SARS-CoV-2 Liability: The Hidden Mystery Behind Its Presentation in Children.

Coronavirus disease 2019 (COVID-19) is now of global concern because of its rapid dissemination across the globe. It is unclear whether COVID-19 is as hazardous as previous coronavirus outbreaks, though there are many overlapping similarities between these viruses. An important similar feature includes the virus's pathogenicity in pediatric populations. Additionally, genetic factors are recognized as important contributors to infectious disease susceptibility. Further understanding of this area can help make sense of the pathogenesis of COVID-19 and the varying clinical spectrums of the disease. The available data suggests that COVID-19 most likely produces mild symptoms in a healthy pediatric population regardless of their age, and recovery appears to occur without serious sequelae in the vast majority. However, the available data regarding the detailed repercussions of COVID-19 in children is very limited. To date, only some theoretical issues could be responsible for the COVID-19 susceptibility in pediatric patients, including a more intact but mature immune system within the respiratory system, possible role of viral interference in pediatric populations that are more often infected with common respiratory viruses, possible role of gut-lung axis, and a respiratory system with different amounts of cellular receptors for COVID-19 virus. Moreover, there is little data available on the genetic risk factors for COVID-19, and future research should aim to cover this gap in knowledge. This chapter aims to summarize the recently published data on the impact of COVID-19 in the pediatric population and to systematically review the available evidence of genetic risk factors for COVID-19.

Moyamoya disease mimicking encephalitis.

Moyamoya disease is a rare vaso-occlusive illness with an unknown etiology characterized by stenosis of the internal carotid arteries with spontaneous development of a collateral vascular network. A 15-month-old girl was referred to the emergency ward of Imam Reza Hospital due to decreased level of consciousness, focal seizures and fever during the previous 24 hours with an impression of encephalitis. Physical examination revealed left side hemiparesis; however brain CT-Scan did not show any significant lesions. Initial therapy with vancomycin, ceftriaxone and acyclovir was administered. CSF analysis did not show any abnormality and the blood as well as CSF cultures results were negative. Brain MRI showed hyperintensity at right frontal and parietal regions, suggesting vascular lesion. Magnetic resonance angiography (MRA) showed bilaterally multiple torsions in vessels at the basal ganglia consistent with moyamoya vessels. In all children exhibiting encephalitis, vascular events such as moyamoya disease should be considered. Brain MRI is a critical tool for this purpose. Common causes of encephalitis such as herpes simplex should also be ruled out.

Visceral leishmaniasis with massive hematemesis and peripheral blood involvement.

BACKGROUND: Visceral leishmaniasis can create some unusual clinical manifestations such as hematemesis and also, in rare cases, with peripheral blood involvement. Therefore, these manifestations can be considered in early diagnosis of the disease. CASE PRESENTATION: A 9 year-old boy was admitted to Imam Reza teaching hospital in Mashhad, Iran in 2010 with fever, sweating, abdominal distention, massive hematemesis, weight loss, huge splenomegaly and hepatomegaly. Peripheral blood smears and also bone marrow aspiration (BMA) and biopsy showed leishman bodies in monocytes/macophges. CONCLUSIONS: Although the sensitivity of blood smears for diagnosis of the parasite is low, it is an easy and accessible test we advise to perform for all patients suspected to visceral leishmaniasis in endemic area. We also suggest screening tests for visceral leishmaniasis to be considered in blood donors in the endemic areas.

COVID-19 in Children with Congenital Heart Diseases: A Multicenter Case Series from Iran.

BACKGROUND: Promptly discovering and counteracting COVID-19 is critical as it could have catastrophic effects. As an asymptomatic group, children are highly susceptible to be misdiagnosed, especially those suffering from underlying diseases. Furthermore, discriminating the direct effects of the virus from those of the underlying diseases can pose a dilemma to physicians. This case series aims to determine the relationship between COVID-19 and various types of congenial heart disease among children. Patients and Methods. Seven patients from three different medical centers were enrolled. Their detailed demographic information, past medical history, symptoms, type of congenital heart diseases, imaging tests, laboratory tests, medications, and outcomes were analyzed. RESULTS: The patients included 4 infants, 1 child, and 2 adolescents, with a median age of 9 months and a majority of boys. All of them had either obstructive lesions (right or left ventricular outflow tracts) or significant pulmonary hypertension. The more common clinical symptoms were cough, dyspnea, and fever. Two patients did not survive the illness. CONCLUSION: Prompt treatment of patients with a combination of COVID-19 and severe obstructive cardiac pathology or pulmonary hypertension is essential due to a risk for serious and/or fatal consequences.

Prevalence and risk factors of seizure in children with acute bacterial meningitis: updating previous evidence using an epidemiological design.

OBJECTIVE: The current study aimed to investigate the prevalence and risk factors of seizure in acute bacterial meningitis. MATERIALS & METHODS: In the present study, a total of 180 children (age range, 2 months to 14 years) with acute bacterial meningitis, were separated into two groups based on the diagnosis of seizure. The study was conducted in Mashhad (Iran) from 2002 to 2016. RESULTS: Seizure occurred in 37.4% of children with bacterial meningitis. Streptococcus pneumonia (S. pneumonia) was the most common organism. Most of the children with seizures (53.7%) had more than one episode. Also, 35% of patients had neurologic complications. Complications were more related to the seizure occurrence, the number of episodes, prolonged seizure, and being younger than 12 months. Age categories of less than 1 year and 1-5 year were associated with increased risk of seizure (odds ratio: 4.33 and 6.54, respectively). The more episode of seizure was associated with more complications (odds ratio: 6.33). CONCLUSION: The prevalence of seizures in acute bacterial meningitis was 37.4%. Besides, the seizure was associated with more complications. Hence, timely diagnosis and treatment of bacterial meningitis are necessary for preventing future consequences.

COVID-19 in children with inborn errors of immunity: clinical scenarios.

The new emerging virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a huge burden of morbidity and mortality worldwide. One of the predisposing factors which might increase the infection susceptibility and its complications can be the Inborn Errors of Immunity (IEI). One hundred and seventeen primary immunodeficient (PID) pediatric patients were monitored from March to December 2020 for any signs and symptoms of SARS-CoV-2 infection. Among them twenty-eight children were symptomatic and nineteen out of the twenty-eight patients took the coronavirus PCR test. Out of them, the PCR test results of 9 patients were positive. Herein, we report the nine cases of pediatric patients with IEI who were also infected with SARS-CoV-2 with a positive PCR test. We observed a variation in clinical manifestations, clinical courses, and outcomes among IEI pediatric patients affected with COVID-19. In our survey, prompt diagnosis and appropriate monitoring for possible complications were shown to be effective in reducing the mortality rate of the SARS-CoV-2 affected patients with IEI. Although there is no approved treatment for SARS-CoV-2 infection, supportive treatment might reduce the complications and lead to better outcomes. This study received approval from the Research Ethics Committee of Mashhad University of Medical Science with the ethics code of IR.MUMS.REC.1399.155. (https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=129963).

COVID-19 in a child with primary antibody deficiency.

Although presentation of COVID-19 in patients with immunodeficiency could be mild, it should not be missed, while early diagnosis and appropriate treatment can survive infected patients. Because even severe infections in PID patients may be presented with few symptoms and signs, this diagnosis should be considered in those immunocompromised patients who have exacerbating preexisting symptoms.

Emojis in public health and how they might be used for hand hygiene and infection prevention and control.

Emojis are frequently used picture characters known as possible surrogates for non-verbal aspects of behavior. Considering the ability of emojis to enhance and facilitate communication, there has been a growing interest in studying their effects in scientific and health-related topics over the past few years. Infection prevention and control (IPC) is a field of medicine that is directly associated with specific behaviors. These include hand hygiene, which is the cornerstone of the prevention of healthcare-associated infections, and essential in stemming the spread of antimicrobial resistance. This paper aims to provide an overview of how emojis have been used in the medical and public health literature and proposes their possible use in IPC and hand hygiene to put forth a vision for the future research.

How to Boost our Immune System Against Coronavirus Infection?

New emerging viruses like coronavirus 2019 (COVID-19) infections are always frightening. We know little about their transmission, behaviors, clinical manifestations, and outcomes. There is no vaccine or therapeutic strategies to deal with these infections yet. In this situation, preventive measures may be promising. Hand hygiene is a very important issue in preventing viral infection; however, there are other entities that can enhance the immune response and help in infection prevention. Herein we review some measures for boosting the immune system.

Telemedicine and Computer-Based Technologies during Coronavirus Disease 2019 Infection; A Chance to Educate and Diagnose.

Coronavirus disease 2019 (COVID-19) is now of global concern due to its rapid dissemination across the globe. The rapid spread of this viral infection, along with many of its unknown aspects, has posed new challenges to the health care systems. The main challenging effects of COVID-19 are rapid dissemination through close contact and varying clinical severity among different individuals. Furthermore, the medical staff in endemic areas are becoming exhausted and deal with a considerable level of job burnout, which can negatively affect their medical decision making. Also, due to the variable pulmonary manifestations of COVID-19, some physicians may misdiagnose patients. To overcome these issues, we proposed a web-based software to aid physicians in detecting possible COVID-19 cases through online consultation with different specialists and educate the not-well experienced physicians. Our results demonstrated that this software could improve the diagnostic rate for not-well experienced physicians.

Correction to: Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control.

The original article [1] contained a misspelling in author, Fernando Bellissimo-Rodrigues's name which has since been corrected.

Urinary Canthariasis Due to Tenebrio molitor Larva in a Ten-Year-Old Boy.

Canthariasis is a human disease caused by infestation of beetle larvae. We report here an unusual cause of urogenital infection due to Tenebrio molitor in a 10-year-old boy suffering from severe and intermittent suprapubic pain from Nehbandan City, Northeastern Iran in 2018. After 9 months, three larvae were excreted. Keratinization of bladder wall was observed in histopathology. All laboratory evaluations were normal except for presence of microscopic hematuria. This report implicated that T. molitor could infest bladder accidentally and cause canthariasis and clinical symptoms that may lead to severe pain and bladder inflammation and hyperemia.

Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control.

BACKGROUND: Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a "Train-the-Trainers" (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries. METHODS: We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training. RESULTS: Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively. CONCLUSIONS: The TTT in hand hygiene model proved to be effective in enhancing participant's knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.

Is Escherichia coli O157:H7 a common pathogen in children with bloody diarrhea in Shiraz, Iran?

Escherichia coli (E. coli) O157:H7 is a common cause of bloody diarrhea in developed countries. The aim of this study was to determine whether E. coli O157:H7 is a possible pathogen of bloody diarrhea in southern Iran. Out of 719 children with diarrhea, 243 (34%) patients with positive occult blood took part in our study. The polyclonal antibody test and polymerase chain reaction (PCR) were used to identify E. coli O157:H7. Stool cultures showed enteropathogens in 107 patients (44%). Shigella (34.3%) was followed by E. coli (8.6%), campylobacter (2%) and salmonella (0.4%). None of the E. coli species was of O157:H7 serotype. Antibiotic sensitivity of shigella species was 100% to ceftriaxone, ciprofloxacin and ceftazidime, 94% to nalidixic acid and 13% to co-trimoxazole. The results of the study showed that E. coli O157:H7 is not a cause of bloody diarrhea in our area.

Infective Endocarditis Presented as a Right Atrium Mass in a Patient with Ulcerative Colitis.

Involvement of the heart is infrequently seen in irritable bowel syndrome (IBD). We present a case of severe acute infective endocarditis diagnosed as ulcerative colitis in further workup.

Colonic basidiobolomycosis in a child: report of a culture-proven case.

Basidiobolomycosis is a rare fungal disease caused by Basidiobolus ranarum, which is endemic in tropical and subtropical regions of Africa, Asia, and Latin America. Gastrointestinal basidiobolomycosis poses diagnostic difficulties due to the non-specific clinical presentation and absence of predisposing factors. Eight pediatric cases of the disease have been reported recently from Iran, but none of these, or most of the other cases reported in the literature, has been proven by culture, which is the gold standard method for diagnosis. We present a case of culture-proven colonic basidiobolomycosis that occurred in a 3-year-old boy. The outcome was successful following surgical excision and antifungal therapy with posaconazole.

Herpes simplex virus infection in neonates and young infants with sepsis.

BACKGROUND: Neonatal herpes infection is the most serious complication of Herpes Simplex Virus (HSV) infection during pregnancy and perinatal period. Few studies have reported neonatal HSV infection in developing countries. OBJECTIVES: The aim of this study was to detect the HSV infection among neonates and infants with sepsis. MATERIALS AND METHODS: In a cross sectional study all infants aged less than 3 months, admitted to neonatal intensive care unit and pediatric emergency ward of Ghaem Hospital (a university hospital with 900 beds) in Mashhad (Northeast of Iran) with clinical diagnosis of sepsis and at least one inclusion criteria during one year from November 2009 to October 2010, were enrolled in the study. Polymerase chain reaction (PCR) was done on clinical samples obtained from patients. RESULTS: Among 150 neonates and infants younger than 3 months old with sepsis, the PCR results for detecting the HSV DNA, were positive in 6 samples of 5 patients (3.3 %). None of the mothers had symptomatic HSV infection during delivery. The mean age of the patients was 18 days. Two of them died due to shock and disseminated intravascular coagulation (DIC). CONCLUSIONS: In neonates and infants with primary diagnosis of sepsis, HSV infection should be considered especially if the clinical condition does not improve after 48 hours of antibiotic therapy, and sepsis still exists with elevated liver enzymes.

Clinical features and long term prognosis of childhood brucellosis in northeast iran.

OBJECTIVE: Brucellosis is a prevalent disorder in children of developing countries. The aim of this study is to describe the epidemiology and long term prognosis of Brucellosis in Khorasan, Iran. METHODS: This is a descriptive cross sectional study (from November 2003 up to February 2006), the subjects of which are composed of 82 patients (from Imam Reza hospital, Mashhad, and Health Center of Kashmar). In this study the diagnosis of Brucellosis is based on serology accompanied with clinical signs and symptoms. Our strategy for duration of treatment was to treat all patients for at least 6 weeks. We followed the patients by phone and if necessary by visiting. FINDINGS: During 38 months we had 82 children with Brucellosis. The mean age was 8.02 y, and 40% of them were girls (M/F=1.21). Summer with 45.9% of the cases was the peak season. History of consuming raw dairy products, close contact with farm animals, living in village and Brucellosis in family was found in 91.6%, 76%, 70.24% and 41.1% of the cases respectively. The presenting symptom in 79.7% of the cases was joint pain, 72.9% had history of fever during the course of the disease. Arthritis, splenomegaly and lymphadenopathy were found in 60.97%, 16.9%, 7.5%, of patients respectively. The therapeutic regimen of 48.7% of our patients was Co-trimoxazole and rifampin. We followed 74% of the patients for at least 3 years which showed the relapse rate of 6.5%. There was a case of reinfection, a patient with residual sequel and one death related to Brucellosis in our case series. CONCLUSION: Brucellosis is still a common disease in our children and at least a risk factor for it can be found in the history of almost all cases of pediatric Brucellosis. With at least six weeks treatment with two antibiotics and with close follow up, we can decrease the relapse rate in pediatric Brucellosis to zero, even without repeating the serology during or after treatment.

Congenital tuberculosis presenting as ascites.

Congenital tuberculosis is a rare disease of which the most common presentations include respiratory distress, fever, and organomegaly. We report a case of congenital tuberculosis presenting with ascites.