Journal of Comprehensive Pediatrics
Volume:1 Issue: 1, Jun 2007

Kawasaki disease is an acute vasculitis of childhood that predominantly affects the coronary arteries. The etiology of Kawasaki disease remains unknown, although an infectious agent is strongly suspected based on clinical and epidemiologic features. A genetic predisposition is also likely, based on varying incidences among ethnic groups, with higher rates in Asians. Symptoms include fever, conjunctival injection, erythema of the lips and oral mucosa, rash, and cervical lymphadenopathy. Some children with Kawasaki disease develop coronary artery aneurysms or ectasia, ischemic heart disease, or sudden death. Kawasaki disease is the leading cause of acquired heart disease among children in developed countries. This article provides a summary of the history, etiology, clinical diagnosis, treatment guidelines and lifelong follow up of KD.

The changing epidemiology of Methicillin Resistant Staphylococcus aureus (MRSA) became evident in the 1990s when community- acquired MRSA cases were first reported. Increasing prevalence of MRSA will inevitably increase the use of vancomycin, adding further to the problem of antimicrobial resistance. The previous retrospective study during 1996-1998 in Rasool Akram Hospital determined the increasing prevalence of MRSA. The goal of this prospective descriptive study was to determine the antibiotic resistance pattern of Staphylococci spp responsible for upper respiratory infections in children. From Dec 2001 to Dec 2003, we surveyed 73 Staphylococci spp (78.1%, S. aureus, 21.9% coagulase negative) obtained from children (1 month- 14 yrs) with upper respiratory infections (otitis media; mastoiditis; sinusitis; tracheitis,…). All isolates (blood; CSF or other sterile body fluids) after culturing and antibiogram were first evaluated by disc diffusion and then by Etesting for MIC detection. The results showed an increasing resistance to penicillin (100% vs 70%); and gentamicin (56.3% vs 30%); and a decreased resistance to erythromycin (47% vs 66%); oxacillin (11.6% vs 40%); and chloramphenicol (15.4% vs 22%). Only 6.8% of S.aureus and 25% of coagulase negative staph are MRSA. MRSA prevalence in this study is 6.4% similar to the previous study (5.4%) and there has been no significant increase during 4 years. By using penicillinase inhibitor or other non beta lactam antibiotics more than 80% antibiotic coverage will be achieved. In a minority of cases (6.8%) vancomycin was needed. We conclude that the prevalence of MRSA is rare in the present study. Therefore, vancomycin is not efficient for the empiric therapy of all Staphylococcal suspected infections. Penicillin is not appropriate for the treatment of children with suspected Staphylococcal infections. PRP plus one of the gentamicin; rifampin; clindamycin; chloramphenicol or Trimethoprim/ Sulfamethoxazole are recommended in severe cases. When staphylococci may be involved in more extensive infections, the empirical use of clindamycin provides appropriate coverage including the majority of community- acquired MRSA strains. Limiting broad spectrum antibiotic use will minimize the antibiotic pressure that favors selection of resistant strains. In severe, invasive staphylococcal infections, such as severe pneumonia or toxic shock syndrome, inclusion of vancomycin in an empiric antibiotic regimen may be prudent initially, particularly among children with predisposing risk factors for MRSA carriage.

Lactate dehydrogenase (LDH) is present in almost all body tissues, so the LDH test is used to detect tissue alterations and as an aid in the diagnosis of heart attack, anemia, and liver disease. It is also used as a marker for differentiating multiple organ involvements and excessive destruction of tissues from mild illness. LDH was measured by autoanalyser machine in serum samples of children who were eligible for this study at the time of admission. The t-test was used and differences between the means of the two group's data were expressed as mean. The SPSS commercial statistical software package was used for data analysis. Ninety one cases (group 1) with fever and two or more than two organ involvements and 118 patients as group 0 with less than two organ involvement were studied. Group 0 showed a mean LDH value of 563.12 U/L and group 1 showed a mean LDH value of 700.08 U/L. A total number of 209 children (103 females and 106 males) were studied. The mean LDH value was 639.93 U/L in females and 606.06 U/L in males. One hundred sixty-six patients had an infectious disease. Their mean LDH was 615.90 U/L. Forty three patients had other uncomplicated non-infectious diseases. The mean LDH was 649.21 U/L in them. Differences of mean LDH between the two groups were statistically significant (p-value=0.001). We can conclude that LDH measurement may be useful to identify patients who have severe diseases with excessive destruction of tissues.

Pneumonia in children is known as a common serious disease all over the world. It is one of the major causes of mortality and morbidity in children younger than 5 yrs in developing countries. This study was conducted to evaluate the clinical and paraclinical signs and symptoms in children hospitalized in this center due to pneumonia. This was a descriptive cross-sectional study conducted on children aged 0-15 years who had been hospitalized in the pediatric ward of Masih Daneshvari Hospital during 2000-2005 due to pneumonia. The patients were evaluated in terms of age, sex, body temperature, clinical signs and symptoms, interval between the onset of symptoms and admission, paraclinical findings, hospitalization period and the disease complications. In this study 182 children with pneumonia at the age range of 0-15 years (10% of those who had been hospitalized) had undergone treatment. 48.4% were males and 51.6% were females. The mean age was 4.7 yrs. The most common clinical signs and symptoms were cough (90.1% of cases), fever (63.2% of cases), coryza (21.9% of cases) and respiratory distress (18.2% of cases). Anemia and leukocytosis were detected in 24.2% and 31.3% of cases respectively. Mean ESR was 29.7 and CRP test had been reported positive in medical records of 50% of patients. The most common radiologic findings were pulmonary infiltration (47.2%) and consolidation (28.3%). In 24.5% of cases, pelural effusion and collapse and consolidation were concomitant with infiltration. Right lung, left lung and both lungs were involved in 33.7%, 31.9% and 34.4% of cases respectively. 68% of patients had received antibiotic therapy before the referral/ admission. 4% of patients needed intensive care and no mortality had been reported. Considering the fact that in evaluation of the medical records no data was available regarding the diagnosis of the cause of disease, the results of this study were in accord with most of other researcher's findings and also due to the importance of detecting the cause of disease for specific treatment, performing researches regarding the etiology of disease is necessary.

The diagnosis of Kawasaki Disease (KD) is made by clinical criteria. Intravenous immunoglubolin is dramatically effective in this disease. The aim of this study was to describe the initial diagnosis of Kawasaki disease in Iranian children. We describe the clinical manifestation, organ involvement, management, rate of cardiac anomaly and treatment of Kawasaki disease in Iran. This prospective multicenter study enrolled 159 children with Kawasaki disease. Medical records of all cases of KD treated at pediatric rheumatology department of Children's Hospital between January 1994 and July 2004 were reviewed. One-hundred fifty-nine patients were identified. Demographic features were similar to those reported by other countries. One hundred twenty-five children fulfilled the criteria for typical KD while thirty-four cases had atypical KD. Echocardiographic abnormalities were found in 30 cases, including 20 with coronary arteries aneurysms, and 10 with other abnormalities, but abnormalities were eventually resolved in 15 cases, and remained in 5 cases. Kawasaki disease is a pediatric febrile systemic vasculitis, affecting any organ; although it seems to have a predilection for coronary vessels. It is important to consider KD in any children with unexplained fever. Careful initial evaluation, treatment in the acute phase, and long-term management of patients with coronary artery involvement are recommended.

Infection is one of the major problems in neonates. The diagnosis of neonatal septicemia is difficult to establish based on the clinical criteria alone. However, empirical therapy should not be delayed because of high mortality. Laboratory tests used to support the diagnosis have shown variable values. C-reactive protein (CRP), an acute phase protein, increases in inflammatory disorders and tissue injury. Serial CRP has been shown to be more useful than a single measured CRP in the diagnostic evaluation of neonates with suspected infection. This study was performed to determine prospectively whether, in the presence of proved or presumed bacterial infection, the sensitivity of serum C-reactive protein response could be enhanced by serial rather than single determinations. All infants, aged<60 days treated for suspected bacterial infection were prospectively evaluated using a standardized clinical pathway, from march 2005 to march 2006. Infants were categorized as having proved sepsis (bacteria isolated from blood, cerebrospinal fluid, or urine culture) or probable sepsis (clinical and laboratory findings consistent with bacterial infection without a positive culture). CRP level was determined at initial evaluation and 24 hours later. Sensitivity, specificity, and predictive values were calculated for the first (CRP#1), second (CRP#2) and two serial serum CRP levels. CRP was measured qualitatively (a positive test result indicates a CRP level more than 6 mg/L). Infants who had received antibiotics prior to sepsis work-up were excluded. Positive blood culture was considered as the "Gold Standard" against which the performance of CRP was compared. One hundred infants underwent sepsis work-up during the study period of 1 to 6 days. Of 100 infants, 52 were females (52%) and 48 were males (48%). There were 9 cases (9%) of proven sepsis (positive blood culture) and 91 cases (91%) of probable sepsis as defined in method section. The most common causative organisms were Staphylococcus aureus (5), Coagulase negative staphylococcus (3) and Escherichia coli(1). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CRP#1 were 55.5%, 82.5%, 24% and 95% respectively. Sensitivity, specificity, PPV and NPV of serial CRP were 67%, 80%, 24% and 96% respectively. Serial CRP levels are useful in diagnostic evaluation of neonates with suspected infection. CRP levels<6 mg/L, obtained 24 hours apart from the initial CRP after presentation, indicate that bacterial infection is unlikely.

Poisoning is a health hazard in every country and is currently responsible for 7% of world mortalities and this proportion is predicted to rise. This study was performed to determine the incidence of unintentional children poisoning in Tehran. This was a retrospective study which was performed in one year (2003). Clinical and para clinical investigations were performed including WBC count, BG, and determination of the blood level of drugs. Chest-x-ray was taken if needed. A total number of 3895 patients were admitted and investigated, out of which 3790 were out patients (97.3%). Most cases were at the age range of 2-3 years. 25% were under 6 years of age. kerosene was the most common cause of poisoning in 908 patients (23.5%)followed by whitening products (whitex) in 331 (8.5%) patients. During the past years, morbidity and mortality due to infectious diseases have been controlled in Iran. However at present a high proportion of children are victims of unintentional poisoning because all age groups are at risk of poisoning. Since in most cases poisoning is preventable it must be considered as a priority in health control programs in Iran.

Bronchiectasis in childhood is still one of the most common causes of childhood morbidity in developing countries. The management of these patients remains problematic, and there are few studies of long-term outcome. The aim of this retrospective study was to define the general characteristics, underlying causative factors, radiologic and laboratory findings of bronchiectatic patients. Forty-six patients with bronchiectasis, who had referred to National Research Institute of Tuberculosis and Lung Disease (NRITLD) in Iran, were reviewed during a 6-year period (1999-2005). General characteristics and underlying causes were recorded from the medical reports. Mean age of patients was 12.39 ± 4.1 years at presentation. Forty-six percent were females and 54% were males. The most common clinical symptom was chronic productive cough. According to HRCT-Scan results, RML and lingula were the main affected regions. The most common etiology of bronchiectasis was idiopathic followed by cystic-fibrosis and mucociliary dyskinesia. Four patients with CF expired due to pulmonary insufficiency. In conclusion, bronchiectasis remains a disease of concern to pediatricians, particularly in developing countries. Infections are still important causes of bronchiectasis, and clinical improvement can be achieved by appropriate medical and supportive treatment. Although medical treatment is the mainstay of management, surgery should be considered in selected patients.

High risk infants have a history of one or more risk factors for developmental delay (DD). The incidence of DD in these infants is higher than normal. The aim of this study was to determine the incidence of motor developmental delay (MDD) and most powerful risk factors in high risk infants who had been referred to a developmental disorder center in Iran. This was a descriptive analytical case – control survey. A total of 396 infants, aged 1month 3 years, with the history of one or more risk factors for MDD were studied. Infants with MDD were defined as cases and those without MDD were defined as controls.. Data was collected using a demographic questionnaire, a neurological assessment form, INFANIB Scoring Sheet, and movement and tone assessment in 8 standard positions. The incidence of MDD in high risk infants was 30.55% (significantly higher than normal). The most powerful risk factors in infants with MDD, were prematurity (25.6%), low birth weight (19%), neonatal seizures (7.4%), hyaline membrane disease (6.6%), systemic infections of mothers during pregnancy (5.7%), and severe neonatal hyperbilirubinemia (4.9%) in sequence. Necessary attempts should be done for elimination or limitation of risk factors, in order to decreasing the incidence of MDD. Special attention should be paid to high risk infants in order to early detection and treatment of MDD.

Botulism is a paralytic illness caused by the neurotoxin of clostridium botulinium. Food born botulism may develop after eating foods contaminated with botulinium toxin. Botulinium neurotoxin predominantly affects the peripheral neuromuscular junction and autonomic synapse, and its effects are primarily manifested as weakness.A 12-year-old boy presented with severe weakness, diplopia and dropping eyelids 6 hours following ingestion of barbecued caviar fish. Clinical presentations were constipation, dry mouth, diplopia, blurred vision, ptosis, dilated and reactive pupils, weakness and lethargy. Based on the clinical findings, the patient received three antitoxin A, B, E monovalent; and stool, gastric fluid as well as serum samples were sent for toxicological evaluation with standard mouse bioassay. Type A toxin was detected in stool sample of the patient. Ten days later, the patient was discharged in a good condition. This study confirmed that prompt administration of antitoxin can prevent progression of disease based on clinical judgment and may also be life saving..