An 8-month-old infant with extensive petechial and purpuric rash was accepted to our pediatric intensive care unit (PICU). Patient’s purpuric rash involved the face, chest, and upper and lower ...extremities markedly (Figure 1A). The patient required intubation secondary to decompensated septic shock, and a purpuric lesion was noticed on the right side of the epiglottis during the initial attempt for intubation. A picture of the lesion was taken by video laryngoscopy (Figure 1B). This lesion was considered as a mucosal manifestation of purpura fulminans. Blood culture and cerebrospinal fluid polymerase chain reaction were positive for Neisseria meningitidis.
Invasive aspergillosis (IA) is an important cause of morbidity and mortality. In this study, we aimed to present our 10-year IA experience in a single center. Fifty-nine pediatric patients diagnosed ...with IA were included in the study. The male/female ratio of these patients was 42/17. The median age was 8.75 years. Hematologic malignancy was present in the majority of the patients (40/59, 68%). The mean duration of neutropenia was 18.5 days. Cytosine arabinoside was the most common immunosuppressive therapy directed at T-cells at the time of IA diagnosis. IA cases were categorized as proven (27%), probable (51%) and possible (22%) according to the 2008 EORTC/MSG criteria. The most common site of invasive aspergillosis was the lungs (78%) and nodules were the most frequent radiological finding (75.5%). In 38 (64.4%) patients receiving antifungal prophylaxis, prophylactic agents included fluconazole (30.5%), liposomal amphotericin B (23.7%), posaconazole (8.5%) and voriconazole (1.7%) Initial treatment was most commonly administered as monotherapy (69.5%). The median duration of antifungal treatment was 67 days. A total of 11 (18.6%) deaths occurred due to aspergillosis. We will probably continue to see IA frequently in pediatric patients with increased use of corticosteroids, biological agents, and intensive immunosuppressive chemotherapies.
BACKGROUND:Colistin is active against most multidrug-resistant, aerobic Gram-negative bacteria. Because of the reported nephrotoxicity during the first years of use of colistin, there were concerns ...of its use in pediatrics where there was limited experience The aim of this study is to document the clinical characteristics and outcomes of use of colistin in pediatric patients at a pediatric intensive care unit in Turkey.
METHODS:We reviewed the medical and laboratory records of 29 critically ill children who were treated with colistin for 38 courses between January 2011 and December 2011 at the Department of Pediatric Intensive Care Unit in Ankara University Medical School, Turkey.
RESULTS:The median age was 17 months (range 3–217 months). Male-to-female ratio was 1:1.37. Ventilator-associated pneumonia (21 courses) was the leading diagnosis followed by catheter-related blood stream infection (6 courses), bacteremia (4 courses), ventriculoperitoneal shunt infection, peritonitis and pneumonia (1 course). The most commonly isolated microorganisms were Acinetobacter baumanni, Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia marcescens, Stenotrophomonas maltophilia, and Enterobacter cloacae. Two colistin formulations were used. Colimycin (Kocak Farma) was used in 21 colistin treatment episodes. The median dosage of colistin in this group was 5.0 mg/kg/d (2.3–5.6 mg/kg/d). Colomycin (Forest Laboratories) was used in 17 colistin treatment episodes. The median dosage of colistin in the second group was 75,000 International Unit/kg/d (50,000–80,000 International Unit/kg/d). Thirty colistin treatment episodes (79%) had a good or partial clinical response and 8 (21%) had a poor clinical response. Of the 8 colistin treatment episodes with poor clinical response, 3 were in the Colimycin group and 5 were in the Colomycin group. Ten patients died. There was no evidence of neurotoxicity in this study. Nephrotoxicity was observed in 1 patient but was not attributed to colistin because the patient had multiorgan failure at the same time.
CONCLUSIONS:This study in a small cohort of patients suggests that the use of colistin in severe nosocomial infections caused by multidrug-resistant Gram-negative bacteria is well-tolerated and efficacious.
Broad and deep perianal wounds are challenging in both adult and pediatric ICUs. These wounds, if contaminated with gastrointestinal flora, can cause invasive sepsis and death, and recovery can be ...prolonged. Controlling the source of infection without diverting stool from the perianal region is complicated. The option of protective colostomy is not well-known among pediatric critical care specialists, but it can help patients survive extremely complicated critical care management. These authors present three critically ill children who required temporary protective colostomy for perianal wounds because of various clinical conditions. Two patients were treated for meningococcemia, and the other had a total artificial heart implantation for dilated cardiomyopathy. There was extensive and profound tissue loss in the perianal region in the patients with meningococcemia, and the patient with cardiomyopathy had a large pressure injury. Timely, transient, protective colostomy was beneficial in these cases and facilitated the recovery of the perianal wounds. Temporary diverting colostomy should be considered as early as possible to prevent fecal transmission and accelerate perianal wound healing in children unresponsive to local debridement and critical care.
Adenovirüs üst ve alt solunum yolu, konjuntiva, gastrointestinal
bölgede enfeksiyonlara yol açabilen zarfsız, çift sarmallı bir DNA
virüsüdür. Adenovirüs enfeksiyonları genellikle hafif geçirilmekle
...beraber özellikle immün yetersizlikli hastalarda mortalite ve
morbitideye neden olabilir. Adenovirüs enfeksiyonlarının tedavisinde
sidofovir kullanılabilir. Sidofovir özellikle adenovirüs ve herpesvirüste
kullanılan virostatik etkili bir antiviraldir. Biz bu olgu sunumunda
böbrek yetersizliği nedeniyle tarafımıza sevk edilen ve izlemde
adenovirüse bağlı ağır Akut Solunum Sıkıntısı sendromu gelişen
ve sidofovirle başarılı bir şekilde tedavi edilen 15 yaşındaki immün
yetmezliği olmayan serebral palsili hastayı sunduk.
Purpura fulminans (PF) is a rare but fatal thrombotic disease caused by microvascular thrombosis due to coagulation disorder. Necrosis can progress to muscle and bone tissue contributing to late ...mortality and morbidity. A healthy 4-month-old girl and a 7-month-old girl had previously admitted to our intensive care unit with severe PF due to meningococcemia. Both patients had a severe and critical period in the pediatric intensive care unit and were supported with extracorporeal treatments. We opened colostomy for perineal infection because of large and deep skin lesions. In addition, we waited for a full auto-amputation involving all extremities instead of early surgical amputation. Both survived and acceptable limb function and some mobilization capacity were preserved. In conclusion, we think that early colostomy in severe perineal infections and autoamputation options in severe extremity involvement should be preferred in order to get better results.
An increasing number of pediatric patients with dilated cardiomyopathy (DCMP) undergo mechanical circulatory support (MCS), as a bridge to heart transplantation. Gastrointestinal complications in ...this population are rare, and the treatment is challenging. Patients with DCMP frequently present with heart failure symptoms, such as tachycardia, hypotension, respiratory distress, cyanosis, weak peripheral pulses, and inadequate feed. Rarely, gastrointestinal symptoms, such as nausea and ascites, may be noted if biventricular failure develops. Here we present a case of a 14-year-old girl with severe intractable diarrhea and malnutrition after being diagnosed with DCMP. After extracorporeal cardiopulmonary resuscitation, she was bridged to a long-term left ventricular assist device support. Her recovery was complicated with intractable diarrhea and malnutrition, which were critical. Thus, this case study aimed to emphasize that pediatric patients with DCMP having persistent diarrhea and malnutrition can be successfully treated with MCS.
The aim of this study was to determine the clinical characteristics of children demonstrating neurological complications with pandemic influenza (H1N1). We reviewed the medical and laboratory records ...of all children who were hospitalized with neurological symptoms and who had proven influenza virus infection by reverse transcriptase–polymerase chain reaction on nasal and throat swabs. Eight children aged between 10 months and 7 years had neurological complications due to pandemic influenza (H1N1) and five of them were female. Four of them were previously healthy; there was chronic renal failure (CRF) in one and neurologic disease in three patients. Seven of them had seizure and altered consciousness. Seven of them were followed in pediatric intensive care units. We performed lumbar puncture in four patients and their cerebrospinal fluid examinations showed pleocytosis in one and no cell in three specimens. Neuroimaging was performed in four patients and three of them had abnormalities. We diagnosed aseptic meningitis in one, acute disseminated encephalomyelitis (ADEM) in one, acute necrotizing encephalopathy (ANE) in one, meningoencephalitis in one, and status epilepticus in four patients. All patients were treated with oseltamivir and antiepileptic drugs. One patient with CRF died; four previously healthy patients recovered fully, and three patients who had neurologic disorder returned to their previous neurological status. In conclusion, during pandemic influenza (H1N1) infection, neurological complications may be seen in addition to the respiratory infection. The type of neurological involvement may be variable such as triggering seizure, aseptic meningitis, encephalitis, ADEM, and ANE. Neurological complications frequently recover fully especially in previously healthy children, but sometimes a severe clinical course occurs.
Introduction: The aim of this study was to determine the frequency
of central line-associated bloodstream infections, risk factors, their
relationship with catheter insertion location, and the effect ...of central
line-associated bloodstream infections on mortality and pediatric
intensive care unit (PICU) length of stay.
Methods: This was a prospective, observational and cohort study,
carried out between November 2009 and February 2011. During
this period, all the patients who had central-line were monitored for
central line-associated bloodstream infection.
Results: In the study period, 275 patients were admitted to our PICU.
The frequency of invasive device usage was 38.9% (107) for central
venous catheter, 38.2% (105) for mechanical ventilation, 53.3%
(147) for urinary catheter, and 11.3% (32) for artery line. Central lineassociated
bloodstream infection was detected in 16 (14.8%) of the
patients and 23 central line-associated bloodstream infection attacks
were observed. There were 14 central line-associated bloodstream
infection attacks in 1.000 central venous catheter usage days. There
were 168 patients without central venous catheter and 4 (2.4%) of
them had blood stream infection. Thirty-six patients died and the
mortality rate was 13%. Five of these patients (13.8%) died due to
central line-associated bloodstream infection, 27 (25%) of them had
central venous catheter and 9 (6%) of them did not (p=0.001).
Conclusion: In conclusion, central line-associated bloodstream
infection is one of the serious healthcare-associated infections, and
it is an important cause of morbidity and mortality in PICUs.
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