Lutfu Savas

Epidemiologic, Clinical, and Imaging Findings in Brucellosis Patients with Osteoarticular Involvement

OBJECTIVE The aim of this study was to assess the epidemiologic and clinical features, complications, imaging findings, and outcomes for brucellosis patients with osteoarticular involvement. SUBJECTS AND METHODS This prospective study was performed over 4 years (December 2000-December 2004). The subjects were 251 Turkish patients (age range, 2-77 years) who were diagnosed with brucellosis during that period. Joint sonography, radiography, radionuclide bone scintigraphy, and MRI were performed in all patients with osteoarticular and spinal manifestations. RESULTS The disease was acute in 92 patients (36.7%), subacute in 48 patients (19.1%), and chronic in 111 patients (44.2%). Sonography of the joints showed bursitis in 13 patients (5.2%). Radiography, MRI, and scintigraphy revealed 71 patients (28.3%) with sacroiliitis, 26 (10.4%) with spondylodiskitis, three (1.2%) with acute osteomyelitis, and one (0.4%) with avascular necrosis of the femoral head. All patients received combinations of either two or three antibiotics. Surgery was performed in three patients with spinal instability or radiculopathy. CONCLUSION Brucellosis is endemic to some regions. MRI is the method of choice for diagnosing osteoarticular and spinal complications of human brucellosis, especially during the early phase. It is important to differentiate tuberculous spondylodiskitis from brucellar spondylodiskitis because proper treatment for each of these diseases can prevent complications. The radiologic findings for these two forms of spondylodiskitis are similar, so serologic testing for brucellosis is necessary in such cases.

Clinical Pattern and Abdominal Sonographic Findings in 251 Cases of Brucellosis in Southern Turkey

OBJECTIVE The aim of this study was to report the clinical features, complications, abdominal sonographic findings, and treatment outcomes for a series of brucellosis cases in southern Turkey. SUBJECTS AND METHODS This prospective study involved 251 patients (age range, 2-77 years) who were hospitalized with brucellosis during a 4-year period. Patients were classified as having acute (< 3 months), subacute (3-12 months), or chronic (> 12 months) disease. Physical, laboratory, and abdominal sonographic findings were analyzed. RESULTS The disease was acute in 92 cases (36.7%), subacute in 48 (19.1%), and chronic in 111 (44.2%). Sonographic examination of the abdomen showed enlarged periportal lymph nodes in 23 patients (9.2%), splenomegaly in 21 (8.4%), hepatomegaly in 15 (6%), pleural effusion in 7 (2.8%), splenic abscesses in 4 (1.6%), splenic cysts in 2 (0.8%), acute appendicitis in 2 (0.8%), and acute acalculous cholecystitis in 1 patient (0.4%). The main hematologic and biochemical manifestations were anemia, elevated erythrocyte sedimentation rate, elevated C-reactive protein, and elevated transaminase levels. All patients were treated with combinations of either two or three antibiotics. Surgery was performed in the patients with acute appendicitis, acute cholecystitis, and multiple splenic cysts. CONCLUSION Brucellosis is endemic to Turkey. Sonographic examination is the method of choice for diagnosing abdominal complications of human brucellosis. This disease should be included in the differential diagnosis for any patient with enlarged periportal lymph nodes. The specific treatment regimen and duration of therapy should be based on sites of organ involvement and complications.

Prospective Evaluation of 140 Patients With Brucellosis in the Southern Region of Turkey

The aim of this study was to asses the epidemiological, clinical, and laboratory characteristics of brucellosis in Adana region, Turkey. In this prospective study, a total of 140 patients with brucellosis were investigated in terms of spread of infection; seasonal, age, and sex distribution; clinical and laboratory characteristics; depression and anxiety rates; relapse rates; and response to different treatment combinations. One hundred two patients (72.9%) were female, and 38 patients (27.1%) were male; mean age was 45.81 ± 15.62 years, ranging from 2 to 77 years. Twenty-five patients (17.8%) had history of contact with animals, and 31 patients (22.1%) had history of consumption of raw milk and/or its products. The highest seasonal distribution was observed during summer. Malaise (95.0%), sweating (85.7%), and arthralgia (85.0%) were the major presenting symptoms. The most common physical examination findings were fever (52.9%), hepatomegaly (20.7%), and splenomegaly (12.1%). Osteoarticular involvement, orchitis, and iridocyclitis were observed in 64.9%, 38.0% (of male patients), and 0.7% of the patients, respectively. Scintigraphy was performed for 114 patients who have focal joint and bone complaints and findings. Beck Depression Inventory and State-Trait Anxiety Inventory testing were applied to 98 patients with brucellosis, and depression was observed in 37.8% of these patients. The total point of State Anxiety Inventory testing was 46.21 ± 12.87, and the total point of Trait Anxiety Inventory testing was 46.98 ± 10.11. Either the depression rates or points of State Anxiety Inventory testing and Trait Anxiety Inventory testing in patients with brucellosis were statistically higher than in the control group. In 134 patients, initial standard tube agglutination testing titer was 1/160 or more. Brucella melitensis was found positive in 22 patients. Relapse rate was 3.5%. Brucellosis continues to be a health problem in countries where consumption of unpasteurized dairy products and stockbreeding are common.

Efflux pump genes and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from lower respiratory tract infections acquired in an intensive care unit

The aim of this study was to determine the antimicrobial resistance rates and the resistance genes associated with efflux pumps of Pseudomonas aeruginosa strains isolated from the patients who acquired lower respiratory tract infection (LRTI) in intensive care unit (ICU). Fifty P. aeruginosa strains isolated from the lower respiratory tract specimens of the patients who acquired LRTIs in ICU were included in this study. P. aeruginosa strains were isolated from tracheal aspirate (27), bronchoalveolar lavage (14) and sputum (9). The susceptibilities of the isolates were investigated by the disk diffusion method. Multiplex PCR assay was carried out for the detection of 13 antibiotic-resistance genes. Antimicrobial resistance rates of the isolates were found high and the highest resistance rate of the isolates studied was determined against to mezlocillin (50%) followed by norfloxacin (48%), ciprofloxacin (46%), meropenem (40%). Fourty-three isolates (86%) were determined to carry one and more resistance genes. NfxB gene was most often determined in the genes that were investigated. The significant relation between the resistance to cefepime, piperacilline/tazobactam and the mexC gene, that between the resistance to mezlocillin, piperacilline/tazobactam, ceftazidime, cefepime and ampC genes, and that between the resistance to ciprofloxacin, norfloxacin and oprJ, oprN and nfxB genes was identified. Resistance caused by genes for carbapenemases, aminoglycoside-modifying enzymes and other mechanisms were not identified in this study. Understanding the prevalence and mechanism of antimicrobial resistance in P. aeruginosa may help to select empirical therapy for nosocomial LRTIs due to P. aeruginosa in our ICU.

Ceftriaxone-Associated Biliary Sludge and Pseudolithiasis in Children

Detection of incidence and the risk factors of ceftriaxone (CTX)-associated pseudolithiasis (PL) in children. One hundred fourteen patients (75 boys and 39 girls) who used CTX for the treatment of various infections were admitted to the study. Pseudolithiasis was diagnosed by ultrasonography (USG). Ultrasonography was performed at the beginning, on the 5th and 10th days, and at the end of the treatment. Weekly USG was performed to patients who had PL until the findings improved. It was investigated whether the age, sex, weight, treatment duration, dosage, and the way of administration have effects on PL development. Ceftriaxone was administered intravenously. Fifty-seven patients received once-daily and 57 patients received twice-daily dosage. Pseudolithiasis was observed in 37 (32.5%) of 114 patients. Age, sex, weight, treatment duration, and dosage had no role in PL development, whereas once- or twice-daily administration was found effective. Once-daily dosage of CTX treatment is recommended because of its lower incidence of PL development. Besides that USG should be performed regarding the risk of PL in children who are treated with CTX, further studies are necessary to determine the risk factors.