[Show abstract][Hide abstract] ABSTRACT: Objective: The progress and clinical findings of childhood tuberculosis are distinctly different from those of adult tuberculosis. Children have fewer positive mycobacterial cultures and less specific findings and symptoms than adults. Thus, diagnosis of tuberculosis is difficult and it is rarely evidenced. Materials and Methods: The study involved retrospective evaluation of 35 confirmed tuberculosis cases between May 2009 and February 2013 by the Infectious Diseases Clinic of Şişli Hamidiye Etfal Training and Research Hospital. Results: Of the 35 patients included in this study, 13 had pulmonary tuberculosis, 15 had extrapulmonary tuberculosis, and 7 had both pulmonary and extrapulmonary tuberculosis. Primary tuberculosis (34.3%) was the most commonly diagnosed form of pulmonary tuberculosis; tuberculosis lymphadenitis (25.7%) was the most frequently diagnosed form of extrapulmonary tuberculosis. Acid-resistant bacteria were observed in 40% of cases, mostly in the gastric lavage aspirate (31.4%). The culture was positive in 62.9% of cases, mostly in the gastric lavage aspirate (31.4%). Conclusion: Diagnosis of tuberculosis in childhood is quite difficult and it is rarely confirmed because children have less specific signs and symptoms of the disease and fewer positive mycobacterial cultures than adults. The gold standards for diagnosing tuberculosis in childhood still include a history of close contact with a tuberculosis patient, tuberculin skin test reactivity, and clinical and radiological findings associated with tuberculosis.
[Show abstract][Hide abstract] ABSTRACT: Evidence from the literature has shown that Saccharomyces boulardii provides a clinically significant benefit in the treatment of acute infectious diarrhoea in children. In this multicentre, randomised, prospective, controlled, single blind clinical trial performed in children with acute watery diarrhoea, we aimed to evaluate the impact of S. boulardii CNCM I-745 in hospitalised children, in children requiring emergency care unit (ECU) stay and in outpatient settings. The primary endpoint was the duration of diarrhoea (in hours). Secondary outcome measures were duration of hospitalisation and diarrhoea at the 3rd day of intervention. In the whole study group (363 children), the duration of diarrhoea was approximately 24 h shorter in the S. boulardii group (75.4±33.1 vs 99.8±32.5 h, P<0.001). The effect of S. boulardii (diarrhoea-free children) was observed starting at 48 h. After 72 h, only 27.3% of the children receiving probiotic still had watery diarrhoea, in contrast to 48.5% in the control group (P<0.001). The duration of diarrhoea was significantly reduced in the probiotic group in hospital, ECU and outpatient settings (P<0.001, P<0.01 and P<0.001, respectively). The percentage of diarrhoea-free children was significantly larger after 48 and 72 h in all settings. The mean length of hospital stay was shorter with more than 36 h difference in the S. boulardii group (4.60±1.72 vs 6.12±1.71 days, P<0.001). The mean length of ECU stay was shorter with more than 19 h difference in the probiotic group (1.20±0.4 vs 2.0±0.3 days, P<0.001). No adverse effects related to the probiotic were noted. Because treatment can shorten the duration of diarrhoea and reduce the length of ECU and hospital stay, there is likely a social and economic benefit of S. boulardii CNCM I-745 in adjunction to oral rehydration solution in acute infectious gastroenteritis in children.
No preview · Article · Feb 2015 · Beneficial Microbes
[Show abstract][Hide abstract] ABSTRACT: Tularemia is a zoonotic disease caused by Francisella tularensis. In the recent years, tularemia has become a reemerging infection in Turkey, with epidemics and also sporadic cases. The histopathology of tularemia is similar with tuberculosis. Thus, tularemia should be considered in the differential diagnosis of chronic granulomatous diseases. In this article, we presented a case of a 12-year-old girl with tularemia who applied to another health center with cervical lymphadenomegaly and treated as tuberculous lymphadenitis after the determination of granulomatous lymphadenitis.
[Show abstract][Hide abstract] ABSTRACT: Guidelines consider certain probiotics useful in the management of acute gastroenteritis. This study evaluated the use of Lactobacillus (L) reuteri DSM 17938.
A multicenter, randomised, single blind, clinical trial was performed in hospitalised children with acute gastroenteritis lasting 12 to 72 hours. Children received conventional therapy with, or without, 1x10(8) CFU of L reuteri DSM 17938 for five days. The primary endpoint was the duration of diarrhoea and secondary outcomes were days of hospitalisation and the percentage of children with diarrhoea after each day of treatment.
We compared 64 children receiving L reuteri group with 63 controls. L reuteri reduced the duration of diarrhoea after 24 hours (p<0.001) and more diarrhoea-free children were seen in the L reuteri than control group after 24 and 48 hours (50% versus 5%, p<0.001) and 72 hours (69% versus 11%, p<0.001). L reuteri reduced mean hospital stays (4.31 ± 1.3 days versus 5.46 ± 1.77 days, p<0.001). Prolonged diarrhoea occurred in 17% of the controls, but none of the L reuteri group. No adverse effects were reported.
L reuteri effectively reduced the duration of acute diarrhoea and hospital stays in children hospitalised with acute gastroenteritis. Outpatient data is now required. This article is protected by copyright. All rights reserved.
No preview · Article · Mar 2014 · Acta Paediatrica
[Show abstract][Hide abstract] ABSTRACT: Background:
The primary objective of this study was to compare triple therapy with ertapenem treatments in pediatric patients with perforated appendicitis, especially in terms of postoperative infectious complications. The secondary objective of this study was to assess the relative impact of therapy with ertapenem and triple antibiotic regimen on the emergence of resistant bacteria in bowel flora in the patients.
Materials and methods:
Children aged 3 months to 17 years with perforated appendicitis were randomized 1:1 to receive ertapenem or triple therapy. Serial rectal cultures were obtained from participants enrolled in the study, allowing assessment of the relative impact of therapy with ertapenem and triple therapy on bowel colonization by resistant bacteria.
In this study, 107 patients were included. No difference existed in time to full oral intake and regular diet, the length of antibiotic therapy, the length of the postoperative hospitalization, or the length of hospital stay between the two groups. Patients in the triple-therapy group were more likely to suffer from a postoperative infectious complication than those in the ertapenem group (6/54 vs. 2/53, p > 0.05). Bowel colonization with resistant organisms at the end of therapy in the triple-therapy group was significantly different than in the ertapenem group (35.2 vs. 11.3%, p < 0.05).
Bowel colonization with resistant bacteria was less likely to occur after ertapenem treatment than triple therapy. The results of this trial suggest that ertapenem may be a useful option that could eliminate the need for combination and/or multidosed antibiotic regimens for the empiric treatment of perforated appendicitis in children.
Full-text · Article · Aug 2013 · European Journal of Pediatric Surgery
[Show abstract][Hide abstract] ABSTRACT: Objective: Brucellosis is a zoonosis with high morbidity and low mortality in Turkey. It causes extreme financial losses in societies that depend on agriculture and livestock breeding and physical inadequacy and workforce loss when people are infected. This study evaluated the clinical features of brucellosis and measures of protection against brucellosis in Turkey. Material and Methods: During the 6-year study period, 32 children were evaluated retrospectively in our paediatric infectious disease clinic. Results: The mean age was 10.4±3.7 years and the ratio of girls to boys was 11/21. Of the 32 patients, 12.5% were living in rural areas, and 87.5% in urban areas. Among these cases, 87.5% had consumed unpasteurized milk and milk products, 12.5% had had contact with animals and the possible source of infection was unknown in 12.5%. Most cases (46.9%) were admitted in the summer months, particularly September (25%). The main complaints were fever (81.3%), arthralgia (65.6%), fatigue (37.5%), abdominal pain (18.8%), weight loss (18.8%) and headache (6.3%). Arthritis was the most common pathologic finding on physical examination (50%); splenomegaly (34.4%) and hepatomegaly (12.5%) were also seen. The Brucella agglutination titre was negative in 9.4% and positive in 90.6%. Blood cultures were positive in 39.5%. Doxycyline and gentamycin were administered to 24 patients aged over 8 years. TMP-SMX and rifampisin combination was used in eight patients younger than 8 years. Relapse occurred in three patients. Conclusion: Childhood brucellosis remains a significant public health problem in Turkey, which is endemic for brucellosis. Preventive studies and education should be improved, especially in endemic regions due to clinical findings was not sensitive, the high number of complications, loss of manpower, and effects on a wide range of people.
[Show abstract][Hide abstract] ABSTRACT: Probiotics have been successfully used for the treatment of acute diarrhea in children and this effect depends on the strains and dose. The aim of this study was to assess the effect of a synbiotic mixture on the duration of diarrhea and the length of hospital stay in children with acute watery diarrhea. This is a prospective randomized, multicenter single blinded clinical trial in hospitalized children with acute watery diarrhea. All children were treated with conventional hydration therapy with or without a daily dose of a synbiotic (2.5 × 10(9) CFU live bacteria including Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum, Bifidobacterium longum, Enterococcus faecium, and 625 mg fructooligosaccharide) for 5 days. The primary endpoint was duration of diarrhea and duration of hospitalization was the secondary endpoint. Among 209 eligible children, 113 received the synbiotic mixture and 96 served as a control. The duration of diarrhea was significantly shorter (∼36 h) in children receiving the synbiotic group than the controls (77.9 ± 30.5 vs. 114.6 ± 37.4 h, p < 0.0001). The duration of hospitalization was shorter in children receiving the synbiotic group (4.94 ± 1.7 vs. 5.77 ± 1.97 days, p = 0.002). The effect of synbiotic mixture on diarrhea started after 24th hours and stool frequency significantly decreased after 24th and 48th hours. The percentage of diarrhea-free children is significantly higher in synbiotic group at 48th and 72nd hours of synbiotic group. In conclusion, this study showed a reduction in diarrhea duration by approximately 36 h and a reduction in the duration of hospitalization with approximately 1 day in children with acute diarrhea with this synbiotic mixture.
No preview · Article · Dec 2012 · European Journal of Pediatrics
[Show abstract][Hide abstract] ABSTRACT: Objective: Fluid loss, pain, increased metabolic requirement, post-traumatic stress disorder and infections are the main problems observed in patients with burns. The most important cause of morbidity and mortality in hospitalized patients with burns is sepsis. In this study, our aim is to review the specific infections in a specialized pediatric burn unit during 3 years, including their categorization, diagnosis, and treatment, and to develop strategies for antimicrobial resistance control and treatment of infectious complications. Material and Methods: During the three-year study period, 175 children were evaluated retrospectively in terms of epidemiological features and infection status in our pediatric burn unit. Results: The average length of hospitalization of patients was 12.3±13.4 (1-154) days. Thirty-four infections were documented in 29 (16.6%) of 175 patients. Twenty-one of the total infections were wound infections, 8 were bloodstream infections and 5 were urinary tract infections. The most commonly isolated bacteria were Pseudomonas aeroginosa in burn wound infections, methicillin resistant Staphylococcus aureus in boodstream infections and P. aeroginosa in urinary tract infections. The mortality rate was found to be 2.28%. Coclusion: The damaged tissues in burn patients are highly susceptible to infection. Treatments of burn cases require a multidisciplinary and meticulous approach, especially in pediatric patients. In order to evaluate correct patient management, each burn unit must identify its patient population and infectious agents in order to develop strategies for selecting the appropriate antibiotic.
[Show abstract][Hide abstract] ABSTRACT: Risk factors for recurrent shunt-related cerebrospinal fluid (CSF) infections were analyzed. A total of 58 children were treated for initial shunt infections (ISI): all children were treated with antibiotics and CSF drainage, either by removal of the shunt system and insertion of an external ventricular drainage (EVD) catheter (44 children, 75.9%) or by externalization of the existing ventricular catheter (14 children, 24.1%). Recurrent shunt infections (RSI) were detected in 15 children: nine had been treated with shunt removal and insertion of a new EVD catheter and six had been treated with externalization of the existing ventricular catheter. There was a statistically significant increase in the number of RSI in children treated with externalization of the existing ventricular catheter. Thus, to reduce the risk of RSI, total shunt removal and insertion of a new EVD catheter is preferred.
No preview · Article · Apr 2012 · Journal of Clinical Neuroscience
[Show abstract][Hide abstract] ABSTRACT: Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (<0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was $856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children <1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization.
Full-text · Article · Dec 2011 · European Journal of Pediatrics
[Show abstract][Hide abstract] ABSTRACT: Bacilli Calmette-Guérin (BCG) is a type of Mycobacterium bovis species bearing all the structural features of M. tuberculosis but no disease has been described due to M. bovis. BCG vaccine is indicated for prevention of this disease via stimulation of the development of active immunity against tuberculosis. Vaccination, especially during the first decade of life in children, protects against the risk of tuberculosis and tuberculosis meningitis. The BCG vaccine has a high reliability. Various skin lesions after vaccination are rare complications. We report a patient who presented with a specific complication which is an erythematous nodule after BCG vaccination, and diagnosed as BCG-itis.
[Show abstract][Hide abstract] ABSTRACT: Background: The rate of repeat shunt-related cerebrospinal fluid (CSF) infections and the contributing risk factors were analyzed.Methods: Our clinic treated 58 children for initial shunt infection(ISI). Of the 58 children, 15 were diagnosed with repeat shunt infection(RSI) within 6 months of ISI treatment. For the analysis of potential risk factors for RSI, the following independent variables tested separately: a)age b)aetiology of hydrocephalus c)ISI microorganism d)initial surgical treatment of the ISI e)number of days of external CSF drainage with either an EVD or an externalized shunt, and f)presence of culture positive CSF at ISI.Results: Cerebrospinal fluid(CSF) drainage, initiated with removal of the shunt system and insertion of external ventricular drainage(EVD) catheters in 44(75.8%) children and with externalization of the existing ventricular catheters in 14(24.2%) of them. We detected repeat shunt infection in 15 of these children. Among these 15 RSI children, 9 were the ones who have been treated with removal of shunt and insertion of new EVD catheter while 6 were the ones who have been treated with externalization of ventricular catheters. There is a statistically significant increased number of RSI in cases which have been treated with externalization of ventricular catheter instead of removal of shunt and insertion of new EVD catheter(p=0.032,< 0.05). None of the other variables reached statistical significance as a risk factor in our study.Conclusion: To reduce the risk of repeat shunt infections, total removal of shunt and insertion of new EVD catheter should be preferred instead of externalization of infected ventricular catheter.
Full-text · Article · Nov 2011 · Pediatric Research
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to evaluate the effectiveness of zinc, probiotic bacteria, and lactose-free formula and their different combinations in the treatment of rotavirus diarrhea in young children.
Eight different treatment groups were formed: group 1, 60 patients receiving Saccharomyces boulardii; group 2, 60 patients receiving zinc; group 3, 60 patients receiving lactose-free formula; group 4, 60 patients receiving S. boulardii plus zinc; group 5, 60 patients receiving S. boulardii plus lactose-free formula; group 6, 60 patients receiving zinc plus lactose-free formula; group 7, 60 patients receiving S. boulardii plus zinc plus lactose-free formula; group 8, 60 patients receiving only oral and/or parenteral rehydration solutions.
No statistically significant differences were found in the time to resolution of fever after intervention between the treatment groups and the control group. The time to resolution of vomiting was significantly lower in group 4 compared with groups 1 and 5. The duration of diarrhea was significantly reduced in groups 2 and 4 compared to control. A statistically significant difference in the duration of hospitalization was observed for the groups 2 and 4 in comparison to the control group.
A different combination of adjunct therapies did not seem to bring additional value to rehydration therapy in children with rotavirus diarrhea except for in those receiving only zinc and zinc plus S. boulardii. Further studies are required to determine the optimal protocol of adjunct therapy use in children with rotavirus diarrhea.
Full-text · Article · Oct 2011 · Pediatrics International
[Show abstract][Hide abstract] ABSTRACT: The Mycobacterium tuberculosis complex (MTBC) consists of a group of closely related species that differ in their epidemiological profiles, host ranges, pathogenicities, geographic distributions, and drug resistances. Identification of members in the MTBC is essential for monitoring the epidemiology of tuberculosis (TB) and implementing appropriate public health control measures. In this study, 188 consecutive MTBC clinical isolates from 2007 to 2010 were evaluated to determine the prevalence of MTBC species in Turkey. PCR and restriction fragment length polymorphism analysis (PCR-RFLP) of the gyrB gene were used, and results for species other than M. tuberculosis were confirmed using the GenoType MTBC assay (Hain Lifescience, Nehren, Germany). Most of the strains were found to be M. tuberculosis (94.1%). The prevalences of M. bovis and M. caprae were 4.3% and 1.6%, respectively. Only one M. bovis BCG strain was identified. Overall, the frequency of bovine tuberculosis in humans was 5.3%. We had assumed that bovine TB infection was under control in animal herds, but primary M. bovis infections in humans caused by transmission from infected animals are still an issue in Turkey. Our results indicate that the frequent identification of M. bovis in routine mycobacteriological laboratory work has further importance due to the well-known resistance of this species to pyrazinamide.
[Show abstract][Hide abstract] ABSTRACT: In April 2009 a novel strain of human influenza A, identified as H1N1 virus, rapidly spread worldwide, and in early June 2009 the World Health Organization raised the pandemic alert level to phase 6. Herein we present the largest series of children who were hospitalized due to pandemic H1N1 infection in Turkey.
We conducted a retrospective multicentre analysis of case records involving children hospitalized with influenza-like illness, in whom 2009 H1N1 influenza was diagnosed by reverse-transcriptase polymerase chain reaction assay, at 17 different tertiary hospitals.
A total of 821 children with 2009 pandemic H1N1 were hospitalized. The majority of admitted children (56.9%) were younger than 5 y of age. Three hundred and seventy-six children (45.8%) had 1 or more pre-existing conditions. Respiratory complications including wheezing, pneumonia, pneumothorax, pneumomediastinum, and hypoxemia were seen in 272 (33.2%) children. Ninety of the patients (11.0%) were admitted or transferred to the paediatric intensive care units (PICU) and 52 (6.3%) received mechanical ventilation. Thirty-five children (4.3%) died. The mortality rate did not differ between age groups. Of the patients who died, 25.7% were healthy before the H1N1 virus infection. However, the death rate was significantly higher in patients with malignancy, chronic neurological disease, immunosuppressive therapy, at least 1 pre-existing condition, and respiratory complications. The most common causes of mortality were pneumonia and sepsis.
In Turkey, 2009 H1N1 infection caused high mortality and PICU admission due to severe respiratory illness and complications, especially in children with an underlying condition.
No preview · Article · Aug 2011 · Scandinavian Journal of Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: Genetic variants in Toll-like receptors (TLRs) are considered a potential indicator for host susceptibility to and outcome of several infectious diseases including tuberculosis. The aim of this study was to determine whether -129 C/G and Met1Val polymorphisms of TLR8 were associated with pediatric pulmonary tuberculosis in Turkish population.
The -129 C/G and Met1Val polymorphisms were studied in 124 children with pulmonary tuberculosis compared to 150 age-matched healthy control subjects. Results: We did not identify any statistically significant differences between the patients with TB and control groups with regard to the frequency of genotypes GG or G/(-), CG, and CC or C/(-); and alleles G and C at rs3764879 (p> 0.05). We found a strong association with genotype A/(-) at rs3764880 with susceptibility to pulmonary TB in males (OR 2.87, 95%CI 1.38-5.98, p=0.007).
Our results provide evidence, for the first time, of a role for the TLR8 gene in susceptibility to pulmonary TB in male children. Additional research to verify our results are necessary. Tuberculosis in children presents particularly difficult challenges, but research priorities and advances in pediatric tuberculosis could provide wider insights and opportunities for tuberculosis control.
[Show abstract][Hide abstract] ABSTRACT: Urinary tract infections (UTIs) are a problem frequently encountered by paediatric healthcare providers. Recent data suggest that extended-spectrum β-lactamase (ESBL)-producing bacteria are an emerging cause of UTIs in non-hospitalized patients. We report our experience of ertapenem use in 50 patients with complicated UTIs, mainly pyelonephritis, caused by ESBL-producing organisms.
Fifty patients aged <16 y who had a complicated UTI caused by ESBL-producing organisms and who were treated with ertapenem at our hospital from 1 January 2009 to 31 December 2009, were included in the study.
There were 20 (40%) males and 30 (60%) females with a mean ± standard deviation age of 38.6 ± 36.9 months (range 6-156 months). Twenty-eight patients had no urological abnormality. In 40 patients ertapenem was initiated after results of microbiological cultures became available. Ertapenem was initiated empirically for 10 patients known to be colonized with ESBL-producing bacteria. Urine cultures were negative at 3.3 ± 0.7 days (range 2-5 days) after starting ertapenem treatment. The mean duration of ertapenem treatment was 7.8 ± 1.2 days (range 7-14 days). No laboratory or clinical side effects were observed.
Ertapenem is promising for the culture-guided treatment of ESBL-producing Gram-negative complicated UTIs. Well-designed prospective studies are needed to define the role of ertapenem in treating complicated paediatric UTIs, especially upper UTIs.
No preview · Article · May 2011 · Scandinavian Journal of Infectious Diseases