Safiye Helvaci

Tularemia in Bursa, Turkey: 205 cases in ten years

Tularemia is a zoonotic disease caused by the coccobacillus F. tularensis. Small epidemics and sporadic cases were seen around Bursa since November 1988. In this study, a total of 205 cases of tularemia were observed. All the cases were diagnosed on clinical, bacteriological and serological grounds. The epidemics were thought to be waterborne. The majority of the patients were young and female. In most of the cases the disease presented itself in oropharyngeal form (83%). Analysing sera from the patients with microagglutination method demonstrated that titers were ≥ 1:160 in approximately 85% of the cases, including the ones in subclinical form. Five of ten patients from who the bacteria was isolated were seronegative. Streptomycin was given to the most of the patients by combining with tetracycline, doxycycline or chloramphenicol. The early administration of these antibiotics (before the third week of disease) was found to be much more effective to resolve the infection. As a result, the main mode of transmission of F. tularensis is waterborne in our region. In our region, tularemia should be considered in differential diagnosis for the cases with fever, tonsillopharyngitis and cervical lymphadenopathy to make an early diagnosis and to design relevant treatment.

Re-emergence of tularemia in Turkey

Four tularemia epidemics were reported from three different regions of Turkey between 1936 and 1953. After a long interval, a new tularemia epidemic was reported from the area around Bursa in the northwestern part of Turkey in 1988. Following this first epidemic in Bursa, small epidemics occurred in areas around Bursa between 1988 and 2002. Other tularemia epidemics in different regions of Turkey were reported between 1988 and 2005. Almost all of the cases involved the oropharyngeal form of the disease. However, ulceroglandular and oculoglandular forms were detected in the Bursa epidemics; all of the ulceroglandular cases had dermatitis on their hands. To date, 1300 cases have been serologically confirmed. We reviewed one of the biggest tularemia epidemics in Europe.

Cerebrospinal fluid interleukin-1 beta/interleukin-1 receptor antagonist balance and tumor necrosis factor-alpha concentrations in tuberculous, viral and acute bacterial meningitis.

The levels of interleukin-1 beta, IL-1 receptor antagonist and tumor necrosis factor-alpha (TNF-alpha) were analyzed in 19 cases of tuberculous, 14 cases of viral, and 22 cases of acute bacterial meningitis, and in 18 control subjects. 20 patients (91%) with acute bacterial and 8 (42%) with tuberculous meningitis had detectable amounts of TNF-alpha in the initial cerebrospinal fluid (CSF) sample (mean 1044 +/- 131 pg/ml, range 95-1950, and mean 61 +/- 23 pg/ml, range 25-300, respectively), whereas TNF-alpha was not detectable in any of the patients with viral meningitis, or in any of the control subjects. IL-1 beta levels were 767 +/- 110 pg/ml (185-2000) in acute bacterial, 345 +/- 63 pg/ml (50-670) in tuberculous, 257 +/- 70 pg/ml (20-700) in viral meningitis, and 37 +/- 4 pg/ml (10-68) in control subjects. Il-1 receptor antagonist concentrations were significantly elevated in all meningitis groups, without significant differences between the groups. Il-1 receptor antagonist levels were 2487 +/- 62 pg/ml (2250-2950) in acute bacterial, 2216 +/- 82 pg/ml (1350-2550) in tuberculous and 1985 +/- 92 pg/ml (650-2500) in viral meningitis, and 154 +/- 26 pg/ml (20-245) in control CSF samples. A positive correlation was found between TNF and IL-1 beta levels (p < 0.01), and TNF levels and conscious state (p < 0.05). The ratio of concentrations of IL-1 receptor antagonist to IL-1 beta was 3.2 in acute bacterial meningitis, 6.9 in tuberculous meningitis and 8.3 in viral meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of Brucella melitensis by BACTEC NR 730 and BACTEC 9120 systems

In many parts of the world, brucellosis has significantly decreased, but it is still a problem in some regions of Turkey. In our laboratory we have isolated 58 Brucella spp. through BACTEC NR 730 and 30 Brucella spp. through BACTEC 9120 systems. 31 of the 58 isolates were detected by BACTEC NR 730 system in 72 hours. The majority of the growth values were between 45–65. BACTEC 9120 system detected all the isolates in 84 hours.

A mucormycosis case treated with a combination of caspofungin and amphotericin B

Mucormycosis is a rare, invasive and fatal disease that occurs mainly in diabetes mellitus patients with uncontrolled blood glucose levels or in immunocompromised patients. The mortality rate of this disease is as high as 25 to 80%, despite aggressive surgical treatment and antifungal therapy. This high mortality requires alternative treatment approaches. The accepted treatment modality of invasive mucormycosis are amphotericin B lipid formulations. Although echinocandins generally show no activity against Mucorales, it was shown that Rhizopus oryzae expressed the target enzyme for echinocandins, 1,3-beta-glucan synthase. Additionally, there are some experimental studies in a diabetic mouse model and case reports regarding the effects of caspofungin. In this report, we present a rhinocerebral mucormycosis case treated with liposomal amphotericin B and caspofungin. There was regression of the patients clinical and radiological condition with the addition of caspofungin, but she died due to discontinuation of her treatment and reasons other than mucormycosis.

Influences of alternate therapy protocol and continuous infectious disease consultation on antibiotic susceptibility in ICU.

Abstract In this study, the effects of alternate use of imipenem and cefoperazone/sulbactam(CFP/Sul) on antibiotic resistance in the intensive care unit (ICU) were investigated. Between 1 April 1993 and 1 April 1994, the infectious diseases consultant saw patients when required and there was no alternative therapy for antibiotics. For the following 2 years, the same consultant followed up each patient from admission to discharge by daily visits to the ICU and an alternative therapy protocol was initiated. The most common microorganisms were found to be Acinetobacter baumannii and Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae, respectively, in the two periods. This study demonstrated that sensitivity rates of imipenem, ciprofloxacin and aminoglycosides were improved as a result of this protocol.

Cerebral Toxoplasmosis as the Presenting Manifestation of HIV/AIDS

HIV infeksiyonunun seyri sırasında fırsatçı infeksiyonlar sık olarak görülür. Toksoplazmoz AIDS hastalarında ensefalite neden olan ve intraserebral kitle lezyonu yapabilen fırsatçı bir infeksiyondur. Bu yazıda önceden sağlıklı 41 yaşında bir erkek hastada ortaya çıkan ve ilk kez serebral toksoplazmoza bağlı denge bozukluğuyla kendini gösteren bir HIV/AIDS olgusu sunulmuştur. Klimik Dergisi 2011; 24(1): 62-4.

Akdeniz Benekli Ateşi: 16 Olgunun Retrospektif İncelenmesi

Amac: Rickettsia conorii’nin neden oldugu Akdeniz benekli atesi (ABA), Akdeniz ulkelerinde akut, endemik, zoonotik bir enfeksiyon hastaligidir. Bu hastalik ulkemiz icin endemik oldugundan sunmayi amacladik. Hastalar ve Yontemler: Bu calismada, 1987-2007 yillari arasinda riketsiyoz tanisi alan 16 olgu (4 kadin, 12 erkek; ort. yas 38.9±13.0; dagilim 18-64) retrospektif olarak incelendi. Akdeniz benekli atesi tanisi epidemiyolojik ozellikleri, indirekt floresan antikor testi (IFA), hastalarin klinik bulgulari ve doksisiklin tedavisine verdikleri yanita gore kondu. Bulgular: Olgularin tumunde ates yuksekligi, makulopapuler dokuntu tespit edildi. On uc (%81.3) olguda avuc ici ve ayak tabaninda dokuntu; sekiz olguda (%50) eskar tespit edildi. Tedaviye yanit 2±0.9 gunde gelisti ve tum olgularda tedaviye yanit alindi. Sonuc: Ilkbahar, yaz ve sonbahar aylarinda, ates, makulopapuler dokuntu, bas agrisi ve/ veya kas-eklem agrisi yakinmalariyla basvuran olgularda ayirici tanida mutlaka ABA dusunulmelidir.