Archives of Pediatric Infectious Diseases
Volume:11 Issue: 2, Apr 2023

The purpose of this study is to determine the viability of enterotoxigenic Escherichia coli (ETEC) in a sample of diarrhea. The investigation focuses specifically on the lt gene and utilizes propidium monoazide (PMA) and quantitative real-time polymerase chain reaction (qPCR) to differentiate between live and dead bacteria.

Propidium monoazide is a chemical that can bind to and inhibit the amplification of free DNA during qPCR analysis. In this study, in addition to analyzing diarrhea samples, artificially spiked samples were used to assess the sensitivity and accuracy of the PMA treatment. The qPCR results were compared to the gold standard of culture-based methods both with and without PMA treatment.

The method’s limit of detection was 8 CFU/mL, and it exhibited linearity from a 10-1 to a 10-9 dilution. The qPCR approach revealed a higher bacterial count than the culture method due to the detection of DNA released from dead bacteria. However, when PMA was employed, the bacterial count was similar to that obtained using colony count agar, which is attributed to the elimination of free DNA during investigation.

The present study developed a PMA-based qPCR approach that enables the detection of live bacterial DNA. This method involves PMA and real-time PCR and offers several advantages, including faster detection times (a few hours vs. several days with the traditional culture method) and the ability to exclusively detect live bacteria without interference from free DNA released by dead bacteria. Additionally, the use of real-time PCR enables precise quantification of the live bacterial load. Overall, this approach is cost-effective, rapid, highly sensitive, and specific, making it a valuable tool for various applications.

 Carbapenems are broad-spectrum antibiotics used to treat the family of gram-negative Enterobacteriaceae, especially those that are resistant to first-line antibiotics. Because these drugs are usually prescribed as the last line of treatment, resistance to these antibiotics carries irreparable risks to treatment systems, and screening high-risk individuals in medical centers and using infection control measures are critical strategies for eliminating them.

 We investigated the prevalence of colonization of different strains of Enterobacteriaceae, Klebsiella, Enterobacter, and Escherichia coli and their risk factors in hospitalized children.

 In this descriptive cross-sectional study, stool samples were taken from patients during the first 48 hours of hospitalization in a tertiary children’s hospital and were cultured on Makcanki culture medium or EMB. Cultured Enterobacteriaceae samples were transferred to Müller-Hinton agar medium, and their antibiotic susceptibility was evaluated with meropenem and imipenem discs by disc diffusion method. In the next step, five common carbapenemase genes, including (VIM, IMP, OXA-48, NDM-1, and SPM-1) were examined by PCR method and reported accordingly.

 Two hundred and ninety-five stool samples were examined, of which 242 (82%) samples were cultured positively with Enterobacteriaceae. The prevalence of carbapenem resistance was reported to be 37% among 295 samples using the phenotypic method. Resistance rates were high in patients with a history of antibiotic use, with frequent hospitalizations (more than two episodes in the last six months), and in patients with an underlying disease) malignancy, GI diseases, immunodeficiency, neurologic diseases such as cerebral palsy and epilepsy, endocrine diseases. Most of the genes found were OXA-48, followed by IMP and VIM. NDM-1 was found in 3 samples, and SPM was not found in any of the samples. In 13% of resistant samples, more than one carbapenemase gene was found.

 The results of this study showed that the frequency of carbapenem resistance in stools colonized with Enterobacteriaceae is high in our patients. On the other hand, the presence of carbapenemase genes in these bacteria, which are located on the plasmids that can be rapidly spread in the hospital environment, is an alarm for the hospital infection control committee to take preventive measures in order to prevent the spread of these bacteria in the hospital.

Nutritional status is believed to affect the immune system and parasite density in children diagnosed with malaria from Plasmodium vivax infection. It is known that nutritional status could facilitate the growth of protective immune response towards malaria antigen, but some studies have shown that poor nutrition could cause clinical complications and lead to severe malaria. There have also been different reports on the relationship between nutritional status and parasite density.

This study aimed to examine the association between nutritional status and parasite density in children with vivax malaria in Kualuh Leidong area.

This cross-sectional study was conducted from October 2019 to January 2020 in Kualuh Leidong to investigate 48 children aged between 2 - 18 and diagnosed with vivax malaria. The nutritional status of children with fever and positive Plasmodium vivax confirmed by microscopic examination were evaluated. Parasite density was determined in order to assess the severity of the infection. A non-parametric test was performed to examine the association between these two conditions.

There was a significant association (P = 0.032) between sexual parasite density and nutritional status. There was a significant association (P = 0.032) between sexual parasite density and nutritional status. However, no significant association was found between nutritional status and asexual parasite density (P = 0.222).

Urinary tract infection (UTI) is the most prevalent infection among the community and hospitalized patients.

This study aimed to investigate the current antimicrobial susceptibility patterns among UTI agents in Tehran, Iran.

This retrospective study analyzed 9836 urine samples collected from hospitalized patients within 2019 - 2020. The antibiotic susceptibility for commonly-used antibiotics was tested according to Clinical and Laboratory Standards Institute guidelines.

Based on the findings, Escherichia coli was the most prevalent etiological agent of UTIs (72.3%), followed by Klebsiella spp. (13.4%), Pseudomonas aeruginosa (4.8%), Acinetobacter spp. (2.8%), and other species (6.7%). Of isolated microorganisms, 943 cases (97%) belonged to gram-negative bacilli; however, 32 cases (3.05 %) were gram-positive cocci. The susceptibility rates of E. coli to amikacin, nitrofurantoin, gentamicin, imipenem, and cefoperazone were 88.4%, 87.5%, 68.3%, 65.9%, and 62.6%, respectively. The sensitivity rates of Klebsiella spp. isolates for amikacin, nitrofurantoin, and imipenem were 87.6%, 71.5%, and 68.9%, respectively.

The results of the present study characterized the misuse of antibiotics in Iran. Iranian surveillance studies will assist clinicians in choosing the most appropriate empirical treatment and preventing infections caused by resistant organisms.

 Some studies have shown that low vitamin D is a risk factor for infectious diarrhea, but some have rejected it.

 Considering the high prevalence of infectious diarrhea among children, the high prevalence of vitamin D deficiency, and the possible mutual effect of these two, the present study aimed to measure vitamin D in children with acute diarrhea.

 This study enrolled 222 children aged 2 - 14 in healthy control and acute diarrhea groups. The 25-hydroxyvitamin D (25(OH)D) level was measured in all samples by the Chemiluminescent Immunoassays (CLIA) method.

 The mean age of the participants was 5 ± 2.7 years. Patients with acute diarrhea had lower vitamin D than healthy controls (P = 0.04). The frequency of deficient and insufficient vitamin D levels was higher in the acute diarrhea group than in the healthy control group, but insignificantly (P = 0.146).

 The present study revealed an association between insufficient vitamin D and acute diarrhea. Hence, low vitamin D is a risk factor for acute diarrhea.

 Of all teenage deaths caused by coronavirus disease 2019 (COVID-19), 47% occurred in children aged 0 - 9. Like many other infectious diseases, reducing mortality in children requires widespread vaccination. Despite the availability of the COVID-19 vaccine, a large percentage of children have not received the vaccine.

 This survey aimed to study parents’ reluctance to receive the COVID-19 vaccine for their children in Shiraz, Iran.

 An online questionnaire was sent to parents whose 5 to 11-year-old children had received no COVID-9 vaccine through the health educators of primary schools in Shiraz, Iran. The questionnaire contained demographic questions and 16 beliefs about COVID-19 vaccination that were answered as yes/no.

 We assessed 1093 respondents, including 49.5% (n = 542) male and 50.5% female students’ parents. The mean number of wrong beliefs was 7.21 ± 2.80 in parents who had boys and 7.78 ± 2.95 in girls’ parents. Also, 78.6% of participants had at least five wrong beliefs or excuses for not vaccinating their children. Notably, 82.8% of mothers and 84.3% of fathers were vaccinated with 2 - 3 doses against COVID-19. The most common wrong beliefs were probable vaccines’ side effects in the future, the undesirable effect of vaccination on children’s growth, and the awful effect of the vaccine on fertility, with a prevalence of 82.7%, 81.2%, and 76.7%, respectively.

 This study identified that most participants believed that COVID-19 vaccines have side effects for their children and unfavorable effects on children’s growth and infertility.

 Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported.

 We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved significantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition.

 Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.