Mehtap Yazicioglu

Indoor airborne fungal spores and home characteristics in asthmatic children from Edirne region of Turkey

Abstract Background The contribution of indoor fungal exposure to childhood asthma is not completely clear Objective To investigate airborne fungal flora within the homes of asthmatic and control children, and to assess the influence of housing characteristics regarding indoor fungi Methods Forty-seven atopic asthmatic and 23 nonatopic control children were studied. Allergen sensitivity was determined by skin prick tests. A thorough assessment, using a questionnaire and inspection surveys, was carried out. Home visits were made between October 2000 and February 2001. Samples of airborne fungal spores were collected from four rooms by the “open Petri dish” method. Indoor temperature and humidity were measured Results The total indoor fungal colony counts from the living rooms and bedrooms were significantly higher in the asthma group than in controls (p = .012 and p = .003, respectively). The most commonly isolated genus was Cladosporium. Twelve of the asthmatic patients (25.53 %) were found to be sensitive to fungal allergens. The factors found to be associated with indoor fungal growth in logistic regression were visible fungal patches in the bathrooms [(odds ratio (OR) = 5.75; 95 % CI 1.19 to 27.70)], and the age of the house [OR = 4.24; 95% CI 1.34 to 13.45]. Total fungal colony numbers did not correlate with indoor temperature or humidity Conclusion Fungal colony numbers were higher in the homes of asthmatic children than in those of controls. Therefore, indoor fungal exposure may contribute to childhood asthma. Bathrooms were the main source of fungal propagules. Old houses were more prone to fungal growth

A multi-center survey of childhood asthma in Turkey - I: The cost and its determinants

Successful management of childhood asthma requires a thorough idea of the economic impact of asthma and its determinants, as policy makers and physicians inevitably influence the outcome. The aim of this study was to define the cost of childhood asthma in Turkey and its determinants. In April 2006, a multi‐center, national study was performed where data regarding cost and control levels were collected. Asthmatic children (6–18 yr) with at least a 1‐yr follow‐up seen during a 1‐month period with scheduled or unscheduled visits were included. The survey included a questionnaire‐guided interview and retrospective evaluation of files. Cost and its determinants during the last year were analyzed. A total of 618 children from 12 asthma centers were surveyed. The total annual cost of childhood asthma was US

The association between DRESS and the diminished numbers of peripheral B lymphocytes and natural killer cells.

1597.4 ± 236.2 and there was a significant variation in costs between study centers (p < 0.05). Frequent physician visits [odds ratio (95% confidence intervals)] [2.3 (1.6–3.4)], hospitalization [1.9 (1.1–3.3)], asthma severity [1.6 (1.1–2.8)], and school absenteeism due to asthma [1.5 (1.1–2.1)] were major predictors of total annual costs (p < 0.05 for each). The comparable cost of asthma among Turkish children with that reported in developed countries suggests that interventions to decrease the economic burden of pediatric asthma should focus on the cost‐effectiveness of anti‐allergic household measures and on improving the control levels of asthma.

Generalized fixed drug eruption in a child due to trimethoprim/sulfamethoxazole

To cite this article: Yazicioglu M, Elmas R, Turgut B, Genchallac T. The association between DRESS and the diminished numbers of peripheral B lymphocytes and natural killer cells. Pediatr Allergy Immunol 2012: 23: 289–296.

Predicting Hospitalization in Children with Acute Asthma

To the Editor, Fixed drug eruption (FDE) is a common cutaneous adverse drug reaction characterized by recurrent lesions in the same location upon repeated exposition to the causative drug. Generally, a single lesion arise but multiple lesions can also occur. Lesions heal with residual hyperpigmentation (1). More than 100 drugs are reported to cause FDE. Penicillins, tetracyclines, sulfonamides, sulfones, pyrazolones, barbiturates, and phenolphthalein are the most common culprit drugs (2). A T-cell-mediated delayed type of hypersensitivity reaction type IVc plays a role in the pathogenesis (1). A three-year-old male patient presented with eruptions of the body, desquamation in anal region and a mouth sore. His eruptions started four days ago, 30 min–1 h after taking the first dose of trimethoprim/sulfamethoxazole which was prescribed for the treatment of acute gastroenteritis. He was seen in a public hospital where he was diagnosed with scarlet fever and amoxicillin–clavulanate treatment was started. As the patient’s symptoms continued to worsen, he returned on the second day of the therapy and referred to our allergy department. Physical examination revealed rhagades around lip, an aphthous lesion on hard palate, numerous roundto-oval-shaped, reddish-brown to violaceous macules over the trunk and upper back, the biggest of which were reaching 10 9 10 cm in size, sharply demarcated reddish-brown to violaceous macules in urogenital and anal region, and desquamation in anal region (Fig. 1). Two weeks before, similar lesions appeared in the same locations after ingestion of trimethoprim/sulfamethoxazole. His personal and family history was unremarkable. Upon a presumptive diagnosis of FDE, the patient’s antibiotic therapy (amoxicillin–clavulanate) was stopped. His complete blood count, liver, and renal function tests were normal, and viral serology was negative for CMV, EBV, herpes simplex type 1 and type 2, toxoplasmosis, rubella, hepatitis A, hepatitis B, hepatitis C, and HIV. The punch biopsy of the skin revealed keratinous plugs along the surface of the epidermis, lymphocytic infiltrate of the dermoepidermal junction and upper dermis (Fig. 2). Immunohistochemically, lymphocytes showing positive labeling with anti-CD8 and anti-CD3 were found to be abundant along the basal layer and upper dermis (Fig. 3). Lymphocytes showing positive labeling with anti-CD4 were in upper dermis.

Perceptions of Parents and Physicians Concerning the Childhood Asthma Control Test

BACKGROUND Acute asthma is one of the most common medical emergencies in children. Appropriate assessment/treatment and early identification of factors that predict hospitalization are critical for the effective utilization of emergency services. OBJECTIVE To identify risk factors that predict hospitalization and to compare the concordance of the Modified Pulmonary Index Score (MPIS) with the Global Initiative for Asthma (GINA) guideline criteria in terms of attack severity. METHODS The study population was composed of children aged 5-18 years who presented to the Emergency Departments (ED) of the tertiary reference centers of the country within a period of 3 months. Patients were evaluated at the initial presentation and the 1(st) and 4(th) hours. RESULTS Of the 304 patients (median age: 8.0 years [interquartile range: 6.5-9.7]), 51.3% and 19.4% required oral corticosteroids (OCS) and hospitalization, respectively. Attack severity and MPIS were found as predicting factors for hospitalization, but none of the demographic characteristics collected predicted OCS use or hospitalization. Hospitalization status at the 1(st) hour with moderate/severe attack severity showed a sensitivity of 44.1%, specificity of 82.9%, positive predictive value of 38.2%, and negative predictive value of 86.0%; for MPIS ≥ 5, these values were 42.4%, 85.3%, 41.0%, and 86.0%, respectively. Concordance in prediction of hospitalization between the MPIS and the GINA guideline was found to be moderate at the 1(st) hour (κ = 0.577). CONCLUSION Attack severity is a predictive factor for hospitalization in children with acute asthma. Determining attack severity with MPIS and a cut-off value ≥ 5 at the 1(st) hour may help physicians in EDs. Having fewer variables and the ability to calculate a numeric value with MPIS makes it an easy and useful tool in clinical practice.

EBV-induced erythema multiforme: a case report

Background. The Childhood Asthma Control Test (C-ACT) has been proposed to be a simple, patient-based test that is able to reflect the multidimensional nature of asthma control. In this analysis, the aim was to evaluate the perceptions of physicians and caregivers concerning C-ACT and its predictive value for future asthma-related events. Method. In a multicenter prospective design, 368 children aged 4–11 years with asthma who were either well- or not well-controlled were included in the study. The study participants were evaluated during three visits made at 2-month intervals and the Turkish version of C-ACT was completed each month. Parents completed questionnaires concerning their perception of asthma (before and after the study) and the C-ACT (after the study). Physicians completed a survey about their perception of a control-based approach and the C-ACT. Results. The C-ACT scores increased from visit 1 to visit 3, with improvement seen in all domains of the test. At the end of the study period, the parents more strongly agreed that asthma could be controlled completely and that asthma attacks and nocturnal awakenings due to asthma were preventable (p < .05). Most of the parents reported that the C-ACT helped them to determine asthma treatment goals for their children and also that the C-ACT improved communication with their physicians. The physicians indicated that a control-centered approach was more convenient (95%) and simpler (94.5%) than a severity-centered approach and provided better disease control (93.4%). A higher C-ACT score was associated with a decreased risk of asthma attack and emergency department admittance in the 2 months following the administration of C-ACT. Conclusion. Our findings indicated that the C-ACT improved both parental outlook on asthma control and the communication between the physician and parents. There was a good correlation between the C-ACT score and the level of asthma control achieved, as described by the physician. Additionally the C-ACT score was predictive of future asthma-related events. These findings suggest that the C-ACT may have an important role in asthma management in the future.

Stevens-Johnson syndrome: a case report

rythema multiforme (EM) is a type of dermatosis hat occurs as a hypersensitivity reaction in response o medications or infections. Erythema multiforme is ostly associated with the herpes simplex virus (HSV) or ycoplasma infections,1 but it is rare that EM is associated ith the Epstein Barr Virus (EBV). We report on an 11-year-old male patient admitted to ur hospital with redness, swelling, burning sensation, an tchy rash on hands and feet, and a rash on the body that ad begun four days previously. The patient suffered fever, ore throat and nose running a day before these complaints anifested. The skin rash began on the sole of the right oot, which was noticed upon a sensation of something stuck n the right sole, and then spread to the left sole and he hands. At the outset, the skin rash was pinhead sized, hen increased in size, and swelling in the hands and feet ccurred. The first physician consulted wrote a prescripion for cefuroxime, cetirizine and feniramine. However, the atient’s complaints were not resolved after one day of using his medication, and so he was referred to our hospital. In our physical examination of the patient, a macuopapuler rash that included desquamation regions which aled under pressure, was observed on both palms, oles, arms and legs. His body temperature was 37 ◦C. ther system examinations revealed no abnormal findings Figures 1 and 2). Face, body and mucosal involvement was ot noted. Laboratory examination revealed leukocyte count: 9900 mm3, haemoglobin: 14.1 gr/dl, platelet count: 214000 mm3, erythrocyte sedimentation rate: 22 mm/hour, urea: 2 mg/dl, creatinine: 0.8 mg/dl, serum sodium: 134 MEq/L, otassium: 4.5 MEq/L, AST: 31 IU/L, ALT: 22 IU/L. The patient was also tested for the Rickettsia IgG, HSV ype I IgM, HSV type II IgM, EBV VCA IgM, CMV IgM, the arvovirus IgM, and Mycoplasma pneumoniae IgM antibodes in order to rule out rickettsiosis and other infectious skin ruptions because of the symmetrical maculopapular rash nvolving the hands and feet. Doxycycline treatment was ubsequently initiated with a clinical presumptive diagnosis f rickettsiosis. On the second day following the patient’s dmission to hospital, typical target lesions appeared, the argest of which was 2 cm in diameter, on both thighs and he proximal area of the forearms (Figure 3). EBV VCA IgM nd Rickettsia IgG were positive at a titer of 1/10 and 1/64 espectively. In the repeated tests performed one week and ne month later, there was no increase in the Rickettsia gG titres. Doxycycline treatment was halted on day seven, nd EBV infection was thought to be responsible for EM n our patient. Other viral markers and examinations for ycoplasma were found to be negative. On the fifth day f admission, the patient was discharged from the hospital s the rash had a tendency to pale. The rash disappeared on he 14th day from the beginning and the patient was cured ithout sequela. One month later, in order to rule out a possible adverse rug reaction due to cefuroxime use reported in the atient’s history, a patch test (10 mg/ml) was done, which c h J a igure 1 A dispersed red-purple colored maculopapular rash hat pales under pressure was shown around ankle and medial ide of the foot.

Severe Acute Allergic Contact Dermatitis Presenting as Erythroderma: A Case Report

Stevens-Johnson syndrome is a serious systemic disorder in which there are fever, vesicobullous lesions involving the skin and mucous membranes. It can result as an immune response to an antigen or as a drug reaction. Most often it is considered as an allergic reaction. It is a self-limiting condition which responds to immediate management or may result in fluid loss, sepsis and death. There is no specific treatment for Stevens-Johnson syndrome. Suspected drug discontinuation and supportive therapy is the first step in treatment of Stevens- Johnson. Systemic steroid use in the treatment of Stevens-Johnson syndrome is a controversial issue. Here, we present a case of Stevens-Johnson syndrome who responded well to the treatment with systemic steroids.

Oxcarbazepine-induced Stevens–Johnson syndrome: a pediatric case report

Eritroderma vucut yuzey alaninin %90’dan fazlasini tutan eritem ve soyulma olarak tanimlanmakta olup cocukluk yas grubunda cok cesitli sistemik ve kutanoz hastaliklara bagli olarak gelisebilmektedir. Ancak kontakt dermatite bagli eritroderma cocuklarda oldukca nadir gorulmektedir. Bu yazida kara kedi esansi isimli bir esansa bagli alerjik kontakt dermatit ve eritroderma gelisen on uc aylik bir kiz hasta sunulmustur.