Archives of Clinical Infectious Diseases
Volume:15 Issue: 3, Jun 2020

Context: 

One of the emerging diseases that has spread in 2019 is COVID-19.

 The present systematic review (SR) was performed to evaluate the status of laboratory and radiological findings in the age group of children and adolescents with COVID-19.

 In this SR study, three of the research team members conducted searches in SCOPUS, PUBMED, Science Direct, and ISI international sites. The keywords that were searched included children- pediatric- adolescents- coronavirus- COVID-19- Novel coronavirus SARS-CoV-2-epidemiology- diagnostic findings- laboratory findings- CT SCAN- computed tomography- percentage of lymphocyte- alanine aminotransferase- white blood cell count (WBC). The combination of search keywords with AND as well as OR was performed. For analysis, descriptive data reporting was performed using EndNote software.

 The analysis of the laboratory and radiology findings of 197 patients of 12 studies included in the SR study showed notable changes in the lung CT scan and laboratory ranges that confirm the COVID-19 infection in these patients.

 This systematic review provides information on the laboratory and radiology findings of children and adolescents with COVID-19 for the health care team.
 

 The purpose of this study was to identify bacteria in urine samples of pregnant women of asymptomatic and symptomatic women by 16S rRNA gene sequencing. This study aims to identify different strains of microbes causing urinary tract infection (UTI).

 In the semi-quantitative culture technique, bacterial isolates such as Escherichia coli, Klebsiella, Pseudomonas, Staphylococcus, Coagulase-negative Staphylococcus, and Proteus were subjected to 16S rRNA gene sequencing followed by BLAST analysis and phylogenetic tree formation. The 16S rRNA gene sequencing was carried out to identify the specific strains of bacteria causing UTI.

 According to the BLAST analysis, sample 1 revealed a 100% similarity to E. coli strain U5/41. Likewise, samples 2, 3, 4, 5 and 6 exhibited a 100% similarity to Klebsiella aerogenes strain F26, Pseudomonas entomophila strain 2014, Staphylococcus aureus strain NCTC13616, Staphylococcus saprophyticus strain FDAARGOS_355, Proteus mirabilis strain NCTC 11938, respectively.

 Six bacterial isolates were analyzed by 16S RNA gene sequencing followed by the construction of a phylogenetic tree construction up to the species level. This method was a valuable tool for cost-effective and accurate diagnosis of an array of uropathogens in both asymptomatic and symptomatic pregnant women.

 Treatment of hepatitis C virus (HCV) infection with direct-acting antiviral agents in patients with HCV/human immunodeficiency virus (HIV) co-infection remains controversial due to drug interactions with antiretroviral therapy (ART).

 In this study, we assessed the efficacy and tolerability of daclatasvir/sofosbuvir (DCV/SOF) in patients with HIV-HCV co-infection in the real-life setting in Iran.

 A total of 44 patients with HCV-HIV co-infection (genotypes 1, 3, and 4) were treated with DCV/SOF±RBV (ribavirin) (dose-adjusted DCV for concomitant ART). Assessment of risk factors, sustained virologic response at 12 weeks after the end of treatment (SVR12), safety, and serum CD4 count was performed.

 Most patients were male (95.2%). Four patients were HCV treatment-experienced cases, and 15 had cirrhosis or advanced fibrosis. The most common genotype was 3 (53.5%), followed by 1 (44.2%) and 4 (2.3%). HIV-1 RNA < 50 copies/mL and CD4 count > 250 cells/mm3 were observed in 81.8% and 79.1% of patients, respectively. The highest risk factor was a history of IV drug use (81.8%), followed by using a common syringe (77.3%) and tattooing (70.5%). All patients with or without cirrhosis (100%) completed the HCV treatment course and achieved SVR12. Also. 92.6% of patients on ART had CD4 count > 250 cells/mm3 at the end of treatment. The HCV treatment regimen was well-tolerated. Moreover, 15.9% of patients experienced adverse events (AEs), including anorexia, nausea, diarrhea, palpitations, and anxiety. No serious AEs or discontinuation due to AEs were reported.

 Our study showed excellent tolerability and efficacy of DCV/SOF±RBV in HIV-HCV co-infected patients with or without cirrhosis.

Shigella flexneri causes bacillary dysentery in developing countries. Due to recent reports regarding antimicrobial resistance in human S. flexneri, finding alternative therapeutics is of vital importance. Toxin-antitoxin (TA) systems have recently been introduced as antimicrobial targets owing to their involvement in bacterial survival in stress conditions and “persister” cell formation. In this study, the presence of four TA loci were studied in S. flexneri ATCC 12022. The presence of genes coding for the identified TA loci and Lon protease were confirmed by the PCR method using specific primers. Caco-2 cell lines were then infected with this standard strain, and 8 and 24 h post-infection, expression levels of genes coding for the studied TA loci, and Lon protease were evaluated using a real-time PCR method. Expression of mazF, GNAT (Gcn5-related N-acetyltransferase), yeeU, pfam13975, and Lon genes showed 5.4, 9.8, 2.3, 2.7, and 13.8-fold increase, respectively, 8 h after bacterial invasion of the Caco-2 cell line. In addition, the expression of the aforementioned genes showed 4.8, 10.8, 2.3, 3.7, and 16.8-fold increase after 24 h. The GNAT and lon genes showed significantly higher expression levels compared to the control (P value < 0.05). However, the increase in the expression level of yeeU was the same at 8 h and 24 h post-infection. In addition, mazF expression level showed a slight decrease at 24 h compared to 8h post-infection. Genes coding for GNAT and Lon protease showed a significantly higher expression after invading the Caco-2 cell line. Therefore, targeting GNAT or Lon protease can be taken into consideration for finding novel antimicrobial drug strategies. The exact functions and mechanisms of TA systems in S. flexneri isolates are suggested to be experimentally determined.

 Burns patients are predisposed to infectious complications. Amongst microbial infections, Gram-negative bacilli are the most prevalent bacteria in the burn units.

 The current study aimed to identify the risk factors associated with antibiotic-resistant Gram-negative bacilli in hospitalized burn patients and determine the in-vitro susceptibility of these organisms to colistin.

 Two hundred burn patients hospitalized in the burn unit and ICU burn ward were allocated to two groups (each with 100 patients) of patients with antibiotic-resistant Gram-negative bacilli infections and the other with antibiotic susceptible Gram-negative bacilli associated infections. The susceptibility of Gram-negative bacilli was done towards various antibacterial agents by the Kirby-Bauer method. Susceptibility of colistin was performed using both E-test and disc diffusion methods.

 The history of antibiotic usage, length of ICU stay, mechanical ventilation, and catheter usage were the most important risk factors for infections associated with antibiotic-resistant Gram-negative bacilli. Pseudomonas aeruginosa and Acinetobacter baumannii were the most prevalent bacteria in the burn unit. Only one A. baumannii isolate was found resistant toward colistin by both disk diffusion and E-test methods.

 Burn patients are prone to infections, and Gram-negative bacilli predominates in patients harboring risk factors. These findings influence the choice of traditional therapeutic regimens in such patients. Colistin served as an appropriate antibiotic choice.

 Cerebral aspergillum is rare and usually misdiagnosed because its presentation mimics tuberculous meningitis, brain abscess, or tumor. The diagnosis and treatment of central nervous system (CNS) infections due to Aspergillus are very difficult because accurate diagnosis is often made intra-operatively.

 Here, we report a case of cerebral aspergilloma in an immunocompetent host. A 35-year-old man admitted with progressive left hemifacial paresthesia followed by severe pain in trigeminal nerve territory. On physical examination, except for fifth nerve palsy and difficult mastication, there was not any sensory and motor deficit. Magnetic resonance imaging (MRI) of the brain showed T1 iso and T2 low signal lesion in the left parasellar region with enhancement. The lesion is extended to the left side of the prepontine cistern in the course of trigeminal nerve, craniotomy, and total surgical resection of the mass was performed. Isolated brain lesion and the pathology from stereotactic biopsy confirmed cerebral aspergillosis. The result of testing for human immunodeficiency virus (HIV) was negative. Although the patient had two subsequent recurrences, at first, good outcome was achieved by treatment with a combination of surgical intervention, and antifungal amphotericin B deoxycholate was administered, then changed to voriconazole. Unfortunately, after two years, he experienced new progressive symptoms, and the patient died despite several reoperations due to malfunctioning of external ventricle devices as well as the treatment of recurrent post-operation meningitis and voriconazole therapy.

 Most cases of intracranial aspergillosis show that this infection is pathogenic in immunocompromised hosts; however, in some cases, invasive Aspergillus was reported as an opportunistic infection in immunocompetent patients. In these patients, though primary cranial aspergillosis is very rare, it is possible that isolated brain involvement in a previously healthy case may be explained by unknown defects in immune pathways or massive exposure to spores.
 

Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus affecting adults and children. The spread of severe acute respiratory syndrome resulted in a global pandemic by SARS-CoV-2. The pediatric population is responsible for a smaller proportion, and 2% of cases are described under age 20 (1). Whether this ratio is a sign of low sensitivity to the disease in children vs. adults or a higher rate of asymptomatic cases is unclear. Recently, attention has been drawn to the link between Kawasaki-like disease and coronavirus disease-2019 (Covid-19) in children (2). Kawasaki disease (KD) initially described in 1967 in Japan is a multisystem inflammatory syndrome, typically occurs in six months to five years old children. Tomisaku Kawasaki stated that there may be a correlation between viral infection and a cluster of patients with "Mucocutaneous Lymph Node Syndrome", 40 years later, Espar et al. found eight coronavirus-positive nasal swabs among eleven patients with KD (3). Chang et al. have shown that viruses, including coronavirus, has been linked to KD (4). Recently, there is an increasing occurrence of KD potentially linked with coronavirus between children in a high-risk area (5). Cases of multisystem inflammatory syndromes and Kawasaki occurred in Europe and the USA named pediatric inflammatory, multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS), and multisystem inflammatory syndrome in children (MIS-C), respectively (6). A cluster of 8 children with features of atypical KD, toxic shock syndrome (TSS), and KD shock syndrome (KDSS) were reported in South Thames retrieval services pediatric ICU during 10 days in mid-April 2020. Laboratory feature of these children was hyperferritinemia, elevated proBNP, Procalcitonin, and CRP. Most of them were Afrocaribian and were treated with inotropes, hydrocortisone, and IVIG. SARS-CoV-2 was positive in two cases, one of whom died (7). After the outbreak started in February 2020, Italy, the first affected European country, experienced a high incidence of Kawasaki-like disease in children. In Bergamo city with the highest rate of death and infection in Italy, 10 cases of newly diagnosed KD (first group) were compared with 19 cases of KD in the last five years (second group). The incidence of KD was 30 times higher in cases admitted from February 18 to April 20, 2020, in contrast to cases admitted from January 1, 2015, to February 17, 2020 in which 8/10 of first group cases were positive for IgG and 3/10 were positive for IgM too. Mean age was significantly higher in the first group; cardiac involvement occurred in 2/19 in second and 6/10 in the first group. Kawasaki disease shock syndrome (KD with hemodynamic instability) and macrophage activating syndrome (MAS) occurred in 0/19 in the second and 5/10 in both KDSS and MAS cases in the first group. The first group had significantly lower WBC, lymphocyte, and platelet count. The first group included more severe cases with atypical KD and they required more adjunctive treatment (8). In response to this cluster in the UK, the emergence of an unusual disorder was notified to National Health Services on April 25. Owing to the rise in antibodies and little evidence of viral replication in most patients, the mechanism of MIS-C seems to be antibody or immune complex-mediated (2). Given the recent increase in MIS-C or PIMS-TS in the final stage of the first epidemic of SARS-CoV-2, it is important to warn about the possibility of its occurrence in children. However, its prevalence is low in children equivalent to one in 1,000 children exposed to SARS-CoV-2 (8), early detection and appropriate treatment with a corticosteroid, IVIG, Inotropes, and other modalities are important.

Dear Editor, After the arrival of Zika to the Americas in 2014, and its rapid spread across the continent in less than two years, colonizing from the southern cone to North America and conditioning well-established neurological and teratogenic syndromes such as Guillain Barre syndrome and Zika congenital syndrome (characterized by microcephaly, arthrogryposis, and other congenital disorders), which had their origin in regions of Asia and Oceania, where unlike their behavior in these lands, they were conferred benignity and zero mortality. However, when presenting mutations in American lands, Zika had greater virulence and pathogenicity that led to new manifestations not observed in Asian regions such as full neurotropic and teratogenic potential, which has led to a new American lineage (1, 2). Luckily, like any pandemic, Zika has diminished its potential to become a subclinical virus. However, there are still few case reports that have occurred in the same way with dengue and chikungunya. Regarding respiratory viruses, after the 2009 H1N1 influenza pandemic, other serotypes such as A H3N2 and influenza B virus have been reported, which have caused outbreaks in Asia, but without sufficient pandemic potential to colonize other continents. However, at the end of 2019 and the beginning of 2020, a new coronavirus called the novel coronavirus 2019 (2019-nCoV) emerged and was detected in the Wuhan region of China, conditioning SARS, and severe pneumonia conditions. It was quickly spread to other Asian countries and due to human migration, to the Americas, with a first case detected in the United States followed by other cases detected in Latin America. However, it has not yet been corroborated whether these cases were infected with 2019-nCoV. In these cases, ecological niches are involved, in which various species intervene and act as reservoirs, ultimately transmitting viruses to humans. However, human intervention in an ecological niche, in addition to generating disturbances, causes the pandemic spread of various enzootic infectious agents (3, 4). Both viruses stand out for being new in the Americas, coupled with their pathogenic potential and virulence. Being positive single-stranded RNA gives the viruses a higher replication rate, making them potentially pandemic. The viruses also share other characteristics such as the vertical transmission of which zika It was also teratogenic, which is unknown from 2019-nCoV. Influenza H1N1 has no such attribute and only contributes to premature deliveries in infected pregnant women without fetal involvement. Another characteristic of the viruses is the transmission from person to person, without mediating a vector or having sexual contact, which is attributed to the circulating viral load and physical contact in addition to flugge drops dispersed in the environment close to patients. This situation causes a contagion between family members and health workers. Finally, asymptomatic cases with Zika, feverish or afebrile cases, and asymptomatic carriers have been reported. These symptoms have also been recently reported in children with no typical symptoms of infection and with a pneumonia radiological picture, which suggests the asymptomatic condition of the new coronavirus (5-9). We conclude that both viruses have major similarities that make pandemics comparable (Table 1). Although 2019-nCoV has rapidly spread throughout Asia and countries in Europe and North America, it is still pandemic and probably continues to colonize other countries. Thus, we must be alert for both new cases and routes of transmission and be expectant of new features that may arise, as was the case of Zika that increased the incidence of neurological and teratogenic syndromes upon arrival in the Americas. In the same way, they probably have to change various cultural situations as a result of the spread of these new viruses that could start in a jungle or an enzootic environment and may become true epidemics of great repercussion for the population through human intervention. Moreover, they must intervene in food hygiene control as well as in importation and human migration. They also need to improve epidemiological surveillance globally (10).

Dear Editor, Coronavirus disease 2019 (COVID-19) has recently become a multidimensional crisis (1). In Iran, the first cases of COVID-19 were documented on 19 February 2020 (2). Although there is no definitive treatment for this newly-developed viral infection, there are multiple non pharmaceutical preventive measures for the respiratory infection control (3). Different communities may have different recommendations on the use of face mask use (4). One of the important strategies to slow down the spread of infection is identifying super spreading events (SSEs). What SSEs are in any community depends on multiple factors. Identifying and interrupting these events are crucial in the infection control (5). Today, people use a face mask to avoid the COVID-19 virus. Wearing a face mask is one of the many tips encouraged by the social media every day. However, due to the limitation of resources for proper face masks, many people have resorted to the use of non-standard masks (better called Respiratory Etiquettes), which are often handmade and inefficient (6). They these non-standard masks while walking confidently on the streets and doing their daily social activities while they are unaware that the masks they use will only protect them against dust and not the virus. Not only can these masks not prevent the virus from entering the respiratory system, but also they provide false confidence, exposing people to infected environments and increasing the chance of infection. In other word, the improper use of face mask could increase the risk of infection as much as the use of improper masks.