Kutbettin Demirdag

Serum cytokine levels in patients with acute brucellosis and their relation to the traditional inflammatory markers

The number of clinical studies on gamma interferon (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha) and interleukin-4 (IL-4) in human brucellosis is limited. The present study was focused on IFN-gamma, TNF-alpha and IL-4 levels in acute brucellosis cases, in the acute phase and at the end of the treatment. The relation of these cytokines to traditional inflammation markers was also investigated. The study included 27 cases of acute brucellosis and 20 healthy volunteers who had no complaints. It was found that mean IFN-gamma and TNF-alpha levels, CRP (C-reactive protein) levels and ESR (erythrocyte sedimentation rate) values were significantly higher in acute brucellosis cases as compared to post-treatment values and values measured in the control group. In addition, IFN-gamma and TNF-alpha levels measured in the acute phase correlated with the increase in CRP levels and ESR values. Our results confirmed that IFN-gamma and TNF-alpha are involved in the pathophysiology of brucellosis and are closely related to the inflammatory activation of the disease. In view of the present findings, it is suggested that IFN-gamma and TNFalpha may be used for monitoring brucellosis.

Extended-spectrum beta-lactamases in ceftazidime-resistant Escherichia coli and Klebsiella pneumoniae isolates in Turkish hospitals.

PURPOSE To study the prevalence of TEM-, SHV- and GES-type beta -lactamases among Escherichia coli and Klebsiella pneumoniae strains having ceftazidime MICs higher than 2 mg/L. METHODS A total of 63 E. coli and 41 K. pneumoniae isolated from five different university hospitals were studied for the existence of TEM-, SHV- and GES-type beta -lactamases. Susceptibility tests were carried out according to the criteria of National Committee for Clinical Laboratory Standards. MICs were obtained by agar dilution method. Existence of extended-spectrum beta -lactamases (ESBLs) were assessed by double-disc synergy test (DDST). Existence of the above-mentioned beta -lactamase genes were studied both by PCR with specific oligonucleotide primers and isoelectric focusing methods. RESULTS None of the isolates were carbapenem-resistant. DDSTs were positive in 50 (79.3%) and 33 (80.5%) of E. coli and K. pneumoniae , respectively. TEM gene was detected in 41 (65.1%) and 19 (46.3%), whereas SHV gene in 18 (28.6%) and 20 (48.8%) of E. coli and K. pneumoniae strains, respectively. GES genes were not detected. CONCLUSIONS TEM and SHV genes are highly prevalent among ESBL-producing E. coli and K. pneumoniae , whereas GES-type ESBLs are absent and found not to be responsible of ceftazidime resistance in Turkish hospitals.

A national survey of surgical antibiotic prophylaxis in Turkey.

OBJECTIVE To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN A cross-sectional, country-wide survey. SETTING Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95 0.225-0.772; P < .001) were associated with inappropriate prophylaxis. CONCLUSION Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

Resistant bacteria in the adenoid tissues of children with otitis media with effusion

OBJECTIVE To investigate the relationship between the resistant bacteria in the adenoid tissue and the middle ear effusion of children who underwent myringotomy and adenoidectomy with the diagnosis of otitis media with effusion (OME). METHODS This study was performed in the ENT Clinic, Firat University between January 2001 and June 2001. Forty-one subjects who were enrolled in the study were diagnosed as OME, their age ranged from 1 to 11 years, and they underwent a myringotomy together with an adenoidectomy because of adenoid hyperthrophy. Bacteriological cultures were performed on the samples obtained from adenoid tissues and middle ear fluids, in the bacteria that were cultured; the resistance to oxacilline sodium and beta-lactamase were investigated. The resistance of penicillin was confirmed by MIC test. The control group composed of individuals who did not have OME but who underwent adenotonsillectomy due to adenotonsillary hyperthrophy. RESULTS In the adenoid tissue cultures; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis species were isolated from the 70% (29/41) of the study group and 40% (20/41) of the control group (P<0.01). In the isolated bacteria, the resistance rates for oxacilline or beta-lactamase were found to be 48% (20/41) in the study group and 16% (4/25) in the control group (P<0.05). We observed that bacterial growth in 29% (9/31) of the middle ear cultures of the study group and resistant bacteria were isolated in 77% (7/9) of them. The same pathogens which have grown in the middle ear cultures were also present in the adenoid tissue cultures. CONCLUSION The isolation of resistant bacteria in most of the adenoid tissue samples of the children with OME, makes us to consider the possible role of these bacteria in the development of OME.

A case of Brucella spondylodiscitis with extended, multiple-level involvement

Brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse was seen with a combined treatment (doxycycline/rifampin) for 3 months, followed by doxycycline alone for 6 months. Almost all radiologic findings disappeared at the end of a 1-year follow-up without any further treatment.

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.

Anthrax of the gastrointestinal tract and oropharynx: CT findings.

Anthrax is an acute infection caused by the Gram-positive organism Bacillus anthracis. It causes cutaneous, respiratory, and gastrointestinal (GI) infections in humans. We present the computed tomography findings of anthrax of the GI tract and oropharyngeal involvement which include inflammatory lesion in the oropharynx and GI hemorrhage.

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.

The effects of pegylated interferon/lamivudine therapy on auditory functions in patients with chronic hepatitis B

OBJECTIVES The aim of this study was to assess the effects of pegylated interferon monotherapy and pegylated interferon+lamivudine combination therapy on auditory functions in patients with chronic hepatitis B (CHB) infection. METHODS A total of 54 patients with a diagnosis of CHB were grouped into four treatment groups: patients in Group 1 received pegylated interferon-alpha 2a; patients in Group 2 received pegylated interferon-alpha 2a+lamivudine; patients in Group 3 received pegylated interferon-alpha 2b, and patients in Group 4 received pegylated interferon-alpha 2b+lamivudine treatment. The auditory system (using standard and high frequency audiometry) and the vestibulocochlear adverse effects including otalgia, tinnitus, vertigo and imbalance were assessed immediately before the onset of the study, and at the 12th, 24th, and 48th weeks of the study. RESULTS A mean elevation of auditory threshold of 1-10dB was found in all treatment groups when the thresholds at the onset of the study and the thresholds at the 12th, 24th, and 48th weeks were compared. However, the elevations were not significant. The elevations were mostly at high frequencies (10,000, 12,000 and 16,000Hz). The most common vestibulocochlear adverse effects related to treatment were tinnitus, vertigo, imbalance, and otalgia, respectively. Tinnitus was the most common adverse effect in Group 2, vertigo was the most common in Group 3, imbalance was at equal frequency in Group 2 and 3, and otalgia was the most common adverse effect in Group 2 (p>0.05). CONCLUSION There were no significant auditory adverse effects in the treatment groups. We think that it may be beneficial to monitor the auditory functions in patients receiving PEG-IFN treatment because of the mild elevation in the auditory thresholds (although not significant).

A case of mumps conjunctivitis: detection of the virus RNA by nested PCR in tear sample.

Mumps is a disease caused by a virus that can infect many parts of the body, especially the parotid salivary glands. A case of epidemic parotitis in an adult female affected by bilateral conjunctivitis is presented. Mumps virus was detected in tear samples by reverse transcription nested polymerase chain reaction (RT-n-PCR). The conjunctivitis resolved completely within 11 d.