Archives of Pediatric Infectious Diseases
Volume:4 Issue: 3, 2016 Jul

Bone pain is common in children. The cause may be as benign as growing pains or as life threatening as a malignancy. When a cause cannot be established by patient history and physical examination, imaging of the affected body part is often carried out. However, it is not always easy to discriminate between benign and malignant lesions of the bones in children using imaging methods.
We report the case of a 4.5-year-old boy with acute onset bilateral hip and low back pain and inability to walk. Examination of passive movements showed that both hips were painful and restricted.
Bone pain presenting as localized bilateral irritable hip could be considered as a diagnostic clue related to malignancies.

An 11-year-old female patient with autoimmune hepatitis (AIH) was referred to our rheumatology clinic due to her current musculoskeletal manifestations. The patient had been diagnosed with AIH 3 months previously, based on jaundice and impaired liver function tests, and she had been treated with low-dose prednisolone and azathioprine. She presented with malaise, arthritis, a malar rash on the face, and oral ulcers. Laboratory tests revealed a positive ANA/anti-dsDNA test. Liver biopsy showed chronic hepatitis with severe inflammatory activity, in favor of a diagnosis of definite AIH. She fulfilled the international criteria for both SLE and AIH. The clinical symptoms and laboratory findings of SLE improved with ongoing treatment with corticosteroids and azathioprine, accompanied with hydroxychloroquine sulfate. The present case indicates that AIH can be the first manifestation of SLE in children.

Pseudomonas aeruginosa is an important cause of hospital-acquired infections that can create serious problem for patients and physicians. Many factors are associated with the antibiotic resistance of P. aeruginosa, such as efflux pumps.
The aim of this study was the phenotypic and molecular detection of efflux pumps in our clinical P. aeruginosa isolates in a comparison between burn and non-burn specimens.
In this study, clinical strains of P. aeruginosa were collected from burn and non-burn specimens from April - July 2013. Antibiotic susceptibility testing of the isolates was performed after biochemical and molecular identification. The minimum inhibitory concentration (MIC) of imipenem, cefepime, gentamycin, and ciprofloxacin, with and without carbonyl cyanide 3-chlorophenylhydrazone (CCCP), was determined for phenotypic detection of efflux pumps.
Our results confirmed 203 and 60 P. aeruginosa isolates from burn and non-burn specimens, respectively. The most antibiotic resistance was observed against tobramycin in both group of specimens, and no resistance was seen to colistin. Phenotypic detection of efflux pumps was determined to correlate to a > 4-fold decrease in the MICs of the tested antibiotics with CCCP compared to without CCCP in 57 strains.
High-level antibiotic resistance can occur as a result of multidrug efflux pumps combined with other mechanisms of resistance. However, the association between over-expression of these genes and highly resistant clinical isolates cannot be ignored.

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.

Urinary tract infection (UTI) is one of the most common bacterial infections in outpatient settings. Enterococcus species is currently considered the second most common cause of UTI.
The aim of this study was to investigate antibiotic resistance patterns among Enterococcus faecalis strains and evaluate the association of antibiogram patterns from urine and fecal samples in community-acquired UTIs using phenotypic and molecular methods.
A total of 144 urine and fecal samples were obtained from outpatients with UTI who had been referred to Labbafinejad hospital and Milad hospital from August 2014 to April 2015. For bacteriological study, samples were cultured in enterococcosel and blood agar. Antimicrobial susceptibility tests were evaluated using the disk diffusion method and the E. test according to criteria recommended by the clinical and laboratory standards institute (CLSI). PCR was performed for the detection of specific species and the antibiotic resistance genes tetM and vanA.
Of the 72 E. faecalis strains isolated from urine samples, 63 (87.5%) were also isolated from fecal samples. 40 (63.4%) of the isolates found in both urine and feces had similar antibiotic sensitivity patterns. 17 (26.9%) of the isolates found in both specimens were different in a class of antibiotic (related) and 8 (12.6%) isolates in more than one or two class of antibiotics (difference). The results of the disk diffusion methods were analyzed according to CLSI breakpoints. The antibiotic resistance of strains isolated from urine samples was evaluated for tetracycline (65 strains [90.3%] resistant), minocycline (64 [88.9%]), gentamicin (120 µg) (21 [29.2%]), ciprofloxacin (17 [23.6%]), levofloxacin (12 [16.7%]), and gatifloxacin (11 [15.3%]). The same evaluation was conducted for the strains isolated from fecal samples for tetracycline (48 [76.1%]), minocycline (45 [71.4%]), gentamicin (10 [15.8%]), ciprofloxacin (8 [12.6%]), and gatifloxacin (4 [6.3%]). All strains were sensitive to vancomycin, ampicillin, penicillin, nitrofurantoin, linezolid, and daptomycin. According to the PCR results as a gold standard and molecular method, 67 (93%) of the isolates from urine and 52 (82.5%) of the isolates from feces were positive for tetM genes. The vanA gene was not found in any strain.
The simultaneous detection of E. faecalis in a patient’s gastrointestinal and urine tracts can indicate the presence of uropathogenic Enterococcus. Further study is essential to identify virulence factors involved in the colonization of these isolates in the urinary tract.

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.

Recent advances in medicine and the pharmaceutical industry have led to a multitude of treatment options for the management of illness in both adults and children.
To identify prescribing patterns for children hospitalized with common acute illnesses in a tertiary-care children’s hospital.
Case notes of children hospitalized from October 2013 to September 2014 with urinary tract infection, respiratory distress, pneumonia, acute gastroenteritis, febrile convulsions, acute bacterial meningitis, and fever with rash or without a localized source, as well as case notes of previously healthy children scheduled for surgery, were reviewed. Relevant data regarding diagnoses, hospital course, and treatment were documented on information sheets and reviewed independently by two members of the faculty (pediatric infectious disease specialists) to evaluate the appropriateness of prescriptions given for each patient.
A total of 227 case notes were reviewed, 129 (56.8%) of which belonged to male patients. No medication was prescribed for 13 patients, whereas 697 drug prescriptions (excluding intravenous fluids) were given for 214 patients, equaling 3.25 drugs/patient; antibiotics were prescribed for 161 children (70.92%). Overall, 87.96% of drugs were prescribed by their generic names; 20% of prescribed medications were unnecessary; the dose was incorrect in 15% of prescriptions; and the duration of treatment was inappropriate in about 27% of prescriptions. Only 29% of children with acute diarrhea received oral rehydration therapy.
Findings reveal a significant degree of prescription errors, emphasizing the need for stringent surveillance.

Antimicrobial resistance is one of the most severe threats to human health. The first report of plasmid-mediated colistin resistance in Escherichia coli from animals, food, and humans was in 2015 from China. The current increasing trend of resistance is extremely troubling because polymyxins are the last-resort antibiotics for treating infections with carbapenem-resistant Enterobacteriaceae.

Respiratory infections caused by Pseudomonas aeruginosa play an important role in the pathogenesis of cystic fibrosis (CF).
The aim of this study was the detection of metallo-β-lactamases (MBLs) and Klebsiella pneumonia carbapenemases (KPCs) among P. aeruginosa isolates from children with CF in Mofid Children’s Hospital, Tehran, Iran during 2012 - 2013.
Patients and This descriptive study consisted of CF patients who were referred to Mofid Children’s hospital of Tehran during 2012 - 2013. Sputum was collected from the CF patients in sterile containers and tested as early as possible. P. aeruginosa was isolated using standard bacteriologic methods. Antimicrobial susceptibility testing was performed by the disc diffusion method based on the guidelines of the clinical laboratory standards institute (CLSI). Screening of MBLs and KPC production was done using the combination disk diffusion test (CDDT) and modified hodge Test (MHT), respectively. The frequency of imipenemases (IMPs), Verona integron-encoded metallo-β-lactamases (VIMs), and KPC-type genes was detected by PCR and further sequencing methods.
Using the DDST, 43.3% of P. aeruginosa isolates were positive for the production of MBLs. In contrast, KPC was not identified in these isolates. IMP, VIM, and KPC genes were detected in 2 (6.66 %), 2 (6.66%), and 0 (0%), respectively.
The incidence of MBLs producing P. aeruginosa in patients with CF was not low. The findings indicate that the identification of drug-resistance patterns in P. aeruginosa and the detection of MBL-producing isolates are important in the prevention and control of infections.

Human papillomavirus (HPV) is a DNA virus that establishes productive infections only in keratinocytes of the skin or mucous membranes.
This study aimed to determine the frequency of two high-risk genotypes of HPV among married and unmarried Iranian women.
This cross-sectional population-based study consisted of two groups of women: non-married girls referred for premarital counseling, and married women referred for pregnancy diagnosis. Blood samples were evaluated serologically with the ELISA method for HPV types 16 and 18.
A total of 177 women (89 single and 88 married) were tested for HPV strains. The frequency of HPV type 16 in single women was significantly higher than in married women (66.3% vs. 40.9%, P The results showed remarkable rates of high-risk HPV types (16 and 18) in the studied population, which can be a serious alert for public health. This result highlights the potential impact of prophylactic vaccines for future protection against high-risk HPV types in Iranian women.