Yusuf Ziya Demiroglu

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.

Evaluation of 28 cases of mucormycosis.

Mucormycosis is a rare but invasive fungal disease with high mortality. The present study aimed to retrospectively investigate the demographic characteristics, as well as the clinical, radiological and laboratory features and the results of treatment, in the patients followed in our hospital because of mucormycosis. The present study retrospectively evaluated 28 cases, which were followed in our hospital because of mucormycosis between January 2002 and July 2013. The clinical form was rhinocerebral in 27 cases (rhinoorbital in 12, nasal in 8 and rhinoorbitocerebral in 7) and disseminated in one case. With regard to predisposing factors, diabetes mellitus (n = 20), haematological malignancy (n = 6) and chronic renal insufficiency (n = 5) were the leading concomitant diseases. Seventeen (61%) of 28 cases showed atypical clinical picture. With regard to the therapeutic outcomes; it was found that 14 (50%) cases died and six cases recovered with sequel. Today, when particularly the prevalence of immunosuppressive diseases and conditions are gradually increasing, the incidence of mucormycosis is also increased. Considering that the majority of our cases had atypical clinical involvement and complications, being familiar with the characteristics of this disease could be life‐saving together with early diagnosis and treatment.

Chest radiography and CT findings in patients with the 2009 pandemic (H1N1) influenza.

PURPOSE To present chest radiography and thoracic computed tomography (CT) findings for patients with pandemic influenza A (H1N1) from November-December 2009 and to explore any differences compared to previously reported imaging findings. MATERIALS AND METHODS Fifty-two hospitalized patients with pandemic influenza (H1N1) were included in the study. All of the patients underwent chest radiography, and 28 patients were also evaluated by thoracic CT. Group 1 comprised 24 (46%) patients with no identified risk factors for H1N1 influenza infection. Group 2 comprised the remaining 28 (54%) patients with identified risk factors. The distribution of lung involvement, consolidation, ground-glass opacity (GGO), lymph nodes, and pleural effusion were evaluated. RESULTS Abnormal findings were observed in 85% of the patients. Bilateral lung involvement was present in 80% of the patients. The most common finding was a mixture of GGO and air-space consolidation. Lower zone predominance occurred in 89% of group 1 and 85% of group 2 patients. The involvement was observed most frequently in the peripheral and central perihilar areas of the lung in 80% of the patients. The extent of disease was greater in group 2 patients with the involvement of three or more lung zones in 62% of the patients. CONCLUSION The most common imaging finding for lung involvement was a mixture of air-space consolidation and GGO with a patchy pattern and lower/middle zone predominance. Pulmonary involvement of the disease was more extensive than that described in previous reports.

Brucellosis in cases of end-stage renal disease

BACKGROUND Patients with brucellosis frequently present with joint and bone pain. However, brucellosis may be overlooked in patients with end-stage renal disease (ESRD) who undergo dialysis since amyloidosis due to renal osteodystrophy and beta-2 microglobulinaemia may cause bone pain as well. Only four cases of end-stage renal failure accompanied by brucellosis have been reported in the literature. We evaluated clinical and laboratory characteristics and organ involvement of seven brucellosis patients with end-stage renal failure and compared them with brucellosis cases without any renal diseases. METHODS This is a prospective study and involved 158 patients diagnosed with brucellosis. All the patients were divided into two groups: brucellosis patients with ESRD (Group 1) and brucellosis patients without any renal disease (Group 2). RESULTS Group 1 included 7 patients (5 males and 2 females with the mean age 52.1 +/- 14 years) and Group 2 included 151 patients (62 males and 89 females with the mean age 45.4 +/- 16 years). Out of seven patients in Group 1, one had neurobrucellosis, one had paravertebral abscess, one had epidural abscess and one had peripheral arthritis. In addition, one patient in Group 1 with accompanying sickle cell anaemia presented with pain crisis and was diagnosed with brucellosis on admission. Serological tests were negative for brucellosis, but Brucella melitensis was isolated in blood cultures in another patient with accompanying continuous ambulatory peritoneal dialysis. Group 1 more frequently had joint pain and malaise. B. melitensis was isolated in blood cultures in blood taken in the absence of fever in half of the cases in Group 1 positive for B. melitensis in blood cultures on admission. CONCLUSION B. melitensis can be isolated in blood cultures even in the absence of high fever. In fact, in the present study, B. melitensis was isolated in most of the cases without high fever. For this reason, blood cultures should be performed in cases of end-stage renal diseases suspected of having brucellosis although fever is not present. In addition, brucellosis can present various clinical forms in endemic areas, mimics several diseases and can be characterized with severe complications.

Risk factors for occupational brucellosis among veterinary personnel in Turkey

Veterinarians and veterinary technicians are at risk for occupational brucellosis. We described the risk factors of occupational brucellosis among veterinary personnel in Turkey. A multicenter retrospective survey was performed among veterinary personnel who were actively working in the field. Of 712 veterinary personnel, 84 (11.8%) had occupational brucellosis. The median number of years since graduation was 7 (interquartile ranges [IQR], 4-11) years in the occupational brucellosis group, whereas this number was 9 (IQR, 4-16) years in the non-brucellosis group (p<0.001). In multivariable analysis, working in the private sector (odds ratio [OR], 2.8; 95% confidence interval [95% CI], 1.55-5.28, p=0.001), being male (OR, 4.5; 95% CI, 1.05-18.84, p=0.041), number of performed deliveries (OR, 1.01; 95% CI, 1.002-1.02, p=0.014), and injury during Brucella vaccine administration (OR, 5.4; 95% CI, 3.16-9.3, p<0.001) were found to be risk factors for occupational brucellosis. We suggest that all veterinary personnel should be trained on brucellosis and the importance of using personal protective equipment in order to avoid this infection.

Three Cases of Serious Infection Caused by Aerococcus urinae: A Patient with Spontaneous Bacterial Peritonitis and Two Patients with Bacteremia

Aerococcus urinae (A. urinae) is an unusual urinary tract pathogen [1–3], which is also reported in case of endocarditis [1, 3–5], septicemia [6–9], balanitis and phlegmon [1], lymphadenitis [10], and spondylodiscitis [11] in elderly patients with local or systemic predisposing conditions such as neutropenia and prostatic diseases. A. urinae is a grampositive, catalase-negative, microaerophilic, alpha-hemolytic coccus, growing predominately in tetrads and clusters. A. urinae is usually susceptible to b-lactam antibiotics and resistant to sulfonamides and aminoglycosides. Susceptibility to trimethoprim and cotrimoxazole is variable [9]. This paper presents three case reports of the serious A. urinae infections, two associated with bacteremia and to our knowledge the first case recorded of spontaneous bacterial peritonitis (SBP).

Bone marrow necrosis: a rare complication of herbal treatment with Hypericum perforatum (St. John's wort).

A 22-year-old man presented with fever and ulceration of the oral mucosa. The patient had pharyngeal and esophageal candidiasis. For the 3 weeks prior to presentation, he had been taking approximately 1000 mg/day of flowering herbs (Hypericum perforatum L, known as St. Johns wort) for treatment of depression. A complete blood count on the first day of hospitalization showed agranulocytosis and normocytic anemia. His condition worsened, and he developed progressive dysphagia. A bone marrow biopsy on day 3 revealed bone marrow necrosis. After the diagnosis was established (day 3 of hospitalization), treatment with granulocyte colony-stimulating factor 48 U/day, intravenous immunoglobulin 400 mg/kg, and amphotericin B 100 mg/day was initiated. The patient did not respond, and died within one week of the diagnosis. This cases suggests that Hypericum species may lead to severe hematologic toxicity, with conditions involving bone marrow necrosis.

The Place and the Efficacy of Infectious Disease Consultations in the Hospitals

Abstract Our study aims to determine the efficacy of infectious disease consultations and the interrelations between doctors in this social laboratory. This study was conducted at 34 centers located in 22 cities across Turkey and contributed by 210 infectious disease specialists (IDSs) and 970 non–infectious disease specialists (NIDSs), totaling 1180 medical doctors. Infectious disease specialists and NIDSs have separately contributed by responding to questionnaires designed specifically for the consultation process. It appears that a satisfactory collaboration has been established between IDSs and NIDSs during the consultation practices. There are some discrepancies in the perceptions of some of the NIDSs. These are the evaluation of patients holistically, the expectation of NIDSs in critical infection cases to start the therapy immediately, losing the support of drug companies by NIDSs, and the restriction of NIDSs in routine medical practice. On the other hand, NIDSs seem to have real problems in the diagnosis or treatment of infectious diseases. The consultation service provided by the IDSs in Turkey is widely accepted among other clinicians and appears to be of a crucial importance.

Tunnelled central venous catheter-related problems in the early phase of haematopoietic stem cell transplantation and effects on transplant outcome.

Objective: Haematopoietic stem cell recipients need central venous catheters (CVCs) for easy administration of intravenous fluid, medications, apheresis, or dialysis procedures. However, CVCs may lead to infectious or non-infectious complications such as thrombosis. The effect of these complications on transplantation outcome is not clear. This manuscript presents the complication rates of double-lumen tunnelled CVCs and their effect on transplantation outcome. Materials and Methods: Data from 111 consecutive patients, of whom 75 received autologous and 36 received allogeneic peripheral blood stem cell transplantations, were collected retrospectively. The data were validated by the Record Inspection Group of the related JACIE-accredited transplantation centre. Results: Thrombosis developed in 2.7% of recipients (0.9 per 1000 catheter days). Catheter-related infection was identified in 14 (12.6%) patients (3.6 per 1000 catheter days). Coagulase-negative Staphylococcus was the most common causative agent. Engraftment time, rate of 100-day mortality, and development of grade II-IV graft-versus-host disease were not found to be associated with catheter-related complications. Conclusion: These results indicate that adverse events related with tunnelled CVCs are manageable and have no negative effects on transplant outcome.