Archives of Pediatric Infectious Diseases
Volume:6 Issue: 2, Apr 2018

The aspects of the epidemiology of bloodstream Candida infections including clinical features, the causal agents, underlying conditions, and risk factors have not been well-defined in Iranian pediatric patients. The aim of this observational study was to identify uncommon Candida species isolated from blood and other normally sterile specimens of the neonates and children admitted to intensive care units at Children’s medical center, Tehran, Iran.
The study was carried out prospectively on patients A total of 16 out of 136 isolates were recognized as uncommon or rare Candida species. According to the sequence analysis, these isolates were identified as C. orthopsilosis (N = 5, 3.7%), C. glabrate (n = 4, 2.5%), C. dubliniensis (n = 2, 1.5%), C. lusitaniae (n = 2, 1.5%), C. kefyr (n = 2, 1.5%), and C. intermedia (n = 1, 0.75%)
Candida species, which were once considered harmless, have now been recognized as causative agents of candidemia. It is essential to consider, manage, and control the conditions that lead to the development of these unusual but severe cases of candidemia.

Acute diarrhea, a leading cause of morbidity and mortality worldwide, still remains a major global health problem, especially among children in the developing countries. Diarrheagenic E. coli represent one of the most common etiological causes of diarrhea in children worldwide.
This study was conducted in order to determine the rate of Enteroaggregative E. coli (EAEC) among 50 E. coli isolates as well as its antimicrobial resistance patterns.
A total of 50 Escherichia coli strains had been isolated among children under 5 years of age during 75 reported outbreaks in various provinces of Iran from October 2013 to May 2014. PCR was employed for the identification of different groups of diarrheagenic E. coli. Antimicrobial susceptibility testing was performed using disc diffusion methods. In addition, extended spectrum beta-lactamase (ESBL) production ability was checked by way of combination disc methods of CLSI. Minimum inhibitory concentration of cefotaxime, ceftriaxone, and ceftazidime in EAEC with the ability of ESBL production was determined using the micro-broth dilution method of CLSI.
Out of the 50 E. coli isolates, 17 were identified as Enteroaggregative E. coli (EAEC) in that they were positive for at least 1 of the 2 tested virulent genes: agg and aap. ESBL production ability was observed in 4/17 (23.5%) EAEC isolates. MIC of cefotaxime and ceftriaxone in ESBL positive EAEC varied between 8 - 32 µg/mL and 8 - 64 µg/mL, respectively. Resistance to ampicillin and nalidixic-acid (47.1%), trimethoprim/sulfamethoxazole (41.2%), and ciprofloxacin (11.8%) was observed among the EAEC isolates. No evidence of resistance to gentamycin and meropenem was detected.
This research has revealed that the most common type of diarrheagenic E. coli among children, who were affected in the diarrheal outbreak in different cities of the country, is Enteroaggregative E. coli (34%). The rate of ESBL positive cases in EAEC isolates were 23.5 %.

Nonencapsulated, nontypeable Haemophilus influenzae (NTHi) is considered an important cause of acute otitis in children and respiratory diseases among adults. The bacteria express several outer membrane proteins, some of which have been studied as vaccine candidates. Protein D is a highly conserved surface lipoprotein, which has been found in strains of both encapsulated and nonencapsulated H. influenzae.
Opsonin and protective antibodies against protein D play major roles in the prevention of infections caused by NTHi. Since NTHi can be also an intracellular organism, it needs to be removed through immune-mediated mechanisms.
In this study, groups of BALB/c mice were subcutaneously immunized with recombinanat truncated D protein and an aluminum hydroxide (alum) adjuvant or protein D combined with an outer membrane vesicle (OMV) adjuvant from Neisseria meningitidis bacteria. Then, opsonophagocytic activities of antibodies were measured in serum samples collected on days 14, 28, and 42. The levels of interleukin-4 (IL-4), IL-10, and interferon-gamma were measured in splenocyte cultures of immunized mice.
The opsonophagocytic activity of antibodies significantly increased in the immunized mice, compared to the control group, particularly on day 42. In addition, the secretion level of cytokines significantly increased in both groups of immunized mice, compared to the control group.
The results of this study demonstrated that recombinant truncated D protein can induce specific immune responses against nonencapsulated H. influenzae. It was suggested that the recombinant truncated D protein, as a vaccine candidate against the nonencapsulated strains of H. influenza, is essential in protection and development of sustainable immunity against infections caused by this bacterium.

Our aim was to investigate the acute effect of inhaled NaCl 5% on spirometry indices in patients aged over six years with cystic fibrosis (CF).
44 children over 6 years of age with CF took part in this study. Spirometry indices were measured. After receiving two puffs of salbutamol spray, the children were administered with 5 ml NaCl 5% by a medical compressed air system using a nebulizer kit and immediately a spirometric test was taken again. Spirometry results were recorded and the data were analyzed by SPSS v.18.
The percentages of the annual decline of forced expiratory volume in one second (FEV1) were 10.12 ± 31.28, 7.26 ± 17.10, and 13.8 ± 21.7 in children aged 6 - 8 years, 9 - 12 years, and over 13 years, respectively. There were significant differences in FVC, FEV1/FVC, MEF50, MEF75, MMEF25/27 before and after hypertonic NaCl 5% inhalation (P Patients with CF exhibited a suitable response to acute inhalation of hypertonic NaCl 5%.

Recently, a relationship has been demonstrated between red blood cell distribution width (RDW) and mortality risk in critically ill patients although the exact mechanism of this association is still vague. However, the impact of changes in RDW on sepsis and its outcome in critically ill patients has not been widely studied. Therefore, we studied the prognostic impact of changes in RDW in critically ill pediatric patients with sepsis.
A total of 304 patients who were admitted to pediatric intensive care unit were selected to participate in this study. The changes in RDW on the day of admission and 4 and 8 days after admission in PICU were documented and their relationship with SIRS positivity, sepsis, and mortality were analyzed.
The mortality rate in our patients was 10.5%. In total, 39.8% of patients were SIRS positive and 50.4% fulfilled the criteria of sepsis. The mean of RDW at the time of admission, on Day 4 and on Day 8 of admission was 14.8%, 16.1%, and 16.6%, respectively. At the time of admission, RDW had a significant correlation with mortality and SIRS positivity, but RDW measured on Days 4 and 8 of admission did not correlate with neither of them. Neither of RDW0, RDW4, nor RDW8 did correlate with sepsis criteria fulfillment. ΔRDW day 4-adm > 0.2%, ΔRDW day 8-adm > 0.2%, ΔRDW day 8-day 4 > 0.2% exhibited no correlation with SIRS positivity, sepsis, and mortality.
We found that an increase in RDW from baseline during the first 4 and 8 days after admission of critically ill pediatric patients did not correlate with their mortality, SIRS positivity, and sepsis. However, elevated baseline RDW is a valuable prognostic marker in patients with sepsis.

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.

The reported prevalence and pattern of thrombocytopenia in neonatal sepsis vary widely.
We aimed to determine the prevalence and severity of thrombocytopenia in blood culture proven neonatal sepsis.
The study was conducted in a University hospital by recruiting neonates with sepsis in whom blood culture had grown microorganisms. The initial platelet count refers to the one obtained at the same time as the positive blood culture. Platelet counts were monitored 12 - 24 hourly. Thrombocytopenia was considered mild if between 50,000/mm3 and 150,000/mm3, moderate if between 20,000/mm3 and 50,000/mm3, and severe if A total of 143 episodes of blood culture proven sepsis in 131 neonates were studied. Gram positive bacteria identified in 33.6%, gram negative bacteria in 53.8%, and fungi in 12.6%. Klebsiella predominated among Gram negative bacteria (39%) and Candida species (94.4%) among fungi. Initial thrombocytopenia was observed in 84 (58.7%) episodes; it was mild, moderate, and severe in 39.3%, 25%, and 35.7% respectively. Initial thrombocytopenia among Gram positive, Gram negative, and fungal sepsis were 41.7%, 70.1%, and 55.6%, respectively. Severe thrombocytopenia in the respective groups was 20%, 44.4% and 20%. Overall (80%) and severe thrombocytopenia (45.8%) was highest in Klebsiella sepsis. Thrombocytopenia was moderate in 60% of Candida sepsis. An additional 23.7% had thrombocytopenia subsequently. In 51.2%, thrombocytopenia persisted beyond 3 days.
Thrombocytopenia was observed in 58.7% of culture proven neonatal sepsis. Initial thrombocytopenia was common among Gram negative sepsis and mostly of a moderate degree in Candida sepsis.

Critically ill children at the intensive care unit frequently develop hospital-acquired pneumonia (HAP). Human herpes viruses (HHVs), primarily or by reactivation may cause bronchopneumonitis in mechanically ventilated patients. The exact prevalence and role of HHVs in morbidity and mortality of pediatric patients undergoing mechanical ventilation is unclear. The current study was conducted to evaluate the prevalence of 5 Herpes viruses by polymerase chain reaction (PCR) method in bronchoalveolar lavage (BAL) samples in critically ill children at a pediatric intensive care unit (PICU).
Overall, 140 bronchoalveolar lavage samples from 83 mechanically ventilated cases were studied. Samples were taken via the mini-BAL technique. Samples were analyzed by qualitative PCR for detection of herpes simplex virus type 1 and 2 (HSV1/HSV2), human herpes virus type 6 and 7 (HHV6/HHV7), Ebstein-Barr virus (EBV), and cytomegalovirus (CMV).
Out of 83 cases, 53% (44) were male and 47% (39) were female. The mean age was 29.12 ± 33.67 months (32.53 months in males and 25.29 months in females). The estimated prevalence of HSV1, HHV6, HHV7, EBV, and CMV were 2.4%, 13.2%, 2.4%, 7.2%, and 2.4%, respectively.
Molecular study of BAL specimens and investigation of HHVs may be the first step in the evaluation of the possible role of these viruses in the development of viral pneumonia during VAP. The current results are useful for guiding other well-designed studies for correlation of viral load and clinical outcome in ill ventilated children. The Modified protected BAL may be of use as a safe modality in critically ill ventilated pediatric patients for investigation of possible viral (and also bacterial and fungal) infections. Local study of high-risk patients at the PICU and estimation of the true prevalence of HHVs infection may assist in finding the exact role of HHVs in mortality and morbidity of critically ill patients.

Pertussis is a vaccine-preventable disease that affects infants and adults around the world despite high vaccination coverage.
The present study was preformed to assess pertussis seroprevalence in maternal serum and cord blood after delivery.
A cross-sectional, descriptive analytical study was carried out in a single urban hospital (Tehran-Iran), during years 2015 and 2016. The target population included term-healthy neonates with their mothers. Immediately after birth, mother’s blood was tested for PT IgG, FHA IgG, FHA IgA, and PT IgA, and umbilical cord blood was tested for PT IgG and FHA IgG by the enzyme linked immunosorbent assay (ELISA). Potentially protective antibody levels were evaluated.
Eighty-eight parturient mother-neonate pairs entered the study. Seventy-two mothers (81.8%) had childhood vaccination yet with regards to negative PT IgA and FHA IgA (90.9% and 95.5%), more than 90% of them did not show antibodies related to acute pertussis infection. According to the cutoff, PT IgG in 33%, 13.6%, and 53.4% was negative, equivocal, and positive, respectively. Based on the cord blood PT-IgG concentration, 61.4% of newborns were also unprotected against B. pertussis. A significant positive correlation was observed between mother and neonate’s FHA IgG (P value 0.05).
This study demonstrated a low level of immunity against B. pertussis in pregnant females, which may increase the risk of pertussis in very young infants. Implementing strategies, such as Tdap vaccination during the antenatal period, seems to be of great importance.

Acute lymphoblastic leukemia (ALL) has various clinical manifestations due to bone marrow or extra medullary involvement. Osteomyelitis may occur as the first presentation or relapsing sign of ALL. Multifocal osteomyelitis in non-neutropenic children with ALL is rare.
This study reported on an 8-year-old male with ALL during the maintenance phase of his treatment, who presented fever and generalized body pain. Bone scan showed multiple bones involvement and biopsy was in favor of osteomyelitis.
Multifocal osteomyelitis should be kept in mind as a possible diagnosis in patients with leukemia, who are presented with prolonged fever.