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Objectives: In this study, we aimed to evaluate the clinical and laboratory features of the patients with rotavirus (RV) antigen positivity on or following admission to the pediatric intensive care unit (PICU). Methods: Patients admitted to the PICU due to community-acquired rotavirus (CA-RV) or hospital-acquired rotavirus (HA-RV)-induced gastroenteritis between January 1, 2013, and December 31, 2019 were evaluated. Results: Thirty-four patients with a mean age of 14.00 ± 19.17 months were enrolled. Forty-four percent were girls. Twenty (58.8%) patients had a history of chronic diseases. Nine (26.5%) patients had CA-RV and 25 (73.5%) patients had HA-RV infection. RV antigens were simultaneously found in 44.1% (n = 14) of the other patients at the time of diagnosis. In the study sample, 5 patients had hyponatremia, 8 had hypernatremia, 6 had hypokalemia, 4 had hypoalbuminemia, 21 had leukocytosis, 2 had leukopenia and 3 had thrombocytopenia, and 17 had elevated C-reactive protein (CRP) levels. Three patients had seizures, 1 patient had cardiac arrest, and 2 patients had secondary bacteremia. The mean (SD) PICU length of stay was 6 (6.02) with CA-RV gastroenteritis. All CA-RV patients survived, but 8 of the HA-RV patients succumbed to causes other than RV. Conclusion: RV-related PICU admission is not rare, and occasional severe clinical consequences occur, especially in young children, with both CA-RV and HA-RV gastroenteritis. Appropriate timely intervention and meticulous follow-up improve survival. [ABSTRACT FROM AUTHOR]

Broad and deep perianal wounds are challenging in both adult and pediatric ICUs. These wounds, if contaminated with gastrointestinal flora, can cause invasive sepsis and death, and recovery can be prolonged. Controlling the source of infection without diverting stool from the perianal region is complicated. The option of protective colostomy is not well-known among pediatric critical care specialists, but it can help patients survive extremely complicated critical care management. These authors present three critically ill children who required temporary protective colostomy for perianal wounds because of various clinical conditions. Two patients were treated for meningococcemia, and the other had a total artificial heart implantation for dilated cardiomyopathy. There was extensive and profound tissue loss in the perianal region in the patients with meningococcemia, and the patient with cardiomyopathy had a large pressure injury. Timely, transient, protective colostomy was beneficial in these cases and facilitated the recovery of the perianal wounds. Temporary diverting colostomy should be considered as early as possible to prevent fecal transmission and accelerate perianal wound healing in children unresponsive to local debridement and critical care. [ABSTRACT FROM AUTHOR]

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Purposes: The aims of this study were to review the frequency, characteristics, and the clinical course of primary immunodeficiency (PID) patients admitted to pediatric intensive care unit (PICU) and attempt to identify factors related with mortality that might predict a poor outcome. Methods: We performed a retrospective review of children with PID aged 1 month to 18 years and admitted to PICU from January 2002 to January 2012 in our tertiary teaching children's hospital. Results: There were a total of 51 patients accounting for 71 admissions to the PICU. The most common diagnosis was severe combined immunodeficiency. Respiratory problems were the leading cause for admission. A total of 20 patients received hematopoietic stem cell transplantation. Immune reconstitution was achieved in 9 (45 %) patients and eight of them did survive. In all 56 % of all admission episodes resulted in survival. Risk factors for mortality included requirement of mechanical ventilation ( P < .001), number of organ system failure ( P = .013), need for renal replacement therapy ( P < .001), use of inotropes ( P < .001), higher Pediatric Logistic Organ Dysfunction (PELOD) score ( P = .005), and length of PICU stay ( P < .001). Conclusions: This is the first study regarding the outcome and mortality-related risk factors for PID patients requiring PICU admission. We suggest that PICU management is as important as early diagnosis and treatment for these patients. Prediction of those at risk for poorer outcome might be beneficial for accurate intensive care management and survival. [ABSTRACT FROM AUTHOR]

Objective: To present the mesalamine-induced acute exacerbation of symptoms and inflammatory markers in children with Crohn's disease (CD).Clinical Presentation and Intervention: Three children who presented with CD had acute exacerbation of colitis symptoms or elevated inflammatory markers when mesalamine was added to treatment while tapering/ceasing steroid treatment. While on steroid treatment, the patients maintained clinical and laboratory remission, but with the initiation of mesalamine treatment, they had abdominal pain and bloody mucoid diarrhoea and/or elevation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate. Bacterial pathogens were excluded from the urine, throat and blood cultures, parasites with stool examination, viral pathogens with serology. Within 3-7 days after the mesalamine treatment had been stopped, the patients showed improvement of colitis symptoms and normalisation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate.Conclusion: In this study mesalamine mimicked CD relapse in children with CD while tapering or after stopping steroid treatment. Awareness of this side effect of mesalamine could prevent a misdiagnosis of steroid dependency. [ABSTRACT FROM AUTHOR]

Pulmonary hemorrhage, a rare and life-threatening event in children, results from various disorders. Idiopathic pulmonary hemosiderosis characterized by repeated episodes of pulmonary hemorrhages is a rare disease with unknown etiology. It has also been reported that pulmonary hemorrhage may be seen during Epstein-Barr virus infection. In this report we present 2 year-old-girl complained with respiratory distress, pallor, fever and sore throat. She diagnosed Epstein-Barr virus infection, anemia and pneumonia. Because she had anemia and respiratory distress simultaneously, we highly suspected from pulmonary hemorrhage. But hemosiderin-laden macrophages were not demonstrated in gastric aspirates. The girl treated symptomatically and healed uneventfully. After one uneventfully year, she was admitted with pallor and respiratory distress, and pulmonary hemorrhage was demonstrated on lung biopsy. The diagnosis of idiopathic pulmonary hemosiderosis was established. Three other pulmonary hemorrhage attacks were observed at the follow-up. We suggest that Epstein-Barr virus infection might be one of the possible factors responsible from idiopathic pulmonary hemosiderosis. [ABSTRACT FROM AUTHOR]

Acute disseminated encephalomyelitis (ADEM) is a presumed immune-mediated, demyelinating disease of the central nervous system. Many infections and vaccinations have been reported to be associated with ADEM. In this report, we present a girl with ADEM associated with Epstein-Barr virus infection. She was treated with methylprednisolone and exhibited complete clinical and radiological improvement. [ABSTRACT FROM AUTHOR]