Archives of Pediatric Infectious Diseases
Year:2013 | Volume:1 | Issue:3|Papers Count:10

The purpose of this editorial is to raise awareness of the care of cystic fibrosis (CF) patients in Iran. The outlook for patients diagnosed with cystic fibrosis internationally has improved substantially in the past 30 years, but the same does not hold true for a child born with cystic fibrosis in Iran.

Background: Serious infections by Pseudomonas aeruginosa are commonly treated with the combination of a beta-lactam antibacterial and an aminoglycoside. Therefore, production of a 16S rRNA methylase may result in an extremely important antibacterial resistance profile.Objectives: The present study was conducted to determine the prevalence of Cephamycinase (CMY), aminoglycoside 6' -N-acetyltransferase (aac (6') -Ib) and 16S rRNA methylase genes amongPseudomonas aeruginosa isolates from Iran. Patients and Materials: This descriptive study was performed on hospitalized burnt patients during 2011and 2012. Antibiotics susceptibility tests were performed by disc diffusion and broth microdilution methods. CMY, aac (6') -Ib, 16S rRNA methylase genes were detected by PCR method.Results: Seventy-seven (77%) of 100 isolates were resistant to Imipenem and Ceftazidime. aac (6) -Ib, Cephamycinase (CMY), and rRNA methyltransferase (rmtB and rmtD) were detected in 57 (74.02%), 7 (9.09%), 11 (14.28%), and 9 (11.68%) isolates, respectively. PCR results for aminoglycoside resistance methyltransferase (armA) and rRNA methyltransferase (rmtC) were all negative. Aminoglycoside resistance methyltransferase (armA), and rRNA methyltransferase (rmtC) were not detected.Conclusions: This study detected multiple drug resistance in Pseudomonas aeruginosa including resistance to b-lactams, Aminoglycosides, and Fluoroquinolones. Therefore, identification of drug resistance patterns in P. aeruginosa and detection of panresistant producing isolates are of great importance in prevention and control of infections in burn center ward.

Background: Idiopathic thrombotic thrombocytopenia (ITP) the most common cause of acute onset thrombocytopenia in children, can be classified as primary (idiopathic) or secondary to different causal agents (drugs, vaccination, infections).Objectives: This study is aimed to observe the severity of ITP based on the probable cause of the disease, specifically vaccination.Patients and Methods: This retrospective observational study surveyed the records of all patients, aged 1 to6 months, who were admitted with the diagnosis of ITP at Mofid Children’s hospital in a 5 year period (2005-2010). Based on history of recent vaccination (<6 weeks), patients were divided into two groups. The severity of ITP, described by the platelet count, was then compared between the recently vaccinated and not recently vaccinated groups. Severe ITP was defined as platelet count below 20, 000/mm3. All ITP patients with concomitant diseases, diagnoses other than ITP, or simultaneous history of vaccination and probable virus infection were excluded.Results: 51 patients were enrolled in this study (mean age=3.86±1.53 months, males=32 [62.7%]). In 33 (64.7%) patients the platelets level was below 20000 /mm3. Thrombocytopenia following vaccination was observed in 25 (49%) patients. The number of patients with platelet count below 20000 /mm3 was significantly higher in the recently-vaccinated group (P value=0.006). ITP was more frequent in the recently vaccinated children under3 months of age (P Value=0.03). Conclusions: In this study, a higher rate of more severe ITP in recently vaccinated young children was observed in comparison with other probable etiologies. Further investigations are needed to explain this finding.

Background: Acute respiratory tract infections (ARTIs) play a major role in hospitalizations of children, and Respiratory syncytial virus (RSV) is well recognized as the most important pathogen causing ARTI.Objectives: This study aimed to evaluate the epidemiological and clinical patterns of RSV infection in children hospitalized for lower ARTI in Ahvaz, Iran.Patient and Methods: Respiratory specimens collected from 100 children with lower ARTI from October 2008 until the end of April 2009, were screened for RSV using reverse transcription-polymerase chain reaction (RT-PCR).Results: During the study period, 9 children had a positive result for RSV infection. The median age of these patients was 10 months. Bronchiolitis was the clinical diagnosis of patients with RSV infections. All of these patients were less than 24 months. Cough (77.7%) and chest wall retraction (100%) were the leading symptoms and signs respectively.Conclusions: This study indicates that RSV is a substantial cause of respiratory tract infection in infants less than 2 years old. RT-PCR offers a rapid method for detection of RSV in hospitalized children with LRTI.

Background: Early detection of renal diseases in children can be beneficial for prevention, delaying disease progression, reduction of the number of patients with progressive renal failure. The most common metabolic disorders predisposing renal calculus in children are: hypercalciuria, hyperuricosuria, hyperoxaluria, renal tubular acidosis, and hypocitraturia.Objectives: In this research, we studied the prevalence of urinary infection in healthy elementary school children in Tabriz city and analyzed their urinary profiles.Patients and Methods: This cross-sectional descriptive research was performed in the year 2011, on 312 students who were selected from the students of Tabriz city schools using random cluster sampling. A second morning urine sample was collected in order to analyse the urine and the random levels of calcium, creatinine, uric acid, oxalate, citrate and protein, and the kidneys and urinary tract ultrasonographies were performed.Results: In this research 312 students were studied. Prevalence rate of urinary infection was 3.8 %, 6.3% of girls and 0.7% of boys were positive. The performed ultrasonographies indicated, 0.3% hydronephrosis, 0.3% renal calculus, 0.6% duplication and 5.4% thickened bladder.1.6% of children had Proteinuria. There were 4 cases, 1.28%, of girls’ and 1 case, 0.32%, among boys’ who had hematuria. A total of 8.01% (n=25) hypercalciuria, 7.05% of oxaluria (n=22), 1.28% of hyperuricosuria (n=4) and 13.46% of hypocitraturia (n=42) were observed among the subjects.Conclusions: The results of this research, showed the effectiveness of urinary screening in schools, indicated that early detection of renal diseases in children can be beneficial for prevention, delaying disease progression, reduction of progressive renal failure. These results might be due to geographic differences, diet and genetic background.

Background: The superiority of antipyretic efficacy of high dose rectal acetaminophen is not well established yet. Objectives: The present study aimed to compare the antipyretic effectiveness of high loading dose (30 mg/kg) and standard dose (15 mg/kg) of rectal acetaminophen in febrile children.Patients and Methods: This triple blind randomized clinical trial was conducted on 76 patients aged 6 months to 6 years with rectal temperature of>39oC who had been referred to 17th Shahrivar training hospital of Rasht, Guilan, Iran. The patients were assigned to one of two groups: First group (n=37 patients) received 15 mg/kg and the second group (n=39 patients) received 30 mg/kg of acetaminophen rectally. The patient’s rectal temperatures were measured before rectal acetaminophen administration and one and three hours post administration using Microlife rectal digital thermometer (Sweden) and were compared between the two groups.Results: One hour after rectal administration of acetaminophen the mean temperature changes in groups 1 and 2 were 0.97±0.59oC and 1.03±0.62oC, respectively (P value=0.663). A significant difference was seen in the mean temperature reduction between the two groups three hour after treatment (1.22±0.72oC vs.1.57±0.65oC, respectively, P value=0.028).Conclusions: In febrile children, administration of 30 mg/kg of rectal acetaminophen as the loading dose may be more effective than the standard dose in reducing fever after 3 hours of medication.

Background: Tuberculosis in children still remains as one of the main causes of morbidity and mortality throughout the world. Objectives: The aim of this study was to evaluate the epidemiological aspects of childhood tuberculosis in Kermanshah, Iran.Patients and Methods: Medical records of all 150 patients aged 0-18 in Kermanshah district who were diagnosed according to WHO criteria for 10 years were retrospectively reviewed. As well as presenting demographic and clinical aspects of patients, we calculated notification rate.Results: 35% of cases were male and 65% were female. Of total 150 tuberculosis cases, 56% were pulmonary and 44% were extra pulmonary. The most common symptoms were fever and cough. About 16% were asymptomatic. About 17% of patients had adult pulmonary tuberculosis in their families. The mean of the number of people living in a family (5.5) was similar in both pulmonary and extra pulmonary types. Except for year 2002, for all years the notification rate in girls was higher than that in boys. Over 10 years of study, the notification rate was 3.75/100, 000 with no significant trend.Conclusions: Based on our results, rate of diagnosis seemed under the expected range, in particular in children under 5. Therefore, we recommend that authorities come up with programs that aim at raising awareness about the importance of diagnosis of pediatric tuberculosis.

Cough is a common reason for seeking medical advices for children. Cough is a natural defense mechanism and can frequently occur in healthy children and can be increased by urban living and polluted cities. Thus, previous history, cough exacerbations factors and quality of cough are very helpful in diagnosis of pathological cough. There are different definitions for chronic cough. In this article chronic cough in children is referred to as a cough over a three week period, which is divided into two categories specific and nonspecific chronic coughs. In case of finding no specific cause for chronic cough, the elective management is follow up of the patient, insurance of parents and avoidance of unuseful antitussive drugs. Symptomatic treatment of cough has similar effects as the placebo. Thus, they are generally not recommended for children. Considering various aspects of diagnostic and therapeutic management of chronic cough in children and the right approach, are essential for different medical disciplines.

Children under 2 years of age suffer from some of the highest rates of invasive pneumococcal disease (IPD) in the world. (Turkey) Rates of IPD had a decline after statewide introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2008. Introduction of PCV7, PCV10 and PCV13 vaccines resulted in elimination of IPD caused by vaccine serotypes, but was followed by increasing rates of IPD caused by nonvaccine serotypes. Although the heptavalent vaccine has demonstrated its ability to reduce the incidence of pneumococcal disease, its efficacy is limited due to the restricted number of serotypes included. We report a case involving a 3-monthold girl who developed meningitis with Streptococcus pneumoniae serotype 2 despite the use of heptavalent conjugate vaccine.

Background: Multi drug resistant (MDR) Pseudomonas and Acinetobacter species are defined as resistant to at least three classes of antibiotics. Most studies have demonstrated that MDR gram negative infections convey increased mortality and morbidity.Case: An 11-year-old girl was admitted to pediatric burns unit with burn injury of approximately 68% total body surface area (TBSA). Discussion: Role of systemic antibiotics is adjunctive and never replaces surgical debridement, use of topical agents, nutritional support, increasing in immune system function and grafting. Evidence in the published literature suggests that combination therapy with Meropenem and Colistin are effective for burned patients with MDR gram negative sepsis.