Kemalettin Özden

Serum IL-18 levels in tuberculosis: Comparison with pneumonia, lung cancer and healthy controls

Objective:  The aim of the present study was to document the serum IL‐18 levels in patients with pulmonary tuberculosis (P‐TB), extrapulmonary tuberculosis (EP‐TB), pneumonia, lung cancer and in healthy controls, and to investigate whether it may assist in the differential diagnosis of P‐TB.

Liver transplantation for alveolar echinococcosis in an endemic region

Alveolar echinococcosis (AE) is a chronic disease caused by ingestion of the eggs of the parasitic cestode Echinococcosis multilocularis (EM). In severe cases, liver transplantation (LT) may represent the only possibility of survival and cure. Patients undergoing LT associated with hepatic AE at our institution between April 2011 and October 2014 were investigated retrospectively. The clinical findings of the 27 patients who participated in the study were noted. Kaplan‐Meier and chi‐square tests were used to investigate the effect of these characteristics on survival and mortality. Living donor LT was performed on 20 patients (74.1%), and deceased donor LT was performed on 7 patients (25.9%). Hilar invasion was the most common indication (14 patients, 51.9%) for transplantation. The patient follow‐up was 16.1 ± 11.4 months, and the overall survival rate was 77.8%. Primary nonfunction developed only in 2 patients in the posttransplantation period. Six patients died during monitoring, the most common cause of death being sepsis (3 patients). The relationship between the mortality rate of the patients and the invasion of the bile duct and/or portal vein by alveolar lesions was found to be statistically significant (P = 0.024 and P = 0.043, respectively). According to PNM staging, when the AE disease exceeds the resectability limits, the only alternative for the treatment of the disease is LT. However, different from LT due to cirrhosis, it is extremely difficult to perform a transplantation for AE disease because of the invasive characteristics of it. In order to decrease the difficulty of the operation and the postoperative mortality, the intracystic abscess and cholangitis which occur because of AE must be treated via medical and percutaneous methods before transplantation. Liver Transpl 21:1096‐1102, 2015.

Bacteremic and Nonbacteremic Brucellosis: Clinical and Laboratory Observations

Brucellosis is a highly contagious endemic zoonosis that remains synonymous with low socioeconomic status, as exemplified by its incidence in poor regions of southern countries of Europe, such as rural Greece, Sicily, and various Spanish provinces [1, 2]. It is a systemic febril infection in which any organ or system of the body can be involved [3–5]. The diagnosis of brucellosis is based on the isolation of organisms from blood and/or body tissues or on a combination of suggestive clinical symptoms upon presentation and positive serology. The rate of positive blood cultures in brucellosis ranges from 15% to 90%. The number of positive results is usually greater in acute brucellosis; however, this figure is notably reduced in the case of focal complications and chronic illness [3]. We report here epidemiological, clinical, serological, and prognostic features of bacteremic and nonbacteremic brucellosis based on our clinical experience with patients presenting with brucellosis. Between June of 2001 and 2006, we carried out a retrospective study of 123 patients with brucellosis who were diagnosed and treated at the Infectious Diseases and Clinical Microbiology Department of Ataturk University Research Hospital, a 1,200-bed tertiary hospital. A complete medical history of each patient was obtained, and a physical examination was carried out. At least three blood cultures and the standard tube agglutination test (SAT) were performed on each patient. Included in the laboratory assessments were a complete blood count (CBC), Creactive protein (CRP), and blood chemistry (including levels of ALT and AST). Our case definition was such that patients with positive culture results for Brucella spp. were grouped as having bacteremic brucellosis and those without positive culture results – and therefore diagnosed on the basis of clinical features and SAT – were grouped as having nonbacteremic brucellosis. We then evaluated the epidemiological, clinical, and serological features of bacteremic brucellosis vs nonbacteremic brucellosis. Using symptom duration as the criterium, cases were classified as acute (less than 8 weeks), subacute (from 8 to 52 weeks), or chronic (more than 52 weeks) brucellosis [1, 3]. Brucellosis was diagnosed on the basis of one of the following criteria:

Comparison of coagulase-negative staphylococci isolated from blood cultures as a true bacteremia agent and contaminant in terms of slime production and methicillin resistance.

OBJECTIVE The aim of this study is to determine the species distribution, slime activity, and methicillin resistance of coagulase-negative staphylococci (CoNS) isolated from blood cultures as either contaminants or true bacteremia agents. MATERIALS AND METHODS In this study, 13.268 blood culture samples sent to our laboratory from various clinics during a two-year period were examined in terms of the presence of CoNS to clarify whether the isolates are true bacteremia agents, as defined by Centers for Disease Control and Prevention (CDC) criteria. The slime activities of true bacteremia agents (58 CoNS strains) and contaminants (50 randomly selected CoNS strains) were investigated by the Christensen method. The methicillin susceptibilities of the strains were determined by the disk diffusion method. RESULTS Although the frequency of slime production was 39.7% among the true bacteremia CoNS agents, it was 18% in CoNS that were judged to be contaminants (p<0.05). S. epidermidis was the most frequently isolated species for both the true bacteremia agent group (56.9%) and contaminant group (74%). Additionally, S. epidermidis was the bacterium most frequently characterized as slime producing in both groups. The methicillin resistance of slime-producing CoNS was determined to be 82.6% for the true bacteremia agent group and 77.8% for the contaminant group. CONCLUSION The presence of slime activity in CoNS isolated from blood culture samples is supportive evidence that they are most likely the agents of true bacteremia cases.

Co-existence of tuberculous meningitis and pulmonary tuberculosis in a denim sandblaster.

Silicosis is a well-known occupational lung disease that was discovered by the ancient Greeks and Romans. In 2001, it has emerged again in an unexpected occupation: denim sandblasting. Exposure to crystalline silica, with or without clinical disease, is one of the most important predisposing factors for the development of tuberculosis; however, there has been no previous report of tuberculosis among cases of silicosis due to denim sandblasting. Herein, we report the first case of a denim sandblaster with silicosis who developed both pulmonary tuberculosis and tuberculous meningitis.

Prognostic Significance of Antithrombin Activity in Patients with Crimean-Congo Hemorrhagic Fever

OBJECTIVE Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic fever. Disseminated intravascular coagulation (DIC) is an important complication of this disease, especially in severe and fatal cases. Antithrombin (AT) acts as an anticoagulant by inactivating thrombin, Factor IX, Factor X and Factor XI. We conducted this study to investigate the AT levels and their prognostic value in CCHF. MATERIALS AND METHODS Twenty-eight confirmed CCHF patients were included in this study. Diagnosis of the disease was made by CCHF IgM and/or PCR positivity. Patients were grouped based on the severity criteria described previously. The patients with platelet counts <20 000×10(6) cell/L, white blood counts >10×10(9) cell/L, prothrombin times >60 seconds, aspartate aminotransferase levels >700 IU/L or alanine aminotransferase levels >900 IU/L were accepted as severe cases. Patients whose illnesses were self-limited and who did not require blood component replacement were accepted as mild cases, and patients who improved but required blood component replacement were accepted as moderate cases. Blood samples were obtained on the day that the patient had the lowest platelet count and before any thrombocyte replacement. The antithrombin activity was measured using a chromogenic substrate test (Diagnostica Stago STA Compact) at a research laboratory. RESULTS Twenty-two (78.6%) of the cases were mild, 3 (10.7%) were moderate, and 3 were (10.7%) severe. The mean AT value was 101% for mild cases, 116.6 % for moderate cases, and 88% for severe cases (p>0.05). Although there were no statistically significant differences between the AT values, the mean AT activity was lower in severe CCHF cases. CONCLUSION The AT activity may have been decreased in severe CCHF cases. Further studies with greater numbers of patients are required to determine the level of AT activity and its correlation with disease severity and the prognosis of CCHF.