Aseptic Meningitis in Pediatrics: Epidemiologic Evaluation and Cerebrospinal Fluid Changes

ObjectiveThis study aimed at investigating seasonal variation, clinical symptoms, and cerebrospinal fluid (CSF) changes in patients with aseptic meningitis admitted in Mofid hospital between 1995 and 1996.Materials & MethodsA total of 63 children with aseptic meningitis were enrolled in the study. Their age, gender, season of the disease, etiology, clinical symptoms, CSF changes, and treatment were evaluated and  documented. Data were analyzed using SPSS 11.5.ResultsThe male to female ratio of the patients was 2.5 to 1, mean age being 6.5 years. The disease occurrence was most common in spring and summer, and the most common symptoms observed were fever (92.6%), followed by nausea and vomiting (88.88% and 68.25%), neck stiffness, neck stiffness (54%), seizure (19%), kernig sign (14.28%), Brudzinski's sign (11.11%), and 1.58% of the patients had history of head injury. Mean white blood cell count for CSF was 165/mm3 (range, 6 to 850/mm3), the common cells being mononuclear cells; mean red blood cell count was 538 (range, 0 to 8100/mm3); protein and glucose levels were within the normal ranges. Blood and CSF culture and CSF smear were negative. Prognosis was excellent and mean duration of recovery was 5 days (range, 2 to 18 days).ConclusionAlthough the clinical symptoms of aseptic meningitis are similar to those of bacterial meningitis, its prognosis is excellent. The CSF features can be used to diagnose the disease.

Febrile Convulsions: The Role Played by Paraclinical Evaluation

ObjectiveThis survey evaluates the necessity of biochemical and imaging findings for patients with initial diagnosis of febrile convulsion, and also aims at determining the degree to which results of paraclinical examinations delineate management of patients.Materials & MethodsData of 302 patients referred to Mofid Children Hospital during two years (2005-2006) for febrile convulsions (FC), were collected in formatted questionnaires and analyzed.ResultsAbnormal lumbar punctures were reported in 9 patients, 3 of which had bacterial meningitis (1%). Biochemical tests including sodium, potassium, calcium, urea and glucose measurement, were performed for 289 (of 302 patients); of these 289, 9 cases were reported with hyponatremia, one casewith hypokalemia and one case with hypocalcemia. Brain CT was done in 51 cases and the results were abnormal in 4%, included a patient with status epilepticus.ConclusionConsidering the results obtained from data, we suggest that most of the paraclinical examinations are not needed for Febrile Convulsions (FC), for simple FC, in particular.

The Relationship between Osteogenesis Imperfecta and Spinal Muscular Atrophy

ObjectiveA 4-month-old female with osteogenesis imperfecta (OI) type II was admitted in PICU of our center due to severe respiratory distress and fever with a diagnosis of severe pneumonia, and mechanical ventilation was initiated. Due to severe hypotonia, NCV and EMG were performed, and spinal muscular atrophy (SMA) type I was diagnosed.Keywords: Osteogenesis imperfecta; spinal muscular atrophy; hypotoni

Antibiotic susceptibility evaluation of group a streptococcus isolated from children with pharyngitis: A study from Iran

Background: The aim of this study was to evaluate the antibiotic susceptibility of Group A streptococcus (GAS) to antibiotics usually used in Iran for treatment of GAS pharyngitis in children. Materials and Methods: From 2011 to 2013, children 3-15 years of age with acute tonsillopharyngitis who attended Mofid Children's Hospital clinics and emergency ward and did not meet the exclusion criteria were enrolled in a prospective study in a sequential manner. The isolates strains from throat culture were identified as GAS by colony morphology, gram staining, beta hemolysis on blood agar, sensitivity to bacitracin, a positive pyrrolidonyl aminopeptidase (PYR) test result, and the presence of Lancefield A antigen determined by agglutination test. Antimicrobial susceptibility was identified by both disk diffusion and broth dilution methods. Results: From 200 children enrolled in this study, 59 (30) cases were culture positive for GAS. All isolates were sensitive to penicillin G. The prevalence of erythromycin, azithromycin, and clarithromycin resistance by broth dilution method was 33.9, 57.6, and 33.9, respectively. Surprisingly, 8.4 of GAS strains were resistant to rifampin. In this study, 13.5 and 32.2 of the strains were resistant to clindamycin and ofloxacin, respectively. Conclusion: The high rate of resistance of GAS to some antibiotics in this study should warn physicians, especially in Iran, to use antibiotics restrictedly and logically to prevent the rising of resistance rates in future. It also seems that continuous local surveillance is necessary to achieve the best therapeutic option for GAS treatment. © 2015 by The Korean Society of Infectious Diseases | Korean Society for Chemotherapy

Association of systemic anaplastic large cell lymphoma and active toxoplasmosis in a child

Introduction: Anaplastic large cell lymphoma is a subset of non-Hodgkin lymphoma and an unusual disease in children. Case Presentation: Herein we have reported a 7- year- old girl with a large necrotic skin ulcer on the chest caused by systemic form of anaplastic large-cell lymphoma and simultaneous active toxoplasmosis diagnosed by PCR on lymph node specimen. There were few reports showing a role for toxoplasma infection to cause some malignancies such as lymphoma in adults. Conclusions: Based to our knowledge, this has been the first report of simultaneous systemic anaplastic large cell lymphoma and active toxoplasmosis, documented by positive PCR on tissue biopsy in a child. This case report has suggested more attention to the accompanying Toxoplasma gondii infection as a probable cause of some types of lymphomas. © 2015, Iranian Journal of Cancer Prevention

Neural Differentiation of Human Umbilical Cord Mesenchymal Stem Cells by Cerebrospinal Fluid

How to Cite This Article: : Farivar S, Mohamadzade Z, Shiari R, Fahimzad AR. Neural Differentiation of Human Umbilical CordMesenchymal Stem Cells by Cerebrospinal Fluid. . Iran J Child Neurol. 2015 Winter; 9(1):87-93.  Abstract Objective Wharton’s jelly (WJ) is the gelatinous connective tissue from the umbilical cord. It is composed of mesenchymal stem cells, collagen fibers, and proteoglycans. The stem cells in WJ have properties that are interesting for research. For example, they are simple to harvest by noninvasive methods, provide large numbers of cells without risk to the donor, the stem cell population may be expanded in vitro, cryogenically stored, thawed, genetically manipulated, and differentiated in vitro. In our study, we investigated the effect of human cerebrospinal fluid (CSF) on neural differentiation of human WJ stem cells.Material & Methods The cells in passage 2 were induced into neural differentiation with different concentrations of human cerebrospinal fluid. Differentiation along with neural lineage was documented by expression of three neural markers: Nestin, Microtubule-Associated Protein 2 (MAP2), and Glial Fibrillary Astrocytic Protein (GFAP) for 21 days. The expression of the identified genes was confirmed by Reverse Transcriptase PCR (RT-PCR).Results Treatment with 100 and 200μg/ml CSF resulted in the expression of GFAP and glial cells marker on days 14 and 21. The expression of neural-specific genes following CSF treatment was dose-dependent and time-dependent. Treatment of the cells with a twofold concentration of CSF, led to the expression of MAP2 on day 14 of induction. No expression of GFAP was detected before day 14 or MAP2 before day 21, which shows the importance of the treatment period. In the present study, expression analysis for the known neural markers: Nestin, GFAP, and MAP2 using RT-PCR were performed. The data demonstrated that CSF could play a role as a strong inducer.Conclusion RT-PCR showed that cerebrospinal fluid promotes the expression of Nestin, MAP2, and GFAP mRNA in a dose-dependent manner, especially at a concentration of 200 μl/ml. In summary, CSF induces neurogenesis of WJ stem cells that encourages tissue engineering applications with these cells for treatments of neurodegenerative defects and traumatic brain injury.References Gage, F. H. Mammalian neural stem cells. Science 2000 Feb 25;287(5457):1433-8.Da Silva Meirelles L, Chagastelles PC, Nardi NB. Mesenchymal stem cells reside in virtually all postnatal organs and tissues. J Cell Sci 2006 Jun 1;119(Pt 11):2204- 13. Epub 2006 May 9.Pittenger MF, Mackay AM, Beck SC, Jaiswal RK, Douglas R, Mosca JD, Moorman MA, Simonetti DW, Craig S, Marshak DR. Multilineage potential of adult human mesenchymal stem cells Science 1999 Apr 2;284(5411):143-7.Tse WT, Pendleton JD, Beyer WM, Egalka MC, Guinan EC. 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Amniotic fluid as a novel source of mesenchymal stem cells for therapeutic transplantation. Blood 2003;102(4):1548-49.Magatti M, De Munari S, Vertua E, Gibelli L, Wengler GS, Parolini O. Human amnion mesenchyme harbors cells with allogeneic T-cell suppression and stimulation capabilities. Stem Cells 2008 Jan;26(1):182-92. Epub 2007 Sep 27.Kang XQ, Zang WJ, Bao LJ, Li DL, Xu XL, Yu XJ. Differentiating characterization of human umbilical cord blood-derived mesenchymal stem cells in vitro. Cell Biol Int 2006 Jul;30(7):569-75. Epub 2006 Mar 6.Kern S, Eichler H, Stoeve J, Kluter H, Bieback K. Comparative analysis of mesenchymal stem cells from bone marrow, umbilical cord blood, or adipose tissue. Stem Cells 2006 May;24(5):1294-301. Epub 2006 Jan 12.Wagner W, Wein F, Seckinger A, Frankhauser M, Wirkner U, Krause U, et al. Comparative characteristics of mesenchymal stem cells from human bone marrow, adipose tissue, and umbilical cord blood. 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A Case Report of Gastrointestinal Basidiobolomycosis Treated With Voriconazole: A Rare Emerging Entity

Introduction: Basidiobolomycosis is an unusual fungal disease that rarely involves the visceral organs such as gastrointestinal tract. Gastrointestinal basidiobolomycosis (GIB) has been increasingly reported in the literature, and it is an emerging disease from arid regions worldwide, in particular, the south-western Saudi Arabia. We report a case of GIB in a 36-year-old Saudi Arabian male patient showing resistance to itraconazole and best treated with voriconazole. Computed tomography showed diffusely thickened small bowel with edematous change. Conclusions: As GIB presents diagnostic challenges due to lack of specific features, this case emphasizes the importance of considering GIB in the differential diagnosis in patients presenting with fever, abdominal pain with fast-growing abdominal mass

Clinical Characteristics and Mortality of a Hospitalized 13 Years Old Patient with Covid-19: A Case Report

The corona virus is a global problem that threatens human life. According to the latest data from different countries the mortality of this virus in children is less than adult. A 13-year-old girl was hospitalized for 6 months following a gunshot trauma and its complications. When her general condition was finally improving, she was diagnosed with the corona virus and passed away. Children who are suffering from underlying diseases and need medical care are at a higher risk of death from the corona virus

Prevalence of resistance to colistin, tigecycline and minocycline in Acinetobacter baumannii isolated from clinical samples in 2014

Background: Colonization rate of Acinetobacter baumannii is increasing in hospitalized patients especially in long term hospitalized one and / or who were treat with extended spectrum antibiotics or anticancer. Antibiotic resistance in A. baumannii is considerable because more prevalence of them cause nosocomial infections and can impose high cost to health systems and patients. The aim of this study was determination of tigecycline, minocycline and colistin resistance A. baumannii in selected center in Tehran, Iran. Materials and Methods: This study was descriptive and functional foundation. In this study A. baumannii were collected from Milad, Mofid, Taleghani, Motahari and Loghman hospital, Tehran and transferred to laboratory of pediatric infections research center. Collected bacteria were identified by conventional microbiology tests. Antibiotic susceptibility testing was determined according to CLSI guide line. Tigecycline, minocycline and colistin resistance strains were isolated.  Results: In this study, 105 A. baumannii were collected from five selected hospitals: 48 (46%) from Milad, 33 (31%) from Motahari, 17 (16%) from Loghman, 4 (4%) from Mofid and 3 (3%) from Taleghani hospital. The highest resistance was observed against cefepime and high frequency of carbapenem and minocycline was observed. On the other hand, observed resistance to aminoglycosides was 93% at least. Tigecycline is the most effective antibiotic after colistin. Colistin resistant confirmed just in one isolate by E. test. Conclusion: The results of this study indicated that high rate of antibiotic resistance in A. baumannii even resistant to third and fourth generation of cephalosporin and carbapenem antibiotics. The treatment of MDR strains of A. baumannii become more complicated if the spread of them were not been controlled

Overview of hydatid disease in Iranian children

Background: Hydatid disease (HD) is still an important health hazard in the world. This disease is a parasitic infestation endemic in many sheep- and cattle-raising areas such as Iran. Objectives: This study aimed to review the clinical manifestations, laboratory aspects, imaging findings, and management of HD. Patients and Methods: Data were collected from the medical records of patients diagnosed with HD in eight referral hospitals in different provinces of Iran from 2001 to 2014. Results: Overall, 161 children at a mean age of 9.25 ± 3.37 years (age range = 1 - 15 years old) hospitalized with a definite diagnosis of the hydatid cyst between 2001 and 2014 were studied. The male-to-female ratio was 1.6:1. The most commonly involved organ was the lung (67.1), followed by the liver (44.1) and a combined liver and lung involvement was found in 15.5 of the patients. The cysts were found more frequently in the right lobe of the liver and lung than in the left lobe. The most frequent complaints were fever (35.4) and abdominal pain (31.7), and the most frequent sign was an abdominal mass in the liver involvement and cough in the lung involvement. There was a high eosinophil count (> 500/micL) in 41 of our cases. A high erythrocyte sedimentation rate (> 30) or positive C-reactive protein (based on the qualitative method) was found in 18.6 of the patients and leukocytosis > 15000/micL in 29.2 of the children. Ultrasonography was the main imaging test, with an accuracy rate of 96, and chest X-ray was helpful in 88.6 of the cases. Surgery was performed in 89 of the patients, and selective patients underwent percutaneous aspiration-injection-reaspiration drainage or medical treatment. Conclusions: The lung was the most commonly involved organ in the children recruited in the present study. Given the high probability of multiple organ involvement, we recommend that patients with HD be assessed via ultrasonography and chest X-ray. In endemic regions, unexplained eosinophilia should be considered as a parasitic disease like HD and its complications. © 2015 Pediartric Infections Research Center