[Septic arthritis of hip due to Salmonella Typhi in a patient with multiple sclerosis]. / Multipl Sklerozlu Bir Olguda Salmonella Typhi'ye Bagli Kalça Eklemi Artriti.

The most common microorganisms isolated from septic arthritis are Staphylococcus aureus and streptoccocci. Septic arthritis due to Salmonella spp. are rare and the most commonly isolated species are S.Choleraesuis and S.Typhimurium. However the number of septic arthritis cases due to S.Typhi is low in literature. In this report, septic arthritis of hip due to S.Typhi in a multiple sclerosis patient who was under steroid therapy, was presented. A 25-year-old female patient was admitted to our clinic with the complaints of fever, left hip pain, standing and walking disability for 10 days. Her anamnesis revealed that she had had a multiple sclerosis attack and underwent triple pulse steroid therapy. Laboratory findings were as follows; WBC count: 16.300/mm3 (70% polymorphonuclear leukocyte), hemoglobin: 10.6 g/dl, erythrocyte sedimentation rate: 140 mm/hour, CRP: 28.7 g/L, AST: 86 U/L and ALT: 77 U/L. In lumbosacral magnetic resonance imaging, trochanteric bursitis and generalized myositis were detected in left hip joint compatible with septic arthritis. S.Typhi was isolated from patient's blood and operational tissue samples. Serum Salmonella TO and TH titers were found as 1/400 and 1/200, respectively. Antibiotic susceptibility test was performed by disk diffusion method, and the isolate was found susceptible to ampicillin, chloramphenicol, ceftriaxone, ciprofloxacin and trimethoprim-sulphametoxazole. The patient was treated by surgery and also by two weeks parenteral (2 x 400 mg) and 6 weeks oral (2 x 500 mg) ciprofloxacin treatment. Six months follow-up of the patient revealed that clinical, radiological and laboratory findings were normal. As far as the national literature was considered, this was the first S.Typhi septic arthritis case involving the hip joint and demonstrating bacterial growth both in blood and operational tissue. The presentation of the infection as arthritis plus diffuse myositis and bursitis, is also noteworthy.

Rate of chronicity and time of disappearance of HBsAg following acute hepatitis B.

BACKGROUND/AIMS: Chronic hepatitis B is associated with significantly increased risk of developing cirrhosis, and hepatocellular carcinoma. It's, therefore, important to understand the incidence and risk factors associated with chronicity following acute hepatitis B. METHODOLOGY: Among 863 acute hepatitis patients admitted consecutively to the hospital, 320 with serum immunoglobulin M antibody to hepatitis B core antigen were classified as acute hepatitis B. Of these patients, serum samples were collected 3 and 6 months after clinical onset. RESULTS: Complete follow-up was achieved in 240 patients and 11 (4.6%) became chronic carriers. Only alcohol addiction other than epidemiological, clinical or biochemical parameters was found to be significantly associated with chronic evaluation. In serum samples collected from 205 of 240 patients 3 months after the onset of infection, hepatitis B surface antigen clearance was observed in 181 (88.3%). Number of patients increased to 194 (94.6%) at the end of 6 month and both of these rates were found to be highly significant. CONCLUSIONS: There is still no certain way of predicting the outcome of acute hepatitis B whether a newly infected patient will resolve the illness or not. Alcohol addiction seems to have an impact on the chronicity but additional research is needed.