Tehran University Medical Journal

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Background: Acute respiratory tract infections, both bacterial and viral, cause 4.5 million childhood deaths worldwide, most of which occur in developing countries. Parainfluenza viruses, of the paramyxoviridae family, are among the common causes of acute respiratory infections, giving rise to 30% of respiratory infections in children before school age. The four parainfluenza viruses that cause a spectrum of respiratory illness in humans are designated as human para influenza virus-1 through 4. Spreading from the respiratory tract by aerosolized secretions or direct hand contact with secretions, parainfluenza viruses replicate in the respiratory epithelium without evidence of systemic spread. The destruction of cells in the upper airways can lead to secondary bacterial invasion and resultant bacterial tracheitis. Eustachian tube obstruction can lead to secondary bacterial invasion of the middle ear space and acute otitis media. In otherwise healthy children, the majority of illnesses remain in the upper respiratory tract. As with many viruses, three approaches to the diagnosis of parainfluenza virus are currently used: viral culture, detection of viral antigen or nucleic acid, and serologic analysis. The gold standard remains the isolation of virus in tissue culture.

Methods: This descriptive case-series study was conducted from January 2003 to January 2004, and included 96 children five years of age and younger. To determine the relative frequency of parainfluenza respiratory tract infection, the nasopharyngeal secretions were studied by immunofluorescent antibody (IFA) assay. Seasonal incidence, age distribution and clinical signs and symptoms of this infection were also recorded.

Results: Among our study group, the relative frequency of parainfluenza respiratory infection was 26%, most commonly in children aged 25-36 months and in autumn. Cough (84%) and rhinorrhea (96%) were the most common symptoms, with fever (68%) as the most common sign in our patients. Pharyngotonsilitis was the most common (40%) clinical manifestation in our patients.

Conclusions: According to above data, patient age and the frequency of parainfluenza infection were similar to other studies.

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Background: There are many methods for removal of tracheobronchial foreign bodies but there are many situations where removal of a foreign body seems impossible and may require a major surgical procedure. Familiarity with each method improves physician decision making.
Case: A 17 months old baby with a history of foreign body aspiration suffered from long term pneumonia. There was a round shape foreign body in bronchoscopic view that could not be removed with standard methods, but was removed by application of Fogarty catheter Conclusion: Removal of round, spherical foreign bodies may be performed by Fogarty Catheter preventing surgical intervention.

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Background: Early diagnosis of bacteremia and its complications is the most important part of care and management of the patients. The utility of polymerase chain reaction (PCR) techniques have been shown to identify pathogens in less and more optimal time. The aim of our study was to evaluate prevalence of bacteremia using universal PCR in febrile patients admitted in Pediatric Medical Center comparing other routine methods like blood culture.
Methods: One hundred febrile children suspected to septicemia who were admitted in Pediatric Medical Center, were included. From all patients whole blood samples were obtained for blood culture and PCR.
Results: Of all patients, 65% were 3 to 36 months old. The frequency of male and female patients was 45 and 55, respectively. The prior oral and parental antibiotic therapy had been taken for 45 and 12 patients. The mean temperature of body was 38.98±0.57 at presenting time. Twelve patients were positive blood culture. Nineteen patients had positive PCR test which consisted of 11 patients with positive blood culture. The severity of fever and laboratory findings such as WBC, ESR, and CRP had no significant difference between patients with positive and negative blood culture and PCR.
Conclusion: universal PCR technique is more sensitive and specific than conventional blood culture and other methods to diagnose bacterial infection.