Mustafa Gençeli

Objective: This study aims to characterize the clinical spectrum, outcomes, and factors associated with influenza‐associated encephalopathy in hospitalized children with influenza‐associated neurological complications. Methods: This retrospective cohort study included children younger than 18 years who were hospitalized with laboratory‐confirmed influenza at a tertiary university hospital between 2018 and 2023. We reviewed demographic, clinical, laboratory, neuroimaging, electroencephalographic, cerebrospinal fluid, treatment, and outcome data. Patients with and without encephalopathy were compared, and multivariable logistic regression analysis was performed to identify factors independently associated with influenza‐associated encephalopathy. Results: Among 3040 hospitalized children with laboratory‐confirmed influenza, 115 (3.8%) developed influenza‐associated neurological complications. The median age was 32 months (interquartile range [IQR], 19–58 months), and 67 (58.3%) were male. Influenza A accounted for 80.0% of infections. Seizures were the presenting neurological manifestation in all patients, with generalized tonic–clonic seizures occurring in 101 (87.8%). Encephalopathy and encephalitis were identified in 15 (13.0%) and 11 (9.6%) patients, respectively. Two patients (1.7%) were diagnosed with acute necrotizing encephalopathy (ANE). Most children recovered without permanent neurological deficits; however, one patient developed persistent neurological sequelae and two died during hospitalization. In multivariable analysis, focal seizures (adjusted odds ratio [aOR], 16.98; 95% confidence interval [CI], 3.42–84.27; p = 0.001) and higher lymphocyte counts (aOR, 1.53 per 1000 cells/mm ³ increase; 95% CI, 1.11–2.12; p = 0.009) were independently associated with influenza‐associated encephalopathy. Conclusion: Seizures predominantly characterized influenza‐associated neurological complications in hospitalized children and generally had favorable short‐term outcomes. However, influenza‐associated encephalopathy was associated with substantially greater clinical severity, including prolonged hospitalization, more frequent pediatric intensive care unit admission, and poorer in‐hospital outcomes. Recognition of focal seizures may help identify children who warrant closer assessment for concurrent encephalopathy and timely neurological evaluation.

Objective: Diffuse leptomeningeal glioneuronal tumor (DLGNT), including primary diffuse leptomeningeal oligodendroglial tumors (PDLOs) and leptomeningeal spread of high-grade gliomas, are rare pediatric neoplasms with diffuse leptomeningeal dissemination and limited parenchymal involvement. Their often nonspecific neurological symptoms frequently lead to misdiagnosis as infectious or inflammatory meningitis, complicating early identification. Methods: To investigate these diagnostic challenges, the authors retrospectively reviewed the records of 4 pediatric patients (2-13 years) diagnosed with leptomeningeal glial tumors over a 5-year period. Clinical features, neuroimaging, cerebrospinal fluid (CSF) findings, histopathology, treatment, and outcomes were analyzed. Results: All patients had subacute or chronic neurological symptoms, including gait ataxia (4/4), motor weakness (3/4), headache or vomiting (3/4), cognitive or behavioral decline (3/4), and seizures (2/4). Cerebrospinal fluid abnormalities contributed to diagnostic confusion but were not identical across all cases: pleocytosis was present in all patients, elevated protein was documented in those with available protein measurements, and reduced or relatively low glucose was observed only in some patients. Magnetic resonance imaging (MRI) demonstrated diffuse leptomeningeal involvement along the neuraxis in all patients, with cystic/nodular T2-hyperintense lesions and variable enhancement. Three patients were diagnosed within the DLGNT/PDLO spectrum and 1 with high-grade glioma with leptomeningeal dissemination. Hydrocephalus requiring ventriculoperitoneal shunting developed in 3/4 patients. All received chemotherapy; 1 required decompressive spinal surgery and craniospinal radiotherapy. At last follow-up, 3 patients were alive with neurological sequelae and 1 had died of progressive disease. Conclusion: These findings highlight that pediatric leptomeningeal glial tumors are diagnostically challenging and easily mistaken for chronic meningitis. Characteristic MRI findings, elevated CSF protein, and spinal dissemination are important clues.

Invasive meningococcal disease (IMD) remains a major cause of morbidity and mortality in children. Post-pandemic epidemiological patterns of pediatric IMD are not well defined in Türkiye. This study aimed to evaluate the epidemiology, clinical characteristics, outcomes, and serogroup distribution of pediatric IMD in a large multicenter cohort in Türkiye, comparing the during-COVID and post-COVID periods. This retrospective multicenter hospital-based study included children aged 1 month–18 years hospitalized with laboratory-confirmed IMD in 39 hospitals across 23 provinces. Cases were grouped as during-COVID (January 2020–May 2022) and post-COVID (June 2022–December 2025). A total of 166 patients (median age 25 months; 59.6% male) were included; 25 occurred during-COVID and 141 post-COVID. The number of reported cases in participating centers increased after 2022, with seasonal peaks in winter and early spring. Children under 5 years accounted for 62.7% of cases, and infants (< 1 year) were the largest single age group overall (38.6%). The proportion of children under 5 years was lower in the post-COVID period (58.9% vs 84.0%; OR 0.27, 95% CI 0.09–0.84), indicating a relative shift toward older age groups rather than a reduction in disease burden among infants. Pediatric intensive care admission occurred in 69.9% of cases, and overall mortality was 13.3%. Mortality varied markedly by clinical form, from 1.2% in meningitis alone to 21.7% in combined meningitis and meningococcemia and 38.1% in meningococcemia alone (p < 0.001). Only 2.4% of children had received any meningococcal vaccine before their illness. Serogroup data were available for 60.8% of patients, with grouping coverage differing between periods (32.0% vs 66.0%). Among cases with available serogroup data, serogroup B accounted for 69.9% in the post-COVID period and for half of the eight grouped cases during the pandemic. In unadjusted exploratory analysis restricted to cases with serogroup data, mortality was higher in serogroup B than non-B infections (21.7% vs 3.1%; OR 8.61, 95% CI 1.08–68.8); in an exploratory model adjusting for clinical form, age, and period, with ungrouped cases retained as a separate category, serogroup B remained associated with mortality (aOR 7.59, 95% CI 1.55–75.65). Conclusion: In this multicenter hospital-based cohort, reported pediatric IMD cases increased in the post-pandemic period, with a persistent burden in infants, a relative shift toward older age groups, and predominance of serogroup B among grouped cases. These findings highlight the importance of strengthened surveillance and support further evaluation of meningococcal vaccination strategies, including MenB vaccination. What is Known: • Invasive meningococcal disease remains a severe pediatric infection with high morbidity and mortality, despite treatment. • The COVID-19 pandemic and the subsequent easing of restrictions altered IMD epidemiology globally. What is New: • Reported pediatric IMD cases increased in the post-pandemic period, with a relative shift toward older children while the proportion of infants remained unchanged (38.3% vs 40.0%); serogroup B predominated among cases with an available serogroup result, although differential availability of these data precludes conclusions about change over time. • Mortality was determined principally by clinical form, ranging from 1.2% in meningitis alone to 38.1% in meningococcemia alone, and only 2.4% of children had received any meningococcal vaccine before their illness.

Tuberculosis has is an important public health issue that has been leading to morbidity and mortality for ages. A treatment for the disease is available; but the most significant problem is adherence to treatment. The leading reason for poor adherence to treatment is side effects of the drugs. We present an 8-year-old male boy with immune thrombocytopenia, a rare complication on isoniazid prophylaxis for tuberculosis, to contribute to the literature. Questioning for drug use is important in cases diagnosed with immune thrombocytopenia.

Pertussis resurged globally, after the relaxation of COVID-19 measures, underscoring its continued relevance as a public health concern, yet data remain li

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe clinical entity emerging after severe acute respiratory syndrome coronavirus 2 infection, often characterized by cardiovascular involvement. This study aimed to evaluate the frequency and spectrum of cardiovascular involvement in children with MIS-C and to assess its association with clinical severity, biomarker profiles, and recovery outcomes. Methods: This study included 54 children diagnosed with MIS-C between June 2020 and December 2023. Clinical features, laboratory parameters, electrocardiographic and echocardiographic findings, treatments, and outcomes were analyzed. Clinical severity was classified as mild, moderate, or severe. Kaplan–Meier and Cox regression analyses were used to evaluate recovery trajectories and identify independent predictors. Results: Cardiovascular involvement was detected in 37% of patients. The most common findings were mitral regurgitation (50%), left ventricular dysfunction (20.4%), and pericardial effusion (18.5%). Patients with cardiovascular involvement were older and more likely to present with dyspnea, chest pain, tachycardia, tachypnea, and hypotension (all p < 0.01). They exhibited significantly higher C-reactive protein (CRP), interleukin-6 (IL-6), B-type natriuretic peptide (BNP), urea, and creatinine levels, and lower lymphocyte counts ( p < 0.05). Moderate-to-severe cases showed markedly higher rates of left ventricular dysfunction (44%), mitral regurgitation (100%), pericardial effusion (36%), arrhythmias (16%), hypotension (44%), and inotropic requirement (44%) compared with mild cases (all p < 0.01). Recovery was significantly delayed in patients with cardiovascular involvement (median 12.5 vs. 8.0 days; p = 0.008) and in moderate-to-severe cases (14.0 vs. 7.5 days; p < 0.01). In Cox regression analysis, independent predictors of delayed recovery included cardiovascular involvement (HR: 0.48), CRP > 200 mg/L (HR: 0.52), lymphocyte count < 1000/µL (HR: 0.41), BNP > 10,000 ng/L (HR: 0.35), and IL-6 > 100 pg/mL (HR: 0.44). Conclusion: Cardiovascular involvement in MIS-C is a strong marker of severe disease, heightened systemic inflammation, and prolonged recovery. Echocardiographic abnormalities, combined with elevations in CRP, IL-6, and BNP provide valuable prognostic information.