Işık Yalçın

Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children

Ceftriaxone is a widely used third‐generation cephalosporin. In this prospective study, we used sonography to investigate the incidence and outcome of biliary complications in children receiving ceftriaxone therapy.

Presentation of Interleukin-12/-23 Receptor β1 Deficiency with Various Clinical Symptoms of Salmonella Infections

Clinical disease caused by weakly pathogenic mycobacterial species, Mycobacterium bovis Bacille Calmette-Guérin (BCG) and non-tuberculous environmental mycobacteria (EM), which is known as Mendelian susceptibility to mycobacterial disease (MSMD), is a rare entity defined recently. Infections with the more virulent Mycobacterium species, M. tuberculosis, may have largely gone unnoticed in these patients due to early death. Mutations in five proteins (IFNγR1, IFNγR2, IL-12/IL-23Rβ1, IL-12/IL-23p40 and STAT1) have been found in MSMD. These patients are prone to surprisingly few other infectious diseases mainly to salmonellosis. Here we present three IL-12/IL-23Rβ1 deficient patients from three different families and with different genetic mutations, who presented exclusively with Salmonella infections. Bacteremia and lymph node involvement were common clinical expressions. Leukocytoclastic vasculitis developed in one of these patients. Two patients were not inoculated with BCG, the third patient did not develop BCG infection although BCG vaccine had been given twice at ages of 1 and 7 years. All three patients responded well to antibiotic treatment. In conclusion, patients with chronic, recurrent or complicated Salmonella infections should be screened for MSMD, particularly for IL-12/IL-23p40/IL-12R/-23Rβ1 deficiency. Conversely, in patients with genetic IL-12/-23Rβ1 deficiency a full evaluation for Salmonella infection is required. IL-12/IL-23p40/IL-12R/IL-23Rβ1 deficiency seem to be underdiagnosed in patients with salmonellosis, and since such patients need prolonged therapy, diagnosis is important.

Serotype distribution and antibiotic susceptibility of invasive Streptococcus pneumoniae disease isolates from children in Turkey, 2001–2004

Streptococcus pneumoniae is a major cause of childhood invasive infections, including sepsis, pneumonia and meningitis, and of non-invasive disease such as otitis media. Most S. pneumoniae strains from invasive infections capable of creating treatment problems in children because of antibiotic resistance belong to serogroups 14, 6, 9, 19 and 23. Despite progress in antimicrobial therapy, effective treatment is becoming increasingly complicated because of the rising worldwide emergence of pneumococci resistant to penicillin G and other commonly used antimicrobial agents [1, 3, 5].The aim of the present study was to investigate the antibiotic susceptibility pattern and serotype distribution of S. pneumoniae isolates from children younger than 10 years of age hospitalized with invasive pneumococcal disease (IPD) in Turkey during the years 2001–2004. All patients admitted and treated for invasive infections attributable to S. pneumoniae, between November 2001 and April 2004, in the six large university hospitals in Turkey, located in Istanbul, Adana, Ankara and Izmir, were included in this study. The study cohort represents roughly 30% (20 million) of the population of Turkey. Cases were eligible for evaluation if S. pneumonia, isolated from a normally sterile body site, was identified on the basis of typical colony morphology on blood agar as well as Gram strain, optochin sensitivity and bile solubility tests. Isolate identity was confirmed at the central study laboratory (Department of Microbiology and Infection Disease, Istanbul Faculty of Medicine). Susceptibility tests to antimicrobial agents (penicillin G, amoxicillin-clavulanic acid, cefotaxime, erythromycin and trimethoprim-sulfamethoxazole) were performed by standard disc diffusion method on Müller Hinton agar supplemented with 5% sheep blood. The susceptibility for penicillin was detected with a 1-μl oxacillin disc. The minimal inhibitory concentration (MIC) of the antibiotics was determined by the E test. Disc diffusion tests were employed according to the Clinical and Laboratory Standards Institute guidelines (formerly known as the NCCLS guidelines). An inoculum density equivalent to 0.5 MacFarland standard was prepared in Muller Hinton broth. Capsular typing was carried out by the Quellung reaction, using group and factor sera provided by the Statens Serum Institute (Denmark). Vaccine-type strains included serotypes 4, 6B, 9V, 14, 18C, 19F and 23F. We defined vaccine-related strains as pneumococci with serotypes within the same serogroup as the vaccine types (i.e. serotypes 6A, 9A, 9L, 9N, 18A, 18B, 18F, 19A, 19B, 19C, 23A and 23B) [6]. I. Yalçın Department of Paediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey