A case with solitary rectal ulcer syndrome

Soliter rektal ülser sendromu (SRUS) çocuklarda nadir görülen, rektal kanama, tenesmus, ishal, kabızlık ve mukuslu dışkılama bulgularıyla karakterize bir hastalıktır. SRUS etyolojisi multifaktoriyeldir ve etiyolojide iskemi ve travma önemli role sahiptir. Burada rektal kanama, değişmiş dışkılama alışkanlıkları ve karın ağrısı ile başvuran, kabızlığın olduğu dönemlerde sert fekalomların rektumdan parmakla çıkarıldığı öğrenilen onaltı yaşındaki erkek olgu sunulmuştur. Olguya endoskopik inceleme ile SRUS kesin tanısı konuldu. Bu olgu sunumu ile rektal kanama ve değişken dışkılama şekli yakınmaları olan olgularda mutlaka soliter rektal ülser sendromunun düşünülmesi gerektiği ve yineleyen yakınmaları olan olgularda SRUS'u tanımlamada endoskopik incelemenin önemi vurgulanmak istenilmiştir.Solitary rectal ulcer syndrome (SRUS) is an unusual disease of childhood, which usually presents with rectal bleeding, tenesmus, diarrhea, constipation and mucous discharge.The etiology of SRUS is multifactorial, both trauma and ischemia have an important role in the etiology. Here we describe a 16-year old boy with complaints of abdominal pain, rectal bleeding, disturbed defecatory behavior with a history of digital extraction of feces during constipation periods. The diagnosis was made by endoscopy. In this report we emphasize that in the cases with rectal bleeding and disturbed defecatory behavior, solitary rectal ulcer syndrome must be considered and that in the cases with recurrent complaints, endoscopic investigation is important for the diagnosis

A case of amebiasis and ulcerative colitis during adolescense

Ulseratif kolit çeşitli organ ve sistemleri etkileyen gastrointestinal sistemin inflamatuar hastalığıdır. En sık yakınma kanlı mukuslu diaredir. E. Histolytica'nın neden olduğu amibiazis de kanlı mukuslu diareyle birlikte olup ayırıcı tanıda önem taşır. Her iki tablo da bir arada olabilir. Bu yazıda her iki hastalığın bir arada olduğu rekurren kanlı mukuslu diareyle klinik veren hasta sunulmaktadır. Kronik semptomları olan adölesan hastalarda amibiazis yanında ülseratif kolit de olabileceğini göz önüne alıp kolonoskopi ve histopatolojik inceleme yapılması unutulmamalıdır.Ulcerative colitis is a chronic inflammatory disease of the gastrointestinal system that affects organs and systems. Most common complaint in ulcerative colitis is bloody mucous diarrhea. Amebiasis is also a disease that presents with bloody mucous diarrhea caused by E. histolytica. Therefore it needs to be differentiated from ulcerative colitis. Moreover amebiasis and inflammatory bowel disease are known to exist together. An adolescent patient who was initially diagnosed as amebiasis due to recurrent bloody mucous diarrhea and stool analysis results and which was later diagnosed as ulcerative colitis, was presented. It was thought that in adolescents who were diagnosed as amebiasis with chronic symptoms, diagnostic information may be obtained by evaluation with colonoscopic and histopathological examination, keeping in mind the coexistence of ulcerative colitis

The seropositivity of celiac disease in children with true non-responsiveness to hepatitis B vaccine

Giriş ve Amaç: Günümüzde Hepatit B virüs enfeksiyonuna bağlı mortaliteyi, kronik karaciğer hastalığını ve beraberinde görülen komplikasyonları önlemek için HBV aşıları rutin olarak kullanılmaktadır. Aşıya yanıtsızlık yaş, cinsiyet, kronik hastalıklar ve HLA haplotipleri ile ilişkilidir. Genetik zemin üzerinde ortaya çıkan otoimmün bir hastalık olan çölyak hastalığında (ÇH) HBV aşısına yanıtsızlık daha sık görülmektedir. Bu çalışmada rekombinan HBV aşısına gerçek yanıtsız çocuklarda AGA ve AEA antikorlar yoluyla ÇH seropozitivitesinin araştırılması amaçlanmıştır. Materyal ve Metod: Bu çalışmada doğumdan sonra standart doz ve miktarda HBV aşılaması yapılmış yaşları 8-24 ay arasında olan 153 çocuktan, aşıya gerçek yanıtsız 13 çocuk (5 kız, 8 erkek) saptandı. Bu çocuklarda çölyak hastalığı için ELISA yöntemi ile antigliadin IgA, antigliadin IgG ve antiendomisyal IgA antikor düzeyleri belirlendi. Bulgular: HBV aşısına tam yanıtsız ortalama yaşları 14.0 ± 2.67 ay olan 13 çocuğun antigliadin ve antiendomisyal antikor sonuçları değerlendirildiğinde, iki çocukta antigliadin IgA pozitifliği saptanırken üç çocukta antigliadin IgG pozitif, bir çocukta hem antigliadin IgA hem de antigliadin IgG pozitif, bir çocukta antigliadin IgA ve antiendomisyal antikor ve bir çocukta da sadece antiendomisyal antikor pozitif olarak belirlendi . Sonuç: Çocukluk çağında HBV aşısına gerçek yanıtsız çocuklarda ÇH’a yönelik öncelikle tarama testleri yapılarak hastanın değerlendirilmesi ve serolojik pozitiflik saptananlarda histopatolojik inceleme ile kesin ÇH tanısı konulmasının gerekli olduğu düşünülmüştürO bjective: Universal hepatitis B virus (HBV) vaccination has been carried out in most countires to prevent mortality, chronic liver disease and complications of hepatitis B virus infections during last decade. Unresponsiveness to HBV vaccine is related with age, sex, chronic diseases and HLA haplotypes. Unresponsiveness to HBV vaccine is seen more often in the celiac disease. It’s reported that HLA types which are related with HBV vaccine unresponsiveness like HLA-DRB1 are also related with celiac disease. The aim of this study was to determine the cases of celiac disease in children unresponsive to HBV vaccine. Material and Method: In this study 153 children at the age of 8 to 24 months whose HBV vaccines were done at a standard dosage were included. 13 of the children (5 girls, 8 boys) were true non-responders to vaccine. Antigliadin IgA, antigliadin IgG and antiendomysial IgA antibody levels were detected by ELISA method for celiac disease in true non-responders children. Results: When antigliadin and antiemdomisial antibody results of 13 children at the age of 14.0 ± 2.67 months were evaluated; two children were antigliadin IgA positive, three children were positive for antigliadin IgG, one children was positive for both antigliadin IgA and IgG, one children for antigliadin IgA and antiendomisial antibody and one children for only antiendomisial antibody. Conclusion: It’s concluded that screening tests might be used in children who are true non-responders to HBV vaccine. If the serology is positive, histopathological investigation must be done to diagnose celiac disease

Unrecognized pediatric and adult family members of children with acute brucellosis

Background and aim: Brucellosis is an infectious, contagious and zoonotic disease that occurs worldwide. The family members of an index case of brucellosis may be especially susceptible, due to sharing the same source of infection and similar risk factors for brucellosis. In this study, we propose to screen pediatric and adult family members of brucellosis index cases for detecting additional unrecognized infected family members. Materials and methods: 114 family members of 41 pediatric patients with brucellosis were evaluated. All family members completed a brief questionnaire and were tested by a standard tube agglutination test (STA). Results: The majority of family members (n = 96, 84.2%) were children. Among the 114 family members, 42 (36.8%) were seropositive, and 15 (35.7%) were symptomatic. The majority of the symptomatic seropositive family members (n = 12, 80%) had STA titers (≥1:640) higher than asymptomatic seropositive family members (n = 9, 33%; p = 0.004). Conclusion: The routine screening of both pediatric and adult family members of index cases is a priority in endemic areas. Using this screening approach, unrecognized family members who are seropositive for brucellosis will be identified earlier and be able to receive prompt treatment. Keywords: Brucellosis, Screening, Unrecognized, Turke

Urinary antigen screening in pneumococcal infections in children

Streptococcus pneumoniae is a leading cause of meningitis, bacteremia, pneumonia and otitis media in childhood. The diagnosis of pneumococcal infections still remains problematic. Binax NOW;reg; is a rapid immunochromatographic test (ICT) that detects S. pneumoniae C-polysaccharide antigen in the urine. We evaluated the usefulness of ICT in the diagnosis of pneumococcal infections in children in our study. Fifty children with sepsis, pneumonia, otitis or meningitis (patient group) and 50 healthy children (control group) were enrolled in the study. Urine samples and nasopharyngeal cultures were obtained from all cases. Blood, transtracheal aspirate, urine and CSF (cerebrospinal fluid) cultures were also taken from the patient group when possible. We found urinary antigen positivity in 7 cases in the control group and 10 cases in the patient group. All the children who carried S. pneumoniae in their nasopharynx (1 in the control group and 2 in the patient group for a total of 3 cases) had positive ICT. We detected S. pneumoniae in 3 patients (1 blood culture and 2 CSF cultures) and ICT was positive in all. There was no effect of antimicrobial treatment, vaccination and acute phase reactant levels on the urinary antigen detection test. We concluded that this test is not useful in the diagnosis of pneumococcal infections in children as high carrier rates cause false positivity. This test can only be used with other conventional microbiological tests as a supplementary method.Streptococcus pneumoniae çocukluk çağındaki menenjit, bakteriyemi, pnömoni ve otitlerin en önemli nedenidir. Pnömokokkal enfeksiyonların tanısı halen problemdir. Binax NOW, idrarda S. pneumoniae C- polisakkarit antijenini tarayan hızlı bir immunkromotografik testtir (İKT) . Biz çalışmamızda, çocuklardaki pnömokok enfeksiyonlarının tanısında İKT in kullanılabilirliğini araştırdık. Çalışmamıza 50 sağlıklı çocuk (kontrol grubu) ile sepsis, pnömoni, otit ve menenjit tanılı 50 çocuk (hasta grubu) alındı. Tüm olgulardan idrar örnekleri ve nasofaringeal kültürler elde edildi. Ayrıca hasta grubunda uygun olan olgulardan kan, transtrekeal aspirat, idrar ve BOS (beyin omurilik sıvısı) örnekleri alındı. Kontrol grubunda 7 olguda ve hasta grubunda da 10 olguda üriner antijen pozitifliği bulduk. Nazofarinkslerinde S. pneumoniae taşıyan 3 çocuktan (1 kontrol grubunda, 2 hasta grubunda) hepsinde IKT pozitifti. Biz 1 kan kültüründe, 2 BOS kültüründe olmak üzere 3 olguda pnömokok saptadık. Hepsinde İKT pozitifti. Antimikrobial tedavinin, aşılamanın ve akut faz reaktan düzeylerinin üriner antijen tarama testi üzerine etkisi yoktu. Biz, çocuklardaki pnömokoksik enfeksiyonların tanısında yüksek taşıyıcılık oranlarının yanlış pozitifliğe yol açması nedeniyle bu testin kullanılabilir olmadığı sonucuna vardık. Bu test, sadece diğer geleneksel mikrobiyolojik yöntemlerle birlikte destekleyici yöntem olarak denenebilir

Invasive Pneumococcal Disease Presenting as Purpura Fulminans in a Child with Mondini’s Dysplasia

A case of Mondini's dysplasia who presented with purpura fulminans caused by Streptococcus pneumoniae is described in this case report. Invasive pneumococcal disease is usually related to immune deficiencies or anatomical defects of the upper respiratory tract, like Mondini's dysplasia in our case, which is a developmental anomaly of the middle ear. It is still controversial as to how to protect these people and prevent invasive pneumococcal disease. In this report we tried to discuss possible reasons of invasive infection despite chemoprophylaxis and vaccination. (J Pediatr Inf 2011; 5: 74-6)Bu makalede Mondini displazisi tanısı ile izlenen bir olguda Streptococcus pneumoniae etkeni ile gelişen purpura fulminans tablosu tanımlanmıştır. İnvaziv pnömokokkal hastalık, çoğunlukla altta yatan bir immun yetmezlik ya da olgumuzda varolon Mondini displazisi gibi ortakulak gelişim sorunu ve dolayısı ile solunum yolu ile ilişkili bir anatomik defekt varlığında gelişir. Bu olguların korunması ve invaziv pnömokokkal hastalık gelişimine karşı alınacak önlemler halen tartışmalıdır. Bu yazıda aşılama ve kemoprofilaksiye rağmen invaziv enfeksiyon gelişiminin olası nedenlerini tartışmaya çalıştık. (J Pediatr Inf 2011; 5: 74-6

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