Affan Denk

Genitourinary brucellosis: results of a multicentric study

This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n=327, 83.8%), as epididymo-orchitis (n=204, 58%), orchitis (n=112, 31.8%) and epididymitis (n=11, 3.1%). In female patients, pyelonephritis (n=33/38, 86.8%) was significantly higher than in male patients (n=11/352, 3.1%; p<0.0001). The mean blood leukocyte count was 7530±3115/mm3. Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p<0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.

Magnetic resonance imaging findings of musculoskeletal brucellosis

OBJECTIVE The aim of this retrospective study was to determine the magnetic resonance imaging (MRI) findings of patients with musculoskeletal brucellosis. MATERIALS AND METHODS Sixty-eight among 304 patients with musculoskeletal brucellosis, aged 12-82 years (average, 50.2 years), were included in the study. Patients were diagnosed based on clinical findings, Brucella agglutination tests, and MRI findings. MRI was performed to all of the patients with sacroiliitis, spondylitis-spondylodiscitis, and peripheral arthritis. RESULTS Brucella serum agglutination test was >1/160 in all cases and blood cultures were positive in twelve cases. The most commonly affected site was the spine (57.3%), wherein lumbar vertebrae were found to be most commonly affected. The second most common affected site was sacroiliac joint (26.4%), whereas peripheral joints were affected in 11 cases (16.1%). CONCLUSION Brucellosis may affect various sites in musculoskeletal system. The spine was the most frequently affected site in our study. Sacroiliac joints and the other peripheral joints were less commonly involved sites. Brucellosis should be included in the differential diagnosis of a patient with arthralgia or symptoms of musculoskeletal system disorders especially in endemic areas.

Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study.

AIM Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. METHODS The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). RESULTS A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. CONCLUSIONS Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.

In vitro activity of Brucella melitensis isolates to various antimicrobials in Turkey

Abstract Background: Brucellosis is a systemic infectious disease caused by Brucella bacteria. A successful treatment requires antibiotics that can penetrate into the cell at high concentrations. The aim of this study was to assess the biotype and in vitro activity of 80 Brucella isolates obtained from blood against various antimicrobials for human brucellosis in Turkey. Methods: Identification of the types of the species designated Brucella species was made using the polymerase chain reaction (PCR), with type-specific primers. Serotyping was performed using mono-specific A and M antisera. The minimum inhibitory concentrations (MICs) of antibiotics known to have good intracellular penetration (doxycycline, rifampicin, ofloxacin, levofloxacin, moxifloxacin, clarithromycin, and azithromycin) were determined by the agar dilution method. Results: All of the 80 Brucella isolates were determined to be Brucella melitensis: 75 B. melitensis biotype 3 (93.7%) and 5 B. melitensis biotype 1 (6.3%). Doxycycline was the most effective among the tested antibiotics against Brucella species (MIC50–MIC90, 0.25–0.5 μg/ml), and it was followed by levofloxacin (MIC50–MIC90, 0.5–1 μg/ml), moxifloxacin (MIC50–MIC90, 1–1 μg/ml), ofloxacin (MIC50–MIC90, 1–1 μg/ml), rifampicin (MIC50–MIC90, 2–4 μg/ml), azithromycin (MIC50–MIC90, 4–8 μg/ml), and clarithromycin (MIC50–MIC90, 8–32 μg/ml), respectively. Conclusions: The in vitro activity of doxycycline and rifampicin, which are used in the classic treatment of brucellosis, was found to be very good. Quinolones were found to have in vitro activity against Brucella isolates. Among the macrolides, azithromycin had a higher level of activity compared with clarithromycin. A combination of quinolones and azithromycin could be an alternative to doxycycline and rifampicin in the treatment of brucellosis.

Hepatocyte growth factor (HGF) in patients with acute brucellosis

In this prospective study, we investigated the serum levels of hepatocyte growth factor (HGF) and C-reactive protein (CRP) before and after the treatment of patients with acute brucellosis. The study comprised 58 patients with acute brucellosis and 30 healthy volunteers. Pre-treatment serum HGF levels of 58 patients with acute brucellosis (1548.6±220.1) were significantly higher than levels of the control group (401.4±69.7) (p<0.001). Serum levels of HGF and CRP significantly decreased at the end of the treatment period (p<0.001). Post treatment, levels did not differ from those of the control group (p>0.05). Serum HGF levels of patients with acute brucellosis correlated to CRP and ALT levels (r: 0.922, 0.752; p<0.001, respectively). Our findings suggest that serum HGF levels may be used as a supplementary marker to evaluate the effectiveness of the treatment in patients with acute brucellosis.

Tetanus in adults: results of the multicenter ID-IRI study

Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital’s Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival.

Cutaneous anthrax: evaluation of 28 cases in the Eastern Anatolian region of Turkey

Abstract Context: Anthrax is an endemic disease in developing countries. Human cases are usually associated with animal products. About 95% of naturally acquired cases are cutaneous anthrax. Objective: In this study, cutaneous anthrax cases from the Elazig province (the Eastern Anatolian region) of Turkey seen in our hospital within a 6-year period were evaluated with respect to epidemiological and clinical features, diagnosis, treatment and outcome. Methods: Twenty-eight patients with cutaneous anthrax observed between January 2009 and December 2014 were investigated retrospectively. The diagnosis of cutaneous anthrax was based on detailed history, dermatologic findings, including painless, ulcers covered by a characteristic black eschar and/or microbiological procedures, including Gram stain and culture of materials obtained from the lesions. Results: Of the 28 patients followed up with cutaneous anthrax diagnosis, 14 (50%) were female and 14 (50%) were male. The mean age of the cases was 39.6 years (age range 17–65 years). The patients have an incubation period in the range of 1–9 days (mean 4.6 ± 0.5 days). The cases were seen between April and November of each year during the study period. Twenty-three cases (82%) had a history of contact with animals or animal products. Twenty patients (71.4%) showed malignant pustules and eight (28.6%) malignant edema. Bacillus anthracis was isolated in three cases (10.7%) and Gram stain smear were positive in five cases (17.8%). All patients were treated successfully with penicillin or ciprofloxacin. Systemic corticosteroids were added to the antibiotic treatment in six patients with malignant edema. Sepsis no developed in patients, all the cases recovered. Conclusion: Anthrax is still a serious public health problem in Turkey. Cutaneous anthrax must always be kept in mind when characteristic lesions such as a painless ulcer with vesicles, edema, and a history of contact with animals or animal products are observed in an individual. Early and correct diagnosis significantly affects course of the disease. Protective precautions such as vaccination of animals against anthrax and education of the population would reduce the incidence of the disease.

Assessment of nasal carriage of staphylococcus aureus in patients with acne vulgaris

Türkderm-Deri Hastalıkları ve Frengi Arşivi Dergisi, Galenos Yayınevi tarafından basılmıştır. Turkderm-Archives of the Turkish Dermatology and Venerology, published by Galenos Publishing. Background and Design: Systemic antibiotics, such as tetracycline and doxycycline are used in the treatment of inflammatory forms of moderate acne, or acne that is resistant to topical treatment. Oral isotretinoin treatment is the most effective treatment option in severe papulopustular and nodular forms of acne. Dose-related nasal carrier state of Staphylococcus aureus (S. aureus), has been reported in 90% of patients using isotretinoin. Long-term oral and/or topical antibiotic use in the treatment of acne causes changes in antibiotic susceptibility and emergence of methicillin-resistant S. aureus (MRSA) pathogens. The present retrospective study examined the colonization rates of S. aureus in patients who had an increase in acneiform lesions while taking medications for the treatment of acne and whose nasal swap samples were obtained and also investigated their relationship with treatment options. Materials and Methods: A total of 86 patients with moderate acne who attended our dermatology outpatient clinic with the complaints of acne and in whom nasal swap samples were obtained due to increased pustules during acne therapy. The patients were divided into three groups according to the treatment methods as patients receiving topical treatment, patients treated with oral doxycycline, and patients treated with oral isotretinoin. The results of the cultures were evaluated in three groups: no growth, methicillin-sensitive S. aureus (MSSA), and MRSAisolated. Amaç: Orta veya topikal tedaviye dirençli aknenin enflamatuvar formlarında tetracycline ve doxycycline gibi sistemik antibiyotik tedavileri kullanılmaktadır. Oral isotretinoin tedavisi aknenin şiddetli papülo-püstüler ve nodüler formlarında en etkili tedavi seçeneğidir. İsotretinoin kullanan hastaların %90’ında dozla ilişkili nazal Staphylococcus aureus (S. aureus) taşıyıcılığı bildirilmiştir. Diğer taraftan akne tedavisinde oral ve/veya topikal uzun süreli antibiyotik kullanımı antibiyotik duyarlılığının değişmesine ve metisiline dirençli S. aureus (MRSA) patojenlerin ortaya çıkışına neden olmaktadır. Biz bu retrospektif çalışmada akne tedavisi için ilaç kullanmakta iken akneiform lezyonlarında artış gözlenen ve bu nedenle nazal sürüntüleri alınmış olan hastalardaki S. aureus kolonizasyon oranlarını ve hastaların almakta oldukları tedavi seçenekleri ile ilişkisini inceledik. Gereç ve Yöntem: Bu çalışmaya akne şikayeti ile dermatoloji polikliniğine başvuran ve akne tedavisi alırken, sivilcelerinde artış olduğu için nazal mukozasından sürüntü örneği alınmış olan toplam 86 orta şiddetli akneli hasta alındı. Hastalar kullandıkları tedavilere göre topikal tedavi alanlar, oral doxycycline ve oral isotretinoin alanlar olmak üzere 3 gruba ayrıldı. Ayrıca kültür sonuçları; üreme olmayan, metisiline duyarlı S. aureus (MSSA) ve MRSA üreyen olmak üzere 3 grupta incelendi. Bulgular: Hastaların 34’ünde (%39,5) kültürde üreme (S. aureus) tespit edildi. Otuz dört pozitif kültür sonucunun 32’si (%94,1) MSSA, 2’si (%5,9) ise MRSA idi. Oral isotretinoin alan 50 hastanın 29’unda (%58) kültürde üreme tespit edildi. Oral isotretinoin alan hastalarda diğer tedavileri alan hastalara göre istatistiksel olarak anlamlı düzeyde kültür pozitifliği tespit edildi (p<0,001). Sonuç: Akne tedavisi için sistemik isotretinoin kullanan hastalarda ilaç dozu ve kullanım süresinden bağımsız olarak S. aureus kolonizasyonunun arttığını, sistemik doxycycline kullananlarda belirgin bir değişiklik olmadığını, topikal antibiyotik tedavi kullananlarda ise azaldığını gözlemledik. (Türk derm 2015; 49: 196-9) Anahtar Kelimeler: Akne vulgaris, staphylococcus aureus, nazal taşıyıcılık