The incidence of Mycoplasma pneumoniae in community acquired pneumonia among children: one centre study

Background: Mycoplasma pneumoniae (M. pneumoniae) is an important cause of pediatric community acquired pneumonia (CAP). Aim: The aim of this study was to determine the incidence of M. pneumoniae in pediatric community acquired pneumonia and to determine the most frequent clinical findings of M. pneumoniae CAP. Methods: A total of 83 pediatric CAP patients were subjected to history taking, clinical examination, chest X-ray, CBC, CRP and serum antimycoplasma pneumonia IgM and IgA by ELISA. Results: Twenty-nine (34.9%) out of 83 patients were positive for M. pneumoniae Ig M while 2 (3.4%) patients were positive for M. pneumoniae Ig A. There were more infection (54%) in age group (5-9 years; p value = <0.001). M. pneumoniae pneumonia infected patients were presented with cough (29/29; 100%), fever (29/29; 100%), malaise (18/29; 43.8%), headache (16/29; 33.8%), wheeze (21/29; 52.5%), chest discomfort (13/29; 44.8%), sore throat (13/29; 46.4%), rhinitis (8/29; 27.5%) and pharyngitis (6/29; 24%). The most frequent X ray findings in M. pneumoniae pneumonia was air space pneumonia (71%); segmental more than lobar form (p-value = < 0.0001). Conclusion: The findings of this study highlight the clinical significance of M pneumoniae in pediatric community acquired pneumonia

Plasma transforming growth factor beta-1 level in asthmatic children

Airway remodeling is a characteristic feature of asthma. The mechanism of this remodeling is thought to involve Transforming growth factor - beta1 [TGF-beta1]. We compare plasma level of TGF-beta1 among asthmatic patients and healthy children and to evaluate these levels with atopic status. 50 asthmatic patients divided into: 30 asthmatics in between attack and 20 during attack . As regard to atopy they were subdivided into: atopic during and in between attack and non-atopic during and in between attack. Group II [Control group]: this group included 20 healthy volunteers. All subjects were subjected to history taking, chest X-ray, CBC, intra-dermal skin tests, serum level of total IgE and determination of plasma TGF-beta1. There was statistical significant difference between asthmatics and control group, also between asthmatics inbetween attack and control group as regard the mean total leucocytic count. Regarding the mean eosinophilic count, there was extremely statistical significant difference between asthmatics [during and in between attack] with control group, there was statistical significant difference between asthmatic patients inbetween attack and during attack. Regarding the mean neutrophil count there was statistical significant difference in asthmatics compared to the control group, there was no statistical significant difference between asthmatics in between attack and asthmatics during attack. Regarding to serum level of total IgE, there was statistical significant difference between both asthmatic group and the control group. But no statistical significant difference between asthmatic patients in between attack and during attack. Regarding plasma level of TGF beta1, there was significant difference between asthmatic group and the control group, also between asthmatics during and in between attack. The most risky offending allergen was mixed pollens [71.4%], followed by hay dust [61.9%], smoke [57.1%], house dust [47.6%], mixed fungi [38%], cotton [28.5%], wool [19%] and lastly, human hair [9.5%]. There was statistical significant difference as regard the mean total leucocytic and neutrophil count in non- atopic patients compared to atopic patient. Statistical significant difference as regard the mean serum level of total IgE in atopic patients in between attack compared to the other groups. There was also statistical significant difference between both groups of atopic patient, also both groups of non-atopic as regard to serum total IgE. As regard the mean level of plasma TGF beta1, there was statistical significant difference in non-atopic asthmatic patients inbetween attack compared to other groups. There was also statistical significant difference between both groups of atopic and both group of non-atopic patients. This study concludes that patients with non atopic asthma have elevated plasma TGFbeta1 levels that may reflect a post-infective phenomenon that serves to down-regulate the host immune response

role of apoptosis of lymphocytes in pediatric patients with chronic renal failure and end stage renal disease

Apoptosis is an essential form of physiological cell suicide in which the cell itself initiates, regulates and executes cell death pathway using a highly structured arsenal of specific proteins. Patients with chronic kidney disease [CKD] have an impairment of the immune response. Apoptosis of lymphocytes can contribute to this immune defect. The aim of this study is to study the effect of apoptosis on lymphocytes of chronic renal failure and end stage renal disease pediatric patients. This study was conducted on 7 pediatric patients with chronic renal failure under conservative treatment, 7 pediatric cases with end stage renal disease [ESRD] under hemodialysis and 8 healthy control subjects. Lymphocytes were isolated by ficoll-Hypaque method. Apoptosis of lymphocytes was assessed by Annexin V: FITC assay kit. Percentage of apoptotic lymphocytes [annexin V: FITC +ve and propidium iodide -ve] was determined by flow cytometer. Extraction of DNA from lymphocytes was done using DNeasy prep-kit. DNA electrophoresis was done on 2% agarose gel and stained with ethidium bromide. The bands are seen through UV trans-illuminator. Mean positive apoptotic lymphocytes were 35%, 27%, and 4% in end stage renal disease, chronic renal failure patients and control personnel respectively. Apoptosis was significantly higher in end stage renal disease patients in comparison to control personnel [Chi Square and p value, 28. 7 and <0.0001 respectively]. Apoptosis was significantly higher in chronic renal failure patients in comparison to control personnel [Chi Square and p value, 18.5 and <0.0001 respectively]. Apoptosis was more in lymphocytes of end stage renal disease patients than chronic renal failure patients but this difference is not significant [Chi Square and p value, 1.145 and 0.2845 respectively]. By DNA electrophoresis, 7 cases of ESRD and 6 out of 7 CRF cases give the DNA ladder characteristic to apoptosis while no control gives this ladder pattern. This study concludes -that apoptosis significantly affects lymphocytes in chronic renal failure and end stage disease renal disease pediatric patients so it can contribute to immune deficiency seen in these patients

Interferon-gamma inducing factor [IL-18], interferon-gamma and cystatin C levels of children with meningitis

The objective of this study was to measure the levels of interleukin [IL]-18, interferon [IFN]- gamma and cystatin C in the cerebrospinal fluid [CSF] of children with meningitis. The study was carried out on 30 patients [12 males and 18 females] admitted to in-patient pediatric department in El Minya fever hospital and EL-Minya University hospital, for evaluation and treatment from meningitis during the period from January 2004 to December 2004. Within the entire group of the study the most common signs of meningitis were included. Thirteen children had septic meningitis [positive CSF culture] and 17 children had aseptic meningitis [negative CSF culture and lymphomonocytic pleocytosis in CSF analysis]. Twenty children of matched age and sex, having normal CSF during evaluation for meningitis, served as a control group. All CSF samples were obtained under aseptic conditions. CSF samples were cultured, analyzed for glucose, protein and WBCs. Another part from CSF samples assayed were immediately frozen at-70°C unit cystatin C, IFN-gamma and IL-18 in CSF were assaved by using a two -site enzyme linked immunosorbent assayed for cystatin C, IL-18 and IFN-gamma. The results showed that septic meningitis group had significantly higher CSF WBCs and protein levels than in aseptic meningitis and control groups [P<0.005]. IL-18 was significantly higher in septic group, it was detected in 95% of children with septic meningitis and only in the CSF of 48% of aseptic meningitis group. In control subjects, 10% had detectable levels of IL-18 in the CSF. IFN-gamma was significantly higher in aseptic group, it was detected in 96% of aseptic meningitis and 35% of children with septic meningitis, while 21% was detected in CSF of control subjects. cystatin C was detected in 44% of children with septic and aseptic meningitis, compared with control children [P<0.001], While cystatin C was significantly decreased in septic and aseptic groups. No significant correlation was found between IL-18,IFN-Y and cystatin C levels and total leukocyte count in the CSF of children with meningitis. Our data suggest that IL18, IFN-gamma and cystatin C are significantly changed in the CSF of children with meningitis. IL18 had greatest elevations while cystatin C was significantly decreased in those children with septic meningitis. IFN-gamma had greatest elevation seen in those children with aseptic meningitis. So, cystatin C and IL18 could be considered as sensitive and specific parameters for detection of septic meningitis, while IFN-gamma could be considered as sensitive and specific parameter for detection of aseptic meningitis

Cord blood activin A level as index of fetal hypoxia

Perinatal hypoxic-ischemic cerebral injury is a major determinant of neurologic morbidity and mortality in the neonatal period and later in childhood. Activin-A is a growth factor involved in cell growth and differentiation, neuronal survival, early embryonic development and erythropoiesis. Hypoxemia is a specific trigger for increasing activin-A in fetal lamb circulation. We evaluated the effects of asphyxia on cord blood activin-A levels. The study was carried out on 30 newborns who suffered from perinatal asphyxia and who selected from El-Minia university hospital from January 2005 through June 2005 in addition to 30 newborns of the same age and sex matched as a control group. Blood samples were obtained from the umbilical artery and vein for blood gas analysis, complete blood count with determination of nucleated red blood cells [nRBCs] and measurement of free activin-A. In this study, the arterial cord blood mean values of PH, PaO[2] and base deficit were lower and PaCO2 was higher in asphyxiated group than the control group. Newborns with clinical signs of perinatal asphyxia had higher activin-A levels, which were correlated with indices of hypoxia such as lower pH suggesting that hypoxia is a trigger to stimulate activin-A secretion. It was found that the mean value of activin-A was higher in arterial than in the venous cord blood in both asphyxiated and control groups suggesting that the fetus is the main source of activin-A. Nucleated RBCs were increased in asphyxiated group. The level of nRBCs per 100 WBCs correlated with asphyxia. The correlation found suggests that hypoxia is one of the common stimulus for increased erythropoiesis and activin-A release. intrauterine hypoxia is one of the common factors responsible for increasing activin-A levels in fetal circulation. The strong correlation between activin-A and clinical and biochemical signs of fetal and neonatal hypoxia lead us to suggest that activin-A is a possible indicator of intrauterine hypoxia

Evaluation of auditory brainstem evoked responses and neuron-specific enolase for detection of auditory neuropathy in neonatal hyperbilirubinemia

This study was designed to evaluate the correlation between neuron-specific enolase and neonatal hyperbilirubinemia in children diagnosed as having auditory neuropathy by auditory brainstem evoked responses. Thirty infants admitted in neonatology unit of AL-Minya university hospital in the period from July 2002 to January 2004 for treatment from hyperbilirubinemia and 20 neonates as a control group all infants and bilirubin levels above 20mg/dl and had a full work-up hyperbilirubinemia. All study group infants were treated with phototherapy. And 16 infants required blood exchange transfusion as well. Hyperbilirubinemic infants were placed into two groups according to serum bilirubin values group [A]: total bilirubin 20-25mg/dl, group [B]: total bilirubin >25mg/dl. The control group consisted of 20 healthy full-term neonates with bilirubin levels within physiologic ranges [<13mg/dl]. Serum samples for neuron specific enolase [NSE] determination were taken on the day of admission and stored at-20°C until the time of assayed by a commercial enzyme immunoassay [EIA] kit. All hyperbilirubinemic infants in the study were evaluated with auditory brain stem evoked responses [ABERs] and transient evoked otoacoustic emission [TEOAE] tests. ABERs were recorded using nihon kohden 4 channels equipment, while TEOAEs were obtained by using the quickscreen option of the ILO 92 OAE system. The results showed no significant differences between serum NSE value in hyperbilirubinemic groups [50.19 +/- 34.37] when compared with control infants [44.50 +/- 27.68 ng/ml] [p=0. 253]. A significant difference was detected between serum NSE values of group A [33.29 +/- 16.98 ng/ml] and group B [67.09 +/- 39.33 ng/ml] [p = 0.02]. NSE and total bilirubin levels of patients with absent ABRs but present TEOAEs [36.43 +/- 16.47 ng/ml and 25.06 +/- 4.25 mg/dl, reciprocal] were significantly higher than those of the patients with normal ABRs [70.83 +/- 43.82 ng/ml and 31.29 +/- 7.34 mg/dl, reciprocal], [p=0.001]. no correlation was found between serum NSE and bilirubin values [r-= 0.15, p= 0.33]. there was no relationship between NSE concentration and the duration of the hyperbilirubinemia [r = 0.29, p=0.23]. In this preliminary study, although we could not demonstrate any correlation between serum NSE and bilirubin levels but NSE levels were significantly higher in infants with auditory neuropathy which diagnosed by ABER. Thus, this finding indicated the importance of a close follow-up with dual screening of hearing by ABER and TEOAEs in hyperbilirubinemic newborns to avoid the auditory neuropathy. Biochemical index of neuronal damage [e.g. NSE] and ABERs can be used to evaluate the neurological sequels of neonatal hyperbilirubinemia like auditory neuropathy. For appropriate results to demonstrate the role of NSE and ABER for diagnosis of auditory neuropathy in neonatal hyperbilirubinemia, we must test a much larger sample of subjects in the future