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Hakan Erdem, Murat Dizbay,
Selma Karabey,
Selcuk Kaya,
Tuna Demirdal,
Iftihar Koksal,
Asuman Inan,
Ibrahim Erayman,
Oznur Ak,
Aysegul Ulu-Kilic, [......],
Ayşe Willke,
Levent Gorenek,
Salman Shaheer Ahmed,
Yesim Tasova,
Asim Ulcay,
Saim Dayan,
Saban Esen,
Hakan Leblebicioglu,
Begin Altun,
Serhat Unal
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ABSTRACT: BACKGROUND: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. METHODS: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value ≤.01 was considered significant. RESULTS: Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001). CONCLUSIONS: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs.
American journal of infection control 05/2013; · 3.01 Impact Factor
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ABSTRACT: Combined antifungal therapy has been suggested to enhance the efficacy and reduce the toxicity of antifungal agents. The aim
of the study was to investigate the in vitro synergistic activity of caspofungin, voriconazole, and fluconazole with amphotericin B against ten isolates of Candida parapsilosis and Candida albicans strains which were resistant to azoles or amphotericin B. Three different antifungal combinations (amphotericin B [AP] —
caspofungin [CS], amphotericin B — fluconazole [FL], and AP — voriconazole [VO]) were evaluated for in vitro synergistic effect by the microdilution checkerboard and E-test methods. For the majority of strains, the combination test
showed indifferent activity. Via the E-test method, synergistic activity was seen in 3 strains in response to AP-CS combination treatment and in one strain
after administration of AP-FL; however, no synergy was observed in response to combination treatment with P-VO. Antagonistic
activity was the result in 1 strain treated with AP-CS as well as in 6 strains treated with AP-FL and AP-VO combinations.
Via the microdilution test, no synergistic activity was seen after treatment with all 3 combinations. Antagonistic activity was
the result in 2 strains with AP-CS, in 6 strains with AP-VO and in 5 strains with AP-FL combinations. Agreement between the
checkerboard and E-test methods was observed to be approximately 72%. These combinations may be used in the case of antifungal
resistance.
KeywordsAntifungals-chequerboard-E-test
Central European Journal of Medicine 04/2012; 5(2):194-197. · 0.31 Impact Factor
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Hakan Erdem,
Suda Tekin-Koruk,
Ibrahim Koruk,
Derya Tozlu-Keten,
Aysegul Ulu-Kilic,
Oral Oncul,
Rahmet Guner,
Serhat Birengel,
Gurkan Mert,
Saygin Nayman-Alpat, [......],
Asim Ulcay,
Halil Kurt,
Bulent A Besirbellioglu,
Haluk Vahaboglu,
Yesim Tasova,
Gaye Usluer,
Dilek Arman,
Husrev Diktas,
Sercan Ulusoy,
Hakan Leblebicioglu
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ABSTRACT: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.
A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.
A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.
The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.
Annals of Clinical Microbiology and Antimicrobials 12/2011; 10:38. · 2.64 Impact Factor
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Hakan Erdem,
Aysegül Ulu-Kilic,
Selim Kilic,
Mustafa Karahocagil,
Ghaydaa Shehata,
Necla Eren-Tulek,
Funda Yetkin,
Mustafa Kemal Celen,
Nurgul Ceran,
Hanefi Cem Gul, [......],
Serhat Unal,
Saim Dayan,
Levent Gorenek,
Ahmet Karakas,
Yesim Tasova,
Gaye Usluer,
Yasar Bayindir,
Behice Kurtaran,
Oguz Resat Sipahi,
Hakan Leblebicioglu
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ABSTRACT: 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.
Antimicrobial Agents and Chemotherapy 12/2011; 56(3):1523-8. · 4.84 Impact Factor
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ABSTRACT: Recently, colistin has become a salvage therapy in the treatment of serious Intensive Care Unit infections owing to the emergence of extensively drug-resistant (XDR) bacterial isolates. This study aimed to show the effectiveness of colistin in critically ill patients with renal failure. A prospective case-control study of 94 patients admitted to medical intensive care units of a university hospital from December 2008 to June 2010 was conducted. All patients had infections with XDR Acinetobacter baumannii or Pseudomonas aeruginosa and received colistin. Cases comprised 39 patients with chronic renal failure (CRF) and controls were other patients without CRF. Apart from the male dominancy in the CRF group, there was no statistical difference between the two groups regarding demographic characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and site and type of infection. In patients who completed colistin therapy, bacteriological cure was seen in 87% of patients with CRF and 95% of patients without CRF (P=0.890). Mortality in patients with CRF was similar to that in patients without CRF (44% and 42%, respectively) (P=0.999). Nephrotoxicity developed in 23.6% of patients in the control group. Concomitant nephrotoxic agents and total defined daily dose of colistin did not affect the development of nephrotoxicity. The mortality rate was 38% in patients with nephrotoxicity, similar to the mortality rate in patients without nephrotoxicity (36%) (P=0.999). In conclusion, in critically ill patients with CRF, colistin therapy, although used at a reduced dosage, was as effective as in patients without CRF.
International journal of antimicrobial agents 11/2011; 39(2):142-5. · 3.03 Impact Factor
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Journal of critical care 10/2011; 26(5):526-7. · 2.13 Impact Factor
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ABSTRACT: We investigated the characteristics of Acinetobacter baumannii infection in critically ill patients with hematologic malignancies.
The prospectively collected data of patients with hematologic malignancies admitted to a medical intensive care unit of a university hospital from 2007 through 2010 were reviewed retrospectively.
One hundred twenty-eight patients were included in the study, among whom 35 (27%) developed 39 A baumannii infections. Pneumonia was the most common infection site of A baumannii. Presence of neutropenia, underlying hematologic malignancy, and the disease status did not affect the acquisition of the infection. Advancing age, prior exposure to aminoglycosides, central venous catheterization, and presence of nasogastric tube were the independent risk factors for the development of A baumannii infections. The mortality rate was higher in patients with A baumannii infections compared with the ones without (P = .009). However, in multivariate analysis, low Glasgow coma scale, prior immunosuppressive treatment, neutropenia, invasive mechanical ventilation, and severe sepsis were independently associated with mortality, whereas presence of A baumannii infection was not.
Despite the high mortality rate in critically ill patients with hematologic malignancies, presence of A baumannii infection was not an independent risk factor for mortality.
Journal of critical care 06/2011; 26(5):460-7. · 2.13 Impact Factor
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ABSTRACT: Pulmonary aspergillosis which is an important opportunistic infection in neutropenic patients, is usually caused by Aspergillus fumigatus. Since the pathogenesis of disease is not well understood, the main proposed mechanism is thought to be cell-mediated immunity and cytokine response. The aim of this study was to investigate the local production of cytokines in the lung tissues of rats with experimentally developed aspergillosis, by reverse transcriptase-polymerase chain reaction (RT-PCR). A total of 33 Wistar albino type rats were included in the study with the consent of Experimental Animal Ethics Committee. Twenty-five of the rats were infected with A.fumigatus by intratracheal way, while 8 animals were used as controls. The presence of A.fumigatus in the lung tissues of infected rats was confirmed with the use of quantitative culture and histologic staining methods. RNA isolation from the lung tissue samples of both groups were performed by a commercial kit (Qiagen, Germany). After obtaining complementary DNAs from the genomic RNAs, in-house qualitative and quantitative (real-time) PCR methods were used to amplify the target regions for interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-?) and interferon-gamma (IFN-?) by using specific primers (Tıb Molbiol, Germany). Mean mRNA levels achieved by real-time PCR for IL-10, TNF-? and IFN-? in aspergillosis group were 6.5 x 106 copies/ml, 7.9 x 105 copies/ml and 2.2 x 103 copies/ml, respectively, while those values in control group were 4.3 x 102 copies/ml, 5.6 x 103 copies/ml and 1.3 x 102 copies/ml, respectively. Our data indicated that rat model of aspergillosis was associated with significantly increased expression of mRNA encoding IL-10 and TNF-? than controls (p< 0.05), however there was no statistically significant difference between the groups with respect to IFN-? expression (p= 0.53). In conclusion, the production of proinflammatory cytokines which mediate the influx of phagocytic cells might account for the localization of Aspergillus infection to the upper respiratory tract. The up-regulation of the expression of the immunomodulatory cytokine TNF-? and IL-10 in lung tissue from infected rats might be important to limit the extent of local tissue destruction, but might also account for the fact that infected rats are generally unable to clear the infection spontaneously.
Mikrobiyoloji bülteni 04/2011; 45(2):344-52. · 0.40 Impact Factor
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Volkan Korten,
Güner Söyletir,
Ata Nevzat Yalçın,
Dilara Oğünç,
Başak Dokuzoğuz,
Harika Esener,
Sercan Ulusoy,
Alper Tünger,
Bilgehan Aygen,
Bülent Sümerkan,
Dilek Arman, Murat Dizbay,
Murat Akova,
Gülşen Hasçelik,
Haluk Eraksoy,
Seniha Başaran,
Iftihar Köksal,
Gülçin Bayramoğlu,
Halis Akalın,
Melda Sınırtaş
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ABSTRACT: The aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical gram-negative isolates. A total of 596 clinical isolates were obtained from intensive care unit (ICU) and non-ICU patients in 10 centers over Turkey between September-December 2008. The origin of the isolates was patients with nosocomial pneumonia (42.4%), bloodstream infections (%40.4), and complicated intraabdominal infections (17.1%). Of the isolates, 51.8% were obtained from ICU patients. The study isolates consisted of Pseudomonas spp. in 49.8%, Enterobacteriaceae in 40.3%, and other gram-negative agents in 9.9%. The minimum inhibitory concentrations (MIC) for doripenem, imipenem and meropenem were determined for all isolates in each center using Etest® strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC50 of doripenem against Pseudomonas spp. Was 1 mg/L which was similar to that of meropenem and two-fold lower than imipenem. Susceptibility to carbapenems in P.aeruginosa was 64% for doripenem at an MIC level of 2 mg/L, 53.9% and 63% for imipenem and meropenem at an MIC level of 4 mg/L, respectively. Doripenem and meropenem showed similar activity with the MIC90 of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gramnegative pathogens, mostly Acinetobacter spp., MIC50 was 8 mg/L for doripenem and 32 mg/L for other two carbapenems. P.aeruginosa isolates were inhibited 84.2% with doripenem and 72.1% with meropenem at the MIC level of 8 mg/L. Doripenem generally showed similar or slightly better activity than meropenem and better activity than imipenem against pathogens collected in this study. Against Pseudomonas spp., doripenem was the most active of the three carbapenems. Doripenem and meropenem were equally active against Enterobacteriaceae and at least four-fold more active than imipenem. It was concluded that doripenem seemed to be a promising agent in the treatment of nosocomial pneumonia, blood stream infections and intraabdominal infections particularly in patients who were under risk of developing antimicrobial resistance.
Mikrobiyoloji bülteni 04/2011; 45(2):197-209. · 0.40 Impact Factor
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ABSTRACT: The incidence, clinical characteristics, risk factors, antimicrobial susceptibility, and outcomes of nosocomial imipenem-resistant A. baumannii (IRAB) infections during a 5-y period (2003-2007) were retrospectively analyzed. A total of 720 patients with 925 episodes of A. baumannii infection were included in the study. A. baumannii infections were seen mostly in intensive care units. The incidence was 6.2 per 1000 admissions. The most common infections were pneumonias and bloodstream infections. Imipenem resistance among Acinetobacter strains increased significantly each y of the study (from 43.3% to 72.9%). Mortality was related to the presence of imipenem resistance, stay in intensive care unit, female gender, old age, and pneumonia. Haemodialysis, malignancy, and mechanical ventilation were significant risk factors for IRAB infections. Imipenem resistance was higher in strains isolated from patients with pneumonia. IRAB strains showed higher resistance rates to other antibiotics than imipenem-susceptible strains. The most active antimicrobial agents against A. baumannii were cefoperazone-sulbactam and netilmicin. The incidence of A. baumannii infections and imipenem resistance increased during the study period. IRAB infections should be considered in patients on mechanical ventilation and haemodialysis and in patients with malignancies.
Scandinavian Journal of Infectious Diseases 10/2010; 42(10):741-6. · 1.72 Impact Factor
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ABSTRACT: The emergence of extensive drug-resistant (XDR) Acinetobacter baumannii limits the therapeutic options and leads to high mortality in intensive care units. Combined antibiotic therapy is frequently recommended for the treatment of these infections. Colistin (CO) and tigecycline (TIG), alone or in combination with other antimicrobials, are the most commonly used antibiotics in the treatment of these resistant infections. In this study, the in vitro synergistic activity of TIG and CO were tested for 25 XDR-A. baumannii strains isolated from ventilator-associated pneumonia by the Etest method. Resistance to CO was not detected, whereas 8% of the strains were resistant to TIG. The TIG–CO combination was more synergistic than TIG–rifampin and CO–rifampin according to the fractional inhibitory concentration index. No antagonism was detected between the drugs in the study. There was no strong correlation between the activity of the combinations with reference to strains or genotypes. Our results suggest that the combined use of TIG and CO may be useful for the treatment of XDR-A. baumannii infections.Keywords: Acinetobacter baumannii, colistin, combination, rifampin, synergy, tigecycline
The Journal of Antibiotics 11/2009; 63(2):51-53. · 1.65 Impact Factor
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ABSTRACT: The epidemiological and antifungal susceptibility data for 35 episodes of candidemia in intensive care units (ICU) in 2007 were evaluated by prospective active surveillance. The incidence of fungaemia was 39.1 cases per 1000 ICU admissions and 2.85 cases per 1000 patient-days. The crude mortality was 65.7%; 70.8% of the fatalities occurred within 7 days of admission to the ICU. Only 2 species were isolated, Candida parapsilosis (77.1%) and Candida albicans (22.9%). There was no association between mortality and patient characteristics, prior antifungal usage, Candida subspecies or antifungal resistance (p > 0.05). Of the isolates, 5.7% were resistant to fluconazole and caspofungin, and 3.4% to voriconazole and amphotericin B. In molecular analysis of the isolates, 2 clusters of C. parapsilosis in the neurology and anaesthesiology ICUs were detected by randomly amplified polymorphic DNA (RAPD), suggesting a nosocomial transmission. In conclusion, a high incidence and high mortality rate of C. parapsilosis candidaemia were found in the ICUs. An excessive use of invasive procedures, total parenteral nutrition and broad-spectrum antibiotics in the ICUs, combined with a lack of proper infection control measures, may possibly explain the high incidence of C. parapsilosis candidaemia in our hospital.
Scandinavian Journal of Infectious Diseases 11/2009; 42(2):114-20. · 1.72 Impact Factor
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ABSTRACT: We report a case of Crimean-Congo Hemorrhagic Fever (CCHF) infection in a 36-week pregnant woman. She was treated with ribavirin. She did not transmit the disease to her baby. Her baby was the first known to survive being delivered by a woman with CCHF. The initialization of ribavirin treatment probably resulted in the survival of the mother and her baby.
The Journal of infection 09/2009; 59(4):281-3. · 4.13 Impact Factor
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ABSTRACT: Mucor spp. are rarely pathogenic in healthy adults, but can cause fatal infections in patients with immuosuppression and diabetes mellitus. Documented mucor fungemia is a very rare condition in the literature. We described a fungemia and cutaneous mucormycosis case due to Mucor circinelloides in an 83-year-old woman with diabetes mellitus who developed acute left frontoparietal infarctus while hospitalized in a neurological intensive care unit. The diagnosis was made based on the growth of fungi in the blood, skin biopsy cultures, and a histopathologic examination of the skin biopsy. The isolates were identified as M. circinelloides by molecular methods. This case is important in that it shows a case of cutaneous mucormycosis which developed after fungemia and provides a contribution to the literature regarding Mucor fungemia.
Japanese journal of infectious diseases 04/2009; 62(2):146-8. · 1.49 Impact Factor
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ABSTRACT: Burkholderia cepacia has the potential to cause fatal infections in ICUs, and multidrug resistance makes them a serious threat in hospital settings. The aim of this study was to evaluate the epidemiology of B. cepacia infections in our hospital.
The incidence, clinical characteristics, antimicrobial susceptibility, and outcomes of nosocomial B. cepacia infections during a five-year period were retrospectively analysed according to the infection control committee records.
A total of 39 cases with nosocomial B. cepacia infection were included in the study. B. cepacia was identified from 0.7% of the nosocomial isolates. Its incidence was 0.26 per 1,000 admissions with 53.8% crude mortality rate. The most frequent nosocomial B. cepacia infection was pneumonia (58.9%), followed by bloodstream infections (25.6%), surgical site infections (7.6%), urinary tract infections, (5.1%), and skin-soft tissue infections (2.5%). Nosocomial B. cepacia infections were most commonly observed in intensive care units (61.5%). The most active antimicrobial agents were piperacillin-tazobactam, cefoperazone-sulbactam, and carbapenems.
The incidence of nosocomial B. cepacia infections was rare in our hospital, and no outbreak was detected during the study period. However, infections caused by B. cepacia should be taken into consideration because of their high mortality due to multidrug resistance in ICU settings.
The Journal of Infection in Developing Countries 01/2009; 3(4):273-7. · 1.19 Impact Factor
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ABSTRACT: Splenectomized patients are likely to suffer from severe infections, such as sepsis and meningitis, which is called overwhelming postsplenectomy infection (OPSI) syndrome. It seems to be more common in children, but occurs at all ages. The risk is greatest in the early months and years after operation, but never disappears entirely. The course is rapid, the clinical symptoms are serious, and the prognosis is very poor. In this paper, three cases of OPSI syndrome are described, in which infection developed 8, 8 and 15 years after splenectomy; two of the patients died. With the help of these case reports, we want to again emphasize the importance of vaccination, antibiotic prophylaxis and seeking earlier medical attention in splenectomized patients.
The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases 01/2009; 12(6):549-51. · 0.55 Impact Factor
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ABSTRACT: We investigated a nosocomial cluster of four Candida parapsilosis fungemia episodes that occurred in a neurological intensive care unit over a two-week period. The four infected patients had received parenteral nutrition through central lines, and all four had catheter-related candidemia. All of the isolates were susceptible to all of the antifungals tested, including amphotericin B, fluconazole, voriconazole, and caspofungin. They had strictly related fingerprints, based on randomly amplified polymorphic DNA analysis. Additional DNA sequencing data revealed that they were same strain. Although no isolate of Candida parapsilosis was recovered from other clinical, surveillance, or environmental samples, nosocomial spread of this yeast ceased, following the reinforcement of infection-control measures. Candida parapsilosis may require an intravascular foreign body to cause fungemia, but this outbreak shows that it can be transmitted nosocomially and can cause epidemics.
The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases 11/2008; 12(5):395-9. · 0.55 Impact Factor
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ABSTRACT: Antimicrobial resistance in Staphylococcus aureus and coagulase-negative staphylococci (CNS) has become an increasing problem in hospital settings. These strains often reveal resistance to various drug classes in addition to beta-lactam resistance. Clindamycin, as a well-tolerated and cost-effective antimicrobial agent, is used widely in the treatment of intra-abdominal and skin-soft tissue infections. However, a major concern with regard to the use of clindamycin for staphylococcal infections is the possible presence of inducible resistance to clindamycin. The aim of this study was to determine the prevalence of constitutive and inducible clindamycin resistance among nosocomially acquired S. aureus and CNS strains. A total of 375 staphylococcal isolates were tested for clindamycin and erythromycin by the disk diffusion induction test (D-test) according to CLSI criteria. Oxacillin disks were used for the detection of methicillin resistance. The isolates resistant to erythromycin (ER-R) and susceptible to clindamycin (CL-S) with a D-shaped zone around clindamycin disk were considered positive for inducible resistance (D-test positive). Constitutive clindamycin resistance was found in 64.6% of methicillin-resistant S. aureus, 11.8% of methicillin-susceptible S.aureus, 53.8% of methicillin-resistant CNS and 4.9% of methicillin-susceptible CNS. Erythromycin-resistant clindamycin-susceptible (ER-R/CL-S) phenotype was found more frequent in CNS than in S. aureus strains. Among these strains, inducible clindamycin resistance was detected in 90% of S. aureus and 52.2% of CNS. In conclusion, to avoid using clindamycin when the antibiotic susceptibility test result showed an ER-R/CL-S phenotype may prevent a possible clindamycin treatment failure since inducible clindamycin resistance is frequent among such isolates, however, it may also deter the use of clindamycin in the treatment of infections that would likely respond to clindamycin therapy. Decision about clindamycin use for staphylococci with the ER-R/CL-S phenotype should be made according to the local prevalence data.
Mikrobiyoloji bülteni 05/2008; 42(2):217-21. · 0.40 Impact Factor
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ABSTRACT: Wegener’s granulomatosis (WG) is a relatively rare disease characterized by necrotizing granulomatous vasculitis of the upper and lower respiratory tract and glomerulonephritis. The clinical presentation of WG can be so diverse. Therefore the list of differential diagnosis is vast. We describe here a 46-year-old male patient with severe headache and fever following saddle nose deformity operation and medpor implantation. Although the patient had no risk factors for invasive fungal rhinosinusitis (IFR) such as immunosuppression or diabetes, the macroscopic examination of the nasal cavity and pathologic examination of biopsy specimen was relevant with IFR. No fungi was examined or isolated from the biopsy specimen. Detailed investigation for other granulomatous pathologic conditions revealed C-ANCA positivity. The patient was diagnosed as WG and treated with cyclophosphamide and corticosteroids for six weeks. The patient was discharged in a good condition and recovered with this treatment. We report this case to alert physicians to the significance of considering the unusual clinicopathological features of Wegener’s granulomatosis in complicated ‘difficult-to-diagnose’ febrile patients.
The Anatolian Journal of Clinical Investigation. 01/2008;
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ABSTRACT: Brucellosis is a multisystemic disease that rarely leads to a fatal outcome. While reticuloendothelial system organs are mostly affected, peritonitis and posthepatitic cirrhosis are also complications of brucellosis, though they are very rare. Brucella spp. can also trigger immunological reactions. We report a case of brucellosis with peritonitis, renal failure and leucocytoclastic vasculitis caused by Brucella melitensis, which led to a fatal outcome. Brucellosis should be considered in the differential diagnosis of vasculitic diseases, especially in endemic areas.
Brazilian Journal of Infectious Diseases 09/2007; 11(4):443-4. · 1.00 Impact Factor
