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Background. The prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA) has been increasing worldwide. We aimed to investigate the prevalence of MRSA in community-acquired S. aureus infections, the risk factors for CA-MRSA infection and the clinical features of CA-MRSA. Methods. A multi-center study with prospective and retrospective sections was conducted. Patients ≥ 3 months old and ≤18 years of age who were diagnosed with community-acquired S. aureus infections were included in this study and the patients' information were reviewed from the medical and microbiological database of the hospital. A standard question form about living conditions and exposure risk factors was administered to the parents of patients. The CA-MRSA infections were compared with the methicillin-susceptible S. aureus (CAMSSA) infections in terms of the queried risk factors and clinical variables. Results. We identified 334 pediatric patients with S. aureus infection, 58 (17.4%) had an infection with CAMRSA. The refugee rate was higher in the CA-MRSA group. There was no significant difference regarding the exposure risk. The treatment modalities and outcomes were similar. Conclusions. The study was not able to show reliable clinical variables or epidemiological risk factors except for being a refugee for CA-MRSA infections. Empirical antibiotic treatment should therefore be determined according to the local CA-MRSA prevalence in patients presenting with a possible staphylococcus infection. [ABSTRACT FROM AUTHOR]

Background. Mycoplasma pneumoniae (MP) is one of the most important etiological agents of community acquired pneumonia in children. Methods. The medical records of children with an MP infection between 2008 and 2015 were reviewed for their clinical, laboratory radiological features. Results. This study included 244 patients (male 57.4%) with a median age of 80.5 months (IQR, 46.5-120 months). A total of 78 (32%) patients were < 5 years old, and 166 (68%) were ≥ 5 years old. The most common complaints before admission to the hospital were cough (84.8%), fever (57.4%), and weakness (18.9%). In the <5 years old age group, oxygen saturation was lower, and tachypnea was more common than in the ≥ 5 years old age group (p=0.02 and p=0.05, respectively). Similarly, the physical findings such as the prolonged expiration, presence of retractions, and rhonchi were more frequent in the < 5 years old age group (p=0.001, p=0.000, p=0.02, respectively). Extrapulmonary manifestations were present in 45 (18.4%) patients, and skin involvement was the most common one (7.7%). Two hundred-thirty-eight (97.5%) patients had chest radiographs, and 45 (18.4%) had normal radiography. The most common radiological involvement was peribronchial infiltration (n=70, 28.7%). Of the patients, 147 (60.2%) were hospitalized, and 97 (39.7%) were followed up as outpatients. It was determined that 156 (63.9%) patients had commenced macrolide empirically, and 61 (25%) patients were treated with positive serology results. Conclusions. The prolonged fever, cough and expiration time, wheezing and rhonchi in younger children, and segmental-lober consolidation in chest radiography could be clues for MP infection. Further studies in different age groups can facilitate an understanding of MP infection’s epidemic characteristics and clinical features that will provide early diagnosis and appropriate treatment. [ABSTRACT FROM AUTHOR]

Background. Human brucellosis is one of the most widespread zoonotic diseases that are presented with predominantly hematological manifestations. We aimed to evaluate the hematological findings of childhood brucellosis and to determine the predictive clinical findings and laboratory tests that might be related to hematologic involvement. Methods. We retrospectively analyzed the medical records of children with brucellosis between 1 January 2005 and 31 December 2018. We compared predictive clinical and physical examination findings and laboratory tests in patients with and without hematological involvement. Results. A total of 212 patients (127 boys (59.9%)) with a mean age of 9.4±4.7 years were evaluated in this study. Blood cultures were performed in 161 (75.9%) patients and Brucella spp were isolated in 70 (43.4%) of them. Ninety-two (43.4%) patients had hematological involvement at least in one series. Anemia was detected in 66 (31.7%) patients, leukopenia in 22 (10.6%) and thrombocytopenia in 10 (4.8%). Four patients (1.9%) had pancytopenia. Age distrubutions of the patients with and without hematological involvement were similar (p=0.6). In patients presented with fever, hepatomegaly and splenomegaly, hematologic involvement was significantly higher (p<0.05). Hematological involvement was higher in patients who had elevated aspartate aminotransferase and alanine aminotransferase concentrations (p<0.05). Hematological involvement was higher in patients with positive blood culture (p=0.005). Six patients (2.8%) were treated with intravenous immunoglobulin at 1000 mg/kg/day for two days in addition to anti-brucellosis treatment. Conclusions. Hematological involvement in brucellosis is a common finding regardless of age, especially in febrile, bacteremic patients and in patients who had hepatosplenomegaly and elevated liver enzymes. Anemia is the most common hematological abnormality. [ABSTRACT FROM AUTHOR]

Cystic echinococcosis (CE) is among the most common zoonotic infections worldwide. Studies about CE are limited in childhood. The aim of this study was to evaluate clinical, radiological and laboratory characteristics of childhood CE at a tertiary care pediatric hospital. Medical records of children with CE were analyzed between January 2005 and January 2015. A total of 130 patients with a median age of 10.4 years (IQR= 7.2-years-13.2 years) were evaluated. The anatomic locations of cysts were as follows; liver (76.9%), lung (36.9%), spleen (6.2%), pelvic region (3.8%) and kidney (2.3%). The most common symptoms were abdominal pain and cough in the patients with liver cysts and lung cysts, respectively. The indirect hemagglutination (IHA) test positivity was 58%. Elevated serum total immunoglobulin E levels were detected in 59% of the patients. Fourty-four patients with liver CE, 33 patients with lung CE were treated surgically and 23 patients with liver CE were treated with percutaneous aspiration, injection and re-aspiration (PAIR) along with medical treatment. The recurrence was observed in five patients with liver CE. It was demonstrated that CE mainly involves liver but lung cysts are more frequently symptomatic and prone to be complicated than liver cysts in children. IHA test positivity together with abdominal ultrasonography are useful to diagnose liver CE but thorax CT is usually needed to diagnose lung CE. Liver cysts that are sized greater than 5 cm are more frequently treated with PAIR or surgery but smaller liver cysts can be treated medically. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Parapneumonic effusion (PPE) and empyema are most often seen as a complication of bacterial pneumonia and occasionally associated with atypical bacteria or viruses. The aims of this study were to describe and compare demographic characteristics, clinical, laboratory, microbiological findings and treatment modalities of patients with PPE and empyema. We retrospectively reviewed 116 pediatric patients with PPE and empyema. Seventy (60.3%) had pleural empyema and 46 patients (39.6%) had PPE. The median age of patients with empyema [72.0 months (IQR 68.0 months)] was lower than the patients with PPE [92.5 (IQR 80.0 months)] (p=0.003). Children in the empyema group had significantly more dyspnea symptoms than the children with PPE (p=0.022). Mean fever duration before hospitalization was similar in both groups. Streptococcus pneumoniae and group A streptococcus were the most common causes of empyema. All of the patients were treated with intravenous antibiotics. In addition to medical treatment, tube thoracostomy was performed in 59 of 70 (84.3%) patients in empyema group; 27 (45.8%) of them required intrapleural fibrinolysis also. In the presence of antibiotic treatment failure or in cases with moderate or large pleural effusion with loculations and clinical deterioration; it is necessary to perform drainage of the purulent fluid by tube thoracostomy, to add intrapleural fibrinolytics or to perform video-assisted thoracoscopic surgery (VATS), in order to enhance prompt recovery. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the clinical, radiological, microbiological characteristics, side effects of anti-TB drugs and treatment outcome of childhood definite or probable TB. The medical records of all childhood TB patients were investigated in the department of pediatric infectious disease of a tertiary care hospital between January 2005 and December 2012. Patients who followed-up until the anti-TB treatment was completed were included in the study. One hundred forty four pediatric cases with active TB were included in the study (27 definite, 117 probable). Twentyfour (16.7%) patients were asymptomatic at admission. Pulmonary TB was the most common type. The most common localizations for extrapulmonary TB were superficial lymphadenitis. An index case was detected in 39.6% of the patients. In conclusion, the absence of constitutional symptoms does not exclude TB. Household contact screening plays an important role in the diagnosis of childhood TB especially in asymptomatic patients. [ABSTRACT FROM AUTHOR]

Streptococcus pneumoniae is a leading cause of bacterial meningitis in children. It is also responsible for bacteremia, sepsis, pneumonia, sinusitis and acute otitis media in young children worldwide. The serotypes included in the 7-valent conjugated pneumococcal vaccine (PCV7)--1, 5, 6A, 6B, 14, 19F, 23F--are those most commonly responsible for invasive pneumococcal disease (IPD) globally. Unvaccinated children are at greater risk for meningitis. The rate of non-vaccine serotypes as causes of invasive disease has increased. Although the incidence rate of IPD is highest in children aged <2 years, the rare, non-vaccine serotypes of S. pneumoniae may be responsible for acute meningitis in older, unvaccinated children. In this report, we present a pediatric case of meningitis due to S. pneumoniae serotype 33D, which has not been previously identified as a cause of IPD in those countries where PCV7 is routinely administered, including Turkey. [ABSTRACT FROM AUTHOR]

The aim of this study was to elucidate the clinical presentations, diagnostic clues and management of deep neck infections (DNI) in pediatric patients. Demographic characteristics, clinical manifestations, predisposing factors, duration of symptoms before presentation, history of previous antibiotic use, duration of hospitalization, laboratory and radiographic evaluations, management, complications, and outcomes of 25 patients (19 male/6 female; mean age: 47.9±39.0 months) diagnosed with DNI were analyzed retrospectively. Retropharyngeal abscesses occurred especially in preschool children, whereas peritonsillar abscesses occurred especially in school children. Nine of 25 (36%) patients underwent surgical intervention in addition to medical therapy. Contrast-enhanced computed tomography provided additional information in half of the patients. DNIs should be considered in the differential diagnosis of children who present with fever and neck mass even in the absence of more specific findings. Medical treatment can be considered an option to surgical treatment by utilizing the advantages of imaging techniques and empirical antibiotics. [ABSTRACT FROM AUTHOR]

We performed a retrospective study of pertussis patients seen during the period July 2007-December 2011. All patients were microbiologically confirmed through polymerase chain reaction (PCR) or culture. Thirty-one patients with positive Bordetella spp. culture or PCR were identified, with a median age of two months. Seventeen patients had received no pertussis vaccination. The most frequent symptoms were paroxysmal cough (100%) and cyanosis (87.1%). The mean duration of the symptoms prior to admission was 12.8±8.0 days. Leukocytosis and thrombocytosis were detected in 64.3% and 67.9% of the 28 hospitalized patients, respectively. Erythromycin had been given to eight patients and clarithromycin to 23 patients. The mean hospital stay was 9.5±5.5 days (range: 3 to 28 days). No patients were readmitted or died. We believe that patients with characteristic paroxysmal cough with cyanosis but no fever should alert clinicians to the possibility of pertussis, and they should be treated without delay. PCR assay provided additional benefit in the diagnoses of the study patients. [ABSTRACT FROM AUTHOR]

Tetanus is still a difficult-to-treat disease with high morbidity and mortal Although it most commonly occurs in non-immunized children, it can also be seen in partially immunized or immunized children We report herein two pediatric cases of generalized tetanus. Case 1 presented with signs of acute abdomen, while Case 2 presented with the typical clinical findings of tetanus. In this report, we highlight the importance of obtaining a history of the vaccination status of pediatric patients as an essential part of the evaluation. Furthermore, the differential diagnosis of non-immunized children with abdominal rigidity should include generalized tetanus. [ABSTRACT FROM AUTHOR]

Kawasaki disease is an acute, systemic vasculitis of unknown etiology. Although gastrointestinal involvement does not belong to the classic diagnostic criteria; diarrhea, abdominal pain, hepatic dysfunction, hydrops of gallbladder, and acute febrile cholestatic jaundice are reported in patients with Kawasaki disease. We describe here two cases presented with fever, and acute jaundice as initial features of Kawasaki disease. [ABSTRACT FROM AUTHOR]

Background Chronic granulomatous disease (CGD) is a rare primary immunodeficiency caused by inborn errors of the phagocyte nicotinamide adenine dinucleotide phosphate oxidase complex. From the first year of life onward, most affected patients display multiple, severe, and recurrent infections caused by bacteria and fungi. Mycobacterial infections have also been reported in some patients. Objective Our objective was to assess the effect of mycobacterial disease in patients with CGD. Methods We analyzed retrospectively the clinical features of mycobacterial disease in 71 patients with CGD. Tuberculosis and BCG disease were diagnosed on the basis of microbiological, pathological, and/or clinical criteria. Results Thirty-one (44%) patients had tuberculosis, and 53 (75%) presented with adverse effects of BCG vaccination; 13 (18%) had both tuberculosis and BCG infections. None of these patients displayed clinical disease caused by environmental mycobacteria, Mycobacterium leprae , or Mycobacterium ulcerans . Most patients (76%) also had other pyogenic and fungal infections, but 24% presented solely with mycobacterial disease. Most patients presented a single localized episode of mycobacterial disease (37%), but recurrence (18%), disseminated disease (27%), and even death (18%) were also observed. One common feature in these patients was an early age at presentation for BCG disease. Mycobacterial disease was the first clinical manifestation of CGD in 60% of these patients. Conclusion Mycobacterial disease is relatively common in patients with CGD living in countries in which tuberculosis is endemic, BCG vaccine is mandatory, or both. Adverse reactions to BCG and severe forms of tuberculosis should lead to a suspicion of CGD. BCG vaccine is contraindicated in patients with CGD. [ABSTRACT FROM AUTHOR]