C - reactive protein of cerebrospinal fluid, as a sensitive approach for diagnosis of neonatal meningitis.

BACKGROUND: Meningitis, is a potentially life-threatening condition that can rapidly progress to permanent brain damage, neurologic problems, and even death. Bacteria and viruses cause the great majority of meningitis disease in infants and children. CRP is used mainly as a marker of inflammation. OBJECTIVE: This study was conducted to assess the diagnostic value of CSF-CRP levels for differentiating between septic (bacterial) and aseptic infantile meningitis. METHODS: 49 hospitalized infants aged less than two months with suspected meningitis were enrolled in a cross-sectional analytic study. All of patients underwent lumbar puncture to obtain CSF. smears, cultures, cytological and biochemical analysis and latex agglutination testing were carried out on all CSF samples. Latex agglutination test was carried out on all CSF samples using a commercially available kit. CSF-CRP level of all infants was measured using the immunoturbidometric technique. RESULTS: Of 49 infants in this study, 20 and 29 cases were diagnosed as septic and aseptic meningitis, respectively. The CRP levels were obtained as 0.95±0.68 mg/L in septic and 0.16±0.36 mg/L in aseptic meningitis groups and this difference was statistically significant (p<0.001) between the two groups (0.79±0.32 mg/L). Based on the ROC curve, cut off levels for CRP was obtained 0.17 mg/L. At this level, there was 95% sensitivity and 86% specificity to differentiate septic and aseptic meningitis. CONCLUSION: CSF-CRP has suitable diagnostic value in distinguishing between infantile bacterial from aseptic meningitis especially in cases of negative bacterial culture of the blood and spinal fluid.

Molecular detection of six virulence genes in Pseudomonas aeruginosa isolates detected in children with urinary tract infection.

Although a vast majority of Urinary tract infections (UTIs) are caused by E. coli, epidemiological reports have indicated an increasing rate of such infections caused by some other opportunistic organisms including Pseudomonas aeruginosa. Antimicrobial susceptibility and pathogenesis mechanisms of P. aeruginosa are poorly understood. The aim of this study was to detect some virulence factor genes and antimicrobial susceptibility patterns of P. aeruginosa isolates detected in patients with UTI, in children hospital of Tehran, Tehran, Iran. Eighty-four Pseudomonas aeruginosa were isolated. Then, the presence of six virulence genes, in the genome of the isolates was evaluated using PCR amplifications techniques. Finally, antimicrobial susceptibility pattern of the isolates was determined by disk diffusion method. According to the results, lasB was the most prevalent virulence gene that could be detected in the P. aeruginosa isolates (92.9%) used in this study. This was followed by aprA (81.2%), toxA (69.4%), and algD (60%) genes. Two genes, plcH and plcN, were detected in about 38.8% of the isolates. Additionally, Imipenem was found as the most active agent against the P. aeruginosa isolates used in this research. However, Cefotaxime resistance was observed in most of the isolates. Our P. aeruginosa isolates exhibited a great degree of heterogeneity not only in their virulence genes but also in their antimicrobial susceptibility profiles. Imipenem therapies tend to be among the best choices in the management of UTI caused by P. aeruginosa. As a conclusion, assessment of antimicrobial susceptibility pattern and also analyzing the virulence factors can be highly helpful to develop effective treatment strategies against P. aeruginosa urinary infections.

Detection of the M. pneumonia in Synovial Fluid of Children with Negative Culture Arthritis: A Cross Sectional Study in Tehran, Iran.

BACKGROUND: Arthritis could be caused by different etiologies ranging from rheumatologic diseases to infectious conditions. Therefore, early diagnosis of etiology and treatment is important. The purpose of this study was to determine the the M. pneumonia in synovial fluid of children with arthritis by 2 methods (serology and qualitative PCR). METHODS & MATERIALS: This trial was carried out as a cross sectional study in pediatric and orthopedic ward of Rasoul-e Akram hospital in Tehran, Iran. Seventy three patients (39 boys and 34 girls) with mean age of 11± 3.9 y/o were selected by continuous sampling after synovial fluid aspiration. All samples were evaluated by direct smear, culture and latex tests. Septic arthritis was diagnosed in 18 patients (25.4%). PCR and serology tests for M. pneumonia (specific IgM and IgG) were performed in 50 cases with negative culture. The results were compared by Independent T test. RESULTS: According to physical examination and culture 18 patients (25.4%) were diagnosed with septic arthritis, 50 patients with non-septic arthritis were studied. Seventeen patients (33.3%) were IgG positive and 2 patients (4%) were IgM positive. Only 2 patients (4%) showed weakly positive results on PCR which did not demonstrate any association with serology. CONCLUSION: Positive PCR in SF (4%) definitely indicates active infection and M. pneumonia induced arthiritis. Although positive SF-IgM (4%) suggests either a current or a very recent M. pneumonia infection but not for SF-IgG (previous infection). So, we can summate that PCR, though being the best and most accurate method to detect M. pneumonia infection arthritis, is not considered a practical one due to costs and availability issues. Hence it can be safely replaced by serology test (Specific IgM) in SF for diagnosis of M. pneumonia arthritis, which is available in most of the hospitals and is much more economical as compared to PCR.

Th1 and Th2 cytokine gene expression in atopic and nonatopic patients with nasal polyposis.

The pathogenesis of nasal polyps has been debated for many years. The lymphocytes that infiltrate nasal polyps have been identified as predominantly memory T cells in an activated state, and these cells produce a mixed cytokine pattern of T1 helper (Th1) and T2 helper (Th2) cells. We conducted a prospective study to compare the expression levels of some Th1 and Th2 cytokines in atopic and nonatopic patients. Our study population consisted of 75 adults-42 men and 33 women (mean age: 38 yr)-with nasal polyposis. Patients with an allergy were distinguished from those without an allergy on the basis of the history, the results of skin-prick testing, and measurement of total IgE serum concentrations. Based on these criteria, patients were divided into two groups: atopic (n = 38) and nonatopic (n = 37). Levels of cytokine gene expression in the atopic patients were compared with those of the nonatopic patients by real-time polymerase chain reaction. Statistical analysis found no significant differences in the rate of interleukin (IL) 10 and IL-12 gene expression between the allergic and nonallergic patients. On the other hand, rates of interferon gamma and IL-4 gene expression were significantly higher in the atopic patients (p = 0.03 and p = 0.02, respectively). Our research suggests that an imbalance of Th1 and Th2 cells plays an important role in the pathophysiology of nasal polyps. Although nasal polyposis is a multifactorial disease associated with several different etiologic factors, chronic persistent inflammation is undoubtedly a major factor, regardless of the specific etiology.

Group A ß-hemolytic Streptococcal Infection in Children and the Resultant Neuro-psychiatric Disorder; a Cross Sectional Study; Tehran, Iran.

INTRODUCTION: Group A Beta-Hemolytic Streptococcus (GABHS) can induce PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection). GABHS is the most important and common bacterial cause of acute pharyngitis in Iranian children. We studied the role of GABHS (anti-streptococcal antibodies) in suspected cases of PANDAS in a cross sectional studies. METHODS: Across sectional study was done in 2 pediatric psychiatric/and neurologic clinics in Tehran (Rasul Akram and Aliasghar Hospital) during 2008-2010. We studied serum anti-streptococcal antibodies (anti streptolysin O, anti Deoxyribonuclease B, and anti-streptokinase (ABcam-ELISA, USA) in 76 cases with psychiatric manifestation (OCD, ADHD) in compare with 39 healthy controls. These antibodies were studied in 53 cases with movement disorders (Tic/Tourette syndrome) in compare with 76 healthy controls. Sensitivity, specificity and positive predictive value of tests were calculated. RESULTS: In movement disorders ASOT, Anti-DNase and Anti streptokinase was significantly higher than controls (P<0.0001, P=0.000, P<0.00001) ASOT (cut off level> 200 IU/ml) had 75% sensitivity; 84% specificity and 80% PPV; Anti-streptokinase (cut off level > 332 IU/ml) had 34% sensitivity; 85% specificity, and 72% PPV; Anti-DNase (cut off level > 140 IU/ml) had 70% sensitivity; 99% specificity and PPV 90% for differentiating the group. ASOT, Anti-DNase and Anti streptokinase titer was significantly higher than controls (P<0.0001, P=0.000, P<0.0001). ASOT had 90% sensitivity; 82% specificity, PPV 92%; Anti streptokinase: 82% sensitivity; 82% specificity, PPV 95%; Anti DNase: 92% sensitivity; 82% specificity, PPV 92% for differentiation the cases from normal controls. DISCUSSION: These findings support that a post infectious immune mechanism to GABHS may play a role in the pathogenesis of PANDAS in our children. A combination of throat culture, rapid antigen detection test, and serologic testing for GABHS is required to achieve maximum sensitivity and specificity for diagnosis. We prefer to use antibiotic prophylaxis in PANDAS cases for preventing recurrent streptococcal infections. Ongoing research is needed for identifying optimum diagnostic, prevention and therapeutic approach especially, aggressive treatment (intravenous immunoglobulin, plasmaphresis).

Assessments of blood lead levels in children with febrile convulsion.

BACKGROUND: Lead elements have an adverse effect on human health. The most important complications of lead poisoning are disorders of nervous system particularly seizure .This study aimed to evaluate the blood lead levels and its association with convulsion in a group of hospitalized febrile children. METHODS: In this analytic cross-sectional study, 60 hospitalized febrile children with 1- 60 month old participated in the study via non-probability convenience sampling method. All of the information included sex, age, weight, blood lead levels and history of convulsion gathered in the questionnaire. Finally all of data were statistically analyzed. RESULTS: 66.7% of samples were male and 33.3% were female. The mean age was 32.57±38.27 months and the mean weight was 13.04±9.61kg. The Mean and Standard deviation of Blood lead level was 4.83±3.50µg/dL. 10% of samples had lead levels greater than 10µg/dL. 53.3% of patients have convulsion and other don't have it. Blood lead levels was 4.91±3.65µg/dL in children with convulsion and 4.73± 3.38µg/dL in children without it; the difference was not significant (p= 0.8). CONCLUSION: Overall, no significant association was found between blood lead levels and convulsion.