Evaluation of 68 Brucellosis Cases According to System Involvement

Involvement of systems in cases with brucellosis in a five year period were evaluated retrospectively. Sixty-eight cases with at least one manifestation of involvement of systems were included. Rates of involvement of systems was found; hematologic system 72%, osteoarticular system 49%, hepatobiliary system 37%, neurologic system 7%, respiratory system, genitourinary system, cutaneous 3% and cardiovascular system 1%. Anemia (60%) was found as the most frequent manifestation of involvement of hematologic system and peripheric arthritis (40%) was found as the most frequent involvement of osteoarticular system. Forty-eight patients had one system involvement. Twenty patients had more than one system involvement (17 patients had two, 16 patients had three, eight patients had four). Anemia and arthritis were found as the most frequent manifestations seen together. Surgical treatment was required in three (4.4%) patients with complications (two patients with radiculoneuritis, one with endocarditis). There was not any important complication related with system involvement of brucellosis except two cases with neurobrucellosis related paraplegia. Relaps rate was 4.7%

Kikuchi-Fujimoto Disease: A Case Report

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lympadenitis, is an uncommon clinical and patological autolimited feature of bening prognosis that may mimic many other diseases diagnosed chiefly in young adults. It is clinically significant because of possible misdiagnosis of other diseses such as malignant lymphoma or tuberculosis. Thus, an early biopsy is instrumental in making definite diagnosis and preventing unnecessary investigation. We described a case of Kikuchi-Fujimoto disease in a 22-year-old woman who presented with swollen lymph nodes and a fever. A rapid clinical improvement after lymph nodes excisional biopsy was remarkable. No treatment was given, and a full recovery was achived within six weeks. In this case had emphasized the clinical, histologic features, and outcome of Kikuchi-Fujimoto disease

Complicated Upper Urinary Tract Infections Followed in Our Clinic

In this study, the clinical and epidemiologic spectrum of 200 cases of complicated upper urinary tract infection which treated at a university hospital were evaluated, retrospectively. The mean age was 62.9 years and female/male ratio was 118/82. The most common complaints were fever (n= 131) and disuria (n= 71). Bacteriuria was detected in 119 patients and bacteremia was detected in 20 patients. The most common etiologic agent was Escherichia coli (%63). Advanced age, recent antimicrobial usage and diabetes mellitus were found as common complicating factors. Fourty-six patients had urosepsis and 17 patients were died. The rates of susceptibility of E. coli isolated from urine samples were detected as 100% to imipenem, meropenem & fosfomycin, 98% to amicasin, 70% to gentamycin, 73% to ciprofloxacin, to ofloxacin 56%, to nitrofurantoin 93%, to ceftriaxone 88% and to piperacilin-tazobactam 86%. Trimethoprim/sulfamethoxazole and ampicilin demonstrated the fewest susceptibility (46% and 47%, respectively). Consequently, the patients with complicated upper urinary tract infections should be treated in hospital. A third generation cephalosporin or fluoroquinolones may be suitable choices for ampiric treatment of the patients without urosepsis; and a third generation cephalosporin or beta-lactam with beta-lactamase inhibitor combined with aminoglycosides and carbapenemes may be suitable choices for the patients with urosepsis

Clinical Features and Prognosis in Ocular Toxoplasmosis: A Review of 15 Cases

Ocular toxoplasmosis is one of the causes of severe visual loss in young people. We reviewed the records of 15 patients with ocular toxoplasmosis who were examined between 2003 and 2005. The diagnosis of ocular toxoplasmosis was established by detecting morphologically characteristic toxoplasmic fundus lesions in either eye by ophthalmologist. A positive serologic test for toxoplasmosis was used to support the diagnosis. All patients were treated. Our treatment protocol included the combination of primethamine and trimethoprim-sulfamethoxazol (TMP-SMX) or clindamicin and TMP-SMX or spiramycin and TMP-SMX with corticosteroid. Duration of treatment was average of four-six weeks. There were active lesions in 11 of the patients. There was also inflammation accompanied with chorioretinitis scars in four patients. Macular involvement were seen in three patients. Fourteen patients had unilateral and one had bilateral involvement. Retinochroidal lesions of 12 patient showed full regression. Relaps was seen in four patients. In conclusion, ocular toxoplasmosis seriously impairs vision acuity. Patients who have active choroidoretinitis of T. gondii should be treated and followed to avoid late compllications

Etiology of Fever of Unknown Origin in Eskisehir

Introduction: Fever of unknown origin is first defined in 1961 as a temperature higher than 38.3°C lasting longer than 3 weeks, with a diagnosis that remains uncertain after 1 week of investigation. In this study, it’s aimed to evaluate etiology of fever of unknown origin cases hospitalized in department of infectious diseases and clinical microbiology. Patients and Methods: Fifty three fever of unknown origin cases hospitalized at our department between January 2002-August 2007 were evaluated retrospectively. Fever of unknown origin was diagnosed according to the criteria described by Petersdorf and Beeson. Patients with a history of immunosuppressive disease and nosocomial fever were excluded. Results: Median days with fever was 15.8 days (20-160 days), median days for diagnosis was 4.8 days (3-120 days). Seventeen (32.1%), 10 (18.9%) and 5 (9.4%) of the 53 cases were diagnosed as infection, collagen vascular disease and malignancy respectively. Eight (15.1%) of all cases were diagnosed as other diseases such as thyroiditis, pheochromocytoma, ulcerative collitis, and familial mediterrenean fever. Origins of the fever was not defined for 13 (24.5%) of the patients. Fever decreased spontaneously in 61.5% of undiagnosed patients at follow up. Invasive procedures were performed at 20.8% of whole cases. Conclusion: As a result infectious diseases are the leading causes of fever of unknown origin. For diagnosis routine tests should be performed first and then if necessary, more complicated or invasive tests may be performed. Endemic, regional infectious diseases should be considered primarily

Several Cytokines and Protein C Levels with the Apache II Scoring System for Evaluation of Patients with Sepsis

Objective: We investigated whether determination IL-6, IL-8, IL-1beta and TNF-alpha at baseline, total protein C (PC) levels at time of admission and 48 hours after initiation could complement the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system to identify patients with sepsis, severe sepsis or septic shock for clinical outcome.Material and Methods: The study was carried out prospectively. 60 consecutive patients with sepsis, severe sepsis or septic shock were included. Blood samples were obtained at baseline and 48 hours after initiation. Cytokines and PC levels in plasma were measured with an enzyme-linked immunoabsorbent assay (ELISA). APACHE II score was calculated on admission.Results: Baseline IL-6 levels and PC levels 48 hours after initiation were predictive of increased mortality (p=0.016, p=0.044 respectively). Baseline IL-6, IL-8 and TNF-alpha baseline levels correlate with the severity of physiologic insult, as determined by the APACHE II score. However, our multiple logistic regression analysis of these did not reveal any predictive value in combination with the APACHE II score.Conclusion: Determination of baseline IL-6 and PC 48 hours after initiation were of predictive value for prognostic evaluation of septic patients, but did not significantly increase predictive power of the APACHE scoring system to identify patients with sepsis for fatal clinical outcome

Comparison of adefovir dipivoxil andpegylated interferon alpha-2a treatmentin chronic hepatitis B patients

OBJECTIVE: In this study, we aimed to evaluate the efficacy of pegylated interferon alpha 2a and adefovir dipivoxil treatment in chronic hepatitis B patients. METHODS: This study was performed on patients treated for chronic hepatitis B in the Infectious Disease Clinic of Eskişehir Osmangazi University between 01.09.2005 and 31.03.2008. A total of 30 patients aged between 18 and 65 years constituted the study group. One of patient groups received (10 HBeAg negative, 4 HBeAg positive) PEG-IFN alpha 2a at a dose of 180 μg/once a week, whereas the other group (11 HBeAg negative, 5 HBeAg positive) received daily oral doses of 10 mg ADV. Treatment responses were evaluated at week 48. RESULTS: Reductions in serum HBV DNA levels at the end of 48 weeks were 4.8 log10 copy/ml and 4.2 log10 copy/ml in HBeAg negative patients who received ADV or PEG-IFN alpha 2a, respectively. Biochemical response rates were 60% and 91% in PEG-IFN alpha 2a and ADV groups, respectively. Among HBeAg positive patients, reductions in serum HBV DNA levels were 3. 2 log10 copy/ml and 4 log10 copy/ml in ADV and PEG-IFN alpha 2a groups, at week 48, respectively. Biochemical response rates were 50% and 40% in PEG-IFN alpha 2a and ADV groups, respectively. No significant difference was determined in biochemical and virological responses in HBeAg positive and negative patients between PEG-IFN alpha 2a and ADV groups, at week 48. When both treatment groups were evaluated for side effects, it was observed that side effects were significantly common in PEG-IFN alpha 2a group. CONCLUSION: When we compared PEG-IFN alpha 2a and ADV treatment in both HBeAg positive and negative patients, biochemical and virological response rates at 48 weeks were similar