prospective study to assess vancomycin serum concentrations in pediatric patients with current dosing guidelines

Concerns about increasing bacterial resistance to vancomycin, have caused the adult treatment guidelines to recommend higher trough concentrations based on the type and location of infectious disease. Although these recommendations are not specific to children, the values can be extrapolated. This prospective study was designed to evaluate efficacy of current vancomycin dosing recommendations to achieve therapeutic trough serum concentration in pediatric patients. Laboratory data, vancomycin dosing and subsequent serum concentrations of children in a community teaching pediatrics hospital were collected and analyzed. Trough serum levels were determined at steady state and compared with Infectious Disease Society of America [IDSA] 2011 guidelines for the treatment of Methicillin-Resistant Staphylococcus Aureus [MRSA] infections. In a prospective observational, cross-sectional study in a university medical center in Tehran, Iran, 50 patients, who received vancomycin for more than 4 doses, were recruited and their trough vancomycin level was determined. The mean age and creatinine clearance of patients were 5.47 +/- 4.24 and 87.5 +/- 31.25, respectively. Eleven [22%] patients received vancomycin at 40 mg/kg/day [low dose] and 39 [78%] at 60 mg/kg/day [high dose]. Considering trough goals of 10-14 and 15-20mg/L in low and high dose groups, serum levels in 91% [73% sub-therapeutics] and 85% [69% sub-therapeutics] of patients were not in recommended therapeutic range, respectively. This study has shown that current recommended vancomycin dosing regimens in pediatric patients [40-60 mg/kg/day], resulted in sub-therapeutic serum concentrations in our study population

Colonization with Clostridium difficile in children with cancer

Clostridium difficile is a gram-positive, anaerobic, spore-forming bacillus. Usually it does not cause disease unless a patient who is colonized with toxin-producing strains has been treated with antibiotics, particularly those that change the anaerobic flora of the large intestine. We investigated in a prospective study intestinal colonization of C. difficile and its toxins in children with malignancy that used different antibiotics and cytotoxic drugs. One hundred fifty-two patients were included in this prospective study. Stool samples were obtained within the first 48 hours after admission and cultured for C. difficile; cytopathic effect of C. difficile was detected on HELA cells, also ELISA test was performed for detection of toxins A and B. 25% of patients had positive culture for C. difficile; 36/38 [92%] revealed positive cytopathic effect on HELA cells. No significant relation was found between age, gender, history of antibiotic consumption and C. difficile positive culture and cytopathic effect on HELA cells. The only relation was seen between cotrimoxazol and cytopathic effect on HELA cells [P=0.03]. Although the rate of C. difficile colonization [25.6%] and toxigenic strains [23.7%] in admitted children in hematologic ward is high, the rate of ELISA positive test for toxin A+B was not correspond with culture and HELA cell. With respect to sensitivity and specificity of ELISA test, possibility for existence of toxin C with cytopathic effect is high in this type of patients

Adverse reactions following immunization with MMR vaccine in children at selected provinces of Iran

Several adverse events following immunization [AEFI] have been attributed to immunization with live attenuated measles, mumps, and rubella [MMR] vaccines. The MMR vaccine was introduced into the routine infant immunization schedule in 2003, followed by a second dose of vaccine at school-entry for children 4 to 6 years of age. The objective of this study was to characterize adverse reactions following MMR vaccination in Iran. Children who received the MMR vaccine and resided in five selected provinces of Iran were examined weekly for four weeks to detect well-known AEFIs that included: parotitis, fever and convulsions, convulsions without fever, encephalopathy, and anaphylactic reactions. Incidence of AEFIs were calculated and compared among recipients in both age groups. During the follow-up period, trained providers reported 792 AEFIs. Parotitis was the most frequent event occurring in 1.8% of recipients. Of 14, 109 children vaccinated at 12 months of age the following AEFIs occurred: parotitis [147], fever and convulsions [8], convulsions [7], encephalopathy [1], and anaphylactic reactions [1]. Of 29,338 children vaccinated to 4 to 6 years of age, parotitis, fever and convulsions, encephalopathy, and anaphylaxis occurred in 626, 5, 1, and 1 child, respectively; no convulsions without fever were reported in this age groups. Parotitis is the most frequent AEFI among MMR vaccine recipients in Iran. Incidence rates of AEFIs following MMR vaccination in Iran are similar to rates of AEFIs reported in other studies

[Chronic cough and its approach in children]

In childhood the most common reason for referring to clinics is coughing. As a protective mechanism the normal child has some cough during the day especially in polluted urban areas [expected cough]; therefore previous history of cough, time of severity and its quality is important in diagnosis of pathologic cough. Chronic cough in children is a 3 weeks duration one, it is divided to specific and non specific cough. After ruling out possible exposure to allergens we take chest x-ray as the first step and then if x-ray or history and physical exam were abnormal we evaluate it as a specific cough. If we didn't find any specific etiology for chronic cough, follow up and observation is recommended, and it should be told to parents there is no harm for their child and usage of drugs is not necessary. Usage of symptomatic anti cough drugs has the same effects as placebo. Paying attention to this symptom and appropriate approach for diagnosis and treatment of each type of chronic cough will help physician to do their best in the management of this symptom

Approach of lymphadenopathy in children

Appropriate approach of the lymphadenopathy in children as a common finding is necessary .The proper time for following and checking up the palpable lymph node and its biopsy are significant considerations of approaching lymphadenopathy in children that are described in this review study. The lymphadenopathy could be properly studied using the correct patient history, physical examination and the characteristics of lymph nodes including: generalized or localized and associated signs and symptoms such as organomegaly, skin and mucosal lesions, fever, weight lose and sweating. The lymphadenopathy in children could be resulted from a common and insignificant finding following upper respiratory tract infections to a serious malignant etiology. The correct evaluation of unimportant and serious forms of lymphadenopathy can inhibits the wasting in money and refers on time

Urinary lnterleukin-8 in acute pyelonephritis of children: a before-after study

The aim of this study was to assess urinary interleukin-8 [IL-8] levels in pyelonephritis and its relation with the clinical course of the infection and of inflammatory changes detected by renal scintigraphy. In this quasi-experimental before-after study, we evaluated 91 children aged 1 to 144 months [mean 34.4 +/- 35.2 months] with pyelonephritis. Inflammatory markers including erythrocyte sedimentation rate, C-reactive protein, leukocyte count, and urinary IL-8, together with the results of ultrasonography, voiding cystourethrography, and dimercaptosuccinic acid renal scintigraphy were evaluated in these children. The ratios of urinary IL-8 to creatinine [IL-8/C] before and after the treatment were compared with each other. Urinary IL-8/C levels were significantly higher after the empirical treatment in comparison with those before the treatment [0.19 +/- 0.21 versus 0.51 +/- 0.53, P < .001]. No correlation was found between the urinary IL-8 levels and leukocyturia, urine culture results, other inflammatory markers, or findings of imaging examinations. We found high urinary IL-8 levels in children with pyelonephritis. We also documented its increasing after the treatment. We conclude that evaluation of urinary IL-8 can be a noninvasive test for diagnosis of upper urinary tract infection and its response to treatment

First report of Griscelli syndrome from Afghan population in Iran

A 4 month old Afghan male infant presented with partial albinism, hepatosplenomegaly and pancytopenia. Skin and hair shaft microscopic examination revealed large clumped melanosomes and Griscelli syndrome was diagnosed. Unless treated with bone marrow transplantation, it is a fatal disease in accelerated phase. Pediatricians should consider this syndrome in infants with abnormal light hair because early diagnosis could be life saving

Subcutaneous fat necrosis of the newborn complicated with hypercalcaemia

Subcutaneous fat necrosis of the newborn [SCFN] is an unusual disorder which occurs in term or post-term newborns due to perinatal stress. SCFN appears by firm nodules over the trunk, arm, buttock, thigh and cheeks in the first several weeks of life. Prevalence of SCFN is unknown. Race and sex do not play a role in this condition Hypocalcaemia and rarely hypercalcaemia are considered as major causes of morbidity and mortality in cases of SCFN. We report a case of SCFN in a two month male infant complicated with hypercalcemia and hyperuricemia

Staphylococcal nasal colonization in Mofid children hospital staff; carrier state and antibiotic susceptibility

Staphylococcus aureus [SA] is frequently found on normal human skin and mucous membranes. Methicilline resistance S. aureus [MRSA] strains have spread in many hospital isolates world wide since 1970s. Hospital personnel tend to have higher colonization rates than the general population. Colonized residents and personnel are sources for dissemination of organism. For this cross sectional study, Mofid children's hospital staff were evaluated for staphylococcal nasal colonization. Isolated staphylococci tested for methicilline sensitivity by MIC method and their antibiotic susceptibility was investigated for six antibiotics by Disk diffusion technique. Of 284 tested personnel, 56 [19.7%] revealed to have nasal colonization of whom 23 [8.1%] were methicilline resistant [MRSA]. Working in the office [p<0.003], age [p<0.008] and years of employment in hospital [p<0.039] were correlated with colonization with MRSA. Totally, 96% of carriers were persistent carrier. Logistic regression showed a significant association between the working place [health care] [p<0.049] and years of employment [p<0.07] with S. aureus nasal colonization rate. Hospitals should assess the advantages and disadvantages of routinely culturing personnel, however, in outbreak situation hospital personnel especially older persons may be sources of nosocomial infection

HIV-infected child with recurrent parotitis: a case report

Human immunodeficiency virus [HIV] infection in children causes a broad spectrum of diseases and varied clinical courses. Parotitis is one of the manifestations of paediatric HIV infection, occurs in 4-47% of children. We present a 4-year old boy with recurrent bilateral parotitis. He had been admitted twice with the diagnosis of iron deficiency anaemia and chronic hepatitis. During the last admission for recurrent parotitis, based on clinical and paraclinical findings, he was suspected to have HIV infection that was finally confirmed with laboratory tests. Despite low prevalence of HIV-infection among children, physicians should consider HIV infection in any pediatric patient who presents with unexplained signs and symptoms such as chronic or recurrent parotitis

Mucocutaneous candidiasis or psoriasis? A case report

Pustular psoriasis is a rare form of psoriasis in childhood. The prevalence of psoriasis in various parts of the world varies from 0.1% to 3% and the most frequently observed variant is the plaque type, followed by the guttate psoriasis. A 4-year-old boy with a history of repeated self-limited arthritis, onycholysis, recurrent erythematous skin, diaper rash, fever and pustular lesions, had several hospital admissions with no benefits. After a 2-year delay in the diagnosis, he was treated as a case of pustular psoriasis which was shown by skin biopsy

Isolation of mycobacterium and other microorganism from skin infectious in children during Bam earthquake

The Bam earthquake in southeastern Iran turned an ancient city to dust, killing thousands and destroying 80% of all infrastructures. More than 30,000 people died and It left some 100,000 people homeless. Direct contact with polluted water increases the risk of infection, particularly wound infections, cellulitis, dermatitis, conjunctivitis, and ear, nose and throat infections. The prevalence of NTM [non-tuberculosis mycobacteria] is difficult to obtain. The aim of this study was isolation of bacteria and mycobacterial agents, especially atypical species from dermal lesions of children in Bam earthquake. In this descriptive study, 88 children settled in camps in 2004 were enrolled. Samples from dermal lesions of children were obtained and transported with middle brook 7H9 and Brain Heart [BH] media to laboratory for isolation of mycobacterial agents and other bacteria. For isolation of mycobacterium, after decontamination and acid-fast staining, they had been cultured in Lewenstein-Jensen medium. Having isolated mycobacteria by differential tests their antibiotic resistance and susceptibility were studied. Meanwhile, other bacteria were identified by staining and culturing in standard media. The study population included 32 girls and 56 boys. Of 88 samples, 3 mycobacteria were isolated [3.4%] of which 2 were M. chelonae [rapidly growing] and 1 was M. scrofulaceum [slowly growing]. The most common isolated bacteria were E.coli [41%] and Coagulase negative staphylococcous [38%].Infectious disease epidemics may play a role in the post disaster period. Since atypical mycobacteria exist in soil, and some cases were reported from Iran, isolation of these microorganisms is of utmost importance especially in children after a disaster such as earthquake

Interleukins 1 and 6 in children with acute pyelonephritis

Renal infection and scarring are the leading causes of end stage renal disease [ESRD] in some parts of the world [e.g. Iran]. Urinary interleukins [IL] 1 and 6 have been reported to be high in acute pyelonephritis in previous studies. This study was performed to determine the relation between IL 1 and 6 levels in the presence of acute pyelonephritis and the relation between the amount of these cytokines and the severity of pyelonephritis by dimercaptosuccinic acid [DMSA] scan. Children ages 1 month to 12 years who were admitted to the nephrology ward of Mofid Children's Hospital for pyelonephritis from January to July 2004 were enrolled in the study. Interleukins 1 and 6 and creatinine were measured in 80 random urine samples of 37 patients [81%female] with acute pyelonephritis and 43 healthy children [81% female]. Urinary cytokines were measured by Enzyme Linked Immunosorbent Assay [ELISA] and creatinine by spectrophotometry methods and recorded in microgram per mg of creatinine. Pyelonephritis was confirmed by positive urine culture and/or DMSA scan in all patients using SPECT apparatus. Data were analyzed by paired student t test and differences considered significant if p<0.05. Mean interleukin 1/creatinine [IL 1/Cr] ratio in patients with pyelonephritis was 0.70 +/- 0.96 [range 0.02-5.08] and in healthy children was 0.04 +/- 0.12 [range 0-0.51]. Mean interleukin 6/creatinine [IL 6/Cr] ratio in patients with pyelonephritis was 4.80 +/- 10.06 [range 0.01-44.74] and in healthy children was 0.15 +/- 0.37 [range 0-2.32]. There were significantly higher levels of urinary IL-1 and IL-6 in children with pyelonephritis than healthy children, but we didn't find any significant relationship between urinary interleukin levels and other parameters such as pyuria, ESR, CRP and different grades of renal involvement in DMSA scans