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ÖZET Amaç: Hastanemizde gelişen hastane enfeksiyonuna (HE) neden olan etkenlerin dağılımı ve antibiyotik duyarlılıklarının belir lenmesi. Hastalar ve yöntem: Yaklaşık 116 yatak kapasiteli hastanemizde, Ocak 2017 – Aralık 2017 tarihleri arasındaki hastane enfeksiyon ları surveyans yöntemi ile retrospektif olarak değerlendirildi. Bulgular: Ocak 2017-Aralık 2017 tarihleri arasında Acıbadem Adana Hastanesinde 9931 hasta yatışı yapıldı. Hastaların 92’sinde hastane enfeksiyonu geliştiği saptandı. Tüm hastane genelinde enfeksiyon hızı %1,32 idi. HE dağılımı; 30 hastada bakteriyemi (%29,4), 22 hastada cerrahi alan enfeksiyonu (%21,5), 20 hastada üriner sistem enfeksiyonu (%19,6) ve 15 hastada pnomoni (%14,7) olarak saptandı. Çocukluk yaş grubunda bakteriyemi ve pnömoni, yetişkin yaş grubunda ise üriner sistem ve cerrahi alan enfeksiyonu en sık sapta nan HE idi. HE gelişen hastaların %97,7’de bir ya da daha fazla etken izole edilirken, %2,3’de herhangi bir etken izole edilemedi. Hastane genelinde en sık izole edilen mikroorganizmalar sırasıyla; Klebsiella spp. (%29,5), E.coli (%22,7), maya mantarları %20 ,5 ve S.aureus (%9) idi. HE en sık olarak onkoloji servisinde (%57,8), genel yoğun bakım ünitesinde (%24,5) ve pediatrik kemik iliği ünitesinde (%17,6) görüldü. Sonuçlar: HE yataklı tedavi kurumlarının hizmet kalitesinin önemli göstergelerinden biri olup artık tüm dünyada önemli bir sağ lık sorunu olarak görülmektedir. HE önlemek için düzenli olarak surveyans çalışmaları yapılarak elde edilen sonuçlar düzenli bir şekilde takip edilmeli, ayrıca gereksiz invaziv işlemlerden kaçınılmalıdır. Tüm hastaneler ve hastane içinde birimlerin; hastane enfeksiyonuna neden olan mikroorganizmaları ve bunların direnç oranlarını surveyans çalışmaları ile belirlemeleri, tedavi karar larını buna göre vermeleri gerekir.

Purpose: The aim of this retrospective study is to evaluate the etiology clinical and laboratory features of fever of unknown origin (FUO) diagnosed in 30 pediatric patients. Materials and methods: The clinical data including the etiology, diagnostic approaches and clinical characteristics were retrospectively analysed in 30 pediatric patients with FUO who presented to our clinic in one year period. Results: The median age of the patients was 63 (6-192) months. Among the patients, 12 were male (40%), while 18 were female (60%). The median duration of the fever was 22.5 (3-60) days during hospital admission. The most common physical findings were hepatomegaly and splenomegaly, which were observed in 53. 3 and 40 patients, respectively. The cause of the FUO was detected to be infection in 14 patients (46.6%), connective tissue-vascular diseases in 8 patients (26.7%), malignancies in 5 patients (16.7%), and miscellaneous diseases in 1 patient (3.3%). In two patients (6.6%) the etiology could not be identified. Leishmaniasis, tuberculosis and brucellosis were the most commonly identified infections, whereas juvenile rheumatoid arthritis and acute lymphoblastic leukemia were the most common non-infectious causes. Conclusion: The most common cause of FUO in our study was infection diseases. Connective-vascular tissue diseases and malignancies are also important causes of FUO. In our opinion, detailed patient history, carefully physical examination and close clinical follow-up may reduce the number of the invasive procedures and non-invasive tests., Amaç: Bu çalışmada nedeni bilinmeyen ateş (NBA) tanısı almış 30 çocuk hastada etyolojinin, hastaların klinik ve laboratuvar özelliklerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde bir yıllık süreçte NBA tanısı alan 30 çocuk hastanın ateş etyolojisini, tanısal yaklaşımlarını ve klinik özelliklerini içeren veriler geriye dönük olarak hasta dosyaları incelenerek elde edilmiştir.Bulgular: Hastaların median yaşı 63 ay (6-192 ay) idi. Hastaların 12’si (%40) erkek, 18’i(%60) kız idi. Başvuruda ateşin süresi median 22.5 gün (3-60 gün) idi. Ensık saptanan fizik muayene bulgusu sırasıyla %53.3 ve %40 hepotomegali ve splenomegali idi. Nedeni bilinmeyen ateş nedeni olarak 14 (%46.6) hastada enfeksiyon, 8 (26.7) hastada kollajen vasküler hastalık, 5 (%16.7) hastada malign hastalık, 1 (%3.3) hastada diğer hastalık grubundan hastalık saptandı. İki (%6.6) hastada ateşin nedeni belirlenemedi. Nedeni bilinmeyen ateşin etyolojisinde Leishmania, tüberküloz ve brusellozis enfeksiyon hastalıklarından en sık tespit edilen neden iken juvenile romatoid artrit ve akut lenfoblastik lösemi enfeksiyon dışı ensık neden idi.Sonuç: Çalışmamızda NBA’nın en sık nedeni enfeksiyon hastalıkları idi. Kollajen vasküler hastalıklar ve malign hastalıklar da NBA’nın önemli nedenlerindendir. Bize göre detaylı öykü dikkatli fizik muayene ve yakın klinik izlem uygulanacak invaziv işlemler ve invaziv olmayan test sayısını azaltacaktır.

WOS: 000490575700006 Aim: Visceral leishmaniasis (VL) is a systemic infection that spreads hematogenously and affects the reticuloendothelial system by the infection of macrophages. VL occurs commonly in children, and only rarely in adults. VL should be considered in patients with prolonged high fever, hepatosplenomegaly, pancytopenia, weight loss, pallor and hypergammaglobulinemia. Materials and Methods: In this study, a total of 18 pediatric patients -9 (50%) males and 9 (50%) females- treated for VL at our clinic from January 2004 to July 2014 were analyzed retrospectively. Average time from symptom onset to hospital admission was 64 +/- 21 days (range: 30-100 days). The mean age of patients was 88 +/- 40 months (range: 36-182 months). Results: The most common symptom at presentation was fever (88.9%). Other common symptoms were fatigue, chills, weight loss and anorexia. Physical examination revealed splenomegaly and hepatomegaly in all patients. Anemia (92.4%), leukopenia (78.7%) and thrombocytopenia (76.2%) were the most prominent laboratory abnormalities and 82.2% of the patients were pancytopenic on admission. Bone marrow smear was positive for leishmania in 100% of the patients. All patients received treatment with liposomal amphotericin B. Conclusion: In certain regions, increased humidity rates associated with construction of dams and irrigation canals may lead to changes in the ecological balance and thus cause an increase in the population of disease-spreading vectors. Additionally, recent migration from the middle-eastern region to western parts of the world due to regional civil wars may have contributed to the observed increase in the incidence of various diseases such as VL.

PubMedID: 25910370 BACKGROUND/AIMS: The aim of the study was to determine the epidemiological shift that may have occurred in the last 11 years of Hepatitis A virus (HAV) seroprevalence.MATERIALS AND METHODS: In 1998, we reported the anti-HAV seroprevalence in 711 children aged between 2 and 16 years children in Adana city center. Eleven years later we repeated the same study at the same locations in a similar population with the same method.RESULTS: From 1998 to 2009 anti-HAV seroprevalence declined from 33.9% to 22.2%, 29.5% to 25.3% (p>0,05), 52.2% to 30.8%, 69.7% to 35.2%, 66.9% to 37.7% and 71.4% to 47.3% (p

WOS: 000388736900040, PubMed: 27454468, This is an observational epidemiological study to describe causes of bacterial meningitis among persons between 1 month and 18 y of age who are hospitalized with suspected bacterial meningitis in 7 Turkish regions. covering 32% of the entire population of Turkey. We present here the results from 2013 and 2014. A clinical case with meningitis was defined according to followings: any sign of meningitis including fever, vomiting, headache, and meningeal irritation in children above one year of age and fever without any documented source, impaired consciousness, prostration and seizures in those < 1 y of age. Single tube multiplex PCR assay was performed for the simultaneous identification of bacterial agents. The specific gene targets were ctrA, bex, and ply for N. meningitidis, Hib, and S. pneumoniae, respectively. PCR positive samples were recorded as laboratory-confirmed acute bacterial meningitis. A total of 665 children were hospitalized for suspected acute meningitis. The annual incidences of acute laboratory-confirmed bacterial meningitis were 0.3 cases / 100,000 population in 2013 and 0.9 cases/100,000 in 2014. Of the 94 diagnosed cases of bacterial meningitis by PCR, 85 (90.4%) were meningococcal and 9 (9.6%) were pneumococcal. Hib was not detected in any of the patients. Among meningococcal meningitis, cases of serogroup Y, A, B and W-135 were 2.4% (n = 2), 3.5% (n = 3), 32.9% (n = 28), and 42.4% (n = 36). No serogroup C was detected among meningococcal cases. Successful vaccination policies for protection from bacterial meningitis are dependent on accurate determination of the etiology of bacterial meningitis. Additionally, the epidemiology of meningococcal disease is dynamic and close monitoring of serogroup distribution is comprehensively needed to assess the benefit of adding meningococcal vaccines to the routine immunization program., GlaxoSmithKline Biologicals SAGlaxoSmithKline, Funding for this study was provided by GlaxoSmithKline Biologicals SA. GlaxoSmithKline Biologicals SA was provided the opportunity to review a preliminary version of this manuscript for factual accuracy but the authors are solely responsible for final content and interpretation. The authors received no financial support or other form of compensation related to the development of the manuscript.

ABS TRACT Objective: It has be en pos tu la ted that ge ne tic pre dis po si ti on may inf lu en ce the sus cep ti bi lity to in fec ti on and the di se a se out co me. The D al le le of the an gi o ten sin-con ver ting enz yme (ACE) ge ne is as so ci a ted with many di se a ses. Ho we ver, the re are only few re ports ava i lab le abo ut in fec ti on. We ha ve in ves ti ga ted the as so ci a ti on bet we en ACE I/D poly morp hism and sep sis, its cli ni cal fe a tu res such as acu te res pi ra tory dis tress syndro me (ARDS), mul ti or gan dysfunc ti on syndro me (MODS) and mor ta lity. Material and Met hods: Ni nety-eight chil dren who had be en di ag no sed with sep sis and 100 he althy in di vi di u als we re inc lu ded. The pa ti ents we re di vi ded in to gro ups ba sed on the pre sen ce of ARDS, MODS and sur vi vor or non sur vi vor. The ACE ge ne poly morp hism was analy zed by the poly me ra se cha in re ac ti on. Re sults: The re was no sta tis ti cal dif fe ren ce bet we en the con trol and pa ti ent’s ge noty pe (p= 0.29). No evi den ce emer ged re gar ding the as so ci a ti on of ACE I/D poly morp hism with MODS, but the re was evi den ce of as so ci a ti on with sep sis-re la ted ARDS. It was fo und that carr ying D/D ge noty pes in cre a sed the risk of the ha ving ARDS 4.5 fold (95%CI 1.15-19.6, p= 0.028). On the ot her hand, the re was not sta tis ti cally sig ni fi cant dif fe ren ce be t we en ACE ge ne poly morp hism and mor ta lity. Conc lu si on: In our study, the de le ti on poly morp hism in an gi o ten sin-con ver ting enz yme ge ne is as so ci a ted with in cre a se in the risk of sep sis-re la ted ARDS but not MODS and mor ta lity in Tur kish chil dren.

The aim of the present study is to investigate the types of healthcare-associated infections (HC-AIs) caused by Acinetobacter baumannii and the related antibiotic susceptibility patterns as well as the genotypic characteristics of the Acinetobacter baumannii isolates from our center. Sixty-nine Acinetobacter baumannii isolates originating from various samples collected from 69 pediatric patients during their hospital stays were included in the study. The types of healthcare-associated infections caused by these isolates were evaluated, and the antibiotic susceptibility pattern and the genotypic characteristics of the isolates were determined using the pulsed-field gel electrophoresis (PFGE) method. Fifty of the 69 children were observed to have HC-AIs, and 19 children had Acinetobacter baumannii colonization. Healthcare-associated pneumonia (58%) was the most common type of these infections. The rate of carbapenem resistance was found as 91.3%, while tigecycline resistance was found as 18.84%. No colistin resistance was observed in any of the isolates. A total of 10 groups, comprising eight major and two minor groups, were determined using the pulsed-field gel electrophoresis method. Acinetobacter baumannii isolates are the leading cause of healthcare-associated infections, and they show high rates of multidrug antibiotic resistance. Molecular epidemiological evaluation using PFGE plays an important role in preventing healthcare-associated infections.

Velipasaoglu, Sevtap/0000-0002-0200-8079; ONCEL, Selim/0000-0002-5493-1818; Dinleyici, Ener Cagri/0000-0002-0339-0134; NUHOGLU, CAGATAY/0000-0003-2187-4121; Ciftci, Ergin/0000-0002-4955-160X; Ozdemir, Halil/0000-0002-7318-1688; Emiroglu, Melike/0000-0003-1307-0246; Yasa, Olcay/0000-0002-1347-5019 WOS: 000358460500031 PubMed: 26133048 Introduction: Varicella in previously immunized individuals, known as "breakthrough varicella". While the majority of breakthrough cases are mild, some may be severe, requiring hospitalization in previously healthy children or children with an underlying condition. Methods: This report, as a part of the prospective national pediatric varicella hospitalizations study (including 29 centers, represent 50% of pediatric population) in Turkey, is aimed to evaluate breakthrough varicella infection requiring hospitalization before the routine use of single-dose live varicella vaccine in national program from 2008 to 2013 (

Infections of cerebrospinal fluid shunts continue to be a substantial source of mortality and morbidity in children with hydrocephalus. Although several therapeutic modalities are currently used for the treatment of shunt infections, there are no clear guidelines for treatment. The purpose of this study was to determine the common pathogens of cerebrospinal fluid shunt infections and evaluate the success of our management. Thirty-five children treated for ventriculoperitoneal shunt infections over the past 9 years were reviewed. The management protocol consisted of the removal of the infected shunt, the application of ventricular taps or reservoir placement, intraventricular antibiotic treatment, and the placement of a new shunt when cerebrospinal fluid sterility was achieved. Four patients were treated with antibiotics alone. Most episodes occurred within 4 months of shunt placement. The most common causative microorganism identified was Staphylococcus epidermidis, followed by S. aureus, and S. warneri. Three patients died from complications of shunt infections, 2 patients had a recurrent shunt infection, while the remaining 29 patients remained free from shunt-related complications. In agreement with the evidence published in the literature, our findings suggest that the above management protocol is effective for the treatment of cerebrospinal fluid shunt infections.

Background: Acute otitis media (AOM) is one of the most common childhood diseases requiring antimicrobial prescription drugs in pre-school children. In this study, we sought to describe the bacterial etiology of pediatric cases of AOM in Turkey. Materials and Methods: This prospective, multi-center, tympanocentesis-based epidemiological study was performed during 2010-2012in children aged between3 months and 6 years. All isolates were cultured and sero grouped by the Quellung reaction. Results: During 2010-2012, 38 cases fulfilled the study inclusion criteria. Overall, 45% of samples were culture positive for bacterial pathogens Streptococcus pneumonia (13.1%) was the leading cause of bacterial AOM followed by Streptococcus pyogenes (10.5%) and H. influenza (7.9%). Serotype-3 was detected in two of the samples, and serotypes 9V, 19, and 19A were isolated from one patient each. S. pneumoniae was detected in 36% (4/11) of otorrhea samples. All H. influenzae-positive samples were collected by tympanocentesis. All H. influenzae isolates were identified as non-typeable. The pneumococcal serotype coverage rates for PCV-7, PVC-10 and PCV-13 were 20% (1/5), 20% (1/5), and 80% (4/5), respectively. PHiD-CV (PCV-7 types plus 1, 5, and 7F) targets non-typeable H. influenza, and 4 of 38 (11%) of the pathogens causing episodes of AOM were also covered. Conclusion and Recommendation: In Turkey, S.pneumonia remains the most common pathogen in children with AOM. Both S. pneumonia and non-typeable H. influenzae represent important targets for vaccination strategies to reduce AOM in children. Based on our results, conjugated pneumococcal vaccines may have potential impact to decrease the burden of AOM. © 2013 Ceyhan M, et al.

WOS: 000348316800043, PubMed: 25483487, Successful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to, Novartis Vaccines and Diagnostics; GlaxoSmithKlineGlaxoSmithKline, The study was supported by Novartis Vaccines and Diagnostics (for 5 years) and by GlaxoSmithKline (for 2 years). The authors declare that they have no other conflicts of interest.

BACKGROUND: Commonly used trivalent vaccines contain one influenza B virus lineage and may be ineffective against viruses of the other B lineage. We evaluated the efficacy of a candidate inactivated quadrivalent influenza vaccine (QIV) containing both B lineages. METHODS: In this multinational, phase 3, observer-blinded study, we randomly assigned children 3 to 8 years of age, in a 1:1 ratio, to receive the QIV or a hepatitis A vaccine (control). The primary end point was influenza A or B confirmed by real-time polymerase chain reaction (rt-PCR). Secondary end points were rt-PCR-confirmed, moderate-to-severe influenza and rt-PCR-positive, culture-confirmed influenza. The vaccine efficacy and the effect of vaccination on daily activities and utilization of health care resources were assessed in the total vaccinated cohort (2584 children in each group) and the per-protocol cohort (2379 children in the QIV group and 2398 in the control group). RESULTS: In the total vaccinated cohort, 62 children in the QIV group (2.40%) and 148 in the control group (5.73%) had rt-PCR-confirmed influenza, representing a QIV efficacy of 59.3% (95% confidence interval [CI], 45.2 to 69.7), with efficacy against culturecon-firmed influenza of 59.1% (97.5% CI, 41.2 to 71.5). For moderate-to-severe rt-PCR-confirmed influenza, the attack rate was 0.62% (16 cases) in the QIV group and 2.36% (61 cases) in the control group, representing a QIV efficacy of 74.2% (97.5% CI, 51.5 to 86.2). In the per-protocol cohort, the QIV efficacy was 55.4% (95% CI, 39.1 to 67.3), and the efficacy against culture-confirmed influenza 55.9% (97.5% CI, 35.4 to 69.9); the efficacy among children with moderate-to-severe influenza was 73.1% (97.5% CI, 47.1 to 86.3). The QIV was associated with reduced risks of a body temperature above 39°C and lower respiratory tract illness, as compared with the control vaccine, in the per-protocol cohort (relative risk, 0.29 [95% CI, 0.16 to 0.56] and 0.20 [95% CI, 0.04 to 0.92], respectively). The QIV was immunogenic against all four strains. Serious adverse events occurred in 36 children in the QIV group (1.4%) and in 24 children in the control group (0.9%). CONCLUSIONS: The QIV was efficacious in preventing influenza in children. Copyright © 2013 Massachusetts Medical Society.

PubMedID: 17700207 Leishmaniasis is caused by infection with the hemoparasite Leishmania. The disease is a major public health problem in at least 88 countries, including Turkey. Prolonged fever with anorexia and loss of appetite are the major presenting features of visceral leishmaniasis. It is rarely defined as an etiological cause of hemophagocytic syndrome. The clinical course triggered by leishmania infection and hemophagocytosis may coincide, and this may lead to considerable diagnostic difficulty, especially in young children.In this report, we describe an adolescent boy with visceral leishmaniasis as a rare cause of the hemophagocytic syndrome. This is the first reported association between hemophagocytosis and visceral leishmaniasis in an adolescent. © Copyright 2007 Southern Society for Clinical Investigation.

In this study, we tested 137 Turkish children with cancer (51 with acute leukemia, 48 with lymphoma, 38 with solid tumors) while they were undergoing chemotherapy, and a control group of 45 for evidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections using the enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). The control group included children with other disease who had applied to the outpatient clinic during the study period and had no history of jaundice or transfusion. Sixty-five (47.4%) patients with cancer and 7 (20%) children in the control group were positive for hepatitis B surface antigen (HBsAg) (p 0.05). Eight patients (5.8%) had circulating HCV RNA, but none had in the control group (p = 0.09). Ten (13.9%) of the 72 patients who were negative for HBsAg had circulating HBV DNA, and 7 (5.4%) of the 129 patients who were negative for anti-HCV had circulating HCV RNA. We concluded that HBV and HCV infections are common among Turkish children with cancer. In countries where HBV infection is widespread among the general population as in Turkey, children with cancer are under greater risk for HBV infection.

WOS: 000320857300004, PubMed ID: 23637041, Streptococcus pneumoniae is the most common etiological cause of complicated pneumonia, including empyema. In this study, we investigated the serotypes of S. pneumoniae that cause empyema in children. One hundred fifty-six children who were diagnosed with pneumonia complicated with empyema in 13 hospitals in seven geographic regions of Turkey between 2010 and 2012 were included in this study. Pleural fluid samples were collected by thoracentesis and tested for 14 serotypes/serogroups using a Bio-Plex multiplex antigen detection assay. The serotypes of S. pneumoniae were specified in 33 of 156 samples. The mean age +/- the standard deviation of the 33 patients was 6.17 +/- 3.54 years (range, 0.6 to 15 years). All of the children were unvaccinated according to the vaccination reports. Eighteen of the children were male, and 15 were female. The serotypes of the non-7-valent pneumococcal conjugated vaccine (non-PCV-7), serotype 1, serotype 5, and serotype 3, were detected in eight (14.5%), seven (12.7%), and five (9.1%) of the samples, respectively. Serotypes 1 and 5 were codetected in two samples. The remaining non-PCV- 7 serotypes were 8 (n = 3), 18 (n = 1), 19A (n = 1), and 7F/A (n = 1). PCV-7 serotypes 6B, 9V, 14, 19F, and 23F were detected in nine (16.3%) of the samples. The potential serotype coverages of PCV-7, PCV-10, and PCV-13 were 16.3%, 45.4%, and 60%, respectively. Pediatric parapneumonic empyema continues to be an important health problem despite the introduction of conjugated pneumococcal vaccines. Active surveillance studies are needed to monitor the change in S. pneumoniae serotypes that cause empyema in order to have a better selection of pneumococcal vaccines., GlaxoSmithKlineGlaxoSmithKline, The study was supported by GlaxoSmithKline.

PubMedID: 8744003 A patient is reported with a suprasellar tuberculoma which imitated a craniopharyngioma on cumputed tomography scan and magnetic resonance imaging of the brain. This lesion developed during irregularly used antituberculous therapy and caused endocrinologic disorders 3 years after the original diagnosis of tuberculous meningitis. Surgery was performed to confirm the diagnosis and also to decompress the optic pathways. Five months later, the lesion disappeared completely after appropriate antituberculous treatment. © 1995 S. Karger AG, Basel.

Dinleyici, Ener Cagri/0000-0002-0339-0134; Carman, Kursat Bora/0000-0002-4629-1873; Akarsu, Saadet/0000-0002-2673-8842; Kondolot, Meda/0000-0002-1168-3228; Ozdemir, Halil/0000-0002-7318-1688; ONCEL, Selim/0000-0002-5493-1818; Velipasaoglu, Sevtap/0000-0002-0200-8079; Ciftci, Ergin/0000-0002-4955-160X; NUHOGLU, CAGATAY/0000-0003-2187-4121; Aykan, Hayrettin Hakan/0000-0001-5136-3977; Emiroglu, Melike/0000-0003-1307-0246; Yasa, Olcay/0000-0002-1347-5019 WOS: 000303054700011 PubMed: 22170238 Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (< 0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was $856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children < 1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization.

2010-2011 kış sezonunda influenza benzeri semptomlarla başvuran hastalarda influenza virüs tiplerinin (influenza A, influenza B ve H1N1) dağılımı, klinik özellikleri ve tedavide oseltamivirin etkinliğinin belirlenmesidir. Gereç ve Yöntemler: Çalışmaya Ocak-Mart 2011 tarihlerinde üç farklı merkeze influenza benzeri semptomlarla başvuran 18 yaş altındaki 300 hasta dahil edildi. İnfluenza sorgulama formu oluşturulan hastaların yaşı, influenza aşı durumu, başvuru semptomlarının başlangıç ve bitiş tarihleri, komplikasyonların varlığı, antiviral tedavi ve antiviral tedavi dışındaki kullanılan ilaçlar (antipiretik, antibiyotik vb.), hospitalizasyon durumu, altta yatan kronik bir hastalık olup olmadığı kaydedildi. Tüm hastalardan influenza virüsleri için nazal sürüntü (swab) örnekleri alındı. Örneklerden influenza virüs tipleri için "reverse-transcription" polimeraz zincir reaksiyonu (RT-PCR) çalışıldı. Hastaların bir kısmına RT-PCR sonuçları beklenmeden rastgele oseltamivir tedavisi başlandı ve takibe alındı. Bulgular: Hastalarda başvuru sırasında en sık görülen semptomlar ateş (%87.3), öksürük (%84.7), burun tıkanıklığı (%86.3), burun akıntısı (%83.7), boğaz ağrısı (%32), baş ağrısı (%21.3), kas ağrısı (%16.3) idi. Hastaların 45’ine (%15) mevsimsel influenza aşısı yapılmışken, 255’inin (%85) aşısı yoktu. Hastaların 129’unda (%43) influenza RT-PCR pozitif bulundu ve bunların 71’ine oseltamivir başlanmıştı. İnfluenza pozitif grupta yer alan ve oseltamivir başlanan hastalarda ateş, öksürük, burun tıkanıklığı ve burun akıntısı süresinin istatistiksel olarak daha kısa olduğu saptandı (p

WOS: 000291147300019, PubMed ID: 21508171, Before use of the pneumococcal conjugate vaccine PCV7 became widespread in Turkey, 202 invasive pneumococcus isolates were analyzed. The most common serotypes were 19F and 6B. In children, Wyeth-Turkey [0887X1-4439], This study was supported by an unrestricted research grant, 0887X1-4439, from Wyeth-Turkey.

Solebo, Colette N/0000-0001-9764-2541 WOS: 000273987200009 PubMed: 19487149 Objectives: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. Methods: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). Results: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p < 0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p = 0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p = 0.008). Conclusions: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials. (C) 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

WOS: 000270655100026, PubMed ID: 19817603, Rotavirus is the main cause of gastroenteritis and dehydration requiring hospitalization among infants and children. Despite the high diarrhea-related mortality rate, there are limited studies describing the prevalence of rotavirus in Turkey. The disease burden of rotavirus gastroenteritis in Turkey was assessed by active, prospective surveillance conducted in accordance with a modified World Health Organization generic protocol from 1 June 2005 through 1 June 2006. A total of 411 children aged, GlaxoSmithKline Biologicals, Rixensart, BelgiumGlaxoSmithKline [104377]; GAVI Alliance, Financial support: research grant from GlaxoSmithKline Biologicals, Rixensart, Belgium (eTrack 104377).; Supplement sponsorship: This article was published as part of a supplement entitled "Global Rotavirus Surveillance: Preparing for the Introduction of Rotavirus Vaccines," which was prepared as a project of the Rotavirus Vaccine Program, a partnership between PATH, the World Health Organization, and the US Centers for Disease Control and Prevention, and was funded in full or in part by the GAVI Alliance.

The role of endothelial nitric oxide synthase gene intron 4 a/b (eNOS4a/b) variable number of tandem repeats (VNTR) polymorphism in various diseases was investigated. We investigated whether this polymorphism is associated with susceptibility to sepsis and its clinical features such as acute respiratory distress syndrome (ARDS), multiorgan dysfunction syndrome (MODS) and shock. eNOS4a/b VNTR polymorphism was determined by the polymerase chain reaction in 100 children with sepsis and in 134 healthy controls. The genotype distribution of eNOS4 was not different between the patients and controls (p=0.44). There was no statistically significant association between genotypes/allele frequency and outcomes like mortality, MODS, ARDS, and shock (p0.05). This is the first study that evaluates the effect of eNOS4a/b polymorphism in sepsis. We were unable to show a relationship between eNOS gene intron 4 a/b VNTR polymorphism and MODS, ARDS, mortality and shock. Larger studies that do research on the interaction of such genes are needed to clarify the association between eNOS4a/b polymorphism and sepsis.

Vaccines to prevent bacterial meningitis in this region must provide reliable protection against serogroup W-135., Determination of the etiology of bacterial meningitis and estimating cost of disease are important in guiding vaccination policies. To determine the incidence and etiology of meningitis in Turkey, cerebrospinal fluid (CSF) samples were obtained prospectively from children (1 month–17 years of age) with a clinical diagnosis of acute bacterial meningitis. Multiplex PCR was used to detect DNA evidence of Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis. In total, 408 CSF samples were collected, and bacterial etiology was determined in 243 cases; N. meningitidis was detected in 56.5%, S. pneumoniae in 22.5%, and Hib in 20.5% of the PCR-positive samples. Among N. meningitidis–positive CSF samples, 42.7%, 31.1%, 2.2%, and 0.7% belonged to serogroups W-135, B, Y, and A, respectively. This study highlights the emergence of serogroup W-135 disease in Turkey and concludes that vaccines to prevent meningococcal disease in this region must provide reliable protection against this serogroup.

PubMedID: 18092150 Objective: To evaluate the effect of terlipressin on oxygenation, PaO 2/FIO2, heart rate, mean arterial pressure, and mortality in children with septic shock refractory to high doses of dopamine/dobutamine and adrenaline. Design and setting: A randomized, nonblind study in the pediatric intensive care unit of a university hospital. Patients and measurements: We studied 58 children with septic shock and refractory hypotension despite fluid loading and high doses of catecholamines, randomly enrolled to terlipressin (TP, n = 30) or control (n = 28). TP was administered as intravenous bolus doses of 20 µg/kg every 6 h for a maximum of 96 h. Hemodynamic changes, PaO2/FIO2 rates, length of stay, and mortality rate in PICU were recorded prospectively. Results: Mean arterial pressure and PaO2/FIO2 significantly increased, and heart rate significantly decreased 30 min after each TP treatment, but mortality did not differ from control (67.3% vs. 71.4%). Mean stay in the PICU was shorter in the TP group (13.4 ± 7.9 vs. 20.2 ± 9.7 days and was longer among nonsurvivors of the TP group vs. control (10.4 ± 6.9 vs. 6.2 ± 3.4 days). Blood urea nitrogen, creatinine, AST, ALT, and urine output of patients in the TP group did not change after terlipressin. Conclusions: Although terlipressin infusion had no effect on mortality, it significantly increases mean arterial pressure, PaO2/FIO2, and survival time in nonsurvivors. Terlipressin seems to cause no adverse effect but warrants further evaluation as a rescue therapy in refractory septic shock. © 2007 Springer-Verlag.

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PubMedID: 16602003 [No abstract available]

PubMedID: 15672717 Bacillary angiomatosis is an infectious disease which usually develops in immunocompromised patients. Contact with cats is implicated in its pathogenesis. We report a seven-year-old immunocompetent boy with bacillary angiomatosis without a history of direct contact with cats. The clinical diagnosis of bacillary angiomatosis was made following histopathological examination of a biopsy sample from the infected facial wound, in the vicinity of which angiomatous lesions had developed. Surprisingly, similar lesions also appeared at the donor site of the skin graft which was grafted on the facial wound. This case demonstrates that bacillary angiomatosis may also be seen in immunocompetent patients and that it may contaminate wounds without the intermediary of cats.

H1V ile infekte çocuklarda görülen en önemli komplikasyonlardan olan fırsatçı infeksiyonlann %20'sinden Gram-negatif bakteriyel infeksiyonlar sorumlu tutulmaktadır. Bu yazıda Salmonella sepsisi nedeniyle tedavi edilen, ancak kontrol edilemeyen ateş, anemi ve trombositopeni nedeniyle yapılan araştırmalar sonucu H1V iııfeksiyonu saptanan, takiplerinde lenf nodlarmda hızla büyüme ve vena cava superior sendromu sonucu akut solunum yetmezliği ile kaybedilen bir vaka sunulmaktadır. The most common and serious complication in HIV infected children are opportunistic infections and approximately 20 % of the causative organisms are Gram-negative hacterias. We present an HIV infected case admitted with reccwent fever, anemia and thrombocytopenia and had previously been diagnosed as Salmonella septicemia and died as a result of acute respiratory failure because of vena cava superior syndrome.

Objective: To compare the effectiveness and rate of temperature reduction of three antipyretic medications in febrile children. Design: A single-dose, randomised, prospective, modified double-blind, parallel clinical trial. Setting: The paediatric emergency department of a university hospital that has 13 000 annual visits. Study participants: 252 otherwise healthy children aged 6 months to 14 years with acute, intercurrent, febrile illness. Interventions: Enrolled children were assigned to receive a single dose of oral ibuprofen 10 mg/kg, oral nimesulide 2.5 mg/kg, or parenteral dipyrone 10 mg/kg. Main outcome measures and results: Axillary temperature was measured at the time of antipyretic administration and at 30, 45, 60 and 120 minutes thereafter. All three medications were effective in reducing the axillary temperature during the 2-hour testing period. The rates of axillary temperature change between the three medications were significantly different for the ibuprofen and dipyrone groups (p = 0.023). In addition, the axillary temperature in the dipyrone group was significantly lower than that in the ibuprofen group (p = 0.036) at 120 minutes. There was no significant difference in antipyretic effect between the nimesulide group and the other two groups during the testing period. Within each group the difference between initial temperature and the temperature at the end of the testing period was statistically significant (p = 0.036) for the dipyrone group only. Conclusions: All three antipyretic medications were effective in reducing the axillary temperature in febrile children. Although administration of intramuscular dipyrone seemed to be more effective than ibuprofen, this relationship was not significant when nimesulide was considered. In addition, in view of its known side effects and the problems associated with intramuscular administration in children, the preference for orally administered nimesulide or ibuprofen over dipyrone in the setting of the emergency department seems more logical provided that the child accepts oral therapy.

The present study was aimed at determining the seroprevalence of anti-HAV in children and adolescents in the city of Adana, Turkey. The overall prevalence of anti-HAV was 44.4% (316/711). The prevalence increased with advancing age i.e. 28.8% (2.1-6 yr), 49.8% (6.1-12 yr), and 68% (12.1-16.5 yr) (P0.0001). Seroprevalence was significantly lower in children less than 6 years and belonging to higher socioeconomic status.

PubMedID: 10608640 [No abstract available]

The prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among hemophiliac children in Turkey was investigated in a study of 41 male patients (age range 7 months to 16 years) registered at Balcali Hospitals Department of Pediatric Hematology and Oncology. 11 children (26.8%) had hemophilia A and 30 (73.2%) had hemophilia B. Only 7.3% of these children had received HBV vaccination. Enzyme-linked immunosorbent assay revealed the presence of HBV surface antigen in 11 children (26.8%) and of HCV-specific antibody in 10 (24.4%). No child was infected with HIV. Mean age duration of diagnosis and the number of blood and/or plasma transfusions were higher in children with HCV antibodies than those without such antibodies. Although donor screening has been carried out in blood banks in large cities for HBV since 1983 and for HCV since 1996 this practice is not yet routine in many parts of the country. When effective blood screening and use of heat-inactivated factor concentrates become widespread parenteral hepatitis transmission to hemophiliacs should decrease in Turkey.

PubMedID: 7793264 Six patients with Bardet-Biedl syndrome who have been followed in our clinics for the last 5 years are reported in this study. Of the five classic features of this syndrome; obesity and mental retardation were present in all cases, retinal disturbances were present in five, Polydactyly in three and hypogenitalism was observed in all four male patients. Renal involvement, often suggested as a cardinal feature of this syndrome, was described in two patients. Iron deficiency anemia occurred in three patients, two patients were of short stature, one patient presented with an empty sella, and in two patients clinodactyly was detected. The results are compared to previously published literature and discussed. 1995 Japan Pediatric Society

59 patients were treated for meningococcal infections in Cukurova University Faculty of Medicine, Division of Pediatric Infectious Diseases. 50.8% of patients were male, 33.9% were under two years of age and 61% were under five. 78% of patients were admitted to hospital in winter and spring time. Meningococcal meningitis (MM) was present in 39% of patients on admission, however, meningococcemia in 27.1% and meningococcemia and meningococcic meningitis (Meningococcemia + MM) in 33.9%. Fatality rate was 18.6% and no association was found between mortality and clinical type of disease (p0.05), but mortality ratio decreased with an increasing age (p0.01). No deaths occurred among the 12 patients who received i.v. penicillin treatment shortly before admitting to hospital, on the other hand 11 of 47 patients (23.4%) without such a previous treatment died.The clinical and laboratory findings of 59 patients treated for meningococcal disease between January 1, 1989, and December 31, 1993, in Adana, Turkey's Cukurova University, Faculty of Medicine, Division of Pediatric Infectious Diseases were analyzed retrospectively. The diagnosis was based on clinical findings, positive blood or cerebrospinal fluid (CSF) cultures, and the presence of gram negative diplococci in the CSF and in the smears from petechiae. Of 59 patients, 29 (49.2%) were female and 30 (50.8%) were male, with ages ranging from 1 month to 14 years. 20 (33.9%) patients were in the 0-2 and 36 (61%) were in the 0-5 age group. Most of the patients (45.7%) were admitted to the hospital in the winter, followed by spring (32.2%), summer (15.3%), and fall (6.8%). In January and February there seemed to be a peak in admission rates (18.6% and 16.9%, respectively). The distribution of patients with respect to seasons showed a statistically significant difference (p .0001). The overall case fatality was 18.6% (11/59). Meningococcal meningitis (MM) was diagnosed in 23 (39%) patients, meningococcemia in 16 (27.1%), and MM + meningococcemia in 20 (33.9%). 10 of 20 children 0-2 years of age presented with meningococcemia alone. On the other hand, 11 (47.8%) of the 23 patients over 5 years showed MM alone. Clinical presentation revealed a significant association with certain age groups (p .05). Fatality ratios in children under 2 years old and in children 2-14 years old were 35% and 10.2%, respectively, and there was a significant trend for decreasing case fatality rate with increasing age (p .01). All patients aged 0-3 months died. The fatality rate was the lowest among patients over 5 years of age (8.7%, 2/23). The mortality rate did not change with clinical presentation (p .05). Two patients (8.7%) with MM died, while this rate was 20% (4/20) in patients with MM + meningococcemia. 5 of 16 (31.3%) patients died in the group with meningococcemia only. Signs of upper respiratory tract infection were present in 11 (18.6%) patients during their initial physical examination, but no statistically significant relationship was found in respect to mortality (p .05).

WOS: 000301663800010, PubMed ID: 22310296, Objective: The aim of this multicenter prospective study was to evaluate the efficacy of a new bioequivalent formulation of oseltamivir for the treatment of influenza A, influenza B, and H1N1 during the 2010-2011 influenza season. Methods: We compared the symptoms and signs of 300 pediatric patients presenting to three university hospitals with an influenza-like illness between January and March 2011. Nasal swab specimens were collected from all children and tested by reverse-transcription polymerase chain reaction (RT-PCR) for influenza viruses. After randomization, half of the participants were prescribed oseltamivir, while the other half were observed conservatively. Forty patients who were followed-up for influenza prior to the study were also included in the evaluation. Results: Influenza was confirmed by RT-PCR in 129 children, 71 of whom were prescribed oseltamivir. The durations of the symptoms fever, cough, nasal congestion, and rhinorrhea were significantly shorter for patients who were treated with oseltamivir compared with untreated patients (p < 0.002 for all symptoms). Early initiation of oseltamivir therapy (within 48 h of the onset of symptoms) was associated with more favorable outcomes and an earlier recovery than in patients for whom treatment was delayed (beyond 48 h). Thirty-seven patients (28.7%) had H1N1, 44 (34.1%) had influenza A, 46 (35.7%) had influenza B, one (0.8%) had H1N1 plus influenza A, and one (0.8%) had influenza A plus influenza B viruses. In the comparison of the duration of symptoms according to the different virus types, a statistically significant difference was only observed in patients with influenza B who had a longer duration of cough (p < 0.001), nasal congestion (p < 0.001), and rhinorrhea (p < 0.001). Conclusions: Oseltamivir is an effective treatment for the management of seasonal influenza and H1N1, and should be initiated immediately without waiting for laboratory confirmation of diagnosis. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.