Comparative study for detection of candidemia using PCR-REA and fungal blood culture in children with hematological malignancies

The incidence of opportunistic fungal infection has increased dramatically in the past few decades, especially in immunocompromised hosts. Candida albicans the major cause of invasive candidiasis, has become one of the pathogens most frequently isolated from the blood of post-operative and imunocompromised patients in the last decade with a mortality rate of about 50%. Diagnosis of candidemia or hematogenous candidiasis has been problematic due to the low positivity of blood cultures, with the rate of recovery from blood cultures ranged between 40-60%. The development of DNA-based methods for detection of candida provides an alternative and potentially more sensitive means for diagnosing disseminated candidiasis. The aim of the work was detection of candidemia in children with hematological malignancies and determination of Candida species using PCR-REA in comparison with fungal blood culture. Thirty-two [32] children [20 males and 12 females] with hematological malignancies their ages were below 18 years; were admitted at Oncology Unit of Pediatric Department of Tanta University Hospitals and were subjected to complete history taking, thorough clinical examination complete blood picture and bone marrow examination. They were tested for candidemia by conventional blood culture, and polymerase chain reaction [PCR] method with appropriate restriction enzyme analysis [REA] of the resultant amplicons. The study revealed that the PCR-REA method detected that 8 patients [25% of the examined Population] had Positive results for candidemia with Candida albicans was the most common species found in 50% of patients with candidemia, while conventional blood culture detected candidemia in only 2 patients [6.25% of the examined population]. However, emergence of other Candida species were noticed. This study also revealed that patients suffering from fever of unknown origin [FUO], severe neutropenia dysphagia, and mucosal barrier injuries are at high risk to develop candidemia. Immunocompromised patients especially those at high risk to develop candidemia such as hematological malignant patients should be examined for candidemia using PCR-REA technique to obtain rapid and accurate results

Diagnostic and therapeutic study of Helicobacter pylori infection in children with recurrent upper abdominal pain

Recurrent abdominal pain [RAP] is a common pediatric diagnostic problem. Upper gastrointestinal [UGI] endoscopy is sometimes performed as a part of the evaluation. Although gastritis and/or Helicobacter pylori [H pylori] infection is often present, it is not known if they contribute to the symptomatology. H pylori infection is primarily acquired in childhood. However, the role of H pylori infection in children with RAP is still unclear and controversial. H pylori infection can be detected by a variety of methods. Diagnostic tests for H pylori are based either on direct demonstration of the organism or indirectly by detecting a by-product [of the urease reaction] or by demonstrating antibodies. H pylori infection can be eradicated by a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics [clarithromycin plus amoxicillin or metronidazole], but experience with such therapy in the pediatric population is limited. The study aimed to determine the prevalence of H pylori among children with RAP; to evaluate the contribution of various diagnostic tests [biopsy based tests [histology, Gram's staining, culture, and rapid urease test] and serology] for the detection of H pylori; and to assess the efficacy of the triple-drug regimen of omeprazole amoxicillin, and clarithromycin in H pylori-positive children. Thirty children with RAP without identifiable cause of pain [17 males and 13 females; age ranged from 5 to 15 years with a mean of 10.3 years] underwent UGI endoscopy and four antral gastric mucosal biopsy specimens were taken and subjected to rapid urease test [RUT], Gram's staining, histology and culture for H pylori. Sera were assayed for H pylori lgG antibodies by ELISA. These children were selected from those attending the pediatric gastroenterology outpatient clinic of Pediatric Department of Tanta University Hospitals who were referred for UGI endoscopic evaluation of chronic upper abdominal pain. H pylori-positive children were treated by a triple-drug regimen of oral omeprazole amoxicillin and clarithromycin for 14 days and they were re-evaluated clinically and by repeating the previous investigations at one month after the end of treatment. The study revealed that 12 [40%] children of the examined population, were found to be positive by all used tests and considered H pylori-positive, the remaining 18 [60%] children were H pylori-negative. Compared with H pylori-negative children, H pylori-positive children were more often from large families and lower socioeconomic classes and had growth impairment. H pylori culture had a high efficiency for detecting H pylori and gave a sensitivity of 100%, a specificity of 96% and an accuracy of 98%. It was evident that values of endoscopy and serology were low and those for culture were high. In the present study, a positive correlation was observed between histological gastritis and the presence of H pylori organism whether seen histologically by Gram's staining [76%] or by culture [71%] of the organism. Also, it was found that culture was highly associated with active gastritis but the association with inactive gastritis was less pronounced. It was found that there were highly significant correlations between the results of the different used laboratory tests and that of gastric H pylori culture in studied patients with RAP. Among the H pylori-negative children, abnormal results for UGI endoscopy, histology, Gram's stain, urease test and serology were 22.2%, 27.8%, 16.7%, 27.8%, and 33.3% respectively but none had positive culture. The used triple-drug regimen eradicated H pylori in 9 of 12 [75%] of H pylori-positive children with concomitant histological resolution and recovery from abdominal pain at one month after the end of treatment. H pylori is common [40%] among children with RAP and a significant association possibly exists between H pylori infection and RAP in children and H pylori culture could be used as a "gold standard" test and use of a combination of diagnostic methods is helpful in accurate diagnosis of H pylori infection. The used triple-drug regimen proved successful in H pylori eradication, gastritis healing, and symptoms relief. long-term population based studies are needed to identify the exact prevalence and clinical significance of H pylori infection in Egyptian children. To ensure the effectiveness of the recommended treatment, further studies are required with a long-term follow-up period in a larger group of children undergoing UGI endoscopy for exclusion of an organic cause of RAP

Evaluation of serum cystatin C as a marker for detection of early renal function impairment in children with chronic liver disease

Evaluation of renal failure is essential in patients with decompensated liver cirrhosis, because a significant proportion of them manifest reduced glomerular filtration rate [GFR]. Careful assessment of GFR is critically important for prognosis because the indicators of renal function are sensitive markers of severity of liver dysfunction in cirrhosis and are better predictors of patient survival than estimating hepatic dysfunction. Plasma creatinine concentrations and calculated creatinine clearance are of limited values as GFR markers in patients with chronic liver diseases [CLD] especially liver cirrhosis. Recently, assessment of serum cystatin C concentrations was proposed as a possible indicator of early GFR changes in such patients. The aim of this work was to study the utility of measurement of serum cystatin C level as a marker of early detection of renal impairment in patients with CLD and to assess its correlation to the severity of liver dysfunction. This study was conducted on 30 children [17 males and 13 females] with CLD. Their ages ranged from 2 to 16 years. Twenty healthy children with matched age and sex were chosen as a control group. They were selected from those admitted to the Hepatology Unit of Pediatric Department, Tanta University Hospitals. In this study all patients were subjected to the following: full clinical history, through physical examination, abdominal ultrasonography, histopathological assessment of liver biopsy and laboratory investigations. The latter included complete blood count, liver function tests, complete urine analysis, blood urea, serum creatinine, creatinine clearance [CrCI], hepatitis markers as well as measurement of serum cystatin concentrations by particle induced immunonephelometry. Control children were subjected to the whole previous investigations except liver biopsy. Severity of liver dysfunction in studied patients was classified into grades A, B and C according to modified Child-Pugh' classification. This study showed that mean CrCl values were significantly reduced in patients [77.03 +/- 17.4 ml/min/1.73m[2]] compared to controls [86.7 +/- 9.2 ml/min/1.73m[2]]. Mean CrCI values were impaired in 3 [10%] patients. All of them had ascites. Serum cystatin C levels were significantly higher in the studied patients [1.02 +/- 0.55mg/L] compared to controls [0.38 +/- 0.10mg/L], and significantly higher in grade C patients [1.35 +/- 0.65mg/L] than in those with grades B [0.92 +/- 0.46 mg/L] and A [0.73 +/- 0.29 mg/L]. Serum cystatin C levels were high in 10 [30%] patients of whom 70% [7/10] had ascites. Regarding ascitic patients, there was a significant reduction in CrCl values in ascitic compared to non-ascitic patients. Furthermore, there was a significant increase in serum cystatin C levels in ascitic compared to non-ascitic patients. Serum cystatin C correlated significantly with CrCI and severity of CLD as assessed by its correlation with liver function tests and Child's scores. ROC curve plots demonstrated that the area under the curve [AUC] of cystatin C [0.92] was greater than that of CrCI [0.76] and serum creatinine [0.58]. Therefore, sensitivity, specificity and diagnostic accuracy of cystatin C were higher than those of CrCl and both were better than those of serum creatinine. The positive and negative predictive values of serum cystatin C were higher than those of CrCl and serum creatinine. From this study, we can conclude that serum cystatin C is more accurate and simple than serum creatinine and creatinine clearance as a marker of GFR changes for prediction of early renal impairment in patients with CLD. Furthermore, serum cystatin C concentration was significantly high in patients with CLD that was correlated with the severity of liver dysfunction. Measurement of serum cystatin C may be recommended or at least added to serum creatinine in the routine assessment of early GFR changes in patients with CLD. However, further prospective comparative studies on a large scale with a gold standard method for measuring GFR are required to evaluate serum cystatin C concentration in different stages of renal impairment In children with CLD