The incidence of Mycoplasma pneumoniae in community acquired pneumonia among children: one centre study

Background: Mycoplasma pneumoniae (M. pneumoniae) is an important cause of pediatric community acquired pneumonia (CAP). Aim: The aim of this study was to determine the incidence of M. pneumoniae in pediatric community acquired pneumonia and to determine the most frequent clinical findings of M. pneumoniae CAP. Methods: A total of 83 pediatric CAP patients were subjected to history taking, clinical examination, chest X-ray, CBC, CRP and serum antimycoplasma pneumonia IgM and IgA by ELISA. Results: Twenty-nine (34.9%) out of 83 patients were positive for M. pneumoniae Ig M while 2 (3.4%) patients were positive for M. pneumoniae Ig A. There were more infection (54%) in age group (5-9 years; p value = <0.001). M. pneumoniae pneumonia infected patients were presented with cough (29/29; 100%), fever (29/29; 100%), malaise (18/29; 43.8%), headache (16/29; 33.8%), wheeze (21/29; 52.5%), chest discomfort (13/29; 44.8%), sore throat (13/29; 46.4%), rhinitis (8/29; 27.5%) and pharyngitis (6/29; 24%). The most frequent X ray findings in M. pneumoniae pneumonia was air space pneumonia (71%); segmental more than lobar form (p-value = < 0.0001). Conclusion: The findings of this study highlight the clinical significance of M pneumoniae in pediatric community acquired pneumonia

role of Interleukin-9 in patients with allergic rhinitis

Background: Allergic rhinitis [AR] is a common allergic disease. It has a marked effect on quality of life. Various populations of effector and regulatory T cells and their cytokines play a crucial role in allergic inflammation

Objectives: This study was designed to evaluate serum levels of IL-9 in subjects with allergic rhinitis and to investigate the association of its serum level with the severity of the disease, and its clinical parameters

Methodology: This study included 19 AR cases and 19 healthy controls. All patients and controls were subjected to the followings: full medical history, allergy skin test, nasal smear to detect eosinophilia, and measurement of serum levels of IL-9 by enzyme linked immune-sorbent assay [ELISA]. Cases were classified according to Allergic Rhinitis and its Impact on Asthma [ARIA] guidelines into mild, moderate and severe

Results: The median values of serum levels of IL-9 in AR cases were higher than in the controls [8.5 vs 6.85 pg/ml] with statistically significant difference [p =0.02]. Roc curve analysis, also showed significant association between the serum level of IL-9 in AR patients than controls [P value < 0.0001], the cut point was >7.5 pg/ml in AR patients with sensitivity and specificity of 77.78 and 83.33 % respectively. In addition, there was a significant association between the serum levels of IL-9 and degree of disease severity [P=0.01], and AR symptoms [nasal obstruction and irritative symptoms]. There was a significant association between sensitization to multiplicity of allergens and the mean level of IL-9 in AR cases [P< 0.05]

Conclusion: The elevated serum level of IL-9 in AR cases may provide new insight into the patho-physiology of the disease and into development of novel therapeutic targets

Intracranial germ cell tumors: a single-institution experience

Intracranial germ cell tumors [GCTs] are not a common disease. We reviewed the experience of a single institution to determine the variables that affect treatment outcome. A retrospective review of patients with the diagnosis of intracranial germ cell tumors treated in a single institution [KFSHRC] during the period from March 1985 to December 2007. Fifty-seven patients with the diagnosis of intracranial GCT were recorded in the KFSHRC Tumor Registry during the period from 1985 to 2007. Seven patients with a pineal region tumor treated as germinomas in the earlier years without a tissue diagnosis were excluded. This retrospective study was restricted to the remaining 50 patients with a tissue or marker diagnosis: 31 germinomas and 19 non-germinomatous germ cell tumors [NGGCTs]. The 10-year overall survival [OS], event-free survival [EFS] and relapse-free survival [RFS] were 87%, 88% and 96% for patients with germinoma, with a median follow-up of 4.5 [range 2-17] years, compared with 26%, 29% and 46% for patients with NGGCT with a median follow-up of 3 [range 1.5-13] years. For NGGCT, variables favorably influencing OS were younger age [< 16 y vs >/= 16 y, P=.01], higher radiation dose [>50 Gy vs 1990 vs <1990 P=.002]. Tissue diagnosis of GCTs is mandatory prior to treatment except for patients with elevated markers. In germinoma, localized radiotherapy [RT] for M0 patients may be adequate. Long-term follow-up is needed to define the benefit of adding chemotherapy. For NGGCT, the use of combined modality treatment and RT dose >50 Gy are important factors that influence the outcome. Second-look surgery and resection of residual/refractory tumors is always recommended

Candida colonization in very low birth weight neonates with early-onset neutropenia

Candida species are the leading cause of invasive fungal infections in hospitalized children. Colonization by Candida spp. is' almost always the first step in the development of invasive candidiasis. Preterm neonates in NICUs are at high risk for severe fungal infections. Early-onset neutropenia is a well-known risk factor for bacterial sepsis in preterm neonates. The aim of this case control study was evaluation of the role of early onset neutropenia as a risk factor for Candida colonization in preterm very low_ birth weight neonates in NICU, the current role of granulocyte colony-stimulating factor in treatment of these conditions and to screen the antifungal susceptibility of the isolated Candida spp to help management of emerging fungal infections. Forty four very low birth weight" [VLBW] neonates were enrolled in this study. ·They were classified into two groups. Group I: twenty two VLBW neonates [<1500gm] with early onset neutropenia [EON] in the 1st week of life and group II: twenty two matched VLBW neonates without EON as a control group. Group I was further divided into: group IA: Eleven neonates received recombinant granulocyte colony stimulating factor [G CSF] for 3 consecutive days plus routine therapy and group IB: Eleven neonates received routine therapy. Surveillance microbiological swabs from ear canal, oropharyngeal secretions, perianal area and rectum, urine and blood in the 1st and 2nd weeks were collected and cultured according to standard methods. Colonies identified as Candida by colonial morphology on sabouraud dextrose agar and CHRO Magar candida media. All isolated strains were subjected to broth microdilution assays to detect MIC for voriconazole, fluconazole, Iitraconazole, and amphotericin B with calculation of MIC50 and MIC90 for the isolated strains. The study revealed a significant difference of colonization by Candida spp in neutropenic group I as 9 cases out of 22 patient in group I were colonized while only 3 cases out of 22 patient in group II were colonized by Candida spp. [P value 0. 04]. Out of 220 samples cultured from each group, Candida spp were significantly isolated from group I [26] in comparison to group II [JO] [P value 0.05]. C. albicans was the most commonly isolated Candida species followed by C. tropicalis, then C. glabrata. There was a good therapeutic effect of rhG-CSF on intensity of colonization as three cases with high grade colonization in the 1st week improved to low grade colonization in the second week. Treatment with rhGCSF significantly improved absolute neutrophilic count in group IA receiving rhGCSF than group IB [conventional treatment]. Among all isolates of Candida spp, the highest MIC 50 and MIC 90 were for fluconazole [4 and 64 microglml respectively]. The lowest MIC50 and MIC90 were for voriconazole [0.06and0.5 microg/ml]. C. albicans was the most susceptible species to voriconazole [MIC50, 0.03 microg/ml while MIC90, 0.06 microg/ml]. C. tropical is the least susceptible to voriconazole [[MIC50, 0.5 microg/ml while MIC90, 2 microg/ml]. Amphotericin B MICs show a very narrow range [0.25-1 microglml]. Isolated strains were all susceptible to amphotrocinB. As regards to azoles tested, isolated strains were most sensitive to voriconazole [97.2%], followed by Iitraconazole [88.9%] and fluconazole [83.3%] respectively. This study concludes that early onset neutropenia is an independent risk factor for Candida colonization and treatment with rhGCSF corrects ANC sooner and decreases the intensity but fails to completely clear Candida colonization so it recommends proper antenatal and post-natal care to decrease other risk factors of pre-maturity and Candida colonization. This study also concludes that Candida spp isolated is still sensitive to amphotericin B. But resistance to azole antifungal drugs is an emerging problem so it recommends further studies to evaluate the antifungal resistance

role of apoptosis of lymphocytes in pediatric patients with chronic renal failure and end stage renal disease

Apoptosis is an essential form of physiological cell suicide in which the cell itself initiates, regulates and executes cell death pathway using a highly structured arsenal of specific proteins. Patients with chronic kidney disease [CKD] have an impairment of the immune response. Apoptosis of lymphocytes can contribute to this immune defect. The aim of this study is to study the effect of apoptosis on lymphocytes of chronic renal failure and end stage renal disease pediatric patients. This study was conducted on 7 pediatric patients with chronic renal failure under conservative treatment, 7 pediatric cases with end stage renal disease [ESRD] under hemodialysis and 8 healthy control subjects. Lymphocytes were isolated by ficoll-Hypaque method. Apoptosis of lymphocytes was assessed by Annexin V: FITC assay kit. Percentage of apoptotic lymphocytes [annexin V: FITC +ve and propidium iodide -ve] was determined by flow cytometer. Extraction of DNA from lymphocytes was done using DNeasy prep-kit. DNA electrophoresis was done on 2% agarose gel and stained with ethidium bromide. The bands are seen through UV trans-illuminator. Mean positive apoptotic lymphocytes were 35%, 27%, and 4% in end stage renal disease, chronic renal failure patients and control personnel respectively. Apoptosis was significantly higher in end stage renal disease patients in comparison to control personnel [Chi Square and p value, 28. 7 and <0.0001 respectively]. Apoptosis was significantly higher in chronic renal failure patients in comparison to control personnel [Chi Square and p value, 18.5 and <0.0001 respectively]. Apoptosis was more in lymphocytes of end stage renal disease patients than chronic renal failure patients but this difference is not significant [Chi Square and p value, 1.145 and 0.2845 respectively]. By DNA electrophoresis, 7 cases of ESRD and 6 out of 7 CRF cases give the DNA ladder characteristic to apoptosis while no control gives this ladder pattern. This study concludes -that apoptosis significantly affects lymphocytes in chronic renal failure and end stage disease renal disease pediatric patients so it can contribute to immune deficiency seen in these patients

Evaluation of oxacillin resistant screening agar for rapid conventional screening of methicillin resistant staphylococcus aureus in infection control unit

Rapid assessment of clinical specimens for the presence of methicillin resistant Staphylococcus aureus [MRSA] is an important part of the infection control measures taken to control the spread of MRSA and thus, to decrease hospitalization costs. A novel medium, Oxacillin resistant screening Agar [ORSA] medium, was evaluated for the screening of specimens for MRSA in our infection control unit. Swabs of the nose, throat, perineum, and other infected sites [1527] were inoculated onto the ORSA medium and into an enrichment broth [Muller- Hinton broth supplemented with Na Cl and oxacillin[OX-MH broth]]. After 24h of incubation, the enrichment broth was sub-cultured onto one ORSA plate and one lipovitellin chapman salt agar plate. All MRSA isolates were confirmed by PCR amplifying MecA gene. Out of 1527 specimens, 242 [16%] were positive for MRSA. A sensitivity of [70%] was obtained when ORSA medium was used alone as a primary culture, whereas the sensitivity was 88% when a single selective enrichment was used before subculture on ORSA. Among the 414 blue colonies observed on ORSA plates, only 48% were found to be MRSA, 42% were coagulase - negative staphylococci, 4.4% were Enterococcus species, and 3.3% were methcillin sensitive S .aureus. Among 43 MRSA colonies, 21 [49%] were visible only after 48 h of incubation. However, when ORSA plate was used for subculture, 88% of blue colonies were detected after only 24 h of incubation. In conclusion, the ORSA is suitable for screening of MRSA in a simple laboratory of infection control unit with the advantage of the ease of recognition of mannitol fermenting bacteria. An enrichment broth is still needed to ensure a good sensitivity for the recovery of MRSA, and incubation time of 48 h is required for primary culture on ORSA medium

Nosocomial infections with extended spectrum beta lactamase producing enterobacteriaceae in pediatric intensive care unit of Zagazig university hospitals

Enterobacteriaceae are of great concern because antimicrobial therapy of infections due to these resistant pathogens remains a clinical dilemma in hospitalized patients. It is also noted that there is an increase in the antibiotic resistance among Gram negative bacilli to third generation cephalosporins which is caused by expression of ESBL enzymes. Therefore, infections due to ESBL producing isolates continue to pose a challenge to infection management worldwide. The present study was conducted to highlight ESBL production among Eenterobacteriaceae isolated from nosocomial infections [NI] acquired in PICU of Zagazig University hospital by phenotypic and molecular method. The study was done on 604 PICU patients. Specimens for cultures were obtained according to site of NI: blood, urine, CSF, endotracheal tube [ET] aspirates and tips. isolates were confirmed by API 20E and subjected to double disc diffusion test for Phenotypic detection of the extended spectrum beta lactamases. The SHV genes were amplified by PCR, each on a 930 bp fragment. Resulting amplicons were subjected to restriction enzyme digestion for genotypic detection of SHV ESBL. From positive 96 specimens, 68 Enterobacteriaceae were isolated. The most numerous isolated enterobacteria were klebsiella spp [40.6 %], followed by E.coli [9.4%], Enterobacter Spp and Proteus spp [6.3% each], Serratia spp[5.2%], and Citrobacter spp [3.1%].66.2% of Enterobacteriaceae were ESBL producing isolates. Klebsiella pneumonia showed the highest percentage of ESBL producing strains [84.6%], followed by Citrobacter spp [66.7%], Serratia [60%], Enterobacter [50%], Porteus [33.3 %], and the least ESBL producer was E.coli [22.2%]. There is high significant difference between ESBL and Non ESBL producing organisms as regarding the presence of SHV ESBL type gene. 41 Out of 45 isolates [91.1%] of phenotypically ESBL producing Enterobacteriaceae carried the SHV ESBL type gene as indicated by presence of 2 bands of 768 and 162 by RFLP. This study concludes that extended spectrum beta lactamase [ESBL] producing Enterobacteriaciaeae should be put in mind while dealing with specimens of PICU. Double disc diffusion test is a simple and sensitive confirmatory test for ESBL detection. Also, PCR-RFLP is a rapid test for genotypic ESBL detection but needs molecular equipments and facilities