Intracerebral tuberculoma in children with tuberculous meningitis.

Not all patients with tuberculosis develop tuberculoma during the disease or antituberculous therapy. Therefore, we compared various parameters in patients with and without tuberculoma and presented the results. We formed two groups from the patients with tuberculous meningitis: Group I consisted of 18 patients with tuberculoma, and Group II consisted of 18 randomly selected patients without tuberculoma. Significant difference between the groups was found with respect to level of consciousness and CSF-glucose level (p < 0.05). The consciousness level was more depressed and the CSF-glucose level more decreased in the group without tuberculoma. These findings were discussed.

Measles antibody response in vaccinated children.

The incidence of measles has declined in our country since the routine administration of measles vaccination was initiated. However, measles outbreaks have been observed even among previously vaccinated children. The objective of this study was to evaluated the measles antibody response of children vaccinated at nine months of age. Measles-specific IgG antibodies were determined by enzyme-linked immunosorbent assay. Of 345 children tested, 20.3 percent were immunologically measles-susceptible. When measles-specific antibody titers were analyzed with respect to the elapsed time since prior vaccination, the result was found to be insignificant (p > 0.05). These data suggest that the underestimated seropositivity rate of measles antibody may be related to both primary vaccine failure and inappropriate vaccination age.

Epidemiology of meningococcal infections in children in mid-southern part of Turkey.

59 patients were treated for meningococcal infections in Cukurova University Faculty of Medicine, Division of Pediatric Infectious Diseases. 50.8% of patients were male, 33.9% were under two years of age and 61% were under five. 78% of patients were admitted to hospital in winter and spring time. Meningococcal meningitis (MM) was present in 39% of patients on admission, however, meningococcemia in 27.1% and meningococcemia and meningococcic meningitis (Meningococcemia + MM) in 33.9%. Fatality rate was 18.6% and no association was found between mortality and clinical type of disease (p > 0.05), but mortality ratio decreased with an increasing age (p < 0.01). No deaths occurred among the 12 patients who received i.v. penicillin treatment shortly before admitting to hospital, on the other hand 11 of 47 patients (23.4%) without such a previous treatment died.

PIP: The clinical and laboratory findings of 59 patients treated for meningococcal disease between January 1, 1989, and December 31, 1993, in Adana, Turkey's Cukurova University, Faculty of Medicine, Division of Pediatric Infectious Diseases were analyzed retrospectively. The diagnosis was based on clinical findings, positive blood or cerebrospinal fluid (CSF) cultures, and the presence of gram negative diplococci in the CSF and in the smears from petechiae. Of 59 patients, 29 (49.2%) were female and 30 (50.8%) were male, with ages ranging from 1 month to 14 years. 20 (33.9%) patients were in the 0-2 and 36 (61%) were in the 0-5 age group. Most of the patients (45.7%) were admitted to the hospital in the winter, followed by spring (32.2%), summer (15.3%), and fall (6.8%). In January and February there seemed to be a peak in admission rates (18.6% and 16.9%, respectively). The distribution of patients with respect to seasons showed a statistically significant difference (p .0001). The overall case fatality was 18.6% (11/59). Meningococcal meningitis (MM) was diagnosed in 23 (39%) patients, meningococcemia in 16 (27.1%), and MM + meningococcemia in 20 (33.9%). 10 of 20 children 0-2 years of age presented with meningococcemia alone. On the other hand, 11 (47.8%) of the 23 patients over 5 years showed MM alone. Clinical presentation revealed a significant association with certain age groups (p .05). Fatality ratios in children under 2 years old and in children 2-14 years old were 35% and 10.2%, respectively, and there was a significant trend for decreasing case fatality rate with increasing age (p .01). All patients aged 0-3 months died. The fatality rate was the lowest among patients over 5 years of age (8.7%, 2/23). The mortality rate did not change with clinical presentation (p .05). Two patients (8.7%) with MM died, while this rate was 20% (4/20) in patients with MM + meningococcemia. 5 of 16 (31.3%) patients died in the group with meningococcemia only. Signs of upper respiratory tract infection were present in 11 (18.6%) patients during their initial physical examination, but no statistically significant relationship was found in respect to mortality (p .05).

Clinical features of Bardet-Biedl syndrome.

Six patients with Bardet-Biedl syndrome who have been followed in our clinics for the last 5 years are reported in this study. Of the five classic features of this syndrome; obesity and mental retardation were present in all cases, retinal disturbances were present in five, polydactyly in three and hypogenitalism was observed in all four male patients. Renal involvement, often suggested as a cardinal feature of this syndrome, was described in two patients. Iron deficiency anemia occurred in three patients, two patients were of short stature, one patient presented with an empty sella, and in two patients clinodactyly was detected. The results are compared to previously published literature and discussed.

Tuberculous meningitis in children.

Between May 1988 and November 1992 the data from 52 patients with tuberculous meningitis (TBM) were noted down for their symptoms and signs, BCG vaccines, PPD tests; clinical, laboratory, radiologic and microbiologic findings. These data were discussed by means of literature knowledge. Cranial computed tomography (CT) demonstrated hydrocephalus (HC) in 98% of the patients. There was a statistically significant difference among the clinical stages on admission in respect to prognosis (P < 0.05). In addition, there was also a significant relationship between prognosis and HC (P < 0.05). However, we did not find any significant relationship between parenchymal involvement, basilar meningitis and prognosis (P > 0.05).

Influence of smoke exposure on serum IgE levels of atopic patients.

The effect of environmental tobacco smoke on serum total immunoglobulin E (IgE) of respiratory allergic patients was evaluated in this study. A total of 558 patients with respiratory allergies (311 boys and 248 girls) aged between 1 and 17 years (mean 6.92 +/- 3.81 years) were included. None of the subjects were active smokers. IgE levels were significantly higher in children with smoking parents compared with non-smokers (P < 0.05). Children with smoking mothers were found to have higher levels of IgE than children with smoking fathers. The highest level of IgE was found in children when both parents were smokers (P < 0.005).

The Aicardi syndrome. A case report and review of the literature.

A case of Aicardi's syndrome is described. The main features described are infantile spasms, pathognomonic chorioretinal lacunar defects, agenesis of the corpus callosum, psychomotor retardation, female sex, characteristic EEG changes and costovertebral anomalies. This is the second reported case in Turkey.