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    Clindamycin Hypersensitivity and Management in a Case with Invasive Group A Streptococcal Cellulitis Caused by Chickenpox
    (Aves Yayincilik, Ibrahim Kara, 2019) Durmus, Sevgi Yasar; Tanir, Gonul; Kaman, Ayse; Akcan, Ozge Metin; Demir, Merve
    Chickenpox is commonly known as a benign exenthamatous disease of childhood that causes vesicular rashes. Symptomatic therapy is usually adequate for chickenpox but in some cases secondary bacterial infections constitute the most common cause of morbidity in children. Primer varicella is an important predisposing factor for invasive group A streptococcal infection. In the treatment of invasive group A streptococcal infection generally accepted therapeutic management includes early administration of penicillin in combination with clindamycin, intravenous immunoglobulins and early surgical intervention. In this report we describe a patient who developed clindamycin hypersensitivity during invasive group A streptococcal cellulitis management.
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    Clinical Characterics, Laboratory Features, and Management of Odontogenic Facial Cellulitis
    (Aves Yayincilik, Ibrahim Kara, 2018) Kaman, Ayse; Teke, Turkan Aydin; Oz, Fatma Nur; Bayhan, Gulsum Iclal; Metin, Ozge; Aydin, Zeynep Gokce Gayretli; Durmus, Sevgi Yasar
    Objective: Dental caries remain one of the most common chronic diseases in childhood, globally. The purpose of this study is to determine clinical characteristics and treatment modalities of pediatric patients with odontogenic facial cellulitis. Material and Methods: Medical records of children with odontogenic facial cellulitis hospitalized in pediatric infectious disease clinic were analyzed retrospectively between January 2013 and December 2017. Results: Ninety-eight patients (43 girls, 55 boys) with median age of 86 months (min-max: 19-207 months) were evaluated. Forty-five (45.9%) patients had no regular toothbrushing habits. Forty-eight (48.9%) patients had no any dental treatment procedure history. Eighteen (18.3%) patients had never recoursed to a dentist. Seventy-five patients (76.5%) were diagnosed with odontogenic facial cellulitis for the first time. Four patients (4%) were hospitalized with the same diagnosis previously. On admission, 37 (37.8%) patients had fever. On admission, the mean white blood cell (WBC) count, erythrocyte sedimentation rate, and C-reactive protein (CRP) were 11.981 +/- 4.433/mm(3), 29.1 +/- 17.6 mm/h and 35.2 +/- 39.4 mg/L, respectively. The mean duration of intravenous antibiotic treatment was 5.5 +/- 2.5 days, and total medical treatment was 12.5 +/- 2.9 days. Ampicillin-sulbactam was started to 82 (83.7%) of the patients. Clindamycin was added to 15 (15.3%) patients. Increased mean WBC count on admission was correlated with duration of hospital stay (p = 0.036), while increased CRP level was correlated with total medical treatment duration (p = 0.032). Patients who received clindamycin had longer duration of intravenous and total medical treatment (p < 0.001 and p < 0.001). Conclusion: If dental caries are not recognized and treated immediately, they may spread into surrounding connective tissue as cellulitis and may lead to hospitalization in young patients. Oral health is a mainstone of life-long well-being, so oral health problems should be considered as a major public health problem and preventive measures should be taken to improve oral health.
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    Risk Factors of Stenotrophomonas maltophilia Blood Stream Infections: Comparison With Other Gram-Negative Blood Stream Infections in Children
    (Lippincott Williams & Wilkins, 2020) Aydin, Zeynep Gokce Gayretli; Tanir, Gonul; Bayhan, Gulsum Iclal; Teke, Turkan Aydin; Akcan, Ozge Metin; Kaman, Ayse; Durmus, Sevgi Yasar
    Background: Stenotrophomonas maltophilia, is a nonfermentative, aerobic, Gram-negative bacilli which is intrinsically resistance to several antibiotics. Treatment options for this bacteria are quite different from the other Gram-negative bacilli, which can represent a therapeutic challenge. To initiate appropriate empiric treatment and to reduce mortality, differentiation of S. maltophilia from other Gram-negative bacteria is critically important. The aim of this study is to distinguish the risk factors of S. maltophilia blood stream infections (BSI) from other Gram-negative BSI. Methods: This was a retrospective, case-control study. Patients with S. maltophilia BSI were selected as cases and patients with non-S. maltophilia Gram-negative BSI were selected as controls. Demographic and clinical characteristics of patients were recorded. Results: Forty-eight cases with S. maltophilia BSI and 144 controls were enrolled in the study. Risk factors for S. maltophilia BSI compared with the control group includes prior use of antibiotics, especially carbapenem, pediatric intensive care unit stay, mechanical ventilator use, indwelling catheters and duration of hospitalization. Conclusions: Breakthrough infection by S. maltophilia can occur in severely ill patients being treated with carbapenem. In the presence of risk factors, to reduce morbidity and mortality, S. maltophilia should be kept in mind when starting empiric treatment.
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    Vitamin D Receptor Gene Polymorphisms in Childhood Brucellosis in Turkish Children
    (Georg Thieme Verlag Kg, 2021) Kaman, Ayse; Oz, Fatma Nur; Sahin, Gulseren; Metin Akcan, Ozge
    Objective The vitamin D receptor gene (VDR) polymorphisms and the risk of various infections have been studied. An association with brucellosis and vitamin D levels has been investigated but not yet with VDR gene polymorphisms. We aimed to examine the association between VDR gene polymorphisms and susceptibility to childhood brucellosis. Methods This case-control study included patients with brucellosis and healthy controls. After extracting genomic DNA using a Qiagen blood DNA isolation kit, five VDR single nucleotide polymorphisms (SNPs), including Cdx-2, FokI, BsmI, ApaI, and TaqI gene, were amplified. Genetic distribution of these SNPs of VDR gene in patient and control groups were compared. Results A total of 38 patients with brucellosis and 89 healthy controls were evaluated. The genotype distribution of Cdx2, FokI, BsmI, and ApaI polymorphisms were similar between patients and healthy controls. However, the CC homozygous genotype for VDR gene TaqI was significantly overexpressed in patients compared with controls (23.7 vs. 7.9%; p = 0.042). The frequency of the C allele of the TaqI genotype was significantly different between patients and controls ((p = 0.018). On the other hand, presence of the A allele in the BsmI was associated considerably with an increased risk of brucellosis (p = 0.037). VDR polymorphism distribution was similar according to age, presence of complicated disease, and presence of bacteremia. The heterozygote TaqI polymorphism was more common in patients presented as subacute and chronic symptoms (p = 0.036). Conclusion Our results indicated the possible role in TaqI polymorphism of the VDR gene for the risk of brucellosis at the time of exposure to infection.