Neurobrucellosis Presenting with Unilateral Abducens Nerve Palsy

How to Cite This Article: Andisheh M, Amirsalari S, Torkaman M, Sabzechian M, Afsharpaiman Sh. Neurobrucellosis Presenting with Unilateral Abducens Nerve Palsy. Iran J Child Neurol. Spring 2017; 11(2):61-64. AbstractOne of the rare complications of brucellosis is neurobrucellosis. There have been numerous reports showing clinical forms of brucellosis affecting CNS, such as cranial nerve involvement, myelitis, vascular disease, radiculoneuritis, meningitis, meningoencephalitis, and demyelinating disease. In this case report, we introduce a 2.5 yr old girl with unilateral abducens nerve palsy referred to Baghiyatallah Hospital Outpatient Clinic, Tehran, Iran in June 2015. References 1. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med 2005; 352:2325–2336.2. Al-Sous MW, Bohlega S, Al-Kawi MZ, Alwatban J, McLean DR. Neurobrucellosis: clinical and neuroimaging correlation. AJNR Am J Neuroradiol 2004; 25:395–4013.Bingöl A, TogayIsikay C. Neurobrucellosis as an exceptional cause of transient ischemic attacks. Eur J Neurol 2006; 13:544–548.4.Adaletli I, Albayram S, Gurses B, et al. Vasculopathic changes in the cerebral arterial system with neurobrucellosis. Am J Neuroradiol 2006; 27:384–386.5.Shakir RA, Al-Din AS, Araj GF, Lulu AR, Mousa AR, Saadah MA. Clinical categories of neurobrucellosis. A report on 19 cases. Brain 1987; 110:213–223.6.Esra Özkavukcu, Zeynep Tuncay, Ferda Selçuk, İlhan Erden: An unusual case of neurobrucellosis presenting with unilateral abducens nerve palsy: clinical and MRI findings; Turkish Society of Radiology 20097. Tena D, Gonzáles-Praetorius A, LópezAlonso A, Peña JL, Pérez-Pomata MT, Bisquert J. Acute meningitis due to Brucella spp. Eur J Pediatr 2006; 165:726–727.8. Rangel Guerra R, Martinez HR, Leon Flores L. Neurobrucellosis. Report of five cases and literature review. Rev Inwest Clin 1982;34:62–8.9. Mugerwa RD, D’Arbela PG. Brucella meningitis; a case report and review of the literature. East African Med J 1976;53:266–9.10. Bashir R, Al-Kawi MZ, Harder EJ, Jinkins J. Nervous system brucellosis: diagnosis and treatment. Neurology 1985; 35:1576–1581.11. Al Deeb SM, Yaqub BA, Sharif HS, Phadge JG. Neurobrucellosis: clinical characteristics, diagnosis, and outcome. Neurology 1989; 39:498–501.12. Lubani MM, Dudin KI, Araj GF, Manandhar DS, Rashid FY. Neurobrucellosis in children. Pediatr Infect Dis J 1989;8:79–82.13. Santini C, Baiocchi P, Berardelli A, Venditti M, Serra P. A case of brain abscess due to Brucella melitensis. Clin Infect Dis 1994;19:977–8.14. Koussa S, Chemaly R. Neurobrucellosis presenting with diffuse cerebral white matter lesions. Eur Neurol 2003; 50:121–123.15. Fincham RW, Sahs AL, Joynt RJ. Protean manifestation of nervous system brucellosis. Case histories and a wide variety of clinical forms. JAMA 1963; 184:269–27516. Marconi G. Su un caso di sclerosis multipla acuta insorta dopo un’infezione da Brucella abortus. Riv Patol Nerv Ment 1966; 87:548–565.17. Bussone G, La Mantia L, Grazzi L, Lamperti E, Salmaggi A, Strada L. Neurobrucellosis mimicking multiple sclerosis: a case report. Eur Neurol 1989; 29:238–240.18. KarakurumGöksel B, Yerdelen D, Karataş M, et al. Abducens nerve palsy and optic neuritis as initial manifestation in brucellosis. Scand J Infect Dis 2006; 38:721–725.19. Yilmaz M, Ozaras R, Mert A, Ozturk R, Tabak F. Abducent nerve palsy during treatment of brucellosis. Clin Neurol Neurosurg 2003; 105:218–220

Frequency and antimicrobial susceptibility of Shigella species isolated in Children Medical Center Hospital, Tehran, Iran, 2001-2006

AbstractAppropriate antimicrobial treatment of shigellosis depends on identifying its changing resistance pattern over time. We evaluated 15,255 stool culture submitted from July 2001 to June 2006 to the Laboratory of Children Medical Center Hospital. Specimen culture, bacterial identification, and disk diffusion susceptibility testing were performed according to National Committee for Clinical Laboratory Standards guidelines. From 15,255 stool samples, 682 (4.5%) were positive for Shigella species. The most common species of Shigella were S. flexneri (48%) and S. sonnei (45%); other results were S. dysenteriae (5%) and S. boydii (2%). The rate of Sensitivity to ceftriaxone (95%), ceftizoxime (94%), and nalidixic acid (84%) were among our isolates. Resistance to co-trimoxazole and ampicillin was 87% and 86%, respectively. S. flexneri was more multiresistant than other species (47.9%). Our isolates are overall most sensitive to ceftriaxone, ceftazidime, and nalidixic acid (> 84%). They were most resistant to co-trimoxazole and ampicillin (> 86%). Because resistance varies according to specific location, continuous local monitoring of resistance patterns is necessary for the appropriate selection of empirical antimicrobial therapy

Influenza; A Threatening Respiratory Infection for Armed Forces, Symptoms, Prevention, and Treatment

peer reviewe

The effect of probiotics on reducing hospitalization duration in infants with hyperbilirubinemia

peer reviewedBackground: Approximately 60% of term and 80% of premature infants are hospitalized for hyperbilirubinemia in the first week of life. Hyperbilirubinemia is the most common cause of infant hospitalization and readmission. Due to the high frequency of hyperbilirubinemia in infants and the high costs of treatment, it is necessary to find a way to decrease hospitalization duration. Objectives: The aim of this study is to assess the adjunctive effect of probiotics on decreasing hospitalization time for infants with hyperbilirubinemia. Methods: In this randomized, controlled clinical trial, 92 term infants with hyperbilirubinemia who met the inclusion criteria were randomly assigned to either the probiotic or control group. Patients in both groups underwent common phototherapy. Once a day, those in the probiotic group were also given half of a capsule of Prokid probiotic, while those in the control group received half of a placebo capsule. The duration of phototherapy and hospitalization, the blood groups of mothers and infants, and each patient’s bilirubin levels before and after phototherapy, direct Coombs test results, and levels of hemoglobin, G6PD, and reticulocytes were recorded. Results: Data from 92 patients with a mean age of 5.25 ± 2.35 days underwent analysis. The control group had 47 (51.1%) patients with a mean age of 5.19 ± 2.51 days and the probiotic group had 45 (48.9%) patients with a mean age of 5.31 ± 2.19 days (P = 0.81). The 92 patients had a mean bilirubin level of 16.70 ± 3.07 mg/dL, with a mean of 16.42 ± 3.53 mg/dL in the control group and 17.00 2.49 mg/dL in the probiotic group (P = 0.37). The duration of hospitalization averaged 3.34 ± 0.70 days overall, with an average of 3.55 ± 0.74 days for the control group and 3.13 ± 0.70 days for the probiotic group. The probiotic group had a significantly lower hospitalization stay in comparison to the control group (P = 0.004). Conclusions: Our findings suggest that probiotics may be beneficial as an adjunct treatment for infants with hyperbilirubinemia by reducing the duration of hospitalization

Assessment of Toxoplasma Seropositivity in Children Suffering from Anxiety Disorders.

peer reviewed[en] OBJECTIVE: This study aimed to assess the seroprevalence of Toxoplasma gondii in children with anxiety disorders. MATERIALS & METHODS: This cross-sectional study was conducted between Sep 2012 and May 2013 in Pediatrics Clinic of Baqiyatallah Hospital, Tehran, Iran. Children were assessed clinically. Diagnosis of patients with anxiety disorders was based on DSM-4 system, performed by child psychiatrist. Then their anti-Toxoplasma antibodies were measured. A questionnaire was verbally administered to all individuals' parents including demographic information and questions about life style, family history, medical history, economic situation, residence, nutritional patterns and contact with animals. RESULTS: Ninety-six male and female cases with a mean age of 8.56±2.5 and 8.42±1.9 yr underwent analysis. Anti- T. gondii IgG antibody was found in one case of each group. There was no significant difference between case and control groups for serum Toxoplasma IgG antibody (P=0.14). No case individuals had Anti- T. gondii IgM antibody, while it was found in one control individual. No significant difference was seen between case and control groups for Toxoplasma IgM antibody (P=0.27). CONCLUSION: Toxoplasmosis has no direct effect on the incidence of anxiety disorders. More studies are needed with a larger volume of individuals in future

Assessment of Toxoplasma Seropositivity in Children Suffering from Attention Deficit Hyperactivity Disorder

peer reviewedBackground: Toxoplasmosis, a protozoan infection caused by Toxoplasma gondii, is suggested to be a risk factor for many psychological disorders such as schizophrenia and depression. Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders among children. Previous studies have assessed the correlation between ADHD and infectious diseases like toxoplasmosis. So we aimed to investigate the possible correlation between Toxoplasma seropositivity and ADHD in children. Materials and Methods: In this cross-sectional study children with signs of ADHD were regarded as patients and underwent clinical assessments. Diagnosis of these patients was based on DSM-IV-TR system which was performed by a pediatric psychiatrist. Forty-eight Children without signs of ADHD or other psychic disorders were considered as control, and 48 patients were considered as case group. Parents were asked to answer a questionnaire including demographic, pregnancy and habitual questions. Blood samples were taken from all individuals and assessed for anti-Toxoplasma IgM and IgG antibodies. Results: Ninety-six male and female patients with a mean age of 8.12 years underwent analysis. Seropositivity rate for anti-T.gondii IgG antibody was 4.2% in the case and 2.1% in control individuals (P=0.92). Anti-T.gondii IgM antibodies were not found in control individuals while it was found in 2.1% of case individuals (P=0.74). There was no statistically significant association between seroprevalence of IgM (P=0.74) and IgG (P=0.92) antibodies and ADHD in study individuals. Conclusion: Our findings showed that the toxoplasmosis seropositivity has no significant difference between children with and without ADHD. Further studies are needed with a larger amount of individuals. [GMJ. 2016;5(4):188-93

Maternal perceptions of advice on sleep in young children: how, what and when

Objectives: Parental knowledge on sleep hygiene in children may be a contributing factor for sleep difficulties in preschoolers. As sleep is crucial for healthy development, it is important to understand how parental knowledge can be improved. The aim of this qualitative study was to develop an understanding of advice available in the United Kingdom (UK) on sleep in young children. Design: This study employed constructivist grounded theory methodology. Methods: Participants were recruited via social media and a previously constructed participant database. Interviews were audio-recorded, transcribed, and analysed. Results: Fourteen mothers were interviewed independently, whilst one mother was interviewed together with her husband. Themes relating to how UK mothers wish advice on sleep to be formulated, what they believe it should include and when they would like to receive it, were identified from the data. Specifically, this study suggests that UK mothers value experience and thus recommends that advice be made through collaboration projects involving both professionals and parents. It also suggests that advice should be readily available and given to expecting parents prior to the arrival of their baby as well as at regular follow-ups. In addition, the participating mothers wanted advice to be balanced and non-judgemental. Conclusion: This study looks at the views of mainly White British mothers currently residing within the United Kingdom. Thus, it may not represent the views of everyone in the United Kingdom. Nevertheless, it still makes important recommendations for practice. For example, relationships between health professionals and parents need to be improved and information on different sleeping practices widely dispersed

BRUCELLOSIS: REVIEW OF CLINICAL AND LABORATORY FEATURES AND THERAPEUTIC REGIMENS IN 44 CHILDREN

"nBrucellosis is not uncommon in children in endemic areas. We described clinical and laboratory features and therapeutic regimens for brucellosis in children under 14 who admitted in the Pediatric Medical Center Hospital, Tehran, Iran from March 1988 until February 2001. The male: female ratio was 2:1. Family history of brucellosis and consumption of un-pasteurized milk and dairy products was positive in 20.4% and 65.9%, respectively. The common clinical findings were arthritis (79.5%), fever (77.4%), anorexia (61.4%), sweating (52.3%), splenomegaly (43.2%), hepatomegaly (34.1%) and lymphadenopathy (13.65). Anemia, leukopenia and thrombocytopenia were recorded in 56.8%, 31.8% and 9.1%, respectively. Out of all patients, seropositivity rate for brucellosis was found in 97.7% using serum agglutination test. Culture of blood and bone marrow specimen were positive in 30% and 50% of samples obtained, respectively. Rifampin and co-trimoxazole were the most commonly used combination in 68.1%. The overall relapse rate was 13.6%. Arthritis and fever were the most common clinical findings of brucellosis. Wright test is a very sensitive method to detect brucella infection. Public education and control measures should be applied to prevent the zoonotic and human brucellosis.&nbsp