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Diarrhea and vomiting with or without fever are common symptoms in children, while one of the most common clinical findings of Coronavirus disease 2019 (COVID-19) is gastrointestinal symptoms. Therefore, there is a need to develop an algorithm for dealing with a patient with gastroenteritis in the SARS-CoV-2 epidemic.

The coronavirus disease 2019 (COVID-19) pandemic has imposed a significant burden worldwide, manifesting as a severe disease and causing mortality even in children. Severe COVID-19 disease is characterized by cytokine storm with progression to secondary hemophagocytic lymphohistiocytosis (sHLH). We describe an 18-month-old boy in Iran, previously healthy, diagnosed with COVID-19-induced sHLH. Three weeks after close contact with COVID-19 confirmed cases, he was admitted with high fever, lethargy, mild respiratory distress, skin rash, and conjunctivitis with swollen eyelids and lips. Laboratory data revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and liver enzymes, and mild thrombocytopenia. His clinical condition rapidly deteriorated, with septic shock, hepatosplenomegaly, and respiratory failure. Laboratory tests showed cytopenia, coagulopathy, hyperferritinemia, and hypertriglyceridemia, which met the criteria for sHLH diagnosis. Chest computed tomography (CT) revealed bilateral infiltrations that suggested acute respiratory distress syndrome (ARDS) of COVID-19 that was confirmed by a positive real-time polymerase chain reaction (RT-PCR) test. Therefore, the child was treated with intravenous immunoglobulin (IVIG), glucocorticoid, hydroxychloroquine, lopinavir/ritonavir, and interferonβ-1a. This therapeutic strategy enabled complete recovery from fever, regaining consciousness, weaning from respiratory support, and resolving shock. Serial chest radiographs showed diminishing infiltrations. Sequential physical examinations revealed an overall significant reduction in spleen and liver span. Laboratory data showed rapid improvement from cytopenia and coagulopathy, normalization of liver enzyme levels, and reduction in hyperinflammation markers. Although ARDS is the most common cause of death from COVID-19, other complications such as sHLH may be lethal; thus, early diagnosis and appropriate treatment are necessary for saving patients’ lives.

The first case of Kawasaki-like disease in children infected with COVID-19 was reported in a preprint case report. In the present case series, three pediatric probable cases with COVID-19, who presented signs and symptoms of Kawasaki-like syndrome, and their three-month follow-up are provided.

COVID-19 is an ongoing pandemic that is not known well. According to our current knowledge, although respiratory manifestations are the most common symptoms of COVID-19, but non-pulmonary manifestations are also commonly reported, such as rashes, appendicitis, volvulus, diverticulitis, and mesenteric lymphadenitis. In this case series, we introduced four children with COVID-19 who presented with gastrointestinal symptoms.

Brucellosis, with multi-organ involvement, is recognized as a zoonotic infection in Iran. This infection has multiple signs and symptoms. On the other hand, hemophagocytic lymphohistiocytosis (HLH) is described as an uncommon disorder. The secondary type of this disease may be associated with infection. However, the association between HLH and brucellosis has been rarely reported, especially in pediatric populations. Herein, we present a pediatric case of secondary HLH associated with brucellosis. Based on our findings, HLH should be considered in patients diagnosed with brucellosis with profound cytopenia and increased spleen size despite treatment.

Background: Antibiotic-associated diarrhea (AAD) is of great concern in children due to the wide range of antibiotic administration among this population. Studies considering the use of synbiotics for prevention or treatment of AAD are limited. In the current study, the effectiveness of synbiotics in preventing AAD was investigated. Methods: This randomized, double-blinded clinical trial was conducted on 100 patients undergoing antibiotic therapy for over five days. The patients were randomly divided into a case group receiving synbiotic therapy (Protexin; The United Kingdom) and a control group undergoing placebo therapy (consisting of starch sachets). Both groups began their medication within 24 hours after antibiotic initiation and continued it for further seven days after antibiotic therapy cessation. The two groups were compared regarding the incidence of diarrhea, stool consistency based on the Bristol Stool Scale (BSS), and the duration of diarrhea. Results: The members of case and control groups were not statistically different regarding age, gender distribution, length of hospitalization, the frequency of defecation, and stool consistency based on BSS before antibiotic therapy, primary and final diagnosis, the type of antibiotics prescribed, and duration of antibiotic therapy (P > 0.05). The incidence of AAD was significantly less in the case group compared with the control group (P = 0.016), while those with AAD did not show significant difference regarding the duration of diarrhea, stool consistency based on BSS, and the frequency of defecation a day (P = 0.51, 0.26, and 0.18, respectively). Conclusions: The findings of this study showed that early initiation of synbiotics and its long-term administration following antibiotic therapy cessation could considerably prevent AAD; however, in case of AAD occurrence synbiotic therapy cannot positively affect duration, stool consistency, and the frequency of defecation.

Background: Vitamin D plays an important role in regulating the immune system, calcium and phosphorus homeostasis, and bone formation. This micronutrient plays an important role in the incidence and severity of respiratory infections. Objectives: The aim of this study was to evaluate the vitamin D serum level in children with acute lower respiratory infections (ALRIs) and its association with the severity of infection with vitamin D serum level. Methods: This cross-sectional study was conducted on 99 children with ALRIs aged 20.13 ± 17.55 months who were selected with a simple random sampling technique. The children were examined and evaluated at the time of admission. Their data, including demographic characteristics and the findings of the physical examination and laboratory, were recorded in the questionnaires. Serum level of 1,25-dihydroxy vitamin D3 [1,25(OH)2D] and 25-hydroxyvitamin D3 [25(OH)D] were measured by HPLC method. Results: children with severe acute lower respiratory infection had a significant lower level of 25(OH) D (P = 0.02). Indeed, data analysis showed a level of 25(OH) D inversely associated with severity of acute lower respiratory infections in children (B = -0.7, P = 0.00). Conclusions: The severity of the lower respiratory tract infections was inversely proportional to the level of 25(OH)D, and it may be hoped that increasing 25(OH)D level may reduce the severity of ALRIs.

Salmonella typhi is a Gram-negative microorganism. This enteric pathogen causes a variety of signs and symptoms, but the more prevalent is fever and gastrointestinal signs. It is important to consider this microorganism in the differential diagnosis in patients coming from the regions with a high prevalence of salmonella typhi and unusual signs and symptoms.

Objectives: The aim of this study was to evaluate endothelial dysfunction in pediatric patients with Helicobacter pylori infection. Methods: In a cross sectional study, 50 children between six and twelve years old were evaluated for Helicobacter pylori infection by a histopathologic specimen. C-reactive protein (CRP) and Interleukin -12 of all subjects was checked. Endothelial dysfunction was evaluated by echocardiography of brachial artery and through measuring flow mediated dilatation (FMD). Results: Mean of FMD level was significantly higher in children with H. pylori infection (P value: 0.04). Interlukin-12 (IL-12) was higher in children with H. pylori infection (P value: 0.04). Linear regression showed a positive association of Helicobacter pylori infection and endothelial dysfunction (beta = 0.3, P value = 0.08). Conclusions: Children with Helicobacter pylori infection have more endothelial dysfunction independent of IL-12.