Bruselloza bağlı gelişen epidural abse ile ilişkili spondilodiskit

Spondylodiskitis with epidural abscess due to brucellosis is very rare and serious complication, and it may result in neurological deficits. Here, we report a 29 year-old male patient with brucellosis causing spondylodiskitis and spinal epidural abscess resulting in neurological deficits such as paresis. Surgical therapy is the main approach in the treatment of the abscess. However, the patient did not accept the surgery. Therefore, initial drug combination therapy (doxycycline and rifampicin) was changed to another therapeutic protocol (streptomy- cin and doxycycline and rifampicin), and the treatment period was extended to three months. He was completely cured in aspect of the disorder and complications. In conclusion, brucellar spinal epidural abscesses are a rare complication of brucellosis. In contrast to the high morbidity and mortality rates reported in pyogenic or tuberculo- sis abscess, brucellosis with epidural abscess has a good prognosis with early diagnosis and appropriate treatment.Bruselloza bağlı spondilodiskitle birlikte görülen epidural abse nörolojik defisite de neden olabilen çok nadir bir komplikasyondur. Burada bruselloz nedeniyle spondilodiskitle birlikte epidural abse ve buna bağlı parezisi olan, 29 yaşında erkek hasta sunuldu. Cerrahi tedavi abselerde temel tedavi yaklaşımı olmasına rağmen hasta cerrahi tedaviyi kabul etmedi. Bu nedenle hastaya daha önce başlanan kombinasyon tedavisi (doksisiklin ve rifampisin) değiştirilerek diğer bir tedavi protokolüne (streptomisin + doksisiklin + rifampisin) geçildi ve tedavi süresi 3 aya uzatıldı. Hastanın bruselloz ve komplikasyonu tam olarak tedavi edildi. Sonuç olarak, pyojenik ve tuberküloz abselerinde yüksek morbidite ve mortalite bildirilmesine rağmen bruselloza bağlı epidural abselerde erken tanı ve uygun tedavi iyi prognoza sahiptir

ORIGINAL ARTICLE - RADIOLOGIC AND CLINICAL FINDINGS IN TUBERCULOUS MENINGITIS

We aimed to evaluate the radiologic and clinical findings of patients with tuberculous meningitis encountered during a 4-year period, retrospectively. Sixteen patients with tuberculous meningitis were admitted to our hospital. The diagnosis was based on abnormal neurologic symptoms and signs, cerebrospinal fluid findings, negative bacteria culture, and abnormalities on brain-imaging studies. CT and MR examinations were performed in 16 and 9 patients, respectively. A retrospective comparison was done between CT and MR findings. All patients had fever, lethargy, and some of them had cough. Neurologic presentations included increased intracranial pressure, vomiting, seizures, paresis, nuchal rigidity, and disturbance of consciousness. Acid-fast stain of cerebrospinal fluid for tuberculous bacilli was negative for all samples. All bacterial cultures of cerebrospinal fluid yielded no growth, with the exception of one that grew Mycobacterium tuberculosis. Radiologic findings compatible with tuberculous meningitis including hydrocephalus, basilar cistern enhancement and infarction was observed more clearly on MR than CT. Early diagnosis in tuberculous meningitis may prevent neurologic damage. Imaging studies is an important part of diagnosis and MR imaging should be performed as a first choice of imaging modalities in patients with tuberculous meningitis

A Case Of Typhoid Fever Presenting With Multiple Complications

An 18-year old female patient was admitted to the Emergency Department with complaints of fever and fatigue beginning 15 days ago associated with headache, weakness, palpitation, abdominal pain, and diarrhea a week later. The patient who apathic confused and discordant was transferred to the Department of Infectious Diseases. There was also hypocalcemia, hypopotassemia, pancytopenia, intestinal hemorrhage, and hepatic involvement. S. typhi was grown in the blood culture. The patient was discharged with full recovery after ciprofloxacin treatment in addition to electrolyte replacement. Typhoid fever is a widespread infectious disease in our country and should be taken into consideration in differential diagnosis of many diseases because it may involve a number of systems and may present with a variety of complications

A Case Of Brucellosis Lymphadenitis Mimicking Scrofuloderma

Brucellosis is a zoonotic disease, which may be manifested by multisystemic involvement. While the complications related to musculoskeletal and gastrointestinal system are frequently seen, those related to the other systems are rarely encountered. In this paper, we present a brucellosis lymphadenitis case in the right side of the neck in a 20 years old female patient, presenting with a mass formation in the soft tissue mimicking scrofuloderma, with dimensions of 10x6x4 cm. Especially in endemic areas, brucellosis lymphadenitis should also be remembered in addition to scrofuloderm

Technika Dowlinga i Orlando w leczeniu olbrzymiej pierwotnej torbieli bąblowcowej mózgu: opis przypadku

Hydatid cyst disease is a parasitic illness that is rarely located in the brain. We present a case of a 26-year-old female who complained of headache, nausea, and vomiting. The diagnosis was intracranial hydatid cyst disease and was confirmed with radiological and serological tests. Neurological examination revealed papilloedema and left-sided pyramidal signs. She was operated on using the Dowling-Orlando technique. The cyst was removed without rupture, and therapy was completed with albendazole for a period of four weeks. In this article, we discuss the application of the Dowling-Orlando technique, microsurgery, the Valsalva manoeuvre and the positioning of the patient such that gravity could facilitate surgical removal of a giant cerebral hydatid cyst.Bąblowica jest chorobą pasożytniczą, która rzadko umiejscawia się w mózgu. Przedstawiono przypadek dotyczący 26-letniej chorej, która skarżyła się na ból głowy, nudności i wymioty. Rozpoznanie bąblowicy śródczaszkowej potwierdzono w badaniach obrazowych i serologicznych. Pacjentka była operowana z wykorzystaniem techniki Dowlinga i Orlando, mikrochirurgii, manewru Valsalvy i ułożenia w taki sposób, aby grawitacja ułatwiła chirurgiczne usunięcie z mózgu olbrzymiej torbieli bąblowca

The seropositivity of parvovirus B19 in patients with ankylosing spondylitis

Amaç: Parvovirüs B19 viral artritlerin en sık nedenlerindendir. Bazı hastalarda romatoid artrit benzeri kronik bir poliartrite neden olması, parvovirüs B19'un otoimmün hastalıkların patogenezinde önemli bir etken olabileceğini düşündürmektedir. Bu çalışmada, ankilozan spondilitli (AS) hastalarda parvovirüs B19 seropozitifliğinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Ankilozan spondilit tanısı ile takip edilen 43 kişi hasta grubunu, herhangi bir kemik eklem şikayeti olmayan 70 kişi ise kontrol grubunu oluşturdu. Tüm serum örneklerinde ELİSA yöntemi ile anti parvovirüs B19 IgM ve IgG antikorlarına bakıldı.Bulgular: Hasta ve kontrol grubu karşılaştırıldığında, parvovirüs B19 IgM pozitifliği AS'li hasta grubunda anlamlı olarak yüksek bulundu (p<0,001).Sonuç: Ankilozan spondilitli hastalarda yüksek oranda parvovirüs B19 IgM pozitifliğinin saptanması, bu hastalarda immün yetmezliğine bağlı virüsün reaktivasyonu veya persistansını düşündürmektedir.Objective: Parvovirus B19 is one of the most common causes of viral arthritis, which suggests that it can be a significant factor in the pathogenesis of chronic inflammatory diseases, such as rheumatoid arthritis. The aim of the present study was to investigate the seropositivity of parvovirus B19 in patients with ankylosing spondylitis (AS).Material and Methods: The patient group consisted of 43 patients with ankylosing spondylitis; the control group consisted of 70 subjects who did not have any bone joints complaints. Anti-parvovirus B19 IgM and IgG antibodies were measured by ELISA.Results: Parvovirus B19 IgM antibody positivity in patients with AS was significantly higher than that in the control group (p&lt;0.001). Conclusion: The high frequency of anti-parvovirus B19 IgM positivity in patients with AS suggests that the virus reactivates or persists in these patients due to immuno deficiency

The evaluation of health-care associated infections in intensive care unit of Mustafa Kemal University Medical School in 2011

Bu çalışmada, hastanemiz yoğun bakım ünitesinde 2011 yılında gelişen sağlık hizmeti ile ilişkili infeksiyonların değerlendirilmesi amaçlanmıştır. Yoğun bakım ünitesinde hastaya dayalı, aktif, prospektif sürveyans yapılmıştır. Hastane infeksiyonu tanısında Hastalık Kontrol ve Önleme Merkezi (CDC) tanı kriterleri kullanılmıştır. İzole edilen infeksiyon etkenleri konvansiyonel yöntemler ve VİTEK2 Compact (bioMérieux, Fransa) otomatize sistemle tanımlanmıştır. Antibiyotik duyarlılık testleri Klinik ve Laboratuvar Standartları Enstitüsü (CLSI) kriterlerine göre disk difüzyon yöntemi ile yapılmıştır. Çalışma boyunca yoğun bakım ünitesinde 415 hasta 3654 hasta günü izlenmiştir. Bu sürede 70 hastane infeksiyonu tanımlanmış, hastane infeksiyonu hızı % 16.9; hastane infeksiyonu insidans dansitesi binde 19.2 olarak hesaplanmıştır. Hastane infeksiyonu tanısı alan hastalardan 71 mikroorganizma izole edilmiş, bunların 36’sını Gram negatif bakteriler, 17’sini Gram pozitif bakteriler ve 18’ini kandida türleri oluşturmuştur. Tüm sağlık hizmeti ile ilişkili infeksiyonların yaklaşık yarısı kateter ilişkili üriner sistem infeksiyonu (% 47.1), % 35.7’si kan dolaşımı infeksiyonu ve % 17.1’i ventilatör ilişkili pnömoni olarak tespit edilmiştir. Sürveyans çalışmaları sonucu her merkezin mikroorganizma dağılımı ve direnç durumlarını belirleyerek bu doğrultuda akılcı antibiyotik kullanımına önem vermesi, dirençli mikroorganizmalarla mücadelede başarı sağlayacaktır.The aim of the present study was to evaluation the health-care associated infections developing in intensive care unit of our hospital in 2011. Based on the patient, active, prospective surveillance is made in intensive care unit. Centers for Disease Control and Prevention (CDC) diagnostic criteria were used for nosocomial infection diagnosis. Infectious agents isolated were identified by conventional methods and VITEK2 Compact System (bioM&eacute;rieux, France). According to the standards of Clinical and Laboratory Standards Institute (CLSI); antibiotics susceptibility tests were performed by using disc diffusion method. During the study, 415 patients were observed on 3654 patients’ days in intensive care unit. This period, 70 nosocomial infections were described. Nosocomial infection rate of 16.9 %, nosocomial infection incidence density was calculated as 19.2 per thousand. Totally 71 microorganisms were isolated; 36 of them were determined as Gram negative bacteria while 17 were Gram positive bacteria and 18 were Candida spp. Urinary tract catheter-associated infection (47.1 %) was approximately half of the health-care associated infections, followed by bloodstream infections (35.7 %), and ventilator associated pneumonia (17.1 %). As a result of surveillance studies each center determining the distribution of microorganisms and resistance status give importance to the rational use of antibiotics in this direction will ensure success in the fight against with resistant microorganisms

Clinical characteristics of the patients with pandemic influenza A (H1N1)

Amaç: Mart 2009’da Meksika ve ABD’de ilk kez görülen bir influenza tipi olan A (H1N1) hızla tüm dünyaya yayılmış ve Ekim-Aralık aylarında tüm Türkiye’de etkili olmuştur. Bu çalışmada, hastanemizde influenza A (H1N1) tanısı ile yatarak tedavi edilen hastalarımızın klinik özelliklerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Kasım-Aralık 2009 tarihlerinde Enfeksiyon Hastalıkları, Göğüs Hastalıkları ve Kardiyoloji servislerinde influenza benzeri semptomlarla yatarak tedavi gören 41 hasta retrospektif olarak değerlendirildi. H1N1 testi Refik Saydam Hıfzıssıhha Merkez Laboratuarında yapıldı. Bulgular: Çalışmaya alınan 41 hastanın 19’unda (%46.3) H1N1 testi pozitif iken 22’sinde (%53.7) negatif idi. Bu hastaların 19’u (%46.3) erkek, 22’si (%53.7) kadındı ve yaşları 16-75 (ortalama 32,1 (±14.7) idi. Kadın hastaların 8’i (%36.4) hamile, 14’ü (%63.6) hamile değildi. Hastalarımız genel olarak tedaviye iyi cevap verdiler. H1N1 testi pozitif iki hamile hastamızın kliniği çok ağır seyretti. Yoğun bakımda takip edilen hastalardan birisi tedaviye cevap vermedi ve Akut Solunum Yetmezliği Sendromu nedeniyle kaybedildi. Sonuç: Pandemik influenza A (H1N1) alt solunum yollarını mevsimsel influenzaya göre daha sık tutmaktadır. Hastalık genel olarak kısa süreli bir klinik gidişe ve hamileler dışında iyi bir prognoza sahip olmasına rağmen, hamilelerde ölümcül olabilmektedir.Introduction: Influenza A (H1N1) was observed in Mexico and the United States for the first time in March 2009. It has spread to the whole world, quickly. It has been seen also in allover Turkey between October and December 2009. In this study, we aimed to evaluate the clinical characteristics of hospitalized patients with diagnosis of influenza A (H1N1). Material and Method: Retrospectively, 41 patients with influenza-like symptoms reviewed in Infectious Diseases, Chest Diseases, and Cardiology Services between November and December 2009. H1N1 test was performed in the Refik Saydam Hıfzıssıhha Central Laboratory. Results: Nineteen of 41 patients (46.3%) tested as positive for H1N1, while 22 (53.7%) were negative. Nineteen of these patients (46.3%) were male and 22 (53.7%) were female, and age distribution was 16-75 (mean 32.1 (&plusmn; 14.7). Eight female patients (36.4%) were pregnant and 14 (63.6%) were not. Patients generally responded well to treatment. The prognosis was poor in two pregnant patients with H1N1 positivity. One of the patients did not respond to treatment in intensive care unit and died because of adult respiratory distress syndrome. Conclusion: Pandemic influenza A (H1N1) affects the lower respiratory tract more often than the seasonal influenza. Generally, this disease has a short-term clinical course with a good prognosis except for the pregnant women, in whom it may be fatal

Investigations of ALS1 and HWP1 genes in clinical isolates of Candida albicans

Aim: To explore the presence of ALS1 and HWP1 genes by multiplex polymerase chain reaction (PCR) in Candida albicans strains. Materials and methods: By using the multiplex PCR method, the presence of agglutinin-like sequence 1 (ALS1) and hyphal wall protein 1 ( HWP1) genes were investigated in 206 C. albicans strains that were isolated from various clinical samples. Phenotypic identification of slime formation by microplate and tube adherence tests was performed. Results: The presence of the ALS1 gene was detected in 53.9% of all strains, while the HWP1 gene was present in 5.3%. Slime formation was phenotypically detected in the 62.2% of the strains in which the ALS1 and/or the HWP1 gene was found, using the microplate and/ or tube adherence test. The genes evaluated were found to be present in the 76.7% of strains in which slime formation was detected by phenotypic tests. There was a moderate correlation between the presence of the ALS1 gene and the microplate method, yet there was no correlation when using the tube adherence test. Conclusion: It was concluded that various genes other than those evaluated could be present in slime formation of C. albicans, and the presence of the genes may not always be represented in the phenotype.Aim: To explore the presence of ALS1 and HWP1 genes by multiplex polymerase chain reaction (PCR) in Candida albicans strains. Materials and methods: By using the multiplex PCR method, the presence of agglutinin-like sequence 1 (ALS1) and hyphal wall protein 1 ( HWP1) genes were investigated in 206 C. albicans strains that were isolated from various clinical samples. Phenotypic identification of slime formation by microplate and tube adherence tests was performed. Results: The presence of the ALS1 gene was detected in 53.9% of all strains, while the HWP1 gene was present in 5.3%. Slime formation was phenotypically detected in the 62.2% of the strains in which the ALS1 and/or the HWP1 gene was found, using the microplate and/ or tube adherence test. The genes evaluated were found to be present in the 76.7% of strains in which slime formation was detected by phenotypic tests. There was a moderate correlation between the presence of the ALS1 gene and the microplate method, yet there was no correlation when using the tube adherence test. Conclusion: It was concluded that various genes other than those evaluated could be present in slime formation of C. albicans, and the presence of the genes may not always be represented in the phenotype