Özlem Özdemir

Nosocomial candidaemia in children: results of a 9‐year study

The aim of this study was to determine changes in the incidence of nosocomial candidaemia and to evaluate the risk factors, demographic features, treatment and clinical outcome associated with candidaemia in a Turkish tertiary care paediatric unit within a 9‐year period. The data of children who were diagnosed as nosocomial candidaemia, were examined in this study. Between January 1997 and December 2005, a total of 102 nosocomial candidaemia episodes were identified in 102 patients. The rate of nosocomial candidaemia in our clinic increased from 3.2 cases per 1000 admissions in 1997–1999, to 5.5 per 1000 admissions in 2000–2002 and to 6.9 per 1000 admissions in 2003–2005 (P = 0.003). The species most frequently causing candidaemia were Candida albicans (39.2%), Candida parapsilosis (21.6%) and Candida tropicalis (15.7%). The mortality of C. albicans (37.5%), was significantly higher than the mortality of non‐albicans species (17.7%) (P = 0.04). Independent risk factors associated with candidaemia‐related deaths by logistic regression analysis were disseminated candidiasis (odds ratio, 5.7; P = 0.01), paediatric intensive care unit stay (odds ratio, 8.1; P = 0.001), prolonged antibiotics therapy (odds ratio, 5.2; P = 0.014), use of total parenteral nutrition (odds ratio, 4.4; P = 0.038) and mechanical ventilation (odds ratio, 4.9; P = 0.01). The rate of nosocomial candidaemia in our clinic increased >2‐fold during the study period.

Involuntary movements during vitamin B12 treatment.

It has been known for many years that vitamin B12 deficiency can cause neurologic problems. One of these problems is involuntary movements that can appear both before and after the initiation of vitamin B12 treatment. Here, we report 3 infants who developed movement disorder during vitamin B12 administration. The movement disorder consisted of a combination of tremor and myoclonus affecting face, tongue, and limbs. Because of the severity of the symptoms, they all needed symptomatic treatment. In 2 of them, the involuntary movements resolved with clonazepam. The involuntary movements in the other patient were successfully treated with piracetam.

Reversible Posterior Leukoencephalopathy Induced by Cancer Chemotherapy

Reversible posterior leukoencephalopathy, defined by both clinical and neuroimaging findings, can affect children receiving chemotherapy. The syndrome is characterized by hypertension, alterations in mental status, seizures, hallucinations, and acute visual changes and is associated with abnormalities seen in magnetic resonance imaging of symmetric white matter lesions, especially in the parietal and occipital lobes. The etiology of reversible posterior leukoencephalopathy is as yet unknown. Presented here are four cases of reversible posterior leukoencephalopathy induced by chemotherapy, with a brief review of the literature and consideration of possible mechanisms. A diagnosis of reversible posterior leukoencephalopathy should be considered when patients receiving cancer chemotherapy suddenly develop hypertension followed by neurologic complications, especially if presenting with seizures.

Nosocomial Gram‐positive bacterial infections in children: Results of a 7 year study

Background: The aim of the present paper was to determine the rate of culture‐proven nosocomial infections and evaluate the episodes of nosocomial Gram‐positive (GP) bacterial infections in pediatric patients.

Lymphoma of the Cavernous Sinus Mimicking Tolosa-Hunt Syndrome in a Child

Some children with malignancies initially present with neurologic signs. Cavernous sinus syndrome is a rare manifestation of lymphomas, more commonly reported in adults. A patient presenting with third and fourth cranial nerve palsies was initially thought to manifest Tolosa-Hunt syndrome, but during follow-up a diagnosis of lymphoma without systemic involvement was established. This patient is the youngest, to our knowledge, to be diagnosed with primary cavernous sinus lymphoma. He remains in remission 5 years after chemotherapy. Malignancies (especially non-Hodgkins lymphoma) should be considered in young children with cavernous sinus syndrome, even without systemic involvement.

Clofarabine-induced capillary leak syndrome in a child with refractory acute lymphoblastic leukemia.

Clofarabine has significant efficiency in children with relapsed or refractory leukemia. In previous pediatric trials, various adverse effects have been described. In this case, we report a child with refractory acute lymphoblastic leukemia who developed fatal capillary leak syndrome during clofarabine therapy.

Chronic Inflammatory Demyelinating Polyneuropathy in Common Variable Immunodeficiency

Common variable immunodeficiency comprises a heterogeneous group of primary antibody deficiencies with complex clinical and immunologic phenotypes. Immune dysregulation leads to the generation of multiple autoantibodies against various antigenic targets in patients with common variable immunodeficiency. Chronic inflammatory demyelinating polyneuropathy is a heterogeneous disorder that indicates an autoimmune response against peripheral nerve myelin. We describe a 7-year-old girl with common variable immunodeficiency who developed chronic inflammatory polyneuropathy. A 5-day course of intravenous immunoglobulin (500 mg/kg/day) improved her neurologic disorder. Chronic inflammatory demyelinating polyneuropathy should be added to the broadening spectrum of neurologic complications in common variable immunodeficiency. Early detection and consequent treatment may reverse the neurologic sequelae.

Resolution of autoimmune oophoritis after thymectomy in a myasthenia gravis patient.

Myasthenia gravis (MG) is an autoimmune disorder characterized by autoantibodies against acetylcholine receptors. MG is generally an isolated disorder but may occur concomitantly with other autoimmune diseases. We describe an eighteen-year-old girl with MG who was admitted to our clinic with secondary amenorrhea and diagnosed as autoimmune oophoritis. Since her myasthenic symptoms did not resolve with anticholinesterase therapy, thymectomy was performed. After thymectomy, her menses have been regular without any hormonal replacement therapy. To our knowledge, this is the first report on a patient with autoimmune ovarian insufficiency and MG in whom premature ovarian insufficiency resolved after thymectomy, without hormonal therapy. Conflict of interest:None declared.

Hot Water Epilepsy Successfully Treated With Daily Clobazam.

Hot water epilepsy (HWE) is a rare form of reflex epilepsy precipitated by a bath or shower in hot water. Although the condition is benign and a decreased bath temperature will help, antiepileptic drugs may be needed in some cases. Prophylactic clobazam is currently the first choice treatment option. Here we report the case of a 10-year-old boy with HWE successfully treated with daily doses of clobazam. Daily clobazam was preferred over prophylactic clobazam because of the patients frequent bathing and parental concern. Daily clobazam is a novel treatment option for HWE and seems to be a good choice where antiepileptic drugs are necessary.

Yürüyemeyen On Dokuz Aylık Bir Hastada Düşünülmesi Gereken Bir Tanı: Sma Tip Iı

Spinal muskuler atrofi (SMA) proksimal kaslari tutan, ilerleyici gucsuzluk ve kas atrofisi ile giden noromuskuler bir hastaliktir. Spinal muskuler atrofi Tip I kolaylikla tani konulabilirken, SMA Tip II ve III gozden kacabilmektedir. SMA Tip II 7-18 aylik donemde baslar ve daha yavas seyirlidir. Besinci kromozomun uzun kolundaki SMN (survival motor neuron) genindeki delesyondan kaynaklanmaktadir. Bu cocuklar genellikle yurume guclugu ile basvururlar. Tedavisi henuz mumkun olmayan bu hastalikta amac hastalarin yasam kalitesini arttirmaktir. Ailelere prenatal genetik danismanlik saglamak onemlidir. Bu yazida SMA Tip II tanisi konulan on dokuz aylik olgu sunularak, yuruyememe sikayeti ile getirilen hastalarda SMA Tip II’nin akilda tutulmasi gerektigi vurgulanmak istendi.