Skeletal involvement of Brucella melitensis in children: a systematic review

Brucellosis is a protean disease and should be excluded in any febrile child with a constellation of symptoms such as fever, malaise, sweating, arthralgia, and joint swelling in endemic areas. Skeletal system involvement is the most common source of complaints in brucellosis. The frequency of skeletal involvement in children is 6.4% to 73.5%. There are some controversies regarding the most common sites of involvement: sacroiliac versus peripheral joints. In the vast majority of cases, peripheral joint involvement in pediatric brucellosis has a monoarticular pattern, although there is no agreement about the most commonly involved peripheral joint. In this systematic review, published articles that describe the bone involvement of Brucella melitensis, as the most prevalent kind of the microorganism in the region, in children are evaluated

child with intestinal basidiobolomycosis

Fungal infections of the gastrointestinal tract are not common in children, especially in immunocompetent ones. In this case report we describe a child who was presented with abdominal pain and mass, bloody diarrhea and fever. He was treated for amebiasis, but due to treatment failure and deterioration of his condition, he underwent a laparatomy. Histologic examination of the excised bowel in the second look revealed Basidiobolomycosis, a fungus belonging to the order Entomophthorales. The signs, symptoms, treatment and diagnosis of the present case indicate that fungal infections must be considered not only in immunocompromised patients with abdominal pain and mass, but also in apparently immunocompetent ones

ELISA cut-off point for the diagnosis of human brucellosis; a comparison with serum agglutination test

Brucellosis is a world-wide disease, which has a diverse clinical manifestation, and its diagnosis has to be proven by laboratory data. Serum agglutination test [SAT] is the most-widely used test for diagnosing brucellosis. The enzyme linked immunosorbent assay [ELISA] can also determine specific antibody classes against brucella. It is a sensitive, simple and rapid test, which could be an acceptable alternative to SAT with fewer limitations, however, like any other new test it should be further evaluated and standardized for various populations. This study was planned to determine an optimal cut-off point, for ELISA which would offer maximum sensitivity and specificity for the test when compared to SAT. Four hundred and seven patients with fever and other compatible symptoms of brucellosis were enrolled in the study. Serum agglutination test, 2-Mercaptoethanol test, and ELISA were performed on their sera. The cut-off point of 53 IU/ml of ELISA-IgG yielded the maximal sensitivity and specificity comparing to the other levels of ELISA-IgG, and was considered the best cut offpoint of ELISA-IgG to diagnose acute brucellosis. At this cutoff, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 84.09%, 85.38%, 62.20, 94.90, 5.75, 0.18, respectively. The best cut-off point of ELISA-IgG is 53 IU/ml, which yields the maximal sensitivity and specificity to diagnose acute brucellosis

Serologic evidence of pertussis infection in vaccinated Iranian children

It seems that the incidence of pertussis-like illnesses is considerably increasing despite the wide coverage of immunization with the whole cell pertussis vaccine. We aimed to investigate the occurrence of pertussis in vaccinated children by measuring anti-pertussis antibodies. In this cross-sectional study, blood samples were taken from vaccinated children aged 2, 4, 6, 12, 18, and 72 months. Anti-pertussis IgG and IgA were measured by ELISA. P < 0.05 was considered significant. 725 children were enrolled in the study. Geometric mean titers for IgG that showed a slight decease after 2 months of age and increased distinctly in children aged 72 months. The frequency of the individuals whose IgG was above the determined cut-off [derived from mean+2SD] was observed in 1% of the 2, 4, and 6-month-old infants, 6% of the 12 and 18-month-olds and 12% of the 6-year -old children. Positive IgA titers were detected in 5, 9, 6, 23, 11, and 8% of children aged 2, 4, 6, 12, 18, and 72 months, respectively. Since a considerable percentage of children had high levels of anti-pertussis IgG antibodies [>/=2 SD], positive anti-pertussis IgA, and most importantly an increased level of anti-pertussis IgG geometric mean titer at 6 years of age, further investigations regarding the protection provided by the presently used pertussis vaccine seems necessary