فهرست مطالب roya nikfar

Despite the global vaccination program, there are many new cases of pertussis in different societies annually.

This study aimed to investigate the prevalence of some microorganisms associated with pertussis-like syndrome and compare the clinical presentations between Bordetella pertussis and pertussis-like syndrome in children.

Children younger than 5 years old suspected of pertussis-like syndrome were admitted to a hospital in Ahvaz, Iran, and examined from July 2018 to July 2019. Nasopharyngeal samples were evaluated using molecular methods. The studied microorganisms were the following: Bordetella pertussis, B. parapertussis, Mycoplasma pneumoniae, Chlamydophila pneumoniae, adenovirus, respiratory syncytial virus, and parainfluenza virus type III.

Forty-five children were enrolled. Bordetella pertussis was detected in 15 cases (33.3%), respiratory syncytial virus in 14 (31.1%), C. pneumoniae in 3 (6.7%), and parainfluenza virus type III in 3 (6.7%). The collected samples were negative in terms of M. pneumoniae, adenovirus, and B. parapertussis. In the case of paroxysmal cough, the clinical symptoms were significantly different between pertussis and pertussis-like groups.

The results indicated that children with pertussis-like syndrome are commonly infected with B. pertussis and respiratory syncytial virus, so more attention should be paid to this issue. The study also demonstrated the importance of molecular diagnosis methods, along with diagnosis based on clinical symptoms, in children suspected of pertussis-like syndrome.

Tuberculosis (TB) is one of the most important infectious diseases worldwide. Bacillus Calmette-Guerin (BCG) is a live attenuated vaccine, entered into the childhood immunization program by the World Health Organization (WHO) in 1974 to prevent TB. One of the relatively common complications of BCG vaccination is regional lymphadenitis.

This study aimed to determine the lymphadenitis incidence in BCG-vaccinated children in southwest Iran.

In a prospective descriptive study, infants born from March to June 2017 were evaluated for BCG vaccine complications at two, four, six, nine, and 12 months of age in Ahvaz, southwestern Iran.

The study enrolled 1,506 infants (794 males and 712 females). Among the vaccinated infants, four (0.26%) had injection site reactions, and 106 (7.03%) presented lymphadenitis (66 males and 40 females). The lymphadenitis rate was significantly higher in males than in females (P = 0.024). The mean age at presentation was 4.28 ± 0.79 months. Suppurative lymphadenitis was seen in 53 (50%) cases and nonsuppurative lymphadenitis in 53 (50%) cases. About 80% of nonsuppurative lymphadenitis resolved entirely or partially after a one-year follow-up. Of 53 cases with suppurative lymphadenitis, 46 (43.4%) developed spontaneous drainage, and seven (6.6%) were drained by needle aspiration. No significant relationship was found between the BCG inoculation site and lymphadenitis rate. No other complications such as osteomyelitis or disseminated BCG infection were observed after one year of follow-up.

The relatively high incidence of BCG lymphadenitis in this study may be due to the vaccine strain, young vaccinees, and improper vaccination techniques. In most cases, nonsuppurative lymphadenitis regressed spontaneously, and suppurative lymphadenitis was drained spontaneously or by needle aspiration.

Entamoeba histolytica is one of the important parasitic diseases in many parts of the world, especially the tropical and subtropical regions. The parasite is transmitted through contaminated water and vegetables. The exact diagnosis of infection with the parasite is crucial in many medical laboratories since there are many false positive and negative results in their reports. Therefore, the current study aimed at evaluating and comparing microscopic and coproantigen ELISA (the enzyme-linked immunosorbent assay) results to reach an appropriate test for the correct diagnosis of amoebiasis in children. One hundred stool samples were collected from children under 15 years old with dysenteric diarrhea from April to September 2018. Microscopic tests and coproantigen ELISA were performed on all the samples. The results showed that 5% of the samples had E. histolytica/E. dispar cysts. The findings of ELISA to detect coproantigen did not show any specific E. histolytica antigen in the samples. Hence, all the patients received chemotherapy for shigellosis. E. histolytica infection is not the main causative agent for dysenteric diarrhea in children in the studied area, and laboratory experts should be trained to prevent false-positive reports.

Diarrhea is one of the most significant diseases in children, causing morbidity and mortality worldwide. Diarrhea is caused by viruses, bacteria, and parasites. There are several viruses that can cause diarrhea, including some groups of enteroviruses that have a significant role in acute diarrhea in children.

This study was conducted to evaluate the presence of enteroviruses in the stool of children with diarrhea.

We collected 85 stool samples including 50 (58.82%) from males and 35 (41.17%) from females with acute diarrhea. All the stool samples proved negative for bacterial and parasitic pathogens. The RNA was extracted from the stool samples and cDNA was prepared. The semi-nested PCR was carried out for the detection of the 5’-UTR region of enteroviruses. To determine the enterovirus serotypes, the sequences of semi-nested PCR product was performed using conserved primers for the 5’-UTR region.

Overall, 21/85 (24.7%) patients including 12/50 (24%) males and 9/35 (25.71%) females showed positive results for enteroviruses (P = 0.3). Based on the results of sequencing, one of the isolated serotypes was identified as coxsackievirus A6 and the other isolated serotype was echovirus 9.

Overall, 21/85 (24.7%) children with acute diarrhea were infected with enteroviruses. The distribution of enteroviruses was not significantly different between male and female patients. The results of sequencing indicated that one of the isolated serotypes was coxsackievirus A6 and the other isolated serotype was echovirus 9. The remaining 64/85(75.29%) isolates were negative for enteroviruses. The role of other viral gastroenteritis agents including rotaviruses, noroviruses, calicivirus, astrovirus, and adenoviruses was not explored that needs further investigation.

Human enteroviruses (EV) are the most common causes of neonatal sepsis-like disease. The frequencies of EV including coxsackievirus A, coxsackievirus B and Echovirus serotypes have been studied in young infants (younger than three months) with sepsis. So far, the role of enteroviruses among neonates with sepsis was not determined in Ahvaz, Iran. Therefore, this study was aimed to evaluate the frequency of EV among hospitalized young infants with clinical signs and symptoms of sepsis in Ahvaz. Blood specimens from 128 neonates (younger than 90 days), including 56 (43.75%) girls and 72 (56.25%) boys, were collected from hospitalized neonates with clinical signs and symptoms of sepsis-like symptoms. All blood samples were negative for bacterial culture. RNA was extracted from all sera and tested for detection of 5'UTR (Untranslated Region) of the EV by RT-PCR. To determine specific strains of EV, positive 5ˊUTR samples were further tested for detection of the VP1 region of EV by RT-PCR. Overall, 50/128 (39.06%) specimens, including 24 (48%) girls and 26 (52%) boys, were positive for EV. 21/ 50 (42%) specimens were positive for the VP1 region. Randomly, 8 positive VP1 were selected and sequenced. Analysis of sequencing data showed 7/21 (33.33%) samples were positive for Echovirus 30 and 1/21 (4.76%) samples were positive for CVA9. The results of this survey indicate high prevalence of 39.06% of EV among young neonates with sepsis. A high prevalence of 33.3% Echoviruses 30 and a low rate of 4.76% coxsackievirus A9 infection has been observed in neonatal patients with viral sepsis. This outbreak is probably one of the first Enterovirus outbreaks to be reported in Ahvaz, Iran. The results of this survey will help to minimize unneeded use of antimicrobial drugs and reduce unnecessary hospitalization.

Nosocomial infection that is limited or diffuse reactions associated with pathogenic infectious agent or its toxins at least 48 to 72 hours accepting patients in the hospital will be created.The present study has been designed for the effect of controlled contactson nosocomial infections in children wards.
This study is a interventional study in wich 120 children in the control group and 120 children in the case group who were eligible for inclusion sampled purposefully.The data gathering tool was a infection control checklist for checking the care of doctors,nurses and parents and the standard protocols of infection control was used in Ahvaz hospitals.Data analysis was performed using descriptive statistics and inferential statistics spss v.20.
There is no any significant difference beatween two groups in the rate of pneumonia, urinary infection, blood stream infection and rate of whole nosocomial infections with (p=0/582).
The controlled contact is a solution for infection control but is was not the ultimate method of infection control,so it is best done research on other methods of nosocomial infection control.

Systemic candidiasis has been on the rise in recent years due to the increasing number of patients with malignancies and use of immunosuppressants. The present study seeks to identify the distribution of Candida species isolated from malignant patients and determine in vitro antifungal susceptibility patterns of the isolates to promote their effective management.
Blood and urine samples from 385 patients with malignancies were cultured. Identification and susceptibility patterns of the Candida isolates from clinical samples to antifungal drugs were done using API 20C AUX system and microdilution methods.
From 90/385 patients (23.4%), 102 Candida spp. were isolated. The most prevalent species was Candida albicans with sensitivity rates of 91%, 96%, 100%, 96%, and 60% to fluconazole, amphotericin B, caspofungin, voriconazole, and itraconazole, respectively. Epidemiological cutoff values for amphotericin B and voriconazole were 0.064 and 0.032, respectively. All the isolated species were of wild-type for all antifungal agents except 4% of Candida albicans, which were non-wild type to amphotericin B and voriconazole and 6% to itraconazole. No relationship was seen between the rate of isolated species and sex, age, and the type of malignancy; but the relationship between the use of antibacterial agents and Candida isolation was significant (P Mutations in drug sensitivity were found in some species (non-wild type). As there was a relationship between the use of antibacterial agents and the isolation of Candida species from immunocompromised patients, accurate diagnosis of Candida species isolated and their antifungal susceptibility patterns are needed for the management of such patients.

Bronchiolitis is one of the most common diseases of the lower respiratory tract in infants. Vitamin D has been shown to be protective against lower respiratory infections; however, there are limited and contradictory results in relation to serum vitamin D level and the incidence of bronchiolitis in children. The aim of this study was to compare serum levels of this vitamin in healthy infants and infants with acute bronchiolitis.
This case-control study conducted at Abuzar hospital in Ahvaz city, during October to March of 2014. Three groups of 45 eligible infants including control, low and high intensity of bronchiolitis enrolled to study. The severity of bronchiolitis classified according to scores derived from the respiratory distress assessment index. One to eight scores considered as low intensity and 9 to 17 scores considered as high intensity of bronchiolitis. Subsequently, 3 ml of venous blood sample were taken from them and the serum levels of 25(OH)D were measured by using an enzymatic kit.
60 (44.4%) infants were girls. The mean age of the control, low and high intensity of bronchiolitis groups were 11.2±5.2, 10±5.8 and 9.8±4.7 months, respectively (P=0.1). The mean of 25(OH)D concentrations in the control, low and high intensity bronchiolitis groups were 28.3±19.4, 17.7±11.7 and 13.6±5.7 nm/l, respectively. There was a significant difference in levels of 25(OH)D between the control-low intensity bronchiolitis groups (P=0.001) and the control-high intensity bronchiolitis groups (P=0.002), this difference was not significant between the two groups of bronchiolitis. There was a direct and significant correlation between serum level of 25(OH)D and age (r=0.2, P=0.005), breast milk consumption (r=0.3, P=0.001), and vitamin D supplementation (r=0.6, P=0.000).
In the present study, levels of 25(OH)D were significantly lower in infants with bronchiolitis than control group. In addition, 25(OH)D levels did not affect the severity of bronchiolitis.

Group A rotavirus (RVA) mainly causes acute gastroenteritis, exclusively in young children in developing countries. The prevalence and determination of the molecular epidemiology of rotavirus genotypes will determine the dominant rotavirus genotypes in the region and will provide a strategy for the development of appropriate vaccines.
A total of 100 fecal samples were collected from children below five years with acute gastroenteritis who referred to Aboozar Children’s Hospital of Ahvaz city during October 2015 to March 2016. All samples were screened by latex agglutination for the presence of rotavirus antigen. Rotavirus-positive samples were further analyzed by the semi-multiplex RT-PCR, and the sequencing was performed for G/P genotyping.
Findings showed that 32% of the specimens were RVA-positive. Among the 32 VP7 genotyped strains, the predominant G genotype was G9 (37.5%), followed by G2 (21.9%), G1 (12.5%), G12 (9.4%), G4 (9.4%), G2G9 (6.3%), and G3 (3.1%). Among the 31 VP4 genotyped strains, P[8] genotype was the dominant (62.5%), followed by P[4] (31.3%) and P[4] P[8] (3.1%). The genotypes for G and P were identified for 31 rotaviruses (96.87%), but only one strain, G9, remained non-typeable for the P genotype. The most prevalent G/P combination was G9P[8] (28.5%), followed by G2P[4] (18.8%), G1P[8] (9.4%), G12P[8] (9.4%), G4P[8] (9.4%), G2G9P[4] (6.3%), G9P[4] P[8] (3.1%), G3P[8] (3.1%), G9P[4] (3.1%), G2P[8] (3.1%), and G9P[non-typeable] (3.1%).
A novel rotavirus strain, G12, was detected, for the first time, in patients from the southwest of Iran. Comprehensive investigations are required to evaluate the emergence of this strain.

Shigella infections are one of the major causes of diarrhea worldwide, and especially in developing countries. Antimicrobial resistance has complicated the empirical treatment. The aim of this study was to define the clinical and antibiotic resistance patterns of Shigella gastroenteritis cases.
Stool samples of patients with diarrhea and fever diagnosed with shigellosis were collected, from June 2013 to May 2014 at Abuzar Hospital, Iran. All samples were cultured for Shigella spp on selective and differential media. Shigella isolates were evaluated for antimicrobial resistance.
Among 193 Shigella isolates, S. flexneri (64.8%) was the predominant species followed by S. sonnei (32.6%). The most frequent antibiotic resistance observed, was towards co-trimoxazole (89%), ampicillin (77%) and ceftriaxone (51%) and the lowest resistance were seen in ciprofloxacin (1.5%), azithromycin (7%).
Due to the high resistance to ceftriaxone, this drug is not recommended as an empirical therapy for shigellosis. However, azithromycin should be used as the first-line treatment for paediatric patients, suffering from shigellosis and ciprofloxacin can be used as an alternative.

Hydatid disease (HD) is still an important health hazard in the world. This disease is a parasitic infestation endemic in many sheep- and cattle-raising areas such as Iran.. This study aimed to review the clinical manifestations, laboratory aspects, imaging findings, and management of HD..Patients and Data were collected from the medical records of patients diagnosed with HD in eight referral hospitals in different provinces of Iran from 2001 to 2014.. Overall, 161 children at a mean age of 9.25 ± 3.37 years (age range = 1 - 15 years old) hospitalized with a definite diagnosis of the hydatid cyst between 2001 and 2014 were studied. The male-to-female ratio was 1.6:1. The most commonly involved organ was the lung (67.1%), followed by the liver (44.1%) and a combined liver and lung involvement was found in 15.5% of the patients. The cysts were found more frequently in the right lobe of the liver and lung than in the left lobe. The most frequent complaints were fever (35.4%) and abdominal pain (31.7%), and the most frequent sign was an abdominal mass in the liver involvement and cough in the lung involvement. There was a high eosinophil count (> 500/micL) in 41% of our cases. A high erythrocyte sedimentation rate (> 30) or positive C-reactive protein (based on the qualitative method) was found in 18.6% of the patients and leukocytosis > 15000/micL in 29.2% of the children. Ultrasonography was the main imaging test, with an accuracy rate of 96%, and chest X-ray was helpful in 88.6% of the cases. Surgery was performed in 89% of the patients, and selective patients underwent percutaneous aspiration-injection-reaspiration drainage or medical treatment.. The lung was the most commonly involved organ in the children recruited in the present study. Given the high probability of multiple organ involvement, we recommend that patients with HD be assessed via ultrasonography and chest X-ray. In endemic regions, unexplained eosinophilia should be considered as a parasitic disease like HD and its complications..

The prevalence of community acquired methicillin resistant Staphylococcus aureus (CA-MR- SA) is increasing around the world. It involves healthy people and causes a variety of diseases. This cross sectional study was conducted from September 2010 - June 2011 on children less than 14 years of Ahvaz, southwest Iran. The participants were selected with two staged cluster sampling. A sterile cotton nasal swab was used to collect the samples from the 864 participants. MRSA isolates were identifed by catalase and coagulase tests and 1 μg oxacillin disk method. Polymerase chain reaction (PCR) was performed on all the MRSA colonies to detect the mecA gene. Data was put in SPSS 16 software and descriptive statistics and chi-square test were used for analysis. Out of 864 children, 471(54.51%) were male and 393 (45.49%) were female. 235 children (27.1%) had Staphylo- coccus aureus and 11 (1.3%) of all children diagnosed with MRSA. PCR showed that 7 colonies (0.8%) had the mecA gene. The results of this study indicate that MRSA exists in healthy children of Ahvaz. Although the prevalence of CA-MRSA is lower than many other regions, it still needs close attention to prevent its transmission. Further studies are needed to identify the risk factors of CA-MRSA.

Hepatitis A is the most common type of hepatitis in developing countries with a wide range of clinical features.. The aim of this study was to evaluate clinical findings and epidemiologic characteristics of children with hepatitis A in in the southwest part of Iran.. Patients and A total of 105 patients with hepatitis A (53 males and 52 females) were enrolled in this study. The mean age of patients was 7.02 years (range, 4 months to 13 years). The majority of patients (81.9%) were in the age group of two to ten years. The disease occurred more frequently in summer and spring (71.5%). In a retrospective study, we reviewed the medical records of all children with acute hepatitis A (positive anti-hepatitis A virus IgM) who had been admitted to the main children’s hospital in Ahvaz, southwest Iran from March 2005 to March 2010. Statistical analysis was performed using SPSS 21.. The main clinical findings included jaundice (80%), vomiting (75.2%), fever (62.8%), and hepatomegaly (37.1%). The mean of the paraclinical parameters were as follows: ALT, 22.38 μkat/L; AST, 19.40 μkat/L; and bilirubin, 179.60 μmol/L. Mean duration of hospital stay was 4.7 days. All patients cured with supportive therapy. There was not any case of fulminant hepatitis, chronic hepatitis, or death. Hepatitis A was a relatively common disease in children in Southwest Iran.. The disease is more prevalent in children younger than ten years. The prognosis is excellent with low mortality and morbidity..

Shigellosis is an acute gastroenteritis that is one of the most common causes of morbidity and mortality in children with diarrhea in developing countries. The purpose of this study was to describe the distribution of Shigellaserogroups and serotypes and their antibacterial drug resistance profiles.fecal samples of all children suffering from shigellosis who had been admitted to Abuzar Children’s Hospital in Ahvaz, southwestern Iran, from September 2008 to August 2010 were examined. Antibiotics susceptibility testing was performed according to the Kirby Bauer disk diffusion method.Shigellaflexneriwas the predominant serogroup and being identified in 87 isolates (49.8%). The most common S. flexneriserotypes were type 2 (57.56%) and type 1 (21.87%). High rates of resistance were observed to trimethoprime-sulfamethpxazole (85%) and ampicillin (87.5%).S. flexneri and its serotypes was the most frequently isolated Shigella species from southwest of Iran, Ahvaz. Identification of predominant S. flexneriserotypes in developing countries can help in prioritizing strategies such as development of effective vaccines.

With changes in lifestyle، childhood overweight and obesity are most important health problems in both developed and developing countries. The aim of this study was to determine the frequency of overweight and obesity in schoolchildren in Ahvaz. Subjects and In a descriptive cross-sectional study 1،594 (52. 38% male) healthy schoolchildren aged 6 to 10 in Ahvaz were assessed. Height and weight were measured and body mass index (BMI) calculated for all. They were considered overweight and obese if BMI was >85 and >95 percentile respectively compared to standards. 52. 38% were male. Age distribution for 6 to 10 years old was 18، 21. 3، 19. 9، 20. 2، and 20. 5% respectively. Prevalence of overweight and obesity was 17. 7 and 18. 8%. Girls had greater risk to be overweight and obese compared to boys (21. 74 vs. 16. 17%; P=0. 001، and 21. 08 vs. 14. 65 %، P=0. 005 respectively). The results of this study showed that prevalence of overweight and obesity is noticeable، especially among girls. Near a hundred percent increase in both overweight and obesity in less than ten years is a warning. Intervention with education and change in habits and feeding behavior are mandatory.

Urinary tract infections are always treated empirically before the results of bacteriological cultures are obtained. The choice of antibiotics depends upon the causative organism and its expected local antibiotic susceptibility pattern.. We analyzed the spectrum and resistance patterns of uropathogens against common antimicrobial agents in Ahvaz Abuzar Children's Hospital, a tertiary care pediatric unit in southwest of Iran..Patients and In this retrospective study, all urine samples of children hospitalized with urinary tract infection (288 patients, aged 1mon -14.5 years) during October 2008 to May 2011 were included in the study. After bacteria were identified by standard methods, antimicrobial susceptibility testing was performed using a panel of antimicrobial agents.. The most of patients were girls (n = 226, 78.5%), and the median age was 13 months. The most common pathogens were Escherichia coli (84%), Klebsiella spp. (10.1%), Enterococcus spp. (2.4%), Proteus spp. (1.7%), and Pseudomonas spp. (1.7%). Overall bacterial resistance spectrum was the highest for co-trimoxazole (64.8%), followed by gentamicin (44.6%), amikacin (40.5%), nalidixic acid (37.3%), cefotaxime (28.9%), cefixime (27.5%), ceftriaxone (27.4%), and nitrofurantoin (10.2%). The female:male ratio was 2:1 (67.1% versus 32.9%) in infants aged < 1 year and 8:1 in those aged >1 year (89.4% vs. 10.6%). Vesicoureteral reflux and abnormal sonography findings were associated with high resistance to cefotaxime (P = 0.017), ceftriaxone (P = 0.004), nitrofurantoin (P = 0.014), and nalidixic acid (P < 0.001).. Increasing resistance to third-generation cephalosporins changed our opinion for using them as a single empiric intravenous therapy in hospitalized and very ill patients with acute pyelonephritis; the success will be achieved by concomitant use of an aminoglycoside or using other potent antibiotics..

Acute respiratory tract infections (ARTIs) play a major role in hospitalizations of children, and Respiratory syncytial virus (RSV) is well recognized as the most important pathogen causing ARTI. This study aimed to evaluate the epidemiological and clinical patterns of RSV infection in children hospitalized for lower ARTI in Ahvaz, Iran.Patient and Respiratory specimens collected from 100 children with lower ARTI from October 2008 until the end of April 2009, were screened for RSV using reverse transcription-polymerase chain reaction (RT-PCR). During the study period, 9 children had a positive result for RSV infection. The median age of these patients was 10 months. Bronchiolitis was the clinical diagnosis of patients with RSV infections. All of these patients were less than 24 months. Cough (77.7%) and chest wall retraction (100%) were the leading symptoms and signs respectively. This study indicates that RSV is a substantial cause of respiratory tract infection in infants less than 2 years old. RT-PCR offers a rapid method for detection of RSV in hospitalized children with LRTI..

Mumps, measles and rubella viruses lead to various kinds of complications such as meningoencephalitis, deafness, congenital abnormalities and even cause mortality in malnourished patients,. Since 2004, MMR vaccination in two series of one year of age and four to six years has been administered to Iranian children as a part of routine vaccination program. Recently, MMR vaccination schedule has been changed to one year and 18 months series. Since MMR vaccine has been recently entered childhood vaccination program, this study was performed to determine immunity response against mumps, measles and rubella six months after one year and four to six years of age vaccination. Patients and In a cross-sectional study, antibody titers after MMR vaccination at 18 months (six months after dose of one year) in 70 children, and at 6.5 years (six month after dose of six years) in 90 children referred to Ahvaz Abuzar Children’s Hospital Vaccination Clinic during 2007-2008 were detected by ELISA method. In 70 children (34 boys and 36 girls) who were vaccinated at one year, 30 (42.9 %) had antibody against measles, 63 (90 %) against rubella and 41 (58.6 %) against mumps. In 90 children (54 boys and 36 girls at 6.5 years of age (six months after vaccination), 41 (45.6%) children had antibody against measles, 79 (87.8 %) against rubella and 69 (76.7%) against mumps. the results of this study showed that after MMR vaccination, the level of antibody for measles was about 45 % and for mumps about 50-80 %. This level of immunity is not acceptable for successful vaccination. while the level of antibody against rubella was sufficient. For better evaluation of MMR vaccination, further studies and from other parts of the country is needed.