Publications by authors named "Setareh Mamishi"

142 Publications

The Emergence of Co-Infection of Visceral Leishmaniasis in an Iranian Child with Chronic Granulomatous Disease: A Case Report.

Iran J Parasitol 2021 Jan-Mar;16(1):159-163

Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Chronic granulomatous disease (CGD) described as an essential immunodeficiency problem of phagocytic cells resulting in a phagocyte dysfunction and inability to kill a spectrum of bacteria and fungi. Despite the fact that CGD patients are more susceptible to intracellular infections, visceral leishmaniasis has been reported rarely in these cases. Here, we report an uncommon case of visceral leishmaniasis in a child with CGD. An 8-yr old boy with CGD presented to the infectious disease ward, Children's Medical Center, Tehran University of Medical Sciences, Iran after the onset of 20 days fever with chronic crusted ulcer approximately 3 cm × 3cm on the left upper limb and a small ulcer measuring 0.5 cm × 0.5 cm on the right knee with moderate secretion. Bone Marrow Aspiration (BMA) and Bone Marrow Biopsies (BMB) of fragmented samples were performed and polymorphic population of hematopoietic cells, Megakaryocytes and Leishman bodies were seen. The patient was treated with meglumine antimoniate (Glucantime) 20 mg/kg for 28 days and after partial improvement patient discharged and continue the treatment at home. Amphotericin B lipid complex (Ambisome) (3-5 mg/kg per dose once) was administered every 3-4 weeks for 18 months as secondary prophylaxis that was well tolerated and effective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/ijpa.v16i1.5536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988672PMC
March 2021

Autoimmune Manifestations among Patients with Monogenic Inborn Errors of Immunity.

Pediatr Allergy Immunol 2021 Mar 27. Epub 2021 Mar 27.

Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran.

Background: The inborn errors of immunity (IEIs) are a group of heterogeneous disorders mainly characterized by severe and recurrent infections besides other complications including autoimmune and inflammatory diseases. In this study, we aim to evaluate clinical, immunological, and molecular data of monogenic IEI patients with and without autoimmune manifestations.

Methods: We have retrospectively screened cases of monogenic IEI in the Iranian PID registry for the occurrence of autoimmunity and immune dysregulation. A questionnaire was filled for all qualified patients with monogenic defects to evaluate demographic, laboratory, clinical, and molecular data.

Results: A total of 461 monogenic IEI patients (290 male and 171 female) with a median (IQR) age of 11.0 (6.0-20.0) years were enrolled in this study. Overall, 331 patients (72.1%) were born to consanguineous parents. At the time of the study, 330 individuals (75.7%) were alive and 106 (24.3%) were deceased. Autoimmunity was reported in 92 (20.0%) patients with a median (IQR) age at autoimmune diagnosis of 4.0 (2.0-7.0) years. Sixteen patients (3.5%) showed autoimmune complications (mostly autoimmune cytopenia) as the first presentation of the disease. Most of the patients with autoimmunity were diagnosed clinically with common variable immunodeficiency (42.4%). The frequency of sinusitis and splenomegaly was significantly higher in patients with autoimmunity than patients without autoimmunity. In patients with autoimmunity, the most common pathogenic variants were identified in LRBA (in 21 patients, 23.0%), ATM (in 13 patients, 14.0%), and BTK (in 9 patients, 10.0%) genes. In the evaluation of autoimmunity by different genes, 4 of 4 IL10RB (100%), 3 of 3 AIRE (100%), 21 of 30 LRBA (70.0%) mutated genes had the highest prevalence of autoimmunity.

Conclusions: Autoimmune phenomena are common features among patients with monogenic IEI and are associated with a more complicated course of the disease. Therefore, when encountering autoimmune disorders especially in the setting of dysgammaglobulinemia, it would be appropriate to conduct next generation sequencing (due to phenocopies of IEI genes) to discover responsible genes for the immune dysregulation at an early stage of the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/pai.13510DOI Listing
March 2021

Evaluation of treatment response in active tuberculosis using QuantiFERON-TB Gold Plus.

Eur Cytokine Netw 2020 Dec;31(4):129-133

Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Tuberculosis (TB) is one of the leading infectious causes of death worldwide and despite the progress recently made in TB control at a global level, the decline in its incidence is still slow. It is therefore crucial to evaluate the performance of new tools for monitoring of TB treatment. The aim of this study was to evaluate the response to tuberculosis treatment using the QuantiFERON-TB Gold Plus (QFT-Plus) kit. Blood samples of 100 patients with active TB were taken before treatment and after three months, if treatment was successful and sputum culture was negative. Whole blood was incubated in the presence or absence of the TB antigens, TB1 and TB2-specific antigens, and the production of IFN-γ was determined using the QuantiFERON-TB Gold Plus (QFT-Plus) test. The data were analyzed using SPSS 16 software and statistical significance was assessed at a two-tailed P value of 0.05. The median values of IFN-γ released following stimulation with TB1 peptides decreased slightly after treatment (2.5 IU/mL (IQR: 0.9-5.3), compared to the baseline (3.4 IU/mL (IQR: 0.5-6.6)). Also, with respect to the TB1 antigen, 38 out of 45 patients were positive for the QFT test before treatment (84.4%) and 37 cases after treatment (82.2%). On the other hand, the median values of IFN-γ determined with the TB2 test declined marginally after treatment (2.7 IU/mL; IQR: 0.95-5.8), as compared to pretreatment (3.0 IU/mL; IQR: 0.7-8.9). Thirty-nine out of 45 patients (86.7%) before initiation of treatment and 37 cases following a 3-month treatment (82.2%) were had positive values. Moreover, the median values of IFN-γ of TB2 minus TB1 before and after treatment were 0.17 (IQR: 0-1.0) and 0.03 (IQR: 0.0.48), respectively; however, these differences were not significant (p value=0.29). Conclusion: The results of this study show no significant differences between the IFN-γ release in TB patients prior to and after treatment. However, more extensive studies are needed in different populations with higher sample sizes to validate these results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1684/ecn.2020.0457DOI Listing
December 2020

COVID-19 and congenital heart disease: a case series of nine children.

World J Pediatr 2021 Feb 2;17(1):71-78. Epub 2021 Jan 2.

Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran.

Background: Coronavirus disease 2019 (COVID-19) is the current pandemic disease without any vaccine or efficient treatment to rescue the patients. Underlying diseases predispose the patients to a more severe disease and to a higher mortality rate. However, little evidence exists about COVID-19 outcomes in the pediatric population with congenital heart disease (CHD). Here, we report nine children with COVID-19 and concomitant CHD.

Methods: Our study included nine children with COVID-19 and concomitant CHD who were admitted to Children Medical Center Hospital during March and April 2020. The patients were classified based on the final outcome (death), and their clinical sign and symptoms, type of CHD, and drugs administered were compared.

Results: Among the nine patients, two died and we compared different characteristics, laboratory results and clinical findings of these cases based on the mortality. The deceased patients had severe types of CHD, worse arterial blood gases, severe clinical symptoms, higher mean level of partial thromboplastin time and C-reactive protein, and required more medications.

Conclusions: The present study showed that the general consideration of mild COVID-19 in children does not include patients with CHD and that it is necessary to pay greater attention to children with CHD to determine guidelines for treatment of COVID-19 in these children. Owing to the scarcity of CHD and COVID-19, we reported only nine cases. However, further studies are highly required in this regard.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12519-020-00397-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775830PMC
February 2021

The diagnostic accuracy of direct agglutination test for serodiagnosis of human visceral leishmaniasis: a systematic review with meta-analysis.

BMC Infect Dis 2020 Dec 11;20(1):946. Epub 2020 Dec 11.

Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib St., Tehran, Iran.

Background: Direct agglutination test (DAT) as a simple, accurate and reliable method, has been widely used for serodiagnosis of visceral leishmaniasis (VL) during the last three decades. The present study is a systematic review and meta-analysis to evaluate the diagnostic accuracy of DAT for serodiagnosis of human VL.

Methods: Electronic databases, including MEDLINE (via PubMed), SCOPUS, Web of Science, SID and Mag Iran (two Persian scientific search engines) were searched from December 2004 to April 2019. We determined the pooled sensitivity and specificity rates of DAT for the diagnosis of human VL, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic (ROC) curves parameters across the eligible studies.

Results: Of the 2928 records identified in the mentioned electronic databases and after examining reference lists of articles, 24 articles met inclusion criteria and were enrolled in the systematic review and out of them 20 records qualified for meta-analysis. The pooled sensitivity and specificity rates of DAT was 96% [95% CI, 92-98] and 95% [CI95% 86-99], respectively. The likelihood ratio of a positive test (LR+) was found to be 21 [CI95%, 6.6-66.5] and the likelihood ratio of a negative test (LR-) was found to be 0.04 [(CI95%, 0.02-0.08]. The combined estimate of the diagnostic odds ratio for DAT was high [467 (CI95%, 114-1912]). We found that the summary receiver operating characteristic curve (SROC) is positioned near the upper left corner of the curve and the area under curve (AUC) was 0.98 (95% CI, 0.97 to 0.99).

Conclusion: Referring to our analysis, we determined that DAT can be considered as a valuable tool for the serodiagnosis of human VL with high sensitivity and specificity. As DAT is a simple, accurate and efficient serological test, it can be recommended for serodiagnosis of human VL particularly in endemic areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12879-020-05558-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729288PMC
December 2020

The First Confirmed Case of Coronavirus Disease 2019 (COVID-19) in an Adolescent with Abdominal Pain in Iran.

Tanaffos 2020 Nov;19(2):156-159

Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: The outbreak of coronavirus disease 2019 (COVID-19) is evolving rapidly. However, there is limited information about this disease in children and adolescents. Only a few pediatric cases of COVID-19 have been reported so far. Since the immune responses of children are different from adults, their clinical findings and therapeutic responses may differ. To the best of our knowledge, this is the first confirmed case of COVID-19 in a 12-year-old girl with abdominal pain in Iran.

Case Presentation: A 12-year-old girl with a history of cold, dry cough, sore throat, fever, and left-sided abdominal pain was referred to the Children's Medical Center, Tehran, Iran, on March 7, 2020. The chest X-ray indicated air space opacification in the right lower lobe and faint ground-glass opacity in the left lower lung. A subsequent chest computed tomography (CT) scan indicated blialteral patchy lower lobe consolidations. The patient's oropharyngeal swab was positive for COVID-19, based on the result of real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. The patient's clinical status was improved, and she was discharged five days after admission (March 11, 2020).

Conclusion: Since the number of infected cases with COVID-19 is growing rapidly in Iran, early detection and management of infected cases are highly recommended for preventing the disease transmission and reducing the rate of infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680510PMC
November 2020

Antimicrobial Resistance and Genotyping of Bacteria Isolated from Urinary Tract Infection in Children in an Iranian Referral Hospital.

Infect Drug Resist 2020 29;13:3317-3323. Epub 2020 Sep 29.

Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood, and the increasing rate of antibiotic resistance to the commonly prescribed antimicrobial agents against it has become a major concern. The aim of this study was to determine the antibiotic resistance and genotyping of bacteria isolated from urine cultures in patients referred to the Children's Medical Center, Tehran, Iran.

Methods: During the 1-year period, antimicrobial susceptibility profiles of strains isolated from patients with UTI were determined. Typing of the isolates causing nosocomial infections was performed by random amplified polymorphic DNA (RAPD) analysis, and the results were analyzed by Gelcompar II software.

Results: In this study, 203 children (130 girls and 73 boys) were included. The patients' age ranged from 1 day to 16 years (IQR average=4 months to 4 years). The most frequent isolated organisms were (118 isolates, 58%), followed by (30 isolates, 15%). Sixty-two strains (18 strains of , 13 strains of , 11 strains of , and five strains of complex) had criteria of nosocomial infection. A high resistance rate to trimethoprim-sulfamethoxazole (69%) and cefotaxime (60%) was reported in and strains, respectively. strains showed high sensitivity to amikacin (100%). All strains were susceptible to trimethoprim-sulfamethoxazole (100%), and 23% of the strains were resistant to vancomycin. The analysis of RAPD-typing revealed the presence of three clusters in , two clusters in , and one clone in . Besides, four out of five isolates of complex had more than 90% genetic similarity.

Conclusion: The most frequent isolated pathogen was , and an increasing rate of antibiotic resistance to the commonly prescribed antimicrobial agents such as trimethoprim/sulfamethoxazole and cephalosporins was observed. Moreover, the results of this study showed the presence of clones with ≥80% similarity in , , , and complex isolates; therefore, the transmission of nosocomial infections from one patient to another or one ward to another is probable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/IDR.S260359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535122PMC
September 2020

Acute aortic dissection in a patient with Williams syndrome infected by COVID-19.

Cardiol Young 2021 Jan 12;31(1):132-134. Epub 2020 Oct 12.

Department of Pediatric Cardiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Cardiovascular involvement in COVID-19 has different features. Here we report the ominous fate of a neglected adolescent with Williams syndrome that was infected by SARS-CoV-2 and ended by acute aortic dissection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1047951120003236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550877PMC
January 2021

Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran.

Epidemiol Infect 2020 08 28;148:e196. Epub 2020 Aug 28.

Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

During the coronavirus disease 2019 (COVID-19) pandemic, a new phenomenon manifesting as a multisystem inflammatory syndrome in children (MIS-C) which has a similar clinical presentation to Kawasaki disease, toxic shock syndrome and severe sepsis has emerged. Although the number of MIS-C reports is increasing, rare reports in Asia is still available. To our knowledge, this study is the largest series of published MIS-C cases in Iran. We performed a retrospective study of all patients with case definition for MIS-C admitted to the three paediatric hospitals in Iran. All of these hospitals are located within the most active COVID-19 pandemic areas (Tehran, Qom and Mazandaran) in Iran. Demographic characteristics, clinical data, laboratory findings, imaging and echocardiographic findings, treatment and outcomes were collected. Between 7 March and 23 June 2020, 45 children were included in the study. The median age of children was 7 years (range between 10 months and 17 years). Common presenting symptoms include fever (91%), abdominal pain (58%), nausea/vomiting (51%), mucocutaneous rash (53%), conjunctivitis (51%) and hands and feet oedema (40%) with median duration of symptoms prior to presentation of 5 (interquartile range (IQR) 3, 7) days. Fifty-three percent of children showed lymphopaenia. Overall, the majority of cases at admission had markedly elevated inflammatory markers erythrocyte sedimentation rate (ESR) (95.5%) and C-reactive protein (CRP) (97%). Ferritin was abnormal in 11 out of 14 tested patients (73%), and it was highly elevated (>500 ng/ml) in 47% of cases. Median fibrinogen level was 210 (IQR 165, 291) mg/dl, D-dimer was 3909 (IQR 848, 4528) ng/ml and troponin was 0.6 (IQR 0.1, 26) ng/ml, respectively. Twenty out of 31 patients (64.5%) had hypoalbuminaemia. In addition, hyponatraemia was found in 64% of cases. Twenty-five patients (56%) presented with cardiac involvement and acute renal failure was observed in 13 cases (29%). Pleural, ascitic, ileitis and pericardial effusions were found in 18%, 11%, 4% and 2% of cases, respectively. In conclusion, this is a first large case series of hospitalised children who met criteria for MIS-C in Iran. There was a wide spectrum of presenting signs and symptoms; evidence of inflammation with abnormal values of CRP, ESR, D-dimer, ferritin and albumin; and multi-organ involvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S095026882000196XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484297PMC
August 2020

Novel coronavirus disease 2019 (COVID-19) outbreak in children in Iran: Atypical CT manifestations and mortality risk of severe COVID-19 infection.

J Microbiol Immunol Infect 2020 Aug 6. Epub 2020 Aug 6.

Department of Pediatric Infectious Disease, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran. Electronic address:

Background: During the coronavirus disease 2019 (COVID-19) pandemic, Iran reported its first confirmed cases of syndrome coronavirus 2 (SARS-CoV-2) infections on 19 February 2020 in Qom. Although the numbers of cases are increasing, no report about clinical manifestations, laboratory results, and imaging findings of the children infected with COVID-19 in Iran has been published. The aim of this study was to evaluate the epidemiological, clinical, and radiological and laboratory findings of 24 children who had proven SARS-CoV-2 infection and performed chest computed tomographic (CT) in Qom, Iran.

Methods: Demographic information and clinical characteristics of the patients including signs and symptoms, chest CT scan manifestation, laboratory findings and clinical outcomes were collected. Diagnosing of the confirmed case was based on positive real-time reverse-transcriptase-polymerase-chain-reaction test for SARS-CoV-2.

Findings: During the first 3 months of the epidemic in Qom, Iran, 24 children with confirmed diagnosis of COVID-19 were included. The median age of the cases was 6 years [inter-quartile range 3.5-9.5 years]. The most common presenting symptoms were fever (100%), dry cough (62.5%), tachypnea (29%), abdominal pain (21%), and vomiting (21%). Three cases (12.5%) presented with a history of diarrhea in addition to fever and cough. According to the chest CT findings, 2 cases (8%) showed no abnormality. Typical CT findings were found in 6 patients (25%), 2 patients showed indeterminate appearance, and 14 patients (58%) showed atypical findings. Two children with SARS-CoV-2 infection manifested as a hyperinflammatory syndrome with multi-organ involvement similar to Kawasaki disease shock syndrome. Seventy-one percent of the patients showed severe SARS-CoV-2 infection and the mortality of 12.5% (3 cases) were reported.

Interpretation: High frequency of atypical chest CT finding in children should raise concern for pediatricians. Early recognition of patients with SARS-CoV-2 infection is of crucial importance in controlling of the outbreak and atypical imaging features should be interpreted with caution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmii.2020.07.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406416PMC
August 2020

The Coronavirus Disease 2019 (COVID-19) in Children: A Study in an Iranian Children's Referral Hospital.

Infect Drug Resist 2020 31;13:2649-2655. Epub 2020 Jul 31.

Tehran University of Medical Sciences, Tehran, Iran.

Background: Despite the worldwide spread of the coronavirus disease 2019 (COVID-19), the epidemiological and clinical patterns of the COVID-19 infection remain largely unclear, particularly among children. In this study, we explored the epidemiological characteristics, clinical patterns, and laboratory and imaging findings of pediatric patients with COVID-19.

Materials And Methods: From March 7 to March 30, 2020, there were a total of 35 patients who had confirmed COVID-19 infection by laboratory virus nucleic acid test (RT-PCR) assay with throat swab samples or typical chest CT manifestation compatible with COVID-19, in addition to a history of close contact with suspected or confirmed SARS-CoV-2 in family members. Information recorded included demographic data, medical history, exposure history, underlying comorbidities, symptoms, signs, laboratory findings and radiologic assessments, severity of disease, treatment, and mortality.

Results: The median age of the patients was 7.5 years (IQR=4-11; range=4 months to 15 years). A total of 63% were male. Cough was present in 80% of the patients, followed by fever (77%), nausea or vomiting (29%), diarrhea (26%), shortness of breath (29%), headache (20%), and myalgia (14%). Lymphopenia was present in 43% of the patients, thrombocytopenia in 9%, neutopenia in 8%, and leucopenia in 26%. We reported severe pneumonia in 40% of the hospitalized patients and 18 (51%) had underlying diseases. Of 35 patients, 11 had positive RT-PCR results (31%). The chest CT images of 24 patients (69%) suggested COVID-19, while their RT-PCR assays from throat swab samples were negative.

Conclusion: This study demonstrates different clinical findings of pediatrics compared to the previous reports of children. Since a high rate of false negative RT-PCR test was observed, early detection of children with COVID-19 infection by CT is conducive to reasonable management and early treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/IDR.S259064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406067PMC
July 2020

Clinical and Genetic Study of X-linked Agammaglobulinemia Patients (The Benefit of Early Diagnosis).

Iran J Allergy Asthma Immunol 2020 Jun 23;19(3):305-309. Epub 2020 Jun 23.

Immunology, Asthma, and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency caused by genetic defects in the Bruton tyrosine kinase (Btk) gene. XLA is characterized as an antibody deficiency by recurrent bacterial infections, the absence of peripheral B cells, and profound reductions in all immunoglobulin isotypes. This study aims to report the clinical and genetic features of five Iranian patients with XLA. Five male cases with recurrent bacterial infection entered this study based on clinical evaluation and Immunological screening tests. The levels of T-cell receptor excision circle (TREC) and kappa-deleting recombination excision circle (KREC) were also measured in dried blood spot (DBS) samples. Sanger sequencing was applied to PCR products of DNA samples of the patients for genetic studies. All patients were from unrelated families with a mean age of 6.7 years (2.5-11) at the time of diagnosis with 4.8 mean years of delay in diagnosis. The most frequent clinical manifestations were recurrent respiratory infections and arthritis. In these patients, five previously reported mutations were found including four mutations (p.Q496X, p.Q497X, p.R520X, and p.R641H) in the Kinase domain besides one mutation (p.L37P) in the pleckstrin homology (PH) domain. Evaluations of KREC and TREC level in patients' DBS showed low-to-undetectable copies of KREC (0-2 copies/3.2mm DBS) with normal copies of TREC. As patients with XLA have complete immunoglobulin defects and develop severe and recurrent infections, early diagnosis would be beneficial for the improvement of their quality of life. The study results may provide valuable information for the diagnosis, genetic counseling and prenatal diagnosis for the patients and their family members and emphasize performing KREC as an early diagnostic test in patients with XLA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/ijaai.v19i3.3458DOI Listing
June 2020

Monogenic Primary Immunodeficiency Disorder Associated with Common Variable Immunodeficiency and Autoimmunity.

Int Arch Allergy Immunol 2020 2;181(9):706-714. Epub 2020 Jul 2.

Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran,

Background: Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency disorder mainly characterized by recurrent bacterial infections besides other immunological defects including loss of or dysfunction of B cells and decreased immunoglobulin levels. In this study, our aim is to evaluate clinical, immunological, and molecular data of patients with a primary clinical diagnosis of CVID and autoimmune phenotype with a confirmed genetic diagnosis.

Methods: Among 297 patients with CVID, who were registered in the Iranian Primary Immunodeficiency Registry at Children's Medical Center Hospital in Iran, 83 patients have been genetically examined and 27 patients with autoimmunity and confirmed genetic mutations were selected for analysis. Whole-exome sequencing and confirmatory Sanger sequencing methods were used for the study population. A questionnaire was retrospectively filled for all patients to evaluate demographic, laboratory, clinical, and genetic data.

Results: In the 27 studied patients, 11 different genetic defects were identified, and the most common mutated gene was LRBA, reported in 17 (63.0%) patients. Two patients (7.7%) showed autoimmune complications as the first presentation of immunodeficiency. Eleven patients (40.7%) developed one type of autoimmunity, and 16 patients (59.3%) progressed to poly-autoimmunity. Most of the patients with mono-autoimmunity (n = 9, 90.0%) primarily developed infectious complications, while in patients with poly-autoimmunity, the most common first presentation was enteropathy (n = 6, 37.6%). In 13 patients (61.9%), the diagnosis of autoimmune disorders preceded the diagnosis of primary immunodeficiency. The most frequent autoimmune manifestations were hematologic (40.7%), gastrointestinal (48.1%), rheumatologic (25.9%), and dermatologic (22.2%) disorders. Patients with poly-autoimmunity had lower regulatory T cells than patients with mono-autoimmunity.

Conclusion: In our cohort, the diagnosis of autoimmune disorders preceded the diagnosis of primary immunodeficiency in most patients. This association highlights the fact that patients referring with autoimmune manifestations should be evaluated for humoral immunity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000508817DOI Listing
February 2021

High prevalence of latent tuberculosis in hematopoietic stem cell transplant recipients: A First Report.

Pediatr Transplant 2020 09 23;24(6):e13770. Epub 2020 Jun 23.

Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran.

TB is an increasing health problem, and patients undergoing HSCT are more prone to develop tuberculosis. The aim of our study was to evaluate prevalence of latent tuberculosis in HSCT recipients. In this study, 84 patients (2 months to 18 years) who were candidates for HSCT at the referral hospital of Tehran Children's Medical Center were enrolled. The TST and the QFT-GIT test were performed in all 84 patients, simultaneously. LTBI was considered when one of the tests was positive. Overall, the prevalence of LTBI in HSCT recipients in our study was 12% (10 cases). TST induration ≥5 mm was seen in only three patients (3.5%). Eight patients (9.5%) had a positive result for IGRA test, and 11 of them (13%) had indeterminate QFT-GIT result. The agreement between the TST results (induration size ≥5 mm) and the QFT-GIT results was poor (kappa = 0.14). In conclusion, there was a high rate of discordance between TST and IGRA results with many more positive QFT-GIT tests. However, more studies are needed in this population to determine whether this discordance reflects true infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/petr.13770DOI Listing
September 2020

The first rare and fatal case of invasive aspergillosis of spinal cord due to in an Iranian child with chronic granulomatosis disease: review of literature.

Curr Med Mycol 2020 ;6(1):55-60

Department of Infectious Diseases, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Background And Purpose: Invasive aspergillosis (IA) of the central nervous system (CNS) is a devastating complication which is rarely reported in immunocompromised children. In this case presentation, we reported a rare and fatal IA with spinal cord involvement in a 10-year-old child with X-linked chronic granulomatosis disease (CGD).

Case Report: The child had a previous history of pulmonary tuberculosis. A cervical spine X-ray revealed the involvement of cervical vertebrae (T4/T5) and s causing spinal cord compression and epidural abscess The patient underwent a decompressive laminectomy and mass removal. The histopathology and culture results suggested IA. Despite the aggressive and prolonged therapy, he died within one year. was identified as the causative agent based on morphological and molecular studies.

Conclusion: This synopsis represents the aggressive behavior of infection caused by in the CGD patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/cmm.6.1.2551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217256PMC
January 2020

No evidence of occult HBV infection in population born after mass vaccination.

Wien Med Wochenschr 2020 Jun 9;170(9-10):218-223. Epub 2020 Apr 9.

Clinical Research Dept., Pasteur Institute of Iran, Pasteur Ave., 13164, Tehran, Iran.

Despite access to efficient hepatitis B virus (HBV) vaccine and universal immunization schedules, HBV infection remains a global health concern. HBV infection has decreased by this program. Nevertheless, breakthrough infections occur due to generation of occult HBV infection (OBI) and surface gene mutants in the immunized population. We aimed to determine the presence of OBI in a population born after initiation of nationwide HBV vaccination in Tehran, Iran. A HBV mass vaccination schedule was launched in Iran in 1993. For this study, we enrolled 1120 cases younger than 24 years. ELISA was applied to evaluate the presence of HBsAg, anti-HBs and anti-HBc. HBV-DNA presence was determined in all HBsAg-negative cases using nested polymerase chain reaction. The prevalence of HBsAg, anti-HBc and anti-HBs was 0.1, 0.54 and 39.9% respectively. Out of 6 anti-HBc-positive individuals, 4 cases also had anti-HBs. One case revealed HBsAg co-existence and the other one showed isolated anti-HBc. HBV-DNA was not detected in HBsAg-negative specimens. A very low prevalence of HBsAg and isolated anti-HBc was observed and no occult HBV infection was detected. It seems that evasion mutants are not a potential threat for HBV universal immunization efficacy in the vaccinated population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10354-020-00748-zDOI Listing
June 2020

Neurobrucellosis in a 9-year-old girl.

J Radiol Case Rep 2019 Dec 31;13(12):13-19. Epub 2019 Dec 31.

Department of radiology, Iran university of medical sciences, Tehran, Iran.

Brucellosis is a zoonotic multi-organ infectious disease most frequent in developing countries. Neurobrucellosis a quite rare but serious complication of brucellosis in the pediatric age group manifests with different neurological symptoms and signs. In the present case a 9-year-old girl was referred to our centre with a 9-months history of headache and back pain, facial nerve palsy and right upper limb weakness. She had undergone ventriculoperitoneal shunting surgery due to communicating hydrocephalus. Magnetic resonance imaging revealed a spinal extramedullary intradural mass, two epidural collections in the cervical spine and thickening/abnormal enhancement in the basal cisterns with invasion to medulla and pons. The patient's serum and cerebrospinal serologic tests were found positive for brucellosis. The patient was successfully treated by anti-brucella antibiotic therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3941/jrcr.v13i12.3734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060014PMC
December 2019

Differential gene expression of ASUN, NEMF, PTPRC and DHX29: Candidate biomarkers for diagnosis of active and latent tuberculosis.

Infect Disord Drug Targets 2020 Mar 13. Epub 2020 Mar 13.

Pediatric Infectious Diseases Research Center, Infectious Disease Department, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Tuberculosis (TB) remains as one of the most important infectious causes of death through the world. A wide range of technologies have been used for the diagnosis of TB. However, current diagnostic tests are inadequate. The aim of this study was to evaluate expression of four genes, namely ASUN, NEMF, PTPRC and DHX29 as candidate biomarkers for the discrimination of Latent tuberculosis infection (LTBI) and active TB among individuals with active TB, LTBI, and healthy Bacilli Calmette-Guerin (BCG) vaccinated cases.

Material And Methods: The expression of the mentioned four genes as well as ACTB as a housekeeping gene was evaluated by real-time PCR. Receiver operating characteristic (ROC) curve analysis was conducted to assess the specificity and sensitivity of each validated biomarker.

Results: The results of real-time PCR presented that these four differentially expressed genes could be perceived as potential biomarkers for the detection of active and latent TB infections. ROC analysis showed that the expression level of ASUN, PTPRC and DHX29 may discriminate active TB patients from healthy individuals, whereas ASUN and NEMF could differentiate LTBI from healthy BCG vaccinated cases. In addition, DHX29 and PTPRC could be used to discriminate LTBI from active TB patients.

Conclusion: Expression of these four host genes can accurately differentiate between active TB/LTBI cases and healthy individuals as well as between LTBI and active TB patients. However, our findings deserve further validation in larger studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871526520666200313144951DOI Listing
March 2020

Cystic echinococcosis in children: high frequency of multiple organ involvement in North of Iran.

Infect Disord Drug Targets 2020 Feb 27. Epub 2020 Feb 27.

Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran. Iran.

Introduction: Echinococcosis as an important zoonotic infection has a major worldwide distribution. Pediatric echinococcosis has still become a health concerning issue in developing countries specifically in the Middle East and Iran. The aim of this study was to investigate the human echinococcosis in children in the northern Iran.

Material And Methods: Patients admitted to the pediatric subspecialty hospital of Amir Kala, Babol, Iran from 2011 to 2016 with a confirmed diagnosis of echinococcosis were reviewed. Records of the patients including demographic data, clinical manifestations of the disease, type of cysts and other related factors were collected.

Results: Sixteen pediatric patients, twelve (75%) male and four (25%) female were evaluated. All cases had cystic echinococcosis. The results showed that fever (75%) following vomiting, nausea, and coughing (44%) were the most common clinical manifestations. The most common localizations of cases were determined as liver (n=10, 62.5%) and lung (n=9, 56%). The frequency of involvement of more than one organ was 31% (5 cases). The co-occurrence of liver and lung was seen in 2 (12.5%) cases and in one case co-occurrence of liver and spleen was reported. In one case lung, liver and, the pelvis was involved, while in another case liver, sub diaphragm and kidney involvement were observed.

Conclusion: Cystic echinococcosis should be kept in mind when a cystic lesion is encountered anywhere in the body, particularly in patients lining in the endemic regions. Since cystic echinococcosis has a considerable economic impact in Iran, the implementation of a control program as well as the surveillance system are highly recommended to reduce the economic burden of this disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871526520666200228104316DOI Listing
February 2020

Can Interferon-γ Release Assays Be Useful for Monitoring the Response to Anti-tuberculosis Treatment?: A Systematic Review and Meta-analysis.

Arch Immunol Ther Exp (Warsz) 2020 Feb 3;68(1). Epub 2020 Feb 3.

Pediatric Infectious Disease Research Center, Children's Medical Center Hospital, Tehran University of Medical Sciences, Dr. Gharib Street, Keshavarz Boulevard, Tehran, Iran.

The number of studies which evaluated interferon-gamma release assays (IGRAs) results after anti-tuberculosis (TB) treatment has been rapidly increasing. The aim of this study was to investigate the potential use of IGRAs (QFT-GIT, T-SPOT.TB, QFT-Plus) in assessing the response to anti-TB treatment. We searched all studies in English language published from 1 October 2011 to 18 November 2018 in PubMed, Web of Science, and Scopus. Our search included the term "tuberculosis treatment AND interferon-γ release assay". We included studies evaluating the performance of commercial IGRAs (including QFT-GIT, T-SPOT.TB and QFT-Plus) before and after the anti-TB treatment. We performed subgroup analysis based on the age (children, adults), type of TB (active, latent, active and latent, and contacts exposed to MDR defined as MDR LTBI), type of IGRAs (QFT-GIT and T-SPOT.TB), and follow-up interval (2, 3, 4, 6, 9 months). Of the 18 included studies, 12 used QFT-GIT for assessment of IGRA performance after therapy, 1 used T-SPOT.TB, and 3 used both QFT-GIT and T-SPOT.TB. Since then, only two studies have assessed the QFT-Plus performance during therapy. According to the results of the meta-analysis, the pooled rate of positive IGRAs (QFT-GIT and T-SPOT.TB) following anti-TB therapy was estimated at 76% [95% CI 70-81%] and no difference was found compared to the pooled positive rate of IGRAs before initiation of therapy which was 76% [95% CI 60-89%]. The subgroup analysis showed that the pooled rate of positive IGRAs (QFT-GIT and T-SPOT.TB) after anti-TB therapy was significantly higher in monitoring active TB subjects [80% (95% CI 74-88%)] than LTBI [71% (95% CI 70-81%)]. Available data are now sufficient to suggest that monitoring changes in the IGRAs (QFT-GIT and T-SPOT.TB) response during anti-TB treatment may have limited use in evaluating the effectiveness of treatment, while the monitoring changes in QFT-Plus during anti-tubercular treatment are recommended to determine treatment efficacy or for treatment monitoring. Further research is needed to establish the efficacy of this new assay as marker on a larger scale for treatment monitoring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00005-020-00568-4DOI Listing
February 2020

Antibiotic Resistance And Genotyping Of Gram-Positive Bacteria Causing Hospital-Acquired Infection In Patients Referring To Children's Medical Center.

Infect Drug Resist 2019 27;12:3719-3726. Epub 2019 Nov 27.

Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: A serious problem affecting human society is the development of bacterial resistance. The purpose of the current study was to evaluate the antibiotic resistance of Gram-positive bacteria (GPB) and genotyping of common GPB causing hospital-acquired infections (HAIs) in patients who were referred to Children's Medical Center during a 6-month period by random amplified polymorphic DNA (RAPD) and enterobacterial repetitive intergenic consensus sequence polymerase chain reaction (ERIC-PCR).

Methods: During the 6-month period, antimicrobial resistance profiles of GPB isolates recovered from patients in Children's Medical Center were determined using the Kirby-Bauer disk diffusion and MIC. Typing of common GPB was performed and the results were analyzed by gel compare software.

Results: In this cross-sectional study, 6524 cultures were performed and 138 Ggram-positive bacteria were isolated (2%). strains showed the highest antibiotic penicillin resistance (96.3%). Twenty-six per cent of the strains were methicillin-resistant (MRSA) and no resistance was found against vancomycin. All isolates of were resistant to ciprofloxacin (100%). The resistance to vancomycin was very high (67%) and no resistance was observed to linezolid. The results of genotyping analysis of strains showed the presence of two clones with a genetic relationship of over 80%. All of the strains were in one cluster and half of the strains were in a cluster with a genetic predilection of over 80%.

Conclusion: This study indicated frequent occurrence of antimicrobial resistance, especially in spp. isolates. Rapid spreads of MRSA and VREF from a clonal origin require implementing careful isolation and infection control measures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/IDR.S220522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885556PMC
November 2019

Prevalence of active tuberculosis infection in transplant recipients: A systematic review and meta-analysis.

Microb Pathog 2020 Feb 2;139:103894. Epub 2019 Dec 2.

Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran. Electronic address:

Introduction: Tuberculosis (TB) is considered as a serious complication of organ transplant; therefore, the detection and appropriate treatment of active TB infection is highly recommended for the reduction of mortality in the future. The aim of this review was to conduct a systematic review and meta-analysis assessing the prevalence of active TB infection in transplant recipients (TRs).

Material And Methods: Electronic databases, including MEDLINE (via PubMed), SCOPUS and Web of Science were searched up to December 24, 2017. The prevalence of active TB was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 14.

Results: The pooled prevalence of post-transplant active TB was estimated 3% [95% CI: 2-3]. The pooled prevalence of active TB in different transplant forms was as follows: renal,3% [95% CI: 2-4]; stem cell transplant (SCT), 1% [95% CI: 0-3]; lung, 4% [95% CI: 2-6]; heart, 3% [95% CI: 2-4]; liver, 1% [95% CI: 1], and hematopoietic stem cell transplant (HSCT), 2% [95% CI: 1-3]. The prevalence of different clinical presentations of TB was as follows: pulmonary TB (59%; 95% CI: 54-65), extra pulmonary TB (27%; 95% CI: 21-33), disseminated TB (15%; 95% CI: 12-19) and miliary TB (8%; 95% CI: 4-13). The pooled prevalence of different diagnostic tests was as follows: chest X-ray, 57% [95% CI, 46-67]; culture, 56% [95% CI, 45-68]; smear, 49% [95% CI, 40-58]; PCR, 43% [95% CI, 40-58]; histology, 26% [95% CI, 20-32], and tuberculin skin test, 19% [95% CI, 10-28].

Conclusion: A high suspicion level for TB, the early diagnosis and the prompt initiation of therapy could increase the survival rates among SOT patients. Overall, renal and lung TRs appear to have a higher predisposition for acquiring TB than other type of recipients. Monitoring of the high-risk recipients, prompt diagnosis, and appropriate treatment are required to manage TB infection among TRs especially in endemic areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.micpath.2019.103894DOI Listing
February 2020

Antibiotic resistance and genotyping of gram-negative bacteria causing hospital-acquired infection in patients referred to Children's Medical Center.

Infect Drug Resist 2019 29;12:3377-3384. Epub 2019 Oct 29.

Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran.

Background And Aim: Hospital-acquired infection (HAI) is a major problem worldwide. Understanding patterns of bacterial etiology and antibiotic susceptibility is vital to combating HAI. Besides, typing of isolates is important to establish the intra-hospital surveillance of resistant clones. In this study, we aimed to evaluate antibiotic resistance and genotyping of a number of gram-negative bacteria (GNB) causing HAI in patients who were referred to Children's Medical Center.

Methods: During the 6-month period, antimicrobial susceptibility profiles of GNB isolates recovered from patients in Children's Medical Center were determined. Typing of common GNB was performed by random amplified polymorphic DNA (RAPD) analysis and the results were analyzed by Gelcompar II software.

Results: In total, 142 (1.1%) gram-negative bacterial strains were isolated, among which 59.2% were from males. The most organisms were isolated from blood (63%) followed by wounds (13.7%). The greatest proportion of strains came from intensive care units (51%). Low sensitivity of to common antibiotics and high resistance of spp. To cefotaxime (100%) were reported. The most efficient antibiotics for strains were amikacin (84%) and gentamycin (81%). However, just 12.5% of strains were resistant to trimethoprim-sulfamethoxazole. The analysis of RAPD-typing revealed the presence of one clone in and and two clones in , whereas the trend varied completely in strains and spp.

Conclusion: The results of this study showed a possibility of an outbreak in the Children's Medical Center. Since there is a possibility of transmission of an infection from one patient to another, high attention should be paid to the basic methods of preventing infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/IDR.S195126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825472PMC
October 2019

Epidemiology of echinococcosis in Iran: a systematic review and meta-analysis.

BMC Infect Dis 2019 Nov 4;19(1):929. Epub 2019 Nov 4.

Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran.

Background: Echinococcosis is a zoonotic disease caused by the larval stages of taeniid cestodes of the genus Echinococcus. The two major types of infection in humans are cystic echinococcosis (CE) or hydatidosis and alveolar echinococcosis (AE). It is endemic in some parts of the world, such as the Middle East, with Iran being a part of it. This systematic review and meta-analysis were conducted to determine the prevalence of CE and AE echinococcosis and their epidemiological and clinical aspects in Iran.

Methods: Electronic databases, including MEDLINE (via PubMed), SCOPUS, Web of Science, SID and Mag Iran (two Persian scientific search engines) were searched from 1 January 1990 to 8 August 2017. The prevalence of CE and AE echinococcosis was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 12.

Results: Of the 2051 records identified in the mentioned electronic databases, Seventy-eight articles met our eligibility criteria, with a total of 214124individuals. The meta-analysis was performed on only 37 out of 78 included studies. The pooled prevalence of CE and AE in Iran was 5% [95% confidence interval )CI(: 3-6%] and 2% [95% CI: 0-5%], respectively. Subgroup meta-analysis revealed that the prevalence of CE was significantly higher in North [9%, 95% CI: 4-18%] and West of Iran [6%, 95% CI: 3-11%], patients younger than 40 years of age [7%, 95% CI: 4-12%], villagers and nomads [6%, 95% CI: 2-12%], and studies that used the combination of serological, clinical, and imaging diagnostic methods [7%, 95% CI: 5-9%]. There were no significant differences between the prevalence of CE among low and high-quality studies. Housewives were the most affected group by hydatidosis (n=24/77, 31%), followed by illiterate people (n=11/77, 14%) and farmers (n= 9/77, 12%). Liver [55%, 95% CI: 46-65%] and lung [28%, 95% CI, 22-35%] were the most common sites of cyst formation.

Conclusions: Given to the importance of echinococcosis on human health and domestic animals industry, it is necessary to implement monitoring and control measures in this regard.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12879-019-4458-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830007PMC
November 2019

Comparison of the QuantiFERON-TB Gold Plus and QuantiFERON-TB Gold In-Tube interferon-γ release assays: A systematic review and meta-analysis.

Adv Med Sci 2019 Sep 3;64(2):437-443. Epub 2019 Oct 3.

Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran. Electronic address:

Purpose: QuantiFERON-TB Gold Plus (QFT-Plus) is a new generation of QuantiFERON assay that differs from QuantiFERON-TB Gold In-Tube test (QFT-GIT). The aim of this study was to compare the performance of the new FDA-approved QFT-Plus interferon (IFN)-γ release assays (IGRAs) with the QFT-GIT version of this assay.

Material And Methods: We searched all studies published in English in electronic databases, including PubMed, Scopus, and Web of Science.

Results: The positive proportion of positive results by QFT-Plus was higher than QFT-GIT in cured tuberculosis (TB) cases (82% vs. 73%). The two tests showed a substantial agreement and the majority of the latent tuberculosis infection (LTBI) subjects responded concomitantly to both QFT-Plus and QFT-GIT. However, QFT-Plus showed a stronger association with surrogate measures of TB suspects than QFT-GIT. The QFT-Plus test demonstrated a higher sensitivity than QFT-GIT in the older adults. The sensitivity, specificity, LR+, LR- and DOR overall were 94% (95% CI 89-97), 96% (95% CI 94-98), 24.4 (95% CI 15-39), 0.05 (95% CI 0.03-0.11) and 414 (95% CI 251-685), respectively. The area under summary ROC curve was 0.99 (95% CI 0.97-0.99).

Conclusion: QFT-Plus performs equivalently to the QFT-GIT for detection of patients at risk for LTBI; however, QFT-Plus test had higher sensitivity than the QFT-GIT test, with similar specificity among the older participants. Higher IFN-γ release in TB2 compared to TB1 might be due to recent LTBI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.advms.2019.09.001DOI Listing
September 2019

Diagnostic accuracy of interferon (IFN)-γ inducible protein 10 (IP-10) as a biomarker for the discrimination of active and latent tuberculosis.

Mol Biol Rep 2019 Dec 28;46(6):6263-6269. Epub 2019 Sep 28.

Pediatric Infectious Disease Research Center, Children Medical Center Hospital, Tehran University of Medical Sciences, No.62, Gharib St., Keshavarz Blvd., Tehran, Iran.

To assess the potency of Interferon (IFN)-γ inducible protein 10 (IP-10) stimulated by recombinant PE35 and PPE68 as a biomarker in differentiating between active and latent tuberculosis. Patients with active pulmonary TB (PTB) (n = 30), latent TB infection (LTBI) (n = 29), and BCG-vaccinated healthy controls (HCs) (n = 30) were enrolled and blood samples were taken from them. The diagnostic performance of IP-10 was evaluated by the Receiver operator characteristic (ROC) curve and the area under the curve (AUC) and their 95% confidence intervals (CI) were calculated. The median IP-10 concentrations following stimulation with recombinant PE35 and PPE68 were significantly higher in TB-infected group (both PTB and LTBI) compared with HCs (P < 0.05). It was also significantly higher in PTB patients compared with individuals with LTBI (P < 0.05). The discriminatory performance of IP-10 following stimulation with recombinant PE35 and PPE68 (assessed by AUC) between TB patients and HCs were similar (AUC: 0.79 [95% CI 0.68-0.89] and 0.79 [95% CI 0.69-0.89], respectively). AUCs of IP-10 following stimulation with recombinant PE35 and PPE68 for distinguishing between PTB and LTBI groups were 0.63 (95% CI 0.47-0.79) and 0.61 (0.45-0.77), respectively. Under the selected cut-off values, the sensitivity and specificity of IP-10 for distinguishing of TB-infected and HCs after stimulation with recombinant PE35 was 74.5% and 73%, respectively and after stimulation with recombinant PPE68 were 76.5% and 63%, respectively. Moreover, the sensitivity and specificity of IP-10 for differentiating of PTB and LTBI following stimulation with recombinant PE35 and PPE68 were 770 pg/ml (sensitivity: 63%; specificity: 62%) and 502 pg/ml (sensitivity: 80%; specificity: 52%), respectively. IP-10 stimulated by recombinant PE35 and PPE68 is a promising biomarker for TB diagnosis. However, it doesn't have desirable sensitivity and specificity in distinguishing between PTB and LTBI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11033-019-05067-0DOI Listing
December 2019

Prevalence of Antibodies and DNA in Iranian HIV Patients.

Iran J Pathol 2019 27;14(1):68-75. Epub 2018 Dec 27.

Infectious Diseases Specialist, Dept. of Clinical Research, Pasteur Institute of Iran, Tehran, Iran.

Background & Objective: infection has public health importance and can lead to serious diseases in immunosuppressed patients, such as HIV cases. Appropriate control of infection in HIV patients requires information about the prevalence of antibodies and DNA in different population. In this study, we aimed to determine the prevalence of antibodies and DNA in HIV patients in Tehran, Iran.

Methods: A total of 149 HIV patients from the Iranian Research Center for HIV/AIDS, Tehran, Iran were enrolled in the study. Anti-Toxoplasma IgG and IgM were detected by ELISA and DNA was evaluated by PCR and quantita- tive real-time PCR. IgG positive samples were also assessed for their avidity.

Results: Anti-Toxoplasma IgG and IgM were positive in 46.3% and 2.7% of cases respectively. 92.7% of our patients showed past infection and 4.3% revealed recently acquired toxoplasmosis based on their IgG avidity test. T. gondii DNA was not detected by PCR but real-time PCR results showed DNA in 4.7% of total patients and 13.1% of the IgG seropositive cases.

Conclusion: Our findings indicated that latent toxoplasmosis was relatively prevalent in our study population, but new infection had low prevalence. Almost half of our patients were IgG negative and at risk of acquiring toxoplasma infection. Low copy numbers of DNA were detected in 4.7% of the cases without any clinical manifestation. Therefore, detection and monitoring of anti-Toxoplasma antibodies and DNA in HIV patients is substantial to estimate the risk of reactivation and new infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.30699/IJP.14.1.68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708569PMC
December 2018

Lupus Erythematosus and Chronic Granulomatous Disease: Report of Four Iranian Patients with AR-CGD and One XL-CGD.

Iran J Allergy Asthma Immunol 2019 Aug 17;18(4):452-458. Epub 2019 Aug 17.

Immunology, Athma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Chronic granulomatous disease (CGD) is a rare genetic disorder of neutrophil activity, resulting in increased rate of recurrent infections with catalase-positive bacteria and fungi, as well as various autoimmune diseases such as sarcoidosis, rheumatoid arthritis, and discoid and/or systemic lupus erythematosus. Few reports have reported lupus erythematosus (LE) in patients with X-linked CGD (XL-CGD) and carriers, and very few in autosomal recessive CGD (AR-CGD). Here, we present 5 patients with CGD developing LE at different ages to emphasize on the importance of appropriate follow-up and treatment in patients with CGD with clinical signs and symptoms of autoimmune diseases and even in those with negative serologic results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/ijaai.v18i4.1426DOI Listing
August 2019

Epidemiologic and clinical findings of children with acquired immunodeficiency syndrome in four provinces of Iran.

Wien Med Wochenschr 2020 Jun 13;170(9-10):212-217. Epub 2019 Aug 13.

Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran.

Introduction: The human immunodeficiency virus (HIV) is still a remarkable challenge throughout the world, especially in developing countries. Despite the fact that HIV in children is becoming one of the most challenging diseases, it seems that pediatric AIDS in Iran is an unknown disease and there is a lack of studies about it. The aim of this study was to describe the characteristics of HIV-positive children who referred to the hospitals of Tehran, Kermanshah, Kurdistan, and Qom provinces of Iran.

Materials And Methods: This study was a retrospective investigation of medical records among 61 children with a diagnosis of HIV who were admitted to the children's hospitals in the four provinces of Iran during a 3-year period (2013-2016).

Results: The frequency of HIV in the center of Iran (Tehran and Qom provinces) was higher (N = 37, 61%). Most of the infected patients were between 5 and 15 years old, 52% were male, and 93% had a history of HIV in their family. Median age at diagnosis of HIV was 2 years. Most of the hospitalized patients were discharged and only two patients (3%) died due to HIV infection. The vast majority of patients (93%) were infected through maternal transmission and a low percentage (29%) were diagnosed before 1 year of age. All of them were in the third stage of the disease. All patients had a positive HIV PCR test. HIV EIA was positive in the majority of cases (98%). A history of addiction in the family was demonstrated in 22 cases (36%). Weight loss (N = 51, 84%), prolonged fever (N = 50, 81%), and respiratory infection (N = 26, 47%) were the most common symptoms.

Conclusion: This study demonstrated a high frequency of pediatric HIV among children aged 5-15 years in four provinces of Iran. Novel strategies to prevent and eliminate mother-to-child transmission of HIV, diagnostic facilities, and treatment of infected mothers during pregnancy in our country are highly recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10354-019-0703-1DOI Listing
June 2020

Clinical and Epidemiologic Features of Visceral Leishmaniasis in Children: A 6-year Study from an Iranian Referral Hospital.

Infect Disord Drug Targets 2020 ;20(4):461-466

Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran

Background: Visceral leishmaniasis (VL) is an emerging zoonosis disease that is endemic in the northwestern and southern part of Iran. This study aimed to evaluate the clinical characteristics and laboratory findings of the children with VL hospitalized at Children Medical Center Hospital (CMC), Tehran, Iran.

Methods: A retrospective study was performed based on studied medical records of children with a final diagnosis of VL from 2011 to 2016. For each patient's demographics, clinical laboratory findings and treatment were examined.

Results: The clinical features of 17 children were examined and the most frequent symptoms were fever (94.1%, n=16), pallor, loss of appetite (76.5%, n=13), splenomegaly (82.4%, n=14) and hepatomegaly (58.8%, n=10). The most frequent laboratory abnormalities were hematological including anemia (94.1%, n=16), leukopenia (52.9%, n=9) and thrombocytopenia (70.5%, n=12). In order to detect anti-Leishmania antibodies, DAT was performed in 11 patients and 82% of them were positive (titers ≥ 1: 3200). In addition, rK39 was used in 9 cases and 7 children (78%) had positive results. Direct parasitology revealed the presence of amastigotes of Leishmania in bone marrow aspirate (BMA) stained by Giemsa stain in 9 patients (69%, among 13 children).

Conclusion: Leishmaniasis is a regional disease therefore management and control of disease, particularly in an endemic area, as well as detection of new emerging foci are recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1871526519666190613123217DOI Listing
October 2020