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.

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

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

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