COVID-19 in hospitalized infants aged under 3 months: multi-center experiences across Turkey.

To investigate coronavirus disease 2019 (COVID-19) in infants aged 0 to 3 months because there is currently a significant gap in the literature on the subject. A cross-sectional study was conducted with the involvement of 19 medical centers across Turkey and 570 infants. The majority of the patients were male (58.2%), and the three most common symptoms were fever (78.2%), cough (44.6%), and feeding intolerance (39.9%). The results showed that a small percentage of infants had positive blood (0.9%) or urine cultures (10.2%). Most infants presented with fever (78.2%). Children without underlying conditions (UCs) had mostly a complicated respiratory course and a normal chest radiography. Significant more positive urine culture rates were observed in infants with fever. A higher incidence of respiratory support requirements and abnormal chest findings were seen in infants with chronic conditions. These infants also had a longer hospital stay than those without chronic conditions.  Conclusions: Our study discloses the clinical observations and accompanying bacterial infections found in infants aged under 3 months with COVID-19. These findings can shed light on COVID-19 in infancy for physicians because there is limited clinical evidence available. What is Known: • COVID-19 in infants and older children has been seen more mildly than in adults. • The most common symptoms of COVID-19 in infants are fever and cough, as in older children and adults. COVID-19 should be one of the differential diagnoses in infants with fever. What is New: • Although most infants under three months had fever, the clinical course was uneventful and respiratory complications were rarely observed in healthy children. • Infants with underlying conditions had more frequent respiratory support and abnormal chest radiography and stayed longer in the hospital.

Distinguishing orbital cellulitis from preseptal cellulitis in children.

PURPOSE: We aimed to evaluate clinical and laboratory characteristics of children with preseptal cellulitis (PC) and orbital cellulitis (OC) and also to determine whether clinical and/or laboratory parameters could be used to distinguish OC from PC. METHODS: The medical records of pediatric patients (aged between 1 month and 18 years) with PC and OC who had been hospitalized at our center from January 2008 to December 2020 were retrospectively reviewed. Multivariable regression analysis was performed to identify possible parameters useful in differentiating between PC and OC. RESULTS: A total of 375 patients [202 (53.9%) boys], of whom 35 (9.3%) had OC, were evaluated. Median age was 44 (range, 1-192) months. Compared to those with PC, patients with OC were older (p = 0.001), had fever, upper respiratory tract infection (URTI) symptoms, and sinusitis more frequently, and demonstrated prolonged symptom and hospitalization times (p Ë‚ 0.001 for all). Significant differences between groups were observed for numerous laboratory parameters; however, multivariable regression analysis revealed that only C-reactive protein (CRP) and platelet count could be used to predict OC among the laboratory findings. Taken together, factors independently associated with OC diagnosis were proptosis, ophthalmoplegia, age (>35 months), CRP level (˃116.5 mg/L), and platelet count (˃420.5 × 103/mm3). CONCLUSION: In addition to showing previously known properties of OC versus PC, our study demonstrated that combined demographic, clinical and laboratory factors such as being aged above 35 months, having a CRP level of ˃116.5 mg/L, and platelet count of ˃ 420.5 × 103/mm3 could be used to distinguish OC from PC.

Multisystem inflammatory syndrome in children during severe acute respiratory syndrome coronavirus-2 pandemic in Turkey: A single-centre experience.

AIM: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may result in a life-threatening hyperinflammatory condition named multisystem inflammatory syndrome in children (MIS-C). We aimed to assess demographics, clinical presentations, laboratory characteristics and treatment outcomes of patients with MIS-C. METHODS: We performed a retrospective study of patients with MIS-C managed between August 2020 and March 2021 at Dr. Sami Ulus Maternity Child Health and Diseases Training and Research Hospital in Turkey. RESULTS: A total of 45 patients (23 male, 51%) with a median age of 8.7 years (interquartile range: 5.6-11.7 years) were enrolled to study. The SARS-CoV-2 serology was positive in 43 (95%) patients. Organ-system involvement included the dermatologic in 41 (91%), cardiovascular in 39 (87%), hematologic in 36 (80%) and gastrointestinal in 36 (80%) patients. Acute anterior uveitis was diagnosed in nine (20%) patients. Two patients presented with clinical findings of deep neck infection such as fever, neck pain, trismus, swelling and induration on the cervical lymph node. One patient presented with Henoch-Schonlein purpura-like eruption. Coronary artery dilatation was detected in five (11%) patients. For treatment of MIS-C, intravenous immunoglobulin was used in 44 (98%) patients, methylprednisolone in 27 (60%) and anakinra in 9 (20%) patients. The median duration of hospitalisation was nine days. All patients recovered. CONCLUSIONS: Children with MIS-C might have variable clinical presentations. Acute anterior uveitis might be a prominent presentation of MIS-C and require ophthalmological examination. It is essential to make patient-based decisions and apply a stepwise approach for the treatment of this life-threatening disease.

Bacteremic and Nonbacteremic Brucellosis in Children in Turkey.

INTRODUCTION: Human brucellosis is one of the most common zoonotic infections in the world. The definitive diagnosis of brucellosis is based on cultured Brucella organisms from blood or other tissue samples. We aimed to compare bacteremic and nonbacteremic brucellosis patients with demographical, epidemiological, clinical and laboratory features and determine the predictive factors affecting blood culture positivity. MATERIALS AND METHODS: Children aged 1 month to 18 years who were followed up with the diagnosis of brucellosis between January 2005 and March 2021 were included in this retrospective study. According to the isolation of Brucella melitensis in blood culture, the patients were divided into two groups as bacteremic and nonbacteremic and compared in terms of demographic, clinical and laboratory characteristics. RESULTS: One hundred eighty-nine (116 male, 61.4%) patients diagnosed with brucellosis were included in the study. There were 76 (40.2%) bacteremic and 113 (59.8%) nonbacteremic patients. Bacteremic patients were younger than nonbacteremic patients. Fever, arthralgia, hepatomegaly and splenomegaly were significantly higher in the culture positive group. High levels of C-reactive protein (CRP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were found to be significant in the bacteremic group. CONCLUSION: In our study, history of fever and arthralgia, hepatomegaly and splenomegaly in physical examination and high CRP, ALT and AST levels in the biochemical analysis were important factors determining blood culture positivity.

Ventilator associated pneumonia due to carbapenem resistant microorganisms in children.

BACKGROUND: Infections due to carbapenem resistant pathogens have become a major health threat especially for hospitalized patients. Acinetobacter baumanii (AB) and Pseudomonas aeruginosa (PA) are important pathogens causing ventilator-associated pneumonia (VAP) with a trend of high resistance to carbapenems. The aim of this study is to investigate the risk factors for VAP due to carbapenem resistant Acinetobacter baumanii (CRAB) and Pseudomonas aeruginosa (CRPA) in children. METHODS: Between 2009 and 2013, an active, prospective observational study was conducted in Gazi University Hospital. Patients from Pediatric Intensive Care Unit (PICU), between 1 month and 12 years of age with VAP due to AB and PA were included. RESULTS: During this period, 74 children experienced 126 VAP episodes due to Acinetobacter baumanii (N.=58) and Pseudomonas aeruginosa (N.=68). Among these, 93.1% (N.=54) of AB and 51.5% (N.=35) of PA were carbapenem resistant. In univariate analysis, length of stay in PICU until the diagnosis of VAP, presence of central venous catheters, prior use of cefepime, ciprofloxacin, colistin, and teicoplanin were associated with VAP due to CRPA (P=0.02, P=0.02, P=0.006, P=0.01, P=0.001, and P=0.009 respectively). Significant association was not found between the development of VAP due to CRAB and the investigated risk factors. Regression analyses revealed previous use of cefepime (OR, 2.11; 95% CI, 0.016-0.595, P=0.039) and colistin (OR: 2.33; 95% CI: 0.061-0.789, P=0.023) to be independently associated with VAP due to CRPA. CONCLUSIONS: This study suggests that broad spectrum antibiotic usage was the most important risk factor for the development of VAP due to CRPA.

Risk factors for bacteremia in children with febrile neutropenia

Background/aim: Bacteremia remains an important cause of morbidity and mortality during febrile neutropenia (FN) episodes. We aimed to define the risk factors for bacteremia in febrile neutropenic children with hemato-oncological malignancies. Materials and methods: The records of 150 patients aged ≤18 years who developed FN in hematology and oncology clinics were retrospectively evaluated. Patients with bacteremia were compared to patients with negative blood cultures. Results: The mean age of the patients was 7.5 ± 4.8 years. Leukemia was more prevalent than solid tumors (61.3% vs. 38.7%). Bacteremia was present in 23.3% of the patients. Coagulase-negative staphylococci were the most frequently isolated microorganism. Leukopenia, severe neutropenia, positive peripheral blood and central line cultures during the previous 3 months, presence of a central line, previous FN episode(s), hypotension, tachycardia, and tachypnea were found to be risk factors for bacteremia. Positive central line cultures during the previous 3 months and presence of previous FN episode(s) were shown to increase bacteremia risk by 2.4-fold and 2.5-fold, respectively. Conclusion: Presence of a bacterial growth in central line cultures during the previous 3 months and presence of any previous FN episode(s) were shown to increase bacteremia risk by 2.4-fold and 2.5-fold, respectively. These factors can predict bacteremia in children with FN.

Parental vaccine knowledge and behaviours: a survey of Turkish families.

BACKGROUND: Personal and herd immunity require durability in high vaccination coverage rates, and this mainly depends on the interaction between parental and service/provider factors. AIMS: The aim of this study was to assess Turkish parents' knowledge and behaviours concerning childhood vaccination and their association with familial sociodemographic characteristics. METHODS: A cross-sectional survey, including a questionnaire, was conducted with parents of children aged between 1 day and 120 months. RESULTS: Of the 903 index children, 881 (97.6%) were up to date for all vaccinations by age. Demographic variables were not related to belief in protection through vaccination or rejection of obligatory vaccines. Mean age, education level, occupation of mother (P = 0.006, P < 0.001, and P = 0.01, respectively) and father (P = 0.002, P < 0.001, and P = 0.006, respectively), average monthly household income (P < 0.001), and experience of vaccine side-effects (P = 0.02) were associated with knowledge about optional childhood vaccines. Father's education level was independently associated with knowledge about optional childhood vaccines. CONCLUSIONS: Having any experience of vaccine side-effects and parental sociodemographic characteristics, especially father's education level, affect Turkish parents' knowledge of childhood optional vaccines.

[Multicenter investigation of bufavirus in the etiology of viral central nervous system infections of adults and children]. / Bufavirusun çocuklar ve eriskinlerdeki viral santral sinir sistemi enfeksiyonlarinin etiyolojisi açisindan çok Mmerkezli olarak arastirilmasi.

Bufavirus (BuV) is a newly-identified parvovirus in the family of Parvoviridae. Metagenomic analysis of fecal samples from children in Burkina Faso with acute diarrhea showed a highly divergent parvovirus, which was named bufavirus (BuV). The global distribution, epidemiology and genetic characteristics of BuVs infections are obscure. It was first discovered as an agent causing gastroenteritis but the association of BuV infections with various clinical presentations mostly remain to be explored. The aims of this study were to investigate probable impact of BuV in central nervous system infections in a region where it was previously reported to cause human infections and to detect enteroviruses (EV) which are reported as a cause of central nervous system infections in our country. The study was undertaken in three institutions in Ankara province, Central Anatolia, Turkey. Patients, clinically diagnosed with febrile disease and/or central nervous system infections of presumed viral etiology, were enrolled in the study with informed consent. Cerebrospinal fluid specimens were collected from 93 children attended to Gazi University Hospital and Diskapi Yildirim Beyazit Hospital from October 2011-April 2015 and 33 adult patients, attended to Hacettepe University Hospital from June 2012 to March 2013. Clinical history and follow-up, physical examination and standard laboratory findings of the patients were recorded. Nucleic acid extraction was performed via commercially available spin-column assays and complementery DNA (cDNA) synthesis was performed by using commercially available cDNA synthesis kit with randomised hexamer primers. BuV detection was carried out by in house nested-polymerase chain reaction (PCR) utilized with previously-described primers. EV detection was carried out by in house PCR with pan-enterovirus primers. Seventy-four percent (93/126) and 26% (33/126) of the patients were children (0-18) and adults (19-86), respectively. In all patients, bacterial, mycobacterial and fungal cultures were negative, as well as PCR for herpes simplex virus (HSV) types 1 and 2. PCR results of all samples were negative for BuV and EV. This is the first study that evaluates a probable association of BuV and central nervous system infections. Although Parvovirus B19, a well-characterized human pathogen can rarely cause encephalitis, our findings did not confirm such an association for BuV in this preliminary investigation. However, long-term evaluation of individual cases with unknown etiology is required to reveal the relationship of the virus with specific environments.

Frequency of neutropenia among Turkish and Syrian pediatric thalassemia patients under deferiprone monotherapy.

Weekly monitoring of absolute neutrophil count (ANC) under deferiprone therapy in thalassemia patients is recommended to avoid agranulocytosis adverse event. Actually, this recommendation may not be applicable in clinical setting. Our study aimed to establish incidence of neutropenia under deferiprone (DFP) monotherapy when it was monitored bimonthly due to socioeconomic conditions effecting local and refugee thalassemic patients including Syrian origin (SYR; n = 26) and Turkish origin (TR; n = 26) groups. Patients on DFP were followed up for 12 months. Fifteen neutropenic episodes were seen in 5 patients. All 5 patients (4 from SYR group and 1 from TR group) had splenomegaly and hypersplenism, and neutropenia ceased in 4 patients after splenectomy despite continuation of deferiprone. In the TR group, the frequency of patients who have neutropenia (absolute neutrophil count [ANC] <1500/mm(3)) was 3.8% (n = 1) in the 1st month, no patients in TR group had neutropenia until 10th month when again there was 1 patient with mild neutropenia. In SYR group, the frequency of patients who have neutropenia was 3.8% (n = 1), 7.7% (n = 2), and 11.5% (n = 3) in the 1st, 2nd, and 3rd months, respectively, and was found to be 3.8% (n = 1) between 6 and 12 months. Whether or not DFP therapy should be interrupted in case of mild neutropenia and the frequency of monitoring ANC in real-life conditions should be documented with further studies. Other causes of neutropenia in DFP-treated patients should also be kept in mind.

Tularemia in children, Turkey, September 2009-November 2012.

Tularemia, a zoonotic disease caused by Francisella tularensis, is found throughout most of the Northern Hemisphere. It is not well known and is often misdiagnosed in children. Our aim with this study was to evaluate the diagnosis, treatment, and prognosis for 100 children with tularemia in Turkey. The mean patient age was 10.1 ± 3.5 years (range 3-18 years), and most (63%) patients were male. The most common physical signs and laboratory findings were cervical lymphadenopathy (92%) and elevated erythrocyte sedimentation rate (89%). Treatment response was higher and rate of relapse lower for children 5-10 years of age than for those in other age groups. Associated with treatment failure were female sex, treatment delay of ≥16 days, and use of doxycycline. Tularemia is endemic to Turkey, and the number of cases has been increasing among children as well as adults.

Successful treatment of Paecilomyces variotii peritonitis in a liver transplant patient.

Paecilomyces variotii has previously been reported as a causative pathogen for peritonitis in patients on continuous ambulatory peritoneal dialysis and shown to be usually sensitive to amphotericin B and resistant to voriconazole. We report the first case, to our knowledge, of P. variotii peritonitis in a liver transplant patient, which was unresponsive to initial liposomal amphotericin B (L-AmB) treatment and resolved dramatically after the addition of voriconazole. The present case provides evidence for the clinical and microbiological effectiveness of voriconazole combined with L-AmB in treating P. variotii peritonitis refractory to initial L-AmB treatment.