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BK polyomavirus infection is a critical complication affecting graft survival after kidney transplant. We aimed to determine the frequency, the effect on graft function, and the risk factors of BK polyomavirus infection in pediatric kidney transplant patients.We retrospectively reviewed data of 144 pediatric patients (female/male: 67/77; 0-18 years of age) who received kidney transplants in the past 10 years at our center. Demographic/ laboratory data, kidney failure etiologies, donor types, and immunosuppressive treatments were recorded. Patients were grouped as those with and without BKV infection, with groups compared in terms of transplant age, sex, kidney failure etiology, donor type, immunosuppressive treatments, presence of ureteral stents, acute rejection episodes, accompanying viral infections, glomerular filtration rate, and graft loss rate.Twelve patients (8.3%) had BK polyomavirus infection. All 12 patients had viruria (8.3%), 8 (5.5%) had viremia, and 4 (2.8%) had BK polyomavirus nephropathy. Two patients (1.4%) had graft loss because of BK polyomavirus nephropathy. When patients with and without infection were compared, no significant differences were found in terms of sex, transplant age, donor type, presence of a ureteral stent, acute rejection, graft loss, or immunosuppressive treatment (P.05). Rates of congenital anomalies of the kidney and urinary tract were 30.3% and 66.6% in those without and with BK polyomavirus infection, respectively (P.05). The group positive for BK polyomavirus had a significantly higher incidence of cytomegalovirus infection versus the group without infection (P.05). Glomerular filtration rate values at years 1 and 3 were similar between groups (P.05).Frequency of BK polyomavirus nephropathy in pediatric patients undergoing kidney transplant in our center was consistent with data from other centers. Graft loss can be prevented by early detection and treatment through close periodic control and adequate evaluation of risk factors.

Introduction: We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method: We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results: The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion: We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.

OBJECTIVES In this retrospective study, we aimed to determine the most common infectious agents in infants within the first 6 months of liver transplant. MATERIALS AND METHODS Thirty-four infant patients with median age of 8 months (range, 4-12 mo) at the time of liver transplant were retrospectively evaluated. We evaluated causative organisms in bloodstream cultures and in subclavian catheter, urine, and intra-abdominal drainage fluid cultures. We also evaluated Epstein-Barr and cytomegalovirus infections by polymerase chain reaction in all recipients. RESULTS The most common isolated bacteria from the bloodstream were Klebsiella pneumoniae, Staphylococcus epidermidis, and Enterococcus faecium. Staphylococcus epidermidis was the most common isolated bacteria from subclavian catheter cultures. Klebsiella pneumoniae was the most common bacteria isolated from intra-abdominal drainage fluid. Only 1 recipient had cytomegalovirus infection during this period. CONCLUSIONS Our study showed a high incidence of Klebsiella pneumoniae infections in infants after liver transplant. New prophylactic antibiotic strategies can be promoted to prevent Klebsiella pneumoniae infections in infants.

BACKGROUND Isolated sulfite oxidase deficiency (ISOD), caused by mutations in SUOX gene, is an autosomal recessive disease manifesting with early onset seizures, developmental delay, microcephaly, and spasticity. It mimics hypoxic-ischemic encephalopathy (HIE) in the neonatal period and is characterized by progressive severe neurological impairment due to accumulation of toxic metabolites. CASE This report presents a late diagnosed male patient with ISOD manifesting with neonatal-onset seizures, developmental delay, microcephaly, and spastic quadriplegia. Brain magnetic resonance imaging of the patient showed bilateral subcortical multi-cystic encephalomalacia involving bilateral parieto-occipital regions. A novel homozygous c.590_595delAGCCTC in-frame deletion in SUOX gene was identified in the patient, while both parents were heterozygous for that mutation. CONCLUSION The mutation identified in our patient causes severe ISOD. Early diagnosis of ISOD is essential for accurate genetic counseling and achieving prenatal diagnosis. Screening for urinary sulfite in patients with neonatal or early infantile onset seizures, developmental delay, microcephaly and cystic encephalomalacia in neuroimaging mimicking HIE helps in early diagnosis.

Adherence of Haemophilus influenzae to respiratory epithelial cells is the first step in the pathogenesis of H. influenzae infection and is facilitated by the action of several adhesins located on the surface of the bacteria. In this study, prevalences of hifBC , which represent the pilus gene cluster; hmw1A , hmw2A , and hmwC , which represent high-molecular-weight (HMW) adhesin genes; and hia , which represents H. influenzae adhesin (Hia) genes were determined among clinical isolates of encapsulated type b (Hib) and nonencapsulated (NTHi) H. influenzae. hifBC genes were detected in 109 of 170 (64%) Hib strains and in 46 of 162 (28%) NTHi isolates ( P = 0.0001) and were more prevalent among the invasive type b strains than invasive NTHi strains ( P = 0.00003). Furthermore, hifBC genes were significantly more prevalent ( P = 0.0398) among NTHi throat isolates than NTHi middle ear isolates. hmw1A , hmw2A , hmwC , and hia genes were not detected in Hib strains. Among NTHi isolates, the prevalence of hmw1A was 51%, the prevalence of hmw2A was 23%, the prevalence of hmwC was 48%, and the prevalence of hia was 33%. The hmw genes were significantly more prevalent among middle ear than throat isolates, while hia did not segregate with a respiratory tract site. These results show the variability of the presence of adhesin genes among clinical H. influenzae isolates and suggest that hemagglutinating pili may play a larger role in H. influenzae nasopharyngeal colonization than in acute otitis media whereas the HMW adhesins may be virulence factors for acute otitis media.

Background Oral administration of probiotics in newborn preterm infants has been shown to be helpful, especially ın reducıng the incidence of necrotizing enterocolitis and overall mortality rates.Objective To evaluate the effect of probıotıc supplementation on ıntestınal colonization by antibiotic-resistant microorganisms in preterm infants receiving antibiotics in a neonatal intensive care unit (NICU).Methods The prospective, randomized trial was performed ın preterm infants who were hospitalized in the NICU at Baskent University Ankara Hospital between January 2011 and February 2012. A total of 51 infants were enrolled and randomly assigned to one of two groups: Group 1 (n=27) received probiotic therapy and Group 2 (n=24) did not receive probiotics. The probiotic used was Lactobacillus reuteri (Biogaia® AB, Sweden). Subjects underwent weekly nasal swab and stool cultures for a maxımum of 6 weeks, and at the tıme of dıscharge ıf thıs was prıor to 6 weeks. All posıtıve cultures were further tested for culture-specıfıc ıdentıfıcatıon and antıbıotıc suceptibility.Results A total of 607 cultures were evaluated. Posıtıve cultures were found ın 37.9% from Group 1 and 35.2% from Group 2. Intestınal colonızatıon by antıbıotıc-resıstant bacterıa dıd not sıgnıfıcantly dıffer between groups (P>0.05). Conclusions Oral supplementation with probiotics do not prevent the intestınal colonization of antibiotic-resistant microorganisms in preterm NICU patıents who receıved antıbıotıc treatment.

The aim of this study was to determine the effects of adjuvant immunoglobulin M (IgM)-enriched intravenous immunoglobulin (IVIG) therapy on mortality rate, hematological variables and length of hospital stay in newborn infants with blood culture-proven sepsis. Demographic and clinical features and outcome measures of 63 newborn infants with blood culture-proven sepsis were documented retrospectively from the medical records. The patients were divided into two groups according to their treatment history. The patients in Group 1 received antibiotic therapy only and the patients in Group 2 received both antibiotic and adjuvant IgMenriched IVIG. The study revealed that mortality rates were 28.1% and 12.9% in Group 1 and Group 2, respectively. The mortality rate was lower in Group 2, but the difference between the two groups was not statistically significant (p=0.21). Coagulase-negative Staphylococcus was the most common type of bacteria isolated from the blood culture in both groups. When changing laboratory results were compared between the two groups, hemoglobin, leukocyte count and C-reactive protein levels were different during the first three days of antibiotic treatment. Our study revealed that if diagnosed at an early stage and treated aggressively with appropriate and effective antibiotics, adjuvant IgM-enriched IVIG treatment has no additional benefits in neonatal sepsis.

We compared 75 nontypeable (NT) Haemophilus influenzae isolates by pulsed-field gel electrophoresis (PFGE), enterobacterial repetitive intergenic consensus (ERIC)-PCR, and automated ribotyping. PFGE was the most discriminatory of the techniques. ERIC-PCR provides a useful screen but should not replace other techniques as the sole method to group NT H. influenzae strains.

Haemophilus influenzae is an important cause of respiratory infections, including acute otitis media, sinusitis, and chronic bronchitis, which are preceded by asymptomatic H. influenzae colonization of the human pharynx. The aim of this study was to describe the dynamics of pharyngeal colonization by H. influenzae and an intimately related species, Haemophilus haemolyticus , in healthy adults. Throat specimens from four healthy adult carriers were screened for Haemophilus species; 860 isolates were identified as H. influenzae or H. haemolyticus based on the porphyrin test and on dependence on hemin and NAD for growth. Based on tests for hemolysis, for the presence of the 7F3 epitope of the P6 protein, and for the presence of iga in 412 of the isolates, 346 (84%) were H. influenzae , 47 (11%) were H. haemolyticus , 18 (4%) were nonhemolytic H. haemolyticus , and 1 was a variant strain. Carriers A and B were predominantly colonized with nontypeable H. influenzae , carrier C predominantly with b − H. influenzae mutants, and carrier D with H. haemolyticus . A total of 358 H. influenzae and H. haemolyticus isolates were genotyped by pulsed-field gel electrophoresis (PFGE) following SmaI or EagI digestion of their DNA, and the carriers displayed the following: carrier A had 11 unique PFGE genotypes, carrier B had 15, carrier C had 7, and carrier D had 10. Thus, adult H. influenzae and H. haemolyticus carriers are colonized with multiple unique genotypes, the colonizing strains exhibit genetic diversity, and we observed day-to-day and week-to-week variability of the genotypes. These results appear to reflect both evolutionary processes that occur among H. influenzae isolates during asymptomatic pharyngeal carriage and sample-to-sample collection bias from a large, variable population of colonizing bacteria.

We describe 9 nonimmunosuppressed patients with central nervous system cryptococcosis. Morbidity and mortality were high, especially among patients with cerebral infarcts. This was attributed to delayed diagnosis and apparent sequelae of overwhelming host immune responses. We present clues suggesting the diagnosis. Increased recognition and timely diagnosis of this condition may improve outcomes.

High-molecular-weight proteins of Haemophilus influenzae mediate attachment to epithelial cells. Previous reports describe several allelic versions of hmwA genes that have different adherence properties. Here we report three new alleles of hmwA ( hmwA from strain AAr96, hmwA from strain AAr105, and hmwA from strain G822), demonstrating the high degree of DNA variation of these genes among different strains.

Periorbital cellulitis was retrospectively investigated in a cohort of 69 children, 1.5-16 years of age, who were admitted to Hacettepe University Children's Hospital. The aim of the study was to define the most important cause of the disease and to choose the most appropriate antimicrobial regimen. Sinusitis (43%) was found to be the most frequent disease associated with periorbital cellulitis. Trauma (25%) and odontogenic infections (6%) were the next most common predisposing causes. Staphylococcus aureus was isolated from 14 (74%) of 19 cultures. Two antibiotic combinations, penicillin plus chloramphenicol and sulbactam-ampicillin (SAM) with or without ornidazole was used in 30 (43%) and 39 (57%) of 69 cases, respectively. The duration of treatment with these two antibiotic combinations was generally between 7 and 10 days. No statistical difference was found between the two antibiotic combinations in the cure and recurrence rates but five (17%) of the 30 cases using penicillin plus chloramphenicol, and one (3%) of the 39 cases using SAM with or without ornidazole had recurrent periorbital cellulitis. It was concluded that SAM can be the first line of drug treatment for periorbital cellulitis as it is easily used in every age group and etiology (trauma, sinusitis, etc.). It provides total recovery and has less side effects and risk of recurrence. It also has a broad antimicrobial spectrum.

Background and Aims To investigate the effect of probiotics on colonization of resistant organisms in preterm infants receiving antibiotics. Methods This study comprised of preterm infants who were born < 36 weeks and received antibiotic treatment or prophylaxis. Preterm infants were divided into two groups according to receiving probiotic (Lactobacillus reuteri). Stool culture and nasal swab culture were taken to determine colonization. Results In the group receiving probiotics, mostly colonizing the stool cultures bacteries were Klebsiella spp, Escherichia coli, Enterococcus spp., Enterobacteriae spp., Staphylococcus spp. respectively, and in the group not receiving probiotic mostly colonizing the stool cultures bacteries were Klebsiella spp , Enterococcus spp., Staphylococcus spp. , Escherichia coli , Enterobacteriae spp. respectively. When probiotic receiving group compared was with not receiving group, proliferation rate of stool cultures was higher in probiotic group. In the groups receiving and not receiving probiotic, proliferation of the nose cultures were similar. Increase in the proliferation rates of weekly stool cultures in probiotic receiving group was statistically significant but there was no statistically difference in the proliferation rates of nose and other cultures that were taken weekly. There was no statistical difference in both groups in the development of resistant organisms. Conclusions The use of probiotics in neonatal intensive care unit for premature infants who received treatment with antibiotics, did not prevent the colonization of pathogenic microorganisms.