Mehmet A. Tasyaran

Efficacy of oral ribavirin treatment in Crimean-Congo haemorrhagic fever: a quasi-experimental study from Turkey.

OBJECTIVE The aim of this study was to evaluate the efficacy of oral ribavirin treatment in patients with Crimean-Congo haemorrhagic fever (CCHF). METHODS In 2004, all patients diagnosed with CCHF were treated with oral ribavirin, however in 2003 none of the CCHF patients had been given treatment due to lack of confirmatory diagnostic information at that time in Turkey. In this study, patients treated with ribavirin in 2004 (n=126) were compared with ribavirin-untreated CCHF patients (n=92) in 2003. Patients only with a definitive diagnosis of CCHF (clinical symptoms plus the presence of specific IgM antibodies against CCHF virus and presence of viral antigen) were included in this study. RESULTS There was no difference in the case-fatality rate between treated and untreated patients (7.1% vs. 11.9%; P>0.05). A Cox Proportional Hazards regression analysis revealed that altered sensorium and prolonged international normalized ratio were independent predictors of mortality. CONCLUSION Our results showed that oral ribavirin treatment did not improve the survival rate in CCHF patients. Ribavirin and supportive care are the only available choices for treatment of CCHF patients, but to ascertain the efficacy of ribavirin, more laboratory and observational studies are necessary and ultimately, to elucidate these conflicting results and evaluate the efficacy undoubtedly, a multicenter randomised controlled trial will be needed.

Anthrax in adults and children: A review of 132 cases in Turkey

Abstract.In this retrospective study, 132 cases of anthrax observed in a Turkish hospital over a 14-year period (October 1986 to October 2000) were evaluated with respect to clinical features, therapy, and outcome. The results show that anthrax is a disease of significance in the Eastern Anatolian region of Turkey. Preventive measures such as education of the population and vaccination of animals against anthrax would reduce the incidence of the disease.

Anthrax during Pregnancy: Case Reports and Review

We review, in detail, 2 cases of anthrax during pregnancy, its maternal and perinatal complications, and its management. Patient 1 was a 33-year-old woman at 32 weeks of gestation. She had a submandibular eschar; extensive edema on her face, neck, and upper thorax that inhibited respiratory function; and fever. The patient was treated with penicillin G and prednisolone after the diagnosis of anthrax. She recovered within 10 days but delivered a preterm baby. Patient 2 was a 29-year-old woman at 33 weeks of gestation. Her anthrax lesion was on her right elbow, and therapy consisted of procaine penicillin. She also delivered a preterm baby. These 2 cases show that anthrax during pregnancy can be successfully managed, but preterm delivery could be a complication.

An unusual presentation of hepatitis A virus infection : Guillain-Barré syndrome

Few cases of Guillain–Barré syndrome (GBS) that are secondary to acute hepatitis A virus (HAV) infection have been reported in the literature. Only two of them were on children. GBS, now regarded as a clinical syndrome consisting of acute weakness and reduced or absent tendon reflexes, with or without sensory loss, is often preceded by an infectious disease. Although hepatitis A (HA) itself is commonly reported, we report a case where GBS is preceded by HA.

Cerebrospinal Fluid Rhinorrhea and Recurrent Pneumococcal Meningitis after Submucous Resection of the Nasal Septum

In an immunologically competent individual, recurrent bacterial meningitis is usually the consequence of a transdural communication between the subarachnoid space and the base of the skull. Cerebrospinal fluid (CSF) rhinorrhea is the most common sign of a CSF fistula. This condition is most commonly caused by trauma, either accidental or iatrogenic. CSF rhinorrhea following a nasal surgical procedure is an unusual condition. We report here the case of CSF rhinorrhea and recurrent bacterial meningitis in a 24-year-old female patient following submucous resection of the nasal septum. We discuss the etiology, diagnosis and clinical course.