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ABSTRACT: Stevens-Johnson syndrome (SJS) is a rare, life-threatening acute allergic drug reaction presenting with target lesions and
blebs of epidermis. Although a variety of etiologies such as infections and underlying malignancies have been implicated as
potential causes of SJS, drugs remain the predominant inciting agent. This report presents a SJS case due to combined use
of lamotrigine and fluoxetine. A 41-year-old man was admitted to our clinic with fever, skin eruptions (especially on the
face and trunk) and lesions around the mouth. The patient’s history revealed lamotrigine and fluoxetine use during the previous
three weeks for major depression. Dermatological examination revealed a typical clinical picture of SJS; his psychotropic
medications were all stopped. While topical and ocular prednisolone (1mg/kg/day) cares were initiated, steroid dosage was
reduced within 15 days. The condition of patient rapidly improved through this treatment. Effective management of SJS begins
with prompt recognition of the entity, combined with attention to each of the major organs that may be affected, potential
comorbidities and withdrawal of all potentially causative drugs. Clinicians should bear in mind the possibility that drugs
with potential risk in developing SJS must be used carefully.
KeywordsStevens — Johnson syndrome-Lamotrigine-Fluoxetine-Medical treatment
Central European Journal of Medicine 04/2012; 5(6):733-736. · 0.31 Impact Factor
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ABSTRACT: To evaluate the effects of intravitreal moxifloxacin with or without dexamethasone on experimental Bacillus cereus endophthalmitis.
The right eyes of 21 New Zealand albino rabbits weighing 2-3 kg were used in this study. Each eye was inoculated with 1×10(6) colony-forming units of B. cereus microorganisms via intravitreal injection into the vitreous cavity, and an experimental model of B. cereus endophthalmitis was formed. The rabbits were separated into 3 groups: Group 1 was given 0.1 mL of balanced saline solution intravitreally, group 2 was given 50 μg of moxifloxacin, and group 3 was given 50 μg of moxifloxacin plus 400 μg of dexamethasone 24 h after the inoculation. Vitreous aspirates were taken for microbiological examination on the 3rd day. Clinical inflammation scores were evaluated on days 1, 7, and 14. The rabbits were killed on the 14th day, and the eyes were enucleated for histopathological examination.
On the 7th day, only the vitreous scores of the treatment groups were significantly low compared with those of the control group (P<0.05). On day 14, the clinical scores of vitreous inflammation were 2.43±0.79, 1.43±0.53, and 1.29±0.49 in Groups 1, 2, and 3, respectively. The clinical scores of the treatment groups were significantly lower compared with those of the control group on day 14 (P<0.05). Histopathological scores were 2.43±0.79, 1.43±0.53, and 1.43±0.79 for the iris and 2.14±0.69, 1.57±0.53, and 1.14±0.38 for the vitreous in Groups 1, 2, and 3, respectively. Apart from the conjunctiva, the histopathological scores of the other tissues in the treatment groups were significantly lower compared with those of the control group (P<0.05). No significant differences were found in the histopathological or clinical scores among the treatment groups (P>0.05). Microbiological scores at day 14 were 151±6.43, 125.43±13.44, and 131.14±16.99 for Groups 1, 2, and 3, respectively. The microbiological scores of the treatment groups were significantly lower compared with those of the control group (P<0.05).
Intravitreal moxifloxacin injection is effective in experimental B. cereus endophthalmitis. The addition of intravitreal dexamethasone may not significantly affect treatment efficacy.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 08/2011; 27(6):593-8. · 1.46 Impact Factor
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ABSTRACT: Osteomyelitis in adolescents is a serious disease with the potential for lifelong disability. The key to successful management is early diagnosis, including bone sampling for microbiological and pathological examination to allow targeted and long-lasting antibiotic therapy. Staphylococcus aureus is the most frequently isolated microorganism in these patients. Methicillin-resistant S. aureus (MRSA) is usually considered a nosocomial pathogen, but increasingly it is acquired in the community. We present a case of acute osteomyelitis caused by community-associated MRSA (CA-MRSA) who had never been hospitalized and had no other known risk factors for MRSA. The changing epidemiology of MRSA became evident when infections occurred in previously healthy patients without established risk factors. MRSA infections have been increasingly reported in pediatric patients, but they are uncommon in adults. Skin and soft tissue infections remain the most common manifestations of CA-MRSA infections. Glycopeptides can be used as initial therapy and oral trimetoprim-sulfamethoxazole as sequential therapy for these patients.
The Journal of Infection in Developing Countries 01/2011; 5(12):896-900. · 1.19 Impact Factor
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The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases 12/2010; 14(6):641-2. · 0.55 Impact Factor
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ABSTRACT: Infectious Mononucleosis (IM), a benign lymphoproliferative disease, is the best known clinical syndrome caused by Epstein-Barr Virus (EBV). It usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. In this report we describe a patient with acute hepatitis following EBV-IM in a previously healthy woman. A 26-year-old woman who presented with fever, generalized weakness, nausea, sore throat, yellowing of skin, and a generalized skin rash was admitted to our clinic. Tonsillar enlargement, pharyngeal erythema, palatal petechiae, lymphadenopathy, and jaundice were noted. Significant atypical lymphocytes ( > 10%) were seen on the peripheral blood smear. Liver function tests such as ALT: 303 U/L, AST: 172 U/L, ALP: 193 U/L and total bilirubin: 7.3 mg/dl were elevated. Serological tests for EBV infection were consistent with acute infection (EBV virus capsid antigen was reactive with IgM and IgG antibodies). The Monospot test was also positive. On the seventh day, liver function tests and bilirubin had risen to peak level and platelets were decreased. The patient was managed supportively and her critical condition improved and was finally stabilized. Although the prognosis for IM is very favorable, a variety of acute complications may occur.
The Journal of Infection in Developing Countries 01/2010; 4(10):668-73. · 1.19 Impact Factor
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ABSTRACT: Streptococcus pyogenes is a well-known cause of a variety of clinical infections including local symptoms such as tonsillopharyngitis, cervical lymphadenitis, otitis media, cellulites, erysipelas, as well as more severe diseases such as scarlet fever, osteomyelitis, necrotizing fasciitis, sepsis, and toxic shock syndrome. However, acute bacterial meningitis caused by this pathogen is unusual.
We report a case of group A streptococcus (GAS) meningitis in a previously healthy woman with a dramatically rapid course and fatal outcome.
A 41-year-old previously healthy woman presented a history of fever, headache, vomiting, and sore throat of three days' duration. Neurological examination revealed diminished consciousness and neck rigidity. The cerebrospinal fluid (CSF) was turbid with 10,000 leukocytes/mm(3). Direct examination of CSF showed Gram-positive cocci in chains, and cultures yielded S. pyogenes. Blood cultures yielded growth of S. pyogenes. The patient was treated initially with ceftriaxone (4 g/day) and the control CSF examination was not changed on the third day, so vancomycin (2 g/day) was added to the treatment; however, she died on the fourth day of the treatment.
S. pyogenes meningitis is uncommon and the incidence seems to be persistently low; nevertheless, clinicians should be aware that sporadic cases may occur and may have a fulminant course with a relevant neurological sequel.
The Journal of Infection in Developing Countries 01/2009; 3(3):241-4. · 1.19 Impact Factor
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ABSTRACT: Although the commonest manifestation of Salmonella infection is acute gastroenteritis, infection may spread to the blood-stream may and the illness can present with focal lesions in almost any organ with or without septicemia. We describe here a case of Salmonella typhi infection of a sacroiliac joint that was cured with ciprofloxacin therapy for six weeks. The patient was immunologically normal. Salmonella etiology was not suspected in this case, and the diagnosis was made only after bacterial isolation. Physicians should be aware of this rare manifestation of Salmonella infection, especially in endemic areas.
The Journal of Infection in Developing Countries 01/2009; 3(7):564-8. · 1.19 Impact Factor
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ABSTRACT: To evaluate the efficacy and safety of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C.
Thirty-six hemodialysis patients with chronic hepatitis C were enrolled in a controlled and prospective study. All patients were treatment naive, positive tested for anti-HCV antibodies, and positive tested for serum HCV-RNA. Twenty-two patients received 135 microg peglyated-interferon alpha-2a weekly for 48 wk (group A). The remaining patients were left untreated, eleven refused therapy, and three were not candidates for kidney transplantation and were allocated to the control group (group B). At the end of the treatment biochemical and virological response was evaluated, and 24 wk after completion of therapy sustained virological response (SVR) was assessed. Side effects were monitored.
Of 22 hemodialysis patients, 12 were male and 10 female, with a mean age of 35.2 +/- 12.1 years. Virological end-of-treatment response was observed in 14 patients (82.4%) in group A and in one patient (7.1%) in group B (P = 0.001). Sustained virological response was observed in 11 patients (64.7%) in group A and in one patient in group B (7.1%). Biochemical response parameters normalized in 10/14 patients (71.4%) at the end of the treatment. ALT levels in group B were initially high in six patients and normalized in one of them (25%) at the end of the 48 wk. In five patients (22.7%) therapy had to be stopped at mo 4 due to complications of weakness, anemia, and bleeding.
SVR could be achieved in 64.7% of patients on hemodialysis with chronic hepatitis C by a treatment with peglyated-interferon alpha-2a. Group A had a significantly better efficacy compared to the control group B, but the side effects need to be concerned.
World Journal of Gastroenterology 02/2008; 14(2):255-9. · 2.47 Impact Factor
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ABSTRACT: Renal failure is an important complication of snakebite and a major cause of mortality. We aimed to study the clinical profile of snake envenomation in Southeast Anatolia, Turkey, in an adult population. We retrospectively analyzed the records of 200 snakebite victims from 1998 to 2006 at the Dicle University School of Medicine, Diyarbakir, Turkey. Sixteen patients (8%) developed AKI (acute kidney injury). Of those, 25% required dialysis and 18% died. There was no difference between groups in age, arrival time to hospital, and hospital stay time. Both groups received similar hydration and therapy at admission. Disseminated intravascular coagulation (DIC) was observed in 25% of the AKI group and was significantly higher than the non-AKI group (7.1%; p = 0.014). There was no significant difference regarding hemoglobin, platelet levels, and prothrombin time at admission. The prevalence of thrombocytopenia (<150,000 K/UL ) was 60% in the AKI group and 40% in the non-AKI group (p > 0.05). WBC count was significantly higher in the AKI group than in those without AKI (p = 0.001); serum albumin was significantly lower in the AKI group than in those without AKI (p = 0.013). AKI is an important complication of snakebite that may lead to mortality. Despite some troublesome aspects due to its retrospective design, this is a large series from Southeast Anatolia of Turkey in an adult population. Subjects with high WBC, low albumin, and DIC should be closely followed up for the development of AKI.
Renal Failure 01/2008; 30(1):51-5. · 0.82 Impact Factor
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ABSTRACT: AIM: To evaluate the efficacy and safety of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C.METHODS: Thirty-six hemodialysis patients with chronic hepatitis C were enrolled in a controlled and prospective study. All patients were treatment naive, positive tested for anti-HCV antibodies, and positive tested for serum HCV-RNA. Twenty-two patients received 135 μg peglyated-interferon α-2a weekly for 48 wk (group A). The remaining patients were left untreated, eleven refused therapy, and three were not candidates for kidney transplantation and were allocated to the control group (group B). At the end of the treatment biochemical and virological response was evaluated, and 24 wk after completion of therapy sustained virological response (SVR) was assessed. Side effects were monitored.RESULTS: Of 22 hemodialysis patients, 12 were male and 10 female, with a mean age of 35.2 ± 12.1 years. Virological end-of-treatment response was observed in 14 patients (82.4%) in group A and in one patient (7.1%) in group B (P = 0.001). Sustained virological response was observed in 11 patients (64.7%) in group A and in one patient in group B (7.1%). Biochemical response parameters normalized in 10/14 patients (71.4%) at the end of the treatment. ALT levels in group B were initially high in six patients and normalized in one of them (25%) at the end of the 48 wk. In five patients (22.7%) therapy had to be stopped at mo 4 due to complications of weakness, anemia, and bleeding.CONCLUSION: SVR could be achieved in 64.7% of patients on hemodialysis with chronic hepatitis C by a treatment with peglyated-interferon α-2a. Group A had a significantly better efficacy compared to the control group B, but the side effects need to be concerned.
World Journal of Gastroenterology. 01/2008;
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Salih Hoşoğlu,
Saban Esen,
Recep Ozturk,
Mustafa Altindis,
Mustafa Ertek,
Sedat Kaygusuz,
Rahmet Caylan,
Kutbettin Demirdag,
Irfan Sencan,
Gunay Tuncer Ertem,
Selda Aslan,
Vuslat Bosnak,
Pakize Aygun,
Serpil Erol, Mustafa Kemal Celen
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ABSTRACT: The total annual expenditure of antimicrobials in Turkey in 2002 was 24% of all drug spending. In order to reduce the cost of drug expenditure, the Turkish government introduced a new restriction policy on the prescription of antimicrobials in June 2003. This new policy is based on the justification that the physicians specializing in infectious diseases should be primarily responsible for the prescription of antimicrobials.
Compare and contrast the usage of antimicrobials at hospitals before and after the implementation of the new restriction policy.
The data was collected from the same departments in two different periods in 2003 at 15 hospitals throughout Turkey. The first set of data was collected a few days before the new policy was implemented in May 2003 and the second data set 6 months after that. Antimicrobial usage was calculated as defined daily doses (DDDs) per 100 patient days according to ATC-DDD index. The change in antimicrobial consumption was determined by comparing the mean DDD values before and after the implementation of the new policy.
Before the intervention, the mean antimicrobial use density was 71.56 DDD/100 patients-day at the hospitals in the study. Six months after the implementation, the mean antimicrobial use density was 52.64 DDD/100 patients-day. There was a 26.4% decrease in the antimicrobial usage between that prior to and that after the intervention (P < 0.025).
The study shows that the implementation of the new policy resulted in a significant reduction in the prescription of antimicrobials.
European Journal of Clinical Pharmacology 11/2005; 61(10):727-31. · 2.85 Impact Factor
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ABSTRACT: The risk of transmission of hepatitis C virus (HCV) infection is an important problem for the health care worker. HCV transmission by blood splashing into eyes is very rare. In a hemodialyses department, a 23-year-old female nurse splashed blood from a patient who was anti-HCV positive into her eyes. She washed her eyes with water immediately and reported to the infection control department. She had never used intravenous drugs nor received transfusions. At the time of exposure, there was no abnormality in her laboratory tests. Her anti-HCV and HCV-RNA tests produced negative results. She was followed up for anti-HCV and alanine aminotransferase activity. After 6 months, she presented with sore throat, nausea, vomiting, fatigue, and weight loss. She had icterus and hepatomegalia. In laboratory tests, alanine aminotransferase level was 504 U/L, aspartate aminotransferase level was 388 U/L, and anti-HCV and HCV-RNA tests produced positive findings. She was treated with interferon alfa-2a for a 1-year period. After treatment, an HCV-RNA test produced negative results and transaminase levels were normal. In conclusion, splashing blood from patients who are HCV positive into the face or eyes is a risk for health care workers. They should be educated to prevent a nosocomial acquisition of bloodborne infection and they should observe protective precautions.
American Journal of Infection Control 01/2004; 31(8):502-4. · 2.40 Impact Factor
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ABSTRACT: This study was undertaken to investigate the usefulness of spiramycin in treatment for brucellosis in an animal model.
Eighty-four Sprague-Dawley rats were infected by intraperitoneal injection of Brucella melitensis suspension. Seven days after inoculation, four rats were selected randomly, killed and spleen cultures and Brucella standard tube agglutination test were carried out. All four rats were found to be infected. Eighty adult rats were randomly divided into four groups of 20 rats each. Tap water was given to the first group. Rifampicin 50 mg/kg per day and doxycycline 40 mg/kg per day were given to the second group, spiramycin 50 mg/kg per day orally was given to the third group, and a combination of spiramycin and rifampicin at the same dose and period was given to the fourth group. Duration of therapy regimens in all groups was 21 days. The spleens of all 80 rats were removed aseptically, homogenized, and placed onto Brucella agar plates to determine if viable bacteria were present.
Bacterial growth occurred in all of the rats' spleens in the first group and in two rats' spleens in the spiramycin group. Mean colony forming unit (c.f.u.) values were at the highest in the first group. The effectivities of spiramycin and rifampicin-spiramycin were similar to rifampicin-doxycycline. There were no differences in the treatment results between the three groups that received combined rifampicin-doxycycline, rifampicin-spiramycin and only spiramycin (P>0.05).
The results show that spiramycin cures experimental rat brucellosis and may be an effective alternative in the therapy of human brucellosis.
Pediatrics International 02/2003; 45(1):31-4. · 0.63 Impact Factor
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ABSTRACT: To compare the efficacy of a combination of a-interferon (IFN-a) and lamivudine with IFN-a alone in the treatment of patients with HBeAg-positive chronic hepatitis B (CHB).
Sixty-eight treatment-naove patients with HBeAg-positive CHB were randomized to receive either 9 MU of IFN-a2a three times a week and lamivudine 100 mg daily (Group 1), or IFN-a2a alone in the same dosage (Group 2), for 12 months. Serum ALT, HBeAg, anti-HBe and HBV DNA were tested at the end of treatment and 6 months later. Complete response was defined as normal ALT, negative HBeAg and negative HBV DNA, six months after stopping treatment.
Of the 68 patients, 64 completed the study. In Group 1 (n=31), mean (SD) ALT levels decreased from 124 (59) IU/L to 39 (18) IU/L at 12 months; corresponding values in Group 2 (n=33) were 128 (57) and 56 (11) IU/L (p< 0.05). Absence of HBV DNA at the end of treatment was more common in Group 1 (28/31) than in Group 2 (22/33; p< 0.022). The number of patients with seroconversion to anti-HBe (4/31 [13%] vs. 4/33 [12%], respectively; p>0.05), as also those with complete response (4/31 [13%] and 4/33 [12%], respectively; p>0.05) six months after completion of treatment was similar in Group 1 and Group 2.
Combination treatment with IFN-a and lamivudine was better than IFN-a monotherapy in normalization of ALT and clearance of HBV DNA; however, it did not have a better sustained response rate than IFN-a alone.
Indian Journal of Gastroenterology 25(2):71-3.
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The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases 14(3):218. · 0.55 Impact Factor
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ABSTRACT: Treatment of perianal abscesses requires prompt surgical drainage and antimicrobial therapy. However, we should encourage the selective use of antimicrobial agents on a case-by-case basis, especially because there is no evidence that uncomplicated perianal abscesses can be safely treated only with drainage. For this reason, it is important to identify the causative organisms; therefore, we accessed the microbiological analysis of these patients.
In this study, 81 consecutive adult patients with perianal abscesses, who presented at a university hospital in Diyarbakir from January 2004 to December 2006, were included. Clinical and laboratory data, and results of microbiological analysis were recorded.
All specimens, except seven, yielded bacterial growth. Escherichia coli, Bacteriodes spp., coagulase-negative Staphylococci, and Staphylococcus aureus were the most common isolated organisms.
In contrast to other investigators, this study demonstrated that aerobic organisms are the predominant isolates in these infections.
The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases 14(3):225-9. · 0.55 Impact Factor
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ABSTRACT: the different clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis (BEO) reporting to the reference hospital in Southeastern Anatolia of Turkey.
in this study, 27 male patients with brucellosis, who presented with epididymitis or epididymo-orchitis (EO) at the university hospital in Diyarbakir from 1998 to 2006, were included. They were compared with the other male patients. Positive blood culture or high agglutination titers of > 1/160 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis.
fourteen patients had unilateral EO. Leukocytosis was present in 10 patients; all of them had initial agglutination titers of > 1/160 and 10 patients had a positive blood culture. All patients received combined therapy with streptomycin for the first 21 days (or oral rifampicin for 6-8 weeks) with doxycycline or tetracycline for 6-8 weeks. All showed improvement, fever subsided in 3-7 days, and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year.
in brucellosis-endemic areas, clinicians encountering EO should consider the likelihood of brucellosis. In this study, young age was the most common risk factor, and leukocytosis and high CRP level were the most common laboratory findings. Most cases were unilateral. All patients responded to medical management very well. Conservative management with combination antibiotic therapy was adequate for managing BEO. Conclusively, brucellosis must be considered as a cause of orchitis, especially in endemic regions like Turkey.
The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases 14(1):109-15. · 0.55 Impact Factor
