Ali Pekcan Demiröz

Central nervous system brucellosis: Presentation, diagnosis and treatment

Although neurological symptoms in brucellosis are frequent, central nervous system (CNS) involvement is uncommon. Five patients with neurobrucellosis are presented. Three patients presented with meningoencephalitis, one with polyradiculoneuritis and one with myelitis and an eighth nerve palsy. All patients had lymphocytic pleocytosis, low glucose and elevated levels of protein in the cerebrospinal fluid (CSF). Gamma-globulin and IgG values in the CSF were also increased. Results of agglutination tests for Brucella in serum and CSF were positive for all patients, although titres were less in the CSF. Brucella melitensis was cultured from two patients. Treatment included concurrent administration of three of the following drugs: doxycycline, rifampicin, streptomycin, co-trimoxazole, ceftriaxone or ciprofloxacin. The three patients with meningoencephalitis fully recovered; the other two patients were left with minor disability.

Evaluation of clinical and laboratory predictors of fatality in patients with Crimean-Congo haemorrhagic fever in a tertiary care hospital in Turkey.

Abstract The fatality rate of Crimean-Congo haemorrhagic fever (CCHF) disease has been reported as 5.4–80%. In this prospective study our aim was to evaluate the clinical and laboratory predictors of fatality in patients with CCHF. Among probable CCHF patients admitted to our clinic between 2005 and 2008, patients with positive IgM antibodies and/or polymerase chain reaction for CCHF virus were included in the study. To determine the predictors of fatality, we compared epidemiological, clinical and laboratory findings of the fatal cases with survivors. Ninety-three confirmed CCHF patients were included in the study; 56 (60.2%) of them were female. Mean patient age was 48.4±17.7 y and mean hospital stay was 7.9±3.0 days. Five patients died (5.4%). The rates of haemorrhage, diarrhoea and confusion were higher in fatal cases compared with non-fatal cases (p<0.05). Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, lactate dehydrogenase (LDH), and C-reactive protein levels were higher in fatal cases; the international normalized ratio (INR) and activated partial thromboplastin time (aPTT) were longer and mean platelet counts were lower (p<0.05). By multivariate analysis, diarrhoea, melena, haematemesis, haematuria, elevated ALT and LDH, and prolongation of aPTT were independent clinical and laboratory predictors associated with fatality. We suggest that for patients who have diarrhoea, melena, haematemesis, haematuria, elevated AST and LDH, and a prolonged aPTT, physicians should be aware of the high fatality risk.

Clinical and laboratory findings of a sandfly fever Turkey Virus outbreak in Ankara

Sandfly fever (SF) is an arthropod-borne disease, which has not yet been reported from Ankara. In the summer of 2007, the disease started to be seen in our region, surprisingly causing severe clinical presentations. This report reviews the clinical and laboratory findings of patients with sandfly virus infection of disease outbreaks in 2008 and 2009. A retrospective single-centre descriptive study was performed. Clinically suspected cases were defined on the basis of epidemiologic history and clinical and laboratory findings. The sera samples of the suspected patients were sent to Germany for diagnostic assistance. 50 patients were included in the study. Fever, headache, photophobia, conjunctivitis, myalgia, arthralgia, nausea, abdominal pain and anorexia were common symptoms. Although the fever lasted only 3-6 days, complete recovery required up to 30 days. Leukopenia, thrombocytopenia and elevated serum aspartate-aminotransferase and alanine-aminotransferase levels were remarkable findings. The viral-load of Sandfly fever Turkey Virus (SFTV) was detected in the serum of acute patients ranged from 3.19×10(6) to 2.79×10(9) viral RNA molecules/ml. As a result we want to underline that the new type of sandfly virus causes a severe clinical picture with elevated liver enzymes and thrombocytopenia, to an extent not described before in the literature, which might be due to the elevated viral-load observed.

Antibody responses and viral load in patients with Crimean-Congo hemorrhagic fever: a comprehensive analysis during the early stages of the infection.

This study was performed to assess viral load, viral nucleocapsid (N), and glycoprotein precursor (GPC) antibodies in consecutive samples obtained from Crimean-Congo hemorrhagic fever patients to reveal viral replication kinetics and antiviral immune responses during the early stages of the infection. Among 116 samples from 20 individuals, 43.9% and 76.7% were positive for viral RNA and IgM/IgG antibodies, respectively, whereas both markers could be detected in 22.4%. Mean duration of viremia was 3 days (range: 1-6 days). N-IgM antibodies were identified as the initial serological marker during the infection, becoming detectable in a median of 2-3 days after disease onset, followed by GPC-IgM (4-6 days) and IgG antibodies (5-6 days). Clearance of viremia followed or coincided N-IgM response. Partial S gene sequences amplified in viremic patients were identical or closely related to previously characterized strains and grouped within European lineage I group II viruses via neighbor-joining analysis without significant amino acid substitutions.

Acute Kidney Injury due to Rhabdomyolysis in H1N1 Influenza Infection

Acute kidney injury (AKI) is rarely reported in the clinical course of H1N1 infection and this condition is strongly related with increasing of mortality risk. However, there are no sufficient data about the development of AKI due to H1N1 infections. The recent reports were documented for elevation of creatinine phosphokinase levels in the course of influenza infection, but rhabdomyolysis was rarely reported. Herein, we present a 28-year-old female patient and a 19-year-old male patient with AKI in the course of H1N1 influenza infection due to rhabdomyolysis.

Sonographic findings in patients with Crimean-Congo hemorrhagic fever.

Crimean‐Congo hemorrhagic fever (CCHF) has been endemic in Turkey since 2002. Some radiologic findings are considered common by clinicians and radiologists. In this regard, we aimed to assess the sonographic findings in patents with CCHF in a pilot study to obtain basic knowledge for planning further controlled studies.

Antimicrobial Susceptibilities of Clinical Acinetobacter baumannii Isolates With Different Genotypes

Background: The treatment of Acinetobacter baumannii infections is difficult. Carbapenems, sulbactam, and colistin are the most effective antibiotics. Objectives: The aim of this study was to evaluate the susceptibilities of genotypically different A. baumannii isolates to sulbactam, amikacin, netilmicin, meropenem, tigecycline and colistin. Patients and Methods: Isolates from various clinical samples of patients with hospital-acquired infections that were identified by the VITEK 2 Compact system in our hospital’s microbiology laboratory between January 2010 and March 2012 were included in the study. To determine genetic relatedness of the isolates, the rep-PCR method was used. The broth microdilution method was used for amikacin, netilmicin, meropenem and colistin, while E-test was used for sulbactam and tigecycline. Results: Among the 300 isolates, 30 were found to be genotypically different and were evaluated in terms of their antimicrobial susceptibilities. All isolates were susceptible to colistin. The susceptibility rates were 66.6%, 50%, 36.6%, 30%, and 10% for netilmicin, tigecycline, sulbactam, amikacin, and meropenem, respectively. For carbapenem resistant isolates, the susceptibility rates were 66.6%, 51.8%, 33.3%, and 25.9% for netilmicin, tigecycline, sulbactam, and amikacin, respectively. The sulbactam minimum inhibitory concentration (MIC) 50 and MIC 90 were 8 μg/mL and 12 μg/mL, respectively. Conclusions: In this study, it was concluded that determining the cut-off value for MIC breakpoints for sulbactam alone has a critical impact on the susceptibility results.

Acupuncture for depression and myalgia in patients with hepatitis: an observational study

Background Depressive symptoms and myalgia are commonly seen in patients with chronic hepatitis B and chronic hepatitis C. Objective To investigate the efficacy of acupuncture treatment on depressive symptoms and myalgia in patients with hepatitis. Methods Of 44 patients with hepatitis screened for depression and myalgia, 28 were enrolled and included in the study. The main outcome measure for depressive symptoms was Becks Depression Inventory (BDI). For pain/myalgia, patients rated their pain on a scale from 0 to 10. Patients with a score greater than the cut-off point in either score were allocated to acupuncture treatment. The Chinese method of acupuncture was used. Treatment continued for 6 weeks. Results At baseline, 17/44 patients (39%) had a BDI score ≥17 and 24 (55%) had a pain score ≥5. A total of 28 patients were allocated to acupuncture treatment, forming three groups: group 1, 13 patients with high BDI and high myalgia scores; group 2, 11 patients with low BDI score but high myalgia score; group 3, 4 patients with high BDI score but low myalgia score. Adherence to treatment was good; all patients completed the sessions and there were no drop-outs. Significant improvements in end-treatment BDI and in myalgia scores compared with baseline levels was found. Conclusion Acupuncture seems to be a promising treatment for patients with hepatitis. Further studies are warranted in large populations to establish the therapeutic role of acupuncture.

Investigation of 1377C/T polymorphism of the Toll-like receptor 3 among patients with chronic hepatitis B

The immunopathogenesis of chronic hepatitis B (CHB) has not been clarified yet. Toll-like receptors (TLR) are a receptor family that initiates immunity with exogenous-endogenous ligands and plays a role in the pathogenesis of infections. In this study, we aimed to investigate the frequency of TLR 3 1377C/T (rs3775290) polymorphism and its role in patients with CHB. We included 50 healthy individuals as control group and 73 active and 43 inactive hepatitis B patients. All DNA samples were isolated from blood samples. For the detection of TLR 3 1377C/T single-nucleotide polymorphism, restriction fragment length polymorphism was used. A statistically significant difference was determined in Hepatitis B virus (HBV) DNA levels of CHB patients with the CC, CT, and TT genotypes (p = 0.013). The highest levels of HBV DNA were detected in individuals with TT genotypes. Additionally, the frequency of CC genotype was higher in the active CHB patients compared with that of the inactive CHB patients (p = 0.044). No statistically significant difference in TLR 3 1377C/T polymorphism was detected between healthy controls and the hepatitis B patients (p = 0.342). In conclusion, HBV DNA level was higher in the individuals with TT genotype, and CC genotype was more frequent in the active CHB patients. These results suggest a possible association between CHB and TLR 3 gene (1377C/T) polymorphism.

Addison hastalığı ile renal tüberküloz birlikteliği

Renal tuberkuloz akciger tuberkulozunun lenfohematojen yayilimi sonucunda gelisir. Renal tuberkulozun en onemli bulgusu steril pyuridir. Gelismekte olan ulkelerde Addison hastaliginin %10-15’inden tuberkuloz hastaligi sorumludur. Tuberkuloza bagli adrenal tutulum bilateral adrenal genisleme, atrofi ve kalsifikasyon seklinde gorulebilir. Mycobacterium tuberculosis komplekse bagli adrenal bezlerin infeksiyonu hematojen yaylilim sonucu gelisir. Klinik bulgulari yillar sonra belirgin olabilir, asemptomatik infeksiyon oldukca siktir. Bu yazida, onceden Addison hastaligi (adrenokortikal yetmezlik) tanisi alan 60 yasinda bir kadin hastada saptanan renal tuberkuloz sunuldu .