Background. The novel coronavirus disease 2019 (COVID-19) started in Wuhan, China, in December 2019. It spread widely around the world and was described as a pandemic by the World Health Organization (WHO). The knowledge regarding the mortality rate and risk factors of COVID-19 among the pediatric population is lacking. In this regard, we aimed to report the clinical and laboratory characteristics of deceased pediatric patients with SARS-CoV-2 infection. Method. This cross-sectional study was conducted in Mofid Children’s Hospital, Tehran, Iran, from February 2020 to April 2021. Recorded documents of 59 pediatric patients (under 18 years old) assumed to have COVID-19 who had died in the COVID-19 ward and COVID-19 intensive care unit (ICU) were retrospectively evaluated. All statistical analyses were performed using SPSS software (v. 26.0, Chicago, IL). A P value of less than 0.05 was considered statistically significant. Results. From 711 COVID-19 definite and suspected patients, 59 children died. Of these deceased pediatric patients, 34 were boys (57.62%) and 25 were girls (42.37%), with a total mean age of 5.6 years. The median length of stay in the hospital was 10 days (range 1–215). 91.52% had underlying comorbidities of which neurological diseases accounted for the largest share. 54 patients were admitted to the ICU and 83.05% of them had intubation during their hospitalization. In addition, the most common reasons for death in our study were related to respiratory and multiorgan failure. Conclusion. According to our knowledge, we are the first team to report such a thorough study in the field of COVID-19 pediatric mortality in Iran. Mortality was observed in all age groups of children, especially in those with previous comorbidities, specifically neurological disease. Abnormally elevated tests of ESR, CRP, LDH, AST, and ALT as well as the presence of proteinuria and hematuria were found in more than 50% of patients in our investigations, and ICU admission between both definite and suspected groups had significant differences, so monitoring and considering these factors may help to control and reduce the progression of the disease to death.

Objective. In this study, by using clinical and paraclinical characteristics, we have aimed to predict the severity of the disease in hospitalized COVID-19 children. Method. This cross-sectional study was conducted on medical records about epidemiologic data, underlying diseases, symptoms, and laboratory tests from March to October, 2020, on 238 hospitalized confirmed COVID-19 paediatric cases in several children’s hospitals of Tehran, Ahwaz, Isfahan, and Bandar Abbas. Results. From 238 patients, 140 (59%) were male and most of them were in the age group of 1 to 5 years (34.6%). Among all hospitalized patients, 38% had an underlying disease and in total, 5% of cases were expired. Conclusion. Determining patient severity is essential for appropriate clinical decision making; our results showed that in hospitalized pediatric patients, by using several variables such as SGOT, CRP, ALC, LDH, WBC, O2sat, and ferritin, we can use clinical and paraclinical characteristics for predicting the severity of COVID-19.

Resistance to carbapenems has been increasingly reported from the Enterobacteriaceae family, with different mechanisms in different geographic parts of the world. This study investigated the mechanisms of carbapenem resistance in Escherichia coli, Klebsiella pneumoniae and Enterobacter spp. carried out as a multicentre study ( n = 10). All third-generation cephalosporin-resistant E. coli, K. pneumoniae and Enterobacter spp. that had been recovered from the selected provinces were included. Modified Hodge test and Carba NP test were done as a phenotypical method for detection of carbapenemase; the most common carbapenemase was detected by PCR. We evaluated the presence of an active efflux pump by using cyanide 3-chlorophenylhydrazone. Overexpression of AcrA/B and presence of OqxAB was detected by real-time PCR and conventional PCR respectively. Microorganisms in this study included 58 E. coli , 95 K. pneumoniae and 60 Enterobacter spp. Modified Hodge test showed a sensitivity of 41% and a specificity of 83%, and the Carba NP test showed a sensitivity of 26% and a specificity of 92% for detection of carbapenemase. OXA-48 was the most frequently detected carbapenemase, followed by NDM-1. Thirty-nine percent and 27% of positive cyanide 3-chlorophenylhydrazone test organisms included active AcrA/B and OqxAB efflux pumps respectively. The result showed the Carba NP test was more specific than MHT. Data confirmed the involvement of AcrA/B and OqxAB efflux pump as a carbapenem resistance mechanism in selected bacteria. Similar to other reports from the Middle East, we found OXA-48 and NDM-1 to be the most frequent carbapenemase.

Introduction: Since the end of December 2019, most countries have been affected by the coronavirus disease 2019 (COVID-19) epidemic. The prevalence of COVID-19 in children has been reported much lower than adults. Most patients have mild symptoms, whereas some cases are asymptomatic. Information on the pediatric clinical manifestations is limited; therefore, reporting specific cases can improve the diagnosis process. Case Presentation: In this article, we reported a 12-year-old boy with chickenpox and COVID-19 at the same time. The patient initially had symptoms of chickenpox and then developed pneumonia. The PCR-test for COVID-19 was positive. The IgM test was positive, and IgG was negative. Chickenpox infection was confirmed by the serological test (positive IgM). The radiographic results showed reverse halo sign and vascular enlargement. Conclusions: These imaging findings are uncommon signs of COVID-19 in pediatrics. The patient was treated with hydroxychloroquine and azithromycin and discharged a few days later with good condition.

Background: The spread of resistant bacteria has caused serious concern worldwide. The spread of multidrug-resistant (MDR) and extensive drug-resistant (XDR) limits the choice of antibiotics, making available antibiotics less effective. Objectives: This study aimed to investigate resistance patterns to seven global threatening organisms announced by the Centers for Disease Control and Prevention (CDC) for one year in Iran, called ESKAPE bacteria (Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.). Methods: Clinical isolates were collected from 10 selective hospitals in nine provinces. Antibiotic susceptibility testing was performed according to the Clinical and Laboratory Standards Institute for each bacterium. Results: A total of 5522 bacterial species were considered, of which 30% were ESKAPE. Multidrug-resistant A. baumannii and Staphylococcus aureus methicillin-resistant Staphylococcus aureus (MRSA) were the most identified in Gram-negative and -positive bacteria, with the frequency of 44% and 39%, respectively. The remaining bacteria, including E. coli, K. pneumoniae, Enterobacter spp. P. aeruginosa, and Enterococcus spp., had the frequency of 30%, 32%, 21%, 20%, and 22%, respectively. Conclusions: The determined patterns for the antibiotic resistance of the ESKAPE bacteria can help determine antibiotic stewardship. Also, the high rates of the ESKAPE bacteria in Iran could be alarming for healthcare centers not to misuse broad-spectrum antibiotics.

Background: Malta fever caused by the Brucella spp. is an endemic zoonotic infectious disease in Iran. Evaluation of the disease control is essential for socioeconomic and public health-related concerns.Objectives: This study aimed to evaluate the prevalence of Brucella spp. and the frequency of mutations responsible for resistance to rifampin, streptomycin, and fluoroquinolones in sheep from Mianeh, Southwest of West Azarbaijan Province, Iran. Methods: A total number of 1,220 blood samples were collected in Mianeh. Positive samples screened using Rose Bengal Plate Test (RBPT) were subjected to Polymerase Chain Reaction (PCR). Finally, positive samples were investigated for the presence of mutated aminoglycoside adenylyl-transferase-A1 (aadA1) (conventional PCR), DNA gyrase subunit A (gyrA), topoisomerase IV subunit C (parC) (MAMA PCR for both) and RNA polymerase β-subunit (rpoB) (MAS PCR) responsible for antibiotic resistance.Results: There were 41 Brucella abortus Cell Surface Protein 31 Positive (BCSP31+) samples out of 111 RBPT positive samples which 15% (n = 7) of them were obtained from vaccinated sheep. Of the total BCSP31+ samples 9 were carrying mutated aadA1, 3 carrying mutated parC and only one sample carrying mutated rpoB. None of the samples were positive for mutated gyrA. Conclusions: The prevalence of Brucellosis in livestock in the city of Mianeh has been higher than in other areas in Iran, and some antibiotic resistance genes have been identified in livestock specimens. It can be concluded that due to the relatively good efficacy of the vaccines, the need for vaccination in all livestock farms of this city is important.

Carbapenem is a broad-spectrum beta-lactam antibiotic considered the last choice for the treatment of antibiotic-resistant Gram-negative bacteria. Thus, the increasing rate of carbapenem resistance (CR) in Enterobacteriaceae is an urgent public health threat. This study aimed to evaluate the antibiotic susceptibility pattern of carbapenem-resistant Enterobacteriaceae (CRE) to new and old antibiotics. In this study, Klebsiella pneumoniae, E. coli, and Enterobacter spp. were collected from 10 hospitals in Iran for one year. CRE is recognized by resistance to meropenem and/or imipenem disk after identification of the collected bacteria. Antibiotic susceptibility of CRE against fosfomycin, rifampin, metronidazole, tigecycline, and aztreonam was detected by disk diffusion method and colistin by MIC. In this study, 1222 E. coli, 696 K. pneumoniae, and 621 Enterobacter spp. were collected from 10 hospitals in Iran in one year. Fifty-four E. coli (4.4%), 84 K. pneumoniae (12%), and 51 Enterobacter spp. (8.2%) were CRE. All CRE strains were resistant to metronidazole and rifampicin. Tigecycline has the highest sensitivity on CRE and levofloxacin for Enterobacter spp. Tigecycline showed an acceptable effectiveness rate of sensitivity on the CRE strain. Therefore, we suggest that clinicians consider this valuable antibiotic to treat CRE.

Background: Rotavirus (RV) is associated with diarrhea in children under 5 years old. It leads to severe dehydration. RV infection is the third cause of hospitalization and death in children under 5 years old. Objectives: This study aimed to assess the frequency of RV infection in hospitalized children under 5 years old with diarrhea during 2021-2022. Methods: In this cross-sectional observational study, a total of 190 stool samples from hospitalized children with diarrhea were collected in Mofid Children’s Hospital in Tehran from December 2020 to March 2021. RV infection was detected by an enzyme-linked immunosorbent assay (ELISA). Chi-square tests were performed to determine the difference in age and gender group, time, and symptoms. Results: The overall prevalence of RV infection was 28.5% and higher in boys (68.5%), children aged ≤ 12 months (44.4%), and children with mixed feeding (33.3%); it is more common in winter. Vomiting (79.6%), fever (87.03%), and non-exudative stool (88.8%) were observed in most children with RV, but there were no significant differences in children with and without RV. Conclusions: Due to the prevalence of RV among children under 5 years of age, establishing a national RV registration system and control programs, like vaccination, seems to be considered.