Archives of Pediatric Infectious Diseases
Volume:5 Issue: 1, Jan 2017

Patients’ privacy is an important ethical responsibility in medicine and an inseparable part of treatment. Children’s privacy is no exception. Children’s rights to privacy are recognized under the Children’s Rights Convention as part of good medical practice.
Few studies have examined children’s privacy in Iran or in other countries. Thus, the present study was designed to investigate views expressed by relatives who accompanied sick children to the hospital about various aspects of the children’s privacy.
In this descriptive cross-sectional study, data on two dimensions of privacy (informational privacy and physical privacy) of children in pediatric wards were collected using a researcher-made questionnaire from 90 individuals who accompanied children (90 children, 57.8% boys and 38.9% girls) to hospitals (Imam Hossein and Mofid) affiliated to Shahid Beheshti University of Medical Sciences. The data were analyzed using SPSS-18 software. Pearson’s correlation coefficients were calculated, and t-tests and ANOVAs were performed.
With regard to the two dimensions of privacy, informational privacy was respected more than physical privacy. No significant relationship was observed between the observance of privacy and duration of the hospital stay or admission ward, but there was significant linear correlation between the number of beds in a room and informational and physical privacy. The mean score for respecting privacy increased in accordance with the child’s age, with the overall mean score significantly higher in the 11 - 14-y age group than the other age groups. Information disclosure occurred mainly through conversations with parents (52.2%) and during rounds (30%). Very little information disclosure (1.1%) occurred via discussions between personnel and discussions with parents. Hospital authorities investigated 40% of complaints about privacy violations or disclosure of a sick child’s information.
The results showed that the level of respect for informational privacy was relatively acceptable. However, the level of respect for physical privacy was poor. Therefore, it is essential to provide appropriate training on the issue of children’s privacy, especially physical privacy (e.g., using separate rooms and ensuring that medical staff knock before entering a room), and to ensure that rules governing children’s privacy are followed.

Diarrhea is a cause of concern due to high morbidity and mortality in children. Enteropathogenic E. coli (EPEC) strains contribute to outbreaks of infantile diarrhea, especially in developing countries.
This study was performed to investigate the contribution of EPEC as a cause of infectious diarrhea among Iranian infants.
A total of 140 E. coli isolates from children with diarrhea and 110 from children without diarrhea were evaluated for the presence of EPEC. The E. coli isolates were examined for uidA, eae, and stx genes by polymerase chain reaction (PCR). The eae positive isolates were tested for the bfpA gene to differentiate typical and atypical EPEC. The EPEC isolates were typed by random amplified polymorphic DNA (RAPD-PCR).
The E. coli isolates were confirmed by the presence of the uidA gene. The EPEC was diagnosed in 6 cases (4.2%) with diarrhea, which were positive for the eae gene, compared with negative results in the asymptomatic group. The bfpA were positive in 5 isolates (3.6%) that were categorized as tEPEC and 1 (0.09%) as aEPEC. All isolates showed genetically different patterns in RAPD-PCR.
This study suggests that EPEC strains are important contributors to diarrhea in Iranian children. Because of the weakness of routine microbiological tests and poor specifity of serological tests, it is recommended that the EPEC strains are better detected by molecular methods.

Acute respiratory tract infection is associated with significant morbidity, mortality, and economic loss worldwide. Viral infections seem to be responsible for 80% of the cases. There are several reports on the influence of dual or multiple respiratory viral infections on the severity of disease in childhood.
A limited number of studies have been conducted on co-infection of Adenovirus (AdV) with coxsackievirus, human bocavirus (HBoV) and Mycoplasma pneumoniae (MP) in Iran. To address this, the present article focuses on both the etiology and epidemiology of multiple microbial respiratory infections (coxsackievirus, HBoV, MP and influenza virus) and their clinical significance in young Iranian children with confirmed AdV infection.
Patients and Molecular detection of HBoV, coxsackievirus, MP and influenza virus was performed by conventional PCR in 71 respiratory adenovirus-positive samples obtained from children younger than 5 years of age.
Among the 71 adenovirus-positive samples, 6 (8.4%) were co-infected, three were co-infected with MP and three of which were co-infected with influenza A/H3N2. Of the six patients with co-infection, four were male and two were female; three patients were less than 1 year of age and the remaining were 2, 3 and 4 years of age. Moreover, there were two inpatients and four outpatients.
Although several studies have investigated viral respiratory co-infection, no study has evaluated the rate of respiratory co-infections in adenovirus-positive samples from children younger than 5 years. However, this study has filled this gap, the the number of co-infections were too small to draw any definite conclusions. Therefore, large-scale studies using bigger samples are required to understand the clinical significance of polymicrobial acute respiratory infections.

Coagulase-negative staphylococci (CoNS) are clinically important, especially in nosocomial and neonatal infections. The increasing emergence of glycopeptide-resistant CoNS has made these agents therapeutically challenging.
We aimed to investigate the susceptibility patterns of CoNS to teicoplanin and vancomycin in Gorgan, northern Iran.
A total of 100 clinical samples were obtained from different wards of a hospital and screened for CoNS with standard microbiological and biochemical tests. Antibiogram testing was carried out for the detection of vancomycin-, teicoplanin-, and multidrug-resistant (MDR) species. The minimum inhibitory concentration (MIC) of vancomycin was determined using E-test strips. The presence of the vanA gene was investigated with PCR.
Only 1% of CoNS (Staphylococcus haominis) showed resistance to vancomycin and 15% of these were intermediate-resistant to teicoplanin on the disc diffusion agar test. In addition, all isolates (100%) were negative for vanA on PCR and sensitive with E-test methods. The mean MIC value of vancomycin was 1.35 ± 0.29 µg/mL. S. haemolyticus and S. epidermidis showed the highest rates of MDR (50% and 24%, respectively). Additionally, CoNS isolated from blood (42%) and urine samples (30%) had the highest rates of MDR.
Vancomycin, but not teicoplanin, can be considered an effective antibiotic of choice for controlling infections caused by MDR CoNS in Gorgan, depending on the bacterial species.

Staphylococcus aureus is a common pathogen in hospitals and communities. Antibiotic resistance is a major public health problem.
The aim of this study was the determination of antimicrobial susceptibility patterns and to perform molecular detection of macrolide and lincosamide-resistance genes in clinical S. aureus isolates from Kerman, Iran.
From February 2014 to December 2015, a total of 170 clinical S. aureus isolates were obtained. Resistance to different antibiotics was determined by the disk diffusion method. Methicillin-resistant S. aureus (MRSA) and inducible clindamycin resistance were confirmed by phenotypic methods, and polymerase chain reaction (PCR) was used to detect the nuc, mecA, ermA, ermB, ermC, and mrsA/B genes.
All isolates were sensitive to linezolid and vancomycin. In total, more than 50% of the isolates were multidrug resistant (MDR) and 52.5% were MRSA. Inducible clindamycin resistance was observed in 12.5% of the isolates. The prevalences of the mecA, ermA, ermB, ermC, and mrsA/B genes in the isolates were 39.5% (69/170), 11% (19/170), 3.5% (6/170), 20.5% (35/170), and 10.5% (18/170), respectively.
A high prevalence of macrolide and lincosamide-resistant genes were found in S. aureus isolates from nosocomial and community-acquired infections in Kerman, Iran. The investigation of antibiotic resistance may provide crucial information about the control of such infections, and it is necessary to accurately identify antibiotic resistance on routine susceptibility tests.

Cronobacter is a genus within the family Enterobacteriaceae and was previously known as Enterobacter sakazakii. Cronobacter sakazakii is an opportunistic ubiquitous bacterium and is identified throughout the world as an emerging food-borne pathogen. This pathogen causes meningitis, necrotizing enterocolitis (NEC), and sepsis (septicemia) in patients hospitalized in neonatal intensive care units and has a high mortality and morbidity rate. Contamination of powdered infant milk formula occurs more easily because it is a nonsterilized product.
The aims of the present study were as follows: Isolation of Cronobacter sakazakii from powdered infant formula milk (PIF), confirmation of isolates by biochemical tests and polymerase chain reaction (PCR) molecular method, and characterization of an antibiotic susceptibility profile.
A cross-sectional study was performed on 125 powdered infant formula milk (PIF) samples purchased from hospital drug stores between June 2014 and March 2015. Cronobacter sakazakii was recovered according to FDA protocol. For the final confirmation of isolates, different biochemical tests embedded in the API-20E kit system and manual biochemical tests were used according to the directions of the manufacturer. Antibiotic susceptibility testing was performed on Mueller-Hinton agar by disk diffusion method according to CLSI recommendations. For molecular confirmation of isolates confirmed by biochemical tests, PCR was performed on 16S rRNA gene specific for Cronobacter sakazakii.
Out of the 125 PIF samples investigated, nine (7.2%) of the samples were positive for Cronobacter sakazakii. All C. sakazakii strains isolated from PIF samples were uniformly susceptible to ticarcillin, chloramphenicol, levofloxacin, ciprofloxacin, moxifloxacin, cefepime, piperacillin-tazobactam, and colistin. All isolates were confirmed by PCR..
Results showed that PIF that is being consumed in Iran is contaminated with this pathogen and can cause disease in infants; especially those hospitalized in neonatal intensive care units (NICUs) and fed PIF. The number of reported cases of Cronobacter infections is very low, but nevertheless there has been a slight increase recently. While the reported cases worldwide are few, it needs to be noted that the number of infections may be underestimated since not all clinical analysis laboratories carry out research on other bacterial pathogens, and not all countries have a system for reporting diseases.

Detection of fastidious enteropathogenic bacteria in fecal samples of patients with gastroenteritis is a challenge in clinical microbiological laboratories.
The aim of this study was to compare the detection limits of the PCR and culture methods for the diagnosis of Campylobacter spp., Yersinia spp., Clostridium perfringens, and Clostridium difficile in human stool samples.
Healthy human stool and sterile phosphate-buffered saline (PBS) samples were separately spiked with 10-fold dilutions of C. jejuni, C. difficile, Y. enterocolitica, and C. perfringens reference strains to obtain final concentrations of 101 - 108 colony forming units (CFU) per gram. Dilutions of each suspension were inoculated onto specific culture media and colony counts were determined. Polymerase chain reaction (PCR) was carried out on DNA extracts of each dilution using specific primers. All of the assays were performed in two separate replicas.
In the cases of the culture and PCR assays, detection limits of 101 and 102 CFU/g for C. difficile, 2 × 104 and 2 × 104 CFU/g for C. perfringens, 104 and 102 CFU/g for C. jejuni, and 102 and 104 CFU/g for Y. enterocolitica, respectively, were obtained. In the cases of the spiked PBS samples, a detection limit of 101 for C. jejuni and Y. enterocolitica was obtained using the culture method. While 102 -fold higher sensitivity was observed for C. jejuni via PCR compared with the culture assay, equal (C. perfringens) or lower sensitivity limits (C. difficile and Y. enterocolitica) were detected for the spiked stool samples with other bacteria.
These results showed differences in the bacterial culture and PCR methods for quantitative detection of fastidious bacteria in human stool samples. However, a bacterial load of 104 CFU per gram of stool was measured as a sufficient amount for detection of the fastidious bacteria by either culture or PCR assays. More suitable PCR methods could be used for rapid diagnosis of the slow-growing bacteria in the patients’ stool samples.

Streptococcus pneumoniae is the major cause associated with otitis, sinusitis, bronchitis, and pneumonia, as well as an outstanding cause of meningitis, bacteremia, and many other infections. Throughout the world, an increase in antibiotic resistance S.pneumoniae has become a serious problem in the recent years in many different countries. Penicillin resistance in S. pneumoniae cause of altered on the penicillin target position, the penicillin-binding proteins (PBPs).
In the present study, we describe the prevalence and antimicrobial susceptibility pattern and identification of the pbp2b gene of S. pneumoniae isolates at specimens of several general hospitals in Tehran, the capital of Iran.
A total of 73 S. pneumoniae were obtained from various clinical specimens from hospitals in Tehran from September 2012 to July 2015. Antibiotic susceptibility of isolates was determined by the broth microdilution method. The genes pbp2b in penicillin-resistant streptococcus pneumoniae (PRSP) were detected using polymerase chain reaction (PCR).
In total, 73 isolates were collected and diagnosed as S. pneumoniae. Isolates were susceptible to ofloxacin 95.9%, vancomycin 93%, penicillin 78%, trimethoprim-sulfamethoxazole 61.6%, ceftriaxone 53.5%, meropenem 52%, cefotaxime 46.5%, and erythromycin 8.2%. Of the 15 PRSP isolates, the pbp2b gene was identified in 12 (80%). In 1 penicillin-intermediate S. pneumoniae isolate the pbp2b was detected.
These results in comparison with same studies in other parts of the world showed us an increase in resistant S. pneumoniae isolates to conventional drugs in the treatment of the acute infections caused by this bacteria. In the present study, PRSP possess the pbp2b gene were the most frequently found, which means they have a high level of resistance of S. pneumoniae. For decreasing the mortality and morbidity of patients, it is suggested to determine the antibiotic susceptibility pattern of the isolates in each hospital for doing necessary medical interventions.

Staphylococcus aureus (S. aureus) is a bacterium responsible for a variety of clinical conditions, ranging from skin diseases and pneumonia to bloodstream infections. Methicillin-resistant S. aureus (MRSA) is a perpetual concern in medical settings due to its resistance to many antibiotics; accordingly, the periodic surveillance of antibiotic susceptibility patterns is an everlasting concern in the clinical arena.
This quantitative study aimed to detect intrinsic and acquired methicillin resistance precisely, testing for the effect of beta-lactamase inhibitors and assessing the antibiotic sensitivity patterns of clinical isolates for S. aureus.
One hundred and five isolates of S. aureus were ascertained for their resistance toward methicillin by agar screening and agar dilution (minimal inhibitory concentration [MIC]) methods. Acquired resistance was detected in methicillin-resistant isolates by the addition of beta-lactamase inhibitors. The tolerance phenomenon in these isolates was determined by a ratio of their minimal bactericidal concentration (MBC) over their MIC.
Methicillin resistance was detected in 38% of S. aureus isolates, confirmed by the agar dilution method and MIC > 8 µg/mL (intrinsic resistance). These isolates were mostly collected from ICU burn patients (32.5%). No isolate was found to have acquired resistance or modified (MOD) type resistance. Tolerance was not observed in any isolate. Antibiotic susceptibility toward other therapeutic agents showed that all intrinsic methicillin-resistant isolates were susceptible to vancomycin; however, methicillin-susceptible isolates were the least sensitive (30%) to penicillin.
Methicillin resistance is a specialized concern in clinical studies, and it is mandatory to detect this mechanism by an accurate method that is updated periodically. Increasing the resistance of S. aureus to multiple antibiotics underlines the need for intermittent resistance surveillance.

Methicillin-resistant Staphylococcus aureus (MRSA) strains are a common cause of emerging nosocomial infections and are a major public health concern.
The aim of the present study was to determine the prevalence of MRSA, its antibiotic resistance pattern, and the virulence gene profiles in hospitalized patients admitted to ICUs.
During a 6-month period, a total of 70 S. aureus isolates were collected from 249 patients admitted to the ICU in five hospitals. In vitro antibiotic susceptibility testing of the S. aureus isolates was carried out using the Kirby-Bauer disk diffusion method with 16 antibiotic disks. Molecular detection of toxin and adhesion genes was carried out using PCR.
All the 70 S. aureus isolates were confirmed to be MRSA strains. The largest number of S. aureus isolates was found in the blood (42.9%) and wound (21.4%) samples. The MDR pattern was detected in 71.4% of the isolates, which were obtained from wound and blood samples. Simultaneous resistance to seven, six, five, four and three drugs was common in 35 (50%), 7 (10%), 8 (11.4%), 11 (15.7%), 2 (2.9%) and 5 (7.1%) isolates, respectively. The frequency of the spa, fnbB, fnbA, clfB, clfA, can, bbp, ebp, etb, eta, pvl, and tst genes was 100%, 75.7%, 74.3%, 78.6%, 71.4%24.3%, 0%, 58.6%, 2.9%, 7.1%, 21.4%, and 51.4%, respectively. In addition, among all the examined genes, the clfB (78.6%) and etb (2.9%) genes had the highest and lowest prevalence respectively.
In the present study, we found a high prevalence of MRSA at the hospitals studied. The findings emphasized the increased prevalence of MRSA isolates containing different toxin and adhesion genes, probably accompanied by antimicrobial resistance. Infection with such isolates worsens the clinical outcomes as well as the morbidity and mortality rates in hospitalized patients in ICUs.

The methicillin-resistant Staphylococcus aureus (MRSA) strain is now the most commonly reported antibiotic-resistant bacterium in clinical settings. Therefore, there is an urgent need to develop novel antibacterial agents to control this pathogen. Bacteriophages are a potential alternative treatment for MRSA infections.
The objective of this study was the isolation and characterization of MRSA phages from the sewage at a tertiary pediatric hospital.
Two MRSA strains were isolated from patient blood. The isolated strains were confirmed as MRSA through the conventional methods. Phages were then isolated from the sewage at the tertiary pediatric hospital. Lytic activity was determined with a spot test, while the titers of phage lysates were measured using the DLA technique. The morphology was assessed using electron microscopy, and the latent period time and burst size were determined.
Electron microscopy showed MRSA phages’ resemblance to members of the family Siphoviridae, serogroups A and F. They exhibited a latent period of 70 minutes and a relatively burst size of 2,400 plaque-forming units (PFU)/infected cell. The titer of the phages was determined to be 3 × 109 PFU/mL using the by DLA technique.
In this study, two phages from the family Siphoviridae were isolated and characterized from sewage at a tertiary pediatric hospital; these phages specifically target MRSA. Their presence may be one reason for the transfer of antibiotic resistance or virulence factors, resulting in transduction and the conversion of nonvirulent strains of Staphylococcus to virulent strains. Considering that phages through can be transferred to wards in an air-born manner, it is better to create negative pressure in the sewage pipes at hospitals until the phages can no longer transfer to the wards via aerosols.

Neonatal sepsis is one of the major causes of morbidity and mortality in newborns. Since early diagnosis of neonatal septicemia is important for timely initiation of correct antimicrobial therapy and considering the existence of variability in non-specific clinical laboratories, we assessed the role of clinical manifestations and laboratory findings to find the right diagnosis.
The aim of this study was to evaluate, record and rank the clinical manifestations and lab data of neonates with clinical sepsis.
In a cross sectional descriptive prospective study in 2013, a total of 110 consecutive infants with clinical manifestations of sepsis were studied in two groups including early onset sepsis (EOS) taking place at 72 hours of age or younger, and late onset sepsis (LOS) occurring after 72 hours. Check list of infant’s data, presenting symptoms or signs and laboratory data in both groups were evaluated and recorded. Significant differences were set at as P Overall, 81.8% of infants had EOS while 18.2% of infants had LOS. The mean age at the time of EOS and LOS presentation was one to two days and four to twelve days, respectively. The most common clinical manifestations were respiratory distress in 49 (44.5%), jaundice in 28 (25.5%), vomiting in 26 (23.6%) and poor feeding in 23 (20.9%) of the infants. Other clinical manifestations were lethargy (weakness), decreased sucking reflex, fever, tremor, abdominal distention and seizure, found in 12 (10.9%), 10 (9.1%), 4 (3.6%), 4 (3.6%), 3 (2.7%) and 2 (1.8%) neonates, respectively. Early Onset Sepsis was considerably associated with respiratory distress (P Respiratory distress is more common in EOS whereas jaundice, fever and seizure are more likely to be observed in LOS infants. Considering the results, clinical manifestations should be regarded as an important part of early diagnosis of sepsis.

Osteomyelitis (OM) is a rare but serious inflammation of the bone resulting from an infection caused by an organism. Chronic osteomyelitis is an unusual inflammatory process involving multiple osseous sites. In children, osteomyelitis can be either acute or chronic.
This case concerns a 3-year-old girl whose medical history includes an acid attack suffered 3 years ago. She began treatment for the restoration of her scalp hair, but five weeks later, she presented at our clinic with a high-grade fever and infectious discharge from the commissure of the skull following a scalp expansion graft. Microbiologic and radiologic work-ups were conducted, and the patient was given an experimental antibiotic treatment. The brain spiral CT scan without contrast and brain MR imaging showed chronic osteomyelitis of her cranial bones. After 25 days patient was discharged with a course of oral antibiotics to continue at home.
Although chronic skull base osteomyelitis is rare, it is a very serious condition that should be considered in the differential diagnosis of any patient who has suffered trauma to the cranial bones or undergone skin grafts or hair restoration on their scalp. Thorough evaluation is mandatory in these cases.

Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation (ROHHAD) is a rare disease. To date, there have been only few reported cases of ROHHAD syndrome.
We report a 5-year-old- Iranian girl who had normal growth and development until her 4th year of life. At that time, the patient developed weight gain, constipation, coldness in the extremities, and hyperhidrosis. She first presented to our children’s hospital with a suspected mediastinal mass on chest radiography. After surgery and resection of the mass (a ganglioneuroblastoma), extubation was unsuccessful, with tachycardia and hypertension occurring after each attempt. After 48 days in the ICU, we were still unable to wean her from mechanical ventilation. Finally, based on the rapid weight gain, hypoventilation, hypothalamic dysfunction, and signs of autonomic dysregulation, the patient was diagnosed with ROHHAD syndrome.
Only a few case reports have described ROHHAD syndrome, and it is therefore difficult to manage. In children with rapid and early-onset obesity associated with hypothalamic-pituitary endocrine dysfunction, ROHHAD syndrome should be considered in the differential diagnosis.