healing process and increase mortality.

This manuscript describes the case of a 2-year-old boy with hyper IgM syndrome and COVID-19 infection. The patient developed spontaneous pneumothorax and recovered without chest tube by supportive care and was discharged in good general condition after the completion of the antibiotic course and cessation of fever.

The severity, prognosis, and best treatment for spontaneous pneumothorax in COVID-19 infection, especially in children, remain nebulous. It is recommended that conservative treatment be performed if the patient has stable vital signs and no severe respiratory failure. However, this requires more detailed clinical evaluations.

Candida albicans is the predominant yeast reported from human infection. Non-albicans Candida species have been recently developed as medically vital fungi. Therefore, it is essential to detect and identify the pathogens at the species level to prescribe appropriate treatment.

This study assessed two complementary methods, including real-time polymerase chain reaction-high resolution melt (PCR-HRM) and polymerase chain reaction-restriction fragment length morphism (PCR-RFLP) with standard PCR and Sanger sequencing as the benchmark.

In total, 66 samples were tested, and two newly-advanced assays were more effective and displayed comprehensive concordance (66/66, 100%) with Sanger sequencing outcomes. Moreover, accurate and economical tests were positively advanced by real-time PCR-HRM for C. albicans and C. parapsilosis complexes.

Given the number of studies performed on the comparison of sensitivity and specificity of phenotypic and genotypic methods to diagnose and identify invasive fungal pathogens and the findings of this study, it could be stated that the correlative PCR-HRM and PCR-RFLP methods were effectively advanced as substitutes for conventional Sanger sequencing for the reasonable identification. However, supplementary evaluations and confirming studies should be carried out with a broad range of samples to standardize this method for routine application in medical laboratories.

Surgical procedures may be complicated by post-surgical infections. This study investigates the role of administering perioperative narrow-spectrum antibiotic prophylaxis in preventing post-surgical infections as compared to routine broadspectrum antibiotic usage in the surgical ward.

Narrow-spectrum perioperative antibiotic prophylaxis, in accordance with CDC guidelines, was implemented in our hospital in October 2019. In this quasi-experimental study, all the children (one month to fifteen years old) who underwent surgery from April to September 2019 and had received broad-spectrum antibiotics for various durations, as well as those operated after the implementation of the perioperative narrow-spectrum antibiotic prophylaxis plan (October 2019 to March 2020) were enrolled. Surgical wound type (clean, clean/contaminated, contaminated, and dirty), type and site of the infection, and the patient’s age and sex were recorded. Cases with postoperative infections were followed up in the two groups during hospitalization and for 30 days (or 90 days if a prosthetic material was implanted) after discharge. The rate of post-surgical infections was compared between the two groups by the Mann-Whitney and chi-squared tests.

In total, 4308 cases were enrolled in the first six months and 3650 in the second six months of the study. The rate of postsurgical infections in the first group was 31/4380 (23.7%) as compared to 22/3650 (20%) in the second group (P-value = 0.3365)

There was no increase in the frequency of post-surgical infections after the implementation of the perioperative narrow-spectrum antibiotic prophylaxis protocol. Reducing the use of antibiotics before surgery shrinks costs and antibiotic resistance without any effect on the post-surgical infection rate.

The present study was performed to raise attention on thefrequency of Candida spp. and evaluation of risk factors of candiduria in neonates andchildren.

In total, 60 urine samples were collected from the suspectedneonates and children. Identification of Candida at species level was performed usingthe polymerase chain reaction-restriction fragment length polymorphism approach.

The restriction fragment length polymorphism fingerprint analysis revealedthat Candida parapsilosis (n=17; 28.33 %) is the most prevalent isolated speciesfollowed by Candida albicans (n=9; 15%), Candida tropicalis (n=4; 9.52%), and C.glabrata (n=2; 4.76%). All of the C. albicans and C. parapsilosis complex strains wereidentified as C. albicans with HWP1 gene primers and using the NlaIII restrictionenzyme activity, respectively. In this study, none of the mentioned factors was the causeof infection, but they could be considered risk factors. The mean hospital stay was 21days (range: 7-21 days). More than 90% of the patients had a urinary catheter, and about26% of them received antibiotics. Regarding the risk factors, there was no significantdifference between the two groups of candidiasis in terms of C. albicans and nonalbicans Candida (P<0.01).

Candiduria has always been a challenging issue, especially in childrenadmitted to hospitals. Outcome of candiduria in patients with generally healthy is little.

Multiple inflammatory syndrome in children (MIS-C) is a multisystem inflammatory disease following COVID-19 in children. This disease occurs a few weeks after COVID-19. A child with this condition develops a cytokine release cascade that results in organ damage. The involved organs include the heart, lungs, brain, gastrointestinal tract, and central nervous system. Fever is present in all patients and Kawasaki-like symptoms are one of the common features in these children. In this article, we introduce a child with MIS-C who has skin, gastrointestinal, neurological, and renal symptoms and has been hospitalized in the PICU.

The purpose of the present study was to isolate Candida species from individuals with the COVID-19 disease and evaluate the susceptibility pattern of Candida spp. to routine antifungal drugs.
A total of 25 Candida spp. isolated from hospitalized patients with COVID-19, who were suspected to have pulmonary candidiasis, and 26 archived Candida spp. specimens were enrolled in this study. For the identification of Candida spp., PCR was performed to detect and amplify the ITS1 and ITS4 genes. Then the products were subjected to the Msp I restriction enzyme to precisely identify the species. The amplification of the WHP1 gene was conducted to identify Candida albicans species. The antifungal activities of routine drugs and the synthesize AuNPs against Candida spp. were assessed based on the protocols presented by the Clinical and Laboratory Standards Institute M60.
In the present study, C. albicans (24; 96%) and C. parapsilosis (1; 4%) were identified as the etiologic agents of the pulmonary candidiasis associated with the COVID-19 infection. Voriconazol and amphotericin B had superior activity against all the isolates in this study. Treatment with fluconazole and itraconazole did not significantly change the formation of colony-forming units (CFU). However, treatment with the AuNPs significantly decreased (within the range of 92-99.1%; P<0.05) the number of CFUs.
The azole prophylaxis has likely been associated with the development of resistant isolates; the results of the present study suggested the promising role of novel antifungal agents such as AuNPs in overcoming drug resistant fungi.

The coronavirus, which is caused by acute respiratory syndrome, appeared in Wuhan, China, in December 2019 and gradually spread around the world until almost all countries became infected with the coronavirus. In Iran, the outbreak of coronavirus began on February 21, 2020, with the report of infection of two people in the city of Qom. The aim of this study is to evaluate the clinical findings of neonates born to pregnant women with corona disease.

During this case study (February 21 to November 30, 2020), out of 88 pregnant mothers who referred to the hospitals of Shahid Beheshti University of Medical Sciences, 44 live neonates were born from 42 pregnant women with COVID‑19, who were evaluated for clinical signs by studying their files and reported as a case series, due to limited samples, No statistical analysis of the study was performed.

In studies of clinical records of hospitalized mothers and infants, among the polymerase chain reactions (PCRs) provided for all infants, one PCR was reported positive 2 days after birth, whereas this infant 10 min after birth, immediately after routine procedures, due to positive mother’s PCR was isolated from the operating room. However, all of the infant’s clinical symptoms were normal during the 3‑day hospital stay for routine postpartum care. Twenty‑eight days after birth, the baby was reevaluated for clinical, laboratory, and chest X‑ray symptoms, all of which were normal. The PCR of other neonates was negative, and five intubated neonates, two twin, and two single died, and the other neonates were discharged. In evaluating the clinical records of mothers of these infants, the mean age is 30 years, and the average gestational age is 35 weeks, 32 cases of caesarean section, and 10 cases of normal delivery.

We describe epidemiological data, demographics, signs and symptoms on admission, laboratory results, comorbidities, infection COVID‑19 in the mothers and neonates, chest radiography and computed tomography findings, treatment received for COVID‑19, and clinical maternal, fetal, and neonatal outcomes. Due to the fact that the study population is small consist of 42 mothers with COVID‑19 infection, among all PCR samples from infants born to COVID‑19 positive mothers, the PCR result of one case was positive, and the rest of was negative. Therefore, vertical transmission of COVID‑19 through the placenta to the fetus cannot be confirmed or denied, nor can the COVID‑19 confirmed or denied the baby’s postnatal complication during pregnancy.

Background :

The World Health Organization (WHO) has announced that severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) outbreak is a public health emergency requiring international concern. Thalassemia syndromes are the most prevalent monogenic hemoglobin disorder in world and Iran is located on thalassemia belt, so this type of hemoglobinopathy has a critical importance in our country.

In this overview, the research was conducted by screening the relevant articles evaluating the COVID-19 in patients with thalassemia. An electronic search was performed in online data bases of Scopus, Sid.ir, EMBASE, Cochrane, Web of Science and Medline (via PubMed) with English and Persian language from December 2019 up to November 2020.

Results:

 Overall, 59 articles could be originally identified, 43 of which were excluded and 16 articles have been investigated. Thalassemic patients had a higher risk for severe clinical events due to 2019 novel corona virus. Presence of comorbidities could aggravate the course of COVID-19 in these patients. In thalassemic patients, the protocol of transfusion should not be altered. Also in asymptomatic thalassemic cases, iron chelation should not be stopped but in thalassemic patients with confirmed COVID-19 infection, iron chelation must be discontinued.

Conclusion :

According to low number of reported cases of infected thalassemic patient with confirmed COVID19, there are many unanswered question in management of these vulnerable patients. In this setting treatment decision need to be individualized on a case-by-case basis. In order to deliver an appropriate treatment for these patients, a teamwork between attending clinicians is of utmost importance.

This study aims to define S. pneumoniae serotypes in children hospitalized with an invasive pneumococcal disease from March 20, 2012 to March 10, 2013 by polymerase chain reaction (PCR) method.

Specimens from cerebrospinal fluid and blood were collected from children aged one month-18 years with suspected invasive pneumococcal infection admitted to Mofid Children’s Hospital and other regional hospitals. Multiplex PCR with 13 groups of primers were used to detect 33 serotypes of S. pneumoniae in positive blood and cerebrospinal fluid cultures. Out of 563 samples, 83 S. pneumoniae isolates were identified. Sixty-seven samples were typeable.

The results showed that serotypes 3 (21.7%), 23F (13.2%), and 19F (10.8%) were the most prevalent serotypes. Sixteen samples (19.3%) were non-typeable by Multiplex PCR method. The 13-valent pneumococcal vaccine provides the highest coverage (66.23%), followed by the 10-valent vaccine (34.9%) and, lastly, the 7-valent vaccine (33.71%).

We found that serotypes 3, 23F, and 19F accounted for almost 46% of invasive pneumococcal isolates. As per relatively high coverage of prevalent serotypes, PCV13 should be considered for routine childhood vaccination programs.

 Currently, it appears that new molecular-based methods could substitute microscopic and culture assessment for the first-line detection of microorganisms isolated from clinical specimens. However, it will remain the "continual strategy" until this technology is attuned to identifying all fungi that can be isolated from biological specimens.

 The present study aimed to validate a high-resolution melting (HRM) technique to identify clinical filamentous fungi. Moreover, it was attempted to compare the results with those of the target gene’s polymerase chain reaction (PCR) sequencing.

 A total of 54 specimens of bronchoalveolar lavage (BAL), nail, ear discharge, blood culture, and cornea were collected from patients suspected of fungal infection. All Fusarium spp. and Aspergillus spp. were recognized based on Tef-α and beta-tubulin region sequencing, as well as PCR-HRM analysis.

 The Tef-α sequence analysis revealed the most frequent spp. to be Fusarium solani followed by F. oxysporum (n = 3), F. caucasicum (n = 3), F. coeruleum (n = 3), F. falciforme (n = 1), F. proliferatum (n = 1), F. brevicatenulatum (n = 1), F. globosom (n = 1), and F. verticillioides (n = 1). Based on the beta-tubulin sequences, Aspergillus flavus (n = 10), A. fumigatus (n = 7), A. niger (n = 2), A. terreus (n = 1), and A. orezea (n = 1) were identified in this study. Furthermore, the dataset analysis of PCR-HRM revealed that 33 isolates belonging to Fusarium spp. were F. solani (n = 24), F. oxysporum (n = 3), F. proliferatum (n = 3), F. falciforme (n = 1), F. verticillioides (n = 1), and F. brevicatenulatum (n = 1). Moreover, isolates (n = 21) belonging to Aspergillus spp. included A. flavus (n = 11), A. fumigatus (n = 7), A. niger (n = 2), and A. terreus (n = 1).

 The sequencing method has a time-consuming and costly nature, and there exists conformity between the sequence results of the Tef-α/beta-tubulin regions and PCR-HRM. The PCR-HRM method is a reliable approach in the clinical laboratory to identify Aspergillus and Fusarium spp. However, some closely related spp. show no curve algorithm differences in PCR-HRM.

 This study aimed to investigate the spectrum of bacterial pathogens and their antimicrobial sensitivity in pediatric patients admitted with febrile neutropenia (FN) and hematologic malignancies.

 This prospective, cross-sectional study was carried out on 65 children (60% boys, mean age 7.3 5.3 years) with hematologic malignancies and FN hospitalized at the Amir Hematology and Oncology Hospital, Shiraz, Iran, between December 2018 and May 2019. Samples were taken from blood, nose, axilla, and inguinal area (NAI). NAI cultures were repeated after 72 hours of admission, and blood culture was repeated if needed. A demographic questionnaire on age, sex, and admission time was filled out for each patient.

 The most common grown bacteria in the NAI samples were coagulase-negative staphylococci (CoNS). Second cultures from these sites revealed nosocomial contamination. Eighteen patients (27.7%) had positive blood cultures, with 61.1 % of the isolated pathogens being Gram-negative (mostly Escherichia coli and Pseudomonas aeroginosa) and 38.9% Gram-positive. The blood cultures results did not match those of the NAI cultures in 61.1% of the patients. About one-fourth of the Gram-negative pathogens isolated from blood were resistant to cefepime, the main empirical antibiotic for FN management at our center.

 Gram-negative bacteria are predominant organisms in pediatric FN patients at our center, most resistant to cefepime. If a similar antimicrobial sensitivity pattern is observed in future studies, a change in local guidelines might be considered for FN management.
 

 Peritonitis remains a significant complication of peritoneal dialysis (PD) in children.

 The current study aimed to evaluate the causative agents of PD-related peritonitis in pediatric patients treated by continuous ambulatory peritoneal dialysis (CAPD) in order to provide evidence for improving the empirical treatment of PD-related peritonitis and avoid antimicrobial resistance.

 The medical records of children diagnosed with PD-related peritonitis hospitalized at Mofid and Ali-Asghar Children’s Hospitals from January 2018 to December 2019 were retrospectively reviewed. Cases of relapsing peritonitis and fungal peritonitis were excluded. Data on demographics, clinical manifestations, para-clinical evaluations, peritoneal fluid culture and antibiogram, and antibiotic regimen were analyzed.

 A total of 23 CAPD children aged 1 - 17 years were hospitalized with a confirmed diagnosis of PD-related peritonitis, accounting for a total of 27 peritonitis cases. The most frequent manifestation of peritonitis was cloudy dialysate (85.2%), followed by abdominal pain (59.3%). Gram-negative organisms were isolated in 48.1% of cases, and 4 cases had negative cultures. The frequency of antibiotic prescription within 14 days of admission was significantly higher in culture-negative cases (P = 0.002), and abdominal pain was more prevalent in Gram-negative peritonitis (P = 0.004). All Gram-negative organisms were sensitive to ceftazidime and imipenem; while 61.6% of them were sensitive to gentamycin. All Gram-positive organisms were sensitive to cefazolin, and vancomycin was effective against all Staphylococcus strains. Oxacillin resistance was reported in 50% of Staphylococcus strains.

 PD-related peritonitis should be suspected even in cases with clear dialysis effluent who present with other manifestations of peritonitis such as fever or abdominal pain. Moreover, intraperitoneal administration of a first-generation cephalosporin (cefazolin) combined with ceftazidime was an appropriate therapeutic option for empiric therapy.

Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus affecting adults and children. The spread of severe acute respiratory syndrome resulted in a global pandemic by SARS-CoV-2. The pediatric population is responsible for a smaller proportion, and 2% of cases are described under age 20 (1). Whether this ratio is a sign of low sensitivity to the disease in children vs. adults or a higher rate of asymptomatic cases is unclear. Recently, attention has been drawn to the link between Kawasaki-like disease and coronavirus disease-2019 (Covid-19) in children (2). Kawasaki disease (KD) initially described in 1967 in Japan is a multisystem inflammatory syndrome, typically occurs in six months to five years old children. Tomisaku Kawasaki stated that there may be a correlation between viral infection and a cluster of patients with "Mucocutaneous Lymph Node Syndrome", 40 years later, Espar et al. found eight coronavirus-positive nasal swabs among eleven patients with KD (3). Chang et al. have shown that viruses, including coronavirus, has been linked to KD (4). Recently, there is an increasing occurrence of KD potentially linked with coronavirus between children in a high-risk area (5). Cases of multisystem inflammatory syndromes and Kawasaki occurred in Europe and the USA named pediatric inflammatory, multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS), and multisystem inflammatory syndrome in children (MIS-C), respectively (6). A cluster of 8 children with features of atypical KD, toxic shock syndrome (TSS), and KD shock syndrome (KDSS) were reported in South Thames retrieval services pediatric ICU during 10 days in mid-April 2020. Laboratory feature of these children was hyperferritinemia, elevated proBNP, Procalcitonin, and CRP. Most of them were Afrocaribian and were treated with inotropes, hydrocortisone, and IVIG. SARS-CoV-2 was positive in two cases, one of whom died (7). After the outbreak started in February 2020, Italy, the first affected European country, experienced a high incidence of Kawasaki-like disease in children. In Bergamo city with the highest rate of death and infection in Italy, 10 cases of newly diagnosed KD (first group) were compared with 19 cases of KD in the last five years (second group). The incidence of KD was 30 times higher in cases admitted from February 18 to April 20, 2020, in contrast to cases admitted from January 1, 2015, to February 17, 2020 in which 8/10 of first group cases were positive for IgG and 3/10 were positive for IgM too. Mean age was significantly higher in the first group; cardiac involvement occurred in 2/19 in second and 6/10 in the first group. Kawasaki disease shock syndrome (KD with hemodynamic instability) and macrophage activating syndrome (MAS) occurred in 0/19 in the second and 5/10 in both KDSS and MAS cases in the first group. The first group had significantly lower WBC, lymphocyte, and platelet count. The first group included more severe cases with atypical KD and they required more adjunctive treatment (8). In response to this cluster in the UK, the emergence of an unusual disorder was notified to National Health Services on April 25. Owing to the rise in antibodies and little evidence of viral replication in most patients, the mechanism of MIS-C seems to be antibody or immune complex-mediated (2). Given the recent increase in MIS-C or PIMS-TS in the final stage of the first epidemic of SARS-CoV-2, it is important to warn about the possibility of its occurrence in children. However, its prevalence is low in children equivalent to one in 1,000 children exposed to SARS-CoV-2 (8), early detection and appropriate treatment with a corticosteroid, IVIG, Inotropes, and other modalities are important.

The causal role of Parvovirus B19 (B19V) in Juvenile Idiopathic Arthritis (JIA) is still a matter of debate. In this study, an attempt was made to investigate the frequency of B19V infection and the association between patients’ characteristics and B19V infection in children with JIA.

Synovial fluid samples were obtained from 27 children (13 boys, 14 girls, aged 3-16 years) with JIA and were analyzed by polymerase chain reaction to detect B19V DNA. Age, sex, number of involved joints, time elapsed between beginning of symptoms and arthrocentesis, serum Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were compared between JIA patients with and without B19V.

Six patients (22.2%) were B19V+. There was no significant association between presence of B19V DNA in synovial fluid and number of joints involved, duration of disease, treatment with Disease-Modifying Anti rheumatic Drugs (DMARD) or glucocorticoid therapy and mean ESR and CRP levels. However, there was a slightly significant relationship between sex and age and detection of B19V DNA in the synovial fluid of JIA patients.

Our study demonstrated a 22% prevalence of B19V infection in JIA patients, and also that there was a significant relationship between sex and age and detection of B19V DNA in the synovial fluid of JIA patients.

Congenital CMV infection is the most prevalent congenital infection in the world, and perinatal Listeria infection is an important cause of neonatal sepsis. The identification of these two infections is hard. The PCR technique is a sensitive method, which is not simply available in Iran.

This study investigated the prevalence of CMV and Listeria in 100 urine samples from under 21-day-old neonates with positive risk factors by PCR electrophoresis and fluorescent end-point detection (FEP) PCR in Tehran referral hospitals.

We used 100 urine samples from neonates admitted to 11 medical centers in Tehran with positive selected clinical symptoms compatible with these infections. Electrophoresis and FEP PCR for CMV and Listeria were performed on all urine samples. For the data analysis, SPSS version 21 software was used, and p values of less than 0.05 were considered significant.

We collected 100 urine samples from 100 under 21-day-old neonates, referring to Tehran hospitals. Seven cases were positive for Listeria, and 58 cases were positive for CMV by electrophoresis and FEP PCR. Respiratory distress was the most common clinical finding in both groups. The Mc-Nemar test revealed a statistical agreement between calcification and CMV and meningitis and Listeria (P = 0.18 and 0.07, respectively). There was a positive relationship between the neonates’ age and CMV-positive condition (P = 0.001). This result was not significant among Listeria-positive cases.

Screening for CMV and Listeria infections in neonates with clinical features compatible with these intrauterine infections may give important information for their treatment and follow-up.

 This scoping review tries to synthesize early findings on the immunopathogenicity of SARS-CoV-2 to assess the emerging therapies and vaccines by evaluating their impact based on the mechanism of pathogenicity.

The three databases of PubMed, Scopus, and Google Scholar were searched from January 1, 2020, to March 15, 2020. To extract the results from the studies, the content, thematic analysis method was used. In this method, the topics studied were coded in the articles, and then major topics related to the articles were determined. After identifying major issues, the contents of the articles were reviewed.

A total of 2,250 articles were retrieved after deleting duplications, and after reviewing the thematic relevance, 45 of them were selected for the final analysis. Topics studied in the articles were classified into four main areas, including “virus entry inhibition and immune response”, “vaccine and treatment targets”, “genome structure similarity to other coronaviruses,” and “pathogensis”.

Results of this review showed that we have a long way to develop an effective and safe vaccine due to the structural and behavioral complexities of this virus. In the meantime, the scientific community should use results of megatrials, but until their accomplishing them, we have to use results of systematic reviews of randomized controlled trials.