Plasmodium falciparum Malaria of Foreign-Origin in Kocaeli Province: Assessment of 16 Cases

WOS: 000389267200008Objective: This paper intends to underline that malaria should be borne in mind in the differential diagnosis of patients with history of visiting endemic regions and of malaria prophylaxis for those intending to travel to these regions. Methods: 16 cases of P. falciparum malaria that were followed in the clinic between 2009 and 2015 were included in our study. Diagnosis was based on plasmodia seen under light microscope in thick and thin smears prepared from peripheral blood samples obtained from febrile patients and stained with Giemsa method. Results: Out of 16 patients, one was female and 15 were males. 14 of these patients, whose average age was 32 years, did not receive prophylaxis. Complaints of all patients were fever with chills, rigor, weakness, and anorexia; other accompanying complaints were headache, nausea, abdominal pain, diarrhea, cough and sore throat. Body temperatures over 38 degrees C were detected in all patients. 11 patients were treated with artemether-lumefantrin and 5 patients treated with combination of quinine and doxycycline. Ertapenem was added in the treatment of a patient due to Serratia marcescens isolation in his blood culture obtained during his febrile period. Acute hepatitis A as a co-infection was detected in a patient and he was followed with symptomatic treatment. Somnolence, bleeding, bilateral pleural effusion and pulmonary infiltrates were observed in two patients diagnosed as severe malaria. Conclusions: Malaria chemoprophylaxis for the people intending to travel endemic regions is crucial

Current Diagnosis and Treatment Approach to Sepsis

Sepsis is a major healthcare problem worldwide. Its mortality and morbidity is still high. Early diagnosis of sepsis and appropriate management in the initial hours improve outcomes. The Surviving Sepsis Campaign published new definitions for sepsis in 2016. In Sepsis-3 definitions, sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be identified as an acute change in total SOFA score of at least two points consequent to the infection. However, this definition is endorsed by two international societies and there is much discussion regarding new definitions. Prospective validation of this definition on different levels is needed. The infectious source in sepsis depends on patients' underlying diseases and origin of the infection (community-acquired or healthcare-associated). In the literature, urinary tract and skin-soft tissue infection are the common sites in community-acquired sepsis, whereas respiratory system and intraabdominal infections are more common in nosocomial sepsis. Another challenge in sepsis management is the increasing incidence of sepsis due to multidrug-resistant bacteria and limited treatment options. New antibiotics may be treatment options in the future. In this review, current definitions of sepsis, physiopathology of sepsis, foci of sepsis and causative microorganisms, microbiological diagnosis and rapid diagnosis methods, biomarkers used in the diagnosis of sepsis, antimicrobial treatment and resistance, new antibiotics and non-antibiotic therapy are discussed

Mortality predictors of Staphylococcus aureus bacteremia: A prospective multicenter study

Background: Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals. Methods: Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis. Results: A total of 255 episodes of SAB were enrolled. The median age of the patients was 59years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1%. Healthcare associated SAB was defined in 55.7%. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2%. Initial empirical therapy was inappropriate in 28.2%. Although overall mortality was observed in 52 (20.4%), 28-day mortality rate was 15.3%. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12h, respectively; p>0.05). High Charlson comorbidity index (CCI) score (p=0.002), MRSA (p=0.017), intensive care unit (ICU) admission (p<0.001) and prior exposure to antibiotics (p=0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p=0.023], ICU admission (HR 6.9; p=0.002), and high CCI score (HR 1.32; p=0.002) as the independent predictive factors mortality. Conclusions: The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB