Effects of COVID-19 on brain and cerebellum: a voxel based morphometrical analysis.

OBJECTIVE: COVID-19 is caused by SARS-CoV-2 virus and turned into a pandemic in a short time, affects many organs and systems, especially the nervous system. In the present study, it was aimed to determine the morphological and volumetric changes in cortical and subcortical structures in recovered COVID-19 patients. BACKGROUND: We think that COVID-19 has a long-term effect on cortical and subcortical structures. METHODS: In our study, 50 post-COVID-19 patients and 50 healthy volunteers participated. In both groups, brain parcellations were made with Voxel-Based Morphometry (VBM) and regions showing density changes in the brain and cerebellum were determined. Gray matter (GM), white matter, cerebrospinal fluid and total intracranial volume were calculated. RESULTS: Neurological symptoms developed in 80% of COVID-19 patients. In post-COVID-19 patients, a decrease in GM density was detected in pons, gyrus frontalis inferior, gyri orbitales, gyrus rectus, gyrus cinguli, lobus parietalis, gyrus supramarginalis, gyrus angularis, hippocampus, lobulus semilunaris superior of cerebellum, declive, and Brodmann area 7-11-39-40. There was a significant decrease in GM density in these regions and an increase in GM density in amygdala (p<0.001). The GM volume of post-COVID-19 group was found to be less than in the healthy group. CONCLUSIONS: As a result, it was seen that COVID-19 negatively affected many structures related to the nervous system. This study is a pioneering study to determine the consequences of COVID-19, especially in the nervous system, and to determine the etiology of these possible problems (Tab. 4, Fig. 5, Ref. 25). Text in PDF www.elis.sk Keywords: COVID-19, pandemic, Voxel-based morphometry (VBM), brain, magnetic resonance imaging (MRI).

Brucellosis in pregnancy: results of multicenter ID-IRI study.

Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p = 0.019), nausea and/or vomiting (p < 0.001), vaginal bleeding (p < 0.001), anemia (blood hemoglobin < 11 g/dL; p < 0.001), high level of serum aspartate aminotransferase (> 41 IU/L; p = 0.025), oligohydramnios on ultrasonography (p = 0.0002), history of taking medication other than Brucella treatment during pregnancy (p = 0.027), and Brucella bacteremia (p = 0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study.

OBJECTIVE: Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes. METHODS: Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain. RESULTS: A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000-0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.3-2.7, p = 0.0001) were associated with diffuse inflammation. CONCLUSIONS: In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases.

BACKGROUND: Tuberculosis is a disease that can involve every organ system. While pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis (EPT) is also an important clinical problem. The current study aimed to outline and compare the demographic and clinical features of pulmonary and extrapulmonary tuberculosis cases in adults. METHODS: Medical records of 411 patients (190 women, 221 men) treated between January 2010 and July 2014 in provincial tuberculosis control dispensary was retrospectively reviewed. Demographic and clinical characteristics were compared for pulmonary and extrapulmonary tuberculosis cases. RESULTS: Of these 411 cases, 208 (50.6%) had pulmonary tuberculosis (PTB) and 203 were diagnosed with extrapulmonary tuberculosis (EPTB) (49.4%). The average ages for PTB and EPTB groups were 33.00-27.00 and 31.00-29.75, respectively (p = 0.513). Men were more frequently affected by PTB (59.6%), while EPTB was more commonly detected in women (52.2%) (p = 0.016). Main diagnostic modalities for PTB were sputum/smear analyses (72.7%), clinical-radiological data (21.7%) and biopsy (6.1%); while biopsy (71.5%), sputum/fluid analysis (18.8%) and clinical-radiological data (4.9%) were used for confirming EPTB (p < 0.0019). The most common sites of EPTB involvement were lymph nodes (39.4%), followed by pleura (23.6%), peritoneum (9.9%) and bone (7.4%). CONCLUSIONS: Extrapulmonary involvement of tuberculosis is common and females are more likely to be affected. Increased clinical awareness is important since atypical presentations of the disease may constitute diagnostic and therapeutic challenges.

Asymmetric dimethylarginine levels in patients with cutaneous anthrax: a laboratory analysis.

BACKGROUND: Asymmetric dimethylarginine (ADMA), the main endogenous inhibitor of nitric oxide synthase, is considered to be associated with endothelial dysfunction. High ADMA levels have been shown to be related with disorders causing vascular inflammation such as hypertension, hypercholesterolemia, atherosclerosis, chronic heart failure, stroke and sepsis. Cutaneous anthrax (CA) is a serious infectious disease which may cause vasculitis. The aim of the study was to investigate the serum ADMA levels in patients with CA. METHODS: A total of 35 serum samples of the patients with CA and 18 control sera were tested for ADMA levels using ADMA ELISA kit (Immunodiagnostik AG, Bensheim, Germany). RESULTS: ADMA levels were found to be significantly higher in the patients group than the controls (p < 0.001). In addition, ADMA levels were found to be positively associated with sedimentation rates (R = 0.413; p = 0.026), and inversely associated with international normalized ratio (INR) levels (R = -0.46; p = 0.011). A cut-off value of 0.475 of ADMA had a sensitivity of 74.3%, specificity of 77.8%, and accuracy of 75.5% in the diagnosis of CA. CONCLUSION: Although the exact mechanism still remains unclear, ADMA levels could be related to immune activation in CA. In addition, these data might suggest the higher ADMA levels in patients could be due to the perivascular inflammation and vasculitis in CA.

Serum adenosine deaminase activity in cutaneous anthrax.

BACKGROUND: Adenosine deaminase (ADA) activity has been discovered in several inflammatory conditions; however, there are no data associated with cutaneous anthrax. The aim of this study was to investigate serum ADA activity in patients with cutaneous anthrax. MATERIAL AND METHODS: Sixteen patients with cutaneous anthrax and 17 healthy controls were enrolled. We measured ADA activity; peripheral blood leukocyte, lymphocyte, neutrophil, and monocyte counts; erythrocyte sedimentation rate; and C reactive protein levels. RESULTS: Serum ADA activity was significantly higher in patients with cutaneous anthrax than in the controls (p<0.001). A positive correlation was observed between ADA activity and lymphocyte counts (r=0.589, p=0.021) in the patient group. CONCLUSIONS: This study suggests that serum ADA could be used as a biochemical marker in cutaneous anthrax.

Predictive Significance of Laboratory Tests in Bacteremic Brucellosis.

Background: Brucellosis is one of the most common zoonotic infections. Although culture is the gold standard diagnostic method, bacterial growth in blood cultures may not always occur due to various factors. We aimed to investigate demographic, clinical, and laboratory findings that may have predictive significance for bacteremia in brucellosis. Methods: Patients older than 18 years of age followed up with a diagnosis of brucellosis between 2012 and 2022 were included in this retrospective multicenter study. They were divided into two main subgroups according to their Brucella species reproductive status as bacteremic and non-bacteremic. Results: A total of 743 patients, 370 (49.80%) bacteremic and 373 (50.20%) non-bacteremic brucellosis patients, were enrolled. The mean age of the bacteremic group (36.74 years) was lower than the non-bacteremic group (43.18 yr). High fever, chills/cold, sweating, nausea, vomiting, and weight loss were more common in the bacteremic group. In the bacteremic group, white blood cell count, platelet count, hemoglobin level, mean platelet volume, eosinophil, and neutrophil counts were lower, and lymphocyte, erythrocyte sedimentation rate, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and ferritin levels were higher. According to the receiver operating characteristic (ROC) analysis, when the cut-off value of ferritin was considered 67, it was the parameter with the strongest predictive significance in Brucella bacteremia. Conclusion: High ferritin level, low eosinophil count, and increased erythrocyte sedimentation rate were determined as the most critical laboratory findings in predicting bacteremia in brucellosis.

[Evaluation of Colistin-Ampicillin/Sulbactam Combination Efficacy in Imipenem-Resistant Acinetobacter baumannii Strains]. / Imipeneme Dirençli Acinetobacter baumannii Izolatlarinda Kolistin-Ampisilin/Sulbaktam Kombinasyonu Etkinliginin Degerlendirilmesi.

The increasing emergence of multi-drug resistant Acinetobacter baumannii strains as nosocomial pathogens lead to the use of antimicrobial combinations in the treatment of infections due to these bacteria. The aim of this study was to determine the MIC values of colistin and ampicillin/sulbactam and their in vitro synergistic activities by E-test in order to evaluate the effect of this combination against imipenem-resistant A.baumannii isolates. A total of 33 A.baumannii strains isolated from clinical specimens as etiologic agents of nosocomial infections and identified as imipenem-resistant were included in the study. Identification of the isolates was performed by conventional methods and their imipenem resistance was detected with BD Phoenix automated system (Becton Dickinson, USA). MIC values and in vitro synergistic activity of colistin and ampicillin/sulbactam combination were analyzed by E-test (AB Biodisk, Sweden) on Mueller-Hinton agar medium. Synergistic, additive, indifferent and antagonist effects of A.baumannii strains were evaluated by fractional inhibitory concentration (FIC) index. The combination was considered to be synergistic when the FIC index was ≤ 0.5, additive when it was 1- > 0.5 and antagonistic when ≥ 2. Of the 33 strains included in the study, 21 were resistant to colistin; 30 were resistant and 3 were moderately susceptible to ampicillin/sulbactam. MIC50 and MIC90 values and MIC range of A.baumannii strains for colistin were 8, 32 and 0.13-128 µg/ml; for ampicillin/sulbactam those values were 48, 256 and 12-256 µg/ml, respectively. According to the FIC indices, 15 strains showed synergistic, four additive, five indifferent and nine antagonistic activity to colistin and ampicillin/sulbactam combination. Among the 12 colistin-susceptible strains, nine showed antagonistic, two indifferent and one synergistic activity to the tested combination while among the 21 colistin-resistant strains 14 showed synergistic, four additive and three indifferent activity. As a result, the combination of colistin with ampicillin/sulbactam, demonstrated high synergistic activity in vitro. While the synergistic effect of this combination was more significant in colistin-resistant strains, antagonistic effect of colistin-susceptible strains was found to be notable. Therefore, colistin resistance should be primarily determined before using colistin and ampicillin/sulbactam combination in A.baumannii infections since this combination seemed to be more effective in case of colistin resistance. However, these data should be supported by further advanced clinical studies.

Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study.

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

Plasma Free Amino Acid Profile in HIV-Positive Cases.

BACKGROUND: Increasing the sensitivity and availability of liquid chromatography tandem mass spectrometry (LC-MS/MS) devices may provide advantages in terms of revealing the changes in metabolic pathways in HIV-positive patients and elucidating the physiopathology. INTRODUCTION: The aim of this study was to determine the difference in amino acid levels between HIV-positive patients and healthy individuals by using LC-MS / MS and investigate its relationship with HIV infection. MATERIAL AND METHODS: Concentrations of 36 different amino acids and their derivatives were measured and compared in venous plasma samples from 24 HIV-positive patients and 24 healthy individuals by using the LC-MS/MS method (Shimadzu North America, Columbia, MD, USA). RESULTS: HIV-positive subjects had significantly lower alanine, 1-methyl-L-histidine, valine, aspartate, cysteine, cystine, methionine, lysine, glutamine, imino acid, tyrosine, tryptophan, threonine, sarcosine, and argininosuccinic acid and significantly higher 3-methyl-L -histidine, asparagine, glutamate, and carnosine levels as compared to healthy controls. No significant differences were detected in other amino acids. CONCLUSION: The significant differences in amino acid profile between HIV-positive and healthy subjects may represent an auxiliary biomarker of cellular damage in asymptomatic HIV-positive patients that may be examined in more detail in further studies. It may also provide guidance for symptomatic cases in terms of the association between symptoms, clinical manifestations, and deficiency or excess of certain amino acids in the context of the complete metabolomics record of HIVpositive patients.

Brucellosis in pregnancy: a 6-year clinical analysis.

AIM: To review our experience with brucellosis in pregnancy and to characterize the risk factors, clinical presentations, the rates of possible perinatal complications, and the effect of hospitalization on pregnancy outcomes. METHODS: We reviewed the medical records of 21 pregnant women at a tertiary care hospital and 12 at a maternity hospital, who presented with acute, subacute, chronic, or relapsing brucellosis. Their risk factors and clinical presentations were defined. The reproductive outcomes of 29 cases were compared within themselves according to the hospitals they were managed and with the outcomes for all women followed in the maternity hospital for the period from January 2008 through December 2008. RESULTS: Consumption of unpasteurized dairy products had occurred in 92.3% of the cases. Spontaneous abortion, intrauterine fetal death, and preterm delivery rates were 24.14, 3.45, and 6.9%, respectively. Only spontaneous abortion rate substantially exceeded that among the general population of pregnant women in our maternity hospital (P<0.05). Hospitalization did not affect pregnancy outcomes significantly (P>0.05). CONCLUSIONS: Brucellosis in pregnancy is associated with increased incidence of spontaneous abortion without an association with the magnitude of serum agglutination titer, the clinical type of brucellosis and hospitalization. In endemic areas with inhabitants of low socioeconomic class and low educational level, educating women of childbearing age about brucellosis may help to prevent the disease and its complications in pregnancy.

Clinical characteristics and outcome of Brucella endocarditis.

Brucella endocarditis, a rare complication of brucellosis, is the main cause of death attributable to this disease. There are difficulties in the diagnosis and uncertainty regarding many aspects of the treatment of Brucella endocarditis. We retrospectively examined the clinical characteristics and outcome of patients diagnosed with Brucella endocarditis. Of the six patients diagnosed as having Brucella endocarditis, four had valvular disease, one had aortic and mitral mechanic valve prosthesis (AVR+MVR) and one had secundum type atrial septal defect. Transesophageal echocardiography showed vegetations in four patients. Blood culture grew Brucella mellitensis only in two patients. Standard agglutination tests were elevated in all patients (range 1/320-1/10240). Four patients were managed with combined antibiotherapy and surgery. One refused further treatment and one refused an operation and follow-up was lost for that patient. Two patients died during follow-up; one having had a previous AVR+MVR operation refused further treatment and the other suffering renal failure. Due to the fulminant course of the disease, treatment should be initiated when there is a clinical suspicion, even if the culture results are unknown or negative. Agglutination titres aid in the diagnosis. A combination of antibiotherapy and surgery seems to be preferable treatment modality.

[A meningitis case of Brucella and tuberculosis co-infection]. / Menenjitli bir olguda Brucella ve tüberküloz koenfeksiyonu.

Turkey is located at an endemic area for brusellosis and tuberculosis which are both important public health problems. Meningitis caused by Brucella and Mycobacterium spp. may be confused since the clinical and laboratory findings are similar. In this report, a meningitis case with Brucella and tuberculosis co-infection has been presented. A 19-years-old woman was admitted to our clinic with severe headache, fever, vomiting, meningeal irritation symptoms, confusion and diplopia. The patient was initially diagnosed as Brucella meningitis based on her history (stockbreeding, consuming raw milk products, clinical symptoms concordant to brucellosis lasting for 4-5 months), physical examination and laboratory findings of cerebrospinal fluid (CSF). Standard tube agglutination test for brucellosis was positive at 1/80 titer in CSF and at 1/640 titer in serum, whereas no growth of Brucella spp. was detected in CSF and blood cultures. Antibiotic therapy with ceftriaxone, rifampicin and doxycyclin was started, however, there was no clinical improvement and agitation and confusion of the patient continued by the end of second day of treatment. Repeated CSF examination yielded acid-fast bacteria. The patient was then diagnosed as meningitis with double etiology and the therapy was changed to ceftriaxone, streptomycin, morphozinamide, rifampicin and isoniazid for thirty days. Tuberculosis meningitis was confirmed with the growth of Mycobacterium tuberculosis on the 14th day of cultivation (BACTEC, Becton Dickinson, USA) of the CSF sample. On the 30th day of treatment she was discharged on anti-tuberculous treatment with isoniazid and rifampicin for 12 months. The follow-up of the patient on the first and third months of treatment revealed clinical and laboratory improvement. Since this was a rare case of Brucella and tuberculosis co-infection, this report emphasizes that such co-infections should be kept in mind especially in the endemic areas for tuberculosis and brucellosis.

Brucellosis and uveitis.

A 30-year-old-lady, (Case 1) was found to have brucella uveitis in her left eye. Serum agglutination (SAT) and SAT/Coombs titers were positive at 1:320 and 1:160, respectively. In Case 2, a 12-year-old-girl diagnosis of left brucellosis uveitis was made. Both SAT and SAT/Coombs titers were positive at 1:1280. This report confirms that Brucellae organisms as a cause of uveitis.

Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study.

This multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.

Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study.

AIM: Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. METHODS: The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). RESULTS: A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. CONCLUSIONS: Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.

Seroprevalence of human fascioliasis in Van province, Turkey.

BACKGROUND/AIMS: Fasciola hepatica is a rare zoonotic parasite that infects the liver of many mammals including humans. The aim of this study was to determine the seroprevalence of fascioliasis in Van province by ELISA (antibody detection) on the assumption that not all cases could be detected by stool examination alone. MATERIALS AND METHODS: A total of randomly selected 1,600 patients, directed from affiliated outpatient clinics to Yüzüncü Yil University Medical Faculty Parasitology Laboratory, were enrolled in the study. Their mean age was 44.44±19.00 years. Blood samples were collected from all the patients, and their stool samples were examined. For the stool examination, native-lugol and sedimentation (in formalin-ethyl acetate) methods were employed. ELISA for F. hepatica was performed on the blood samples from all patients. Seropositive patients were treated with triclabendazole. RESULTS: F. hepatica was detected by ELISA in 89 (5.6%) of the 1,600 patients, but eggs were identified on the stool examination in only 29 (1.8%) patients. The prevalence of F. hepatica was higher in females (7.2%) than in males (4.2%) and was higher in the ≥36-year age group (6.7%) than in the ≤35-year age group (4.4%). Abdominal pain (93.3%), fatigue (88.8%), and weight loss (69.7%) were the most common symptoms. Eosinophilia was present in 89.9% of the patients. All seropositive patients had a history of eating raw aquatic plants. CONCLUSION: Stool examination alone is not sufficient to diagnose F. hepatica. Serological tests such as ELISA must be used together with stool examination.

Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: a multicenter retrospective analysis.

OBJECTIVES: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A). MATERIALS AND METHODS: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. PRIMARY END-POINT: 14-day mortality. SECONDARY END-POINTS: Microbial eradication and clinical improvement. RESULTS: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 ± 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. CONCLUSION: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

Tuberculous and brucellosis meningitis differential diagnosis.

BACKGROUND: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM. METHOD: BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups. RESULTS: The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently. CONCLUSIONS: When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries.

Cutaneous manifestations of anthrax in Eastern Anatolia: a review of 39 cases.

Anthrax is essentially a disease of grazing herbivorous animals. The most common form of the disease is cutaneous anthrax, which accounts for 95% of all cases. We report here 39 cutaneous anthrax cases in humans that were seen in Eastern Anatolia over a six-year period. The clinical presentation was malignant edema in 16 of the cases (41%) and malignant pustule in 23 (59%). A secondary bacterial infection was present in 13 patients (33.3%) in the vicinity of the lesions. The agent was observed using Gram-stained smears in 25 patients (64%), and Bacillus anthracis was isolated from 15 patients (38.5%). All of the patients were treated with penicillin G or penicillin procaine, except one patient who had a penicillin allergy. One patient with cervical edema (2.5%) died as a result of laryngeal edema and sepsis syndrome. In conclusion, we found that the appearance of the skin lesion of cutaneous anthrax may vary, and this fact, combined with the rarity of this disease, which contributes to a general lack of experience among medical personnel, may make diagnosis difficult in nonagricultural settings