Evaluation of Post-operative Meningitis: Comparison of Meningitis Caused by Acinetobacter spp. and Other Possible Causes.

AIM: To analyse postoperative meningitis (POM) after craniotomy, and to compare the clinical characteristics, treatment outcomes and mortality rates of POM that were caused by Acinetobacter spp. or other possible causes. MATERIAL AND METHODS: In this study, POM cases in our hospital between 2008 and 2016 were retrospectively reviewed. Cases were divided into three groups; Acinetobacter spp. meningitis (case group), non-Acinetobacter bacterial meningitis (control group 1) and culture negative meningitis (control group 2). Demographic, clinical, laboratory features, treatment modalities and mortality rates were compared between case and control groups. RESULTS: A total of 112 patients with POM were included in the study. Cerebrospinal fluid (CSF) culture results were negative in 50 (44.6%) patients; bacteria were isolated from CSF of 62 (55.3%) patients. Acinetobacter spp. was isolated from 28 (45%) patients, while bacteria other than Acinetobacter spp. were detected in 34 (55%) patients. No significant differences were observed between case and control groups in terms of age, gender, comorbidity and operation type. For the case group, change of treatment according to culture result was significantly different from control groups (p < 0.001). Mortality was 55.6% in the case group, 24.2% in control group 1 (p=0.013), and 24% in control group 2 (p=0.006). In multivariate analysis, isolation of Acinetobacter spp. from CSF culture [OR < sub > adj < /sub > 5.2, 95% confidence interval (CI):1.2-22.0, p=0.026] and inappropriate treatment (OR < sub > adj < /sub > 15.7, 95%CI:3.6-68.9, p < 0.001) were determined to be independent risk factors for mortality. CONCLUSION: Postoperative meningitis, especially caused by Acinetobacter spp., and its inappropriate empirical treatment are associated with high mortality.

Surgical site infection rates in 16 cities in Turkey: findings of the International Nosocomial Infection Control Consortium (INICC).

BACKGROUND: Surgical site infections (SSIs) are a threat to patient safety; however, there were no available data on SSI rates stratified by surgical procedure (SP) in Turkey. METHODS: Between January 2005 and December 2011, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in 20 hospitals in 16 Turkish cities. Data from hospitalized patients were registered using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) methods and definitions for SSIs. Surgical procedures (SPs) were classified into 22 types according to International Classification of Diseases, Ninth Revision criteria. RESULTS: We recorded 1879 SSIs, associated with 41,563 SPs (4.3%; 95% confidence interval, 4.3-4.7). Among the results, the SSI rate per type of SP compared with rates reported by the INICC and CDC NHSN were 11.9% for ventricular shunt (vs 12.9% vs 5.6%); 5.3% for craniotomy (vs 4.4% vs 2.6%); 4.9% for coronary bypass with chest and donor incision (vs 4.5 vs 2.9); 3.5% for hip prosthesis (vs 2.6% vs 1.3%), and 3.0% for cesarean section (vs 0.7% vs 1.8%). CONCLUSIONS: In most of the 22 types of SP analyzed, our SSI rates were higher than the CDC NHSN rates and similar to the INICC rates. This study advances the knowledge of SSI epidemiology in Turkey, allowing the implementation of targeted interventions.

Predictors of response to pegylated interferon treatment in HBeAg-negative patients with chronic hepatitis B.

INTRODUCTION: Although pegylated interferons (pegIFNs) alpha-2a and alpha-2b have been used in chronic hepatitis B (CHB) treatment for many years, there are few studies concerning predictors of sustained virologic response (SVR) to pegIFN therapy. In this study, we aimed to investigate the predictors of response to pegIFN treatment in cases with HBeAg-negative CHB infection. METHODOLOGY: Seventeen tertiary care hospitals in Turkey were included in this study. Data from consecutively treated HBeAg-negative CHB patients, who received either pegIFN alpha-2a or alpha-2b, were collected retrospectively. SVR is defined as an HBV DNA concentration of less than 2,000 IU/mL six months after the completion of therapy RESULTS: SVR was achieved in 40 (25%) of the 160 HBeAg-negative CHB patients. Viral loads in patients with SVR were lower compared to those with no SVR, beginning in the third month of treatment (p < 0.05). The number of cases with a decline of 1 log10 IU/mL in viral load after the first month of treatment and with a serum HBV DNA level under 2,000 IU/mL after the third month of treatment was higher in cases with SVR (p < 0.05). The number of patients who had undetectable HBV DNA levels at week 48 among responders was significantly greater than among post-treatment virological relapsers (p < 0.05). CONCLUSIONS: Detection of a 1 log10 decline in serum HBV DNA level at the first month of treatment and a serum HBV DNA level < 2000 IU/mL at the third month of therapy may be predictors of SVR.

Acute mercury poisoning presenting as fever of unknown origin in an adult woman: a case report.

INTRODUCTION: Mercury intoxication may present in a wide range of clinical forms from a simple disease to fatal poisoning. This article presents a case of acute mercury poisoning, a rare condition that presents challenges for diagnosis with fever of unknown origin. CASE PRESENTATION: A 52-year-old Caucasian woman was admitted to the hospital with high fever, sore throat, a rash over her entire body, itching, nausea, and extensive muscle pain. She had cervical, bilateral axillary and mediastinal lymphadenopathies. We learned that her son and husband had similar symptoms. After excluding infectious pathologies, autoimmune diseases and malignancy were investigated. Multiple organs of our patient were involved and her fever persisted at the fourth week of admission. A repeat medical history elicited that her son had brought mercury home from school and put it on the hot stove, and the family had been exposed to the fumes for a long period of time. Our patient's serum and urine mercury levels were high. She was diagnosed with mercury poisoning and treated accordingly. CONCLUSIONS: Mercury vapor is a colourless and odorless substance. Therefore, patients with various unexplained symptoms and clinical conditions should be questioned about possible exposure to mercury.

Complicated brucellar spondylodiscitis: experience from an endemic area.

The demographical, clinical, and therapeutical features of patients with brucellar spondylodiscitis (BS) were evaluated in this study. Of the 96 patients with brucellosis, 20 (20.8%) were diagnosed with spondylodiscitis. Patients who had BS were more likely to be older (p = 0.001), have higher erythrocyte sedimentation rates (p = 0.01), and more likely to be anemic (p = 0.017). Lumbar segment (18/20) was frequently involved region. BS was complicated with paravertebral or epidural abscess in seven, radiculitis in six, and psoas abscess in five of cases. Antibiotic regimens including two or three antibiotics with combination of doxycycline, rifampin, and streptomycin were used. In this series, the mean duration of antimicrobial therapy was 18 weeks (range 12-56 weeks). Attention is drawn to this disease given the need for prolonged duration of treatment especially in complicated cases in order to avoid possible sequelae.

Evaluation of factors predictive of the prognosis in Crimean-Congo hemorrhagic fever: new suggestions.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is one of the viral hemorrhagic fevers caused by tick bites. Common symptoms of the infection are fatigue, high fever, headache, and myalgia. In some patients hemorrhage may accompany these symptoms and is a sign of a poor prognosis. Typical laboratory changes are thrombocytopenia, leukopenia, elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase (LDH), and prolongation of prothrombin time (PT) and activated partial thromboplastin time (aPTT). Mortality rates vary between 3% and 30%. The aim of this study was to determine the factors affecting the prognosis of CCHF. METHODS: A total of 70 patients with a diagnosis of CCHF who were followed at our clinic between 2005 and 2008 were included in this study. As well as patient clinical history, biochemical parameters tested during the first 5 days and the prognosis were evaluated. Findings were compared between patients who died and those who recovered. Non-parametric statistical tests were used for the statistical analysis. RESULTS: When the laboratory parameters of patients who died and recovered were compared, PT, aPTT, international normalized ratio (INR), AST, LDH, fibrinogen, C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), D-dimer, IgM, IgG, C3 and C4 levels, and platelet count were found to be positively related with fatality. On the other hand, there was no significant difference between groups regarding ALT, CPK, prealbumin, ceruloplasmin, protein C, protein S, and antithrombin III levels, and white blood cell counts. CONCLUSIONS: It is essential to determine the possibility of a fatal prognosis in CCHF patients using clinical history and biochemical parameters so that the necessary precautions can be taken.

Lamivudine resistance mutations in patients infected with hepatitis B virus genotype D.

AIM: To determine the distribution of viral genotypes for primary or acquired lamivudine resistance. METHODS: A total of 283 patients with chronic hepatitis B virus (HBV) infection (245 patients with chronic hepatitis B and 38 inactive hepatitis B surface antigen carriers) were included in the study. The HBV genotype was determined by using quantitative real-time polymerase chain reaction and sequence analysis, and tyrosine-methionine-aspartate-aspartate (YMDD) motif mutations were determined using the reverse transcriptase hybridization method. RESULTS: Lamivudine resistance was determined in a total of 25 (10.7%) chronic hepatitis B patients. Eight subjects (4%) had primary resistance to lamivudine, and 17 (53.1%) had secondary resistance to lamivudine. Genotype D, which was isolated from 267 of the patients with chronic HBV infection, was the dominant genotype in Turkey. CONCLUSION: Identification of YMDD motif mutations should have a positive impact on the selection of proper antiviral medication for patients, even for those who are nucleoside naïve.

[Rhino-orbital mucormycosis with orbital abscess: a case report]. / Orbital apseyle seyreden rino-orbital mukormikozis: Olgu sunumu.

Sinonasal mucormycosis is a rare, life-threatening and insidious fungal infection. Uncontrolled diabetes mellitus and immunsupression are the most important risk factors. The infection is clinically characterized by black necrotic tissues and crusting in the nasal cavity. In acute fulminant rhinosinusitis and particularly in infections caused by mucor species, black scar tissues seen on the nasal mucosa are pathognomonic. High level of suspicion in the risk group the diagnosis is confirmed by histopathological examination. The rhinoorbital form is even rarer and the findings may range from orbital pain to ophtalmoplegia and blindness. In this report we present a 72-year-old female patient with uncontrolled type 2 diabetes mellitus who was admited with the complaints of exophtalmos in the left eye, diplopia and headache. In the physical examination there was purulent discharge in the middle meatus and left orbital abscess was detected on computed tomography. We performed an emergency endoscopic sinus surgery. While we did not observe any necrotic tissues, granulation tissues were detected and pus was drained from the orbital cavity. The result of the histopathological examination was reported as invasive mucormycosis. We presented this case to emphasize the importance of early diagnosis and treatment of rhinoorbital mucormycosis.

Evaluation of the association of serum levels of hyaluronic acid, sICAM-1, sVCAM-1, and VEGF-A with mortality and prognosis in patients with Crimean-Congo hemorrhagic fever.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic disease. Pathogenesis of the disease has not been well described yet. A well-known pathogenic feature of CCHF virus is its capability to damage endothelium. Increased hyaluronic acid (HA) levels indicate liver sinusoidal endothelial damage. Soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) and vascular endothelial growth factor-A (VEGF-A) play a role in the inflammatory process, vascular damage and plasma leakage. OBJECTIVES: To investigate whether or not there is a relationship between HA, sICAM-1, sVCAM-1 and VEGF-A serum levels and fatality in CCHF. STUDY DESIGN: Sixty-one patients who were confirmed by RT-PCR and serological tests for CCHF, included in the current study. HA, sICAM-1, sVCAM-1, VEGF-A levels in serum samples were analyzed by ELISA. RESULTS: There were statistically significant differences between fatal and non-fatal CCHF patients in terms of HA, sICAM-1, sVCAM-1, and VEGF-A levels. In addition, AST and ALT levels were positively correlated with HA, sICAM-1, sVCAM-1, and VEGF-A levels. CONCLUSION: HA, sICAM-1, sVCAM-1, and VEGF-A levels of the patients that died during hospitalization were statistically significantly higher than the patients that survived, and this finding suggests that the level of these molecules could be used as a prognostic marker in CCHF.

A case of nosocomial transmission of Crimean-Congo hemorrhagic fever from patient to patient.

Crimean-Congo hemorrhagic fever (CCHF) is an acute, tick-borne viral disease, with the potential for human to human transmission. Infection often has severe hemorrhagic manifestations and considerable mortality. Healthcare workers (HCWs) caring for patients with CCHF constitute a major risk group for infection. Although nosocomial transmission from patients to HCWs accounts for a significant proportion of CCHF cases and outbreaks worldwide, transmission of CCHF from patient to patient has not previously been reported. A case of nosocomial transmission of CCHF from patient to patient at a hospital is described.