Nervous system is the most affected area in mycoplasma pneumoniae infections with exception of respiratory system. It is an important agent of childhood acute encephalitis and respiratory system infections in school-age children and young adults. Routine clinical and laboratory findings to identify spesific diagnosis is limited. Twelve-year-old female patient was admitted with fever, fatigue, sore throat, slipping the right eye, withdrawal of the mouth from the right and right hemiclonic seizures. Test of anti-Mycoplasma pneumoniae (M. pneumoniae) IgM was positive and IgG antibodies were found to be 4-fold increase in the sera of follow-up. This article was presented with the aim of remembering M. pneumoniae to be an differential diagnosis in children with acute encephalitis.
Inherited metabolic diseases are pathologic conditions that generally develop as a result of impairment of the production or breakdown of protein, carbohydrate, and fatty acids. Early determination of hematological findings has a positive effect on the prognosis of metabolic diseases. Three hundred eighteen patients who were being followed-up within the previous 6 months at Department of Pediatric Nutrition and Metabolism, Gazi University, Turkey, were included in the study. The hematological findings were classified under 7 main groups: anemia of chronic disease, iron deficiency anemia, vitamin B12 deficiency anemia, hemophagocytosis, leukocytosis, and thrombocytosis. Nine hundred twenty-two hematological examinations of the 319 patients were included in the study, and 283 hematological findings were determined, 127 anemia of chronic disease, 81 iron deficiency anemia, 56 cytopenia, and 4 vitamin B12 deficiency anemia. Leukocytosis (n=1), thrombocytosis (n=5), and hemophagocytosis (n=9) were also observed. It was determined that, although anemia of chronic disease and nutritional anemia are the most common hematological findings, these may be diagnosed late, whereas neutropenia, thrombocytopenia, pancytopenia, and hemostasis disorders may be diagnosed earlier. Our study is the most comprehensive one in the literature, and we think it would positively contribute to the monitoring and prognosis of congenital metabolic diseases.
Neonatal renal vein thrombosis (RVT) is a well-known entity and neonates with RVT usually have co-existing risk factors such as dehydratation, sepsis, asphyxia, maternal diabetes mellitus, catheterization and prematurity (1). Hereditary risk factors also play a role in the pathogenesis, so screening for known hereditary phrothrombotic conditions is suggested. The most common hereditary risk factor is Factor V Leiden mutation and is associated with prenatal onset RVT.The incidence of prenatal RVT is unknown, 12 cases were reported in the literature till now. The most common clinical presentation is fetal distress signs. The others are hydrops fetalis and incidental finding on prenatal US in otherwise normal pregnancies. Slow onset of thrombosis may have allowed the development of collateral circulation, so some of them were detected incidentally by prenatal US or detected after delivery (5,7).Here we report a prenatal onset RVT together with inferior vena cava thrombosis and adrenal hemorrhage in a late preterm infant having heterozygote mutations for Factor V Leiden and MTHFR gene.One day old female who was 35 weeks gestational aged with a birth weight 2680 gr, was bom by CIS. She was outbom and admitted to NICU due to neonatal jaundice at 24 hours of life. The cause of the preterm delivery was fetal distress. Just before the delivery the obstetrician noticed that left kidney of fetus was large and edeumatous in ultrasonographic examination (US). There was no history about perinatal asphyxia. Known prenatal risks were maternal gestational diabetes mellitus regulated by diet and prematurity. There was no consanguinity between mother and father. The grandmother had systemic lupus erythamotosus; the grandfather had diabetes mellitus and polycystic kidney disease. Physical examination on admission showed jaundice and palpable left flank mass. There was no thrombocytopenia, hematuria and no elevation in serum creatinin level. Phototherapy was started. On the second day of admission, the right lower extremity swelling was detected. Abdominal US, hip and knee US; both abdominal and lower extremity Doppler US were done. Abdominal US revealed bilateral adrenal hematoma (right 3x2.5 cm; left 2.5x1.5 cm) (Fig. 1), enlarged and edematous left kidney (52x40x27 mm) (Figs 2 and 3). Doppler US demonstrated thrombosis of infrahepatic segment of inferior vena cava (IVC) (Fig. 4), bilateral main iliac veins, right external iliac vein and left renal vein. US is the radiographic test most commonly used to diagnose neonatal RVT. The initial sonographic findings are marked renal enlargement, increased echogenicity, lost-of corticomedullary differentiation and echogenic interlobular streaking that indicates interlobar and interlobular thrombus (2,4). CT with contrast was performed to evaluate vascular collaterals and to make differential diagnosis of the surrenal lesion. CT confirmed the results of US and Doppler US. Right renal vein was draining to retroperitoneal collaterals and right kidney was 42x27x28 mm in size (Fig. 5). The thrombophilia tests of mother and infant including protein C, protein S levels, prothrombin gene 20210, MTHFR, Factor V Leiden G1691A mutations were done. Infant was heterozygote positive for Factor V Leiden and MTHFR gene mutations while her mother was negative.For unilateral RVT if there is extension into the IVC, Unffaxioned heparin or Low molecular weight heparin (LMWH) in therapeutic doses is suggested. Recommended duration of therapy is between 6 weeks and 3 months (6). LMWH was started in dose of 1.5 mg/kg twice a day according to the recommendation of pediatric hematologist. The renal outcomes of RVT have not been changed by the modalities of therapy; nearly three quarters of affected kidney become atrophic regardless of the treatment (5). Although treatment with LMWH, the affected kidney of our case became atrophic during follow-up. …
To provide a basis for clinical management decisions in Paecilomyces variotii infection.Unpublished cases of invasive P. variotii infection from the FungiScope® registry and all cases reported in the literature were analysed.We identified 59 cases with P. variotii infection. Main baseline factors were presence of indwelling devices in 29 cases (49.2%), particularly peritoneal catheters (33.9%) and prosthetic heart valves (10.2%), haematological or oncological diseases in 19 (32.2%), major surgery in 11 (18.6%), and diabetes mellitus in 10 cases (16.9%). The most prevalent infection sites were peritoneum (n = 20, 33.3%) and lungs (n = 16, 27.1%). Pain and fever were frequent (n = 35, 59.3% and n = 33, 55.9%, respectively). Diagnosis was established by culture in 58 cases (98.3%). P. variotii caused breakthrough infection in 8 patients. Systemic antifungals were given in 52 patients (88.1%). Amphotericin B was administered in 39, itraconazole in 15, and posaconazole in 8 patients. Clinical isolates were frequently resistant to voriconazole, whereas the above-mentioned antifungals showed good in vitro activity. Infections of the blood and CNS caused high mortality. Overall mortality was 28.8% and death was attributed to P. variotii in 10 cases.P. variotii causes life-threatening infections, especially in immunocompromised and critically ill patients with indwelling devices. Patients undergoing peritoneal dialysis are at particular risk. Multidisciplinary management is paramount, including molecular techniques for diagnosis and treatment with efficacious systemic antifungals. Amphotericin B, itraconazole and posaconazole are regarded as treatments of choice. Combination with flucytosine may be considered. Surgical debridement and removal of indwelling devices facilitate favourable outcome.
Aim: To investigate the ratio of rickets and vitamin D deficiency in healthy adolescents at Van region. Method: Totally 126 cases were included in this study. All cases were evaluated for the presence of rickets symptoms, daily sun exposure, and vitamin usage, covering and eating habit. Diagnosis of rickets was made based on biochemical findings. The children whose vitamin D levels were lower than 10 ng/dl were accepted as vitamin 25(OH)D3 deficiency, but whose levels between 10-20 ng/dl were accepted as vitamin D insufficiency. Result: Sixty girls (47.6%) and 66 boys (52.4%) were included in this study. They were between 9 and 17 years old (11.94 ± 1.9 years). Vitamin D levels in 60 (47.6%) cases were normal, but 48 (38.1%) cases had rickets, 13 (10.3%) cases had vitamin D insufficiency and 5 (4.0%) cases had vitamin D deficiency. There was no statistically significant difference in the incidence of rickets between the cases with or without covered-dress. However, there was a significant difference in the incidence of vitamin D insufficiency (p<0.05). All of the cases had less daily calcium, phosphorus, protein and vitamin D intake than recommended daily amount. In the rickets group, alkaline phosphatase levels were significantly higher comparing with the others (p<0.05), but there was no difference in plasma intact parathyroid hormone levels. Conclusion: Our findings revealed that most adolescents who appeared to be healthy (52.4%) could have vitamin D insufficiency. Therefore, we believe that dietary education and/or vitamin D prophylaxis might be given to all adolescents. However, more extensive researches should be done to elucidate of our suggestion’s correction
Summary Acute disseminated encephalomyelitis is an inflammatory and demyelinating disorder of central nervous system A 9 year old male was admitted with unable to walk non sensation of legs urinary incontinence and encopresis for 2 days On physical examination muscle strength was 5 5 on upper extremities and 1 5 on lower extremities Loss of pain temperature and touch sensation was present on both lower extremities reaches to T8 level On spinal magnetic resonance imaging diffuse hyperintensity from C3 to conus medullaris was detected While electromyography was consistent with polyradiculoneuritis magnetic resonance imaging findings were concordant with acute disseminated encephalomyelitis On account of this case we would like to emphasize that acute disseminated encephalomyelitis should be considered in patients presented with transverse myelitis; therefore in addition to spinal magnetic resonance imaging cranial magnetic resonance imaging should be examined in these patients Turk Arch Ped 2010; 45: 299 302 Key words: Acute disseminated encephalomyelitis child transverse myelitis
Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March-May 2020) and the second wave (October-December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases. This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases.
