Diagnostic value of lung ultrasonography in children with COVID-19

Background: Lung ultrasound (LUS) has been successfully used in the diagnosis of different pulmonary diseases. Present study design to determine the diagnostic value of LUS in the evaluation of children with novel coronavirus disease 2019 (COVID-19). Methods and objectives: Prospective multicenter study, 40 children with confirmed COVID-19 were included. LUS was performed to all patients at admission. The chest X-ray and computed tomography (CT) were performed according to the decision of the primary physicians. LUS results were compared with chest X-ray and CT findings and diagnostic performance was determined. Results: Of the 40 children median (range) was 10.5 (0.4-17.8) years. Chest X-ray and LUS were performed on all and chest CT was performed on 28 (70%) patients at the time of diagnosis. Sixteen (40%) patients had no apparent chest CT abnormalities suggestive of COVID-19, whereas 12 (30%) had abnormalities. LUS confirmed the diagnosis of pulmonary involvement in 10 of 12 patients with positive CT findings. LUS demonstrated normal lung patterns among 15 of 16 patients who had normal CT features. The sensitivity and the area under the receiver operating characteristics (ROC) curve (area under the ROC curve) identified by the chest X-ray and LUS tests were compared and statistically significantly different (McNemar's test: p = .016 and p = .001 respectively) detected. Chest X-ray displayed false-negative results for pulmonary involvement in 75% whereas for LUS it was 16.7%. Conclusions: LUS might be a useful tool in the diagnostic steps of children with COVID-19. A reduction in chest CT assessments may be possible when LUS is used in the initial diagnostic steps for these children

Bloodstream Infections by Extended-spectrum β-lactamase-producing Klebsiella Species in Children

Infections caused by resistant Gram-negative bacteria are a serious public health problem, with Klebsiella spp. being the most common cause and increasing over the years. There is a striking increase in antibiotic resistance worldwide. The aim of this study was to retrospectively evaluate the characteristics and treatment of bloodstream infections (BSIs) caused by Klebsiella spp. and to identify possible risk factors for extended-spectrum β-lactamase (ESBL) resistance in our hospital between August 2019 and March 2023. Of 250 Klebsiella isolates, 112 (44.8%) were ESBL producers and 138 (55.2%) were ESBL nonproducers. Catheter-related BSIs (CRBSIs) accounted for 49.6% of infections and were more common in the ESBL nonproducer group. Most of the Klebsiella spp. were K. pneumoniae (233/250). Most of the infections were healthcare-associated infections (85.6%). Most patients had an underlying disease, the most common underlying disease in the ESBL-producing group was neurometabolic disease (26.8%), whereas in the ESBL-non-producing group it was malignancy (35.5%). The median age of the ESBL-producing group was 14 months and was younger (p=0.01). Previous antibiotic use in the last 30 days, especially aminoglycosides (p<0.006), β-lactam-β-lactamase inhibitor combinations (p<0.001) and cephalosporins (p<0.001), increased ESBL-resistant infection. Use of β-lactam-β-lactamase inhibitor combinations in the last 30 days increased the risk of ESBL resistance by approximately 7.4 times, and cephalosporins increased the risk by 5 times. In the ESBL-producing group, the median duration of treatment was longer at 14 days (p=0.01), and carbapenems were most commonly used (p<0.001). Thrombocytopenia (p=0.003), elevated C-reactive protein (p<0.001), CRBSI (p=0.009), presence of central venous catheter (p=0.03), urinary catheter (p<0.001), mechanical ventilation (p<0.001), intensive care admission (p=0.005), previous use of carbapenems, aminoglycosides, fluoroquinolones in the last 30 days (p=0.003, p=0.001, p=0.006, respectively) and colistin treatment (p<0.001) increased the risk of mortality. The 28-day mortality rate was 11.6%. Appropriate use of narrow-spectrum antibiotics and reduction of invasive procedures is important in reducing ESBL resistance and BSI-related mortality

A case of Horner's syndrome after the surgical treatment of pulmonary hydatid cyst.

We report a case of right-sided iatrogenic Horner’s syndrome developed after surgical treatment for pulmonary hydatid cyst. This occurred in a 10 year old girl who had been diagnosed as having a ruptured lung hydatid cyst on the basis of clinical, radiological, serological, histopathological and perioperative fi ndings. The patient underwent right thoracotomy and the cystotomy-capitonnage for the cyst. Right upper lid ptosis, right miosis and anisocoria were recognized on the fi rst postoperative day. Findings of Horner’s syndrome were ameliorated completely at the 6th month. In conclusion, iatrogenic transient Horner’s syndrome may develop after surgery for pulmonary hydatid cyst, especially if the cyst is located at the lung apex

Clinical and microbiological features of resistant gram-negative bloodstream infections in children

Summary: Background: Bloodstream infections (BSIs) caused by Gram-negative (GN) bacteria cause significant morbidity and mortality. There is a worldwide increase in the reported incidence of resistant microorganisms; therefore, surveillance programs are important to define resistance patterns of GN microorganisms causing BSIs. The objective of this study was to describe the clinical and microbiological features of resistant GN BSIs in a tertiary pediatric hospital in Turkey. Methods: Patients between 1 month and 18 years of age hospitalized between January 2005 and December 2012 were included in this study. The presence of ESBL and AmpC type beta-lactamase activity were evaluated using the Clinical and Laboratory Standards Institute (CLSI) disk diffusion and double-disk synergy tests. Results: A total of 209 resistant GN bacterial BSI episodes were identified in 192 patients. Of 192 children, 133 (69.2%) were aged ≤48 months of age. Sixty-six (31.6%) of the BSIs were considered community-acquired and 143 (68.4%) were hospital-acquired infections. The most common isolates were non-fermenting GN bacteria (n = 117, 55.9%). The major causative pathogens were Pseudomonas spp. in non-fermenting GN bacteria. The resistance rates to imipenem for Pseudomonas spp. and Acinetobacter spp. were 40.5% and 41.6%, respectively. The most common isolates in fatal patients were Pseudomonas spp. followed by Escherichia coli. The overall 28-day mortality rate was 16.3%. Conclusions: Although our study was performed at a single center and represents a local population, based on this study, it is concluded that surveillance programs and studies of novel antibiotics for resistant GN bacteria focusing on pediatric patients are required. Keywords: Bloodstream infection, Gram-negative, Resistance, Childre

Clinical Characterics, Laboratory Features, and Management of Odontogenic Facial Cellulitis

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

The Role of Adenovirus in Hepatitis of Unknown Etiology Among Children in Turkey, July 2022 to January 2023

Background: In the first half of 2022, the increase in cases of severe acute hepatitis in children with no epidemiological link and unknown cause has aroused concern worldwide. In this study, we aimed to determine the frequency of adenovirus in children with hepatitis of unknown origin in Turkey. Methods: In this study, which was conducted with the participation of 16 centers from Turkey, between July 2022 and January 2023, 36 pediatric patients under the age of 18 who met the definition of acute hepatitis were included. Results: Twenty (55,6%) of patients were female and 16 (44,4%) were male, with a mean age of 41.55 ± 39.22 (3-192) months. The most common symptoms were fever (66.7%), weakness (66.7%), loss of appetite (66.7%), fatigue (61.1%), vomiting (61.1%), and diarrhea (47.2%). Six (16 %) children had acute hepatic failure. Eight of the 15 children (46%) had respiratory viral infections (rhinovirus/enterovirus, n = 4; rhinovirus + parainfluenza, n = 1; parainfluenza, n = 1, SARS-CoV-2 n = 2). Adenovirus was detected in 16 (44%) patients. Adenovirus and coinfections were detected in 7 patients. History of diarrhea and fatigue in the last month was significantly higher in the adenovirus group (P = 0.023 and 0.018). One child who had both adenovirus and rhinovirus infection required liver transplantation; all others recovered with supportive care. Conclusion: There were no deaths in our series; however, the number of cases, etiology, and severity of the clinical course may have differed between countries owing to differences in case definitions, laboratory facilities, or regional genetic differences