Role of Superantigens in Various Childhood Inflammatory Diseases.

Superantigens (Sags) are a part of some viral or bacterial proteins that stimulate T cells and antigen-presenting cells leading to systemic immune repose and inflammation. SAgs might have a possible role in various inflammatory childhood diseases (e.g., Kawasaki disease, atopic dermatitis, and chronic rhinosinusitis). Worldwide studies have been conducted to determine the role of staphylococcal SAgs (TSST-1) in various inflammatory diseases. The SAgs (TSST-1) not only induce sepsis and septic shock (even in negative blood culture for S. aureus), but may also have a significant role in various childhood inflammatory diseases (e.g., KD, OMS, Polyp, dermatitis, psoriasis). In proven Sags-induced inflammatory diseases, the inhibition of the cell-destructive process by SAgs suppressants might be helpful. In toxic shock or sepsis-like presentation and even in cases with negative blood cultures, immediate use of anti staphylococcal drugs is required. Occasionally, the clinical presentation of some human viruses (e.g., coronavirus and adenovirus) mimics KD. In addition, coinfection with adenovirus, coronavirus, and para-influenza virus type 3 has also been observed with KD. It has been observed that in developed KD, bacterial sags induced an increase in acute-phase reactants and in the number of white blood cells, and neutrophil counts. Multisystem inflammatory syndrome in children (MISC) and KS were observed during the recent COVID-19 pandemic. This study summarized the relationship between viral and bacterial SAgs and childhood inflammatory diseases.

Lessons from Ten Years' the Prevalence of Congenital Rubella Syndrome (CRS) in the Young Population Living in a Developing Country, Tehran; Iran.

BACKGROUND: A safe and effective rubella vaccine is available and prescribed in IRAN. OBJECTIVE: This is a survey of CRS cases collected based on WHO criteria one decade after the MR vaccination campaign (2003). METHODS: This Multi-stage prospective/cross-sectional study was carried out in three stages in 3 educational hospitals in Tehran (Rasoul Aram, Akbar Abadi, and Firoozabadi), In the first stage of the study between 2011 and 2012 total of 186 infants were evaluated, and in the second stage of the study, total 163 blood samples of infants with suspected INTRA UTERINE INFECTION were compared with a group of healthy matched infants. In the first and second stages, Rubella immunity (IgG&IgM) in cord blood was evaluated by the Eliza method. RESULTS: Despite MR vaccination in Iran, after one decade"confirmed CRS" and " compatible CRS" was diagnosed in 5 and 31 from 89 CRS suspected cases. CONCLUSION: The incidence of "confirmed CRS" in every 100 CRS suspected infants (after campaign) is 5.6 %, and 31 CRS Compatible cases are so important. Without active CRS surveillance, mild infection such as IUGR, hearing loss, heart abnormalities, impaired vision, and mental retardation even in the developed country might be missed. Fetal infection is persistent, which imposes additional costs on the country. Another mass vaccination in women and girls is needed. Also, the anti-rubella IgG testing before pregnancy in women who were not vaccinated; vaccination of women before marriage /pregnancy should be obligatory in order to prevent the CRS.

Searching the Staphylococcal Toxic Shock Syndrome Toxin -1 in Septic Children with negative Cultures: A Comparative Study in Tehran, Iran.

BACKGROUND: Bacteria induced sepsis is common in infants and children. Staphylococcus aureus produces numerous exotoxins, like staphylococcal Toxic shock syndrome toxin (TSST- 1), which stimulate the immune system by T cell activation and inflammation in various organs. Recent studies suggest that staphylococcal toxins, generally named super antigens (SAgs), may also have a significant role in the pathogenesis of some pediatric disorders especially in the clinical presentation of sepsis and septic shock. This study was carried out in order to compare staphylococcal TSST- 1 (SAgs) in children with sepsis symptoms (and septic shock) with negative blood culture versus a control group. MATERIALS AND METHODS: This cross-sectional study was conducted during 2 years (2014 -2016) in two referral hospitals (Rasoul Akram and Bahrami hospitals) in Tehran, Iran. We selected 44 children) mean age of 4 years) who were admitted in pediatrics and PICUs wards with sepsis symptoms- /+septic shock. Forty-five children (mean age of 3.9 years) were selected as a control group. All cases with blood samples were examined for TSST-1 (SAgs) by polymerase chain reaction (PCR) method in both case and control groups and results were compared. Data were analyzed by SPSS-16software. Chi-square or Fisher test was used to compare the variables. P-value < 0.05 was considered as a valuable tool. RESULTS: Positive blood cultures with other bacteria, Streptococcus pneumonia, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli, were detected in 5 cases with negative TSST-1 in blood samples. S.aureus isolated from blood culture was detected in 2 cases with positive TSST- 1.Positive TSST-1 (SAgs) was detected in 6 cases (14%) with negative blood culture for S.aureus; it was significantly higher in cases (14% vs. 2%; P value = 0.05). CONCLUSION: This study indicates the probable role of TSST-1(SAgs) in the progression of sepsis (and septic shock) in toxic children with negative blood culture for S.aureus. Anti-staphylococcal treatment is immediately required, especially in toxic children with related clinical presentations, even in cases with negative blood cultures. Indeed, the clinical use against SAgs suppressants of downstream cell-destructive events might be helpful.

The Resistance Rate of Helicobacter Pylori to Clarithromycin and Main Mutations on Bacterial Genomic Responsible for Bacterial Resistance: A Comparative Study in Children and Adults, Tehran and Iran.

BACKGROUND: High resistance to common antibiotics has become a huge global dilemma in eradicating Helicobacter Pylori infection in both children and adults. The great concern is about the resistance to different classes of antibiotics especially Clarithromycin because of its widespread use. OBJECTIVES: The present survey aimed to assess the resistance rate to Clarithromycin in Helicobacter Pylori isolated in patients aged less than 15 years as compared to patients older than 15 years of age. METHODS: In this cross-sectional study, total 72 patients with upper gastrointestinal symptoms requiring diagnostic endoscopy referred to Rasoul-e-Akram Hospital in Tehran during one year (August 2015 to August 2016). Helicobacter Pylori infection was diagnosed in patients using the Rapid Urease Test. The antibiotics resistance was detected in genomes using the real-time polymerase chain reaction (PCR) on 23S rRNA gene. RESULTS: In total 72 patients, 36 cases aged less than or equal to 15 years and 36 patients were older than 15 years. Of all patients in this study, 17 cases were detected with gene mutations or polymorphisms related to resistance to Clarithromycin. Overall prevalence rate of resistance was reported 23.61%. Three polymorphisms on 23S rRNA gene including A2142G, A2142C, and A2143G were revealed in 47.1%, 5.9%, and 47.1% of patients, respectively. The bacterial resistance to Clarithromycin was observed more prevalent in patients that aged older than 15 years compared to patients younger than 15 years of age. Also, frequent consumption of any type of antibiotics was significantly associated with the higher resistance of bacterium to Clarithromycin. CONCLUSION: The results of our study regarding the resistance of Helicobacter Pylori to Clarithromycin were similar to findings of other studies around the world. But, the Clarithromycin resistance rate was reported higher in patients older than 15 years of age and those patients who repeatedly received different types of antibiotics regardless of their age. Of all mutations in bacterial genome, the prominent mutations responsible for bacterial resistance to Clarithromycin included A2142C, A2142G, and A2143G nucleotide polymorphism on 23S rRNA gene.

Detection of the M. pneumonia in Synovial Fluid of Children with Negative Culture Arthritis: A Cross Sectional Study in Tehran, Iran.

BACKGROUND: Arthritis could be caused by different etiologies ranging from rheumatologic diseases to infectious conditions. Therefore, early diagnosis of etiology and treatment is important. The purpose of this study was to determine the the M. pneumonia in synovial fluid of children with arthritis by 2 methods (serology and qualitative PCR). METHODS & MATERIALS: This trial was carried out as a cross sectional study in pediatric and orthopedic ward of Rasoul-e Akram hospital in Tehran, Iran. Seventy three patients (39 boys and 34 girls) with mean age of 11± 3.9 y/o were selected by continuous sampling after synovial fluid aspiration. All samples were evaluated by direct smear, culture and latex tests. Septic arthritis was diagnosed in 18 patients (25.4%). PCR and serology tests for M. pneumonia (specific IgM and IgG) were performed in 50 cases with negative culture. The results were compared by Independent T test. RESULTS: According to physical examination and culture 18 patients (25.4%) were diagnosed with septic arthritis, 50 patients with non-septic arthritis were studied. Seventeen patients (33.3%) were IgG positive and 2 patients (4%) were IgM positive. Only 2 patients (4%) showed weakly positive results on PCR which did not demonstrate any association with serology. CONCLUSION: Positive PCR in SF (4%) definitely indicates active infection and M. pneumonia induced arthiritis. Although positive SF-IgM (4%) suggests either a current or a very recent M. pneumonia infection but not for SF-IgG (previous infection). So, we can summate that PCR, though being the best and most accurate method to detect M. pneumonia infection arthritis, is not considered a practical one due to costs and availability issues. Hence it can be safely replaced by serology test (Specific IgM) in SF for diagnosis of M. pneumonia arthritis, which is available in most of the hospitals and is much more economical as compared to PCR.

Assessments of blood lead levels in children with febrile convulsion.

BACKGROUND: Lead elements have an adverse effect on human health. The most important complications of lead poisoning are disorders of nervous system particularly seizure .This study aimed to evaluate the blood lead levels and its association with convulsion in a group of hospitalized febrile children. METHODS: In this analytic cross-sectional study, 60 hospitalized febrile children with 1- 60 month old participated in the study via non-probability convenience sampling method. All of the information included sex, age, weight, blood lead levels and history of convulsion gathered in the questionnaire. Finally all of data were statistically analyzed. RESULTS: 66.7% of samples were male and 33.3% were female. The mean age was 32.57±38.27 months and the mean weight was 13.04±9.61kg. The Mean and Standard deviation of Blood lead level was 4.83±3.50µg/dL. 10% of samples had lead levels greater than 10µg/dL. 53.3% of patients have convulsion and other don't have it. Blood lead levels was 4.91±3.65µg/dL in children with convulsion and 4.73± 3.38µg/dL in children without it; the difference was not significant (p= 0.8). CONCLUSION: Overall, no significant association was found between blood lead levels and convulsion.