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AIM: To demonstrate the importance of an integrated viral surveillance to tackle the changing epidemiology and the continuing disease burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). BACKGROUND: International institutions such as European Centre for Disease Prevention and Control provide guidance for integrated surveillance of respiratory viruses. However, SARS-CoV-2 is not an integral part of sentinel influenza like illness and severe acute respiratory infections surveillance in Türkiye. METHODS: We utilized the database from the Global Influenza Hospital Surveillance Network project in Türkiye between November 1st, 2022 and May 31st, 2024 over two seasons. Patients admitted to five hospitals with influenza like illness symptoms in the last 7 days and stayed overnight in the hospital were screened three days a week and swabbed within 72 hours of admission in a standardized year around surveillance methodology. An oligonucleotide panel analysis was utilized during November 1st 2022 to October 31st 2023 and multiplex PCR was utilized thereafter to test for influenza A and B, SARS-CoV-2 and respiratory syncytial virus (RSV). RESULTS: A total of 984 inpatients were enrolled and 969 of them, 724 (75%) of whom were adults, had valid laboratory results. RSV was the most prevalent pathogen detected in 4.9% of the samples, followed by SARS-CoV-2 (4.8%) and influenza A and B (3%). CONCLUSIONS: SARS-CoV-2 is circulating and resulting in hospital admissions among all age groups adding onto the influenza and RSV peaks. Integrated respiratory virus surveillance is crucial to guide informed public health policies and effective vaccination programs.

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) typically leads to mild infectious disease in children, although both acute infection and multisystem inflammatory syndrome in children can cause severe complications. Additionally, SARS-CoV-2 is a neurotropic virus that can present with a wide spectrum of neurological symptoms. Acute necrotizing encephalopathy of childhood (ANE) is a rare acute encephalitis characterized by symmetrical lesions in the thalamus with variable involvement of the white matter, brainstem, and cerebellum. It usually develops after viral infection in genetically predisposed patients. Although the prognosis is poor, some patients respond to steroid and intravenous immunoglobulin (IVIG) treatment. In this case report, we present the case of an 11-year-old patient with no previously known disease who developed SARS-CoV-2-related ANE that did not respond to steroid and IVIG treatment. Our patient was incidentally diagnosed with Takayasu arteritis, and brain death occurred in the 32nd hour of admission.

Objective: The role of combination regimens in the treatment of invasive fungal infections (IFIs) in hematologic malignancies remains unclear. We aimed to demonstrate data about combined antifungal therapy (CAT) in pediatric leukemia patients with IFI. Method: Between January 2014 and December 2018, a total of 33 IFI episodes in 28 leukemia patients were analyzed retrospectively. Results: The study patients had acute lymphoblastic leukemia (n=19), acute myeloblastic leukemia (n=9), leukemia relapse (n=21; 75%) and remission (n=7; 25%). The patients were classified as having possible (n=26; 78.8%), probable (n=5; 15.1%) and proven IFI (n=2; 6.1%). Liposomal amphotericin B (LamB) was the most preferred agent (50%) in monotherapy. Mean duration of monotherapy was 12.84+-4.28 (5-24) days. LamB plus voriconazole (54.5%) was the most commonly preferred CAT. Mean duration of CAT was 42.36+-36.4 days, and this combination regimen was not changed throughout the treatment period (p=0.571). Total and IFI-related mortality rates were 60.7% vs 46.4%, respectively. Mortality rates were significantly higher in patients with relapse (p=0.006). Complete response was obtained in 81.8% of surviving patients. Side effects of CAT were observed at quite a low level. Conclusion: CAT has been found to be safe in the treatment of IFI episodes of pediatric leukemia. Uncontrolled underlying disease is the most important factor affecting the mortality rates in IFI.

Objective: To investigate the clinical and epidemiological features and outcome of Chryseobacterium and Elizabethkingia spp. infections in children, together with antimicrobial susceptibilities. Methods: This retrospective study was conducted at a tertiary pediatric hospital in Turkey. All patients infected with Chryseobacterium/Elizabethkingia spp. among those presenting to Ankara City Hospital between March 2014 and March 2022 were included. Results: A total of 49 cases were included and 29 cases were identified as Elizabethkingia. The median age was 14 (0.2-185.0) months. The majority (89.8%) of these patients had an underlying disease, including malignancy (42.9%). Bacteremia (46.9%) and central line-associated bloodstream infection (28.6%) were the most common infections. The thirty-day all-cause mortality rate was 12.2%. The most commonly used antibiotics were ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX). Forty-five (91.8%) isolates were susceptible to ciprofloxacin, 44 (91.6%) to TMP-SMX, and 21 (87.5%) to levofloxacin. Conclusions: Chryseobacterium and Elizabethkingia spp. are emergent, nosocomial pathogens and the majority of cases were older than the neonatal period. They were mainly seen in patients with long hospital stays, indwelling devices, and those who have received antibiotics within the last month, especially carbapenems. In addition, they were associated with bloodstream infection and malignancy. The most commonly useful antibiotics according to the resistance patterns were ciprofloxacin and TMP-SMX.

Hematopoietic stem cell transplantation is a curative therapy for pediatric patients with malignancies and blood or immune system disorders. However, recipients are at risk of opportunistic infections, including cytomegalovirus infection, due to immunosuppression from conditioning regimens. This retrospective study analyzed 439 pediatric hematopoietic stem cell transplantation patients to identify risk factors for cytomegalovirus infection and assess the impact of conditioning regimens. Significant factors included graft source, graft versus host disease, and pre‐transplant clinically significant cytomegalovirus infection. Myeloablative conditioning regimens and the use of anti‐thymocyte globulin increased the risk of clinically significant cytomegalovirus infection. Additionally, the risk of cytomegalovirus infection in patients was found to be statistically significant in the myeloablative subgroup analyses who received anti‐thymocyte globulin alone and those who received both anti‐thymocyte globulin and total body irradiation. In our study, total body irradiation did not significantly affect the risk of clinically significant cytomegalovirus infection. This study covers a 10‐year period and a large pediatric patient population from a single center. Our findings highlight the importance of understanding risk factors for clinically significant cytomegalovirus infection to guide preventive strategies in pediatric HSCT recipients. [ABSTRACT FROM AUTHOR]

Current data on fosfomycin usage in children are limited. We present data on the clinical use of intravenous (IV) fosfomycin in children. Hospitalized patients who received ≥3 days of IV fosfomycin between April 2021 and March 2023 were analyzed retrospectively. Forty-three episodes of infection in 39 patients were evaluated. The mean age of the patients was 5.35 (10 days to 17.5 years) years, and 54% were male. Infections were hospital-acquired in 79% of the episodes. Indications for fosfomycin were urinary tract infection (35%), bacteremia (32.6%), catheter-related bloodstream infection (16.3%), soft tissue infection (4.7%), sepsis (4.7%), surgical site infection (2.3%), burn infection (2.3%), and pneumonia (2.3%). Klebsiella pneumoniae was identified in 46.5% of the episodes, and a pan-drug or extensive drug resistance was detected in 75% of them. Carbapenem was used before fosfomycin at significantly higher rates in K. pneumoniae episodes (P  = .006). Most (88.5%) patients received fosfomycin as a combination therapy. Culture negativity was achieved in 80% of episodes within a median treatment period of 3 (2–22) days, which was significantly shorter in K. pneumoniae episodes (P  < .001). Treatment-related side effects were seen in 9.3% of the episodes. Side effects were significant after 3 weeks of treatment (P  = .013). The unresponsivity rate to fosfomycin was 23.3%. Nine (21%) of the patients who were followed up in the intensive care units mainly died because of sepsis (56%). IV fosfomycin is an effective agent in treating severe pediatric infections caused by resistant microorganisms. Fosfomycin can be used in various indications and is generally safe for children. [ABSTRACT FROM AUTHOR]

This study aimed to retrospectively evaluate the baseline and follow‐up viral loads and viral clearance times in cases followed for asymptomatic and symptomatic congenital cytomegalovirus (cCMV) infection between August 2010 and August 2022. Among 93 cases, they had asymptomatic (n: 55) and symptomatic (n: 38). The median baseline blood viral load detected in the symptomatic cCMV (ScCMV) infection (13 054 IU/mL) was significantly higher than that of asymptomatic cCMV (AcCMV) infection (4636 IU/mL) (p < 0.013). There was no difference in median viral clearance times (75 and 90 days, respectively) in baseline viremic cases in the ScCMV and AcCMV infection groups. There were no differences in median baseline blood viral load (6930 IU/mL and 14 268 IU/mL, respectively) and median viral clearance times (75 and 85 days, respectively) between the 6‐week and 6‐month antiviral treatment group. No correlation was found between baseline blood viral load, clinical severity, and the number of systems involved. However, in initial viremic cases, the viral load threshold for a symptomatic case was 8856 IU/mL, with 85.7% sensitivity and 54.5% specificity. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate our pediatric HSCT recipients routinely monitored for adenoviremia and to determine the adequacy of this monitoring in predicting adenoviral disease (AD). Methods: A retrospective cohort of patients who underwent allogeneic HSCT between January 2021 and August 2022, and routinely monitored for adenoviremia by real‐time PCR was included in our survey. Demographic and clinical data of the patients were recorded. Incidence rates, risk factors, and mortality rates related to adenoviremia, and AD were analyzed. Results: Among 104 HSCTs performed in 94 patients adenovirus (AdV) was revealed in 27 (26%) episodes and adenoviremia in 18 (17.3%) HSCT episodes. AD without adenoviremia developed in nine episodes (8.6%). Disseminated disease was significantly more frequently detected in episodes with adenoviremia (p =.008). GVHD was independent risk factor for AdV detection (OR: 8.6, 95% CI: 2.03–33.7, p =.001). Viremia developed within a shorter time interval after HSCT in isolated episodes of adenoviremia compared to those with concomitant AD (p =.006). Initial and peak viral loads were significantly higher in adenoviremia with AD (p <.001). Mortality was higher in the AdV‐detected episodes (p <.001) than in the AdV‐undetected episodes. AdV‐related mortality was found to be 22.2%. Adenoviremia increased the risk of mortality (OR: 1.2, 95% CI: 0.22–1.33, p =.01). Conclusions: Adenoviremia monitoring is an important process in the detection of AD. Since some patients may develop AD without accompanying by adenoviremia, monitoring for AdV in blood samples should be supported with other monitoring methods in order to evaluate the probable involvement of different organs or systems. [ABSTRACT FROM AUTHOR]

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There is limited data on the pattern and severity of myocardial injury in patients with COVID-19 vaccination associated myocarditis. We aimed to define the myocardial damage occurring after BNT162b2 vaccination, raise awareness about adverse reactions developing after vaccination, and determine the patterns and scope of Cardiac magnetic resonance imaging (MRI) findings. A total of 9 patients diagnosed with vaccine-associated myopericarditis were followed up. The mean age of the patient at diagnosis was 15.3 ± 1.0 (range: 14–17) years, and all patients were male. Seven patients presented with myocarditis symptoms after their second vaccine dose, one patient presented with pericarditis symptoms after his first dose, and the other patient presented with myocarditis symptoms after his booster dose. The median time at presenting to the hospital was 3 (range: 2–22) days. Seven (77.7%) patients had abnormal electrocardiography (ECG) findings, and the most prevalent finding was diffuse ST-segment elevation. Initial cardiac MRI results were abnormal in all patients, where 8 (88.8%) patients had late gadolinium enhancement, and 5 (55.5%) had myocardial edoema. Three patients showed local left ventricular wall-motion abnormalities. In their follow-up MRIs 3–6 months later, myocardial edoema was present in 2 (28.5%) patients, while late gadolinium enhancement was present in all patients (7/7, 100%, 2 patients did not have control MRI time). Hypokinetic segments were still present in one of the 3 patients. No negative cardiac events were observed in the short-term follow-up of any patient. Further follow-up evaluation and larger multicenter studies are needed to determine the clinical significance of persistent cardiac MRI abnormalities. [ABSTRACT FROM AUTHOR]