Necmi Aksaray

Cerebrospinal Fluid Shunt Infections in Children

Infections of cerebrospinal fluid shunts continue to be a substantial source of mortality and morbidity in children with hydrocephalus. Although several therapeutic modalities are currently used for the treatment of shunt infections, there are no clear guidelines for treatment. The purpose of this study was to determine the common pathogens of cerebrospinal fluid shunt infections and evaluate the success of our management. Thirty-five children treated for ventriculoperitoneal shunt infections over the past 9 years were reviewed. The management protocol consisted of the removal of the infected shunt, the application of ventricular taps or reservoir placement, intraventricular antibiotic treatment, and the placement of a new shunt when cerebrospinal fluid sterility was achieved. Four patients were treated with antibiotics alone. Most episodes occurred within 4 months of shunt placement. The most common causative microorganism identified was Staphylococcus epidermidis, followed by S. aureus, and S. warneri. Three patients died from complications of shunt infections, 2 patients had a recurrent shunt infection, while the remaining 29 patients remained free from shunt-related complications. In agreement with the evidence published in the literature, our findings suggest that the above management protocol is effective for the treatment of cerebrospinal fluid shunt infections.

Systemic phaeohyphomycosis due to Exophiala (Wangiella) in an immunocompetent child

We report a rare case of systemic lymphadenitis and hepatic involvement due to Exophiala (Wangiella) dermatitidis in a pediatric patient. An 8-year-old immunocompetent boy with chronic fever was examined through the use of sonography and CT scan which demonstrated cervical and mesenteric lymph node enlargement and numerous small hepatic lesions. The etiologic agent was isolated by means of lymph node aspiration. The fungus was identified by its morphological characteristics and through DNA sequencing of the internal transcribed spacer region of rDNA. Despite initial amphotericin B and voriconazole therapy, the childs jaundice subsided and he died 7 months later. In addition to pathogenic aspects of Exophiala dermatitidis, the diagnostic approaches and relevant therapeutic strategies are discussed.

Hepatitis B and C virus infections in Turkish children with cancer

In this study, we tested 137 Turkish children with cancer (51 with acute leukemia, 48 with lymphoma, 38 with solid tumors) while they were undergoing chemotherapy, and a control group of 45 for evidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections using the enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). The control group included children with other disease who had applied to the outpatient clinic during the study period and had no history of jaundice or transfusion. Sixty-five (47.4%) patients with cancer and 7 (20%) children in the control group were positive for hepatitis B surface antigen (HBsAg) (p < 0.01). HBV DNA was detected in 59 (43.1%) patients and in 9 (20%) controls (p < 0.01). HCV specific antibody (anti-HCV) was detected in 8 (5.8%) patients and in 1 (2.2%) control (p > 0.05). Eight patients (5.8%) had circulating HCV RNA, but none had in the control group (p = 0.09). Ten (13.9%) of the 72 patients who were negative for HBsAg had circulating HBV DNA, and 7 (5.4%) of the 129 patients who were negative for anti-HCV had circulating HCV RNA. We concluded that HBV and HCV infections are common among Turkish children with cancer. In countries where HBV infection is widespread among the general population as in Turkey, children with cancer are under greater risk for HBV infection.

Suprasellar tuberculoma causing endocrinologic disorders and imitating craniopharyngioma

A patient is reported with a suprasellar tuberculoma which imitated a craniopharyngioma on computed tomography scan and magnetic resonance imaging of the brain. This lesion developed during irregularly used antituberculous therapy and caused endocrinologic disorders 3 years after the original diagnosis of tuberculous meningitis. Surgery was performed to confirm the diagnosis and also to decompress the optic pathways. Five months later, the lesion disappeared completely after appropriate antituberculous treatment.

Tuberculous meningitis in children

Between May 1988 and November 1992 the data from 52 patients with tuberculous meningitis (TBM) were noted down for their symptoms and signs, BCG vaccines, PPD tests; clinical, laboratory, radiologic and microbiologic findings. These data were discussed by means of literature knowledge. Cranial computed tomography (CT) demonstrated hydrocephalus (HC) in 98% of the patients. There was a statistically significant difference among the clinical stages on admission in respect to prognosis (P < 0.05). In addition, there was also a significant relationship between prognosis and HC (P < 0.05). However, we did not find any significant relationship between parenchymal involvement, basilar meningitis and prognosis (P > 0.05).

Hepatitis B and C virus infections in Turkish children with haemophilia.

We examined 41 Turkish children with haemophilia for evidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections using the enzyme‐linked immunosorbent assay (ELISA). Hepatitis B surface antigen was found to be positive in 11 patients (26. 8%) and HCV‐specific antibody (anti‐HCV) was detected in 10 (24. 4%) patients. There was a close relationship of the number of transfusions of blood plasma to the presence of HCV specific antibody, but not to the serum markers of HBV infection. In countries where HBV infection is commonly seen and problems in transfusion practice continue, as in Turkey, children with haemophilia are at greater risk for HBV and HCV infections.

Bacillary Angiomatosis in an Immunocompetent Child with a Grafted Traumatic Wound

Bacillary angiomatosis is an infectious disease which usually develops in immunocompromised patients. Contact with cats is implicated in its pathogenesis. We report a seven‐year‐old immunocompetent boy with bacillary angiomatosis without a history of direct contact with cats. The clinical diagnosis of bacillary angiomatosis was made following histopathological examination of a biopsy sample from the infected facial wound, in the vicinity of which angiomatous lesions had developed. Surprisingly, similar lesions also appeared at the donor site of the skin graft which was grafted on the facial wound. This case demonstrates that bacillary angiomatosis may also be seen in immunocompetent patients and that it may contaminate wounds without the intermediary of cats.

Helicobacter pylori Antibodies in Patients on Chronic Hemodialysis

Prof. Yahya Sagliker, Department of Internal Medicine, Cukurova University, Faculty of Medicine, TR-01330 Adana (Turkey) Table 1. Characteristics of hemodialysis patients Hp(-) Dear Sir, A variety of gastrointestinal tract disorders are seen in uremic patients and gastritis, gastroduodenal ulceration, and bleeding are frequent complications of uremia [1]. Reduced gastric motility, changes in gastric morphology and histology, and increased gastrin levels may induce gastroduodenal lesions [2]. Helicobacter pylori (HP), a gram-negative spiral bacterium, has been shown to be strongly associated with gastritis, peptic ulcer disease and nonulcer dyspepsia, to be increased with gastritis, peptic ulcer disease and nonulcer dyspepsia [3]. Increased urea content of the gastric mucus could be a risk factor for HP in patients with chronic renal failure [4]. We measured the prevalence of HP in 91 hemodialysis (HD) patients and the results were correlated with dialysis duration, blood urea levels, receiving antacids or not. Ninety-one HD patients, 55 males and 36 females, aged between 16 and 70 years (mean age 41.4 ± 1.4 years) were studied. The mean duration of HD was 22.9 ± 2.2 months (range: 6-120 months). Sixty-eight HD patients (74.7%) were receiving aluminium antacids and calcium carbonate as phosphate binders. Serum samples for blood urea and Hp were taken before dialysis. Thirty-five age-matched healthy subjects with normal renal function were used as controls. Patients who had received antibiotics and colloidal bismuth preparations prior to blood sampling were excluded. IgG antibodies against HP were measured by using the IgG ELISA test where the sensitivity and specificity of this technique was near 95%. The χ2 test and the t test were used for statistical analysis. NS = Not significant. HP was detected in 13 (14.3%) of 91 patients undergoing regular HD. The mean predialysis serum urea in HP positive (+) and HP negative (-) patients was 127.3 ± 16.1 and 108.6 ± 19.8mg/dl, respectively, the difference being significant at p < 0.001. There were no difference between HP (+) and HP (-) patients with respect to sex, age, and HD duration. The receiving

Epidemiology of meningococcal infections in children in mid-southern part of Turkey

Abstract59 patients were treated for meningococcal infections in Çukurova University Faculty of Medicine, Division of Pediatric Infectious Diseases. 50.8% of patients were male, 33.9% were under two years of age and 61% were under five. 78% of patients were admitted to hospital in winter and spring time. Meningococcal meningitis (MM) was present in 39% of patients on admission, however, meningococcemia in 27.1% and meningococcemia and meningococcic meningitis (Meningococcemia + MM) in 33.9%. Fatality rate was 18.6% and no association was found between mortality and clinical type of disease (p>0.05), but mortality ratio decreased with an increasing age (p<0.01). No deaths occurred among the 12 patients who received IV penicillin treatment shortly before admitting to hospital, on the other hand 11 of 47 patients (23.4%) without such a previous treatment died.

Detection of Hepatitis B and C Infection by Polymerase Chain Reaction among Hemodialysis Patients

Accessible online at: www.karger.com/journals/nef Dear Sir, Patients undergoing hemodialysis (HD) potentially have an increased risk of exposure to viral hepatitis. As anemia is an unavoidable complication of chronic renal failure, HD patients often require frequent blood transfusions with consequent high risk of posttransfusion hepatitis. Additionally, they may be exposed to viruses from other patients by being crowded and common use of equipment. Firstly, the risk of hepatitis B virus (HBV) infection has been determined and problems due to HBV have been reduced by use of immunization, periodic testing, isolation of infected patients and by improved disinfectant procedures. Despite these control measures, elevated serum alanine aminotransferase (ALT) levels have been found in some HD patients. Currently, because of the detection of a high rate of antibody to hepatitis C virus (HCV) in these patients, HCV is thought to be the major cause of hepatitis in HD units. The detection of viral hepatitis is still a difficult problem because of the use of less sensitive and specific serological assays. Seropositivity may indicate infection or immune response. The polymerase chain reaction (PCR) method that amplifies viral genome is a highly specific and more sensitive technique. The aim of our study was to determine the prevalence of HBV DNA and HCV RNA by the PCR method in HD patients. In this study, the association of HBsAg and anti-HCV positivity with blood transfusion and duration of HD were also investigated.