After the outbreak of 2019 novel corona virus infection in China, we have the outbreak of disease in Iran and until March 05, 2020 have been reported a total number of confirmed cases more than 3500 and approximately 3.3% deaths. The corona virus disease 2019 (COVID-19) infection as a newly emerging disease in East Asia has caused a great challenge in managing the patients and controlling the disease especially in children. This algorithm is based on the standard diagnosis and treatment strategies for pediatric viral infections and available strategies to prevention of COVID-19 infection. It is hoped that with international cooperation , this global dilemma will end with the least burden of disease. Due to the lack of scientific evidences in children, this algorithm is essential for decision making.
Pertussis remains one of the etiologies of prolonged cough, even in communities with high immunization in children. The specificity of the WHO criteria is low in diagnosing pertussis compared with PCR.
Current understanding of adaptive immune, particularly T cell, responses to human rhinoviruses (RV) is limited. Memory T cells are thought to be of a primarily T helper 1 type, but both T helper 1 and T helper 2 memory cells have been described, and heightened T helper 2/ lessened T helper 1 responses have been associated with increased RV-induced asthma exacerbation severity. We examined the contribution of T helper 1 cells to RV-induced airways inflammation using mice deficient in the transcription factor T-Box Expressed In T Cells (Tbet), a critical controller of T helper 1 cell differentiation. Using flow cytometry we showed that Tbet deficient mice lacked the T helper 1 response of wild type mice and instead developed mixed T helper 2/T helper 17 responses to RV infection, evidenced by increased numbers of GATA binding protein 3 (GATA-3) and RAR-related orphan receptor gamma t (RORγt), and interleukin-13 and interleukin-17A expressing CD4+ T cells in the lung. Forkhead box P3 (FOXP3) and interleukin-10 expressing T cell numbers were unaffected. Tbet deficient mice also displayed deficiencies in lung Natural Killer, Natural Killer T cell and γδT cell responses, and serum neutralising antibody responses. Tbet deficient mice exhibited pronounced airways eosinophilia and mucus production in response to RV infection that, by utilising a CD4+ cell depleting antibody, were found to be T helper cell dependent. RV induction of T helper 2 and T helper 17 responses may therefore have an important role in directly driving features of allergic airways disease such as eosinophilia and mucus hypersecretion during asthma exacerbations.
Clostridium difficile is a Gram positive, spore-forming organism that has become a significant cause of nosocomial infection in hospitalized adults. Colonization with this organism results in a wide spectrum of clinical conditions, including an asymptomatic carrier state, mild self-limited diarrhea, pseudomembranous colitis, and fulminant colitis. It's role in disease in children remains controversial. This is a prospective study in which we evaluated all the patients hospitalized in the infectious diseases ward of Mofid Children's Hospital, Tehran during 12 months (between September 2006 and September 2007). Stool samples from 250 patients were cultured for C. difficile and specimens analyzed for detection of toxin A and B. Data were analyzed by SPSS software version 11.5. Stool culture was positive for C. difficile in 113 (45.2%) patients, 10 (4%) of these were positive for both toxins A and B by enzyme-linked immunosorbent assay (ELISA). ELISA was negative in all patients with negative culture. None of the variables tested (age and antibiotic exposure) was significantly correlated with colonization. This is the first study about colonization rates of C. difficile in children in Iran. We conclude that although the C. difficile colonization rate in our children is high (45.2%), the rate of toxigenic strains is low (4%). This may explain the low rate of C. difficile associated disease (CACD) in our population.
Background: Studies revealed that severity of atopic dermatitis correlates with colonization by S.aureus and the density of bacteria and antibiotic resistance is one of the factors in S.aureus recolonization. Objectives: We aimed to determine the pattern of colonization with different subtypes of S.aureus in patients with atopic dermatitis and its correlation with SCORAD (Scoring Atopic Dermatitis) index. Materials and Methods: We studied 114 sample cultures from normal skin, nose and active lesions of 38 patients with atopic dermatitis to detection of Staphylococcus aureus colonization and MRSA (methicilin resistance Staphylococcus aureus) subtypes with E test. The severity of the disease was identified by the SCORAD criteria. Logistic regression analysis was used for the evaluation of the coexistence between MRSA colonization and SCORAD index in these patients. Results: We studied 114 sample cultures from 38 children (73% boys, 27% girls) with atopic dermatitis. Mean age of the patients was 19 ± 22.7 months. Mean objective SCORAD was 37.8 + 16.4 (range: 15-80). Twelve patients (31.6%) had mild, 18 patients (47.4%) had moderate and 8 patients (21%) had severe SCORAD. Seventeen patients (44%) were colonized by S. aureus in the nose, 14 (36%) on skin lesions, and 8 (21%) on healthy skin. Among all the cultures, MSSA was noted in 26 (22%) and MRSA was noted in 13 (11%). There was a significant relationship between SCORAD index and colonization of nose and active lesions with Staphylococcus aureus (P value = 0.001). We found MRSA only in patients with moderate SCORAD. Conclusions: This study shows lower rate of S. aureus colonization in atopic dermatitis cases but similar rate of MRSA colonization in comparison with previous studies. A higher rate of MRSA colonization was found in patients with moderate SCORAD.
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