Clinical and Laboratory Features of Invasive Group A Streptococcal Infections: 8 Years Experience

Objective: Invasive infections caused by group A streptococci, including bacteremia, pneumo-nia, sepsis, necrotizing fasciitis, streptococcal toxic shock syndrome, and focal infections, are the significant causes of mortality and morbidity worldwide. This study aimed to assess the clinical and laboratory features and management of children with invasive group A streptococci infections. Materials and Methods: A descriptive observational study was conducted on children younger than 18 years with invasive group A streptococci infection in a single center between 2012 and 2019. The clinical and laboratory features, treatment options, and patient outcomes were evaluated retrospectively. Results: Forty-nine patients diagnosed with an invasive group A streptococci infection were analyzed. Among them, 28 (57.1%) were boys and 21 (42.9%) were girls, with a median age of 84 months (IQR: 48-150). Group A streptococci strains were found to be isolated mainly from the skin and soft tissue abscesses (60.7%). It was found that 21 (42.9%) of the cases were hos-pitalized, and the median duration of hospitalization was 7 (IQR: 5-11) days. It was noted that all of the cases were treated, and infection-related mortality was not observed in any patient. Conclusions: For correct management of invasive group A streptococci infections, timely diag-nosis, appropriate duration of antimicrobial therapy, and surgical intervention in selected cases are required. It is thought that examining this issue in future studies may provide clues regard-ing the localization, severity, management of the infection clinic, and treatment

A prospective long-term evaluation of the ocular findings of children followed with the diagnosis of multisystem inflammatory syndrome (long-term evaluation of ocular findings following MIS-C)

Background/Objectives: The most frequently reported ocular finding in the acute phase of the multisystem inflammatory syndrome in children (MIS-C), is conjunctivitis. More rarely, punctuate epitheliopathy, anterior uveitis and optic disc oedema can be seen. We aimed to investigate the acute and long-term ocular effects of MIS-C. Subjects/Methods: Cases aged 1 month to 18 years who were diagnosed with MIS-C between January 2022 and June 2022 in the Department of Pediatric Infectious Diseases in our hospital were included in the study. Ophthalmological examinations were performed immediately after diagnosis, at one month, three months, and six months. Results: Males consisted of 64.7% of the 34 cases included in the study and the mean age was 8.68 ± 4.32 years (min-max:2–17). In the first examination, conjunctivitis was observed in 6 (17.6%), punctuate epitheliopathy in 4 (11.7%), and subconjunctival haemorrhage in 3 (8.8%) patients. Two patients (5.8%) had optic disc oedema. No pathological anterior or posterior segment findings were observed in the sixth-month examination. The relationship between subconjunctival haemorrhage and intensive care hospitalisation was statistically significant (p = 0.014). Also, all patients with subconjunctival haemorrhage were clinically classified as severe MIS-C (p = 0.002). Conclusion: Although pathological ocular findings were observed in the acute phase of the disease, all of them were found to be improved at the sixth-month follow-up. The most striking finding of our study is that cases with subconjunctival haemorrhage were clinically more severe, and all patients needed intensive care. This study may be informative in establishing ocular follow-up protocols that are expected to be carried out in the acute period and in the follow-up of these patients

Colistin Treatment for Multidrug-Resistant Gram-Negative Infections in Children: Caution Required for Nephrotoxicity

Objectives: Colistin has come to the fore as a treatment option, especially with the occurrence of multidrug-resistant Gram-neg ative infections across the world. However, the high nephrotoxic effects of colistin should be taken into consideration in children. The study’s primary outcome was to determine the clinical success of the colistin treatment, and the secondary outcome was to detect the side effects related to colistin. Methods: The patients who received intravenous colistin in our hospital’s last 5 years were included in the study. In addition to the patients’ demographic and clinical characteristics, the clinical success of the colistin treatment, 28-day infection-related mortality of the patients, and side effects of colistin were recorded. Results: A total of 37 patients received colistin therapy during 2015–2019. Four of these patients had colistin treatment twice a year, so we accepted them as separate cases in each infection attack. Therefore, 41 cases were included in the study. The median age of the cases was 26 months (IQR: 4.50–144.50) and 27 (65.9%) were male. Twenty-seven cases (65.9%) had sepsis. The median dose of colistin was 4.2 (IQR: 3–5) mg/kg/day. Among 44 cultures obtained from the patients, the most common microorganism was Acinetobacter baumannii, with 58.5%. The clinical success was detected in 18 patients (43.9%). While overall nephrotoxicity developed in 14 (34.1%) patients, only two of them needed dialysis. Conclusion: Colistin should not be considered the first choice in treating Gram-negative infections but should be kept as salvage therapy in multidrug-resistant Gram-negative infections across the world. During the treatment process, close monitoring of renal function tests and urinary output were recommended due to the risk of developing nephrotoxicity

Knowledge and Attitudes of Pediatricians to The Human Papilloma Virus Vaccines

Objective: Human papilloma virus (HPV) infection is the most common sexually transmitted viral infection worldwide. It is the cause of cervical cancer, and also causes many malignant, and benign diseases. Although it has an effectual vaccine, vaccination rates are still at an undesired level. In this cross-sectional study, it was aimed to investigate the knowledge and attitudes of pediatricians about HPV vaccine. Method: A questionnaire consisting of 18 questions about HPV disease and vaccine was applied to pediatricians working in our hospital via face-to-face interviews. Demographic characteristics, duration of their working in the field of pediatrics, and some questions and suggestions about HPV disease and vaccine were included in the questionnaire. Results: Ninety-eight (66.6%) out of 147 pediatricians participated in the questionnaire survey..The median age of the participants was 30.5 years (min-max: 25-66), and they were consisted mostly (70.4%).of female pediatricians. In terms of distribution of their academic positions, 54 (55.1%) of them were working as pediatric residents. Only 15.3% of the participants had received HPV vaccine. When questions about the vaccine were analyzed, 94.9% of the participants knew that the HPV vaccine was not included in the national vaccination schedule, 64.3% knew the recommended vaccination age, and 84.7% knew that application gender of the vaccine. Some ( 60.2%) participants recommended HPV vaccine to their patients. When pediatricians were asked why they did not recommend the vaccine, according to their responses, the most important factor was the fact that had not sufficient knowledge about the vaccine (14.3%) and had not encountered a patient within the indication (14.3%).The vaccine recommendation rates of the vaccinated physicians were statistically significantly higher than unvaccinated physicians (p=0.028).There was no statistically significant difference between medical experience and recommendation for HPV vaccine beforehand and knowing the names of HPV vaccines (p=0.316, p=0.414, respectively). Conclusion: Although the overall attitude towards HPV vaccination was generally positive in our study, additional training should be provided to both pediatricians and healthcare professionals in order to achieve higher HPV vaccination coverage rates in Turkey

Evaluation of Ocular Findings Following Multisystem Inflammatory Syndrome in Children

Objective Multisystem inflammatory syndrome (MIS-C) in children is associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and can be mortal with the involvement of multiple organ systems. However, long-term effects on all organs and organ systems involvement are still unclear or even whether this condition may still occur in which organs. This report aims to identify ocular findings in children with MIS-C on the follow-up. Methods This is a prospective cross-sectional study. Cases diagnosed with MIS-C between May 2020 and February 2021 in our hospital (e.g., cases aged 1 month-18 years old) were included in the study. The same ophthalmologist followed up with the patients after discharge. Patients underwent detailed ophthalmic examinations, including slit lamp biomicroscopy and fundoscopy, best-corrected visual acuity, and Schirmer's 2 test. Results Our study included 22 patients treated with the MIS-C. Twelve (54.5%) were girls, and 10 (45.5%) were boys. Their mean age was 8.7 ± 4.9 years. Pathological ocular findings were found in six (27.2%) patients in the follow-up. The most common finding was punctate epitheliopathy in four (18.2%) patients. The cause of punctate epitheliopathy was dry eye. All patients recovered with treatment. Conclusion Our study is the first to evaluate ocular findings in MIS-C in the long term. Regardless of the severity of the disease, the most common ocular finding in our study was punctate epitheliopathy, that is, dry eye. According to our results, we think patients should be followed up on pathological ocular findings after discharge

A rare case series of central nervous system cystic echinococcosis

A total of three cases of childhood central nervous system (CNS) echinococcosis with spinal or posterior fossa involvement having rare localizations, have been presented. Case presentation: A 7-year-old boy with spinal involvement applied to our hospital with left leg weakness and inability to walk. A 16-year-old girl with posterior fossa involvement had peripheral facial paralysis, while a 9-year-old girl had headache and vomiting. These cases, diagnosed with cystic echinococcosis with the necessary laboratory and imaging methods, improved with appropriate medical treatment and surgery. Discussion: Especially in endemic areas, it should be kept in mind that cystic echinococcosis may present with CNS involvement and should become to mind in the differential diagnosis when neurological findings are detected. Lay Summary: With this report, we attempted to share our experience with cystic echinococcosis in the spinal region and posterior fossa in three children over 1 year, including a description of associated signs and symptoms as well as laboratory and radiological findings. It should be kept in mind that cystic echinococcosis may present with CNS involvement in endemic areas and should be considered in the differential diagnosis when neurological findings are detected. Afterward, the diagnosis should be confirmed with appropriate laboratory and imaging methods. In these cases, rapid recovery can be achieved with appropriate surgical intervention as well as medical treatment

One year period of invasive pneumococcal disease in children from a tertiary care hospital in Turkey in the post-vaccine era

The incidence of invasive pneumococcal disease (IPD) has decreased after pneumococcal conjugate vaccine used; however, a breakthrough infection may still be seen after vaccination. In this study, eight pediatric inpatients and nine episodes with IPD in our center were included. Their age and gender, diagnoses, facilitating factors, the status of immunization and the antibiotic resistance of Pneumococci, serotypes of Pneumococci were noted. The isolates were subjected to disc susceptibility tests for penicillin, macrolides, and fluoroquinolones, according to the guidelines of the Clinical and Laboratory Standards Institute. Of the vaccinated seven cases, four of them (57.1%) developed IPD which their serogroups were in vaccine content. It was observed that all four cases in question had an underlying facilitating factor. Pneumococcal antibiotic susceptibility is also crucial. Three of nine isolates (33.4%) were resistant, and one isolate (11.2%) was intermediate susceptible to penicillin. Six of the nine isolates (66.7%) had macrolide resistance in our investigation. Invasive pneumococcal infections with serogroups that exist in pneumococcal conjugate vaccine content may occur in vaccinated individuals

Parental Attitudes About Lumbar Puncture in Children With Suspected Central Nervous System Infection

Objectives This study aimed to evaluate parents' attitudes toward lumbar puncture (LP) for their children with suspected central nervous system infection to determine the reasons for rejection and related factors. Methods The survey was provided to parents of children (1 month to 18 years old) for whom LP was recommended because of a concern for central nervous system infection. Sociodemographic characteristics and other related factors of parents who did and did not approve of LP were compared statistically. The reasons for the disapproval of parents who refused LP were revealed. Results A total of 100 parents were included in the study. Eighty-two percent of the participating parents were mothers, and the median age of the mothers was 31 years (min: 17 years; max: 70 years). The median age of the fathers was 37 years (min: 22 years; max: 60 years). Among the parents, 34% did not give consent for LP. The most common reason for the participants to refuse LP was fear of paralysis of their children due to the procedure (82.3%). There was a statistical difference between the approval of the LP procedure and the person who informed the parents about the LP procedure and read the informed consent form (P = 0.004 and P = 0.038, respectively). As a result of the binary logistic regression analysis, it was seen that the rate of acceptance of the LP procedure by the parents informed by the specialist doctors was 7.1-fold (P = 0.02; 95% confidence interval, 1.3-37.6) higher than the parents informed by the resident physicians. Conclusion The informed consent process mainly influenced parents' attitudes toward LP. To increase the acceptance rates of LP, we should standardize the informed consent process so that it is not affected by factors such as seniority of the physician