Archives of Pediatric Infectious Diseases
Volume:3 Issue: 3, Jul 2015

Hemophagocytic lymphohistiocytosis (HLH) is a heterogeneous group of clinical syndromes characterized by activation and subsequent uncontrolled non-malignant proliferation of T-lymphocytes, histiocytes and macrophages leading to a cytokine storm and manifesting as prolonged fever, organomegaly, cytopenia, hyperferritinemia and demonstrable hemophagocytosis in the bone marrow.. Here we present a case of infection associated HLH in a five-year-old girl as a complication of Hepatitis A virus infection. The girl developed acute fulminant hepatic failure with multisystem involvement and was treated with a short course of steroid.. Hemophagocytic lymphohistiocytosis is broadly classified as two types, either familial or acquired. The acquired variety may be secondary to any type of infection, mostly viral. Hepatitis A virus is rarely reported to give rise to HLH in the pediatric population. Less intensive immunosuppressive therapy with steroids was successful in maintaining remission..

X-linked Agammaglobulinemia (XLA) is one of the primary humoral immunodeficiencies. It usually presents symptoms of recurrent infections, but in some unusual cases it may present rheumatologic manifestations.. The current paper presents the cases of two boys with arthritis treated for juvenile rheumatoid arthritis (JRA) without proper responses. Addition of some recurrent infections in the course of their disease led to work-up them for immunodeficiencies.. According to the results of these work-ups, XLA was diagnosed for the cases..

Context: Food allergy is a growing health problem. Avoidance of the food allergen is the only accepted treatment. Because the major food allergens are among the most commonly used foods including cow’s milk, egg, nuts, wheat, soya, fish, and seafood, avoiding them is difficult and might negatively affect the patients’ and their families’ health..Evidence Acquisition: This brief review concerns the prevalence, importance, definition, types, clinical symptoms, diagnosis, and management of food allergy. The information were retrieved searching a wide range of published data, especially in PubMed, from January 2000 through July 2014.. Food allergies are mainly classified into IgE mediated and non-IgE mediated; the latter is classified into cell-mediated, and mixed IgE-non-IgE-mediated food allergy. Medical history can provide detailed information essential to make the diagnosis. The current approach to the management of food allergy substantially relies on allergen avoidance and prescriptions to treat allergic reactions.. The characteristic features of IgE-mediated food allergy are abrupt onset of clinical symptoms, which may result in a life-threatening events, and positive results of the majority of the paraclinical tests that mainly trace the specific IgE to foods. Moreover, non–IgE-mediated food allergies present as chronic diseases and due to lack of proper diagnostic tests the similarity of the clinical presentation with other chronic clinical conditions, the exact prevalence may remain underestimated..

Familial Mediterranean Fever (FMF) is an auto-inflammatory disease presenting with periodic fever and various clinical manifestations. Almost 10% of the patients with FMF do not respond to colchicine therapy.. Herein was reported a colchicine non-responsive patient with accurate diagnosis and early treatment of FMF. She had presented with recurrent and persistent acute abdominal pain attacks and several abdominal surgeries. Addition of recombinant interleukin-1 receptor antagonist (Anakinra) to colchicine was effective to decrease the number and severity of abdominal pain in the patient.. This case showed the effect of additional Anakinra on children with FMF who were colchicine resistant..

The icaABCD genes encode a Polysaccharide Intercellular Adhesion (PIA), which is a tight structure protecting Staphylococcus aureus community against adverse environmental conditions. The ica dependent biofilm formation plays an important role in persistent infections in hospitalized patients.. The aim of this study was to detect icaADBC genes encoding PIA among S. aureus isolates from children in Loghman Hospital of Tehran.. We collected 22 clinical specimens from hospitalized pediatrics and identified the isolates. Then, we detected mecA gene among Methicillin Resistant S. aureus (MRSA), SCCmec types and icaABCD gens by PCR assay and specific primers.. Five isolates (22.7%) were methicillin resistant (MRSA) and mecA gene was detected among them. All the MRSA isolates harbored SCCmec type III. Prevalence of icaA, icaB, icaC and icaD in the isolates were 16 (73%), 14 (63.6%), 16 (73%) and 16 (73%), respectively. Moreover, all the MRSA strains were icaADBC positive.. Prevalence of icaADBC genes was relatively high among children and also all the four ica genes were detected among MRSA strains..

Viral infections are the most frequent causes of morbidity and mortality due to respiratory dysfunction worldwide, especially in children under five years of age. Several studies have reported the association of human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) with acute respiratory infection.. The present study aimed to investigate the prevalence of hMPV, RSV, and their coinfection in children with respiratory symptoms hospitalized in Shiraz City, Fars Province, Iran. The study also attempted to determine the association between asthma and wheezing with hMPV, RSV, and coinfection with both in studied children..Patients and The study included 280 younger than five years old children with non-influenza infection that were hospitalized for respiratory infection from 2011 to 2013. Nasopharyngeal swabs were collected from patients and tested for RSV and hMPV with reverse transcriptase polymerase chain reaction.. The hMPV and RSV were detected in 44 (15.7%) and 84 (30.0%) samples, respectively. Coinfection with both viruses was found in ten patients (3.57%). The incidence of hMPV and RSV infections were observed in children younger than one year old. Infections occurred predominantly from October to April. The most common clinical symptoms were bronchiolitis, wheezing, and cough.. Infection with hMPV and RSV are most frequent infections among pediatric patients with respiratory tract symptoms. Coinfection with these viruses may exacerbate the clinical symptoms and increase hospitalization rates, especially in children younger than one year old..

Enteroaggregative Escherichia coli (EAEC) is commonly associated with pediatric diarrhea, in developing countries.. In this study, we investigated the distribution of virulence genes, enterotoxin and biofilm formation among EAEC strains isolated from stools of children with diarrhea referred to three hospitals in south east Iran..Patients and A total of 464 diarrheic stools were screen for the presence of E. coli using conventional tests. Well isolated colonies were then evaluated for the presence of EAEC diagnostic genes (aggR and pCVD432) by duplex polymerase chain reaction (D-PCR). Positive samples were further subjected to three sets of multiplex-PCR for detection of fimbrial subunits (AAF), serine protease autotransporter toxins (SPATE) and at least one enterotoxin gene. Hemolytic activity was observed on sheep blood agar. Biofilm formation was measured by using a microtiter plate assay.. Among the 322 E. coli isolated, 23 were identified as EAEC. All EAEC carried a 630-bp fragment of the plasmid (pAA) encoded pCVD432 and aggR genes. Four major EAEC fimbriae variants aggA, agg4A, agg3A and aafA were detected, with the frequencies of 21.7% (n = 5), 26.8% (n = 6), 21.7% (n = 5) and 4.3% (n = 1), respectively. The class I and II virulence toxins pic, sat, sepA, pet and sigA were detected with frequencies of 56.5% (n = 13), 30.4% (n = 7), 26.8% (n = 6), 21.7% (n = 5) and 4.3% (n = 1), respectively. A heat-stable Shigella enterotoxin-1 gene (astA) was detected in 17.3% (n = 4) of the cases. In addition, 56.4% of the EAEC isolates were α-hemolytic. Quantification of the biofilm revealed six isolates with strong biofilm.. Overall, except for pCVD432 and aggR, we detected high heterogeneity of virulence factors among EAEC isolates causing diarrhea in children. One set of genes, in the combination, pic- sepA- agg4A, was associated with strong biofilm..

Gastric pull up is performed in patients with esophageal atresia (EA) and caustic injuries. In general, elective gastric pull up is performed when patients weigh above 10 kg. Obesity can cause respiratory compromises and lengthen duration of hospitalization and children may have poor general condition.. Our goal was to investigate whether patients who weighed less than 10 kg had better clinical status after gastric pull up operation compared to those who were more than 10 kg..Patients and We retrospectively reviewed the records of 90 patients who underwent gastric pull up due to esophageal atresia in Mofid Children Hospital, Tehran, Iran. Clinicopathological features of children were studied according to their weights on the operation day.. The mean age was 5 ± 2 years in patients who were above 10 kg and 3 ± 1 years in those less than 10 kg. Patients who were less than 10 kg had shorter duration of intubation, compared to the children who were above 10 kg (P < 0.05).. Elective gastric pull up can be performed for children who are not above 10 kg. In such settings, the risk of respiratory infections and other complications would be significantly reduced because of shorter duration of intubation..

There are several oral problems in pediatrics relating to normal general health. The most common problems are tooth decay and periodontal disease.. This study was conducted to evaluate medical interns’ knowledge about oral/dental problems in educational hospitals affiliated to the medical universities in Tehran.. In this cross-sectional descriptive study, conducted between 2011 and 2012, 391 educational hospital interns from medical universities of Tehran, Shahid Beheshti, Iran, and Islamic Azad were included. The data, collected via questionnaires, were analyzed through descriptive statistics and central index tests.. In this study, the average age of the interns was 25.18 (standard deviation (SD) = 1.25 years). Males accounted for 44.2% of the study population, and the rest were female. The average score of the interns’ knowledge level was 4.87 from a maximum of 15 (SD = 1.73). Age, sex, and duration of education did not have any effect on the level of knowledge.. According to this study, it seems that the educational hospital interns do not have enough essential information and knowledge about pediatric oral/dental health. Therefore, it is recommended to incorporate new learning programs about pediatric oral/dental health in their curricula..

Hydatid disease (HD) is still an important health hazard in the world. This disease is a parasitic infestation endemic in many sheep- and cattle-raising areas such as Iran.. This study aimed to review the clinical manifestations, laboratory aspects, imaging findings, and management of HD..Patients and Data were collected from the medical records of patients diagnosed with HD in eight referral hospitals in different provinces of Iran from 2001 to 2014.. Overall, 161 children at a mean age of 9.25 ± 3.37 years (age range = 1 - 15 years old) hospitalized with a definite diagnosis of the hydatid cyst between 2001 and 2014 were studied. The male-to-female ratio was 1.6:1. The most commonly involved organ was the lung (67.1%), followed by the liver (44.1%) and a combined liver and lung involvement was found in 15.5% of the patients. The cysts were found more frequently in the right lobe of the liver and lung than in the left lobe. The most frequent complaints were fever (35.4%) and abdominal pain (31.7%), and the most frequent sign was an abdominal mass in the liver involvement and cough in the lung involvement. There was a high eosinophil count (> 500/micL) in 41% of our cases. A high erythrocyte sedimentation rate (> 30) or positive C-reactive protein (based on the qualitative method) was found in 18.6% of the patients and leukocytosis > 15000/micL in 29.2% of the children. Ultrasonography was the main imaging test, with an accuracy rate of 96%, and chest X-ray was helpful in 88.6% of the cases. Surgery was performed in 89% of the patients, and selective patients underwent percutaneous aspiration-injection-reaspiration drainage or medical treatment.. The lung was the most commonly involved organ in the children recruited in the present study. Given the high probability of multiple organ involvement, we recommend that patients with HD be assessed via ultrasonography and chest X-ray. In endemic regions, unexplained eosinophilia should be considered as a parasitic disease like HD and its complications..