Archives of Pediatric Infectious Diseases
Volume:10 Issue: 3, Jul 2022

Context: 

Coronaviruses are the largest RNA viruses associated with some ocular manifestations. There are various contradictory reports about the ocular manifestations of coronaviruses in humans. Different ocular tissues can affect coronavirus-associated infectious diseases.

Evidence Acquisition:

 All manuscripts were collected from PubMed, Google Scholar, and other relevant databases. All searches were done by specific keywords, including "coronavirus," "ocular disease," and "eye."

 There are various contradictory reports about the ocular effects of coronaviruses in humans. Different ocular tissues are involved in coronavirus-associated infectious diseases. The ductal connection between the upper respiratory tract and eye mucosa through the nasolacrimal duct can be an entrance to respiratory viruses, such as coronaviruses. The coronavirus can infect the retina, conjunctiva, cornea, and uvea of the eye. The primary SARS-CoV-2 receptor, ACE2, is mainly expressed in the posterior tissues of the eye, such as the retina and RPE. Feline CoV, SARS-CoV, MERS-CoV, and infectious bronchitis virus (IBV) are responsible for conjunctiva involvement in coronavirus-related ocular pathogenesis. Also, various studies are held on COVID-19 and the impact of the conjunctiva on diagnosis and medical complications. Given that the cornea has an acceptable expression of ACE2 and TMPRSS2 genes compared to lung tissue, some studies were done on the impact of the cornea in COVID-19. Feline infectious peritonitis virus (FIPV) is also related to uvea complications. The experiments of human and animal models on the effects of coronaviruses on the retina and cornea in the event of various epidemics of coronaviruses and new and unknown ocular complications can be of great help to future studies.

 Given the importance of investigating the pathogenesis and other routes of SARS-CoV-2 infection, especially in areas other than the respiratory tract, this report attempts to highlight the importance of eye infections caused by the virus, its role in maintaining the virus transmission chain, and its impact on public health.

Human Bocavirus (HBoV) is a parvovirus associated with mild to severe upper and lower respiratory tract infections in children.

This study aimed to detect the virus in the nasopharynx of children under 5-year-old with respiratory infection by polymerase chain reaction (PCR).

Two hundred samples were taken from children referred to pediatric clinics in Kerman, southeastern Iran, with respiratory infections and were positive for virus by PCR. Next, the positive samples were genotyped by real-time PCR.

Out of 200 samples, 13 (6.5%) were positive for the Bocavirus gene, and all positive samples were infected by HBoV-1. We observed that 116 patients were male, and there was no difference in the prevalence of the virus based on gender (P = 0.345). The prevalence was significantly higher in infants under 10 months old (P = 0.049). Infection by Bucavirus virus was significantly correlated with symptoms, such as fever (P = 0.035, r = 0.7), otitis media (P = 0.013, r = 0.8), diarrhea, nausea, and vomiting (P = 0.001, r = 0.4).

According to our findings, HBoV could be one of the causes of infections in the respiratory system of children, and the only type in the studied region is HBoV-1.

Segregation of Escherichia coli (E. coli) into the phylogenetic groups was observed in the experiments so that group B2 contained the enteropathogenic E. coli (EPEC) strains and extraintestinal pathogenic E. coli (ExPEC).

This study aimed to identify B2 phylogenetic groups in the extended-spectrum Cephalosporins resistant E. coli isolated from the stool of healthy children under 10 years old.

One hundred E. coli resistant to broad-spectrum Cephalosporins were collected from the feces of healthy children under 10. Subsequently, we grouped phylogenetic via PCR based on the genes yjaA, chuA, arpA, as well, as TspE4.C2. Then, according to Clermont et al.’s study, we used two individual multiplex PCRs for identifying B2 sub-groups (I-X subgroups). Serogroup typing with the 12 O-antigen was analyzed via PCR, and finally, 10 virulence genes (cnf1, papG, ibeA, malX, usp, cdt, eae, bfp, and afa-Dr) were identified with PCR.

The age range of the healthy children was between 1 and 10 years. The B2 and unknown phylogroups were the most common strains in this study. The most common B2 subgroups were I (2%), IX (1%), V (8%), IV, V, VII (1%), IX, V (3%), IX, V, III, I (1%), IX, V, III, VII, I (%1), V, I (6%), V, III, I (3%), and V, III, VII (1%), with each subgroup carrying distinctive sets of ExPEC virulence markers. The results also showed that 29% of E. coli in the healthy children had malX and 23% had papGII. It was also found that 32% of the strains isolated from the healthy children had antigens O2 and 36% were unknown.

In this study, 27% of the strains belonged to B2 phylogroup and 6% to B1 phylogroup. Moreover, serogroups O2, O16, and O25 were predominant and belonged to B2 phylogroup. Moreover, malX, papGII, usp, papGIII, aggR, and eae virulence genes also had the highest to lowest supply among the tested strains, respectively. Moreover, B2 isolates were shown to have further virulence-related genes in comparison to the non B2 isolates.

Ocular symptoms are prevalent in coronavirus infectious disease 2019 (COVID-19) patients, which may be related to clinical/paraclinical conditions. This study investigated the association between laboratory indexes and ocular symptoms in COVID-19 patients.

In this cross-sectional study, 108 polymerase chain reaction (PCR)-confirmed COVID-19 patients admitted to the Rouhani Hospital, Babol, Iran, were enrolled. Ocular symptoms were investigated using standard ophthalmologic examinations. Routine laboratory investigation was done according to the standard management in patients with COVID-19 infection.

The erythrocyte sedimentation rate (ESR) and the serum levels of the blood urea nitrogen (BUN) and creatinine (Cr) were significantly higher in COVID-19 patients with ocular discharge and exudate (P = 0.002, 0.045, 0.046, and 0.027, respectively), while the red blood cell (RBC) and albumin were lower in COVID-19 patients with ocular discharge and exudate (P = 0.029 and 0.027, respectively). The serum levels of creatine kinase (CPK) and iron (Fe) were significantly higher in non-photophobic COVID-19 patients than in photophobic patients (P =0.033 and 0.050, respectively). In contrast, the serum level of procalcitonin was lower than photophobic COVID-19 patients (P = 0.024). The serum level of phosphorus (P) was significantly higher in COVID-19 patients with itchy eyes compared to COVID-19 patients without itchy eyes (P = 0.026).

The footprint of laboratory indexes was demonstrated in ocular symptoms of COVID-19 patients. The kidney biomarkers were correlated with ocular discharge and exudate, and electrolytes were associated with tear-related symptoms.

IL-17 producing T cells are a distinct subset of CD4+ T cells, which are recognized to have an essential role in protection against certain fungi and extracellular pathogens.

This study aims to evaluate the number of IL-17 producing T cells as a predictor of primary immunodeficiency disorders in patients with Candida infections and low numbers of IL-17 producing T cells.

Seven newly diagnosed patients with documented Candida infections aged between 4 and 35 years were included in this study. Before establishing the diagnosis of chronic mucocutaneous candidiasis, a thorough immunodeficiency workup, including complete blood count, serum Ig levels and antibody responses, flow-cytometry evaluation, and LTT, was completed for all the patients, and other immunodeficiency disorders, including combined and phagocytic deficiencies, were ruled out. Then, IL-17 producing T cells were detected using antiCD3 and anti-IL-17 antibodies through flow-cytometry evaluation.

The IL-17 producing T cells significantly decreased in the peripheral blood of patients with PID and candida infections. A P-value of less than 0.05 was considered statistically significant.

To conclude, in cases of recurrent candida infections, initial assessment of IL-17 producing T cells may act as a predictor of an underlying primary immunodeficiency. In patients with low counts of IL-17 producing T cells, selecting a targeted panel of genetic tests may become more helpful in the detection of certain immunodeficiency disorders than performing whole-exome sequence analysis.

Childhood bacterial meningitis (BM) requires prompt and precise diagnosis to provide proper treatment and decline mortality and morbidity.

We aimed to evaluate the World Health Organization (WHO) criteria and polymerase chain reaction (PCR) for diagnosing BM in children admitted to a tertiary referral hospital in Shiraz, southern Iran. Materials: We included all 492 children aged one month to 17 years suspected of meningitis who had cerebrospinal fluid (CSF) leukocytosis admitted to Nemazi Hospital from August 2016 to September 2017. The CSF specimens were examined for routine analysis, Gram staining, and culture. A multiplex real-time PCR was used to identify Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis in the CSF samples. Seven viruses were also investigated using real-time PCR. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the WHO criteria and the multiplex real-time PCR results.

Seventy-four CSF samples had leukocytosis. Nineteen (22.9%) patients had BM caused by S. pneumoniae (n = 14), Hib (n = 2), Salmonella enterica (n = 2), and N. meningitidis (n = 1). The PCR test detected all cases, except for two with Salmonella meningitis (sensitivity 89.4%, specificity 100%, PPV 100%, and NPV 96%). The WHO criteria detected all cases, except three who received antibiotics at least four days before performing lumbar puncture (sensitivity 84.2%, specificity 98.2%, PPV 94.1%, and NPV 94.7%). Enterovirus was the most common viral etiology (6.75%).

The WHO criteria and the multiplex real-time PCR had high accuracy in our setting, and their use could decrease the antibiotic over-prescription in febrile children suspected of meningitis.

The World Health Organization has declared coronavirus disease 2019 (COVID-19) a pandemic worldwide. Older people, individuals with comorbidities, and pregnant women are more susceptible to this virus, leading to adverse outcomes and mortality.

Mothers with COVID-19 were divided into two groups of symptomatic and asymptomatic positive cases. Neonates were clinically evaluated and screened at 24 - 48 hours of age for SARS-CoV-2 by real-time polymerase chain reaction. Maternal and neonatal demographics, clinical characteristics, and follow-up at 14 days post-discharge were recorded. The adverse birth outcomes, preterm premature rupture of membrane (PPROM), cesarean section delivery (C-section), and duration of hospital stay were evaluated.

Out of 453 pregnant women, 59 (13.1%) and 394 (86.9%) were positive and negative for SARS-CoV-2, respectively. We subclassified 59 infected pregnant women into two groups symptomatic (10.1%) and asymptomatic (89.8%). The PPROM (P = 0.001), gestational diabetes mellitus (P = 0.006), C-section (P = 0.002), and APGAR score (P = 0.029) had a significant association with SARS-CoV-2 presence in mothers and neonates.

None of the neonates from infected pregnant women were infected with SARS-CoV-2, suggesting negligible risk for mother-to-child transmission of the virus. However, the mother-newborn dyad needs to be followed up further to confirm our results.

 chronic granulomatous disease (CGD) is a genetic disease characterized by recurrent life-threatening fungal and bacterial infections and granuloma formation. Pericardial effusion is rare in this disease.

 The study reports a 13-year-old boy with CGD and a history of recurrent infections such as pneumonia and abscesses. The patient presented with shortness of breath, cough, abdominal pain, and chest pain and was diagnosed with severe pericardial and pleural effusion. The patient was treated with antibiotics, antifungals, and steroids and finally underwent pericardiotomy.

 Treatment of CGD patients with recurrent infections and inflammatory lesions is challenging and requires individual decision-making for each patient.

 Lemierre’s syndrome (LS) is a rare and serious condition that often affects school-aged children, adolescents, and healthy young adults. It is defined as an oropharyngeal infection with secondary septicemia, internal jugular vein thrombosis, and septic emboli. Rare cases of atypical LS in which thrombosis occurs in other locations have been reported.

 We presented a case of an adolescent with fever, sore throat, and neck tenderness. Physical examination revealed acute pharyngitis and bilateral small cervical lymph nodes. Rapid antigen group A Streptococcus and viral serologic tests were negative. Complete hemogram and blood biochemical analysis showed leukocytosis and elevated serum C-reactive protein (CRP). Cervical computerized tomography (CT) scan revealed a heterogeneous right tonsil and small cervical lymph nodes. The chest radiograph was normal. After admission, the adolescent started complaining of dyspnea and thoracic pain and had a painful small cervical right mass. In the thoracic CT angiography (CTA), several pulmonary septic emboli were apparent throughout the pulmonary parenchyma. Cervical Doppler ultrasound showed right facial vein thrombophlebitis, later confirmed in a CTA. Thromboses in other locations, including the internal jugular vein, were excluded, as well as cervical abscesses. The patient was successfully treated with intravenous antibiotic therapy and anticoagulation.

 To this date, no reports of LS presenting with isolated thrombosis of the facial vein have been described in pediatric patients. We highlighted the importance of early recognition of LS and its atypical variants. Pediatric international guidelines regarding its management and treatment would also greatly affect the outcome of these patients.