[show abstract][hide abstract] ABSTRACT: Diagnosing GABHS (Group A-beta Hemolytic Streptococcus) tonsillopharyngitis by clinical scoring is a recommended approach in developed countries, but there is still much controversy for low resource settings.
We aimed to assess the impact of Centor criteria with the support of practical laboratory tests.
We prospectively included patients complaining sore throat (N = 282). We evaluated them in terms of Centor scoring and performed white blood cell count (WBC), C-reactive protein (CRP), rapid antigen detecting test, and throat culture.
In GABHS cases (N = 32, 11·3%), two of the criteria were observed to be positive in more than half of the cases (N = 19, 59·3%), while 13 (40·7%) cases met three/four criteria. The specificity of having two criteria was found to be 65·5% and increased to 91·5% after including CRP and WBC.
Centor criteria could be safely used to reduce unnecessary antibiotic usage for tonsillopharyngitis in developing countries.
[show abstract][hide abstract] ABSTRACT: The incidence of invasive aspergillosis has increased after solid organ transplant. However, aspergillus osteomyelitis in vertebrae is rare. We report a case of aspergillus spondylodiskitis after pulmonary aspergillosis in a renal transplant recipient. He was treated by antifungal therapy and surgical intervention. The transplantist should be alert for a diagnosis of aspergillus spondylodiskitis in recipients who developed back pain after aspergillosis infection in other sites.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 08/2011; 9(4):265-9.
[show abstract][hide abstract] ABSTRACT: Acute invasive fungal rhinosinusitis (AIFRS) is a serious disease with a high mortality and morbidity rate, which almost always affects immunocompromised patients and/or patients with diabetes mellitus. Our purpose was to present the diagnostic and therapeutic management and outcome of these patients.
Case series with chart review.
Tertiary care university hospital.
Twenty-six patients, who were operated on because of AIFRS between September 1999 and June 2009, were retrospectively evaluated in this study. Endoscopic surgery was used in 19 patients, and open surgical debridement was performed in seven patients.
Overall survival rate of the patients in the open surgery group (4 of 7; 57.1%) was similar to that of the endoscopically treated group (9 of 19; 47.3%). Thirteen patients (50%) died of complications related to the underlying disease (9 of 13; 69.2%) and AIFRS (4 of 13; 30.7%). AIFRS-specific survival rate is 76.5 percent; 90 percent (9 of 10) and 57.1 percent (4 of 7) for endoscopic and open surgery groups, respectively. Four patients who died had pathological diagnosis of mucormycosis (P = 0.52).
AIFRS can be successfully treated with a combination of endonasal surgical debridement and antifungal medications. Endonasal approach is suitable for patients diagnosed in the early stages of the disease and provides a less traumatic option in those patients who already have a poor health status. Open surgery should be preferred in the presence of intraorbital extension, palatinal, and/or intracerebral involvement. Reversing the underlying disease process and immunosuppression is as important as the surgical and antifungal treatment.
Otolaryngology Head and Neck Surgery 11/2010; 143(5):614-20. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background: Because of high morbidity of the brucellosis in humans and the potential use of the microorganism as an agent of biologic warfare, protection of effective vaccines and specific diagnostic reagents become necessary to eradicate brucellosis. Objective: In this study we aimed to investigate the cytokine responses and changes in peripheral blood lymphocyte subgroups of acute brucellosis patients in response to L7/L12 and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) recombinant proteins derived from Brucella abortus. Methods: levels of IFN-γ, IL-4 and IL-10 secreted from PBMCs of 25 acute brucellosis patients and 15 healthy controls, stimulated with Phytohemagglutinin (PHA), L7/L12 or GAPDH were measured by ELISA. Furthermore alterations in lymphocyte subgroups in response to these Brucella antigens were determined by flow cytometry. Results: Extracellular IFN-γ levels were found to be elevated after stimulation with L7/L12 in patients with acute brucellosis, whereas no significant changes were found in IL-4 and IL-10 levels. Similar data was also obtained with GAPDH, but the stimulation of IFN-γ production was not observed in all patients and was not as strong as that observed for L7/L12. Moreover, when the distribution of lymphocytes subgroups (CD3+, CD3+CD4+, CD3+CD8+, CD4+CD25+, CD3+CD69+ and CD3+CD152+) was evaluated, it was found that the stimulation with L7/L12 and GAPDH only led to an increase in the percentage of CD3+CD69+ lymphocytes. Conclusion: These data indicate that Brucella abortus L7/L12 or GAPDH induce a Th1 type immune response in acute brucellosis patients. Additionally, these recombinant proteins, especially L7/L12, may be used in new vaccine preparations and diagnostic tests.
Iranian journal of immunology: IJI 09/2010; 7(3):132-41.
[show abstract][hide abstract] ABSTRACT: The incidence of nosocomial candidaemia was evaluated in a retrospective study in a Turkish tertiary-care hospital. Over a 12-year period (1996-2007), a total of 743 episodes of candidaemia occurred in 743 patients, accounting for an average incidence of 1.9 episodes/1000 admissions and 2.9 episodes/10 000 patient-days per year. The annual incidence was almost constant during the study period except for 1996 when it was significantly higher in comparison with other years (P<0.05). The most common species isolated was Candida albicans (45%), followed by C. parapsilosis (26%), C. tropicalis (7%), C. krusei (7%), and C. glabrata (3.5%). A significant increase in C. albicans isolates causing candidaemia linked to a decrease in C. parapsilosis isolates in adult patients and C. krusei isolates in children was found between the two 6-year study periods. This trend reflects improved infection control at Uludağ University Hospital. Ninety percent of isolates were susceptible to fluconazole (8 microg/ml) and resistance was found only in C. glabrata and C. parapsilosis isolates. Regular local surveillance of Candida spp. is important in order to develop empirical treatment protocols to reduce the incidence and mortality of candidaemia.
Epidemiology and Infection 09/2010; 138(9):1328-35. · 2.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: Clostridium difficile (C. difficile) is a well-established cause of nosocomial diarrhea. The aim of our study was to define the incidence of nosocomial diarrhea in our hospital and to determine the role of C. difficile. Additionally, the risk factors for nosocomial diarrhea and Clostridium difficile associated diarrhea (CDAD) were investigated.
We included all patients, 18 years of age or more, who were admitted to the Uludag Teaching Hospital between October 1, 2004 and February 1, 2005, and developed diarrhea at least three days after hospital admission. A case-control study was performed.
The total incidence of nosocomial diarrhea was 0.6 per 1,000 hospitalization-days and 5 per 1,000 patients' admissions. Previous use of chemotherapy was found to be an important predisposing factor for nosocomial diarrhea. The incidence of CDAD was 0.26 per 1,000 hospitalization-days and 2.1 per 1,000 admissions, comparable with incidence rates in Europe. CDAD was diagnosed in 43% of patients with nosocomial diarrhea. No severe cases of CDAD were diagnosed. A correlation was found between CDAD and antibiotic use before admission and during admission in univariate analysis. PCR ribotyping revealed four strains of PCR ribotype 002 and 1 strain of ribotype 012 out of 5C. difficile strains available for extensive identification.
The incidence rates of nosocomial diarrhea and CDAD are not different than the usual incidence rates in Europe. C. difficile was the causative agent in 43% of patients with nosocomial diarrhea.
[show abstract][hide abstract] ABSTRACT: In recent years there has been an increase in life-threatening infections caused by Acinetobacter baumannii with multiple antibiotic resistance, which has lead to the use of polymyxins, especially colistin, being reconsidered. The aim of this study was to investigate the colistin sensitivity of A. baumannii isolates with multiple antibiotic resistance via different methods, and to evaluate the disk diffusion method for colistin against multi-resistant Acinetobacter isolates, in comparison to the E-test and Phoenix system.
The study was carried out on 100 strains of A. baumannii (colonization or infection) isolated from the microbiological samples of different patients followed in the clinics and intensive care units of Uludağ University Medical School between the years 2004 and 2005. Strains were identified and characterized for their antibiotic sensitivity by Phoenix system (Becton Dickinson, Sparks, MD, USA).
In all studied A. baumannii strains, susceptibility to colistin was determined to be 100% with the disk diffusion, E-test, and broth microdilution methods. Results of the E-test and broth microdilution method, which are accepted as reference methods, were found to be 100% consistent with the results of the disk diffusion tests; no very major or major error was identified upon comparison of the tests. The sensitivity and the positive predictive value of the disk diffusion method were found to be 100%.
Colistin resistance in A. baumannii was not detected in our region, and disk diffusion method results are in accordance with those of E-test and broth microdilution methods.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 03/2009; 13(5):e217-20. · 2.17 Impact Factor
[show abstract][hide abstract] ABSTRACT: Four tularemia epidemics were reported from three different regions of Turkey between 1936 and 1953. After a long interval, a new tularemia epidemic was reported from the area around Bursa in the northwestern part of Turkey in 1988. Following this first epidemic in Bursa, small epidemics occurred in areas around Bursa between 1988 and 2002. Other tularemia epidemics in different regions of Turkey were reported between 1988 and 2005. Almost all of the cases involved the oropharyngeal form of the disease. However, ulceroglandular and oculoglandular forms were detected in the Bursa epidemics; all of the ulceroglandular cases had dermatitis on their hands. To date, 1300 cases have been serologically confirmed. We reviewed one of the biggest tularemia epidemics in Europe.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 01/2009; 13(5):547-51. · 2.17 Impact Factor
[show abstract][hide abstract] ABSTRACT: We investigated the risk factors for community acquired/onset urinary tract infections due to extended spectrum beta-lactamase (ESBL)-positive Escherichia coli or Klebsiella pneumoniae in 62 patients who were followed-up from August 1, 2003 to September 1, 2006. Sixty patients with community-acquired urinary tract infections caused by ESBL-negative E. coli or K. pneumoniae who were followed-up during the same dates were included as a control group. Age (> or =65 or <65 years old), sex, bladder cancer, benign prostate hypertrophy (BPH), prostate cancer, urolithiasis, urethral catheter, previous urological operation, diabetes mellitus, use of antibiotics during the last 3 months and hospitalization during the last 3 months were investigated as risk factors. The presence of previous urological operation and quinolone or cephalosporin use for any infection during the last 3 months were found to be independent risk factors. Knowing the risk factors for community acquired/onset urinary tract infections caused by ESBL-positive E. coli or K. pneumoniae is of great importance in planning empirical antibiotic therapy.
[show abstract][hide abstract] ABSTRACT: Invasive Aspergillosis occurs in almost every human organ, most commonly in the lungs. Bone involvement classically has been considered exceedingly rare for both immunocompromised and immunocompetent hosts, however, there are limited data in transplant recipients. We report an unusual case of osteomyelitis and joint infection of the ankle caused by Aspergillus fumigatus in a renal transplant recipient.
[show abstract][hide abstract] ABSTRACT: We present the cases of two patients with cryptococcal meningitis who were predisposed to fungal infection because of diabetes mellitus (Case 1) and systemic lupus erythematosus (Case 2). Both patients were tested negative for anti-HIV antibodies.
[show abstract][hide abstract] ABSTRACT: In this study, the clinical and laboratory features of 26 infectious mononucleosis (IMN) cases who have been diagnosed between the years of 1984-2005 were evaluated retrospectively. The mean age of the patients was 26+/-11 years, the rate of being hospitalized was 65%, and mean hospitalization period was 9.2+/-6 days. Fever (81%), weakness (50%), sore throat (50%), headache (50%) and swollen neck (35%) were the most common symptoms, while in the physical examination cervical lymphadenopathy (81%), splenomegaly (69%), hyperemic pharynx (65%), hepatomegaly (54%) and tonsillitis (50%) were observed. Laboratory results yielded leukocytosis in 21%, leucopenia in 12%, anemia in 44%, thrombocytopenia in 5% and elevated transaminase levels in 84% of the patients. Of the patients 15 (57.7%) had the history of using antibiotics before the diagnosis. Serological diagnosis was performed by Paul-Bunnel test and/or IgM positivity against Epstein-Barr virus (EBV) viral capsid antigen (VCA). Tonsillo-pharyngitis secondary to edema and respiratory distress due to lymphadenopathy pressure were detected in four patients, whereas pancytopenia was established only in one patient, as complications. This study emphasized that, although IMN is a self-limited infection, the diagnostic difficulties may arise when the clinical course is atypical, and rarely seen life-threatening complications may also develop during IMN course.
[show abstract][hide abstract] ABSTRACT: Between April 2000 and May 2005, 350 bacteraemic episodes occurred among patients treated in our haematology unit. Two hundred and twenty-eight of these episodes were caused by Gram-positive pathogens, most commonly coagulase-negative staphylococci and Staphylococcus aureus. One hundred and twenty-two episodes were due to Gram-negative pathogens, with a predominance of Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. Bacillus bacteraemias constituted 12 of these episodes occurring in 12 patients, and accounted for 3.4% of all bacteraemic episodes. Of the 12 strains evaluated, seven were Bacillus licheniformis, three were Bacillus cereus and two were Bacillus pumilus. Seven episodes presented with bloodstream infection, three with pneumonia, one with severe abdominal pain and deterioration of liver function, and one with a catheter-related bloodstream infection. B. licheniformis was isolated from five patients who had been hospitalized at the same time. This outbreak was related to non-sterile cotton wool used during skin disinfection. B. cereus and B. licheniformis isolates were susceptible to cefepime, carbapenems, aminoglycosides and vancomycin, but B. pumilus isolates were resistant to all antibiotics except for quinolones and vancomycin. Two deaths were observed. In conclusion, Bacillus spp. may cause serious infections, diagnostic and therapeutic dilemmas, and high morbidity and mortality in patients with haematological malignancies. Both B. cereus and B. licheniformis may be among the 'new' Gram-positive pathogens to cause serious infection in patients with neutropenia.
Journal of Hospital Infection 11/2006; 64(2):169-76. · 2.86 Impact Factor
[show abstract][hide abstract] ABSTRACT: Molecular epidemiologic surveillance of Acinetobacter baumannii by polymerase chain reaction-randomly amplified polymorphic DNA analysis in a university hospital for 3 consecutive study periods.
Twelve different Acinetobacter baumannii genotypes (A-L) were detected. Although only 2 genotypes were detected during the first period and genotype A appeared to be the most common genotype, genotype D was included in these genotypes during the second study period. Genotype A completely disappeared during the third period. Although the presence of genotype C and the genotype D continued during the third period, 9 new genotypes were detected during this period. Genotype A appeared to be the most common genotype in the hospital (detected in 19 different clinics). The distribution of genotypes in clinical samples correlated with patient traffic between them. Some genotypes were found in both clinical and environmental samples. Seventeen different antibiotypes were detected, according to antibiotic susceptibility profiles.
Environmental contamination, airborne transmission, patient transfer, and cross-contamination play important roles in epidemics caused by A. baumannii in our hospital. The distribution of genotypes can change over time, so antibiotyping is not appropriate for the epidemiological analysis of A. baumanii infection.
Infection Control and Hospital Epidemiology 05/2006; 27(4):404-8. · 4.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N=64) or a standard triple-lumen catheter (N=69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P=0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal (P=0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P=0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P=0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P=0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.
Journal of Hospital Infection 03/2006; 62(2):156-62. · 2.86 Impact Factor
[show abstract][hide abstract] ABSTRACT: ZET Tifo Salmonella Typhi'nin neden olduğu sistemik bir hastalıktır. Ateş, baş ağrısı, kırgınlık, iştahsızlık, relatif bradikardi, konstipasyon veya diyare ile karakterizedir. Gastrointestinal kanama tifonun major intestinal komplikasyonlarından birisidir. Bununla beraber tifoya bağlı masif alt gastrointestinal kanama literatürde nadir olarak bildirilmiştir. Masif alt gastrointestinal kanama ayırıcı tanısına bu hastalığın da dahil edilmesi önemlidir. Tifoya bağlı intestinal kanamanın tedavisinde klasik yaklaşım konservatiftir. Konservatif tedaviye yanıt vermeyen hastalarda acil rezeksiyon düşünülmelidir. Burada, tifoya bağlı masif alt intestinal kanamanın görüldüğü ve konservatif olarak tedavi edilen bir olguyu sunduk. ABSTRACT Typhoid fever is a systemic infection caused by the bacterium Salmonella Typhi. It is characterized by fever, headache, malaise, anorexia, relative bradycardia, constipation or diarrhea. Gastrointestinal bleeding is one of the major intestinal complication of typhoid fever. However, typhoid fever complicated by massive lower gastrointestinal bleeding has rarely been reported in the literature. It is important to include this disease in the differential diagnosis of massive lower gastrointestinal haemorrhage. The classic approach to the management of intestinal haemorrhage due to typhoid infection has been conservative. In the event of massive haemorrhage which does not respond to conservative measures, emergency resection should be considered. Here, we present a case of typhoid fever complicated by massive lower intestinal bleeding and treated conservatively by medical agents.
Ulusal İç Hastalıkları Kongresinde. 01/2006; 32:99-10216.
[show abstract][hide abstract] ABSTRACT: Echinococcosis, also known as hydatid disease or hydatidosis, is a zoonotic illness caused by the larval form of Echinococcus spp. It is highly prevalent in areas where the parasite is endemic such as the Mediterranean region. However, occurrence of echinococcosis and cancer together is rare. We treated and followed approximately 1200 patients with different hematologic neoplastic diseases between 1985 and 2003, and only one of these individuals had concomitant acute leukemia and liver hydatidosis. This report describes the case of a 19-year-old man who had both primary refractoriness of acute leukemia (AML-M4) and liver hydatidosis. Management is discussed. The patient had cystic echinococcosis (CE) of the liver that was classified as CE1 according to the system established by the World Health Organization's Informal Working Group on Echinococcosis. The patient underwent 3 months of treatment with agents that targeted the leukemia (daunorubicin, idarubicin, cytarabine, fludarabine) and its complications (amphotericin B, amphotericin B lipid complex, liposomal amphotericin B). Throughout this period, the size and the contents of the cyst did not change, Echinococcus titers remained unchanged, and the cyst classification remained CE1.
Microbes and Infection 08/2005; 7(9-10):1073-6. · 2.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: In this study, 21 HIV/AIDS cases (18 male, 3 female; age range 17-64 years), followed up in the Department of Infectious Diseases of Uludag University Medical Faculty between 1997-2003 have been analyzed retrospectively, by means of epidemiological, clinical and laboratory aspects. Nineteen (90%) of them were heterosexual, and in 9 cases the diagnosis was coincidental during the blood donations or routine testing. The non-compliance rate of patients to antiretroviral treatment was found as 76%, and the most important factor for non-compliance was the difficulty in providing antiretroviral drugs. The most frequently encountered opportunistic infections were oropharyngeal candidiasis (n:5), herpes zoster (n:4) and community acquired pneumonia (n:4).