Radiographic findings of adenoviral pneumonia in children.

OBJECTIVE: Adenovirus pneumonia is a common cause of community-acquired pneumonia in children and can mimic bacterial pneumonia, but there are few publications on its radiographic features. This study has evaluated the chest radiography findings of community-acquired adenovirus pneumonia in children. The frequency of radiological findings mimicking bacterial pneumonia was investigated. The clinical features of patients with adenovirus pneumonia possessing radiological findings mimicking bacterial pneumonia were also evaluated. MATERIALS AND METHODS: The chest radiographs of patients diagnosed with adenovirus pneumonia were retrospectively reviewed. The chest radiographs were interpreted independently by a pediatric infectious disease specialist and a pediatric radiologist. Chest radiography findings mimicking bacterial pneumonia (bacterial-like) were specified as consolidation +/- pleural effusion. Other findings on chest radiography or a completely normal chest X-ray were specified as findings that were compatible with "typical viral pneumonia". RESULTS: A total of 1407 patients were positive for adenovirus with respiratory multiplex PCR. The 219 patients who met the study criteria were included in the study. Chest radiographs were normal in 58 (26.5 %) patients. The chest radiograph findings mimicked bacterial pneumonia in 41 (18.7 %) patients. CONCLUSION: Adenovirus pneumonia occurs predominantly in children aged five years and younger, as with other viral pneumonias. The radiographic findings in adenovirus pneumonia are predominantly those seen in viral pneumonia. Increasing age and positivity for only adenovirus without other viruses on respiratory multiplex PCR were associated with the chest radiograph being more likely to be "bacterial-like". Adenovirus may lead to lobar/segmental consolidation at a rate that is not very rare.

Monitoring of adenoviremia in pediatric patients undergoing hematopoietic stem cell transplantation: Is it alone sufficient to predict adenoviral disease?

BACKGROUND: We aimed to evaluate our pediatric HSCT recipients routinely monitored for adenoviremia and to determine the adequacy of this monitoring in predicting adenoviral disease (AD). METHODS: A retrospective cohort of patients who underwent allogeneic HSCT between January 2021 and August 2022, and routinely monitored for adenoviremia by real-time PCR was included in our survey. Demographic and clinical data of the patients were recorded. Incidence rates, risk factors, and mortality rates related to adenoviremia, and AD were analyzed. RESULTS: Among 104 HSCTs performed in 94 patients adenovirus (AdV) was revealed in 27 (26%) episodes and adenoviremia in 18 (17.3%) HSCT episodes. AD without adenoviremia developed in nine episodes (8.6%). Disseminated disease was significantly more frequently detected in episodes with adenoviremia (p = .008). GVHD was independent risk factor for AdV detection (OR: 8.6, 95% CI: 2.03-33.7, p = .001). Viremia developed within a shorter time interval after HSCT in isolated episodes of adenoviremia compared to those with concomitant AD (p = .006). Initial and peak viral loads were significantly higher in adenoviremia with AD (p < .001). Mortality was higher in the AdV-detected episodes (p < .001) than in the AdV-undetected episodes. AdV-related mortality was found to be 22.2%. Adenoviremia increased the risk of mortality (OR: 1.2, 95% CI: 0.22-1.33, p = .01). CONCLUSIONS: Adenoviremia monitoring is an important process in the detection of AD. Since some patients may develop AD without accompanying by adenoviremia, monitoring for AdV in blood samples should be supported with other monitoring methods in order to evaluate the probable involvement of different organs or systems.

The Role of Adenovirus in Hepatitis of Unknown Etiology Among Children in Turkey, July 2022 to January 2023.

BACKGROUND: In the first half of 2022, the increase in cases of severe acute hepatitis in children with no epidemiological link and unknown cause has aroused concern worldwide. In this study, we aimed to determine the frequency of adenovirus in children with hepatitis of unknown origin in Turkey. METHODS: In this study, which was conducted with the participation of 16 centers from Turkey, between July 2022 and January 2023, 36 pediatric patients under the age of 18 who met the definition of acute hepatitis were included. RESULTS: Twenty (55,6%) of patients were female and 16 (44,4%) were male, with a mean age of 41.55 ± 39.22 (3-192) months. The most common symptoms were fever (66.7%), weakness (66.7%), loss of appetite (66.7%), fatigue (61.1%), vomiting (61.1%), and diarrhea (47.2%). Six (16 %) children had acute hepatic failure. Eight of the 15 children (46%) had respiratory viral infections (rhinovirus/enterovirus, n = 4; rhinovirus + parainfluenza, n = 1; parainfluenza, n = 1, SARS-CoV-2 n = 2). Adenovirus was detected in 16 (44%) patients. Adenovirus and coinfections were detected in 7 patients. History of diarrhea and fatigue in the last month was significantly higher in the adenovirus group ( P = 0.023 and 0.018). One child who had both adenovirus and rhinovirus infection required liver transplantation; all others recovered with supportive care. CONCLUSION: There were no deaths in our series; however, the number of cases, etiology, and severity of the clinical course may have differed between countries owing to differences in case definitions, laboratory facilities, or regional genetic differences.

Three Cases of Catheter-related Bloodstream Infection Caused by Phialemonium curvata : A Case Report and Literature Review.

BACKGROUND: With recent developments in the field of microbiology, an increasing number of yeasts and molds with the potential to cause infections in humans are identified every year. In addition to the challenges in identifying clinical isolates, there is limited antifungal susceptibility data available for Phialemonium species, leading to uncertainty in optimal treatment recommendations. METHODS: In this article, catheter-related bloodstream infections caused by Phialemonium curvata (previously Phialemonium curvatum ) in 3 immunosuppressed patients are presented. Furthermore, the literature was reviewed to identify the clinical spectrum and treatment approaches for the reported infections. RESULTS: The cases presented here were analyzed along with 24 cases reported in the literature. Among all cases, 21 (77.7%) patients had an underlying condition. Nine (33.3%) patients had hematological/oncological malignancies and solid organ transplants. Twenty-two (81.4%) patients had a history of device or invasive interventions. Surgical procedures, removal of contaminated devices or tissue were found to reduce the risk of death by 86.7%. Correspondence analysis revealed a significant association between antifungal treatment and outcome ( P < 0.001). The correspondence analysis could explain 53.9% of this relationship. Monotherapy and combination therapy were associated with survival. While salvage treatment or no antifungal therapy was associated with mortality, intravitreal injection or topical application of voriconazole was associated with sequelae. CONCLUSIONS: Surgical intervention and removal of contaminated devices or tissue should be considered at an early stage.

Mild encephalopathy with reversible extensive white matter lesions in a child with acute adenoviral infection and a literature review.

BACKGROUND: Mild encephalopathy with a reversible splenial lesion (MERS) is a known clinical-radiological description. However, MERS with extensive lesions (MERS type-2) is rarely associated with adenovirus. There are only three published cases of MERS type-2 associated with adenovirus infection. CASE: We present a 10-year-old previously healthy girl who presented with speech difficulty and mild encephalopathy after three days of prodromal illness. The magnetic resonance imaging (MRI) revealed bilateral diffusion restriction in the parietal white matter, splenium and genu of the corpus callosum without mass effect and slight thickening at the splenium of corpus callosum with no contrast enhancement. With empirical and support treatment, her neurological examination was completely normal by the 18th hour. The nasopharyngeal respiratory adenoviral PCR resulted positive. She was discharged with total clinical and radiological resolution on the 10th day of admission. The case was diagnosed with MERS type-2 which is rarely associated with adenoviral infection. CONCLUSION: This report is the first case of adenovirus related MERS type-2 in a Turkish child. Pediatricians, child neurologists, child infection specialists and radiologists should recognize this condition to ensure appropriate diagnosis.

Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID-19.

OBJECTIVE: Although the initial reports of COVID-19 cases in children described that children were largely protected from severe manifestations, clusters of paediatric cases of severe systemic hyperinflammation and shock related to severe acute respiratory syndrome coronavirus 2 infection began to be reported in the latter half of April 2020. A novel syndrome called "multisystem inflammatory syndrome in children" (MIS-C) shares common clinical features with other well-defined syndromes, including Kawasaki disease, toxic shock syndrome and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Our objective was to develop a protocol for the evaluation, treatment and follow-up of patients with MIS-C. METHODS: The protocol was developed by a multidisciplinary team. We convened a multidisciplinary working group with representation from the departments of paediatric critical care, cardiology, rheumatology, surgery, gastroenterology, haematology, immunology, infectious disease and neurology. Our protocol and recommendations were based on the literature and our experiences with multisystem inflammatory syndrome in children. After an agreement was reached and the protocol was implemented, revisions were made on the basis of expert feedback. CONCLUSION: Children may experience acute cardiac decompensation or other organ system failure due to this severe inflammatory condition. Therefore, patients with severe symptoms of MIS-C should be managed in a paediatric intensive care setting, as rapid clinical deterioration may occur. Therapeutic approaches for MIS-C should be tailored depending on the patients' phenotypes. Plasmapheresis may be useful as a standard treatment to control hypercytokinemia in cases of MIS-C with severe symptoms. Long-term follow-up of patients with cardiac involvement is required to identify any sequelae of MIS-C.

How does the immunogenicity of hepatitis B vaccine change over the years in childhood?

Hepatitis B is the leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma worldwide. The incidence of HBV infection has significantly decreased with hepatitis B vaccination. Hepatitis B vaccine is administered to children at 0, 1 and 6 months of age according to the national schedule. There is a high rate of protective antibody (anti-HBs) development after hepatitis B vaccination. We conducted the study to investigate how the hepatitis B surface antibody (anti-HBs) positivity rates and the titers change over time in childhood following vaccination. Patients who presented at the general pediatric outpatient clinic of Yenimahalle Education and Training Hospital and the HBsAg and anti-HBs titers were tested for any reason between July 2011 and May 2018 were retrospectively evaluated. The cutoff level for protection by the anti-HBs titer was accepted as ≥10 mIU/mL with lower levels indicating no protection. Anti-HBs positivity was compared by age group. Anti-HBs levels were studied in 4326 children. The mean age of the included in the study was 127 ± 62 months. A protective anti-HBs level (≥10 mIU/mL) was present in 2292 children (69.2%). The highest anti-HBs antibody positivity rate was in the under 3 years' age group. The positivity rate significantly decreased after age 7 years. The HBsAg level was determined in all children in the study and five had a positive result. In conclusion, our study found that the anti-HBs positivity rate and the anti-HBs level decreased with age. However, the anti-HBs antibody result remained positive in more than half of the children.

[A liver cycst hydatid case with widespread embolies to vena cava inferior]. / Vena kava inferior'a yaygin embolilerle seyreden bir karaciger kist hidatik olgusu.

Hydatid Cyst is a public health problem in Turkey. Although it can lead to cyst formation in all organs and systems, the most frequently affected organs are the liver and lungs. Here, we reported a 14-year-old girl who presented with low back pain and hydatid vomita symptoms and signs. The abdominal and thoracic CT examinations of the patient revealed that hydatid cyst found in the liver was opened to the inferior vena cava and it was determined that it caused multiple emboli in the right atrium, pulmonary arteries and lungs. Albendazole treatment was commenced and the hydatid cyst in the liver was excised by surgery, and surgery was planned for the hydatid cyst lesion in the right atrium. However, in the control thorax BT before the surgery, it was found that the cysts in the cardiovascular structures disappeared, causing widespread pulmonary embolism and spread to the entire pulmonary field. The most important complication of intense hydatid pulmonary embolization is the development of pulmonary hypertension and right heart failure. In our patient, pulmonary artery pressures and right heart functions were normal in repeated echocardiography. With this case, we wanted to emphasize that the cardiovascular involvement of hydatid cyst may not always require surgery.

Bulging fontanel during a measles infection.

INTRODUCTION: Introduction Causes of a bulging fontanel in children include viral/bacterial meningitis, encephalitis, hydrocephaly, intracranial bleeding, psedotumor cerebri and central nervous system tumors. A less well-known cause of acutely-developing fontanel bulging is transient intracranial hypertension. CASE REPORT: A 7-month-old female was brought to our hospital with fever, cough, watery nasal secretion and bulging fontanel for the last 3 days. The cranial ultrasound examination and cerebrospinal fluid examinations were normal. The patient's irritability and fontanel bulging improved the day after admission but a maculopapular rash developed. The measles Ig M was positive. Measles PCR was positive from urine and nasopharyngeal swab samples. The signs of intracranial hypertension of the patient recovered completely the day after admission and did not recur during the follow-up. The patient was discharged on the 5th day of admission. DISCUSSION: Transient intracranial hypertension is thought to result from a transient increase in the quantity of the circulating cerebrospinal fluid but the pathogenesis is not clear. CONCLUSIONS: Based on this case, we report that transient intracranial hypertension could develop during a measles infection.

Pediatric pleural tuberculosis.

Background: Pleural tuberculosis (TB) diagnosis is sometimes controversial because the microbiologic confirmation ratio is very low in pleural fluid. There are few pediatric pleural TB case series in the literature. Methods: We retrospectively evaluated our TB cases below 18 years of age and extracted pleural TB cases. Results: Seven cases with pleural TB were identified. About 42.9% of the patients had isolated pleural TB whereas 57.1% of the patients had accompanying pulmonary TB. Lymphocytic pleural effusion and increased adenosine deaminase (ADA) (>40 U/L) level are found in 85.7% of the patients. Six patients had uncomplicated effusion (transudate) according to Light's criteria and one had complicated effusion (exudate). Lung decortication was needed in three patients. All patients were given 6 months anti-TB medication and recovered completely. Conclusion: In the lymphocyte-predominant pleural effusion, an increased ADA level highly supported TB disease. The complicated effusion (exudate) in pleural TB is not rule; uncomplicated effusion (transudate) could be seen.

Brucellar Aortitis and Meningoencephalitis in an Adolescent.

Brucellosis can affect any organ system and result in possible complications. We present an adolescent male who had brucellar aortitis and meningitis simultaneously. Brucellar aortic involvement is a rare complication of brucellosis and can occur without concomitant endocarditis. Here, the patient was managed with prolonged antibiotic therapy without any surgery.

Epidemiology of hepatitis E virus in children in the province of Van, Turkey.

Aim: Hepatitis E virus is an etiological agent of hepatitis which is transmitted enterically and may lead to water-born outbreaks. Although it is mainly transmitted by the fecal-oral route, it is estimated that many cases are associated with zoonotic transmission in developing countries. In this study, we aimed to investigate the seroprevalence of hepatitis E in the childhood age group in the province of Van and to demonstrate the relationship between seroprevalence and demographic properties, residential house/region, water supply used at home, dealing with livestock and history of surgery. Material and Methods: In this study, hepatitis E virus IgG antibody was studied by ELISA method in children aged between 2 months and 18 years between June 2014 and September 2014 in the province of Van. Results: A total of 408 children and adolescents were enrolled in the study. Hepatitis E IgG was found to be positive in 4.2% of the subjects. 179 (43.8%) of the subjects were female and 229 (56.2%) were male. The mean age was 123 months±56.6 months (minimum 2 months, maximum 214 months). When the seropositivity rates were compared by age groups and gender, no difference was found. No correlation was found between hepatitis E seropositivity and the variables of residence, dealing with livestock and water resources. No correlation was found between anti-hepatits E virus seropositivity and parental education level, number of cohabitants and history of surgery. Conclusion: In our study, hepatitis E virus seropositivity was found to be lower compared to the mean seropositivity in Turkey. Hepatitis E infection does not constitute a serious problem in children in the province of Van in accordance with the results reported from different parts of our country. Livestock dealing and usage of well water are not considered risk factors for Hepatitis E infection.

Evaluation of complicated and uncomplicated parapneumonic effusion in children.

Parapneumonic effusion (PPE) and empyema are most often seen as a complication of bacterial pneumonia and occasionally associated with atypical bacteria or viruses. The aims of this study were to describe and compare demographic characteristics, clinical, laboratory, microbiological findings and treatment modalities of patients with PPE and empyema. We retrospectively reviewed 116 pediatric patients with PPE and empyema. Seventy (60.3%) had pleural empyema and 46 patients (39.6%) had PPE. The median age of patients with empyema [72.0 months (IQR 68.0 months)] was lower than the patients with PPE [92.5 (IQR 80.0 months)] (p=0.003). Children in the empyema group had significantly more dyspnea symptoms than the children with PPE (p=0.022). Mean fever duration before hospitalization was similar in both groups. Streptococcus pneumoniae and group A streptococcus were the most common causes of empyema. All of the patients were treated with intravenous antibiotics. In addition to medical treatment, tube thoracostomy was performed in 59 of 70 (84.3%) patients in empyema group; 27 (45.8%) of them required intrapleural fibrinolysis also. In the presence of antibiotic treatment failure or in cases with moderate or large pleural effusion with loculations and clinical deterioration; it is necessary to perform drainage of the purulent fluid by tube thoracostomy, to add intrapleural fibrinolytics or to perform video-assisted thoracoscopic surgery (VATS), in order to enhance prompt recovery.

Voriconazole-associated visual disturbances and hallucinations.

Voriconazole is a second-generation azole widely used for the prevention and treatment of fungal infection in leukemia patients. Voriconazole is considered the primary antifungal agent for invasive aspergillosis. We report a case of 16-year-old girl who developed visual disturbance and visual and auditory hallucinations after intravenous voriconazole treatment for invasive pulmonary aspergillosis. Due to the visual hallucinations and visual disturbance began acutely and shortly after the initiation of voriconazole, and no other cause could be determined, the symptoms were considered to be the side effects of voriconazole. Simultaneous development of visual side effects and hallucinations rarely have been reported before.

[Coexistence of Pulmonary Hydatid Cyst and Mycoplasma pneumoniae Pnömonia in a Child]. / Akciger Kist Hidatigine Eslik Eden Mycoplasma pneumonia Pnömonili Çocuk Olgu .

Hydatid cyst is a zoonotic disease and endemic in Turkey. The disease can involve any organ. The most common involved organ is lung in childhood. Hydatid cyst of lung may be asymptomatic or may be sometimes ruptured or infected. Secondary bacterial infections associated with the hydatid cyst are well known. A previously not reported pediatric case of hydatid cyst with Mycoplasma pneumoniae pneumonia is described in this report. It is emphasized that M. pneumoniae should be kept in mind as a cause of infected hydatid cyst which is unresponsive to beta-laktam antibiotics.

First Case of Ascaris lumbricoides Infestation Complicated with Hemophagocytic Lymphohistiocytosis.

Ascariasis is a common soil-transmitted helminth infestation worldwide. Ascaris lumbricoides infestation is generally asymptomatic or cause nonspecific signs and symptoms. We report a 5-year-old male with hemophagocytic lymphohistiocytosis associated with A. lumbricoides infestation. The presented patient recovered completely after defecating an A. lumbricoides following intravenous immunoglobulin (IVIG) and mebendazole treatment. We wanted to emphasize that because helminth infestation is easily overlooked, the diagnosis of ascariasis should be considered in patients who live in endemic areas and treated timely to prevent severe complications.

Miliary tuberculosis disease complicated by Pott's abscess in an infant: Seven year follow-up.

A 20-month-old boy presented with 1-year history of persistent fever, cough, and progressive abdominal distention. Abdominal ultrasonography showed hepatomegaly and multiple calcifications in the liver and spleen. Thoracic computed tomography showed multiple mediastinal lymph nodes and consolidation in both lungs. Additionally, there was a 2-cm thick retroperitoneal soft tissue mass destroying the T7-8 and L1-L2 vertebral bodies. The patient was preliminarily diagnosed with miliary tuberculosis (TB) and Pott's disease, and began administering anti-TB treatment consisting of isoniazid, rifampin, ethambutol, and pyrazinamide. Acid-resistant bacilli analysis and mycobacterial culture of the biopsy specimen of Pott's abscess were positive. Mycobacterial culture and PCR of gastric aspirate were also positive. The patient's condition progressively improved with anti-TB treatment and he received 12 months of antiTB therapy. At the end of the treatment all of the patient's symptoms were relieved and he was well except for kyphosis. Miliary TB complicated by Pott's abscess is a very rare presentation of childhood TB. The presented case shows that when Pott's abscess is diagnosed and surgically corrected without delay, patients can recover without squeal.

Coexistence of liver hydatid cyst and brucellosis in an adolescent.

A 15-year-old girl, who was evaluated for arthralgia of knees, was diagnosed as having brucellosis by serum agglutination and enzyme linked immunosorbent assay tests. Physical examination of the patient revealed massive hepatomegaly. Abdominal ultrasonography and computerised tomography showed a single large cystic lesion of the liver. The echinococcus indirect haemagglutination was positive at a titre of 1/1280. A giant hydatid cyst was removed with surgical intervention; in addition, she was treated with albendazole and antibrucellosis drug combination with success. Here, an immunocompetent adolescent case with brucellosis and concomitant hydatid cyst disease was reported to emphasise that the coexistence of both entities are infrequent but may occur due to increased prevalence of the diseases.

Testicular adrenal rest tumor in a patient with 11beta-hydroxylase deficient congenital adrenal hyperplasia.

In patients with congenital adrenal hyperplasia, testicular adrenal hyperplasia and tumors can develop. A three-year-old boy was admitted to our hospital with complaints of enlarged penis and development of pubic hair. 11beta-hydroxylase deficient congenital adrenal hyperplasia was diagnosed and hydrocortisone treatment was started. His family did not accept treatment well and did not come for check-ups regularly, which is why his metabolic control was poor. In ultrasonographic evaluation, a hypoechoic mass, 10x10 mm in size, was detected in his left testis at 15 years of age and steroid dose was increased. Almost two years later the tumor completely disappeared with high dose steroid treatment. In conclusion, the monitoring of congenital adrenal hyperplasia with ultrasonography is recommended, especially in puberty, because it is important that testicular adrenal rest hyperplasia should be determined before testicular adrenal rest tumors develop. In this case we observed that small testicular adrenal rest tumors disappeared completely with high dose steroid treatment in nearly two years.

A case of Horner's syndrome after the surgical treatment of pulmonary hydatid cyst.

We report a case of right-sided iatrogenic Horner's syndrome developed after surgical treatment for pulmonary hydatid cyst. This occurred in a 10 year old girl who had been diagnosed as having a ruptured lung hydatid cyst on the basis of clinical, radiological, serological, histopathological and perioperative findings. The patient underwent right thoracotomy and the cystotomy-capitonnage for the cyst. Right upper lid ptosis, right miosis and anisocoria were recognized on the first postoperative day. Findings of Horner's syndrome were ameliorated completely at the 6th month. In conclusion, iatrogenic transient Horner's syndrome may develop after surgery for pulmonary hydatid cyst, especially if the cyst is located at the lung apex.