[Show abstract][Hide abstract] ABSTRACT: Crimean Congo haemorrhagic fever (CCHF) has been an emerging tick-borne infection in some parts of Turkey since 2002, with a number of fatalities. Many of the initial non-specific symptoms of CCHF can mimic other common infections. Additionally, the seasonal pattern of the epidemic, and the waning attention of healthcare workers to the yearly index cases caused some delays in appropriate patient care and treatment. Between March 2004 and August 2008, 140 confirmed adult cases were evaluated retrospectively for initial diagnosis and treatment delays. This study clearly demonstrated that there are particular delays (4.8 days) in the referral system to initiate effective antiviral treatment in the tertiary-care centre which significantly affect fatality rates (P>0.05). A large number of patients (n=95, 68%) received an initial misdiagnosis of various infections other than CCHF. In conclusion, continuous medical education regarding CCHF in the epidemic area is essential in order to achieve a better survival rate from this deadly infection.
Epidemiology and Infection 08/2009; 138(1):139-44. DOI:10.1017/S0950268809990318 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal viral disease. In this study, the aim was to investigate the prognostic factors affecting the patient's survival and risk factors to fatality. At Ondokuz Mayis University Faculty of Medicine, a tertiary referral centre near the CCHF epidemic region, patients with typical clinical findings and indicative microbiological results for IgM and/or reverse transcriptase-polymerase chain reaction of CCHF virus were enrolled in the study, from 2004 to 2007. Patients were divided into two subgroups according to their survival outcomes; group I (n = 44) survived patients and group II (n = 6) consisted of fatal cases. The median platelet count was significantly lower in the fatal group (11000/mm(3)) when compared to the survived group (49500/mm(3)). Aspartate transferase and alanine transferase (ALT) levels were significantly higher in group II, when compared to group I. Also, the median range of serum lactic dehydrogenase (LDH) and creatinine phosphokinase (CPK) levels were much more elevated, and prothrombin time (PT) and activated partial thromboplastin time (aPTT) were prolonged in fatal cases. There was also a significant difference in median age of these two groups. Advanced age, late admission, low platelet count, increased AST, ALT, CPK and LDH levels, and prolonged PT and aPTT could be an early indicator of poor prognosis in patients with CCHF.
Tropical Doctor 08/2009; 39(3):158-60. DOI:10.1258/td.2008.080092 · 0.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Crimean-Congo hemorrhagic fever (CCHF) is a disease with high fatality. To demonstrate the effectiveness of ribavirin against CCHF. The first group of 21 patients received ribavirin within 4 days of the onset of symptoms (early use of ribavirin, EUR); the second group of 20 patients received ribavirin > or =5 days after the onset of the symptoms of the disease (late use of ribavirin, LUR); and the last group of 11 patients did not receive ribavirin (no use of ribavirin, NUR). At 5-10 days from the onset of symptoms the mean platelet counts of the patients in the EUR group were significantly higher than those of the patients in LUR group, and at 7-9 days, they were significantly higher than that of the patients in the NUR group. The mean aspartate transferase levels in the EUR group were significantly lower than of the NUR group on days 8 and 9, and the mean alanine transferase level was significantly lower on day 8 after the onset of the symptoms. There is a beneficial effect of ribavirin if given at an early phase of the CCHF. We suggest ribavirin use especially in the early phase of the disease.
European Journal of Clinical Microbiology 03/2009; 28(8):929-33. DOI:10.1007/s10096-009-0728-2 · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although the pathology of Crimean Congo haemorrhagic fever (CCHF) is mainly related to a haemorrhagic process with secondary cytokine storm, there have been no published reports of this fatal disease being a cause of diffuse alveolar haemorrhage (DAH). There are many aetiological factors emphasizing the direct role of endothelial injury on DAH. We present the case of a young adult Turkish man with diffuse bilateral alveolar haemorrhage without an episode of gross haemoptysis caused by the CCHF virus. Successful clinical results and a rapid clinical and radiological clearance were obtained within few days after starting daily oral ribavirin treatment. This fatal infection should be considered to exist in any patient presenting with DAH, and should rapidly be treated with ribavirin. Another very important factor which should always be borne in mind is the contagious character of the CCHF virus. It is one of the most dangerous microorganisms transmitted from person to person. Even the bronchoscopes contaminated with patient blood carry a high risk for nosocomial spread to medical staff and other patients.
Tropical Doctor 11/2008; 38(4):252-4. DOI:10.1258/td.2008.070406 · 0.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Crimean-Congo hemorrhagic fever (CCHF) is highly fatal tick-borne viral disease in Euroasia and seen endemically in Turkey in the recent years. In this prospective study, the aim is investigating the patient’s survival with early initiation of ribavirin and correlation of platelets count, AST and ALT levels with this early use. Methods: Consecutive patients in the epidemic season in beginning of 2004 to end of 2007 with typical clinical findings and indicative microbiological results for IgM and/or PCR for CCHF virus were enrolled in the study in Ondokuz Mayis University Faculty of Medicine Samsun-Turkey, a tertiary referral center near the CCHF epidemic region. Patients were divided in three subgroups according to initiating time of ribavirin use and; group I (n: 21) ribavirin given ≤4 days within the clinical infection, group III (n: 20) ribavirin given ≥5 days after the clinical symptoms of the disease and group II (n: 11) ribavirin not given. Results: The case fatality rate between the patients who received ribavirin earlier and the patients, who did not receive ribavirin was different, but statistically nonsignificant (p=0.067). Patient’s PLT counts, maximum daily AST and ALT values were statistically investigate for a significance, according to the onset time of symptoms (days) in each groups. PLT counts in early ribavirin group had higher daily level from 5th day to 10th day than the group who had no ribavirin treatment. Conclusions: Similar positive impacts in progression of the disease seen on AST and ALT values in 8th and 9th days in the group I and these results were calculated statistically significant. This study had a very important conclusion stating that early ribavirin use (4 days or less) has a strong positive impact for the survival rates from CCHF with positive indicators on PLT counts and AST, ALT levels
Infectious Diseases Society of America 2008 Annual Meeting; 10/2008
[Show abstract][Hide abstract] ABSTRACT: In the indexed medical literature, there have been a very limited number of studies to investigate the epidemiologic and clinical
features of enteroviral meningitis in Turkey. The aim of the present retrospective study is to update the actual situation
to recognize the spectrum and magnitude of this important clinical entity. Between June 1999 and December 2004, 612 cases
of aseptic meningitis were followed up at our hospital. Enteroviral meningitis was defined by isolation of enteroviruses from
cerebrospinal fluid (CSF) and/or stool samples. Mumps virus was detected in 310 cases (50.7%) and enteroviruses were the etiologic
agents in 104 (17%) of the patients with aseptic meningitis. Most of the enteroviral meningitis cases (36 cases, 34.6%) were
diagnosed in August and 70 (67.3%) of them were male. The mean age was 5.6 ± 3.4 years. The most common initial symptoms were
fever (81.7%), vomiting (77.9%) and headache (57.7%). In the physical examination, 46.2% of the cases had neck stiffness and
38.5% had pharyngitis. Echovirus 30 was the most frequently (38 cases, 36.5%) isolated enterovirus with peaks in 1999, 2002
and 2004. The other frequently isolated enteroviruses were Coxsackie virus type B (17 cases, 16.3%), echovirus 6 (11 cases,
10.6%), echovirus 11 (6 cases, 5.8%), and echovirus 13 (4 cases, 3.8 %). Mean hospitalization time was 6.2 ± 2.4 days. All
patients recovered without any sequelae. Enteroviruses have an important role in childhood aseptic meningitis cases in Turkey
too, and the predominant serotypes vary according to years.
Central European Journal of Medicine 06/2008; 4(2):253-258. DOI:10.2478/s11536-008-0055-5 · 0.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In daily medical practice, streptococcal toxic shock syndrome is an infrequent clinical entity which carry a very high risk of fatality. Early recognition of this toxin mediated immunopathological disease is very important to apply necessary invasive procedures such as an prompt amputation of the effected areas to save the patient. Here, we report a 47 year-old male farmer with a fatal streptococcal toxic shock syndrome to highlight the importance of emergency care and aggresive surgical intervention in similar situations.
Tropical Doctor 05/2008; 38(2):129-31. DOI:10.1258/td.2007.070135 · 0.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Here, we describe a 38-year-old male with an abrupt manifestation acute panniculitis as unusual presentation of brucellosis. Brucellosis is a reemerging disease in Turkey, and the disease is primarily transmitted from farm animals to humans. Farmers and shepherds are the major risk groups for brucellosis in Anatolia. Brucellosis may involve almost all systems and organs, including the skin, and may mimic a wide range of illness and syndromes. Although the cutaneous manifestation of brucellosis is not disease specific, but it occurs in about 6%-13% of patients with brucellosis. Some of these lesions including rashes, papules, ulcers, abscess, erythema nodosum, ecchymosed skin rash, purpura, and vasculitis may be seen frequently in brucellosis, but panniculitis is rarely described. The case confirmed by positive blood culture had manifest skin lesion as an initial finding represented by lobular panniculitis with vasculitis.
The American Journal of dermatopathology 05/2008; 30(2):169-71. DOI:10.1097/DAD.0b013e31816563f5 · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Three pediatric and two adult Turkish patients with Crimean Congo Hemorrhagic Fever (CCHF) induced hemophagocytic syndrome (HPS) were admitted to Ondokuz Mayis University Hospital, which is in the Middle Black Sea Region of Turkey. All of them had remarkable hemophagocytosis in the bone marrow with severe bleeding symptoms along with the other known clinical and laboratory findings of CCHF. We would like to present these patients and to discuss the pathophysiology and the effect of acquired HPS on the severity of the disease.
American Journal of Hematology 01/2008; 83(1):73-6. DOI:10.1002/ajh.20969 · 3.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We reported a case of septic arthritis due to Chryseomonas luteola known as a rarely considered human pathogen in a previously healthy boy. This is the first case report of septic arthritis caused by this pathogen in the English literature. Antibiotic susceptibility of this pathogen is also described in this report.
[Show abstract][Hide abstract] ABSTRACT: Although the availability of effective antimicrobial therapy, both otitis media with effusion (OME) and acute bacterial meningitis (ABM) are still important infections for children, leading serious health problems. The most frequently isolated bacteria from cerebrospinal fluid (CSF) of ABM patients are Haemophilus influenzae type b, Neisseria meningitidis and Streptococcus pneumoniae, and middle ear effusion (MEE) samples of OME patients are H. influenzae, S. pneumoniae, Moraxella catarrhalis, respectively. Since they are fastidious bacteria, various problems may arise in the rapid diagnosis in both ABM and OME settings. In this study, the diagnostic value of polymerase chain reaction (PCR) has been searched for the detection of bacterial DNA in CSF and MEE specimens and evaluated in comparison to conventional culture method accepted as the "gold standard". A total of 75 samples (53 CSF, 22 MEE) collected from meningitis and OME suspected children were included in the study. With the conventional culture method, one S. pneumoniae strain was isolated from a CSF sample, and one H. influenzae (non-type b) and two M. catarrhalis strains were isolated from three of MEE samples (total isolation rate: %5.3; 4/75). Standard PCR protocol was applied for the detection of H. influenzae, while multiplex PCR protocol was used for M. catarrhalis and S. pneumoniae, since H. influenzae and S. pneumoniae amplification products were of similar size. PCR revealed genomic DNA sequences of S. pneumoniae from five of the CSF samples, while three H. influenzae, three M. catarrhalis and two S. pneumoniae+M. catarrhalis were detected from MEE samples (total detection rate: %17.3; 13/75). Sensitivity and specificity rates of PCR method were found as 100% and 92.3% for CSF samples, and 100% and 73.7% for MEE samples, respectively, with a total sensitivity of 100%, specificity of 87.3%, positive predictive value of 30.8%, and negative predictive value of 100%. As a result it was concluded that PCR method could be considered as a rapid, reliable and feasible method for the detection of the most common fastidious bacteria that lead to meningitis and OME.
[Show abstract][Hide abstract] ABSTRACT: Genotyping of Mycobacterium tuberculosis isolates from infected individuals can play an important role in tracking the source of infection and unraveling the epidemiology of a tuberculosis pandemic. A total of 114 M. tuberculosis isolates were genotyped by spoligotyping and results were compared with an international spoligotype database (SpoIDB4). Twenty-one spoligotyping-defined clusters including 97 patients were established, and an additional 17 unique patterns were found. Ninety-eight (85.9%) isolates belonged to previously defined shared types (STs). The ST53 (ill-defined T1 superfamily, n=31), ST41 (LAM7-TUR family, n=9), ST118 (T undefined, n=8) and ST50 (Haarlem 3, n=6) were four major clusters of our isolates. After comparison with the international SpoIDB4 database, two new intrafile clusters, ST2136 and ST2139, were created and two new interfile clusters, ST2135 and ST2140, were defined. Eight (7%) of the 17 isolates with unique patterns were found to be orphans, whereas the STs of 9 isolates had previously been deposited in the international SpoIDB4 database. In addition, two isolates with an ST pattern characteristic of the Beijing family of M. tuberculosis were found. This study shows that, although ubiquitous spoligotypes are common, several spoligotypes specific to Turkey also exist. Thus, our study may help us to better understand the spread of M. tuberculosis genotypes to Turkey.
Research in Microbiology 05/2007; 158(4):318-23. DOI:10.1016/j.resmic.2007.01.004 · 2.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The isolation of Brucella species from blood may be achieved by using classic culture techniques, but detection of the organism is difficult due to its slow growth. The time-to-detection of Brucella can take up to 30 days using the Castaneda blood culture method. Automated blood culture systems have reduced the growth time of Brucella.
In this report we would like to contribute our experience on detection time in the isolation of Brucella species from 33,039 blood culture sets using BacT/ALERT between 1995 and 2000 (13 isolates) and thereafter using both the BACTEC and BacT/ALERT systems (17 isolates).
Thirty Brucella spp. (17 by both systems and 13 by BacT/ALERT only) were isolated from 33,039 blood culture sets between 1995 and 2002. Brucellae were recovered between 1.8 and 3.7 days (mean: 2.5 days) in the BacT/ALERT blood culture system and between 2.1 and 3.8 days (mean: 2.8 days) in BACTEC 9240 system.
We concluded that the mean time-to-detection could be <or=3 days, which is considered rapid enough for starting appropriate evidence-based treatment in an endemic setting.
Medical science monitor: international medical journal of experimental and clinical research 08/2006; 12(7):BR235-8. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In total, 171 students from a boarding school in Izmir, Turkey, with mild and non-specific symptoms of toxoplasmosis, were screened during September-October 2002. All 171 students were seropositive for Toxoplasma gondii IgG and IgM. Of 43 students tested, 40 (93%) had low IgG avidity. None showed evidence of ophthalmic involvement. The data suggest that T. gondii may spread rapidly in close living conditions, possibly following exposure to cat litter. This is the largest recent outbreak of toxoplamosis described in the medical literature.
[Show abstract][Hide abstract] ABSTRACT: Tuberculosis is an opportunistic infection that carries substantial morbidity and mortality in renal transplant recipients. We report here about a 21 year-old man with a living related renal transplant from his mother who developed persistent extra-pulmonary tuberculosis. The disease showed aggressive invasion to the axillary and mediastinal regions with abscess formations, despite standard antituberculosis treatment. During the course of the disease, immunosuppressive therapy was stopped, and the patient received extraordinary doses of multiple antituberculosis drugs. The patient then showed an uneventful course with good clinical and radiological responses.
[Show abstract][Hide abstract] ABSTRACT: The aim of our prospective study was to evaluate the predictive value of serum procalcitonin (PCT) level in comparison with C-reactive protein level and erythrocyte sedimentation rate for the diagnosis of pulmonary tuberculosis (PTB) on admission and 6 months after the administration of anti-tuberculous chemotherapy (ATCT). Seventy-five adult male patients with active PTB who were mycobacteriologically diagnosed (smear and culture positivity) were examined in this study. As a control group, 75 healthy adult males were enrolled. The measured serum PCT levels were within the normal range both in healthy individuals and in patients 6 months after ATCT. Serum PCT levels had been slightly high on admission in patients with PTB in comparison with controls (P = 0.01) and patients who had ATCT (P = 0.001), and this difference was statistically significant, but the PCT levels of most cases with PTB (58.7%) were below the usual cut-off level (0.5 ng/mL). We conclude from this study that the serum PCT level was not a reliable indicator in the diagnosis of active PTB because of its low sensitivity (41.3%), and in most cases it was not capable of overcoming the cut-off level even if statistically meaningful results were obtained. The PCT test for the presumptive diagnosis of PTB cannot be substituted for microbiological, epidemiological, clinical and radiological data.
Japanese journal of infectious diseases 07/2006; 59(3):164-7. · 1.20 Impact Factor