Archives of Pediatric Infectious Diseases
Year:2013 | Volume:1 | Issue:4|Papers Count:10

Mucocutaneous lymph node syndrome (MCLN) or Kawasaki disease (KD) is a notable disease of unknown etiology and although pediatricians are familiar with different aspects of it, they tend to make under and over diagnosis which can result in cardiovascular disorders, misapply of intravenous immunoglobulin (IVIG) and its consequences which can also cause a delay in diagnosis of mimicking diseases.

Kawasaki disease is believed to be the commonest vasculitis of medium vessels in Asian children. However, the majority of children with Kawasaki disease continue to remain undiagnosed perhaps because of the lack of awareness amongst pediatricians. The clinical features of Kawasaki disease can be confused with other common conditions such as Scarlet fever, Stevens Johnson syndrome, Measles fever, systemic onset JIA, etc. Development of coronary artery abnormalities is the hallmark of Kawasaki disease and accounts for most morbidity and mortality associated with the disease. Quick recognition of the disease and early treatment with intravenous immunoglobulin results in a significant decrease in the occurrence of coronary artery abnormalities.This review emphasizes that Kawasaki disease should be considered in differential diagnosis of all febrile illnesses in young children.

Background: Herpes virus group can persist in the latent form in the body, Pneumocystis jerovecii, on the other hand, is a fungus which is ubiquitous in the respiratory tract of mammals, with 90% of adult human beings possessing antibodies to this organism. Concomitant presence of different microorganisms, may result in one microorganism altering the activity of another.Objectives: To determine the frequency of 5 latent Herpes viruses and Pneumocystis jirovecii and to ascertain the rate of concomitant presence of these microorganisms in saliva of healthy children.Patients and Methods: This cross-sectional study was performed on 150 immune-competent children 1 to 15 years old visited in the outpatient clinics at a university-affiliated children’s hospital from 22nd May to 21st August 2011. Samples of saliva obtained from the children were subjected to DNA extraction by polymerase chain reaction.Results: At least one microorganism was isolated from saliva of 148 children, (98.6%). In 13 cases only 1 microbe was detected, (8.6%), 2 pathogens were isolated from 24 children, (16%), 3 from 20 cases, (13.3%), 4 from 54 individuals (36%), and 5 from 37 subjects (54.4). HSV was the most frequent organism detected in 80.7%, and P. jirovecii the least frequent, (32.7%). Other viruses were HHV6, 66.7%, CMV 66.0%, HHV7 64.7%, and EBV 37.3% in order. No significant difference was found in the frequency of microorganisms in the two sexes or in different age groups, except for CMV which was significantly less frequent in age group of 6-10 years (P value=0.001).Regression analysis revealed an association between HHV6 and HHV7 (OR=1599.4; P value<0.001); a correlation was also found between EBV and CMV (OR=3.1; P value=0.012). In contrast, a negative correlation was found between P. jirovecii and three viruses of the Herpes virus group including EBV (OR=0.27; P value=0.006), HSV1 (OR=0.36; P value=0.028), and CMV (OR=0.48; P value=0.075).Conclusions: Shedding of latent Herpes viruses and concomitant presence of multiple inactive micro-organisms is common in saliva of immune-competent children.

Background: CTX-M-type b-lactamases are increasingly becoming the predominant ESBLs globally in recent years. Integrons are genetic elements which can integrate gene cassettes, usually antibiotic resistance genes.Objectives: The aims were to determine antibiotic susceptibility and to detect genes encoding CTX-M-1 group enzymes and class 1, 2, and 3 integrons among the Klebsiella pneumoniae isolated from children in Tehran hospitals, Iran.Patients and Methods: Thirty-one K. pneumoniae isolates were collected from samples of children aged 0-12 years admitted to three hospitals in Tehran between May and December 2011, and identified using biochemical tests and PCR. Susceptibility of isolates to 14 antibiotic disks was determined using disk diffusion method. The combined disk method was used for the detection of ESBL. The presence of blaCTX-M-1 group and class 1, 2, and 3 integrons was investigated by PCR.Results: Most of the isolates showed high level of resistance: 17 isolates were simultaneously resistant to Amoxicillin-Clavulanic acid, Cefotaxime, Ceftriaxone, Aztreonam, and Ceftazidime (17.31, 54.9%). All were susceptible to Imipenem and Ciprofloxacin. ESBL production was detected in 54.9% (17.31). The blaCTX-M-1 group was detected in all Cefotaxime-resistant isolates (17.31, 54.9%). Class 1 integron was detected in 8 isolates (25.8%). The class 2 and 3 integrons were not detected.Conclusions: The results showed that the CTX-M-1- producing K. pneumoniae is already present in some parts of Tehran. The presence of class I integron genes among resistant strains of K. pneumoniae highlights the continued monitoring of drug resistance in clinical settings.

Background: The etiology of the Guillain-Barre syndrome (GBS) is not clear; in many cases, GBS is triggered by a bacterial or viral illness.Objectives: To evaluate the role of active infection with Herpesviridae group and its association with this syndrome we have investigated the cerebrospinal fluid (CSF) and serum of patients with GBS for detection of these viruses.Patients and Methods: In a prospective and cross sectional study, CSF and serum samples were obtained from 15 consecutive patients admitted with GBS in the department of neurology in a university-affiliated children’s hospital in Tehran. Patients had been diagnosed with GBS based on clinical and paraclinical findings. The level of IgM and IgG antibodies to Herpes simplex virus (HSV), Epstein–Barr virus (EBV), and Cytomegalovirus (CMV) were tested by enzyme linked immunosorbent assay, (ELISA) in CSF and serum. A highly sensitive polymerase chain reaction (PCR) assay was also used for virus detection in all samples.Results: We detected viral DNA in 3 of 15 patients revealing current systemic or central nervous system (CNS) virus infection; in 2 cases CMV PCR had positive results in serum and in one case HSV PCR had positive findings in CNS.Conclusions: The clinical significance of this finding has yet to be elucidated but we showed footprint of Herpes viruses in some patients with definite GBS.

Background: Probiotics are thought to interfere with the mechanisms involving in the pathogenesis of necrotizing enterocolitis in neonates.Objectives: This study was planned to assess the effect of prophylactic probiotics for the prevention of necrotizing enterocolitis in low birth weight neonates.Patients and Methods: This prospective triple-blinded, interventional, randomized clinical trial enrolled 136 low birth weight newborn infants with a minimum birth weight of 700 g, from September 2010 to September 2011. The study and control groups were compared regarding; 1- occurrence of NEC, 2- time to reach full feeding, defined as days required to reach full enteral feeding, 3- duration of hospital course, and 4-incidence of sepsis and death. The study group was fed with milk and Protexin (restore) and the control group was fed with milk and a placebo that was physically indistinguishable from the probiotic powder. SPSS version 16 was used, and P-value less than 0.05 was considered significant.Results: One hundred thirty six neonates were enrolled in the study. Seventy six (54.4%) were male. The mean of gestational age and birth weight were 31 weeks and 1407 grams, respectively. The mean age to start feeding was 4.36 days. There was not any significant difference in the NEC cases between the two groups.Conclusions: This study did not show any benefit from prophylactic probiotics in the prevention of necrotizing enterocolitis in low birth weight neonates which could be probably due to low dose probiotics used.

Common variable immunodeficiency (CVID) is one of the primary immunodeficiencies, which usually presents with recurrent bacterial infections, particularly in respiratory and gastrointestinal systems and hypogammaglobulinemia. We present here a case of CVID who was suffering from chronic watery diarrhea since 3 months before admission. Past medical history was uneventful about recurrent infections. No abnormality was revealed on physical examination. After thorough investigations about other possible causes of chronic diarrhea, and based on laboratory data of hypogammaglobuliemia, we considered him as a case of CVID with an isolated manifestation.

Co-infection of tuberculosis and leishmaniasis has been reported previously in patients with altered immune response due to primary or secondary immunodeficiency. These intracellular pathogens have a unique interaction in the host immune response and their development depends on impaired cell-mediated immunity. A case of chronic non-healing cutaneous ulcer with chronic fistulating soft-tissue mass is presented here which co-infected with tuberculosis and leishmaniasis, interestingly in an otherwise healthy young female.

Carbapenemase producing bacteria frequently possess resistance mechanisms to a wide-range of antibacterial agents, and are associated with high mortality and morbidity rates. Some enzymes like extended-spectrum b-lactamase (ESBL), New Delhi metallo-beta-lactamase-1 (NDM-1), Klebsiella pneumoniae carbapenemase (KPC), and OXA-producing Enterobacteriaceae are very important in frequently isolated nosocomial bacteria, which cause resistant to many classes of drugs. NDM-1 or KPCs, is a worldwide health problem which is slowly increasing. There is no vaccine to prevent infections produced by carbapenem-resistant bacteria.

Dear Editor, We read the article entitled “Colonization with Methicillin Resistant and Methicillin Sensitive Staphylococcus aureus Subtypes in Patients With Atopic Dermatitis and Its Relationship With Severity of Eczema” by Rezaei et al. with great interest.Assessment of Colonization with Staphylococcus aureus is important because of its involvement in community and healthcare associated infections. Since community acquired methicillin resistant Staphylococcus aureus (MRSAs) is a worldwide concern, it is really helpful for us to be aware of the pattern of colonization and antimicrobial resistance in our country especially in different patient population. However, there are some points in the article that is worth to be mentioned.