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This study evaluates the clinical/immunological features and outcomes of 91 patients with the diagnosis of transient hypogammaglobulinemia of infancy(THI). Mean age at diagnosis was 8.4±5.2 months. IgG levels normalized at 30.6±11.88 months. Sixty three patients (69.3%) resolved in their first 3 years of life and 28 patients (30.7%) thereafter. In the univariate analysis, presence of atopy, occurrence of recurrent infections (6/year) and hospitalization, initial low IgA and IgM levels were found to be associated with the late recovery. Patients with longer breastfeeding duration recovered earlier. Recovery time for Ig levels was found to be longer in patients who received IVIG (n=55, 60.4%). This study confirmed that delayed resolution in THI is not rare. Frequent infections, initial low IgA and/or IgM levels and presence of atopy were found as associated factors for the late recovery. Breastfeeding should be encouraged and IVIG should be used in well selected patients.

Infectious diseases are the leading cause of FUO. A case of prolonged fever with hepatic and pulmonary tuberculosis as a final diagnosis is herein presented. A 4-year-old, otherwise healthy boy presented with an axillary temperature of up to 39.5ºC for the previous 3 weeks. His medical history revealed an occasional increase in body temperature up to 38.5ºC for the last 6 months. Physical examination revealed coarse breath sounds on the basal lung area. Chest X-ray showed mediastinal lymphadenomegaly and computed tomography revealed paratracheal conglomerated lymph nodes and a groundglass appearance on the right lung. There were multiple contrast-enhanced, hypoechoic nodules with central necrosis in the liver parenchyma on abdominal magnetic resonance imaging. Open liver biopsy yielded chronic granulomatous inflammation compatible with pathological findings of tuberculosis infection. The culture specimen was positive for Mycobacterium tuberculosis. The patient improved rapidly after antituberculous therapy was initiated. Tuberculosis, especially in its disseminated form, poses a distinct diagnostic challenge in cases of prolonged fever with unproven etiology, and thus persistence should be exercised in disclosing the cause of such fevers.

We investigated the frequency of pertussis among children in the İstanbul Faculty of Medicine Hospital during a period of four years. Clinical specimens were obtained from children who exhibited symptoms of whooping cough; a portion of the cases were confirmed microbiologically by PCR as pertussis. A total of 410 nasopharyngeal aspirates were taken for detection of Bordetella pertussis/parapertussis. The age groups of the patients were 0-4 months (n=201),4 -12 months (n=49), 1-4 years (n=79), 5-9 years (n=46), 10-14 years (n=27) and15 years (n=8). 106 (26%) of all samples were positive for B. pertussis/parapertussis by the PCR method. The Bordetella PCR positivity rates were 36% in 2010, 29% in 2011, 15% in 2012 and 15% in 2013. Due to administration of the DTaP-IPV vaccination at seven years of age starting in 2010, pertussis was not detected in the 5-9 age group after that year. According to this result, the five doses of pertussis vaccination administered as the national vaccine scheme are effective in protecting against the infection. A booster dose for adolescents at 14 years of age as well as a cocoon strategy might also be considered in our country.

Sütçü M, Aktürk H, Gülümser-Şişko S, Acar M, Erol OB, Somer A, Bilgiç B, Salman N. Granulomatous amebic encephalitis caused by Acanthamoeba in an immuncompetent child. Turk J Pediatr 2018; 60: 340-343. Acanthamoeba may lead to granulomatous amebic encephalitis (GAE) with high mortality rates generally in patients with immunosupression and/or chronic disease. Here, we present a rare GAE case, who was a previously healthy child. A Georgian 9 year old boy presented with focal seizure on his left arm and confusion. Since computed tomography (CT) demonstrated hypodense lesion on right occipital lobe, brain biopsy was performed. Histopathological examination of the biopsy material revealed Acanthamoeba cysts and trophozoites together with granulomatous inflammation. The patient, who had no clinical and laboratory findings consistent with immunedeficiency, was diagnosed as GAE. He was treated with a combination drug therapy. Even if it is very rare, amebic meningoencephalitis may also be seen in immunocompetent children, as in our case. Definitive diagnosis is made by microbiological and histopathological examination of brain biopsy material.

Tumor necrosis factor-alpha inhibitors (TNFIs) increase the risk of tuberculosis (TB). The aim of this study was to evaluate pediatric patients who are under TNFIs regarding the emergence of TB, and to determine the effectiveness of screening methods. This was a retrospective observational study of 73 patients receiving TNFIs therapy for at least 6 months duration between January 2011 and January 2016. Detailed demographic and clinical data were gathered from patients` files. Seventy-three patients (female n=41, 56.2%) with a median age of 129 (38-215) months were enrolled. Median follow-up period was 18 (6-60) months. Median duration of primary illness prior to TNFI therapy was 24 (2-184) months. Sixteen patients (21.9%) with latent tuberculosis infection (LTBI) were given isoniazid (INH) prior to TNFI therapy. TNFIs were adalimumab (n=39, 53.5%), infliximab (n=22, 30.1%) and etanercept (n=12, 16.4%). During follow-up, 16 patients (21.9%) were started on INH treatment. Median time of starting INH was 20 (4-42) months. One patient (3.1%) who received INH had elevated liver transaminases. One patient (1.3%) developed active TB during follow-up. In conclusion, patients who are candidates for TNFI treatment should be screened for TB before and during therapy.

This study was performed to investigate the viral etiological agents, age distribution and clinical manifestations of lower respiratory tract infection (LRTI) in hospitalized children. The viral etiology and clinical findings in 147 children (1 month to 5 years of age) hospitalized with acute LRTI were evaluated. Cell culture was used for isolation of influenza viruses and direct fluorescent antibody assay for parainfluenza viruses (PIVs), respiratory syncytial virus (RSV) and adenoviruses (ADVs). Reverse-transcriptase polymerase chain reaction was employed for human metapneumovirus (hMPV). One hundred and six of all patients (72.1%) were male, and 116 children (79.8%) wereor = 2 years. A viral etiology was detected in 54 patients (36.7%). RSV was the most frequently isolated (30 patients, 55.6%), and PIV (27.8%), hMPV (13%), influenza-A (9.3%), and ADV (5.6%) were also shown. Dual infection was detected in six patients. There were no statistically significant differences between the two groups (with isolated virus or no known viral etiology) with respect to symptoms, clinical findings, laboratory work-up, or radiological data. Length of hospital stay was also not different. Determination of the etiology of acute LRTI in children less than 5 years of age seems impossible without performing virological work-up, whether viral or nonviral in origin.

The aim of this study was to evaluate the children presenting with the complaint of recurrent infections and to determine the possible predictive factors foreseeing the requirement for further investigations. Turk J Pediatr 2016; 58: 609-615. This study is a retrospective analysis of 507 children (221 female, 43.6%) with median age of 46 (range 4-190) months, who attended our department with the complaint of recurrent infections between January 2013 and December 2014 during two years period. The majority of the patients were preschool age children (n: 360, 71%). Most of the infections were upper repiratory tract infections [URTI (n: 380, 75%)]. The patients were divided into 4 diagnostic groups; as atopic children (n: 148, 29.2%), children with primary immune deficiency [PID (n: 54, 10.7%)], patients with chronic disorders (n: 40, 7.9%) and the majority, healthy subjects (n: 265, 52.3%). Among school age patients, the incidence of atopic children was significantly high (p: 0.016). Presenting at adolescent age group, growth retardation and hypogammaglobulinemia were the predictive risk factors for PID. Antibody (B cell) deficiencies (n: 43, 80%), and among those, selective IgA deficiency (n: 23, 4.5%) constituted the majority of the patients in PID. Rheumatological diseases (n: 9, 1.8%), mainly periodic fever syndromes, were the most common chronic disorders. Malignancy (acute lymphoblastic leukemia and lymphoma) was obtained in two patients (0.4%). Complaint of recurrent infections is very common among children attending health care facilities. It is crucial for clinicians to differentiate the children who need further investigations, urgent medical attention.

The first asthma camp in Turkey was organized for one week in Iznik in September 1996. The camps were continued annually around the same time of the year in 1997, 1998, 2000, and in the consecutive years thereafter. The camp includes educational, sports and social activities. Children's knowledge about asthma and their attitudes towards physical and social activities were evaluated by a questionnaire. Pulmonary function tests were performed on the first and last day of the camp. There was no statistically significant difference between the mean spirometric values of the first and last day of the camp in spite of a vigorous physical and social program. Children enhanced their skills and knowledge about asthma and gained self-confidence in participating in sportive and social activities during the camp program. They did not experience any emergency room visit in the following year. In conclusion, a summer camping experience is very beneficial for asthmatic children in terms of both self-education and social and physical participation.