Archives of Pediatric Infectious Diseases Archives of Pediatric Infectious Diseases Arch Pediatr Infect Dis http://www.pedinfect.portal.tools 2322-1828 2322-1836 10.5812/pedinfect en jalali 2018 10 20 gregorian 2018 10 20 3 4
en 10.5812/pedinfect.24744 Diffuse Hyperpigmented Subcutaneous Nodules as a Primary Manifestation of Disseminated Bacillus Calmette-Guerin Disease in Young Infants Diffuse Hyperpigmented Subcutaneous Nodules as a Primary Manifestation of Disseminated Bacillus Calmette-Guerin Disease in Young Infants case-report case-report Conclusions

Subcutaneous nodules in the absence of a local reaction at the site of BCG vaccination may be the sole manifestation of disseminated BCG disease.

Case Presentation

We report on an 11-months-old boy with prolonged fever and diffuse hyperpigmented subcutaneous nodules. Due to lymphopenia, oral thrush and severe adverse reaction to BCG vaccination, the possibility of primary immunodeficiency was considered for him and immunological investigations were done.

Introduction

There are increasing reports of serious adverse events of bacillus Calmette-Guerin (BCG) vaccination in infants with unrecognized primary immunodeficiency disorders (PIDs) in our country. Among these adverse events skin manifestations occur less frequently and are less noticed.

Conclusions

Subcutaneous nodules in the absence of a local reaction at the site of BCG vaccination may be the sole manifestation of disseminated BCG disease.

Case Presentation

We report on an 11-months-old boy with prolonged fever and diffuse hyperpigmented subcutaneous nodules. Due to lymphopenia, oral thrush and severe adverse reaction to BCG vaccination, the possibility of primary immunodeficiency was considered for him and immunological investigations were done.

Introduction

There are increasing reports of serious adverse events of bacillus Calmette-Guerin (BCG) vaccination in infants with unrecognized primary immunodeficiency disorders (PIDs) in our country. Among these adverse events skin manifestations occur less frequently and are less noticed.

Mycobacterium Bovis;Skin;Immunologic Deficiency Syndromes Mycobacterium Bovis;Skin;Immunologic Deficiency Syndromes http://www.pedinfect.portal.tools/index.php?page=article&article_id=24744 Sedigheh Rafiei Tabatabaei Sedigheh Rafiei Tabatabaei Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Ali Amanati Ali Amanati Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Amir Oncology Hospital; Address: Fars - Shiraz - Farhang Shahr - against Kosar pool, Fax: +98-7136325655, Postal code: +98-7187915998 Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Amir Oncology Hospital; Address: Fars - Shiraz - Farhang Shahr - against Kosar pool, Fax: +98-7136325655, Postal code: +98-7187915998 Abdollah Karimi Abdollah Karimi Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Kourosh Goudarzipour Kourosh Goudarzipour Pediatric Congenital Hemathologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Congenital Hemathologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Zahra Chavoshzadeh Zahra Chavoshzadeh Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Maryam Kazemi Aghdam Maryam Kazemi Aghdam Pediatric Pathology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Pathology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mohammad Bagher Haghighi Mohammad Bagher Haghighi Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 10.5812/pedinfect.30478 The Importance of Pyrazinamide in Antimycobacterial Combination Therapy of BCG Disease: Do We Need a Treatment Guideline in The Future? The Importance of Pyrazinamide in Antimycobacterial Combination Therapy of BCG Disease: Do We Need a Treatment Guideline in The Future? letter letter BCG Vaccine;Disseminated BCG Infection;Pyrazinamide BCG Vaccine;Disseminated BCG Infection;Pyrazinamide http://www.pedinfect.portal.tools/index.php?page=article&article_id=30478 Ikhwanuliman Putera Ikhwanuliman Putera Faculty of Medicine,University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. Tel: +62-81933815103 Faculty of Medicine,University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. Tel: +62-81933815103 Ikrar Syahmar Ikrar Syahmar Faculty of Medicine,University of Indonesia, Jakarta, Indonesia Faculty of Medicine,University of Indonesia, Jakarta, Indonesia
en 10.5812/pedinfect.23516 Barriers to Breast Feeding: A Review Barriers to Breast Feeding: A Review review-article review-article Conclusions

As available data on the effect of pacifier use is conflicting, and continuation of breast feeding till 6 months of age is crucial for optimal health outcomes in infants, it is prudent to avoid pacifier use totally or at least till breast feeding is established.

Results

Rates of breastfeeding at 6 months were reported to vary from 3% to 95% and EBF from less than 1% to 33% in different parts of the world. A negative association between pacifier use and duration of breastfeeding was reported by 10 authors, with a meta-analysis from Turkey reporting a Risk Ratio of 1.952, 95% CI: 1.662 - 2.293. Some researchers, although observed an association between pacifier use and early cessation of EBF, but refuted a causal relationship.

Context

Exclusive breast feeding, (EBF) protects young infants from infectious illnesses; various factors, including pacifier use, may adversely affect the initiation and duration of breast feeding.

Evidence Acquisition

Mesh terms relating to EBF were used to search articles published in PubMed between 2000 and 2014. In addition to studies done outside Iran, articles from Iran addressing the issue of pacifier use in infants that had not been published in the PubMed, but were collected from Iranian journals, were also included. Regarding pacifier use, search was limited to papers published during the last 5 years.

Conclusions

As available data on the effect of pacifier use is conflicting, and continuation of breast feeding till 6 months of age is crucial for optimal health outcomes in infants, it is prudent to avoid pacifier use totally or at least till breast feeding is established.

Results

Rates of breastfeeding at 6 months were reported to vary from 3% to 95% and EBF from less than 1% to 33% in different parts of the world. A negative association between pacifier use and duration of breastfeeding was reported by 10 authors, with a meta-analysis from Turkey reporting a Risk Ratio of 1.952, 95% CI: 1.662 - 2.293. Some researchers, although observed an association between pacifier use and early cessation of EBF, but refuted a causal relationship.

Context

Exclusive breast feeding, (EBF) protects young infants from infectious illnesses; various factors, including pacifier use, may adversely affect the initiation and duration of breast feeding.

Evidence Acquisition

Mesh terms relating to EBF were used to search articles published in PubMed between 2000 and 2014. In addition to studies done outside Iran, articles from Iran addressing the issue of pacifier use in infants that had not been published in the PubMed, but were collected from Iranian journals, were also included. Regarding pacifier use, search was limited to papers published during the last 5 years.

Breast Feeding;Infant;Pacifier;Infections Breast Feeding;Infant;Pacifier;Infections http://www.pedinfect.portal.tools/index.php?page=article&article_id=23516 Farideh Shiva Farideh Shiva Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences,, Tehran, IR Iran; Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9126789986 Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences,, Tehran, IR Iran; Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9126789986
en 10.5812/pedinfect.27594 Jaundice as an Unusual Presentation of Kawasaki Disease: A Case Report Jaundice as an Unusual Presentation of Kawasaki Disease: A Case Report case-report case-report Conclusions

KD should be kept in mind as one of the causes of childhood acalculous cholestasis, abdominal discomfort and prolonged fever.

Case Presentation

We report a four-year-old boy with fever, abdominal pain, vomiting, jaundice and mild liver enlargement who gradually developed other signs of KD. He was treated by aspirin, intravenous immunoglobulin and finally methylprednisolone pulse therapy with no sequela.

Introduction

Atypical Kawasaki disease (KD) is a diagnostic dilemma. Acute acalculous cholestasis and liver involvement sometimes indicate atypical presentations of KD.

Conclusions

KD should be kept in mind as one of the causes of childhood acalculous cholestasis, abdominal discomfort and prolonged fever.

Case Presentation

We report a four-year-old boy with fever, abdominal pain, vomiting, jaundice and mild liver enlargement who gradually developed other signs of KD. He was treated by aspirin, intravenous immunoglobulin and finally methylprednisolone pulse therapy with no sequela.

Introduction

Atypical Kawasaki disease (KD) is a diagnostic dilemma. Acute acalculous cholestasis and liver involvement sometimes indicate atypical presentations of KD.

Jaundice;Kawasaki Disease;Liver;Cholestasis Jaundice;Kawasaki Disease;Liver;Cholestasis http://www.pedinfect.portal.tools/index.php?page=article&article_id=27594 Ahmad Talebian Ahmad Talebian Department of Pediatrics, Kashan University of Medical Sciences, Kashan, IR Iran Department of Pediatrics, Kashan University of Medical Sciences, Kashan, IR Iran Babak Soltani Babak Soltani Department of Pediatrics, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Pediatrics, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-03155575840, Fax: +98-03155548900 Department of Pediatrics, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Pediatrics, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-03155575840, Fax: +98-03155548900 Mostafa Haji Rezaei Mostafa Haji Rezaei Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
en 10.5812/pedinfect.26552 Acute Focal Bacterial Nephritis Secondary to Vesicoureteric Reflux in a Young Boy Acute Focal Bacterial Nephritis Secondary to Vesicoureteric Reflux in a Young Boy case-report case-report Conclusions

Timely detection and appropriate antibiotic therapy of AFBN are essential to prevent renal abscess formation. A possible diagnosis of AFBN needs to be considered in all patients being treated for febrile UTI. Detection and surgical correction of the underlying malformation are necessary to prevent further recurrences.

Case Presentation

Here we describe a case of a 4-year-old boy admitted for a febrile urinary tract infection (UTI). Radiological investigations led to a diagnosis of AFBN. He was later found to also have a pre-existing malformative uropathy.

Introduction

Acute focal bacterial nephritis (AFBN), previously called acute lobar nephronia, is a rare form of interstitial bacterial nephritis in children. The majority of patients with AFBN have an underlying urinary tract abnormality. Timely initiation of appropriate antimicrobial therapy can prevent abscess formation and help avoid the need for invasive surgical procedures.

Conclusions

Timely detection and appropriate antibiotic therapy of AFBN are essential to prevent renal abscess formation. A possible diagnosis of AFBN needs to be considered in all patients being treated for febrile UTI. Detection and surgical correction of the underlying malformation are necessary to prevent further recurrences.

Case Presentation

Here we describe a case of a 4-year-old boy admitted for a febrile urinary tract infection (UTI). Radiological investigations led to a diagnosis of AFBN. He was later found to also have a pre-existing malformative uropathy.

Introduction

Acute focal bacterial nephritis (AFBN), previously called acute lobar nephronia, is a rare form of interstitial bacterial nephritis in children. The majority of patients with AFBN have an underlying urinary tract abnormality. Timely initiation of appropriate antimicrobial therapy can prevent abscess formation and help avoid the need for invasive surgical procedures.

Nephritis;Urinary Tract Infections;Vesicoureteric Reflux;Child Nephritis;Urinary Tract Infections;Vesicoureteric Reflux;Child http://www.pedinfect.portal.tools/index.php?page=article&article_id=26552 Rajesh Kumar Rajesh Kumar Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India Devi Dayal Devi Dayal Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Tel: +91-1722755657, Fax: +91-1722744401 Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Tel: +91-1722755657, Fax: +91-1722744401 Anju Gupta Anju Gupta Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India Rakesh Kumar Rakesh Kumar Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India Kushaljit Singh Sodhi Kushaljit Singh Sodhi Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India Anish Bhattacharya Anish Bhattacharya Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
en 10.5812/pedinfect.30632 SCCmec Typing of Methicillin-Resistant Staphylococcus aureus: An Eight Year Experience SCC<italic>mec</italic> Typing of Methicillin-Resistant <italic>Staphylococcus aureus</italic>: An Eight Year Experience research-article research-article Conclusions

As about 70% of methicillin-resistant isolates belonged to SCCmec III, the present study can conclude that, over an 8-year period, only one dominant and stable clone of MRSA strain was found in Tabriz hospitals. This finding could be a result of incorrect medical orientations, inadequate infection controlling policies, and insufficient preventive approaches.

Objectives

The current study aimed to evaluate the different SCCmec types in MRSA isolates from hospitals of Tabriz, by staphylococcal cassette chromosome mec (SCCmec) typing.

Materials and Methods

The present descriptive and retrospective study was performed on 151 selected S. aureus isolates obtained from clinical specimens who were referred to Tabriz university of medical sciences educational-health care centers from April 2005 to September 2012. MRSA isolates were identified by agar disk diffusion and mecA PCR assays. Ultimately, they were typified according to the genetic diversity of the chromosome cassette of SCCmec and ccr regions.

Results

Of the 151 isolates, 53 were recognized as MRSA. All of these 53 samples were sensitive to teicoplanin and vancomycin. Antibiotic resistance patterns were as follows: azithromycin 56.6%, ciprofloxacin 28.3%, imipenem 11.3%, meropenem 9.4%, ofloxacin 13.2%, ceftriaxone 66%, cotrimoxazole 49.1%, gentamicin 52.8%, linezolid 11.3%, penicillin 90.6%, and rifampicin 5.7%. The majority of MRSA isolates belonged to SCCmec III (69.8%) followed by SCCmec IVc (7.5%), SCCmec IVa (3.8%), and SCCmec I (1.9%). Other types of SCCmec were not observed in the present study. Moreover, from the 53 MRSA samples, 9 were recognized as non-typable. However, staphylococcal cassette chromosome recombinase (ccr ) genetic complex analysis revealed that among the 53 studied samples, 4 isolates had ccr type 1 pattern, and 11 and 32 isolates had ccr type 2 and ccr type 3 pattern, respectively. Furthermore, 6 isolates were considered as non-typable with ccr -typing.

Background

Methicillin resistant Staphylococcus aureus strains (MRSA) are important pathogens that cause serious diseases in humans. Throughout the recent years, the spread of these strains has increased in medical environments and society, and has become a serious challenge in health systems. Therefore, it is vital to investigate the various MRSA types to identify the origins of the infections and to control the spread of these infections in hospitals.

Conclusions

As about 70% of methicillin-resistant isolates belonged to SCCmec III, the present study can conclude that, over an 8-year period, only one dominant and stable clone of MRSA strain was found in Tabriz hospitals. This finding could be a result of incorrect medical orientations, inadequate infection controlling policies, and insufficient preventive approaches.

Objectives

The current study aimed to evaluate the different SCCmec types in MRSA isolates from hospitals of Tabriz, by staphylococcal cassette chromosome mec (SCCmec) typing.

Materials and Methods

The present descriptive and retrospective study was performed on 151 selected S. aureus isolates obtained from clinical specimens who were referred to Tabriz university of medical sciences educational-health care centers from April 2005 to September 2012. MRSA isolates were identified by agar disk diffusion and mecA PCR assays. Ultimately, they were typified according to the genetic diversity of the chromosome cassette of SCCmec and ccr regions.

Results

Of the 151 isolates, 53 were recognized as MRSA. All of these 53 samples were sensitive to teicoplanin and vancomycin. Antibiotic resistance patterns were as follows: azithromycin 56.6%, ciprofloxacin 28.3%, imipenem 11.3%, meropenem 9.4%, ofloxacin 13.2%, ceftriaxone 66%, cotrimoxazole 49.1%, gentamicin 52.8%, linezolid 11.3%, penicillin 90.6%, and rifampicin 5.7%. The majority of MRSA isolates belonged to SCCmec III (69.8%) followed by SCCmec IVc (7.5%), SCCmec IVa (3.8%), and SCCmec I (1.9%). Other types of SCCmec were not observed in the present study. Moreover, from the 53 MRSA samples, 9 were recognized as non-typable. However, staphylococcal cassette chromosome recombinase (ccr ) genetic complex analysis revealed that among the 53 studied samples, 4 isolates had ccr type 1 pattern, and 11 and 32 isolates had ccr type 2 and ccr type 3 pattern, respectively. Furthermore, 6 isolates were considered as non-typable with ccr -typing.

Background

Methicillin resistant Staphylococcus aureus strains (MRSA) are important pathogens that cause serious diseases in humans. Throughout the recent years, the spread of these strains has increased in medical environments and society, and has become a serious challenge in health systems. Therefore, it is vital to investigate the various MRSA types to identify the origins of the infections and to control the spread of these infections in hospitals.

MRSA;SCCmec Typing;ccr Typing;Multiplex-PCR MRSA;SCCmec Typing;ccr Typing;Multiplex-PCR http://www.pedinfect.portal.tools/index.php?page=article&article_id=30632 Mohammad Fateh Amirkhiz Mohammad Fateh Amirkhiz Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran Mohammad Ahangarzadeh Rezaee Mohammad Ahangarzadeh Rezaee Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran; Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-41-33364661, Fax: +98-41-33364661 Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran; Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-41-33364661, Fax: +98-41-33364661 Alka Hasani Alka Hasani Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran; Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran; Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran Mohammad Aghazadeh Mohammad Aghazadeh Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran Behrooz Naghili Behrooz Naghili Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
en 10.5812/pedinfect.28054 Incidence of Acute Diarrhea Among Children Aged 0 - 1 Year in Southern Brazil, 2012 Incidence of Acute Diarrhea Among Children Aged 0 - 1 Year in Southern Brazil, 2012 research-article research-article Conclusions

The high incidence density of diarrhea among the children recruited in this study indicates the need for educational programs directed at people who are involved in this issue.

Results

The incidence of acute diarrhea among the 0 - 1-year-old children was 26.7 cases per 1,000 children per month. Independent risk factors for the occurrence of diarrhea were maternal age under 20 years and health care services provided by the Brazilian National Health System (SUS).

Objectives

The aim of this study was to estimate the incidence and risk factors for acute diarrheal disease in children aged 0 - 1 year.

Patients and Methods

An observational prospective cohort study was conducted on 210 children recruited at Hospital Nossa Senhora da Conceicao, in Tubarao, state of Santa Catarina, Brazil. Children born between July and September 2012 were followed up for 12 months. The presence of three or more liquid or loose stools during a 24-hour period was considered acute diarrhea. The categories of variables evaluated were comprised of sociodemographic characteristics (per capita income, maternal education, maternal age, access to medical care [public or private], and housing and living conditions [sanitation and hygiene, water supply, daycare attendance, and domestic animal]) and characteristics of the child (gender, birth weight, and breastfeeding).

Background

The incidence rate of acute diarrheal disease in children is a health indicator, and the estimation of these data can help guide public health policies.

Conclusions

The high incidence density of diarrhea among the children recruited in this study indicates the need for educational programs directed at people who are involved in this issue.

Results

The incidence of acute diarrhea among the 0 - 1-year-old children was 26.7 cases per 1,000 children per month. Independent risk factors for the occurrence of diarrhea were maternal age under 20 years and health care services provided by the Brazilian National Health System (SUS).

Objectives

The aim of this study was to estimate the incidence and risk factors for acute diarrheal disease in children aged 0 - 1 year.

Patients and Methods

An observational prospective cohort study was conducted on 210 children recruited at Hospital Nossa Senhora da Conceicao, in Tubarao, state of Santa Catarina, Brazil. Children born between July and September 2012 were followed up for 12 months. The presence of three or more liquid or loose stools during a 24-hour period was considered acute diarrhea. The categories of variables evaluated were comprised of sociodemographic characteristics (per capita income, maternal education, maternal age, access to medical care [public or private], and housing and living conditions [sanitation and hygiene, water supply, daycare attendance, and domestic animal]) and characteristics of the child (gender, birth weight, and breastfeeding).

Background

The incidence rate of acute diarrheal disease in children is a health indicator, and the estimation of these data can help guide public health policies.

Diarrhea;Children;Risk Factors Diarrhea;Children;Risk Factors http://www.pedinfect.portal.tools/index.php?page=article&article_id=28054 Deisy da Silva Fernandes Nascimento Deisy da Silva Fernandes Nascimento Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarao, Santa Catarina, Brazil Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarao, Santa Catarina, Brazil Ana Luisa Oenning Martins Ana Luisa Oenning Martins Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarao, Santa Catarina, Brazil Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarao, Santa Catarina, Brazil Fabiana Schuelter-Trevisol Fabiana Schuelter-Trevisol Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarao, Santa Catarina, Brazil; Clinical Research Center, Hospital Nossa Senhora da Conceicao, Tubarao, Santa Catarina, Brazil; Clinical Research Center, Hospital Nossa Senhora da Conceicao, Tubarao, Santa Catarina, Brazil. Tel: 55-4836213363 Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Tubarao, Santa Catarina, Brazil; Clinical Research Center, Hospital Nossa Senhora da Conceicao, Tubarao, Santa Catarina, Brazil; Clinical Research Center, Hospital Nossa Senhora da Conceicao, Tubarao, Santa Catarina, Brazil. Tel: 55-4836213363
en 10.5812/pedinfect.30462 Drug Resistant Tuberculosis: Gold, Glitter and Hope Drug Resistant Tuberculosis: Gold, Glitter and Hope letter letter Tuberculosis;Multidrug-Resistant Tuberculosis;Bedaquiline;Risk Benefit Assessment Tuberculosis;Multidrug-Resistant Tuberculosis;Bedaquiline;Risk Benefit Assessment http://www.pedinfect.portal.tools/index.php?page=article&article_id=30462 Eduardo Lopez Briz Eduardo Lopez Briz Department of Pharmacy, Hospital Universitario y Politecnico La Fe, Valencia, Spain; Department of Pharmacy, Hospital Universitario y Politecnico La Fe, Valencia, Spain. Tel: +34-678543696 Department of Pharmacy, Hospital Universitario y Politecnico La Fe, Valencia, Spain; Department of Pharmacy, Hospital Universitario y Politecnico La Fe, Valencia, Spain. Tel: +34-678543696 Yolanda Borrego Izquierdo Yolanda Borrego Izquierdo Department of Pharmacy, Hospital Universitario de Valme, Sevilla, Spain Department of Pharmacy, Hospital Universitario de Valme, Sevilla, Spain
en 10.5812/pedinfect.21234 Candida Colonization in Low Birth Weight and Very Low Birth Weight Infants in a Neonatal Intensive Care Unit Candida Colonization in Low Birth Weight and Very Low Birth Weight Infants in a Neonatal Intensive Care Unit research-article research-article Conclusions

These results show that maturity and birth weight are related to a decrease in the risk of developing a candidiasis infection.

Objectives

The purpose of this study was to determine the rate, risk factors, and sources of colonization in low birth weight (LBW) and very low birth weight (VLBW) infants in an NICU.

Patients and Methods

All cases were classified in to 1 of 2 groups: LBW and VLBW. A questionnaire that collected demographic data was completed for each case. Swabs were obtained from the ear, umbilicus, and rectum, as well as catheters, tracheal tubes, and nasogastric tubes. Samples were cultured on Sabouraud dextrose agar. The data were analyzed using SPSS software. A P value < 0.05 was considered significant.

Results

A total of 102 cases were examined in this study. The mean weight of the infants was 1720 ± 474 gr (range 850 - 2500 gr). Positive Candida cultures were isolated in 19 (31.7%) cases in the LBW group and 20 (47.6%) cases in the VLBW group. In addition, 36 (35.3%) cases showed signs of sepsis. The mortality rate was 1.7% (n = 1). The umbilicus and rectum were the most common sites for Candida colonization in both groups. The analysis also indicated that the duration of hospitalization, prolonged use of corticosteroids, central venous catheters, total parenteral nutrition, and mechanical ventilation were associated with candidiasis infection in VLBW infants while prolonged use of corticosteroids and central venous catheters were major risk factors associated with candidiasis infection in LBW infants.

Background

Candida colonization is a major risk factor for invasive candidiasis in premature infants in the neonatal intensive care unit (NICU).

Conclusions

These results show that maturity and birth weight are related to a decrease in the risk of developing a candidiasis infection.

Objectives

The purpose of this study was to determine the rate, risk factors, and sources of colonization in low birth weight (LBW) and very low birth weight (VLBW) infants in an NICU.

Patients and Methods

All cases were classified in to 1 of 2 groups: LBW and VLBW. A questionnaire that collected demographic data was completed for each case. Swabs were obtained from the ear, umbilicus, and rectum, as well as catheters, tracheal tubes, and nasogastric tubes. Samples were cultured on Sabouraud dextrose agar. The data were analyzed using SPSS software. A P value < 0.05 was considered significant.

Results

A total of 102 cases were examined in this study. The mean weight of the infants was 1720 ± 474 gr (range 850 - 2500 gr). Positive Candida cultures were isolated in 19 (31.7%) cases in the LBW group and 20 (47.6%) cases in the VLBW group. In addition, 36 (35.3%) cases showed signs of sepsis. The mortality rate was 1.7% (n = 1). The umbilicus and rectum were the most common sites for Candida colonization in both groups. The analysis also indicated that the duration of hospitalization, prolonged use of corticosteroids, central venous catheters, total parenteral nutrition, and mechanical ventilation were associated with candidiasis infection in VLBW infants while prolonged use of corticosteroids and central venous catheters were major risk factors associated with candidiasis infection in LBW infants.

Background

Candida colonization is a major risk factor for invasive candidiasis in premature infants in the neonatal intensive care unit (NICU).

Candida;Neonatal Intensive Care Units;Risk Factor Candida;Neonatal Intensive Care Units;Risk Factor http://www.pedinfect.portal.tools/index.php?page=article&article_id=21234 Mehran Noori Sanami Mehran Noori Sanami Department of Infectious Diseases, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Infectious Diseases, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mitra Radfar Mitra Radfar Department of Neonatal Diseases, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Neonatal Diseases, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9124963019, Fax: +98-8646342678 Department of Neonatal Diseases, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Department of Neonatal Diseases, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9124963019, Fax: +98-8646342678 Fariba Shirvani Fariba Shirvani Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mahmood Nabavi Mahmood Nabavi Department of Infectious Diseases, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Department of Infectious Diseases, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Latif Gachkar Latif Gachkar Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 10.5812/pedinfect.30512 Treatment Outcomes of Adolescents With Drug-Resistant Tuberculosis in Resource-Constrained Settings Treatment Outcomes of Adolescents With Drug-Resistant Tuberculosis in Resource-Constrained Settings letter letter Drug-resistant;Tuberculosis;Adolescents Drug-resistant;Tuberculosis;Adolescents http://www.pedinfect.portal.tools/index.php?page=article&article_id=30512 Vicente Ausina Vicente Ausina Service of Microbiology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Genetic and Microbiology, Universitat Autonoma of Barcelona, School of Medicine, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Department of Genetic and Microbiology, Universitat Autonoma of Barcelona, School of Medicine, Barcelona, Spain. Tel: +93-4978894, Fax: +93-4978895 Service of Microbiology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Genetic and Microbiology, Universitat Autonoma of Barcelona, School of Medicine, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Department of Genetic and Microbiology, Universitat Autonoma of Barcelona, School of Medicine, Barcelona, Spain. Tel: +93-4978894, Fax: +93-4978895 Carlos Rodrigo Carlos Rodrigo Department of Pediatrics, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Pediatrics, Universitat Autonoma of Barcelona, School of Medicine, Barcelona, Spain Department of Pediatrics, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Pediatrics, Universitat Autonoma of Barcelona, School of Medicine, Barcelona, Spain
en 10.5812/pedinfect.32554 Antimicrobial Resistance Patterns of Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus Isolated From Patients With Nosocomial Infections Admitted to Tehran Hospitals Antimicrobial Resistance Patterns of <italic>Acinetobacter baumannii</italic>, <italic>Pseudomonas aeruginosa</italic> and <italic>Staphylococcus aureus</italic> Isolated From Patients With Nosocomial Infections Admitted to Tehran Hospitals research-article research-article Objectives

The aim of this study was to determine the 3 most prevalent bacterial pathogens including Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus causing nosocomial infections and their antimicrobial resistant profiles in patients admitted to three hospitals in Tehran city, Iran.

Materials and Methods

In this cross-sectional study, the A. baumannii, P. aeruginosa and S. aureus isolates were obtained from different samples of patients with nosocomial infections admitted to different wards of three hospitals including Milad, Motahary and Loghman from November 2014 to April 2015. Nosocomial infections were defined as a culture-proven infection, which occurred more than 48 hours after admission. Antimicrobial susceptibility testing was performed using the disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results

In total, 539 samples were collected during the study period from patients with nosocomial infections. Overall, 198, 75 and 98 A. baumannii, P. aeruginosa and S. aureus isolates were obtained, respectively. Cefepim and meropenem were found to be the most effective antibiotics for nosocomial infections caused by S. aureus with only 1 resistant isolate. Resistance to gentamicin and amikacin and susceptibility to cefepim was the highest compared to other antibiotics amongst P. aeruginosa isolates which is in consistent with the fact that cephalosporins remain useful agents for the management of nosocomial infections caused by P. aeruginosa. Acinetobacter baumannii isolates showed lower susceptibility rates to imipenem and ciprofloxacin than other antibiotics with 189 and 187 resistant isolates, respectively; however 155 isolates were susceptible to co-trimoxazole and ceftazidime. The high resistant rate amongst A. baumannii to carbapenems is likely consequence of heavy empirical usage of this group of antibiotics.

Conclusions

The high prevalence of antimicrobial resistance in the hospitals highlights the need for further infection control programs. Future regional epidemiological data on antimicrobial resistance patterns will be required to implement strict national antibiotic policies to restrict the spread of these resistance bugs.

Background

Nosocomial infections constitute a global health problem, leading to a high rate of morbidity and mortality. The choice of antimicrobial treatment for nosocomial infections is often empirical and based on the knowledge of local antimicrobial activity patterns of the most common bacteria causing such infections.

Objectives

The aim of this study was to determine the 3 most prevalent bacterial pathogens including Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus causing nosocomial infections and their antimicrobial resistant profiles in patients admitted to three hospitals in Tehran city, Iran.

Materials and Methods

In this cross-sectional study, the A. baumannii, P. aeruginosa and S. aureus isolates were obtained from different samples of patients with nosocomial infections admitted to different wards of three hospitals including Milad, Motahary and Loghman from November 2014 to April 2015. Nosocomial infections were defined as a culture-proven infection, which occurred more than 48 hours after admission. Antimicrobial susceptibility testing was performed using the disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results

In total, 539 samples were collected during the study period from patients with nosocomial infections. Overall, 198, 75 and 98 A. baumannii, P. aeruginosa and S. aureus isolates were obtained, respectively. Cefepim and meropenem were found to be the most effective antibiotics for nosocomial infections caused by S. aureus with only 1 resistant isolate. Resistance to gentamicin and amikacin and susceptibility to cefepim was the highest compared to other antibiotics amongst P. aeruginosa isolates which is in consistent with the fact that cephalosporins remain useful agents for the management of nosocomial infections caused by P. aeruginosa. Acinetobacter baumannii isolates showed lower susceptibility rates to imipenem and ciprofloxacin than other antibiotics with 189 and 187 resistant isolates, respectively; however 155 isolates were susceptible to co-trimoxazole and ceftazidime. The high resistant rate amongst A. baumannii to carbapenems is likely consequence of heavy empirical usage of this group of antibiotics.

Conclusions

The high prevalence of antimicrobial resistance in the hospitals highlights the need for further infection control programs. Future regional epidemiological data on antimicrobial resistance patterns will be required to implement strict national antibiotic policies to restrict the spread of these resistance bugs.

Background

Nosocomial infections constitute a global health problem, leading to a high rate of morbidity and mortality. The choice of antimicrobial treatment for nosocomial infections is often empirical and based on the knowledge of local antimicrobial activity patterns of the most common bacteria causing such infections.

Nosocomial Infection;A. baumannii;P. aeruginosa;S. aureus;Antimicrobial Drug Resistance Nosocomial Infection;A. baumannii;P. aeruginosa;S. aureus;Antimicrobial Drug Resistance http://www.pedinfect.portal.tools/index.php?page=article&article_id=32554 Shahnaz Armin Shahnaz Armin Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Abdollah Karimi Abdollah Karimi Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Fatemeh Fallah Fatemeh Fallah Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Sedighe Rafiei Tabatabaii Sedighe Rafiei Tabatabaii Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Seyedeh Mahsan Hoseini Alfatemi Seyedeh Mahsan Hoseini Alfatemi Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Parvaneh Khiabanirad Parvaneh Khiabanirad International Branch of Shahid Beheshti University of Medical Sciences, Tehran, IR Iran International Branch of Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Farideh Shiva Farideh Shiva Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Alireza Fahimzad Alireza Fahimzad Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Mohammad Rahbar Mohammad Rahbar Department of Microbiology, Iranian Refrence Health Laboratory, Tehran, IR Iran Department of Microbiology, Iranian Refrence Health Laboratory, Tehran, IR Iran Roxana Mansoorghanaii Roxana Mansoorghanaii Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Fariba Shirvani Fariba Shirvani Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Infections Research Center (PIRC), Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Hamed Abdolghafoorian Hamed Abdolghafoorian Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Raheleh Sadat Sajadi Nia Raheleh Sadat Sajadi Nia Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
en 10.5812/pedinfect.26362 Molecular Detection of blaVEB-1 Beta-Lactamase Encoding Gene Among Extended Spectrum B-Lactamase Positive Wound Isolates of Pseudomonas aeruginosa Molecular Detection of <italic>bla</italic><sub>VEB-1</sub> Beta-Lactamase Encoding Gene Among Extended Spectrum B-Lactamase Positive Wound Isolates of <italic>Pseudomonas aeruginosa</italic> research-article research-article Conclusions

More than behalf of the wound isolates were ESBL positive, and the presence of blaVEB-1 was determined in less than half of these isolates. Fortunately, resistance to imipenem and meropenem was low.

Results

The majority of the wound isolates were resistant to augmentin (90%, n = 80) and cefpodoxime (87.6%, n = 78). However, the majority was susceptible to imipenem and meropenem. Fifty-eight (42%) wound isolates were ESBL positive. The antibiotic resistance amongst ESBL positive isolates was relatively higher than ESBL negative isolates. Twenty-three (40%) ESBL-positive isolates amplified the blaVEB-1 gene.

Materials and Methods

A total of 89 wound isolates of P. aeruginosa were collected from patients (47% (n = 42) were male and 53% (n = 47) were female) at six Iranian hospitals between years 2009 and 2011. Antibiotic susceptibility and phenotypic ESBL production tests were conducted. The combined disk was used to determine ESBLs production. The blaVEB-1 gene was detected with the polymerase chain reaction (PCR).

Objectives

The aim of this study was to detect Extended Spectrum Beta-Lactamases (ESBL) positive wound isolates and the genes encoding blaVEB-1 ESBL among wound isolates of P. aeruginosa.

Background

Pseudomonas aeruginosa is considered as a leading cause of nosocomial infections. Burn and wound infections are mainly caused by multidrug-resistant P. aeruginosa isolates. Drug resistance frequently occurs among nosocomial isolates and can usually resist a myriad of antibiotics such as novel β-lactam antibiotics. Detection of multidrug-resistant isolates could assist better drug administration.

Conclusions

More than behalf of the wound isolates were ESBL positive, and the presence of blaVEB-1 was determined in less than half of these isolates. Fortunately, resistance to imipenem and meropenem was low.

Results

The majority of the wound isolates were resistant to augmentin (90%, n = 80) and cefpodoxime (87.6%, n = 78). However, the majority was susceptible to imipenem and meropenem. Fifty-eight (42%) wound isolates were ESBL positive. The antibiotic resistance amongst ESBL positive isolates was relatively higher than ESBL negative isolates. Twenty-three (40%) ESBL-positive isolates amplified the blaVEB-1 gene.

Materials and Methods

A total of 89 wound isolates of P. aeruginosa were collected from patients (47% (n = 42) were male and 53% (n = 47) were female) at six Iranian hospitals between years 2009 and 2011. Antibiotic susceptibility and phenotypic ESBL production tests were conducted. The combined disk was used to determine ESBLs production. The blaVEB-1 gene was detected with the polymerase chain reaction (PCR).

Objectives

The aim of this study was to detect Extended Spectrum Beta-Lactamases (ESBL) positive wound isolates and the genes encoding blaVEB-1 ESBL among wound isolates of P. aeruginosa.

Background

Pseudomonas aeruginosa is considered as a leading cause of nosocomial infections. Burn and wound infections are mainly caused by multidrug-resistant P. aeruginosa isolates. Drug resistance frequently occurs among nosocomial isolates and can usually resist a myriad of antibiotics such as novel β-lactam antibiotics. Detection of multidrug-resistant isolates could assist better drug administration.

Extended Spectrum Beta Lactamases;Wound Samples;bla VEB-1;Pseudomonase aeruginosa Extended Spectrum Beta Lactamases;Wound Samples;bla VEB-1;Pseudomonase aeruginosa http://www.pedinfect.portal.tools/index.php?page=article&article_id=26362 Elham Davodian Elham Davodian Department of Microbiology, School of Paramedical Sciences, Ilam University of Medical Sciences, Ilam, IR Iran; Department of Microbiology, School of Paramedical Sciences, Ilam University of Medical Sciences, P. O. Box: 6931873911, Ilam, IR Iran. Tel: +98-8413383711, Fax: +98-8413383711 Department of Microbiology, School of Paramedical Sciences, Ilam University of Medical Sciences, Ilam, IR Iran; Department of Microbiology, School of Paramedical Sciences, Ilam University of Medical Sciences, P. O. Box: 6931873911, Ilam, IR Iran. Tel: +98-8413383711, Fax: +98-8413383711 Nourkhoda Sadeghifard Nourkhoda Sadeghifard Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR Iran Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR Iran Abdolmajid Ghasemian Abdolmajid Ghasemian Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran Samileh Noorbakhsh Samileh Noorbakhsh Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, IR Iran Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, IR Iran