Meltem Arzu Yetkin

Crimean-Congo Hemorrhagic Fever: Prognostic Factors and the Association of Leukocyte Counts with Mortality

We aimed to determine the relationship between leukocyte counts and the survival of patients with Crimean-Congo hemorrhagic fever (CCHF), a life-threatening illness. This is the first study to do so. A total of 220 patients with CCHF were evaluated retrospectively. The mortality rate was 16.4%. Analysis of the relationship between leukocyte counts and mortality rates provided insight into the pathogenesis of CCHF. Receiving operating curve analysis revealed that leukocyte counts ≥2,950/mm(3) on the day of admission predicted mortality rate with 62.1% sensitivity. The mean hospitalization stay in patients with fatal disease was 4.3 days; therefore, leukocyte counts were compared on the day of admission and day 3 of the hospital stay. Increases in neutrophil levels and decreases in lymphocyte and monocyte levels were identified as significant risk factors for mortality (P = 0.01, 0.037, and 0.001, respectively). The mortality risk was 7-12 fold higher in patients whose levels of leukocytes (2,950 μL), lactate dehydrogenase (967.5 U/L), and alanine aminotransferase (>119.5 U/L) and activated partial thromboplastin time (42.4 s) exceeded the cut-off values; these were identified as independent predictors of mortality. Depletion of monocytes and lymphocytes and accumulation of neutrophils correlated with poor outcome. These results highlight the importance of the mononuclear immune response for the survival of patients with CCHF.

Emergence of multidrug resistant isolates and mortality predictors in patients with solid tumors or hematological malignancies

INTRODUCTION Infections are an important preventable cause of death in cancer patients. The aim of this study was to clarify the epidemiologic characteristics and resistance patterns of causative isolates and mortality predictors in infections of cancer patients. METHODOLOGY Patients with sterile site infections were evaluated in a retrospective cohort study. Etiological agents, antimicrobial resistance patterns of the isolates, and possible risk factors for mortality were recorded. Survivors and non-survivors on day 30 after each infection onset were compared to identify the predictors of mortality. RESULTS A total of 205 infection episodes of 132 patients were included in this study. Of them, 75% had hematologic malignancies and 25% had solid tumors. Febrile neutropenia was diagnosed in 61.5%. Bloodstream infections were the most frequent infection (78%). The majority of the pathogens were Enterobacteriaceae (44.3%) and nonfermentative isolates (17.6%). Multidrug-resistant (MDR) infections were responsible for 40% of the episodes. The mortality rate was 23.4%. Inadequate initial antibiotic treatment (OR = 4.04, 95% CI = 1.80-9.05, p = 0.001), prolonged neutropenia (> 7 days) before infection (OR = 3.61, 95% CI = 1.48-8.80, p = 0.005), infection due to Klebsiella species (OR = 3.75, 95% CI = 1.31-10.7, p = 0.013), and Acinetobacter baumannii (OR = 5.00, 95% CI = 1.38-18.2, p = 0.014) were independent predictors of mortality. CONCLUSIONS Gram-negative isolates were found to be the predominant pathogens with higher mortality rates. Local epidemiological data should be taken into account when administering empirical therapy since the inadequacy of initial antibiotherapy is associated with a poor outcome.

Does the course of laboratory parameters help us to predict the outcome of CCHF

BACKGROUND/AIM This study was performed to identify the characteristics distinguishing fatal and nonfatal cases of patients diagnosed with Crimean-Congo hemorrhagic fever (CCHF). MATERIALS AND METHODS A total of 92 patients with confirmed diagnosis of CCHF in 2009-2013 were included in the study. RESULTS A high level of urea and aPTT on the third day of hospital stay, diarrhea, somnolence, and the interval from the beginning of the symptoms to hospital admission were independently associated with fatality. Each 10-unit increase in aPTT and urea levels increased the fatality rate by 3.379-fold and 1.236-fold, respectively. Delay in hospital admission increased the fatality rate 1.453-fold for each day of delay. When comparing first and third admission-day laboratory values, the increase in leukocyte counts and the decrease in CPK, urea, creatinine, aPTT, PT, INR, and hemoglobin levels were significant in nonfatal cases. CONCLUSION This study showed that the course of these laboratory tests helps us to predict the outcome of the disease. In a few days of hospitalization, persistence or progress of the abnormal laboratory parameters may warn us about poor prognosis.

A long-term survey of brucellosis: Is there any marker to predict the complicated cases?

Abstract Background: This study aimed to find markers to predict complicated cases in brucellosis. Patients with and without complications were compared in terms of epidemiological, clinical and laboratory properties. Methods: A total of 700 patients hospitalised at the Department of Infectious Diseases and Clinical Microbiology were evaluated retrospectively. Results: Of a total of 700 patients, 383 (54.7%) were male and mean age was 41.5 ± 17.0 years. Of the patients, 517 (73.8%) were classified as acute cases. Complications occurred significantly less frequently in acute infections (p < 0.001). Increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) occurred more frequently in patients with complicated cases (p = 0.005 and 0.021, respectively), whereas malaise, myalgia and blood culture positivity occurred significantly less frequently in those cases (p <0.001, <0.001 and 0.014, respectively). Fever at examination, loss of malaise and myalgia and blood culture negativity were statistically significant predictive factors for complicated patients in multivariate analysis (p < 0.001, for each). As compared to patients without orchitis, leukocytosis occurred more often in cases with orchitis (p < 0.001); leukopenia occurred more often in neurobrucellosis than in cases without neurobrucellosis (p = 0.008). Of patients who attended control regularly, 422 (98%) were treated successfully. All of the nine patients who did not recover fully were cases with osteoarticular involvement. Conclusions: Fever was the most significant predictive marker of complications. Other classical symptoms of brucellosis like myalgia and malaise were absent in most of the complicated cases. Blood culture was of limited value in the diagnosis of complicated cases most of the time.

Evaluation of epidemiological, clinical, and laboratory features and mortality of 144 HIV/AIDS cases in Turkey

Background The number of HIV/AIDS cases in Turkey is increasing rapidly, as is the number of cases worldwide. The aim of this study is to evaluate the characteristics of the clinical and laboratory findings and epidemiological features of HIV/AIDS patients to obtain useful data on the epidemic type and transmission routes associated with Turkey and to identify risk factors for mortality. Methods The patient records of 144 HIV-infected patients who were admitted to our clinic between 2000 and 2015 were analyzed retrospectively. Results Most of the cases (55%) were diagnosed due to the detection of anti-HIV-positive individuals without clinical symptoms. The mean CD4 + lymphocyte count on first admission was 108 cells/μL for those admitted before 2009 and 265 cells/μL for those admitted after 2009 (p = 0.003). When the pre- and post-2009 groups were compared for the status of the disease, 55.6 and 44.4% of patients were in the AIDS stage, respectively (p = 0.04). The most noted opportunistic infection was mycobacterial, and throughout the follow-up, 31.2% of the cases were fatal. Conclusions Early diagnosis of HIV infection can have a direct impact on prognosis and survival. Therefore, screening laboratory investigations should be extended, particularly in high-risk groups.

Investigating the in vitro synergistic activities of several antibiotic combinationsagainst carbapenem-resistant Acinetobacter baumannii isolates.

BACKGROUND/AIM Acinetobacter baumannii (A. baumannii) is one of the most common healthcare-associated infectious agents worldwide. The aim of this study was to investigate the in vitro synergistic activities of several antibiotic combinations against carbapenem-resistant (CR) A. baumannii isolates. MATERIALS AND METHODS Eighteen CR A. baumannii strains were isolated from the patients who were hospitalized in the intensive care unit between June 2012 and August 2012. The in vitro effects of single and binary combinations of meropenem (MEM), colistin (CST), tigecycline (TGC), and sulbactam (SUL) on these isolates were determined using the Epsilometer test (E-test) method. RESULTS All 18 isolates were resistant to MEM and SUL and susceptible to CST. TGC was detected as susceptible in two of the isolates and intermediate susceptibility results were observed in the remaining isolates. With MEM-CST and MEM-TGC combinations, synergism was determined against all isolates. The synergistic and/or additive effect ratios were detected in MEM-SUL, CST-SUL, TGC-SUL, and CST-TGC combinations as 16.7%, 38.9%, 16.7%, and 5.6%, respectively. CONCLUSION Among the tested antimicrobial combinations, the in vitro combination of MEM with TGC or CST was most effective against the CR A. baumannii strains.

767Association of Mortality with Leukocyte Distribution in Crimean-Congo Hemorrhagic Fever: Twelve Years Experience in A Retrospective Case Control Study

Background. Crimean-Congo hemorrhagic fever (CCHF) is a life threatening illness. In this study we aimed to detect the effect of the leukocyte, lymphocyte and monocyte levels on the survival. To our knowledge this is first study analyzing the relationship between mortality and leukocyte distrubition. Methods. A total of 220 patients were evaluated between 2002 and 2013 years retrospectively. Demographic, clinic and laboratory parameters of the fatal and non-fatal patients were compared statistically. Results. The mean age of the patients was 50.21 ± 17.07 years (15-85) and the mortality rate was 16.4%. The most frequent symptoms were fever (88.2%), lack of appetite (79. %) and myalgia (75%). Of the 220 patients 29.5% had hemorrhages and 11.4% had somnolence. Most of the patients (75%) were working in animal husbandry and 63.6% had tick bite history. Mean duration of symptoms after tick bite was 3.87 ± 3.06 days. Mean hospitalization time (6.42 ± 3.06 days) was significantly shorter in fatal cases (p < 0.001). Univariate analysis revealed that hemorrhages (66,7 %), somnolence (47.2%), petechia 36.1% and ecchymoses 38.9% were significantly higher in fatal cases (p < 0.001). In multivariate analysis; somnolence, hemorrhages and diarrhea were independent factors for mortality (OR:36.5, OR:12.4 and OR: 5.9, respectively). In comparison of the first and third admission-day laboratory values, increase of leukocytes (WBC), lymphocytes and monocytes were significant in non-fatal cases (p < 0.001). ROC curve analysis revealed that if the first day WBC count was ≥ 2950/mm, mortality rate could be predicted with 62.1% sensitivity and 33.1% specifity. In consideration of mean hospitalisation length in fatal cases (4.3 days), third-admission day leukocyte distributions were analyzed between the two groups. It was found that, increases of the neutrophils and decreases of the monocytes were independent risk factors in mortality. Although decreases of lymphocytes were significant in univariate analysis, there was no difference in multivariate analysis. Conclusion. The depletion of monocyte and lymphocyte counts and the increase of neutrophils were correlated with poor outcome. This result suggests the importance of mononuclear immune response for survival in CCHF. Disclosures. All authors: No reported disclosures.

Fever of Unknown Origin Owing to Salmonellosis with Nalidixic Asid Resistant Salmonella Schottmuelleri: A Case Report -

Resistance to fluoroquinolones is a rare situation in Salmonella strains. We report here a case of fluoroquinolone-resistant Salmonella schottmuelleri which caused a confusion in the diagnosis. Forty years-old female was admitted to our clinic with a 19 day-history of fever. The patient had applied to another hospital five days ago and had been given ciprofloxacin. In our hospital, her blood Gruber-Widal test showed a titer of 1/200 against BO and BH antigens. However, because the patient was unresponsive to ciprofloxacin, this result was ignored and specific antibiotic therapy was not started. Later, Salmonella schottmuelleri was isolated in bone marrow culture, but blood cultures were negative. The isolate was resistant nalidixic acid, susceptible to ciprofloxacin and ceftriaxone. Ceftriaxone was begun. After three days, fever disappeared. The purpose of this report is to emphasize the probability of quinolone resistant salmonella strains in the differential diagnosis of fever of unknown origin and to call attention to ineffectiveness of ciprofloxacin even tough seems to be susceptible in vitro.

Acute hepatitis with concomitant graves\' disease -

Acute hepatitis A with concomitant Graves’ disease was reported rarely in the literature. To our knowledge there is one case in the literature from New York in which acute hepatitis A infection was not thought predominant. It is difficult to manage these cases because of the limited therapy options especially when cholestasis occurs. A 36-year-old male presented with severe cholestasis who was diagnosed as acute hepatitis A infection together with Graves’ disease. He had severe cholestasis with elevated liver enzymes and bilirubin levels. Thyroid functions tests decreased to normal levels with plasmapheresis therapy and then he was sent to general surgery for thyroidectomy. Plasmapheresis is an alternative therapy option for thyrotoxicosis in patients with Graves’ disease concomitant with acute HAV infection.