The relationship between scoring systems and cytokine levels in neonatal sepsis.

In this study, 20 newborn infants with sepsis were evaluated and scored according to the criteria of Töllner and Rodwell and associates. Leukocyte count, serum C-reactive protein (CRP), tumour necrosis factor (TNF)-alpha and interluekin (IL)-6 levels were also studied in all infants. The aim of this study was to determine if a relationship exists between the scoring systems and the cytokine levels in neonatal sepsis. The infants were divided into two groups as blood culture positive and negative. Blood culture was positive in 12 (60%) infants. We did not find a significant difference for leukocyte count, cytokine levels and scoring systems between the blood culture positive and negative groups. However, we found a positive correlation between the scoring systems and serum CRP and TNF-alpha levels (P < 0.05), but no correlation with IL-6. In conclusion, we suggest that only serum CRP level without performing scoring and studying serum TNF-alpha concentration may be used in early diagnosis of neonatal sepsis. However, further studies are necessary to define this because of the small sample size of our pilot study.

Septic arthritis in childhood.

BACKGROUND: The purpose of the present study was to determine whether there was a difference between septic arthritis (SA) combined with osteomyelitis and SA alone with regard to clinical and laboratory findings, such as symptoms on admission, age, sex, joint involvement and isolated micro-organisms, and a relationship between age and joint involvement in SA. In addition, we also aimed to determine the prognostic factors in SA. METHODS: The clinical and laboratory findings of 40 patients who were diagnosed with SA in our hospital were reviewed retrospectively. The diagnosis of SA was made according to the following criteria: immediate joint fluid aspiration (culture and Gram's stain positive, leukocyte count markedly elevated and glucose level low), blood culture positive and positive cultures from other possible sites of infection. RESULTS: Of the 40 patients, 22 were boys, 18 were girls and the male to female ratio was 1.2/1. Patient ages ranged from 6 months to 14 years (mean (+/- SD) 8.44 +/- 4.18 years). The most observed symptoms were fever (52.5%), arthralgia (50%) and joint swelling (45%). Thirty-four (85%) patients had only one joint and six patients (15%) had more than one joint involved. In total, arthritis was diagnosed in 49 joints. The joints diagnosed as having arthritis were the following: knee (n = 18), hip (n = 12), ankle (n = 12), elbow (n = 3), shoulder (n = 2), wrist (n = 1) and interphalangeal joint (n = 1). Of the 40 patients, 21 (52.5%) had SA alone and 19 (47.5%) had arthritis together with osteomyelitis. While arthritis was diagnosed in 27 joints in the group of patients with SA, it was diagnosed in 22 joints in the group of patients with SA combined with osteomyelitis; in the latter, an increase was not observed in the number of joints involved. Joint fluid culture was positive in 22 (55%) patients; the growth of Staphylococcus aureus was observed in 20 cases and Pseudomonas aeruginosa and Staphylococcus epidermidis were isolated in each patient. In contrast, in one patient, arthritis occured during meningococcal meningitis (in this patient, Gram-negative diplococci was isolated from a cerebrospinal fluid culture). Patients with SA combined with osteomyelitis and those with SA alone were compared for symptoms on admission, the history of trauma and antibiotic use, sex, age, fever, joint involvement, anemia, leukocytosis and micro-organisms isolated from joint fluid and blood; there were no significant differences for these parameters between the two groups (P > 0.05). In addition, we found that there was no relationship between age and joint involvement in SA and there was no effect of micro-organisms on mortality. Three of 40 patients died; the mortality rate was 7.3%. Of the three patients who died, two had SA alone and one had SA combined with osteomyelitis. The primary disease was sepsis in these three patients; S. aureus was cultured from blood in two patients and Gram-positive cocci was observed following examination of the joint fluid in the other patient. CONCLUSIONS: We would like to emphasize that SA is mono-articular, frequently localized in the knee, hip and ankle in 85% of patients, joint fluid culture was positive in 55% of patients, bacteria was isolated from one or more cultures of blood, joint fluid, pus or bone in 70% of patients and the most common isolated micro-organism was S. aureus. In addition, it must be pointed out that children younger than 2 years of age with fever, a positive trauma history and/or abnormal joint findings should be carefully examined for SA because the rate of SA was lower (7.5%) than expected in this age group. We also found that the mortality of SA was not influenced by age, joint involvement and bacterial agents, and there was no significant difference in symptoms on admission, the history of trauma and antibiotic use, sex, age, fever, joint involvement,anemia, leukocytosis and micro-organisms isolated from joint fluid and blood between patients with SA

Pulmonary complications in patients with staphylococcal sepsis.

BACKGROUND: The aim of the present study was to determine the pulmonary findings in patients with sepsis caused by Staphylococcus aureus. METHODS: The clinical and laboratory findings of 32 cases (82%) of pulmonary involvement (secondary pneumonia) of 39 patients with sepsis caused by S. aureus were studied retrospectively. The criteria for the diagnosis of sepsis were clinical evidence of infection plus hyperthermia/hypothermia, tachycardia, tachypnea and white blood cell abnormalities. Secondary pneumonia was diagnosed in patients who presented with staphylococcal disease at one or more non-pulmonary sites and who developed radiologic evidence of pulmonary involvement during the course of illness. RESULTS: Of the 32 patients, 23 were male and nine were female; the male to female ratio was 2.5/1. The ages of the patients ranged from 2 months to 14 years (7.87 +/- 4.71 years). Bronchopneumonic infiltration was bilateral in 18 patients and unilateral in 14 patients (20 patients (62.5%) had lobar consolidation). Pleurisy was noted in 12 (37.5%) patients; it was on the right side in five patients, on the left in five patients and bilateral in two patients. In contrast, pneumatocele and pneumothorax were observed in seven (21.9%) and four (12.5%) patients, respectively. Closed chest tubes were placed through a closed thoracotomy in five children who developed dyspnea, orthopnea with imminent respiratory failure and mediastinal shift. As well as the pulmonary involvement, arthritis was noted in 13 patients, osteomyelitis in 11 patients, rash in six patients, pericarditis in five patients and renal failure in one patient. Staphylococcus aureus was isolated from blood culture in all except for seven cases. While S. aureus was isolated from blood culture in all of the 12 patients with pleurisy, it was isolated from pleural fluid in only two (16.6%) patients. Six of 32 patients died; the mortality rate was 18.75%. CONCLUSIONS: It was found that the rate of pulmonary involvement was as high as 82% in sepsis caused by S. aureus, and the pulmonary findings, including bronchopneumonic infiltration and lobar consolidation, were frequently seen in S. aureus pneumonia, causing a mortality rate of 18.75%.

Diagnostic value of troponin T in neonates of mild pre-eclamptic mothers.

The measurement of myocardial damage by newer, highly specific markers of myocardial damage is now possible, including cardiac structural proteins such as troponin T (TnT). In neonates of pre-eclamptic mothers, it identifies minor myocardial damage missed by other biochemical markers. The present study was designed to determine the diagnostic value of TnT concentrations in neonates of pre-eclamptic mothers. Fifteen neonates of pre-eclamptic mothers were studied (9 boys and 6 girls), and 17 healthy full-term neonates (9 boys and 8 girls) were selected as a control group. The serum TnT concentration in neonates of pre-eclamptic mothers (0.70 ng/ml) was significantly higher than that in the control group (0.10 ng/ml). In an echocardiographic study, the mean mitral peak velocity at an atrial contraction (A) value of 39 cm/s in neonates of pre-eclamptic mothers was significantly lower than that in the control group (53 cm/s), and the mean mitral peak velocity of early diastole to peak velocity of the atrial contraction (E/A) value (1.75) in neonates of pre-eclamptic mothers was significantly higher than that in the control subjects (1.23). In conclusion, our study demonstrated high levels of cardiac TnT, lower mitral A values and high mitral E/A values in neonates of pre-eclamptic mothers, presumably associated with mild myocardial damage in the neonates of pre-eclamptic mothers.

Amitraz poisoning in children: clinical and laboratory findings of eight cases.

Amitraz poisoning is a rare disorder characterised by central nervous system and respiratory depression, bradycardia, hypotension, hypothermia, hyperglycemia, vomiting, convulsion and glycosuria. In this study, eight pediatric patients with amitraz poisoning were presented. This study revealed that clinical manifestations of poisoning by oral and dermal route emerged within 30-120 min and that central nervous system depression which is the most important sign resolved with 8-18 h and others 36-48 h. All cases were discharged as recovered after 48 h. To our knowledge only six cases have been reported in the literature. Because of the limited information in the literature, the cases were reported.

A case of the cardiofacial syndrome (Cayler's syndrome).

An infant whose face appears asymmetrical at rest and whose mouth is pulled downward to one side when crying is said to have an 'asymmetric crying facies' (ACF). The association of ACF with congenital cardiac anomalies is known as cardiofacial syndrome (Cayler's syndrome). The present report describes a case with cardiofacial syndrome and ACF associated other congenital anomalies, and provides criteria for differentiating absence of the depressor anguli oris muscle (DAOM) from palsy of the seventh cranial nerve and its central connections.

Primary cardiac echinococcosis in childhood. Case report.

Cardiac echinococcosis is rare and usually occurs in adults. In a 12-year-old boy a left ventricular hydatid cyst was diagnosed by two-dimensional echocardiography and computed tomography and the cyst was surgically removed.