A Turkish case of congenital chloride diarrhea with SLC26A3 gene (c.2025-2026insATC) mutation: Diagnostic pitfalls

Congenital chloride diarrhea is a rare autosomal recessively inherited disorder characterized by impairment of Cl-/HCO3- exchange in an otherwise normal distal ileum and colon. Infrequency of congenital chloride diarrhea makes diagnostics difficult. The typical presentation is watery Cl- rich diarrhea, hypochloremia, hypokalemia, metabolic alkalosis and failure to thrive. This is a report of a Turkish female infant who was falsely diagnosed with Bartter syndrome when she was two months old. Ibuprofen was commenced at that time. However, severe watery diarrhea, dehydration, failure to thrive, abdominal distention, and electrolyte abnormalities persisted. She was diagnosed with congenital chloride diarrhea based on high fecal Cl- level and SLC26A3 gene c.2025-2026insATC mutation at the age of eight months. Oral NaCl and KCl supplementation was started. Our patient is now 26 months old. Her growth and development are normal. Early diagnosis and treatment are essential for normal growth and development and prevention of other severe complications of congenital chloride diarrhea

A case of glandular tularemia presenting with prolonged fever and mesenteric lymphadenopathy

Tularemia is a zoonotic disease caused by Francisella tularensis, a gramnegative coccobacillus that is transmitted to humans by direct contact with or ingestion of infected animal tissues, through the bite of infected arthropods, by consumption of contaminated food or water, or from inhalation of aerosolized bacteria. Presented herein is a case of a four-year-old girl who was diagnosed with glandular tularemia after presenting with prolonged fever and mesenteric lymphadenopathy. A history of contact with a rabbit was a valuable clue for the diagnosis

Implantable vascular access port-associated bloodstream infection caused by rhizobium radiobacter: A case report

Rhizobium radiobacter is an uncommon opportunistic pathogen present in soil. It has been particularly associated with indwelling intravascular devices in immunocompromised patients. Reported herein is a case of R. radiobacter bloodstream infection associated with an implantable vascular access port, which was easily controlled with antimicrobial treatment and did not require removal of the intravascular device, in a child diagnosed with acute lymphoblastic leukemia. Also included is a review of the pertinent literature regarding the clinical presentation and management of R. radiobacter infections in the childhood period

Esophageal stricture due to recurrent mucositis in a patient with acute lymphoblastic leukemia

An esophageal stricture is one of the complications that may develop during cancer treatment in children. Although more commonly associated with radiotherapy, recurrent mucositis has also been implicated. Presented herein is a case of a patient with acute lymphoblastic leukemia who suffered recurrent attacks of severe mucositis. Initial management of ensuing dysphagia included antifungal treatment for candida esophagitis. A subsequent upper endoscopy due to persistence of dysphagia revealed the presence of an esophageal stricture. Our aim in presenting this case is to emphasize the importance of considering a diagnosis of esophageal stricture in patients receiving anti-cancer treatment; early endoscopic intervention may be warranted in some patients

Demographic and clinical findings in children with enteroviral infection outbreak Enteroviral enfeksiyon salgi{dotless}ni{dotless} olan çocuklarda demografik ve klinik bulgular

Objective: Enteroviral infections is a group of common childhood infection particularly in children under 5 years. Patients generally present with hand-footmouth disease or herpangina which are benign and self-limiting. Bu rarely enteroviruses cause life-threatening diseases like viral meningitis, encephalitis and myocarditis. This study aimed to review epidemiological and clinical data for cases with enteroviral infections diagnosed in our hospital, in order to help develop and implement precautionary measures applicable for future epidemics. Material and Methods: In this study; demographic and clinical data for patients with enteroviral infection were investigated between April and November 2012. Enteroviral infections were diagnosed by typical symptoms and clinical findings for enteroviruses. Results: A total of 39 patients were diagnosed with enteroviral infection in the study. Most patients (79%) were under 5 years old, with a median age at onset of 3.9 years (10 months-16 year 6 months) and 59% were male. Disease peaked in July and August and decreased in the Autumn months. The most common symptoms on presentation were rash (77%), rash with fever (18%) and fever (5%). Gastrointestinal tract symptoms such as nausea, vomiting, diarrhea and constipation were reported in 18% of patients. Neurological symptoms were not seen frequently in our patients, only one of them (2.5%) had a headache. One patient (2.5%) was hospitalized due to severe mucositis, resistant fever and feeding problems. Conclusion: In contrast to Asian countries, enteroviruses caused benign and self-limited disease in our country. All clinical findings were mild and reversible in our patients. © 2013 by Pediatric Infectious Diseases Society

Demographic and Clinical Findings in Children with Enteroviral Infection Outbreak

Objective: Enteroviral infections is a group of common childhood infection particularly in children under 5 years. Patients generally present with hand-footmouth disease or herpangina which are benign and self-limiting. Bu rarely enteroviruses cause life-threatening diseases like viral meningitis, encephalitis and myocarditis. This study aimed to review epidemiological and clinical data for cases with enteroviral infections diagnosed in our hospital, in order to help develop and implement precautionary measures applicable for future epidemics. Material and Methods: In this study; demographic and clinical data for patients with enteroviral infection were investigated between April and November 2012. Enteroviral infections were diagnosed by typical symptoms and clinical findings for enteroviruses. Results: A total of 39 patients were diagnosed with enteroviral infection in the study. Most patients (79%) were under 5 years old, with a median age at onset of 3.9 years (10 months-16 year 6 months) and 59% were male. Disease peaked in July and August and decreased in the Autumn months. The most common symptoms on presentation were rash (77%), rash with fever (18%) and fever (5%). Gastrointestinal tract symptoms such as nausea, vomiting, diarrhea and constipation were reported in 18% of patients. Neurological symptoms were not seen frequently in our patients, only one of them (2.5%) had a headache. One patient (2.5%) was hospitalized due to severe mucositis, resistant fever and feeding problems. Conclusion: In contrast to Asian countries, enteroviruses caused benign and self-limited disease in our country. All clinical findings were mild and reversible in our patients. © 2013 by Pediatric Infectious Diseases Society

Brucellosis in childhood: Hacettepe University experience Çocukluk çaǧinda bruselloz: Hacettepe Üniversitesi deneyimi

In the present study, 24 cases with brucellosis followed up from 1 January 2000 to 30 April 2010 in the Infectious Diseases Unit of Hacettepe University İhsan Doǧramaci Children's Hospital were retrospectively reviewed. Brucellosis was diagnosed by an increased brucella agglutination titer of 1:160 or greater and/or isolation of the organism by culture in the presence of clinical findings. The 24 patients (13 males, 11 females) were aged 11.2±3.5 years. File records were obtained, and the most common symptoms on admission were fever (93.3%), malaise (86.6%), lack of appetite (80%), sweating (66.6%), and joint pain and swelling (53.3%). On physical examination, the findings and percentages were as follows: fever (93.3%), arthritis (46.6%), lymphadenopathy (26.6%), splenomegaly (6.6%), and maculopapular rash (6.6%). Seventeen percent of the patients had high aminotransferase levels, 63% had high erythrocyte sedimentation rate and 72% had increased levels of positivity of C-reactive protein (CRP). In 30.7% of the cases, blood cultures were positive. All of the cases received combined antibiotic therapy. One of the cases (6.6%) had relapse during the follow-up period

Brain abscess in childhood: A 28-year experience

Brain abscess is an uncommon intracranial suppurative infectious disease, especially in children. The clinical presentation, treatment and outcome of 75 children with brain abscesses admitted to the Department of Pediatric Infectious Diseases at Hacettepe University Faculty of Medicine were retrospectively analyzed. Seventy-five cases of brain abscess within a 28-year period were included in this study. Fever and headache were the most common presenting symptoms. Cyanotic congenital heart disease was the most common predisposing factor. The most common pathogen was Streptococcus spp. Although congenital heart disease remained the most common predisposing factor for development of intracerebral abscess, the rate of immunocompromised diseases as a predisposing factor of brain abscess has increased in recent years, and better management of otogenic infections also influences the prevalence of the disease

Characteristics and Results of Hospital Admission Caused by Influenza Virus Infections in Children under 5 Years Old

Aims: The influenza virus is an infectious disease with acute respiratory tract infections, caused secondary bacterial infections and death. In this study, we aimed to determine which predictors were associated with the need for high-flow nasal cannula oxygen therapy (HFNC) and transition to intensive care for influenza virus and also to compare single viral pathogens with multiple ones. Methods: Inpatients under the age of 5 with influenza virus-related respiratory tract infections between November 2015 and March 2019 were included in the study. Demographic features, comorbidities, symptoms, secondary bacterial infection, need for HFNC and pediatric intensive care unit and respiratory support system, length of hospital stay, polymerase chain reaction tests were recorded. Results: A total of 93 patients were included in the study. It was determined that 53.8% of the cases were male and 84.9% were under the age of 2. Comorbidities were present in 50.5% of the cases. Secondary bacterial pneumonia developed in 56.9% of the cases. Patients with secondary bacterial pneumonia had higher PICU need, HFNC need and hospital stay (p = 0.014, p ≤ 0.001 and p ≤ 0.001, respectively). Patients with comorbidity had longer hospital stays and a higher need for HFNC (p ≤ 0.001 and p = 0.001, respectively). Conclusions: In this study, it was determined that especially comorbidity and secondary bacterial infection aggravated the clinical treatment of hospitalized patients. Therefore, it was concluded that patients with comorbidity should be followed closely and secondary bacterial pneumonia should be recognized and treated early

Oseltamivir use in infants under one year of age: Are there still unanswered questions?

The influenza A (H1N1) virus responsible for the 2009 pandemic follows a more severe course in children, thus increasing the need for hospitalization. On the other hand, during the first weeks of the pandemic, use of oseltamivir (Tamiflu®) in children was restricted, and it was not yet approved for use in children younger than one year of age because of the lack of adequate safety and efficacy data and because of concerns regarding central nervous system (CNS) toxicity in newborn rats. However, citing a state of emergency, conditional approval was granted first in the United States, then Europe and finally in Turkey. The main aim of this study was to share our experience with oseltamivir in 35 patients less than one year of age during the 2009 H1N1 pandemic. A total of 35 infants (21 boys, 14 girls; mean age: 160 days [24-335]) were treated during the study period. Six patients required hospitalization, five of whom (14.2%) had an underlying chronic disorder. During the pandemic, we diagnosed H1N1 infection based on clinical symptoms. Nasal swabs were positive for H1N1 in 88.5% of cases. Mild elevations in liver enzymes were present in 39.1% of patients with available blood work-up at presentation, and no changes in liver enzymes were observed with oseltamivir treatment. None of the patients developed any neurological, dermatological or gastrointestinal side effects in association with oseltamivir treatment. No complaints of drowsiness, lethargy or sleep disturbance were reported by the parents. Although our case number is very limited, our study results suggest that oseltamivir is well tolerated in young infants, and we can conclude that oseltamivir could be used in the treatment of influenza A in this age group. Nevertheless, further studies are needed to evaluate using oseltamivir in more cases among infancy age groups