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.

Antibacterial activity assessment and high performance liquid chromatography associated with nuclear magnetic resonance (HPLC/NMR) data revealed that the EtOAc extract of the fermented endophytic fungus Trichoderma saturnisporum DI-IA, obtained from the marine sponge Dictyonella incisa, contained conjugated olefinic metabolites with antibacterial activity. Chemical examination of the fungal strain resulted in the isolation of eight new sorbicillinoid-based compounds, namely saturnispols A–H (1–8). Their structures were determined on the basis of extensive spectroscopic analysis, including the experimental and calculated electronic circular dichroism (ECD) data for the configurational assignments. Saturnispol F exerted significant inhibition against a panel of bacteria strains including vancomycin-resistant enterococci (VRE) with a minimum inhibitory concentrations (MIC) ranging from 1.63 to 12.9 μg/mL, while saturnispol H showed selective effects against VRE and B. subtilis.

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.

Introduction.Naegleria fowleri, a free living amoeba, can cause devastating and deadly diseases in humans. This is the first report of primary amoebic meningoencephalitis from Iran.Case report. A five-month-old male infant presented with the history of fever and eye gaze for three days, after beginning of bacterial meningitis, a plain and contrast CT revealed communicated hydrocephalus. In the repeat of CSF analysis on microscopic examination of wet preparation of CSF,Naegleria Fowleriwas seen. Then, Amphotericin B and Rifampin were started. On followup, two months later, the patient was totally asymptomatic.Conclusion. Though occurrence of PAM is rare, this unusual disease has grave prognosis, so infection with free living amoebas must be considered in differential diagnosis of pediatric patients of purulent meningitis without evidence of bacteria on Gram’s stain and imaging findings, nonspecific brain edema on CT or hydrocephalus even without history of contact.

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