Infection caused by Nocardia farcinica mimicking pulmonary metastasis in an adolescent girl.

Nocardia farcinica infections are rare and potentially life threatening. Herein, we describe a case of pulmonary nocardiosis caused by N. farcinica. This 13-year-old girl admitted with 1-year history of cough, intermittent fever, and recurrent hemoptysis. She was examined for multiple pulmonary nodules mimicking pulmonary metastasis that were detected with chest radiography and computed tomography of the thorax. Eventually, N. farcinica was yielded in culture of sputum and aspiration material of pulmonary nodules. No predisposing factor could be shown for Nocardia infection. Although infections caused by N. farcinica have tendency to disseminate, and are mostly resistant to antibiotics, the patient was successfully treated with prolonged intravenous antibiotic therapy followed with oral amoxicillin-clavulanate.

Chlamydia pneumonia mimicking miliary tuberculosis.

Chlamydia trachomatis is a common cause of subacute, afebrile pneumonia with onset from 1 to 3 months of age. On physical examination, crepitant inspiratory rales are commonly heard. Infiltration is usually bilateral and interstitial; reticulonodular pattern and atelectasis have also been described, which distinct the disease from miliary tuberculosis. We report an infant who had a disseminated miliary pattern in the chest radiograph and computed tomographic scan of the thorax that was diagnosed as Chlamydia pneumonia with serologic investigations. We emphasized that Chlamydia trachomatis can cause a miliary reticulonodular pattern in radiological examinations of infants who were admitted with respiratory symptoms. We suggest that pneumonia due to C. trachomatis should be kept in mind in the differential diagnosis of infants examined because of a diffuse miliary pattern.

Contact dermatitis with henna tattoo.

Allergic and irritant reactions to henna are rare. Para-phenylenediamine, which is sometimes added to obtain a dark, blackish henna, causes the majority of contact dermatitis reported related with tattoos. Allergic contact dermatitis due to temporary paint-on tattoo with black henna is described in two adolescents.

Retrospective evaluation of 113 children with scoliosis.

To evaluate demographic features, preoperative pulmonary function tests and echocardiographic examinations of 113 children with scoliosis and to determine the associations between preoperative investigations and postoperative complications. Medical records, preoperative pulmonary function tests and echocardiographic examinations of 113 children with scoliosis who were operated between January 2004 and 2006 were evaluated retrospectively. Associations between preoperative pulmonary function tests, preoperative pulmonary symptoms and postoperative pulmonary complications were investigated. There were 37 male and 76 female patients. The mean ages of the patients at the time of the first and last surgery were 11.2 +/- 3.8 and 11.7 +/- 3.6 years respectively. The mean number of surgery performed for scoliosis was 1.5 +/- 1.4. Idiopathic scoliosis was the most common form constituting 42.5% of the patients. 68.1% of the patients had no preoperative pulmonary symptoms. Normal preoperative FVC, FEV(1), PEF and MEF(25-75) values were detected in 43.4%, 58.4%, 53.1% and 65.5% of the patients respectively. Echocardiograms were found normal in 34.5% of them. The most common cardiac valve anomaly was mitral valve prolapse which was detected in 25.7% of the patients. No significant associations were found between preoperative pulmonary function tests, preoperative pulmonary symptoms and postoperative pulmonary complications of children with scoliosis in our study.

Relation between serum IL-4, IL-13 and IFN-gamma levels and recurrence of wheezing episodes in infants with acute bronchiolitis.

Lower respiratory tract infections are the most important factors among various causes which trigger wheezing in the first year of life. The factors associated with episodic wheezing in children with acute bronchiolitis are still subjects of research. Infections, environmental factors, immunologic mechanisms are sorted as etiologic risk factors of episodic wheezing. We aimed to investigate the relationship between serum interleukin (IL)-4, IL-13 and gamma-interferon (IFN-gamma) levels and recurrence of wheezing episodes in infants with acute bronchiolitis. One hundred twenty infants between 3 and 36 months with acute bronchiolitis enrolled in the study. Personal histories, clinical and laboratory data of infants were recorded. The patients were followed for a year. Venous blood samples were obtained to determine serum IL-4, IL-13, and IFN-gamma levels during acute bronchiolitis episode. The number of wheezing episodes was significantly higher in infants with a positive family history of allergy. A statistically significant correlation was determined between serum IL-13 levels of infants and number of wheezing episodes. High serum IL-13 levels and a positive history of allergy may have important roles in the recurrence of acute bronchiolitis.

Efficacy of sulphasalazine on lung histopathology in a murine model of chronic asthma.

Sulphasalazine is a specific inhibitor of nuclear factor kappa B (NF-kappa B) which plays a key role in asthma. To determine the impact of sulphasalazine in the treatment of chronic asthma, BALB/c mice were sensitized and challenged with ovalbumin. Mice with experimentally induced asthma in group I received saline, group II sulphasalazine 200 mg/kg, group III sulphasalazine 300 mg/kg, and group IV dexamethasone 1 mg/kg intraperitoneally once a day in the last 7 days of the challenge period. Histological findings of the airways were evaluated by light and electron microscopies. Dexamethasone and sulphasalazine in both doses significantly improved all airway histopathologic parameters of asthma except numbers of goblet cells. Both doses of sulphasalazine improved thicknesses of basement membrane better than dexamethasone. Dexamethasone reduced the number of mast cells better than sulphasalazine (200 mg/kg). Further studies are needed to evaluate the efficacy of sulphasalazine in the treatment of asthma.

Helicobacter pylori infection and gastroesophageal reflux in asthmatic children.

The aim of this article is to investigate the prevalence of Helicobacter pylori (HP) infection, frequency of gastroesophageal reflux (GER), existence of atopy and levels of serum immunoglobulin E (IgE) in children with bronchial asthma. One hundred and thirty seven children who were diagnosed as bronchial asthma and/or wheezy child aged between 1 and 17 years were enrolled into the study. Peripheral venous blood samples were obtained to determine the total IgE and HP IgG antibody levels. GER was evaluated by the scintigraphic method and the presence of atopy was investigated by skin prick test. The study was conducted in 86 (62.8%) boys and 51 (37.2%) girls. HP IgG antibody levels were found negative in 125 (91.2%) and positive in 12 (8.8%) cases. GER was detected in 73 (53.7%) of the children. Forty-one (37.3%) children were accepted as atopic according to skin prick test results. The average total IgE levels of the participants was 168.89 +/- 270.76 IU/ml. A significant difference could not be determined related to GER, atopy frequency and serum IgE levels between the cases who had HP antibody positivity or not. The present findings suggest that the rate of HP antibody positivity is low in patients with bronchial asthma and a significant difference could not be determined in GER, and atopy between patients with positive and negative HP antibodies. High atopy frequency found in our patient group raises the question of whether allergic diseases can be protective against fecal-oral infectious diseases.

Late presentation of cystic adenomatoid malformation type 4 of lung in an asymptomatic child.

Congenital cystic adenomatoid malformation of lung is an uncommon embryonic developmental anomaly usually diagnosed perinatally. Rarely the presentation is delayed until childhood and adulthood. Herein we present a 10-years-old girl with a late presentation of congenital cystic adenomatoid malformation type 4 of lung who was diagnosed coincidentally.

Stevens-Johnson syndrome associated with brucella infection.

Stevens-Johnson syndrome is a potentially fatal condition that manifests mainly on the skin and mucosal surfaces but also affects other vital organs. There are no report of Stevens-Johnson syndrome caused by brucella infection in the literature. In this article, a previously healthy boy, diagnosed as Stevens-Johnson syndrome associated with brucella infection, is reported.

Follicular bronchiolitis associated with lung abscess in an eight-year-old girl.

Hemoptysis as a result of pulmonary or bronchial pathologies is a rare but potentially serious problem in childhood. The presented case is an eight-year-old previously healthy girl who was admitted to the emergency department because of recurrent hemoptysis. Because high resolution computerized tomography (HRCT) showed an abscess cavity, antibiotic therapy was continued about six weeks. Lobectomy was done when massive hemoptysis recurred. Histopathological examination revealed follicular bronchiolitis, which is a very rare entity, particularly in childhood. Although HRCT imaging is of great value in the diagnosis of this disease, in our case it failed to show any evidence of follicular bronchiolitis. In conclusion, the definitive diagnosis of follicular bronchiolitis always requires histopathologic examination of open lung biopsy.

A rare presentation of hydatid cyst in a child.

Cyst hydatid is the most widespread, serious cestode infection in the world. The most common organ affected by hydatid disease is the liver followed by the lungs and the two organs are affected simultaneously in about 5-13% of cases. The involvement of kidneys are rarely reported. Here we reported a patient with hydatid cysts in lung and kidney which the surgery was effective for both organs. The rarity of this case is the unusual combination of the cyst development in these organs without the involvement of liver.

Chlamydia and Mycoplasma serology in respiratory tract infections of children.

One of the challenges in planning the treatment of respiratory tract infection in children is identifying the causative agent. The objective of the present study was to investigate the incidence of Mycoplasma and Chlamydia in the etiology of respiratory tract infections of children. The present study included 100 children, three months to 12 years of age, admitted to the outpatient department of pediatrics with such respiratory symptoms as fever, cough and respiratory distress. Following a detailed clinical history and physical examination, complete blood count, erythrocyte sedimentation rate, peripheral blood smear and chest X-ray were obtained from each patient. At admission, IgG and IgM for Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis and Chlamydia psittaci were determined serologically. Positive antibody titer was found for Chlamydia and Mycoplasma in 18 (18%) of the patients. It was found that 2% of the patients had acute C. pneumoniae infection. When the subjects who had infections in the past or had re-infection were also considered; 6% were infected with C. pneumoniae, 3% with C. trachomatis, 1% with C. psittaci and 8% with M. pneumoniae. The presence of eosinophilia (> or = 4%) or the presence of siblings in the house were considered as factors favoring Chlamydial infections. High antibody titers for M. pneumoniae and C. pneumoniae were found more frequently after the age of two. Patients older than two years should be evaluated carefully for antibiotic treatments against atypical agents in pediatric lower respiratory tract infections.

The role of mean platelet volume predicting acute exacerbations of cystic fibrosis in children.

OBJECTIVE: The aim of this study is to evaluate the relationship between acute exacerbations and the mean platelet volume (MPV) trend in children with cystic fibrosis (CF), to predict the exacerbations. METHODS: A total of 46 children with CF and 37 healthy children were enrolled in the study. White blood cell count (WBC), hemoglobin level, platelet count, mean platelet volume (MPV), and mean corpuscular volume (MCV) were retrospectively recorded. RESULTS: Our study population consisted of 25 (54.3%) males and 21 (45.7%) females with CF and 20 (54.0%) males and 17 (46.0%) females in the healthy control group. The mean age of the CF patients was 6.32 ± 4.9 years and that of the healthy subjects was 7.02 ± 3.15 years. In the acute exacerbation period of CF, the MPV values were lower and WBC and platelet counts were higher than those in the healthy controls (P = 0.00, P = 0.00, P = 0.00, respectively). Besides, in acute exacerbation, the MPV values were lower and the WBC count was higher than the values in the non-exacerbation period (P 0= 0.01, P = 0.00, respectively). In the non-exacerbation period MPV was lower and platelet count was higher when compared to healthy subjects (P = 0.02, P = 0.04, respectively). CONCLUSION: This study suggests that MPV might be used as a simple, cost effective, diagnostic, predictive indicator for platelet activation in pediatric CF patients related to chronic inflammation, which might be helpful to discriminate or estimate exacerbations.

A neglected problem of developing countries: Noncystic fibrosis bronchiectasis.

BACKGROUND: Bronchiectasis has been defined as the abnormal and permanent dilation of the bronchi. It is still an important problem in many developing countries. AIM: The aim of this study was to identify the chacteristics and underlying etiology of children followed with the diagnosis of noncystic fibrosis bronchiectasis. MATERIALS AND METHODS: Children with bronchiectasis confirmed with high-resolution computed tomography were enrolled into the study. The data of the patients, including symptoms of the disease, age at the onset of symptoms, findings of physical examination, labrotory investigations performed in order to identify the etiology of bronchiectasis, etiology of bronchiectasis if found, radiologic findings and treatment modalities were noted. RESULTS: Sixty-six children between 1 and 17 years were included in the study retrospectively. Forty-four of them were males (66.7%) and 22 (33.3%) were females. The most common presenting symptoms were cough (100%) and sputum expectoration (50%). An underlying etiology was identified in 44 (66.7%) of the study subjects. The four most common underlying causes were found as infections (21.2%), asthma (16.7%), aspiration syndromes and/or gastroesophageal reflux disease (9.1%) and immunodeficiency syndromes (7.6%), respectively. CONCLUSION: Identifying an underlying etiology will have a significant effect on the management of noncystic fibrosis bronchiectasis. Defining the cause of bronchiectasis may also decrease its incidence, progression and complications.

Effects of Ginkgo biloba on airway histology in a mouse model of chronic asthma.

Platelet-activating factor (PAF) is an inflammatory mediator involved in the pathophysiology of asthma, suggesting a therapy antagonizing its effects may play a role in the disease treatment. The aim of the study was to determine the effects of Ginkgo biloba, a PAF antagonist, on lung histology. Thirty-five BALB/c mice were divided into five groups; A, B, C, D, and the control. All mice except controls were sensitized and challenged with ovalbumin. Mice in group A (placebo) received saline; group B received G. biloba, 100 mg/kg; group C received G. biloba, 150 mg/kg; and group D received dexamethasone, 1 mg/kg via orogastric gavage for 7 consecutive days. Chronic structural changes and airway remodeling were evaluated by using light and electron microscopy in all groups. Evaluation of lung histology indicated that the number of goblet cells, mast cells, thicknesses of epithelium, and basement membrane were significantly improved in groups B and C when compared with group A. There was no statistically significant difference in thicknesses of subepithelial smooth muscle between groups A, B, and C. When doses of G. biloba were compared with each other, only the number of goblet cells was significantly lower in group C than in group B. When G. biloba and dexamethasone groups were compared with each other, thicknesses of basement membrane and subepithelial smooth muscle were found to be lower in group D than in groups B and C. G. biloba alleviates all established chronic histological changes of lung except smooth muscle thickness in a mouse model of asthma.

Ginseng ameliorates chronic histopathologic changes in a murine model of asthma.

Currently, asthma therapies are effective in reducing inflammation but airway remodeling is poorly responsive to these agents. New therapeutic options that have fewer side effects and reverse chronic changes in the lungs are essential. This study aimed to determine the efficacy of oral administration of ginseng on lung histopathology in a murine model of chronic asthma. BALB/c mice were divided into four groups: control, placebo, ginseng, and dexamethasone. All mice except those in the control group were sensitized and challenged with ovalbumin. Then, mice in the ginseng group were given 2 gr/kg per day of ginseng and mice in the dexamethasone group received 1 mg/kg per day of dexamethasone via orogastic gavage once daily for 1 week. Lung histopathology was evaluated by using light and electron microscopy in all groups. All of the chronic changes of airways in the ginseng group were significantly ameliorated when compared with the placebo group. When compared with the dexamethasone group, the ginseng group had significantly lower numbers of mast cell count. Thicknesses of basement membrane, epithelium, and subepithelial smooth muscle were not statistically different between the ginseng and dexamethasone groups. Goblet cell numbers were much more reduced in the dexamethasone group. Ginseng is effective in resolving the established chronic histopathological changes of the lungs in the murine model of asthma.

The effectiveness of asthma therapy alternatives and evaluating the effectivity of asthma therapy by interleukin-13 and interferon gamma levels in children.

This study evaluated the superiority of combination therapy over steroid therapy alone by using clinical and laboratory data including interleukin (IL)-13 and interferon (IFN) gamma, which participate in the characteristic inflammation and have not been studied to evaluate the efficiency of asthma treatment sufficiently. Moderate persistent asthma patients, aged 7-17 years were included in the study. Patients were randomized to three groups. Group 1 used inhaled budesonide, group 2 used inhaled budesonide plus inhaled formoterol fumarate, and group 3 used inhaled budesonide and oral montelukast sodium therapy. At the beginning and at the end of the 2nd month a detailed physical examination and clinical evaluation; total IgE levels and total eosinophil count in peripheral venous blood, serum IL-13, and IFN-gamma levels; pulmonary function tests; and an assessment questionnaire (Pediatric Asthma Quality-of-Life Questionnaire with Standardized Activities [PAQLQ{S}] were performed. Sixty-seven patients completed the study. Serum IL-13 levels and PAQLQ(S) scores before the therapy and serum IL-13 levels after the therapy were significantly different between the groups and other parameters did not show any significant differences. Serum IgE level was decreased after the therapy in group I and increased in groups 2 and 3, but the difference was insignificant. In all groups total eosinophil levels were decreased insignificantly. After the therapy, IL-13 levels were decreased in groups 1 and 2 and increased in group 3, but the difference was not statistically significant. When compared with the levels before the therapy IFN-gamma levels were decreased after the therapy but the difference was not statistically significant. When the improvement rates for IgE, total eosinophil, IL-13, and IFN-gamma levels and each parameter of respiratory function tests were compared, there were no significant differences between the therapy groups. In all groups PAQLQ(S) scores were significantly improved after the therapy. Our results showed that steroid and other agent combinations do not have any superiority to steroids only; but according to pulmonary function tests and clinical indicators, all three therapy models are effective. These results suggested that the inhalation steroids, as the oldest agents, are still preserving their place and importance in asthma therapy.

Circulating adhesion molecules in sera of asthmatic children before and after steroid therapy.

The aim of this study was to evaluate respiratory function tests, total eosinophil counts, serum immune globulin E (IgE), and serum concentrations of soluble intercellular adhesion molecule (sICAM)1, soluble vascular cell adhesion molecule (sVCAM) 1, and soluble P-selectin (sP-selectin) levels in the children with mild and/or moderate asthma before and 3 months after inhaled steroids and to determine whether adhesion molecule levels showed any difference between asthmatic and healthy children and whether these levels changed with disease activity. A total of 28 children with bronchial asthma and 24 children as a control group were included in the study. All of the patients in the study group were administered inhaled budesonide treatment. The patients were reevaluated 3 months later. Respiratory functions tests were performed and total eosinophil count and serum total IgE level were determined. Serum levels of sICAM-1, sVCAM-1, and sP-selectin were determined and skin-prick tests were performed. Significant difference paralleled to clinical improvement was found in the study group for respiratory function tests, total eosinophil count, serum IgE level, and sICAM-1 levels determined before and after the treatment. However, no significant difference was found for sP-selectin and sVCAM-1 levels before and after the treatment. The higher level of sICAM-1 before the treatment suggests that leukocyte-endothelial adhesion have a role in bronchial asthma, which is an inflammatory airway disease. Reduction in the level of sICAM-1 after the treatment may be related to the decreased inflammation in response to therapy. However, no strong relationships were found between the determinants representing the inflammation and respiratory function tests.

The frequency of vitamin D insufficiency in healthy female adolescents.

AIM: To establish the frequency and causes of vitamin D insufficiency in healthy female adolescents in Izmir, Turkey. METHODS: 64 adolescents from a low--(Ikinci Inönü) and a high--(Ilica) socio-economic settlement were included. Parents' monthly income was classified as low, middle and high. The blood samples were drawn at the end of the summer and winter periods. RESULTS: Vitamin D insufficiency percentages for the end-of-winter period were 59.4% in Ikinci Inönü and 15.6% in Ilica, and for the end of summer 25% and 15.6%, respectively. Calcidiol levels of cases from Ikinci Inönü were found to be lower compared with the levels of cases from Ilica (34+/-15 vs 59+/-24 nmol/l for end of winter, p=0.000; 51+/-22 vs 65+/-28 nmol/l for end of summer, p=0.03). Calcidiol levels of cases whose parental monthly income was low and whose mothers were illiterate were significantly lower than the others (48+/-18 vs 65+/-29 nmol/l for end of summer, p=0.01; 33+/-16 vs 56+/-23 nmol/l for end of winter, p=0.000; 45+/-13 vs 64+/-29 nmol/l for end of summer, p=0.007; 36+/-17 vs 51+/-25 nmol/l for end of winter, p=0.02; respectively). CONCLUSION: Vitamin D insufficiency was frequent, especially in the end-of-winter period. Basic risk factors were low socio-economic status, illiteracy of mothers and low calcium intake.

The determination of asthma, rhinitis, eczema, and atopy prevalence in 9- to 11-year-old children in the city of Izmir.

The International Study of Asthma and Allergies in Childhood (ISAAC) phase II was designed to allow comparisons between populations in different countries and to investigate possible etiologic factors. This study was conducted to better delineate the prevalence and etiologic factors of asthma, rhinitis, and eczema in Izmir (Turkey) and to be included in the international comparisons by using a standard methodology of ISAAC phase II. The questionnaire was distributed to 2112 students in the 3rd, 4th, and 5th grades of 12 selected primary schools in urban and rural boroughs of Izmir. One thousand two hundred seventeen of these questionnaires were evaluated and physical examinations and skin-prick tests were performed on 1098 of these children. The prevalence values were 15.9% for recent wheezing and 4.8% for physician-diagnosed asthma. The prevalence of sneezing or runny or blocked nose in the past 12 months when the child did not have a cold or flu was 30%. The prevalence of physician-diagnosed allergic rhinitis was 17%. The prevalence of an itchy rash that was coming and going for at least 6 months was 7.2% and the prevalence of physician-diagnosed eczema was 4.9%. Atopic sensitization prevalence in the population was 8.8% with house-dust mite sensitization being the most frequent one. Secretion rales and sibilant wheezing rhoncus were detected in 2.7% of children by chest auscultation. In 1.1% of children flexural dermatitis was detected. Objective tests are necessary for epidemiologic studies of the aforementioned diseases.