Serodiagnostic Value of ELISA in Pulmonary Tuberculosis in Turkey Where Tuberculosis Is Highly Prevalent

PubMedID: 9044479We studied the diagnostic utility of ELISA in pulmonary tuberculosis (TBC) using serologically active glycolipid antigens. Twenty-seven patients who were smear positive, and 30 patients who were smear negative, but with evidence of active TBC (sputum culture positive in 10, response to anti-TBC chemotherapy in 20) were included in the study group. Twenty cured patients who had been free of TBC for at least 1 year, 50 TBC-free persons with PPD results of 0-10 mm and more than 10 mm, and 21 patients with active inflammatory diseases other than TBC formed the control groups. Sensitivity and specificity were 96 and 91%, respectively. We think that serologically active glycolipid antigens are as sensitive and specific as other purified antigens, and even superior to them from the point of view of their production: their extraction is quicker and easier. © 1997 S. Karger AG, Basel

Osteoarthricular involvement of brucellosis in Turkey

PubMedID: 11206346The aim of this study was to determine the rates, types, clinical features and treatment of osteoarthricular involvement of brucellosis in Turkey. In a restrospective study in adults, we investigated 238 patients diagnosed with brucellosis over a period of 6 years. A diagnosis of brucellosis was established by isolation of Brucella species in blood or by a compatible clinical picture together with a standard tube agglutination titre of ? 1/160 of antibodies for brucellosis and/or demonstration of an at least four-fold rise in antibody titre in serum specimens taken over 2 or 3 weeks. Osteoarthricular involvement was defined by inflammatory signs in peripheral joints or by unrelieved pain at rest together with radiological alterations and/or radionuclide uptake in any deep joint. Eighty-seven patients (36.5%) had osteoarthricular involvement (58.6% female, 41.4% male), 47 (54.1%) of whom were reported to consume unpasteurised dairy products. The mean age was 32.3 ± 16 years. Sacroiliitis was the most common involvement (n = 53, 60.9%) followed by peripheral arthritis (n = 17, 19.5%), spondylitis (n = 12, 13.8%) and bursitis (n = 5, 5.7%). During the observation period, 60 (69%) patients with osteoarthricular involvement and radiographic abnormalities. A bone scan was positive in 15 patients with no radiographic abnormalities. All patients received merely medical treatment and relapse occurred in five (5.7%) patients. Sacroiliitis has been determined as the most frequently observed type of osteoarthricular involvement in brucellosis in Turkey

The prevalence of anti-HCV positivity in patients undergoing haemodialysis or with malignant disease

PubMedID: 8179977We studied the occurrence of anti-hepatitis C (HCV) antibodies in patients with malignant disease (53), in patients undergoing haemodialysis (56), and in blood donors (204) as healthy population controls. The study was carried out using the second-generation EIA test. Anti-HCV positivity was 23.2% in haemodialysis (HD) patients, 0.5% in blood donors, and 0% of the patients with malignant disease (MD). There was no association between anti-HCV positivity and the results of AST, ALT and HBsAg tests in patients and controls. But there was significant association of blood transfusion frequency and duration of HD with anti-HCV positivity in patients undergoing HD, and conversely an absence of this association in patients with MD. However, two of the anti-HCV-positive HD patients did not have any blood transfusion history. One HCV-positive blood donor had a history of surgical operation. Nosocomial transmission of HCV infection has replaced blood transfusion as the main risk factor in HD patients, and preventive measures should be performed in this direction to control infection

Disseminated herpes zoster infection in a patient with lymphoma

Immunosuppression facilitates varicella zoster virus (VZV) reactivation in immunocompromised patients. Atypical presentation such as disseminated disease of herpes zoster infection has been described in immunosuppressed patients. One of the best choices of therapy in herpes zoster infection is acyclovir, but long-term therapy may cause resistance to it. In this report a disseminated herpes zoster infection is described in a patient with T cell lymphoma after acyclovir/valacyclovir therapy. The infection was irresponsive to acyclovir and valacyclovir and we were unable to control the infection because it was not possible to obtain foscarnet and the patient died due to Staphylococcus epidermis sepsis. © TÜBİTAK

Plasma levels of tumor necrosis factor alpha during hemodialysis

PubMedID: 2046832Tumor necrosis factor ? (TNF-?) levels were measured by immunoradiometric assay in chronically hemodialyzed patients consisting of 9 males and 3 females aged between 14 and 60 years. TNF-? levels were 5.47-l5.1 pg/ml (mean 9.76 ± 6.63) before hemodialysis (HD), and 5.75-58.55 pg/ml (mean 22.15 ± 15.14) after HD. According to these results TNF-? levels in chronically hemodialyzed patients were within normal limits, but after 4 h of HD, higher levels of TNF-? were found

Fever of unknown origin in Turkey: Evaluation of 87 cases during a nine-year-period of study

PubMedID: 14667795Objectives. To investigate fever of unknown origin (FUO) in 87 patients. Methods. We investigated 87 (61 male) patients with FUO using the criteria of Petersdorf and Beeson [Medicine 40 (1961 ) 1] hospitalized between January 1994 and August 2002 at Cukurova University Hospital. Results. The median age of the patients was 38.5 years (range: 14-80 years). Eleven patients (12.6%) were over 65. The mean duration of hospitalization was 22.5 ± 13 days. Infectious diseases were the most common causes of FUO. Tuberculosis (n = 15, 17.2%), infective endocarditis (n = 6), abdominal abscess (n = 6), brucellosis (n = 5), urinary tract infection (n = 5), visceral leishmaniasis (n = 4), salmonellosis (n = 3), rhinocerebral mucormycosis (n = 4), atypical pneumonia, cerebral toxoplasmosis, Cytomegalovirus infection or encephalitis were diagnosed in 51 (58.6%) patients. The second most common causes of FUO were collagen vascular diseases (n = 16, 18.3%) determined as vasculitis syndrome, adult Still's disease (n = 4), systemic lupus erythematosus, Behçet's disease, juvenile ankylosing spondylitis. Neoplasm was found in 12 (13.7%) patients; (non-Hodgkin lymphoma, Hodgkin lymphoma, chronic myeloid leukemia, gastrointestinal tract carcinoma, glioma). Miscellaneous diseases thyroiditis, granulomatous hepatitis were diagnosed in two (2.2%) patients. On admission, six patients (6.8%) were neutropenic. Conclusions. Infectious diseases, especially tuberculosis, were the leading diagnostic category of FUO in this study. Adult Still's disease was more common than expected. An aetiological diagnosis could not be reached in six (7%) patients who were followed for 1 year. Five of these patients completely recovered, and one patient died. © 2003 The British Infection Society. Published by Elsevier Ltd. All rights reserved

Invasive device-associated nosocomial infections of a teaching hospital in Turkey; four years' experience [Türkiye'deki bir hastanenin invazif araç ilişkili enfeksiyon hızları; dört yıllık deneyim]

Aim: To determine our setting's IDAI rates, infecting microorganisms, and their resistance patterns to achieve standardization and make comparisons among other Turkish and developed country hospitals all over the world. Materials and methods: The numbers of total patient days, ventilator days, central catheter days and, urinary catheter days in the ICUs were recorded and IDAI rates were calculated. Clinical specimens were obtained from patients, cultivated at appropriate culture media, and infecting microorganisms and resistance patterns were determined. Results: Totally 1450 invasive device-associated infection episodes were determined (16.4% of patients) with a rate of 21.12/1000 days. Ventilator associated pneumonia rate was 22.05/1000 ventilator days and most common microorganism was Acinetobacter baumannii. Central catheter associated blood stream infection rate was 9.14/1000 central catheter days and the most common infecting organism was A. baumannii. Catheter associated urinary infection rate was 10.12/1000 urinary catheter days and the most common pathogen was Candida species. MRSA rate decreased from 89.6% in 2006 to 61.8% in 2009 (P < 0.001). ESBL production rates were between 70.7% and 45.6% in Escherichia coli and 66.7% and 55.9% in Klebsiella pneumoniae isolates. Vancomycin resistance among Enterococci was between 34.3% and 21.7% in these years. Conclusion: Our hospital infection rates were found to be similar to those of country data but higher than those in developed nations. Considering the high infection and resistance rates to most of the available antibiotics, it is highly urgent that infection control measures be taken and more effective antibiotic control policies be adopted. © TÜBİTAK

Clinical appearance of brucellosis in adults: Fourteen years of experience [Erişkinlerde brusellozun klinik görünümü: Ondört yıllık deneyim]

Aim: To indicate the clinical course and results of brucellosis in our region during the recent years, and to compare these findings to the literature. Materials and methods: This study was based on a review of the medical records of adult patients older than 14 years who were followed with the diagnosis of brucellosis from March 1997 to October 2010. Results: Included in this analysis were 317 patients, including 136 males (43%), with an average age of 40 ± 17 years. In 66 patients (21%), reproduction of Brucella was identified in the blood. Of the patients, 61% were identified as having the acute form, 35% the subacute form, and 4% the chronic form. Arthralgia, fever, weight loss, sacroiliitis, and spondylitis were the most frequent symptoms and findings accompanying the disease. There was a significant relationship between advanced age and the development of both spondylitis and arthritis (P = 0.000 and P = 0.028, respectively). Furthermore, there was a significant relationship between a high erythrocyte sedimentation rate and the presence of spondylitis, sacroiliitis, and visceral abscesses (P = 0.001, P = 0.013, and P = 0.049, respectively). Conclusion: This study provides a review of the disease and its complications. Osteoarticular involvement, and particularly the presence of spondylitis in patients and the complications in elderly patients, should be studied. Laboratory parameters, the patient's age, and the duration of symptoms may help to identify complicated cases. © TÜBİTAK

Antibiotic resistance in community-acquired urinary tract infections: Prevalence and risk factors

PubMedID: 20424552Background: This study aimed to identify the agents causing community-acquired urinary tract infections (CAUTIs) and their resistance patterns and to investigate risk factors for ESBL production. Material/Methods: Patients diagnosed at the Department of Infectious Diseases in the Cukurova University School of Medicine Hospital with CAUTI between January 2006 and April 2007 were included prospectively. Patient data were recorded and the microorganisms and their sensitivity patterns were evaluated by the university's central microbiology laboratory. Results: A total 146 patients with CAUTIs, 109 women and 37 men (mean age: 50.9±18.44 years), were included in the study. The most common infectious agents were Escherichia coli (76.9%), Klebsiella pneumoniae (9.2%), Proteus mirabilis (4.1%), and Enterococcus spp. (1.6%). The ciprofloxacin resistance rate for E. coli was 35% and resistance to TMP-SMZ 43%, whereas amikacin resistance was substantially low (3%). Four of 12 K. pneumoniae strains were resistant to ciprofloxacin and 2 to TMP-SMZ. Resistance to amikacin was not found in the K. pneumoniae strains. ESBL production was identified in 25 of the 112 E. coli and K. pneumoniae strains. A history of a UTI within the last 6 months (p=0.029) and a history of frequent UTI (p=0.028) were found to be significant risk factors for ESBL production by univariate analysis. The only independent risk factor was a history of urinary system infection in the past 6 months (p=0.025) according to multivariate regression analysis. Conclusions: These high resistance rates to antimicrobials and particularly the extremely high rate of ESBL production in CAUTI should be carefully considered. © Med Sci Monit, 2010

Association of insulin resistance, viral load, and adipokine levels with liver histology in patients with chronic hepatitis C: An observational, multicenter study in Turkey

PubMedID: 23114743OBJECTIVE: To evaluate the association of insulin resistance (IR), viral load, and adipokine levels with liver histology in patients with chronic hepatitis C (CHC). PATIENTS AND METHODS: In this noninterventional, multicenter study carried out at 11 infectious diseases clinics in Turkey, 103 CHC patients [mean (SD) age: 50.2 (11.0) years, 60 (58.3%) women] planned to be treated by ribavirin and peginterferon-?2a were included. Data on hepatic fibrosis and steatosis, IR, viral load, and hepatitis C virus-RNA genotyping, adipokine, and cytokine levels were collected. RESULTS: The mean (SD) Knodell score was 8.1 (3.6); grade I steatosis was evident in 46 (44.7%) patients and IR was identified in 56 (54.9%). There was a significant positive correlation of the homeostasis model assessment-IR index with Knodell fibrosis (r=0.235; P=0.027) and hepatic steatosis (r=0.435; P<0.001). There was a significant positive correlation of leptin levels with Knodell fibrosis (r=0.265; P=0.013) and hepatic activity index (r=0.218; P=0.041). Hepatic steatosis was correlated negatively with adiponectin (r=-0.320; P=0.001) and positively with leptin (r=-0.368; P<0.001) levels. Logistic regression analysis showed that increase in age [odds ratio (OR), 1.056; 95% confidence interval (CI), 1.005-1.110; P=0.030] was the only significant predictor of hepatic fibrosis (OR, 1.056; 95% CI, 1.005-1.110; P=0.030), whereas increase in age (OR, 1.066; 95% CI, 1.006-1.130; P=0.030), the presence of IR (OR, 5.621; 95% CI, 1.547-20.425; P=0.009), and decrease in adiponectin levels (OR, 0.808; 95% CI, 0.682-0.957; P=0.013) were the significant predictors of hepatic steatosis. CONCLUSION: Our findings indicate a significant relationship of hepatic fibrosis and hepatic steatosis with IR and leptin levels, but not with the viral load in Turkish patients with CHC. © 2012 Wolters Kluwer Health / Lippincott