Can mean platelet volume and mean platelet volume/platelet count ratio be used as a diagnostic marker for sepsis and systemic inflammatory response syndrome?

OBJECTIVE: To determine whether the mean platelet volume (MPV) and MPV/platelet (PLT) values can be used in the study of sepsis and systemic inflammatory response syndrome (SIRS). METHODS: In this retrospective case-controlled study, 69 sepsis, 69 SIRS patients, and 72 control group who were treated in the years 2012-2013 were reviewed, and both the MPV and MPV/PLT rates were evaluated in all groups. RESULTS: Statistically significant difference was found between sepsis, SIRS, and control groups when comparing the MPV and MPV/PLT ratio (p less than 0.05), and no significant difference was found between sepsis and SIRS groups in terms of MPV and MPV/PLT ratio (p more than 0.05). Mean platelet volume values for sepsis and control groups was 10.07/8.731 femtoliter (fL) (p=0.000), and 9.45/8.731 fL (p=0.000) for SIRS and control groups. In the group of sepsis patients, the MPV was found to be at cut-off 8.915, sensitivity 71%, and specificity 63.9%. In the group of patients with SIRS, MPV was found to be at cut-off 8.85, sensitivity 69.6%, and specificity 62.5%. For the MPV/PLT values, the specificity and sensitivity were found to be insignificant. CONCLUSION: This study shows that although there was no significant reduction in the PLT values between the sepsis and SIRS patients, the MPV and MPV/PLT ratio values were found to have significant differences. However, the specificity and sensitivity of the values were not reliable standard to be used as a test.

Evaluation of pulmonary and extrapulmonary tuberculosis in immunocompetent adults: a retrospective case series analysis.

OBJECTIVE: It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis (EPTB) compared to those of pulmonary tuberculosis (PTB) among adult immunocompetent patients. SUBJECTS AND METHODS: A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period (2007-2012). Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study. RESULTS: Of the 372 patients, 227 (61%) were males and 168 (45.2%) had EPTB; 204 (54.8%) patients had PTB. The most frequent sites of EPTB were the lymph nodes (n = 45, 12.1%), pleura (n = 40, 10.7%) and brain (n = 7, 1.8%). The most common symptoms were cough (n = 174, 46.7%), night sweats (n = 127, 34.1%) and fever (n = 123, 33%). Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guérin vaccination (odds ratio 0.41, 95% confidence interval 0.2-0.63; p < 0.001). Eighty-one (48.2%) of the EPTB and 146 (71.6%) of the PTB patients were males. Pulmonary involvement was more common among men (n = 146, 71.6%) than among women (n = 58, 28.2%; p = 0.000). CONCLUSION: There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB.

Human brucellosis in Turkey: different clinical presentations.

INTRODUCTION: Brucellosis is still endemic in Turkey and presents a major public health risk. The aim of this study wasto investigate the clinical and laboratory properties and complications of brucellosis cases. METHODOLOGY: The files of 370 patients (162 males, 208 females) with brucellosis between March 2006 and January 2012 were analyzed retrospectively. RESULTS: The mean age of patients was 39, 6±18.2 years. The major risk factor was unpasteurized dairy products in 155 (41.8%) cases. The complications included hematological (58.1%), osteoarticular (48.3%), hepatobiliary (26.7%), gastrointestinal (10%), and genitourinary system involvement (4.8%). The most frequently seen symptoms were weakness (64.3%), fever (63.2%), sweating (62.7%), arthralgia (59.1%), and lack of appetite (47.8%). A total of 261 patients (70.5%) were acute, 73 patients (19.7%) were subacute, and 36 patients (9.7%) were chronic. In the laboratory tests, AST, ALT and CRP levels were found as elevated in 27.6%, 21.6%, and 69.6% of the patients, respectively. On complete blood count analysis, leukopenia (21.4%), thrombocytopenia (23%), and anemia (70%) were determined. Pancytopenia was more common in acute cases (p = 0.019). Osteoarticular complications increased significantly with increased age (p = 0.005). CONCLUSIONS: Brucellosis is a common disease that may be accompanied by serious complications. In endemic regions of brucellosis, people should be taught to avoid unpasteurized dairy products. Clinicians must be aware of multiple system involvement in brucellosis, especially hematological and musculoskeletal systems. Hematological abnormalities occurring during the course of the disease may be misdiagnosed as hematological malignancies.

Withdrawal of Staphylococcus aureus from intensive care units in Turkey.

BACKGROUND: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. METHODS: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value ≤.01 was considered significant. RESULTS: Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001). CONCLUSIONS: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs.

A sandfly fever virus outbreak in the East Mediterranean region of Turkey.

OBJECTIVES: To report a sandfly fever virus (SFV) outbreak that occurred in Kahramanmaras Province, Turkey. METHODS: We investigated the cases of 40 patients with a history of sandfly bites and with clinical findings, who were referred to our emergency service between July and August 2010. Serum samples of 19 patients were selected and analyzed using a commercial mosaic immunofluorescence test (IFT) to detect IgM and IgG antibodies against SFV. RESULTS: Sandfly fever was diagnosed in nine patients. All cases had a history of fly bite, and the clinical findings included fever, headache, myalgia, conjunctival hyperemia, and gastrointestinal symptoms such as diarrhea, nausea, and vomiting. In two patients, the diagnosis was confirmed by real-time PCR as sandfly Sicilian virus (SFSV). Laboratory findings in the patients included leukopenia, thrombocytopenia, and elevated levels of aspartate aminotransferase, alanine aminotransferase, creatine kinase, and C-reactive protein. All patients made a complete recovery with symptomatic treatment. CONCLUSIONS: SFV is endemic in the Mediterranean Basin and data regarding SFV activity in Turkey are limited. This is the first report of an SFV outbreak from Kahramanmaras Province, Turkey, and provides information on epidemiological, clinical, and laboratory aspects of SFV infections.

Negative pressure wound therapy and skin graft in madura foot treatment.

Madura foot is a rare, loca, chronic granulomatous skin infection which commonly affects the adult male foot. Medical treatment reduces the size of the lesion but surgical excision is necessary for radical treatment. We present a case of a 59 year old male farmer diagnosed as actinomadura of the right foot treated with medical treatment, total excision, negative pressure wound therapy and split thickness skin graft.

Serratia ficaria isolated from sputum specimen.

Serratia ficaria was first described in 1979 as a Gram-negative facultative anaerobic rod. S. ficaria was found in figs, but also isolated from human specimens in a few cases. We now report an isolate of S. ficaria from sputum specimen.A 46-year-old man was suffering from a chronic renal failure of five years, four months of peritoneal dialysis and one week of fever due to respiratory tract infection, accompanied by cough. Sputum culture yielded a Gram-negative rod. It was identified as S. ficaria and the antibiotic susceptibility test was performed by automated Vitek II (bioMerieux). The tested S. ficaria strain was susceptible to amikacin, gentamicin, cefepime, trimethoprim-sulfamethoxazole, imipenem, meropenem, tigecycline and ciprofloxacin. This strain was resistant to ampicillin, amoxicillin-clavulanic acid, cephalothin, cefoxitine, cefuroxime and ceftriaxone. The patient was treated successfully (80 mg trimethoprim/400 mg sulfamethoxazole twice daily for 7 days)S. ficaria is an opportunistic pathogen responsible for intestinal colonization or serious infections such as septicaemia, gall bladder empyema in immunocompromised patients. The fig tree and fig play an important role in human colonization. It should be remembered that S. ficaria infections may be encountered frequently especially in fig tree culture zones.

An outbreak of Serratia marcescens septicemia in neonates.

Serratia marcescens is a well recognized nosocomial pathogen. We report an outbreak with this organism in 8 neonates in a neonatal intensive care unit (NICU). Seven cases were treated successfully with meropenem after the failure of imipenem treatment. Although they have similar anti-microbial effects, meropenem can effectively treat the S. marcescens sepsis resistant to imipenem.

Long-term efficacy of pegylated interferon alpha-2a in HCV-positive hemodialysis patients.

BACKGROUND AND AIM: Hepatitis C virus (HCV) is prevalent in hemodialysis (HD) patients. The current "best therapy" for HCV-positive hemodialysis patients is not known. The aim of the present study was to evaluate the long-term efficacy of pegylated interferon (PEG-IFNalpha-2a) in HCV-positive hemodialysis (HD) patients. MATERIALS AND METHODS: Twenty-five HCV-RNA-positive hemodialysis patients were included into the study. Twelve patients were allocated to the PEG-IFN treatment group (group 1). Six refused the therapy, and seven were not candidates for kidney transplantation and were allocated to the control group (group 2). All patients underwent chronic hemodialysis treatment for end-stage renal disease during the study period. Group 1 patients received PEG-IFN alpha-2a at a dose of 135 mug weekly for 48 weeks. The patients were prospectively followed up for a period of 192 weeks. Biochemical and virological responses were evaluated at 144 weeks after the completion of therapy. Results. Two patients in group 1 and five patients in group 2 died during 144 weeks of follow-up. SVR was observed in six patients (50%) in group 1 and one patient (1/13) (7.7%) in group 2. ALT levels were normal in 8/10 (80%) in group 1 and in 5/7 (70%) in group 2. CONCLUSION: In summary, our data showed that treatment of chronic HCV infection in dialysis patients with PEG-IFN alpha-2a at a dose of up to 135 mug weekly was well tolerated. Furthermore, SVR was achieved in half of patients at the end of 144 weeks of follow-up. Our results are encouraging for the administration of PEG-IFN alpha-2a in HCV-positive HD patients waiting for kidney transplantation.

Epididymoorchitis and pancytopenia caused by brucellosis.

A 15 year old boy presented with fever and acute painful scrotal swelling. Complete blood count showed pancytopenia. Serum brucella antibodies were positive. Pancytopenia and epididymoorchitis are rare complications of brucellosis and clinicians must consider this entity in the differential diagnosis of adolescents with epididiymoorchitis associated with pancytopenia.

Efficacy of vitamin E in children with immunotolerant-phase chronic hepatitis B infection.

BACKGROUND: The purpose of the present paper was to investigate the efficacy of vitamin E in children with immunotolerant-phase chronic hepatitis B virus (CHB) infection. METHODS: Fifty-eight immunotolerant children were prospectively and randomly recruited into two groups. Group 1 (study group) included 30 patients who received vitamin E at a dose of 100 mg/day throughout 3 months; group 2 (control group) contained 28 patients who did not receive any medication. Comparison of serological, virologic, and biochemical response ratios were done at the end of the therapy and after 6 months of vitamin E discontinuation. RESULTS: Mean alanine transaminase (ALT) values in group 1 at the beginning of the therapy, 3 months after the therapy initiation and 6 months after discontinuation were 30.4 +/- 7.3 IU/L, 31.3 +/- 7.8 IU/L and 32.1 +/- 8.5 IU/L, respectively. The mean hepatitis B virus (HBV)-DNA load of group 1 at onset, and at the third and ninth months of the treatment were 3106 +/- 718 pg/mL, 3530 +/- 137 pg/mL and 3364 +/- 1246 pg/mL, respectively. These changes in both ALT and HBV-DNA values did not reach significant levels (P > 0.05). In group 2, mean ALT values at the beginning of therapy, and at the third and ninth months were 28.0 +/- 1.8 IU/L, 34.6 +/- 8.1 IU/L, and 34.1 +/- 7.0 IU/L, respectively (P > 0.05), and mean viral load of HBV-DNA was 4227 +/- 1435 pg/mL, 3368 +/- 2673 pg/mL, and 3018 +/- 2814 pg/mL, respectively (P > 0.05). There was no statistically significant difference between group 1 and group 2 at the third and ninth months in the mean ALT values and viral load of HBV-DNA (P > 0.05). Hepatitis B s antigen and hepatitis B e antigen clearance or hepatitis B s antibody and hepatitis B e antibody seroconversion were not observed in either group. CONCLUSION: As a first study investigating the effect of vitamin E in children with immunotolerant CHB infection, no beneficial effect could be demonstrated. Different immunomodulator protocols should be considered for future investigations.

Fatal congenital cytomegalovirus infection following recurrent maternal infection after a 7-year interval.

It is generally accepted that the risk for fetal infection is greatest with maternal primary cytomegalovirus CMV infection and much less likely with recurrent infection. Here, we report a fatal case of congenital CMV infection following recurrent maternal infection after a 7-year interval. A 3-month-old female baby presented with fever, jaundice, vomiting and stopping breast-feeding. Physical examination revealed mild respiratory distress, hepatosplenomegaly, microcephaly and growth retardation. Laboratory examination included bilirubin concentrations Total: 7.17 mg/dl; conjugated 6.67 mg/dl, aspartate transaminase 141 IU, and alanine transaminase 499 IU. Enzyme-linked immunosorbent assay test results revealed + CMV IgM and + CMV IgG. She died on the 10th day of admission with the diagnosis of CMV hepatitis, pneumonia, and multi-organ failure. Nuclear and cytoplasmic inclusions were demonstrated in the lung, liver and brain on postmortem biopsy. This case highlights that the outcome of babies born to mothers with recurrent maternal CMV infection may be more severe and fatal than previously thought.

Efficacy and tolerability of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C.

BACKGROUND AND AIM: Hepatitis C virus (HCV) is prevalent in hemodialysis (HD) patients. These patients experience more side-effects with antiviral treatment. The aim of the present study was to evaluate the efficacy and tolerability of pegylated interferon (PEG-IFN) alpha-2a in chronic hemodialysis patients with chronic hepatitis C. METHODS: Twenty-five patients were included into the study. All of the patients were interferon naive, anti-HCV antibodies positive and polymerase chain reaction HCV-RNA positive. Twelve of the patients received PEG-IFN alpha-2a at a dose of 135 microg weekly for 48 weeks (Group 1). The remaining 13 patients who received no specific treatment were used as controls (Group 2). The patients were prospectively followed up for a period of 18 months. Biochemical and virological responses were evaluated at the end of the study period (end-of-treatment response) and 6 months after the completion of therapy (sustained response). RESULTS: Virological end-of-treatment response was observed in 10 patients (83.4%) in Group 1 and one patient (7.7%) in Group 2 (P < 0.001). Sustained virological response was observed in nine patients (75%) in Group 1 and one patient (7.7%) in Group 2 (P < 0.001). Alanine aminotransferase (ALT) levels were initially increased in seven patients in Group 1 and normalized in five of these patients at the end of the treatment and sustained biochemical response was 71.4%. In contrast, ALT levels in Group 2 were initially high in five patients and normalized in two of them (40%) at the end of the 48 weeks. Even if most of the patients experienced several side-effects (anemia 75%, fatigue 58.3%, thrombocytopenia 33.3% and leukopenia 33.3%), they did not impose the discontinuation of the treatment. CONCLUSION: The present study showed that PEG-IFN alpha-2a for 48 weeks is efficacious and well tolerated in hemodialysis patients with HCV.

A national survey of surgical antibiotic prophylaxis in Turkey.

OBJECTIVE: To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN: A cross-sectional, country-wide survey. SETTING: Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS: Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS: A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS: Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95 0.225-0.772; P < .001) were associated with inappropriate prophylaxis. CONCLUSION: Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

Failure of therapeutic vaccination using hepatitis B surface antigen vaccine in the immunotolerant phase of children with chronic hepatitis B infection.

AIM: The aim of this study was to investigate the efficacy of specific hepatitis B virus (HBV) vaccination as active immunotherapy in treating chronic hepatitis B (CHB) infection during the immune-tolerant phase in children with normal aminotransferase levels and high viral load. METHODS: Fifty-one immunotolerant patients were randomly and prospectively recruited into two groups. Group 1 included 23 patients that were vaccinated with three standard injections of the GenHevac B vaccine in the deltoid or quadricep muscle, initially, and at 30 days and 60 days, for specific immunization. Group 2 contained 28 patients who did not receive any medication or vaccination and were recruited as the control group. Post-vaccination evaluation was performed at 6 months from the first injection and at the end of the 12th month by serological and virological analyses. A response criterion to therapy was defined as loss of HBV-DNA in serum and hepatitis B early antigen (HBeAg) seroconversion (loss of HBeAg, development of antibody to HBeAg (anti-HBe)). RESULTS: The mean alanine aminotransferase (ALT) value in group 1 at the beginning of the vaccination was 33.6 +/- 8.1 IU/L; this changed to 31.7 +/- 9.0 IU/L at 6 months after first injection and 29.2 +/- 7.1 IU/L at the end of 12 months (P > 0.05). In this group, mean HBV-DNA load at the starting point of the vaccination was 3,709 +/- 1,126 pg/mL; this value changed to 3,569 +/- 726 pg/mL at the sixth month and 3,295 +/- 832 pg/mL at the 12th month (P > 0.05). In group 2, the mean ALT values at the beginning of therapy, and at the 6th and 12th month were 32 +/- 8 IU/L, 31.8 +/- 8 IU/L, and 29.7 +/- 7 IU/L, respectively (P > 0.05), and the mean viral load of HBV-DNA values were 3,827 +/- 1,375 pg/mL, 3,498 +/- 886 pg/mL, and 3,059 +/- 731 pg/mL, respectively (P > 0.05). The load of HBV DNA of all patients in both groups was greater than 2,000 pg/mL. There was no statistically significant difference in the mean ALT values and mean viral load of HBV DNA (P > 0.05) between group 1 and group 2 at the end of the 6th and 12th months. Except for one each patient in each group, hepatitis B surface antigen (HBsAg) and HBeAg clearance or antibody to HBsAg (anti-HBs) and anti-HBe seroconversion were not observed during the follow-up period (P > 0.05). CONCLUSION: In this study, comparison of vaccinated and unvaccinated groups of immunotolerant children with CHB infection showed no difference in the clearance of HBV DNA and seroconversion of HBeAg to anti-HBe. Different immunization protocols should be considered for future investigations in the immunotolerant phase of children with CHB infection.