Abstract Objective The aim of the present study was to evaluate the diagnostic value of soluble triggering receptor on myeloid cells-1 as a novel marker for diagnosis of childhood urinary tract infections (UTI). Methods This study enrolled 30 pediatric patients diagnosed with acute febrile UTIs; 30 healthy children were included as the control group. The blood samples from the patients and healthy controls were collected for a soluble triggering receptor on myeloid cells-1 (sTREM-1) test. Results The study group was composed of 9 males and 21 females, and the mean age of the study population was 6.6 ± 3.2 (range = 1–14) years. sTREM-1 levels were significantly higher in UTI patients than in the controls (592 ± 323 vs. 490 ± 299 pg/mL, p = 0.04). The receiver operating curve analysis revealed a cut-off value of soluble triggering receptor expressed on myeloid cells-1 of 514 ng/mL (area under the curve = 0.562). When the cut-off value was taken 514 pg/mL, soluble triggering receptor expressed on myeloid cells-1 had a sensitivity of 57% and a specificity of 50% for the diagnosis of UTI. Conclusion The present study revealed that plasma sTREM-1 level may be elevated in UTI and may therefore serve as a useful predictive tool for the diagnosis of UTI.

The Journal of Pediatric Infectious Diseases wishes to recognize to those who contributed as an expert peer reviewer of submitted scientific papers in 2020.

Abstract The number of children infected with new type coronavirus disease 2019 (COVID-19) is relatively small; its atypical, mild, and unexpected clinical pictures can be suggested as the reason. In this article, we reported a 25-month-old girl patient without any symptom besides high fever and who had no risk factor or suspicious contact. Also, she developed maculopapular rash that is not reported before in the COVID-19 patients to the best of our knowledge. In the pandemic states, any symptom should be evaluated as potential COVID-19 and detection and isolation of these cases are necessary as it can affect dissemination.

Abstract Objective The interpretation of serologic tests in brucellosis can be difficult because of nonspecific symptoms and vague signs of disease, and limitations of serological tests to distinguish persistent and cleared infection. Here, we evaluated the role of Brucellacapt test in conjunction with Rose Bengal test (RBT) in the follow-up of children treated for brucellosis. Methods A total of 174 children diagnosed with brucellosis were included in the study. Data about demographic characteristics of patients, clinical and laboratory findings including Brucellacapt and RBT results, therapeutic approach, and response to treatment were collected from medical records. Results Of the 174 cases, 109 (62.6%) were boys and 65 (37.4%) were girls. The mean age of children at the diagnosis was 122 ± 54 months. Sixty-four cases were excluded from the study for loss to follow-up. The follow-up period for the remained 110 cases was 4.3 ± 2.9 months. Eleven cases (10%) had persistent illness, 7 (6.4%) had recurrence/relapse, and 92 had favorable outcome. During the follow-up, Brucellacapt titers did not drop under 1/320 in cases with persistent illness, and it increased again to 1/320 in cases with relapses at average 6.1 months after treatment. In 48 of cases with favorable outcome, Brucellacapt titers decreased to 1/160 in average 3.3 ± 1.8 months; in 35 cases, RBT became negative in average 3.8 ± 2.5 months, and there was no statistically significant difference between them (p = 0.241). In cases with higher Brucellacapt titers on admission, decrement of titers took longer time. Conclusion Persistent serological titers without clinical findings of brucellosis should not lead physician to prolong or repeat treatment because the decline in Brucellacapt titers and RBT negativity may be delayed in contrast to clinical recovery.

Abstract Objective Typhoid fever is a common systemic bacterial infection in children with a complex interplay between serum hepcidin and iron. We investigated the relationship between iron deficiency anemia (IDA) and serum hepcidin level in children with acute typhoid fever. Methods We conducted a preliminary case–control study in Mansoura University Children's Hospital, Egypt from April 2017 to May 2019 including 30 children aged 5 to 15 years with confirmed acute typhoid fever. We recruited 15 healthy nonanemic children, of comparable ages and sex as controls from the same hospital while attending for nonfebrile complaints. Typhoid fever cases were subdivided according to IDA existence into 16 cases with IDA and 14 non-IDA cases. We excluded all children having diseases which may affect serum iron and hepcidin levels, for example, liver, blood, gastrointestinal, and kidney diseases, and patients receiving drugs interfering with iron metabolism. All participants were subjected to complete blood count, serum ferritin, iron, hepcidin levels, and total iron-binding capacity (TIBC). Results In non-IDA typhoid fever group, serum iron level was significantly low, while serum hepcidin level was significantly high when compared with controls (p < 0.001 and p = 0.02, respectively). In IDA typhoid fever group, no statistically significant difference existed as regards serum hepcidin level when compared with controls (p = 0.53). No significant correlations were detected between serum hepcidin levels and hemoglobin, serum iron, ferritin, and TIBC values in each group. Conclusion Preexisting iron status could affect serum hepcidin level in patients with acute typhoid fever. Coexistence of IDA might oppose the up-regulatory effect of acute typhoid fever on serum hepcidin level.

Abstract Objective The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Bulgaria for universal childhood vaccination in 2010. The objective of this study was to describe bacterial pathogens responsible for acute otitis media (AOM) in children in the era of routine PCV10 immunization. Materials and Methods Middle ear fluid (MEF)/otorrhea or nasopharyngeal specimens were collected between May 2012 and April 2017 from 425 children aged < 12 years diagnosed with AOM; 71.5% of them were vaccinated. Capsular types of Streptococcus pneumoniae and Haemophilus influenzae and antimicrobial nonsusceptibility were determined. Results Among 240 children with “severe” AOM, the studied specimens were MEF/otorrhea, and a total of 132 (55.0%) children were culture-positive. The most frequently identified bacteria were S. pyоgenes (31.1%), followed by Staphylococcus aureus (21.2%), S. pneumoniae (20.4%), and nontypeable H. influenzae (12.1%). Among 185 nasopharyngeal specimens obtained from children at the onset of a “mild” AOM episode, 67.0% were culture-positive for otopathogens. The most common pathogens were S. pneumoniae (41.9%), followed by H. influenzae (25.8%), Moraxella catarrhalis (23.4%), and S. pyоgenes (14.5%), alone or in combinations. Among children with pneumococcal AOM (79), PCV10 serotypes (VTs) were 21.5%. A high prevalence (50%) of nonvaccine serotypes 3 (14), 19A (11), and 6C (7) was found among vaccinated children. Rates of nonsusceptibility of S. pneumoniae to penicillin, amoxicillin and erythromycin, and of multidrug resistance, were 51.2, 10.1, 51.2, and 51.2, respectively. The rate of ampicillin-non-susceptibility in H. influenzae was 25%. All M. catarrhalis isolates were β-lactamase producers, and 32.2% of S. pyogenes were erythromycin-resistant. Conclusion Following implementation of PCV10, S. pyogenes was the most prevalent pathogen in children with “severe” AOM. Numbers of S. pneumoniae recovered from MEF/otorrhea significantly decreased, as did the overall proportion of VTs among AOM patients. Streptococcus pneumoniae, H. influenzae, and M. catarrhalis were the most commonly found pathogens in the nasopharynx of children with less severe AOM episodes.

Objective We reported an outbreak of human parainfluenza virus type 1 (HPIV1) in a kindergarten and explored the genetic characteristics of HPIV1 hemagglutinin-neuraminidase (HN) and fusion (F) genes to provide more evidence about HPIV1 outbreaks. Methods Suspected cases were the children with an influenza-like illness during June 20 to 26, 2018. Nasopharyngeal swabs were collected and screened to determine the presence of respiratory pathogens by real-time fluorescent quantitative polymerase chain reaction. The HN and F gene sequences of HPIV-positive samples were further amplified and sequenced to confirm the HPIV genotype and identify genetic characteristics. A phylogenetic tree, based on the HN and F genes, was reconstructed by maximum likelihood method. Results Fourteen children in the outbreak were diagnosed as upper respiratory tract infection. The most common symptom was cough (10/14), followed by rhinorrhea (5/14), sore throat (4/14), headache (1/14), and abdominal pain (1/14). Eight patients were positive for HPIV1 and negative for other pathogens. Phylogenetic tree demonstrated that the eight strains from the year 2018 in our study located in the clade 2.3. Two specific substitutions (N333S and I509M) in the amino acids of the F protein and two substitutions (V19A and L436I) in the HN protein were different from other strains in the clade 2. Conclusion HPIV1 was attributed to the outbreak, which may be related to the genetic variations of HPIV1.

Acute lower respiratory infection (ALRI) is a major cause of morbidity and mortality worldwide. Data regarding the etiology of acute respiratory infection (ARI) is scarce in developing countries. The aim of this study was to identify the viral etiology of ARI/ALRI in hospitalized children and factors associated with increased length of stay (LoS) and severe disease presentation in Northern Jordan. This was a prospective viral surveillance study using real-time reverse transcriptase-polymerase chain reaction in children younger than 5 years admitted with ARI to two main hospitals in Northern Jordan during the winter of 2016. Nasopharyngeal swabs were obtained and tested for respiratory syncytial virus (RSV) and other viruses. Demographic and clinical characteristics of RSV-positive patients were compared with those of RSV-negative patients. There were 479 patients hospitalized with ARI. Their mean age (standard deviation) was 10.4 (11.6) months. 53.9% tested positive for at least one virus, with RSV being the most commonly detected virus (34%). Compared with RSV-negative patients, RSV-positive patients were younger, more likely to have chronic lung disease, and more likely to present with cough, rhinorrhea, difficulty in breathing, retraction, flaring, grunting, wheezing, and a higher respiratory rate. Prematurity, presence of a chronic illness, oxygen saturation < 90%, and atelectasis and consolidation on chest X-rays were significantly associated with an increased mean LoS. Patients with a history of prematurity had higher risk of severe disease (odds ratio = 2.6; 95% confidence interval: 1.5, 4.7; p = 0.001). Compared with patients 6 months old and younger, patients aged 6.1 to 12 months were less likely to have severe disease. Human metapneumovirus (HMPV)-positive ALRI was associated with increased odds of severe disease. Viruses are recognized as etiological agent of ARI/ALRI-associated morbidity in developing countries that need more attention and implementation of targeted strategies for prevention and detection. HMPV can be a cause of severe ALRI.

Background Invasive group A streptococcal disease (IGAS) carries significant morbidity and mortality in children. Fluctuations in disease incidence are well documented. However, the modulating factors that contribute to these changes remain unclear. Prospective monitoring of IGAS cases in Victoria, Australia, showed an increased number of cases in 2017, coinciding with a peak of influenza illness. Methods Children identified to have IGAS are prospectively monitored in Melbourne through a disease surveillance network. Data on their presentation, investigations, and clinical course are collected. An increased number of cases identified between June 1, 2017, and October 31, 2017, have been retrospectively analyzed. Results We identified 22 cases of pediatric IGAS during the study period. Increased case detection occurred during a period of increased influenza disease. Of 11 children in our cohort who underwent respiratory viral testing, 4 were confirmed to have concurrent respiratory tract illnesses, and 2 were confirmed to have influenza.