Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

Pediatric hematology / oncology patients are faced with an increased risk of nosocomial infections [NIs] that vary in different populations and different institutes with considerable morbidity and mortality. Our aims were to assess the frequency and patterns of NIs in this group of patients relation to the risk of neutropenia and to determine the prevalence of causative organisms and their antimicrobial sensitivities. A retrospective analysis of the data for all children admitted to pediatric hematoloy/oncology unit of Mansoura University, Egypt, was done over one year from January, 2007 to January, 2008. A total of 1564 patients were included [173 children with leukemia, 39 with lymphoma, 49 with other solid tumors, 1293 with thalassemia and 10 withaplastic anemia] corresponding to 2084 admissions and 27092 inpatient days. The Centers for Disease Control and Prevention criteria were used as standard definition for NI. The overall incidence density rates of NIs in all patients and neutropenic patients were 8.6 and 25.3 per 1000 patient-days respectively. The most frequent sites of microbiologically and or clinically documented NIs were blood stream [42.7%], respiratory [25.3%], Urinary [22.2%] and CNS infections [9.8%] whereas nosocomial fever of unknown origin [nFUO] constituted 52.9% of defined cases with incidence density rates of 9.7 and 15.4 per 1000 patient-days in, all patients and neutropenic patients respectively. The frequency of NIs and nFUO were significantly higher during neutropenic days [p<0.001]. Gram-positive organisms represented 64.5% of isolated pathogens [Staphylococci 71.5%, Streptococci 16%, Pneamococci 7% and Enterococci 5.5%], gram-negative organisms represented 30% [E coli 48.6%, Klebsiella 15.7%, and Pseudomonas 35.7%], and Candida 5.5%. Positive cultures were more frequent in summer months [July to September]. The antimicrobial susceptibilities of the isolated organisms were relatively low [cefoperazone/sulbactam 49.9%, amikacin 35.9%, imipenem/cilastatin 34.4%, cefoperazone 33.6% and vancomycin 36.5%]. Blood stream infection and fever of unknown origin are the most common nosocomial infections in pediatric hematology / oncology patients with a higher risk during neutropenic days. Isolated organisms are multi-drug resistant, predominantly gram-positive pathogens

Glucosidase acid beta mutations in children with gaucher and relation to disease phenotype

More than 200 mutations have been described in patients with Gaucher disease [GD] and usually more than one mutation achieves a high population frequency. Genotype I phenotype correlation in patients with GD are not established. This study was designed to determine the underlying mutations in Egyptian children with GD and to assess their relation to disease phenotype. The study comprised 17 children with GD, 13 males and 4 females with mean age 6,09 +/- 441 years in addition to 10 healthy controls with matched age and sex. Patients included 13 children with type 1, 2 children with type 2 and 2 with type 3 GD. DNA was extracted from peripheral blood leukocytes; exon 9 and 10 were amplified by PCR using specific primers and DNA sequences were determined by ABI 310 genetic analyzer. Wild type allele was detected in 95%of controls [19/20] and a normal variant in 1/20 [5%]. L444P allele was encountered in 50%of the alleles in type 1 patients [13/26], H451 P in 2/26 [7.7%] and recombinant alleles [RecNcil, RecNcil+M450L RecFs, RecFs+M450L] in 9/26 [34.6%]. L444P and Rec alleles each occurs in 214 [50%] of type 2 and 3. A new mutation has been described in this study [g.7336A>C, [M450L]] and 2 mutant alleles have not been determined. Genotypes in type 1 patients comprised; L444P/L444P [23,1%], Rec alleles/L444P [53.8%]. Type 2 and 3. patients had Rec alleles/L444P genotypes in all patients [100%]. There was no significant association between mutant alleles frequency [p=0.63] or genotype frequency [p=0.41] and disease phenotypes. L444P is the most frequent mutant allele followed by Rec alleles in studied patients. Novel mutations are continuosly detected adding more to this expanding panel of GD mutations. No significant genotype-phenotype association was observed in studied patients

Evaluation of myrrh [Mirazid] therapy in fascioliasis and intestinal schistosomiasis in children: Immuno - logical and parasitological study

This study was done on 21 children with fascioliasis and 8 children with schistosomiasis mansoni treated with myrrh [mirazid], which is an oleo-gum resin from the stem of Commiphora molmol tree [family Burseraceae]. Also, ten healthy cross matched children were utilized as controls. The diagnosis was based on the detection of Fasciola hepatica or Schistosoma mansoni eggs in stool by Kato-Katz technique. Mirazid was given as 10 mg/kg/d an hour before breakfast for three consecutive days in schistosomiasis and for six days in fascioliasis. Clinical evaluation and stool analysis were done initially and at 2, 4 and 12 weeks post treatment to evaluate the cure rate. Rectal snip was done for responding schistosomiasis cases to confirm recovery. Automated complete blood count with manual assessment of eosinophils, serum total IgE [enzyme immunoassay] and in vitro cytokines assay [IL-1 beta, IL- 4 and IL-5] by ELISA were performed for all subjects before treatment and repeated at 12 weeks only for patients after therapy. It was concluded that mirazid is an effective fasciolicidal and schistosomicidal drug. IL-1 beta and IL-5 were high in fascioliasis and schistosomiasis, but decreased with therapy denoting immunopathogenesis. The depressed IL-4 production may be a parasite immune evasion or host regulatory mechanism and the cytokines levels may be the criteria of cure