The microbiological diagnosis of tuberculous meningitis: results of Haydarpasa-1 study.

We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon-γ release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Löwenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p <0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p <0.05). Combination of L-J and ACS was superior to using these tests alone (p <0.05). There were poor and inverse agreements between EZNs and L-J culture (κ = -0.189); ACS and L-J culture (κ = -0.172) (p <0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (κ = -0.299, p <0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources.

Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study.

No detailed data exist in the literature on the accurate diagnosis of chronic brucellar meningitis or meningoencephalitis. A multicentre retrospective chart review was performed at 19 health centres to determine sensitivities of the diagnostic tests. This study included 177 patients. The mean values of CSF biochemical test results were as follows: CSF protein, 330.64 ± 493.28 mg/dL; CSF/ blood-glucose ratio, 0.35 ± 0.16; CSF sodium, 140.61 ± 8.14 mMt; CSF leucocyte count, 215.99 ± 306.87. The sensitivities of the tests were as follows: serum standard tube agglutination (STA), 94%; cerebrospinal fluid (CSF) STA, 78%; serum Rose Bengal test (RBT), 96%; CSF RBT, 71%; automated blood culture, 37%; automated CSF culture, 25%; conventional CSF culture, 9%. The clinician should use every possible means to diagnose chronic neurobrucellosis. The high seropositivitiy in brucellar blood tests must facilitate the use of blood serology. Although STA should be preferred over RBT in CSF in probable neurobrucellosis other than the acute form of the disease, RBT is not as weak as expected. Moreover, automated culture systems should be applied when CSF culture is needed.

Increased serum nitric oxide and malondialdehyde levels in patients with acute intestinal amebiasis.

OBJECTIVE: To determine the level of oxygen-nitrogen stress parameters in the pathogenesis of amebiasis. METHODS: Twenty-four acute intestinal amebiasis patients and 20 healthy controls were enrolled in the present study. Serum malondialdehyde and nitric oxide levels were determined spectrophotometrically. RESULTS: Serum malondialdehyde and nitric oxide levels were significantly higher in acute intestinal amebiasis patients than healthy controls (P<0.001). CONCLUSIONS: These results suggest that oxidative and nitrosative stress may play a major role in tissue damage in acute intestinal amebiasis patients. Also these parameters can be used to supplement the conventional microscopic method for reliable diagnosis of intestinal amebiasis.

Rheumatic manifestations of hepatitis B and C and their association with viral load and fibrosis of the liver.

The objective of this study is to investigate rheumatologic manifestations of hepatitis B and C and their relation with viral load and degree of hepatic fibrosis. Thirty-six HBV and 36 HBV patients were included. Liver biopsy was performed for all participants. We detected arthralgia 53-50%, myalgia 58-61% and fatigue 64-81% in HBV and HCV groups in order. All manifestations did not differ between groups significantly. Pain intensity was higher in HCV group (P = 0.023). Arthralgia is associated with viral load of the patients in both groups (P = 0.000 and P = 0.001). Viral load and fatigue are correlated in both groups (P = 0.000 and P = 0.001). There is a considerable relation between inflammation and arthralgia (P = 0.000) and myalgia (P = 0.033). We conclude that rheumatologic manifestations are common both in HBV and HCV and related with viral load and fibrosis.

Brucellosis-induced immune thrombocytopenia mimicking ITP: a report of seven cases.

Brucellosis continues to be an important cause of fever in underdeveloped countries and in rural areas of developed world. It is a multisystemic disease, associated with wide variety of symptoms. A wide variety of symptoms, including haematological abnormalities, such as anaemia, thrombocytopenia, pancytopenia, dissemine intravascular coagulation and leucopoenia could be seen, all of which are more common than usually thought. In this short study, we present a relatively uncommon haematological manifestation that of isolated thrombocytopenia mimicking idiopathic thrombocytopenic purpura, which we observed in seven of 114 patients who were diagnosed with brucellosis in our hospital over a 2-year period. Having given brucellosis treatment with rifampicin and doxycycline, complete remission was achieved and thrombocyte count returned to normal in all cases.

Antibiotic resistance of bacterial ventilator-associated pneumonia in surgical intensive care units.

Ventilator-associated pneumonia (VAP) is the most common infection in intensive care units. It is caused by prolonged hospitalization and results in high mortality rates. This retrospective clinical study, of 140 patients in a surgical intensive care unit, aimed to identify the bacterial agents responsible for VAP infection, and determine antibiotic resistance rates in VAP. Antibiotic sensitivity was evaluated by culturing and testing tracheal aspirates from patients with clinical and radiological findings of VAP. The bacteria isolated most frequently were Pseudomonas aeruginosa (33.9%), Staphylococcus aureus (30.0%), Acinetobacter baumannii (26.1%), and Enterobacter species (4.3%). A. baumannii was more prevalent than in previous years. The results of antibiotic sensitivity testing suggested sulbactam/cefoperazone as the most appropriate drug for treating these patients. We suggest, however, that when staphylococcal pneumonia is suspected, a glycopeptide (vancomycin or teicoplanin) or combined trimethoprim-sulfamethoxazole is used as first-line therapy until sensitivity results are obtained. In conclusion, development of antibiotic policies for individual hospitals can reduce high antibiotic resistance rates due to VAP.

A case of septicaemia, meningitis and pneumonia caused by Streptococcus bovis type II.

We present a case of septicaemia, pneumonia and meningitis due to Streptococcus bovis type-II in a patient who had undergone a total hip prosthesis under general anaesthesia three weeks earlier. This organism is an uncommon human pathogen that sometimes causes bacteraemia and endocarditis and is usually connected with colon pathology and dental procedures. In the reported case, there were no risk factors for S. bovis infection except for the hip operation. S. bovis type II sensitive to penicillin was isolated from all blood and pleural fluid cultures. The patient recovered and was discharged from hospital two weeks after presentation.

Churg-Strauss syndrome in an HCV seropositive patient.

Churg-Strauss syndrome was considered rare until leukotriene modifiers were introduced into medical practice in 1996. Since then, an increasing number of reports considering a possible relationship between leukotriene receptor antagonists and the Churg-Strauss syndrome have been published. Hepatitis C virus (HCV) is a blood-borne infection and a major health problem with an increasing prevalence worldwide. Previously, numerous reports suggested a relationship between HCV and certain autoimmune disorders such as cryoglobulinaemia and polyarteritis nodosa. We present a patient with HCV seropositive Churg-Strauss syndrome and a history of systemic corticosteroid and leukotriene receptor antagonist use, and discuss the possible risk factors in the aetiology of Churg-Strauss syndrome.

Epidemiological, clinical and laboratory features of brucellosis: a prospective evaluation of 120 adult patients.

This prospective study was carried out in the department of infectious diseases of Gaziantep University between January 1997 and December 1999 to evaluate the epidemiological, clinical and laboratory features of brucellosis in south-eastern Turkey. One hundred and twenty consecutive patients with active brucellosis were enrolled. The commonest way of transmission was ingestion of milk products from diseased animals. Brucella melitensis was isolated in the specimens of 31 (45.5%) of 68 patients. The commonest abnormalities on physical examination were fever (66.6%), hepatomegaly (63.3%) and splenomegaly (56.6%). Osteoarticular involvement was found in 34 patients (28.3%). Fifteen (12.5%) patients had ocular involvement. Hepatitis, orchiepididymitis, pulmonary involvement and meningitis were found in one (0.8%), four (6.8%), three (2.5%) and one (0.8) patient, respectively. The commonest haematological abnormalities were relative lymphomonocytosis (71.6%) and anaemia (36.6%). In conclusion, brucellosis continues to be a common health problem in communities where the consumption of unpasteurised dairy products is common. Since prevention is as important as early diagnosis in reducing the morbidity of brucellosis, we suggest that improving current health policies with additional educational programmes is essential.

Guillain-Barré syndrome associated with acute neurobrucellosis.

We report the case of a 14-year-old girl with Guillain-Barré syndrome associated with brucellosis due to Brucella melitensis. The diagnosis was established by the isolation of B. melitensis from her blood and by the determination of high levels of Brucella aglutinins in her sera and cerebrospinal fluid. A combination of rifampin, co-trimoxazole and physical therapy resulted in complete healing within 30 days. Antibrucellar treatment continued for 12 weeks. This case report suggests that brucellosis should be kept in mind in the aetiology of Guillain-Barré syndrome in the endemic areas for brucellosis, and bacteriological and serological tests for brucellosis should be performed.

Ocular complications associated with brucellosis in an endemic area.

PURPOSE: To report the ocular manifestations associated with brucellosis in an endemic area. METHODS: We prospectively evaluated 147 patients with the diagnosis of brucellosis between May 1996 to May 2000 and recorded the ocular and systemic findings. The diagnosis was based on clinical findings, positive serological and bacteriological tests (Brucella agglutination test: over 1/160 titer, blood culture). RESULTS: Thirty-eight patients (26.0%) with brucellosis had ocular complications: conjunctivitis in 26 (17.7%), anterior uveitis in six (4.1%), posterior uveitis in one (0.7%), dacryoadenitis in two (1.4%), episcleritis in three (2.1%). Three of the seven patients with uveitis had spondylitis associated with brucellosis. Osteoarticular complications in brucellosis were more frequent in the patients with ocular involvement though the difference was not statistically significant compared with patients without ocular involvement. CONCLUSIONS: Ocular manifestations are frequent in brucellosis so an ophthalmologic examination should be routinely performed in patients with brucellosis in endemic areas.

Recurrent episcleritis associated with brucellosis.

PURPOSE: To document the clinical course and the treatment of episcleritis associated with brucellosis. METHODS: Three consecutive cases of patients with recurrent episcleritis associated with brucellosis were evaluated through clinical and laboratory data including serology (tube agglutination), blood culture, and synovial fluid culture. RESULTS: All the patients had ingested contaminated milk and/or fresh cheese. The diagnosis of brucellosis was confirmed by high antibody titer, positive blood culture, negative synovial fluid culture and unresponsive condition to the previous nonspecific therapy for episcleritis and reactive arthritis. The patients responded well to the therapy with doxycycline and rifampicin. CONCLUSION: We proposed that recurrent episcleritis had a co-occurence with reactive arthritis in the course of the brucellosis, and that it responded well to the antibrucellar antibiotics rather than to steroids. This also implies that brucellosis as a rule is an underlying triggering infection associated with reactive arthritis.

Brucella melitensis dacryoadenitis: a case report.

PURPOSE: To present a case of brucellosis-related unilateral dacryoadenitis. METHODS: A 16-year-old boy had unilateral lacrimal gland enlargement, shown by magnetic resonance imaging of the orbits. Clinical findings, tube agglutination, the culture of a lacrimal gland aspirate, and histopathological examination confirmed the diagnosis of brucellosis. RESULTS: Tube agglutination testing for brucellosis gave a titer of over 1/640. The aspirate from the lacrimal glands grew Brucella melitensis and histopathological findings were consistent with brucellosis. CONCLUSIONS: Dacryoadenitis may occur in the course of systemic brucellosis caused by Brucella melitensis.