Echovirus 30 and coxsackievirus A9 infection among young neonates with sepsis in Iran.

BACKGROUND AND OBJECTIVES: Human enteroviruses (EV) are the most common causes of neonatal sepsis-like disease. The frequencies of EV including coxsackievirus A, coxsackievirus B and Echovirus serotypes have been studied in young infants (younger than three months) with sepsis. So far, the role of enteroviruses among neonates with sepsis was not determined in Ahvaz, Iran. Therefore, this study was aimed to evaluate the frequency of EV among hospitalized young infants with clinical signs and symptoms of sepsis in Ahvaz. MATERIALS AND METHODS: Blood specimens from 128 neonates (younger than 90 days), including 56 (43.75%) girls and 72 (56.25%) boys, were collected from hospitalized neonates with clinical signs and symptoms of sepsis-like symptoms. All blood samples were negative for bacterial culture. RNA was extracted from all sera and tested for detection of 5'UTR (Untranslated Region) of the EV by RT-PCR. To determine specific strains of EV, positive 5'UTR samples were further tested for detection of the VP1 region of EV by RT-PCR. RESULTS: Overall, 50/128 (39.06%) specimens, including 24 (48%) girls and 26 (52%) boys, were positive for EV. 21/50 (42%) specimens were positive for the VP1 region. Randomly, 8 positive VP1 were selected and sequenced. Analysis of sequencing data showed 7/21 (33.33%) samples were positive for Echovirus 30 and 1/21 (4.76%) samples were positive for CVA9. CONCLUSION: The results of this survey indicate high prevalence of 39.06% of EV among young neonates with sepsis. A high prevalence of 33.3% Echoviruses 30 and a low rate of 4.76% coxsackievirus A9 infection has been observed in neonatal patients with viral sepsis. This outbreak is probably one of the first Enterovirus outbreaks to be reported in Ahvaz, Iran. The results of this survey will help to minimize unneeded use of antimicrobial drugs and reduce unnecessary hospitalization.

Human Rhinoviruses A9, A49, B14 and Echovirus 3, 9 among the patients with acute respiratory infection.

  Background: Acute respiratory infection result in high mortality and morbidity worldwide. There are several viral factors that originate respiratory diseases among them Enteroviruses(EVs) and Human Rhinoviruses(HRVs) can be mentioned. HRVs and EVs belong to Picornaviridae family and they have been recently classified under Enteroviruses. The pattern of respiratory infections generating organisms varies according to geographical locations. Therefore, it seems necessary to organize an appropriate plan to manage common viral diseases exclusively about Rhinoviruses and Enteroviruses. PATIENT AND METHODS: A total of 100 samples were collected from patients with acute respiratory infections (ARIs) who were hospitalized in Ahvaz city hospitals during December 2012 to November 2013 (one year longitude). Semi-Nested PCR was done on samples for detection of HRVs and EVs using region gene of VP4/VP2. Phylogenetic and molecular evolutionary analyses performed with MEGA version 5 software find out the sequence homology among the detected HRV and EV serotype. RESULTS: The results of this study revealed that from of 100 cases of ARIs 19 patients (19%) were HRV positive and 3 (3%) patients positive for EVs. Most positive cases of HRVs were observed in the autumn season while 3 positive cases of EVs were equally found in spring, summer and autumn. Phylogenetic analyses showed that the HRV strains were HRV-A9, HRV-A49, HRV-B14 and EV strains were Echo3 and 9. CONCLUSION: The results of this study revealed that high prevalence of 19% HRVs, HRV-A9, HRV-A49, HRV-B14 serotypes and low frequency of 3% Echo Viruses, Echo3 and Echo 9 serotypes have been detected in patients with ARI.

Distribution of Rotavirus Genotypes Ccirculating in Ahvaz, Iran in 2016

Background: Group A rotavirus (RVA) mainly causes acute gastroenteritis, exclusively in young children in developing countries. The prevalence and determination of the molecular epidemiology of rotavirus genotypes will determine the dominant rotavirus genotypes in the region and provide a strategy for the development of appropriate vaccines. Methods: A total of 100 fecal samples were collected from children below five years with acute gastroenteritis who referred to Aboozar Children's Hospital of Ahvaz city during October 2015 to March 2016. All samples were screened by latex agglutination for the presence of rotavirus antigen. Rotavirus-positive samples were further analyzed by the semi-multiplex RT-PCR, and the sequencing was performed for G/P genotyping. Results: Findings showed that 32% of the specimens were RVA-positive. Among the 32 VP7 genotyped strains, the predominant G genotype was G9 (37.5%), followed by G2 (21.9%), G1 (12.5%), G12 (9.4%), G4 (9.4%), G2G9 (6.3%), and G3 (3.1%). Among the 31 VP4 genotyped strains, P[8] genotype was the dominant (62.5%), followed by P[4] (31.3%) and P[4] P[8] (3.1%). The genotypes for G and P were identified for 31 rotaviruses (96.87%), but only one strain, G9, remained non-typeable for the P genotype. The most prevalent G/P combination was G9P[8] (28.5%), followed by G2P[4] (18.8%), G1P[8] (9.4%), G12P[8] (9.4%), G4P[8] (9.4%), G2G9P[4] (6.3%), G9P[4] P[8] (3.1%), G3P[8] (3.1%), G9P[4] (3.1%), G2P[8] (3.1%), and G9P[non-typeable] (3.1%). Conclusion: A novel rotavirus strain, G12, was detected, for the first time, in patients from the southwest of Iran. Comprehensive investigations are required to evaluate the emergence of this strain.

A Study of prevalence of Shigella species and antimicrobial resistance patterns in paediatric medical center, Ahvaz, Iran.

BACKGROUND AND OBJECTIVES: Shigella infections are one of the major causes of diarrhea worldwide, and especially in developing countries. Antimicrobial resistance has complicated the empirical treatment. The aim of this study was to define the clinical and antibiotic resistance patterns of Shigella gastroenteritis cases. MATERIALS AND METHODS: Stool samples of patients with diarrhea and fever diagnosed with shigellosis were collected, from June 2013 to May 2014 at Abuzar Hospital, Iran. All samples were cultured for Shigella spp on selective and differential media. Shigella isolates were evaluated for antimicrobial resistance. RESULTS: Among 193 Shigella isolates, S. flexneri (64.8%) was the predominant species followed by S. sonnei (32.6%). The most frequent antibiotic resistance observed, was towards co-trimoxazole (89%), ampicillin (77%) and ceftriaxone (51%) and the lowest resistance were seen in ciprofloxacin (1.5%), azithromycin (7%). CONCLUSION: Due to the high resistance to ceftriaxone, this drug is not recommended as an empirical therapy for shigellosis. However, azithromycin should be used as the first-line treatment for paediatric patients, suffering from shigellosis and ciprofloxacin can be used as an alternative.

Three cases of mumps virus and enterovirus coinfection in children with enteroviral meningitis.

Several viruses are responsible for aseptic meningitis; however, in the region of Southwest Iran, the role played by each virus is still not very well known. The aim of this study is to determine the relative frequencies of mumps virus, herpes viruses, and enteroviruses, as well as coinfections among them, in patients with aseptic meningitis.In this cross-sectional study, samples of cerebrospinal fluid were collected between December 2012 and December 2013 from patients under 14 years, who were hospitalized in Abuzar Children's Hospital in Ahvaz, Southwest Iran (the only children's hospital in Khuzestan province and Southwest Iran).All 66 cerebrospinal fluid samples and corresponding clinical data were collected from patients with aseptic meningitis by specialists, and with the patients' consent. The DNA and RNA were extracted from these samples and subjected to polymerase chain reaction as well as reverse transcription polymerase chain reaction (RT-PCR) for detection of mumps virus, herpes viruses, and enteroviruses. Nine of the samples (3 mumps-positive and 6 enterovirus-positive) were sequenced. The mumps virus sequences were investigated for possible mutations in the SH and partial HN regions.Up to 39 patients (59.09%) were found to be positive for enteroviruses, 3 (4.5%) for mumps virus, and 1 (1.5%) for herpes viruses (specifically, the varicella-zoster virus). Two patients (3.03%) had a mumps virus and enterovirus coinfection. Among the 3 detected mumps virus samples, 1 belonged to genotype B, while the others belonged to genotype N. Six sequenced enteroviruses indicated the highest similarity with Echovirus 30. An amino acid substitution at position 51 (N→T) was detected in the HN region of genotype N mumps virus samples, in comparison to the reference strain.

Surveillance of Antibiotic Consumption Point Prevalence Survey 2014: Antimicrobial Prescribing in Pediatrics Wards of 16 Iranian Hospitals.

BACKGROUND: Antibiotics are among the most commonly prescribed drugs in pediatrics. Due to lack of uniformity in pediatric antimicrobial prescribing and the emergence of antibiotic resistance, appropriate drug utilization studies have been found to be crucial to evaluate whether these drugs are properly used. METHODS: Data were collected between January 2014 and February 2014 in 16 Iranian pediatric hospitals using a standardized method. The point prevalence survey included all inpatient beds. RESULTS: Of 858 children, 571 (66.6%) received one or more antimicrobials. The indications were therapeutic in 60.6%. The parenteral route was used in 92.5% of therapeutic indications. Ceftriaxone was the most prescribed antimicrobials for therapeutic indications (32.4%) and combination-therapy was the most type of therapy in pediatric intelligent care unit (PICU). CONCLUSION: According to results of this study, antibiotics' prescribing in pediatrics wards of Iranian hospitals is empirical. Therefore, for quality improvement of antimicrobial use in children continuous audit process and antibiotic prescriptions require further investigation.

Frequency of methicillin-resistant Staphylococcus aureus nasal carriage in healthy children.

BACKGROUND AND OBJECTIVE: The prevalence of community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is increasing around the world. It involves healthy people and causes a variety of diseases. MATERIAL AND METHODS: This cross sectional study was conducted from September 2010-June 2011 on children less than 14 years of Ahvaz, southwest Iran. The participants were selected with two staged cluster sampling. A sterile cotton nasal swab was used to collect the samples from the 864 participants. MRSA isolates were identifed by catalase and coagulase tests and 1 µg oxacillin disk method. Polymerase chain reaction (PCR) was performed on all the MRSA colonies to detect the mecA gene. Data was put in SPSS 16 software and descriptive statistics and chi-square test were used for analysis. RESULTS: Out of 864 children, 471 (54.51%) were male and 393 (45.49%) were female. 235 children (27.1%) had Staphylococcus aureus and 11 (1.3%) of all children diagnosed with MRSA. PCR showed that 7 colonies (0.8%) had the mecA gene. CONCLUSION: The results of this study indicate that MRSA exists in healthy children of Ahvaz. Although the prevalence of CA-MRSA is lower than many other regions, it still needs close attention to prevent its transmission. Further studies are needed to identify the risk factors of CA-MRSA.

Serotype determination of adenoviruses in children with respiratory infection.

OBJECTIVE: To determine adenovirus serotypes among children with acute respiratory infection (ARI) in Khoozestan province, Iran during years 2010-2011. METHODS: One hundred sixty three nasopharyngeal swabs were collected from children between 1 and 15 y who were hospitalized for the acute respiratory infection. The viral DNA was extracted from the nasopharyngeal swabs and adenoviruses were detected by Nested PCR. Positive PCR samples were sequenced in order to confirm the adenovirus serotypes. RESULTS: Out of 163 samples, 30 (18.4 %) were positive for adenoviruses by nested PCR. Twenty two PCR products were sequenced and recognized as Ad5 and Ad2 serotypes including 19 (86.3 %) Ad5 and 3 (13.7 %) Ad2. CONCLUSIONS: This study reveals that adenoviruses with Ad5 predominance are important cause of respiratory tract infection in children.

Shigella flexneri: a three-year antimicrobial resistance monitoring of isolates in a Children Hospital, Ahvaz, Iran.

BACKGROUND AND OBJECTIVES: Shigellosis is an acute gastroenteritis that is one of the most common causes of morbidity and mortality in children with diarrhea in developing countries. The purpose of this study was to describe the distribution of Shigella serogroups and serotypes and their antibacterial drug resistance profiles. MATERIALS AND METHODS: Fecal samples of all children suffering from shigellosis who had been admitted to Abuzar Children's Hospital in Ahvaz, southwestern Iran, from September 2008 to August 2010 were examined. Antibiotics susceptibility testing was performed according to the Kirby Bauer disk diffusion method. RESULTS: Shigella flexneri was the predominant serogroup and being identified in 87 isolates (49.8%). The most common S. flexneri serotypes were type 2 (57.5%) and type 1 (21.8%). High rates of resistance were observed to trimethoprime-sulfamethpxazole (85%) and ampicillin (87.5%). CONCLUSION: S. flexneri and its serotypes was the most frequently isolated Shigella species from southwest of Iran, Ahvaz. Identification of predominant S. flexneri serotypes in developing countries can help in prioritizing strategies such as development of effective vaccines.

Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI.

BACKGROUND AND OBJECTIVE: Urinary tract infections (UTIs) are common childhood bacterial infections that may involve renal parenchymal infection (acute pyelonephritis [APN]) followed by late scarring. Prompt, high-quality diagnosis of APN and later identification of children with scarring are important for preventing future complications. Examination via dimercaptosuccinic acid scanning is the current clinical gold standard but is not routinely performed. A more accessible assay could therefore prove useful. Our goal was to study procalcitonin as a predictor for both APN and scarring in children with UTI. METHODS: A systematic review and meta-analysis of individual patient data were performed; all data were gathered from children with UTIs who had undergone both procalcitonin measurement and dimercaptosuccinic acid scanning. RESULTS: A total of 1011 patients (APN in 60.6%, late scarring in 25.7%) were included from 18 studies. Procalcitonin as a continuous, class, and binary variable was associated with APN and scarring (P < .001) and demonstrated a significantly higher (P < .05) area under the receiver operating characteristic curve than either C-reactive protein or white blood cell count for both pathologies. Procalcitonin ≥0.5 ng/mL yielded an adjusted odds ratio of 7.9 (95% confidence interval [CI]: 5.8-10.9) with 71% sensitivity (95% CI: 67-74) and 72% specificity (95% CI: 67-76) for APN. Procalcitonin ≥0.5 ng/mL was significantly associated with late scarring (adjusted odds ratio: 3.4 [95% CI: 2.1-5.7]) with 79% sensitivity (95% CI: 71-85) and 50% specificity (95% CI: 45-54). CONCLUSIONS: Procalcitonin was a more robust predictor compared with C-reactive protein or white blood cell count for selectively identifying children who had APN during the early stages of UTI, as well as those with late scarring.

Neurological manifestations of shigellosis in children in southwestern Iran.

BACKGROUND: Shigella spp. are important causative agents of acute diarrhea and dysentery. Neurological signs are among the most common extraintestinal manifestation of shigellosis. The aim of this study was to determine the relative frequency of neurological signs in children with shigellosis in southwestern Iran. METHODS: In a retrospective study, the medical records of all children suffering from shigellosis who had been admitted to Abuzar Children's Hospital in Ahvaz, southwestern Iran, from March 2006 to March 2009 were reviewed. The epidemiological characteristics, clinical findings, and laboratory data of the patients with shigellosis were analyzed. The statistical analysis was performed using SPSS version 13.0 software. RESULTS: During the study period, 154 children suffering from shigellosis were admitted. Of the patients studied, 85 (55.2%) were male and 69 (44.8%) female. The majority of patients were in the age group of 1-4 years. A total of 129 children (83.3%) had fever; dysentery was the presenting complaint of 43 (27.9%) of the patients. Shigella sonnei was isolated from 77 cases (50%), Shigella flexneri from 59 (38.2%), Shigella boydii from 11 (7.1%), and Shigella dysenteriae from seven (4.5%). Neurological manifestations were observed in 106 (68.8%) of the children. There were no statistically significant associations between the presences of neurological manifestations and sex, age, leukocytosis, bandemia, electrolyte imbalance or species of Shigella. The associations between neurological manifestations and the presence of fever and dysentery were statistically significant. CONCLUSIONS: Shigella sonnei was the most common species of Shigella in southwestern Iran. Neurological manifestations were common in the children with shigellosis. Fever and dysentery were significant risk factors for the development of neurological signs.

Usefulness of procalcitonin rapid test for the diagnosis of acute pyelonephritis in children in the emergency department.

BACKGROUND: Urinary tract infection (UTI) is a common problem in children. The aim of this study was to determine the usefulness of the procalcitonin (PCT) rapid test in the diagnosis of renal involvement in children with urinary tract infection. METHODS: Through a case series study, PCT and C-reactive protein rapid tests were measured in children with proven UTI at the Tehran Children's Medical Center, Iran. One-hundred patients aged 1 month-14 years old (19 boys and 81 girls) with documented UTI were enrolled in the study. RESULTS: Of 100 children, 62 patients (62%) had renal involvement on the basis of abnormal Tc-dimercaptosuccinic acid scintigraphy and 38 patients (38%) had infection restricted to the lower urinary tract. There were no differences related to age or gender among the groups. The sensitivity and specificity of PCT were 77% and 89%, respectively, in prediction of renal involvement, whereas C-reactive protein had a sensitivity of 80% and a specificity of 65%. CONCLUSION: We concluded that a rapid determination of PCT concentration could be useful for the management of children with febrile UTI in the emergency room.