Post-exposure Rabies Prophylaxis for Children in Southern Turkey.

OBJECTIVE: To evaluate the prophylaxis practices used on children with animal exposures in a major southern city of Turkey, close to the Syrian border. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Emergency and Outpatient departments, Adana City Training and Research Hospital, Turkey between September 2017 and September 2018. METHODOLOGY: The demographic data of the patients, who presented due to animal contact; the interval between animal contact and hospital presentation; species of exposed animals, type, and apparent condition of the animals; risk categories based on national assessment scale; the number of rabies vaccines and anti-rabies immunoglobulin (RIG) administrations; administration of tetanus prophylaxis; adherence of patients to the follow-up schedule; vaccine refusals; and development of rabies disease (if any), were recorded. RESULTS: Of the 2,068 presentations after animal exposure, 906 (43.8%) were children, mostly boys (62%), and the mean age was 97.15 ± 57.68 months. Risky contact was most frequently caused by cats (52.8%) and dogs (45.6%). Exposure to stray animals was the most common (58.5%). For serial prophylaxis vaccinations, 761 (83.99%) families were in full compliance and 145 (16%) families had discontinued vaccinations. The discontinuation rate of the immigrant population was significantly higher (p = 0.001). CONCLUSION: Risky contacts were mostly due to stray animals. Efforts to minimise the stray animal population should be increased. The rate of discontinuation of rabies prophylaxis follow-ups was 16%. Significantly higher prophylaxis discontinuation among the immigrant population was noted. Key Words: Rabies, Vaccines, Prophylaxis, Turkey.

A different clinical presentation of Heiner syndrome: The case of diffuse alveolar hemorrhage causing massive hemoptysis and hematemesis.

Heiner syndrome is a non-IgE-mediated hypersensitivity to cow's milk, which often causes pulmonary disease in infants and young children. Patients often have symptoms of chronic or recurrent upper or lower respiratory tract infection. It has been reported that the Heiner's syndrome can cause recurrent pulmonary hemorrhage, and it is difficult to differentiate from the entity of idiopathic pulmonary hemosiderosis, another disease with recurrent pulmonary hemorrhage of unknown etiology usually occurring in the older children. Acute respiration is a rare problem in Heiner syndrome, which usually has symptoms and signs of chronic respiratory disease. In this case report, we present a 6-month-old patient who was admitted to our hospital with massive hemoptysis, hematemesis, and deep anemia.

Anafilaxia tras la administración de amikacina con metabisulfito de sodio a un recién nacido prematuro / Anaphylaxis after administration of amikacin containing sodium metabisulfite in a premature newborn

La anafilaxia es una reacción de hipersensibilidad sistemica y grave, de inicio rápido y potencialmente mortal. En los recién nacidos prematuros, el sistema inmunitario aún no ha madurado y, por lo tanto, tienen menos probabilidades de presentar anafilaxia. La administración de amikacina, que contenía metabisulfito de sodio, a un prematuro de 3 días de vida le indujo anafilaxia casi mortal. Debido a que se sospechaba un caso de anafilaxia, se inició la administración de amikacina en el bebé. Una vez comenzado el tratamiento, se observó una mejoría clínica. Al tercer día de tratamiento con amikacina, el recién nacido tuvo, repentinamente, taquipnea, taquicardia, angioedema y cianosis. Se le diagnosticó anafilaxia y se inició el tratamiento. Una hora después de la mejoría clínica, se produjo una reacción tardía. Inmediatamente, se intubó al recién nacido. La anafilaxia es una emergencia médica; por lo tanto, los médicos deben realizar una evaluación rápida y atenta para detectar esta reacción potencialmente mortal. Incluso después del tratamiento satisfactorio de la anafilaxia, el paciente debe permanecer bajo observación durante 72 horas dada la posibilidad de una reacción bifásica.

Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and can cause death. Premature newborns, whose immunological system is immature, are less likely to develop anaphylaxis. Administration of amikacin, containing sodium metabisulfite, to a 3-day-old premature newborn, induced a near fatal anaphylaxis. After suspicion of sepsis, the baby was started on amikacin. Clinical improvement was observed after initiation of treatment. On the third day of treatment with amikacin, the newborn suddenly developed tachypnea, tachycardia, angioedema and cyanosis. Anaphylaxis was diagnosed and treated. Latent reaction occurred after one hour of clinical improvement. The baby was intubated immediately. Anaphylaxis is a medical emergency; therefore the clinicians should have a rapid and careful assessment about this potentially fatal reaction. Even after successful treatment of anaphylaxis, the patient should be under observation for 72 hours because of the possibility of a biphasic reaction.

Anaphylaxis after administration of amikacin containing sodium metabisulfite in a premature newborn. / Anafilaxia tras la administración de amikacina con metabisulfito de sodio a un recién nacido prematuro.

Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and can cause death. Premature newborns, whose immunological system is immature, are less likely to develop anaphylaxis. Administration of amikacin, containing sodium metabisulfite, to a 3-day-old premature newborn, induced a near fatal anaphylaxis. After suspicion of sepsis, the baby was started on amikacin. Clinical improvement was observed after initiation of treatment. On the third day of treatment with amikacin, the newborn suddenly developed tachypnea, tachycardia, angioedema and cyanosis. Anaphylaxis was diagnosed and treated. Latent reaction occurred after one hour of clinical improvement. The baby was intubated immediately. Anaphylaxis is a medical emergency; therefore the clinicians should have a rapid and careful assessment about this potentially fatal reaction. Even after successful treatment of anaphylaxis, the patient should be under observation for 72 hours because of the possibility of a biphasic reaction.

La anafilaxia es una reacción de hipersensibilidad sistemica y grave, de inicio rápido y potencialmente mortal. En los recién nacidos prematuros, el sistema inmunitario aún no ha madurado y, por lo tanto, tienen menos probabilidades de presentar anafilaxia. La administración de amikacina, que contenía metabisulfito de sodio, a un prematuro de 3 días de vida le indujo anafilaxia casi mortal. Debido a que se sospechaba un caso de anafilaxia, se inició la administración de amikacina en el bebé. Una vez comenzado el tratamiento, se observó una mejoría clínica. Al tercer día de tratamiento con amikacina, el recién nacido tuvo, repentinamente, taquipnea, taquicardia, angioedema y cianosis. Se le diagnosticó anafilaxia y se inició el tratamiento. Una hora después de la mejoría clínica, se produjo una reacción tardía. Inmediatamente, se intubó al recién nacido. La anafilaxia es una emergencia médica; por lo tanto, los médicos deben realizar una evaluación rápida y atenta para detectar esta reacción potencialmente mortal. Incluso después del tratamiento satisfactorio de la anafilaxia, el paciente debe permanecer bajo observación durante 72 horas dada la posibilidad de una reacción bifásica.