Seçmeer G

Beneficial effects of dexamethasone in children with pneumococcal meningitis.

Fifty-six children older than 2 years with meningitis caused by Streptococcus pneumoniae were enrolled in a prospective, double blind, placebo-controlled trial to evaluate the efficacy of dexamethasone therapy in addition to antimicrobial therapy. Twenty-nine of 56 received dexamethasone (0.6 mg/kg/day iv, divided into 4 daily doses for 4 days) and the remaining 27 received placebo. At the beginning of therapy the clinical and laboratory characteristics of the patients in the treatment groups were comparable, except for the Glasgow coma score (P = 0.004), which was lower in the dexamethasone group. Patients were examined daily during hospitalization and 6 weeks after discharge from the hospital. Hearing was assessed 6 weeks after discharge by means of pure tone audiometry. Two patients in the dexamethasone group and one patient in the placebo group died. There were no differences between the two groups with regard to the duration of fever, the incidence of secondary fever and electrolyte imbalance, seizure activities occurring during hospitalization and rash. Although the differences were statistically insignificant, moderate or severe unilateral or bilateral sensorineural hearing loss at 6 weeks and the overall neurologic sequelae, including hearing loss, at 1 year were higher in the placebo group, at 23% vs. 7.4% (P = 0.11) and 26.9% vs. 7.4% (P = 0.062), respectively. At 3 months after discharge, because of the improvement in hearing loss in one dexamethasone-treated patient the incidence of hearing impairment was significantly less than that in the placebo group, at 3.7% vs. 23%, respectively (P = 0.044). No improvement in hearing loss was observed after 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective study of etiology of childhood acute bacterial meningitis, Turkey.

Vaccines to prevent bacterial meningitis in this region must provide reliable protection against serogroup W-135.

Role of procalcitonin and CRP in differentiating a stable from a deteriorating clinical course in pediatric febrile neutropenia.

In clinical practice, when neutropenic-fever patients present with no microbiologically and clinically defined infection, the risk of underestimating an occult infection is of major concern, the clinicians have to make a decision on when to modify antibiotic therapy. Hence, a reliable, specific, and sensitive marker, which is regulated independently from the leukocyte count and the underlying disease, is needed for the early diagnosis of infections in cases of neutropenic fever. We have evaluated the diagnostic and follow-up value of procalcitonin (PCT) compared with C-reactive protein (CRP) and erythrocyte sedimentation rate in documenting the infection in neutropenic-fever patients undergoing intensive chemotherapy, as evidenced by the durational change in these parameters in the presence of defined infection. Forty-nine patients, who had 60 febrile episodes, and who were hospitalized in the Hacettepe University Ihsan Doğramacı Childrens Hospital between January 1, 2004 and January 1, 2005 were included in this prospective study. All patients had been diagnosed with neutropenic fever after intensive chemotherapy. In our study, PCT and CRP levels were significantly higher in neutropenic-fever patients (group I and group II separately) than in control patients (P<0.001) throughout the study period; but erythrocyte sedimentation rate levels did not show any significant difference (P>0.05). In sequential analyses of patients without documented infections, the median of PCT concentrations shows a tendency to fall after the 8th hour of onset of fever, whereas in patients with documented infections PCT concentrations fell after the 48th hour. In conclusion, our study suggests that PCT, when measured periodically, is a more useful diagnostic inflammation parameter in pediatric neutropenic-fever patients than CRP, both in estimating the severity of the infection and, the duration and origin of the fever. Hence, PCT might be helpful when deciding on initial therapy modification.

Secondary hemophagocytic lymphohistiocytosis in Turkish children.

Between January 1998 and January 2005, a total of 18 children 2 weeks–72 months of age were diagnosed as having secondary hemophagocytic lymphohistiocytosis. The frequency of secondary hemophagocytic lymphohistiocytosis among total hospitalized patients during this period was 0.05% (18 of 34,250). Of the 18 patients, 8 (44.5%) had bacterial infections; cytomegalovirus and Epstein-Barr virus infections were present in 5 (28%) and 1 (5.5%), patient, respectively. Leishmaniasis was diagnosed in 2 patients (11%), and herpes simplex virus was diagnosed in 2 patients (11%). Six patients died during treatment, and 1 patient was lost to follow-up. The survival rate was 61%.

Measurement Accuracy of Fever by Tympanic and Axillary Thermometry

As the basic sciences develop, temperature measurement methods and devices were improved. For hundreds of years both in clinics and home, mercury-in-glass thermometer was the standard of human temperature measurements. In this study, we aimed to compare tympanic infrared thermometers with the conventional temperature option, mercury-in-glass thermometer, which is historical standard in the clinical conditions. Methods: A total of 102 randomly selected pediatric patients who admitted to our hospital were enrolled, and simultaneous temperature measurements were performed via axilla and external auditory canal with 3 different techniques. For external auditory recordings, infrared tympanic First Temp Genius for clinical use and Microlife IR 1DA1 for home usage were used. Classic mercury-in-glass thermometers were used for axillary recording. For each method, 886 measurements were performed. Results: The mean results of the axillary mercury-in-glass thermometers, infrared tympanic First Temp Genius, and Microlife IR 1DA1 were 36.8 ± 0.7, 37.5 ± 0.9, 36.9 ± 0.8, respectively. The Bland-Altman plot of differences suggests that 95% of the infrared tympanic clinical use thermometer readings were within the limits of agreement, which is +0.27 and −1.75°C range of mercury-in-glass thermometer. The Bland-Altman plot of differences suggests that 95% of the tympanic home-use thermometer readings were within the limits of agreement, which is +0.98 and −1.27°C range of mercury-in-glass thermometer. In our group, 15% of the patients were misdiagnosed as febrile with home-use tympanic thermometer, whereas this percentage was 4% with clinical tympanic thermometer. Also, 5% and 31% of febrile patients were misdiagnosed as afebrile with clinical tympanic and home-use tympanic thermometer, if axillary mercury-in-glass thermometer recording defines fever. Discussion: Our results showed that there is a significant difference in each recording with different thermometers, and this variance was present in both higher and lower readings. We recommend thathome-use infrared tympanic thermometer could be used for screening but must not be considered as a tool to decide patients follow-up.

Complement component deficiencies and infection: C5, C8 and C3 deficiencies in three families

Three families are described with complement component deficiencies. In one family, five children had C5 deficiency; in a second family, two children had C8 deficiency and one child in a third family had C3 deficiency. The index cases were identified during screening of patients with recurrent pyogenic infections, recurrent meningitis and meningococcaemia. Two of the five C5 deficient patients had recurrent meningitis and meningococcaemia, two had recurrent respiratory tract infections and otitis and one was healthy. One of the C8 deficient patients had meningitis, meningococcaemia and pneumonia, whereas his sibling with the same deficiency was healthy. The patient with C3 deficiency had four episodes of meningitis and recurrent otitis.

PIPERACILLIN/TAZOBACTAM PLUS AMIKACIN VERSUS CARBAPENEM MONOTHERAPY AS EMPIRICAL TREATMENT OF FEBRILE NEUTROPENIA IN CHILDHOOD HEMATOLOGICAL MALIGNANCIES

A prospective, randomized clinical trial was conducted to compare the efficacy of piperacillin/tazobactam and amikacin combination with carbapenem monotherapy for the empirical treatment of febrile neutropenic episodes of children with acute lymphoblastic leukemia or acute myeloblastic leukemia. Patients aged 2–16 years with hematological malignancies who had febrile neutropenia were randomly assigned to receive piperacillin/tazobactam (80 mg/kg piperacillin/10 mg/kg tazobactam, q6h) combined with amikacin (PTA) (7.5 mg/kg, q12h) or meropenem or imipenem (20 mg/kg, q8h) (C). Response to antimicrobial therapy, evaluated for etiological agents, was measured. Duration of fever, neutropenia, and hospitalization, mortality, and the need for additional antibiotics or antifungal drugs were compared for the treatment success between the two groups. Out of 87 febrile neutropenic episodes that were evaluable for comparison, 46 patients received PTA and 41 patients were treated with carbapenems (imipenem or meropenem). Overall, the microbiologically documented infection rate was 21.9%, with Staphylococcus epidermidis as the most common cause of bacteremia. The rate of treatment modification was 56.5% in the PTA group and 53.6% in the carbapenem group with no statistical difference (p >. 05). There was no infection-related mortality during the study period.There was no difference between the two regimens for durations of fever, neutropenia, and hospitalization (p >. 05 for all categories). PTA was as effective as carbapenem monotherapy as an initial empirical regimen in febrile neutropenic episodes of pediatric hematological malignancies.

Severe Protein S Deficiency Associated with Heterozygous Factor V Leiden Mutation in a Child with Purpura Fulminans

Homozygous or compound heterozygous protein S (PS) deficiency is very rare in the population; only 8 patients from 6 different families have been reported. On the other hand, the factor V Leiden (FVL) mutation is a frequent cause of inherited prothrombotic disorder. Here the authors report a case of patient with severe PS deficiency associated with the FVL mutation who has had purpura fulminans since the age of 10 days. She is the first child of a consanguineous marriage. Her father is double heterozygous for PS deficiency and FVL mutation and has recurrent thrombosis. This is the first case of severe PS deficiency combined with the FVL mutation. This suggests the need for complete evaluation of patients with purpura fulminans for thrombotic factors.

Take of rhesus-human reassortant tetravalent rotavirus vaccine in breast-fed infants

Rhesus‐human reassortant tetravalent rotavirus vaccine at a titer of 4 x 104 plaque forming units was evaluated for immmunogenicity in 194 6–8‐week‐old breast‐fed Turkish infants. The vaccine was administered orally as a single dose following either a meal of breast milk or 30 ml of sodium bicarbonate‐buffered soy milk formula. Four‐fold or greater responses in rotavirus IgA ELISA antibody were detected in 62% and 65′% of the infants in the two groups, respectively (p= 0.62). In a smaller comparison group of non‐breast‐fed infants, an IgA response was detected in 7 of 11 (64%) cases. In all vaccinees, a serological response was detected in 72% of the initially seronegative and 47% of the initially seropositive infants (p= 0.001). We conclude that the take of rhesus‐human reassortant tetravalent rotavirus vaccine in breast‐fed infants is not compromised by breast feeding before vaccination. However, a higher titered preparation of the same vaccine may be required to improve overall immunogenicity in young infants, particularly in those with pre‐vaccination rotavirus antibody.

Influenza Vaccine Adverse Event and Effect on Acceptability in Pediatric Residents

Despite the demonstrated benefits of influenza vaccinations, the coverage is lower than expected among health-care personnel (HCP). In this study we surveyed the attitudes of pediatric residents regarding influenza immunization and adverse reactions. Forty-five female and 35 male pediatric residents with ages ranging from 24 to 28 years were vaccinated with an influenza vaccine on 2 days in the 3rd week of September 2005 by the same nurse. Among our resident, 27 (33.7%) thought the vaccine unnecessary; their vaccine coverage was only 12% in the previous year. Thirteen residents (16%) had soreness at the vaccination site; 7 (8%) had other local reactions that did not interfere with everyday activities, and 16 (20%) had any systemic side effects. The overall rate of side effects from the vaccination was 36.5% (n=29). Twenty of the 29 vaccinees who experienced side effects stated they did not want to receive the vaccine the following year because of the side effects, while 13% in the group without side effects stated the same thing, mainly because of the cost of vaccination. We would like to recommend an influenza vaccination campaign for HCP by employers, but first we must plan to take steps to improve the acceptability of the influenza vaccine among HCP.C vaccine delivery methods for prevention of global childhood diseases carry a high risk for needle contamination, vaccine wastage, and transportation and storage difficulties. Aktiv-Dry LLC’s focus is on R&D of safe and effective microparticles of vaccines and pharmaceuticals for easier storage, greater thermal stability, and ease of use. We utilize our patented CO2-Assisted Nebulization with a Bubble Dryer® (CAN-BD) system to create stable dry microparticles of compounds for administration by needle-free aerosol inhalers, sublingual solid formulations, or safer unit-dose, all-in-one auto-reconstitution syringe devices. Recently, our work has focused on vaccine prevention of measles and hepatitis B. Aktiv-Dry has developed inhalable and sublingual vaccines for measles along with a human-powered, active dry powder inhaler called the PuffHaler® for intrapulmonary delivery of the dry powder measles vaccine. CAN-BD processed measles vaccine shelf-life stability has been shown for 4 years at 2-8oC, protective immunity after intrapulmonary delivery to rhesus macaques, and no serious adverse events reported to date during on-going clinical Phase I safety trials in 60 adult males in India. We have also demonstrated stability of CAN-BD processed and dried microparticles of hepatitis B vaccine for use in a preloaded, single-dose, field-reconstitution device for parenteral delivery. Aktiv-Dry-formulated hepatitis-B vaccine was stabilized with trehalose, processed, and determined to retain stability using in-house stability assays. Our immunogenicity results from intrapulmonary mucosal membrane delivery of measles vaccine dry powder aerosols and fundamental project goals may be extended to prevention and treatment (e.g., antibiotics and antivirals) of other pulmonary diseases (e.g., tuberculosis and influenza). Jessica M.H. Thrall et al., J Vaccines Vaccin 2013, 4:5 http://dx.doi.org/10.4172/2157-7560.S1.017