Meningitis after MMR vaccination in Mashhad, Iran

Background: More than 20 years after the introduction of the mumps vaccine in the Iranian national vaccination program, there are concerns about meningitis induced by the Measles, Mumps, and Rubella (MMR) vaccine. The aim of this study is to virologically determine the incidence of MMR-induced meningitis in Mashhad, Iran. Method: This is an observational prospective study during which all children who were admitted (in all hospitals of Mashhad) under the clinical suspicion of meningitis and had a history of MMR vaccination during the past 45 days were included. A polymerase chain reaction (PCR) test for mumps virus and enterovirus (EV) was done on cerebrospinal fluid (CSF) samples with pleocytosis. Results: During 13 months of study, 55 children were hospitalized for suspicion of meningitis and had a history of recent MMR shots (94% presented with a febrile seizure). Meningitis was confirmed by CSF pleocytosis in 23 (2 bacterial and 21 aseptic) cases (44.2%). All incidents of meningitis had occurred after the first MMR. The incidence of any kind of aseptic meningitis, EV meningitis, and mumps meningitis during 45 days after the first MMR was, respectively, 19.9, 5.71, and 1.9 per 100,000 cases. The number of meningitis cases during the first 3 months after MMR was, respectively, 4.5 and 2 times more than the cases that occurred during the 3 months before and 3-6 months after MMR. Conclusion: Around 40% of all cases of meningitis (between 4 and 43 months of age) occur during the first 3 months after the first MMR vaccination (12-15 months). The disproportionate increase of aseptic meningitis after the first MMR is strong epidemiologic evidence in favor of mumps vaccine induced meningitis

4-Hydroxybutyric Aciduria as a Rare Presentation of Global Developmental Delay in Children: Case Report of Two Different Patients

Succinic semialdehyde dehydrogenase (SSADH) deficiency or 4-Hydroxybutyric Aciduria is an autosomal recessive inherited disorder of amma-aminobutyric acid (GABA) degradation. It is characterized by developmental delay, infantile-onset hypotonia, cognitive impairment language deficit, and ataxia. Epilepsy, aggression, Hyperkinetic behavior, hallucinations, and sleep disturbances have been described in about half of the patients, more frequently in older individuals. Its management is largely symptomatic, conducted at the treatment of seizures and neurobehavioral disorder. We present two girls with chief complaint of hypotonia and developmental delay how referred to department of Pediatrics (Ghaem hospital), Mashhad, Iran

Psychological signs as the only presentation of Wilson’s disease in an 11 year-old boy (a case report)

Wilson’s disease (WD) is a rare autosomal recessive disease due to copper metabolism disturbance. The clinical presentation spectrum of Wilson’s disease is wide and initial findings of the disease depend on the organ involved. Neurologic disorders can develop insidiously or precipitously with intention tremor, dysarthria, rigid dystonia, parkinsonism, deterioration in school performance or behavioral changes. The aim of this article is presenting an 11-year old boy with chief complaint of falling and upper limb spasm referred to our center. His symptoms began from 6 month earlier as mood instability (prolonged spontaneous crying). He was also suffering from occasionally tremor and micrographia. Initial work ups were normal and with diagnosis of depression and psychiatric problems he was undergone treatment of fluoxetine and risperidone. Finally, concluded that Wilson’s disease should be considered in the diagnosis of all children with psychiatric and musculoskeletal symptoms