Inhaled Colistin Usage in the Treatment of Health-Care Associated Pneumoniae Due to Multi-Drug Resistant Gram-Negative Microorganism

Hospital-acquired pneumoniae and ventilatory-associated pneumoniae (VAP) were the most common health-care associated infections leading to high mortality rates. Intravenous colistin which is used for infections due to multi-drug resistant microorganisms has poor penetration into the lung. Inhaled colistin usage seems promising in the treatment of the VAP causing high mortality. The results of the studies regarding clinical efficacy of colistin were controversial. Inhaled colistin usage in the treatment of VAP was reviewed according to the literature

Hepatitis B and Hepatitis C Co-infection

Hepatitis B virus (HBV)/hepatitis C virus (HCV) coinfection is occurred generally in highly endemic areas and among persons with a high risk of parenteral infections, because of both virus have common routes of transmission. The worldwide prevalence of coinfection is unknown, but it is estimated to be about 15 million HBV/HCV co-infected patients. HBV/HCV co-infection presents with a heterogeneous clinical appearance depending on the individual differences and diversity of the viral replication. HCV superinfection in patients with chronic HBV infection was the most common clinical features of coinfection in Asia-Pacific countries, while HBV superinfection was more common in Europe and United States. HBV/HCV interact with each other. HBV viral replication is generally suppressed by HCV. However, the longitudinal studies suggest that the viral interference is a fl uctuating dynamic process. Co-infection is characterized by a more severe liver injury and a higher incidence of cirrhosis and hepatocellular carcinoma (HCC). The dominant virus should be determined by pretreatment serological and virological evaluations. A good treatment response was obtained with pegile-interferon(Peg-IFN)/ribavirin in co-infected patients. Treatment outcomes was similar to HCV monoinfection. The effective treatment of HCV infection in the HBV/HCV co-infected patients may lead to HBV reactivation. For this reasons, long-term follow-up and monitoring for HBV infection are recommended in this patients. Although adding to a nucleos(t)ide analogues to the combination of Peg-IFN/ribavirin is a treatment alternative in HBV-active or dually-active co-infection, the optimal treatment strategies remains still unknown. The role of IFN-free direct acting antivirals treatment in co-infection is another issue to be resolved. However, the treatment of HCV with new potent drugs without any anti-HBV effect may increase the risk of HBV reactivation. The introduction of new antiviral for the treatment of hepatitis C may alter the optimal treatment of HBV/HCV coinfection. Further studies are needed in this regard

A Travel-Associated Legionella Pneumonia Case Diagnosed with Urinary Antigen Detection Test

A 70-year old man admitted to the hospital with malaise, high fever and cough. He had travelling history to Saudi Arabia 15 days before his admission. Physical findings revealed high fever (39°C), relative bradycardia, cyanosis and hepatomegaly. Thorax examination was normal but chest-radiography showed a pneumonic infiltration in the right lung. Urinary antigen detection test for Legionella pneumophila was positive. The symptoms of the patient were recovered and body temperature was normal on 3rd day of moxifloxacin intravenous 400 mg treatment. The patient has been discharged from hospital on the 10th day of therapy

Diagnostic Approches in Legionnaires’ Disease: A Clinical, Microbiological and Epidemiological Review on Cases Between 1995-2002

In this report, results of 183 cases, dispatched to our laboratory by suspicion of Legionnaires’ disease between February 1995 and July 2002, were interpreted for matching to the standard case definitions and outcomes. As diagnostic techniques, culture, direct fluorescence antibody assay, urinary antigen test, and serology were used according to the samples. Demographical, clinical and epidemiological characteristics were analyzed from the records of “Laboratory Request Log”. It is observed that the most of the cases (60.4%) were classified as community-acquired pneumonia. The 80.3% of these individuals came from the populations by having medium- and low socio-economic standards, that are controversial for the epidemiology of Legionnaires’ disease, were comprehended. The most preferred samples were urine (145) and the less preferred samples were from lower respiratory tract (52) for sending to the laboratory. Totally 6 (3.3%) cases were confirmed as Legionnaires’ disease based on positive urinary antigen test results. Four of these cases were reported as travel-associated Legionnaires’ disease based on their travel histories. Additionally 9 (4.1%) cases were classified as probable Legionnaires’ disease by serological findings. Since the clinical and radiological presentations of Legionnaires’ disease are not discriminative, definitive diagnosis requires application of specialized microbiology techniques. However, it seems that as the samples are sending to the laboratory to take into account some of the clinical and epidemiological characteristics is essential for using the time and sources effectively

Listeria Meningoencephalitis in Immunocompetent Person Complicated with Hydrocephalus

Listeria monocytogenes is a common cause of central nervous system infection, especially in immunosuppressed patients, infants, and the elderly and in pregnancy; it is uncommon in individuals with immunocompetent status. In this case report, we aimed to present the case of an immunocompetent 45-year-old patient who presented with meningoencephalitis due to Listeria, which was complicated with hydrocephalus

The Evaluation of Knowledge of the Health-Care Personnel Regarding Crimean-Congo Haemorrhagic Fever

Introduction: Crimean-Congo haemorrhagic fever (CCHF) has been encountered in Turkey since 2002. Education of health-care personnel is very important to control CCHF. The aim of this study was to determine the knowledge of health-care personnel who are working in endemic area and working in a secondary or tertiary hospital caring the patients regarding CCHF. Materials and Methods: A questionnaire including 12 questions was prepared and it was applied to health-care personnel working in seven provinces. Eighty-nine doctors, 310 nurses and 112 laboratory technicians were included in the study. Results: 94.3% of doctors’, 80.4% of nurses’ and 77.6% of laboratory technicians’ knowledge level about CCHF were good or very good according to theirself. Tick-bite, contact with blood or body fluid of infected animals and contact with blood or body fluid of CCHF patients were known as transmission routes by 85.7%, 77.1% and 69.1% of health-care personnel respectively. Ribavirin treatment was required according to the 30.3% of doctors while 63.3 of them offered only supportive therapy. 83.6% of personnel described that tick has been removed completely with pleat or tweezers. But 11.9% and 3.3% of personnel told that alcohol or olive-oil can be applied before removing tick, respectively. Conclusion: It is very important to perform continuous education of health-care personnel especially in the epidemic region for early diagnosis of the patient, appropriate management and to reduce nosocomial infection risk