The frequency of bacterial factors causing central nervous system infections has decreased as a result of the development of our national immunization program. In this study, it is aimed to obtain ...the data of our local surveillance by defining the viral etiology in cases diagnosed with meningoencephalitis for 1 year. Previously healhty 186 children, who applied with findings suggesting viral meningoencephalitis to 8 different tertiary health centers between August 2018 and August 2019, in Istanbul, were included. The cerebrospinal fluid (CSF) sample was evaluated by polymerase chain reaction. The M:F ratio was 1.24 in the patient group, whose age ranged from 1 to 216 months (mean 40.2 ± 48.7). Viral factor was detected in 26.8%. Enterovirus was the most common agent (24%) and followed by Adenovirus (22%) and HHV type 6 (22%). In the rest of the samples revealed HHV type 7 (10%), EBV (6%), CMV (6%), HSV type 1 (6%), Parvovirus (4%) and VZV (2%). The most common symptoms were fever (79%) and convulsions (45.7%). Antibiotherapy and antiviral therapy was started 48.6% and 4% respectively. Mortality and sequela rate resulted 0.53% and 3.7%, respectively. This highlights the importance of monitoring trends in encephalitis in Turkey with aview to improving pathogen diagnosis for encephalitis and rapidly identifying novel emerging encephalitis-causing pathogens that demand public health action especially in national immunisation programme.
Background
The most common cause of acute viral hepatitis is the hepatitis A virus (HAV). Millions of people are thought to be infected each year. It is transmitted either by the fecal-oral route or ...by consuming contaminated food. Extrahepatic complications, notably cardiologic ones, are infrequent. This case report was presented due to the development of HAV-related bradycardia without hypotension in an unvaccinated refugee patient.
Case presentation
A 9-year-old male presented with the complaint of jaundice and vomiting. There was no history of fever, diarrhea, or abdominal pain. A precise knowledge of suspected food intake is lacking. There was no pathological examination finding except jaundice. Total bilirubin, direct bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were high. The coagulation test was normal. Anti-HAV-IgM/IgG was positive in the patient with suspicious viral hepatitis. In the follow-up, the heart rate decreased to 43 beats/min during sleep and 46 beats/min when awake. Cardiological examination and tests were within normal limits. Hypotension was not accompanied. In the follow-up, bradycardia and impaired liver function tests regressed. The patient was discharged on the 10th day.
Conclusions
Cardiologic complications are rare, and patients diagnosed with acute hepatitis A should be monitored. The most effective way of protection from the hepatitis A virus is vaccination.
Gut microbiota is closely related to acute infectious diarrhea, one of the leading causes of mortality and morbidity in children worldwide. Understanding the dynamics of the recovery from this ...disease is of clinical interest. This work aims to correlate the dynamics of gut microbiota with the evolution of children who were suffering from acute infectious diarrhea caused by a rotavirus, and their recovery after the administration of a probiotic,
CNCM I-745. The experiment involved 10 children with acute infectious diarrhea caused by a rotavirus, and six healthy children, all aged between 3 and 4 years. The children who suffered the rotavirus infection received
CNCM I-745 twice daily for the first 5 days of the experiment. Fecal samples were collected from each participant at 0, 3, 5, 10, and 30 days after probiotic administration. Microbial composition was characterized by 16S rRNA gene sequencing. Alpha and beta diversity were calculated, along with dynamical analysis based on Taylor's law to assess the temporal stability of the microbiota. All children infected with the rotavirus stopped having diarrhea at day 3 after the intervention. We observed low alpha diversities in the first 5 days (
-value < 0.05, Wilcoxon test), larger at 10 and 30 days after probiotic treatment. Canonical correspondence analysis (CCA) showed differences in the gut microbiota of healthy children and of those who suffered from acute diarrhea in the first days (
-value < 0.05, ADONIS test), but not in the last days of the experiment. Temporal variability was larger in children infected with the rotavirus than in healthy ones. In particular,
class was found to be abundant in children with acute diarrhea. We identified the microbiota transition from a diseased state to a healthy one with time, whose characterization may lead to relevant clinical data. This work highlights the importance of using time series for the study of dysbiosis related to diarrhea.
A six-year-old male patient with no known history of disease was presented due to an unfamiliar Streptococcus constellatus growth that developed alongside a tooth abscess and fistulized. The patient ...was admitted with redness, swelling, and tenderness in the left-most section of his face. We learned that the patient visited a dentist three weeks prior due to complaints of swelling in the jaw and tooth decay. The patient had a leukocyte count of 22,600/μL (neutrophil: 17,190/μL), C-reactive protein level was 105.2 mg/L. The patient was put on an intravenous treatment of clindamycin and cefoperazone-sulbactam. There was spontaneous discharge in the abscess. S. constellatus grew in abscess culture dish. The current therapy was changed to ampicillin-sulbactam. Observations on the seventh day of hospitalization showed that the lesion had subsided almost entirely. S. constellatus is a rare microorganism that produces abscesses and requires immediate medical attention.
Bilinen bir hastalık öyküsü olmayan altı yaşında bir erkek hasta, diş absesine ikincil gelişen ve fistülize olan cilt apsesinden alınan mikrobiyolojik incelemede alışık olmadığımız bir etken olan Streptococcus constellatus üremesi sebebiyle sunuldu. Hasta yüzün sol yarısında izlenen kızarıklık, şişlik ve hassasiyet ile başvurdu. Hastanın üç hafta önce çenede şişlik ve diş çürüğü şikayetleri ile diş hekimine gittiği öğrenildi. Lökosit sayısı 22.600/μL (nötrofil: 17.190/μL), C-reaktif protein 105,2 mg/L idi. Hastaya intravenöz klindamisin ve sefoperazon-sulbaktam tedavisi başlandı. Apse kendiliğinden drene oldu. Kültürde S. consellatus üredi. Mevcut tedavi ampisilin-sulbaktam ile değiştirildi. Yatışının yedinci gününde lezyonun neredeyse tamamen gerilediği görüldü. S. constellatus nadir görülen ancak yol açtığı apseler nedeniyle dikkat edilmesi gereken bir mikroorganizmadır.
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.
Objective: Two randomized controlled clinical trials have shown that Lactobacillus (L) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. ...This was the first trial evaluating the efficacy of L.reuteri DSM 17938 in outpatient children with acute infectious diarrhea. Methods: This was a multicenter, randomized, single‐blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1 × 108 CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS) and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours). The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded. Results: The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15 hours, 60.4 ± 24.5 hours 95% CI: 51.0‐69.7 hours vs. 74.3 ± 15.3 hours 95% CI: 68.7‐79.9 hours, p < 0.05). The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8%) after 48 hours than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34‐0.79, p < 0.01). From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted. Conclusion: L. reuteri DSM 17938 is effective, safe, and well‐tolerated in outpatient children with acute infectious diarrhea.
Two randomized controlled clinical trials have shown that Lactobacillus (L) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the ...first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea.
This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1×108CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS) and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours). The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded.
The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15h, 60.4±24.5h 95% CI: 51.0–69.7h vs. 74.3±15.3h 95% CI: 68.7–79.9h, p<0.05). The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8%) after 48h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34–0.79, p<0.01). From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted.
L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea.
Dois ensaios clínicos randomizados controlados demonstraram que o Lactobacillus (L) reuteri DSM 17938 reduz a duração de diarreia em crianças hospitalizadas devido a diarreia infecciosa aguda. Este é o primeiro ensaio que avalia a eficácia do L. reuteri DSM 17938 em crianças com diarreia infecciosa aguda no ambulatório.
Este foi um ensaio clínico multicêntrico, randomizado, único cego, com grupos paralelos e controlado em crianças com diarreia aguda. Um total de 64 crianças internadas na clínica ambulatorial foram inscritas. O grupo probiótico recebeu 1×108CFU L. reuteri DSM 17938 por cinco dias, além de uma solução de reidratação oral (SRO), e o segundo grupo foi tratado apenas com SRO. O desfecho principal foi a duração da diarreia (em horas). O desfecho secundário foi o número de crianças com diarreia em cada um dos cinco dias da intervenção. Os eventos adversos também foram registrados.
A duração média da diarreia foi significativamente reduzida no grupo L. reuteri em comparação ao grupo de controle (aproximadamente 15horas; 60,4±24,5horas 51, 0–69, 7horas, IC de 95% em comparação a 74,3±15,3horas 68, 7–79, 9horas, IC de 95%, p<0,05). O percentual de crianças com diarreia foi menor no grupo L. reuteri (13/29; 44,8%) após 48 horas que no grupo de controle (27/31; 87%) (RR: 0,51; 0, 34–0, 79; IC de 95%, <0,01). A partir da 72ª hora de intervenção, não havia nenhuma diferença entre os dois grupos no percentual de crianças com diarreia. Nenhum efeito adverso com relação ao L. reuteri foi observado.
O L. reuteri DSM 17938 é eficaz, seguro e bem tolerado por crianças com diarreia infecciosa aguda no ambulatório.
Background The purpose of this study was to establish species distribution of Candida isolates from pediatric patients in Istanbul, Turkey, and to determine risk factors associated with nosocomial ...Candida infections. Methods This study was conducted between June 2013 and June 2014 by participation of 7 medical centers in Istanbul. Candida spp strains isolated from the clinical specimens of pediatric patients were included. Clinical features were recorded on a standardized data collection sheet. Results A total of 134 systemic Candida infections were identified in 134 patients. The patients were admitted in pediatric and neonatal intensive care units (41.8% and 9.7%, respectively) and in pediatric wards (48.5%). Candida albicans was the most prevalent species (47%), followed by Candida parapsilosis (13.4%), Candida tropicalis (8.2%), Candida glabrata (4.5%), Candida lusitaniae (3.7%), Candida kefyr (2.2%), Candida guilliermondii (1.5%), Candida dubliniensis (0.7%), and Candida krusei (0.7%). Types of Candida infections were candidemia (50.7%), urinary tract infection (33.6%), surgical site infection (4.5%), central nervous system infection (3.7%), catheter infection (3.7%), and intra-abdominal infection (3.7%). In multivariate analysis, younger age (1-24 months) and detection of non-albicans Candida spp was found to be risk factors associated with candidemia ( P = 0.040; odds ratio OR, 4.1; 95% confidence interval CI, 1.06-15.86; and P = 0.02; OR, 2.4; 95% CI, 1.10-5.53, respectively). Conclusions This study provides an update for the epidemiology of nosocomial Candida infections in Istanbul, which is important for the management of patients and implementation of appropriate infection control measures.
Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes ...in this distribution in time to guide effective vaccine strategies.
Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population.
Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%).
Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination.
BackgroundVaccines have the most important role in the battle against the COVID-19 pandemic. With the widespread use of vaccines, COVID-19 has remarkably declined. Adolescents were vaccinated after ...approvals for this age group, which was later than adults, and a nationwide vaccination program was implemented in August 2021 in Turkey for adolescents ≥12 years of age. Therefore, we aimed to determine the effects of the COVID-19 nationwide adolescent vaccination program on adolescent hospitalizations due to COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by comparing two periods, including the vaccination period (VP) and the pre-VP (PVP). The second aim of this study is to compare the clinical features and disease severity of vaccine-breakthrough COVID-19 hospitalizations with unvaccinated individuals in the VP.MethodsA retrospective multicenter study was conducted to determine and compare the number of hospitalizations due to COVID-19 and MIS-C between the VP (September 1, 2021, to August 31, 2022) and PVP (September 1, 2020, to August 31, 2021). We also compared the characteristics, risk factors, and outcomes of breakthrough infections of adolescents aged 12-18, which required hospitalization with the same age group of unvaccinated hospitalized individuals during the VP.ResultsDuring the study period, 3967 children (0-18 years) were hospitalized in the PVP and 5143 (0-18 years) in the VP. Of them, 35.4% were adolescents (12-18 years) in the PVP, and this rate was 18.6% in the VP; relative risk was 0.6467 (95% confidence interval CI: 0.6058-0.6904; p < 0.001). Patients with breakthrough COVID-19 were older (201 vs. 175 months, p < 0.001) and less commonly hospitalized for COVID-19 (81.5% vs. 60.4%, p < 0.001, odds ratio OR: 0.347 95% CI: 0.184-0.654). The majority of these infections were asymptomatic and mild (32% vs.72.9%: p < 0.001, OR: 5.718 95% CI: 2.920-11.200), and PICU admission was less frequently required (p = 0.011, OR: 0.188 95% CI: 0.045-0.793). Most breakthrough COVID-19 infections occurred within three months after the last vaccine dose (54.2%).ConclusionsThis study demonstrated a significant decrease in adolescent hospitalizations due to COVID-19 and MIS-C after implementing COVID-19 vaccines in Turkey. Breakthrough cases were less severe and mostly occurred three months after the last dose. This study emphasizes the importance of COVID-19 vaccines and that parents’ decisions may be changed, particularly those who hesitate to or refuse vaccination.
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