Kubra Aykac

Background: The Paed‐EQUAL Candida Score was developed to assess adherence to guideline‐recommended management in paediatric candidemia; however, its clinical utility in predicting outcomes remains unclear, particularly in paediatric populations where validation data are scarce. Methods: We conducted a retrospective observational study including paediatric patients diagnosed with candidemia at a tertiary‐care centre between 2014 and 2024. The Paed‐EQUAL Candida Score was calculated for each patient, and its association with 30‐day and 90‐day mortality was evaluated using ROC curve analysis, and optimal cut‐off values were explored. Results: A total of 127 paediatric patients with candidemia were included, of whom 17 (13.4%) died within 30 days and 27 (21.3%) within 90 days. Central venous catheter removal was significantly associated with improved survival at both 30 days (76.4% vs. 35.3%, p = 0.001) and 90 days (77% vs. 48.1%, p = 0.007). Higher adherence to Paed‐EQUAL Candida Score components was observed among survivors, with significantly higher median scores in survivors compared to non‐survivors at 30 days (17 [IQR 14–18] vs. 14 [12–16], p = 0.026). However, the score indicated modest discriminative ability for predicting mortality, with an AUC of 0.667 (95% CI 0.577–0.748) for 30‐day mortality and no significant predictive value for 90‐day mortality (AUC 0.594, 95% CI 0.503–0.680). Conclusion: The Paed‐EQUAL Candida Score demonstrated limited prognostic performance in paediatric candidemia and may have constraints in its ability to support clinical decision‐making, particularly given its modest discriminative capacity. While it remains a potentially useful tool for assessing adherence to quality‐of‐care measures, further refinement or development of paediatric‐specific and outcome‐oriented scoring systems may be needed to improve risk stratification and prediction of clinical outcomes.

Crimean–Congo hemorrhagic fever (CCHF) is a zoonotic viral infection that may present mildly in children but can progress to severe clinical states due to secondary hemophagocytic lymphohistiocytosis (HLH). We retrospectively analyzed the clinical, laboratory, and treatment data of children aged 0–18 years with polymerase chain reaction (PCR)-confirmed CCHF who were hospitalized at Hacettepe University, a large referral center for CCHF, between January 2019 and July 2025. Serial laboratory values (Days 0, 3, 7, and 10) and therapeutic interventions were evaluated. Twenty-two children (median age 13 years, 72% male) were included. The most frequent symptoms were fever (100%), bradycardia (59%), and conjunctival hyperemia (41%). HLH was diagnosed in 18 patients (82%). Ribavirin (91%), intravenous immunoglobulin (IVIG) (86%), and corticosteroids (68%) were administered. Platelet counts began to recover by Day 7, whereas ferritin declined gradually and normalized later. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels showed a progressive decrease. No patient required intensive care, and none died. Secondary HLH was highly prevalent among pediatric CCHF cases, yet outcomes were favorable with early antiviral and immunomodulatory therapy. Platelet recovery and delayed ferritin normalization may serve as practical biomarkers of disease resolution. Prospective multicenter studies with cytokine and viral-load profiling are warranted.

: Tularemia is a rare zoonotic infection with marked geographic clustering and long interepidemic periods. Pediatric data, particularly those on host immune responses during active disease and treatment, remain scarce. The authors aimed to evaluate clinical characteristics and treatment-associated cytokine dynamics in children with tularemia. In the present multicenter prospective study conducted in Türkiye, 40 pediatric patients with laboratory-confirmed tularemia and nine age- and sex-matched healthy controls were enrolled between April 2023 and November 2024. Clinical features, exposure history, and treatment outcomes were recorded. Serum cytokine levels, including interleukin (IL)-6, IL-2, IL-9, IL-5, IL-13, tumor necrosis factor-α, IL-10, interferon (IFN)-γ, IL-4, and IL-22, were measured using a multiplex bead-based assay and compared between patients and controls, between good and poor outcome groups, and longitudinally before and after therapy. A good outcome was defined as complete clinical resolution without suppuration, the need for surgical intervention, or relapse, whereas a poor outcome was defined as clinical nonresolution or progression. A total of 24 (60%) participants had a good outcome, and 16 (40%) had a poor outcome. Although baseline cytokine levels did not differ between groups, paired analyses revealed significant posttreatment reductions in IFN-γ ( P = 0.018), IL-6 ( P = 0.018), and IL-10 ( P = 0.032), consistent with resolution of infection-associated immune activation. A poor outcome was associated with increased exposure to natural water sources and a higher frequency of suppurative lymphadenopathy requiring surgical drainage. Baseline cytokine profiles did not predict treatment response; however, dynamic changes in IFN-γ, IL-6, and IL-10 were associated with clinical recovery. These findings highlight the importance of longitudinal immune monitoring and provide insight into immune dynamics in pediatric tularemia.

Background. Influenza remains a major cause of morbidity and mortality in children worldwide, yet vaccination coverage is still suboptimal in many countries. We aimed to understand parental awareness, attitudes, and determinants of vaccine uptake to guide effective strategies for increasing coverage and protecting vulnerable pediatric populations. Method. A cross-sectional study was conducted between October 2023 and May 2024 in 38 hospitals across 23 provinces in Türkiye. Data were collected from 5002 families through face-to-face interviews, with 4404 valid responses analyzed. Results. The overall influenza vaccination rate among children was 4.4% (n=195/4404). Vaccination coverage was slightly higher in high-risk groups compared to non-high-risk groups (5.2% vs. 3.5%, p=0.003). Factors positively associated with vaccination uptake included the presence of chronic illness in the child (15.1% in vaccinated vs. 4.7% in unvaccinated, p

Human adenoviruses (HAdVs) may cause and are responsible for a broad range of pediatric illnesses. Although several cases are self-limiting, certain children may develop complications requiring pediatric intensive care (PICU). To address the role of HAdVs in children, we aimed to characterize the 10-year clinical spectrum of pediatric HAdVs infections and to identify factors associated with hospitalization and severe disease. This retrospective observational cohort study analyzed the clinical course of children (< 18 years) with laboratory-confirmed HAdV infection episodes treated at a tertiary pediatric center between 2014 and 2024. Demographic features, comorbidities, laboratory results, respiratory support requirements, PICU, and clinical outcomes were collected. The severe outcome was defined as a composite endpoint including PICU admission, invasive mechanical ventilation, and/or 30-day mortality. A total of 877 HAdV infection episodes were included, whereas 276 (31.5%) of the patients were hospitalized. Among hospitalized patients, 32.2% required respiratory support, 18.8% required PICU care, and the 30-day mortality was 2.5%. Overall, 104 children (11.9%) developed severe disease. Underlying medical conditions were significantly more frequent among children with severe disease, while those without underlying disease were more common in the non-severe group (69.8% vs. 22.1%; p < 0.001). Viral coinfections were detected in 35.8% of patients but were not associated with increased hospitalization or severity. In multivariable analysis, male sex (OR 2.30, 95% CI 1.23–4.29; p = 0.009), neurologic disease (OR 2.12, 95% CI 1.01–4.42; p = 0.045), cardiac disease (OR 3.27, 95% CI 1.49–7.17; p = 0.003), and hematopoietic stem cell transplantation (HSCT) (OR 4.32, 95% CI 1.36–13.7; p = 0.013) were independently associated with severe outcome. Conclusion : Human adenovirus infection represents a notable clinical burden in children, with a considerable proportion requiring hospitalization and developing severe disease. Underlying neurologic and cardiac diseases, as well as HSCT, were key risk factors for severe outcome, whereas viral coinfections were common but not associated with worse clinical outcome. What is Known? • Human adenovirus (HAdV) infections are common in children and usually self-limiting but may lead to severe disease. • Underlying medical conditions and immunosuppression have been associated with worse clinical outcomes in pediatric HAdV infections. What is New? • Underlying neurologic disease, cardiac disease, and HSCT were identified as independent predictors of severe outcome. • The findings highlight that host-related factors rather than viral coinfection are the main aspects of disease severity.

Following the relaxation of COVID‑19 mitigation strategies, Mycoplasma pneumoniae (MP) infections have resurged worldwide. Although respiratory involvement predominates, extrapulmonary manifestations in children are increasingly recognized. We aim to report a recent rise in pediatric MP infections with notable extrapulmonary features, including rash, mucositis, acute myocarditis, and other parainfectious eruptions. We describe 6 pediatric cases with extrapulmonary MP manifestations admitted to our center from March 2025 to October 2025. The diagnosis was confirmed through serology or PCR testing. We reviewed the clinical features, laboratory results, and treatment outcomes. Five patients exhibited generalized targetoid rashes, often accompanied by fever, conjunctival hyperemia, or mucosal changes. The median age 14 years (min: 13 months -max: 17.5 years), and 3 patients were female. Several were initially misdiagnosed as meningococcemia, Kawasaki disease, or MIS‑C. One adolescent developed MP‑associated acute myocarditis, with hypotension, elevated cardiac markers, and mild cardiomegaly. Another patient presented with reactive infectious mucocutaneous eruption (RIME) limited to oral lesions. All patients received macrolide therapy (clarithromycin or azithromycin), with rapid clinical improvement, resolution of lesions, normalization of cardiac markers, and no major adverse effects. MP infection in children may present with dermatologic, mucocutaneous, or cardiac involvement even in the absence of respiratory symptoms. Clinical awareness beyond respiratory findings is crucial to avoid misdiagnosis and inappropriate treatment. Broader diagnostic and surveillance approaches are needed to improve recognition, especially in the context of evolving post‑pandemic host and pathogen dynamics.

Background. Adenovirus infections are commonly associated with respiratory tract infections, conjunctivitis, gastrointestinal disturbances, and in some cases, more severe illnesses such as pneumonia. Guillain-Barré syndrome (GBS), a rare autoimmune disorder that causes progressive peripheral nerve inflammation and paralysis, has been linked to various infections, including viral ones. Case Presentation. We describe two newly diagnosed pediatric cases of GBS following adenovirus infection. Both patients were previously healthy boys, aged 3 and 6 years. Adenovirus was detected by nasopharyngeal PCR shortly preceding the neurological manifestations. Both were treated with intravenous immunoglobulin (IVIG); one also required plasma exchange and respiratory support. Both recovered fully during follow-up. Additionally, a relevant case from the literature was reviewed for comparison. Treatment included respiratory support, IVIG and plasma exchange therapy. During the 12-month follow-up no severe complications were observed in our patients. Conclusions. In conclusion, while GBS is a well-established complication of several viral infections, including adenovirus, the association between adenovirus and GBS remains relatively underexplored. Our case reports, along with a review of the literature, highlight the rare but plausible link between adenovirus infection and the development of GBS. Although adenovirus infections are common, the occurrence of GBS following these infections appears to be uncommon, suggesting that additional factors may be at play. However, given the potential severity of GBS and the growing body of evidence, it is important for clinicians to remain vigilant for this rare complication in patients with a history of adenovirus infection.