There are many difficulties distinguishing bacterial from viral meningitis that could be reasonably solved using biomarkers. The aim of this study was to evaluate lactate, procalcitonin (PCT), ferritin, serum-CRP (C-reactive protein), and other known biomarkers in differentiating bacterial meningitis from viral meningitis in children. All children aged 28 days to 14 years with suspected meningitis who were admitted to Mofid Children's Hospital, Tehran, between October 2012 and November 2013, were enrolled in this prospective cross-sectional study. Children were divided into 2 groups of bacterial and viral meningitis, based on the results of cerebrospinal fluid (CSF) culture, polymerase chain reaction, and cytochemical profile. Diagnostic values of CSF parameters (ferritin, PCT, absolute neutrophil count [ANC], white blood cell count, and lactate) and serum parameters (PCT, ferritin, CRP, and erythrocyte sedimentation rate [ESR]) were evaluated. Among 50 patients with meningitis, 12 were diagnosed with bacterial meningitis. Concentrations of all markers were significantly different between bacterial and viral meningitis, except for serum (P = .389) and CSF (P = .136) PCT. The best rates of area under the receiver operating characteristic (ROC) curve (AUC) were achieved by lactate (AUC = 0.923) and serum-CRP (AUC = 0.889). The best negative predictive values (NPV) for bacterial meningitis were attained by ANC (100%) and lactate (97.1%). The results of our study suggest that ferritin and PCT are not strong predictive biomarkers. A combination of low CSF lactate, ANC, ESR, and serum-CRP could reasonably rule out the bacterial meningitis.

The increasing incidence of antimicrobial resistance bacterial infection and decreasing effectiveness of conventional antibiotics to treatment have caused serious problems worldwide. The demand for new generationantibiotics to combat microbial pathogens is imperative. Cationic antimicrobial peptides (AMPs) with different sources from prokaryotic to complex eukaryotic organisms, with variable length, amino acid composition and secondary structure, have been consideredduring the past decades. The advantages of large number of AMPs are related to broad spectrum and morphogenetic activities, low resistance rate among microorganismswithout side effect on human cells, rapid killing of bacteria via membrane damage and intracellular targets,and their critical roles in anti-inflammatory. Ribosomal synthesized peptides of Gram positive bacteria with various post translational modificationsrepresent extended types of antimicrobial peptide with different structural and functional diversity. These types of peptides have been considered as new therapeutic agents for pharmaceutical development .In addition, non- ribosomal synthesized peptides are a wide range of peptides , an extremely extensive range of biological activities and pharmacological properties that are not synthesized by ribosomes, show interesting biological properties ranging from antibiotic to bio surfactants. This review focused on genetics, mechanism of action and modifications, resistance mode of Gram positive bacteria to AMPs and the biotechnological application of ribosomally and non-ribosomally synthesized peptides derived from Gram positive bacteria.

To explore the serotype distribution and drug resistance patterns of invasive pneumococcal isolates from children under 5 years of age. During a 32-month period, 585 clinical samples (including blood, cerebrospinal fluid (CSF), and synovial fluid) from children suspected of having meningitis, sepsis, pneumonia, or septic arthritis were analyzed using the BACTEC culture system. Positive cultures were examined using biochemical tests and lytA amplification for the identification of pneumococcal strains. The confirmed pneumococcal isolates were examined to determine capsular types using a modified sequential multiplex PCR and susceptibility to antimicrobial agents. Fifty-three pneumococcal isolates were detected in the 585 clinical samples: 21 (39.6%) blood samples and 32 (60.4%) CSF samples. The most frequent serotype was 23F (24.5%), followed by serotypes 19F (18.9%), 19A (7.5%), and 9V (7.5%). Twenty-one percent of pneumococcal isolates were penicillin-non-susceptible and serotype 19A was significantly associated with resistance to penicillin. This study indicated that the 13-valent pneumococcal conjugate vaccine (PCV13) could cover the majority of the invasive pneumococcal isolates. Drug-resistant and multidrug-resistant Streptococcus pneumoniae strains are circulating in Iran. Therefore, public immunization of infants using PCV13 is recommended to reduce the incidence of pneumococcal disease and pneumococcal-resistant strains in Teheran.