Archives of Pediatric Infectious Diseases
Volume:10 Issue: 4, Oct 2022

This systematic review and meta-analysis aimed to compare coronavirus disease 2019 (COVID-19) (Wuhan strain) features in children and adults during the initial pandemic phase.

Until June 4, 2020, a systematic search was conducted on the EMBASE, PubMed, Web of Science, Google Scholar, and Scopus to find and collect studies based on available data among adults and children. The heterogeneity of the studies was assessed using I2 statistics and chi-square testing. The random-effect model was used to pool the effect sizes due to inter-study heterogeneity (chi-square P-value 0.1 and I2 >50%).

Fever (65.73%), cough (53.78%), expectoration (37.9%), gastrointestinal symptoms (37.01%), headache (23.41%), shortness of breath (21.65%), and myalgia (20.79%) were the most common symptoms reported in children, according to the pooled estimation analysis. Arthralgia (Effect estimate (ES): adults = 2.15, children = 17.94) and headache (ES: adults = 9.22, children = 23.41) were significantly observed higher in children (P-value = 0.019). Adult patients had a higher rate of abnormal computer tomography (CT)-scan findings, while most children had a normal study. Adults had significantly higher rates of comorbidities, whereas children had significantly higher rates of asthma (ES: 17.94% vs 8.85%; P-value = 0.026) and malignancy (‎ES: 10.36‎% vs ‎5.47‎‎%; P-value = 0.045‎). During initial pandemic phase, hydroxychloroquine (ES: 66.21% vs ‎‎29.01%; P-value = 0.001) and antibiotics (ES: 77.86% vs 38.01%; P-value = 0.001) ‎were used much more frequently in adult patients. Adults used much more antibiotics than children. Nonetheless, antibiotics were given to around 40% of the children studied. ‎

Although children were afflicted less than adults in the early stages of the pandemic and had lower mortality, clinical and radiological findings, as well as prognostic factors, did not differ significantly between adults and children. However, with the advent of novel variants, clinical signs and symptoms, complications, and outcomes changed in children significantly.

Given that immunocompromised patients are more at risk for the infection of SARS-CoV-2, epidemiological data are critical for assessing the corresponding prevalence among health care workers (HCWs) and patients at health centers.

This study aims to investigate the prevalence of SARS-CoV-2 infection among the staff of two hospitals that take care of immunocompromised patients, including pediatrics and adults with special medical conditions.

This cross-sectional study includes all HCWs of the two hospitals; Abu Ali Sina Transplant Hospital (AASTH) and Amir al-Momenin Burn Injury Hospital (AABIH) in Shiraz, southern Iran, conducted from April 11, 2020, to June 16, 2021. The TaqMan real-time PCR assay was used to assess the SARS-CoV-2 infection rate in the suspected HCWs.

Out of 1232 sampled HCWs, 694 (56%) were female. Two hundred sixty-five samples (21.5%) and 967 samples (78.5%) were prepared from AABIH, and AASTH, respectively. The results showed that 30% (373) of the clinically suspected employees had positive test results. There was a significant correlation between the risk of exposure to COVID-19 patients and the PCR positivity rate, which could be explained by the fact that 58% of the infected HCWs were in a high-risk group, 20% medium-risk, and the remaining 22% were low-risk (P < 0.0001). The rates of positive cases in females were higher than that among male counterparts (P < 0.05).

In order to protect health care workers and reduce the prevalence and transmission of diseases, deficiencies must be identified and eliminated.

The coronavirus disease 2019 (COVID-19) pandemic has affected human life for more than a year. Coronavirus disease 2019 is well known for its respiratory manifestations; however, other important symptoms help with its diagnosis. Although clinical presentations in adults have been understood, clinical data in pediatric COVID-19 cases are still lacking.

We investigated gastrointestinal (GI) manifestations of COVID-19 in pediatric cases.

This study included 184 cases with GI manifestations referred to the pediatric emergency department of Namazi hospital from 20 March to 20 November 2020. Their clinical and laboratory data were extracted and analyzed with SPSS22.

Of 184 patients, 51 had positive SARS-CoV-2 PCR results. The most common symptom in SARS-CoV-2-positive patients was vomiting in 22 (43%) patients, followed by watery diarrhea in 12 (23.5%) and dysentery in 11 (21%). Significantly elevated CRP (P value = 0.002), ESR (P value < 0.001), and lymphocyte count (P value = 0.037) were found in PCR-positive patients.

Our result demonstrates that COVID-19 could present with different GI symptoms. Also, the symptoms and lab data could help clinicians diagnose COVID-19, besides other differential diagnoses in pediatric patients with GI symptoms.

Liver transplantation (LT) is the definitive treatment for patients with advanced liver failure. Bacterial infections are common consequences of organ transplantation resulting from immune suppression and prolonged hospitalization.

This retrospective cohort study examined the records of all liver transplant pediatrics under 18 years of age in Abu-Ali Sina hospital, Shiraz, Fars province, Iran, from April 2019 to February 2020. Demographic, laboratory, and clinical data were extracted along with the administered therapeutic approach for the patient.

Of 80 enrolled patients, 52 were male, and 28 were female, with a median age of 60 months. An incidence of 67.9% of bacterial infections was recorded. Gram-negative and Gram-positive pathogens accounted for 64.06% and 35.93% of infections, respectively. Surgical site infections were the most common ones. The length of ICU stay, hospitalization, mechanical ventilation duration, and re-hospitalization were significantly higher in the infected group than in non-infected pediatrics (P-value < 0.05). Multivariate regression analysis showed that the only risk factor for bacterial infections after LT was the length of ICU stay. The mortality rate was 22%, which was significantly higher among the infection group (P = 0.008).

A high rate of bacterial infections and an increasing prevalence of nosocomial and antibiotic-resistant pathogens were detected in the early period after LT.

SARS-CoV-2 has been characterized since December 2019 as the etiology of severe pneumonia throughout the world. However, the majority of children and adolescents with the respective infection have mild COVID-19. In April 2020, a warning was issued by the National Health Service (NHS), based on which a multisystem inflammatory syndrome in children (MIS-C) could be associated with COVID-19, presenting with cardiovascular shock, fever, and hyperinflammation. The syndrome presents with fever and organ involvement but with no pathognomonic findings or diagnostic tests, while some of the manifestations are almost the same as those of Kawasaki disease.

Knowledge of clinical course, demographic data, treatment, and prognosis can contribute to the more efficient management of the patients and, consequently, a decrease in morbidity and mortality.

Seventy-five patients < 18 years from September 22, 2020, to March 10, 2021, in Namazi hospital, Shiraz, Iran, with a diagnosis as per MIS-C defined criteria, were recruited.

Median age of the patients was 6.2 years, and 58.6% were male. Of the patients, 46% had positive SARS-CoV-2 RT-PCR, antibody, or both. Thirty percent of the total patients reported contact with proven COVID-19 cases. The abdominal free fluid in 17 patients, hepatitis in one patient, and stasis in both kidneys of one patient were detected. Upon echocardiography on the first day, 77%, 48%, 21%, and one patient were with tricuspid regurgitation, mitral regurgitation, abnormal LV function, and myocarditis, respectively; however, after 5 - 7 days, the repeated echocardiography revealed 44% of patients with tricuspid regurgitation, 30% with mitral regurgitation, and 6% with abnormal LV function. For the treatment, 18% of the patients received inotropes, 60% ASA, 32% IVIG, 84% glucocorticoids, and 25.3% received furosemide. All of the patients received antibiotics as well. Finally, 97% of the patients were discharged alive, while two cases died.

The results of this study suggest the importance of cardiac consultation along with early hospital care during the course of MIS-C in order to prevent the associated short-term and long-term complications.

Working children are susceptible to infection with various infectious microorganisms. Unfortunately, the difficulties of working children are growing at a remarkable speed worldwide.

The aim of this research was to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, as well as to evaluate the level of anemia, calcium, and phosphorus in working children.

This cross-sectional research was performed on 370 Iranian and Afghan working children from February 2018 to May 2019. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb), and anti-HCV Ab were evaluated using an enzyme-linked immunosorbent assay (ELISA). Furthermore, HCV-RNA and genomic HBV-DNA in the plasma and peripheral blood mononuclear cell (PBMC) specimens of the participants were investigated. The restriction fragment length polymorphism (RFLP) method was used to determine the genotype of HCV, and sequencing was performed to confirm.

The mean age of the participants was 10.1 ± 2.1 years (range, 6 - 15 years), and 229 (61.9%) were male. None of the studied children had any detectable HBV-DNA in the plasma and PBMC. The HCV genome was not detected in the plasma of the children, but HCV-RNA was assessed in the PBMC sample of 1 child (0.3%). Therefore, one of the children had occult HCV infection (OCI). The genotype of HCV in this child was subtype 1a. Furthermore, HBsAb was detected in Iranian (41.5%) and Afghan children (40.0%), and 2 (0.54%) of the working children were HBsAg positive. In 3 participants (0.8%), a positive HBcAb test result was noted.

The prevalence of HCV and HBV infection in working children in Iran is extremely rare. However, there is a possibility of the presence of OCI in these children.

COVID-19 pandemic imposed significant challenges on the health systems. COVID-19 management policies such as lockdown have made access to the health centers difficult. Pregnant women are a high-risk group whose pregnancy outcomes may be affected by COVID-19 pandemic. So, it is necessary to determine changes in the prevalence of preterm births and complications of prematurity during the pandemic.

This study aimed to determine the prevalence of preterm births and complications of prematurity during the first year of COVID-19 pandemic compared with the previous year.

In this cross-sectional study, we included all live births born between March 2019 to March 2021 in Mahdiyeh hospital, Tehran, Iran. We reviewed medical records to extract the prevalence of preterm births and prematurity complications. Then, the prevalence of preterm births and prematurity complications during COVID-19 pandemic compared with the previous year. We used Chi-square test to analyze categorical variables.

A total of 10,830 live births were included in this study. During COVID-19 pandemic, the prevalence of moderate or late prematurity had a 4.64% reduction (P < 0.001), and the prevalence of term birth increased by 5.37% (P < 0.001) compared with the previous year. The prevalence of respiratory distress syndrome (RDS) decreased significantly during COVID-19 pandemic compared with the previous year (23.64% vs. 26.56%, P < 0.001). The prevalence of retinopathy of prematurity (ROP) significantly increased during COVID-19 pandemic compared with the previous year (3.97% vs. 2.28%, P < 0.001). Additionally, sepsis was significantly more prevalent during COVID-19 pandemic compared with the previous year (6.84% vs. 1.23%, P < 0.001). Moreover, intraventricular hemorrhage (IVH) significantly increased during COVID-19 pandemic in comparison to the previous year (1.10% vs. 0.08%, P < 0.001).

The prevalence of preterm birth decreased during COVID-19 lockdown. Also, major complications of prematurity such as RDS, ROP, sepsis, and IVH may be affected by COVID-19 lockdown.

Global growing infections by multi-drug resistance (MDR) or extensively drug-resistant (XDR) bacteria are a serious public health problem which can increase the rate of mortality and morbidity even in children. Carbapenem is the last choice therapy in case of antibiotic-resistant bacteria presence.

This study aimed to evaluate the easy to use method to identify carbapenemase producing bacteria which include in CLSI.

In this descriptive study, 125 carbapenem-resistant and 97 carbapenem-susceptible gram-negative bacteria were included. PCR was used to identify carbapenemase enzymes include VIM, IMP, KPC, NDM-1, SPM-1, OXA-48 as a gold standard method. The modified carbapenem inactivation method (mCIM) was employed to phenotypically identify carbapenemase-producing bacteria. Some modifications were made to the CLSI proposed mCIM to ensure more accurate results in contrast of PCR.

The OXA-48 is the most prevalent detected carbapenemase and SPM-1 was not detected in any of strain. The results of the mCIM according to CLSI guide line demonstrated 100% sensitivity to define carbapenemase-producing bacteria. However, in the cases of non-carbapenemase-producing bacteria, only 4% of mCIM test results were consistent with the outcome of PCR. Decrease of the incubation time and the consider 15mm as a break point could increase the accuracy of mCIM against PCR.

The results of this study endorse that mCIM test is a valuable method to detect carbapenemase producing bacteria if the three hours consider instead of 4 hours with 15mm break point.

Coronavirus disease 2019 (COVID-19) is known as the most recent pandemic condition declared by the World Health Organization (WHO). It is widely believed that this infection is less frequent and severe in children, but few mortality reports are available in this age group population.

We described nine pediatric patients with probable or confirmed COVID-19 who died due to disease complications. Their age ranged between seven months and 14 years. All had underlying diseases, and three of them had been hospitalized before the COVID-19 diagnosis due to their previous medical conditions. Cough and respiratory symptoms were the most common symptoms observed in these patients. Bilateral ground-glass opacities were common radiologic findings.

Although COVID-19 is less common in the pediatric group, all ages are vulnerable to this infection, and mortality may occur, especially in patients with underlying diseases. We emphasize that children with underlying diseases and COVID-19 should be hospitalized and monitored tightly during treatment.