Gülnar Şensoy

Clinical and epidemiological features of Turkish children with 2009 pandemic influenza A (H1N1) infection: Experience from multiple tertiary paediatric centres in Turkey

Abstract Background: In April 2009 a novel strain of human influenza A, identified as H1N1 virus, rapidly spread worldwide, and in early June 2009 the World Health Organization raised the pandemic alert level to phase 6. Herein we present the largest series of children who were hospitalized due to pandemic H1N1 infection in Turkey. Methods: We conducted a retrospective multicentre analysis of case records involving children hospitalized with influenza-like illness, in whom 2009 H1N1 influenza was diagnosed by reverse-transcriptase polymerase chain reaction assay, at 17 different tertiary hospitals. Results: A total of 821 children with 2009 pandemic H1N1 were hospitalized. The majority of admitted children (56.9%) were younger than 5 y of age. Three hundred and seventy-six children (45.8%) had 1 or more pre-existing conditions. Respiratory complications including wheezing, pneumonia, pneumothorax, pneumomediastinum, and hypoxemia were seen in 272 (33.2%) children. Ninety of the patients (11.0%) were admitted or transferred to the paediatric intensive care units (PICU) and 52 (6.3%) received mechanical ventilation. Thirty-five children (4.3%) died. The mortality rate did not differ between age groups. Of the patients who died, 25.7% were healthy before the H1N1 virus infection. However, the death rate was significantly higher in patients with malignancy, chronic neurological disease, immunosuppressive therapy, at least 1 pre-existing condition, and respiratory complications. The most common causes of mortality were pneumonia and sepsis. Conclusions: In Turkey, 2009 H1N1 infection caused high mortality and PICU admission due to severe respiratory illness and complications, especially in children with an underlying condition.

Crimean-Congo haemorrhagic fever: peritoneal and pleural effusion

Abstract In Crimean–Congo haemorrhagic fever (CCHF), haemorrhagic manifestations are usually petechiae and ecchymoses on mucous membranes and skin. Rarely, there is bleeding from the nose, gingiva, gastro-intestinal tract, genito-urinary tract, brain and lungs. A 13-year-old boy with CCHF presented with gastro-intestinal bleeding and developed peritoneal and pleural effusion. He made a complete recovery with supportive treatment and ribavirin, without requiring chest or peritoneal fluid drainage. To our knowledge, this is the first report of CCHF associated with peritoneal and pleural fluid.

Invasive Candida infections in solid organ transplant recipient children.

Solid organ transplantation (SOT) is now an accepted therapy for many end-stage organ disorders and fungal infections are the principal cause of infection-related mortality in SOT recipients. Among invasive fungal infections, Candida species are the most common pathogens identified, associated with high mortality rates. The epidemiology and clinical manifestations of Candida infections vary with the type of organ transplantation. This article reviews invasive Candida infections in pediatric SOT recipients.

Severe myopathy caused by the new pandemic influenza A (H1N1) in a child

Myopathy is a rare complication of influenza infections. Here, we report on an eight-year-old girl with severe myopathy due to new pandemic influenza A (H1N1). She presented with severe myopathy following generalized tonic-clonic seizure and recovered completely within a few days.

Treatment-failure tularemia in children

Purpose Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment. Methods A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included. Results Before diagnosis, the duration of symptoms in patients was 32.15±17.8 days. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10–14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment. Conclusion The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.

Prolonged acyclovir treatment in a child with opercular syndrome related to herpes simplex encephalitis.

HSV 1 encephalitis is the most common cause of sporadic and focal viral encephalitis. Opercular syndrome is characterized by swallowing and speech difficulties which are associated with deterioration of voluntary control of face, pharynx, tongue and chewing muscles. It can be developed in patients with Herpes simplex encephalitis (HSE). Here, a twelve-year-old boy who was diagnosed with HSE and Opercular syndrome, is presented. The patient recovered without sequela as a result of 30 days of intravenous and 10 days of oral acyclovir treatment. It might be important as well, to personalize and elongate the treatment in terms of prognosis.

Çocukluk Çağı Sarkoidozu: İki Farklı Klinik Tablo

Etiyolojisi bilinmeyen non-nekrotizan epiteloid granulomlar ve coklu organ tutulumu ile karakterize bir hastalik olan sarkoidoz; cocuklarda cok nadir olup, prezantasyonu ve prognozu eriskinlerden farklidir. Erken yaslarda uveit, artrit ve deri tutulumu on planda iken; adolesan doneminde akciger ve lenf dokusu tutulumu gorulmektedir. Yaslarina gore farkli klinik tablo arz eden iki vaka sunuldu. Sarkoidoz cocuklarda iki farkli klinik tablo ile gorulebilir. Childhood sarcoidosis: Two different clinical picture Background: Sarcoidosis is a disease characterized with non-necrotizing granulomas and multiorgan involvement and unknown etiology. This disease is less common and has different presentation and prognosis in children than adults. In children younger than 5 years of age, the disease is mainly characterized by the involvement of the skin, eyes and joints, whereas in older children, involvement of the lungs, lymph nodes and eyes predominate. Case: Two cases that have different clinics according to their age are presented here. Conclusion: In children sarcoidosis have two different clinical pictures.