Differences in hepatitis A seroprevalence among geographical regions in Turkey: a need for regional vaccination recommendations.

Hepatitis A is a worldwide vaccine-preventable infection. Recommendation of vaccination depends on the endemicity of the disease. The World Health Organization recommends universal hepatitis A vaccination in intermediate areas; however, there is no need of mass vaccination in high and low endemicity regions. Therefore, most of the countries are using a vaccination policy according to the endemicity characteristic representing the whole of the country. The endemicity of this infection varies due to sanitary and hygiene conditions and socioeconomic differences among the countries and in various regions of the same country. A sample of 1173 persons between the age of 0 and 91 years from nine randomly selected medical centres from five different geographical centres of Turkey were tested for the level of anti-hepatitis A virus (anti-HAV) immunoglobulin-G antibodies using an enzyme-linked immunosorbent assay. The overall prevalence of anti-HAV antibodies was 64.4% (1142/1173). While the rate of sero-positivity was over 80% in the 5-9 age group and more than 90% after 14 years of age in south-eastern and eastern regions, it was lower than 50% at the age of 5-9 years in central and western regions and remains under 80% in those areas. We conclude that the differences observed in HAV sero-positivity among various geographical regions in Turkey support a universal HAV immunization policy for children currently living in regions of intermediate endemicity.

An outbreak of Aseptic Meningitis due to echovirus type 30 in two cities of Turkey.

An outbreak of aseptic meningitis due to echovirus 30 occurred in Ankara and Antalya in Turkey, during June to September 1999, with 176 cases fitting the clinical case definition. Cases were ascertained from attendees of the three hospitals in Ankara and one in Antalya. Medical files were reviewed and evaluated retrospectively. Clinical presentation and laboratory findings were typical of viral meningitis. Cerebrospinal fluid and/or stool samples of 86 patients were cultured for enteroviruses. Echovirus type 30 was isolated in 38 patients (44%). This is the first report and epidemiologic data about an aseptic meningitis outbreak due to echovirus type 30 from Turkey.

The role of Clostridium difficile in childhood nosocomial diarrhea.

The role of Clostridium difficile was investigated in 100 children with nosocomial diarrhea. An etiologic agent was identified in 69 cases, 8 of whom had dual infection. C. difficile-associated diarrhea (Cdad) was defined in 16 children (16%). The mean age of the patients with Cdad was 5.4 y (range 2 months to 13 y) and the male:female ratio was 1.2. All cases with Cdad were on antibiotic therapy. Cdad occurred more frequently in the cases given combined antibiotic treatment than in those given single antibiotic treatment (p < 0.05). One case with neutropenic sepsis died. C. difficile was also investigated in the stool samples of 50 hospitalized children treated with antibiotics who did not develop diarrhea. C. difficile toxins A and B were found in 5 children aged < 2 y in the control group. This study shows that C. difficile is an important cause of nosocomial diarrhea in our hospital population.

Magnetic resonance imaging in diagnosis of childhood central nervous system tuberculosis.

BACKGROUND: We investigated the role of magnetic resonance imaging (MRI) in diagnosis of central nervous system (CNS) tuberculosis. PATIENTS AND METHODS: The MRI findings (T1, T2 and T1 sequence after contrast) of 11 children with CNS tuberculosis were evaluated and the diagnostic value of contrast enhanced MRI and its correlation with the clinical findings were investigated. RESULTS: The median age of the patients was 6 years; seven were male and four female. MRI findings of the cases were meningeal enhancement (90.9%), hydrocephalus (63.6%), infarction (45.5%), tuberculomas (27.2%), cranial nerve involvement (27.2%) and severe cortical atrophy (9.1%). MRI provided early diagnosis in two cases by demonstrating tuberculomas, and supported the diagnosis in seven cases. However, in two cases MRI findings were inadequate to diagnose CNS tuberculosis, especially at the beginning. CONCLUSION: Contrast enhanced MRI is a very useful technique for diagnosing CNS tuberculosis, particularly by demonstrating the localized lesions, meningeal enhancement and the brain stem. However, a family history of tuberculosis, chest X-ray findings and the clinical picture are still very important for diagnosis.

Biliary ascariasis.

Biliary ascariasis is a less frequent, but important complication of ascaris infestation, because it may cause biliary colic, pyogenic cholangitis, and septicemia. Early diagnosis and treatment is important to prevent these complications. We present here a five-year-old girl with biliary ascariasis, whose main complaint was abdominal pain. After giving piperazin salt, multiple ascaris worms were seen in the stool within 10 days. She is at the follow-up without any complication.

Phakomatosis pigmentovascularis with Sturge-Weber syndrome: a case report.

We describe here a Turkish girl with pigmentovascularis type 2b, consisting of disseminated Mongolian-spot-like maculae and unilateral Sturge-Weber angiomatosis.

Clinical risk factors for fatal diarrhea in hospitalized children.

It is important to determine the specific factors for diarrheal deaths in infants & young children to enable the intervention and reduce the mortality rates. This study aimed to identify these factors in children under five years of age, hospitalized with diarrheal complaints. Four hundred diarrheal children were included in the study. Twenty-seven (6.75%) of them died and 373 (93.25%) survived. The nutritional status of the patients was determined using weight for height for age as percentage of Harward Standard. It was found that severe malnutrition (p = 0.000 for weight for height ration < 70% and p = 0.036 for height for age < 85%), co-existent sepsis (p = 0.000), shigella infection (p = 0.0014), hypoalbuminemia (p = 0.0000), hypoglycemia (p = 0.0002), hyponatremia (p = 0.016), hypokalemia (p = 0.0041) and metabolic acidosis (p = 0.0069 for pH < 7.35 and p = 0.000 for HCO3 < 20 moL/l) were significant risk factors for diarrheal deaths in the univariate analysis. In the multivariate analysis, young age (under 6 months of age) ¿Odds ratio (OR) 10.49, 95% confidence interval (CI) 1.75, 62.75)¿, moderate or severe dehydration (OR 8.17, 95% CI 1.53, 43.67), severe malnutrition (OR 0.04, 95% CI 0.00, 0.22 of weight for height < 70% and OR 0.03, 95% CI 0.00, 0.36 for height for age < 85%), co-existent sepsis (OR 37.26, 95% CI 6.94, 200.06), shigella infection (OR 23.01, 95% CI 3.08, 171.98), hypoalbuminemia (OR 0.11, 95% CI 0.02, 0.54), metabolic acidosis (OR 0.03, 95% CI 0.00, 0.33 of HCO3 < 20 mMol/L) were significant risk factors. It is concluded that, in addition to electrolyte and fluid treatments, prevention of malnutrition, continuation of feeding which lessens weight loss and may prevent fatal hypoglycemia, and early detection and treatment of probable sepsis are important in reducing diarrheal deaths.

Cerebrospinal fluid nitric oxide levels in childhood bacterial meningitis.

The role of nitric oxide (NO) in childhood bacterial meningitis was investigated by determining the levels of nitrate/nitrite, stable end products of NO metabolism, in cerebrospinal fluid (CSF). Eighteen children with bacterial meningitis and 18 as a control group were included in the study. Mean (+/- SD) CSF nitrate/nitrite levels were 27.6 +/- 26 micromol/l in the bacterial meningitis group and 3.2 +/- 1.8 micromol/l in the control group (p = 0.0005). We found no correlation between CSF nitrate/nitrite levels and CSF white blood cell count (r = 0.22), protein (r = 0.26) or tumour necrosis factor alpha (TNF-alpha) levels (r = 0.046), but a moderate negative correlation between CSF nitrate/nitrite and glucose levels (r = -0.46).

Disseminated pyomyositis with high creatine phosphokinase levels.

Pyomyositis is a rare purulent infection of skeletal muscle caused predominantly by Staphylococcus aureus. We report a patient who presented with high fever, widespread muscle pain and high creatine phosphokinase levels. He also developed multiple muscle and lung abscesses associated with a S. aureus septicaemia.

Campylobacter jejuni gastroenteritis in Turkish children.

Four hundred children between the ages of 1 month and 14 years with the complaint of diarrhea were studied to assess Campylobacter jejuni isolation rates in childhood acute gastroenteritis in Turkey and to clarify clinical presentations of C. jejuni enteritis. C. jejuni was found to be the second most common isolate with a rate of 8.3%, the first being Shigella strains. The highest isolation rate was in the 6 to 14-year age range at 12%. The most frequent symptoms in patients with C. jejuni enteritis were abdominal pain (51.5%), vomiting (36.4%) and fever (30.3%). Stool examination revealed bloody mucous stool in 51.5% of the patients, and erythrocytes and/or leucocytes were detected in 42.4%. Only 12.1% of the patients with C. jejuni enteritis were hospitalized in this study.