[Two leptospirosis cases and review of the national literature]. / Iki leptospiroz olgusu ve yerli literatürün gözden geçirilmesi.

In this report, two cases of leptospirosis admitted to our clinic in the same periods, have been presented. The first patient was a 29 years old male farmer, and the other was a 44 years old male prisoner. Both of them were from Middle Anatolian Region with the similar clinical findings (subfebrile fever, gastrointestinal complaints, ichterus in sclera, leucocytosis, and increased levels of liver enzymes, urea and creatine). The diagnosis was based on the antibody positivities against Leptospira with microscopic agglutination test which performed in the Etlik Central Veterinary Control and Research Institute. The first case was positive for L. grippotyphosa, and the second was positive for L. australis serovar bratislava at the titers of 1/800. Both of the patients were given empirical antibiotic treatment (ceftriaxone 2 x 1 gr, and ampicillin-sulbactam 4 x 1 gr, respectively), and discharged with complete healing. These cases led us to review the other leptospirosis cases in our country.

Characteristics of cutaneous anthrax in Turkey.

BACKGROUND: Incidence of anthrax is diminishing in developed countries; however, it remains a public health problem in developing countries, especially those whose main source of income is farming. METHODOLOGY: Charts of patients hospitalized between 1992 and 2008 in the Infectious Diseases and Clinical Microbiology Department of Ankara Numune Education and Research Hospital were reviewed. RESULTS: Fifty-eight cases with cutaneous anthrax were reviewed. The mean age was 49.8, and 36.2% were female. The most common professions were farmers (62%), butchers (19%), and housewives (15%). The mean incubation period was eight days. Most cases (62%) were exposed to bacteria when butchering sick animals. Eighteen patients used an antibiotic before admission to hospital (31%). The predominantly affected sites were hands (39%) and fingers (29%), followed by forearms (12%), eyelids (7%) and necks (3%). All cases initially had painless ulcers with vesicles; dissemination of the lesion was seen in 27.5% of patients. Gram stain was positive in 11 cases; culture was positive in 7 cases for Bacillus anthracis. All patients except one were discharged and treated with penicillin and/or ciprofloxacin or imipenem. One patient with a disseminated lesion on the neck died even though a steroid was used with the antibiotic. CONCLUSIONS: Cutaneous anthrax should be considered as a possible diagnosis in cases with a painless ulcer with vesicles, edema, and a history of exposure to animals or animal products. Despite previous antibiotic use, taking smears and cultures should be encouraged. Treatment with penicillin G or penicillin procain alone is effective for cases with cutaneous anthrax without severe edema and superinfection.