The validity of a scoring system in predicting intravenous immunoglobulin treatment failure in children with kawasaki disease

Background: Between 10 and 20 of children with Kawasaki disease (KD) will not respond to intravenous immunoglobulin (IVIG) treatment, and are prone to coronary abnormalities. A variety of predicting scoring systems, including the Kobayashi system, have been proposed, but have not yet been evaluated using Iranian patients. Objectives: To evaluate the Kobayashi scoring system with regard to predicting response to IVIG treatment in Iranian children. Patients and Methods: All patients who received a final diagnosis of KD at Aliasghar children�s hospital between 1982 and 2013, and who met the inclusion criteria, were enrolled in this retrospective cohort study. We excluded patients with missing data, abnormal echocardiographic finding on admission, late admission, atypical or afebrile cases, and those who had received an insufficient amount of IVIG. We compared demographic and echocardiographic data before IVIG, and within 7 days of treatment, as well as C reactive protein (CRP), sodium, aspartate aminotransferase, platelet levels, neutrophil percentage, age of patients, and duration of fever before IVIG administration, in treatment responders and non-responders. Results: Of the 141 cases, 97 patients met the criteria and were enrolled. Of these, 19 (19.6) did not respond to IVIG. A total of 61.8 of patients were male, and the mean patient age was 36.9 months (SD = 32.1 months). Echocardiographic evaluation revealed early coronary involvement in 15.3 of patients, and coronary abnormalities were diagnosed in 10 of patients within the first 10 days of presentation and concurrent with their IVIG treatment. A between-groups comparison of quantitative CRP, absolute neutrophil count, and platelet count showed that platelet count alone was significantly higher in nonresponders (P = 0.04). With regard to items of Kobayashi scoring system, data were present for just 41 cases, but a significant difference between the two groups was shown, with the treatment-refractory group having a significantly higher score (P = 0.002). Receiver-operating characteristic curve analysis revealed that the optimum cut-off point for our population would be 2, which makes the sensitivity of the test equal to 75, with a specificity of 60. Conclusions: This preliminary study showed that patients with KD and a high Kobayashi score are at greater risk of being unresponsive to IVIG treatment. Further studies, preferably multicenter evaluations, are required in order to understand the exact application of various scoring systems in the management of people with KD in Iran. © 2016, Pediartric Infections Research Center

Leptospirosis mimicking collagen vascular disease in a thirteen-year-old Iranian girl

A thirteen-year-old girl from Dezfoul, Iran was referred to our hospital with a history of eight days of high fever, headache, odynophagia, diffuse abdominal and body pain especially limb pain. She then developed conjunctival erythema, transient maculopapular rash on the trunk and also diplopia. No obvious or specific point was shown in the history. In the lab studies, she had very high sedimentation rate (ESR), bandemia and leukocytosis and thrombocytosis with negative results for an array of infectious diseases. Before making a vasculitis diagnosis a microscopic agglutination test for leptospira and then PCR test in blood and stool were requested and revealed to be positive for leptospira. She responded to doxycycline and remained well after one year of follow-up. Leptospirosis should be considered in differential diagnosis of vasculitic syndromes in Iran even for patients from seemingly non-enzootic areas. © 2012, Shahid Beheshti University of Medical Sciencces

Detection of human metapneumovirus and respiratory syncytial virus by real-time polymerase chain reaction among hospitalized young children in Iran

Background: Acute respiratory infection plays an important role in hospitalization of children in developing countries; detection of viral causes in such infections is very important. The respiratory syncytial virus (RSV) is the most common etiological agent of viral lower respiratory tract infection in children, and human metapneumovirus (hMPV) is associated with both upper and lower respiratory tract infections among infants and children. Objectives: This study evaluated the frequency and seasonal prevalence of hMPV and RSV in hospitalized children under the age of five, who were admitted to Aliasghar children�s hospital of Iran University of Medical Sciences from March 2010 until March 2013. Patients and Methods: Nasopharyngeal or throat swabs from 158 hospitalized children with fever and respiratory distress were evaluated for RSV and hMPV RNA by the real-time polymerase chain reaction (PCR) method. Results: Among the 158 children evaluated in this study, 49 individuals (31.1) had RSV infection while nine individuals (5.7) had hMPV infection. Five (55.5) of the hMPV-infected children were male while four (44.5) were female and 27 (55.2) of the RSV-infected patients were females and 22 (44.8) were males. The RSV infections were detected in mainly one year old children. Both RSV and hMPV infections had occurred mainly during winter and spring seasons. Conclusions: Respiratory syncytial virus was the major cause of acute respiratory infection in children under one-year of age while human metapneumovirus had a low prevalence in this group. The seasonal occurrence of both viruses was the same. © 2016, Ahvaz Jundishapur University of Medical Sciences

Comparison of antimicrobial sensitivity to older and newer quinolones versus piperacillin-tazobactam, cefepime and meropenem in febrile patients with cancer in two referral pediatric centers in Tehran, Iran

Background: Infection in pediatric cancer patients has become a concerning problem due to increasing antimicrobial resistance. The goal of this study was to determine the antimicrobial resistance patterns of blood isolates from pediatric oncology patients in Iran to determine if there was significant resistance to quinolones. Methods: Children with cancer who were admitted with or developed fever during admission to Aliasghar Children's Hospital or Mahak Hospitals July 2009 through June 2011 were eligible for enrollment. Two blood cultures were obtained. Antimicrobial sensitivity test was performed for ciprofloxacin, moxifloxacin, gatifloxacin, meropenem, cefepime, and piperacillin-tazobactam on isolates from children who were bacteremic. Results: Blood cultures were positive for 38 episodes in 169 enrolled children but 9 episodes were excluded as blood cultures were thought to be contaminated, yielding a bacteremia rate of 29/160 (18). The mean age of children and the stage of malignancy did not differ between those with and without bacteremia. Meropenem was the most likely antibiotic to cover isolates (97) with cefepime having the lowest coverage rate (21). Quinolone coverage ranged from 63 to 76. Conclusion. Quinolones may not be suitable for use as empiric therapy in febrile pediatric oncology patients in Iran

Transplacental transmission of SARS-CoV-2 infection: A case report from Iran

We report a case of SARS-CoV-2 vertical transmission through the placenta in a neonate whose mother had non-M3 acute myeloid leukemia (AML) that was complicated with Covid-19 in the last trimester. Viral load in nasopharyngeal swabs from mother and neonate were high. Real-time PCR of the fetal side of the placenta was positive for SARS-CoV-2, which makes it possible to consider this case as a congenital case of SARS-CoV-2 infection that is transmitted through vertical transmission. © 2020, Author(s)

Postoperative differences between colonization and infection after pediatric cardiac surgery-a propensity matched analysis

BACKGROUND: The objective of this study was to identify the postoperative risk factors associated with the conversion of colonization to postoperative infection in pediatric patients undergoing cardiac surgery. METHODS: Following approval from the Institutional Review Board, patient demographics, co-morbidities, surgery details, transfusion requirements, inotropic infusions, laboratory parameters and positive microbial results were recorded during the hospital stay, and the patients were divided into two groups: patients with clinical signs of infection and patients with only positive cultures but without infection during the postoperative period. Using propensity scores, 141 patients with infection were matched to 141 patients with positive microbial cultures but without signs of infection. Our database consisted of 1665 consecutive pediatric patients who underwent cardiac surgery between January 2004 and December 2008 at a single center. The association between the patient group with infection and the group with colonization was analyzed after propensity score matching of the perioperative variables. RESULTS: 179 patients (9.3%) had infection, and 253 patients (15.2%) had colonization. The occurrence of Gram-positive species was significantly greater in the colonization group (p=0.004). The C-reactive protein levels on the first and second postoperative days were significantly greater in the infection group (p=0.02 and p=0.05, respectively). The sum of all the positive cultures obtained during the postoperative period was greater in the infection group compared to the colonization group (p=0.02). The length of the intensive care unit stay (p<0.001) was significantly longer in the infection group compared to the control group. CONCLUSIONS: Based on our results, we uncovered independent relationships between the conversion of colonization to infection regarding positive S. aureus and bloodstream results, as well as significant differences between the two groups regarding postoperative C-reactive protein levels and white blood cell counts

Partial seizure due to COVID19 infection in an infant

We live at the time of the coronavirus pandemic in the world (1, 2). The symptoms of COVID19 are similar in children and adults. However, children with confirmed COVID19 have generally shown mild symptoms (3). The symptoms in children include cold-like symptoms, such as fever, runny nose, and cough, vomiting, and diarrhea. In this study, we describe an eight-month-old boy with recurrent partial seizure and mild diarrhea. It was later revealed that he was COVID19 positive. © 2020, Iranian Child Neurology Society. All rights reserved

Report of 6 cases with rhinocerebral mucormycosis

Background : With respect to low prevalence of immunocompromised infectious diseases and their related difficulties in diagnosis and treatment, in the present study we review our experience with 3 adult and 3 infant patients with rhinocerebral mucormycosis. Materials and methods : Initial data including demographic features, clinical, laboratory and radiologic manifestations, therapeutic approach and clinical course of 6 cases of rhinocerebral mucormycosis were reviewed. Three patients died and 3 improved. Conclusion : Diabetes mellitus and metabolic cirrhosis were the most common predisposing factors. Rhinocerebral manifestations were present in all patients. Biopsy was the gold standard for diagnosis and the most efficient therapeutic approach is appropriate usage of immunosuppressive agent