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Soysal A, Topçu B, Atıcı S, Gönüllü E, Öner CN. MIS-C patients who were reinfected with SARS-CoV-2. Report of 2 cases. ARCH ARGENT PEDIATR 2023; 121:e202202893. [PMID: 36929517 DOI: 10.5546/aap.2022-02893.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a rare condition. It is still unknown if children who have recovered from MIS-C are at a risk of recurrence of MIS-C when they are reinfected with SARSCoV-2. In this study, we aimed to report 2 children who recovered from MIS-C and reinfected with SARSCoV-2 without recurrence of MIS-C.
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Affiliation(s)
- Ahmet Soysal
- Division of Pediatric Infectious Disease, Ataşehir Memorial Hospital. Istanbul, Turkey
| | - Burcu Topçu
- Division of Pediatric Infectious Disease, Ataşehir Memorial Hospital. Istanbul, Turkey
| | - Serkan Atıcı
- Division of Pediatric Infectious Disease, Okan University School of Medicine. Istanbul, Turkey
| | - Erdem Gönüllü
- Department of Pediatrics, İstanbul Health and Tecnology University. Istanbul, Turkey
| | - Cevat N Öner
- Department of Pediatrics, İstanbul Health and Tecnology University. Istanbul, Turkey
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2
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Atıcı S, Soysal A, Gönüllü E, Aydemir G, Öner N, Alan S, Engin H, Yıldız M, Karaböcüoğlu M. Comparison of humoral immune response in heterologous and homologous COVID-19 booster vaccine groups using CoronaVac and mRNA-based BNT162b2 vaccines. Rev Soc Bras Med Trop 2023; 56:e00462023. [PMID: 37493731 PMCID: PMC10367218 DOI: 10.1590/0037-8682-0046-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Heterologous COVID-19 booster vaccination is an alternative strategy to homologous vaccination, especially in developing countries, due to shortages, delays, or unequal distribution of COVID-19 vaccines. We compared cohorts vaccinated with different vaccine combinations to investigate whether a heterologous booster dose of mRNA-based BNT162b2 vaccine boosts the immune response in individuals primed with the CoronaVac vaccine. METHODS Anti-RBD IgG is generally measured 4 weeks after primary immunization and 4 weeks after booster vaccination. Data on anti-receptor-binding domain (anti-RBD) IgG antibody titers and clinical characteristics were provided by infection control units. RESULTS The highest median anti-RBD IgG antibody titers (14589 AU/mL) after primary immunization was observed in the group vaccinated with two doses of BNT162b2 vaccine. Antibody titers were lower 4 months or more after the second CoronaVac vaccine dose in CoronaVac recipients with or without previous COVID-19. In the homologous COVID-19 booster vaccine group (primed with two doses of CoronaVac 4 weeks apart and a single booster dose of CoronaVac) the median anti-RBD titers decreased from 1025 to 242 AU/mL before the booster dose. In the heterologous group (primed with two doses of CoronaVac 4 weeks apart and a single booster dose of BNT162b2), the median anti-RBD titer increased to 31624 AU/mL, a 132-fold increase, 16 days after the booster dose. CONCLUSIONS After the second dose of CoronaVac, protective neutralizing antibody levels decrease over time, and a booster dose is required. Heterologous COVID-19 booster vaccination with BNT162b2 is effective at boosting neutralizing antibody levels.
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Affiliation(s)
- Serkan Atıcı
- Okan University School of Medicine, Division of Pediatric Infectious Diseases, İstanbul, Turkey
| | - Ahmet Soysal
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, İstanbul, Turkey
| | - Erdem Gönüllü
- Istanbul Health and Technology University, Department of Pediatrics, İstanbul, Turkey
| | - Gökhan Aydemir
- Haliç University, Department of Pediatrics, İstanbul, Turkey
| | - Naci Öner
- Istanbul Health and Technology University, Department of Pediatrics, İstanbul, Turkey
| | - Servet Alan
- Memorial Ataşehir Hospital, Clinic of Infectious Diseases, İstanbul, Turkey
| | - Havva Engin
- Memorial Ataşehir Hospital, Clinic of Infectious Diseases, İstanbul, Turkey
| | - Melek Yıldız
- Memorial Şişli Hospital, Clinic of Infectious Diseases, İstanbul, Turkey
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3
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Gönüllü E, Soysal A, Atıcı S, Engin M, Yeşilbaş O, Kasap T, Fedakar A, Bilgiç E, Tavil EB, Tutak E, Yıldız İ, Akçay T, Ağladıoğlu SY, Tunç T, Can İ, Karaböcüoğlu M, Karabayır N. Pediatricians' COVID-19 experiences and views on the willingness to receive COVID-19 vaccines: a cross-sectional survey in Turkey. Hum Vaccin Immunother 2021; 17:2389-2396. [PMID: 33861165 PMCID: PMC8475573 DOI: 10.1080/21645515.2021.1896319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/04/2021] [Accepted: 02/22/2021] [Indexed: 01/26/2023] Open
Abstract
Developing an effective and safe vaccine against Covid-19 will facilitate return to normal. Due to hesitation toward the vaccine, it is crucial to explore the acceptability of the COVID-19 vaccine to the public and healthcare workers. In this cross-sectional survey, we invited 2251 pediatricians and 506 (22%) of them responded survey and 424 (84%) gave either nasopharyngeal swap or antibody assay for COVID-19 and 71 (14%) of them got diagnosis of COVID-19. If the effective and safe COVID-19 vaccine was launched on market, 420 (83%) of pediatrician accepted to get vaccine shot, 422 (83%) of them recommended vaccination to their family members, 380 (75%) of them accepted to vaccine their children and 445 (85%) of them offered vaccination to their pediatric patients. Among the participated pediatricians 304 (60%) of them thought COVID-19 vaccine should be mandatory. We found that there are high COVID-19 vaccine willingness rates for pediatricians for themselves, their own children, family members and their pediatric patients. We also found that being a pediatric subspecialist, believing in achieving an effective vaccine, willingness to participate in the phase 1-2 clinical vaccine trial, willingness to get an influenza shot this season, believing a vaccine and vaccine passport should be mandatory were significant factors in accepting the vaccine. It is important to share all information about COVID-19 vaccines, especially effectiveness and safety, with the public in a clear communication and transparency. The opposite will contribute to vaccine hesitancy and anti-vaccine movement.
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Affiliation(s)
- Erdem Gönüllü
- Department of Pediatrics, Üsküdar University Medical School, İstanbul, Turkey
- Clinic of Pediatrics, Memorial Ataşehir Hospital, İstanbul, Turkey
| | - Ahmet Soysal
- Clinic of Pediatrics, Memorial Ataşehir Hospital, İstanbul, Turkey
| | - Serkan Atıcı
- Department of Pediatric Infectious Diseases, Okan University Hospital, İstanbul, Turkey
| | - Mesut Engin
- Department of Pediatrics, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Osman Yeşilbaş
- Department of Pediatrics, Karadeniz Technical University, Trabzon, Turkey
| | - Tuba Kasap
- Department of Pediatrics, Tokat Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Atiye Fedakar
- Department of Pediatrics, Afiyet Hospital, Istanbul, Turkey
| | - Emre Bilgiç
- Clinic of Pediatrics, Bingöl State Hospital, Bingöl, Turkey
| | | | - Ercan Tutak
- Clinic of Pediatrics, Memorial Şişli Hospital, İstanbul, Turkey
| | - İsmail Yıldız
- Department of Pediatrics, Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Teoman Akçay
- Clinic of Pediatrics, Memorial Şişli Hospital, İstanbul, Turkey
| | | | - Turan Tunç
- Clinic of Pediatrics, Memorial Ataşehir Hospital, İstanbul, Turkey
| | - İlkay Can
- Department of Dermatology, Burhaniye State Hospital, Balıkesir, Turkey
| | | | - Nalan Karabayır
- Department of Pediatrics, Prof. Dr. Medipol University School of Medicine, İstanbul, Turkey
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Soysal A, Gönüllü E, Karabayır N, Alan S, Atıcı S, Yıldız İ, Engin H, Çivilibal M, Karaböcüoğlu M. Comparison of immunogenicity and reactogenicity of inactivated SARS-CoV-2 vaccine (CoronaVac) in previously SARS-CoV-2 infected and uninfected health care workers. Hum Vaccin Immunother 2021; 17:3876-3880. [PMID: 34324409 PMCID: PMC8330011 DOI: 10.1080/21645515.2021.1953344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15–136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202–10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8–15547 AU/mL, p = .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals.
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Affiliation(s)
- Ahmet Soysal
- Memorial Ataşehir Hospital, Clinic of Pediatrics, İstanbul, Turkey
| | - Erdem Gönüllü
- Istanbul Health and Technology University, Department of Pediatrics, İstanbul, Turkey
| | - Nalan Karabayır
- Medipol University Hospital, Department of Pediatrics, İstanbul, Turkey
| | - Servet Alan
- Memorial Şişli Hospital, Clinic of Infectious Diseases, İstanbul, Turkey
| | - Serkan Atıcı
- Okan University Hospital, Department of Pediatric Infectious Diseases, İstanbul, Turkey
| | - İsmail Yıldız
- Department of Pediatrics, Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Havva Engin
- Memorial Ataşehir Hospital, Hospital Infection Control Unit, İstanbul, Turkey
| | - Mahmut Çivilibal
- Department of Pediatrics, Memorial Bahçelievler Hospital, İstanbul, Turkey
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5
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Soysal A, Gönüllü E, Arslan H, Kibar BS, Pop S, Yurttaş GN, Demirbacak H, Ünal F, Öktem S, Atıcı S, Yücel Şen AD, Karabayır N, Karaböcüoğlu M. Comparison of Clinical and Laboratory Features and Treatment Options of 237 Symptomatic and Asymptomatic Children Infected with SARS-CoV-2 in the Early Phase of the COVID-19 Pandemic in Turkey. Jpn J Infect Dis 2020; 74:273-279. [PMID: 33250495 DOI: 10.7883/yoken.jjid.2020.781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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
Little is known about the therapeutic use of hydroxychloroquine in pediatric patients with coronavirus disease 2019 (COVID-19). Here, we retrospectively retrieved data of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR-positive pediatric patients from 20 hospitals in 8 Turkish cities. We obtained epidemiological, clinical, and laboratory features of the patients, as well as the drugs used for treating COVID-19. A total of 237 nasopharyngeal swab SARS-CoV-2 PCR-positive children were included in the study from March 26, 2020 to June 20, 2020. The mean age of asymptomatic children (118 ± 62 months) was higher than that of symptomatic children (89 ± 69 months). Symptomatic children had significantly lower mean lymphocyte counts and higher mean CRP, D-dimer, procalcitonin, and LDH levels than asymptomatic children in the univariate analysis. Among 156 children, 78 (50%), 15, 44, and 21 were treated with a hydroxychloroquine-containing regimen, hydroxychloroquine + azithromycin + oseltamivir, hydroxychloroquine + azithromycin, and hydroxychloroquine alone, respectively. Among 156 patients who received medical treatment, 90 (58%) underwent pre- and/or post-treatment electrocardiogram (ECG). However, none of them had ECG abnormalities or required hydroxychloroquine discontinuation due to adverse drug reactions.
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Affiliation(s)
- Ahmet Soysal
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, Turkey
| | - Erdem Gönüllü
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, Turkey
| | | | | | | | | | | | - Füsun Ünal
- Medipol University, Department of Pediatrics, Turkey
| | - Sedat Öktem
- Medipol University, Department of Pediatrics, Turkey
| | - Serkan Atıcı
- Okan University Hospital, Division of Pediatric Infectious Diseases, Turkey
| | | | | | - Metin Karaböcüoğlu
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, Turkey
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Öcal Demir S, Atıcı S, Kepenekli Kadayifci E, Akkoç G, Yakut N, İnceköy Girgin F, Yalındağ Öztürk N, Soysal A. Influenza A (H1N1)-associated severe complications; hemolytic uremic syndrome, myocarditis, acute necrotizing encephalopathy. J Infect Dev Ctries 2019; 13:83-86. [PMID: 32032028 DOI: 10.3855/jidc.10049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/13/2017] [Accepted: 08/16/2018] [Indexed: 10/31/2022] Open
Abstract
Influenza is a generally self-limited infection agent that only rarely causes severe complications. To increase awareness about its serious complications, we report three cases of influenza A (H1N1) infection complicated with hemolytic uremic syndrome, myocarditis and acute necrotizing encephalopathy. In all three cases, nasopharyngeal samples confirmed influenza A (H1N1) infection by antigen test and multiplex PCR detection. The first case, a 3-year-old girl, had respiratory distress, anemia, thrombocytopenia and renal failure at admission, and was diagnosed with hemolytic uremic syndrome. Supportive treatment and oseltamivir did not prevent the development of chronic renal failure. The second case, a 5-year-old girl admitted with lethargia and flu-like symtoms and was diagnosed with myocarditis and cardiogenic shock. Oseltamivir and supportive treatment including extra-corporeal membrane oxygenation (ECMO) failed. She died on the 3rd day of admission. The third case, a 21-month-old boy, presented with decreased level of consciousness and was diagnosed with acute necrotizing encephalopathy with the aid of cranial magnetic resonance imagining (MRI). He was discharged without any neurological sequelae three weeks after admission. It should be kept in mind that influenza virus does not always cause a self-limited flu. Multidisciplinary management, early diagnosis and antiviral treatment are critical for the disease and to prevent its life-threatening complications.
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Affiliation(s)
- Sevliya Öcal Demir
- Department of Pediatrics, Division of Pediatric Infection Disease, Marmara University School of Medicine, Istanbul, Turkey.
| | - Serkan Atıcı
- Department of Pediatrics, Division of Pediatric Infection Disease, Marmara University School of Medicine, Istanbul, Turkey.
| | - Eda Kepenekli Kadayifci
- Department of Pediatrics, Division of Pediatric Infection Disease, Marmara University School of Medicine, Istanbul, Turkey.
| | - Gülşen Akkoç
- Department of Pediatrics, Division of Pediatric Infection Disease, Marmara University School of Medicine, Istanbul, Turkey.
| | - Nurhayat Yakut
- Department of Pediatrics, Division of Pediatric Infection Disease, Marmara University School of Medicine, Istanbul, Turkey.
| | - Feyza İnceköy Girgin
- Department of Pediatrics, Pediatric Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey.
| | - Nilüfer Yalındağ Öztürk
- Department of Pediatrics, Pediatric Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey.
| | - Ahmet Soysal
- Department of Pediatrics, Division of Pediatric Infection Disease, Marmara University School of Medicine, Istanbul, Turkey.
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7
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Pekuz S, Soysal A, Akkoc G, Atıcı S, Yakut N, Gelmez GA, Kadayifci EK, Güneser D, Demir SO, Söyletir G, Bakır M. Prevalence of Nasopharyngeal Carriage, Serotype Distribution, and Antimicrobial Resistance of Streptococcus pneumoniae among Children with Chronic Diseases. Jpn J Infect Dis 2018; 72:7-13. [PMID: 30175734 DOI: 10.7883/yoken.jjid.2017.410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the prevalence of nasopharyngeal (NP) carriage and the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae in children with chronic diseases, which predisposes them to invasive pneumococcal disease in comparison with that in healthy children. A cross-sectional prevalence study was performed between February 2015 and February 2016 in Istanbul, Turkey. We enrolled 1,024 children with chronic diseases and 394 healthy children aged 0-18 years. The overall prevalence of S. pneumoniae NP (SPNP) carriage was 9.8%, with 8.4% in healthy children and 10.3% in children with chronic diseases. The prevalence rates of SPNP carriage were 17.5%, 13.5%, 10.5%, 9.3%, 8.6%, 8.6%, 8%, 6.7%, and 4%, respectively, in each of the following risk groups: primary immunodeficiency, asthma, chronic renal failure, congenital heart disease, chronic lung disease, leukemia, nephrotic syndrome, solid organ tumors, and type 1 diabetes mellitus. In the multivariate analysis, a history of otitis media within the last year, a history of pneumonia within the last year, and more than one sibling under 8 years of age were found to be independent risk factors for SPNP carriage.
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Affiliation(s)
- Serdar Pekuz
- Sanlıurfa Training and Research Hospital, Clinics of Pediatrics
| | - Ahmet Soysal
- Atasehir Memorial Hospital, Clinics of Pediatrics
| | - Gulsen Akkoc
- T.C. Sağlık Bakanlığı-Marmara University Pendik Training and Research Hospital, Clinic of Pediatric Infectious Diseases
| | | | - Nurhayat Yakut
- T.C. Sağlık Bakanlığı-Marmara University Pendik Training and Research Hospital, Clinic of Pediatric Infectious Diseases
| | | | - Eda Kepenekli Kadayifci
- T.C. Sağlık Bakanlığı-Marmara University Pendik Training and Research Hospital, Clinic of Pediatric Infectious Diseases
| | | | - Sevliya Ocal Demir
- T.C. Sağlık Bakanlığı-Marmara University Pendik Training and Research Hospital, Clinic of Pediatric Infectious Diseases
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8
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Atıcı S, Alp Ünkar Z, Öcal Demir S, Akkoç G, Yakut N, Yılmaz Ş, Erdem K, Çınar Memişoğlu A, Ülger N, Soysal A, Özek E, Bakır M. A rare and emerging pathogen: Raoultella planticola identification based on 16S rRNA in an infant. J Infect Public Health 2017; 11:130-132. [PMID: 28433493 DOI: 10.1016/j.jiph.2017.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 01/01/2017] [Revised: 03/06/2017] [Accepted: 03/26/2017] [Indexed: 11/25/2022] Open
Abstract
Raoultella planticola is rarely associated with clinical infection, and a limited number of pediatric cases have been reported. Herein we report a case of bacteremia presumptively secondary to bilateral conjunctivitis in an infant caused by R. planticola which was successfully treated with piperacillin-tazobactam. It should be kept in mind that R. planticola can be a pathogen in pediatric age groups.
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Affiliation(s)
- Serkan Atıcı
- Marmara University School of Medicine, Division of Pediatric Infectious Diseases, Turkey.
| | - Zeynep Alp Ünkar
- Marmara University School of Medicine, Division of Neonatology, Turkey
| | - Sevliya Öcal Demir
- Marmara University School of Medicine, Division of Pediatric Infectious Diseases, Turkey
| | - Gülşen Akkoç
- Marmara University School of Medicine, Division of Pediatric Infectious Diseases, Turkey
| | - Nurhayat Yakut
- Marmara University School of Medicine, Division of Pediatric Infectious Diseases, Turkey
| | - Şerife Yılmaz
- Marmara University School of Medicine, Department of Microbiology, Turkey
| | - Kübra Erdem
- Marmara University School of Medicine, Department of Microbiology, Turkey
| | | | - Nurver Ülger
- Marmara University School of Medicine, Department of Microbiology, Turkey
| | - Ahmet Soysal
- Marmara University School of Medicine, Division of Pediatric Infectious Diseases, Turkey
| | - Eren Özek
- Marmara University School of Medicine, Division of Neonatology, Turkey
| | - Mustafa Bakır
- Marmara University School of Medicine, Division of Pediatric Infectious Diseases, Turkey
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Atıcı S, Soysal A, Karadeniz Cerit K, Yılmaz Ş, Aksu B, Kıyan G, Bakır M. Catheter-related Saccharomyces cerevisiae Fungemia Following Saccharomyces boulardii Probiotic Treatment: In a child in intensive care unit and review of the literature. Med Mycol Case Rep 2017; 15:33-35. [PMID: 28280685 PMCID: PMC5333505 DOI: 10.1016/j.mmcr.2017.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/21/2017] [Indexed: 12/31/2022] Open
Abstract
Although Saccharomyces boulardii is usually a non-pathogenic fungus, in rare occasions it can cause invasive infection in children. We present the case of an 8-year-old patient in pediatric surgical intensive care unit who developed S. cerevisiae fungemia following probiotic treatment containing S. boulardii. Caspofungin was not effective in this case and he was treated with amphotericin B. We want to emphasize that physicians should be careful about probiotic usage in critically ill patients.
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Affiliation(s)
- Serkan Atıcı
- Department of Pediatrics and Division of Pediatric Infectious Diseases, Medical School, Marmara University, Istanbul, Turkey
| | - Ahmet Soysal
- Department of Pediatrics and Division of Pediatric Infectious Diseases, Medical School, Marmara University, Istanbul, Turkey
| | | | - Şerife Yılmaz
- Department of Microbiology, Medical School, Marmara University, Istanbul, Turkey
| | - Burak Aksu
- Department of Microbiology, Medical School, Marmara University, Istanbul, Turkey
| | - Gürsu Kıyan
- Department of Pediatric Surgery, Medical School, Marmara University, Istanbul, Turkey
| | - Mustafa Bakır
- Department of Pediatrics and Division of Pediatric Infectious Diseases, Medical School, Marmara University, Istanbul, Turkey
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10
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Karaaslan A, Çağan E, Kadayifci EK, Atıcı S, Akkoç G, Yakut N, Demir SÖ, Soysal A, Bakır M. Intravenous Colistin Use for Multidrug-Resistant Gram-Negative Infections in Pediatric Patients. Balkan Med J 2016; 33:627-632. [PMID: 27994915 DOI: 10.5152/balkanmedj.2016.16210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 04/06/2015] [Accepted: 12/04/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The emergence of infections due to multidrug-resistant Gram-negative bacilli (MDR-GNB) has led to the resurrection of colistin use. The data on colistin use and drug-related adverse effects in children are scarce. AIMS In this study, we aimed to evaluate the clinical efficacy and safety of colistin use in critically ill pediatric patients. STUDY DESIGN This study has a retrospective study design. METHODS Sixty-one critically ill children were identified through the department's patient files archive during the period from January 2011 to November 2014. RESULTS Twenty-nine females and thirty-two males with a mean±standard deviation (SD) age of 61±9 months (range 0-216, median 12 months) received IV colistin due to MDR-GNB infections. Bacteremia (n=23, 37.7%) was the leading diagnosis, followed by pneumonia (n=19, 31%), clinical sepsis (n=7, 11.4%), wound infection (n=6, 9.8%), urinary tract infection (n=5, 8.1%) and meningitis (n=1, 1.6%). All of the isolates were resistant to carbapenems; however, all were susceptible to colistin. The isolated microorganisms in decreasing order of frequency were: Acinetobacter baumanni (n=27, 44.2%), Pseudomonas aeruginosa (n=17, 27.8%), Klebsiella pneumoniae (n=6, 9.8%), K. pneumoniae and Stenotrophomonas maltophilia (n=1, 1.6%), K. pneumoniae and A. baumanni (n=1, 1.6%), K. oxytoca (n=1, 1.6%) and Enterobacter cloacae (n=1, 1.6%). In seven patients, no microorganisms were detected; however, five of these patients were colonized by carbapenem-resistant K. pneumoniae. The mean duration of colistin therapy was 12 days (range 3-45). Colistin was administered concomitantly with one of the following antibiotics: carbapenem (n=50, %82), ampicillin-sulbactam (n=5, 8%), quinolones (n=5, 8%), rifampicin (n=1, 1.6%). Carbapenem was the most frequently used antibiotic. Nephrotoxicity was observed in only 1 patient, and we did not observe neurotoxicity in this study. All the patients received intravenous colistin (colisthimethate) at a dosage of 5 mg/kg daily by dividing it in three equal doses. Seven (11.4%) patients died during the study period. CONCLUSION Colistin appears to be a safe and efficacious drug for treating MDR-GNB infections in children.
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Affiliation(s)
- Ayşe Karaaslan
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
| | - Eren Çağan
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
| | - Eda Kepenekli Kadayifci
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
| | - Serkan Atıcı
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
| | - Gülşen Akkoç
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
| | - Nurhayat Yakut
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
| | - Sevliya Öcal Demir
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
| | - Ahmet Soysal
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
| | - Mustafa Bakır
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine, İstanbul, Turkey
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Atıcı S, Ünkar ZA, Erdem K, Kadayifci EK, Karaaslan A, Memişoğlu AÇ, Soysal A, Toprak NÜ, Söyletir G, Özek E, Bakır M. Ventilator-associated pneumonia caused by Chryseobacterium indologenes: a rare infant case and review of the literature. Springerplus 2016; 5:1741. [PMID: 27795884 PMCID: PMC5055521 DOI: 10.1186/s40064-016-3449-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/29/2016] [Indexed: 11/22/2022]
Abstract
Background Chryseobacterium indologenes is an uncommon organism that has been documented to cause a variety of invasive infections mostly in hospitalized patients with severe underlying diseases. Case presentation A three-month-old female infant born at term by caesarean section with meningomyelocele and congenital diaphragmatic hernia had two surgeries for the repair of meningomyelocele and diaphragmatic hernia on her 3rd and 14th day, respectively. On the 3rd month of her life, she deteriorated clinically with fever, leukocytosis and increase of acute-phase reactants. Gas exchange condition became worse than it was before. Respiratory secretions, oxygen requirements and ventilator demand increased. Chest X-ray showed bilateral pulmonary infiltrates. Bacteriological blood, urine and cerebrospinal fluid culture test results were negative. C. indologenes was isolated from tracheobronchial secretion sample obtained by endotracheal aspiration. Although susceptible to ciprofloxacin (MIC:0.5 gr/L), levofloxacin and piperacillin–tazobactam, the isolate was resistant to meropenem, imipenem and colistin. She was treated with ciprofloxacin successfully. Her fever resolved and gas exchange condition improved after 72 h of the treatment. The antibiotic treatment was given for a course of 14 days. Conclusion Chryseobacterium indologenes may emerge as a potential pathogen in infants with the factors such as invasive equipment, having underlying diseases and prolonged hospitalization.
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Affiliation(s)
- Serkan Atıcı
- Department of Pediatrics and Division of Pediatric Infectious Diseases Medical School, Marmara University, Istanbul, Turkey ; T.C. Sağlık Bakanlığı-Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Fevzi Çakmak Mah. Mimar Sinan Cad. Üstkaynarca, Pendik, Istanbul, Turkey
| | - Zeynep Alp Ünkar
- Department of Pediatrics and Division of Neonatology, Medical School, Marmara University, Istanbul, Turkey
| | - Kübra Erdem
- Department of Microbiology, Medical School, Marmara University, Istanbul, Turkey
| | - Eda Kepenekli Kadayifci
- Department of Pediatrics and Division of Pediatric Infectious Diseases Medical School, Marmara University, Istanbul, Turkey
| | - Ayşe Karaaslan
- Department of Pediatrics and Division of Pediatric Infectious Diseases Medical School, Marmara University, Istanbul, Turkey
| | - Aslı Çınar Memişoğlu
- Department of Pediatrics and Division of Neonatology, Medical School, Marmara University, Istanbul, Turkey
| | - Ahmet Soysal
- Department of Pediatrics and Division of Pediatric Infectious Diseases Medical School, Marmara University, Istanbul, Turkey
| | - Nurver Ülger Toprak
- Department of Microbiology, Medical School, Marmara University, Istanbul, Turkey
| | - Güner Söyletir
- Department of Microbiology, Medical School, Marmara University, Istanbul, Turkey
| | - Eren Özek
- Department of Pediatrics and Division of Neonatology, Medical School, Marmara University, Istanbul, Turkey
| | - Mustafa Bakır
- Department of Pediatrics and Division of Pediatric Infectious Diseases Medical School, Marmara University, Istanbul, Turkey
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12
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Karaaslan A, Soysal A, Yakut N, Akkoç G, Demir SO, Atıcı S, Toprak NU, Söyletir G, Bakır M. Hospital acquired Clostridium difficile infection in pediatric wards: a retrospective case-control study. Springerplus 2016; 5:1329. [PMID: 27563524 PMCID: PMC4980864 DOI: 10.1186/s40064-016-3013-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/05/2016] [Indexed: 12/13/2022]
Abstract
Background Clostridium difficile is a major cause of antibiotic-associated diarrhea and frequently results in healthcare-associated infections. The aim of this study was to determine the incidence and potential risk factors for C. difficile infection (CDI) in hospitalized children who developed diarrhea. A retrospective study was performed at a university hospital in İstanbul over a three-year period (2012–2014). Results During the study period 12,196 children were hospitalized, among them 986 (8 %) children with diarrhea were investigated for CDI and 100 (0.8 %) children were diagnosed with CDI. The incidence of CDI in hospitalized children was 4/1000, 9/1000 and 9/1000 patients per year in year 2012, 2013 and 2014, respectively (p = 0.008, p < 0.01). The mean age of children with CDI (2.6 ± 2.6 months) was lower than children without CDI (57.5 ± 63.5 months) [p = 0.001]. In the multivariate analysis, the presence of underlying chronic diseases [presence of malnutrition (OR 7, 95 % CI 1.33–36.7, p = 0.021), presence of solid organ tumors (OR 6, 95 % CI 2.4–15.7, p < 0.00), presence of congenital heart diseases (OR 4.6, 95 % CI 1.13–18.7, p = 0.03), hospitalization in PICU (OR 15.6, 95 % CI 3.2–75.8, p = 0.001) and hospitalization in hematology and oncology ward (OR 7.8, 95 % CI 2–29.9, p = 0.002)] were found to be independent risk factors for CDI. Conclusion This is the first description of the incidence and associated risk factors of CDI in Turkish children. One of the most important risk factor was prior antibiotic exposure which emphasizes the importance of antibiotic stewardship programs.
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Affiliation(s)
- Ayse Karaaslan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi No: 41 Üstkaynarca, Pendik, Istanbul, Turkey
| | - Ahmet Soysal
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi No: 41 Üstkaynarca, Pendik, Istanbul, Turkey
| | - Nurhayat Yakut
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi No: 41 Üstkaynarca, Pendik, Istanbul, Turkey
| | - Gulsen Akkoç
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi No: 41 Üstkaynarca, Pendik, Istanbul, Turkey
| | - Sevliya Ocal Demir
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi No: 41 Üstkaynarca, Pendik, Istanbul, Turkey
| | - Serkan Atıcı
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi No: 41 Üstkaynarca, Pendik, Istanbul, Turkey
| | - Nurver Ulger Toprak
- Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Guner Söyletir
- Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Mustafa Bakır
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi No: 41 Üstkaynarca, Pendik, Istanbul, Turkey
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13
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Soysal A, Karabağ-Yılmaz E, Kepenekli E, Karaaslan A, Cagan E, Atıcı S, Atınkanat-Gelmez G, Boran P, Merdan S, Hasdemir U, Söyletir G, Bakır M. The impact of a pneumococcal conjugate vaccination program on the nasopharyngeal carriage, serotype distribution and antimicrobial resistance of Streptococcus pneumoniae among healthy children in Turkey. Vaccine 2016; 34:3894-900. [PMID: 27269059 DOI: 10.1016/j.vaccine.2016.05.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 06/20/2015] [Revised: 05/09/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The 7-valent conjugate pneumococcal vaccine (PCV7) was introduced by the Turkey National Immunization Program in 2008 and replaced by the PCV13 in 2011. We assessed the impact of PCV vaccination on the nasopharyngeal (NP) carriage, serotype distribution and antimicrobial resistance of Streptococcus pneumoniae (SP) among healthy Turkish children. METHODS A prospective surveillance study was performed between September 2011 and September 2013 in Istanbul, Turkey. NP swabs, demographic data, and vaccination statuses were obtained from 2165 healthy children aged 0-18years. Pneumococcal carriage was defined by a positive culture; serotyping was performed via multiplex conventional PCR, and the antibiotic susceptibilities of the isolates were determined based on the minimum inhibitory concentration (MIC) values of the Clinical Laboratory Standards Institute (CLSI). RESULTS The prevalence of pneumococcal carriage was 6.4%. The carriage rates were 8%, 7%, and 5% in the following age groups: 0-24months, 25-60months, and >60months, respectively. The carriage rate was significantly higher in the 0-24month age group than in the >60months age group (p=0.03). Sixty percent of the children were not vaccinated with any PCV; 4%, 2%, and 4% received at least 1, 2 or 3 doses and 30% children received the full schedule (4 doses) of either PCV7 or PCV13. Among the isolated S. pneumoniae strains, 45% were of the non-vaccine type (NVT) and 55% were of the vaccine type (VT). The children who received at least a single PCV dose had significantly lower odds of colonization via VT serotypes than the non-vaccinated children [odds ratio: 0.61 (95% confidence interval=0.41-0.91), p=0.01]. The percentages of the serotypes covered by PCV7 and PCV13 were 51% and 56%, respectively. The most frequently isolated serotypes were 6A/B/C (n=22, 16.5%), 19F (n=18, 13.5%), 23F (n=15, 11.2%), serotype 9V/A (n=10, 7.5%), 12F (n=5, 4.5%), 15A/F (n=7, 4.5%) and 22 A/F (n=6, 4.5%). Using the meningitis criteria and the MIC, 62% of the isolates were resistant to penicillin and 13% were non-sensitive to ceftriaxone. Erythromycin and clindamycin resistance were 43% and 31%, respectively. CONCLUSION We shown that following nation-wide PCV vaccination, S. pneumoniae NP carriage was decreased.
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Affiliation(s)
- Ahmet Soysal
- Marmara University, Faculty of Medicine, Division of Pediatric Infectious Diseases, Istanbul, Turkey.
| | - Esra Karabağ-Yılmaz
- Marmara University, Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey
| | - Eda Kepenekli
- Marmara University, Faculty of Medicine, Division of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Ayşe Karaaslan
- Marmara University, Faculty of Medicine, Division of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Eren Cagan
- Marmara University, Faculty of Medicine, Division of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Serkan Atıcı
- Marmara University, Faculty of Medicine, Division of Pediatric Infectious Diseases, Istanbul, Turkey
| | | | - Peran Boran
- Marmara University, Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey
| | - Selim Merdan
- Marmara University, Faculty of Medicine, Department of Microbiology, Istanbul, Turkey
| | - Ufuk Hasdemir
- Marmara University, Faculty of Medicine, Department of Microbiology, Istanbul, Turkey
| | - Güner Söyletir
- Marmara University, Faculty of Medicine, Department of Microbiology, Istanbul, Turkey
| | - Mustafa Bakır
- Marmara University, Faculty of Medicine, Division of Pediatric Infectious Diseases, Istanbul, Turkey
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14
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Kepenekli Kadayifci E, Güneşer Merdan D, Soysal A, Karaaslan A, Atıcı S, Durmaz R, Boran P, Turan İ, Söyletir G, Bakır M. Prevalence of Neisseria meningitidis carriage: a small-scale survey in Istanbul, Turkey. J Infect Dev Ctries 2016; 10:413-7. [PMID: 27131006 DOI: 10.3855/jidc.7483] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/18/2015] [Accepted: 01/03/2016] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION The human nasopharynx is the main reservoir of Neisseria meningitidis, and asymptomatic carriage is common. N. meningitidis one of the common causes of bacterial meningitis in Turkey, especially after the implementation of the national immunization program that includes conjugated pneumococcal and Haemophilus influenzae type b vaccines. The purpose of this study was to evaluate the prevalence of meningococcal carriage and determine the leading serogroup, which may help authorities to adapt appropriate meningococal vaccine into the national immunization programme. METHODOLOGY The prevalence of oropharyngeal carriage of N. meningitidis in 1,000 healthy subjects, 0-79 years of age, was investigated. Oropharyngeal swabs were collected during an 18-month period. Samples obtained were inoculated onto Thayer-Martin agar. The API-NH test and VITEK-MS system were used for identification of colonies. Multiplex real-time polymerase chain reaction assay was used to determine serogroups with serogroup-specific genes. RESULTS N. meningitidis was isolated from 6 of 1,000 subjects (0.6%). Meningoccocal carriers were between 21 and 40 years of age. All isolates were serogrouped as B, except one that did not survive on subculture. N. lactamica was isolated from 13 of 1,000 subjects (1.3%). CONCLUSIONS Carriage rate of meningococci in our study was relatively low. However, we detected that serogroup B was the leading strain in meningococcal carriage in Istanbul; choosing an appropriate meningococcal vaccine containing serogroup B should therefore be considered. High absolute humidity throughout the year in Istanbul may explain the low prevalence of carriage in our study. This should be verified with a multicenter national survey.
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Öcal Demir S, Kepenekli Kadayıfçı E, Karaaslan A, Atıcı S, Akkoç G, Yakut N, Şenay ER, Tokuç G, Koç A, Soysal A, Bakır M. The Role of Acyclovir in the Treatment of Herpes zoster Virus Infections in Immunocompromised Children. J Pediatr Inf 2015. [DOI: 10.5152/ced.2015.2147] [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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16
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Akkoc G, Kepenekli Kadayıfcı E, Karaaslan A, Atıcı S, Yakut N, Demir SO, Soysal A, Bakir M. Human Bite-induced Cellulitis Due to Streptococcus pyogenes. Wounds 2015; 27:E20-E23. [PMID: 27101437] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The rate of infection after a human bite is 10%-30%. Streptococcus spp. are the most common pathogens that may cause serious infections, such as necrotizing fasciitis. The authors describe a 5-year-old girl admitted to the emergency room with cellulitis due to S. pyogenes after human bites. She presented with fever and pain in her left arm, and her medical history revealed a human bite by her cousin on the arm 3 days prior. The wound culture yielded S. pyogenes. She was successfully treated with intravenous ampicillin-sulbactam regimen. S. pyogenes may cause serious wound infections following human bites. In such cases, the patient should be closely followed. Chemoprophylaxis should be initiated in an appropriate clinical setting to prevent secondary bacterial infections. This case was first reported as cellulitis due to S. pyogenes after a human bite.
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Affiliation(s)
- Gulsen Akkoc
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Eda Kepenekli Kadayıfcı
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayse Karaaslan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Serkan Atıcı
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Nurhayat Yakut
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Sevliya Ocal Demir
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Soysal
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Mustafa Bakir
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
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Demir SÖ, Çeliker H, Karaaslan A, Kadayifci EK, Akkoç G, Atıcı S, Yakut N, Şenay E, Kazokoğlu H, Koç A, Bakır M, Soysal A. Cytomegalovirus Retinitis in Three Pediatric Cases with Acute Lymphoblastic Leukemia: Case Series and Review of the Literature. Jpn J Infect Dis 2015; 69:534-538. [PMID: 26567834 DOI: 10.7883/yoken.jjid.2015.223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cytomegalovirus (CMV) retinitis is typically diagnosed in patient with AIDS and those who underwent allogeneic hematopoietic cell transplant. However, it may develop in patients with acute lymphoblastic leukemia (ALL) who have not undergone hematopoietic cell transplantation. To increase awareness of CMV retinitis in this group, we describe 3 patients ages 3, 9, and 12, with ALL who developed CMV retinitis. The diagnosis of CMV retinitis was made on the basis of ophthalmological findings suggesting typical retinal lesions. In 2 cases, CMV DNAemia was present, while in 1 patient CMV DNA was detected only in vitreous fluid using the PCR technique. All cases were treated with intravenous ganciclovir for 2 or 3 weeks as induction therapy, followed by oral valganciclovir prophylaxis. Initially, active retinitis lesions resolved in all cases; however, in 1 patient CMV retinitis relapsed 3 times during follow-up. In this case, by using foscarnet therapy, satisfactory responses were achieved and the progression of CMV retinitis lesions stopped and eventually regressed.
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Affiliation(s)
- Sevliya Öcal Demir
- Division of Pediatric Infectious Diseases, Marmara University School of Medicine
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Karaaslan A, Soysal A, Sarmış A, Kadayifci EK, Cerit K, Atıcı S, Söyletir G, Bakır M. Lactococcus lactis Catherter-Related Bloodstream Infection in an Infant: Case Report. Jpn J Infect Dis 2014; 68:341-2. [PMID: 25672357 DOI: 10.7883/yoken.jjid.2014.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lactococcus lactis is a gram-positive coccus that is nonpathogenic in humans. Herein, we present the case of a 1-year-old boy with Down syndrome and Hirschprung's disease (HD) who developed a catheter-related bloodstream infection with L. lactis after gastrointestinal surgery. The patient had been hospitalized in the pediatric surgery unit from birth because of HD, and had undergone the Duhamel-Martin procedure which caused recurrent diarrhea episodes and feeding intolerance. On the infant's 430th day of life, he had an episode of gastroenteritis and feeding intolerance. Because of clinical suspiction of sepsis, blood cultures were taken both from the central venous catheter and peripheral vein, and evidence of a growing microorganism was detected in 2 different central venous catheter blood cultures taken 2 days apart. The colonies were then identified by both the Vitek 2 and Vitek MS systems (bioMérieux, Marseille, France) as L. lactis spp. lactis. The central venous catheter could not be removed because of the absence of a peripheral venous line, and the patient was subsequently successfully treated with vancomycin. Therefore, although Lactococcus species is generally thought to be nonpathogenic, it should still be kept in mind as a potential pathogen in infants.
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Affiliation(s)
- Ayşe Karaaslan
- Department of Pediatrics and Division of Pediatric Infectious Diseases, Medical School, Marmara University
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Karaaslan A, Kepenekli Kadayifci E, Atıcı S, Sili U, Soysal A, Çulha G, Pekru Y, Bakır M. Compliance of healthcare workers with hand hygiene practices in neonatal and pediatric intensive care units: overt observation. Interdiscip Perspect Infect Dis 2014; 2014:306478. [PMID: 25525428 PMCID: PMC4262750 DOI: 10.1155/2014/306478] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022] Open
Abstract
Background. The objective of this study was to assess the compliance of hand hygiene (HH) of healthcare workers (HCWs) in the neonatal and pediatric intensive care unit in a tertiary university hospital in Istanbul. Methods. An observational study was conducted on the compliance of HH for the five World Health Organization (WHO) indications. HCWs were observed during routine patient care in day shift. The authors also measured the technique of HH through hand washing or hand hygiene with alcohol-based disinfectant. Results. A total of 704 HH opportunities were identified during the observation period. Overall compliance was 37.0% (261/704). Compliance differed by role: nurses (41.4%) and doctors (31.9%) [P = 0.02, OR: 1.504, CI 95%: 1.058-2.137]. HCWs were more likely to use soap and water (63.6%) compared to waterless-alcohol-based hand hygiene (36.3%) [P < 0.05]. Conclusion. Adherence to hand hygiene practice and use of alcohol-based disinfectant was found to be very low. Effective education programs that improve adherence to hand hygiene and use of disinfectants may be helpful to increase compliance.
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Affiliation(s)
- Ayşe Karaaslan
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | - Eda Kepenekli Kadayifci
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | - Serkan Atıcı
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | - Uluhan Sili
- Department of Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | - Ahmet Soysal
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | - Gülcan Çulha
- Infectious Control Nurses, Marmara University Medical Faculty, Istanbul, Turkey
| | - Yasemin Pekru
- Infectious Control Nurses, Marmara University Medical Faculty, Istanbul, Turkey
| | - Mustafa Bakır
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
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