Archives of Pediatric Infectious Diseases
Volume:11 Issue: 3, Jul 2023

The global spread of the coronavirus since 2019 has caused significant concern.

In this study, we aimed to investigate the clinical manifestations and laboratory findings of children infected with the alpha, beta, delta, and omicron strains.

We included all patients who were referred to Mofid Children's Hospital during the peak of the alpha strain in November 2020, the beta strain in April 2021, the delta strain in August 2021, and the omicron strain in February 2022, corresponding to the national peaks of four SARS-CoV-2 variants of concern (VOC). All patients had a positive nasopharyngeal PCR test and were admitted to the emergency ward. We analyzed the collected data using SPSS software.

A total of 649 patients were included in this survey, of whom 58.1% were male. The most and least frequent clinical manifestations were fever and skin presentation, respectively. The mean white blood cell count (WBC) was 8423.9 ± 5427.3. The mean values for C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 30.14 ± 20.07 and 38 ± 22.6, respectively. There was no significant association between coronavirus type, age, and gender. Gastroenteritis, urinary tract infection, and croup showed a statistically significant positive correlation with delta, beta, and omicron (P-values of < 0.003, 0.000, and 0.000, respectively). Cough was more frequent in patients infected with alpha and beta subtypes, while lymphocyte counts were elevated in patients suffering from delta, omicron, and alpha. C-reactive protein and ESR levels were significantly increased in patients with delta infection, and in patients with omicron infection, CRP levels were significantly elevated.

Our study revealed that the different strains of COVID-19, corresponding to the World Health Organization (WHO) peak of VOCs, can cause variable clinical symptoms in children. These findings could be helpful in the diagnosis of COVID-19.

 Staphylococcal scalded skin syndrome (4S) is caused by Staphylococcus aureus exfoliative toxin and is characterized by the separation of the surface layers of skin. Given the existence of conflicting treatment strategies and differences in antibiotic resistance patterns, this study aimed to compare the effectiveness of clindamycin, clindamycin with another anti-staph agent, and antibiotic regimen without clindamycin in the management of pediatric 4S.

 To compare the effectiveness of different treatment strategies in the management of pediatric 4S.

 In this cross-sectional study, children with 4S (based on the final documented clinical diagnosis) admitted to the 17th-Shahrivar Hospital of Rasht, Iran, from 2005 to 2021 were enrolled. Exclusion criteria comprised being a neonate, having chronic skin diseases or immunodeficiencies, and incomplete data files. The variables gathered included age, sex, type of antibiotic received, time of fever cessation (if fever existed), recovery time, duration of hospitalization, and complications. The data were entered into SPSS v.24 software and analyzed.

 This study was conducted on 73 patients with the final diagnosis of 4S. The mean age of the patients was 17.70 ± 15.85 months, and 47.9% of them experienced fever during hospitalization. The mean duration of hospital stay was 6.52 ± 1.90 days. Also, the average duration of recovery in these children was 4.90 ± 1.73 days. There were no differences in terms of sex (P-value = 0.245), age (P-value = 0.383), and duration of fever (P-value = 0.568) between the three groups receiving different antibiotic regimens. Meanwhile, the durations of recovery (P-value = 0.018) and hospitalization (P-value = 0.020) were significantly longer in children who did not receive clindamycin. Moreover, the duration of hospitalization was significantly shorter in the patients who received clindamycin alone compared to those treated with clindamycin plus another antibiotic (P-value = 0.044). There was no significant difference in the occurrence of disease/drug complications between the three groups, and the most common complication in all patients was scaling.

 Clindamycin (alone or in combination with other anti-staphylococcal agents) could shorten the recovery period, and hospital stay in children with 4S. Besides, it did not have any adverse impact on the occurrence of complications. The patients who received clindamycin alone had a shorter hospital stay than patients who were treated with clindamycin plus another antibiotic. Considering the lower complications, lower costs, and shorter length of hospital stay associated with monotherapy, we recommend using clindamycin alone for treating 4S patients.

 Widespread and inappropriate use of antibiotics has led to an increase in antibiotic-resistant bacteria worldwide. Extended-spectrum β-lactamases (ESBLs) are among the most important resistance mechanisms in members of Enterobacteriaceae, which can pose a threat to patients.

 This study aimed to investigate the carrier status and alteration in the fecal transmission of ESBL-producing Enterobacteriaceae (ESBL-E) on admission and during the hospital stay, as well as its correlation with the usage of antibiotics among children in a pediatric intensive care unit (PICU). Molecular typing between the primary and secondary isolates was done to detect the homotypic clonal strains.

 Demographic and medical data of PICU children were collected, and the carrier status of ESBL-E was investigated in pairs of their rectal swab samples at the admission and discharge time. Detection of ESBL phenotype and antimicrobial susceptibility to 12 antibiotics were performed by double-disk synergy and disc diffusion methods, respectively. Polymerase chain reaction for detection of blaTEM, blaSHVblaPER, blaCTX-M, and blaVEB genes was performed using specific primers. The phylogenetic relations were analyzed by the enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) method.

 Extended-spectrum β-lactamase-producing Enterobacteriaceae was detected in 48% of the samples at admission and 42% at discharge time. The highest frequency of resistance was observed in cephazolin, amoxicillin-clavulanic acid, and ampicillin. Children with a history of meropenem administration showed a significantly higher frequency of meropenem resistance Enterobacteriaceae in their samples. Moreover, the administration of metronidazole increased the isolation of ESBL-Escherichia species in hospitalized children. The most common gene associated with the ESBL phenotype was blaCTX-M, while blaPER and blaVEB were not detected in the ESBL-E isolates. The phylogenetic analysis did not confirm the occurrence of the cross-transmission of ESBL-E in the patients during hospitalization.

 Our results showed a high frequency of ESBL-E in the feces of children upon admission to the PICU, which did not change significantly during the hospital stay. Although the prescription of metronidazole showed an association with the enrichment of ESBL-E due to observed diversity in the molecular types and resistance phenotypes of the isolates, the community seems to be the primary source of ESBL-E transmission in children. Further investigations are needed to understand the role of hospital stay in the colonization and enrichment of ESBL-E in the intestinal tract of children and their association with infections during the medical interventions in the PICU.

 Urinary tract infections (UTIs) are among the most common childhood infections and can lead to serious complications, such as hypertension and renal failure, if not diagnosed and treated promptly. The prompt initiation of appropriate empiric therapy in children with upper UTIs requires the identification of causative bacteria and their antibiotic resistance patterns.

 The aim of this study was to investigate the frequency and patterns of antibiotic resistance among uropathogenic bacteria causing UTIs in children under 3 years of age admitted to the 17th Shahrivar Hospital in Rasht, Iran.

 A total of 259 children diagnosed with UTIs from 2014 to 2020 were admitted to our hospital and included in the study. The age, sex, clinical symptoms, urine analysis results, urine culture findings, and antibiogram of the patients were documented in a questionnaire. The data were then analyzed in SPSS software version 21.

 The mean age of the children was 4.9 ± 2.7 months. Boys comprised 53.3% of the patients. Escherichia coli was the most frequent cause of UTIs in the children (56.4%), followed by Klebsiella (33.2%). The highest resistance was related to cephalothin (77.1 %), cephalexin (77.1 %), ampicillin (78.8 %), and amoxicillin (100 %).

 The most common uropathogenic bacterium causing UTIs in young children was E. coli, which showed sensitivity to ciprofloxacin, amikacin, gentamicin, nitrofurantoin, imipenem, ceftriaxone, and nalidixic acid. Accordingly, it is advisable to use aminoglycosides as the drugs of choice to treat UTIs in children under the age of 3 years. In the case of any contraindication, third-generation cephalosporins are recommended for empirical treatment, and if there is no response to these treatments within 48 to 72 hours, ciprofloxacin can be considered.

 To date, multiple outbreaks of coronavirus disease 2019 (COVID-19) have been reported. Moreover, a wide spectrum of multiple organ involvements has been reported.

 This study aimed to describe and compare the clinical characteristics, laboratory features, and outcomes of pediatric patients with COVID-19 and Multisystem Inflammatory Syndrome of Children (MIS-C).

 This cohort retrospective study was performed on patients under 18 years admitted with a diagnosis of COVID-19 and MIS-C in a pediatric referral center in the northwest of Iran from March 2020 to June 2021. This study included the data obtained from three time points, including on admission, 1 week, and 3 months after admission.

 In this study, 151 patients with a mean age of 5.3 ± 4.1 years were enrolled, out of whom 51.7% and 48.3% were in COVID-19 and MIS-C groups, respectively. Fever was observed in 64.9% of the patients. In the third-month follow-up, there was no abnormality in the neurologic, respiratory, or gastrointestinal systems. For most patients with cardiovascular involvement, normal ventricular and valvar function, and coronary arteries were obtained in follow-up. Approximately one-third of the subjects were admitted to the pediatric intensive care unit (PICU). Neonates, those with cardiac involvement and underlying disease, were at a higher risk for PICU admission (P < 0.001). Moreover, six patients died.

 Although irreversible post-COVID-19 organ involvement is uncommon among pediatric patients, routine and preplanned follow-up programs play an important role in achieving satisfactory outcomes.

 Types of viral strains play an important role in developing respiratory infections in children, but what strains are prominent in each community and how they are distributed in both sexes and different ages is not yet fully understood in many countries, such as Iran.

 We aimed to determine the prevalence of viral infections caused by different types of respiratory viruses in children with viral respiratory symptoms admitted to a referral children's hospital in Iran.

 In this cross-sectional study, 87 nasopharyngeal specimens were collected from 90 children hospitalized in our children's hospital with respiratory symptoms. Multiplex real-time PCR techniques detected 17 different viruses.

 The most common respiratory symptom was cough revealed in 82.8%, followed by respiratory distress in 13.8% and tachypnea in 6.9%. Respiratory viruses were detected in 28.7% of patients, and co-infections were observed in one case. The most frequent viral strain detected was the Coronavirus (COVID-19) in 16.1%, followed by the Influenza A virus in 5.7%. The frequency of other viruses is Metapneumovirus 3.4%, respiratory syncytial virus (RSV) 2.3%, Bocavirus (1.1%), HCOV NL63 1.1%, and Parainfluenza 3.4%. The distribution of viral strains was independent of children's gender and age.

 Viruses were detected in 31% of children with respiratory symptoms, so other causative respiratory infections, except COVID-19, should be considered in children with respiratory symptoms even during the COVID-19 pandemic.