فهرست مطالب

Archives of Pediatric Infectious Diseases - Volume:9 Issue: 2, Apr 2021

Archives of Pediatric Infectious Diseases
Volume:9 Issue: 2, Apr 2021

  • تاریخ انتشار: 1400/01/14
  • تعداد عناوین: 9
|
  • Soheila Siroosbakht, Nahid Aarabi, Bijan Rezakhaniha * Page 1
    Background

     Sepsis is the third cause of death in the first month of life, and the umbilical cord is an important source for sepsis

    Objectives

     We compared the effects of bathing or not bathing on bacterial colonization and cord separation time.

    Methods

     A quasi-experimental study assessed term newborns at Golestan hospital, Tehran, Iran, from 2019 to 2020 in three groups. Bath (B) group included neonates who were bathed with tub water every two days (n = 90). Clean product (CP) group neonates were bathed with cleaners every two days (n = 87). Dry care cord (D) group neonates were not bathed during the first 10 days (n = 63). Periumbilical cord swabs were collected on the 10th day and cultured in blood agar and Eosin methylene blue agar. Bacterial sensitivity tests were done by disk diffusion.

    Results

     The average time to cord separation was 8.2 ± 1.74 days (group B: 9.1 ± 2.1 days, group CP: 8.7 ± 1.82 days, group D: 6.8 ± 1.3 days), which was shorter in group D (P= 0.048). The positive culture rates were 77.8% in group B, 78.1% in group CP, and 74.6% in group D, which were not significantly different between the groups (P = 0.073). Staphylococcus aureus was the most common isolated species. Staphylococcus epidermis and Escherichia coli were the other most common species.

    Conclusions

     Bathing with or without cleaners is safe. No-bath and water bath with or without cleaners had no difference in the rate and type of bacterial culture in umbilical cord but the cord separation time was shorter in the no-bath group. Therefore, in the first week, if a mother does not believe in bathing her baby, she should not be denounced and told that she did something wrong with cord hygiene.

    Keywords: Newborn, Umbilical Cord, Separation, Bath, Bacterial Colonization
  • Roya Salehi Kahish, Arash Alghasi *, Shekoufe Hadadi, Marziyeh Abasi Nasab, Aida Mafakherzadeh Page 2
    Background

    Blastocystis spp. is known as one of the few intestinal parasites, prevalent in more than 5% and 30 - 60% of the population in industrialized and developing countries, respectively. In this respect, immunocompromised individuals, such as patients undergoing chemotherapy or those with malignancies, are at risk of the clinical symptoms of Blastocystis infection; however, the given condition is often self-limiting in healthy individuals.

    Objectives

    The current study aimed at evaluating the prevalence of Blastocystis infection in children with malignancies receiving chemo drugs.

    Methods

    The current descriptive, cross-sectional study was conducted on 52 stool specimens collected from patients with cancer admitted to the Oncology Ward of Shahid Baqaei 2 Hospital, Ahvaz, Iran, for six months. A standardized questionnaire was filled out for all cases. Each specimen was also prepared using direct smear, the Lugol iodine staining, and the formalin-ether condensation method.

    Results

    Blastocystis spp. was detected in 21.1% of the cases among them, 11.5% demonstrated gastrointestinal symptoms; therefore, a significant relationship was observed between Blastocystis infection and gastrointestinal symptoms.

    Conclusion

    Patients undergoing chemotherapy should be screened for opportunistic parasitic infections such as Blastocystis to avoid potentially life-threatening outcomes. Besides, further studies are required to identify the subtypes of Blastocystis.

    Keywords: Chemotherapy, Blastocystis, Children with Cancer, Immunocompromised Individuals
  • Karolina Kuczborska *, Agnieszka Rustecka, Agata Wawrzyniak, Agata Będzichowska, Bolesław Kalicki Page 3
    Background

     Acute lower respiratory infection (ALRI) is one of the main causes of morbidity and mortality in children under five years of age, and the respiratory syncytial virus (RSV) remains its leading etiological factor. Although RSV infections occur in all age groups, the most severe course is observed among children. The clinical manifestations include both mild upper respiratory infections and severe infections of the lower tract, such as bronchiolitis and pneumonia that can lead to hospitalization and severe complications, including respiratory failure.

    Objectives

     The study aimed to evaluate the manifestations of RSV infection in hospitalized children younger than 18 months of age and predictors of disease severity, as well as their comparison with the same age group hospitalized due to ALRI of different etiology.

    Methods

     A retrospective analysis was performed on medical records of 448 children hospitalized due to ALRI. The analysis was performed on the total study group and subgroups of children with positive and negative results of the nasal swab for RSV detection. In each group, clinical data, laboratory test results, and imaging results were analyzed.

    Results

     The most common manifestation was pneumonia (n = 82; 63.08%). Otitis media was observed mainly in children under six months of age with lowered inflammatory markers (P < 0.05), conjunctivitis in those with a positive family history of allergies (P < 0.05), and pneumonia in children under six months of age, with lower blood oxygen saturation and inflammatory markers, features of acidosis, and fever-free course (P < 0.05). Respiratory failure affected 13 children (10%). However, no predictors of this complication were noted.

    Conclusions

     As pneumonia was the most common manifestation in children with both RSV-positive and RSV-negative ALRI, it seems advisable to perform the imaging of the lungs on admission and carefully monitor the child’s condition during hospitalization. In both groups, special attention should be paid to the youngest children with low inflammatory markers on hospital admission, increased clinical symptoms, and family history of allergies. Nevertheless, widely known risk factors of RSV infection itself do not reflect the risk of developing pneumonia or respiratory failure in its course.

    Keywords: Conjunctivitis, Otitis Media, Pneumonia, Respiratory Failure, Respiratory Syncytial Virus
  • Brigitta I. R. V. Corebima *, Ayunda Almiradani, Eko Sulistijono Page 4
    Introduction

     Congenital Syphilis (CS) is caused by the vertical transmission of Treponema pallidum during pregnancy. Here, we describe a case of CS, diagnosed solely by serological tests.

    Case Presentation

     The patient was a newborn with CS, whose mother was infected with Treponema pallidum at the gestational age of 16 - 20 weeks. However, the patient had no signs of early CS, such as low birth weight, nasal congestion, maculopapular rash, or hepatosplenomegaly. The histopathological features in both mother and neonate suggested syphilitic placentitis. Regarding the serological tests, a non-reactive Venereal Disease Research Laboratory (VDRL) test result and a reactive Treponema pallidum haemagglutination (TPHA) test result were reported. After establishing the diagnosis of CS, we initiated treatment with procaine penicillin G (50,000 U/kg body weight), which was injected intramuscularly once a day for 10 days. Six months after discharge, physical examinations showed normal findings and non-reactive results of VDRL and TPHA tests.

    Conclusions

     It can be concluded that detailed history-taking and serological tests play a vital role in establishing the diagnosis of CS, particularly in patients with asymptomatic congenital syphilis. An early diagnosis of CS can guide clinicians to initiate a standardized treatment and improve patient outcomes.
     

    Keywords: Diagnosis, VDRL, TPHA, Congenital Syphilis
  • Azadeh Jafrasteh, Abdollah Karimi, Seyedeh Mahsan Hoseinialfatemi, Leila Azimi, Payam Tabarsi, Mahshid Nasehi, Mansoor Naseri, Abolfazl Panahi Mishkar, Mahnaz Sheikhi, Roxana Mansour Ghanaie * Page 5
    Background

     The interferon-gamma release assays (IGRAs) are the most important diagnostic approach to Mycobacterium tuberculosis infection diagnosis. However, they cannot discriminate between latent tuberculosis infection (LTBI) and active tuberculosis (TB). Some recent studies suggested that interleukin-2 (IL-2) response to M. tuberculosis could be utilized as a potential biomarker to discriminate active disease from LTBI.

    Objectives

     The current study aimed at evaluating the potential role of IL-2 to detect both active TB and LTBI among household contacts of patients with pulmonary TB in two TB-endemic regions of Iran.

    Methods

     A total of 650 household contacts of patients with TB were invited to participate in the current study. All subjects were diagnosed on extensive clinical evaluation of active TB and LTBI based on clinical manifestations and laboratory findings. The IGRA test was performed using QuantiFERON®-TB Gold Plus. The serum level of IL-2 was measured using the ELISA Development Kit.

    Results

     A total of 237 household contacts entered the final analysis, including 132 patients with LTBI and three with active TB. In addition, 14 subjects were included as TB controls and 102 as TB-uninfected controls. The serum level of IL-2 was significantly higher in active TB and LTBI patients than TB-uninfected controls. The ROC curve was plotted between active TB and LTBI, revealing that the cutoff point of 25.5 pg/mL identifies the active form with 88.24% sensitivity and 36.36% specificity.

    Conclusions

     The current study indicated that the IL-2 assay could not discriminate between active TB and LTBI with acceptable sensitivity.

    Keywords: Mycobacterium tuberculosis, Interferon-Gamma Release Assays, Interleukin-2, Latent Tuberculosis Infection, Active Tuberculosis
  • Andre Ricardo Araujo da Silva, Deborah Cardoso Albernaz de Almeida Dias * Page 6
    Background

     Antimicrobial stewardship programs (ASPs) are coordinated programs developed in recent years to promote the appropriate use of antimicrobials and reduce microbial resistance. One important action for a successful ASP is the implementation of an antimicrobial policy restriction.

    Objective

     The study analyzed the quality of target-antimicrobial requisitions after the introduction of an antimicrobial policy restriction for children.

    Methods

     We conducted a retrospective study in a neonatal intensive care unit (NICU) and three pediatric intensive care units (PICUs). An ASP was implemented in October 2016, and 14 target antimicrobials were selected to be prescribed after pre-approval by a pediatric infectious disease specialist. All requisitions were analyzed according to indication, antimicrobial type, dose, duration, and collection of cultures before administration. There were no exclusion criteria for requisition analysis.

    Results

     Between October 2016 and December 2017, 1,173 patients were admitted to the units with 120 requisitions of target antimicrobials. Sepsis (43/120; 35.8%) was the most common indication, followed by respiratory infections (23/120; 19.2%) and infections in two or more sites (11/120; 9.2%). The most common target antimicrobials requested were meropenem (68/120; 56.7%), amphotericin B lipid formulations (12/120; 10%), teicoplanin (11/120; 9.2%), and linezolid (11/120; 9.2%). In 98 (81.7%) cases, previous cultures before antimicrobial administration were collected. An infectious agent was detected in 52 of the 98 cultures (53.1%), and Gram-negative and Gram-positive bacteria represented 50% and 26.9% of all positive samples, respectively. Besides, 111 (92.5%) requisitions were approved. In five refused requisitions, a narrow-spectrum antimicrobial was prescribed after further discussion; four were refused due to lack of information, and in one case, the de-escalation of the antimicrobial was possible. No mistake regarding dosage and duration was detected.

    Conclusions

     We found a high-quality rate of target antimicrobial requisition. Antimicrobial policy restriction could contribute to improving the quality of antimicrobial prescription, even in NICUs and PICUs.

    Keywords: Children, Intervention, Neonates, Antimicrobial Stewardship, Quality
  • Zahra Habib, Farah Bokharaei Salim *, Seyed Jalal Kiani, Saba Garshasbi, Saeed Kalantari, Khadijeh Khanaliha, Sedigheh Taghinezhad S, Seyed Hamidreza Monavari, Angila Ataei Pirkooh, Maryam Esghaei Page 7
    Background

     Early diagnosis of immunodeficiency virus-1 infection in children and access to treatment for this infection is critical in decreasing infant mortality.

    Objectives

     The aim of the current survey was to determine the presence of HIV-1 genomic RNA in plasma and proviral DNA in peripheral blood mononuclear cell (PBMC) specimens of neonates born to HIV-infected mothers.

    Methods

     From March 2014 to February 2018, 73 neonates born to HIV-1-infected mothers covered by the prevention of mother-to-child transmission (PMTCT) program were enrolled in this study to compare two different diagnostic methods. After the extraction of viral RNA of plasma and genomic DNA of PBMC specimens, HIV-1 RNA and proviral DNA was tested by amplification of the long terminal repeat (LTR) region of HIV-1 using real-time PCR.

    Results

     Out of 73 evaluated infants, 41 infants (56.2%) were male. The average age of the mothers with HIV-1 infection was 30.7 ± 5.2 (range: 19–47) years. The results revealed that none of the infants were infected with HIV-1, and also all were negative for HIV-1 genomic RNA in plasma specimen and proviral DNA of HIV-1 in PMBC samples. During the present study, 20 infants born to HIV-1 positive mothers who were not included in the PMTCT project were accidentally identified. Four infants (20%) out of these 20 infants were infected with HIV, all were infected with CRF35-AD of HIV, and none carried variants with surveillance drug-resistant mutations.

    Conclusions

     The results of the present study showed that two molecular methods of detecting HIV infection (presence of genomic RNA of HIV-1 in plasma and proviral DNA of HIV-1 in PBMC specimens) are completely in agreement with each other, and the PMTCT program is possibly an effective program.

    Keywords: Neonates, Peripheral Blood Mononuclear Cells (PBMCs), HIV-1 Proviral DNA, Human Immunodeficiency Virus Type 1 (HIV-1), Prevention of Mother-to-Child Transmission (PMTCT), Surveillance Drug-Resistant Mutations (SDRMs)
  • Farhad Abolhasan Choobdar, Maral Ghassemzadeh *, Mohammad Attarian, Ezzat Abbariki, Alireza Nateghian, Behrooz Ghanbari, Samira Shah Hamzehi, Melika Razavi Hashemi, Zahra Azarbin Page 8

    We report a case of SARS-CoV-2 vertical transmission through the placenta in a neonate whose mother had non-M3 acute myeloid leukemia (AML) that was complicated with Covid-19 in the last trimester. Viral load in nasopharyngeal swabs from mother and neonate were high. Real-time PCR of the fetal side of the placenta was positive for SARS-CoV-2, which makes it possible to consider this case as a congenital case of SARS-CoV-2 infection that is transmitted through vertical transmission.

    Keywords: Infection, Congenital, Premature, Immunosuppression
  • Tahereh Fathi Najafi, Sareh Dashti, Narjes Bahri * Page 9

    Context: 

    Evidence regarding the vertical transmission of COVID-19 from infected pregnant women to the fetus are not sufficient.

    Methods

     The current study intended to systematically assess the possibility of vertical transmission of COVID-19 in published literature. We systematically searched international bibliographic databases, including PubMed, SCOPUS, and Google Scholar, to identify relevant studies from the time of inception of these databases until July 2020. The search strategy was finalized based on the results of the primary search in PubMed. All observational studies, including cross-sectional, cohort, case-control, case reports, and case series, published in peer-reviewed journals in any language. Editorials, commentaries, and letters to editors were excluded. Twenty articles (6 retrospective studies, 2 prospective, one cohort, 9 case reports, and 2 case series) with a total of 145 subjects were eligible for the review. Data were collected based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist.

    Results

     Methods of assessing COVID-19 included polymerase chain reaction (PCR) analysis of naso/oropharyngeal, vaginal, rectal, urine secretions and gastric and amniotic fluid samples, and serum immunoglobulin (Ig) assays. Vertical transmission was reported in 6 neonates (< 10%), based on PCR, and three were positive based on Ig assays.

    Conclusions

     According to the evidence, the possibility for vertical transmission of COVID-19 is rare.

    Keywords: Vertical Transmission, Infectious Disease Transmission, Coronavirus, COVID-19