Human Mastadenovirus A Infection in a Child During the Course of Hematopoietic Stem Cell Transplant.

Following primary infection, human mastadeno- viruses can persist in various tissues. We report a case of a pediatric patient with Fanconi anemia who had a complicated posttransplant course after allogeneic hematopoietic stem cell transplant that was associated with human mastadenovirus infection. Human mastadenovirus reactivation was detected with metagenomic analysis during a 3-month follow- up period; the predominant rate of occurrence of human mastadenoviruses was 1.1% on day 0, 84% on day +15, 90% on day +30, and 42% on day +82. Virus shedding continued up to 3 months after transplant. At 36 months after hematopoietic stem cell transplant, the patient was in good clinical condition with full donor chimerism. Long-term follow-up studies for human mastadenoviruses are needed to determine latency period.

Evaluation of oxidative and antioxidative parameters in pediatric hematopoietic SCT patients.

Conditioning regimens preceding hematopoietic SCT (HSCT) usually consist of high-dose chemotherapy. Chemotherapy and radiation therapy are associated with increased formation of free radicals and depletion of critical plasma and tissue antioxidants. Oxidative stress and antioxidant depletion have been described during the transplantation period in HSCT patients. In a limited number of studies, it was observed that the conditioning regimen resulted in oxidative stress and antioxidant depletion in HSCT patients. The objective of this study was to look for further evidence of oxidative stress and antioxidant status in pediatric HSCT patients. In this study, blood samples were collected from 21 pediatric allo-HSCT patients before and after conditioning therapy. Erythrocyte and plasma malondialdehyde (MDA) levels, erythrocyte reduced and oxidized glutathione (GSH) levels, erythrocyte antioxidant enzymes activities, plasma α-tocopherol and ß-carotene levels were determined. After high-dose chemotherapy, erythrocyte and plasma MDA levels increased. Reduced GSH levels decreased whereas oxidized GSH levels increased first and then decreased significantly compared with the values before the chemotherapy regimen. It was also observed that catalase, superoxide dismutase and GSH-S-transferase activities decreased, but there was no change in GSH peroxidase activity. On the other hand, plasma α-tocopherol levels increased, but ß-carotene levels did not change.

Relationship of lower breastfeeding score and problems in infancy.

BACKGROUND AND METHODS: We undertook a descriptive study in 2-month-old healthy infants to determine the factors that affect breastfeeding score. Mother's breastfeeding was evaluated and scored according to the World Health Organization/UNICEF B-R-E-A-S-T Feeding Observation Form. RESULTS: The breastfeeding score (BFS) was higher in female than male babies (p=0.005). The babies with regurgitation had lower BFS than the babies without (p=0.016). The BFS was lower in babies who had repeated, without cause, inconsolable crying than in those without such crying (p<0.004). When the crying was problematic for the family, BFS was lower (p=0.028). Babies who had another sibling with a history of colic had a lower BFS (p=0.038). A low BFS was associated with short duration of night sleeping (p=0.032). CONCLUSIONS: A decreased BFS may be a risk factor or indicator for infant crying, regurgitation, and short sleeping duration. As a result, tracking the BFS and appropriate breastfeeding intervention during the newborn period may assist in decreasing the frequency of regurgitation and infant crying.

Naturally acquired hepatitis A antibodies after haematopoetic stem cell transplantation.

Haematopoietic stem cell transplant (HSCT) recipients lose immune memory of exposure to infectious agents and vaccines accumulated throughout their lifetime and therefore need to be revaccinated. We aimed to evaluate the influence of different factors on hepatitis A virus (HAV) immunity in both child and adult HSCT recipients living in an intermediate endemic region, Turkey. Eighty patients (age range 2·5-57 years) who had HAV serology prior to HSCT were evaluated. The prevalence of HAV seropositivity was 85% (n=68) before HSCT. There was no history of HAV vaccination before HSCT in children and HAV vaccine was not available in Turkey 10 years ago, so it was assumed that all seropositive patients reflected natural immunity. After the exclusion of six patients with autologous HSCT, the remaining 62 seropositive and allogeneic patients were included in this retrospective study. The duration of HAV seropositivity was estimated using the Kaplan-Meier method, log-rank analysis and Cox regression models. Estimated mean time to loss of HAV seropositivity was 48·6 months after transplantation. Patients who were older (⩾18 years) at transplantation and who had older (⩾18 years) donors became seronegative later (P<0·05). Cox backward-stepwise regression confirmed that older age of recipient at transplantation was the only significant parameter for HAV seropositivity (P<0·05). HAV-inactivated vaccine might be recommended later to older HSCT recipients in intermediate endemic regions.

Atypical skin graft-vs.-host disease following bone marrow transplantation in an infant.

Herein, we describe an unusual presentation of acute graft versus host disease (GVHD) mimicking contact dermatitis in an infant who underwent 5/6 HLA-matched bone marrow transplantation (BMT) from his mother for malignant infantile osteopetrosis. The initial rash on day +32 simulated diaper rash, which progressed to a belt-shaped rash and then developed hyperkeratotic nodules on the hands. The acute GVHD was atypical and the course was progressive and fatal, with liver and gut involvement. This presentation of atypical initial skin involvement of acute GVHD may be useful for practicing clinicians in the BMT field who need to be aware of the early unusual signs of acute GVHD so that they can initiate prompt treatment.