Mustafa Namiduru

Mycobacterial cervical lymphadenitis.

Cervical lymphadenitis is the most common head and neck manifestation of mycobacterial infections. The incidence of mycobacterial cervical lymphadenitis has increased. It may be the manifestation of a systemic tuberculous disease or a unique clinical entity localized to neck. It remains a diagnostic and therapeutic challenge because it mimics other pathologic processes and yields inconsistent physical and laboratory findings. A high index of suspicion is needed for the diagnosis of mycobacterial cervical lymphadenitis. A unilateral single or multiple painless lump, mostly located in posterior cervical or supraclavicular region can occur. A thorough history and physical examination, tuberculin test, staining for acid-fast bacilli, radiologic examination, fine-needle aspiration and PCR will be instrumental in arriving at an early diagnosis early institution of treatment before a final diagnosis can be made by biopsy and culture. It is important to differentiate tuberculous from nontuberculous mycobacterial cervical lymphadenitis because their treatment protocols are different. Tuberculous adenitis is best treated as a systemic disease with antituberculosis medication. Atypical infections can be addressed as local infections and are amenable to surgical therapy.

Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients

In this study, we aimed to assess the clinical, laboratory and radiological findings of vertebral involvement in brucellosis. Fourteen patients diagnosed with spondylitis and spondylodiscitis due to brucellosis were included in the study. Computed tomography, magnetic resonance imaging, or scintigraphy were used to diagnose the vertebral involvement. The control group consisted of 20 patients with brucellosis but no vertebral involvement. The clinical, laboratory, and radiological findings of both groups were compared. The prevalence of vertebra involvement in brucellosis was found to be 7.5%. Of the 14 study patients, two had thoracic, ten had lumbar, and two had both lumbar and sacral vertebral involvement. The associated pathologies were spondylodiscitis, narrowing in the intervertebral space, inflammation or abscess formation in the paravertebral soft tissue, and osteophyte formation. None of the patients had a collapsed vertebral body, angulation deformity, or inflammation in the epidural space. In conclusion, the possibility of vertebral involvement should be remembered in chronic brucellosis, particularly in elderly patients who present with back pain or tenderness over the spine. A high index of suspicion and clinical, laboratory, and radiological examinations help confirm the diagnosis of vertebral involvement.

Ocular complications associated with brucellosis in an endemic area

PURPOSE To report the ocular manifestations associated with brucellosis in an endemic area. METHODS We prospectively evaluated 147 patients with the diagnosis of brucellosis between May 1996 to May 2000 and recorded the ocular and systemic findings. The diagnosis was based on clinical findings, positive serological and bacteriological tests (Brucella agglutination test: over 1/160 titer, blood culture). RESULTS Thirty-eight patients (26.0%) with brucellosis had ocular complications: conjunctivitis in 26 (17.7%), anterior uveitis in six (4.1%), posterior uveitis in one (0.7%), dacryoadenitis in two (1.4%), episcleritis in three (2.1%). Three of the seven patients with uveitis had spondylitis associated with brucellosis. Osteoarticular complications in brucellosis were more frequent in the patients with ocular involvement though the difference was not statistically significant compared with patients without ocular involvement. CONCLUSIONS Ocular manifestations are frequent in brucellosis so an ophthalmologic examination should be routinely performed in patients with brucellosis in endemic areas. (Eur J Ophthalmol 2002; 12: 232-7).

The microbiological diagnosis of tuberculous meningitis: results of Haydarpasa-1 study

We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon-γ release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Löwenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p <0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p <0.05). Combination of L-J and ACS was superior to using these tests alone (p <0.05). There were poor and inverse agreements between EZNs and L-J culture (κ = -0.189); ACS and L-J culture (κ = -0.172) (p <0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (κ = -0.299, p <0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources.

Increased Pleural Fluid Adenosine Deaminase in Brucellosis Is Difficult to Differentiate from Tuberculosis

Pleural involvement in brucellosis is very rare. Current knowledge on brucella pleuritis is limited to a few case studies, and pleural adenosine deaminase (ADA) in brucellosis has not been studied previously. We report the pleural fluid characteristics, including ADA, of two cases with brucella pleurisy. Analysis of the pleural fluids revealed exudative effusions with increased ADA level, decreased glucose concentration, and lymphocyte predominance. The similarity with tuberculous pleurisy was remarkable. We suggest that brucellosis should be considered in the differential diagnosis of tuberculosis, especially in regions endemic for both diseases.

In vitro synergistic activity of colistin with tigecycline or β-lactam antibiotic/β-lactamase inhibitor combinations against carbapenem-resistant Acinetobacter baumannii

Objective Nosocomial infection caused by carbapenem-resistant Acinetobacter baumannii is a worldwide problem and treatment options remain controversial. This study investigated the in vitro effect of various antibiotic combinations against carbapenem-resistant A. baumannii strains. Methods Antibiotic susceptibility of A. baumannii strains was analysed. In vitro synergistic efficacy of colistin combined with tigecycline, cefoperazone/sulbactam or piperacillin/tazobactam was tested against carbapenem-resistant A. baumannii strains. Synergy studies were performed using an eplisometer test-strip method. Results Of the 50 carbapenem-resistant A. baumannii strains tested, 96% were susceptible to colistin and 64% were susceptible to tigecycline. Colistin–tigecycline, colistin–cefoperazone/sulbactam and colistin–piperacillin/tazobactam combinations were found to have synergistic effects against six (12%), two (4%), and one (2%), respectively, of the strains tested. Conclusions Colistin combined with tigecycline, cefoperazone/sulbactam or piperacillin/tazobactam revealed synergistic effects in some carbapenem-resistant A. baumannii strains. These results, together with the shortage of treatment options and the risk of developing resistance to colistin, suggest that clinicians should use colistin combined with other antibiotics or β-lactamase inhibitors when treating carbapenem-resistant A. baumannii infection.

Serum cytokine levels in bell's palsy

OBJECTIVE To assess the significance of the serum levels of the cytokines (interleukine (IL-6, IL-8, IL-1b, IL-2r, and tumor necrosis factor alpha (TNF - alpha)) in the patients with Bells palsy. STUDY DESIGN A clinical and laboratory study in which serum cytokine levels were compared between the patients who had Bells palsy and healthy controls. METHODS Twenty-three patients with Bells palsy and 30 healthy volunteers were included in the study. The blood samples of the patients and controls were obtained, and serum IL-1b, IL-2r, IL-6, IL-8, and TNF- alpha levels determined with chemiluminescence enzyme immunometric assay on an Immulite Immunoassay. The serum of the patients was taken between 2 days and 1 month after the disease. The assay was not in vitro lymphocyte stimulation. RESULTS The IL-6, IL-8 and TNF- alpha levels were significantly higher in Bells palsy than in controls (p < 0.05). The IL-1b and IL-2r levels were similar in both groups (p > 0.05). The levels of cytokine IL-6, IL-8, TNF- alpha, IL-1b, IL-2r did not correlate with the degree of recovery (p > 0.05). CONCLUSION An alteration in the concentration of the cytokines is expected not only in many inflammatory and infectious diseases but also in Bells palsy. Cytokines are not stored or preformed within cells. Therefore, high cytokine levels (IL-6 and IL-8, and TNF- alpha) should represent their production in response to underlying pathology in Bells palsy, or these cytokines may be pathogenetic factors in Bells palsy. However, serum levels of these cytokines do not help determine the prognosis in Bells palsy as far as the results of this study are concerned.

Brucellosis‐induced immune thrombocytopenia mimicking ITP: a report of seven cases

Brucellosis continues to be an important cause of fever in underdeveloped countries and in rural areas of developed world. It is a multisystemic disease, associated with wide variety of symptoms. A wide variety of symptoms, including haematological abnormalities, such as anaemia, thrombocytopenia, pancytopenia, dissemine intravascular coagulation and leucopoenia could be seen, all of which are more common than usually thought. In this short study, we present a relatively uncommon haematological manifestation that of isolated thrombocytopenia mimicking idiopathic thrombocytopenic purpura, which we observed in seven of 114 patients who were diagnosed with brucellosis in our hospital over a 2‐year period. Having given brucellosis treatment with rifampicin and doxycycline, complete remission was achieved and thrombocyte count returned to normal in all cases.

Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study

No detailed data exist in the literature on the accurate diagnosis of chronic brucellar meningitis or meningoencephalitis. A multicentre retrospective chart review was performed at 19 health centres to determine sensitivities of the diagnostic tests. This study included 177 patients. The mean values of CSF biochemical test results were as follows: CSF protein, 330.64 ± 493.28 mg/dL; CSF/ blood-glucose ratio, 0.35 ± 0.16; CSF sodium, 140.61 ± 8.14 mMt; CSF leucocyte count, 215.99 ± 306.87. The sensitivities of the tests were as follows: serum standard tube agglutination (STA), 94%; cerebrospinal fluid (CSF) STA, 78%; serum Rose Bengal test (RBT), 96%; CSF RBT, 71%; automated blood culture, 37%; automated CSF culture, 25%; conventional CSF culture, 9%. The clinician should use every possible means to diagnose chronic neurobrucellosis. The high seropositivitiy in brucellar blood tests must facilitate the use of blood serology. Although STA should be preferred over RBT in CSF in probable neurobrucellosis other than the acute form of the disease, RBT is not as weak as expected. Moreover, automated culture systems should be applied when CSF culture is needed.

Hearing status in brucellosis

BACKGROUND: Although brucellosis can lead to multisystem complications, involvement of the ear in brucellosis is rarely reported in the literature. The purpose of this study was to assess the hearing status of patients with brucellosis. STUDY DESIGN: Thirty-two patients with brucellosis were included in the study. Pure tone and speech audiometry and tympanometry were performed in the patients. RESULTS: The mean pure tone averages of the patients were within normal limits and were similar in both ears (P > 0.05). The pure tone averages of the patients with or without anti-Brucella treatment were not significantly different (P > 0.05) and were within the normal limits. When the hearing levels of these patients were compared at the frequencies of 250, 500, 1000, 2000, 4000, and 8000 Hz, there was no significant difference as well (P > 0.05). CONCLUSIONS: Peripheral brucellosis does not appear to be associated with hearing loss.