Beneficial effects of dexamethasone in children with pneumococcal meningitis.

Fifty-six children older than 2 years with meningitis caused by Streptococcus pneumoniae were enrolled in a prospective, double blind, placebo-controlled trial to evaluate the efficacy of dexamethasone therapy in addition to antimicrobial therapy. Twenty-nine of 56 received dexamethasone (0.6 mg/kg/day iv, divided into 4 daily doses for 4 days) and the remaining 27 received placebo. At the beginning of therapy the clinical and laboratory characteristics of the patients in the treatment groups were comparable, except for the Glasgow coma score (P = 0.004), which was lower in the dexamethasone group. Patients were examined daily during hospitalization and 6 weeks after discharge from the hospital. Hearing was assessed 6 weeks after discharge by means of pure tone audiometry. Two patients in the dexamethasone group and one patient in the placebo group died. There were no differences between the two groups with regard to the duration of fever, the incidence of secondary fever and electrolyte imbalance, seizure activities occurring during hospitalization and rash. Although the differences were statistically insignificant, moderate or severe unilateral or bilateral sensorineural hearing loss at 6 weeks and the overall neurologic sequelae, including hearing loss, at 1 year were higher in the placebo group, at 23% vs. 7.4% (P = 0.11) and 26.9% vs. 7.4% (P = 0.062), respectively. At 3 months after discharge, because of the improvement in hearing loss in one dexamethasone-treated patient the incidence of hearing impairment was significantly less than that in the placebo group, at 3.7% vs. 23%, respectively (P = 0.044). No improvement in hearing loss was observed after 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Sulbactam/ampicillin in the treatment of pediatric infections.

Seventy eight pediatric patients (43 males, 35 females) aged 34 days to 17 years were treated with intravenous or intramuscular sulbactam/ampicillin 3 or 4 times daily for skeletal system infection (10 cases), systemic salmonellosis (2 cases), intrathoracic infection (12 cases), and soft tissue or miscellaneous infections (54 cases). The dose used to treat the majority of patients was 200 mg of ampicillin plus 100 mg of sulbactam per kg/day. The duration of treatment ranged from 8 to 23 days. Sulbactam/ampicillin alone was used in 68 patients. Ten patients were treated with an additional antibacterial agent. The overall cure rate was 98.7% for all 78 study patients. One patient with an abscess in the neck was shown to be infected with a strain of Escherichia coli resistant to sulbactam/ampicillin. Only one patient experienced a rash, but it did not necessitate discontinuation of therapy. This study shows that sulbactam/ampicillin is a safe and effective agent in the treatment of various pediatric infections.

Unusual neurologic complications of typhoid fever (aphasia, mononeuritis multiplex, and Guillain-Barré syndrome): a report of two cases.

Although typhoid fever can frequently lead to such neurological manifestations as confusion, delirium, and encephalopathy, Guillain-Barré syndrome, aphasia and mononeuritis multiplex occur very rarely. In this report, we describe two patients with typhoid fever who developed these unusual complications.

Comparative therapeutic results of penicillin plus chloramphenicol versus ampicillin plus sulbactam in childhood meningococcemia.

Fifty-seven cases of meningococcemia were evaluated retrospectively. The age of the patients ranged between 2 and 17 years. Of the 57 patients investigated for the efficacy of antibiotic treatment, 31 (54.4%) were treated with benzylpenicillin plus chloramphenicol and 26 (45.6%) with ampicillin plus sulbactam. Patients with criteria for a poor prognosis (presence of disseminated intravascular coagulation, low arterial blood pressure, and altered consciousness) were divided equally into two treatment groups. There were no statistically significant differences between the two treatment groups except for the higher incidence of convulsion in the group given penicillin plus chloramphenicol. The mortality rate was 19.3 percent for patients treated with benzylpenicillin plus chloramphenicol and 7.6 percent for patients treated with ampicillin plus sulbactam (p = 0.19; overall mortality rate 14%).

Microorganisms involved in acute bacterial meningitis in children and the role of Haemophilus influenzae.

Acute bacterial meningitis (ABM) is an important cause of mortality and neurological damage in children. Documentation of the etiological agents is very important both for the treatment of patients and for prophylactic approaches. H.influenzae, N.meningitidis and S.pneumoniae are the three major pathogens involved in ABM. In Turkey for many years H.influenzae has not been isolated in cerebrospinal fluid (CSF) specimens. In order to show the bacteria involved in ABM in our hospital and to see the role of H.influenzae, we investigated the CSF of 59 patients with bacterial meningitis using Gram and Wayson stains, culture and latex agglutination techniques. The agents were determined in 38 (64.4%) specimens by using culture positivity in 30 (50.8%), and latex or stain positivity in eight (13.6%) specimens. The microorganisms causing ABM included S.pneumoniae (25.6%), gram-negative enteric bacillI (17.9%), N.meningitis (12.8%), alpha hemolytic streptococci (10.3%), H.influenzae (10.3%), nonfermentative gram-negative bacillI (5.1%), candida spp. (5.1%), group B streptococci (2.6%), coagulase negative staphylococci (2.6%), S.aureus (2.6%) and pseudomonas spp. (5.1%). In this study it has been shown that H.influenzae can cause ABM in Turkish children. Multicentric studies from different parts of Turkey will be helpful in showing the real incidence in our country.

Multiple intracranial tuberculomas in a child.

Intracranial tuberculomas continue to be a serious complication of central nervous system tuberculosis. Tuberculomas are conglomerates of tubercles resulting from hematogenous spread of infection. Modern neuroimaging studies such as magnetic resonance imaging and molecular biologic techniques such as polymerase chain reaction are helpful in the diagnosis of central nervous system tuberculosis and tuberculomas. We report a boy with multiple intracranial tuberculomas diagnosed and treated with the aids of magnetic resonance and polymerase chain reaction techniques.

Salmonella typhi infections. A 10-year retrospective study.

Enteric fever is still a common health problem in many countries, especially in children. Thus a ten-year retrospective study was carried out to evaluate the clinical and laboratory properties of enteric fever and the incidence of antimicrobial resistance in children. Throughout the past 10 years, Salmonella was isolated in 105 patients by blood culturing, 27 of which were Salmonella typhi. Most of the patients were above the age of two. Besides the typical symptoms and signs of enteric fever, 29.2% of the patients had some neurologic findings. Besides, 68.5% had elevated liver enzymes while only 44.4% had hepatomegaly with or without splenomegaly. Anemia was present in 44%, leukopenia in 16% and leukocytosis in 11.1% of the cases. The emergence of antimicrobial resistance during the last five years against ampicillin, chloramphenicol and trimetoprim-sulfamethoxazole has created a challenge in treating these infections.

Splenic abscess due to brucella in childhood. A case report.

An eleven-year-old male was diagnosed with multiple splenic abscesses due to brucella. He was treated only with antibiotics. Although splenic abscess is very rare in childhood, in febrile patients with upper quadrant abdominal pain, tenderness and splenomegaly, splenic abscess should be suspected especially in epidemic regions. Diagnosis can be confirmed by ultrasonography and computerized tomography.

Typhoid fever with very high transaminase levels.

Typhoid fever is endemic in developing countries and may cause very different clinical findings. Although hepatic involvement and abnormal liver function tests may be seen in 50% of the patients, intravascular hemolysis and renal involvement are rare. In this report, a 10-year-old patient with enteric fever presenting with hepatitis, severe intravascular hemolysis and glomerulonephritis is presented. To see all of these findings together in a patient with typhoid fever is very rare and may cause diagnostic difficulties.

Prognostic factors in Salmonella typhimurium septicemia. A 10-year retrospective study.

In this study, 74 S.typhimurium septicemia cases were evaluated retrospectively from their records, and the age and sex distribution, presence of underlying disease, signs and symptoms, complete blood count, liver function tests and case fatality rate were documented and prognostic factors determined. It has been shown that S.typhimurium is the most common strain causing Salmonella septicemia, which is more fatal in the newborn period and in the presence of an associated disease, while hemoglobin and leukocyte counts do not play an important role in the prognosis. In Salmonella septicemia, congenital heart disease was the second-most common associated disease, which may be attributed to probable underlying immunodeficiency.

Tumor necrosis factor-alpha and interleukin-1 beta levels in children with bacterial, tuberculous and aseptic meningitis.

Cerebrospinal fluid levels of tumor necrosis factor-alpha and interleukin-1 beta in 78 children with nonbacterial, bacterial and tuberculous meningitis, and in 34 control subjects were analyzed in order to evaluate the involvement of these cytokines in the pathogenesis of acute bacterial meningitis and their discriminative value between different etiologies of meningitis. Tumor necrosis factor-alpha and interleukin-1 beta levels were significantly higher in bacterial and tuberculous meningitis than in aseptic meningitis and in control subjects (p < 0.0001). There was no difference in the levels of tumor necrosis factor-alpha and interleukin-1 beta between nonbacterial meningitis and control groups. The finding that both tumor necrosis factor-alpha and interleukin-1 beta are increased in the cerebrospinal fluid of patients with bacterial and tuberculous meningitis whereas normal levels of these two cytokines have been found in patients with nonbacterial meningitis signifies that these cytokines may be used to differentiate between bacterial and nonbacterial meningitis.

Antibiotic susceptibilities of Salmonella serogroups isolated from Turkish children.

This study is performed to show the serogroup distribution and in-vitro antibiotic susceptibilities of Salmonella species that cause either gastroenteritis with/without bacteremia or enteric fever at Hacettepe University Ihsan Dogramaci Children's Hospital. Of the 309 Salmonella strains evaluated, serogroup B was the most common isolate (56%) followed by serogroup D (33%). Antibiotic susceptibility tests using the disk diffusion technique revealed resistance rates of 43 percent for ampicillin, 41 percent for chloramphenicol, 29 percent for trimethoprim-sulfamethoxazole (SXT) and 32 percent for ceftriaxone among Salmonella serogroup B. The same rates were 10, eight, seven and zero percent for Salmonella serogroup D, and seven, 14, and zero percent for serogroup C, respectively. S.thypi strains susceptible to all antibiotics studied except tetracycline (33% resistant). No resistance was detected against the quinolones. The antibiotic resistance of Salmonella species isolated from children seems to be important, especially in serogroup B. Susceptibility tests should be considered in the antimicrobial therapy of Salmonella infections where indicated.

Antibiotic susceptibilities of enterococci isolated from Turkish children.

To evaluate the antibiotic resistance rates of enterococci isolated at Hacettepe Children's Hospital, in vitro antibiotic susceptibility tests were performed in 77 enterococci (32 hospital, 45 nonhospital strains) isolated from various clinical specimens in 1994. Microbroth dilution tests against ampicillin, vancomycin, gentamicin and streptomycin were performed according to the NCCLS standards. High-level resistance to aminoglycosides was investigated. Ampicillin resistance rates were 21.9 percent and 2.2 percent for hospital and nonhospital strains, respectively (p < 0.01). The same rates were 46.9 and 13.3 percent for gentamicin (p < 0.01), and 15.6 and 13.3 percent for streptomycin (p = 0.25). No resistance was detected against vancomycin. Six strains (7.8%) showed high-level resistance to both aminoglycosides studied. Special attention should be paid to enterococci isolated from hospitalized patients. Appropriate antibiotic use in serious infections can only be achieved by choosing an appropriate regimen according to antibiotic susceptibility tests. Periodic evaluation of the antibiotic susceptibility patterns of enterococci is necessary for the empirical treatment of infections due to these microorganisms.

Diagnosis of childhood tuberculosis by polymerase chain reaction.

The polymerase chain reaction (PCR) using oligonucleotides based on the repetitive sequence (IS6110) of Mycobacterium tuberculosis as a primer was evaluated for detection of M.tuberculosis in clinical samples. We tested 55 clinical specimens from patients suspected of having tuberculosis and 71 specimens from control subjects. PCR was more sensitive than culture (positivity rate was 14.5% and 36.3%, respectively, in suspected patients). This approach to the diagnosis of tuberculosis is a valid diagnostic alternative to classical procedures.

Mucormycosis in a diabetic child and its treatment with fluconazole: a case report.

We present here a case of a diabetic patient having complaints of painful swelling of the left eye, blurring of the vision and tonic-clonic convulsion. Surgical exploration of the sinuses was performed, and the histopathological examination revealed mucomycosis. Because of the side effects of Amphotericin B, we tried Fluconazole and the patient recovered completely.

[Giardiasis]. / Giardiazis.

In this review article the general properties, epidemiology, pathogenesis and the clinical course of Giardia lamblia infection has been discussed under the light recent developments.

[A clinical trial with ampicillin and sulbactam in various infections]. / Cesitli enfeksiyonlarda ampisilin ve sulbaktamin klinik etkinligi.

Eighty four patients with various infections were treated with parenteral ampicillin and sulbactam. Twenty seven patients had meningitis five septic arthritis and osteomyelitis, two systemic salmonellosis, nine intrathoracic infections, five of which were complicated with pleural empyema; thirty patients had infection of the deep tissues of the neck, and the remaining eleven had soft tissue infection in different localizations. The clinical and microbiological results were interpreted together and the overall rate of success in treatment with ampicillin and sulbactam was found to be 98.8%.