Archives of Pediatric Infectious Diseases
Volume:1 Issue: 5, Oct 2013

Bordetella pertussis is the causative agent of pertussis. In Brazil, laboratory diagnosis of pertussis is based on the culture. In 2010, was standardized the Real-Time PCR TaqMan® in routine diagnosis. The aim of this study was to evaluate the impact achieved with the introduction of RT-PCR for the routine diagnosis of pertussis and to compare with the results obtained from culture..Patients and 4,697 samples of nasopharyngeal secretions collected from suspected pertussis cases and/or contacts were analyzed for RT-PCR and culture, from January 2008 until the end of December 2011.. According to the results obtained from the samples 6.9% were culture/RT-PCR positive, 14.8% were positive only for RT-PCR and 0.2% only for culture. Negative samples for both techniques was 3,622 (77.1%) and 1.0% were inconclusive for RT-PCR.. The implementation of RT-PCR in routine diagnosis resulted in an increase in laboratory confirmation by almost three times. The RT-PCR assay does not intend to replace the culture technique, but to promote an improvement in the diagnosis of pertussis.

Increased incidence and severity of acute lower respiratory tract infection (ALRI) are variably associated with malnutrition.. We aimed to examine the prevalence of malnutrition in under-five year old hospitalized children with ALRI..Patients and Children aged from 6 to 60 months, mostly from a low socioeconomic population, admitted with ALRI, were enrolled prospectively. WHO case definition was used for ALRI. The data about the weight, length/height, mid-arm circumference (MAC) in 1-5 year old children and acute respiratory infections (ARI) episodes in the preceding 6 months were collected in addition to demographic characteristics. Nutritional status was assessed using an age independent criteria in the form of ratio of weight (in kilograms multiplied by 100) to the length or height (in centimeter) squared. Among 206 children with ALRI, 21.9% had pneumonia, 55.8% had severe pneumonia and 22.3% had very severe disease. About 85% of the children were younger than 3 years old. Male to female ratio was 1.34:1. The prevalence of malnutrition was seen in 54.9% of the children. MAC was below 13.5 cm in 59.4 %. Severe malnutrition was observed in 68.7% of 3-5 years age group and 59.4% of 1-3 years age group. Severe malnutrition had shown higher percentages among children with pneumonia and severe pneumonia. Severely malnourished children had more ARI episodes in the preceding 6 months although it was not statistically significant (OR 1.22; 95% CI 0.71-2.12; P = 0.47).. High prevalence of severe malnutrition and its significant association with increased ALRI in 1-5 year old children highlights the need for strengthened nutrition intervention programs..

Pemphigus is known as an autoimmune bullous disease of the skin and mucous membranes that is relatively prevalent in Iran. The herpes virus is one of the suspected factors that might have role in induction or exacerbation of pemphigus.. Present study was performed to assess the prevalence of HSV1/2 infection in pemphigus patients referred to Shohada-e-Tajrish and Loghman-e-Hakim hospitals during 2010-2011.Patients and Forty pemphigus patients enrolled in the study. A lesional skin or mucosal biopsy was taken from each patient and analyzed by PCR for detection of HSV1/2. The PCR results were positive or negative, and then the frequency of HSV1/2 infections in pemphigus patients was calculated. Ten patients (25%) had a history of orolabial herpes infection. The results of all samples were negative for HSV1 except one sample which showed the positive result for HSV2 in a patient with history of herpes infection. He was considerably resistant to treatment pemphigus vulgaris with about 60 skin lesions and 20 mucosal lesions. Adding Acyclovir to his treatment regime for ten days resulted in full recovery. Prevalence of HSV1/2 in mucocutaneous biopsies from pemphigus patients is 2.5% and possibly HSV1/2 has no role in the pathogenesis of pemphigus lesions. But resistant cases to treatment might be suspected to HSV..

Chronic fatigue syndrome (CFS) is a complex condition involving severe fatigue and disabling musculoskeletal and cognitive symptoms. We reported that 6, 12 and 24 months following infectious mononucleosis (IM), 13%, 7% and 4% of adolescents, respectively, met criteria for CFS. Whether endocrinologic or immunologic dysfunction accompanies CFS is unclear. To determine if salivary cortisol levels or NK cell percentage and function 6, 12 and 24 months following IM in adolescents who met criteria for CFS and recovered, matched controls differ.Patients and Nine adolescents with CFS and nine matched, recovered controls had morning and nighttime salivary cortisol as well as NK cell number and function measured blindly 6, 12 and 24 months following IM. Three subjects with CFS had a depressed morning salivary cortisol; one control subject had a single depressed nighttime cortisol. There was no difference in NK cell percentage or decreased function between cases and recovered controls. We found little evidence of depressed salivary cortisol levels and no decreased NK cell function in adolescents with CFS following IM.

Healthcare-associated infections such as nosocomial infections (NI) are important causes of mortality worldwide.. In this study we evaluated the nosocomial infections terms of microbiology (resistance, culturing, etc.) in a referral pediatric hospital based on national nosocomial infection surveillance system.Patients and In an epidemiological surveillance study during a 14 month-period, patients who had no infection or not been in incubation period at the admission time, but had positive culture after the third day of admission, were defined as a case of nosocomial infection. Characteristics and features of each infection were coded and classified. The total number of hospitalized patients was 7730 and the total number of hospitalized days was 30147 days. The mean age of 103 patients with nosocomial infection was 21.59 ± 3.87 months and the average duration of hospital stay was 25.53 ± 17.63 days. The incidence of NI was 1.33 per 100 hospital discharges and 0.34 per 100 hospital days. The incidence of NI was 1.33 infections per 100 hospital discharges and 0.34 infection per 100 hospital days. The most frequently isolated organisms included coagulase-negative Staphylococcus, Klebsiella, Serratia, yeast, E. coli and Pseudomonas respectively. The frequency of antimicrobial resistant isolated organisms was high. Half of isolated S. aureus were Methicillin resistant. Klebsiella was resistant to third generation Cephalosporins in 87%, against aminoglicosides in 80%, and against Imipenem in 52%. 100% of isolated pseudomonas were resistant to third generation Cephalosporins and Imipenem. 27 cases (of 103 cases) (26.2%) expired with the diagnosis of NI. Increasing frequency of anti-microbial resistant isolates emphasizes the necessity for bacteriological monitoring of hospitalized children..

Seborrheic Keratoses (SK) are common, benign and often multiple skin tumors with disputed etiology. A follicular origin, late onset nevoid disturbance or local arrest in maturation of keratinocytes have been proposed. Human papilloma virus (HPV) has been detected in a small number of cases, particularly those from the genital region. The aim of our study was to evaluate the presence of HPV 6/11, 31 and 33 DNA in SK of nongenital regions. We examined 49 biopsy specimens of nongenital SK for the presence of HPV DNA using PCR technique (INNO-LiPA HPV Genotyping Extra). The SK specimens (n = 49) were negative for all HPV probes (types 6/11, 31 and 33) tested. Genital wart specimens (n = 2) were positive for types 6/11, 31 and 33 HPV DNA (positive controls); while chronic dermatitis specimens (n = 10) were negative for all HPV types (negative controls). Our study results demonstrate that HPV types 6/11, 31 and 33 cannot be causative in SK of nongenital regions.

Brucella endocarditis is a rare, and life threatening complication of human brucellosis. Children are usually infected by consumption of contaminated dairy product. Clinical presentation is similar to rheumatic fever. Aortic valve is most commonly involved. Clinical manifestations of fever, arthritis/arthralgia, aortic insufficiency, echocardiographic evidence of vegetation, and negative findings of blood culture, in a case with suspicious contact should suggest the diagnosis. Perioperative antibiotics combined with surgical treatment are an effective management. In pediatric age group, surgical techniques using biologic valves and preservation of native valves are preferred..

Dear Editor,.The study by Dashti et al. is a single center double-blinded placebo controlled trial that exposed infants ≤ 1800 grams in the intervention group to a multi-species preparation of probiotics. The authors of this paper did not find a difference in the incidence of necrotizing enterocolitis (NEC) between the intervention and the placebo group, nor did they find a difference in any of their secondary outcomes. The paper does not describe the incidence of NEC in their institution and they do not describe how they calculated the sample size based on their historical incidence of NEC. I believe this to be the main weakness of this study and the major reason why the authors of this paper were not powered to find a difference in the primary outcome if in fact this difference did exist. Using the control group incidence of NEC of 1.49% (stage II and III Bell’s classification), a confidence level of 95%, a power of 80% and an expected decrease of 50% in the incidence rate of NEC (to 0.75%), the total sample size required for this study would have been 6,876 infants (3,438 infants in each group). Another possible explanation for the observed lack of efficacy may be due to the inclusion of infants > 1500 grams, a group that traditionally has a much lower incidence of NEC compared to infants born at ≤ 1500 grams. Recruitment of this proportionally large number of more mature infants would tend to dilute the effect of the intervention. Also, the late administration of the probiotic preparation (mean age 4.36 days) when colonization with potential NICU pathogens may already be established could also add to the observed lack of efficacy. The main weaknesses highlighted in this study are not unique to this study but a major theme of the majority of studies included in the multiple meta-analyses published on the use of Probiotics in preterm infants (1-5). Although these meta-analyses have shown a decrease in the incidence of NEC with the use of different species of probiotics, the potential for publication and selection bias is of great concern because of the known tendency for journals to reject studies that do not show efficacy. From this perspective, I welcome Archives of Pediatric Infectious Diseases’s decision to publish this manuscript. Also, the poor quality of the design of many of the studies included in these meta-analyses makes their conclusions at the very least suspicious. Are we ready to start using probiotics for the prevention of NEC in premature infants? Although we understand the urgency of finding an intervention that prevents NEC due to the high mortality and morbidity associated with this outcome, wisdom dictates a more thorough evaluation of the bio-molecular characteristics of specific species, their dosing, quality, and safety. This is especially relevant in the extremely premature infant population where some published studies have demonstrated a higher incidence of sepsis when exposed to probiotics (6, 7). I do not believe that we have at the present time a probiotic species that fulfills all these basic requirements. An international consensus agreement that prioritizes and directs future efforts in this area of research is urgently needed to expedite fulfilling these goals. This fragile population of premature infants embraces and supports our coordinated efforts.

Dear Editor,Science involves controversy, conflicting results and thoughtful analysis. Clinical trials finding a significant efficacy for a new investigational therapy require confirmatory trials, but often subsequent trials result in a negative finding (equivalence or non-significant efficacy). These negative trials are important and, in the past, have had trouble getting published. Publication bias is common, as studies showing a significant efficacy are typically published, while negative studies have been largely ignored. While this trend is slowly reversing, the onerous task for authors in overcoming this bias necessities a higher burden for quality writing and more detailed analysis than required for studies with significant positive findings. It is imperative that scientists explore all the possible explanations for the finding of non-significance efficacy. It may be that the investigated therapy is truly not effective, but it also may be due to insufficient power due to small study size, or the choice of a low dose, or differential attrition, or other types of bias.The field of probiotics for the treatment and prevention of various diseases is replete with both positive (showing significant therapeutic effect) and negative (showing equivalence or non-significant results) clinical trials. This is not surprising, as the efficacy of probiotics is both strain-specific and disease-specific. Not all probiotic strains work for all diseases or even within one disease indication. A recent paper by Dashti et al. in this journal reports finding no significant difference in the incidence of necrotizing entercolitis (NEC) in neonates treated with a probiotic mixture compared to placebo (1).NEC is an important cause of morbidity and mortality in low birth weight neonates and currently there are no modalities to prevent NEC from occurring. The use of probiotics has been suggested by a recent significant finding of pooled efficacy for NEC from 11 randomized trials in a meta-analysis by Deshpande et al. (2). Dashti et al. tested a probiotic mixture of eight bacterial strains, but did not find a significant reduction in NEC when compared to their control group (1). However, when we try to place this result into context, it is difficult to determine why or how this result may have occurred. The authors in this paper failed to provide readers with sufficient details on the study to fully assess the reasons why they did not find a significant efficacy of this probiotic mixture to prevent NEC. The major limitation is that the authors fail to present the identity of the two groups (designated “Group A” and “Group B”), so it is impossible to determine which is the group treated with the probiotic and which is the control group. Blinding a trial is commendable during its operation, but maintaining the blinding when presenting the results is counterproductive.The recommended use of a CONSORT figure would have provided valuable insight into the numbers of infants screened versus number enrolled. No presentation of the rates and reasons for attrition were presented, so it cannot be determined if loss-to-follow-up may have played a role in the negative results. Another common reason for negative efficacy findings in that the trial is too small and lacks the power to detect a significant difference. The authors did not report if they calculated the required sample size in the methods sections, indeed, the power of this study is extremely low (only 4%).Careful description of the investigational treatment is paramount in clinical trials. The investigational mixture was not fully described (missing bacterial strain for one of the Bifidobacterium strains) and the authors failed to indicate that this product contains 990 mg of a prebiotic (FOS) per sachet.The authors discuss some possible reasons for their negative findings (low dose, low rate of NEC or the lack of efficacy of the tested probiotic product). Low dose may be an explanation, in that the neonates most at risk (birth weight < 1500 mg) only received 108 organisms/d and most trials in neonates (BW < 1500 g) at risk for NEC have received a daily dose of 109/d (2). It would have been useful for the authors to present the rate of NEC by the two groups, stratified on birthweight, as 43% of the enrolled neonates were not at high risk for NEC (birthweight > 1500 g). Their rate of NEC is not low (12-14%) compared to other studies (1-10% in various probiotic groups and 6-16% in control groups) (3-5).In conclusion, the results reported by Dashti et al. may not have found a significant efficacy for this specific probiotic mixture in preventing NEC, but insufficient study methods and data presentation limits the interpretation of their data. This study exemplifies the requirement for a higher burden of analysis for possible reasons for non-significant findings.