[Show abstract][Hide abstract] ABSTRACT: This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n = 327, 83.8%), as epididymo-orchitis (n = 204, 58%), orchitis (n = 112, 31.8%) and epididymitis (n = 11, 3.1%). In female patients, pyelonephritis (n = 33/38, 86.8%) was significantly higher than in male patients (n = 11/352, 3.1%; p< 0.0001). The mean blood leukocyte count was 7530 AE 3115/mm 3 . Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p< 0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.
[Show abstract][Hide abstract] ABSTRACT: Background: Rashes in febrile neutropenic patients present an important problem in differential diagnosis for their physicians. In these patients, rashes may be the first and only evidence of a serious and life-threatening infection. In this study, we aimed to retrospectively report the etiology of skin lesions in febrile neutropenic patients with hematologic malignancies.
Methods: In our study, hospitalized febrile neutropenic patients with hematologic malignancy, aplastic anemia, or bone marrow transplantation were included. Patient files were screened retrospectively and patients with skin lesions during febrile neutropenic episodes were selected. Patients with febrile neutropenia were initiated an antipseudomonal beta-lactam therapy according to IDSA guidelines. Skin lesions of these patients during febrile neutropenic episode, consulted and evaluated with infectious disease and dermatology specialists
Results: A total of 50 patients were included in our study. Twenty six (52%) of the patients were male and the average age was 45.8 (± 15), respectively. The most common underlying disease was acute myeloid leukemia with 29 (48%) patients. The most frequently observed type of lesion was maculopapular eruption (40%) whilst it was followed by erythematous necrotic nodule (18%). The most common cause of skin lesions were infections and drug eruptions with 26 (52%) and 16 (32%) patients, respectively. Ecthyma gangrenosum in 8 patients, skin involvement of oppurtunistic fungal infections in 7 patients and herpes labialis in 5 patients were most common causes of skin lesions in infection group. In 16 (32%) patients the skin lesions were found to be related to drugs; piperacillin/tazobactam, co-trimaxazol and etoposid were the most common cause of drug related skin lesions. Of the patients, 6 patients died during or soon after the development of skin lesions and in 5 of 6 patients, the skin lesions were found to be related with infectious causes.
Conclusion: Infections were found to be the most common cause of skin lesions in febrile neutropenic patients.
IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
[Show abstract][Hide abstract] ABSTRACT: Rate of coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) varies in different countries. This may be attributable to common transmission routes as well as social, economic, and cultural factors.
[Show abstract][Hide abstract] ABSTRACT: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It can mimic breast carcinoma clinically and radiologically, and usually affects females of childbearing age. There is no commonly accepted optimal treatment for IGM. In this study, we present the clinical and histopathological features and outcomes of the therapeutic management of IGM, as well as the clinical course of the disease when patients were treated with oral corticosteroids.
[Show abstract][Hide abstract] ABSTRACT: This study reviewed the clinical, laboratory, therapeutic, and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multi-centre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 males, 90.2%) were pooled. In males, the most frequent involved site was scrotal area (n=327, 83.8%) as epididymo-orchitis (n=204, 58%), orchitis (n=112, 31.8%), and epididymitis (n=11, 3.1%). In females pyelonephritis (n=33/38, 86.8%) was significantly higher than males (n=11/352, 3.1%; p<0.0001). The mean blood leukocyte count was 7530±3115/mm(3) . Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The mean treatment duration and length of hospital stay was significantly higher when there were additional brucellar foci (p<0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in males or pyelonephritis in females in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should alert for brucellar genitourinary disease. This article is protected by copyright. All rights reserved.
Clinical Microbiology and Infection 05/2014; · 4.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to report the epidemiological profile of HIV-1 positive patients from, Istanbul, Turkey, which has one of the lowest HIV-1/AIDS prevalences in Europe. The patients were followed by ACTHIV-IST group which was established by the Infectious Diseases Departments of five teaching hospitals (three university hospitals and two public hospitals) in Istanbul, Turkey. The HIV-1positive patients were added to the standard patient files in all of the centers; these files were then transferred to the ACTHIV-IST database in the Internet. A total of 829 naiv-untreated HIV-1 positive patients were chosen from the database. The numbers of male patients were 700 (84.4%) and the mean age of the patients was 37 years (range, 17-79). In our study group 348 (42%) of the patients were married, 318 (38.7%) of the patients were single. The probable route of transmission was heterosexual intercourse in 437 (52.7%) patients and homosexual intercourse in 256 (30.9%) patients. In 519 (62.6%) patients the diagnose was made due to a screening test and in 241 (29.1%) patients, the diagnose was made due to an HIV-related/non-related disease. the mean CD4+ T cell number in 788 of the patients was 357.8/mm3 (±271.1), and the median viral load in 698 of the patients was 100,000 copies/mL (20-9,790,000). In Turkey, the number of HIV-1 positive patients is still low and to diagnose with a screening test is the most common way of diagnostic route.
Current HIV research 04/2014; · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The natural history of hepatitis B virus infection is not uniform and affected from several factors including, HBV genotype. Genotype D is a widely distributed genotype. Among genotype D, several subgenotypes differentiate epidemiologically and probably clinically. D1 is predominant in Middle East and North Africa, and characterized by early HBeAg seroconversion and low viral load. D2 is seen in Albania, Turkey, Brazil, western India, Lebanon, and Serbia. D3 was reported from Serbia, western India, and Indonesia. It is a predominant subgenotype in injection drug use-related acute HBV infections in Europe and Canada. D4 is relatively rare and reported from Haiti, Russia and Baltic region, Brazil, Kenya, Morocco and Rwanda. Subgenotype D5 seems to be common in Eastern India. D6 has been reported as a rare subgenotype from Indonesia, Kenya, Russia and Baltic region. D7 is the main genotype in Morocco and Tunisia. D8 and D9 are recently described subgenotypes and reported from Niger and India, respectively. Subgenotypes of genotype D may have clinical and/or viral differences. More subgenotype studies are required to conclude on subgenotype and its clinical/viral characteristics.
Clinics and Research in Hepatology and Gastroenterology. 01/2014;
[Show abstract][Hide abstract] ABSTRACT: Objectives
We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported.
Haydarpasa-1 study involved microbiologically confirmed patients for TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, and Turkey between 2000-2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients.
506 TBM cases were included. The sensitivities of the tests were as follows: Interferon gamma (IFN-γ) release assay (IGRA, Quantiferon TB gold in tube) 90.2%, automated culture systems (ACSs) 81.8%, Löwenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9%, and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p<0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR test (p<0.05). Combination of L-J and ACS was superior to using these tests alone (p<0.05). There were poor and inverse agreements between EZNs and L-J culture (κ,-0.189); ACS and L-J culture (κ -0.172) (p<0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (κ,-0.299, p<0.05).
Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of nonculture tests appears to contribute early diagnosis. Hence, diagnostic approach to TBM should be individualized according to technical capacities of medical institutions with poor resources in particular.
Clinical Microbiology and Infection 11/2013; · 4.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bacterial isolates producing Class D OXA-48 carbapenemase may be missed in routine laboratory testing, allowing them to spread undetected. The purpose of the present study was to detect bla(OXA-48) among ESBL-producing Klebsiella pneumoniae and Escherichia coli isolates collected from a university hospital, Turkey. Ninety-two ESBL-producing isolates (66 E. coli, 26 K. pneumoniae) were obtained in 2010. Antibiotic susceptibility tests were performed using the disc diffusion method and VITEK 2 system. Carbapenemase activity was screened using modified Hodge test. Beta-lactamase genes were detected by PCR and bla(OXA-48)-positive amplicons were sequenced. Genetic relatedness among K. pneumoniae isolates was investigated by pulsed-field gel-electrophoresis (PFGE). Carbapenemase activity was detected in 1 E. coli and 9 K. pneumoniae isolates and 8 of the K. pneumoniae plus the E. coli isolates were resistant to ertapenem. Three K. pneumoniae and 1 E. coli isolates were resistant to imipenem. All 10 isolates were susceptible to meropenem. bla(OXA-48) was present in all 10 isolates. Additionally, 9 isolates contained at least one beta-lactamase gene, including bla(SHV') bla(CTX-M) and bla(VEB) type. PFGE revealed different karyotypes among 9 K. pneumoniae isolates suggesting that the dissemination of bla(OXA-48) gene was not spread by a single K. pneumoniae clone. Thus OXA-48-producing isolates found in carbapenem-susceptible strains according to CLSI guidelines.
The Southeast Asian journal of tropical medicine and public health 09/2012; 43(5):1178-85. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n=18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients.
International journal of antimicrobial agents 06/2012; 40(2):145-50. · 3.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Helicobacter pylori (HP) is recognized as a common chronic human bacterial infection and is the most common cause of gastritis. Recent studies suggest an increased HP prevalence in patients with various extra-digestive inflammatory diseases. Since many respiratory diseases are characterized by chronic inflammation as well as increased immune response, and HP may enter the nasopharyngeal cavity by gastroesophageal reflux, an association between respiratory disorders and HP infection has been suggested. Several studies discover HP in clinical samples from the patients with upper respiratory system infections. Even some of them revealed a relief after the treatment directed to HP eradication. However some studies do not support this theory and whether this association means a definite proof of a causal relationship between HP and respiratory diseases needs to be clarified. In this study, we aimed to review the reports about the role of HP in upper respiratory system infections.
Current Infectious Disease Reports 04/2012; 14(2):128-36.
[Show abstract][Hide abstract] ABSTRACT: Spontaneous intracranial hypotension (SIH) is recognized with increasing frequency. A throbbing headache occurring or worsening in the upright position and improving after lying down, a so-called 'orthostatic headache', low cerebrospinal fluid (CSF) pressure, and diffuse pachymeningeal enhancement on brain magnetic resonance imaging (MRI) are the major features of the classic syndrome. These patients, who are admitted with fever, headache, and CSF findings revealing lymphocytic pleocytosis, elevated protein concentration, normal glucose levels, and negative culture results, are prone to be misdiagnosed with aseptic meningitis. The aims of this single-centre retrospective study were to determine the epidemiological, clinical, laboratory, and radiological features of patients initially evaluated as having aseptic meningitis but subsequently diagnosed with SIH, and to touch upon the key points of the differential diagnosis in daily infectious diseases practice.
Patients referred to Cerrahpasa Medical School with a presumed diagnosis of aseptic meningitis or viral meningitis between 1 January 2006 and 1 January 2011 were reviewed. Epidemiological, clinical, laboratory, radiological, and follow-up data obtained from the hospital database were processed. Patients confirmed to have SIH syndrome were included for evaluation.
Eleven cases of SIH syndrome were diagnosed during the study period (8 male and 3 female, median age 30 y, range 21-44 y). All had headache, hearing changes, and nausea. Vomiting (10/11) and posterior neck pain (9/11) were also frequent. Seven had fever and 5 had a stiff neck. Four cases had lymphocytic pleocytosis, 4 cases had elevated CSF protein concentrations (> 1.5 times the upper limit of normal), and 2 cases had slightly lower CSF glucose levels. Polymerase chain reaction (PCR) analyses of the CSF for Mycobacterium tuberculosis complex, herpes simplex viruses 1 and 2, and enteroviruses were negative in all cases. MRI of the 11 cases revealed signs of spontaneous CSF leaks with diffuse pachymeningeal gadolinium enhancement (11/11), sagging of the brain (9/11), enlargement of the pituitary (6/11), engorgement of the venous structures (5/11), and subdural fluid collections (2/11). CSF leaks were demonstrated by intrathecal magnetic resonance or computed tomography myelography at different levels along the thoracic spine (7/11), cervico-thoracic junction (2/11), and thoraco-lumbar junction (2/11). Autologous blood injection into the spinal epidural space ('blood patch') was performed for treatment. Strict bed rest followed, and all patients recovered fully within a week; no recurrence or complication was observed during the follow-up periods, which ranged from 6 months to 5 y.
Findings of fever, headache, and meningeal irritation are generally accepted as the clinical features of meningitis. When CSF findings are not characteristically compatible with bacterial meningitis and particularly when the headache is orthostatic in nature, SIH should also be included in the differential diagnosis. MRI findings are characteristic and clearly contribute to the differential diagnosis between viral meningitis and SIH.
[Show abstract][Hide abstract] ABSTRACT: Cutaneous leishmaniasis in Sanliurfa is still a public health problem. In this study, we report the epidemiological, clinical, and demographic properties from Sanliurfa.
7172 patients followed up in the Sanliurfa Leishmaniasis Treatment Center between January 2001 and December 2008.
The rates of male and female patients were 46% and 54% of the 7172 cases, respectively. The incidence of ACL showed a typical trend of an increase between November and May and a decrease in the summer. The face and extremities were the most involved parts of the body. Clinical appearance and Giemsa smear were most used diagnostic tools and intralesional pentavalent antimony compounds were the first choice of treatment.
The incidence of cutaneous leishmaniasis in Sanliurfa is still low but not zero.
International journal of dermatology 03/2012; 51(3):300-4. · 1.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The etiology of fever of unknown origin has changed because of the recent advances in and widespread use of invasive and non-invasive diagnostic tools. However, undiagnosed patients still constitute a significant number.Objective: To determine the etiological distribution and role of non-invasive and invasive diagnostic tools in the diagnosis of fever of unknown origin.Materials & Methods: One hundred patients who were hospitalized between June 2001 and 2009 with a fever of unknown origin were included in this study. Clinical and laboratory data were collected from the patients' medical records retrospectively.Results: Fifty three percent of the patients were male, with a mean age of 45 years. The etiology of fever was determined to be infectious diseases in 26, collagen vascular diseases in 38, neoplastic diseases in 14, miscellaneous in 2 and undiagnosed in 20 patients. When the etiologic distribution was analyzed over time, it was noted that the rate of infectious diseases decreased, whereas the rate of rheumatological and undiagnosed diseases relatively increased because of the advances in imaging and microbiological studies. Seventy patients had a definitive diagnosis, whereas 10 patients had a possible diagnosis. The diagnoses were established based on clinical features and non-invasive tests for 61% of the patients and diagnostic benefit was obtained for 49% of the patients undergoing invasive tests. Biopsy procedures contributed a rate of 42% to diagnoses in patients who received biopsies.Conclusion: Clinical features (such as detailed medical history-taking and physical examination) may contribute to diagnoses, particularly in cases of collagen vascular diseases. Imaging studies exhibit certain pathologies that guide invasive studies. Biopsy procedures contribute greatly to diagnoses, particularly for malignancies and infectious diseases that are not diagnosed by non-invasive procedures.
International journal of medical sciences 01/2012; 9(8):682-9. · 2.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Brucellosis is an endemic disease in Turkey, and testicular abscess is a rare and frequently misdiagnosed complication of brucellosis. In the literature there are only seven reported cases, and all were treated with both medical and surgical therapy. We report a case of brucellar testicular abscess treated with medical therapy only. Although the patient recovered clinically at the end of 6 weeks, the regression of the testicular lesion could not be observed until after 5 months.
Journal of Infection and Chemotherapy 12/2011; · 1.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the presence of carbapenem hydrolysing β-lactamase genes and plasmid-mediated quinolone resistance (PMQR) determinants in 22 Klebsiella pneumoniae isolates collected from the Istanbul Medical Faculty, Turkey, which reduced the susceptibility or resistance to carbapenem. The VITEK® 2 system and E-tests were used to determine the minimum inhibitory concentrations needed to inhibit bacterial growth. Genes were screened by polymerase chain reaction, and gene transferability was evaluated by transconjugation. Strain clonality was investigated by pulsed-field gel electrophoresis (PFGE). All strains were OXA-48 β-lactamase producers and three (13.6%) were also positive for the aac(6′)-Ib-cr gene. Most of the strains harboured other b-lactamase (bla) genes such as blaTEM, blaSHV, blaCTX-M and blaVEB-1. The transconjugants mostly harboured blaOXA-48 and other β-lactamases separately. PFGE revealed eight pulsotypes among the isolates. The coexistence of blaOXA-48 and PMQR in K. pneumoniae isolates may present a significant threat to health, especially in the nosocomial setting.
The Journal of international medical research 10/2011; 39(5):1932-1940. · 0.96 Impact Factor