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

Toxoplasma encephalitis: an HIV / AIDS patient with cerebral mass

WOS: 000399405200030Toxoplasmic encephalitis is an opportunistic infection, which develops as a result of reactivation of the latent tissue cysts of Toxoplasma gondii in patients with reduced CD4+ T lymphocytes. Amongst patients with human immunodeficiency virus or acquired immunodeficiency syndrome, toxoplasmic encephalitis is one of the leading causes of the intracerebral involvement. In this report, we present a toxoplasmic encephalitis case, who has admitted with neurological symptoms and fever. The patient was identified human immunodeficiency virus positive while he was under investigation for cerebral mass lesion, The patient has fully recovered by antiprotozoal and antiretroviral therapy

The relationship between brucellosis and vitamin D

WOS: 000373443300012PubMed ID: 26927460Introduction: This study was aimed to determine the relationship between vitamin D and soluble vitamin D receptor (VDR) levels and brucellosis, a common infection in Turkey, in which the cellular immune system is important in the course of the disease. Methodology: Patients who had been followed up in the Department of Infectious Diseases and Clinical Microbiology of Cukurova University Medical Faculty, having been diagnosed with brucellosis and who had no brucellosis treatment before, were enrolled in the study along with healthy controls. The participants' vitamin D and soluble VDR values were recorded. Laboratory parameters of patients and controls, clinical findings, and disease course of brucellosis patients were also noted. Results: The mean age of the 86 brucellosis patients, of whom 38 (44.2%) were males and 48 (55.8%) were females, was 40.9 +/- 18.4 years. Complicated course of brucellosis rate was found to be 29.1%. Vitamin D and VDR levels were lower in brucellosis patients at the time of diagnosis compared to control group. For males, vitamin D and VDR levels were higher in the control group than in the patient group. In males, VDR levels were higher than in females. A significant difference was not found between clinical forms of the disease and vitamin D and VDR levels. Conclusions: Vitamin D and VDR levels were shown to be significantly lower in brucellosis patients before treatment compared to the control group. These results suggest that vitamin D could be involved in the pathogenesis of the disease

Telaprevir Experience From Turkey

BACKGROUND: In patients with chronic hepatitis C, triple drug regimens containing a protease inhibitor, peginterferon and ribavirin were found to significantly increase sustained virologic response rates compared to dual drug regimen containing pegylated interferon and ribavirin, especially in genotype 1. OBJECTIVES: In Turkey, telaprevir has been used since March 2013. We aimed to evaluate results of patients with chronic hepatitis C treated with telaprevir, peginterferon and ribavirin. PATIENTS AND METHODS: We evaluated 28 patients with genotype 1 chronic hepatitis C infection treated with triple drug regimen containing telaprevir, in three medical centers in Turkey, retrospectively. Demographic data of patients, treatment indications, adverse events and outcomes were recorded. RESULTS: Of 28 patients intended to treat, 25 (89.2%) patients completed the treatment. Overall, 21 (82.1%) patients had relapse and five patients were non-responder. Regarding the treatment outcomes of Telaprevir based regimen, 20/26 patients achieved sustained virological response. Pruritus, rash, dysgeusia, anorectal discomfort and anemia were main adverse effects. Blood transfusion and ribavirin dose reduction required for 7 and 11 patients, respectively. Due to several adverse effects, 10 patients were hospitalized. CONCLUSIONS: Although more frequent and severe adverse effects, telaprevir has been promising for patients with treatment-experienced hepatitis C

IS CRIMEAN-CONGO HEMORRHAGIC FEVER VIRUS TOPOTYPE IMPORTANT IN THE POSSIBILITY OF NOSOCOMIAL TRANSMISSION?

WOS: 000403079700005Introduction: Crimean-Congo hemorrhagic fever (CCHF) is a viral zoonotic disease which is mainly transmitted by tick bite. Contact with blood or body secretions of viremic humans or animals is also among the other modes of transmission. In this study, the serological states in terms of CCHF tested in healthcare workers (HCW) who had had contact with two fatal patients with a diagnosis of CCHF. The relation of the transmission possibility with the phylogenetic analysis of the virus were evaluated. Materials and methods: CCHF IgM and IgG were investigated with ELISA one month after contact with index cases in HCW. The contact levels and states of use of personal protective equipment (PPE) were evaluated. Phylogenetic analysis with sequence analysis based on partial sequences of NP coding region was performed for CCHF viruses detected in the index cases. Results: CCHF IgM and IgG were found negative in any of 20 healthcare workers some of whom had a history of high-risk contact. The sequence analysis revealed that the viruses found in both patients were identical. Phylogenetic evaluation showed that both viruses have high homology with the viruses which were determined previously in the endemic area in Turkey. Conclusion: As in our study, detection of virus topotype with sequence analysis in studies about nosocomial transmission will help to determine if there is a difference between virus subtypes in terms of transmission

Potential Drug–Drug Interactions with Antimicrobials in Hospitalized Patients: A Multicenter Point-Prevalence Study

BACKGROUND: Improper use of antimicrobials can cause adverse drug events and high costs. The purpose of this study was to investigate the frequency and potential drug–drug interactions associated with antimicrobials among hospitalized patients. MATERIAL AND METHODS: This study was conducted on the same day in 5 different hospitals in Turkey. We included patients aged ³18 years who received at least 1 antimicrobial drug and at least 1 of any other drug. The Micromedex® online drug reference system was used to control and describe the interactions. Drug interactions were classified as contraindicated, major, moderate, and minor. RESULTS: Potential drug–drug interactions with antimicrobials were 26.4% of all interactions. Five (42%) of 12 contraindicated interactions and 61 (38%) of 159 major interactions were with antimicrobials. Quinolones, triazoles, metronidazole, linezolid, and clarithromycin accounted for 173 (25.7%) of 673 prescribed antimicrobials, but were responsible for 141 (92.1%) of 153 interactions. In multivariate analysis, number of prescribed antimicrobials (odds ratio: 2.3001, 95% CI: 1.6237–3.2582), number of prescribed drugs (odds ratio: 1.2008, 95% CI: 1.0943–1.3177), and hospitalization in the university hospital (odds ratio: 1.7798, 95% CI: 1.0035–3.1564) were independent risk factors for developing drug interactions. CONCLUSIONS: Due to risk of drug interactions, physicians should be more cautious when prescribing antimicrobials, particularly when prescribing quinolones, linezolid, azoles, metronidazole, and macrolides