Archives of Pediatric Infectious Diseases
Volume:1 Issue: 1, Oct 2012

Staphylococcus aureus is a major cause of serious hospital and community acquired infections, particularly in colonized individuals.. The study was carried out in a tertiary care center in Tehran, Iran to identify the frequency of hospital acquired methicillin resistant Staphylococcus aureus (HA-MRSA) colonization and its antibiotic susceptibility pattern and molecular characteristics..Patients and This point-prevalence study was performed on 631 children who were admitted for at least 48 hours in different wards of Mofid children’s hospital in Tehran, Iran. Samples from anterior nares of these children were taken with sterile swab and cultured. If Staphylococcus aureus (S. aureus) was isolated, methicillin resistance and antibiotic susceptibility pattern were diagnosed according to Center for Disease Control and Prevention (CDC) guidelines of 2011 and Clinical and Laboratory Standards Institute (CLSI), and molecular analysis were determined by minimum inhibitory concentration (MIC) and polymerase chain reaction (PCR) methods.. Rate of colonization with S. aureus and methicillin resistant Staphylococcus aureus (MRSA) were 3.2% and 1.1% (1.1% of total and 35% of S. aureus isolates), respectively. All MRSA isolates were susceptible to rifampin and clindamycin. Resistance to vancomycin was reported in six Staphylococcus strains. Resistance to linezolid was detected in 19/20 Staphylococcus. Molecular analysis of isolates showed that all vancomycin resistant S. aureus isolates contained Van A or Van B gene, and 15/19 linezolid resistant strain was positive for chloramphenicol-florfenicol resistant gene (cfr gene).. The rate of MRSA colonization varies in any area, and the knowledge of acquisition risk factors and antibiotic susceptibility pattern are essential in prevention and treatment of MRSA infections. Based on our study, we suggest that clindamycin and rifampin are good choices in empiric treatment of patients suspected to have HA- MRSA infections until results of culture and antibiotic susceptibility pattern are prepared. In respect to the prevalence of linezolid resistance in this study, we suggest avoiding the use of linezolid as empiric therapy in HA-Staphylococcus infection..

Upper respiratory tract infections (URTI) in children are the most frequent reasons for visiting a family doctor, commonly resulting in inappropriate prescription of antibiotics. In underdeveloped countries, a viral respiratory tract infection may be followed by serious complications. More than 200 viral species are associated with respiratory tract diseases in humans and this number is increasing.. This study was carried out to determine the distribution of common viruses responsible for clinical manifestations of upper respiratory tract infections (URTI) in children throughout the 4 seasons of year..Patients and This cross-sectional study was performed from October 2009 to September 2010 on 2- month and 12- year -old children with clinical manifestations of acute upper respiratory tract infections referring to the outpatient clinics of a children’s hospital affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran. Nasopharyngeal samples were collected and tested for Influenza virus, Parainfluenza, Adenovirus, Respiratory syncytial virus (RSV), Rhinovirus and Enterovirus, by polymerase chain reaction (PCR).. One hundred thirty four out of 330 samples (40.7%) were positive for at least 1 of the tested viruses. Adenovirus was detected with a frequency of 29.9%, followed by Rhinovirus (23.1%), Influenza virus (21.6%), RSV and Parainfluenza viruses (12.7% each) and Enterovirus (9%). Adenovirus was more frequent in spring, summer and winter (35%, 22%, and 36.7%, respectively) and Rhinovirus was common in winter (26.7%), followed by spring and autumn (25% each). Frequency of Influenza virus was 22.5% in spring, 15.6% in summer,21.9% in autumn and 26.7% in winter. The rates of RSV were 9.4%, 15.6%, 12.5% and 13.3%, from spring to winter. Enterovirus was isolated in 7.5% samples in spring, rising to 15.6% in summer, falling to 9.4% and then to 3.3% in cold seasons. Parainfluenza was found 2.5% in spring, 21.9% in summer, 18.8% in the fall and 10% in winter.. Adenoviruses are the most commonly detected viruses in childhood URTI. Although frequency of different viruses varies according to the seasons of year, this difference is not significant..

Viruses are known to cause the majority of acute respiratory infections. A great deal of evidence indicates that the etiology of most cases of wheezing in children, like asthma or bronchiolitis, is also linked to such respiratory infections.. We assessed the prevalence of three common viruses including; Respiratory syncytial virus (RSV), human rhinovirus (HRV), and human Metapneumovirus (hMPV), in children with acute wheezing..Patients and Ninety six wheezy children, 48 males (50%) and 48 females (50%)under the age of 5 years, were enrolled in the study. All patients visited as outpatients or inpatients when referred to the Mofid Children Hospital, in Tehran, from September 2009 to March 2010. A nasopharyngeal sample was taken from each child’s nostril and the three viruses were detected by a molecular polymerase chain reaction method (PCR).. Out of 96 patients, 63 cases (64.8%) had a positive PCR test for at least one virus. Prevalence of each virus including RSV, HRV and hMPV alone or in combination were 44 (45.8%), 13 (13.5%) and 6 (6.3%), respectively. There were no significant relationships between;age, prematurity, fever, respiratory distress and the existence of any kind of virus in the nasopharynx.. Our study revealed that the prevalence of these three viruses in the nasopharyngeal secretions of children suffering from acute wheezing was similar to other studies. The results of this study concluded; PCR assay is a widely available and rapid method to detect the viral etiology which induces wheezing in children in Iran, and the study also provides a baseline for future studies about the clinical importance of this relationship..

Urinary tract infection (UTI) is common in children. UTI with or without vesico-ureteral reflux (VUR) may result in renal scarring. Severe renal scarring impairs renal function and may result in hypertension, renal insufficiency, and end stage renal disease requiring dialyses or transplantation. Beta 2 micro-globulin (ß2MG) is a low molecular weight protein freely filtered by the glomeruli and then actively reabsorbed normally up to 99.9% in the proximal tubules; its urinary excretion is an indication of proximal tubular cell dysfunction.. The current study aimed to determine whether urinary ß2MG excretion would be elevated in patients with various grades of renal scar, and also its relationship with renal outcome in long term follow-up.. Urinary ß2MG and Creatinine (Cr) were measured in 83 spot urine samples of patients that 53 of them did DMSA renal scan both at the time of admission to confirm pyelonephritis, and 6 month later to detect scars. ß2MG was measured by radioimmunoassay method using ß2MG 96-test kit (RADIM Company; Germany), and the creatinine was measurd by spectrophotometry and was recorded as microgram per mg creatinine. Twenty children had various grades of renal scars.Results were compared with the ratios of 19 children with low uptake scanning, 14 children with normal scanning after recovery from pyelonephritis, and 30 normal children served as controls. EXCEL and SPSS softwares were employed to compare the mean urinary ß2MG in groups by student t-test, ANOVA, and Unpaired t-test at P,0.05 significance level. Subsequently patients were followed up for 6 years. The mean urinary ß2MG/Cr ratio was significantly higher in the scarring group (5.23 ± 10.6) than in the normal group (0.19 ± 0.2), and in low uptake group (0.49 ± 0.86) (P < 0.05). When mean ß2MG/Cr ratios were compared for each grade of scarring; patients with sever scar (grade III) had higher values (14.69 ± 15.82) than grades I (0.36 ± 0.35) and II (3.37 ± 5.20) (P < 0.05). Patients without renal scar had a ß2MG/Cr ratio below 0.46 microgram/mg Cr. The mean ß2MG was also higher in the refluxing group (3.45 ± 7.97) than nonrefluxing group (0.23 ± 0.24) ug/mgCr (P = 0.01). Three patients who had the highest ß2MG/Cr ratio values (33.3, 27, and 26.6 microgram/mg Cr) had sever scar that rapidly progressed to ESRD. They were transplanted 2 years later; after transplantation they still had recurrent UTIs. 2nd patient underwent native nephrectomy for renal abscess. Results of the current study revealed that mean ß2MG/Cr ratio was higher in patients with renal scar and poor outcome. Measurement of Urinary ß2MG may be useful in the early detection of tubular damage in refluxing patients and patients with renal scars and has prognostic significance..

Rotaviruses a major group of viruses that cause severe gastroenteritis in young children worldwide. Many different viruses can cause gastroenteritis, including Noroviruses, Adenoviruses, Sapoviruses, and Astroviruses. Serum antibody studies show that most of the children are infected with Rotavirus at least once in their life by the age of 3. In the world, approximately 400-600 thousand children in poor countries die annually by Rotavirus-associated dehydration. Most of the deaths occur in these countries because of delay in treatment. Despite low death rates in industrialized countries, good hygiene and sanitation do not appear to reduce the prevalence or prevent the spread of Rotavirus.. This study was aimed to detect Rotavirus in stool samples of infected patients using enzyme-linked immunosorbent assay (ELISA) serological method in 5 cities of Iran.. In this descriptive study, 2988 stool samples of patients with acute gastroenteritis were collected from children’s hospitals of 5 main cities of Iran. The samples were sent in frozen condition to pediatric infection research center in Tehran and stored at -70°C. ELISA test was performed for detection of Rotavirus antigens. The mean age of study population was 1 to 5 years.. ELISA method on 2988 stool samples from 5 cities revealed rotavirus-positive results in 55.48% cases, including 8.97% in Tehran, 7.56% in Tabriz, 7.76% in Mashhad, 14.42% in Shiraz, and 16.77% in Bandar Abbas). 59.2% of positive samples occurred in males and 40.8% in females.. Rotavirus is one of the major causes of gastroenteritis in children in Iran that can be easily detectable by ELISA method through which early diagnosis, treatment, and preventive vaccination can dramatically reduce mortality and morbidity rates of the disease..

Renal scintigraphy with technetium 99m labeled dimercaptosuccinic acid (99mTc-DMSA) is a traditional imaging technique commonly used to detect renal scar in patients with probable vesicoureteral reflux (VUR) and/or urinary tract infection (UTIs). We determined whether normal results of DMSA renal scan obviate the need for voiding cystourethrography (VCUG) in evaluating children with UTIs.. We observed medical records from June 2006 to April 2007 retrospectively of 208 children admitted with community acquired UTIs to Mofid children hospital (Tehran, IR/Iran) a teaching hospital in Tehran in which their age was between 2-120 months. The association between DMSA renal scan results and VCUG findings performed 48 hours and 1 month after the diagnosis was evaluated. To examine the accuracy of abnormal DMSA results in predicting VUR, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and negative and positive likelihood ratio (LRs) were calculated.. VUR was seen in 14.0% of renal units with normal results of DMSA and 17.3% of renal units with abnormal DMSA findings. High grade VUR (grade III–V) was seen in 18 (7.1%) of the abnormal findings of DMSA group and in (2.8%) 1 of the normal DMSA results group (P = 0.56). In the group with previous UTI (n = 68), the sensitivity and NPV of abnormalities on DMSA renal scan for detecting the presence of VUR (grade III–V) were 100%, and100%, respectively. In the group without evidence of previous UTI, the sensitivity and NPV of abnormalities on DMSA renal scan for detecting the presence of VUR (grade III–V) were 93% and 97%, respectively. Totally the sensitivity and NPV of abnormalities on DMSA renal scan to detect the presence of VUR (grade III–V) were 94% and 97%, respectively.. As a screening test, DMSA renal scan is a high sensitive technique to assess VUR (grade III–V) in children with UTI..

Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and potentially life-threatening disease and has to be considered in the differential diagnosis of many conditions. HLH comprises two different conditions that are difficult to differentiate; Familial hemophagocytic lymphohistiocytosis (FHLH) or familial erythrophagocytic lymphohistiocytosis (FEL), and Secondary hemophagocytic syndromes (secondary HLH, sHLH). Herein, we report a case series of Iranian children with HLH and describe the symptoms and outcome of this disease in Iran.

Pachymeningitis is a rare chronic disorder of the duramater caused by various infectious, autoimmune or malignant diseases. We report a child with chronic tuberculous pachymeningitis, who presented with clinical manifestations of meningitis with a compatible cerebrospinal fluid analysis. Despite signs of progressive neurological involvement, extensive work-up done to rule out known causes of dural inflammation was negative. The patient was started empirically on anti-tuberculous therapy, to which he responded after 2 weeks. He was discharged on anti-TB medications. He remains well on follow-up. We recommend a trial of anti-tuberculous treatment in children presenting with signs of pachymeningitis in whom the cause of chronic meningeal inflammation cannot be identified..