ABSTRACT
BACKGROUND: Viral conjunctivitis are the most frequent infections in ophthalmology clinics. The diagnosis is usually relying on clinical findings and medical history. However, topical antibiotics are often used unnecessarily addition to symptomatic treatment because of unsure agents. We aimed to detect the Adenovirus, Coxsackievirus and Enterovirus from conjunctiva and pharyngeal samples of patients. METHODS: The conjunctiva and pharyngeal samples of the patients with conjunctivitis were taken by Virocult transport media and kept at -80ÌC up to study day. Adenovirus spp, Enterovirus 70 and Enterovirus 71, Coxsackie A24 and Coxsackie A16 were detected by real-time PCR. Samples from healthy health care workers of ophthalmology clinic were used for control group. RESULTS: A total of 176 samples (conjunctival and pharyngeal samples of 62 patient and 26 healthy subjects) were included. The mean age of 34 (55.7%) male and 27 (44.3%) female patients was 34±17. Twenty five (40.3%) of the patients were receiving antibiotic drops at first visit. The main etiologic agent in conjunctival samples was found to be Adenovirus (46/62, 74.2%) followed by Enterovirus 70 (4/62, 6.4%) and Enterovirus 71 (4/62, 6.4%). Coxsackievirus 16 and 24 were also found in 2 patients (1/62 each, 1.6%). Pharyngeal samples were also positive for Adenovirus (20/62, 32.3%), Enterovirus 70 and 71 (7/62, 11.3% and 5/62, 8.1% respectively), Coxsackievirus 16 and 24 (2/62, 3.2% and 1/61, 1.6%). CONCLUSIONS: It is very difficult in viral conjunctivitis to make clinical differentiation caused by different agents because of common clinical signs and symptoms. In routine clinical work, the viral conjunctivitis usually related with Adenovirus. But almost one fourth of the patients' conjunctivitis were not related to Adenovirus, which shows the importance of the laboratory diagnostics. True diagnosis plays an important role on prevention of contamination and unnecessary use of antibiotics in viral conjunctivitis.
Subject(s)
Adenoviridae/isolation & purification , Conjunctivitis, Viral/virology , DNA, Viral/isolation & purification , Enterovirus/isolation & purification , Pharynx/virology , Acute Disease , Adenoviridae/classification , Adenoviridae/genetics , Adult , Case-Control Studies , Enterovirus/classification , Enterovirus/genetics , Female , Humans , Male , Polymerase Chain Reaction , Prospective StudiesABSTRACT
The treatment of brucellosis is still problematic, because of high rates of treatment failure or relapses. As the microorganism is an intracellular pathogen, treatment requires combined regimens. However, limited existing data on in vitro combinations are avaliable for Brucellae. The aim of this study was to investigate the in vitro efficacy of various traditional and new antibiotic combinations against 16 Brucella melitensis strains. The combination effect of antimicrobial agents was evaluated by E-test synergy method to obtain a fractional inhibitory concentration (FIC) index. Co-Trimoxazole (SXT) and moxifloxocin (MXF) exhibited the lowest MIC, while Rifampin (RIF) had the highest MIC in the study. Combinations with RIF showed the best synergistic activity (100 percent of RIF-tetracycline (TET), and 87.5 percent of RIF-SXT). Synergistic activity was also detected at seven (43.7 percent) of ciprofloxocin (CIP)-SXT, four (25 percent) of TET-MXF, and two (12.5 percent) of TET-SXT combinations. The combinations that demonstrated additivity were TET-SXT, CIP-SXT and TET-MXF. Antagonism was observed only with the TET-Streptomycin (STR) combination in three strains (18.8 percent). Further work including randomized controlled clinical trials is required to fully evaluate the usefulness of these data.
O tratamento da brucelose é problemático devido à alta freqüência de tratamentos mal sucedidos e recidivas. Por tratar-se de um patógeno intracelular, o tratamento requer procedimentos combinados. Entretanto, existem poucos dados sobre combinações in vitro para Brucellae. O objetivo deste trabalho foi investigar a eficiência de vários tratamentos tradicionais e novas combinações de antibióticos contra 16 isolados de Brucella melitensis. O efeito combinado foi avaliado através do método do E-test para obtenção do FIC (índice de concentração inibitória fracional). Co-trimoxazol (SXT) e moxifloxocina (MXF) apresentaram o MIC mais baixo, enquanto rifampicina (RIF) apresentou o MIC mais alto. Combinações com RIF mostraram a melhor atividade sinergística (100 por cento para RIF-tetraciclina e 87,5 por cento para RIF-SXT). Atividade sinergística foi também detectada para sete (43,7 por cento) combinações de ciprofloxacina (CIP-STX), quatro (25 por cento) de TET-MXF e duas (12,5 por cento) de TET-SXT. As combinações que apresentaram efeito aditivo foram TET-SXT, CIP-SXT e TET-MXF. Antagonismo foi observado somente para a combinação TET-estreptomicina (STR) em três isolados (18,8 por cento). Mais pesquisas utilizando ensaios clínicos randomizados controlados são necessárias para avaliar a utilidade desses dados.
Subject(s)
Humans , Anti-Bacterial Agents , Brucellosis , Brucella melitensis/isolation & purification , In Vitro Techniques , Diagnostic Techniques and Procedures , Drug Synergism , Methodology as a Subject , MethodsABSTRACT
The treatment of brucellosis is still problematic, because of high rates of treatment failure or relapses. As the microorganism is an intracellular pathogen, treatment requires combined regimens. However, limited existing data on in vitro combinations are avaliable for Brucellae. The aim of this study was to investigate the in vitro efficacy of various traditional and new antibiotic combinations against 16 Brucella melitensis strains. The combination effect of antimicrobial agents was evaluated by E-test synergy method to obtain a fractional inhibitory concentration (FIC) index. Co-Trimoxazole (SXT) and moxifloxocin (MXF) exhibited the lowest MIC, while Rifampin (RIF) had the highest MIC in the study. Combinations with RIF showed the best synergistic activity (100% of RIF-tetracycline (TET), and 87.5% of RIF-SXT). Synergistic activity was also detected at seven (43.7%) of ciprofloxocin (CIP)-SXT, four (25%) of TET-MXF, and two (12.5%) of TET-SXT combinations. The combinations that demonstrated additivity were TET-SXT, CIP-SXT and TET-MXF. Antagonism was observed only with the TET-Streptomycin (STR) combination in three strains (18.8%). Further work including randomized controlled clinical trials is required to fully evaluate the usefulness of these data.
O tratamento da brucelose é problemático devido à alta freqüência de tratamentos mal sucedidos e recidivas. Por tratar-se de um patógeno intracelular, o tratamento requer procedimentos combinados. Entretanto, existem poucos dados sobre combinações in vitro para Brucellae. O objetivo deste trabalho foi investigar a eficiência de vários tratamentos tradicionais e novas combinações de antibióticos contra 16 isolados de Brucella melitensis. O efeito combinado foi avaliado através do método do E-test para obtenção do FIC (índice de concentração inibitória fracional). Co-trimoxazol (SXT) e moxifloxocina (MXF) apresentaram o MIC mais baixo, enquanto rifampicina (RIF) apresentou o MIC mais alto. Combinações com RIF mostraram a melhor atividade sinergística (100% para RIF-tetraciclina e 87,5% para RIF-SXT). Atividade sinergística foi também detectada para sete (43,7%) combinações de ciprofloxacina (CIP-STX), quatro (25%) de TET-MXF e duas (12,5%) de TET-SXT. As combinações que apresentaram efeito aditivo foram TET-SXT, CIP-SXT e TET-MXF. Antagonismo foi observado somente para a combinação TET-estreptomicina (STR) em três isolados (18,8%). Mais pesquisas utilizando ensaios clínicos randomizados controlados são necessárias para avaliar a utilidade desses dados.
ABSTRACT
The treatment of brucellosis is still problematic, because of high rates of treatment failure or relapses. As the microorganism is an intracellular pathogen, treatment requires combined regimens. However, limited existing data on in vitro combinations are avaliable for Brucellae. The aim of this study was to investigate the in vitro efficacy of various traditional and new antibiotic combinations against 16 Brucella melitensis strains. The combination effect of antimicrobial agents was evaluated by E-test synergy method to obtain a fractional inhibitory concentration (FIC) index. Co-Trimoxazole (SXT) and moxifloxocin (MXF) exhibited the lowest MIC, while Rifampin (RIF) had the highest MIC in the study. Combinations with RIF showed the best synergistic activity (100% of RIF-tetracycline (TET), and 87.5% of RIF-SXT). Synergistic activity was also detected at seven (43.7%) of ciprofloxocin (CIP)-SXT, four (25%) of TET-MXF, and two (12.5%) of TET-SXT combinations. The combinations that demonstrated additivity were TET-SXT, CIP-SXT and TET-MXF. Antagonism was observed only with the TET-Streptomycin (STR) combination in three strains (18.8%). Further work including randomized controlled clinical trials is required to fully evaluate the usefulness of these data.
ABSTRACT
The treatment of brucellosis is still problematic, because of high rates of treatment failure or relapses. As the microorganism is an intracellular pathogen, treatment requires combined regimens. However, limited existing data on in vitro combinations are avaliable for Brucellae. The aim of this study was to investigate the in vitro efficacy of various traditional and new antibiotic combinations against 16 Brucella melitensis strains. The combination effect of antimicrobial agents was evaluated by E-test synergy method to obtain a fractional inhibitory concentration (FIC) index. Co-Trimoxazole (SXT) and moxifloxocin (MXF) exhibited the lowest MIC, while Rifampin (RIF) had the highest MIC in the study. Combinations with RIF showed the best synergistic activity (100% of RIF-tetracycline (TET), and 87.5% of RIF-SXT). Synergistic activity was also detected at seven (43.7%) of ciprofloxocin (CIP)-SXT, four (25%) of TET-MXF, and two (12.5%) of TET-SXT combinations. The combinations that demonstrated additivity were TET-SXT, CIP-SXT and TET-MXF. Antagonism was observed only with the TET-Streptomycin (STR) combination in three strains (18.8%). Further work including randomized controlled clinical trials is required to fully evaluate the usefulness of these data.
O tratamento da brucelose é problemático devido à alta freqüência de tratamentos mal sucedidos e recidivas. Por tratar-se de um patógeno intracelular, o tratamento requer procedimentos combinados. Entretanto, existem poucos dados sobre combinações in vitro para Brucellae. O objetivo deste trabalho foi investigar a eficiência de vários tratamentos tradicionais e novas combinações de antibióticos contra 16 isolados de Brucella melitensis. O efeito combinado foi avaliado através do método do E-test para obtenção do FIC (índice de concentração inibitória fracional). Co-trimoxazol (SXT) e moxifloxocina (MXF) apresentaram o MIC mais baixo, enquanto rifampicina (RIF) apresentou o MIC mais alto. Combinações com RIF mostraram a melhor atividade sinergística (100% para RIF-tetraciclina e 87,5% para RIF-SXT). Atividade sinergística foi também detectada para sete (43,7%) combinações de ciprofloxacina (CIP-STX), quatro (25%) de TET-MXF e duas (12,5%) de TET-SXT. As combinações que apresentaram efeito aditivo foram TET-SXT, CIP-SXT e TET-MXF. Antagonismo foi observado somente para a combinação TET-estreptomicina (STR) em três isolados (18,8%). Mais pesquisas utilizando ensaios clínicos randomizados controlados são necessárias para avaliar a utilidade desses dados.
ABSTRACT
Brucellosis is a multisystemic disease that rarely leads to a fatal outcome. While reticuloendothelial system organs are mostly affected, peritonitis and posthepatitic cirrhosis are also complications of brucellosis, though they are very rare. Brucella spp. can also trigger immunological reactions. We report a case of brucellosis with peritonitis, renal failure and leucocytoclastic vasculitis caused by Brucella melitensis, which led to a fatal outcome. Brucellosis should be considered in the differential diagnosis of vasculitic diseases, especially in endemic areas.
Subject(s)
Brucella melitensis/isolation & purification , Brucellosis/complications , Peritonitis/microbiology , Renal Insufficiency/microbiology , Vasculitis, Leukocytoclastic, Cutaneous/microbiology , Anti-Bacterial Agents/therapeutic use , Brucellosis/drug therapy , Fatal Outcome , Female , Humans , Male , Middle Aged , Peritonitis/drug therapy , Severity of Illness Index , Vasculitis, Leukocytoclastic, Cutaneous/drug therapyABSTRACT
Brucellosis is a multisystemic disease that rarely leads to a fatal outcome. While reticuloendothelial system organs are mostly affected, peritonitis and posthepatitic cirrhosis are also complications of brucellosis, though they are very rare. Brucella spp. can also trigger immunological reactions. We report a case of brucellosis with peritonitis, renal failure and leucocytoclastic vasculitis caused by Brucella melitensis, which led to a fatal outcome. Brucellosis should be considered in the differential diagnosis of vasculitic diseases, especially in endemic areas.