Aslinur Ozkaya-Parlakay

Evaluation of Crimean-Congo Hemorrhagic Fever Virus Infection in Children

Crimean-Congo haemorrhagic fever (CCHF) is a fatal viral infection and an important public health issue in Turkey because of its high case fatality rate. Severity criteria of CCHF were defined previously in adults on the basis of epidemiological, clinical, and laboratory findings,. This study evaluated the course of CCHF in children. Between January, 2009, and November, 2012, 41 patients aged between 1 and 17 years (mean 9.78 ± 4.85) with a diagnosis of CCHF were included in the study. According to results of our study, Turkish pediatric patients had a milder course of CCHF.

A Syrian patient diagnosed with meningococcal meningitis serogroup B

Meningococcal infection is an important health problem in children, with significant mortality and morbidity. In this infection, early recognition and aggressive treatment can reduce mortality. Herein we report an 11-year-old-Syrian refugee girl living in Turkey for 3 months admitting with fever, headache, and vomiting diagnosed as meningococcal meningitis type B who was cured with intravenous ceftriaxone therapy. Infections in refugee populations constitute major importance for highlighting importance of investigation of endemic diseases in their own country and contagious diseases in their present place.

Cytokine concentrations in pediatric patients with Crimean-Congo hemorrhagic fever.

Crimean-Congo hemorrhagic fever is a zoonotic disease that can be a severe illness in humans. We investigated concentrations of interleukin (IL)-6, tumor necrosis factor-&agr; and IL-10 in serum samples obtained from 25 pediatric Crimean-Congo hemorrhagic fever cases and 35 control children with no signs of infection. Lower cytokine values in our patients could be a good prognostic factor to for a better outcome.

A case of childhood Brucellosis with neurological involvement and epididymo-orchitis.

Brucellosis is a common zoonotic infection worldwide caused by Brucella species. Central nervous system involvement is a serious complication of brucellosis, and the clinical presentation is quite heterogeneous. The genitourinary system may be affected. Epididymo-orchitis is the most common type of urinary tract involvement, which can cause serious complications. Herein, we present a case of brucellosis in a child with a rare combination of epididymo-orchitis and neurobrucellosis not encountered previously in the literature.

A perinatal cytomegalovirus infection in an immunocompetent patient with chorioretinitis.

Cytomegalovirus (CMV) infection is the most common viral infection of newborns in all periods worldwide. Perinatal form of infection is usually less severe than the congenital form because of having a lower rate for serious organ involvement like central nervous system. In this article, we report a 3-month-old immunocompetent patient who was diagnosed as having perinatal CMV infection with a scar of chorioretinitis after presenting with gastroenteritis and hepatitis.

Parainfluenza virus 4 presenting with pericardial effusion in an immunocompetent child

Key words: parainfluenza virus 4 pleural effusion; children. To the Editors, Human parainfluenza viruses (HPIVs) are common respiratory tract pathogens that can infect persons of any age. They are enveloped, negative-sense RNA viruses that belong to the subfamily Paramyxovirinae of the family Paramyxoviridae. There are four genetically and antigenically different types, HPIV types 1 to 4 (HPIV-1 to-4) [1]. Although HPIV-4 has been regarded as less clinically important and associated with milder respiratory illness, serological studies have shown that it may account for as much as 3% of all respiratory tract infections [2] and demonstrated 50% to 90% seroprevalence in children and young adults [3]. As it is recovered less often in cell culture and reported in association with mild respiratory disease, HPIV-4 is not included in the routine panels of respiratory virus antigen detection on nasopharyngeal aspirates (NPAs) and other respiratory specimens collected in most clinical virology laboratories [1]. For this reason HPIV4 might be detected less often and this could lead to an underestimation of its clinical significance. We report a previously healthy child with HPIV 4 infection presenting with pericardial effusion. A 9-year-old girl was admitted to Ankara Pediatric Hematology Oncology Research Hospital with sore throat, myalgia and lethargy. Physical examination was normal except for tachycardia (114/min). Laboratory studies revealed elevated creatinine kinase (CK) 2419 unit/L (96-140 unit /L), myoglobin 335 ng/ml (10-65), troponin T 0.03 ng/ml (0-0.2), troponin I 0.05 ng/ml (0-0.1), aspartate aminotransferase (AST) 97 U/L (6-21), alanine aminotransferase (ALT) 45 U/L (7-56). Other laboratory tests such as hemogram and C reactive protein and erythrocyte sedimentation rate were within normal limits. Chest x-ray resulted normal. Electrocardiogram was within normal limits. Echocardiography was performed as tachycardia and creatine kinase (CK) elevated levels could not be explained and it showed pericardial effusion of 10 mm size behind the right atrium reaching 15 mm in the basal region. Ibuprofen at a dose of 10mg/kg/day was initiated. Virologic studies from serum for the etiology of pericardial effusion did not yield any positive findings. Tuberculin skin test was negative. Abdominal ultrasonography was normal. Repeated echocardiography on the next day showed diminished pericardial effusion in size. hMPV), from nasal aspirate was positive for human parainfluenza virus-4 (hPIV-4)HPIV-4 were performed. Cytomegalovirus, hepatitis and Coxsackie viruses tests did not yield any positive results. The patient was discharged with resolution of the

Myocarditis in a Child with Crimean-Congo Hemorrhagic Fever

Crimean-Congo hemorrhagic fever (CCHF) is a viral, tick-borne disease that can be fatal, especially in the adult patient population. CCHF involves multiple organ systems. Pericardial effusion, cardiac hypokinesia, T-wave changes, bundle branch block, and myocardial involvement can be seen as a cardiac complication of CCHF. Several different viruses like Coxsackie A/B and adenovirus may cause myocarditis and cardiomyopathy, but myocardial involvement of CCHF in children was rarely reported. We report a 13-year-old boy patient with myocarditis during the course of CCHF who has completely resolved after convalescent period of the disease.

A Cutaneous Lymphoma Mimicking Superficial Skin Abscess in a Child

6-year old boy was admitted with complaints ofredness and swelling on the skin of his abdomenthat developed after an insect bite and was refractoryto treatmentwithtopical and oral antibiotics, with history of10dayswithoutfeveranditching.Thepreviouslyhealthypa-tient’s physical and mental development was consistent withhisage;however,therewasaswollen,5 5-cmerythematouslessionontheabdominalskinthatwas10cmabovefromtheumbilicus, along with normal other system examinations(Figure 1; available at www.jpeds.com). Hemoglobin,platelets, white blood cell count, and biochemistry were allnormal, and there were 80% neutrophils with 20%lymphomonocytic cells in peripheral blood smear withoutatypical cells. Erythrocyte sedimentation rate and C-reactive protein were 12 mm/h (0-20) and 0.42 mg/dL (0-0.8), respectively. Superficial ultrasonography of the lesionwas reported as compatible with a thick-walled densecontent abscesses. The patient, who went through a failureof drainage of abscess, was hospitalized for intravenousantibiotic-therapy. The lesion was expanded gradually andbegan to necrotize from the top with intravenousampicillin-sulbactam treatment (Figure 2).On biopsy of the lesion, anaplastic large cell lymphomawas detected that had made an ulceration in the epidermisand vascular invasion thereunder with large pleomorphiccells consisting of multinucleated and prominent nucleoli(the Hallmark cells) with CD8 and CD30 positivity. The pa-tient, who did not have any tumor metastasis in the brain,abdomen, thorax, and the skeletal system, was transferredto the oncology department for treatment. Primary cuta-neous anaplastic large cell lymphoma, which is classified asaprimarycutaneous CD30-positivelymphoproliferative dis-order,

Successful Treatment of an Infant Infected with Refractory C. parapsilosis with Caspofungin

Neonatal Candida infections are the leading cause of invasive fungal infections that might cause severe morbidity or mortality in a large majority of those affected. Although Candida albicans has been the most common species, Candida parapsilosis is increasingly being recognized as an important cause of invasive candidiasis in neonates. Among the Candida species, C. parapsilosis has been commonly isolated and shown to be less susceptible in vitro to echinocandins than other Candida species. We report an infant who had refractory C. parapsilosis septicemia cured with caspofungin.