Tetanus in adults: results of the multicenter ID-IRI study.

Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital's Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival.

The burden and epidemiology of community-acquired central nervous system infections: a multinational study.

Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

Infections in travellers returning to Turkey from the Arabian peninsula: a retrospective cross-sectional multicenter study.

Mass gatherings pooling people from different parts of the world-the largest of which is to Mecca, Saudi Arabia, for Hajj-may impose risks for acquisition and dissemination of infectious diseases. A substantial number of pilgrims to Hajj and Umrah are Turkish citizens (456,000 in 2014) but data are lacking on scale of the problem. We did a retrospective cross-sectional multicenter study in Turkey to explore the range of infections among inpatients who had recently returned from the Arabian Peninsula. Our inclusion criteria were patients who had acquired an infection during their trip to an Arabian Peninsula country, or who became symptomatic within 1 week of their return. The data were collected retrospectively for January 1, 2013 and March 1, 2015. 185 Turkish patients were recruited to the study across 15 referral centers with travel associated infectious diseases after returning from Arabian Peninsula countries (predominantly Saudi Arabia 163 [88.1 %] for religious purposes 162 [87.5 %]). Seventy four (40.0 %) of them were ≥ 65 years old with numerous comorbidities including diabetes (24.3 %) and COPD (14.1 %). The most common clinical diagnosis was respiratory tract infections (169 [91.5 %]), followed by diarrheal diseases (13 [7 %]), and there was one case of MERS-CoV. Patients spent a median of 5 (3-7) days as hospital inpatients and overall mortality was 1.1 %. Returning travellers from the Arabian Peninsula present as inpatients with a broad range of infectious diseases similar to common community acquired infections frequently seen in daily medical practices in Turkey.

Evaluation of Device-associated Nosocomial Infections in a Paediatric Intensive Care Unit.

OBJECTIVE: The aim of this study was to evaluate the rate of device-associated healthcare-associated infections (DA-HAI) in a paediatric intensive care unit (PICU). In addition, the identities of the responsible micro-organisms and of their antibiotic sensitivities were determined. SUBJECTS AND METHODS: Patients who had been treated and followed-up in a PICU for more than 48 hours between January 2008 and December 2013 were included in the study. Device-associated nosocomial infections were defined by the Centers for Disease Control (CDC) criteria. RESULTS: Nosocomial infections were detected in 244 of the 7376 patients over the six-year period. A diagnosis of DA-HAI was made in 75 (30.7%) of these infections. The rates of device utilization were 26% for mechanical ventilators, 6% for central venous catheters and 0.9% for urethral catheters. The rate of device-associated infections was 30.7%, and their frequency was 1.9/1000 patient-days. The device-associated nosocomial infection rates for mechanic ventilators, central and urethral catheters were 5.6, 1.62 and 3.77 per 1000 patient-days, respectively. Of these infections, Pseudomonas aeruginosa was the most frequent pathogen. Patients who developed hospital infections had longer durations of ICU hospitalizations and more often had to use mechanical ventilators and central and urinary catheters. CONCLUSIONS: The duration of hospitalization and the use of mechanical ventilators and central and urinary catheters were related to the increases in nosocomial infections. Therefore, target-oriented active surveillance should be regularly performed, and the superfluous employment of invasive devices should be avoided.

Liver involvement in patients with brucellosis: results of the Marmara study.

Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with ≥5 times of the upper limit of normal for aminotransferases, total bilirubin level ≥2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.

Risk factors for mortality in patients with nosocomial Gram-negative rod bacteremia.

BACKGROUND: The percentage of hospital-acquired bloodstream infections associated with Gram-negative bacilles has decreased during last decade but it is still a major cause of morbidity and mortality. OBJECTIVES: The aim of this study was to determine the outcome of Gram-negative rod (GNR) bacteremia, which is an important clinical problem with high mortality rates, and the risk factors for GNR related mortality in our Clinic. MATERIALS AND METHODS: During the study period, 520 episodes of bacteremia were detected in 411 patients. Only patients with GNR bacteremia in blood cultures were included in the study (n = 197). Among 197 patients fulfilling study criteria, GNR were grown in 239 samples. RESULTS: Escherichia coli (n = 97, 40.5%), Klebsiella pneumoniae (n = 54, 22.5%), Pseudomonas aeruginosa (n= 24, 10%), Acinetobacter baumannii (n = 24, 10%) were the most commonly isolated bacteria. The most frequently identified infection sources of bacteremia were pneumonia (n = 35, 17.7%), catheter-related infections (n = 24, 12.2%), urinary tract infections (n = 20, 10%). In multivariate analysis, it was found that the GNR bacteremia mortality risk increased in patients treated in intensive care units (ICU) (OR: 0.2, p = 0.03) and patients with ventilatory support (OR: 20.8, p = 0.05). CONCLUSIONS: In clinical practice of the hospital settings, efforts should concentrate on preventive measures for nosocomial infections since pneumonia, catheter-related infections, and urinary infections appear to be the most frequent causes of secondary bacteremia.    

The effects of pomegranate on bacterial translocation in rats with obstructive jaundice.

BACKGROUND: Obstructive jaundice may promote bacterial overgrowth and altered intestinal barrier function, with resultant increased bacterial translocation. AIMS: This study aimed to evaluate potential effects of pomegranate on bacterial translocation after bile duct ligation in rats. MATERIALS AND METHODS: Wistar albino rats were randomized into four groups. Group 1 underwent sham operation; Group 2 underwent sham operation and simultaneous treatment with pomegranate; Group 3 underwent common bile duct ligation, and Group 4 underwent common bile duct ligation and simultaneous treatment with pomegranate. After 8 days, the samples of systemic blood, liver, spleen and mesenteric lymph nodes (MLNs) were obtained under sterile conditions for microbiological culture. The segments of the ileum were removed for histopathological examination. RESULTS: Bacterial translocation significantly decreased in Group 4 compared to Group 3 (p = 0.007). The bacterial counts (Colony forming unit: CFU/g) of Group 3 were significantly higher than those of Groups 1, 2 and 4 (p < 0.05). The mean ileal villus heights in the Groups 1, 2, 3 and 4 were 480.5±20.5 µm, 494.7±17.3 µm, 356.3±25.7 µm and 420.7±23.7 µm, respectively. The mean villus height in Group 4 was higher than that of Group 3 (p = 0.010). CONCLUSIONS: Pomegranate has significant protective effects on intestinal mucosa barrier in obstructive jaundice and reduces bacterial translocation.  

Community-acquired urinary tract infections in children: pathogens, antibiotic susceptibility and seasonal changes.

AIM: Urinary tract infections (UTIs) are common infections affecting children. The aim of our study is to determine microorganisms that cause community-acquired urinary tract infections and their antibiotic susceptibility in children. MATERIALS AND METHODS: Our investigation includes 150 cases which has positive urine culture. The cases are detected at Pediatric Polyclinics of Dicle University between June 2010 and June 2011. RESULTS: The study included 118 (78.7%) female and 32 (21.3%) male children. Urinary tract infections were seen in autumn 10.7% (n = 16), summer 35.3% (n = 53), winter 30.7% (n = 46) and spring 23.3% (n = 35). The culture results indicated 75.3% (n = 113) Escherichia coli; 20.7% (n = 31) Klebsiella; 2.7% (n = 4) Proteus and % 1.3 (n = 2) Pseudomonas. The antibiotic resistance against Escherichia coli was found out is amikacin (3%), ertapenem (7%), imipenem (0%), meropenem (0%), nitrofurantoin (9%), trimethoprim/sulfamethoxazole (58%), piperacillin (83%), amoxicillin/clavulanate (50%), ampicillin/sulbactam (65%), cefazolin (54%), cefotaxime (51%), cefuroxime sodium (51% ) and tetracycline (68%). The resistance ratios of Klebsiella are amikacin (0%), imipenem (0%), levofloxacin (0%), meropenem (0%), amoxicillin/clavulanate (57%), ampicillin/sulbactam (79%), ceftriaxone (68%), cefuroxime sodium (74%) and trimethoprim/sulfamethoxazole (61%). CONCLUSIONS: The results represent the increasing antibiotic resistance against microorganisms among the community-acquired UTI patients in a developing country such as Turkey. So, the physicians should consider resistance status of the infectious agent and choose effective antibiotics which are nitrofurantoin and cefoxitin for their empirical antibiotic treatment. Furthermore, they should be trained about selection of more effective antibiotics and check the regional studies regularly.

Complications of chronic suppurative otitis media: a retrospective review.

The purpose of this study was to review our patients with complications of chronic suppurative otitis media (CSOM) and compare with literature. This retrospective study was performed over 10 years in our tertiary referral university hospital. During this period 4,630 patients with CSOM were admitted to the department and 906 patients underwent a surgery. From the records of the 4,630 patients, 121 patients (2.6%) with complications were identified. Of the 906 CSOM patients that underwent a surgery, 511 had cholesteatoma, and 395 had granulation and/or polyp tissue. Ninety-four of 511 (18.4%) patients with cholesteatoma and 27 of 395 (6.8%) patients with granulation and/or polyp tissue had a complication. Of the 121 complicated CSOM patients, 57 extracranial (47.1%) and 37 intracranial (30.6%). Multiple combined complications were occurred in 27 (22.3%) patients. The mastoid abscess was the commonest extracranial complication (28.3%); it was followed by labyrinthitis (9%), facial nerve paralysis (8.4%), and Bezold's abscess (1.3%). The most common intracranial complication was lateral sinus thrombophlebitis (19.5%), followed by perisigmoid sinus abscess (13.5%), meningitis (9%), brain abscess (6.5%), and extradural abscess (4.5%). Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis. There was no mortality in any of our patients. The additional morbidities were recorded in 25 patients (20.6%). In this study, we emphasize the importance of an accurate and early diagnosis, followed by adequate surgical therapy and a multidisciplinary approach.

Evaluation of elabela, visfatin, and chemerin levels as inflammation biomarkers in COVID-19.

OBJECTIVE: The aim of this study was to investigate if inflammation biomarkers elabela, visfatin, and chemerin will be useful in the diagnosis of patients with COVID-19. PATIENTS AND METHODS: This prospective case-control study included 33 patients with COVID-19 and 30 healthy matched controls. 33 patients, aged 18 years and older, diagnosed with COVID-19 and followed up for one month were included in the study. Blood samples were taken from the patients on the first day they were diagnosed with COVID-19, and levels of elabela (ELA), visfatin, chemerin, white blood cells (WBC), C-reactive protein (CRP) and procalcitonin (PCT) were assessed. Blood samples were also taken from 30 healthy volunteers for the control group. The ELA, visfatin and chemerin levels measured in the patients on day one were compared with those measured in the control group and with the WBC, CRP and PCT levels measured in the patients. RESULTS: Visfatin levels measured in COVID-19 patients were significantly higher than in the healthy control group. There was no significant difference in ELA and chemerin levels between the two groups. A significant positive correlation was found between chemerin and visfatin levels in the patients. A significant negative correlation was found between the levels of ELA-chemerin and ELA-visfatin in the patients. There was no significant correlation between elabela, visfatin and chemerin levels and WBC, CRP, PCT levels. CONCLUSIONS: Measurement of visfatin levels may be helpful in patients with COVID-19. However, two other biomarkers in our study, ELA and chemerin, were found not to be useful in diagnosing COVID-19. New inflammatory biomarkers may help to diagnose a disease in which the inflammatory response is at the forefront, such as COVID-19. New studies are needed on this subject.

Evulation of prolidase enzyme, and galectin levels as a marker for fibrosis in patients with chronic hepatitis B.

OBJECTIVE: The fibrosis can be detected using non-invasive methods including prolidase activity, proline levels and galectin-3 (GAL-3) detection in the serum. The aim of this study was to investigate the liver fibrosis through non-invasive methods in chronic hepatitis B patients. PATIENTS AND METHODS: This prospective case control study includes 56 patients with Chronic Active Hepatitis B (CAHB), 57 patients with Inactive Hepatitis B (IHB), and 60 healthy matched control subjects. The first group included the CAHB [hepatitis B surface antigen (HBsAg): positive; HBV DNA >2,000 IU/mL; normal or high alanine aminotransferase (ALT) value] undergo a liver biopsy, while the second group included the IHB (HBsAg: positive; HBV DNA: negative; normal ALT value). The third group comprised the healthy controls. Serum prolidase enzyme activities (SPEA), proline and galectin-3 levels were measured for each group. RESULTS: Patients with CAHB had significantly higher SPEA levels (1,004.3±186.8 IU/L) than did the controls (196.5±306 IU/L) (p<0.001). Significantly higher serum GAL-3 levels were found in the CHB group compared with HBV carrier and the control groups (27.4±32.2 ng/mL, 6.5±13.4 ng/mL, 3.1±5.7 ng/mL, respectively, p<0.001). The relationship between serum prolidase activity, hidroxiprolyne and fibrosis (p<0.05). There were no significant differences in ALT levels between inactive HBV carriers and the control groups (p>0.05). CONCLUSIONS: We suppose that hidroxiprolyne levels and prolidase enzyme activity might be an indicator as a marker for fibrosis in CAHB and the evaluation of response to treatment.

Factors leading to dissemination of cutaneous anthrax: an international ID-IRI study.

Background: Although anthrax is a rare zoonotic infection, it still causes significant mortality and morbidity. In this multicenter study, which is the largest anthrax case series ever reported, we aimed to describe the factors leading to dissemination of cutaneous anthrax. Methods: Adult patients with cutaneous anthrax from 16 referral centers were pooled. The study had a retrospective design, and included patients treated between January 1, 1990 and December 1, 2019. Probable, and confirmed cases based upon CDC anthrax 2018 case definition were included in the study. A descriptive statistical analysis was performed for all variables. Results: A total of 141 cutaneous anthrax patients were included. Of these, 105 (74%) patients had probable and 36 (26%) had confirmed diagnosis. Anthrax meningitis and bacteremia occurred in three and six patients, respectively. Sequelae were observed in three patients: cicatricial ectropion followed by ocular anthrax (n = 2) and movement restriction on the left hand after surgical intervention (n = 1). One patient had gastrointestinal anthrax. The parameters related to poor outcome (p < 0.05) were fever, anorexia, hypoxia, malaise/fatigue, cellulitis, fasciitis, lymphadenopathy, leukocytosis, high CRP and creatinine levels, longer duration of antimicrobial therapy, and combined therapy. The last two were seemingly the consequences of dissemination rather than being the reasons. The fatality rate was 1.4%. Conclusions: Rapid identification of anthrax is crucial for prompt and effective treatment. Systemic symptoms, disseminated local infection, and high inflammatory markers should alert the treating physicians for the dissemination of the disease.

The effects of caffeic acid phenethyl ester (CAPE) on bacterial translocation and inflammatory response in an experimental intestinal obstruction model in rats.

OBJECTIVE: Intestinal obstruction (IO) is a disease which generates approximately 20% of emergency surgery and tends to with high mortality. Prevention of oxidative stress, bacterial translocation and tissue damage caused by IO is an important medical issue. Caffeic acid phenethyl ester (CAPE) is an anti-inflammatory, antioxidant, anti-bacterial and immunomodulatory agent. In this experimental study, we aimed to investigate the effects of CAPE on bacterial translocation, inflammatory response, oxidative stress and tissue injury caused by intestinal obstruction in a rat model. MATERIALS AND METHODS: Breafly, thirty Wistar albino rats divided into three groups as Sham (n=10), IO (n=10) and IO + CAPE (10 µmol/kg day, intraperitoneal) (n=10). The tissues from the study groups were examined biochemically, microbiologically and histopathologically. RESULTS: In CAPE treated group, decreased serum levels of proinflammatory cytokines (TNF-α, IL-6, IL-1ß) and CRP (p < 0.05), additionally increased serum levels of antioxidant parameters (PONS, TAS) (p < 0.05), were observed after IO. Microbiologically, the rates of positive cultures of the lymph node, spleen, liver and blood were significantly decreased in CAPE treated group compared to the IO group. Also histopathological examination showed that the intestinal mucosal injury score and hepatic portal inflammation score were significantly decreased in the CAPE treated group (p < 0.05). CONCLUSIONS: It is suggested that intraperitoneal administration of CAPE might has potential antibacterial, anti-inflammatory, antioxidant and immunomodulatory effects in IO. So, further studies on IO are needed to evaluate exact antibacterial, antiinflammatory, antioxidant and immunomodulatory effects of CAPE.

Comparison of snakebite cases in children and adults.

OBJECTIVE: There are very few studies that compare the snakebite cases in children and adults. The present study aimed to compare the demographic characteristics, clinical presentations, laboratory findings, and developed complications in pediatric and adult patients due to snakebites. PATIENTS AND METHODS: This study included the patients admitted to the hospital and monitored due to snakebite between July 1999 and December 2012. The condition of each patient who had been bitten was admitted to the hospital was monitored from the time of admission to the end of their hospital stay. The fact that a snakebite occurred was recorded if the subjects saw the snake or if the appearance of the puncture sites was convincingly a snakebite. RESULTS: The present work included 290 patients, of whom 123 were children and 167 were adults. The most common location of the bites was the lower extremity with 78.9% (n=97) and 63.5% (n=106) in pediatric and adult patients, respectively. All of the pediatric patients received prophylactic treatment with antibiotics, whereas 62 (37.1%) adult patients received antimicrobial treatments due to the soft tissue infection. The most common complication developed was pulmonary edema in children at a rate of 33.3% (n=41) and compartment syndrome in adult patients at a rate of 3% (n=5). CONCLUSIONS: Patients admitted to the hospital due to snakebite should be monitored for at least 12 hours, even if there is no sign of clinical envenomation. Antivenom treatment should be administered to the patients requiring clinical staging. Patients should be kept under close monitoring to prevent the development of serious complications such as cellulitis, pulmonary edema, compartment syndrome, and disseminated intravascular coagulation.

The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study.

We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.

Update on treatment options for spinal brucellosis.

We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.

Genitourinary brucellosis: results of a multicentric study.

This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n=327, 83.8%), as epididymo-orchitis (n=204, 58%), orchitis (n=112, 31.8%) and epididymitis (n=11, 3.1%). In female patients, pyelonephritis (n=33/38, 86.8%) was significantly higher than in male patients (n=11/352, 3.1%; p<0.0001). The mean blood leukocyte count was 7530±3115/mm3. Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p<0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.

The evaluation of patients with burns during fifteen years period.

AIMS: Burn is a major health problem that cause of mortality, morbidity and psychological problems in children and adults throughout the world. The aim of this study was to evaluate the epidemiological, etiological features and outcomes of burns in the southeast region of Turkey. PATIENTS AND METHODS: A total of 3010 burn patients (age vary between 2 month to 95 years old) that admitted to the Dicle University burn center during the 15 years period (1994-2008) were reviewed. Age, gender, demographic characteristics, length of hospital stay of patients, etiology and degree of burns, cause of nosocomial infections, the total body surface area (TBSA) percentage and outcomes were analyzed. RESULTS: Of 3010 patients, 1602 (53.2%) cases were female and 1408 (46.8%) were male. The mean age was 10.51±13.45. The most of patients (58.1%, 1748 patients) were ≤ 5 years old, 19.9% (598) were 6-15, 20.1% (606) were 16-50 and 1.9% (58) were ≥51 years old. Burn type of cases were including: 1956 (65%) scalding burns, 624 (20.7%) flame burns and 430 (14.3%) electrical burns. Degree of burns were including: 22 (0.7%) first-degree, 2706 (89.9%) second-degree and 282 (9.4%) third-degree burns. The mean of length of hospitalization was 13.25 ±10.77 days. The most frequent isolated microorganisms were Pseudomonas aeruginosa (55%, 553), Acinetobacter spp. (13%, 128), and Escherichia coli (8%, 78). Mortality rate was 4.6%. CONCLUSIONS: The epidemiology of burns may vary according to lifestyles, age, living conditions and socio-economic status among different regions and hospitals. Improvement of life conditions and socio-economic status, trainings, periodic studies of nosocomial infections and increasing the number of burn centers, would contribute to reduction of deaths due to burns.

Seroprevalence of IgG anti-Toxocara canis antibodies and anti-Fasciola sp. antibodies in patients with urticaria.

AIMS: Chronic urticaria (CU) is defined by recurrent episodes occurring at least twice a week for 6 weeks and generally characterized by the rapid appearance of wheals and/or angioedema and may be associated with parasitic infections. We aimed to investigate the seroprevalance of Toxocara canis and Fasciola species in patients with CU. MATERIALS AND METHODS: We included 55 patients (in age 16-55) with urticaria admitted in study. As a control group we recruited 30 healthy volunteers they had no history of urticaria, rhinitis, asthma, atopic eczema/dermatitis syndrome (AEDS), or other relevant diseases. IgG antibodies to Toxocara canis and Fasciola species were investigated by ELISA method. RESULTS: In a total of 55 patients (mean age: 31.85 ± 8.92), 8 patients (14.5%) were positive for IgG antibodies to Toxocara canis. Among seropositive patients (mean age: 38.62 ± 12.46) 6 patients were female. No patient was positive for Fasciola by ELISA. Six of Toxocara canis seropositive cases were frequently visited or lived in rural areas and had contact with pets. CONCLUSIONS: Patients with urticaria, should be tested for Toxocara canis and treated with anthelminthic drugs in endemics areas for toxocariasis.

Evaluation of adults with acute viral hepatitis a and review of the literature.

AIM: In developing countries HAV infection is very common in the first years of life and it is often asymptomatic. However especially in regions of intermediate endemicity, exposure to the virus may delay and outbreaks of hepatitis A may be encountered in adults. The aim of this study is to evaluate the clinical and laboratory findings and risk factors of adults with acute viral hepatitis A. MATERIALS AND METHODS: In present study we evaluated 203 patient with acute viral hepatitis A, who were admitted to four different hospitals of three cities of Turkey between January 2000-December 2011, retrospectively. The diagnosis of acute viral hepatitis A was performed by laboratory findings and clinically. RESULTS: In a total of 203 patients, 120 (59.1%) patients were male and 83 (40.9%) were female. Mean age of cases with acute viral hepatitis A was 24.7 +11.8 years (ranged 15 to 82 years old). Acute viral hepatitis A were seen in patient who were 15-20 years and 21-30 years old, commonly. Jaundice (74%), fatigue (68%), nausea- vomiting (56%) and dark urine (48%) were the most common symptoms in cases. Prolonged cholestasis (6.8%) was the most common atypical manifestation. Prolonged jaundice was more frequent in the cases with positive HBsAg (P < 0.001). CONCLUSIONS: Acute viral hepatitis A can cause atypical presentations such as prolonged cholestasis, acute kidney injury and fulminant hepatitis. Some precautions such as routine vaccination program, improvement of hygiene conditions and informing people about it, should be taken for reducing of acute viral hepatitis A infection incidence.