Archives of Pediatric Infectious Diseases
Volume:8 Issue: 1, Jan 2020

More than 90% of the world population experience the infection by Epstein-Barr virus (EBV), this virus has the potential to survive in B cells for the entire life period of infected individuals. However, if the balance between host and virus is disturbed, silent EBV infection could change to neoplasms. Socioeconomic factors affect exposure to EBV so the age of primary infection varies worldwide. In underdeveloped population infection occurs at lower age and EBV infection remains subclinical in high number of patients. Different neoplasms associated with EBV infection are EBV-positive Hodgkin lymphoma (HL), EBV-associated Burkitt lymphoma, diffuse large B-cell lymphoma, post-transplant lymphoproliferative disorders (PTLD), smooth muscle tumor and nasopharyngeal carcinoma. This review article presents detail information about pathogenesis, clinical presentation and treatment of pediatric patients with these disorders.

Streptococcus pneumoniae is one of the leading causes of morbidity and mortality worldwide that mainly colonizes the upper respiratory tract in children and produces invasive infections such as meningitis, bacteremia, pneumonia, and otitis media. Pneumococcus species harbor a number of virulent genes that influence disease severity. Neuraminidase is a virulence factor that cleaves sialic acid. Pneumococcal nasopharyngeal carriage is common among healthy individuals and is considered an important transmission source. This topic, however, is less regarded in research from Iran. Therefore, the current study aimed at investigating the prevalence of pneumococcal nasopharyngeal carriage among Iranian children under six years of age. The study also aimed at determining the frequency of pneumococcal serotypes and the neuraminidase virulence genes (nanA, nanB, and nanC) among carriers. A total of 384 nasopharyngeal samples were collected from children under six years of age referred to healthcare centers of six provinces in Iran, including Tehran, Fars, Ardebil, Lorestan, Khorasan, and Sistan va Baluchistan from 2013 to 2016. Of these, 92 carriers were identified (24.0%; 95% confidence interval [CI]: 20.0, 28.5%). Identified pneumococcal serotypes included 6A/B (14.1%), 14, 3, and 19A (each 12.1%), 4, 19F, 23F (each 5.4%), 11 (4.3%), 18C, 22F, 9V, 19, 12, and 33F (each 2.1%), 5, 12F (each 1.1%) and non-typable (14.1%). Frequency of neuraminidase nanA, nanB, and nanC genes among 92 carriers was 100% (95% CI: 96.0, 100%), 85.9% (95% CI: 77.3, 91.6), and 62.0% (95% CI: 51.8, 71.2), respectively. The results showed that about 25% of children (n = 92) were pneumococcus carriers. A wide range of serotypes, some of which are known as virulent, were seen in the population. Prevalence of neuraminidase genes was also considerable.

Cryptosporidiosis is a worldwide zoonotic parasitic disease found in children and HIV-positive individuals, and is mainly accompanied with diarrhea.

This study attempted to compare the sensitivity and specificity of acid-fast (AF) staining, polymerase chain reaction (PCR), and enzyme-linked immunosorbent assay (ELISA) methods to determine Cryptosporidium and its predominant species in diarrheal stool samples of children.

In total, 221 diarrheal stool samples were collected from children admitted to Motahari Hospital in Urmia city, North-West of Iran. The AF staining and ELISA methods were used to analyze all the samples, while the PCR method was considered as the gold standard of the study. Positive samples shown by PCR were sequenced to determine Cryptosporidium species (spp.). The three methods were compared regarding statistical factors, sensitivity, specificity, positive and negative predictive values, time duration, and experiment costs.

Of the 221 analyzed samples, four and seven samples were positive for Cryptosporidium, as indicated by the AF staining and PCR methods, respectively. The sensitivity and specificity of the AF staining method were shown to be 57.14% and 99.53%, respectively, and five out of 94 samples were diagnosed as positive using ELISA (with 71.4% sensitivity and 100% specificity).

Our findings showed that ELISA found less false positive and false negative in comparison with the AF staining method to detect Cryptosporidium. Despite having higher sensitivity and specificity in comparison with the ELISA method, PCR needs more time and cost; therefore, ELISA is preferred for laboratory routine works. Due to limited information on molecular epidemiology of Cryptosporidium spp., more studies using molecular methods are needed to elucidate accurate species.

Scrub typhus, a zoonosis caused by bacteria Orientia tsutsugamushi is associated with varying clinical features and significant mortality due to complication in view of ineffective treatment.

This study was undertaken to identify the factors for predicting severity in scrub typhus.

This retrospective study was conducted at a tertiary care teaching hospital between January 2015 to October 2016. All children younger than 18 years of age admitted with a history of fever for more than seven days and positive IgM ELISA for scrub typhus were included in the study. Cases of “severe scrub typhus” were identified based on criteria from published pediatric studies. A total of 235 patients tested positive for scrub typhus, out of which 39 patients were in the severe scrub group and 196 in the non-severe group. Reports were analyzed for the predictors of severity of scrub typhus in both groups.

Using multivariate analysis, the factors for predicting severity in scrub typhus were hemoglobin < 10 g/L (OR = 2.8, CI = 1.40 to 5.72), platelet < 150 000 cells/mm3 (OR = 2.54, CI = 1.21 to 5.30), albumin < 2.5 g/d (OR = 3.18, CI = 1.42 to 7.11), SGOT > 5 fold rise (OR = 49.7, CI = 13.49 to 183.17), prolongation of PT (P value = 0.03), and altered sensorium (P value = 0.016) were correlated with severe disease.

We conclude that altered sensorium, anemia, thrombocytopenia, elevated transaminases, hypoalbuminemia, and prolongation of prothrombin time to be predictors of severity of illness in scrub typhus.

Malta fever caused by the Brucella spp. is an endemic zoonotic infectious disease in Iran. Evaluation of the disease control is essential for socioeconomic and public health-related concerns.

This study aimed to evaluate the prevalence of Brucella spp. and the frequency of mutations responsible for resistance to rifampin, streptomycin, and fluoroquinolones in sheep from Mianeh, Southwest of West Azarbaijan Province, Iran.

A total number of 1,220 blood samples were collected in Mianeh. Positive samples screened using Rose Bengal Plate Test (RBPT) was subjected to Polymerase Chain Reaction (PCR). Finally, positive samples were investigated for the presence of mutated aminoglycoside adenylyl-transferase-A1 (aadA1) (conventional PCR), DNA gyrase subunit A (gyrA), topoisomerase IV subunit C (parC) (MAMA PCR for both) and RNA polymerase β-subunit (rpoB) (MAS PCR) responsible for antibiotic resistance.

There were 41 Brucella abortus Cell Surface Protein 31 Positive (BCSP31+) samples out of 111 RBPT positive samples which 15% (n = 7) of them were obtained from vaccinated sheep. Of the total BCSP31+ samples and 9 were carrying mutated aadA1, 3 carrying mutated parC and only one sample carrying mutated rpoB. None of the samples were positive for mutated gyrA.

The prevalence of Brucellosis in livestock in the city of Mianeh has been higher than in other areas in Iran, and some antibiotic resistance genes have been identified in livestock specimens. It can be concluded that due to the relatively good efficacy of the vaccines, the need for vaccination in all livestock farms of this city is important.

Elizabethkingia meningoseptica is a Gram-negative Bacillus associated with various nosocomial infections. These bacteria cause meningitis, sepsis, bacteremia, pneumonia, infections of the skin and soft tissue, ocular infections, sinusitis, epididymitis, and endocarditis. They can be opportunistic pathogens in newborns and immunocompromised patients.

The current study reported a case of bacteremia caused by E. meningoseptica in an infant presented with clinical presentations suggestive of necrotizing fasciitis with cerebral salt wasting and disseminated intravascular coagulation. Based on clinical diagnosis and preliminary blood culture report, the patient started receiving intravenous antibiotic (cefepime plus fludrocortisone) and fluid therapy for electrolyte imbalance. The patient also had fasciotomy and an amputation through the distal phalanges due to necrotizing fasciitis. The patient improved clinically after eight weeks of treatment.

E. meningoseptica bacteremia is commonly associated with complications; therefore, an appropriate and adequate antibiotic therapy, and also intensive care procedures and multidisciplinary interventions were crucial for the management of this case.

Brucellosis, with multi-organ involvement, is recognized as a zoonotic infection in Iran. This infection has multiple signs and symptoms. On the other hand, hemophagocytic lymphohistiocytosis (HLH) is described as an uncommon disorder. The secondary type of this disease may be associated with infection. However, the association between HLH and brucellosis has been rarely reported, especially in pediatric populations. Herein, we present a pediatric case of secondary HLH associated with brucellosis. Based on our findings, HLH should be considered in patients diagnosed with brucellosis with profound cytopenia and increased spleen size despite treatment.