Pneumococcal Meningitis in Adults: Evaluation of 24 Episodes

A retrospective study was performed to review the clinical features and the outcome of 24 episodes of pneumococcal meningitis in 23 adult patients in a 5-year period (January 1990-August 1994). Of the 23 patients, 19 were male and 4 female. The median age was 30 years (range 15-80 years). Of the 23 patients 17 had underlying conditions (73.9%). All episodes of pneumococcal meningitis were treated with penicillin G in combination with ceftriaxone. Of the total series 24 episodes, 3 ended fatally; thus overall, mortalitiy was 12.5%. Of the another 21 episodes, 13 ran an uncomplicated course. Only four of 20 survivors suffered from neurological sequelae (20%)

A Case of Brucellosis Admitting with Bleeding

During the course of an acute brucellosis infection, severe thrombocytopenia, ITP and bleeding are rarely seen and can be misleading for hematological diseases. Our case was a 20-year-old male patient. He had admitted to the Emergency Room with the complaints of gingival bleeding and bleeding of his pimples. His platelet count was 1.6 x 10³ /µL and he was hospitalized with the preliminary diagnoses of ITP or hematological malignancy. Despite steroids and IV immunoglobulin treatment, his thrombocytopenia did not improve and he further developed melena. A bone marrow biopsy was planned. No significant pathology was detected in the examination of bone marrow aspiration. Brucella tube agglutination test had been ordered to identify the etiology of thrombocytopenia. Its result was reported as 1/160 (+) leading to an hemoculture. The hemoculture resulted in the growth of Brucella mellitensis. Therefore the patient was diagnosed as Brucellosis. Steroid has stopped, with the administration of antimicrobial treatment, his platelet count started improving from second day onwards. All his hemotological findings improved with this treatment. The fact that the patient had findings of severe thrombocytopenia and bleeding resulted in considering a preliminary diagnosis of hematological malignancy. In our country which is endemic for Brucellosis, the differential diagnosis of several patients admitting with different hematological presentations should definitely include Brucella. [Med-Science 2016; 5(3.000): 889-92

A chronic hepatitis B patient infected with HBsAg diagnostic-escape strain in the presence of anti-HBs positivity

Hepatitis B virus (HBV) is an important pathogen responsible for serious diseases like chronic hepatitis, cirrhosis and liver cancer. Turkey is located in the intermediate endemic region based on the average HBV surface antigen positivity. The high replication capacity of HBV and the lack of proofreading activity of the reverse transcriptase (RT) enzyme makes the virus prone to mutations. In this study, S gene mutation which is detected in a chronic HBV case without any follow-up and treatment is presented. Although patient was HBsAg negative and anti-HBs positive in the examinations, the mutation analysis was performed upon the high level of HBV DNA load and sG145R (vaccine escape) mutation in S gene region and rtI169F, rtV173L, rtA181G and rtT184R mutations in pol gene region were detected. S gene region mutations may cause false negatives in diagnostic assays that detect HBsAg. At the same time, it is a public health problem because these HBV variants can also be transmitted by vertical and horizontal routes. Therefore, when atypical serological profiles are encountered, it is of utmost importance to remember S gene mutations and perform necessary analyses

A Case of Brucellosis Admitting with Bleeding

During the course of an acute brucellosis infection, severe thrombocytopenia, ITP and bleeding are rarely seen and can be misleading for hematological diseases. Our case was a 20-year-old male patient. He had admitted to the Emergency Room with the complaints of gingival bleeding and bleeding of his pimples. His platelet count was 1.6 x 10³ /µL and he was hospitalized with the preliminary diagnoses of ITP or hematological malignancy. Despite steroids and IV immunoglobulin treatment, his thrombocytopenia did not improve and he further developed melena. A bone marrow biopsy was planned. No significant pathology was detected in the examination of bone marrow aspiration. Brucella tube agglutination test had been ordered to identify the etiology of thrombocytopenia. Its result was reported as 1/160 (+) leading to an hemoculture. The hemoculture resulted in the growth of Brucella mellitensis. Therefore the patient was diagnosed as Brucellosis. Steroid has stopped, with the administration of antimicrobial treatment, his platelet count started improving from second day onwards. All his hemotological findings improved with this treatment. The fact that the patient had findings of severe thrombocytopenia and bleeding resulted in considering a preliminary diagnosis of hematological malignancy. In our country which is endemic for Brucellosis, the differential diagnosis of several patients admitting with different hematological presentations should definitely include BrucellaDuring the course of an acute brucellosis infection, severe thrombocytopenia, ITP and bleeding are rarely seen and can be misleading for hematological diseases. Our case was a 20-year-old male patient. He had admitted to the Emergency Room with the complaints of gingival bleeding and bleeding of his pimples. His platelet count was 1.6 x 10³ /µL and he was hospitalized with the preliminary diagnoses of ITP or hematological malignancy. Despite steroids and IV immunoglobulin treatment, his thrombocytopenia did not improve and he further developed melena. A bone marrow biopsy was planned. No significant pathology was detected in the examination of bone marrow aspiration. Brucella tube agglutination test had been ordered to identify the etiology of thrombocytopenia. Its result was reported as 1/160 (+) leading to an hemoculture. The hemoculture resulted in the growth of Brucella mellitensis. Therefore the patient was diagnosed as Brucellosis. Steroid has stopped, with the administration of antimicrobial treatment, his platelet count started improving from second day onwards. All his hemotological findings improved with this treatment. The fact that the patient had findings of severe thrombocytopenia and bleeding resulted in considering a preliminary diagnosis of hematological malignancy. In our country which is endemic for Brucellosis, the differential diagnosis of several patients admitting with different hematological presentations should definitely include Brucell

Stevens-Johnson Syndrome: Case Presentation Related to the Use of Antiepileptic Medications

Stevens-Johnson Syndrome is an acute allergic reaction that can be life-threatening. Here we present a case of Stevens-Johnson Syndrome that has developed due to the use of combined medications. The 18-year-old female patient was hospitalized with the complaints of fever, chills and widespread eruptions all over her body. In her history she had generalized epileptic seizures that have been treated with valproate for the last five years; however, as the seizures could not be controlled, Lamotrigine was added to her treatment about a month ago. She was also on Paroxetine for her hallucinations. She had generalized desquamation on the face, exfoliating brown squames and plaques on the forehead and the cheeks, erythema and blurring around both eyes, redness, xerosis and desqua and white-coloured membranes of the lips, brown-pigmented and itchy papules and plaques and some vesicles on her back and hips that were also seen all around her body.. With these findings, the patient was evaluated as having drug eruptions (SJS) and transferred to the intensive care unit. With steroid treatment, the lesions regressed quickly. When Lamotrigine was added to her treatment regimen, she had been using valproate for 5 years; she had not developed skin lesions that are why valproate was not considered as an ethiological factor. Valproate is known to increase the viability of Lamotrigine by decreasing its glucuronidation.Use of Paroxetine is regarded as a risk factor for SJS also.. When combining medications, an attempt should be made not to combine such medications if possibleStevens-Johnson Syndrome is an acute allergic reaction that can be life-threatening. Here we present a case of Stevens-Johnson Syndrome that has developed due to the use of combined medications. The 18-year-old female patient was hospitalized with the complaints of fever, chills and widespread eruptions all over her body. In her history she had generalized epileptic seizures that have been treated with valproate for the last five years; however, as the seizures could not be controlled, Lamotrigine was added to her treatment about a month ago. She was also on Paroxetine for her hallucinations. She had generalized desquamation on the face, exfoliating brown squames and plaques on the forehead and the cheeks, erythema and blurring around both eyes, redness, xerosis and desqua and white-coloured membranes of the lips, brown-pigmented and itchy papules and plaques and some vesicles on her back and hips that were also seen all around her body.. With these findings, the patient was evaluated as having drug eruptions (SJS) and transferred to the intensive care unit. With steroid treatment, the lesions regressed quickly. When Lamotrigine was added to her treatment regimen, she had been using valproate for 5 years; she had not developed skin lesions that are why valproate was not considered as an ethiological factor. Valproate is known to increase the viability of Lamotrigine by decreasing its glucuronidation.Use of Paroxetine is regarded as a risk factor for SJS also.. When combining medications, an attempt should be made not to combine such medications if possibl

Could Neutrophil CD64 Expression Be Used as a Diagnostic Parameter of Bacteremia in Patients with Febrile Neutropenia?

WOS: 000403951100007PubMed ID: 27348760Objective: The aim of this study is to investigate if neutrophil CD64 expression in febrile neutropenia patients could be used as an early indicator of bacteremia. Materials and Methods: All consecutive patients older than 18 years of age who had developed febrile neutropenia episodes due to hematological malignancies were included in the study. Those patients who had significant growth in their blood cultures constituted the case group, while those who had febrile neutropenia without any growth in their cultures and who did not have any documented infections formed the control group. Blood culture bottles were incubated in the Bact ALERT 3D system (bioMerieux, France), identification and susceptibility testing were performed using an automated broth microdilution method (VITEK 2, bioMerieux), and CD64 expression analysis was performed by the flow cytometry method. C-reactive protein (CRP) was measured by turbidimetric methods (Biosystems, Spain) and erythrocyte sedimentation rate (ESR) was measured by the Wintrobe method. Results: In total, we prospectively evaluated 31 febrile episodes. The case group consisted of 17 patients while the control group included 14 patients. CD64 was found on neutrophils of the case group patients with a mean count of 8006 molecules/cell and of control group with a mean count of 2786 molecules/cell. CD64 levels of the case group were significantly higher than those of the control group (p=0.005). In the differentiation of the case group from the control group, a 2500 cut-off value for CD64 had significant [AUC=0.792 (0.619-0.965)] predictive value (p=0.001). In the prediction of patients with a 2500 cut-off value for CD64, sensitivity was 94.1%, positive predictive value was 76.2%, specificity was 64.3%, and negative predictive value was 90.0%. CRP levels and ESR values did not differ significantly between the groups (p=0.005). Conclusion: Neutrophil CD64 expression could be a good predictor as an immune parameter with high sensitivity and a negative predictive value for bacteremia in febrile neutropenic patients