Evaluation of Aseptic Meningitis Following Measles-Mumps-Rubella Vaccine in Children Admitted due to Febrile Convulsion

Background Febrile convulsion (FC) is the most common neurological problem in children which can occur in 2 to 5% of this population. The most important issue is to identify the cause of fever and rule out bacterial meningitis. The purpose of this study was to evaluate the association of aseptic meningitis due to Measles-Mumps-Rubella (MMR) vaccine in admitted children with febrile convulsion. Materials and Methods This study was a retrospective cross-sectional. Children aged 6 months to 5 years old with FC that admitted to Mousavi Hospital in Zanjan, Iran, during one year (from 2016 to 2017) were enrolled. The demographic information of patients and laboratory parameters of meningitis in their CSF fluid were recorded in a researcher made questionnaire. Results A total of 275 children were admitted due to FC. Of these children, 36.3% had respiratory infections, 33.8% nonspecific febrile infections, 16% gastroenteritis, 5.8% urinary tract infection, 5.1% acute otitis media and 2.2% meningitis. All cases of meningitis were aseptic without evidence of bacterial compromise. There was a significant relationship between the age of febrile convulsion and meningitis (P=0.012). The age of children with meningitis were between 385 to 395 days (equivalent one year and 20- 30 days), which coincide with 20 to 30 days after receiving the MMR vaccine. Conclusion In the study, all cases of meningitis occurred 20 to 30 days after the MMR vaccine at one year of age. It is strongly suspected the association between aseptic meningitis and the MMR vaccine. LP is recommended in children with febrile convulsions in this age range

Recurrent Epistaxis and Bleeding as the Initial Manifestation of Brucellosis

Severe thrombocytopenia with bleeding is rarely reported in children with brucellosis, and recurrent epistaxis is extremely rare. Brucellosis with hemorrhage should be differentiated from viral hemorrhagic fever, malignancy, and other blood disorders. Bone marrow aspiration (BMA) is mandatory to differentiate from other blood diseases. An 8-year-old boy was admitted with recurrent epistaxis, petechiae and purpura on face and extremities and bleeding from the gums. During the hospitalization, he was febrile and complained of muscle pain. Leukopenias associated with thrombocytopenia were observed. BMA showed to be normal. Among the multiple tests requested, only serum agglutination test (SAT) and 2-MercaptoEthanol test (2-ME) were positive. He was treated with Intravenous immunoglobulin (IVIG) associated with co-trimoxazole and rifampin. Finally, fever subsided, and he was discharged with good condition and normal platelet count. Brucellosis should be a differential diagnosis in patients with fever and bleeding disorders and a history of consumption of unpasteurized dairy, in endemic areas

Croup Is One of the Clinical Manifestations of Novel Coronavirus in Children

The manifestations of novel coronavirus are diverse and can manifest through respiratory, gastrointestinal, and even nervous symptoms. Respiratory involvement is usually an upper tract infection or pneumonia but can also present as other forms of pulmonary disorders. A 3-year-old boy presented with cough, hoarseness, and stridor. He was treated with dexamethasone and nebulized adrenaline and a clinical diagnosis of croup was established. After treatment, his symptoms improved for a short time, but suddenly cough exacerbated and was accompanied by respiratory failure and seizures. He was then intubated and mechanically ventilated. Because of the coronavirus epidemic, Reverse-Transcription Polymerase Chain Reaction (RT-PCR) assay was taken from the pharyngeal secretions and was positive. The child was isolated. Due to excessive respiratory secretions and worsening of the general condition, bronchoscopy was performed depicting an image compatible with bacterial tracheitis. He was treated with broad-spectrum antibiotics, antivirals, and supportive care. Finally, after 4 weeks of treatment, the child was discharged in good general condition. Croup is one of the respiratory symptoms of novel coronavirus and can be a risk factor for bacterial tracheitis. Therefore, the presence of clinical manifestations of croup indicates the need for coronavirus PCR testing

Clinical and Epidemiologic Findings of Pertussis Suspected Patients Referred to Zanjan Health Centers in 2011-2012

Introduction: Despite frequent vaccination, Pertussis is still relatively common in the world. The prevalence of this disease has been reported differently in different parts of the world. The aim of this study was to investigate clinical and pediatric findings and compare them with the results of nasopharyngeal culture in suspected Pertussis patients in Zanjan province. Materials and Methods: In this cross-sectional study, records of all patients referred to Zanjan health center during 2011-2015 with suspected Pertussis were evaluated. Data were collected from questionnaires and analyzed by SPSS v16 software using frequency distribution, chi-square and chi-square test. Findings: Of the 243 patients examined, 17 (7%) patients were positive for nasopharyngeal culture. Eight of them were male and 9 were females. The highest number of cases was in winter (9 cases). We found cough in all cases and post coughing vomiting in 15 cases . Of the 17 positive cultured patients, 11 patients were below 6 months (before completing three doses of vaccine). Discussion & Conclusion: In this study, the positive nasopharyngeal culture was similar to most of the national’s studies but was less than that of other countries