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Parvaneh L, Sharifi N, Azizi G, Abolhassani H, Sharifi L, Mohebbi A, Bahraminia E, Delavari S, Alebouyeh M, Tajeddin E, Mohebbi SR, Yazdani R, Behniafard N, Aghamohammadi A. Infectious etiology of chronic diarrhea in patients with primary immunodeficiency diseases. Eur Ann Allergy Clin Immunol 2018; 51:32-37. [PMID: 30417635 DOI: 10.23822/eurannaci.1764-1489.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Background.Primary immunodeficiency diseases (PIDs) are life-threatening disorders, which manifest commonly with gastrointestinal (GI) signs, mainly as chronic diarrhea. Objective. To investigate and compare infectious etiology of chronic diarrhea in different PIDs. Patients and methods. Assessing clinical features, obtaining immunological profiles, as well as characterizing infectious etiology of diarrhea were performed in 38 PID patients with chronic diarrhea. Stool samples and/or biopsy specimens were checked using culture, microscopic examination, RT-PCR, and PCR, as appropriate. The patients were diagnosed to have common variable immunodeficiency (CVID), severe combined immunodeficiency (SCID), X-linked agammaglobulinemia (XLA), and hyper-IgM (HIgM) syndrome. Results. In 32 patients we identified 41 infectious agents including 16 parasitic (39.0%, the most common Giardia lamblia), 11 bacterial (26.8%, the most common salmonella spp), 8 viral (19.5%, the most frequent group A rotavirus), and 6 fungal organisms (14.7%, the most common Candida albicans). From 6 of the patients, no infectious agent was isolated. In CVID bacteria and parasites, in SCID bacteria and viruses, in XLA parasites, and in individuals with HIgM syndrome parasites were the leading causes of chronic diarrhea. Infection with giardia and cryptosporidium were more frequent in XLA and HIgM, respectively. Conclusion. The current study suggests considering both usual and unusual pathogens in laboratory investigation and in the empiric treatment of chronic diarrhea. Opportunistic pathogens should be taken into account when no other pathogen is identified, especially in patients on long-term treatment or prophylaxis with antifungals/antibiotics and in those from geographical locations that favor pathogenicity of these organisms.
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Affiliation(s)
- L Parvaneh
- Department of Biology, Central Tehran Branch, Islamic Azad University, Tehran, Iran. Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - N Sharifi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - G Azizi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - H Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - L Sharifi
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - A Mohebbi
- Growth and Development Research Centre, Paediatrics Centre of Excellence, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - E Bahraminia
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S Delavari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Alebouyeh
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - E Tajeddin
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S R Mohebbi
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - N Behniafard
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - A Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Fazlollahi MR, Pourpak Z, Hamidieh AA, Movahedi M, Houshmand M, Badalzadeh M, Nourizadeh M, Mahloujirad M, Arshi S, Nabavi M, Gharagozlou M, Khayatzadeh A, Dabbaghzade A, Atarod L, Zandieh F, Sadeghi Shabestary M, Mesdaghi M, Mohammadzadeh I, Mahdaviani SA, Eslamian MH, Pesaran F, Bahraminia E, Abolnezhadian F, Arij Z, Moin M. Clinical, Laboratory, and Molecular Findings for 63 Patients With Severe Combined Immunodeficiency: A Decade´s Experience. J Investig Allergol Clin Immunol 2017; 27:299-304. [PMID: 28266921 DOI: 10.18176/jiaci.0147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Severe combined immunodeficiency (SCID) is a life-threatening pediatric disease. We report on the clinical evaluation, immunological assessment, molecular analysis, and outcomes of SCID patients in a tertiary referral center in Iran. METHODS From January 2006 to December 2015, we performed a prospective cohort study in which initial screening and advanced immunological tests were carried out on patients suspected of having SCID. Genetic analysis was also performed to confirm the diagnosis. RESULTS A total of 63 patients were diagnosed with SCID (43 male [68.3%]). The median age at onset and diagnosis and diagnostic delay were 40 and 110 and 60 days respectively. A total of 49 patients (77.8%) had a history of BCG vaccination, and of these, one-third experienced BCG-associated complications. The most common clinical manifestations were pneumonia, recurrent oral candidiasis, chronic diarrhea, and failure to thrive. Of the thirteen patients who underwent hematopoietic stem cell transplantation, 8 survived and 5 died before they could receive the transplant. Most patients (34.9%) were classified as having T-B-NK+ SCID and had a mutation in the RAG2 or RAG1 gene. CONCLUSIONS Autosomal recessive SCID is the most common type in Iranian patients. Providing high-quality training to physicians and patients' families to reduce the diagnostic delay should be prioritized. It is also important to raise awareness of live vaccination and to expand stem cell donor registries to speed up the transplantation process.
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Affiliation(s)
- M R Fazlollahi
- Immunology Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran
| | - Z Pourpak
- Immunology Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran
| | - A A Hamidieh
- Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Movahedi
- Department of Allergy and Clinical Immunology, Children´s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Houshmand
- Immunology Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Genetics, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - M Badalzadeh
- Immunology Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran
| | - M Nourizadeh
- Immunology Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran
| | - M Mahloujirad
- Immunology Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran
| | - S Arshi
- Department of Allergy and Clinical Immunology, Hazrat Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - M Nabavi
- Department of Allergy and Clinical Immunology, Hazrat Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - M Gharagozlou
- Department of Allergy and Clinical Immunology, Children´s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - A Khayatzadeh
- Department of Allergy and Clinical Immunology, Children´s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - A Dabbaghzade
- Department of Allergy and Clinical Immunology, Mazandaran University of Medical Sciences, Sari, Iran
| | - L Atarod
- Department of Pediatrics, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - F Zandieh
- Department of Allergy and Clinical Immunology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Sadeghi Shabestary
- Department of Allergy and Clinical Immunology, Tabriz Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Mesdaghi
- Department of Allergy and Clinical Immunology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - I Mohammadzadeh
- Department of Immunology and Allergy, Amirkola Hospital, Babol University of Medical Sciences, Babol, Iran
| | - S A Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M H Eslamian
- Allergy and Clinical Immunology Group, Faculty of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
| | - F Pesaran
- Immunology Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran
| | - E Bahraminia
- Department of Allergy and Clinical Immunology, Children´s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - F Abolnezhadian
- Department of Immunology and Allergy, Ahvaz University of Medical Sciences, Ahvaz, Iran
| | - Z Arij
- Immunology Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran
| | - M Moin
- Immunology Asthma and Allergy Research Institute (IAARI), Tehran University of Medical Sciences, Tehran, Iran
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Shafiee A, Nazari S, Jorjani S, Bahraminia E, Sadeghi-Koupaei M. Prevalence of Depression in Patients with β-Thalassemia as Assessed by the Beck’s Depression Inventory. Hemoglobin 2014; 38:289-91. [DOI: 10.3109/03630269.2014.929008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Merrikhi A, Bahraminia E. Association of urinary transforming growth factor-β1 with the ureteropelvic junction obstruction. Adv Biomed Res 2014; 3:123. [PMID: 24949294 PMCID: PMC4063104 DOI: 10.4103/2277-9175.133196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 09/16/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We aimed to compare the level of urinary transforming growth factor-beta 1 (TGF-β1) in children with ureteropelvic junction obstruction (UPJO) with the normal peers. MATERIALS AND METHODS In this case-control study, we enrolled children with UPJO and matched normal peers. Sterile urine was collected from the subjects and urinary TGF-β1 was measured by ELISA method. Also, degree of the UPJO and the magnitude of the renal injury were assessed by ultrasonography and measuring glomerular filtration rate (GFR), respectively. Study variables were then compared between the study groups regarding the level of urinary TGF-β1. RESULTS A total of 25 children with UPJO (age = 7.4 ± 4.5 years; male = 16) were compared with 25 healthy peers (age = 6.8 ± 5.6 years; male = 16). Mean GFR in the UPJO and the control group were 112.4 ± 10.1 and 123.29 ± 4.4, respectively. Mean urinary TGF-β1 in the UPJO group was 87.1 ± 12.6 pg/ml vs 30.5 ± 14.5 pg/ml in the control group. The level of urinary TGF-β1 was significantly associated with the degree of TGF-β1 and patients with grade IV hydronephrosis had the highest level of urinary TGF-β (P = 0.0001). CONCLUSION Based on our findings, biomarkers such as TGF-β1 can successfully be used for confirming UPJO. However, further studies are needed to determine the proper cut point for diagnosis confirmation.
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Affiliation(s)
- Alireza Merrikhi
- Department of Pediatrics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Emad Bahraminia
- Department of Pediatrics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Nazari S, Koupaei MTS, Shafiee A, Kashani ZHG, Bahraminia E, Ansari M, Alipour A. Emotional/Behavioral problems in children with acute lymphoblastic leukemia: a case-control study. Int J Hematol Oncol Stem Cell Res 2014; 8:14-20. [PMID: 24800034 PMCID: PMC4003438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 01/09/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite achievements in treating acute lymphoblastic leukemia (ALL) in children, its burden on the psychosocial status of patients is not well defined yet. This study aims to determine the impact of childhood ALL on emotional and behavioral pattern of the patients compared to healthy peers as assessed by the Child Behavior Checklist (CBCL). METHODS We studied 100 children with ALL (aged 6-12 years) and 100 healthy sex/age peers as control group. All ALL cases were treated by chemotherapy alone. After being informed by a psychologist, parents in both groups were asked to complete the CBCL form. Final results were then compared between the two study groups. RESULTS There were no significant differences between the groups regarding the general characteristics. Failure in school performance, restricted group activity and less social relations were significantly higher in the ALL cases. Total competence was also significantly disturbed for the ALL cases. Social problems, attention problems, aggressive behavior, externalization, attention deficit/hyperactivity, conduct and oppositional defiant problems were significantly more prevalent in healthy children. Somatic problems were significantly higher in the ALL cases. CONCLUSION Our findings suggest that except for somatic problems, behavioral problems among the ALL cases are significantly less frequent than the healthy peers, which may stem from better care and support from the families. Our unique findings emphasize the need for more research on the psychosocial status of children with cancer in future.
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Affiliation(s)
- Shiva Nazari
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Akbar Shafiee
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Emad Bahraminia
- Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Ansari
- Department of Pediatric Hematology and Oncology, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Alipour
- Department of Psychology, Payam-e Nour University, Tehran, Iran
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Saneian H, Bahraminia E. Congenital chloride diarrhea misdiagnosed as pseudo-Bartter syndrome. J Res Med Sci 2013; 18:822-4. [PMID: 24381629 PMCID: PMC3872595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 05/14/2013] [Accepted: 08/29/2013] [Indexed: 11/05/2022]
Abstract
Congenital chloride diarrhea (CCD) is a rare autosomal recessive disease which is characterized by intractable diarrhea of infancy, failure to thrive, high fecal chloride, hypochloremia, hypokalemia, hyponatremia and metabolic alkalosis. In this case report, we present the first female and the second official case of CCD in Iran. A 15-month-old girl referred to our hospital due to failure to thrive and poor feeding. She had normal kidneys, liver and spleen. Treating her with Shohl's solution, thiazide and zinc sulfate did not result in weight gain. Consequently, pseudo-Bartter syndrome was suspected, she was treated with intravenous (IV) therapy to which she responded dramatically. In addition, hypokalemia resolved quickly. Since this does not usually happen in patients with the pseudo-Bartter syndrome, stool tests were performed. Abnormal level of chloride in stool suggested CCD and she was thus treated with IV fluid replacement, Total parentral nutrition and high dose of oral omeprazole (3 mg/kg/day). She gained 1 kg of weight and is doing fine until present. CCD is a rare hereditary cause of intractable diarrhea of infancy. It should be considered in infants with unknown severe electrolyte disturbances.
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Affiliation(s)
- Hossein Saneian
- Department of Pediatrics, Child Growth and Development Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Hossein Saneian, Department of Pediatrics, School of Medicine, Child growth and Development research center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Emad Bahraminia
- Department of Pediatrics, Child Growth and Development Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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