Diarrhoeagenic E. coli pathotypes in children with and without diarrhoea in an Iranian referral paediatrics centre

Diarrhoeagenic Escherichia coli can be considered as the most important etiologic agents of diarrhoea in the Islamic Republic of Iran, particularly in children. This study determined the frequency of diarrhoeagenic E. coliisolates collected from children with acute diarrhoea [n= 50] and a control group [n= 50] at an Iranian referral paediatric centre during a 1-year period. Using multiplex PCR, diarrhoeagenic E. coli was identified in 90% of the case group and 20% of controls. Enterotoxigenic E. coli was the most frequently identified pathotype in both groups [26% in cases; 10% in controls]. Shiga toxin-producing E. coli was the second most isolated pathotype [17%], followed by enteroaggregative E. coli [12%]. No enteroinvasive E. coliand enteropathogenic E. colistrains were recovered. More than 80% of isolates harboured the fimHgene. This high proportion of diarrhoeagenic E. coli and diversity of E. coli types highlights the need for enhanced surveillance of gastroenteritis agents in children in this country

Pediatric hydatidosis in Iranian referral pediatrics center

Hydatidosis is one of the major zoonotic diseases that cause considerable public health problems in Iran. The present study was designed to investigate pediatric hydatidosis in patients referred to the Children Medical Center Hospital in Tehran, Iran during 2005-2010. Data were collected from the records of 17 patients referred to the center with hydatidosis. Data included demographic data; laboratory results, type, and site of cysts, clinical manifestations, and treatment. Nine patients were boys [52.9%] and eight [47.1%] were girls. Most patients referred from central areas of Iran [58.8%]. Seven patients had cysts in their lungs [41.2%] and three cases [17.6%] in liver. Six cases [35.3%] had simultaneous lung and liver cysts, 3 patients [17.6%] had brain cysts [alone or in combination with other organs involvement] and 2 patients [11.7%] showed multi-organ involvement. All patients were treated by albendazole and underwent surgery, recurrence was seen in 4 [23.5%] of the cases and one patient died due to rupture of the cyst and anaphylactic shock. Multi-organ involvement seems to be on the rise in children, this has led to the necessity for physicians to be more aware of clinical features, search, and rule out other organs for involvement diagnosis once a cyst is detected in one organ

Multiple organ involvement with hydatid cysts

Hydatid disease is the most common infections worldwide, but it rarely involves multiple organs. Herein, a 12-year-old boy is presented, who was admitted to Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran with symptoms of irritability, sleepless, and weakness of the extremities. Patient's brain computed tomography [CT] scan with contrast media showed large multilocular cystic lesions in right temporal lobe associated with two other smaller similar cystic lesions in centrum semiovale bilaterally. Abdominal sonography revealed intestinal mesenteric and a cardiac cyst. Abdomino-pelvic CT scan showed a cyst medial to the cecum and a cortical cyst in the left kidney as well as a heart cyst. The echocardiography confirmed hydatid cysts at apical and interventricular septum. Serology test was positive for hydatid cyst. Albendazole and praziquantel were started for the patient immediately and right temporal lobe lesions were removed via neurosurgery intervention. After one month, cardiac and mesenteric cysts were operated during two separate surgeries. Pathologic findings of all cysts were compatible with hydatid cyst. Cystic hydatidosis should be suspected in any cystic mass, whilst prompt diagnosis and appropriate treatments are the keys in management of affected patients

Steady-state pharmacokinetic analysis of vancomycin in Iranian pediatric patients

Large inter-individual variability has been reported for vancomycin pharmacokinetics in pediatric patients. On the other hand, the pharmacokinetic parameters of vancomycin should be known in order to individualize its dosage regimen. Therefore, this study was designed and conducted to assess the steady-state vancomycin serum concentration and pharmacokinetics in a population of Iranian pediatric patients. Vancomycin serum concentration at steady-state was determined in 62 children who were treated with vancomycin intermittent intravenous infusion. Also individual steady-steady pharmacokinetic parameters [total body clearance, apparent volume of distribution and elimination half-life] were determined in 30 patients who had both peak and trough vancomycin levels assuming one-compartment model. Calculated pharmacokinetic parameters were compared among patients with different underlying diseases and also with the results of similar studies that used one-compartment pharmacokinetic model for description of serum concentration of vancomycin at steady-state. More than half of the measured vancomycin serum concentrations were outside the recommended therapeutic range. Median trough concentration was significantly lower in critically ill patients as compared to patients of other disease categories. Although critically care patients showed greater values of apparent volume of distribution and also vancomycin clearance, no statistically significant difference of the calculated pharmacokinetic parameters could be detected among different groups of patients. While calculated volume of distribution for patients of this study was greater than those of similar studies, this difference could not be considered statistically significant in the majority of disease categories. It may be concluded that design of vancomycin dosage regimens according to the recommended and general guidelines in literature [e.g. based on patient creatinine clearance] could not result in the desired therapeutic serum concentrations in the study population

Polymorphism in the first intron of interferon-gamma gene [+874T/A] in patients with BCG adenitis

Cytokines and specially interferon-gamma [IFN- gamma] are largely responsible for the regulation of the protective immune response against mycobacterial infections. Several studies have clarified the importance of common variants of IFN-gamma gene regarding the susceptibility to tuberculosis. Bacille Calmette-Guerin [BCG] vaccine that is used to prevent severe forms of tuberculosis could produce local and systemic side effects. In this study we hypothesized that the IFN-gamma [+874T/A] polymorphism was associated with development of BCG adenitis. Thirty patients with BCG adenitis [18 males and 12 females] and 30 age and sex-matched healthy children, vaccinated with BCG during the first two days of life were chosen. All the patients and controls were of Iranian Fars origin and the study was conducted from 2005 to 2007. DNA samples were obtained from 30 patients with BCG adenitis and 30 age and sex matched healthy vaccines. Polymorphism at +874 was identified using allele specific polymerase chain reaction. Allele and genotype frequencies in cases and controls were compared using the chi [2] test and odds ratios [OR] and their 95% confidence intervals [CI] were calculated. The minor allele [T] frequency was significantly lower in patients with BCG adenitis compared to controls [35%vs 55%, P=0.02, OR =0.441, 95% CI= 0.211-0.919]. The Armitage trend test revealed a gradually increasing protection from the AA genotype through AT to TT [common odds ratio= 0.49; P=0.037]. Our data suggest that in an Iranian population, the IFN-gamma [+874T/A] polymorphism is associated with development of BCG adenitis in the vaccines

Isolation of Kawasaki disease-associated with bacterial sequence from peripheral blood leukocytes

The clinical and epidemiologic features of Kawasaki disease [KD] suggest an infectious etiology; however, the agent[s] remain unknown. Our purpose was to isolate the causative bacterial gene from peripheral blood leukocytes of patients with acute KD, by Universal polymerase chain reaction [UPCR], in Tehran Children's Medical Center. Universal polymerase chain reaction [UPCR] assay was used to amplify the bacterial 16S ribosomal RNA gene [rDNA]. Forty three [28 boys and 15 girls] were diagnosed with acute Kawasaki disease included in this study. The median age at diagnosis was 3.5 years [range: 0.5-9 years]. Twenty Nine [29] cases had typical KD criteria and 14 patients had atypical KD at diagnosis. Two of the 43 KD patients were positive for the Universal PCR assay for 16S rRNA, prior to intravenous g-globulin therapy [IVGT], while all specimens were negative by conventional blood culture. In our study, there was fever in 100%, conjunctivitis in 62.7%, rash in 83.72%, oral mucosal changes in 76.74%, peripheral changes in 37.20%, and cervical lymphadenopathy in 39.53% cases. The 16S rDNA sequence was positive in 4.65% of acute KD patients; this data shows that an infectious KD agent is traced in peripheral leukocytes. The question remains as to what true frequency of the16S rDNA sequence in KD is

Detection of chlamydia trachomatis in endocervical specimens by an enzyme- linked polymerase chain reaction assay

Chlamydia trachomatis [CT] is the most common cause of sexually transmitted infections [STI] worldwide and its early detection and treatment can reduces the high morbidity associated with this infection. In this study a sensitive diagnostic polymerase chain reaction [PCR]-based enzyme immunoassay [PCR-EIA] method was developed which detects CT in women with cervicitis. Endocervical swabs collected from 123 women [20-55 years] with cervicitis were tested by both conventional PCR, and PCR-EIA assays, using identical sets of primers to amplify a CT-specific plasmid. For the conventional PCR, amplicons were detected by agarose gel electrophoretic analysis and the PCR-EIA assay used biotin-labeled primers, strepavidin-coated plates, a digoxigenin-labeled probe, and a final enzyme-linked colorometric analysis [405 nm] was used to measure the CT amplicon. The frequency of positive CT infection by conventional PCR and PCR-EIA assay was 7% and 17%, respectively. The highest frequencies of CT infection were among women of 31-40 years old group [25%]. The PCR-EIA limit of detection, calculated by linear regression analysis, was10 pg of CT DNA [r[2]=0.9642]. The degree of agreement [Kappa] between the conventional PCR and PCR-EIA method was 0.556 [p<0.0001]

Preparation of a K39sub recombinant antigen for the detection of Leishmania infantum antibodies in human: a comparative study with an immunochromatographic test and direct agglutination

The Mediterranean type of kala-azar is occurred in different parts of Iran and caused by Leishmania infantum. A rapid and valid test for early detection of visceral leishmaniasis in human would be highly desirable because it could decrease mortality rate of the disease. In this study, we aimed to compare the results of K39sub antigen with a commercial immunochromatographic dipstick rk39 test [Cypress Diagnostic Company, Belgium] for early detection of L. infantum infection in human. K39sub recombinant antigen of L. infantum LON49 was expressed in prokaryotic system and evaluated for the diagnosis of human visceral leishmaniasis. This study evaluated the performance of recombinant K39sub antigen by ELISA and an commercial immunochromatographic dipstick rk39 test for the detection of L. infantum antibodies in 43 clinically infected patients with direct agglutination test [DAT] at a 1: 3200 cut off titer and higher. Controls included 69 healthy volunteers and 28 patients with other diseases including malaria [n=5], tuberculosis [n= 3], toxoplasmosis [n= 4], cystic hydatidosis [n= 5] and cutaneous leishmaniasis [n= 11]. The sensitivity of the K39sub antigen and an immunochromatographic dipstick rk39 test was 90.7%, and 97.7%, respectively, while the specificity was 95.6% and 97.9%, correspondingly. A good concordance was found between k39sub antigen and commercial dipstick rk39 strips [k= 96.4%]. The accuracy of the K39sub antigen in the detection of L. infantum antibodies in human infection is confirmed

Diagnosis of bacteremia using universal PCR in febrile ill children

Early diagnosis of bacteremia and its complications is the most important part of care and management of the febrile patients. However, a majority of patients who appear to be clinically septic have negative blood culture. The use of polymerase chain reaction [PCR] techniques has allowed identifying the pathogenic organisms rapidly and accurately. The objective of this study was to investigate the prevalence of bacteremia in febrile pediatric patients, comparing universal PCR and conventional blood culture. One hundred febrile children [45 males, 55 females] with suspected septicemia were evaluated. A total of 100 paired blood samples were collected from children to analyze for bacterial detection using universal PCR and culture. Twelve patients were blood culture positive. The most common pathogens isolated from blood culture were Staphylococcus aureus, coagulase negative staphylococci [CoNS] and Pseudomonas aeruginosa. The PCR were positive in 19 patients. The comparison revealed sensitively, specificity and accuracy of 91.67, 90.91 and 91%, respectively, for PCR. The present study shows that the use of PCR is more sensitive than the use of conventional blood techniques for the detection of bacterium pathogens based on patients' clinical context

Fogarty catheter for a difficult bronchial foreign body removal: [case report]

There are many methods for removal of tracheobronchial foreign bodies but there are many situations where removal of a foreign body seems impossible and may require a major surgical procedure. Familiarity with each method improves physician decision making. Case: A 17 months old baby with a history of foreign body aspiration suffered from long term pneumonia. There was a round shape foreign body in bronchoscopic view that could not be removed with standard methods, but was removed by application of Fogarty catheter. Conclusion: Removal of round, spherical foreign bodies may be performed by Fogarty Catheter preventing surgical intervention

Diagnosis of canine visceral leishmaniasis by ELISA using K39sub recombinant antigen

Surveillance of the canine reservoir is highly important to help control of visceral leishmaniasis in human. It is therefore imperative to improve and develop new tools reliable, easy to use, and cheap for the diagnosis of canine leishmaniasis. K39 sub recombinant antigen of Leishmania infantum was expressed in prokaryotic system and evaluated for sero-diagnosis of canine visceral leishmaniasis [CVL]. The gene fragment encoding a single 39-amino acid subunit of the kinesin-related protein k39 [k39sub] was amplified from DNA of Iranian strain of L. infantum [MCAN/IR/96/LON49] and cloned into a pMAL-p2 expression vector in frame with maltose-binding protein [MBP] fusion. The antigenic properties of L. infantum recombinant K39 subunit [39 amino acids] have been tested for the serological diagnosis of CVL by ELISA. K39sub ELISA for CVL was compared with a standard direct agglutination test [DAT] on 55 clinically infected dogs and 71 healthy controls from endemic areas of Ardabil and East Azerbaijan provinces, north-west of Iran. A sensitivity of 72.7% and specificity of 87.3% were found at a 1:320 cut off titer when DAT confirmed cases were compared with healthy control. A good concordance was found between k39sub ELISA and DAT [k= 81.0]. Given the antigenic properties shown by the k39sub, we think this protein carry immunodominant epitopes and are valuable for the sero- diagnosis of L. infantum infection in dogs

Clinical and laboratory manifestations of meningococcemia in children

Lack of vaccination and modern health care facilities in many countries including Iran let meningococcemia to remain as a serious challenging disorder especially among children and in spite of improved diagnosis and earlier treatment its prognosis is still dismal. This study describes 68 cases [54.4% male] of proved meningococcemia hospitalized since 1992 up to the end of 2002 in Children Medical Center Hospital, Tehran, Iran. Infants of 6 to 12 month old were a major concern in number [14.7%] and severity of disease. 5.9% of the cases have had at least two hospitalization history for meningococcal septicemia and 19.1% of the patients had Systemic Lupus Erythematosus [SLE], nephrotic syndrome or chronic liver disease in their past medical history. Meningeal irritation signs were seen in 55.9% and cerebrospinal fluid [CSF] smear was positive in 71.4% and culture was positive in 48.5% of patients. Meningococcal septicemia ended in shock [38.2%], Disseminated intravascular coagulation [DIC] [7.4%], thrombocytopenia [10.3%], arthritis [4.4%],ocular complications [2.9%], pericarditis [2.9%] and seizure [8.8%] in 51 of the cases, and death occurred in 7 patients. This study shows that the manifestation of the disease is similar to those described elsewhere except for lower pneumonia and no seasonal variations

Application of direct agglutination test [DAT] for the diagnosis and seroepidemiological studies of visceral leishmaniasis in Iran

Visceral leishmaniasis [VL] is one of the most important parasitic diseases which is endemic in different parts of Iran. Serological studies were conducted by direct agglutination test [DAT] on 12144 human serum samples, collected from four geographical zones of Iran. Sero prevalence, geographical distribution, clinical signs and symptoms for human visceral leishmaniasis based on DAT for the period of 2002 through 2005 were determined. From 516 kala-azar cases detected: 50.6% were from Meshkin-shahr and Moghan districts in Ardabil Province, northwest of Iran and 49.4% were detected from other areas of Iran. In physical examination of seropositive cases, which were detected by DAT with anti-leishmanial antibodies at titers of 1: 3200 to 1: 102400, almost 50% of suspected individuals showed the classical kala-azar signs and symptoms. Predominant signs and symptoms in 233 hospitalized patients with anti-Leishmania antibodies at 1:3200 and higher, were fever [88.0%] and splenomegaly [84.5%]. Statistically significant difference was found between males [58%] and females [42%] [P< 0.01]. Moreover, 93.6% of the VL patients were < 5 yr of age, and 6.4% were older than 5 yr that this difference was statistically significant [P< 0.01]. From 1383 serum samples collected from domestic dogs in the villages that are known as endemic foci of human leishmaniasis, 152 [11.0%] were positive by DAT [>/= 1:320]. Parasitological and serological examinations that were performed in 30 wild canines showed that 10% of these animals were infected by L. infantum. L. infantum Lon49 is the principal agent of the disease in human as well as animal reservoir hosts in different parts of Iran. For the first time in Iran, L. tropica isolated from both skin lesions in the face and bone marrow aspiration in a HIV+ man who co-infected with VL as well as in an infected dog from Ardabil Province

case series study on clinical and epidemiologic aspects of Kala azar in patients referred to the children's medical center since 1991 to 2003

Kala azar is a parasitic disease which belongs to the category of metazoonoses [a communicable disease which requires at cost to an invertebrate host], In Iran canines are major reservoir for it and most of patients are 6 months to 2 years old. The aim of this study was evaluation of the clinical end epidemiologic aspects of visceral leishmaniasis in patients visiting the Children Medical Center over the 12 past years. This study used the hospital records of a case series of 106 kala azar patients hospitalized in the Children's Medical Center between 1 991 and 2001. We extracted and analyzed data on geographical location, background factors, clinical and laboratory findings, response to treatment and Glucantime[R] side effects. The greatest number of cases was seen in 1992 and the smallest number in 1993 and 2003; the number of cases peaked in the spring. Most patients referred to the Center are aged 1 to 4 years, end there is a strong preponderance of males 82.1% vs 17.9%]. The majority of these children come from families in which the breadwinner was a peasants or a laborer. Common laboratory findings included anemia, rising ESR titers and thrombocytopenia. The most striking clinical signs and symptoms were fever, splenomegaly and hepatomegaly. Eighty-three percent of the patients had shown clinical improvement, 1.9% had died and 15.1% had relapsed. Moreover, in 52.8% of cases, the disease was treated successfully with within 2 weeks; The incidence of Glucantim[R] side effects was low. The cities of Khorramabod, Karaj and Saveh had produced the greatest numbers of cases. Compared to other studies, our case series showed a higher proportion of male patients and a somewhat different clinical and laboratory profile. However, the most important achievement of this study was identification of major endemic foci in Ardabil province, northwestern parts of Ghom province. Khorrornabad, and regions located south of the Alborz Mountains [e.g. Saveh]

[ study of the frequency of adenovirus infections by immunofluorescence antibody method in patients with acute respiratory tract infection]

Background: Acute respiratory tract infections cause 4.5 million childhood deaths all over the world. Most of these deaths occur in the developing countries. Both bacterial and viral pathogens arc responsible for these deaths. Adenovirus respiratory tract infections are spread over the entire world, but the fatal disease is rarely seen

Methods: This descriptive case-series study has been conducted from October 2003 to September 2004 on 96 children of up to 5 year old. The relative frequency of adenovirus respiratory tract infection was studied. For this purpose, the nasopharyngeal secretions were obtained to detect adenovirus by Immmofluorescent Antibody [IFA] method. Seasonal incidence age distribution, and clinical signs and symptoms of this infection were studied

Findings: The relative frequency of Adenovirus respiratory infection was 10.4%. Most commonly it occurs in children aged less than 1 year and in autumn. In addition, cough and rhinorrhea are the most common signs [90%] and fever is the most common symptom [100%] in our patients. Similarly, pneumonia was the most common [40%] clinical manifestation in our patients

Conclusion: According to above data, the frequency of Adenoviurs infection and the common age for infection in this study are similar to other studies but pneumonia is the common illness which can be explained by the fact that this hospital is a referral center for these patients