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Objective This study aimed to investigate the frequency of latent and active tuberculosis (TB) in pediatric patients receiving anti-tumor necrosis factor (TNF)-α therapy. Methods Patients younger than 18 years with various inflammatory diseases and treated with anti-TNF-α agents in the past five years were included in the study. The patients' ages, follow-ups, medications received, clinical and laboratory findings, and treatments applied were recorded retrospectively. Results Of the 160 patients included in the study, 78 (48.8%) were girls. The mean age was 139.54 ± 48.74 (30–226) months. Sixty (37.5%) patients had inflammatory eye disease, 55 (34.4%) had rheumatologic and autoimmune disease, and 45 (28.1%) had inflammatory bowel disease. As anti-TNF-α treatment, 67 (41.9%) patients received adalimumab, 50 (31.2%) received infliximab, and 43 (26.9%) received etanercept. As a result of TB screening performed prior to the treatment, 44 (25.4%) patients were started on isoniazid treatment with the diagnosis of latent TB. During follow-up, latent TB infection was detected in 16 (9.2%) patients and isoniazid treatment was started. The time to develop latent TB under anti-TNF-α treatment ranged from 3 to 28 months. During the treatment, active TB infection developed in two (1.2%) patients and anti-TB treatment was initiated. Conclusion It is of vital importance to evaluate patients receiving, or planned to receive, anti-TNF-α treatment, for TB infection and to initiate appropriate treatments if latent or active TB infection is identified.

Objective This study aimed to investigate interferon-gamma-inducible protein-10 (IP-10) values in serum and urine in pediatric patients in the diagnosis of active tuberculosis (TB) or latent TB infection (LTBI). It also aimed to investigate whether it can be used as a biomarker to distinguish between active TB and LTBI. Methods Our study comprised active TB (25 patients), LTBI (25 patients), and the “infected” group (50 patients) formed by combining the two groups. As the control group, 37 healthy children were included in the study. TB skin test, plasma IP-10, and urine IP-10 measurements were performed in all patients included in the study. An additional QuantiFERON-TB Gold In-Tube (QFT-GIT) test was performed on patients evaluated as active TB or LTBI. Results Plasma IP-10 levels of the patients in the active TB, LTBI, and the “infected” groups were significantly higher than the control group (p = 0.022, p = 0.028, and p = 0.007, respectively). Urine IP-10 was successful in distinguishing the active TB and “infected” groups from the control group (p = 0.007 and p = 0.047, respectively). Also, in the combined use of the tests, when QFT-GIT and urine IP-10 were positive together, active TB and LTBI could be distinguished (p = 0.044). Urine IP-10 levels were found to be significantly higher in those with pulmonary TB than those with extrapulmonary TB (p = 0.012). Conclusion Our findings suggest that IP-10 can be used as a useful biomarker in the diagnosis of active TB in children.

Objective Antimicrobial resistance poses a serious threat to children's health. In recent years, high-risk Escherichia coli ST131 has become an important target for global surveillance studies. The E.coli ST131 clone is associated with extended spectrum β-lactamase (ESBL) production, as well as multidrug resistance and treatment failure. Studies on this clone in the pediatric age group are limited. We aim to investigate the rate of high-risk E. coli ST131 clone in ESBL-positive E. coli isolates obtained from pediatric patients.Methods A total of 292 ESBL-positive E. coli isolates from clinical samples of pediatric patients was included in the study. MALDI-TOF MS system was used for bacterial identification. Susceptibility tests were performed using BD Phoenix automated system. ST131 detection was done by MALDI-TOF-MS. Fisher's exact test was used to compare the groups (significance Results A total of 292 isolates was analyzed. The high-risk ST131 clone was detected in 117 (40%) of the 292 ESBL-positive isolates. ST131 rates were found to be significantly higher in children under the age of 5 years compared with children over the age of 5 years (49.3 vs. 31.1%, p = 0.0019). Ciprofloxacin resistance was higher in ST131 isolates (45.6 vs. 31.7%; p Conclusion The rate of the ST131 clone was found to be high in the pediatric population. The significantly high rate of resistance to ciprofloxacin, which is not commonly used in the pediatric population, in ST131 isolates reveals the importance of the spread of high-risk clones for the development of resistance.

Multisystemic inflammatory syndrome (MIS-C) diagnosis remains difficult because the clinical features overlap with Kawasaki disease (KD). The study aims to highlight the clinical and laboratory features and outcomes of patients with MISC whose clinical manifestations overlap with or without KD. This study is a retrospective analysis of a case series designed for patients aged 1 month to 18 years in 28 hospitals between November 1, 2020, and June 9, 2021. Patient demographics, complaints, laboratory results, echocardiographic results, system involvement, and outcomes were recorded. A total of 614 patients were enrolled; the median age was 7.4 years (interquartile range (IQR) 3.9-12 years). A total of 277 (45.1%) patients with MIS-C had manifestations that overlapped with KD, including 92 (33.3%) patients with complete KD and 185 (66.7%) with incomplete KD. Lymphocyte and platelet counts were significantly lower in patients with MISC, overlapped with KD (lymphocyte count 1080 vs. 1280 cells x mu L, p = 0.028; platelet count 166 vs. 216 cells x 10(3)/mu L, p < 0.001). The median serum procalcitonin levels were statistically higher in patients overlapped with KD (3.18 vs. 1.68 mu g/L, p = 0.001). Coronary artery dilatation was statistically significant in patients with overlap with KD (13.4% vs. 6.8%, p = 0.007), while myocarditis was significantly more common in patients without overlap with KD features (2.6% vs 7.4%, p = 0.009). The association between clinical and laboratory findings and overlap with KD was investigated. Age > 12 years reduced the risk of overlap with KD by 66% (p < 0.001, 95% CI 0.217-0.550), lethargy increased the risk of overlap with KD by 2.6-fold (p = 0.011, 95% CI 1.244-5.439), and each unit more albumin (g/dl) reduced the risk of overlap with KD by 60% (p < 0.001, 95% CI 0.298-0.559). Conclusion: Almost half of the patients with MISC had clinical features that overlapped with KD; in particular, incomplete KD was present. The median age was lower in patients with KD-like features. Lymphocyte and platelet counts were lower, and ferritin and procalcitonin levels were significantly higher in patients with overlap with KD., NA

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic.

Objective: For the treatment of invasive candidiasis (IC) which is confirmed or suspected in adults, echinocandins are usually recommended. In children; however, very little is known about using echinocandins for IC management. Micafungin (MCFG) is approved for both treatment and prevention (prophylaxis) of invasive Candida infections. In this study, pediatric patients diagnosed with Candida infection and treated with MCFG were evaluated retrospectively. Clinical characteristics of the patients and the results of MCFG treatment were discussed in light of the literature. Material and Methods: The study included 10 pediatric patients aged between 28 days and 16 years. They were diagnosed with Candida infection between January 01, 2017 and January 01, 2019, and were treated with MCFG. The patients’ microbiological and laboratory data, demographic and clinical characteristics, risk factors for IC, MCFG treatment characteristics and the side effects were recorded retrospectively from electronic records. Results: The median age of the patients in the study was 22 months (range 1.5 to 178 mo). Candida species isolated from the patients were C. parapsilosis, C. orthopsilosis, C. tropicalis, C. albicans, C. kefyr and C. guilliermondii. The most common underlying disease was gastrointestinal anomaly and related problems. The most common risk factors included the use of broad-spectrum antibiotics, total parenteral nutrition, mechanical ventilation, and central venous catheter. The median dose of MCFG was 2 mg/ kg per day (d) and was applied to the patients for a minimum of 3 days and a maximum of 23 days. There were no side effects observed. Conclusion: In our limited case series of pediatric patients, MCFG was found effective in treating both proven and suspected invasive Candida infections and no adverse side effects were observed.

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic.

Amaç Akut ishal tüm dünyada en önemli morbidite ve mortalite nedenleri arasında yer almaktadır. İshal nedeni ile başvuran tüm hastalarda, dehidratasyonun temel tedavisi oral rehidratasyon sıvısıdır. Probiyotikler, akut ishal destek tedavi seçenekleri arasında yer almaktadır. Bu çalışmanın amacı akut ishali olan çocuklarda Lactobacillus rhamnosus GG (LGG) ve Bifidobacterium animalis subspecies lactis BB-12 (BB-12) kombinasyonun ishal süresi ve hastanede yatış süresi üzerine etkisinin değerlendirilmesidir.Yöntem Bu çok merkezli, randomize (240 çocuk, probiyotik ile kontrol 2:1 randomizasyon), tek kör çalışma, akut ishal yakınmalarının başlamasından 24-72 saat içerisinde hastaneye başvuran, yaşları 6 ay ile 60 ay arasında değişen çocuklarda yapıldı. Çalışmaya hafif ve orta derecede dehidratasyonu olan çocuklar dahil edildi. Çalışmaya dahil edilen çocuklarda, kontrol grubu standart tedavi alırken, probiyotik grubu 5 gün süre ile LGG ve BB-12 (her bir probiyotik 1×109 koloni) kombinasyonu aldı. Çalışmanın primer sonlanım noktası olarak ishal süresinin Bristol gayta skoru ile takip edilmesi planlandı. Sekonder sonlanım noktası ise hastanede yatış süresi (gün) ve 72. saatin sonunda ishal tablosu gerileyen çocuk yüzdesi olarak belirlendi.Bulgular Çalışmaya katılan 240 çocuğun 218’nin (probiyotik grubunda 150 çocuk, kontrol grubunda 68 çocuk) verileri değerlendirildi. LGG ve BB-12 grubunda ishal süresinin kontrol grubuna göre anlamlı derecede düşük olduğu saptandı (sırası ile 74.5 ± 40.8 saat, 98.4 ± 22.9 saat, P0.05).Sonuç LGG ve BB-12 kombinasyonun akut ishal olgularında ilk kez değerlendirildiği bu çalışmada,ishal süresi üzerine olumlu etkilerinin olduğu gösterildi. Hastaneye yatan çocuklarda ishal süresinin yaklaşık 24 saat kısaldığı saptandı. Hastaneye yatan çocuklara ek olarak, akut ishal nedeni ile poliklinik başvurusu yapan çocuklarda yapılacak randomize klinik çalışmalar ile bu kombinasyonun etkisi daha detaylı değerlendirilmelidir., Background Acute diarrhea continues to be a leading cause of morbidity and mortality worldwide. The main therapy for all individuals with dehydration caused by diarrhea is oral rehydration. Probiotics have been proposed as a complementary therapy in the treatment of acute diarrhea. We aim to evaluate the effect of a combination of Lactobacillus rhamnosus GG (LGG) with Bifidobacterium animalis subspecies lactis BB-12 (BB-12) on the duration of diarrhea and length of hospital stay in children with acute diarrhea.Methods A multicenter, randomized (240 children, 2:1 randomized for probiotic vs. control), single blind, hospital based clinical trial was performed in children (6 to 60 months) with acute watery diarrhea lasting more than 24 but less than 72 hours, requiring hospitalization. We enrolled children with clinical signs of mild to moderate dehydration. The children received conventional therapy with or without the combination of LGG and BB-12 (1 × 109 colony forming units for each) for 5 days. The primary endpoint was the duration of diarrhea (in hours), defined as the first normal stool according to the Bristol stool score (score < 5). Secondary outcome measures were duration of hospitalization (days) and percentage of children without diarrhea at 72 hours of intervention.Results In total, data from 218 of 240 children could be evaluated (150 in the probiotic group and 68 in the control group). The duration of diarrhea was significantly reduced in the LGG and BB-12 group compared to the control group (74.5 ± 40.8 hours vs. 98.4 ± 22.9 hours, P0.05).Conclusion This is the first clinical trial to test the combination of LGG and BB-12, and show its effects on diarrhea duration in children with acute infectious diarrhea. The duration of diarrhea was reduced by approximately 24 hours in the hospitalized children. Further randomized controlled clinical trials including outpatient cases with acute infectious diarrhea in addition to hospitalized cases should be conducted to assess the potential effects of the combination in more detail.

© 2022 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).Aim: Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey. Methods: The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis. Results: The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6–9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112–228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30–84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58–20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died. Conclusion: The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.

The frequency of bacterial factors causing central nervous system infections has decreased as a result of the development of our national immunization program. In this study, it is aimed to obtain the data of our local surveillance by defining the viral etiology in cases diagnosed with meningoencephalitis for 1 year. Previously healhty 186 children, who applied with findings suggesting viral meningoencephalitis to 8 different tertiary health centers between August 2018 and August 2019, in Istanbul, were included. The cerebrospinal fluid (CSF) sample was evaluated by polymerase chain reaction. The M:F ratio was 1.24 in the patient group, whose age ranged from 1 to 216 months (mean 40.2 +/- 48.7). Viral factor was detected in 26.8%. Enterovirus was the most common agent (24%) and followed by Adenovirus (22%) and HHV type 6 (22%). In the rest of the samples revealed HHV type 7 (10%), EBV (6%), CMV (6%), HSV type 1 (6%), Parvovirus (4%) and VZV (2%). The most common symptoms were fever (79%) and convulsions (45.7%). Antibiotherapy and antiviral therapy was started 48.6% and 4% respectively. Mortality and sequela rate resulted 0.53% and 3.7%, respectively. This highlights the importance of monitoring trends in encephalitis in Turkey with aview to improving pathogen diagnosis for encephalitis and rapidly identifying novel emerging encephalitis-causing pathogens that demand public health action especially in national immunisation programme. Turkish Pediatric Institution [04] This study was supported by the Turkish Pediatric Institution within the framework of the Initial R&D projects support program (02/14/2019 ID 04).

Using OCT and OCTA imaging, we aimed to determine whether COVID-19 induces pathological changes in vascular and morphological structures in the pediatric retina.The current prospective, cross-sectional, observational clinical study included recovered pediatric patients with COVID-19 evaluated between May 2020 and June 2020. Retinal vascular (radial peripapillary, superficial, and deep capillary plexus vessel densities) and morphological (peripapillary retinal nerve fiber, ganglion cell layer, retinal, and choroidal thickness) in the optic disk and macula regions were quantitively assessed using OCT and OCTA. Data were compared between COVID-19 patients and age-matched controls.The COVID-19 group included 32 eyes of 16 patients and the control group included 32 eyes of 16 cases. Fundus and biomicroscopic examinations revealed no signs of pathology in the COVID-19 group. Mean peripapillary retinal nerve fiber, ganglion cell layer, and choroidal thickness values were significantly greater in the COVID-19 group than in the control group (p0.05). OCTA indicated that mean superficial and deep capillary plexus vessel densities, and choriocapillaris flow area values were significantly lower in the COVID-19 group than in the control group, whereas mean radial peripapillary capillary plexus vessel density values were significantly higher (p0.05).Even if fundus examination results appear normal in pediatric patients with COVID-19, vascular and morphological changes may be observed in the retina. Further studies with larger numbers of patients are needed to elucidate the clinical significance of vascular and morphological changes in this population.

Objectives: The pandemic of coronavirus disease 2019 (COVID-19) is still effective all over the world. Compared to adults, data on pediatric patients are limited. In this study, we aimed to retrospectively examine the demographic, clinical, and laboratory characteristics of pediatric patients who were followed up with the diagnosis of COVID-19 in the first 3 months of the pandemic in our hospital. Methods: A total of 190 patients, aged 1 month–18 years, who were followed up with a definite/probable diagnosis of COVID-19, who were treated in the Pediatric Infection Clinic, were included in the study. The demographic features, clinical characteristics, and laboratory findings of the patients were retrospectively analyzed from their electronic medical records. Results: Eighty (42.1%) of the patients were laboratory confirmed (Polymerase chain reaction positive in nasopharyngeal swab). Mean age was 72 (2–216 months) and 102 (53.7%) patients were female. Family contact history was present in 115 (60.5%) patients. The patients were classified as asymptomatic (5.8%), mild (73.2%), moderate (18.4%), and severe/critical (2.6%) according to the severity of the disease. The most common symptoms were cough (71.1%) and fever (51.1%). Hydroxychloroquine alone or in combination was the most commonly used agent. Conclusion: In our study, in which we examined the pediatric COVID-19 patients, most of the patients had a mild clinical course, but there were applications with different clinical pictures such as acute appendicitis. Therefore, COVID-19 infection, which is still very unknown, will continue to surprise us with both changing treatment protocols and clinical presentations such as multisystem inflammatory syndrome in children.

Objectives: the aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children.Methods: a retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined. Results: there were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% (n = 582) and females constituted 49.7% (n = 574). The median age of the confirmed cases was 10.75 years (4.5-14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1-3 years of age (9.3%), 148 were 3-6 years of age (12.8%), 298 were 6-12 years of age (25.8%), 233 were 12-15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) (n = 583) for a median of 2 days (IQR: 1-3 days). Fever was median at 38.4 degrees C (38.0-38.7 degrees C). The second most common symptom was cough (n = 543, 46.9%). The other common symptoms were sore throat (n = 143, 12.4%), myalgia (n = 141, 12.2%), dyspnea (n = 118, 10.2%), diarrhea (n = 112, 9.7%), stomachache (n = 71, 6.1%), and nasal discharge (n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition (p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have (p = 0.38), but the need for intensive care was higher in patients who had an underlying condition (p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma). Conclusions: to the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution., NA

Objectives Coronavirus disease 2019 (COVID-19) have different clinical presentations in children. Most symptomatic children with suspicion of COVID-19 have fever and respiratory symptoms. In this retrospective study, we aimed to describe demographic features, clinical characteristics, and outcomes of confirmed and probable COVID-19 patients admitted to our pediatric emergency department (ED). Methods We identified 135 children (aged 1 month-18 years) with suspicion of the COVID-19 who were admitted to our ED between March 11 and May 12, 2020. The urgency of patients was evaluated according to their Pediatric Assessment Triangle (PAT) and Emergency Severity Index (ESI) scores. Patients were divided into two groups as confirmed cases (Group 1) and probable cases (Group 2). Clinical, laboratory, radiologic features, and the disease severity of patients were analyzed. Results According to PAT evaluation, 82 patients (65.6%) were non-urgent. The most frequent ESI triage category level was 3 (n=102, 76.1%). Forty-one (30.4%) patients were identified as laboratory-confirmed cases. Fifty-five (40.7%) patients were between 28 days and 4 years of age. Fever with cough was the most frequent symptoms at the onset of illness in COVID-19 positive patients (n=16, 39%). Sixty-four (47.4%) patients had mild disease and 40 (29.6%) patients had comorbidities. In Group 1, neutropenia was significantly higher than Group 2 (p=0.024). Mean procalcitonin and erythrocyte sedimentation rate levels of Group 2 were significantly higher than Group 1 (p=0.012 and p=0.028, respectively). Twenty-eight of 51 patients had chest computed tomography findings which were compatible with COVID-19. Fifty-one (37.8%) patients were discharged from ED, 81 (60%) were admitted to the ward, and 3 (2.2%) were admitted to the pediatric intensive care unit. Conclusion During our study, we confirmed the diagnosis of 45 of 135 probable cases with the SARS-CoV-2 polymerase chain reaction test. Among confirmed COVID-19 cases, most of our patients had mild or moderate disease. The clinic of only confirmed three patients was classified as severe disease, and we had no critically ill patient.

Background: understanding SARS-CoV-2 seroprevalence among health care personnel is important to ex-plore risk factors for transmission, develop elimination strategies and form a view on the necessity and frequency of surveillance in the future. Methods: we enrolled 4927 health care personnel working in pediatric units at 32 hospitals from 7 different regions of Turkey in a study to determine SARS Co-V-2 seroprevalence after the first peak of the COVID-19 pandemic. A point of care serologic lateral flow rapid test kit for immunoglobulin (Ig)M/IgG was used. Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. Results: SARS-CoV-2 seropositivity prevalence in health care personnel tested was 6.1%. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19-positive co-worker increased the likelihood of infection. The least and the most experienced personnel were more likely to be infected. Most of the seropositive health care personnel (68.0%) did not suspect that they had previously had COVID-19. Conclusions: health surveillance for health care personnel involving routine point-of-care nucleic acid testing and monitoring personal protective equipment adherence are suggested as important strategies to protect health care personnel from COVID-19 and reduce nosocomial SARS-CoV-2 transmission., NA

In this study, the effectiveness of intraventricular (IVT) antibiotic administration was evaluated in the treatment of ventriculo-peritoneal (VP) shunt infection by comparing patients who received only systemic antibiotic treatment with patients who received antibiotics added to systemic therapy by IVT route. From July 2009 to July 2019, 78 shunt infection episodes of 74 pediatric patients with bacterial growth in cerebrospinal fluid (CSF) culture who were treated with the diagnosis of VP shunt infection were retrospectively analyzed. The demographic data, clinical and laboratory parameters, antimicrobial management, and treatment outcomes of patients with VP shunt infections were recorded. Thirty-eight of 78 shunt episodes received only systemic antibiotic treatment, and 40 had received IV plus IVT treatment. The mean age of the entire patient group was 16.7±21.3 months (range, 1 to 95 months). There was no significant difference between the two treatment groups in terms of mean age. The most common microorganism grown in CSF culture was coagulase-negative Staphylococcus. However, in the group that received IV plus IVT treatment, gram-negative bacteria were predominant (42.1% versus 20%), and this group had carbapenem-resistant and ESBL positive gram-negative bacteria growth. In the duration of CSF sterilization, hospital stay was statistically significantly shorter in the group receiving IV plus IVT treatment (p=0.000, p=0.000, respectively). Our study shows that IVT administration of antibiotics shortens the duration of CSF sterilization, duration of antibiotic use, and the duration of hospital stay. For the treatment of VP shunt infection, the usage of IVT treatment in a particular group of a pediatric age is promising. However, further efforts should be done for supporting the current results by randomized controlled studies.

The rate of ventriculoperitoneal (VP) shunt infection is reported between 3% and 20%. Vancomycin-Resistant Enterococci (VRE) are increasingly prevalent nasocomial pathogens worldwide and they rarely cause infections to the central nervous system. Daptomycin is a cyclic lipopeptide effective antibiotic due to its rapid bactericidal effect. It is a life-saving treatment option for meningitis, bacteriemia, sepsis, endocarditis and urinary system infections caused by VRE. Here, we presented a 2.5-month-old male patient diagnosed with ventriculoperitoneal shunt infection caused by VRE faecium. This is the first pediatric VP shunt infection caused by VRE and treated with a combination of intravenous (IV) linezolid IV and intraventricular (IVT) daptomycin. The patient was admitted to the medical center with the complaint of umbilical discharge and shunt revision was applied with the thought of shunt dysfunction. Intermittent umbilical cerebrospinal fluid (CSF) leakage continued and the patient developed fever 2 weeks after the operation. VRE growth in his CSF culture was treated by meropenem and linezolid treatment. Upon continuation of the growth afterwards, the patient who was referred to our hospital underwent extra ventricular drainage (EVD), and IV linezolid, IV daptomycin (8 mg/kg day) and IVT daptomycin (2.5 mg/kg day) was scheduled as treatment. On the 5th day of treatment, there was no growth in the culture and no side effects were observed during the treatment. VP shunt was placed in the patient for the 15 days of daptomycin IV plus IVT treatment, and 36 days of linezolid. No infection was observed in the 8-month follow-up period.

AIM We aim to investigate the diagnostic value of newly defined criteria for the systemic inflammatory response syndrome (SIRS) for paediatric burn patients by the American Burn Association (ABA) by comparing the non-burn-specific SIRS criteria for children. METHODS A total of 147 paediatric burn patients were included in this study. Patients diagnosed with sepsis were included in the sepsis group. Clinical parameters were obtained from the electronic medical records at the time of preliminary sepsis diagnosis. Both the non-burn-specific SIRS criteria and the burn-specific ABA SIRS criteria were applied to both the sepsis group and the non-sepsis group. RESULTS Of 147 patients, 50 had sepsis according to the non-burn-specific sepsis criteria. When the 50-patient sepsis group was compared to the 97-patient non-sepsis group, the sepsis group had a significantly higher duration of hospitalisation, burn percentage, burn state and abbreviated burn scoring index (ABSI) (P

Objectives Antibiotic Stewardship Programs (ASP) have been developed for the spread of rational antibiotic use. Our hospital is one of the first centers where ASP applications were launched in Turkey. In this study, we aimed to share our experience with ASP which has been applied in our hospital since 2013. Methods We adapted ASP to our hospital program from Centers for Disease Control and Prevention's ASP checklist. Revisions on surgical prophylaxis guidelines and practices were performed. Surgical prophylaxis was evaluated from hospital infection surveillance and antibiotic usage by point prevalence surveys. Antibiotic consumption indexes (ACI) were calculated from hospital pharmacy records. Rapid antigen detection test (RADT) for Group A beta-hemolytic streptococcus and influenza rapid antigen test were started to be used. Cumulative antibiotic susceptibility results were prepared annually. Results Surgical prophylaxis was started to be administered in the operating room within 60 min of incision. Third-generation cephalosporin usage for surgical prophylaxis could be restricted in all clinics but the duration could only be shortened in neurosurgery and general surgery. There was no statistically significant change in antibiotic usage rates and appropriateness between 2014 and 2018. ACI for the class J01 in adult wards was 80.5 daily defined doses (DDD) per 100 patient days in 2014 and reduced to 64.8 DDD per 100 patient days in 2018. 22.445 pediatric patients presenting with complaints of the upper respiratory tract were evaluated with RADT and 75.1% were treated without antibiotics. Conclusion In this global antimicrobial resistance era, all hospitals should have motivated antimicrobial stewardship teams. Each hospital should establish its own stewardship program and often revise it. Improvement in rational antibiotic use is hard to achieve without multidisciplinary involvement.

Factitious disorder imposed on another, also known as Munchausen Syndrome by Proxy (MSBP), is a serious form of child abuse that is difficult to diagnose. In general, signs and symptoms are fabricated or produced by the mother or the caregiver. Delay in diagnosis may cause serious morbidity and mortality. Here, we present the case of an 18-month-old boy who was admitted to the Paediatric Infection Clinic with a diagnosis of acute gastroenteritis. When on intravenous fluid therapy, he developed high fever and subsequently, polymicrobial growth was determined in his blood. He was later diagnosed with MSBP. Despite being a rare condition, MSBP is a disorder that is often overlooked and may have fatal outcomes. Early diagnosis is very important in this disorder, which is considerably difficult to diagnose. In suspected cases, interdisciplinary team work is necessary to prevent adverse consequences.

AIM Tuberculin skin test (TST) is still used in diagnostic algorithms of childhood tuberculosis (TB). QuantiFERON TB Gold In-Tube assay (QFT-GIT) is an alternative test to TST based on the detection of interferon-gamma release upon in vitro induction of peripheral mononuclear cells by TB antigens. In this study, we aimed to determine the diagnostic value and performance of QFT-GIT for active childhood TB. METHODS This retrospective study was conducted between January 2005 and December 2011 in three referral hospitals in Turkey with 124 children who were diagnosed with definite active TB. Sensitivity values of TST and QFT-GIT were determined by accepting the microbiological confirmation as the gold standard of diagnosis of TB. RESULTS In our study, sensitivity of QFT-GIT and TST was found to be 65 and 66% respectively. However, combined usage of QFT-GIT and TST was found to be more sensitive (85%) than TST or QFT-GIT alone (P

Background Ventriculoperitoneal (VP) shunt infection, which is 1 of the most important complications of VP shunt is observed at a rate of 4%–17%. Staphylococcus epidermidis is the most common causative agent. Vancomycin-resistant Enterococcus (VRE) is an increasingly common nosocomial pathogen that rarely causes central nervous system infections globally. Current treatment options that have shown appreciable activity against various VRE infections include daptomycin, linezolid, inquinupristin/dalfopristin, and tigecycline. Daptomycin has a particular mode of action and a potent bactericidal activity, making it a useful addition to the clinician's antibiotic collection. Global surveillance data indicate Case Description Here, we describe, to the best of our knowledge, the first case of successful intraventricular plus intravenous use of tigecycline to treat VP shunt infections caused by daptomycin resistant VRE faecium. Conclusion Tigecycline is a life-saving option in the treatment of resistant nosocomial infections but it has not yet been approved for use and there are not enough data in terms of dose and side effects associated with its use in children.

Background The purpose of this study was to establish species distribution of Candida isolates from pediatric patients in Istanbul, Turkey, and to determine risk factors associated with nosocomial Candida infections. Methods This study was conducted between June 2013 and June 2014 by participation of 7 medical centers in Istanbul. Candida spp strains isolated from the clinical specimens of pediatric patients were included. Clinical features were recorded on a standardized data collection sheet. Results A total of 134 systemic Candida infections were identified in 134 patients. The patients were admitted in pediatric and neonatal intensive care units (41.8% and 9.7%, respectively) and in pediatric wards (48.5%). Candida albicans was the most prevalent species (47%), followed by Candida parapsilosis (13.4%), Candida tropicalis (8.2%), Candida glabrata (4.5%), Candida lusitaniae (3.7%), Candida kefyr (2.2%), Candida guilliermondii (1.5%), Candida dubliniensis (0.7%), and Candida krusei (0.7%). Types of Candida infections were candidemia (50.7%), urinary tract infection (33.6%), surgical site infection (4.5%), central nervous system infection (3.7%), catheter infection (3.7%), and intra-abdominal infection (3.7%). In multivariate analysis, younger age (1-24 months) and detection of non-albicans Candida spp was found to be risk factors associated with candidemia ( P = 0.040; odds ratio [OR], 4.1; 95% confidence interval [CI], 1.06-15.86; and P = 0.02; OR, 2.4; 95% CI, 1.10-5.53, respectively). Conclusions This study provides an update for the epidemiology of nosocomial Candida infections in Istanbul, which is important for the management of patients and implementation of appropriate infection control measures.

Magnusiomyces capitatus is an emerging opportunistic fungal pathogen particularly in immunocompromised patients. We report a case of a M. capitatus peritonitis in child with acute lymphocytic leukemia as a breakthrough infection during caspofungin therapy. The possibility of breakthrough infections caused by M. capitatus must be taken into consideration, particularly in immunosupressed patients being treated for systemic fungal infections by caspofungin. Although there are no defined breakpoints for susceptibility testing of M.capitatus, minimal inhibitory concentration results can be helpful for therapy. Antifungal treatment with amphotericin B lipid complex plus flucytosine can be effective against infections caused by M. capitatus.

WOS: 000510640400001, Objective: Infection is a common complication in children with malignancies. There is no consistent guidance for environmental infection control and isolation precautions for neutropenic patients (NP). There are differences between centers. The aim of this questionnaire study was to determine these differences in Turkey. Material and Methods: A multicenter-descriptive questionnaire was conducted on 36 centers from different geografical locations of Turkey. Bone marrow transplantation units were excluded. Each center was contacted at least three-times. Questionnaire was answered by two different doctors from each center. Results: Thirty-six centers including 20 (55.5%) University Hospitals, 12 (%33.3) Research Hospitals, three (8.3%) State Hospital and one Private University Hospital participated in this survey. 94.3% of the centers had a bed capacity of 50 beds and over. Twenty-one (58.3%) centers had pediatric infection ward that followed febrile NP. All centers had an infection control committee. 25% (9/36) of the centers always followed pediatric neutropenic fever patients in a single room. 66.6% (24/36) of the centers had toilet in all patients' room. The door features of patients' room included mostly (94.1%, 32/34) manually opened door. Ten (27.7%) centers had hepa filter system, five of them had positive-negative pressure room. Thirteen (38.2%, 13/34) centers prefered hickmann catheter for accessing a patient's central line. Training was given for catheteter care in all centers. Sixteen (44.4%) centers had determined policies about keeping toys in patient rooms. Visitor restrictions were performed in all centers. None of the centers allowed plants or flowers in hospital rooms. There was a neutropenic diet specific for pediatric NP provided in twenty-seven centers (75%). Conclusion: The prevention and control of infection contributes to the improvement of the prognosis of patients with hematological malignancies. Physicians must be aware of the infection risks and take precautions for infectious complications through the neutropenic period and standard protocols should be established and implemented for patients with hematological malignancies.

Ventriculoperitoneal (VP) shunt infections are seen in 3%–17% of patients with VP shunts. These infections may cause severe morbidity and mortality. Staphylococci are the most common cause of CSF shunt-associated infections, although gram-negative bacteria (especially multidrug-resistant [MDR] and extensive drug–resistant [XDR] bacteria) also play an important role. Due to increased antibiotic resistance, sometimes off-label usage of antibiotics is considered. Tigecycline is one of these antibiotics. It should not be used unless there are no other antibiotic treatment options available, especially in children. It belongs to the glycylcycline class of antibiotic agents and inhibits protein translation in bacteria by binding to the 30S ribosomal subunit. The authors describe the case of a patient who had an XDR Klebsiella pneumoniae–positive VP shunt infection. After removal of his VP shunt, an external ventricular drain was inserted, and the patient was treated with a combination of intravenous (1.2 mg/kg/day) and intraventricular (4 mg/day) tigecycline in addition to his meropenem (120 mg/kg/day) treatment. On the 7th day of the combined therapy, his CSF culture was sterile. Because tigecycline distribution into the tissues is not sufficient with intravenous administration, combining it with intraventricular infusion can provide new treatment methods. However, further studies are needed for its use as a treatment method in children.

Kytococcus schroeteri is a commensal organism of the human skin, which may cause serious infections in immunocompromised patients. We report the first case of K. schroeteri bacteremia in a child with congenital adrenal hyperplasia, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (Bruker Daltonics, Germany). İdentification was confirmed by 16S rRNA gene sequencing.

Evidence from the literature has shown that Saccharomyces boulardii provides a clinically significant benefit in the treatment of acute infectious diarrhoea in children. In this multicentre, randomised, prospective, controlled, single blind clinical trial performed in children with acute watery diarrhoea, we aimed to evaluate the impact of S. boulardii CNCM I-745 in hospitalised children, in children requiring emergency care unit (ECU) stay and in outpatient settings. The primary endpoint was the duration of diarrhoea (in hours). Secondary outcome measures were duration of hospitalisation and diarrhoea at the 3rd day of intervention. In the whole study group (363 children), the duration of diarrhoea was approximately 24 h shorter in the S. boulardii group (75.4±33.1 vs 99.8±32.5 h, P

WOS: 000359958400014, PubMed ID: 25986615, Objective: Two randomized controlled clinical trials have shown that Lactobacillus (L) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea. Methods: This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1 x 10(8) CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS) and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours). The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded. Results: The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15h, 60.4 +/- 24.5 h [95% CI: 51.0-69.7h] vs. 74.3 +/- 15.3 h [95% CI: 68.7-79.9h], p < 0.05). The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8%) after 48 h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34-0.79, p< 0.01). From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted. Conclusion: L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea. (C) 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Ozet Tularemi Francisella tularensis tarafindan meydana getirilen zoonotik bir hastaliktir. Son yillarda ulkemizde olusan salginlar ve sporadik olgularla yeniden onem kazanmistir. Tulareminin histopatolojik bulgusu tuberkuloz ile cok benzerlik gostermektedir. Granulomatoz infeksiyonlarin ayirici tanisinda tulareminin de dusunulmesi gerekmektedir. Burada servikal lenfadenopati nedeniyle baska bir merkeze basvuran granulamotoz lenfadenit saptanmasi uzere tuberkuloz tedavisi baslanan 12 yasinda tularemili bir olgu sunulacaktir. (J Pediatr Inf 2015; 9: 81-4) Anahtar kelimeler: Tuberkuloz, granulomatoz lenfadenit, tularemi Abstract Tularemia is a zoonotic disease caused by Francisella tularensis. In the recent years, tularemia has become a reemerging infection in Turkey, with epidemics and also sporadic cases. The histopathology of tularemia is similar with tuberculosis. Thus, tularemia should be considered in the differential diagnosis of chronic granulomatous diseases. In this article, we presented a case of a 12-year-old girl with tularemia who applied to another health center with cervical lymphadenomegaly and treated as tuberculous lymphadenitis after the determination of granulomatous lymphadenitis. (J Pediatr Inf 2015; 9: 81-4)

Intradural spinal cord abscesses are rare infections in early childhood and usually result from pre-existing congenital anomalies of the spinal column. The formation of abscess may be the result of hematogenous spread. It is treated by surgical and parenteral antibiotic treatment, but some special cases may require additional treatments. This article presents a 4-year-old male patient who was previously operated on for spina bifida (meningocele and tethered cord syndrome) at another hospital. Upon complaints of not being able to walk after one month, he was operated on with the diagnosis of spinal intradural abscess and referred to our clinic to continue his treatment. The patient underwent an emergency operation when his new spinal magnetic resonance imaging (MRI) at our hospital showed progression of intradural abscess. Due to no regression of neurological deficits in the follow-up and the risk of another operation, antimicrobial treatment as well as hyperbaric oxygen therapy (HBOT) was planned. At the end of 20 HBOT treatment sessions, the patient started to walk with support and the antibiotic treatment was completed in six weeks. In cases where surgical and antimicrobial treatments have failed, HBOT should be considered as an additional treatment method in children with spinal abscess.

Objectives Preseptal cellulitis is an infection that affects the palpebra and the periorbital superficial tissue. This study is an evaluation of the clinical findings, treatment, and complications of patients hospitalized with preseptal cellulitis in a single clinic. Methods The records of 29 patients with preseptal cellulitis who were hospitalized in the Sisli Hamidiye Etfal Education and Research Hospital Pediatric Infection Clinic between November 2012 and November 2017 were analyzed retrospectively. Results Of the 29 cases, 34.5% (n=10) were female and 65.5% (n=19) were male. The mean age was 61.76±46.95 months, and the mean length of hospital stay was 4.03±2.04 days. Periorbital swelling (72.4%) was the most common cause of complaint at hospital admission, and periorbital hyperemia and edema were observed in 93.1% of the clinical findings. Nine (52.9%) of 17 cases with predisposing factors were sinusitis-related. A blood culture was obtained in 21 (72.4%) cases. Imaging methods were used in 9 (31%) cases to support the diagnosis. All of the patients received broad-spectrum intravenous antibiotic therapy during hospitalization. The mean duration of antibiotic use was 10.10±3.41 days, including after discharge. None of the patients developed complications related to preseptal cellulitis. Conclusion Preseptal cellulitis is a very common orbital infection, especially in childhood. Although it generally has a good prognosis, it can progress rapidly to the orbita and intracranial structures. An accurate clinical approach and rapid treatment can prevent the spread of infection and avoid serious complications.