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Objective Preventive measures in the setting of a suspected measles case in a hospital setting are important to stop the secondary spread. In this report, we evaluated the prevention attempts after two suspected cases of measles were reported in a pediatric clinic. Methods We evaluated prevention interventions including isolation, intravenous immunoglobulin, or measles–mumps–rubella (MMR) vaccine after two patients were diagnosed with maculopapular rash compatible with measles in the pediatric clinic. Results There were 50 patients (29 were outpatients, 21 were inpatients), 19 health care personnel (HCP), and 50 caregivers who were in contact with index cases. All of the HCP and 40 of the caregivers were immune to measles. Additional dose of MMR vaccine was recommended to five of the outpatients by phone. A total of 12 patients who were being followed up as inpatients (8 patients aged 6–12 months, 4 patients aged ≥ 12 months) were vaccinated with one dose of MMR vaccine. Only a 12-year-old male patient was admitted due to complaints suggesting measles after 14 days from discharge. It was learned that he had received a single dose of vaccine before so he was recommended an additional dose of MMR vaccine by the phone, but he did not go to the health institution on the day of the call. Conclusion Postexposure prophylaxis is effective to prevent measles transmission. Although young infants have the highest risk for transmission of measles in a health care–associated outbreak, adolescents and older children who are single vaccinated also have high risk for clinical measles.

Kawasaki disease (KD) may cause cardiac and coronary complications. Since definite markers to accurately predict coronary involvement is not present, we aimed to analyze the role of hematological indices [neutrophil-to lymphocyte ratio (NLR), platelet-to lymphocyte ratio (PLR), lymphocyte-to monocyte ratio (LMR), and mean platelet volume (MPV)-to lymphocyte ratio (MPVLR)], prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) in predicting coronary involvement of KD. Patients The medical records of 134 KD patients admitted between January 2008 and December 2019 were investigated. Also, 268 age-matched healthy controls (HCs) were included in the study.KD patients were divided into two groups: KD with coronary artery lesions (KD-CALs) and KD without CALs. Logistic regression analysis was performed to determine parameters that may predict coronary involvement in children with KD.Among KD patients, 39 (29.1%) had CALs. When compared with HCs, the median levels of WBC, neutrophils, monocytes, eosinophils, platelets, MPV and, the values of NLR, PLR, MPVLR, SII were significantly higher; whereas lymphocyte count, PNI, platelet distribution width (PDW), LMR were markedly lower in the KD group (p˂0.001 for all, except for p=0.010 for eosinophil count). The CALs group's SII, PLR, and PNI values were significantly lower than those without (p=0.030, p=0.032, and p ˂0.001; respectively). Multivariable regression analysis revealed that PNI, SII, and gender (male) were associated with CALs in KD.Our analysis revealed that male sex, lower PNI, and lower SII levels were independently associated with CALs in children with KD. Die Kawasaki-Krankheit (KD) kann kardiale und koronare Komplikationen verursachen. Da definitive Marker zur genauen Vorhersage einer koronaren Beteiligung nicht vorhanden sind, wollten wir die Rolle hämatologischer Indizes [Neutrophilen-zu-Lymphozyten-Ratio (NLR), Thrombozyten-zu-Lymphozyten-Ratio (TLR), Lymphozyten-zu-Monozyten-Ratio (LMR) und mittleres Thrombozytenvolumen (MPV)-zu-Lymphozyten-Ratio (MPVLR)], prognostischer Ernährungsindex (PNI) und systemischer Immunentzündungsindex (SII) bei der Vorhersage einer koronaren Beteiligung von KD analysieren.Die Krankenakten von 134 KD-Patienten, die zwischen Januar 2008 und Dezember 2019 aufgenommen wurden, wurden untersucht. Außerdem wurden 268 altersangepasste gesunde Kontrollen in die Studie aufgenommen.KD-Patienten wurden in zwei Gruppen eingeteilt: KD mit Koronararterien-Läsionen (CALs) und KD ohne CALs. Es wurde eine logistische Regressionsanalyse durchgeführt, um Parameter zu bestimmen, die eine koronare Beteiligung bei Kindern mit KD vorhersagen können. Unter den KD-Patienten hatten 39 (29,1 %) Koronararterien-Läsionen. Verglichen mit gesunde Kontrollen, waren die Medianwerte von Leukozyten, Neutrophilen, Monozyten, Eosinophilen, Blutplättchen, MPV und die Werte von NLR, TLR, MPVLR, SII signifikant höher, während Lymphozytenzahl, PNI, Blutplättchenverteilungsbreite (PDW), LMR deutlich niedriger als in der KD-Gruppe (p=0,001 für alle, außer p=0,010 für die Eosinophilenzahl) waren. Die SII-, PLR- und PNI-Werte der CALs-Gruppe waren signifikant niedriger als die ohne (p=0,030, p=0,032 bzw. p ˂ 0,001). Eine multivariable Regressionsanalyse ergab, dass PNI, SII und Geschlecht (männlich) mit CALs bei KD assoziiert waren.Unsere Analyse ergab, dass männliches Geschlecht, niedrigere PNI- und niedrigere SII-Werte unabhängig voneinander mit CALs bei Kindern mit KD assoziiert waren.

Objective The vitamin D receptor gene (VDR) polymorphisms and the risk of various infections have been studied. An association with brucellosis and vitamin D levels has been investigated but not yet with VDR gene polymorphisms. We aimed to examine the association between VDR gene polymorphisms and susceptibility to childhood brucellosis. Methods This case–control study included patients with brucellosis and healthy controls. After extracting genomic DNA using a Qiagen blood DNA isolation kit, five VDR single nucleotide polymorphisms (SNPs), including Cdx-2, FokI, BsmI, ApaI, and TaqI gene, were amplified. Genetic distribution of these SNPs of VDR gene in patient and control groups were compared. Results A total of 38 patients with brucellosis and 89 healthy controls were evaluated. The genotype distribution of Cdx2, FokI, BsmI, and ApaI polymorphisms were similar between patients and healthy controls. However, the CC homozygous genotype for VDR gene TaqI was significantly overexpressed in patients compared with controls (23.7 vs. 7.9%; p = 0.042). The frequency of the C allele of the TaqI genotype was significantly different between patients and controls (p = 0.018). On the other hand, presence of the A allele in the BsmI was associated considerably with an increased risk of brucellosis (p = 0.037). VDR polymorphism distribution was similar according to age, presence of complicated disease, and presence of bacteremia. The heterozygote TaqI polymorphism was more common in patients presented as subacute and chronic symptoms (p = 0.036). Conclusion Our results indicated the possible role in TaqI polymorphism of the VDR gene for the risk of brucellosis at the time of exposure to infection.

The pathophysiology of multisystem inflammatory syndrome (MIS) in children (MIS-C) is unknown. It occurs several weeks after COVID-19 infection or exposure; however, MIS is rarely reported after COVID-19 vaccination, and cases are mostly in adults. Herein, we present a 12-year-old male who had no prior COVID-19 infection or exposure and developed MIS-C after his first dose of COVID-19 mRNA vaccine.

Acyclovir may cause acute kidney injury (AKI) due to the accumulation of relatively insoluble acyclovir crystals in renal tubules. The aim of this study was to evaluate risk factors associated with acyclovir-related AKI in children. Between January 2010 and December 2019, pediatric recipients of intravenous (IV) acyclovir were evaluated retrospectively. There were a total of 472 patients [249 (52.7%) boys] of which 32 (6.8%) had AKI [15 (46.8%) boys]. Patients with AKI had greater mean age, baseline creatinine level, and duration of treatment compared to patients without AKI (p 100.5 months, 1500 mg/m2/day dosage, concomitant use of nephrotoxic drugs). Acyclovir dosing should be evaluated in prospective, multicenter studies in order to identify the lowest possible therapeutic doses that do not increase AKI risk. What is Known: • Although acyclovir is mostly well tolerated, nephrotoxicity may be seen due to the accumulation of acyclovir crystals in renal tubules. • Older age, obesity, and concomitant use of other nephrotoxic drugs are reported to be risk factors for acyclovir-induced AKI in children. What is New: • In this study, pediatric patients with acyclovir-induced AKI were older, received treatment longer, received concomitant nephrotoxic drugs more commonly, and had higher acyclovir dosage and baseline creatinine levels compared to those without AKI. • Being older than 100.5 months of age, use of 1500 mg/m2/day dosage and use of nephrotoxic drugs concomitantly appear to be the prominent risk factors for AKI development in children treated with acyclovir.

Subdural empyema (SDE) is a rare condition which can appear secondary to meningitis in childhood, especially in infants. This study was planned to evaluate and compare clinical and laboratory features, treatment, and outcome of children with SDE to those with acute bacterial meningitis (ABM) without SDE. The electronic medical files of 266 patients diagnosed with ABM between January 2009 and December 2019 were evaluated. Patients' demographic and clinical features, laboratory results, cranial imaging findings, treatment, and outcomes were recorded. SDE was identified in 10 patients, 3.7% of all diagnosed with meningitis. The etiology of SDE was identified in eight (80%). The most common responsible pathogen was Streptococcus pneumoniae. Cranial imaging was performed between the 2nd and 13th days of admission, and the most common reason of performing cranial imaging was persistence of fever. Two patients were healed with 4-6 weeks of antibiotic treatment without surgery, eight (80%) needed surgical intervention.Conclusion: The clinical signs and symptoms of SDE may be subtle. If the fever persists or focal neurological findings are seen during the treatment of bacterial meningitis, SDE should be suspected. Furthermore, patients with ABM who are determined to have a protein-to-glucose ratio in the cerebrospinal fluid above 4.65 should be carefully monitored for SDE development. What is known: • Subdural empyema may develop subsequently to meningitis, especially in the infant age group in whom very little is known in terms of disease characteristics. • Delay in diagnosis and treatment can cause long-term neurologic sequelae and mortality. What is new: • Persistence or relapse of fever during the treatment of acute meningitis is an important warning sign for SDE even if there are no other symptoms. • Children with subdural empyema secondary to bacterial meningitis have higher protein-to-glucose ratio in the CSF, and a threshold of ˃ 4.65 was determined to demonstrate 100% sensitivity and 50.7% specificity.

Human brucellosis is one of the most widespread zoonotic diseases that are presented with predominantly hematological manifestations. We aimed to evaluate the hematological findings of childhood brucellosis and to determine the predictive clinical findings and laboratory tests that might be related to hematologic involvement.We retrospectively analyzed the medical records of children with brucellosis between 1 January 2005 and 31 December 2018. We compared predictive clinical and physical examination findings and laboratory tests in patients with and without hematological involvement.A total of 212 patients (127 boys (59.9%)) with a mean age of 9.4±4.7 years were evaluated in this study. Blood cultures were performed in 161 (75.9%) patients and Brucella spp were isolated in 70 (43.4%) of them. Ninety-two (43.4%) patients had hematological involvement at least in one series. Anemia was detected in 66 (31.7%) patients, leukopenia in 22 (10.6%) and thrombocytopenia in 10 (4.8%). Four patients (1.9%) had pancytopenia. Age distrubutions of the patients with and without hematological involvement were similar (p=0.6). In patients presented with fever, hepatomegaly and splenomegaly, hematologic involvement was significantly higher (p0.05). Hematological involvement was higher in patients who had elevated aspartate aminotransferase and alanine aminotransferase concentrations (p0.05). Hematological involvement was higher in patients with positive blood culture (p=0.005). Six patients (2.8%) were treated with intravenous immunoglobulin at 1000 mg/kg/day for two days in addition to anti-brucellosis treatment.Hematological involvement in brucellosis is a common finding regardless of age, especially in febrile, bacteremic patients and in patients who had hepatosplenomegaly and elevated liver enzymes. Anemia is the most common hematological abnormality.

Introduction Human brucellosis is one of the most common zoonotic infections in the world. The definitive diagnosis of brucellosis is based on cultured Brucella organisms from blood or other tissue samples. We aimed to compare bacteremic and nonbacteremic brucellosis patients with demographical, epidemiological, clinical and laboratory features and determine the predictive factors affecting blood culture positivity. Materials and Methods Children aged 1 month to 18 years who were followed up with the diagnosis of brucellosis between January 2005 and March 2021 were included in this retrospective study. According to the isolation of Brucella melitensis in blood culture, the patients were divided into two groups as bacteremic and nonbacteremic and compared in terms of demographic, clinical and laboratory characteristics. Results One hundred eighty-nine (116 male, 61.4%) patients diagnosed with brucellosis were included in the study. There were 76 (40.2%) bacteremic and 113 (59.8%) nonbacteremic patients. Bacteremic patients were younger than nonbacteremic patients. Fever, arthralgia, hepatomegaly and splenomegaly were significantly higher in the culture positive group. High levels of C-reactive protein (CRP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were found to be significant in the bacteremic group. Conclusion In our study, history of fever and arthralgia, hepatomegaly and splenomegaly in physical examination and high CRP, ALT and AST levels in the biochemical analysis were important factors determining blood culture positivity.

Giriş: Diş çürükleri, dünya çapında en yaygın kronik hastalıklardandır. Bu çalışmanın amacı diş kaynaklı fasiyal selülit nedeniyle hastaneye ya-tırılan çocuk hastaların klinik özelliklerinin ve tedavi yöntemlerinin de-ğerlendirilmesidir.Gereç ve Yöntemler: Bu çalışmada, diş kaynaklı fasiyal selülit tanısı ile Ocak 2013-Aralık 2017 tarihleri arasında çocuk enfeksiyon hastalıkları servisinde yatırılarak takip edilen hastaların diş sağlığına ilişkin öyküle-ri, klinik ve laboratuvar özellikleri ile tedavi şekilleri geriye dönük olarak değerlendirildi.Bulgular: Çalışmaya ortanca yaşları 86 ay (min-maks: 19-207 ay) olan 98 (43 kız, 55 erkek) hasta alındı. Hastaların 45 (%45.9)’inin düzenli diş fırçalama alışkanlığı yoktu. Kırk sekiz (%48.9) hastanın herhangi bir diş tedavisi öyküsü yoktu. On sekiz (%18.3) hasta hiç diş hekimine başvur-mamıştı. Hastaların 75 (%76.5)’i ilk kez diş kaynaklı fasiyal selülit tanısı alırken, 4 (%4)’ü daha önce aynı tanıyla hastanede yatırılmıştı. Otuz yedi (%37.8) hastanın başvuruda ateşi vardı. Hastaların başvurudaki ortala-ma beyaz küre sayısı 11.981 4.233/mm3, eritrosit sedimentasyon hızı 29.1 17.6 mm/saat ve C-reaktif protein (CRP) değeri 35.2 39.4 mg/L olarak saptandı. Ortalama intravenöz (IV) antibiyotik tedavi süresi 5.5 2.5 gün, toplam antibiyotik tedavi süresi 12.5 2.9 gündü. Hastaların 82 (%83.7)’sine ampisilin-sulbaktam başlanmıştı. On beş (%15.3) hastanın tedavisine klindamisin eklenmişti. Başvurudaki beyaz küre sayısı arttıkça hastanede yatış süresinin arttığı (p 0.036) ve yüksek CRP düzeyi olanlarda toplam medikal tedavi süresinin arttığı saptandı (p 0.032). Teda-visine klindamisin eklenen hastaların IV ve toplam tedavi süresinin daha uzun olduğu saptandı (p 0.001 ve p 0.001).Sonuç: Diş çürükleri erken tanınıp tedavi edilmediği takdirde ilerleyerek selülite ve çocuklarda hastaneye yatışa neden olabilir. Hayat boyu temel sağlığın ayrılmaz bir parçası olan ağız sağlığının iyileştirilmesi için koru-yucu önlemler alınmalı ve diş sağlığı sorunlarına bir halk sağlığı sorunu olarak yaklaşılmalıdır., Objective: Dental caries remain one of the most common chronic diseases in childhood, globally. The purpose of this study is to determine clinical characteristics and treatment modalities of pediatric patients with odontogenic facial cellulitis.Material and Methods: Medical records of children with odontogenic facial cellulitis hospitalized in pediatric infectious disease clinic were analyzed retrospectively between January 2013 and December 2017.Results: Ninety-eight patients (43 girls, 55 boys) with median age of 86 months (min-max: 19-207 months) were evaluated. Forty-five (45.9%) patients had no regular toothbrushing habits. Forty-eight (48.9%) patients had no any dental treatment procedure history. Eighteen (18.3%) patients had never recoursed to a dentist. Seventy-five patients(76.5%) were diagnosed with odontogenic facial cellulitis for the first time. Four patients (4%) were hospitalized with the same diagnosis previously. On admission, 37 (37.8%) patients had fever. On admission, the mean white blood cell (WBC) count, erythrocyte sedimentation rate, and C-reactive protein (CRP) were 11.981 4.433/mm3, 29.1 17.6 mm/h and 35.2 39.4 mg/L, respectively. The mean duration of intravenous antibiotic treatment was 5.5 2.5 days, and total medical treatment was 12.5 2.9 days. Ampicillin-sulbactam was started to 82 (83.7%) of the patients. Clindamycin was added to 15 (15.3%) patients. Increased mean WBC count on admission was correlated with duration of hospital stay (p 0.036), while increased CRP level was correlated with total medical treatment duration (p 0.032). Patients who received clindamycin had longer duration of intravenous and total medical treatment (p 0.001 and p 0.001).Conclusion: If dental caries are not recognized and treated immediately, they may spread into surrounding connective tissue as cellulitis and may lead to hospitalization in young patients. Oral health is a mainstone of life-long well-being, so oral health problems should be considered as a major public health problem and preventive measures should be taken to improve oral health.

Büyüme ve gelişmenin en hızlı olduğu 0–5 yaş arası dönem, sağlıklı gelişimi olumsuz etkileyen çok sayıda etmene karşı oldukça duyarlı bir dönemdir. Bu çalışmada 5 yaş altındaki hastaların beslenme öyküleri, büyüme parametrelerini belirlemek ve bu parametreleri etkileyebilecek faktörlerin tespiti amaçlandı.Gereç-yöntem: Çalışmaya 6 aylık dönemde hastanede yatırılarak tedavi edilen 5 yaş altındaki çocuklar dahil edildi. Yaş, cinsiyet, boy ve vücut ağırlıkları (persantilleri), yatış tanıları, kronik hastalık ve hastanede yatış öyküsü, aşılanma durumu, ebeveyn yaşları, ebeveynlerin eğitim durumu ve ortalama gelirleri ile anne sütü alım süreleri ve ek gıdaya geçiş zamanları ile ilgili verileri geriye dönük olarak kaydedildi.Bulgular: Çalışmaya ortanca yaşları 8 ay (1-59 ay) olan 344 hasta (%54,7erkek) dahil edildi. Doğum sonrası hastaların %97,1’i anne sütü ile beslenmeye başlanmışken, çalışma sırasında bir yaştan büyük olanların %18’i 1 yıldan kısa süre emzirilmişti. Hastaların 6. ayda tek başına anne sütü ile beslenme oranı %30,8’di. Hastaların annelerinin eğitim durumu ve ailelerin aylık gelir düzeyleri Türkiye ortalamasından düşük bulundu. Anne-baba yaşı, ebeveyn eğitim düzeyi ve ailenin aylık geliri ile kilo ve boy persantilleri arasında ilişki saptanmadı. Anne yaşı ve annenin eğitim düzeyi ile tek başına anne sütü ile beslenme süresi arasında ilişki bulunmazken, ailenin aylık geliri arttıkça tek başına anne sütü alım süresini uzadığı tespit edildi (p

Background: Non-polio enteroviruses (EVs) are emerged as the most common pathogens of aseptic meningitis in children. In this study we aimed to evaluate clinical, laboratory, cerebrospinal fluid (CSF) findings and the usefulness of CSF EV polymerase chain reaction on management of pediatric patients diagnosed as EV aseptic meningitis. Material-methods:This study included the pediatric patients with aseptic meningitis between January 2014 and January 2016. Results: A total of 23 patients (69.5% boys) diagnosed with EV aseptic meningitis with a median age of 57 months old (range; 1-168 months) were included. The most common months of the patients' admission to hospital were July and May. The most common clinical complaints were womiting (77.2%), fever (73.9%), headache (59%), neck stiffness (36.3%), seizure (22.7%) and altered consciousness (22.7%). CSF pleocytosis was observed in 16 (69.5%) patients and the median CSF white blood cell (WBC) count was 50 cells/mm3 ranged from 0 to 500 cells/mm3. It was found that, CSF cell count was significantly increased with age (p=0.02), whereas acute phase reactant levels and CSF biochemical components were statistically similar according to age (p>0.05). Median duration for hospitalization was 6 days (range: 1-28 days). Eight patients (34.7%) did not receive any antibiotics. Conclusion: Absence of pleocytosis may be a diagnostic challange in very young infants with aseptic meningitis and CSF cell count significantly increases with age. By using rapid EV-PCR assays in the initial diagnosis of aseptic meningitis, the unnecessary usage of antibiotics in viral meningitis can be reduced and also the duration of hospitalization can be shortened.

Pediatrics is one of the medical specialties in which blood cultures for bloodstream infections are performed very frequently. This study aimed to evaluate pediatric residents' knowledge and perceptions of blood culture sampling.Between June 2019 and September 2019, a questionnaire comprising 20 questions about blood culture sampling was sent via email to participants who were pediatric residents at five different hospitals in Turkey. There were 11 true/false and nine multiple-choice questions that assessed three aspects of culture sampling: indications, sampling practice and knowledge, and contamination. The percentage of correct answers was used to calculate an overall score and subsection scores.A total of 132 pediatric residents [102 (77%) female] with a mean age of 28.3±2.8 years completed the questionnaire. Forty-five (35%) were in their 1st year of residency. Sixty (46%) participants reported that they had not performed blood culture sampling in the last week. There was a negative relationship between years in training and the number of cultures performed (Kendal's tau-b=-0.297, p0.001). The overall median score was 65 (range, 35-90) and it seemed to increase with years of training. The lowest median score was in the contamination subscale and only one (0.76%) participant correctly answered all questions concerning contamination.Residents who obtained the majority of blood cultures had the lowest knowledge levels. Therefore, it is evident that the knowledge levels of pediatric residents must be increased in order to improve blood culture sampling practices in centers where they perform blood culture sampling.

Although a significant decrease has been reported in the incidence of diphteria in many regions of the world following the routine diphtheria immunization programs, the emergence of new cases indicated that toxigenic strains are still circulating in the community. Diphtheria vaccine does not provide protection against asymptomatic carriage and colonization of non-toxigenic Corynebacterium diphtheriae. It is a known fact that invasive infections may arise from non-toxigenic C.diphtheriae strains that the non-toxigenic strains can become toxigenic strains leading to diphteria. It is also known that there is a risk of diphteria outbreaks due to decreased antitoxin level and inadequate adult immunization programs. In our country, there is no routine surveillance of toxigenic and non-toxigenic C.diphtheriae. In the present study we aimed to investigate the presence of C.diphtheriae, Corynebacterium ulcerans and Corynebacterium pseudotuberculosis in children presenting with the symptoms of upper respiratory tract infections that might be confused with those moderate diphteria, in order to highlight the requirement of microbiological surveillance and to create awareness about these microorganisms among public health experts, microbiologists and clinicians. Throat swab specimens were obtained from children who were admitted to the pediatric outpatient clinics, in Dr. Sami Ulus Obstectrics, Children Health and Diseases Educational and Research Hospital, with upper respiratory tract infections between 1 February 2016-22 March 2016. The specimens were inoculated in 5% sheep blood agar plates. The plates that were incubated in appropriate conditions, were evaluated for Group A beta hemolytic streptococcocci. Subsequently, culture plates were sent to the Public Health Institution of Turkey, National Respiratory Pathologens Reference Laboratories for the investigation of the presence of C.diphtheriae, C.ulcerans and C.pseudotuberculosis. The growth in each plate were collected with a sterile swab and inoculated in tryptic soy broth. Following 2 hours of incubation at 37oC, subcultures were inoculated in cystine-tellurite-blood agar (CTBA) and 5% sheep-blood agar plates; after an overnight incubation tellurite-reducing colonies were inoculated in Tinsdale agar plates. The suspected colonies with positive cystinase activity were identified by conventional methods and also with Coryne API (Biomerieux, France) systems. Toxicity tests (ELEK, PCR) were performed to investigate whether the C.diphtheriae strains were producing toxins. A total of 500 patients were involved in the study. Of these 260 (52%) were girls and 240 (48%) were boys with a mean age of 76 (range, 21-213) months. All patients except one were fully vaccinated with boosters. Most common presenting symptoms of the patients were fever (19.8%), sore throat (52.6%), cough (49.2%), tonsillar hyperemia (97.6%), presence of crypt (24.6%), and membrane over tonsils (1%). Group A beta-hemolytic streptococcocci were detected in the throat swab cultures of 66 (%13.2) patients. Genotypically toxin negative C.diphtheriae biovar gravis was identified in the throat swab cultures of 3 patients (2 girls and 1 boy). The tonsils were hyperemic and hypertrophic in all the patients with C.diphtheriae biovar gravis. C.ulcerans and C.pseudotuberculosis were detected in none of the patients. It is considered that similar regular cross-sectional studies or routine screening programs are expected to raise awareness about this forgotten microorganism both epidemiologically and microbiologically.

Kaman A, Tanir G, Cakmakci E, Demir P, Oz FN, Aydin Teke T, Metin O, Gayretli Aydin ZG, Karaman A. Characteristics, diagnosis, and treatment modality of pediatric patients with cystic echinococcosis: a single centre experience. Turk J Pediatr 2019; 61: 704-713. Cystic echinococcosis (CE) is among the most common zoonotic infections worldwide. Studies about CE are limited in childhood. The aim of this study was to evaluate clinical, radiological and laboratory characteristics of childhood CE at a tertiary care pediatric hospital. Medical records of children with CE were analyzed between January 2005 and January 2015. A total of 130 patients with a median age of 10.4 years (IQR= 7.2-years-13.2 years) were evaluated. The anatomic locations of cysts were as follows; liver (76.9%), lung (36.9%), spleen (6.2%), pelvic region (3.8%) and kidney (2.3%). The most common symptoms were abdominal pain and cough in the patients with liver cysts and lung cysts, respectively. The indirect hemagglutination (IHA) test positivity was 58%. Elevated serum total immunoglobulin E levels were detected in 59% of the patients. Fourty-four patients with liver CE, 33 patients with lung CE were treated surgically and 23 patients with liver CE were treated with percutaneous aspiration, injection and re-aspiration (PAIR) along with medical treatment. The recurrence was observed in five patients with liver CE. It was demonstrated that CE mainly involves liver but lung cysts are more frequently symptomatic and prone to be complicated than liver cysts in children. IHA test positivity together with abdominal ultrasonography are useful to diagnose liver CE but thorax CT is usually needed to diagnose lung CE. Liver cysts that are sized greater than 5 cm are more frequently treated with PAIR or surgery but smaller liver cysts can be treated medically.

Objective: Ethambutol is an anti-tuberculosis drug which is commonly used in the first line treatment of tuberculosis. It has ophthalmological side effects but it was reported to be safe in children. Herein, we present a boy patient with pulmonary tuberculosis and reversible color blindness due to ethambutol. Case Presentation: A 14 year-old boy admitted with chronic cough and sputum. He had weight loss. Nodular infiltration and bronchiectasis were present both in chest x-ray and chest tomography. ARB was positive in sputum and he was dignosed as pulmonary tuberculosis. Isoniasid (15 mg/kg/d), rifampisin (15 mg/kg/d), ethambutol (15 mg/kg/d) and yyranizamide (30 mg/kg/d) were started as initial treatment. On 7th week of the treatment he had visual complaints. In the ophthalmological examination severe red-green color blindness was detected. Ethambutol was stopped immediately and ophthalmological examination returned to normal after two months Discussion: Although it was reported that optic toxicity of ethambutol is very rare in patients who had lower dose of ethambutol treatment, it should be kept in mind in patient who received ethambutol treatment. Regular ophtalmological examination and questionning the patients in terms of ophtalmological complaints in every visit during tuberculosis treatment is very important for early detection of ophtalmological side effects of ethambutol.

BACKGROUND Kawasaki disease (KD) is an acute, self-limited, systemic vasculitis of unknown etiology. In the present study, we investigated whether there is a relationship between KD and dynamic thiol/disulphide homeostasis. METHODS This case-control study involved KD patients and healthy controls. Plasma total, native and disulphide thiol and the disulphide/native, disulphide/total and native thiol/total thiol ratios of all patients and the control group were analyzed simultaneously. RESULTS A total of 20 patients with KD (male/female, 12/8) and 25 age- and gender-matched healthy controls (male/female, 12/13) were evaluated. Native, total thiol and native thiol/total thiol ratio were significantly lower in KD patients than in the control group (P

Malaria is a potentially life-threatening disease caused by infection with the Plasmodium protozoa transmitted by an infective female Anopheles mosquito. Despite successful control programs in many countries, malaria remains to be a major disease burden worldwide, with approximately 584,000 deaths annually. The incidence of the disease and responsible species may differ due to increased human movements between countries. Plasmodium falciparum infection carries a poor prognosis with a high mortality if untreated, but it has an excellent prognosis if diagnosed early and treated appropriately. In the present study, we described a patient diagnosed with falciparum malaria and treated with atovaquone-proguanil who had a history of traveling to Uganda.

Neurocysticercosis is a parasitic infection of the central nervous system caused by the larval stage of Taenia solium. Although this zoonotic infection is one of the major public health problems in some developing countries, it is extremely rare in Turkey. In this article, we present the case of a pediatric patient with neurocysticercosis who was misdiagnosed with brain abscess because of focal seizures in another hospital.

Objective Leishmaniasis is an infectious disease that is caused by a protozoan parasite of the Leishmania genus and that occurs worldwide. Leishmaniasis is endemic in southeastern Turkey and the neighboring Middle Eastern countries. The purpose of this study was to describe the clinical characteristics of patients admitted to our hospital with a diagnosis of cutaneous leishmaniasis (CL). Methods A total of 16 CL patients [11 (69%) boys and five (31%) girls] were admitted between January 2014 and December 2015. The data of the patients were retrospectively recorded from their medical records. Results Their mean age was 74.3±32.3 months (range: 1-10.5 years). Double lesions were most commonly seen in eight (50%) patients. The face and neck was the most commonly involved site (87.5% of the patients). Skin smears for a parasitological examination were positive in nine (56%) patients. Two patients (12.5%) with limb lesions were treated with intralesional meglumine antimoniate. Fourteen patients were treated with systemic agents. Conclusion We felt that the increase in human movement that include travels and forced migration due to the war might make it possible for CL to appear in non-endemic provinces such as Ankara. In particular, in patients with painless cutaneous lesion(s) who came from endemic areas such as Syria, CL should be kept in mind by the clinicians that residing in even non-endemic areas .

Background Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is an uncommon and serious complication of pediatric brucellosis. Methods We describe seven cases of neurobrucellosis. Results Ataxia (one patient), diplopia (one patient) and hearing loss (one patient) were among the neurological signs and symptoms. The most common diagnoses were acute meningitis and meningoencephalitis. Five of the patients fully recovered, one was lost to follow up and the other had hearing loss as a sequela. Conclusion Neurobrucellosis should be kept in mind in patients with any neurological or neuropsychiatric diseases who live in endemic areas of brucellosis.

Kawasaki disease is an acute, systemic vasculitis of unknown etiology. Although gastrointestinal involvement does not belong to the classic diagnostic criteria; diarrhea, abdominal pain, hepatic dysfunction, hydrops of gallbladder, and acute febrile cholestatic jaundice are reported in patients with Kawasaki disease. We describe here two cases presented with fever, and acute jaundice as initial features of Kawasaki disease.