Archives of Pediatric Infectious Diseases
Volume:8 Issue: 4, Oct 2020

 Pemphigus vulgaris (PV) is an autoimmune blistering disorder of the skin and mucous membranes. The transplacental passage of maternal immunoglobulin G (IgG) autoantibodies to desmoglein-3 (a transmembrane glycoprotein component in the skin) from the mother’s blood to the fetus can cause transient PV in the neonatal period. The duration of PV is short in the neonatal period, and the disease is improved with no prolonged sequelae. The similarity of skin lesions in PV to other skin conditions, such as infectious diseases caused by bacterial, viral, and fungal pathogens, or inherited bullous disorders, such as epidermolysis bullosa and incontinentia pigmenti, leads to misdiagnosis, inappropriate hospital admission, and poor antimicrobial treatment of patients. On the other hand, the maternal history of PV, besides laboratory examination, confirms the exact diagnosis. In this case report, we present a male term neonate with multiple pustules and blisters on the skin, developed within the first hours of life. The patient was admitted to the neonatal ward of our hospital for a sepsis workup and antibiotic treatment. Regarding the positive maternal history of PV in the second trimester of pregnancy and neonatal examinations skin biopsy confirmed the diagnosis of this disease.

 The COVID-19 pandemic has challenged hematopoietic stem cell transplant (HSCT) clinicians to profoundly re-organize their medical care to reduce complications without compromising patients’ inquiries. Since this pandemic is a foggy novel disease, scientific approved data are not available, and so decisions should be made based on expert opinions.

 This is a pediatric HSCT center experience, including preventive and solving strategies specifically undertaken to address problems caused by the COVID-19 outbreak.

 In this report, we have shared our experience to alert healthcare professionals worldwide to get prepared accordingly.

 We are not aware of the duration or outcome of the pandemic, but we are intended to learn from our experiences and figure out the best strategies to minimize the possible harms.

 Hospital-acquired infection is one of the main concerns in Neonatal Intensive Care Units (NICUs), leading to increased mortality, hospital stay, and costs.

 This study aimed to investigate the risk factors of hospital-acquired infection in NICUs.

 A descriptive, cross-sectional, prospective study was conducted in the NICU of Ali Asghar Children Hospital for one year. All admitted newborns were sampled on a simple basis. The criteria for the diagnosis of hospital-acquired infection were based on the definitions of the CDC and the NNIS system. Risk factors such as days of fully catheters usage, nurse-to-patient ratio, history of surgery, prematurity, and mechanical ventilation were considered as variables. The data collection tools consisted of a patient information questionnaire, the monthly report of the hospital infection control committee based on the NNIS system, a daily schedule of all risk factors for each infant, and the monthly nurse-to-patient ratio in the NICU. The STATA software was used for data analysis.

 In our study, 654 newborns were enrolled. The rate of hospital-acquired infections was 13.5%. Moreover, 80.7% of the cases exhibited sepsis (72.7% diagnosed based on clinical findings and 8% based on positive blood culture). Statistical analysis showed 9% pneumonia cases, 8% surgical site infection cases, and 2.3% urinary tract infection cases. The average time to the occurrence of hospital-acquired infection was 13.5 days after admission. All risk factors were significantly higher in the infected group than in the control group (P = 0.0001). Furthermore, surgical interventions were significantly more in the infected group than in the non-infected group (34.1% vs. 6.7%, respectively, P = 0.0001). The prevalence rates in different weight ranges (less than 1000 g, 1001 to 1500 g, 1501 to 2500, and above 2501 g) were 2.6%, 6.9%, 21.4%, and 69.1%, respectively, in the infected group, which were significantly different from those of the non-infected group (P = 0.0001). The most common etiologic microorganism was Acinetobacter baumannii.

 Factors such as surgery, the presence of a central venous catheter, and the increased length of hospital stay significantly increased the hospital-acquired infections. Reducing invasive procedures, maintenance of full catheters, and providing optimal nursing care can help control hospital-acquired infections.

 Pancreatitis is an inflammatory disease of the pancreas. Drug-induced pancreatitis is an important cause of pancreatitis. There are two pathological types of acute pancreatitis, including pancreatic edema with a mild course and pancreatic necrosis with a poor prognosis. Some agents can induce pancreatitis, but so far, posaconazole-induced pancreatitis in children has been not reported. Here, we describe the case of a child with acute pancreatitis who received posaconazole.

 A 10-year-old girl with a three-year history of chronic granulomatous disease (CGD) was admitted to hospital due to epigastric pain, nausea, vomiting, loss of appetite, and fever for the last four days. The pain was persistent and prominent in the periumbilical area. The patient was on lifelong antifungal prophylaxis for her illness. On abdominal sonography, the head of the pancreas was inflated, which can indicate pancreatitis. All the medications were discontinued at the time of admission, and along with sufficient hydration, acetaminophen was administered for the patient’s pain. One, three, and twelve months after discharge, the patient was visited for follow-up with no signs of stomach discomfort, and the lab data was within the normal limits. CGD is a rare disease in which the phagocytes fail to produce hydrogen peroxide. Such patients are prone to bacterial and fungal infections.

 In conclusion, this is the second case of posaconazole-induced pancreatitis and the first case in children; thus, we recommend that physicians should be aware of the signs of pancreatitis in high-risk individuals like immunocompromised pediatric population.

 Hospital-acquired infection is one of the main concerns in Neonatal Intensive Care Units (NICUs), leading to increased mortality, hospital stay, and costs.

 This study aimed to investigate the risk factors of hospital-acquired infection in NICUs.

 A descriptive, cross-sectional, prospective study was conducted in the NICU of Ali Asghar Children Hospital for one year. All admitted newborns were sampled on a simple basis. The criteria for the diagnosis of hospital-acquired infection were based on the definitions of the CDC and the NNIS system. Risk factors such as days of fully catheters usage, nurse-to-patient ratio, history of surgery, prematurity, and mechanical ventilation were considered as variables. The data collection tools consisted of a patient information questionnaire, the monthly report of the hospital infection control committee based on the NNIS system, a daily schedule of all risk factors for each infant, and the monthly nurse-to-patient ratio in the NICU. The STATA software was used for data analysis.

 In our study, 654 newborns were enrolled. The rate of hospital-acquired infections was 13.5%. Moreover, 80.7% of the cases exhibited sepsis (72.7% diagnosed based on clinical findings and 8% based on positive blood culture). Statistical analysis showed 9% pneumonia cases, 8% surgical site infection cases, and 2.3% urinary tract infection cases. The average time to the occurrence of hospital-acquired infection was 13.5 days after admission. All risk factors were significantly higher in the infected group than in the control group (P = 0.0001). Furthermore, surgical interventions were significantly more in the infected group than in the non-infected group (34.1% vs. 6.7%, respectively, P = 0.0001). The prevalence rates in different weight ranges (less than 1000 g, 1001 to 1500 g, 1501 to 2500, and above 2501 g) were 2.6%, 6.9%, 21.4%, and 69.1%, respectively, in the infected group, which were significantly different from those of the non-infected group (P = 0.0001). The most common etiologic microorganism was Acinetobacter baumannii.

 Factors such as surgery, the presence of a central venous catheter, and the increased length of hospital stay significantly increased the hospital-acquired infections. Reducing invasive procedures, maintenance of full catheters, and providing optimal nursing care can help control hospital-acquired infections.

 Cataract is the commonest cause of childhood blindness in sub Saharan Africa (SSA). The significance of congenital rubella and human cytomegalovirus (HCMV) infection in the etiology is not known.

 We aimed to investigate prevalence of both viruses in cases of congenital cataract and controls.

 Lens tissue was collected (from cases), blood and saliva from cases and controls. Using ELISA, we tested blood samples for rubella and cytomegalovirus IgM. Quantitative polymerase chain reaction (qPCR) was also used for detection of the viruses.

 Cytomegalovirus was detected using qPCR in 72.9% saliva specimens of cases compared to 38.5% of controls (P = 0.0001). Cytomegalovirus IgM was also detected in 10.8% blood specimens of cases and only 1.5% control (P = 0.01). Rubella IgM was detected in 13.8% blood specimens of cases and only 3.1% controls (P = 0.01). In lens aspirates of cases, 12.7% were HCMV positive and 11.1% were rubella positive by qPCR. Cases had lower birth weights (mean = 2.8 kg) than controls (mean = 3.2 kg), independent of viral status (P = 0.004).

 Although most of the children in the study presented too late to be sure that infection was congenital, our study strongly suggests that HCMV and rubella infection appear important causes of congenital cataract in Tanzania hence virology testing of infantile cataract cases may be useful in assessing effectiveness of immunization programs as they are established throughout SSA.

 Henoch-Schönlein purpura (HSP) is one of the most common systemic types of vasculitis in children. Although it is a self-limited disease, life-threatening complications such as nephritis may occur. Early diagnosis and follow up might improve the long term outcome in renal involvement. There are few studies that have evaluated HSP in Iran.

 The purpose of this study was to investigate demographic, laboratory data and clinical presentations of admitted HSP patients in a tertiary referral center, over a twelve-year period.

 This retrospective descriptive study evaluated 195 patients, diagnosed with HSP, who were admitted to Namazi Hospital in southwest of Iran (2006 - 2018). Demographic, clinical and laboratory findings, as well as treatment outcome of HSP patients were collected.

 There were 118 males and 77 females with the mean age of 6.7 ± 3.21 years. About 70 (36%) patients showed common cold symptoms two weeks before HSP presentations. Admission course was 1 - 17 days (mean 4.55 ± 2.83) and autumn was recorded with the highest number of admitted patients (44.1%). In the course of hospitalization, 100% of the patients presented with palpable purpura, 61.02% with joint pain and 19.49% with abdominal pain. Moreover, 17.95% of the patients were noted with renal involvement. Laboratory data shows that more than half of patients (54%) had leukocytosis, only 9% of patients had positive CRP but all the patients had high erythrocyte sedimentation rate (ESR). Total of 43.1% of the patients received corticosteroids.

 The observed number of male patients with HSP was higher than females and the highest frequency of the HSP cases was observed in autumn. Joint pain and abdominal pain were the predominant clinical presentations, following skin purpura. The presented data can help with further HSP diagnosis and treatment plan.

Context: Coronavirus Disease 2019 (COVID-19) pandemic has caused irreparable damage to society. The pediatric population may be asymptomatic but has positive viral nucleic acid test results and plays an important role in spreading the infection in populations. However, there is a substantial information gap on the epidemiology, pathology, and clinical presentations of COVID-19 in pediatric patients.

Evidence Acquisition:

 English research articles published before April 18, 2020, were reviewed to understand the clinical characteristics of SARS coronavirus 2, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome in children. The WHO (https://www.who. int/) and CDC (Centers for Disease Control and Prevention, https://www.cdc.gov/) websites were also reviewed to find eligible studies, besides articles extracted from PubMed, Scopus, and Google Scholar.

 In comparison with SARS and MERS, COVID-19 seems to have wider clinical symptoms and routes of transmission. Multisystem inflammatory syndrome is a unique clinical feature of this novel virus. The low prevalence of COVID-19 in children may be due to lower contacts or incomplete identification rather than resistance to the virus.

 As this virus is novel, we believe that lessons learned from SARS and MERS outbreaks are very valuable in handling the current pandemic. The aim of this paper was to provide the updated summary of clinical manifestation, diagnostic, molecular, and genetic aspects of the novel coronavirus in comparison with SARS and MERS coronaviruses in children.

 The frequent use of blood products for patients with sickle cell disease (SCD) may put them at risk of being infected with hepatitis virus infections, especially if such blood products are not properly screened. Hepatitis B and C infections (HBV and HCV, respectively) may result in cirrhosis and liver cell cancer.

 This study determined the prevalence of HBV and HCV infections among pediatric patients with sickle cell disease in comparison with matched controls at the Ekiti State University Teaching Hospitals (EKSUTH), Ado-Ekiti.

 This was a descriptive cross-sectional study that comprised of 116 patients with SCD and their aged and sex-matched controls who were referred to the pediatric clinics at EKSUTH. The hemoglobin (Hb) genotypes of the participants were confirmed by Hb electrophoresis and high-performance liquid chromatography (HPLC), Biorad, USA Variant II, using the Beta thalassemia short program. Moreover, HBV and HCV antigens were assessed by the Enzyme-linked Immunosorbent Assay method (Kits were manufactured by Biotech Laboratories USA).

 The mean ages of the patients with SCD and controls were 8.35 ± 4.50 and 8.92 ± 3.25 years, respectively. The seroprevalence of HBV infection among the children with sickle cell disease and controls was 1% each (P =1.00). The seroprevalence of hepatitis C virus infection was 0% among the two groups. Most (98.3%) of the patients with SCD and controls were fully vaccinated against HBV infection. The two children (100%) that were seropositive for hepatitis B were never vaccinated against HBV infection.

 The seroprevalence of HBV infection is low among patients with SCD and controls. This may be due to the protective effect of high hepatitis B vaccination rate and high quality of care among our study population.
 

 The present study was conducted to raise attention to the frequency of Candida spp. and evaluation of risk factors of candidemia in hospitalized neonates and children.

 Identification of Candida at species level was done using the PCR-RFLP method. The Candida albicans complex and Candida parapsilosis complex were differentiated using the HWP1 gene amplification and PCR-RFLP with NlaIII restriction enzyme, respectively.

 Out of 75 blood culture specimens, 42 (84%) cases were positive for Candida spp. of whom 30 (71.42%) and 12 (28.57%) cases were female and male, respectively. Thirty-two (76%) candidemia were presented in pediatrics with 6 years up to 12 years, 10 (23.80%) in neonates of one month or less. In the present study, Candida parapsilosis (n =25; 59.52%) was the most prevalent isolated species followed by C. albicans (n =11; 26.19%), C. tropicalis (n =4; 9.52%), and Candida glabrata (n =2; 4.76%).

 According to potentially dangerous complications of bloodstream infection by Candida spp. in neonates and children, it is necessary to identify and eliminate the underlying conditions and risk factors of this disease.