Thoracic Air Leak Syndrome, Pulmonary Aspergillosis, and COVID-19 Pneumonia After Allogeneic Stem Cell Transplantation in a Child With Myelodysplastic Syndrome.

Thoracic air leak syndromes (TALS) are very rare among the noninfectious pulmonary complications (PCs). They can either be idiopathic or have several risk factors such as allogeneic hematopoietic stem cell transplantation (allo-HSCT), graft versus host disease and rarely pulmonary aspergillosis. We present a 14-year-old girl with hypoplastic myelodysplastic syndrome who developed graft versus host disease on day 60, TALS on day 150, bronchiolitis obliterans syndrome on day 300, pulmonary aspergillosis on day 400 and COVID-19 pneumonia on day 575 after allo-HSCT. This is the first report of a child who developed these subsequent PCs after allo-HSCT. Therefore, the manifestations of these unfamiliar PCs like TALS and COVID-19 pneumonia, and concomitant pulmonary aspergillosis with management options are discussed.

Pulmonary Mycobacterium abscessus Infection in an 11-Year-Old Child, Successfully Treated with Inhaled/Parenteral Amikacin: A Case Report and Review of Literature.

Mycobacterium abscessus appears to be increasing cause of pulmonary infection in children with underlying risk factors including cystic fibrosis, chronic lung disease and immunodeficiency syndromes. We present a case of pulmonary M. abscessus infection in a pediatric patient with primary ciliary dyskinesia and he was successfully treated with parenteral amikacin, linezolid and oral clarithromycin combined with inhaled amikacin. Clinical improvement was observed after adding inhaled amikacin to the treatment.

Rotavirus infections in children in Turkey: A systematic review.

We aimed to describe rotavirus epidemiology and clinical findings including extraintestinal manifestations in a setting that has yet to introduce rotavirus vaccines in the national immunization program. A literature search was performed by using the key words "Turkey" and "rotavirus." Ninety-eight studies published between 1987 and 2016 including epidemiological, clinical, and genotypical data at least 1 year duration were included. There were a total of 117 741 children with diarrhea and 26 566 rotavirus gastroenteritis with a median detection rate 31.8% (95% CI, 31.3-32.4) under 5 years of age. The rate of dehydration was 47% (95% CI, 23.4-91.6). There were 328 cases reported to be presenting with a various complication related to rotavirus in 2750 children in eight studies. The overall complication rate was 11.7% (95% CI, 10.7-12.9). The cumulative incidence of the most common genotypical combinations circulating worldwide was only 59.7% (G9[P8], 25%; G1[P8], 22%; G2[P4], 5.6%; G3[P8], 2.6%; G4[P8], 4.5%) whereas mixed, untypeable, and other genotypes were 2.4%, 15%, and 22.9% respectively. Our results point out the importance of rotavirus vaccination by presenting that rotavirus may cause severe complications besides severe gastroenteritis. The role of strain diversity in the variability of clinical presentations of rotavirus infections needs to be further investigated.

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.

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.

[A pediatric case of pneumococcal meningitis due to Streptococcus pneumoniae serotype 35F]. / Streptococcus pneumoniae serotip 35F'ye bagli pnömokokal menenjitli bir çocuk olgu.

Pneumococci are one of the most common causes of bacterial meningitis in children. It's also responsible for the other invasive pneumococcal diseases (IPD) including bacteremia and pneumonia worldwide. Unvaccinated children are more prone to IPD. Although IPD tend to have a higher prevalence under 2 years of age and in children with primary/secondary immunodeficiencies, and various predisposing factors, older age groups with no underlying diseases also experience IPD. In this report, a pediatric case diagnosed with meningitis due to Streptococcus pneumoniae serotype 35F with no underlying condition and no history of pneumococcal vaccination was presented. An 11-year-old male patient was admitted to the hospital with the complaints of high (39.4°C) fever, headache, vomiting and sleepiness. On the basis of findings from physical examination and laboratory results, the patient was prediagnosed as bacterial meningitis and empirical ceftriaxone and vancomycin therapy was initiated. The cerebrospinal fluid culture of the patient yielded penicillin-susceptible pneumococci and the isolate was identified as serotype 35F by quellung reaction. Vancomycin treatment discontinued depending on the culture result, and the patient fully recovered with 14-days of ceftriaxone therapy without any complications during his follow-ups. Although effective antibiotics are available for IPD, vaccination is indispensable considering the high mortality rates. Seven serotypes (1, 5, 6A, 6B, 14, 19F, 23F) which are currently included in the vaccine, were the most common serotypes related to IPD globally. After mass infant vaccination has been introduced, invasive pneumococcal diseases due to the vaccine serotypes have tended to decrease in both vaccinated young children and non-vaccinated age groups due to herd immunity. Nevertheless, non-vaccine serotypes (NVTs) have emerged as the agents of IPD as a result of serotype replacement. 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in April, 2011 nationwide in our country. This case report was about a patient who had developed meningitis after the introduction of PCV13. There has been no data evaluating the pneumococcal serotype distribution after PCV13 in our country yet. On February, 2013, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of PCV13 for children aged 6-18 years with underlying disease conditions. However, there is no recommendation for children with no underlying diseases in this age group. Vaccination can be extended for otherwise healthy children older than 6 years of age because of increasing trends in incidence of IPD both with vaccine and NVTs like serotype 35F. Recent studies have indicated the emergence of serotype 35F as a cause of IPD in children over 6 years of age and there have been also reports of IPD cases with 35F after the introduction of PCV13. Although serotype 35F is not yet a well-known serotype causing IPD, it might probably gain importance owing to its increasing frequency and virulence and might attract attention to be considered for inclusion in the future pneumococcal vaccines.

CONCURRENT KLEBSIELLA BACTEREMIA IN TWO INFANTS WITH SEVERE RESPIRATORY SYNCYTIAL VIRUS INFECTION.

Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections in children. In most previously healthy infants, RSV infection is self-limited and resolves without complications. The risk of bacteremia is low in young febrile infants with RSV infection. Herein, we report two previously healthy infants with severe RSV infection who had concurrent Klebsiella bacteremia.

Use of Herbal Tea/Herbal Preparations for Children with Symptoms of Viral Upper Respiratory Infections.

Objectives: Respiratory tract infections (RTIs) are common in children. To treat the symptoms of simple health problems, individuals look for natural healing methods that can be easily prepared at home. The aim of this study was to determine the plants and herbal products used by the parents of children suffering from viral upper respiratory tract symptoms by questionaire. In the study, applications and products, other than plants used by families for their children were also investigated. Materials and Methods: This study is a cross-sectional survey conducted at Faculty of Medicine, Gazi University (Ankara, Türkiye). A questionnaire form was used by scanning the existing literature and reviewed with the patients face to face by the researchers. The data obtained from the study were analyzed with the Statistical Package for the Social Sciences (SPSS) statistical program. Results: About half of the participants reported that they used non-chemical drug practices for their children with upper RTIs. The most common practice was to prepare herbal tea (30.5%), followed by mandarin/orange and/or their juice (26.9%) for oral application. The most used herbal tea for upper RTIs is with linden (Tilia sp.). Patients who used linden usually prepared it as tea, in other words by infusion, and served their children 1-2 cups/1-3 times a week. Except for herbal tea, the participants mostly used honey (19.0%) for their children's symptoms. Conclusion: Where available, appropriate doses and dosage forms of herbal supplement products with scientifically proven efficacy and safety should be determined for the pediatric population. Parents should use these products based on the recommendations of their pediatrician.

Congenital Rubella syndrome: A short report and literature review.

Rubella infections are rarely seen where immunization programmes are in place. Congenital rubella syndrome is however still observed where the vaccination programme against rubella is not administered or interrupted. We present such a case, with typical clinical anomalies including congenital cataracts, sensorineural hearing loss and bone lesions. The diagnosis was verified by detection of rubella immunoglobulin M positivity in the mother in the first trimester and positive rubella serology in both baby and mother.

A pediatric case series of invasive pneumococcal disease caused by S.Pneumonia serotype-19A despite full dose vaccination.

Streptococcus pneumoniae is the leading cause of community-acquired pneumonia and bacterial meningitis in children. Although pneumococcal conjugate vaccines (PCVs) are commonly available, invasive pneumococcal disease (IPD) still remains a life-threatening complication. Serotype 19A has high invasive potential and is capable of causing extensive and destructive lung disease. This strain has greater invasive potential, may have a growth advantage over other pneumococcal serotypes in normally sterile sites, and is often resistant to multiple antibiotics. Although being a component of PCV13 vaccine, serotype 19A may still be seen in fully vaccinated children and can cause invasive disease. Herein, we present four cases of IPD caused by S. pneumoniae serotype 19A who received the full regimen of PCV13 vaccination.