Clinical and laboratory features, complications and treatment outcome of tularemia and a review of literature

Objective: To define the epidemiological and demographical characteristics, laboratory findings, treatment methods and treatment results of 14 patients with tularemia

Design: Retrospective study

Setting: Department of Infectious Diseases and Clinic Microbiology, Private Umit Hospital, Eskisehir, Turkey

Subjects: Fourteen patients with tularemia admitted to this hospital from April 2011 to May 2012

Main outcome measures: Demographic characteristics, clinical and laboratory findings of the patients with tularemia and the treatment outcomes

Results: A total of 14 patients [nine male, five female; mean age: 41 +/- 17 years] with myalgia, cervical lymphadenopathy, sore throat and fever, and failure to respond to beta-lactam antibiotics, were followed up. Ten patients [71.4%] had oropharyngeal tularemia, three [21.4%] had glandular and one [7.1%], oculaglandular. Serum samples were obtained from allpatients and in 13 [92.8%] of them microagglutination test yielded positive results [>/=1/160] in their first serum samples. The most frequent laboratory findings were high C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]. Complete recovery was obtained in nine [64.3%] patients, while five [35.7%] were nonresponsive to the medical treatment

Conclusion: Most of the patients of this study were treated without surgical intervention. Interestingly, medical therapy started within three weeks was found successful. However, it should be considered in differential diagnosis of patients with myalgia, cervical lymphadenopathy and pharyngeal hyperemia, and those who did not respond to beta-lactam antibiotics with high levels of CRP and ESR, and those living in rural areas

Laboratory-acquired brucellosis

Laboratory-acquired infections are rarely diagnosed and reported. Brucella species are highly contagious when handled in the laboratory. Therefeore, brucellosis is one of the most common laboratory-acquired bacterial infections. Laboratory workers get infected by either inhalation or by direct contact through the injured skin. We present a case of laboratory-acquired brucellosis [LAB] caused by Brucella melitensis. In conclusion, despite the enforcement of infection control measures, including the use of biosafety cabinet in the laboratory, laboratory-acquired brucellosis still maintains its importance because of infected sample handling by the workers

Complications of brucellosis in adults: an experience from a state hospital in southeastern anatolia region of Turkey

To evaluate the complications and systems involvement of acute Brucella infection in adults Retrospective study Midyat State Hospital, Mardin, Turkey Seventy-eight patients with acute brucellosis. Brucellosis treatment The frequency of complications and systems involvements. This retrospective study was carried out at the Infectious Diseases and Neurology clinics between April 2007 and August 2008. The diagnosis of brucellosis was made with compatible clinical findings, positive Brucella agglutination 1/160 titers, and / or the isolation of Brucella species. Complication was defined as the presence of symptomsor physical signs of infection at a particular anatomic site in a patient with active brucellosis. This study focuses on the frequency of complications in cases with brucellosis. Out of 78 patients, 46 [59%] were female and 32 [41%] were male. The mean age of patients was 36.4 +/- 14.2 years. Skeletal complications were the most frequent, found in 26 [33.8%] cases, followed by hematological [n=25, 32.1%], cutaneous [n=3, 3.9%], nervous [n=2, 2.6%], genitourinary [n=2, 2.6%], respiratory [n=1, 1.3%] and gastrointestinal system [n=1, 1.3%]. Brucellosis, whether in an endemic region or not, remains a diagnostic puzzle due to occasional misleading unusual presentations and non-specificsymptoms.Itisa systemic infection in which any organ or system of the body can be involved. Our data showed that brucellosis is a preventable disease. Knowledge and early diagnoses of the complications are especially important

diagnostic value of sinus-track cultures in secondary pediatric chronic osteomyelitis

To determine and compare the diagnosis value and accuracy of culture of material from a sinus track with culture of material from bone specimens. Retrospective study. Dicle University Medical School and Batman State Hospital, Turkey. Twenty-one patients with secondary chronic osteomyelitis [COM]. Material for cultures was taken from the sinus as well as the bone specimens. Surgery for COM. The diagnostic value of sinus track cultures. The mean age of patients was 8.5 +/- 3.8 years. 15 [71.4%] were male and six [28.6%] were female. Organisms isolates from bone cultures were Staphylococcus 71.4% [15 / 21], Pseudomonas aeruginosa 9.5% [2 /21], Escherichia coli 9.5% [2 / 21], Proteus mirabilis 4.8% [1 / 21], Klebsiella pneumoniae 4.8% [1 / 21], respectively. Cultures of sinus track material and bone specimens gave identical results in 47.6% of patients. This study shows that if treatment of COM was planned according to the microbiological analysis of material from the sinus-track, it may not result in recovery every time. We found approximately 48% concordance between sinus-track and bone cultures. In other words, antimicrobial therapy guided by antibiograms of bacteria isolated from sinus-track would be inappropriate in 52% of patients with COM and result in treatment failure

efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis

To evaluate the efficacy of dexamethasone added to the treatment of adult patients with bacterial meningitis in our region. One hundred and forty-four patients were randomized prospectively and evaluated to determine the efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis at Dicle University Hospital, Diyarbakir, Turkey between January 2000 and December 2004. While the first group received ceftriaxone 4 gr/day plus dexamethasone, the second group received ceftriaxone 4 gr/day only Dexamethasone was given I 10-15 minutes before the first 8 mg dose of antibiotic treatment. It was continued at 16 mg/day for 3 days. The study included 144 patients with the diagnosis of acute bacterial meningitis. Cerebrospinal fluid [CSF] was analyzed at the time of admission, after 24-48 hours [Table 1], and at the end of treatment. Accordingly, CSF leukocyte level was found to be 1710 +/- 2140/mm3 in group 1 receiving dexamethasone treatment compared to 1950 +/- 2244/mm[3] in group 2 [p=0.001]. The consciousness in the group receiving dexamethasone improved significantly more rapidly than the control group [p=0.001]. While mortality was 9.7% in the patient group receiving dexamethasone it was 16.7% in the control group, however, it was not significant [p=0.093]. The use of dexamethasone in adult patients is still under debate, and the administration of dexamethasone 10-15 minutes before antibiotherapy to unconscious patients in a poor state of health, is effective in the clinical improvement of the patient