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Vitamin D has an immunomodulating property that regulates the inflammatory response. In this study, the aim was to evaluate the relationship between vitamin D levels and clinical severity and inflammation markers in children and adolescents with COVID-19. The clinical and laboratory records of 103 pediatric cases with COVID-19, whose vitamin D levels had been measured, were retrospectively reviewed. The cases were divided into groups according to their clinical severity (asymptomatic, mild, and moderate-to-severe) and vitamin D levels. The moderate-to-severe clinical group had significantly higher inflammation markers (CRP, procalcitonin, fibrinogen, d-dimer) and a lower lymphocyte count compared to both the mild and asymptomatic groups. The 25 OH vitamin D levels were also significantly lower (p < 0.001), and the ratio of vitamin D deficiency was 70.6% in the moderate-to-severe group. The vitamin D–deficient group had a significantly higher age and fibrinogen levels while also having a lower lymphocyte count compared to the insufficient and normal groups. The 25 OH vitamin D level was correlated positively with the lymphocyte count (r = 0.375, p = <0.001), and negatively with age (r = −0.496, p = <0.001), CRP (r = −0.309, p = 0.002) and fibrinogen levels (r = −0.381, p = <0.001). In a logistic regression analysis, vitamin D deficiency, d-dimer, and fibrinogen levels on admission were independent predictors of severe clinical course.Conclusion: This study revealed an association between vitamin D deficiency and clinical severity, in addition to inflammation markers in pediatric COVID-19 cases. Prophylactic vitamin D supplementation may be considered, especially in the adolescent age group. What is Known:• • The pathology of COVID-19 involves a complex interaction between the SARS-CoV-2 and the immune system. Hyperinflammation/cytokine storm is held responsible for the severity of the disease.• Vitamin D has multiple roles in the immune system that can modulate the body reaction to an infection.What is New:• • Clinically more severe group had significantly lower vit D levels and significantly higher inflammation markers.• Lower 25 OH vit D levels were associated with higher inflammation markers, suggesting an important role of vitamin D in the clinical course of COVID-19 in children and adolescents probably by regulating the systemic inflammatory response.

What is Known?• Vitamin D has multiple roles in the immune system that can modulate the body reaction to an infection• Vitamin D binding protein (DBP) is the key transport protein which, along with albumin, binds over 99% of the circulating vitamin D metabolitesWhat is New?• Lower 25 OH vitamin D levels were associated with higher inflammation markers, suggesting an important role of vitamin D in the clinical course of COVID-19 in children and adolescents probably by regulating the systemic inflammatory response• Further studies are warranted to investigate the possible causal association of DBP levels and polymorphism with vitamin D status (total and bioavailable vitamin D) in COVID-19 patients

Background. The term ‘pseudo-outbreak’ refers to a condition in which a microorganism is found in cultures at a greater rate than expected due to contamination of materials that would normally be sterile. This situation cannot be clinically correlated with the infection suggested by the culture results. This can be confusing depending on the patient’s clinical condition, especially in intensive care units (ICU). The pseudo-outbreak with Escherichia coli in patients in ICUs will be discussed in this study to emphasize the importance of strict adherence to microbiology policies and procedures. Methods. In September 2022, growths of Escherichia coli were found in the endotracheal aspirate cultures of six children and eighteen adults in the ICU. Results. The identification of the same microbial agent in 24 patients prompted an investigation into a potential outbreak. The infection control committee compiled a comprehensive patient list to facilitate the assessment. Given that the healthcare personnel and infrastructure of each ICU were distinct and functioned independently, the possibility of cross-contamination within these units was deemed unlikely. Consequently, attention was directed toward the microbiology laboratory as a potential source of the outbreak. A thorough review of culture processing steps and laboratory equipment was conducted. This investigation revealed that the saline solution used for the passage of endotracheal aspiration cultures was contaminated, suggesting a laboratory-associated contamination event as the probable cause. Conclusions. By strictly adhering to the latest protocols, the disinfection and sterilization chain can ensure the safe use of both invasive and non-invasive medical equipment. This manuscript aims to raise awareness among pediatricians and pediatric infectious disease specialists regarding the occurrence of pseudo-outbreaks. A pseudo-outbreak is indicative of a disruption in the sterilization chain.

ObjectiveMany studies have investigated the relationship of hematological, biochemical, immunological, and inflammatory markers with clinical severity during severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. In this study, we determined the use of Pentraxin-3 as an acute phase marker in infection diagnosis, follow-up, and prognosis.MethodThe study was initiated after ethics committee approval and consent from the patients and their relatives. A total of 167 children, including 103 outpatients and inpatients with SARS-CoV-2 infection confirmed by polymerase chain reaction and a control group consisting of 64 healthy children, were included in the study. The treatments, symptoms, radiological pneumonia findings, leukocyte count, absolute lymphocyte and neutrophil counts, neutrophil/lymphocyte ratio, C-reactive protein (CRP) and Pentraxin-3 values of the patients were recorded and compared with those of the control group.ResultsThere was no statistically significant difference between the patient and control groups in terms of age and gender (p>0.05). The mean absolute neutrophil and neutrophil/lymphocyte ratios of the study group were significantly higher than those of the control group. CRP, ferritin averages, and CRP >5 mg/L ratio of the study group were significantly higher than those of the control group. Although Pentraxin-3 values were higher in the study group, no statistically significant difference was found between the control group and the study group. Ferritin levels were found to be significantly higher in inpatients than in the outpatient group.ConclusionWe found high CRP, absolute neutrophil count, neutrophil/lymphocyte ratio, lymphocyte count, and platelet count in children with SARS-CoV-2 infection. It should be noted that patients with high ferritin values may require inpatient treatment at the time of admission. Although Pentraxin-3 values were higher in the study group, no statistically significant difference was found. Further studies with larger patient groups are needed to use Pentraxin-3 as a prognostic indicator in SARS-CoV-2 infection.

Aim:It can be challenging to distinguish between influenza and coronavirus disease-2019 (COVID-19) during the influenza season. Therefore, we aimed to compare the clinical symptoms, laboratory findings, and outcomes of these two diseases in children.Materials and Methods:Thirty-two children with COVID-19 and 22 children with influenza who were hospitalized in our clinic were included in this study. The demographic, clinical, and laboratory findings of these patients were retrospectively reviewed.Results:The median age of patients with influenza and COVID-19 was 1.4 and 15.3 years, respectively. Fever (77.3% vs 46.9%, p=0.02), nasal obstruction (27.3% vs 0%, p=0.003), wheezing (54.5% vs 3.1%, p<0.001), bilateral crackling sounds (63.6% vs 15.6%, p<0.001), prolonged expirium (63.6% vs 3.1%, p<0.001), tachycardia (36.4% vs 0%, p<0.001) and tachypnea (54.5% vs 0%, p<0.001) were significantly more frequent in those patients with influenza compared to COVID-19. Patients with influenza had significantly increased leucocyte count, lymphocyte count, and aminotransferase levels and lower albumin levels compared to those patients with COVID-19. In the influenza group, three patients needed intensive care, and one of them died. None of the patients with COVID-19 needed intensive care and there was no death in this group.Conclusion:In hospitalized children, the clinical and laboratory findings were milder in those patients with COVID-19 compared to influenza.

Background. West Nile virus (WNV) is an uncommon arbovirus infection and is usually asymptomatic in pediatric patients and due to its rarity is not very well known by clinicians. Case. We present a 5-year-old girl admitted to the Pediatric Emergency Service with fever, vomiting, neck stiffness, walking difficulty and sudden deviation of eyes who was diagnosed with a neuroinvasive WNV infection. Conclusions. Ophthalmoplegia is an unusual presentation of neuroinvasive WNV and there are no published pediatric cases with ophthalmoplegia in the literature.

Background. Clostridioides difficile (C. difficile) is a well-known causative agent of healthcare associated infection, it increases medical cost besides increasing morbidity and mortality. This study was conducted to determine the incidence, and economic burden of healthcare facility-onset C. difficile infection (HO-CDI) in children. Methods. Data was acquired with a prospective cohort study conducted in pediatric wards of a tertiary university hospital between August 2015 to August 2016. The HO-CDI was defined as diarrhea that began after 48 hours of admission with a positive cytotoxic stool assay for the presence of toxin A and/or B of C. difficile. Results. In the 3172 admissions in one year, 212 (7%) healthcare associated diarrhea (HAD) episodes were observed, in 25 (12%) of them C. difficile was identified in which 6 (25%) cases < 2-year-old. The incidence of HOCDI was estimated as 8.8/10,000 patient-days. Cases with HO-CDI (n=19) were compared with cases with non- CDI-HAD (n=102); the presence of one of the risk factors for CDI increased the risk for HO-CDI (5,05; 95% Cl: 1.10-23.05; P 0,037), the median length of stay (LOS) attributable HO-CDI was 7 days (IQR,5-10) per admission, whereas for non-CDI-HAD was 2 days (IQR,0-4) (p=0.036). General hospitalization costs in the two groups were similar, specifically estimated costs attributable to HO-CDI and non-CID-HAD were$294.0 and $ 137.0 per hospitalization respectively (p= < 0.0001). Conclusion. Although in children the incidence of HO-CDI is increasing, its clinical manifestation is still milder and effective infection control measures with antibiotic stewardship can limit related morbidly, mortality, LOS, and cost.

Introduction: Healthcare-associated infections (HAIs) are important causes of morbidity and mortality, especially in critically ill patients in intensive care units. The aim of this study was to assess the rate and distribution of HAIs, pathogens, and antimicrobial susceptibility patterns in a newly opened pediatric intensive care unit (PICU). Methodology: The infection control team detected and recorded HAI cases according to the Centers for Disease Control and Prevention’s criteria in the PICU of Marmara University Pendik Training and Research Hospital over a four-year period following its opening. Laboratory-based HAIs surveillance was performed prospectively from 1 January 2011 to 30 November 2014. Results: During the study period, 1,007 patients hospitalized in the PICU and 224 HAIs were identified. The overall HAI rate was 22.24%, and the incidence density was 20.71 per 1,000 patient-days. The most commonly observed HAIs were bloodstream infection (35.7%), pneumonia (21.4%), and urinary tract infection (20.5%), and the three most common HAI pathogens were Klebsiella spp. (19.4%), Pseudomonas aeruginosa (13.8%), and Acinetobacter baumanii (12%). Methicillin resistance was detected in 78% of coagulase-negative Staphylococcus. Presence of extended-spectrum beta-lactamases was determined in 45% and 54% of Klebsiella spp. strains and Escherichia coli isolates, respectively. Conclusions: Our rate of HAIs is higher than the mean rates reported in PICU studies from developed countries. Active surveillance studies of HAIs is an essential component of infection control, which may contribute to improving preventive strategies in developing countries.

Influenza is a generally self-limited infection agent that only rarely causes severe complications. To increase awareness about its serious complications, we report three cases of influenza A (H1N1) infection complicated with hemolytic uremic syndrome, myocarditis and acute necrotizing encephalopathy. In all three cases, nasopharyngeal samples confirmed influenza A (H1N1) infection by antigen test and multiplex PCR detection. The first case, a 3-year-old girl, had respiratory distress, anemia, thrombocytopenia and renal failure at admission, and was diagnosed with hemolytic uremic syndrome. Supportive treatment and oseltamivir did not prevent the development of chronic renal failure. The second case, a 5-year-old girl admitted with lethargia and flu-like symtoms and was diagnosed with myocarditis and cardiogenic shock. Oseltamivir and supportive treatment including extra-corporeal membrane oxygenation (ECMO) failed. She died on the 3rd day of admission. The third case, a 21-month-old boy, presented with decreased level of consciousness and was diagnosed with acute necrotizing encephalopathy with the aid of cranial magnetic resonance imagining (MRI). He was discharged without any neurological sequelae three weeks after admission. It should be kept in mind that influenza virus does not always cause a self-limited flu. Multidisciplinary management, early diagnosis and antiviral treatment are critical for the disease and to prevent its life-threatening complications.