Bu çalışmanın amacı, 20 aylık bir dönem içerisinde kan kültüründe Serratia marcescens üreyen hast... more Bu çalışmanın amacı, 20 aylık bir dönem içerisinde kan kültüründe Serratia marcescens üreyen hastalarda beklenmedik bir artış olması ile bu hastaların demografik, klinik ve laboratuvar sonuçlarının incelenmesi, mortaliteye yol açan özelliklerin ve dirençli suşlara tedavi yaklaşımının gözden geçirilmesidir. Gereç ve Yöntemler: Kan kültüründe S. marcescens üreyen ve bakteriyemi ile uyumlu klinik bulguları olan hastalar geriye dönük olarak incelenmiştir. Yaş, cinsiyet, altta yatan hastalıklar, beyaz küre ve nötrofil sayıları, C-reaktif protein (CRP) ve albümin düzeyleri, hastanede yatış süresi, yoğun bakımda yatış süresi, santral venöz kateter varlığı ve süresi, 28-gün mortalitesi ve antibiyogram kaydedildi. Enfeksiyonlar kan yayım veya kateter ilişkili kan yayım enfeksiyonu olarak ayrıldı. Antimikrobiyal direnci değerlendirmek için suşlar non-MDR, MDR, XDR ve PDR olarak sınıflandırıldı. Bulgular: Hastaların 12 (%26.9)'sinin altta yatan hastalığı maligniteydi. Ortalama hastanede kalış süresi 42.7 ± 41.4 (3-171) gündü. Kan yayım enfeksiyonları sırasında 43 hastada kemo-portlar ve Hickman kateterleri dahil santral venöz kateterler mevcuttu. Yirmi dört hastada kan yayım enfeksiyonu, 21 hastada kateterle ilişkili kan yayım enfeksiyonu mevcut-Abstract Objective: In this study, it was aimed to present a cohort study conducted retrospectively in order to examine the unexpected Serratia marcescens bacteremia prevalence in a children's hospital in Türkiye. Material and Methods: S. marcescens was isolated in the blood cultures of 45 patients at a 20-month period. Demographic features and clinical findings of the 45 patients including age, sex, underlying diseases, white blood cell (WBC), C-reactive protein (CRP), serum albumin level, length of hospital stay and length of pediatric intensive care unit stay, portal of entry, duration of central venous catheter, results of antimicrobial susceptibility testing and 28-day all-cause mortality were examined. Bloodstream infections (BSI) were classified as BSI or catheter-related BSI. Definitions used to characterize antimicrobial resistant bacteria were classified as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). Results: Twelve patients (26.9%) had a malignancy. Mean hospitalization duration was 42.7 ± 41.4 (3-171) days. Central venous catheters (CVCs), including chemo-ports and Hickman catheters, were present in 43 patients during episodes of BSI. Twenty-four patients had primary BSI while 21 patients had catheter-related BSI. Mean length of CVC presence be
Turkish Journal of Pediatric Emergency and Intensive Care Medicine
Purpura fulminans (PF) is a rare but fatal thrombotic disease caused by microvascular thrombosis ... more Purpura fulminans (PF) is a rare but fatal thrombotic disease caused by microvascular thrombosis due to coagulation disorder. Necrosis can progress to muscle and bone tissue contributing to late mortality and morbidity. A healthy 4-month-old girl and a 7-month-old girl had previously admitted to our intensive care unit with severe PF due to meningococcemia. Both patients had a severe and critical period in the pediatric intensive care unit and were supported with extracorporeal treatments. We opened colostomy for perineal infection because of large and deep skin lesions. In addition, we waited for a full auto-amputation involving all extremities instead of early surgical amputation. Both survived and acceptable limb function and some mobilization capacity were preserved. In conclusion, we think that early colostomy in severe perineal infections and autoamputation options in severe extremity involvement should be preferred in order to get better results.
Objective Multisystemic inflammatory syndrome in children (MIS-C) is characterized by persistent ... more Objective Multisystemic inflammatory syndrome in children (MIS-C) is characterized by persistent fever, systemic hyperinflammation, and multiple-organ dysfunction. There are a few reports about MIS-C presenting with acute abdomen. The aim of this study is to demonstrate the clinical characteristics and treatment options for MIS-C-related acute abdomen and appendicitis. Methods This was a retrospective study conducted between April 2020 and October 2020 in our pediatric intensive care unit in Turkey. Patients between the ages of 1 month and 18 years who presented with acute abdomen and were ultimately diagnosed with MIS-C were included. Results Seven patients with a median age of 12.5 (interquartile range 10.5–13) years were enrolled. Four were females. The most frequent symptoms were fever, abdominal pain, and vomiting. Three patients had involvement of the appendix that required surgical intervention. All pathology reports were compatible with appendicitis. The other patients also ...
In Turkey Hepatitis A virus (HAV) infection is considered to be moderateendemic. Hepatitis A vacc... more In Turkey Hepatitis A virus (HAV) infection is considered to be moderateendemic. Hepatitis A vaccine was included in the mandatory vaccination schedule of Turkey on November 2012. We aimed to evaluate the cases of HAV infection followed in Ankara, which is located in the center of Central Anatolia, retrospectively according to the date of the administration of the mandatory hepatitis A vaccine. A total of 272 children followed-up between January 2008 and December 2015 for HAV infection in five separate hospitals were enrolled to the study. There were 200 (68.2%) cases in the pre-vaccination group, 72 (31.74%) cases in the post-vaccination group, and 55.1% were male in total. The immunization status were as follow; 89.7% (n = 244) unvaccinated, 0.4% (n = 1) vaccinated and 9.9% (n = 27) with unknown immune status. There was a statistically significant difference between the groups in hospitalization rates, but no statistically significant differences in hospitalization indications, length of hospital stay, complication types and proportions, and normalization period of transaminases. The national hepatitis A immunization program in Turkey has had a significant impact when the targeted population is considered, with suggestive herd protection effects.
Pneumonia is a significant cause of death for children, particularly those in developing countrie... more Pneumonia is a significant cause of death for children, particularly those in developing countries. The records of children who were hospitalized because of pneumonia between January 2003 and December 2015 were retrospectively reviewed, and patients who met the recurrent pneumonia criteria were included in this study. During this 13-year period, 1395 patients were hospitalized with pneumonia; of these, 129 (9.2%) met the criteria for recurrent pneumonia. Underlying diseases were detected in 95 (73.6%) patients, with aspiration syndrome (21.7%) being the most common. Rhinovirus (30.5%), adenovirus (17.2%) and respiratory syncytial virus (13.9%) were the most frequent infectious agents. These results demonstrate that underlying diseases can cause recurrent pneumonia in children. Viruses are also commonly seen in recurrent pneumonia. Appropriate treatments should be chosen based on an analysis of the underlying disease, the patient's clinical condition and the laboratory and radiological data.
Rotavirus is an important morbidity and mortality agent among previously healthy infants. Rotavir... more Rotavirus is an important morbidity and mortality agent among previously healthy infants. Rotavirus gastroenteritis (RG) causes severe fluid and electrolyte imbalance and development of fatal complications during course of the disease, if untreated. Although there are few case reports in the literature regarding septicemia after RG, it is one of the most important complications of the disease. The main reason of septicemia is unknown but it can be associated with severe consequences such as septic shock, endocarditis, and even death. If complications are taken into consideration on the course of disease, morbidity and mortality can be reduced. Herein, we evaluated the clinical characteristics, incidence and types of the complications during RG in this retrospective study. We evaluated a total of 276 patients (164 male, 112 female) diagnosed with RG between January 2006 and February 2013 at the department of Pediatric Infectious Disease. Male to female ratio was 1.5 and the median ag...
Congenital lobar emphysema is a rare disease, which is characterized by pulmoner hyperinflation. ... more Congenital lobar emphysema is a rare disease, which is characterized by pulmoner hyperinflation. Depending on the degree of bronchial obstruction, the clinical presentation may be variable. We report a rare case with congenital lobar emphysema in a 38-days-old male infant who presented with severe respiratory distress and hypertension. Air trapping in the left upper lung and significant mediastinal shift to the right were observed on the chest x-ray. Emphysematous changes were detected on the thorax computed tomography and considered as congenital lobar emphysema. The upper left lobectomy was successfully performed by pediatric surgeons. On postoperative follow up, no sign of respiratory distress occurred and the patient was normotensive. In this report, a case with congenital lobar emphysema, which is a rare cause of respiratory distress and hypertension is discussed.
Akut gastroenterit, özellikle gelişmekte olan ülkelerde önemli bir morbidite ve mortalite nedenid... more Akut gastroenterit, özellikle gelişmekte olan ülkelerde önemli bir morbidite ve mortalite nedenidir. Beş yaş altı çocuklar daha sık etkilenmekle birlikte ölümlerin %80'i iki yaş altında görülmektedir. Escherichia coli, Salmonella spp. ve Shigella spp. en sık neden olan bakteriyel etkenlerdir. 2014 yazı ile başlayan dönemde hizmet bölgemizde her yıl gördüğümüzden daha fazla sayıda Salmonella ve Shigella gastroenteriti vakaları ortaya çıktı. Vaka sayısında ortaya çıkan ani artış yerel küçük bir salgın olduğunu gösteriyordu. Çalışmamızda bu salgında elde edilen izolatların özellikleri ve antibiyotik duyarlılıklarını bildirmeyi amaçladık. Gereç ve Yöntemler: Çocuk sağlığı ve hastalıkları poliklinikleri ve acil servisine Temmuz-Eylül 2014 tarihleri arasında gelen, akut ishal yakınmasıyla başvuran, öyküsünde 15 günden kısa süreli ishali olan ve akut gastroenterit ön tanısı alan hastalar retrospektif olarak çalışmaya alındı. Salgın sırasında bakılan dışkı mikroskopisi, dışkı kültürü, kan kültürü, Salmonella ve Shigella suşlarına ait antimikrobiyal duyarlılık testleri verileri geçmişe yönelik hasta dosyalarından ve laboratuar tetkiklerinden incelendi. Bulgular: Akut gastroenterit nedeniyle toplam 2425 hasta başvurdu. Salmonella spp. ve Shigella spp. 113 çocukta izole edildi. Çocukların yaşları 91,5±60,3 aydı (4-213 ay). Hastaların %56'sı erkek ve %44'ü kızdı. Etken mikroorganizmalar incelendiğinde Shigella spp. 77 hastada (%3,2) ve Salmonella spp. 36 hastada (%1,5) saptandı. Salmonella enteritidis 29 hastada (%80,5) saptanmışken; S. typhimurium üç hastada (%8,3) saptandı. Ek olarak S. sonnei 63 hastada (%81,8) ve S. flexneri sekiz hastada (%10,3) tespit edildi. Salmonella suşlarında seftriakson direnci bulunmamış iken Shigella suşlarında %9,1 seftriak-Abstract Objective: Acute gastroenteritis is an important cause of morbidity and mortality in developing countries. Children under 5 years of age are more commonly affected, while 80% of deaths occur in children under 2 years of age. Escherichia coli, Salmonella spp., and Shigella spp. are the most common causative bacterial pathogens. Since the summer of 2014, a large number of Salmonella and Shigella gastroenteritis cases have occurred in our region, which is considered as a small local outbreak. We aim to report the features and antibiotic susceptibility of microorganism isolates obtained during this epidemic. Material and Methods: Between July and September 2014, patients who were admitted to pediatric clinics and emergency services on account of acute gastroenteritis lasted less than 15 days were included in this retrospective study. Stool microscopy, stool cultures, and blood cultures were performed. Salmonella and Shigella strains were subjected to antimicrobial susceptibility testing. Results: A total of 2425 patients were admitted because of acute gastroenteritis during the study period. Salmonella spp. and Shigella spp. were isolated in 113 children. The mean age of the children was 91.5±60.3 months (4-213 months). Of the 113 patients, 56% were male and 44% were female. Shigella spp. were found in 77 patients (3.2%), and Salmonella spp. were found in 36 patients (1.5%). Salmonella enteritidis was detected in 29 patients (80.5%), whereas Salmonella typhimurium was detected in 3 patients (8.3%). In addition, Shigella sonnei was identified in 63 patients (81.8%) and Shigella flexneri in 8 patients (10.3%). In contrast to ceftriaxone susceptibility in Salmonella strains, 9.1% of Shigella strains were found to be resistant to ceftriaxone. Ciprofloxacin resistance
BACKGROUND Combined immunodeficiencies are marked by inborn errors of T-cell immunity in which th... more BACKGROUND Combined immunodeficiencies are marked by inborn errors of T-cell immunity in which the T cells that are present are quantitatively or functionally deficient. Impaired humoral immunity is also common. Patients have severe infections, autoimmunity, or both. The specific molecular, cellular, and clinical features of many types of combined immunodeficiencies remain unknown. METHODS We performed genetic and cellular immunologic studies involving five unrelated children with early-onset invasive bacterial and viral infections, lymphopenia, and defective T-cell, B-cell, and natural killer (NK)-cell responses. Two patients died early in childhood; after allogeneic hematopoietic stem-cell transplantation, the other three had normalization of T-cell function and clinical improvement. RESULTS We identified biallelic mutations in the dedicator of cytokinesis 2 gene (DOCK2) in these five patients. RAC1 activation was impaired in the T cells. Chemokine-induced migration and actin polymerization were defective in the T cells, B cells, and NK cells. NK-cell degranulation was also affected. Interferon-α and interferon-λ production by peripheral-blood mononuclear cells was diminished after viral infection. Moreover, in DOCK2-deficient fibroblasts, viral replication was increased and virus-induced cell death was enhanced; these conditions were normalized by treatment with interferon alfa-2b or after expression of wild-type DOCK2. CONCLUSIONS Autosomal recessive DOCK2 deficiency is a new mendelian disorder with pleiotropic defects of hematopoietic and nonhematopoietic immunity. Children with clinical features of combined immunodeficiencies, especially with early-onset, invasive infections, may have this condition.
Turk Pediatri Arsivi-turkish Archives of Pediatrics, 2002
Haemophilus influenzae type b strains cause severe infections such as meningitis pneumonia empyem... more Haemophilus influenzae type b strains cause severe infections such as meningitis pneumonia empyema epiglottitis cellulitis septic arthritis pericarditis and bacteremia In this report five children with invasive H influenzae type b infection are presented All patients were younger than two years None of the patients was immunized with H influenzae type b vaccine All of the patients treated with appropriate antibiotics and surgical interventions recovered without sequel H influenzae type b vaccination must be added to routine vaccination schedule in order to prevent H influenzae type b infections in our country Key words: Haemophilus influenzae type b meningitis pneumonia empyema bacteremia preseptal cellulitis
Bu çalışmanın amacı, 20 aylık bir dönem içerisinde kan kültüründe Serratia marcescens üreyen hast... more Bu çalışmanın amacı, 20 aylık bir dönem içerisinde kan kültüründe Serratia marcescens üreyen hastalarda beklenmedik bir artış olması ile bu hastaların demografik, klinik ve laboratuvar sonuçlarının incelenmesi, mortaliteye yol açan özelliklerin ve dirençli suşlara tedavi yaklaşımının gözden geçirilmesidir. Gereç ve Yöntemler: Kan kültüründe S. marcescens üreyen ve bakteriyemi ile uyumlu klinik bulguları olan hastalar geriye dönük olarak incelenmiştir. Yaş, cinsiyet, altta yatan hastalıklar, beyaz küre ve nötrofil sayıları, C-reaktif protein (CRP) ve albümin düzeyleri, hastanede yatış süresi, yoğun bakımda yatış süresi, santral venöz kateter varlığı ve süresi, 28-gün mortalitesi ve antibiyogram kaydedildi. Enfeksiyonlar kan yayım veya kateter ilişkili kan yayım enfeksiyonu olarak ayrıldı. Antimikrobiyal direnci değerlendirmek için suşlar non-MDR, MDR, XDR ve PDR olarak sınıflandırıldı. Bulgular: Hastaların 12 (%26.9)'sinin altta yatan hastalığı maligniteydi. Ortalama hastanede kalış süresi 42.7 ± 41.4 (3-171) gündü. Kan yayım enfeksiyonları sırasında 43 hastada kemo-portlar ve Hickman kateterleri dahil santral venöz kateterler mevcuttu. Yirmi dört hastada kan yayım enfeksiyonu, 21 hastada kateterle ilişkili kan yayım enfeksiyonu mevcut-Abstract Objective: In this study, it was aimed to present a cohort study conducted retrospectively in order to examine the unexpected Serratia marcescens bacteremia prevalence in a children's hospital in Türkiye. Material and Methods: S. marcescens was isolated in the blood cultures of 45 patients at a 20-month period. Demographic features and clinical findings of the 45 patients including age, sex, underlying diseases, white blood cell (WBC), C-reactive protein (CRP), serum albumin level, length of hospital stay and length of pediatric intensive care unit stay, portal of entry, duration of central venous catheter, results of antimicrobial susceptibility testing and 28-day all-cause mortality were examined. Bloodstream infections (BSI) were classified as BSI or catheter-related BSI. Definitions used to characterize antimicrobial resistant bacteria were classified as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). Results: Twelve patients (26.9%) had a malignancy. Mean hospitalization duration was 42.7 ± 41.4 (3-171) days. Central venous catheters (CVCs), including chemo-ports and Hickman catheters, were present in 43 patients during episodes of BSI. Twenty-four patients had primary BSI while 21 patients had catheter-related BSI. Mean length of CVC presence be
Turkish Journal of Pediatric Emergency and Intensive Care Medicine
Purpura fulminans (PF) is a rare but fatal thrombotic disease caused by microvascular thrombosis ... more Purpura fulminans (PF) is a rare but fatal thrombotic disease caused by microvascular thrombosis due to coagulation disorder. Necrosis can progress to muscle and bone tissue contributing to late mortality and morbidity. A healthy 4-month-old girl and a 7-month-old girl had previously admitted to our intensive care unit with severe PF due to meningococcemia. Both patients had a severe and critical period in the pediatric intensive care unit and were supported with extracorporeal treatments. We opened colostomy for perineal infection because of large and deep skin lesions. In addition, we waited for a full auto-amputation involving all extremities instead of early surgical amputation. Both survived and acceptable limb function and some mobilization capacity were preserved. In conclusion, we think that early colostomy in severe perineal infections and autoamputation options in severe extremity involvement should be preferred in order to get better results.
Objective Multisystemic inflammatory syndrome in children (MIS-C) is characterized by persistent ... more Objective Multisystemic inflammatory syndrome in children (MIS-C) is characterized by persistent fever, systemic hyperinflammation, and multiple-organ dysfunction. There are a few reports about MIS-C presenting with acute abdomen. The aim of this study is to demonstrate the clinical characteristics and treatment options for MIS-C-related acute abdomen and appendicitis. Methods This was a retrospective study conducted between April 2020 and October 2020 in our pediatric intensive care unit in Turkey. Patients between the ages of 1 month and 18 years who presented with acute abdomen and were ultimately diagnosed with MIS-C were included. Results Seven patients with a median age of 12.5 (interquartile range 10.5–13) years were enrolled. Four were females. The most frequent symptoms were fever, abdominal pain, and vomiting. Three patients had involvement of the appendix that required surgical intervention. All pathology reports were compatible with appendicitis. The other patients also ...
In Turkey Hepatitis A virus (HAV) infection is considered to be moderateendemic. Hepatitis A vacc... more In Turkey Hepatitis A virus (HAV) infection is considered to be moderateendemic. Hepatitis A vaccine was included in the mandatory vaccination schedule of Turkey on November 2012. We aimed to evaluate the cases of HAV infection followed in Ankara, which is located in the center of Central Anatolia, retrospectively according to the date of the administration of the mandatory hepatitis A vaccine. A total of 272 children followed-up between January 2008 and December 2015 for HAV infection in five separate hospitals were enrolled to the study. There were 200 (68.2%) cases in the pre-vaccination group, 72 (31.74%) cases in the post-vaccination group, and 55.1% were male in total. The immunization status were as follow; 89.7% (n = 244) unvaccinated, 0.4% (n = 1) vaccinated and 9.9% (n = 27) with unknown immune status. There was a statistically significant difference between the groups in hospitalization rates, but no statistically significant differences in hospitalization indications, length of hospital stay, complication types and proportions, and normalization period of transaminases. The national hepatitis A immunization program in Turkey has had a significant impact when the targeted population is considered, with suggestive herd protection effects.
Pneumonia is a significant cause of death for children, particularly those in developing countrie... more Pneumonia is a significant cause of death for children, particularly those in developing countries. The records of children who were hospitalized because of pneumonia between January 2003 and December 2015 were retrospectively reviewed, and patients who met the recurrent pneumonia criteria were included in this study. During this 13-year period, 1395 patients were hospitalized with pneumonia; of these, 129 (9.2%) met the criteria for recurrent pneumonia. Underlying diseases were detected in 95 (73.6%) patients, with aspiration syndrome (21.7%) being the most common. Rhinovirus (30.5%), adenovirus (17.2%) and respiratory syncytial virus (13.9%) were the most frequent infectious agents. These results demonstrate that underlying diseases can cause recurrent pneumonia in children. Viruses are also commonly seen in recurrent pneumonia. Appropriate treatments should be chosen based on an analysis of the underlying disease, the patient's clinical condition and the laboratory and radiological data.
Rotavirus is an important morbidity and mortality agent among previously healthy infants. Rotavir... more Rotavirus is an important morbidity and mortality agent among previously healthy infants. Rotavirus gastroenteritis (RG) causes severe fluid and electrolyte imbalance and development of fatal complications during course of the disease, if untreated. Although there are few case reports in the literature regarding septicemia after RG, it is one of the most important complications of the disease. The main reason of septicemia is unknown but it can be associated with severe consequences such as septic shock, endocarditis, and even death. If complications are taken into consideration on the course of disease, morbidity and mortality can be reduced. Herein, we evaluated the clinical characteristics, incidence and types of the complications during RG in this retrospective study. We evaluated a total of 276 patients (164 male, 112 female) diagnosed with RG between January 2006 and February 2013 at the department of Pediatric Infectious Disease. Male to female ratio was 1.5 and the median ag...
Congenital lobar emphysema is a rare disease, which is characterized by pulmoner hyperinflation. ... more Congenital lobar emphysema is a rare disease, which is characterized by pulmoner hyperinflation. Depending on the degree of bronchial obstruction, the clinical presentation may be variable. We report a rare case with congenital lobar emphysema in a 38-days-old male infant who presented with severe respiratory distress and hypertension. Air trapping in the left upper lung and significant mediastinal shift to the right were observed on the chest x-ray. Emphysematous changes were detected on the thorax computed tomography and considered as congenital lobar emphysema. The upper left lobectomy was successfully performed by pediatric surgeons. On postoperative follow up, no sign of respiratory distress occurred and the patient was normotensive. In this report, a case with congenital lobar emphysema, which is a rare cause of respiratory distress and hypertension is discussed.
Akut gastroenterit, özellikle gelişmekte olan ülkelerde önemli bir morbidite ve mortalite nedenid... more Akut gastroenterit, özellikle gelişmekte olan ülkelerde önemli bir morbidite ve mortalite nedenidir. Beş yaş altı çocuklar daha sık etkilenmekle birlikte ölümlerin %80'i iki yaş altında görülmektedir. Escherichia coli, Salmonella spp. ve Shigella spp. en sık neden olan bakteriyel etkenlerdir. 2014 yazı ile başlayan dönemde hizmet bölgemizde her yıl gördüğümüzden daha fazla sayıda Salmonella ve Shigella gastroenteriti vakaları ortaya çıktı. Vaka sayısında ortaya çıkan ani artış yerel küçük bir salgın olduğunu gösteriyordu. Çalışmamızda bu salgında elde edilen izolatların özellikleri ve antibiyotik duyarlılıklarını bildirmeyi amaçladık. Gereç ve Yöntemler: Çocuk sağlığı ve hastalıkları poliklinikleri ve acil servisine Temmuz-Eylül 2014 tarihleri arasında gelen, akut ishal yakınmasıyla başvuran, öyküsünde 15 günden kısa süreli ishali olan ve akut gastroenterit ön tanısı alan hastalar retrospektif olarak çalışmaya alındı. Salgın sırasında bakılan dışkı mikroskopisi, dışkı kültürü, kan kültürü, Salmonella ve Shigella suşlarına ait antimikrobiyal duyarlılık testleri verileri geçmişe yönelik hasta dosyalarından ve laboratuar tetkiklerinden incelendi. Bulgular: Akut gastroenterit nedeniyle toplam 2425 hasta başvurdu. Salmonella spp. ve Shigella spp. 113 çocukta izole edildi. Çocukların yaşları 91,5±60,3 aydı (4-213 ay). Hastaların %56'sı erkek ve %44'ü kızdı. Etken mikroorganizmalar incelendiğinde Shigella spp. 77 hastada (%3,2) ve Salmonella spp. 36 hastada (%1,5) saptandı. Salmonella enteritidis 29 hastada (%80,5) saptanmışken; S. typhimurium üç hastada (%8,3) saptandı. Ek olarak S. sonnei 63 hastada (%81,8) ve S. flexneri sekiz hastada (%10,3) tespit edildi. Salmonella suşlarında seftriakson direnci bulunmamış iken Shigella suşlarında %9,1 seftriak-Abstract Objective: Acute gastroenteritis is an important cause of morbidity and mortality in developing countries. Children under 5 years of age are more commonly affected, while 80% of deaths occur in children under 2 years of age. Escherichia coli, Salmonella spp., and Shigella spp. are the most common causative bacterial pathogens. Since the summer of 2014, a large number of Salmonella and Shigella gastroenteritis cases have occurred in our region, which is considered as a small local outbreak. We aim to report the features and antibiotic susceptibility of microorganism isolates obtained during this epidemic. Material and Methods: Between July and September 2014, patients who were admitted to pediatric clinics and emergency services on account of acute gastroenteritis lasted less than 15 days were included in this retrospective study. Stool microscopy, stool cultures, and blood cultures were performed. Salmonella and Shigella strains were subjected to antimicrobial susceptibility testing. Results: A total of 2425 patients were admitted because of acute gastroenteritis during the study period. Salmonella spp. and Shigella spp. were isolated in 113 children. The mean age of the children was 91.5±60.3 months (4-213 months). Of the 113 patients, 56% were male and 44% were female. Shigella spp. were found in 77 patients (3.2%), and Salmonella spp. were found in 36 patients (1.5%). Salmonella enteritidis was detected in 29 patients (80.5%), whereas Salmonella typhimurium was detected in 3 patients (8.3%). In addition, Shigella sonnei was identified in 63 patients (81.8%) and Shigella flexneri in 8 patients (10.3%). In contrast to ceftriaxone susceptibility in Salmonella strains, 9.1% of Shigella strains were found to be resistant to ceftriaxone. Ciprofloxacin resistance
BACKGROUND Combined immunodeficiencies are marked by inborn errors of T-cell immunity in which th... more BACKGROUND Combined immunodeficiencies are marked by inborn errors of T-cell immunity in which the T cells that are present are quantitatively or functionally deficient. Impaired humoral immunity is also common. Patients have severe infections, autoimmunity, or both. The specific molecular, cellular, and clinical features of many types of combined immunodeficiencies remain unknown. METHODS We performed genetic and cellular immunologic studies involving five unrelated children with early-onset invasive bacterial and viral infections, lymphopenia, and defective T-cell, B-cell, and natural killer (NK)-cell responses. Two patients died early in childhood; after allogeneic hematopoietic stem-cell transplantation, the other three had normalization of T-cell function and clinical improvement. RESULTS We identified biallelic mutations in the dedicator of cytokinesis 2 gene (DOCK2) in these five patients. RAC1 activation was impaired in the T cells. Chemokine-induced migration and actin polymerization were defective in the T cells, B cells, and NK cells. NK-cell degranulation was also affected. Interferon-α and interferon-λ production by peripheral-blood mononuclear cells was diminished after viral infection. Moreover, in DOCK2-deficient fibroblasts, viral replication was increased and virus-induced cell death was enhanced; these conditions were normalized by treatment with interferon alfa-2b or after expression of wild-type DOCK2. CONCLUSIONS Autosomal recessive DOCK2 deficiency is a new mendelian disorder with pleiotropic defects of hematopoietic and nonhematopoietic immunity. Children with clinical features of combined immunodeficiencies, especially with early-onset, invasive infections, may have this condition.
Turk Pediatri Arsivi-turkish Archives of Pediatrics, 2002
Haemophilus influenzae type b strains cause severe infections such as meningitis pneumonia empyem... more Haemophilus influenzae type b strains cause severe infections such as meningitis pneumonia empyema epiglottitis cellulitis septic arthritis pericarditis and bacteremia In this report five children with invasive H influenzae type b infection are presented All patients were younger than two years None of the patients was immunized with H influenzae type b vaccine All of the patients treated with appropriate antibiotics and surgical interventions recovered without sequel H influenzae type b vaccination must be added to routine vaccination schedule in order to prevent H influenzae type b infections in our country Key words: Haemophilus influenzae type b meningitis pneumonia empyema bacteremia preseptal cellulitis
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