Pub Date : 2021-01-09DOI: 10.5812/PEDINFECT.106597
M. Mohkam, M. Mirzaee, Fatemeh Abdollah Gorgi, Sedigheh Rafiei Tabatabaei, A. Karimi, S. Armin, Roxana Mansour Ghanaie, S. Fahimzad, Zahra Pournasiri, Seyed Mohammad Taghi Hosseini Tabatabaei, N. Esfandiar, R. Dalirani, E. Pourbakhtyaran, Ayeh Yaraghi, Fereshteh Karbasian
Background: Information about renal involvement in pediatric patients with COVID-19 is limited, and there is not enough data about renal and urinary tract involvement in children infected with this novel virus. Objectives: This study aimed to determine the spectrum of kidney diseases in pediatric patients with COVID-19, admitted to a tertiary children’s hospital. Methods: This cross-sectional study was conducted on 71 pediatric patients with COVID-19 infection. Diagnosis of COVID-19 was established based on the guidelines by the Iranian Ministry of Health. The patients’ demographic characteristics, clinical symptoms, laboratory results, and renal ultrasonography findings were extracted from the hospital medical records. Results: On admission, 10% of patients had oliguria, 7.7% had edema, and 3% had hypertension. The first urinalysis indicated proteinuria, leukocyturia, and hematuria in 46%, 24%, and 23% of the patients, respectively. Overall, 40.7% of the patients showed some degree of renal involvement. During hospitalization, acute kidney injury (AKI) occurred in 34.5% of the patients. Based on the pediatric risk, injury, failure, loss of kidney function, and end-stage kidney disease (pRIFLE) classification, stage I (risk group) was found in 20% of patients, stage II (injury group) in 25% of patients, and stage III (failure group) in 55% of patients with AKI. The total mortality rate was estimated at 12.67%, and the incidence of in-hospital death was 30% in pediatric patients with severe COVID-19 infection associated with AKI. Conclusions: The prevalence of AKI was high in patients with COVID-19 infection hospitalized in our tertiary hospital. We also found that a decrease in renal function was associated with a higher risk of mortality. Overall, early detection of AKI and effective treatment may help reduce mortality in patients with COVID-19.
{"title":"Renal Involvement in COVID-19 Among Iranian Children","authors":"M. Mohkam, M. Mirzaee, Fatemeh Abdollah Gorgi, Sedigheh Rafiei Tabatabaei, A. Karimi, S. Armin, Roxana Mansour Ghanaie, S. Fahimzad, Zahra Pournasiri, Seyed Mohammad Taghi Hosseini Tabatabaei, N. Esfandiar, R. Dalirani, E. Pourbakhtyaran, Ayeh Yaraghi, Fereshteh Karbasian","doi":"10.5812/PEDINFECT.106597","DOIUrl":"https://doi.org/10.5812/PEDINFECT.106597","url":null,"abstract":"Background: Information about renal involvement in pediatric patients with COVID-19 is limited, and there is not enough data about renal and urinary tract involvement in children infected with this novel virus. Objectives: This study aimed to determine the spectrum of kidney diseases in pediatric patients with COVID-19, admitted to a tertiary children’s hospital. Methods: This cross-sectional study was conducted on 71 pediatric patients with COVID-19 infection. Diagnosis of COVID-19 was established based on the guidelines by the Iranian Ministry of Health. The patients’ demographic characteristics, clinical symptoms, laboratory results, and renal ultrasonography findings were extracted from the hospital medical records. Results: On admission, 10% of patients had oliguria, 7.7% had edema, and 3% had hypertension. The first urinalysis indicated proteinuria, leukocyturia, and hematuria in 46%, 24%, and 23% of the patients, respectively. Overall, 40.7% of the patients showed some degree of renal involvement. During hospitalization, acute kidney injury (AKI) occurred in 34.5% of the patients. Based on the pediatric risk, injury, failure, loss of kidney function, and end-stage kidney disease (pRIFLE) classification, stage I (risk group) was found in 20% of patients, stage II (injury group) in 25% of patients, and stage III (failure group) in 55% of patients with AKI. The total mortality rate was estimated at 12.67%, and the incidence of in-hospital death was 30% in pediatric patients with severe COVID-19 infection associated with AKI. Conclusions: The prevalence of AKI was high in patients with COVID-19 infection hospitalized in our tertiary hospital. We also found that a decrease in renal function was associated with a higher risk of mortality. Overall, early detection of AKI and effective treatment may help reduce mortality in patients with COVID-19.","PeriodicalId":44261,"journal":{"name":"Archives of Pediatric Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45879323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Blastocystis spp. is known as one of the few intestinal parasites, prevalent in more than 5% and 30 - 60% of the population in industrialized and developing countries, respectively. In this respect, immunocompromised individuals, such as patients undergoing chemotherapy or those with malignancies, are at risk of the clinical symptoms of Blastocystis infection; however, the given condition is often self-limiting in healthy individuals. Objectives: The current study aimed at evaluating the prevalence of Blastocystis infection in children with malignancies receiving chemo drugs. Methods: The current descriptive, cross-sectional study was conducted on 52 stool specimens collected from patients with cancer admitted to the Oncology Ward of Shahid Baqaei 2 Hospital, Ahvaz, Iran, for six months. A standardized questionnaire was filled out for all cases. Each specimen was also prepared using direct smear, the Lugol iodine staining, and the formalin-ether condensation method. Results: Blastocystis spp. was detected in 21.1% of the cases among them, 11.5% demonstrated gastrointestinal symptoms; therefore, a significant relationship was observed between Blastocystis infection and gastrointestinal symptoms. Conclusion: Patients undergoing chemotherapy should be screened for opportunistic parasitic infections such as Blastocystis to avoid potentially life-threatening outcomes. Besides, further studies are required to identify the subtypes of Blastocystis.
{"title":"The Prevalence of Blastocystis Infection in Pediatric Patients with Malignancy: A Single-Center Study in Ahvaz, Iran","authors":"Roya Salehi Kahish, Arash Alghasi, S. Hadadi, Marziyeh Abasi Nasab, Aida Mafakherzadeh","doi":"10.5812/pedinfect.104068","DOIUrl":"https://doi.org/10.5812/pedinfect.104068","url":null,"abstract":"Background: Blastocystis spp. is known as one of the few intestinal parasites, prevalent in more than 5% and 30 - 60% of the population in industrialized and developing countries, respectively. In this respect, immunocompromised individuals, such as patients undergoing chemotherapy or those with malignancies, are at risk of the clinical symptoms of Blastocystis infection; however, the given condition is often self-limiting in healthy individuals. Objectives: The current study aimed at evaluating the prevalence of Blastocystis infection in children with malignancies receiving chemo drugs. Methods: The current descriptive, cross-sectional study was conducted on 52 stool specimens collected from patients with cancer admitted to the Oncology Ward of Shahid Baqaei 2 Hospital, Ahvaz, Iran, for six months. A standardized questionnaire was filled out for all cases. Each specimen was also prepared using direct smear, the Lugol iodine staining, and the formalin-ether condensation method. Results: Blastocystis spp. was detected in 21.1% of the cases among them, 11.5% demonstrated gastrointestinal symptoms; therefore, a significant relationship was observed between Blastocystis infection and gastrointestinal symptoms. Conclusion: Patients undergoing chemotherapy should be screened for opportunistic parasitic infections such as Blastocystis to avoid potentially life-threatening outcomes. Besides, further studies are required to identify the subtypes of Blastocystis.","PeriodicalId":44261,"journal":{"name":"Archives of Pediatric Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46169954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-03DOI: 10.5812/pedinfect.110479
Roxana Mansour Ghanaie, A. Karimi, Z. Pourmoghaddas, S. Armin, S. Fahimzad, F. Fallah, Katayoun Tayeri, M. Sabri, H. Rahimi, A. Zeinaloo, Seyedeh Mahsan Hoseinialfatemi, V. Ziaee, R. Shiari, Bahador Mirrahimi, A. Saffaei, Sedigheh Rafiei Tabatabaei
{"title":"An Algorithmic Approach to Management of COVID-19 Associated Multisystem Inflammatory Syndrome in Children","authors":"Roxana Mansour Ghanaie, A. Karimi, Z. Pourmoghaddas, S. Armin, S. Fahimzad, F. Fallah, Katayoun Tayeri, M. Sabri, H. Rahimi, A. Zeinaloo, Seyedeh Mahsan Hoseinialfatemi, V. Ziaee, R. Shiari, Bahador Mirrahimi, A. Saffaei, Sedigheh Rafiei Tabatabaei","doi":"10.5812/pedinfect.110479","DOIUrl":"https://doi.org/10.5812/pedinfect.110479","url":null,"abstract":"<jats:p />","PeriodicalId":44261,"journal":{"name":"Archives of Pediatric Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49236744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-03DOI: 10.5812/pedinfect.109843
Anahita Sanaei Dashti, S. S. Dehghani, H. Moravej, Seyyedeh Narjes Abootalebi
: Coronavirus disease 2019 (COVID-19) was officially declared as a pandemic on March 11, 2020. Although most patients with COVID-19 manifest fever and respiratory tract symptoms, extrapulmonary and atypical presentations, such as gastrointestinal, neurologic, and cardiovascular involvement as well as thromboembolic events have been reported amongst COVID-19 patients. Herein, we aim to describe a COVID-19 patient who progressed to purpura fulminans.
{"title":"Association of COVID-19 Infection and Purpura Fulminans","authors":"Anahita Sanaei Dashti, S. S. Dehghani, H. Moravej, Seyyedeh Narjes Abootalebi","doi":"10.5812/pedinfect.109843","DOIUrl":"https://doi.org/10.5812/pedinfect.109843","url":null,"abstract":": Coronavirus disease 2019 (COVID-19) was officially declared as a pandemic on March 11, 2020. Although most patients with COVID-19 manifest fever and respiratory tract symptoms, extrapulmonary and atypical presentations, such as gastrointestinal, neurologic, and cardiovascular involvement as well as thromboembolic events have been reported amongst COVID-19 patients. Herein, we aim to describe a COVID-19 patient who progressed to purpura fulminans.","PeriodicalId":44261,"journal":{"name":"Archives of Pediatric Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48230156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.5812/PEDINFECT.111172
Sara Himri, B. Oumokhtar, S. Atmani, B. Arhoune, K. Moutaouakkil, B. J. Diagne, S. Fakir
Background: Streptococcus pyogenes is responsible for a wide variety of diseases, including noninvasive and severe invasive infections. The emm gene encodes the M protein that is the avirulence factor and immunological determinant of group A streptococci. Emm typing is the group A Streptococci (GAS) standard molecular typing method based on the amplification of the N terminal hypervariable region of the emm gene. Objectives: The aim of the present study was to determine the prevalence of GAS in children with pharyngitis and determine different types of emm gene in the GAS isolates using emm typing. Methods: The study was carried out over a period of 14 months (from February 2017 to March 2018). Throat samples were collected from cases aged ≤ 18 years with pharyngitis referring to a primary health care center in Fez, Morocco. GAS isolates were subjected to conventional tests to confirm species identification. Antimicrobial susceptibility testing was performed using the standard disk diffusion method. We researched emm gene by a polymerase chain reaction (PCR). Emm types were determined by a sequence-based protocol. Demographic and clinical data were recorded from each patient. Results: From a total of 177 throat samples, 11 isolates (6.2%) were identified as GAS in children with pharyngitis. Antibiotic sensitivity testing revealed that all the GAS isolates were sensitive to penicillin. The sequencing of the PCR products of the emm gene revealed that emm90 was the most obtained emm type (30,77%); while emm75 was the least type observed (7.7%). Conclusions: The emm90 is the most prevalent type detected from patients with tonsillitis. Penicillin and erythromycin are still the foremost effective antibiotics to treat GAS pharyngitis.
{"title":"Prevalence of Group A Streptococci in Moroccan Children with Pharyngitis and Emm Type Distribution","authors":"Sara Himri, B. Oumokhtar, S. Atmani, B. Arhoune, K. Moutaouakkil, B. J. Diagne, S. Fakir","doi":"10.5812/PEDINFECT.111172","DOIUrl":"https://doi.org/10.5812/PEDINFECT.111172","url":null,"abstract":"Background: Streptococcus pyogenes is responsible for a wide variety of diseases, including noninvasive and severe invasive infections. The emm gene encodes the M protein that is the avirulence factor and immunological determinant of group A streptococci. Emm typing is the group A Streptococci (GAS) standard molecular typing method based on the amplification of the N terminal hypervariable region of the emm gene. Objectives: The aim of the present study was to determine the prevalence of GAS in children with pharyngitis and determine different types of emm gene in the GAS isolates using emm typing. Methods: The study was carried out over a period of 14 months (from February 2017 to March 2018). Throat samples were collected from cases aged ≤ 18 years with pharyngitis referring to a primary health care center in Fez, Morocco. GAS isolates were subjected to conventional tests to confirm species identification. Antimicrobial susceptibility testing was performed using the standard disk diffusion method. We researched emm gene by a polymerase chain reaction (PCR). Emm types were determined by a sequence-based protocol. Demographic and clinical data were recorded from each patient. Results: From a total of 177 throat samples, 11 isolates (6.2%) were identified as GAS in children with pharyngitis. Antibiotic sensitivity testing revealed that all the GAS isolates were sensitive to penicillin. The sequencing of the PCR products of the emm gene revealed that emm90 was the most obtained emm type (30,77%); while emm75 was the least type observed (7.7%). Conclusions: The emm90 is the most prevalent type detected from patients with tonsillitis. Penicillin and erythromycin are still the foremost effective antibiotics to treat GAS pharyngitis.","PeriodicalId":44261,"journal":{"name":"Archives of Pediatric Infectious Diseases","volume":"113 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71291712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-27DOI: 10.5812/pedinfect.110201
A. Karimi, Roxana Mansour Ghanaie, M. Masjedi, S. Fahimzad, Sedigheh Rafiei Tabatabaei, S. Armin, F. Fallah, Katayoun Tayeri, Mahboobeh Haji Abdolbaghi, A. Shirvani, A. Bidari, M. Mokhtari, M. Sarmadi, Maryam Rajabnejad
Context: In the era of the SARS-CoV-2 virus pandemic, new scoring systems need to be developed to estimate the risk of COVID-19 complications aiding in the accurate prognosis. Improved scoring systems by combining multiple variables allow clinicians to optimize the allocation of limited medical resources for the best clinical outcomes. Methods: Published articles were selected that assessed the relationship between clinical, para-clinical, demographics, co-morbidities, and outcomes of COVID-19 patients in a systematic review to develop a novel scoring system. Results: In this study, by summarizing the results of 97 studies and the experiences of experts, prognostic factors were determined and divided into four groups: Age, clinical symptoms, co-morbidities, and tests. Twenty-three published articles met the selection criteria and were included in this study. Accordingly, by the opinion of experts, prognostic factors were categorized into four main groups: Age, clinical symptoms, co-morbidities, and specific test results. Conclusions: This novel scoring model helps physicians to early identify critical COVID-19 patients and optimize patient management based on recent comprehensive data of the most significant predictive factors.
{"title":"Development of a Novel Scoring System for Comprehensive COVID-19 Patient Evaluation: An Evidence-based Systematic Review","authors":"A. Karimi, Roxana Mansour Ghanaie, M. Masjedi, S. Fahimzad, Sedigheh Rafiei Tabatabaei, S. Armin, F. Fallah, Katayoun Tayeri, Mahboobeh Haji Abdolbaghi, A. Shirvani, A. Bidari, M. Mokhtari, M. Sarmadi, Maryam Rajabnejad","doi":"10.5812/pedinfect.110201","DOIUrl":"https://doi.org/10.5812/pedinfect.110201","url":null,"abstract":"Context: In the era of the SARS-CoV-2 virus pandemic, new scoring systems need to be developed to estimate the risk of COVID-19 complications aiding in the accurate prognosis. Improved scoring systems by combining multiple variables allow clinicians to optimize the allocation of limited medical resources for the best clinical outcomes. Methods: Published articles were selected that assessed the relationship between clinical, para-clinical, demographics, co-morbidities, and outcomes of COVID-19 patients in a systematic review to develop a novel scoring system. Results: In this study, by summarizing the results of 97 studies and the experiences of experts, prognostic factors were determined and divided into four groups: Age, clinical symptoms, co-morbidities, and tests. Twenty-three published articles met the selection criteria and were included in this study. Accordingly, by the opinion of experts, prognostic factors were categorized into four main groups: Age, clinical symptoms, co-morbidities, and specific test results. Conclusions: This novel scoring model helps physicians to early identify critical COVID-19 patients and optimize patient management based on recent comprehensive data of the most significant predictive factors.","PeriodicalId":44261,"journal":{"name":"Archives of Pediatric Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2020-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43620063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-20DOI: 10.5812/pedinfect.107277
Soroosh Salehabadi, Shima Shekari, Shiva Shadani, M. Shoja
Introduction: As COVID-19 spreads rapidly all over the world and nations struggle to control it, the novel presentations of SARS-CoV-2 infection and its possible triggering role for other diseases in pediatrics concern clinicians in frontlines. Case Presentation: We describe a 10-year-old child diagnosed with COVID-19 infection and concurrent Kawasaki disease. He presented with prolonged fever and conjunctivitis. His initial echocardiogram showed coronary artery dilation in RCA. He was treated with IVIG and aspirin as per guidelines and discharged 48 hours after the completion of IVIG and diminishing fever. His follow-up echocardiogram showed improvement in a two weeks’ interval while he was quarantined in the meantime and showed no respiratory complications. Conclusions: In conclusion, we think that there might be a correlation between COVID-19 infection and hyperinflammatory conditions, like Kawasaki disease. Further investigations are needed to enlighten the complications caused by COVID-19 infection, especially in pediatrics. In addition, we emphasize follow-up visits (in person or long-distance) in pediatrics presenting with inflammatory symptoms.
{"title":"A Case Report of Pediatric Kawasaki Disease and COVID-19 Association","authors":"Soroosh Salehabadi, Shima Shekari, Shiva Shadani, M. Shoja","doi":"10.5812/pedinfect.107277","DOIUrl":"https://doi.org/10.5812/pedinfect.107277","url":null,"abstract":"Introduction: As COVID-19 spreads rapidly all over the world and nations struggle to control it, the novel presentations of SARS-CoV-2 infection and its possible triggering role for other diseases in pediatrics concern clinicians in frontlines. Case Presentation: We describe a 10-year-old child diagnosed with COVID-19 infection and concurrent Kawasaki disease. He presented with prolonged fever and conjunctivitis. His initial echocardiogram showed coronary artery dilation in RCA. He was treated with IVIG and aspirin as per guidelines and discharged 48 hours after the completion of IVIG and diminishing fever. His follow-up echocardiogram showed improvement in a two weeks’ interval while he was quarantined in the meantime and showed no respiratory complications. Conclusions: In conclusion, we think that there might be a correlation between COVID-19 infection and hyperinflammatory conditions, like Kawasaki disease. Further investigations are needed to enlighten the complications caused by COVID-19 infection, especially in pediatrics. In addition, we emphasize follow-up visits (in person or long-distance) in pediatrics presenting with inflammatory symptoms.","PeriodicalId":44261,"journal":{"name":"Archives of Pediatric Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2020-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46738960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-19DOI: 10.5812/pedinfect.111434
S. Mostafavi, Atefeh Sadeghizadeh, Sharareh Babaei, Rana Saleh, A. Dehghan, S. Tavakoli, Z. Pourmoghaddas
: The coronavirus disease 2019 (COVID-19) pandemic has imposed a significant burden worldwide, manifesting as a severe disease and causing mortality even in children. Severe COVID-19 disease is characterized by cytokine storm with progression to secondary hemophagocytic lymphohistiocytosis (sHLH). We describe an 18-month-old boy in Iran, previously healthy, diagnosed with COVID-19-induced sHLH. Three weeks after close contact with COVID-19 confirmed cases, he was admitted with high fever, lethargy, mild respiratory distress, skin rash, and conjunctivitis with swollen eyelids and lips. Laboratory data revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and liver enzymes, and mild thrombocytopenia. His clinical condition rapidly deteriorated, with septic shock, hepatosplenomegaly, and respiratory failure. Laboratory tests showed cytopenia, coagulopathy, hyperferritinemia, and hypertriglyceridemia, which met the criteria for sHLH diagnosis. Chest computed tomography (CT) revealed bilateral infiltrations that suggested acute respiratory distress syndrome (ARDS) of COVID-19 that was confirmed by a positive real-time polymerase chain reaction (RT-PCR) test. Therefore, the child was treated with intravenous immunoglobulin (IVIG), glucocorticoid, hydroxychloroquine, lopinavir/ritonavir, and interferonβ-1a. This therapeutic strategy enabled complete recovery from fever, regaining consciousness, weaning from respiratory support, and resolving shock. Serial chest radiographs showed diminishing infiltrations. Sequential physical examinations revealed an overall significant reduction in spleen and liver span. Laboratory data showed rapid improvement from cytopenia and coagulopathy, normalization of liver enzyme levels, and reduction in hyperinflammation markers. Although ARDS is the most common cause of death from COVID-19, other complications such as sHLH may be lethal; thus, early diagnosis and appropriate treatment are necessary for saving patients’ lives.
{"title":"Successful Recovery of a Child with COVID-19-Induced Secondary Hemophagocytic Lymphohistiocytosis","authors":"S. Mostafavi, Atefeh Sadeghizadeh, Sharareh Babaei, Rana Saleh, A. Dehghan, S. Tavakoli, Z. Pourmoghaddas","doi":"10.5812/pedinfect.111434","DOIUrl":"https://doi.org/10.5812/pedinfect.111434","url":null,"abstract":": The coronavirus disease 2019 (COVID-19) pandemic has imposed a significant burden worldwide, manifesting as a severe disease and causing mortality even in children. Severe COVID-19 disease is characterized by cytokine storm with progression to secondary hemophagocytic lymphohistiocytosis (sHLH). We describe an 18-month-old boy in Iran, previously healthy, diagnosed with COVID-19-induced sHLH. Three weeks after close contact with COVID-19 confirmed cases, he was admitted with high fever, lethargy, mild respiratory distress, skin rash, and conjunctivitis with swollen eyelids and lips. Laboratory data revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and liver enzymes, and mild thrombocytopenia. His clinical condition rapidly deteriorated, with septic shock, hepatosplenomegaly, and respiratory failure. Laboratory tests showed cytopenia, coagulopathy, hyperferritinemia, and hypertriglyceridemia, which met the criteria for sHLH diagnosis. Chest computed tomography (CT) revealed bilateral infiltrations that suggested acute respiratory distress syndrome (ARDS) of COVID-19 that was confirmed by a positive real-time polymerase chain reaction (RT-PCR) test. Therefore, the child was treated with intravenous immunoglobulin (IVIG), glucocorticoid, hydroxychloroquine, lopinavir/ritonavir, and interferonβ-1a. This therapeutic strategy enabled complete recovery from fever, regaining consciousness, weaning from respiratory support, and resolving shock. Serial chest radiographs showed diminishing infiltrations. Sequential physical examinations revealed an overall significant reduction in spleen and liver span. Laboratory data showed rapid improvement from cytopenia and coagulopathy, normalization of liver enzyme levels, and reduction in hyperinflammation markers. Although ARDS is the most common cause of death from COVID-19, other complications such as sHLH may be lethal; thus, early diagnosis and appropriate treatment are necessary for saving patients’ lives.","PeriodicalId":44261,"journal":{"name":"Archives of Pediatric Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2020-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47348517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-16DOI: 10.5812/pedinfect.108029
Mohammad Rafi Khourgami, Ali Ershad, K. Mozaffari
Introduction: Myxomas, as primary cardiac tumors, are rare neoplasms manifesting with constitutional, obstructive, and embolic symptoms. Systemic signs and symptoms make infective endocarditis one of the most common differential diagnoses. Nonspecific systemic signs and symptoms of myxomas can cause great challenges in management and treatment. Case Presentation: A 21-month-old boy was admitted to our center with a high-grade fever and gastrointestinal symptoms, but no significant respiratory complaints were noted. A history of lower limb pain and morning claudication was also present. The patient had leukocytosis with an elevated erythrocyte sedimentation rate (ESR) of two months' duration. Other acute phase reactants were detected despite previous antibiotic therapy; however, his blood culture result was negative. In echocardiography, multiple masses were seen in the left atrium near the mitral valve apparatus. The diagnosis of infective endocarditis was made, and intravenous antibiotics were prescribed for up to two weeks. He then underwent surgery because of poor response to medical treatment and renal complications. During surgery, a small mass was seen in the left atrium, and two other masses were within the mitral chordae. The histopathology report confirmed atrial myxoma. Shortly after surgical resection of the tumors, the patient's symptoms improved, and inflammatory indices returned to normal. Conclusions: Constitutional manifestations of myxoma render it reasonable to consider it as a differential diagnosis of infective endocarditis. Obtaining a complete clinical history and using imaging tools are necessary for the correct diagnosis and prevention of complications of inappropriate treatment.
{"title":"Left Atrial Myxoma Misdiagnosis as Infective Endocarditis: A Case Report","authors":"Mohammad Rafi Khourgami, Ali Ershad, K. Mozaffari","doi":"10.5812/pedinfect.108029","DOIUrl":"https://doi.org/10.5812/pedinfect.108029","url":null,"abstract":"Introduction: Myxomas, as primary cardiac tumors, are rare neoplasms manifesting with constitutional, obstructive, and embolic symptoms. Systemic signs and symptoms make infective endocarditis one of the most common differential diagnoses. Nonspecific systemic signs and symptoms of myxomas can cause great challenges in management and treatment. Case Presentation: A 21-month-old boy was admitted to our center with a high-grade fever and gastrointestinal symptoms, but no significant respiratory complaints were noted. A history of lower limb pain and morning claudication was also present. The patient had leukocytosis with an elevated erythrocyte sedimentation rate (ESR) of two months' duration. Other acute phase reactants were detected despite previous antibiotic therapy; however, his blood culture result was negative. In echocardiography, multiple masses were seen in the left atrium near the mitral valve apparatus. The diagnosis of infective endocarditis was made, and intravenous antibiotics were prescribed for up to two weeks. He then underwent surgery because of poor response to medical treatment and renal complications. During surgery, a small mass was seen in the left atrium, and two other masses were within the mitral chordae. The histopathology report confirmed atrial myxoma. Shortly after surgical resection of the tumors, the patient's symptoms improved, and inflammatory indices returned to normal. Conclusions: Constitutional manifestations of myxoma render it reasonable to consider it as a differential diagnosis of infective endocarditis. Obtaining a complete clinical history and using imaging tools are necessary for the correct diagnosis and prevention of complications of inappropriate treatment.","PeriodicalId":44261,"journal":{"name":"Archives of Pediatric Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2020-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42587259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-15DOI: 10.5812/PEDINFECT.108769
T. Fathi Najafi, S. Dashti, N. Bahri
Context: Evidence regarding the vertical transmission of COVID-19 from infected pregnant women to the fetus are not sufficient. Methods: The current study intended to systematically assess the possibility of vertical transmission of COVID-19 in published literature. We systematically searched international bibliographic databases, including PubMed, SCOPUS, and Google Scholar, to identify relevant studies from the time of inception of these databases until July 2020. The search strategy was finalized based on the results of the primary search in PubMed. All observational studies, including cross-sectional, cohort, case-control, case reports, and case series, published in peer-reviewed journals in any language. Editorials, commentaries, and letters to editors were excluded. Twenty articles (6 retrospective studies, 2 prospective, one cohort, 9 case reports, and 2 case series) with a total of 145 subjects were eligible for the review. Data were collected based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Results: Methods of assessing COVID-19 included polymerase chain reaction (PCR) analysis of naso/oropharyngeal, vaginal, rectal, urine secretions and gastric and amniotic fluid samples, and serum immunoglobulin (Ig) assays. Vertical transmission was reported in 6 neonates (< 10%), based on PCR, and three were positive based on Ig assays. Conclusions: According to the evidence, the possibility for vertical transmission of COVID-19 is rare.
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