Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis

Background: Nosocomial meningitis is a rare complication following neurosurgical procedures and is associated with high morbidity and mortality. Aim: The aim of this study was to describe the clinical characteristics and the risk factors associated with mortality in patients who developed nosocomial meningitis following neurosurgical operations. Setting and design: Tertiary care hospital and an observational study. Materials and Methods: The study subjects included 2265 patients who underwent various neurosurgical operations during 2003-05. The diagnosis of nosocomial meningitis was based on the Center for Disease Control criteria. Statistical analysis: It was performed by using Statistical Package for Social Sciences for Windows 10.0 program. Results: The incidence of postoperative nosocomial meningitis was 2.7% (62 episodes in 49 patients among 2265 patients operated). Staphylococcus aureus and Acinetobacter spp. were the most frequently isolated pathogens. Of the 49 with meningitis 20 (40.8%) patients died. In the logistic regression analysis model, Glascow coma scale score less than 10 (Odds Ratio (OR): 19.419, 95% Confidence Interval (CI); 1.637-230.41, P = 0.001), and low cerebrospinal fluid glucose level (= 30 mg/dL) (OR: 10.272, 95% CI; 1.273-82.854, P= 0.002), and presence of concurrent nosocomial infection (OR: 28.744, 95% CI; 1.647-501.73, P= 0.001) were the independent risk factors associated with mortality. Conclusion: The mortality in patients who developed meningitis was high. The high percentage of concurrent nosocomial infections was associated with a high mortality rate which was a serious problem

Malaria: An evaluation of 40 cases

Bu çalışmada, Şubat 1996- Ekim 2009 yılları arasında kliniğimizde izlenen 40 erişkin malaryalı olgu, retrospektif olarak değerlendirilmiştir. Tanı, tüm olgularda Giemsa ile boyanan kalın ve ince yayma preparatlarda parazitin gösterilmesi ile konulmuştur. Otuz dört olgu erkek, 6 olgu kadın olup; ortalama yaş 31.1 olarak belirlenmiştir. Tüm olgularda endemik bölgelere (24 olguda Afrika, Afganistan, Azerbaycan ve Arap Yarımadası'na, 16 olguda Güneydoğu Anadolu Bölgesi'ne) seyahat öyküsü vardı ve hiçbirine kemoproflaksi uygulanmamıştı. Olguların 20'sinde Plasmodium vivax, 18'inde P. falciparum, ikisinde P. vivax ve P. falciparum saptanmıştır. Hastalarda ateş (%100), splenomegali (%72,5), hepatomegali (%45,0), anemi (%67,5), lökopeni (%32,5), trombositopeni (%75,0), sedimantasyon yüksekliği (%65,0), karaciğer fonksiyon testlerinde anormallikler (%62,5), serum kreatininde artış (%27,5) belirlendi. P. vivax sıtması olgularına klorokin ve primakin, P. falciparum olgularına meflokin veya kinin sülfat ile doksisiklin, mikst olgulara kinin sülfat ile doksisiklin, sonrasında primakin tedavisi uygulandı. İki olguda akut böbrek yetmezliği, iki olguda serebral tutulum; bir olguda akut böbrek yetmezliği, serebral tutulum, yaygın damar içi koagülasyon ve erişkin solunum yetmezliği sendromu gelişti. P. falciparum sıtmalı iki olgu kliniğimize yatırıldıkları gün kaybedildi, hastalık diğer olgularda şifa ile sonlandı. Sonuç olarak, endemik bölgelere seyahat öyküsü olan her ateşli olguda sıtma ayırıcı tanıda mutlaka yer almalıdır. Bu bölgelere seyahat edecek bireylere kemoproflaksi uygulanması ve kişisel korunma önlemlerinin sağlanması çok önemlidir.In this study, the epidemiological, clinical, laboratory and therapeutic features of forty adult malaria patients referred our clinic between February 1996-September 2009, were assessed retrospectively. Diagnosis was established by Giemsa-stained thick and/or thin blood smears in all cases. Thirty-four patients were male and 6 patients were female and mean age was 31.1 years. All patients had a history of travel to endemic areas (24 cases to Africa, Afghanistan, Azerbaijan, Arabian Peninsula, 16 cases to Southestern Anatolia Region), and none of them had chemoprophylaxis. Plasmodium vivax was detected in 20 patients, and P.falciparum in 18 and mixed (P. vivax and P. falciparum) in two. Parasitemia ranged from 0.5%- 25%. Fever (100%), periodic fever (62.5%), splenomegaly (72.5%), hepatomegaly (45.0%), anemia (67.5%), leukopenia (32.5%), thrombocytopenia (75.0%), a rise in erytrocyte sedimentation rate (65.0%), abnormalities in hepatic enzymes (62.5%), hyponatremia (32.5%), hypoglisemia (25%) and an elevated serum creatinine level (27.5%) were determined in the patients. Two patients with P. falciparum developed acute renal failure and cerebral involvement died soon after admission. Acute renal failure, acute respiratory distress syndrome, cerebral involvement and dissemine intravasculer coagulation were observed in one patient with falciparum malaria who recovered completely. In conclusion, every febril patients with a history of travel to the endemic regions should raise the suspicion of malaria. Effective pre-exposure chemoprophylaxis and personal protection measures should be provided to travellers visiting endemic regions

Comparison of Coombs Gel Test with ELISA and Standard Tube Agglutination Tests Used in Serological Diagnosis of Brucellosis

Objective: Serological tests are the most commonly used tests in the diagnosis of brucellosis; however, each serological test has some drawbacks. In this study, we aimed to determine the value of the Brucella Coombs gel test (BCGT) in the serological diagnosis of brucellosis in comparison with Standard tube agglutination (STA) and ELISA tests. Materials and Methods: The study included 42 patients who were considered to have brucellosis as a preliminary diagnosis. BCGT, Brucella-IgM/IgG ELISA, and STA tests were performed from serum samples of the patients. The correlation of the diagnostic tests was analyzed using Cohen’s Kappa Analysis. Results: Twenty-seven (64.2%) of 42 patients were diagnosed with brucellosis according to their medical history and clinical and serological tests. The sensitivity and specificity of BCGT to diagnose brucellosis was 96.2%, and 100%, respectively. The sensitivity and specificity for the diagnosis of brucellosis 62.9% and 100% for STA, respectively; 33.3% and 66.6% for Brucella-IgM; and 66.6% and 100% for Brucella-IgG. BCGT was significantly correlated with STA (?= 0.590) and Brucella-IgG (?=0.539)Conclusion: BCGT can be utilized as a simple and reliable test in the diagnosis of brucellosis with high sensitivity and specificity. Nevertheless, the sensitivity and specificity of BCGT should be demonstrated by comprehensive studies, including culture-confirmed cases and control groups

Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010)

The aim of the present study was to determine the rate of device-associated infection (DAI) and the change in profiles and antimicrobial resistance patterns of the causative microorganisms in a medical-surgical intensive care unit (ICU), as well as to evaluate the effect of a new nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs, with an overall rate of 30.2% per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to 5.7 per 1,000 device-days (P < 0.0001), and central venous catheter-associated bloodstream infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P < 0.0001). However, ventilator-associated pneumonia increased from 27.0 to 31.5 per 1,000 device-days. Multidrug-resistant species rates increased from 5.8% to 76.6% (P < 0.0001) for Acinetobacter spp. and from 6.8% to 53.1% (P < 0.0001) for Pseudomonas aeruginosa. The extended-spectrum beta-lactamase-producing Enterobacteriaceae rate increased from 23.1% to 54.2% (P = 0.01); the vancomycin-resistance rate among Enterococcus spp. increased from 0% in 2004 to 12.5% in 2010 (P = 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the increasing prevalence of multidrug-resistant microorganisms indicate that further interventions are urgently needed

Seroprevalence and Risk Factors for Epstein-Barr Virus Infection in Adults

Introduction: Epstein-Barr virus (EBV), also known as human herpesvirus 4, is the causative agent of infectious mononucleosis. Infection with EBV is associated with multiple malignancies. The aim of this study was to determine the seroprevalence and risk factors for seropositivity. Materials and Methods: This study was conducted in Haydarpaşa Numune Training and Research Hospital in İstanbul between August 2012 and October 2012. Epstein-Barr virus viral capsid antigen IgG antibody was measured using ELISA in 500 cases. Age, gender, occupation, education level, family income, the area and type of residence, and chronic illness of the participants were also evaluated. Differences between risk groups were statistically analyzed. Results: The mean age of the 500 study participants was 47.7±19.1 (15-87) years and 289 (57.8%) were male. Mean EBV seropositivity was 96.4%, and 91% of the cases became seropositive for EBV by 15 years of age. No significant associations with age, gender, occupation, education level, family income, area and type of residence, and chronic illness were detected. Conclusion: Epstein-Barr virus seropositivity rates were very high and about 91% of the cases become seropositive for EBV by 15 years of age. There was no significant relationship between risk factors and seroprevalence of EBV