Prognostic factors affecting deaths from adult tetanus

ABSTRACTThe 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 (Çukurova 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 ≤7 days, the mortality rate was 75% (p 0.07). Mortality was significantly associated with generalised tetanus (p < 0.05), fever of ≥ 40 °C, tachycardia of >120 beats/min (p < 0.05), post-operative tetanus (p 0.03), and the absence of post-traumatic tetanus vaccination (p 0.068). Patients who were given tetanus human immunoglobulin or tetanus antiserum (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

Penicillin resistance in Streptococcus pneomoniae isolated in the Balcali hospital in Adana, Turkey [1]

PubMedID: 9661955[No abstract available

Mucormycosis-associated fungal infections in patients with haematologic malignancies

PubMedID: 17362481Among patients with haematologic disorders, mucormycosis most commonly occurs in those with acute leukaemia or lymphoma who have developed neutropenia due to malignancy or to chemotherapy, and in transplanted patients receiving immunosuppressive treatment. Here, we aim to present a retrospective study conducted over a 5-year period (2001-2005). The study included 20 patients with haematologic malignancies with a proven mucormycosis admitted in Medical Oncology Divisions in Cukurova University Hospital. The most frequent sites of infection were paranasal sinuses (95%) and lung (5%). Antifungal treatment was empirically administered in 18 (90%) patients; 18 patients underwent radical surgical debridement (90%). The therapy was successful for only eight patients (40%). Eleven patients died within 1 months of the diagnosis of fungal infection: the cause of death was only by mucormycosis in four patients (36.6%), mucormucosis and systematic inflamatuar response syndrome (SIRS) in two patients (18.2%) and progression of haematologic disease in five patients (45.5%). At univariate analysis, the factors that correlated with a positive outcome from infection were the following: amphotericin B treatment, neutrophil recovery from postchemotherapy aplasia. At multivariate analysis, the factors that significantly correlated with recovery from infection were the liposomal amphotericin B treatment (p = 0.026), doses of L-AmB (p = 0.008) and the length of the treatment (p = 0.01), respectively. It seems to have increased in recent years. Although a reduction of mortality has been observed recently, the mortality rate still remains high. Extensive and aggressive diagnostic and therapeutic procedures are essential to improve the prognosis in these patients. © 2007 The Authors

Penicillin resistance in Streptococcus pneumoniae isolated in the Balcali Hospital in Adana, Turkey

Purpose: There is a continuing increase in resistance to penicillin which is commonly used in treatment of Streptococcus pneumoniae infections. This study was carried out in order to determine the rate of resistance to penicillin in S. pneumoniae isoleted in our hospital. Methods: Colonies on blood agar which resembled pneumonoccoccal colonies were tested with optochin disks. Identification of the bacteria was made using Sceptor system panels each of which contain 24 biochemical test including bile solubility and bile esculin as well as antibiotic susceptibility tests. Results: Between October 1993 and June 1995, 231 Streptococcus pneumoniae strains were isolated from various specimens from hospitalized patients and outpatients. Forty five (19%) of these strains were found to be resistant to penicillin (MIC > 1 µg/ml); 68 (29%), moderately resistant (MIC 0.1-1 µg/ml); and 118 (51%), susceptible (MIC < 0.06 µg/ml). The highest rates of penicillin resistance were detected in S.pneumoniae isolated from wound infections, spinal fluid, and blood (31%, 26%, 23%, respectively). There was no resistance to vancomycin. Conclusion: The results of this study indicated that S.pneumoniae infections should not be treated with penicillin or other antibiotics without confirmation of sensitivity with susceptibility tests

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

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