[Retrospective evaluation of the cases with Candida famata fungemia in a burn unit]. / Yanik ünitesinde Candida famata fungemisi gelisen olgularin retrospektif olarak degerlendirilmesi.

The prevalence of fungemia due to non-albicans Candida species is increasing currently. However, there is no reported case of fungemia due to Candida famata in a burn unit. This retrospective study was aimed to evaluate the clinical and laboratory characteristics and outcomes of seven burn patients with fungemia due to C. famata. The study included a total of 410 burn patients followed-up during January 2003-January 2006. Six of the patients (85.7%) were males and one was female (14.3%), with a mean age of 22.2 years. Mean total body surface area of the burns was 39.2% (24%-64%), flame being the most frequent cause of the burns (n= 4), followed by hot water (n= 2) and electroshock (n= 1). Six of the cases had central venous catheter and in 5 of these catheter-associated bacteremia had developed before the establishment of candidemia. Pseudomonas aeruginosa (n= 5) was the most frequent cause of bacteremia; Escherichia coil being isolated from a patient with urinary tract infection and methicillin-resistant Staphylococcus aureus from a patient with wound infection. All patients had received treatment with systemic antibiotics prior to the development of the C. famata episode. C. famata was detected from the blood cultures of the patients, however, the wound swabs were negative in terms of C. famata growth. The isolates were defined according to their negative germ tube test and their carbohydrate assimilation profile in API 20 C AUX (BioMerieux, France). Since the environmental cultures yielded negative results for C. famata, the infections were thought to be derived from cross contamination. Once a positive blood culture for C. famata was obtained, the catheter was removed, and treatment with liposomal amphotericin-B was implemented. Presence of a central venous catheter and prior antibiotic therapy seem to be the predisposing factors in the development of fungemia due to C. famata. Thus, when fungemia due to C. famata is established, central venous catheter should be removed and amphotericin-B therapy should be implemented promptly.

[Retrospective evaluation of 15 cases with psoas abscesses]. / Psoas apsesi olan 15 hastanin retrospektif olarak degerlendirilmesi.

Psoas abscesses are suppurative collections within the fascia surrounding the psoas and iliacus muscles. In this retrospective study it was aimed to evaluate the demographic characteristics, clinical and laboratory findings and treatment outcomes of 15 psoas abscess cases admitted to Baskent University Hospital, Ankara, Turkey during June 2003-January 2008 period. The mean age of the patients was 55.8 years (range 18 to 70 years) with a female to male ratio of 5/10. Thirteen of the cases (86.5%) were admitted with the complaints of fever and back pain. Thirteen of the cases were diagnosed by abdominal computerized tomography while the other two by abdominal ultrasonography. One of the 15 patients was considered as primary psoas abscess, while the remaining 14 as secondary psoas abscess. The most common accompanying disease was diabetes mellitus (66.6%). Fourteen patients with secondary psoas abscess had vertebral osteomyelitis which was due to tuberculosis in five cases, to urinary tract infection in five cases, to pneumoniae in two cases, to surgical infection in one case and to brucellosis in one case. The cultivation of the abscess material from the 14 secondary psoas abscess cases revealed growth of bacteria in 11 of them (5 Mycobacterium tuberculosis, 1 Escherichia coli, 1 methicillin-sensitive Staphylococcus aureus, 1 methicilin-resistant S. aureus, 1 Acinetobacter baumannii, 1 Brucella melitensis, 1 Serratia marcescens). The biochemical parameters of the cases (mean leukocyte counts: 14.500 cell/mm3; mean erythrocyte sedimentation rates: 78 mm/hour; mean C-reactive protein levels: 108 mg/dl) were also high. Thirteen patients underwent percutaneous drainage and received appropriate antibiotic treatment and the other two patients were treated with open surgical debridement. The duration of antimicrobial treatment was one year for M. tuberculosis cases and about 4-6 weeks in the others. One of the cases died due to complicating meningitis and sepsis. It is remarkable that in our series none of the psoas abscess cases were secondary to the diseases of the digestive tract unlike the series indicated in the literature. The isolation of M. tuberculosis as the causative agent in 5 (33.3%) cases emphasizes the fact that tuberculosis is still an important public health problem in Turkey.

Eleven cases of mucormycosis with atypical clinical manifestations in diabetic patients.

OBJECTIVE: We retrospectively investigated 11 cases of mucormycosis with atypical clinical features accompanied by diabetes mellitus and discussed clinical features, results of laboratory investigations and radiological examinations and treatment outcomes of each case. METHODS: Eleven cases of mucormycosis presenting to our clinic between January 2002 and October 2006 were retrospectively investigated. RESULTS: We will present a total of 11 cases of mucormycosis, including 2 cases of mucormycosis with orbital apex syndrome as an initial sign, 2 cases of mucormycosis involving the carotid artery and cavernous sinus with the resultant fatal stroke, 1 case of disseminated mucormycosis with atypical clinical manifestations. Mucormycosis was accompanied by type II diabetes mellitus in five cases, chronic renal failure and type II diabetes mellitus in four cases and type II diabetes mellitus and chronic myelocytic leukemia in two cases. None of them had diabetic ketoacidosis. Only one patient recovered but with sequels: blindness, complete ophthalmoplegia of the right eye. Ten patients died of mucormycosis. CONCLUSION: In fact, mucormycosis is a fungal infection which may involve all organs and systems. Mucormycosis must be considered in patients presenting with orbital or preorbital sellulitis, even in the absence of ketoacidosis as in our cases.

[Brucellosis: retrospective evaluation of the clinical, laboratory and epidemiological features of 151 cases]. / Bruselloz: 151 olgunun klinik, laboratuvar ve epidemiyolojik özelliklerinin retrospektif degerlendirilmesi.

The aim of this study was to retrospectively evaluate the clinical and laboratory characteristics, complications and treatment oucomes of 151 brucellosis cases (age range: 15-79 years; 89 female), who were followed in our clinic between the period of January 2003-July 2005. Of them, 66.2% were diagnosed as acute, 23.8% as subacute and 9.9% as chronic brucellosis. Risk factors were detected as consumption of unpasteurized milk and diary products (80%), stock-breeding (14%) and risky profession such as veterinary, laboratory technician and butcher (3.3%). Most common complaints were arthralgia (87.4%), malaise (86%), fever (79.5%), sweating (78%), and waist pain (71%). In view of laboratory findings, increased erytrocyte sedimentation rate was detected in 61.6%, C-reactive protein positivity in 60%, lymphomonocytosis in 44.4% and anemia in 51.7% of them. Blood cultures were performed from 125 of the patients, and 64 (51.2%) of them yielded Brucella spp. The other specimens in which bacterial growth were detected in one of each, were bone marrow, sternoclavicular joint, psoas abscess, urine and pleural fluid. Standard tube agglutination (STA) test was found negative in 1.3% of patients who were culture positive, while it was positive at 1/160 titer in 20.5%, at 1/320 in 14%, at 1/640 in 14.6% and > or = 1/1280 in 49.7 percent. The most common complication was found as musculo-skeletal system involvement (30 spondylodiscitis, 15 sacroileitis, five peripheric arthritis, one tendinitis) with a rate of 33.7 percent. Other complications were nervous system involvement in 6% (two acute and seven chronic meningitis), genitourinary involvement in 5.3% (five epididymo-orchitis, two prostatitis, one with Brucella positive urine culture), peritonitis in 0.6% and skin involvement in 0.6 percent. Seven different therapy protocols were applied to the patients according to complications and case specialty, however doxycycline+rifampicin combination during six weeks was the most preferred one. Relapse and unresponsiveness to the therapy were detected in 8% and 2% of the cases, respectively. Gastrointestinal intolerance was found as the most common side effect. In conclusion, since brucellosis which is endemic in Turkey, displays diagnostic difficulties due to the various clinical presentations and leads to labor loss due to serious complications, it should be considered in the differential diagnosis of numerous diseases.

Abducens nerve palsy and optic neuritis as initial manifestation in brucellosis.

Cranial nerve involvement in brucellosis is rare. We present a case of brucellosis presenting with optic neuritis and abducens nerve palsy on the left side. Cerebrospinal fluid findings indicated Brucella meningitis with high protein count, low sugar level and pleocystosis. In addition, Brucella agglutination test (Wright test) was found to be 1/128 in cerebrospinal fluid. Serum agglutination test for Brucella was also positive at 1/1280. This case was diagnosed as brucellosis involving optic and abducens nerves. The patient was treated by ceftriaxone (intravenous), rifampicin (orally) and doxycycline (orally). Two months later the patient's vision acuity in the left eye had moderately improved and the patient's left abducens palsy had almost disappeared. In conclusion, cranial nerve involvement in brucellosis can have good prognosis if anti-Brucella treatment is undertaken early.