Can ratio of neutrophil-tolymphocyte count and erythrocyte sedimentation rate in diabetic foot infection predict osteomyelitis and/or amputation?

The aim of this study was to search for any relations between the neutrophil-tolymphocyte ratio (NLR) and the development of osteomyelitis and the need for amputation in patients with diabetic foot infection (DFI). All data included DFI patients who were hospitalized in our Infectious Diseases Clinic between 2012 and 2015 and who were classified according to International Classification Disease Code System. 75 patients were analyzed in the study. The DFI patients were stratified into 3 groups of whom had amputation procedure, whom had only debridement/drainage procedure and whom had any surgery procedure. Sidac post hoc analysis was used to perform the effects of NLR, C-reactive protein, erythrocyte sedimentation rate and glycosylated hemoglobin on the surgery procedure status. The DFI patients were also stratified into two another separate group for another analysis to search for the effect of NLR values on the development of osteomyelitis. The mean value of NLR in the amputated patients’ group (15.7±10.3 was significantly higher than those with debridement procedure (9.9±5.6) and those without any surgery (6.0±2.8) (P=0.001). NLR values were also found significantly higher in patients with osteomyelitis in the second analysis (P=0.004). In this study, the NLR was found to have a predictive value on the development of osteomyelitis and on the progression to amputation in patients with DFI

A Case of Pulmonary Leptospirosis Treated with a Combination of Corticosteroid and Ceftriaxone

In leptospirosis, pulmonary involvement is the main cause of death. The survival in pulmonary leptospirosis depends on early and appropriate therapy as well as rapid diagnosis. Some immunosuppressive drugs have been known to improve survival because infectious vasculitis is responsible for the pathogenesis of pulmonary damage caused by leptospirosis. In this study, we aimed to report a case of pulmonary leptospirosis not frequently reported in our country or may be overlooked in clinical practice that was successfully treated with corticosteroids in addition to ceftriaxone therapy. A 32-year-old man presented to our hospital with fever, malaise, dry cough, shortness of breath, hemoptysis, and general muscle ache persisting for one week. He had a history of cleaning a barn with mice barefoot two weeks ago. The patient had fever, thrombocytopenia, elevated creatinine, bilirubin, and creatine kinase levels, bilateral pulmonary infi ltrates in chest radiograph, decreased peripheral saturation of hemoglobin with oxygen and epidemiological history compatible with leptospirosis. Due to high index of suspicion of pulmonary leptospirosis, high dose prednisolone was administered at the dose of 1 gr/day for the fi rst 3 days, followed by oral prednisolone 1 mg/kg/day for 7 days alongside ceftriaxone. Rapid clinical improvement was observed. The patient did not need mechanical ventilation and was discharged without sequelae. Consequently, pulmonary leptospirosis should be considered in differential diagnosis of patients with febrile illness associated with pneumonitis and respiratory failure, and it should not be forgotten that corticosteroids therapy may be lifesaving

Kocuria kristinae, a Rare Agent in Community-Acquired Infective Endocarditis: Two Case Reports

Kocuria species are facultative, catalase-positive, coagulase-negative, gram-positive cocci belonging to family Micrococcaceae, suborder Micrococcineae, order Actinomycetales. Besides being widely distributed in nature, Kocuria spp are found in normal flora of the skin, mucous membrane and oropharaynx of human beings. In the literature, reported infections caused by Kocuria species are scanty. Among the etiologic agents of infective endocarditis, endocarditis due to Kocuria species is also very rarely reported. Here, we present two cases of community-acquired infective endocarditis with native valve involvement caused by Kocuria kristinae as the etiological agent

Evaluation of soluble CD200 levels in type 2 diabetic foot and nephropathic patients: Association with disease activity

Background: CD200 (OX-2) is a novel immune-effective molecule, existing in a cell membrane-bound form, as well as in a soluble form in serum (s OX-2), which acts to regulate inflammatory and acquired immune responses