Archives of Pediatric Infectious Diseases
Volume:9 Issue: 4, Oct 2021

Multisystem inflammatory syndrome in children (MIS-C) is an emerging condition after the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, termed COVID-19. This study aimed to describe the cardiac manifestations of children diagnosed with MIS-C.

 This narrative review was conducted by searching the PubMed, Scopus, and Google Scholar databases to review MIS-C cardiac manifestations up to September 30, 2020. The demographic features, past medical history, clinical signs and symptoms, cardiac involvement, and the type of COVID-19 diagnosis confirmation were extracted.

In many children, MIS-C seems to be a post-infectious complication of the COVID-19 infection. This syndrome affects multiple organs and has various clinical manifestations mimicking Kawasaki disease. Patients frequently present with persistent fever, kidney injury, gastrointestinal (GI) problems, neurologic symptoms, mucosal changes, conjunctivitis, and cardiac involvement. Children with MIS are more likely to present with hypotension, shock, and cardiac dysfunction, rather than coronary artery abnormalities and arrhythmia. Children with MIS need close observation; some need to be hospitalized, and a few may need a Pediatric Intensive Care Unit (PICU) admission. Treatment currently includes anticoagulants, IV immunoglobulin, and anti-inflammatory drugs.

As a novel syndrome associated with SARS-CoV-2 infection, MIS-C is potentially lethal. Cardiac manifestations, including coronary and myocardial involvement, are common and should be carefully identified. With prompt diagnosis and proper treatment, most children will survive, but the outcomes of the disease are unknown, so long-term follow-ups are required.

 Due to the increasing research information, knowledge production, development of information technology, and its impact on access to knowledge, the taxonomy of knowledge and information is necessary to manage and use them in the development of science.

The purpose of this study was to provide a complete model that could achieve the objectives of taxonomy in research. For this purpose, after a critical review of existing taxonomies, criteria were developed based on which a complete and practical taxonomy was presented. After reviewing and analyzing different categorizations of research in different fields of medicine, social sciences, and education, research designs were divided into explicative research, psychometric research, descriptive research, exploratory research, explanatory research, theory research, translational research, synthetic research, prescriptive research, implementation research, and evaluative research.

In the next step, the relationship between them was determined based on their cognitive position and their position in the development of knowledge.

Globally, COVID-19 is less prevalent in children than adults. However, in Indonesia, the number of infected children have been increasing rapidly.

To describe characteristics and outcomes of children with COVID-19 in West-Nusa-Tenggara Province, Indonesia.

We retrospectively reviewed registries of children with confirmed COVID-19 collected by the Indonesian-Pediatric-Society, West-Nusa-Tenggara. Children diagnosed with COVID-19 by RT-PCR from March 2 to July 12, 2020, were included in the analysis.

Of 146 COVID-19-confirmed subjects, 47.9% were symptomatic, 45.2% were aged < 5 years old, 58.2% were male, 54.8% had a history of COVID-19 contact, and 2.7% (n = 4) died. Asymptomatic subjects had older median age (P < 0.01), longer median duration of RT-PCR conversion (P < 0.01) than symptomatic children and 88.2% had a history of COVID-19 contact. Forty-eight (out of 55 hospitalized symptomatic subjects or 87%) were < 5 years old, had younger median age (P < 0.01), and 4 (7.3%) had a history of COVID-19 contact. They also had higher respiratory rate and body temperature (P < 0.01), lower oxygen saturation (P < 0.01), higher white-blood-cell counts (P = 0.01), and lower hemoglobin levels (P = 0.015) compared to the non-hospitalized symptomatic subjects. Forty-three (78%) hospitalized subjects were in severe and critical condition, 49 (89%) were pneumonia, and 28 (51%) had bilateral infiltrates on chest X-ray. All registered deaths were due to acute-respiratory-distress-syndrome. Besides, all deaths were in hospitals without a pediatric-intensive-care-unit.

In the present study, we identified both asymptomatic and symptomatic COVID-19 infected children. Most symptomatic COVID-19 cases were in children < 5 years old, presented with severe pneumonia, and few of them had a history of COVID-19 contact.

Toxoplasmosis is an opportunistic infection that affects solid organ transplant (SOT) recipients. The parasite transmission may be occurred from a Toxoplasma-seropositive donor to a Toxoplasma-seronegative recipient by organ transplantation.

In this study, a nested PCR was carried out using different primers targeting the B1, SAG4, and MAG1 genes to assess Toxoplasma infection in pediatric heart transplantation at Shahid Rajaei Heart Center in Tehran.

Blood samples were collected from 46 pediatric heart transplant patients aged 1 - 17 years referring to Rajaei Cardiovascular Medical and Research Center from 2018 - 2019. All patients were on oral administration of Trimethoprim-sulfamethoxazole (cotrimoxazole). Blood samples were collected, and peripheral blood mononuclear cell (PBMC) isolation using the Ficoll gradient method was performed. DNA was extracted from PBMC, and nested PCR was carried out. Serologic tests were performed using ELISA to determine IgG and IgM anti - Toxoplasma gondii antibodies.

The results of serologic tests showed that all 46 patients had negative anti-T. gondii IgM antibody. Furthermore, 6 (13.05%) and 3 (6.5 %) out of the 46 patients were positive for IgG T. gondii antibody before and after transplantation, respectively. All 46 patients were evaluated using PCR using B1, MAG-1, and SAG-4 genes, and PCR results were negative.

In general, due to the negative results of Toxoplasma with PCR using B1 and bradyzoite-specific genes (SAG-4 and MAG-1), it is possible that the results obtained in this study are because of prophylaxis with cotrimoxazole.

Due to frequent exposure to surface water and contact with animals, children represent a group susceptible to zoonotic diseases.

The present study aims to determine the presence and prevalence of the main zoonotic agents in R. norvegicus populations in Tehran, Iran.

In the present study, 100 R. norvegicus were captured within a time span of one year from five districts of Tehran, Iran. Fecal and blood samples were collected from rodents and serum was recovered after centrifugation. The presence of specific IgG antibodies against Leptospira spp. and Rabies virus was detected using a commercial qualitative rat ELISA kit. A conventional PCR assay was employed to detect the presence of Vibrio vulnificus in the commensal R. norvegicus population.

In general, 80% (n = 80/100) and 20% (n = 20/100) of rats were males and females, respectively. The results of the ELSA assay showed that of the 100 R. norvegicus captured in Tehran, 7% (n = 7/100) and 1% (n = 1/100) were positive for Leptospira spp. and Rabies virus, respectively. Leptospira spp. revealed the highest frequency (20%; 4/20) among R. norvegicus collected from the eastern part of Tehran. Rabies virus was detected only from the southern (5%; 1/20) part of Tehran. Results of the PCR method showed that the percentage of the rats tested positive for V. vulnificus was 5%. Overall, the surveyed zoonotic microorganisms had the highest (n = 5/20; 25%) and lowest (n = 1/20; 5%) frequency rates in the eastern and northern parts of Tehran, respectively.

The results accentuate the necessity of implementing rodent control programs and regular disinfection as well as avoiding contact with rodent populations in urban environments.

Streptococcus pyogenes is responsible for a wide variety of diseases, including noninvasive and severe invasive infections. The emm gene encodes the M protein that is the virulence factor and immunological determinant of group A streptococci. Emm typing is the group A Streptococci (GAS) standard molecular typing method based on the amplification of the N terminal hypervariable region of the emm gene.

 The aim of the present study was to determine the prevalence of GAS in children with pharyngitis and determine different types of emm gene in the GAS isolates using emm typing.

 The study was carried out over a period of 14 months (from February 2017 to March 2018). Throat samples were collected from cases aged ≤ 18 years with pharyngitis referring to a primary health care center in Fez, Morocco. GAS isolates were subjected to conventional tests to confirm species identification. Antimicrobial susceptibility testing was performed using the standard disk diffusion method. We researched emm gene by a polymerase chain reaction (PCR). Emm types were determined by a sequence-based protocol. Demographic and clinical data were recorded from each patient.

 From a total of 177 throat samples, 11 isolates (6.2%) were identified as GAS in children with pharyngitis. Antibiotic sensitivity testing revealed that all the GAS isolates were sensitive to penicillin. The sequencing of the PCR products of the emm gene revealed that emm90 was the most obtained emm type (30,77%); while emm75 was the least type observed (7.7%).

The emm90 is the most prevalent type detected from patients with tonsillitis. Penicillin and erythromycin are still the foremost effective antibiotics to treat GAS pharyngitis.

As COVID-19 spreads rapidly all over the world and nations struggle to control it, the novel presentations of SARS-CoV-2 infection and its possible triggering role for other diseases in pediatrics concern clinicians in frontlines.

We describe a 10-year-old child diagnosed with COVID-19 infection and concurrent Kawasaki disease. He presented with prolonged fever and conjunctivitis. His initial echocardiogram showed coronary artery dilation in RCA. He was treated with IVIG and aspirin as per guidelines and discharged 48 hours after the completion of IVIG and diminishing fever. His follow-up echocardiogram showed improvement in a two weeks’ interval while he was quarantined in the meantime and showed no respiratory complications.

In conclusion, we think that there might be a correlation between COVID-19 infection and hyperinflammatory conditions, like Kawasaki disease. Further investigations are needed to enlighten the complications caused by COVID-19 infection, especially in pediatrics. In addition, we emphasize follow-up visits (in person or long-distance) in pediatrics presenting with inflammatory symptoms.

Coronavirus disease 2019 (COVID-19) was officially declared as a pandemic on March 11, 2020. Although most patients with COVID-19 manifest fever and respiratory tract symptoms, extrapulmonary and atypical presentations, such as gastrointestinal, neurologic, and cardiovascular involvement as well as thromboembolic events have been reported amongst COVID-19 patients. Herein, we aim to describe a COVID-19 patient who progressed to purpura fulminans.