Pediatric Hydatidosis in Iranian Referral Pediatrics Center

Background

Hydatidosis is one of the major zoonotic diseases that cause considerable public health problems in Iran. The present study was designed to investigate pediatric hydatidosis in patients referred to the Children Medical Center Hospital in Tehran, Iran during 2005-2010.

Methods

Data were collected from the records of 17 patients referred to the center with hydatidosis. Data included demographic data; laboratory results, type, and site of cysts, clinical manifestations, and treatment.

Results

Nine patients were boys (52.9%) and eight (47.1%) were girls. Most patients referred from central areas of Iran (58.8%). Seven patients had cysts in their lungs (41.2%) and three cases (17.6%) in liver. Six cases (35.3%) had simultaneous lung and liver cysts, 3 patients (17.6%) had brain cysts (alone or in combination with other organs involvement) and 2 patients (11.7%) showed multi-organ involvement. All patients were treated by albendazole and underwent surgery, recurrence was seen in 4 (23.5%) of the cases and one patient died due to rupture of the cyst and anaphylactic shock.

Conclusion

Multi-organ involvement seems to be on the rise in children, this has led to the necessity for physicians to be more aware of clinical features, search, and rule out other organs for involvement diagnosis once a cyst is detected in one organ.     

Evaluation of procalcitonin and neopterin level in serum of patients with acute bacterial infection

BackgroundFever as a common presenting complaint in pediatric patients can be due to various causes. Differentiating bacterial infection from other causes is important because the prompt use of antibiotics is critical in bacterial infection. Traditional markers of infection such as BT and WBC count may be unspecific and culture may be late or absent. CRP and Procalcitonin (PCT) have been considered to evaluate the evolution of infections and sepsis in patients presenting with SIRS. Neopterin has also been proposed to aid in the diagnosis of bacterial infection. In this study, we compared the value of the serum PCT, neopterin level, and WBC count for predicting bacterial infection and outcome in children with fever.Methods158 pediatric (2-120-month-old) patients suspected to have acute bacterial infection, based on clinical judgment in which other causes of SIRS were ruled out were included in the study. WBC count with differential was determined and PCT and neopterin levels were measured.ResultsPCT level was higher in bacterial infection and patients who were complicated or expired.ConclusionRapid PCT test is superior to neopterin and WBC count for anticipating bacterial infection, especially in ED where prompt decision making is critical. Abbreviations: BT, body temperature; WBC, white blood cell; PCT, procalcitonin; CRP, C-reactive protein; SIRS, systemic inflammatory response syndrome; ED, emergency department.     

Assessment of Immune Response following Immunization with DTP/Td and MMR Vaccines in Children Treated for Acute Lymphoblastic Leukemia

Background: This study was performed to determine the antibody titers against diphtheria-tetanus-pertussis, and measles-mumps-rubella before and after re-vaccination in different periods of time in patients with acute lymphoblastic leukemia (ALL) to provide a suitable vaccination schedule. Methods: Ninety patients with ALL were studied in three stages, including newly diagnosed patients, patients on maintenance therapy, and 1 to 12 months after cessation of therapy. Baseline antibody titers were assessed in all participants. Postimmunization antibody titers to DTP/Td and MMR vaccines were evaluated 3 weeks after vaccination. Results: Patients on maintenance therapy had considerable decreased in seropositivity rate; they achieved seroconversion rate of 100% for diphtheria and tetanus and of 71.4% for pertussis following DTP/Td vaccination. In patients after one month off therapy, the seroconversion rates for diphtheria, tetanus, and pertussis were 71.4%, 80%, and 100%, respectively. The amounts of seroconversion in patients after 3 months off therapy were 66.5%, 80%, and 66.5% for measles, mumps, and rubella, respectively. In patients after 6 months off therapy, the seroconversion rates were 85.7% for diphtheria, 100% for pertussis and tetanus, 83.3% for mumps, 50% for rubella, and 41.6% for measles. Patients after 12 months off therapy achieved seroconversion rate of 100% for diphtheria, tetanus, pertussis, and mumps, of 71.5% for rubella, and of 63.5% for measles. Conclusion: Administration of one dosage of DTP/Td vaccine during maintenance therapy and after cessation of therapy could be recommended, while one dosage of MMR vaccine at least three months after completion of therapy could be safe and beneficial.     

Diagnostic accuracy of IL-2 for the diagnosis of latent tuberculosis: a systematic review and meta-analysis

We conducted a systematic review and meta-analysis to evaluate the diagnostic potential of interleukin-2 (IL-2) as biomarkers for the diagnosis of latent tuberculosis. Related studies were identified through searches of PubMed, Embase, Web of Science, and complementary manual searches up to December 30, 2013. We used standard methods recommended for meta-analyses of diagnostic test evaluations. The analysis was based on a summary receiver operating characteristic (SROC) curve. Meta-regression analysis was used to assess the effects of some confounding factors on the results of the meta-analysis. The potential presence of publication bias was tested using the Deeks’ funnel plots. The pooled estimates of IL-2 for latent tuberculosis infection (LTBI) diagnosis were as follows: sensitivity, 0.81 [95 % confidence interval (CI), 0.60 to 0.92]; specificity, 0.95 (95 % CI, 0.90 to 0.97); positive likelihood ratio (PLR), 15.2 (95 % CI, 8.1to 28.4); negative likelihood ratio (NLR), 0.20 (95 % CI, 0.09 to 0.47). We found that the SROC curve is positioned near the upper left corner of the curve and the area under the curve (AUC) was 0.96 (95 % CI, 0.94 to 0.98). In conclusion, according to the meta-analysis, IL-2 is a valid marker for the diagnosis of LTBI. When there is no definite gold standard for the diagnosis of LTBI, IL-2 release assay in addition to interferon-gamma release assays (IGRAs) can improve the ability of IGRAs to identify individuals with LTBI.     

Lethal toxic encephalopathy due to childhood shigellosis or Ekiri syndrome

Lethal toxic encephalopathy due to shigellosis or Ekiri syndrome is a rare complication of shigellosis with a high fatality rate. Data are very limited on factors that can predict this encephalopathy, so we evaluated clinical and laboratory characteristics for these patients. In this study children with extreme toxicity and convulsions followed by rapid neurological deterioration resulting in brain edema and fatal outcome without sepsis and severe dehydration were selected as having lethal toxic encephalopathy. There were 1295 children with shigellosis during the 10 years of the study. Five children (0.4%) had lethal toxic encephalopathy due to shigellosis. Death occurred following rapid neurological detoriation resulting in brain edema despite intensive treatment. Evidence of brain edema may be a prediction factor for death. Early recognition of encephalopathy and measures to prevent brain edema may improve patient outcome.     

Serum levels of mannose-binding lectin and the risk of infection in pediatric oncology patients with chemotherapy

Morbidity and mortality due to infections remain serious problems in pediatric oncology patients receiving chemotherapy. Association of mannose-binding lectin (MBL) levels with an increased risk for infection in previous studies was contradictory. The aim of this study was to determine whether MBL deficiency is associated with the risk of infections in pediatric oncology patients. Before the start of chemotherapy a blood sample was taken from 75 patients with acute lymphoblastic leukemia and MBL serum concentration was measured using a commercially enzyme-linked immunosorbent assay kit. Twenty patients had concentrations under 1000 μg/L, defining MBL deficiency and the remaining 55 patients had concentrations >1000 μg/L. Ten patients suffered from more than 1 episode of severe infection. Sixty-five percent of patients with MBL below 1000 μg/mL suffered from 2 or more episodes of infections (3 of 16 individuals with 1 severe infection; 10 of 16 with 2 and 3 of 16 with 3), in contrast to only 29 of 55 (52%) patients with MBL above 1000 μg/mL (19 of 27 individuals with 1 severe infection and 10 of 27 with 2). The difference between 2 groups was significant (P<0.001). The results of this study indicate that low MBL serum levels (<1000 μg/L) identify pediatric cancer patients at increased risk for infections.     

Frequency of isolation and antimicrobial susceptibility of bacteria isolated from bloodstream infections at Children's Medical Center, Tehran, Iran, 1996-2000

Antimicrobial susceptibility patterns of major bloodstream pathogens from Iran provide essential information regarding the selection of antibiotic therapy for patients with bloodstream infections (BSIs) living in Iran. Unfortunately, data regarding the isolation frequency and antimicrobial susceptibility patterns of endemic BSI pathogens are scarce in Iran. To shed some light on the susceptibility patterns of BSI pathogens endemic to Tehran, Iran, we investigated the antimicrobial susceptibility patterns of 2248 bloodstream isolates from patients in Children's Medical Center (CMC) Hospital in Tehran between January 1996 and December 2000. Microbiology reports of 24600 blood specimens collected from inpatients in CMC Hospital were retrospectively reviewed. Specimen culture, bacterial identification and disk diffusion susceptibility testing were performed according to National Committee for Clinical Laboratory Standards guidelines. Overall, Gram-positive bacteria comprised 72% (1627/2248) of recovered isolates and Gram-negative bacteria comprised 28% (621/2248). Coagulase-negative staphylococci (CoNS) comprised 48.4% of all isolates, followed by Staphylococcus aureus (16.7%) and Klebsiella spp. (8.5%). Among the 621 Gram-negative organisms, Klebsiella spp. (31%) were the most frequently isolated, followed by Escherichia coli (21%) and Pseudomonas aeruginosa (17%). The rates of oxacillin resistance for S. aureus and CoNS isolates were similar (60% versus 61%); however, the rate of S. aureus vancomycin resistance was almost twice that of CoNS resistance (21% versus 11%). Over 55% of S. pneumoniae were resistant to penicillin and co-trimoxazole. Although all isolates of enterococci were susceptible to vancomycin, only 21% were susceptible to gentamicin. Among Gram-negative isolates, amikacin was shown to be very effective, with susceptibility rates of 84%. The susceptibility of Klebsiella spp. to ampicillin and co-trimoxazole was 1% and 39%, respectively. The susceptibility of Klebsiella spp., E. coli and Enterobacter spp. to ceftriaxone was 47%, 86% and 67%, respectively. There were notable differences in the order of the five most common organisms isolated from blood cultures, which can help set priorities for focused control efforts. Our findings highlight the importance of a nationwide surveillance programme to monitor the trends in isolation frequency of bacteria and their antimicrobial resistance patterns throughout Iran.     

Epidemiologic,clinical, and laboratory characteristics of childhood brucellosis

Wiener Medizinische Wochenschrift - Brucellosis is endemic in Iran. Children constitute 20–25% of cases. We determined clinical, laboratory, and epidemiologic characteristics of pediatric...