Clinical Findings, Bacterial Agents, and Antibiotic Resistance in Children with Spontaneous Peritonitis in Southern Iran: An Academic Tertiary Referral Center's Experience.

Background: Spontaneous bacterial peritonitis (SBP) is a fatal complication of ascites fluid infection. The causes of SBP in children differ from those in adults, and these bacteria are frequently resistant to antibiotics. Therefore, this study investigated the clinical findings, bacterial etiology, and antimicrobial resistance in children with SBP. Methods: This study was conducted on all new pediatric ascites patients, who were admitted to the Department of Pediatric Gastroenterology, Namazi Hospital, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from 2021 to 2022. Required data such as demographic information, and clinical information such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Gram staining, blood culture by Automated Blood Culture System (BACTEC), and antibiogram of ascites fluids by disc diffusion method were all collected. Finally, the data were statistically analyzed using SPSS Software (version 26). Besides, the t test, Fisher's exact, Mann-Whitney, and Chi square tests were used for data analysis. In all tests, P≤0.05 was considered statistically significant. Results: The present study examined 62 children with ascites of which 18 (29%) had SBP. The median (IQR) age was 2.5 (8.1) years. Thirty-four (54.8%) of the participants were girls. Abdominal pain was the most common clinical manifestation in patients (54%), and there was a significant association between abdominal pain and SBP (P=0.02). In 12 positive ascites fluid cultures, coagulase-negative staphylococci had the highest frequency (25%), followed by Escherichia coli (16.7%). Third-generation cephalosporins had a 25% sensitivity in the total positive cultures. This sensitivity was 33.3% for Gram-negative cultures and 16.6% for Gram-positive cultures. Conclusion: Although third-generation cephalosporins are recommended as the primary antibiotic for the empirical treatment of SBP, the present study found high bacterial resistance. Finally, empirical therapy should be tailored to each region's bacterial resistance features.

Importance of L. Infantum H2B Recombinant Antigen for Serodiagnosis of Visceral Leishmaniasis.

BACKGROUND: Visceral leishmaniasis (VL) can lead to death in more than 95% of cases if left untreated. Accurate and early diagnosis has an important role in reducing mortality rate of this disease. OBJECTIVE: To express recombinant H2B antigen from an Iranian isolate of Leishmania Infantum and evaluate its efficacy in the diagnosis of VL. METHODS: The recombinant H2B antigen was produced in a prokaryotic system, and its efficacy for VL diagnosis was evaluated by ELISA. The serum samples from 80 VL patients, 100 individuals from endemic and non-endemic regions of VL, and 58 non-VL patients were collected. VL cases were confirmed based on the clinical sign, positive IFAT (>64), real time PCR, and response to treatment. RESULTS: The H2B gene sequence of the Iranian L. infantum isolate had about 4% diversity in comparison with the H2B gene of the L. infantum counterpart. ELISA, using the produced H2B recombinant antigen, showed sensitivity of 71.25% (95% CI: 60.05%-80.82%) and specificity of 69.62% (95% CI: 61.81%-76.68%) regarding VL diagnosis. CONCLUSION: Recombinant H2B antigen expressed in the prokaryotic system had suboptimal performance for the serological diagnosis of VL. It seems that the production and expression of recombinant H2B antigen in a eukaryotic system may enhance the performance of this antigen in the diagnosis of VL in Iran.

Prevalence of colonization and mitochondrial large subunit rRNA mutation of Pneumocystis jiroveci among Iranian children.

BACKGROUND AND OBJECTIVES: Pneumocystis jiroveci is an important causative agent of Pneumocystis pneumonia. During childhood, exposure to Pneumocystis occurs and antibody was built in early childhood. The aim of this study was to describe the molecular epidemiology of P. jiroveci in children without any respiratory syndrome and survey the distribution of different mitochondrial large subunit, ribosomal ribonucleic acid (mtLSU- rRNA) genotypes. MATERIALS AND METHODS: Mini-bronchoalveolar lavage (mini-BAL) fluids from pediatric patients with no history of lung disorders were obtained during a 14-month period. P. jiroveci colonization was confirmed by immunofluorescence staining, nested PCR and sequencing. Genotypic characterization at the mitochondrial large subunit rRNA gene was performed by direct sequencing. RESULTS: Of 172 BAL specimens from patients, with mean age of 4.9 years, the prevalence of P. jiroveci colonization was 3.5% (6 samples). The results of sequencing revealed the two polymorphisms; 85/A; 248/C in 3 cases, and 85/T; 248/C in other cases. One sample also showed a mutation replacement at position 258 (T-to-C change), which was not reported previously. CONCLUSION: Colonized person as an environmental reservoir might play an important role in the progression of infection in immunocompromised patients. Diagnosis of the reservoir and genotyping can be essential for the prevention of nosocomial infections.

Viral etiology of aseptic meningitis among children in southern Iran.

Aseptic meningitis refers to a clinical syndrome of meningeal inflammation in which bacteria cannot be identified in the cerebrospinal fluid (CSF). The viral etiology and the epidemiological, clinical, and laboratory characteristics of aseptic meningitis among children aged 2 months to 15 years in Shiraz, southern Iran were determined. From May 2007 to April 2008, 65 patients were admitted to the hospital with aseptic meningitis. Seven viruses, non-polio human enteroviruses, mumps virus, herpes simplex virus (HSV), varicella-zoster virus (VZV), human cytomegalovirus (HCMV), human herpes virus type 6 (HHV-6), and Epstein-Barr virus (EBV) were investigated by polymerase chain reaction (PCR) method. Viruses were detected in 30 (46.2%) patients in whom non-polio human enterovirus and mumps virus were detected in 13 (43.3%) and 11 (36.7%), respectively. The remaining 6 (20%) of the cases were caused by HSV, VZV, HCMV, and HHV-6. Haemophilus influenzae and non-polio human enterovirus were detected in one patient simultaneously. Viral meningitis was found to be more frequent during spring and summer. The majority (66.6%) of the patients were treated in the hospital for 10 days and had received antibiotics in the case of bacterial meningitis. Rapid diagnosis of viral meningitis using PCR testing of CSF can help shorten hospitalization, and avoid the unnecessary use of antibiotics.

Viral etiology of acute respiratory infections among Iranian Hajj pilgrims, 2006.

BACKGROUND: Every year more than 2 million pilgrims from different countries in the world including Iran participate in the annual Hajj in Saudi Arabia. Respiratory diseases have been the most common cause of illnesses among Iranian pilgrims. METHODS: Direct fluorescent staining and viral culture were performed on nasal wash specimens of Iranian Hajj pilgrims with symptoms of acute respiratory tract infections at Shiraz (a city in southern Iran) airport on return from the Hajj during December 2006 to January 2007. They were screened for influenza A and B, parainfluenza 1 to 3, adenovirus, and respiratory syncytial virus (RSV) by viral culture and immunofluorecent staining. Rhinovirus and enterovirus were diagnosed based on reverse transcription polymerase chain reaction methods. RESULTS: The patients aged between 19 and 82 years (mean: 52.4 years) consisting of 135 females and 120 males. Cough in 213(83.5%) and sore throat in 209 (82%) were the most common symptoms. Eighty-three patients (32.5%) had viral pathogens: influenza in 25 (9.8%), parainfluenza in 19 (7.4%), rhinovirus in 15 (5.9%), adenovirus in14 (5.4%), enterovirus in 5 (2%), and RSV in 4 (1.6%) and coinfection with two viruses in 1 patient (0.4%). Influenza virus was identified more in unvaccinated than in vaccinated pilgrims (16.5% vs. 9.2%) but statistically insignificant (p= 0.19). CONCLUSIONS: According to the results, each of the above-mentioned viruses played a role in the development of respiratory diseases among Iranian pilgrims, with influenza virus as the commonest one. Because influenza vaccine could not prevent respiratory infections in Hajj pilgrims statistically, the possibility of the appearance of new drift variants not included in vaccine and also inappropriate vaccine handling and storage might be considered. So it is also advisable to check if the circulating influenza strains were different from the vaccine strains.

Association of H. pylori virulence genes CagA, VacA and UreAB with ulcer and nonulcer diseases in Iranian population.

To evaluate the association of virulence genes CagA, VacA and UreAB of H. pylori with the development of different gastric disorders, polymerase chain reaction was performed on H. pylori organisms isolated from biopsy samples of stomach of patients with ulcerative disease and nonulcerative disease. The difference between the groups was statistically significant (p < 0.05) only for VacA gene. We detected 8 phenotypes, characterized as CagA(+)-VacA(-)-UreAB(+) (phe 1), CagA(-)-VacA(-)-UreAB(-) (phe 2), CagA(+)-VacA(+)-UreAB(-) (phe 3), CagA(+)-VacA(-)-UreAB(+) (phe 4), CagA(-)-VacA(+)-UreAB(+) (phe 5), CagA(+)-VacA(-)-UreAB(-) (phe 6), CagA(-)-VacA(+)-UreAB(-) (phe 7), CagA(-)VacA(-)-UreAB(+) (phe 8). The prevalence of phenotype 1 was significantly higher in the patients with UD than that in the patients with NUD (p < 0.05). These results suggest that in the population under our study, being infected by a H. pylori strain with the genotype CagA(+)-VacA(+)-UreAB(+) may be associated with an increased risk of acquiring an ulcer disease.

Detection of HCMV DNA in placenta, amniotic fluid and fetuses of seropositive women by nested PCR.

Human cytomegalovirus (HCMV) is the most common viral cause of intrauterine infection throughout the world. Its distribution patterns in different clinical samples are poorly understood. This study was performed to determine the frequency of CMV DNA positivity in maternal/fetus sera, placentas and amniotic fluid, together with maternal/fetus serology. Clinical specimens were obtained from 92 pregnant women who delivered by cesarean section. 98% of women and their neonates were HCMV IgG positive and 5.4% of these mothers were IgM positive, while no IgM was detected in neonates of IgM positive mothers. Among the IgG positive mothers, IgM was detected in 3.3% of their fetuses. 5.4% and 3.3% of maternal and fetal sera were HCMV DNA positive, respectively. The three neonates who were positive for HCMV DNA in sera were also positive for HCMV IgM and the PCR of their amnions was positive (p < 0.0001). 9.8% of placenta samples and 4.3% of amniotic fluid specimens were positive for HCMV DNA while among these placenta samples, two amnions were PCR positive (p = 0.046). Our results showed that there is not always a correlation between placenta and amnion infections. This may be due to reactivation of HCMV leading to placenta infection, as all affected placentas do not pass infection to fetuses and amniotic fluids. Detection of HCMV DNA in amnion and fetus plasma and the existence of fetus IgM against HCMV can also occur without clinical symptoms.