RESUMO
AIMS: The differential diagnosis of Fever of Unknown Origin (FUO) is still a major clinical challenge despite the advances in diagnostic procedures. In this multicentre study, we aimed to reveal FUO aetiology and factors influencing the final diagnosis of FUO in Turkey. METHODS: A total of 214 patients with FUO between the years 2015 and 2019 from 13 tertiary training and research hospitals were retrospectively evaluated. RESULTS: The etiologic distribution of FUO was infections (44.9%), malignancies (15.42%), autoimmune/inflammatory (11.68%) diseases, miscellaneous diseases (8.41%) and undiagnosed cases (19.62%). Brucellosis (10.25%), extrapulmonary tuberculosis (6.54%) and infective endocarditis (6.54%) were the most frequent three infective causes. Solid malignancies (7.1%) and lymphoma (5.6%), adult-onset still's disease (6.07%) and thyroiditis (5.14%) were other frequent diseases. The aetiological spectrum did not differ in elderly people (P < .05). Infections were less frequent in Western (34.62%) compared with Eastern regions of Turkey (60.71%) (P < .001, OR: 0.31, 95% Cl: 0.19 to 0.60). The ratio of undiagnosed aetiology was significantly higher in elderly people (p: 0.046, OR: 2.34, 95% Cl: 1.00 to 5.48) and significantly lower in Western Turkey (P: .004, OR: 3.07, 95% Cl: 1.39 to 6.71). CONCLUSIONS: Brucellosis, extrapulmonary tuberculosis and infective endocarditis remain to be the most frequent infective causes of FUO in Turkey. Solid tumours and lymphomas, AOSD and thyroiditis are the other common diseases. The aetiological spectrum did not differ in elderly people, on the other hand, infections were more common in Eastern Turkey. A considerable amount of aetiology remained undiagnosed despite the state-of-the-art technology in healthcare services.
Assuntos
Febre de Causa Desconhecida , Doença de Still de Início Tardio , Adulto , Idoso , Ásia , Febre de Causa Desconhecida/epidemiologia , Febre de Causa Desconhecida/etiologia , Humanos , Estudos Retrospectivos , Turquia/epidemiologiaRESUMO
OBJECTIVE: Helicobacter pylori (Hp) eradication therapy is crucial for preventing the development of gastritis, peptic ulcers, and gastric cancer. An increase in resistance against antibiotics used in the eradication of Hp is remarkable. This meta-analysis aims to examine the resistance rates of Hp strains isolated in Turkey over the last 20 years against clarithromycin (CLR), metronidazole (MTZ), levofloxacin (LVX), tetracycline (TET), and amoxicillin (AMX) antibiotics. BASIC METHODS: Literature search was carried out in electronic databases, by searching articles published in Turkish and English with the keywords ' helicobacter pylori ' or 'Hp' and 'antibiotic resistance' and 'Turkey'. That meta-analysis was carried out using random-effect model. First, the 20-year period data between 2002 and 2021 in Turkey were planned to be analyzed. As a second stage, the period between 2002 and 2011 was classified as Group 1, and the period between 2012 and 2021 as Group 2 for analysis, with the objective of revealing the 10-year temporal variation in antibiotic resistance rates. MAIN RESULTS: In gastric biopsy specimens, 34 data from 29 studies were included in the analysis. Between 2002-2021, CLR resistance rate was 30.9% (95% CI: 25.9-36.2) in 2615 Hp strains. Specifically, in Group 1, the CLR resistance rate was 31% in 1912 strains, and in Group 2, it was 30.7% in 703 strains. The MTZ resistance rate was found to be 31.9% (95% CI: 19.8-45.4) in 789 strains, with rates of 21.5% in Group 1 and 46.6% in Group 2. The overall LVX resistance rate was 25.6%, with rates of 26.9% in Group 1 and 24.8% in Group 2. The 20-year TET resistance rate was 0.8%, with 1.50% in Group 1 and 0.2% in Group 2. The overall AMX resistance rate was 2.9%, 3.8% between 2002-2011, and 1.4% between 2012-2021. PRINCIPAL CONCLUSION: Hp strains in Turkey exhibit high resistance rates due to frequent use of CLR, MTZ, and LVX antibiotics. However, a significant decrease has been observed in TET and AMX resistance to Hp in the last 10 years. Considering the CLR resistance rate surpasses 20%, we suggest reconsidering the use of conventional triple drug therapy as a first-line treatment. Instead, we recommend bismuth-containing quadruple therapy or sequential therapies (without bismuth) for first-line treatment, given the lower rates of TET and AMX resistance. Regimens containing a combination of AMX, CLR, and MTZ should be given priority in second-line therapy. Finally, in centers offering culture and antibiogram opportunities, regulating the Hp eradication treatment based on the antibiogram results is obviously more appropriate.
Assuntos
Gastrite , Infecções por Helicobacter , Helicobacter pylori , Humanos , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Bismuto/farmacologia , Bismuto/uso terapêutico , Turquia/epidemiologia , Antibacterianos , Amoxicilina/uso terapêutico , Claritromicina/farmacologia , Claritromicina/uso terapêutico , Metronidazol/uso terapêutico , Tetraciclina/uso terapêutico , Resistência Microbiana a Medicamentos , Levofloxacino/uso terapêutico , Gastrite/tratamento farmacológicoRESUMO
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.
Assuntos
Antibacterianos/administração & dosagem , Brucella/efeitos dos fármacos , Brucelose/tratamento farmacológico , Meningite/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Brucella/crescimento & desenvolvimento , Brucelose/microbiologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Injeções Intravenosas , Masculino , Meningite/microbiologia , Meningoencefalite/tratamento farmacológico , Meningoencefalite/microbiologia , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Falha de Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , TurquiaRESUMO
OBJECTIVE: The prevalence of Pseudomonas aeruginosa has remained stable in recent years, and resistant strains has increased dramatically. In this meta-analysis, we aimed to analyze the P. aeruginosa strains isolated from blood cultures in Turkey during the last 11 years and to reveal their antimicrobial susceptibility. METHODS: Data collected between 2007 and 2017 were divided into two groups as Group-1; 2007-2011 and Group-2; 2012-2017. The differences in antibiotic resistance rates between Group-1 and Group-2 were analyzed. The study data were included according to PRISMA criteria, then meta-analysis was performed. RESULTS: A total of 30 study data from 25 studies were included in the study. The prevalence rate of meropenem (MEM) resistance in P. aeruginosa in Turkey was 25.1% (95% Cl: 20.65-29.83) according to a meta-analysis of 637 isolates. MEM resistance rates in Group-1 and Group-2 were 23.4% (95% Cl: 18.34-28.99) and 29.3% (95% Cl: 21.23-38.23), respectively. The prevalence rate of imipenem (IMP) resistance in P. aeruginosa in Turkey was 26.8% (%95 Cl: 23.40-30.35) according to a meta-analysis of 1421 isolates. IMP resistance rates in Group-1 and Group-2 were 26.2% (95% Cl: 22.41-30.27) and 28.4% (95% Cl: 21.57-35.88), respectively. Ciprofloxacin (CIP) resistance rate was 27.04% (95% Cl: 21.88-32.52) in 1388 isolates. CIP resistance rates in Group-1 and Group-2 were 30.8% (95% Cl: 24.35-37.56) and 18.6% (95% Cl: 10.72-28.11), respectively. The prevalence rate of piperacillin-tazobactam (TZP) resistance in P. aeruginosa in Turkey was 29.2% (95% Cl: 21.058-38.088) according to a meta-analysis of 1030 isolates. TZP resistance rates in Group-1 and Group-2 were 26.1% (95% Cl: 17.76-35.31) and 38.2% (95% Cl: 18.48-60.27), respectively. CONCLUSION: There is a remarkable increase in resistance rates in P. aeruginosa to MEM and TZP in Turkey due to frequent use. Other antibiotics with antipseudomonal effect should be prioritized in the treatment of these infections.
RESUMO
The purpose of this study was to investigate the intra-assay correlations amongst initial reactive and repeat screening results used in enzyme immunoassays (EIAs) for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV in blood donors. This study evaluated the value of using the power of the signal to cut-off (S/CO) ratio index for confirming anti-HCV/HIV reactive screening results, thereby touching upon the utility of S/CO indices in determining whether further confirmatory testing was necessary. Screening test results of the 72,695 blood donors were evaluated over a 1-year period. Correlation analysis among each initial test and retests was done by Pearson r test. Appropriate S/CO values to determine the need of the confirmation testing was investigated by ROC analyses. EIA intra-assay correlations were of statistical significance and were determined as follows: 0.948 for anti-HCV, 0.827 for anti-HIV and 0.948 for HBsAg. The threshold S/CO ratio values which predicted more than 95% of the confirmation test result were 3.8 for HCV and 5.6 for HIV. We were able to demonstrate a strong level of intra-assay correlation amongst EIAs, thereby eliminating the need for repetition of the screening test. Hence, we suggest that repeat screening should only be limited to HBV and HIV tests with low EIA S/CO ratios. Thus, using the power of the S/CO ratio in determining the need for HCV confirmation testing can be a cost-effective measure, especially if the S/CO value is >or=3.8.
Assuntos
Algoritmos , Doadores de Sangue , Infecções por HIV/diagnóstico , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Técnicas Imunoenzimáticas , Programas de Rastreamento , Doadores de Sangue/psicologia , Doadores de Sangue/estatística & dados numéricos , Análise Custo-Benefício , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Anticorpos Anti-HIV/sangue , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , HIV-1/imunologia , HIV-2/imunologia , Hepatite B/sangue , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Antígenos de Superfície da Hepatite B/sangue , Hepatite C/sangue , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Anticorpos Anti-Hepatite C/sangue , Humanos , Técnicas Imunoenzimáticas/economia , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , TurquiaRESUMO
Meningococcal infections may develop as episodic or endemic cases particularly among children attending day-care centers, boarding schools or among military personnel. Bivalent (A/C) meningococcal vaccine is applied to all new military stuff since 1993 in Turkey. In this report two cases of meningococcemia and meningitis, developed in two soldiers vaccinated with meningococcal vaccine, were presented. The first case was a 21 years old male patient who was admitted to the emergency service with the complaints of high fever, headache, fatigue and vomiting. He was conscious, cooperative and oriented with normal neurological findings. Maculopapular exanthems were detected at the lower extremities. The patient was hospitalized with the initial diagnosis of sepsis or meningococcemia and empirical treatment was initiated with ceftriaxone and dexamethasone. Cerebrospinal fluid (CSF) examination yielded 10 cells/mm3 (lymphocytes) with normal CSF biochemical parameters. A few hours later skin rashes spread over the body rapidly, the symptoms got worse, confusion, disorientation and disorientation developed, and the patient died due to cardiac and respiratory arrest at the seventh hour of his admission. The second case was also a 21 years old male patient who was admitted to the hospital with the complaints of fever, headache, painful urination, confusion and agitation. He was initially diagnosed as acute bacterial meningitis due to clinical (stiff neck, positive Kernig and Brudzinsky signs) and CSF (8000 cells/mm3; 80% polymorphonuclear leukocytes, increased protein and decreased glucose levels) findings. Empirical antibiotic therapy with ceftriaxone was initiated and continued for 14 days. The patient was discharged with complete cure and no complication was detected in his follow-up visit after two months. The first case had an history of vaccination with bivalent (A/C) meningococcal vaccine three months ago and the second case had been vaccinated one month ago. The bacteria isolated from the blood culture of the first case and the CFS culture of the second case, were identified as Neisseria meningitidis by conventional and API NH system (BioMerieux, France). The isolates were serogrouped as W135 by slide agglutination method (Difco, USA), and both were found to be susceptible to penicillin and ceftriaxone. As far as the last decade's literature and these two cases were considered, it might be concluded that N.meningitidis W135 strains which were not included in the current bivalent meningococcal vaccine, gained endemic potential in Turkey. Since N.meningitidis W135 strains may lead to serious diseases, vaccination of the risk population with the conjugate tetravalent meningococcal vaccine (A/C/Y/W135) should be taken into consideration in Turkey.
Assuntos
Bacteriemia/microbiologia , Meningite Meningocócica/microbiologia , Infecções Meningocócicas/microbiologia , Vacinas Meningocócicas/administração & dosagem , Neisseria meningitidis Sorogrupo W-135/isolamento & purificação , Testes de Aglutinação , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/imunologia , Ceftriaxona/farmacologia , Ceftriaxona/uso terapêutico , Dexametasona/uso terapêutico , Evolução Fatal , Humanos , Masculino , Meningite Meningocócica/tratamento farmacológico , Meningite Meningocócica/imunologia , Infecções Meningocócicas/tratamento farmacológico , Infecções Meningocócicas/imunologia , Vacinas Meningocócicas/imunologia , Vacinas Meningocócicas/normas , Militares , Neisseria meningitidis Sorogrupo W-135/efeitos dos fármacos , Neisseria meningitidis Sorogrupo W-135/imunologia , Penicilinas/farmacologia , Sorotipagem/métodos , Turquia , Vacinação/normas , Adulto JovemRESUMO
OBJECTIVE: To determine the clinical characteristics of patients with cystic echinococcosis and the diagnostic and therapeutic approaches used. METHODS: This is a multicentre, retrospective study. Patients from six centres who were diagnosed with hydatid cysts in the last five years were evaluated. RESULTS: The mean age was 45.4±17.4 years, and 54.7% were female. The most common complaints were abdominal pain, nausea and vomiting, and the most common physical examination finding was abdominal tenderness. Most patients were diagnosed within 2-6 months. Anaemia and eosinophilia were the most common laboratory findings. The liver was the most commonly involved organ (n=153, 90%). One hundred twenty-five (73.5%) patients underwent ultrasonography. The largest cyst was present in the liver at stage four, and its diameter was 160x170 mm. The rates of the negative, grey zone and positive results were 9.4%, 8.8% and 81.8%. Surgery was more common (n=72, 42.4%) than puncture, aspiration, injection, and re-aspiration treatments (n=14, 8.2%). Of the 47 patients who had a recurrence, 22 (46.8%) had a history of hydatid cyst treatment. CONCLUSION: Hydatid disease, which is endemic in our country, is diagnosed at a late stage. In terms of disease diagnosis, serological tests may be misleading. It was not possible to compare the success rates according to the treatment choices because of the lack of randomisation of stages and sizes of the lesions.
Assuntos
Equinococose/diagnóstico , Equinococose/terapia , Echinococcus/isolamento & purificação , Adulto , Animais , Diagnóstico Tardio , Equinococose/epidemiologia , Equinococose/patologia , Feminino , Seguimentos , Humanos , Fígado/diagnóstico por imagem , Fígado/parasitologia , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Turquia/epidemiologia , UltrassonografiaRESUMO
In this study, an appropriate sepsis model was created in rats. Additionally, the effects of steroid treatments on survival, in connection with antibiotic treatment, were investigated. The sepsis model performed via intraperitoneal injection of 3 ml/kg fecal suspension was determined as the most appropriate model for our study. Fifteen rats were used to investigate the effect of piperacillin-tazobactam on sepsis treatment. Forty-five randomly selected rats were used to investigate the efficacy of the antibiotic-plus-steroid combination. The rats were divided into three groups of 15 rats each. Twelve hours after the administration of fecal suspension, methylprednisolone (MP) at the dose of 0.25, 0.5, and 2 mg/kg/day was given to each group, respectively, in addition to an antibiotic administered intravenously. In order to investigate the effect of steroids alone in the treatment of sepsis, 0.5 mg/kg/day MP was given intravenously to 15 rats, 12 h after the fecal suspension was administered. It was concluded that administration of MP alone shortens survival time in rats with sepsis, whereas antibiotic therapy alone increases survival time significantly in rats with sepsis. It was seen that the antibiotic-plus-steroid treatment increases survival significantly compared to rats with no treatment (p < 0.05). In addition, steroids, when added to an antibiotic treatment in sepsis, affect survival positively when compared to the group with antibiotic therapy alone, depending on the dose given. Although, not statistically significant, high doses decrease survival (p > 0.05), and very low doses increase survival and mean survival time (p > 0.05) on the basis of clinical observation and average life time. However, low doses were found to increase survival significantly (p < 0.05). We concluded that low-dose MP, in addition to the appropriate antibiotic therapy, is the optimal in the treatment of rats with intraabdominal sepsis.
Assuntos
Metilprednisolona/uso terapêutico , Sepse/tratamento farmacológico , Animais , Modelos Animais de Doenças , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Ratos , Ratos Sprague-DawleyRESUMO
The aim of our study is to determine the role of oxidative stress on hepatic damage in patients with acute and chronic hepatitis B virus (HBV) infection and the efficacy of antioxidant-enzyme system against oxidative stress. Furthermore, the effect of interferon-alpha (IFN-alpha) plus lamivudine therapy on oxidative stress was also investigated. Nineteen patients with acute hepatitis B virus (AHBV) infection, 17 patients with chronic hepatitis B virus (CHBV) infection, 24 inactive HBsAg carriers and 21 healthy controls were included in the study. In control and patient groups, serum alanine-aminotransferase (ALT) and aspartate aminotransferase (AST) levels, erythrocyte malondialdehyde (MDA) levels, erythrocyte superoxide dismutase (CuZn-SOD) and glutathione peroxidase (GSH-Px) activities were measured. In CHBV group, after IFN-alpha plus lamivudine therapy for 6 months, these parameters were measured again. In all patient groups erythrocyte MDA levels were detected higher than control group (p < 0.05). Activity of CuZn-SOD was found to be the highest in AHBV (p < 0.05), and the lowest before the treatment in CHBV group (p < 0.05) compared with other groups. Activity of GSH-Px was found to be the highest in AHBV compared with inactive HBsAg carriers (p < 0.05) and CHBV group before treatment (p < 0.05). Activity of GSH-Px was found to be the lowest in CHBV group before treatment compared with other groups (p < 0.05). In CHBV group there was a significant decrease of MDA levels after treatment (p < 0.05) while there was a significant increase in activity of CuZn-SOD and GSH-Px compared with pretreatment levels (p < 0.05). A significant positive correlation was determined between MDA values and serum ALT levels, before and after the treatment (p < 0.05). Detection of the increase of MDA levels which is a product of lipid peroxidation in all patient groups, indicates that the oxidative stress is increased in HBV infection. Correlation between the levels of erythrocyte MDA levels and serum ALT levels supports the hypothesis concerning the role of oxidative stress in pathogenesis of HBV infection. Insufficiency of antioxidant capacity in CHBV and inactive HBsAg carrier groups may lead to progression of disease and results in fibrosis. Treatment with IFN-alpha plus lamivudine causes a decrease in products of lipid peroxidation and shows antioxidant activity via increasing the antioxidant enzymes. These data suggest that the addition of antioxidant agents to IFN-alpha and lamivudin combination therapy may be useful in CHBV treatment. Further in-vitro and in-vivo studies are required to enlighten the role of antioxidants on HBV disease progression and treatment.
Assuntos
Antivirais/uso terapêutico , Hepatite B/metabolismo , Interferon-alfa/uso terapêutico , Lamivudina/uso terapêutico , Estresse Oxidativo , Doença Aguda , Adulto , Alanina Transaminase/sangue , Antioxidantes/metabolismo , Antioxidantes/uso terapêutico , Antivirais/farmacologia , Aspartato Aminotransferases/sangue , Portador Sadio/tratamento farmacológico , Portador Sadio/metabolismo , Estudos de Casos e Controles , Quimioterapia Combinada , Feminino , Glutationa Peroxidase/sangue , Hepatite B/tratamento farmacológico , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/metabolismo , Humanos , Interferon-alfa/farmacologia , Lamivudina/farmacologia , Fígado/enzimologia , Fígado/metabolismo , Fígado/patologia , Masculino , Malondialdeído/sangue , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/imunologia , Superóxido Dismutase/sangueRESUMO
BACKGROUND: Invasive pulmonary aspergillosis is a rare, but severe and potentially fatal, complication after liver transplantation. There is no therapeutic regimen accepted worldwide for both initial and continuation therapy; nevertheless, several options have been proposed. METHODS: Case report and review of the pertinent English-language literature. RESULTS: In a patient with pulmonary aspergillosis after a liver transplant, combined and sequential therapy with caspofungin and voriconazole with termination of the immunosuppressive regimen and careful management were helpful to control the infection rapidly, possibly because of a positive drug interaction. CONCLUSION: In cases of invasive aspergillosis that are refractory to monotherapy, this regimen may be used in an attempt to overcome the infection.
Assuntos
Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , Caspofungina , Quimioterapia Combinada , Equinocandinas/uso terapêutico , Humanos , Terapia de Imunossupressão , Lipopeptídeos , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Pirimidinas/uso terapêutico , Radiografia Torácica , Tomografia Computadorizada de Emissão , Triazóis/uso terapêutico , VoriconazolAssuntos
Infecções por Hantavirus/diagnóstico , Infecções por Hantavirus/virologia , Orthohantavírus/genética , Orthohantavírus/isolamento & purificação , Adulto , Anticorpos Antivirais/sangue , Evolução Fatal , Orthohantavírus/classificação , Orthohantavírus/imunologia , Humanos , Imunoglobulina M/sangue , Unidades de Terapia Intensiva , Masculino , RNA Viral/sangue , Turquia , Urina/virologia , Adulto JovemRESUMO
Toxocariasis is a worldwide human helminthiasis, especially seen in temperate and tropical climate regions around the world. The diagnosis of this disease is performed on the basis of clinical symptoms and laboratory findings. Albendazole is one of the treatment choices for toxocariasis, with a currently recommended regimen of 10 mg/kg/day in two doses (400 mg twice daily) for 5 days. However, there is no precise consensus about the duration of the treatment. In this article, we report a case of toxocariasis; the patient visited our infectious disease polyclinic with complaints of long-term itching and urticarial skin lesions that were resistant to routine treatment and that recurred. Then, recurrent disease was resolved and skin lesions were diminished after prolonged albendazole therapy.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Toxocaríase/tratamento farmacológico , Albendazol/administração & dosagem , Animais , Anti-Helmínticos/administração & dosagem , Doença Crônica , Diagnóstico Diferencial , Humanos , Masculino , Prurido/diagnóstico , Prurido/parasitologia , Recidiva , Fatores de Tempo , Toxocaríase/diagnóstico , Urticária/diagnóstico , Urticária/parasitologiaRESUMO
BACKGROUND: Surgical site infections (SSIs) are a threat to patient safety; however, there were no available data on SSI rates stratified by surgical procedure (SP) in Turkey. METHODS: Between January 2005 and December 2011, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in 20 hospitals in 16 Turkish cities. Data from hospitalized patients were registered using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) methods and definitions for SSIs. Surgical procedures (SPs) were classified into 22 types according to International Classification of Diseases, Ninth Revision criteria. RESULTS: We recorded 1879 SSIs, associated with 41,563 SPs (4.3%; 95% confidence interval, 4.3-4.7). Among the results, the SSI rate per type of SP compared with rates reported by the INICC and CDC NHSN were 11.9% for ventricular shunt (vs 12.9% vs 5.6%); 5.3% for craniotomy (vs 4.4% vs 2.6%); 4.9% for coronary bypass with chest and donor incision (vs 4.5 vs 2.9); 3.5% for hip prosthesis (vs 2.6% vs 1.3%), and 3.0% for cesarean section (vs 0.7% vs 1.8%). CONCLUSIONS: In most of the 22 types of SP analyzed, our SSI rates were higher than the CDC NHSN rates and similar to the INICC rates. This study advances the knowledge of SSI epidemiology in Turkey, allowing the implementation of targeted interventions.
Assuntos
Infecção da Ferida Cirúrgica/epidemiologia , Cidades , Estudos de Coortes , Hospitais , Humanos , Prevalência , Estudos Prospectivos , Turquia/epidemiologiaRESUMO
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.
Assuntos
Brucelose/diagnóstico , Tuberculose Meníngea/diagnóstico , Adulto , Brucelose/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose Meníngea/epidemiologia , Turquia , Adulto JovemRESUMO
INTRODUCTION: It was aimed to investigate the frequency of Candida infections (CI) in the intensive care units (ICU), to determine typing of candida to evaluate risk factors associated with CI and mortality, and to evaluate influence of CI on mortality. METHODS: The prospective cohort study was carried out between Jan 1, 2009 and Dec 31, 2010 in ICUs, and the patients were observed with active surveillance. VITEK 2 Compact System (BioMerieux, France) kits were used for the identification of isolates from various clinical samples. RESULTS: A total of 2362 patients had enrolled for 16135 patients-days into the study. During the study, 63 (27,5%) of patients developed 77 episodes of CI were observed. Of the patients; 54% were male, 46% were female. Duration of hospitalization (OR = 1,03, p = 0,007), hyperglycemia (OR = 17,93, p = 0,009), and co-infections (OR = 3,98, p = 0,001) were identified as independent risk factors for CI. The most common infections were bloodstream (53%). 77 of 135 candida strains was isolated as causative pathogens. C. albicans (63,6%) was the most frequent species. Overall mortality rate was 78%. The rates of mortality attributable to CI and candidemia were 27%, and 18,3% respectively. Species- specific mortality rates of C.albicans and C.tropicalis were determined as 12%. High APACHE II scores (OR = 1,37; p = 0,002), and the use of central venous catheter (OR = 9,01; p = 0,049) were assigned as independent risk factors for mortality. CONCLUSION: CI is an important problem in our hospital. CI and associated mortality can be prevented by controlling of risk factors. Updating of epidemiological data is required for successful antifungal treatment.
Assuntos
Candidíase/epidemiologia , Estado Terminal/mortalidade , Infecção Hospitalar/epidemiologia , Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Candidíase/mortalidade , Candidíase/terapia , Estado Terminal/terapia , Infecção Hospitalar/mortalidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Turquia/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: Hepatitis B virus infection is still one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. Liver biopsy is the gold-standard method to assess the severity of liver fibrosis, but the invasive nature of this method limits its usage. Currently, noninvasive parameters are utilized to estimate liver histology. In the present study, we aimed to investigate the relationship between the severity of fibrosis and red blood cell distribution width (RDW), platelet distribution width (PDW), mean platelet volume (MPV), and MPV and red blood cell distribution width to platelet ratio (RPR) in patients with chronic hepatitis B (CHB). DESIGN: A total of 229 biopsy-proven naïve CHB cases were included in the study. The complete blood count variables including white blood cell, hemoglobin, hematocrit value, platelet count, RDW, MPV and PDW, as well as aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin, and other routine biochemical parameters were tested. Liver biopsy samples were examined using the Ishak scoring system. Data analyses were carried out using SPSS 15 software. Statistical significance was set at a P-value of less than 0.05. RESULTS: Of the 229 cases, 210 (91.7%) were men and 19 (8.3%) were women. The mean age of the patients was 30.9 years, and 85 cases (37.1%) had HBeAg positivity. Fibrosis scores of 41 cases (17.9%) were greater than or equal to 3, whereas 188 cases (82.1%) had fibrosis scores less than 3. There was a significant difference between these two groups for MPV (group 1=7.98±1.20, group 2=8.77±1.44, P<0.05). There was also a significant difference between these two groups for RDW (P<0.05). The RDW value in group 1 patients was 11.83±0.89, whereas this value was 12.57±1.32 in group 2. Moreover, the RPR was significantly higher in group 2 than in group 1 (P<0.001). There was no significant difference between the groups for PDW. We have compared the receiver operating characteristic curves for the diagnostic performance of aspartate aminotransferase, alanine aminotransferase, platelet count, RDW, MPV, and RPR in identifying fibrosis in CHB and area under the curve values for these variables were 0.666, 0.463, 0.657, 0.672, 0.677, and 0.758, respectively. CONCLUSION: MPV and RDW values are significantly higher in hepatitis B virus-infected patients, associated with severity, and can be defined as independent predicting factors in hepatic fibrosis. Further studies are required to determine the associations between MPV and the severity of fibrosis in hepatitis B patients.
Assuntos
Índices de Eritrócitos , Hepatite B Crônica/diagnóstico , Cirrose Hepática/diagnóstico , Volume Plaquetário Médio , Adulto , Idoso , Alanina Transaminase/sangue , Área Sob a Curva , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Biópsia , Ensaios Enzimáticos Clínicos , Feminino , Antígenos E da Hepatite B/sangue , Hepatite B Crônica/sangue , Hepatite B Crônica/complicações , Hepatite B Crônica/patologia , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
Malaria is a worldwide infection causing serious health and financial problems. Turkey is in the elimination phase, and malaria cases have been observed in patients who have come from abroad recently. In this study, 2 relapsed Plasmodium vivax (Pv) cases that returned from Afghanistan to our country at least 6 months ago were presented. The first case had received irregular chemoprophylaxis during travel, 6 months after returning to Turkey occurred malaria clinic. The second case had not received chemoprophlaxis during his travel, and he had experienced 2 previous episodes of malaria. He had used inappropriate anti-malarial drugs before returning to Turkey. Two separate incubation periods for P. vivax and P. ovale have been described. One of them is defined as late infection, or relapse, which is maturation of dormant bacilli in the liver, known as the hypnozoite stage. We thought that relapses of Pv infection could result from activation of hypnozoites in these cases. These 2 cases were treated with chloroquine and primaquine. The purpose of presenting these 2 cases is that primaquine should be considered for primer prophylaxis in short travels, especially after traveling to endemic areas, and the patient's relapse should be considered.
Assuntos
Antimaláricos/uso terapêutico , Estágios do Ciclo de Vida/efeitos dos fármacos , Malária Vivax/tratamento farmacológico , Plasmodium vivax/efeitos dos fármacos , Primaquina/uso terapêutico , Prevenção Secundária , Cloroquina/uso terapêutico , Humanos , Fígado/parasitologia , Malária Vivax/parasitologia , Malária Vivax/transmissão , Masculino , Plasmodium vivax/crescimento & desenvolvimento , Plasmodium vivax/isolamento & purificação , Viagem , TurquiaRESUMO
Malaria is a parasitic infection characterized by anemia, splenomegaly and periodic fever. This infection has a tendency to cause serious complications. Falciparum malaria could occur in our country as an imported case due to increasing intercontinental travel opportunities. The World Health Organisation (WHO) recommends arthemether combination treatment as a first line choice. Here we report a Turkish case admitted to the hospital with high fever, sweating and fatigue. He had been in Uganda for 6 months without prophylaxis. Plasmodium falciparum with an intense parasitic load was diagnosed. We started arthemether-lumefantrine combination therapy immediately. 18 days after his discharge he was readmitted with the same complaints and parasitemia was detected once again. This time, we treated him with the quinine-tetracycline combination regime for 7 days. Within 48 hours the patient was afebrile and the blood smear was negative. Falciparum malaria must be considered in infection emergencies for febrile patients especially with any travel history. For an initial therapy, arthemetherlumefantrine combination is a successful choice of treatment. Even with adequate treatment of arthemether-lumefantrine combination, the problems of recurrence (recrudescence or reinfection) could occur due to treatment failure. For the possibility of recurrence, close monitoring of patients is very important in the critical course after adequate treatment.
Assuntos
Antimaláricos/uso terapêutico , Artemisininas/uso terapêutico , Etanolaminas/uso terapêutico , Febre/tratamento farmacológico , Fluorenos/uso terapêutico , Malária Falciparum/tratamento farmacológico , Quinina/uso terapêutico , Tetraciclina/uso terapêutico , Administração Oral , Combinação Arteméter e Lumefantrina , Combinação de Medicamentos , Febre/diagnóstico , Febre/parasitologia , Humanos , Malária Falciparum/diagnóstico , Malária Falciparum/parasitologia , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum/efeitos dos fármacos , Plasmodium falciparum/fisiologia , Recidiva , Viagem , Falha de Tratamento , Turquia , UgandaRESUMO
AIMS: The objective of this study was to describe nosocomial infection (NI) rates, risk factors, etiologic agents, antibiotic susceptibility, invasive device utilization and invasive device associated infection rates in a burn intensive care unit (ICU) in Turkey. METHODS: Prospective surveillance of nosocomial infections was performed according to Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) criteria between 2001 and 2012. The data was analyzed retrospectively. RESULTS: During the study period 658 burn patients were admitted to our burn ICU. 469 cases acquired 602 NI for an overall NI rate of 23.1 per 1000 patient days. 109 of all the cases (16.5%) died. Pseudomonas aeruginosa (241), Acinetobacter baumannii (186) and Staphylococcus aureus (69) were the most common identified bacteria in 547 strains. CONCLUSION: Total burn surface area, full thickness burn, older age, presence of inhalation injury were determined to be the significant risk factors for acquisition of NI. Determining the NI profile at a certain burn ICU can lead the medical staff apply the appropriate treatment regimen and limit the drug resistance. Eleven years surveillance report presented here provides a recent data about the risk factors of NI in a Turkish burn ICU.