Dilek Yilmaz Ciftdogan

Effect on Hearing of Oral Valganciclovir for Asymptomatic Congenital Cytomegalovirus Infection

Congenital cytomegalovirus (CMV) infection is the leading nongenetic cause of congenital sensorineural hearing loss (SNHL). Hearing loss due to congenital CMV infection either has onset after the newborn period or shows progressive decline in auditory thresholds. Although 90% of the congenitally infected infants are asymptomatic at birth, evidence is accumulating that these infants are at risk for audiologic, neurologic and developmental sequelae. In symptomatically infected infants, ganciclovir therapy administered in the neonatal period prevents hearing deterioration. However, preventative therapy of asymptomatic congenital CMV disease is controversial. Here in, we reported a male newborn with asymptomatic congenital CMV with bilateral SNHL. Oral treatment with valganciclovir in patient resulted in progressive improvement of SNHL, which effectively reduced the CMV viral load and was well tolerated without apparent adverse effects.

A case of Mondini dysplasia with recurrent Streptococcus pneumoniae meningitis

Mondinis dysplasia is a developmental anomaly of the middle ear characterized by cochlear malformation with dilation of the vestibular aquaduct, vestibule, and ampullar ends of the semicircular canals. These deformities may result in a connection between subarachnoid space and the middle ear resulting in recurrent episodes of meningitis. Additionally, it is commonly associated with hearing impairment. We describe here a boy with recurrent meningitis and unilateral sensorineural hearing loss. Mondini dysplasia was demonstrated with computed tomographic scans of the temporal bones in the search for pathogenesis of recurrent meningitis.

Brucellosis as a Cause of Fever of Unknown Origin in Children Admitted to a Tertiary Hospital in the Aegean Region of Turkey

The aim of the study was to determine the role of brucellosis in children with fever of unknown origin (FUO) in the Aegean region of Turkey. For this purpose, the records of all children referred or admitted with diagnosis of FUO to the Department of Pediatric Infectious Diseases, Ege University Medical School, between 2003 and 2008 were scanned and 92 cases were identified retrospectively. Fifty-eight of these 92 children (63%) were diagnosed with infectious diseases, brucellosis being the most frequent cause (15.2%). Although several other infectious diseases do appear as a cause of FUO, brucellosis should be particularly considered as a differential diagnosis.

Ventriculoperitoneal shunt infections and re-infections in children: a multicentre retrospective study

Abstract Purpose: Ventriculoperitoneal shunt (VPS) is the most common treatment modality for hydrocephalus. However, VPS infection is a common and serious complication with high rates of mortality and morbidity. The objective of this study was to investigate causative agents and the management of VPS infections and to identify risk factors for re-infection in children. Materials and methods: Retrospective, multicentre study on patients with VPS infection at paediatric and neurosurgery departments in four tertiary medical centres in Turkey between January 2011 and September 2014. Results: A total of 290 patients with VPS infections were identified during the study period. The aetiology of hydrocephalus was congenital malformations in 190 patients (65.5%). The most common symptom of shunt infection was fever in 108 (37.2%) cases. At least one pathogen was identified in 148 VPS infections (51%). The most commonly isolated pathogen was coagulase-negative staphylococci, which grew in 63 cases (42.5%), followed by Pseudomonas aeruginosa in 22 cases (14.9%), Klebsiella pneumoniae in 15 cases (10.1%), and Staphylococcus aureus in 15 cases (10.1). The median duration of VPS infection was 2 months (range, 15 days to 60 months) after insertion of the shunt, with half (49.8%) occurring during the first month. VPS infection was treated by antibiotics and shunt removal in 211 cases (76.4%) and antibiotics alone without shunt removal in 65 patients (23.5%). Among the risk factors, CSF protein level greater than 100 mg/dL prior to VPS insertion was associated with a potential risk of re-infection (OR, 1.65; p =.01). Conclusion: High protein levels (>100 mg/dL) before the re-insertion of a VPS may be a risk factor for VPS re-infection.

Septic pulmonary emboli secondary to disseminated, community-acquired, methicillin-resistant Staphylococcus aureus infection

Community-associated strains of methicillin-resistant Staphylococcus aureus have recently emerged as a major cause of serious infections with rarely observed serious complication, such as deep vein thrombosis (DVT) and septic pulmonary embolism (SPE), among children. SPE, DVT and bone or joint infections are a triad which is rarely seen in children. This clinical syndrome is a life-threatening disorder, which requires prompt diagnosis and aggressive treatment. We report a 14-year-old boy who was diagnosed with SPE, DVT and disseminated, community-acquired, methicillin-resistant S. aureus.

Tuberculous otomastoiditis complicated by sinus vein thrombosis.

Tuberculosis (TB) is a rare cause of chronic suppurative otitis media and mastoiditis, therefore it is usually not considered in the differential diagnosis of chronic infections of this area, especially when evidence of pulmonary tuberculosis is absent.1 This diagnosis should be considered in patients that do not respond to empirical therapy. An 11-year-old previously healthy male was admitted to our hospital with swelling in the mastoid area. Left ear discharge and otalgia had started two months prior. Empirical antibiotic therapy had been prescribed by a pediatrician. Symptoms had persisted despite appropriate antibacterial treatment. Temporal MRI revealed inflammatory swelling in the left middle ear and the mastoid air cells (Fig. 1). The patient was treated with surgery, metronidazole, and cefazolin. The pathological specimen showed granulomatous tissue with necrosis and Langhans giant cells. Acid-resistant bacilli was positive in the tissue. The patient’s history was reviewed. His grandfather had received treatment for tuberculosis one year prior, thus our patient had taken prophylaxis, but for an inadequate period and improperly. The 48-hour tuberculin test (PPD) measured 21 mm (positive), one BCG scar was observed, and the chest X-ray was normal. Acid-resistant bacilli was