Recurrent Staphylococcus warnerii prosthetic valve endocarditis: A case report and review

To our knowledge, there have been only six S. warneri endocarditis cases reported in the English-language literature (Medline: 1966 to April 2011). We report a case of recurrent S. warneri endocarditis in a patient with prosthetic valve and silicon mammoplasty and we also review the relevant literature

Rhinocerebral zygomycosis treated with liposomal amphotericin B and surgery

We report three cases with rhinocerebral zygomycosis in two diabetic persons and one otherwise healthy person. The diagnosis was established by histopathological appearance and computerized tomography (CT) and/or magnetic resonance imaging (MRI) scans. These cases were successfully treated by a combination of surgery and liposomal amphotericin B

Sexual and non-sexual intrafamilial spread of hepatitis C virus: Intrafamilial transmission of HCV

The rate of intrafamilial transmission of the hepatitis C virus (HCV) was investigated in 90 family members of 41 index patients with type C chronic liver disease. Antibody to HCV (anti-HCV) was detected by the EIA method (Abbott-Axsym Sys) and Hepatitis C virus RNA, by the polymerase chain reaction (Nested PCR). We also investigated the presence of anti-HCV in 350 healthy persons (control group). The subjects in the study included 38 spouses, 45 children and others (1 relative and 6 parents). Four family members including 3/38 (7.8%) spouses and 1 sister were found to be positive for anti HCV antibodies but none had HCV RNA. Anti-HCV was not detected in the children of index patients. The prevalence of anti-HCV in the families of index patients was significantly higher than in the controls (4.3% versus 0.85%) (p = 0.0355). We concluded that the intrafamilial transmission of HCV is possible but occurs at a low rate

Osteoarthricular involvement of brucellosis in Turkey

The aim of this study was to determine the rates, types, clinical features and treatment of osteoarthricular involvement of brucellosis in Turkey. In a restrospective study in adults, we investigated 238 patients diagnosed with brucellosis over a period of 6 years. A diagnosis of brucellosis was established by isolation of Brucella species in blood or by a compatible clinical picture together with a standard tube agglutination titre of greater than or equal to 1/160 of antibodies for brucellosis and/or demonstration of an at least four-fold rise in antibody titre in serum specimens taken over 2 or 3 weeks. Osteoarthricular involvement was defined by inflammatory signs in peripheral joints or by unrelieved pain at rest together with radiological alterations and/or radionuclide uptake in any deep joint. Eighty-seven patients (36.5%) had osteoarthricular involvement (58.6% female, 41.4% male), 47 (54.1%) of whom were reported to consume unpasteurised dairy products. The mean age was 32.3 +/- 16 years. Sacroiliitis was the most common involvement (n = 53, 60.9%) followed by peripheral arthritis (n = 17, 19.5%), spondylitis (n = 12, 13.8%) and bursitis (n = 5, 5.7%). During the observation period, 60 (69%) patients with osteoarthricular involvement and radiographic abnormalities. A bone scan was positive in 15 patients with no radiographic abnormalities. All patients received merely medical treatment and relapse occurred in five (5.7%) patients. Sacroiliitis has been determined as the most, frequently observed type of osteoarthricular involvement in brucellosis in Turkey

Prognostic factors affecting deaths from adult tetanus

The objective of this study was to determine prognostic factors related to death from adult tetanus. Fifty-three cases of tetanus, 25 females and 28 males, were treated in C, ukurova University Hospital during 1994 - 2000. The mean age was 46.6 years. Forty-one (77.7%) patients came from rural areas. Most (64.1%) cases had minor trauma, but 19 (35.8%) had deep injuries. The mean incubation period was 11.5 days. Mortality was high (52.8%), caused by cardiac or respiratory failure or complications, and was related to the length of the incubation period. In cases with an incubation period less than or equal to7 days, the mortality rate was 75% ( p 0.07). Mortality was significantly associated with generalised tetanus ( p = 40 degrees C, tachycardia of > 120 beats / min ( p 0.05) had similar outcomes. Patients who were given penicillin had a mortality rate similar to patients who were given metronidazole ( p 0.15). The mortality rate was higher (92%) in patients with severe tetanus than in patients with moderate disease (53%). By multivariate analysis, the time to mortality caused by tetanus, and also the mortality rate, were both related significantly to age and tachycardia

Efficacy of rifampicin plus doxycycline versus rifampicin plus quinolone in the treatment of brucellosis

Objective: The aim of this study was to compare the efficacy, tolerability and side effects of 2 treatment regimens for brucellosis

Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study

Objectives. To investigate fever of unknown origin (FUO) in 87 patients

A clinical review of 40 cases with tuberculous spondylitis in adults

The purpose of this clinical review was to review clinical presentations, laboratory, and radiologic findings and difficulties on management of tuberculous spondylitis from a series of 40 cases. We carried out a retrospective analysis of 40 adult patients (50% male) with tuberculous spondylitis between January 1997 and December 2003. Infection was diagnosed in patients having a presentation compatible with characteristic histologic and/or microbiologic evidence of tuberculous spondylitis and diagnostic radiographic features, or following adequate response to antituberculous therapy with highly suggestive imaging features. Outcome was assessed according to clinical, radiologic, and laboratory criteria. Mean age was 44.7 +/- 19 years. Thirty percent of patients had a history of contact with a patient having active pulmonary tuberculosis. The most frequent symptom and sign were back pain (92.5%) and, spinal tenderness (55%). Magnetic resonance imaging was found to be the most helpful technique for diagnosis. Lumbar spine was the most common affected region (82.5%). Thirty (75%) patients had paraspinal abscess and, 4 (10%) had concomitant sacroihitis. Spinal biopsy had a yield of 76.5%, 52.9%. and 47% granulomas, positive culture, and acid-fast smear, respectively. Resistance to antituberculous drugs was 44.4%. Although medical treatment alone was given in 15% cases, 85% required additional surgical intervention. The mean duration of therapy was 12 12 months. The improvement without sequela was 77.5% of the patients. In developing countries, diagnostic delay in tuberculous spondylitis is still common and disastrous. Bacteriologic confirmation and susceptibility testing should be achievable in all adult cases

A prospective pharmacovigilance study in the infectious diseases unit of a tertiary care hospital

Introduction: The frequency, causality, severity, preventability and risk factors of ADRs (adverse drug reactions) in infectious disease units are not well defined in the literature. Thus, the aim of this study was to determine the characteristics of the ADRs encountered in an infectious disease unit of a tertiary teaching hospital

Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomized clinical trial in a university hospital

P>In this prospective, randomized, open-label clinical trial, we compared the efficacy and safety of two antibiotic regimens for severe diabetic foot infections (DFI). Sixty-two in-patients with DFI received either piperacillin/tazobactam (Pip-Tazo, n = 30) (4.5 g intravenously every 8h) or imipenem/cilastatin (IMP, n = 32) (0.5 g intravenously every 6h). The mean duration of treatment was 21 days for Pip-Tazo and 24 days for IMP. Twenty-two (73.3%) patients in the Pip-Tazo group and 26 (81.2%) patients in the IMP group had DFI associated with osteomyelitis. Successful clinical response was seen in 14 (46.7%) patients in the Pip-Tazo group and in nine (28.1%) patients in the IMP group [relative risk (RR) 1.6 (95% CI 0.84-3.25), p 0.130]. Two patients in the IMP group and none in the PIP-Tazo group relapsed [RR 2 (0.94-4.24), p 0.058]. Eighty-nine microorganisms were isolated: 38 (43%) Gram-positive and 51(57%) Gram-negative. Among patients with positive culture, 47 (96%) had complete and two (4%) had partial microbiological response. Microbiological response rates were similar in both groups (p 1.000). Amputation was performed in 18 (60%) and 22 (69%) patients in the Pip-Tazo and IMP groups (p 0.739) respectively. Side effects were more common in the Pip-Tazo group (30% vs. 9.4%), but they were generally mild and reversible. In conclusion, although the sample size was small and the results did not reach statistical significance, Pip-Tazo produced a better clinical response rate than IMP in the treatment of severe DFI. There was no significant difference between the treatment groups with respect to microbiological response, relapse and amputation rates