فهرست مطالب

Archives of Pediatric Infectious Diseases - Volume:12 Issue: 2, Apr 2024

Archives of Pediatric Infectious Diseases
Volume:12 Issue: 2, Apr 2024

  • تاریخ انتشار: 1403/02/03
  • تعداد عناوین: 7
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  • Farzane Kargar, Mohammad Rahmati, Marzieh Jamalidoust *, Mojtaba Mortazavi, Amir Savardashtaki, Morteza Milani, Amir Vahedi Page 1

    Context: 

    Human papillomavirus (HPV) infections contribute to the cause of 15% - 20% of all human cancers. This review aims to examine and provide updated information on various aspects, with a particular focus on topics that are of interest to dermatologists. 

    Evidence Acquisition:

     Using published studies, the pathogenicity of HPV was investigated. Subsequently, the existing vaccines were explored, followed by a review of the loop-mediated isothermal amplification-lateral flow dipstick (LAMP-LFD) method.

    Results

    For HPV detection, the polymerase chain reaction (PCR), self-sustained sequence replication (3SR), strand displacement amplification (SDA), and nucleic acid sequence-based amplification (NASBA) were used. These methods can have good detection but still have problems. In comparison with nested PCR, the detection of HPV16 and HPV18 using LAMP-LFD has higher sensitivity.

    Conclusions

    Loop-mediated isothermal amplification-lateral flow dipstick is a simple and rapid method for the specific and sensitive detection of HPV. Thus, along with the previous HPV16 and HPV18 diagnostic tools, LAMP-LFDmight be useful in field studies or local hospitals.

    Keywords: HPV16, HPV18, Infection, Pathogenesis, Vaccination, LAMP, LFD
  • Sedigheh Rafiei Tabatabaei, Abdollah Karimi, Masoud Alebouyeh, Ghazal Zahed, Eiman Faghihian, Yalda Jefrideh, Talat Mokhtari Azad, Ahmadreza Shamshiri, Ghazal Shariatpanahi * Page 2
    Background

    Complete immunization against Rubella and Measles (MR) in pediatrics is achieved using 2 doses of the Measles, Mumps, and Rubella-containing vaccine (MMR) in Iran at 12 and 18 months of age, where more than 95% of children under 5 years of age are vaccinated. Antibody waning in mothers and older children, and genetic diversity in immune responses may render them susceptible to infections.

    Objectives

    This study aimed to investigate the diversity in immunoglobulin G (IgG) antibody levels against these two viruses in pregnant women, infants younger than 2 months, children at 6, 12, and 18 months, and 5 - 6 years of age in Iran.

    Methods

    This study was conducted on serum specimens sent to the National Reference Laboratory for Measles and Rubella in Tehran, Iran, from children under 2 months (n: 50), 6 (n: 54), 12 (n: 54), and 18 (n: 39) months, and 5 - 6 years old (n: 49), as well as women at 37 weeks of pregnancy (n: 53), from May to December 2020. Rubella and Measles-specific IgG were measured using an enzyme-linked immunosorbent assay kit.

    Results

    Among serum samples from different provinces of Iran, the lowest positive level of Measles IgG was observed in children aged 6 and 12 months (7.41%), while the highest positive level was found in children aged 18 months (84.62%). For Rubella, the lowest IgG-positive level was seen in children aged 11 - 13 months (11.11%), while the highest positive level was observed in the 5 - 6 years old group (83.67%). Antibody levels against measles and rubella were higher in pregnant women than in children.

    Conclusions

    Measles and Rubella antibody titers were lower in children 12 months before vaccination and reached a positive level in children aged 18 months post-vaccination. Whereas, lower Measles IgG levels in 5 - 6 years old children compared to 18 months old children may be due to waning antibodies. Pregnant women exhibited high levels of protection against these viruses (more than 80% had positive rubella IgG), as anticipated from outcomes of the national vaccination program in 2004.

    Keywords: Infant, Preschool Child, Antibodies, Measles, Pregnant women, Rubella, Vaccination
  • Ali Amanati, _ Hossein Molavi Vardanjani, _ Seyed Omidreza Zekavat, Samane Nematolahi *, Haleh Bozorgi, _ Saranaz Jangjoo, Farima Safari, _ Dena Masoomi Bandari, Mohammad Ebrahim Keliddar Mohammadi Page 3
    Background

    Rituximab (RTX) is approved for treating CD20-positive B-cell malignancies, including non-Hodgkin lymphoma, when used alongside chemotherapy. It has the potential to interact with and alter the host immune system, putting patients at a heightened risk of infection. Therefore, the use of RTX necessitates a meticulous assessment of infectious risks based on the latest evidence.

    Objectives

    We conducted a prospective investigation into infectious complications and mortality among children undergoing RTX treatment over the observation period of the study.

    Methods

    In this observational cohort study, we included 61 pediatric patients treated with RTX for malignancy and immune thrombocytopenic purpura (ITP), as well as 122 cancer patients who had never received RTX (the unexposed group). These patients were prospectively monitored for febrile neutropenia (FN), bloodstream infection (BSI), invasive fungal infection (IFI), and mortality. All infectious complications were documented starting from the initial dose of RTX and continuing for at least six months following the last dose. Logistic regression and Cox regression analyses, with consideration for the proportional hazards assumption, were utilized to evaluate the impact of covariates on mortality and infection-related outcomes.

    Results

    Infectious complications were observed in 52.5% of children treated with RTX. These complications were notably more prevalent in children with malignancy compared to those with chronic ITP (89.5% versus 10.5%, respectively). RTX was found to be associated with an increased likelihood of mortality in children with malignancy (OR [95% CI]: 1.54 [0.41, 5.69]). According to Cox regression analysis, RTX was linked to a higher risk of IFIs, death, FN events, and BSIs over a 36-month observation period (4.33 [1.21, 15.52], 3.26 [1.008, 10.59], 1.68 [0.83, 3.41], and 1.59 [0.27, 9.17], respectively). The total dose of RTX administered was also associated with adverse patient outcomes, with the odds of infectious events and death increasing in the second, third, and fourth quartiles of the total RTX dose administered. Furthermore, the estimated one-year and two-year survival rates for cancer patients treated with RTX were 77% and 58%, respectively.

    Conclusions

    RTX treatment, when used concurrently with immunosuppressive chemotherapy for hematologic malignancies in children, showed additive and dose-dependent effects on clinical outcomes.

    Keywords: Bacteremia, Febrile Neutropenia, Hematologic Neoplasms, Invasive Fungal Infections, Pediatrics, Rituximab, Survival
  • Seyed Ahmad Tabatabaii, Abdolhamid Taghizadeh-Behbahani, Ghamartaj Khanbabaee, Maryam Alibakhshi, Amir Reza Bahadori, Nazanin Farahbakhsh * Page 4
    Background

    Cystic fibrosis (CF) is one of the most prevalent inherited diseases in children. Coronavirus can lead to more severe respiratory complications in patients with comorbidities, such as CF. Additionally, the coronavirus disease 2019 (COVID-19) pandemic has imposed a substantial burden on both national and international healthcare systems. Coronavirus disease could influence CF patients’ morbidities and mortalities.

    Methods

    A descriptive retrospective study was performed at Mofid Children’s Hospital to determine the effect of the COVID-19 pandemic on CF patients. A physician completed 128 valid and reliable questionnaires. Moreover, hospital medical records were also used to revalidate the data and complete the remaining part of the questionnaire. The information collected for this study included demographic data, patients’ height, patients’ weight, body mass index (BMI), past and current positive history of COVID-19-like symptoms, socially determined condition, and influence of COVID-19 on routine therapeutic measurements in CF. The data were analyzed using SPSS software (version 21).

    Results

    The majority of cases continued to perform chest physiotherapy at home, maintained routine follow-ups with pulmonologists, and adhered to their previous medication regimens (59.4%, 42.2%, and 82%, respectively). Moreover, 65.5% of participants reported leaving home less frequently than before, and approximately 73% of patients’ parents also reduced their outings, with no statistically significant differences (P > 0.05).

    Conclusions

    The daily habits of CF patients did not undergo significant changes during the COVID-19 pandemic, particularly during the Omicron wave, despite the dramatic increase in infection rates.

    Keywords: Cystic Fibrosis, COVID-19-Related, Coronavirus, Healthcare-Associated Infectious
  • Hamid Rahimi Hajiabadi, Rana Saleh, Niloofar Javadi, Amin Dehghan, Atefeh Sadeghizadeh, Zahra Pourmoghaddas * Page 5
    Background

    Since December 2019, the Coronavirus disease 2019 (COVID-19) pandemic has impacted the world, including neurologic manifestations among its effects. Additionally, some studies have reported the reactivation of various viruses in patients diagnosed with COVID-19.

    Objectives

    This study aimed to investigate the viral infection patterns of common viruses that cause encephalitis in patients diagnosed with the concurrence of multi-system inflammatory syndrome in children (MIS-C) and encephalitis.

    Methods

    This cross-sectional study was conducted from February 2020 to May 2021. Children diagnosed with both MIS-C and encephalitis were included. Cerebrospinal fluid (CSF) samples were collected from each participant for a biochemistry panel and polymerase chain reaction (PCR) assays for varicella-zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), adenovirus, and influenza virus. Furthermore, patients underwent neuroimaging studies, including magnetic resonance imaging and computed tomography.

    Results

    Thirteen patients with MIS-C and encephalitis were enrolled. Viral detection in CSF samples through PCR assays was successful in six patients. EBV and HSV were detected in four and two patients, respectively. The median age of these six children was 44 months, with four being male. Follow-up visits after six months showed that their quality of life had returned to normal.

    Conclusions

    This study highlighted the co-occurrence of HSV and EBV reactivation with MIS-C. Although viral reactivations, unlike primary infections, resolved spontaneously in our cohort. Consequently, the reactivation of viruses due to MIS-C may open new avenues for future research.

    Keywords: Coronavirus Disease 2019, Multisystem Inflammatory Syndrome, Encephalitis
  • Mohammad Kazemian, Shamsollah Nouripor, Parinaz Alizadeh, Reza Saeidi, Mitra Radfar, Saleheh Tajalli, Ali Vafaee, Bahador Mirrahimi, Minoo Fallahi * Page 6

    Due to the novelty of COVID-19, no definite treatment has yet been found for this infectious disease, especially in neonates and early infants. Although most of the neonates affected by this virus have a mild or silent course of the disease, in the severe form, there is no approved antiviral drug. This study was done to evaluate the safety and efficacy of Remdesivir as the known effective antiviral drug in both adults and children’s populations. In this case series study, we present our experience of the administration of Remdesivir in the treatment of 15 infants with severe neonatal COVID-19, with severe respiratory distress, admitted to our neonatal intensive care unit. We prescribed the drug with a 2 to 3-hour infusion of a loading dose of 5 mg/kg on day 1, followed by 2.5 mg/kg/day 4 days later, concomitant with continuous cardiac monitoring and blood pressure monitoring every 15 minutes. Fortunately, no side effects were reported either during or after the administration of the drug. Long-term patient follows up, for 10 months after birth, did not reveal any particular complications. It seems that the use of Remdesivir to treat severe forms of neonatal and early infancy COVID-19 is safe and effective.

    Keywords: Remdesivir, COVID-19, Neonates
  • Eman Hamza, Shahinda Rezk, Hassan Eshra, Heba Selim, _ Mohamed Samir Turkey * Page 7
    Introduction

    The widespread use of carbapenems increased the prevalence of carbapenem-resistant Enterobacteriaceae with subsequent increases in mortality due to extremely limited treatment options. Following neurosurgical procedures, carbapenem-resistant Klebsiella pneumoniae (CRKP) is the main cause of central nervous system (CNS) infections. The optimal antimicrobial treatment of such infections has not yet been defined.

    Case Presentation

    We present a 4-month-old boy with an extra-ventricular drain-related CNS infection with CRKP. Although meropenem minimum inhibitory concentration (MIC) for the bacterial isolate was  16 mg/L and it harbored blaNDM, blaVIM, and blaOXA-48-like carbapenemase genes, this infection was effectively treated with a combination therapy of intravenous (IV) double dose extended infusion of meropenem in addition to amikacin.

    Conclusions

    This successful treatment regimen for CRKP-causing meningitis may pave the way to manage severe CNS infections with extensive-drug-resistant bacteria in infants and children without inserting an external drain or intra-thecal antibiotic administration.

    Keywords: Carbapenem-Resistant Klebsiella, Intravenous, Extended Infusion, Meropenem, Amikacin