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Yilmaz Ciftdogan D, Ekemen Keles Y, Karbuz A, Cetin BS, Elmas Bozdemir S, Kepenekli Kadayifci E, Metin Akcan O, Ozer A, Erat T, Sutcu M, Buyukcam A, Belet N, Erdeniz EH, Dalgic Karabulut N, Hancerli Torun S, Oncel S, Orbak Z, Turel O, Gayretli Aydin ZG, Kilic O, Yahsi A, Kara Aksay A, Ergenc Z, Petmezci MT, Oflaz MB, Sarikaya R, Otar Yener G, Ozen S, Gul D, Arslan G, Kara SS, Demirkol D, Yazici Ozkaya P, Yozgat Y, Varan C, Kara M, Arga G, Yakut N, Kilic AO, Cakici O, Kucuk M, Kaba O, Karaoglu Asrak H, Bursal Duramaz B, Dalkiran T, Berna Anil A, Turgut M, Karapinar B, Somer A, Elmali F, Dinleyici EC, Ciftci E, Kara A. Multisystem inflammatory syndrome in children associated with COVID-19 in 101 cases from Turkey (Turk-MISC study). J Paediatr Child Health 2022; 58:1069-1078. [PMID: 35199895 PMCID: PMC9115147 DOI: 10.1111/jpc.15913] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/19/2021] [Accepted: 02/06/2022] [Indexed: 12/11/2022]
Abstract
AIM Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey. METHODS The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis. RESULTS The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6-9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112-228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30-84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58-20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died. CONCLUSION The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.
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Affiliation(s)
- Dilek Yilmaz Ciftdogan
- Department of Pediatric Infectious Diseases, Faculty of MedicineIzmir Katip Celebi UniversityIzmirTurkey,Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research HospitalUniversity of Health SciencesIzmirTurkey
| | - Yildiz Ekemen Keles
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research HospitalUniversity of Health SciencesIzmirTurkey
| | - Adem Karbuz
- Department of Pediatric Infectious DiseasesIstanbul Professor Doctor Cemil Tascioglu City HospitalIstanbulTurkey
| | - Benhur Sirvan Cetin
- Department of Pediatric Infectious Diseases, Faculty of MedicineErciyes UniversityKayseriTurkey
| | - Sefika Elmas Bozdemir
- Department of Pediatric Infectious DiseasesBursa Dortcelik Children's HospitalBursaTurkey
| | - Eda Kepenekli Kadayifci
- Department of Pediatric Infectious Diseases, Faculty of MedicinePendik Training and Research Hospital, Marmara UniversityIstanbulTurkey
| | - Ozge Metin Akcan
- Department of Pediatric Infectious Diseases, Faculty of MedicineNecmettin Erbakan University, Meram HospitalKonyaTurkey
| | - Arife Ozer
- Division of Pediatric Infectious Diseases, Van Training and Research HospitalUniversity of Health SciencesVanTurkey
| | - Tugba Erat
- Division of Pediatric Infectious DiseasesSanliurfa Training and Research HospitalSanliurfaTurkey
| | - Murat Sutcu
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstinye University HospitalIstanbulTurkey
| | - Ayse Buyukcam
- Division of Pediatric Infectious DiseasesGaziantep CG Obstetrics and Children's HospitalGaziantepTurkey
| | - Nursen Belet
- Department of Pediatric Infectious Diseases, Faculty of MedicineDokuz Eylul University HospitalİzmirTurkey
| | - Emine Hafize Erdeniz
- Department of Pediatric Infectious DiseasesOndokuz Mayis University HospitalSamsunTurkey
| | - Nazan Dalgic Karabulut
- Division of Pediatric Infectious DiseasesHealth Sciences University Sisli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Selda Hancerli Torun
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Selim Oncel
- Department of Pediatric Infectious Diseases, Faculty of MedicineKocaeli University HospitalKocaeliTurkey
| | - Zerrin Orbak
- Department of Pediatrics, Faculty of Dentistry and MedicineAtatürk UniversityErzurumTurkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Faculty of MedicineBezmialem Vakif University HospitalIstanbulTurkey
| | - Zeynep Gokce Gayretli Aydin
- Department of Pediatric Infectious Diseases, Faculty of MedicineKaradeniz Teknik University HospitalTrabzonTurkey
| | - Omer Kilic
- Department of Pediatric Infectious Diseases, Faculty of MedicineOsmangazi University HospitalEskisehirTurkey
| | - Aysun Yahsi
- Division of Pediatric Infectious Diseases, Samsun Training and Research HospitalUniversity of Health SciencesSamsunTurkey
| | - Ahu Kara Aksay
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research HospitalUniversity of Health SciencesIzmirTurkey
| | - Zeynep Ergenc
- Department of Pediatric Infectious Diseases, Faculty of MedicinePendik Training and Research Hospital, Marmara UniversityIstanbulTurkey
| | - Mey Talip Petmezci
- Department of Intensive CareIstanbul Professor Doctor Cemil Tascioglu City HospitalIstanbulTurkey
| | - Mehmet Burhan Oflaz
- Department of Pediatric Cardiology, Faculty of MedicineNecmettin Erbakan University, Meram HospitalKonyaTurkey
| | - Remzi Sarikaya
- Division of Cardiology, Van Training and Research HospitalUniversity of Health SciencesVanTurkey
| | - Gülcin Otar Yener
- Division of Pediatric RomatologySanliurfa Training and Research HospitalSanliurfaTurkey
| | - Seval Ozen
- Department of Pediatric Infectious Diseases, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
| | - Doruk Gul
- Department of Pediatrics, Faculty of MedicineIstinye University HospitalIstanbulTurkey
| | - Gazi Arslan
- Department of Pediatric Intensive Care, Faculty of MedicineDokuz Eylul University HospitalİzmirTurkey
| | - Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Faculty of MedicineAydin Adnan Menderes UniversityAydinTurkey
| | - Demet Demirkol
- Department of Pediatric Intensive Care, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Pinar Yazici Ozkaya
- Department of Pediatric Intensive Care, Faculty of MedicineEge University HospitalIzmirTurkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Faculty of MedicineBezmialem Vakif University HospitalIstanbulTurkey
| | - Celal Varan
- Department of Pediatric Cardiology, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
| | - Manolya Kara
- Division of Pediatric Infectious DiseasesNecip Fazil City HospitalKahramanmarasTurkey
| | - Gul Arga
- Department of Pediatric Infectious Diseases, Faculty of MedicineAnkara University HospitalAnkaraTurkey
| | - Nurhayat Yakut
- Department of Pediatric Infectious Diseases, Faculty of MedicinePendik Training and Research Hospital, Marmara UniversityIstanbulTurkey
| | - Ahmet Osman Kilic
- Department of Pediatrics, Faculty of MedicineNecmettin Erbakan University, Meram HospitalKonyaTurkey
| | - Ozlem Cakici
- Department of Pediatric Infectious Diseases, Faculty of MedicineKocaeli University HospitalKocaeliTurkey
| | - Mehmet Kucuk
- Division of Pediatric Cardiolgy, Samsun Training and Research HospitalUniversity of Health SciencesSamsunTurkey
| | - Ozge Kaba
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Hatice Karaoglu Asrak
- Department of Pediatric Infectious Diseases, Faculty of MedicineDokuz Eylul University HospitalİzmirTurkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Faculty of MedicineBezmialem Vakif University HospitalIstanbulTurkey
| | - Tahir Dalkiran
- Division of Pediatric Intensive CareNecip Fazil City HospitalKahramanmarasTurkey
| | - Ayse Berna Anil
- Department of Pediatric Intensive Care, Faculty of MedicineIzmir Katip Celebi UniversityIzmirTurkey
| | - Mehmet Turgut
- Department of Pediatric Infectious Diseases, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
| | - Bulent Karapinar
- Department of Pediatric Intensive Care, Faculty of MedicineEge University HospitalIzmirTurkey
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Ferhan Elmali
- Department of BiostatisticsIzmir Katip Celebi UniversityIzmirTurkey
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of MedicineEskisehir Osmangazi UniversityEskisehirTurkey
| | - Ergin Ciftci
- Department of Pediatric Infectious Diseases, Faculty of MedicineAnkara University HospitalAnkaraTurkey
| | - Ates Kara
- Department of Pediatric Infectious Diseases, Faculty of MedicineHacettepe University HospitalAnkaraTurkey
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Yilmaz Ciftdogan D, Ekemen Keles Y, Cetin BS, Dalgic Karabulut N, Emiroglu M, Bagci Z, Buyukcam A, Erdeniz EH, Arga G, Yesil E, Cakici O, Karbuz A, Sahbudak Bal Z, Kara SS, Ozer A, Metin Akcan O, Elmas Bozdemir S, Anil AB, Uygun H, Kilic O, Hancerli Torun S, Umit Z, Sutcu M, Ozgokce Ozmen B, Karaoglu Asrak H, Alkan G, Kara Aksay A, Ugur C, Birbilen AZ, Bursal Duramaz B, Akyuz Ozkan E, Burakay O, Yildirim Arslan S, Karadag Oncel E, Celik SF, Kilic AO, Ozen S, Sarikaya R, Demirkol D, Arslan G, Turel O, Sert A, Sari E, Orbak Z, Sahin IO, Varan C, Akturk H, Tuter Oz SK, Durak F, Oflaz MB, Kara M, Karpuz D, Talip Petmezci M, Hatipoglu N, Oncel S, Turgut M, Elmali F, Somer A, Kuyucu N, Dinleyici EC, Kurugöl Z, Ciftci E, Kara A. COVID-19 associated multisystemic inflammatory syndrome in 614 children with and without overlap with Kawasaki disease-Turk MIS-C study group. Eur J Pediatr 2022; 181:2031-2043. [PMID: 35129668 PMCID: PMC8819197 DOI: 10.1007/s00431-022-04390-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/09/2022] [Accepted: 01/21/2022] [Indexed: 12/17/2022]
Abstract
Multisystemic inflammatory syndrome (MIS-C) diagnosis remains difficult because the clinical features overlap with Kawasaki disease (KD). The study aims to highlight the clinical and laboratory features and outcomes of patients with MISC whose clinical manifestations overlap with or without KD. This study is a retrospective analysis of a case series designed for patients aged 1 month to 18 years in 28 hospitals between November 1, 2020, and June 9, 2021. Patient demographics, complaints, laboratory results, echocardiographic results, system involvement, and outcomes were recorded. A total of 614 patients were enrolled; the median age was 7.4 years (interquartile range (IQR) 3.9-12 years). A total of 277 (45.1%) patients with MIS-C had manifestations that overlapped with KD, including 92 (33.3%) patients with complete KD and 185 (66.7%) with incomplete KD. Lymphocyte and platelet counts were significantly lower in patients with MISC, overlapped with KD (lymphocyte count 1080 vs. 1280 cells × μL, p = 0.028; platelet count 166 vs. 216 cells × 103/μL, p < 0.001). The median serum procalcitonin levels were statistically higher in patients overlapped with KD (3.18 vs. 1.68 µg/L, p = 0.001). Coronary artery dilatation was statistically significant in patients with overlap with KD (13.4% vs. 6.8%, p = 0.007), while myocarditis was significantly more common in patients without overlap with KD features (2.6% vs 7.4%, p = 0.009). The association between clinical and laboratory findings and overlap with KD was investigated. Age > 12 years reduced the risk of overlap with KD by 66% (p < 0.001, 95% CI 0.217-0.550), lethargy increased the risk of overlap with KD by 2.6-fold (p = 0.011, 95% CI 1.244-5.439), and each unit more albumin (g/dl) reduced the risk of overlap with KD by 60% (p < 0.001, 95% CI 0.298-0.559). CONCLUSION Almost half of the patients with MISC had clinical features that overlapped with KD; in particular, incomplete KD was present. The median age was lower in patients with KD-like features. Lymphocyte and platelet counts were lower, and ferritin and procalcitonin levels were significantly higher in patients with overlap with KD. WHAT IS KNOWN • In some cases of MIS-C, the clinical symptoms overlap with Kawasaki disease. • Compared to Kawasaki disease, lymphopenia was an independent predictor of MIS-C. WHAT IS NEW • Half of the patients had clinical features that overlapped with Kawasaki disease. • In patients whose clinical features overlapped with KD, procalcitonin levels were almost 15 times higher than normal. • Lethargy increased the risk of overlap with KD by 2.6-fold in MIS-C patients. • Transient bradycardia was noted in approximately 10% of our patients after initiation of treatment.
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Affiliation(s)
- Dilek Yilmaz Ciftdogan
- Izmir Katip Celebi University, Izmir, Turkey
- Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey
| | - Yildiz Ekemen Keles
- Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey
| | | | - Nazan Dalgic Karabulut
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Zafer Bagci
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | - Ayse Buyukcam
- Gaziantep CG Obstetrics and Children’s Hospital, Gaziantep, Turkey
| | | | - Gul Arga
- Ankara University Hospital, Ankara, Turkey
| | | | | | - Adem Karbuz
- Istanbul Professor Doctor Cemil Tascioglu City Hospital, Istanbul, Turkey
| | | | | | - Arife Ozer
- Van Training and Research Hospital, Van, Turkey
| | | | | | | | | | - Omer Kilic
- Osmangazi University Hospital, Eskisehir, Turkey
| | | | | | - Murat Sutcu
- Istinye University Hospital, Istanbul, Turkey
| | | | | | | | - Ahu Kara Aksay
- Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cuneyt Ugur
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | | | | | | | | | - Eda Karadag Oncel
- Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey
| | | | | | - Seval Ozen
- Adiyaman University Hospital, Adiyaman, Turkey
| | | | | | - Gazi Arslan
- Dokuz Eylul University Hospital, İzmir, Turkey
| | - Ozden Turel
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | - Ahmet Sert
- Selcuk University Hospital, Konya, Turkey
| | - Ergul Sari
- Bakirkoy Sadi Konuk Children Hospital, Istanbul, Turkey
| | | | | | - Celal Varan
- Adiyaman University Hospital, Adiyaman, Turkey
| | | | | | - Fatih Durak
- Gaziantep CG Obstetrics and Children’s Hospital, Gaziantep, Turkey
| | | | | | | | - Mey Talip Petmezci
- Istanbul Professor Doctor Cemil Tascioglu City Hospital, Istanbul, Turkey
| | | | - Selim Oncel
- Kocaeli University Hospital, Kocaeli, Turkey
| | | | | | - Ayper Somer
- Istanbul University Hospital, Istanbul, Turkey
| | | | | | | | | | - Ates Kara
- Hacettepe University Hospital, Ankara, Turkey
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Suskun C, Kilic O, Yilmaz Ciftdogan D, Guven S, Karbuz A, Parlakay AO, Kara Y, Kacmaz E, Sahin A, Boga A, Kizmaz Isancli D, Gulhan B, Kanik-Yuksek S, Kiral E, Bozan G, Arslanoglu MO, Can Kizil M, Dinleyici M, Us T, Varis A, Kaya M, Vandenplas Y, Cagri Dinleyici E. Correction to: Intestinal microbiota composition of children with infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome (MIS-C). Eur J Pediatr 2022; 181:3193-3194. [PMID: 35695956 PMCID: PMC9189620 DOI: 10.1007/s00431-022-04525-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Cansu Suskun
- Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, TR-26040 Turkey
| | - Omer Kilic
- Department of Pediatric Infectious Disease, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Dilek Yilmaz Ciftdogan
- Department of Pediatric Infectious Disease, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Sirin Guven
- Department of Pediatrics, Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Adem Karbuz
- Department of Pediatric Infectious Disease, Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Aslinur Ozkaya Parlakay
- Yildirim Beyazit University, Faculty of Medicine Department of Pediatric Infectious Disease, Ankara City Hospital, Department of Pediatric Infectious Disease, Ankara, Turkey
| | - Yalcın Kara
- Department of Pediatric Infectious Disease, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Ebru Kacmaz
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Aslihan Sahin
- Department of Pediatric Infectious Disease, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Aysun Boga
- Department of Pediatrics, Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Didem Kizmaz Isancli
- Department of Pediatric Infectious Disease, Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Belgin Gulhan
- Department of Pediatric Infectious Disease, Ankara City Hospital, Ankara, Turkey
| | - Saliha Kanik-Yuksek
- Department of Pediatric Infectious Disease, Ankara City Hospital, Ankara, Turkey
| | - Eylem Kiral
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Gurkan Bozan
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mehmet Ozgür Arslanoglu
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mahmut Can Kizil
- Department of Pediatric Infectious Disease, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Meltem Dinleyici
- Department of Social Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Tercan Us
- Department of Microbiology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | | | | | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, TR-26040 Turkey
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Suskun C, Kilic O, Yilmaz Ciftdogan D, Guven S, Karbuz A, Ozkaya Parlakay A, Kara Y, Kacmaz E, Sahin A, Boga A, Kizmaz Isancli D, Gulhan B, Kanik-Yuksek S, Kiral E, Bozan G, Arslanoglu MO, Kizil MC, Dinleyici M, Us T, Varis A, Kaya M, Vandenplas Y, Dinleyici EC. Intestinal microbiota composition of children with infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome (MIS-C). Eur J Pediatr 2022; 181:3175-3191. [PMID: 35585256 PMCID: PMC9117086 DOI: 10.1007/s00431-022-04494-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 02/07/2023]
Abstract
UNLABELLED Microbiota composition may play a role in the development, prognosis, or post-infection of COVID-19. There are studies evaluating the microbiota composition at the time of diagnosis and during the course of COVID-19, especially in adults, while studies in children are limited and no study available in children with multisystem inflammatory syndrome in children (MIS-C). This study was planned to compare intestinal microbiota composition in children diagnosed with MIS-C and acute COVID-19 infection with healthy children. In this prospective multicenter study, 25 children diagnosed with MIS-C, 20 with COVID-19 infection, and 19 healthy children were included. Intestinal microbiota composition was evaluated by 16 s rRNA gene sequencing. We observed changes of diversity, richness, and composition of intestinal microbiota in MIS-C cases compared to COVID-19 cases and in the healthy controls. The Shannon index was higher in the MIS-C group than the healthy controls (p < 0.01). At phylum level, in the MIS-C group, a significantly higher relative abundance of Bacteroidetes and lower abundance of Firmicutes was found compared to the control group. Intestinal microbiota composition changed in MIS-C cases compared to COVID-19 and healthy controls, and Faecalibacterium prausnitzii decreased; Bacteroides uniformis, Bacteroides plebeius, Clostridium ramosum, Eubacterium dolichum, Eggerthella lenta, Bacillus thermoamylovorans, Prevotella tannerae, and Bacteroides coprophilus were dominant in children with MIS-C. At species level, we observed decreased Faecalibacterium prausnitzii, and increased Eubacterium dolichum, Eggerthella lenta, and Bacillus thermoamylovorans in children with MIS-C and increased Bifidobacterium adolescentis and Dorea formicigenerasus in the COVID-19 group. Our study is the first to evaluate the microbiota composition in MIS-C cases. There is a substantial change in the composition of the gut microbiota: (1) reduction of F. prausnitzii in children with MIS-C and COVID-19; (2) an increase of Eggerthella lenta which is related with autoimmunity; and (3) the predominance of E. dolichum is associated with metabolic dysfunctions and obesity in children with MIS-C. CONCLUSIONS Alterations of the intestinal microbiota might be part of pathogenesis of predisposing factor for MIS-C. It would be beneficial to conduct more extensive studies on the cause-effect relationship of these changes in microbiota composition and their effects on long-term prognosis. WHAT IS KNOWN • Microbiota composition may play a role in the development, prognosis, or post-infection of COVID-19. • However, the number of studies on children is limited, and no study on multisystem inflammatory syndrome in children is currently available (MIS-C). WHAT IS NEW • In individuals with MIS-C, the composition of the gut microbiota changed dramatically. • Decreased Faecalibacterium prausnitzii have been observed, increased Eggerthella lenta, which was previously linked to autoimmunity, and predominance of Eubacterium dolichum which was linked to metabolic dysfunction and obesity.
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Affiliation(s)
- Cansu Suskun
- grid.164274.20000 0004 0596 2460Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, TR-26040 Turkey
| | - Omer Kilic
- grid.164274.20000 0004 0596 2460Department of Pediatric Infectious Disease, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Dilek Yilmaz Ciftdogan
- grid.411795.f0000 0004 0454 9420Department of Pediatric Infectious Disease, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Sirin Guven
- grid.414850.c0000 0004 0642 8921Department of Pediatrics, Prof. Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Adem Karbuz
- Department of Pediatric Infectious Disease, Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Aslinur Ozkaya Parlakay
- grid.512925.80000 0004 7592 6297Yildirim Beyazit University Faculty of Medicine Department of Pediatric Infectious Disease, Ankara City Hospital Department of Pediatric Infectious Disease, Ankara, Turkey
| | - Yalcın Kara
- grid.164274.20000 0004 0596 2460Department of Pediatric Infectious Disease, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Ebru Kacmaz
- grid.164274.20000 0004 0596 2460Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Aslihan Sahin
- grid.411795.f0000 0004 0454 9420Department of Pediatric Infectious Disease, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Aysun Boga
- grid.414850.c0000 0004 0642 8921Department of Pediatrics, Prof. Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Didem Kizmaz Isancli
- Department of Pediatric Infectious Disease, Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Belgin Gulhan
- grid.512925.80000 0004 7592 6297Department of Pediatric Infectious Disease, Ankara City Hospital, Ankara, Turkey
| | - Saliha Kanik-Yuksek
- grid.512925.80000 0004 7592 6297Department of Pediatric Infectious Disease, Ankara City Hospital, Ankara, Turkey
| | - Eylem Kiral
- grid.164274.20000 0004 0596 2460Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Gurkan Bozan
- grid.164274.20000 0004 0596 2460Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mehmet Ozgür Arslanoglu
- grid.164274.20000 0004 0596 2460Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mahmut Can Kizil
- grid.164274.20000 0004 0596 2460Department of Pediatric Infectious Disease, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Meltem Dinleyici
- grid.164274.20000 0004 0596 2460Department of Social Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Tercan Us
- grid.164274.20000 0004 0596 2460Department of Microbiology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | | | | | - Yvan Vandenplas
- grid.8767.e0000 0001 2290 8069KidZ Health Castle, UZ Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ener Cagri Dinleyici
- grid.164274.20000 0004 0596 2460Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, TR-26040 Turkey
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Karbuz A, Akkoc G, Bedir Demirdag T, Yilmaz Ciftdogan D, Ozer A, Cakir D, Hancerli Torun S, Kepenekli E, Erat T, Dalgic N, Ilbay S, Karaaslan A, Erdeniz EH, Aygun FD, Bozdemir SE, Hatipoglu N, Emiroglu M, Sahbudak Bal Z, Ciftci E, Bayhan GI, Gayretli Aydin ZG, Ocal Demir S, Kilic O, Hacimustafaoglu M, Sener Okur D, Sen S, Yahsi A, Akturk H, Cetin B, Sutcu M, Kara M, Uygun H, Tural Kara T, Korukluoglu G, Akgun O, Üstündağ G, Demir Mis M, Sali E, Kaba O, Yakut N, Kılıc O, Kanik MK, Cetin C, Dursun A, Cicek M, Kockuzu E, Sevketoglu E, Alkan G, Guner Ozenen G, İnce E, Baydar Z, Ozkaya AK, Ovali HF, Tekeli S, Celebi S, Cubukcu B, Bal A, Khalilova F, Kose M, Hatipoglu HU, Dalkiran T, Turgut M, Basak Altas A, Selcuk Duru HN, Aksay A, Saglam S, Sari Yanartas M, Ergenc Z, Akin Y, Duzenli Kar Y, Sahin S, Tuteroz SK, Bilen NM, Ozdemir H, Senoglu MC, Pariltan Kucukalioglu B, Besli GE, Kara Y, Turan C, Selbest Demirtas B, Celikyurt A, Cosgun Y, Elevli M, Sahin A, Bahtiyar Oguz S, Somer A, Karadag B, Demirhan R, Turk Dagi H, Kurugol Z, Taskin EC, Sahiner A, Yesil E, Ekemen Keles Y, Sarikaya R, Erdem Eralp E, Ozkinay F, Konca HK, Yilmaz S, Gokdemir Y, Arga G, Ozen S, Coksuer F, Vatansever G, Tezer H, Kara A. Epidemiological, Clinical, and Laboratory Features of Children With COVID-19 in Turkey. Front Pediatr 2021; 9:631547. [PMID: 34055680 PMCID: PMC8161543 DOI: 10.3389/fped.2021.631547] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives: The aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children. Methods: A retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined. Results: There were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% (n = 582) and females constituted 49.7% (n = 574). The median age of the confirmed cases was 10.75 years (4.5-14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1-3 years of age (9.3%), 148 were 3-6 years of age (12.8%), 298 were 6-12 years of age (25.8%), 233 were 12-15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) (n = 583) for a median of 2 days (IQR: 1-3 days). Fever was median at 38.4°C (38.0-38.7°C). The second most common symptom was cough (n = 543, 46.9%). The other common symptoms were sore throat (n = 143, 12.4%), myalgia (n = 141, 12.2%), dyspnea (n = 118, 10.2%), diarrhea (n = 112, 9.7%), stomachache (n = 71, 6.1%), and nasal discharge (n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition (p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have (p = 0.38), but the need for intensive care was higher in patients who had an underlying condition (p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma). Conclusions: To the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution.
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Affiliation(s)
- Adem Karbuz
- Division of Pediatric Infectious Diseases, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gulsen Akkoc
- Division of Pediatric Infectious Diseases, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tugba Bedir Demirdag
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Dilek Yilmaz Ciftdogan
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Arife Ozer
- Division of Pediatric Infectious Diseases, Van Training and Research Hospital, University of Health Sciences, Van, Turkey
| | - Deniz Cakir
- Division of Pediatric Infectious Diseases, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Selda Hancerli Torun
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Eda Kepenekli
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Tugba Erat
- Division of Pediatric Infectious Diseases, Sanliurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Nazan Dalgic
- Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sare Ilbay
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayse Karaaslan
- Division of Pediatric Infectious Diseases, Kartal Dr. Lutfi Kırdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Emine H Erdeniz
- Division of Pediatric Infectious Diseases, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - F Deniz Aygun
- Division of Pediatric Infectious Diseases, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - S Elmas Bozdemir
- Division of Pediatric Infectious Diseases, Dortcelik Children's Training and Research Hospital, Bursa, Turkey
| | - Nevin Hatipoglu
- Division of Pediatric Infectious Diseases, Bakirkoy Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Melike Emiroglu
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Zumrut Sahbudak Bal
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ergin Ciftci
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gulsum Iclal Bayhan
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Zeynep Gokce Gayretli Aydin
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - Sevliya Ocal Demir
- Division of Pediatric Infectious Diseases, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Omer Kilic
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Mustafa Hacimustafaoglu
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Dicle Sener Okur
- Division of Pediatric Infectious Diseases, Denizli Hospital, Denizli, Turkey
| | - Semra Sen
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Aysun Yahsi
- Division of Pediatric Infectious Diseases, Samsun Training and Research Hospital, University of Health Sciences, Samsun, Turkey
| | - Hacer Akturk
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Benhur Cetin
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Murat Sutcu
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Manolya Kara
- Division of Pediatric Infectious Diseases, Necip Fazil Training and Research Hospital, University of Health Sciences, Kahramanmaraş, Turkey
| | - Hatice Uygun
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
| | - Tugce Tural Kara
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Gulay Korukluoglu
- Public Health Institutions of Turkey, Director of Virology Department, Ankara, Turkey
| | - Ozlem Akgun
- Division of Pediatrics, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gülnihan Üstündağ
- Division of Pediatric Infectious Diseases, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Mevsim Demir Mis
- Van Training and Research Hospital, University of Health Sciences, Van, Turkey
| | - Enes Sali
- Division of Pediatric Infectious Diseases, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozge Kaba
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurhayat Yakut
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Orhan Kılıc
- Division of Pediatrics, Sanliurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - M Kemal Kanik
- Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ceren Cetin
- Division of Pediatric Infectious Diseases, Kartal Dr. Lutfi Kırdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Adem Dursun
- Division of Pediatrics, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Muharrem Cicek
- Division of Pediatrics, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Esra Kockuzu
- Division of Pediatrics, Dortcelik Children's Training and Research Hospital, Bursa, Turkey
| | - Esra Sevketoglu
- Division of Pediatric Intensive Care, Bakirkoy Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gulsum Alkan
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Gizem Guner Ozenen
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Erdal İnce
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zekiye Baydar
- Department of Pediatrics, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Ahmet Kagan Ozkaya
- Department of Pediatric Emergency, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Husnu Fahri Ovali
- Department of Pediatrics, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Seher Tekeli
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Solmaz Celebi
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | - Alkan Bal
- Department of Pediatric Emergency, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Fidan Khalilova
- Department of Pediatrics, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Mehmet Kose
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Halil Ugur Hatipoglu
- Department of Pediatrics, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Tahir Dalkiran
- Division of Pediatric Intensive Care, Necip Fazıl Training and Research Hospital, University of Health Sciences, Kahramanmaraş, Turkey
| | - Mehmet Turgut
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
| | - Ayse Basak Altas
- Public Health Institutions of Turkey, Director of Virology Department, Ankara, Turkey
| | - Hatice Nilgün Selcuk Duru
- Division of Pediatrics, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahu Aksay
- Division of Pediatric Infectious Diseases, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Sevcan Saglam
- Van Training and Research Hospital, University of Health Sciences, Van, Turkey
| | - Mehpare Sari Yanartas
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Ergenc
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Yasemin Akin
- Division of Pediatrics, Kartal Dr. Lutfi Kırdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yeter Duzenli Kar
- Division of Pediatrics, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Sabit Sahin
- Division of Pediatrics, Dortcelik Children's Training and Research Hospital, Bursa, Turkey
| | - Sadiye Kubra Tuteroz
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Nimet Melis Bilen
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Halil Ozdemir
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mine Cidem Senoglu
- Department of Pediatrics, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Burcu Pariltan Kucukalioglu
- Department of Pediatrics, Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Gulser Esen Besli
- Department of Pediatrics, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Yalcin Kara
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Cansu Turan
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | - Aydın Celikyurt
- Department of Pediatrics, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Yasemin Cosgun
- Public Health Institutions of Turkey, Director of Virology Department, Ankara, Turkey
| | - Murat Elevli
- Division of Pediatrics, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aslihan Sahin
- Division of Pediatric Infectious Diseases, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | | | - Ayper Somer
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Recep Demirhan
- Division of Thoracic Surgery, Kartal Dr. Lutfi Kırdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hatice Turk Dagi
- Department of Microbiology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Zafer Kurugol
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Esra Cakmak Taskin
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aysegul Sahiner
- Department of Pediatrics, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Edanur Yesil
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Yildiz Ekemen Keles
- Division of Pediatric Infectious Diseases, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Remzi Sarikaya
- Van Training and Research Hospital, University of Health Sciences, Van, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Ferda Ozkinay
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hatice Kubra Konca
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Songul Yilmaz
- Department of Pediatrics, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Gul Arga
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Seval Ozen
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Fevziye Coksuer
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Goksel Vatansever
- Department of Pediatric Emergency, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Hasan Tezer
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ates Kara
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Cetin Coban S, Temel F, Duman P, Cosgun Y, Ozarslan F, Kayman T, Guven S, Bezirganoglu H, Gunes O, Yilmaz Ciftdogan D, Karadagli EE, Kaya C, Kara A. Prevalence of Protective Measles Virus Antibody Levels in Umbilical Cord Blood Samples and Sera of Mothers and Transplacental Transport Ratio in Turkey. Jpn J Infect Dis 2019; 72:185-192. [PMID: 30700655 DOI: 10.7883/yoken.jjid.2018.387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Turkey, the Measles Elimination Program has been implemented since 2002. The aim of this study was to evaluate the measles-specific antibody levels of mothers admitted to a hospital for birth and their infants, to determine the factors influencing the antibody levels of both, and to evaluate the transplacental transport ratio. We selected healthy women who came to the hospital for birth and their healthy newborns. We collected blood samples from 1,547 mothers and 1,529 infants. The protective prevalence of measles antibody levels of mothers was 80% (95% confidence interval [CI]: 78-82%) and that of newborns was 85% (95% CI: 83-86%). The antibody levels of mothers and newborns were positively linearly correlated (R: 0.922, p < 0.001) and were associated with parity (p < 0.001). The ratio of neonatal to maternal antibody levels increased with gestational age. The protective levels were 1.6 times higher (95% CI: 1.1-2.4) in mothers ≥ 32 years of age and 2.1 times higher (95% CI: 1.4-3.3) in naturally immune mothers. Two factors affecting the antibody levels of newborns were the mothers' antibody levels and their immunization status. The antibody level of mother was the most significant factor that influenced the infant's antibody level. Vaccination of women before pregnancy could enhance passive antibody protection by increasing the level of transplacental transmission.
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Affiliation(s)
- Serap Cetin Coban
- Department of Health Threats Early Warning and Response, General Directorate of Public Health
| | - Fehminaz Temel
- Department of Health Threats Early Warning and Response, General Directorate of Public Health
| | - Pinar Duman
- Department of Health Threats Early Warning and Response, General Directorate of Public Health
| | - Yasemin Cosgun
- Department of Microbiology Reference Laboratories and Biological Products, General Directorate of Public Health
| | - Fatma Ozarslan
- Department of Health Threats Early Warning and Response, General Directorate of Public Health
| | - Tuba Kayman
- Department of Health Threats Early Warning and Response, General Directorate of Public Health
| | - Sirin Guven
- University of Health Sciences İstanbul Umraniye Training and Research Hospital
| | | | - Omer Gunes
- Zekai Tahir Maternity and Child Health Hospital
| | | | | | | | - Ates Kara
- Children Hospital of Hacettepe University
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Sahbudak Bal Z, Kamit Can F, Yazici P, Berna Anil A, Duyu M, Yilmaz Ciftdogan D, Nisel Yilmaz O, Cilli F, Karapinar B. The evaluation of safety and efficacy of colistin use in pediatric intensive care unit: Results from two reference hospitals and review of literature. J Infect Chemother 2018; 24:370-375. [PMID: 29361414 DOI: 10.1016/j.jiac.2017.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/16/2017] [Accepted: 12/21/2017] [Indexed: 11/25/2022]
Abstract
Colistin, an old cationic polypeptide antibiotic, have been reused due to rising incidence of infections caused by multi-drug resistant (MDR) Gram-negative microorganisms and the lack of new antibiotics. Therefore, we evaluated safety and efficacy of colistin in treatment of these infections. This study included 104 critically ill children with a median age of 55,9 months between January 2011 and January 2016. Nephrotoxicity occurred in 11 (10.5%) patients. Nephrotoxicity occurred between the third and seventh day of treatment in 63% of colistin induced nephrotoxicity episodes. The subgroup analysis between the patients who developed nephrotoxicity during colistin treatment and those that did not, showed no significant difference in terms of age, underlying disease, cause for PICU admission and type of infection required colistin treatment, P values were 0.615, 0.762, 0.621, 0.803, respectively. All patients were receiving a concomitant nephrotoxic agent (P = 0,355). The majority of the patients (52%) were having primary or secondary immune deficiency in treatment failure group and the most common cause of PICU admission was sepsis in treatment failure group, P values were 0.007 and 0.045, respectively. Mortality attributed to colistin failure and crude mortality were 14.4% and 29.8%, respectively. In conclusion, colistin may have a role in the treatment of infections caused by multidrug-resistant Gram-negative bacteria in critically ill children. However, the patients have to be followed for side effects throughout colistin treatment, not for only early stage. And the clinicians should be aware of increase in the rate of nephrotoxicity in patients those have been receiving a concomitant nephrotoxic agent.
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Affiliation(s)
- Zumrut Sahbudak Bal
- Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Bornova/Izmir, 35040, Turkey.
| | - Fulya Kamit Can
- Division of Intensive Care Unit, Department of Pediatrics, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Pinar Yazici
- Medical School of Ege University, Division of Intensive Care Unit, Department of Pediatrics, Izmir, Turkey.
| | - Ayse Berna Anil
- Division of Intensive Care Unit, Department of Pediatrics, Medical School of Katip Celebi University, Izmir, Turkey.
| | - Muhterem Duyu
- Medical School of Ege University, Division of Intensive Care Unit, Department of Pediatrics, Izmir, Turkey.
| | - Dilek Yilmaz Ciftdogan
- Division of Infectious Diseases, Department of Pediatrics, Medical School of Katip Celebi University, Izmir, Turkey
| | - Ozkalay Nisel Yilmaz
- Clinical Microbiology and Infectious Diseases, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Feriha Cilli
- Medical School of Ege University, Department of Microbiology and Infectious Diseases, Izmir, Turkey.
| | - Bulent Karapinar
- Medical School of Ege University, Division of Intensive Care Unit, Department of Pediatrics, Izmir, Turkey.
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Malbora B, Saritas S, Ataseven E, Belen B, Alparslan C, Yavascan O, Yilmaz Ciftdogan D, Atabay B, Turker M. Pure Red Cell Aplasia Due to Parvovirus B19: Erythropoietin-Resistant Anemia in a Pediatric Kidney Recipient. EXP CLIN TRANSPLANT 2017; 15:369-371. [PMID: 28387173 DOI: 10.6002/ect.2016.0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Baris Malbora
- From the Department of Pediatric Hematology and Oncology, Tepecik Education and Training Hospital, Izmir, Turkey
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Kanik A, Eliacik K, Koyun B, Ince OT, Karaca Derici Y, Ozkalay Yilmaz N, Yilmaz Ciftdogan D. Viral Etiology of Acute Bronchiolitis in Hospitalized Infants and the Effect on Clinical Course. Çocuk Enf Derg 2016. [DOI: 10.5152/ced.2016.2425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Yilmaz Ciftdogan D. Varicella after Exposure to Localized Herpes Zoster. Çocuk Enf Derg 2016. [DOI: 10.5152/ced.2015.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Yilmaz Ciftdogan D. Herpes Zoster in Children and Adolescents: Is It a Problem? Çocuk Enf Derg 2016. [DOI: 10.5152/ced.2016.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Eliacik K, Yilmaz Ciftdogan D. Management of Sexually Transmitted Diseases in Adolescents after Sexual Abuse. Çocuk Enf Derg 2015. [DOI: 10.5152/ced.2015.1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Bal ZS, Sen S, Yildiz KB, Ciftdogan DY, Vardar F. Tuberculous otomastoiditis complicated by sinus vein thrombosis. Braz J Infect Dis 2012; 16:608-9. [DOI: 10.1016/j.bjid.2012.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022] Open
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14
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Gulen H, Basarir F, Hakan N, Ciftdogan DY, Tansug N, Onag A. Premature labor and leukoerythroblastosis in a newborn with parvovirus B19 infection. Haematologica 2005; 90 Suppl:ECR38. [PMID: 16266929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Leukoerythroblastosis is a rarely observed disease characterized by the presence of leukocytosis, erythroid and myeloid blast cells in peripheral blood. To our knowledge, it had not been diagnosed in a premature newborn before the case we report have.A female baby weighing 1164 grams, who was born prematurely at the 29th week of gestation by Cesarean section was referred to our newborn intensive care unit due to prematurity and respiratory distress with no prenatal pathological findings. Physical examination revealed tachypnea and hepatosplenomegaly. Routine laboratory measurements showed significant leukocytosis (85,000/mm3) and anemia (Hb: 9.6 g/dL and Hct: 27.6%). The platelet count was normal. The peripheral blood smear suggested leukoerythroblastosis with the presence of nucleated erythrocytes, monocytosis, and 4% blasts. Bone marrow cytogenetic examination was normal. Parvovirus B19 Ig G and M serology were detected to be positive. The etiological factors observed in leukoerythroblastosis occurring during neonatal and early childhood period are congenital-postnatal viral infections, juvenile myelomonocytic leukemia and osteopetrosis. To our knowledge, no case of leukoerythroblastosis in such an early phase has been reported in the in literature. As a result, premature delivery and leukoerythroblastosis were thought to have developed secondary to intrauterine parvovirus B19 infection. Leukoerythroblastosis is a rarely observed disease characterized by the presence of leukocytosis, erythroid and myeloid blast cells in peripheral blood. It is reported that it can be observed following hematologic malignancies especially juvenile myelomonocytic leukemia, acute infections, hemolytic anemia, osteopetrosis, myelofibrosis, neuroblastoma and taking certain medicines. To our knowledge, it has not been diagnosed in a premature newborn before. Here we the case of a newborn who was referred to our intensive care unit due to being born prematurely at the 29th week of gestation and diagnosed with leukoerythroblastosis.
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MESH Headings
- Adult
- Anemia, Myelophthisic/congenital
- Anemia, Myelophthisic/therapy
- Anemia, Myelophthisic/virology
- Antibodies, Viral/blood
- Blood Transfusion
- Female
- Fetal Diseases/virology
- Gestational Age
- Humans
- Immunoglobulin G/blood
- Immunoglobulin M/blood
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/virology
- Parvoviridae Infections/congenital
- Parvovirus B19, Human/immunology
- Parvovirus B19, Human/isolation & purification
- Pregnancy
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Affiliation(s)
- Huseyin Gulen
- Celal Bayar University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology.
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