Campylobacter Data in Childhood from a University Hospital.

Background and Objectives: Due to underdiagnosis because of the technical difficulties plus inadequacy of laboratories, actual incidence of campylobacteriosis may substantially be greater than the reported incidence in many countries including Turkey. The purpose of this study was to evaluate and emphasize the diagnostic methods of campylobacteriosis, and the clinical and laboratory data of children with Campylobacterial gastroenteritis. Methods: This study was conducted in Yeditepe University Hospital, Istanbul, Turkey. Clinical (demographical data, symptoms and findings) and laboratory (stool microscopy, rapid antigen tests, culture, and multiplex PCR and blood test results) variables of children with Campylobacter infection between January 2010 and October 2012 were evaluated retrospectively from the hospital database. Results: Out of 1275 stool cultures, Campylobacter spp. was detected in 90 of them (7%). The diagnosis was made by positive stool culture (n = 87) and/or multiplex polymerase chain reaction (PCR) test (n = 8, whereas 3 of them were culture negative). The distribution of Campylobacter isolates were; C. jejuni (85.5%), C. upsaliensis (8.9%), C. coli (1.1%), and others (4.5%). The presenting symptoms were diarrhea (100%), fever (68.9%), abdominal pain (34.4%), dehydration (27.8%), vomiting (25.5%), bloody diarrhea (5.6%), and convulsion (1%). Hospitalization was required in 25.5% of patients. Conclusions: Although stool culture is a reference method in diagnosis, the PCR test can be used in culture negative patients with clinical manifestations. Diarrhea, fever, abdominal pain, and vomiting were most commonly encountered symptoms whereas bloody diarrhea and convulsion were rarely seen in campylobacteriosis. Also antibiotherapy and hospitalisation were not commonly required.

Abdominal mass in a neonate: hepatoblastoma.

A term neonate born to a 37 year old mother was admitted to our Neonatology Unit because of jaundice and abdominal distention. Gastrointestinal examination revealed abdominal distention and a palpable abdominal mass in right upper quadrant. After the initial radiological studies, it was clear that the mass originated from liver. At postnatal 15th day alfa-feto protein was found to be 60.500 ng/ml (normal level (2 week-1 month):9.452+/-12.610 ng/ml). While due to relatively high frequency in infancy and the type of contrast material enhancement in imaging studies suggested an infantile hemangioendothelioma (IHE), heterogenous nature of the lesion and high AFP levels were consistent with a hepatoblastoma (HB). Since accurate diagnosis could not be achieved by radiological studies a liver biopsy is performed. After the pathological examination of the tru-cut liver biopsy specimen, histomorphological and immunohistochemical findings were consistent with the epithelial component of an embryonal type hepatoblastoma.

Subacute sclerosing panencephalitis presenting as acute disseminated encephalomyelitis.

Subacute sclerosing panencephalitis (SSPE) is a chronic encephalitis of childhood and young adolescence due to persistent measles virus infection of the central nervous system. In majority of cases onset occurs from 5-15 years of age. In a nonimmunized population the average onset is 8 years. Children with SSPE had experienced natural infection with the rubeola virus at an early age, half before age 2 years. SSPE generally occurs 5-10 years after measles infection. In the early stages of the disease behavioral and personality changes is followed by myoclonic jerks and convulsions. In late stages dementia, stupor and coma develops. Diagnosis is achieved by typical clinical findings, measles antibody titer increase in cerebrospinal fluid (CSF) and serum, high amplitude, slow, sharp waves in EEG. Prognosis is poor and death ensues in about 3 yr after the diagnosis. Here it is presented a 7-years-old boy with involuntary movements in both hands, drop attacks while walking, ataxia and stupor. Due to suggestive radiological and clinical findings and a history of recent mumps infection he was thought to have acute disseminated encephalomyelitis initially and given treatment. But due to clinical deterioration and detection of anti measles IgG in serum and CSF, SSPE diagnosis was confirmed. With this SSPE case presenting initially as ADEM, the authors tried to emphasize that presentation of SSPE may clinically and radiologically be diverse and a thorough differential diagnosis is mandatory for a definite diagnosis.