A 49-year-old man with a medical history of polycystic kidney disease was presented to the emergency department with fever and left flank pain. Abdominal examination revealed an enlarged and painful left kidney. The C-reactive protein level was significantly high and the magnetic resonance imaging revealed areas of abnormal intensity and fluid-fluid levels in renal cysts. Brucella abortus was yielded from both blood and cyst fluid culture. Standard therapy (rifampicin plus doxycycline) of brucellosis was started, but the clinical and laboratory signs subsided after the addition of ciprofloxacin. There was no need for aspiration of infected cyst fluid. Hereby, according to the medical database search, we report that the first renal cyst infection caused by B. abortus was successfully treated with triple antibiotic therapy.
[Show abstract][Hide abstract] ABSTRACT: To determine the causes of death in autosomal dominant polycystic kidney disease (ADPKD) patients and to examine whether the extrarenal manifestations of ADPKD influence the causes of death, the medical records of 129 patients who died between 1956 and 1993 were reviewed; 58% of the 129 patients had an autopsy performed. Seventy-seven percent died after reaching ESRD. The mean age at death increased from 51 yr for those who died before 1975 to 59 yr for those who died after 1975, reflecting the introduction of renal replacement therapies. The most common cause of death before 1975 was infection (30%), followed by uremia (28%) and cardiac disease (21%); after 1975, these were cardiac disease (36%) and infection (24%). Infection was equally prevalent before and after 1975, presenting as sepsis in 94% and directly relating to ADPKD in 47% of these patients. Underlying factors for cardiac death were cardiac hypertrophy, seen in 89% of all autopsied patients, and coronary artery disease, seen in 81%. A neurologic event was the cause of death in 12% of patients; these were ruptured intracranial aneurysm in 6%, hypertensive intracranial hemorrhage in 5%, and ischemic stroke in 1%. The mean age of those who died of ruptured intracranial aneurysm was 37 yr. No patient died of renal cancer. Liver cysts were the most common extrarenal manifestation, seen in 70% of the autopsied cases; cysts in other organs were very rare. Colonic diverticula were found in 21%. Thus, the renal and extrarenal manifestations of ADPKD are important contributors to morbidity and mortality.
Journal of the American Society of Nephrology 07/1995; 5(12):2048-56. · 9.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to identify the agents causing community-acquired urinary tract infections (CAUTIs) and their resistance patterns and to investigate risk factors for ESBL production.
Patients diagnosed at the Department of Infectious Diseases in the Cukurova University School of Medicine Hospital with CAUTI between January 2006 and April 2007 were included prospectively. Patient data were recorded and the microorganisms and their sensitivity patterns were evaluated by the university's central microbiology laboratory.
A total 146 patients with CAUTIs, 109 women and 37 men (mean age: 50.9+/-18.44 years), were included in the study. The most common infectious agents were Escherichia coli (76.9%), Klebsiella pneumoniae (9.2%), Proteus mirabilis (4.1%), and Enterococcus spp. (1.6%). The ciprofloxacin resistance rate for E. coli was 35% and resistance to TMP-SMZ 43%, whereas amikacin resistance was substantially low (3%). Four of 12 K. pneumoniae strains were resistant to ciprofloxacin and 2 to TMP-SMZ. Resistance to amikacin was not found in the K. pneumoniae strains. ESBL production was identified in 25 of the 112 E. coli and K. pneumoniae strains. A history of a UTI within the last 6 months (p=0.029) and a history of frequent UTI (p=0.028) were found to be significant risk factors for ESBL production by univariate analysis. The only independent risk factor was a history of urinary system infection in the past 6 months (p=0.025) according to multivariate regression analysis.
These high resistance rates to antimicrobials and particularly the extremely high rate of ESBL production in CAUTI should be carefully considered.
Medical science monitor: international medical journal of experimental and clinical research 05/2010; 16(5):CR246-51. · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 40-year-old Japanese man was admitted to our hospital for investigation of fever and right flank pain starting after watery diarrhea. Salmonella enteritidis was cultured from samples of stool and blood. Although his diarrhea subsided soon, high fever persisted and flank pain got worse. Magnetic resonance imaging (MRI) revealed four areas of abnormal intensity in renal cysts and computed tomography showed the same findings. Renal cysts infection was diagnosed. After ultrasound-guided aspiration of these cysts, his fever subsided. Culture of each aspirate grew Salmonella enteritidis. Although the route of cyst infection in ADPKD generally remains unclear, the clinical course of our patient may indicate that gastrointestinal tract infection progressed to renal cyst infection when bacteremia occurred due to bacterial translocation.
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