A case of systemic lupus erythematosus presented with aseptic meningitis

Aseptik meninjit, sistemik lupus eritematozuz (SLE)'da nadir görülen klinik bir tablodur. Bu yazıda, aseptik meninjit tablosu ile başvuran bir 22 yaşındaki kadın SLE olgusu sunulmuş, bu tabloya neden olabilecek infeksiyon ve infeksiyon dışı hastalıklar tartışılmıştır.Aseptic meningitis is a rarely observed manifestation of systemic lupus erythematosus (SLE). In this paper, a case of SLE-related aseptic meningitis, a 22-year-old female, is presented and infectious and noninfectious etiologies of aseptic meningitis are discussed

BK virus-associated hemorrhagıc cystitis in patients wıth allogeneıc hematopoıetıc cell transplantation: report of three cases

BK virus is a human polyoma virus. It is acquired in early childhood and remains life-long latent in the genitourinary system. BK virus replication is more common in receiving immunosuppressive therapy receiving patients and transplant patients. BK virus could cause hemorrhagic cystitis in patients with allogeneic stem cell transplantation. Hemorrhagic cystitis is a serious complication of hematopoietic stem cell transplantation. Hemorrhagic cystitis could cause morbidity and long stay in the hospital. Diagnosis is more frequently determined by the presence of BK virus DNA detected with quantitative or real-time PCR testing in serum or plasma and less often in urine. The reduction of immunosuppression is effective in the treatment of BK virus infection. There are also several agents with anti-BK virus activity. Cidofovir is an active agent against a variety of DNA viruses including poliomyoma viruses and it is a cytosine nucleotide analogue. Intravenous immunoglobulin IgG (IVIG) also includes antibodies against BK and JC (John Cunningham) viruses. Hereby, we report three cases of hemorrhagic cystitis. Hemorrhagic cystitis developed in all these three cases of allogeneic stem cell transplantation due to acute myeloid leukemia (AML). BK virus were detected as the cause of hemorrhagic cystitis in these patients. Irrigation of the bladder was performed. Then levofloxacin 1×750 mg intravenous and IVIG 0.5 gr/kg were started. But the hematuria did not decreased. In the first case, treatment with leflunomide was started, but patient died due to refractory AML and severe graft-versus-host disease after 4th day of leflunamide and levofloxacin treatments. Cidofovir treatment and the reduction of immunosuppressive treatment decreased the BK virus load and resulted symptomatic improvement in the second case. Initiation of cidofovir was planned in the third case. Administration of cidofovir together with the reduction of immunosuppression in the treatment of hemorrhagic cystitis associated with BK virus in allogeneic stem cell transplant recipients could be a good option

Bruselloz tanısında iki farklı polimeraz zincirleşme yönteminin kullanımı

Tez (Tıpta Uzmanlık) -- Kırıkkale Üniversitesi87169

Two different pcr methods in the diagnosis of brucellosis

YÖK Tez ID: 455937Brusella cinsi bakterilerin neden olduğu bruselloz, pek çok ülkede olduğu gibi ülkemiz için de önemli bir halk sağlığı sorunu olan zoonozdur. Özgül olmayan şikayetler ve bulgularla seyreden hastalığın tanısında altın standart olan kültürde bakteriyi üretmek oldukça zor ve zaman alıcıdır. Rutinde daha sık kullanılan serolojik yöntemlerin ise diğer proteinlerle olan çapraz reaksiyonlardan dolayı özgüllüğü düşüktür. Polimeraz zincirleşme reaksiyonu (PZR) gibi moleküler yöntemler pek çok infeksiyon hastalığı gibi brusellozun erken ve hızlı tanısında iyi bir alternatif yöntem olmaktadır.Bu çalışmada, brusellozun erken tanısı ve maliyet etkinliği yönlerinden iki farklı PZR yönteminin konvansiyonel yöntemlerle karşılaştırılması amaçlandı.Çalışma, K.Ü.T.F. İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji A.D. polikliniğine başvuran bruselloz ön tanılı 35 hasta (Grup 1) ve 20 sağlıklı gönüllüden (Grup 2) oluşturuldu. Gruplardan serolojik çalışma (SAT, Coombs) için serum, PZR için tam kan (EDTA'lı tüplere) alınırken, hastalardan ateşli oldukları dönemde kan kültürleri alındı. Tam kan örneklerinden elde edilen lökosit pelletlerinden DNA izolasyonu yapıldı ve hem in house hem de real time PZR (RT-PZR) yöntemleriyle brusella DNA'sı çalışıldı.Grup 1'deki hastaların SAT değeri 1 olguda 1/80 iken, diğerlerinde ? 1/160 idi. Bunların 16'sında kan kültürü pozitif bulundu. Grup 2'de ise SAT değerleri negatif idi. Nested PZR yöntemiyle yapılan çalışmada hastaların %97'sinde, RT-PZR `de ise % 57 oranında pozitiflik saptanırken, her iki yöntemde de kontrollerin hepsi negatif bulundu. Her iki yöntemde de özgüllük % 100 bulunurken, RT-PZR'de duyarlılığın düşük olmasının kullanılan farklı primerlere veya ekstraktların saklama şartlarına bağlı olabileceği düşünüldü. Kullanılan nested PCR yönteminin erken ve hızlı tanıda yüksek duyarlılıkta olduğu, aynı şekilde RT-PZR'ye göre daha duyarlı ve ucuz olduğu; bu nedenle brusellozun erken ve doğru tanısı için kullanılmasının doğru olacağı sonucuna varıldı.Brucellosis is a public health problem in our country like many parts of the world. The illness is a zoonosis caused by Brucella spp. and has non specific symptoms and physical signs. Bacterial culture is gold standard in the diagnosis of brucellosis but it is difficult and time consuming, so serologic techniques are used routinely. But they have low specificity because of the cross reactions. Molecular methods like polymerase chain reaction (PCR) are good alternatives in the early and rapid diagnosis of brucellosis, like other infectious diseases.The aim of this study is to use two different PCR methods in diagnosis of brucellosis and compare their efficiency and cost with conventional methods.The study included 35 patients who referred to Kırıkkale University Medical Faculty, department of Infectious Diseases and Clinical Microbiology with symptoms and laboratory findings of brucellosis (Group-1) and 20 healthy volunteers (Group-2). Sera for serology (SAT, Coombs test) and whole blood samples (collected in tubes with EDTA) for PCR were collected from each subject in both groups and two blood cultures were done for all patients in Group-1. DNA was extracted from peripheral mononuclear cells obtained from the blood samples and in house and real time PCR assays were used to detect brucella DNA.SAT titers of patients in Grup-1 were ? 1/160 except one patient that was 1/80. Blood cultures were of 16 patients were positive. The SAT titers of Group-2 were negative. Thirty-four (97%) of the patients in Group-1 had positive nested PCR results, while 20 (57%) were positive with RT-PCR. None of the 20 volunteers in Group-2 were positive with both methods. The low sensitivity we found with RT_PCR may be partly explained by primer used or inadequate preservation of the leukocyte pellets (4 months at ?20°C) before RT-PCR assay. Nested PCR has high sensitivity and it has low-priced when compared with RT-PCR; therefore it may be used in rapid diagnosis of brucellosis

Antifungal Stewardship

Antimicrobial stewardship programs have led to significant improvements especially in the management of antibiotic use. There are few studies regarding antifungal stewardship. In recent years, the number of fungal infections has multiplied with the increase in immunosuppressive treatments. As clinical findings are non-specific, diagnostic tools are limited and diagnosis is challenging even for experienced clinicians, and morbidity and mortality is high in these infections. Side effects and drug interactions of antifungal drugs are high and costly. Therefore, there is a need for a multidisciplinary antifungal stewardship program to be developed for the diagnosis and treatment of these diseases

Diagnosis of acute brucellosis by polymerase chain reaction technique

Amaç: Bruselloz, pek çok ülkede olduğu gibi ülkemiz için de önemli bir halk sağlığı sorunu olan zoonozdur. Özgül olmayan şikayetler ve bulgularla seyreden hastalığın tanısında altın standart olan kültürde bakteriyi üretmek oldukça zor ve zaman alıcıdır. Rutinde daha sık kullanılan serolojik yöntemlerin çapraz reaksiyonlardan dolayı özgüllüğü düşüktür. Polimeraz zincir reaksiyonu (PZR) gibi moleküler yöntemler pek çok enfeksiyon hastalığı gibi brusellozun erken ve hızlı tanısında iyi bir alternatif yöntemdir. Bu çalışmada, bruselloz tanısında PZR yönteminin konvansiyonel yöntemlerle karşılaştırılması amaçlandı. Yöntemler: Çalışma grubu bruselloz ön tanılı 35 hasta ve 20 sağlıklı gönüllüden oluşturuldu. Hasta ve kontrol grubundan serolojik çalışma için serum, PZR için tam kan alınırken, hastalardan ateşli oldukları dönemde kan kültürleri alındı. Tam kan örneklerinden elde edilen lökosit pelletlerinden DNA izolasyonu yapıldı ve brusella DNA' sı in house PZR yöntemiyle tespit edildi. Bulgular: Hastaların Standart tüp aglütinasyon (SAT) değeri 1 olguda 1/80 iken, diğerlerinde >=1/160 idi. Bunların 16'sında kan kültürü pozitif bulundu. Kontrollerin SAT değerleri negatif idi. PZR yöntemiyle yapılan çalışmada hastaların %97'sinde pozitiflik saptanırken kontrollerin hepsi negatif bulundu. Sonuç: Kullanılan PZR yönteminin erken ve hızlı tanıda yüksek duyarlılıkta olduğu, bu nedenle bruselloz hızlı ve doğru tanısı için kullanılmasının uygun olacağı sonucuna varıldı.Objective: Brucellosis is a zoonotic disease which is a public health problem in our country like many parts of the world. The illness has nonspecific symptoms and physical signs. Bacterial culture is gold standard in the diagnosis of brucellosis but it is difficult and time consuming, so serologic techniques are used routinely. But serologic techniques have low specificity because of cross reactions. Molecular methods like polymerase chain reaction (PCR) are good alternatives in the early and rapid diagnosis of brucellosis, as it is in other infectious diseases. The aim of this study was to compare PCR method with conventional methods in the diagnosis of brucellosis. Methods: The study included 35 patients and 20 healthy volunteers. Sera for serology and whole blood samples for PCR were collected from each subject in both groups. DNA was extracted from peripheral mononuclear cells obtained from the blood samples and an in house PCR assay was used to detect brucella DNA.Results: Standart tube agglutination (STA) titers of most patients were >=1/160, except one patient which was 1/80. Blood cultures were positive for 16 patients. The STA titers of all controls were negative. PCR was positive for 97% of the patients and all of the volunteers were negative. Conclusion: It is concluded that the tested PCR assay has high sensitivity in the diagnosis of brucellosis and it may be used in rapid and accurate diagnosis of brucellosis

Klorhekzidinin Staphylococcus epidermidis'in airway üzerinde biofilm oluşturmasına etkisi

Amaç: Airway yüzeyinde biofilm oluşması supraglottik kolonizasyona, bu da alt solunum yolu enfeksiyonlarına neden olabilir. Lokal dezenfektanların biofilm oluşumuna etkisini araştıran pek fazla çalışma bulunmamaktadır. Bu çalışmanın amacı airwayleri klorhekzidinle kaplamanın Staphylococcus epidermidis'in biofilm oluşturmasına etkisinin araştırılmasıdır.Yöntemler: Biofilm deneyi için kültür ve elektron mikroskobi yöntemleri kullanıldı. Airwayler, klorhekzidinin biofilm oluşumu ve bakteri sayısına etkisini araştırmak üzere, iki gruba ayrıldı. Grup 1 (Kontrol Grubu): Katkısız airway, Staphylococcus epidermidis, Grup 2: Klorhekzidinle kaplanmış airway, Staphylococcus epidermidis. Grup 1'e bir işlem yapılmazken, Grup 2'ye 4 saniye boyunca % 0,2 konsantrasyonda klorhekzidin sprey sıkıldı ve kurutuldu. Materyale tutunan bakteri sayısı mikrobiyolojik yöntemle incelendi, biofilm oluşumu elektron mikroskobik inceleme ile gösterildi. İstatistik analiz için Mann-Whitney U testi kullanıldı.Bulgular: Grup 2'de bakteri sayısı 1x102-8x102 cfu/ml iken Grup 1'de 3x103-1x104 cfu/ml idi. Klorhekzidinin airwaye tutunan bakteri sayısını istatistiksel olarak anlamlı oranda azalttığı görüldü (p0,04). Elektron microskobik incelemede de sonuç uyumluydu.Sonuç: Bu çalışmada, klorhekzidinin airway üzerinde biofilm oluşumu ve tutunan bakteri sayısını azaltmada etkili olduğu gösterildiObjective: Biofilm formation of microorganisms on the surface of airways may lead to supraglottic colonization that may cause lower respiratuar tract infections. Studies searching the efficiency of local disinfectants on biofilm formation are limited. The aim of this study was to investigate the effects of chlorhexidine coated airways on biofilm formation of Staphylococcus epidermidis.Methods: Culture and electron microscopy methods were used for biofilm assessment. Airways were divided into two groups to investigate the effects of chlorhexidine on number of bacteria attached to the airway and biofilm formation. Group 1(control): naive material, S. epidermidis, Group 2: chlorhexidine coated material, S. epidermidis. No process was applied in Group 1. Chlorhexidine gluconate (0.2%) was sprayed on the surface of naive material for four seconds and then left to dry in air, in Group to. Number of bacteria attached to the airway were counted by microbiological methods and biofilm formation was shown by Scanning Electron Microscope (SEM). Mann-Whitney u test was performed for statistical analyses. Results: In Group 2, bacteria numbers were 1x102-8x102 cfu/ml, whereas they were 3x103-1x104 cfu/ml in Group 1. Chlorhexidine decreased number of microorganisms attached to the airways with statistical significance (p0.04). The results of the electron microscopic evaluation were in accordance with the bacteriological findings.Conclusion: This study has shown that chlorhexidine coating can successfully reduce the number of adhered bacteria and biofilm formation on airways. J Microbiol Infect Dis 2015;5(4): 162-16

A Case of Hodgkin’s Lymphoma with Suppurative Lymphadenitis and Chest Wall Abscess

Nodular sclerosing Hodgkin’s lymphoma can be confused with many infectious diseases, especially due to its course with fever and suppurative lymphadenitis. The feature of this subtype of lymphoma is that it’s cervical and mediastinal lymph node involvement is frequent and skin involvement and abscess formation (0.5-3.5%) are rare. Involvement starts from peripheral lymph nodes and it can occurrence as lymphadenitis or it can occur in advanced stages and occur with suppurative lymphadenitis or with apostemation. Hodgkin’s disease is different from other tumors because in Hodgkin’s disease most of the tumor tissue is made up of normal cells and a small part of it is malignant Reed-Sternberg (RS) cells. Especially in fine needle biopsies performed from lymphadenitis or abscesses where inflammation is intense, RS cells may be overlooked, and it can misinterpreted histopathologically as an acute infectious process. In this case presentation; It is aimed to emphasize that the nodular sclerosing type of classical Hodgkin’s lymphoma may also present with cervical lymphadenitis or with abscess and fistula formation in advanced stages