Cardiac echinococcosis associated with cerebrovascular occlusive disease and subcutaneous bullous eruptions and ulcers.

Cardiac involvement is an uncommon complication of echinococcosis. It is usually asymptomatic and may only be diagnosed incidentally. A 7-year-old boy was admitted with acute stroke and bullous and ulcerated skin lesions. He was diagnosed with cardiac echinococcosis complicated by systemic emboli to the central nervous system and superficial cutaneous arteries. In endemic areas, echinococcosis should be considered in the differential diagnosis of cardiac disease and unexplained cerebral embolism.

Terrestrial venomous animals, the envenomings they cause, and treatment perspectives in the Middle East and North Africa.

The Middle East and Northern Africa, collectively known as the MENA region, are inhabited by a plethora of venomous animals that cause up to 420,000 bites and stings each year. To understand the resultant health burden and the key variables affecting it, this review describes the epidemiology of snake, scorpion, and spider envenomings primarily based on heterogenous hospital data in the MENA region and the pathologies associated with their venoms. In addition, we discuss the venom composition and the key medically relevant toxins of these venomous animals, and, finally, the antivenoms that are currently in use to counteract them. Unlike Asia and sub-Saharan Africa, scorpion stings are significantly more common (approximately 350,000 cases/year) than snakebites (approximately 70,000 cases/year) and present the most significant contributor to the overall health burden of envenomings, with spider bites being negligible. However, this review also indicates that there is a substantial lack of high-quality envenoming data available for the MENA region, rendering many of these estimates speculative. Our understanding of the venoms and the toxins they contain is also incomplete, but already presents clear trends. For instance, the majority of snake venoms contain snake venom metalloproteinases, while sodium channel-binding toxins and potassium channel-binding toxins are the scorpion toxins that cause most health-related challenges. There also currently exist a plethora of antivenoms, yet only few are clinically validated, and their high cost and limited availability present a substantial health challenge. Yet, some of the insights presented in this review might help direct future research and policy efforts toward the appropriate prioritization of efforts and aid the development of future therapeutic solutions, such as next-generation antivenoms.

Listeria monocytogenes meningitis in two immunocompetent children.

Listeria monocytogenes is an uncommon cause of bacterial meningitis beyond the neonatal period. Patients with immunosuppression or neoplastic disease are at increased risk of developing serious invasive disease, particularly meningitis. L. monocytogenes meningitis in two previously healthy, immunocompetent children aged 7 years and 18 months is described. One of them was successfully treated with ampicillin and amikacin. In the other there was resistance to ampicillin, and meropenem, vancomycin and amikacin were given. One patient developed unilateral abducens paralysis and inappropriate antidiuretic hormone secretion. L. monocytogenes should be suspected in children with bacterial meningitis who fail to respond to empirical antibiotic therapy.

Crimean-Congo haemorrhagic fever among children in north-eastern Turkey.

AIM: To analyse the epidemiological and clinical features of children with Crimean-Congo haemorrhagic fever (CCHF) in north-eastern Turkey. METHODS: A retrospective study of demographic features and physical and laboratory findings in 21 children with CCHF is described. Clinical course, treatment modalities and outcome were analysed. RESULTS: Most patients were admitted in June and July 2008; most were from the Gumushane and Kelkit valleys and half of them lived in rural areas. Mean (SD) age was 10.3 (3.9) years and the disease was more common in males (71.4%). Approximately 70% had a history of tick bite. The main symptoms were fever (17, 80.9%), nausea (11, 52.3%), malaise (10, 47.6%) and headache (7, 33.3%). At initial examination, approximately 70% of patients had leukopenia and 65% had thrombocytopenia. Anaemia developed during follow-up in six patients. Liver involvement was seen in 12 patients and one patient had acute tubular necrosis. Six patients had haemophagocytosis. Patients were hospitalised for a median 8 days (range 3-22) and nine patients had bleeding from various sites approximately 3-5 days after hospitalisation. Subcutaneous haematoma (6), especially epistaxis and at venepuncture sites (6) were the most common sites of bleeding. Pulmonary haemorrhage developed in two patients and they required ventilatory support. Overall mortality related to CCHF was 4.7% (one patient). CONCLUSION: Early diagnosis of CCHF and early referral to specialised centres are important for outcome. Exceptional epidemics may be seen in future owing to ecological and environmental changes.

Cranial Doppler ultrasonography as a predictor of neurologic sequelae in infants with bacterial meningitis.

OBJECTIVE: To perform transcranial Doppler sonography in newborns and infants with bacterial meningitis to evaluate predictive value of neurologic sequelae. MATERIALS AND METHODS: Thirty-three patients (15 newborn, 18 infant patients) with bacterial meningitis underwent cranial Doppler ultrasonography during acute phase and 3rd and 6th months after disease. Patients were examined regularly for neurologic outcome with electroencephalography and magnetic resonance imaging. The age-matched control group consisted of 20 healthy children underwent cranial Doppler sonography only. RESULTS: To compare with the healthy controls, the mean blood flow velocity was significantly increased (P < 0.001), and pulsatility index was higher than those control group (P < 0.05) during acute bacterial meningitis. None of the patients were diagnosed with stenosis of cerebral artery. According to neurologic outcome, 14 of 33 patients had neurologic sequelae. The mean cerebral blood flow was significantly higher (P < 0.01) in patients without neurologic sequelae; pulsatility index was significantly higher (P < 0.05) in patients with neurologic sequelae when compared with the healthy controls. There was no significant difference between mean cerebral blood flow velocities and mean pulsatility index values of newborn and infant patients, regarding to neurologic outcome (P < 0.05). CONCLUSION: Cranial Doppler ultrasonography is useful for prediction of neurologic sequelae in infants with bacterial meningitis.

Long-term clinical course of patients with idiopathic pulmonary hemosiderosis (1979-1994): prolonged survival with low-dose corticosteroid therapy.

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology characterized by recurrent episodes of pulmonary symptoms such as cough, hemoptysis, and dyspnea. Our study consisted of 23 patients: 12 males and 11 females with IPH. The diagnosis was based on history, presence of anemia, and characteristic chest X-ray, and was confirmed by showing macrophages laden with hemosiderin in gastric washings or bronchoalveolar lavage and/or open lung biopsy. All but one patient were diagnosed in our department between 1979-1994. There was a history of multiple blood transfusions for anemia in 10 patients. Consanguinity between parents was noted in 11 patients. Severe pallor, cough, hemoptysis, and hepatomegaly were the most common findings on physical examination. All but 2 patients had hypochromic microcytic anemia of varying severity. In 12 children, moderate reticulocytosis was noted. Corticosteroids were administered with doses ranging from 5 mg every other day to 2 mg/kg/day depending on the severity of the episodes (duration of disease from 2-14 years). It is our impression that patients with IPH, benefit from long-term steroid treatment which in turn results in a milder course. Long-term low-dose steroid treatment appeared to prevent crises and assured a prolonged survival.

Amitraz intoxication in children in the rural Black Sea region: analysis of forty-three patients.

Amitraz is used topically in the treatment of demodicosis and other ectoparasitic infestations. Amitraz poisoning in children has been reported in a few cases. We presented 43 cases with amitraz intoxication. Of the patients, 14 had skin exposure. We compared the skin to peroral exposure group considering intoxication findings and outcome. In the peroral exposure group symptoms and recovery were more severe than in the skin exposure group, but mortality was not seen in two groups.

Effectiveness of short-course, intermittent chemotherapy for tuberculosis in young infants aged less than 6 months.

In order to determine the efficacy of short-course intermittent chemotherapy for tuberculosis in young infants less than 6 months of age, 15 newly diagnosed infants were treated with isoniazid (10-15 mg/kg) and rifampin (10-15 mg/kg), with/without streptomycin (30 mg/kg), daily for 15 days followed by similar doses of isoniazid and rifampin twice a week for another 8.5 months. The follow-up period ranged from 1 to 10 years. No patient demonstrated relapse following the termination of the treatment. These results suggest that short-course, intermittent treatment may be safe and effective for treating tuberculosis in young infants.

Drug-resistant tuberculosis in Turkish children.

The purpose of this study was to determine the prevalence of anti-tuberculosis drug resistance in children followed at Hacettepe University Ihsan Dogramaci Children's Hospital. Sixty cases with tuberculosis for whom susceptibility testing was available were searched retrospectively. Teh overall drug resistance was 26.7 percent. Resistance to streptomycin (sm) was the most frequent (18.3%), followed by isoniazid (6.7%), rifampicin (6.5%), and ethambutol (4.2%). Strain resistant to more than one drug was present in two cases (3.3%). In summary, excluding SM, both single and multidrug resistance were relatively low in our pediatric patients.

Recurrent pneumonitis in a 10-year-old girl with pigeon breeder's disease.

Hypersensitivity pneumonitis is an allergic disease resulting from sensitization to inhaled organic dust, usually manifest with recurrent bouts of cough, dyspnea and fever. Most of the reported cases concern the adult population. The disease is rarely seen in the pediatric age group, as stated by most of the reviews on the subject. In this article, a case with hypersensitivity pneumonitis is described. Precipitating antibodies to avian protein were demonstrated in serum from a girl with recurrent bouts of pneumonitis which was otherwise unexplained.

Sputum bacteriology and its antibiotic susceptibilities in Turkish cystic fibrosis patients.

To identify lower respiratory tract pathogens and their in-vitro antibiotic susceptibilities in Turkish cystic fibrosis (CF) patients, a total of 383 sputum cultures were evaluated from 45 CF children in 168 symptomatic and 215 control periods over 25 months. Microorganisms were isolated in 252 of the cultures. The isolation rate was 82 percent for symptomatic periods and 53 percent for control periods. The most common microorganism was P. aeruginosa in the symptomatic period and S. aureus in the control period. Other microbiological species included E. coli, H. influenzae, K. pneumoniae, S. epidermidis, beta-hemolytic streptococcus, H. parainfluenzae, K. oxytoca, E. aerogenes and E. aglomerans. P. cepacia was not found. In 20 cultures more than one microorganism was isolated at the same time. In in-vitro conditions, high susceptibility rates were detected to amikacin, ciprofloxacin and ceftazidim for P. aeruginosa; cefuroxime, ceftriaxone, amikacin, cephalothin, chloramphenicol and erythromycin for S. aureus; amikacin and ceftriaxone for E. coli; ampicillin-sulbactam, amoxicillin-clavulanate, cefuroxime, ceftazidime, ceftriaxone and aztreonam for H. influeanzae; and aztreonam and amikacin for K. pneumoniae. Lower respiratory tract pathogens and their antibiotic susceptibilities in Turkish CF children were not significantly different from those indicated previously in the literature.