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.

Orchiectomy performed in two patients with brucella orchitis mimicking testicular tumour / Orquiectomía realizada en dos pacientes con orquitis brucelosa semejante a un tumor testicular

Brucellosis is a zoonosis caused by gram negative coccobacilli and it is an endemic infectious disease in Turkey. Infection is usually acquired as a result of direct contact with infected animals or by consuming milk or cheese freshly made from them. There exists a wide spectrum of clinical signs and symptoms in brucellosis. Many systems including musculoskeletal, gastrointestinal, cardiovascular and genitourinary may be involved in brucellosis. The genitourinary system is affected in 2% to 20% of the cases with brucellosis. The most common forms of brucellosis are epididymo-orchitis, testicular abscess and atrophy. The serum agglutination test to detect the presence of antibodies is a reliable test in patients with urogenital symptoms. Long-term and combined antibacterial therapy have been found to be effective in brucellosis. We present two cases undergoing orchiectomy because of testicular mass before the diagnosis ofbrucellosis was made.

La brucelosis es una zoonosis causada por cocobacilos gram negativos, y es una enfermedad infecciosa endémica en Turquía. La infección generalmente se adquiere como resultado del contacto directo con animales infectados o por consumo de leche o queso recién producidos a partir de ellos. Existe un amplio espectro de signos y síntomas clínicos de la brucelosis. Muchos sistemas, incluyendo los sistemas musculoesquelético, cardiovascular, gastrointestinal y génitourinario, pueden estar implicados en la brucelosis. El sistema génitourinario se ve afectado en 2% a 20% de los casos con brucelosis. Las formas más comunes de brucelosis son la epidídimo-orquitis, el absceso testicular, y la atrofia. La prueba de aglutinación de suero para detectar la presencia de anticuerpos es una prueba confiable en pacientes con síntomas urogenitales. Se ha hallado que la terapia antibacteriana combinada y a largo plazo son eficaces en la brucelosis. Presentamos dos casos sometidos a orquiectomía debido a una masa testicular antes de que se realizara el diagnóstico de brucelosis.

Intraabdominal abscess related fungaemia caused by Rhodotorula glutinis in a non-neutropenic cancer patient.

Rhodotorula glutinis is a rare fungal infection that is especially observed in immune-compromised patients. It is common in the skin, faeces, nails, sputum, gastrointestinal system and adenoid tissue. However, the incidence of Rhodotorula glutinis is increased in both local and systemic infections in recent years. Presented here is a case of Rhodotorula glutinis fungaemia that isolated from subhepatic abscess formation and blood in a patient who was operated with Roux-en-Y technique due to gastric adenocarcinoma. Fungal sepsis is an important cause of fever resistant to antibiotic therapy that is often taken into marginal account. It should instead be particularly considered in patients with a history of intraabdominal surgery and non-neutropenic cancer patients. The case described illustrates an episode of systemic infection by Rhodotorula glutinis, correlated with the presence of intraabdominal abscess and without central venous catheters. This is the first case of fungaemia by Rhodotorula glutinis with an intraabdominal abscess source reported from Turkey.

Orchiectomy performed in two patients with Brucella orchitis mimicking testicular tumour.

Brucellosis is a zoonosis caused by gram negative coccobacilli and it is an endemic infectious disease in Turkey. Infection is usually acquired as a result of direct contact with infected animals or by consuming milk or cheese freshly made from them. There exists a wide spectrum of clinical signs and symptoms in brucellosis. Many systems including musculoskeletal, gastrointestinal, cardiovascular and genitourinary may be involved in brucellosis. The genitourinary system is affected in 2% to 20% of the cases with brucellosis. The most common forms of brucellosis are epididymo-orchitis, testicular abscess and atrophy. The serum agglutination test to detect the presence of antibodies is a reliable test in patients with urogenital symptoms. Long-term and combined antibacterial therapy have been found to be effective in brucellosis. We present two cases undergoing orchiectomy because of testicular mass before the diagnosis of brucellosis was made.