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Cat scratch disease is a zoonotic infectious disease caused by Bartonella henselae. It is usually observed in children and young adults who have a history of contact with cats. It is an important cause of infectious lymphadenopathies and the most common involvement sites are axillary, cervical and inguinal lymph nodes. In this report, we present two male adult cases who complained of axillary and inguinal lymphadenopathy, respectively. Both have a history of contact with cats. The excisional biopsies of the lymphadenopathies were performed. The histopathological examination revealed the granulomatous lymphadenitis, which is consistent with cat scratch disease. Investigation of the patients' serum samples for the presence of specific B. henselae antibodies by indirect immunofluorescence assay revealed B. henselae IgM type antibodies at a titer of 1/40 and 1/320, respectively. The patients were successfully treated with azithromycin. Since, cat scratch disease is a rare infection of adults, it should be taken into consideration in the patients suffering from regional lymphadenopathy with history of direct contact with cats. [ABSTRACT FROM AUTHOR]

Objective: Urinary tract infection is one of the most common bacterial diseases in elderly patients. The objective of this study is to determine the antibiotic resistance rates against first-line antibiotics used for the treatment of community-acquired urinary tract infections in elderly patients at our hospital, and use the results as guidance for empirical antibiotic therapy. Methods: In this study, data on all elderly patients aged 65 and older who were followed and treated in our hospital between March 2010 and March 2012 were evaluated retrospectively. Results: 406 microorganisms were isolated from the urine cultures of 401 patients included in the study, because 5 (1.2%) patients harbored two microorganisms. Of the 406 microorganisms, 320 (78.8%) were Gram-negative bacilli, 72 (17.7%) were Gram-positive cocci and 14 (3.5%) were Candida spp. Escherichia coli (n=262, 64.5%), Klebsiella pneumoniae (n=27, 6.6%), and Pseudomonas aeruginosa (n=17, 4.1%) were the most common among Gram-negatives, and Enterococcus faecalis (n=36, 8.9%) and coagulase-negative staphylococci (n=25, 6.2%) were the most common among Gram-positives. Susceptibility rates of E. coli strains were 89% for nitrofurantoin, 81% for trimethoprim-sulfamethoxazole, 77% for amoxicillin-clavulanic acid, 70% for gentamicin and 66% for ciprofloxacin. Conclusions: Antimicrobial resistance must be monitored at each hospital in order to make correct choices for empirical antibiotic therapy. Surveillance studies are helpful for this purpose. In conclusion, nitrofurantoin and trimethoprim-sulfamethoxazole can safely be used for the empirical treatment of urinary tract infections in elderly patients. [ABSTRACT FROM AUTHOR]

Objective: Antibiotics are the most frequently used drugs in our country, as being all over the world. It has been shown that the rate of inappropriate use of antibiotics is around 40% to 60% in hospitals. Excessive and inappropriate use of antibiotics causes emergence of resistant organisms, significant adverse effects, increased costs and increased morbidity and mortality. Methods: This study was carried out at Midyat State Hospital between June 2007 and June 2008. The period of time between June 2006 and June 2007 and between June 2007 and June 2008 are defined as Period I and II, respectively. Antibiotics which were given to inpatients and for surgical prophylaxis were followed up. Subsequently, usage ratios of antibiotics in Period I and II were compared for a cost-utility analysis. Results: The total cost of inappropriate antibiotic use per year was calculated as 55 750.4 TL in our hospital. However, the most frequent cause of inappropriate use in surgical prophylaxis was related to prolonged use of prophylactic antibiotics (16.2%). Conclusions: Several strategies for regulating antimicrobial prescribing practices may be proposed, such as formulary replacement or restriction, healthcare provider education, feedback activities, and approval from an infectious diseases physician. However, a multidisciplinary antibiotic team organized for hospitals to approve the appropriate antibiotic use may be another alternative. [ABSTRACT FROM AUTHOR]

Objective: Antibiotics are the most frequently used drugs in our country, as being all over the world. It has been shown that the rate of inappropriate use of antibiotics is around 40% to 60% in hospitals. Excessive and inappropriate use of antibiotics causes emergence of resistant organisms, significant adverse effects, increased costs and increased morbidity and mortality. Methods: This study was carried out at Midyat State Hospital between June 2007 and June 2008. The period of time between June 2006 and June 2007 and between June 2007 and June 2008 are defined as Period I and II, respectively. Antibiotics which were given to inpatients and for surgical prophylaxis were followed up. Subsequently, usage ratios of antibiotics in Period I and II were compared for a cost-utility analysis. Results: The total cost of inappropriate antibiotic use per year was calculated as 55 750.4 TL in our hospital. However, the most frequent cause of inappropriate use in surgical prophylaxis was related to prolonged use of prophylactic antibiotics (16.2%). Conclusions: Several strategies for regulating antimicrobial prescribing practices may be proposed, such as formulary replacement or restriction, healthcare provider education, feedback activities, and approval from an infectious diseases physician. However, a multidisciplinary antibiotic team organized for hospitals to approve the appropriate antibiotic use may be another alternative. [ABSTRACT FROM AUTHOR]

Objective: Tick-borne diseases including Crimean-Congo haemorrhagic fever (CCHF) pose a serious epidemiological problem all over the world. The aim of this study is to determine the demographic properties of the reported cases with a tick bite and to evaluate their results of follow up and investigations. Methods: Age, sex, complaints at admission and on following days, epidemiological history, information on who, when and how removed the tick, bitten region and laboratory findings of patients seen in the Midyat State Hospital due to tick bites between May 2007 and August 2008 were recorded Results: Mean age of 61 patients admitted to the hospital was 18.2±7.1. Lower extremities (57.1%) were the most common sites bitten. Tick bites were most commonly seen in June, July, and August. Physical and laboratory findings were normal except for fever in four patients. In four patients with fever, a rapid defervescence was observed during follow up. In three patients, another infectious disease was also diagnosed. Their serum samples were found negative for CCHF virus. Conclusions: In the majority of tick bites, no symptoms develop. Asymptomatic patients with tick bite should be informed about CCHF and followed until the end of its presumed incubation period. This study revealed that it is not necessary to hospitalize the patients and perform the laboratory tests after removal of ticks. Instead, it is more appropriate to apply for health care if symptoms such as fever, headache, fatigue, nausea and vomiting develop within 10 days. [ABSTRACT FROM AUTHOR]

Objective: Brucellosis is an endemic zoonotic disease in our country and may lead to complications affecting many systems. Infection is frequently transmitted to humans via discharges of infected animals or unpasteurized milk and dairy products. The disease is characterized by fever, malaise, sweating, anorexia and arthralgia, which are non-speci c symptoms. The objective of this study was to evaluate the epidemiological, clinical and laboratory ndings, and complications and treatments of the patients with brucellosis. Methods: In this study, 78 patients with brucellosis, followed in Departments of Infectious Diseases and Neurology between April 2007 and August 2008 were evaluated retrospectively. Diagnostic criteria were standard tube agglutination test at a titer of =1/160 with symptoms suggestive of brucellosis. Results: 46 (59%) of the patients were female and 32 (41%) were male. Mean age was 36.4±14.2 (range 17-73) years. Rates of acute, subacute and chronic infection were 79, 16, and 5% respectively. The most common mode of transmission was consumption of unpasteurized milk products (74%). The main symptoms were fever, malaise, arthralgia, myalgia and sweating. The frequent signs were fever (82%), hepatomegaly (28%) and splenomegaly (23%). Increased C-reactive protein in 69 (88%) patients, increased serum transaminase levels in 32 (41%) patients, anemia in 34 (43%) patients and leukocytosis in 4 (5.2%) patients were detected. The most frequent regimen was doxycyline and rifampicin among three different regimens. Treatment failure and relapse rate was 5.2% and 2.6%, respectively. Conclusions: The fact that the symptoms and ndings of brucellosis show variability makes clinical diagnosis dif cult and can delay treatment. For this reason, in the presence of fever and osteoarticular symptoms, especially in patients living in endemic regions, brucellosis should be considered in differential diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Infection, tissue damage, immunologic reactions and the inflammatory process rapidly cause a systemic response in the organism, generally termed as acute phase response. The aim of this study was to evaluate the levels of acute phase reactants such as C-reactive protein (CRP), ferritin and fibrinogen in patients with acute brucellosis. Methods: This study was carried out in 48 patients (27 female, 21 male) with acute brucellosis who were followed at the Departments of Infectious Diseases and Neurology, between April 2007 and August 2008, and in 42 healthy controls (22 female, 20 male). Results: Serum albumin levels significantly decreased (p<0.001), whereas CRP and ferritin levels significantly increased (p<0.001 and p=0.03) in patients with acute brucellosis. Conclusions: It was concluded that serum levels of CRP and ferritin increased, while albumin decreased in patients with acute brucellosis. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis is a life-threatening soft-tissue infection characterized by progressive necrosis of the skin, subcutaneous tissue, and fascia. A twenty-three year-old female patient presented with erythema and pain in the left thigh; both had started 15 days previously. Physical examination revealed swelling, warmth in the left thigh and pain related to passive movement. During follow up, the area involved developed echymotic bullous lesions which shortly spread to the perineal region. Despite appropriate antibiotic therapy and supportive management, the lesions progressed and surgical debridement was carried out . Deep wound and blood cultures revealed Staphylococcus aureus. Clearly, the mortality and morbidity can be decreased with clinical awareness, early diagnosis, effective surgical debridement, and intensive supportive care. In this study, we present a rare case of necrotizing fasciitis in an adult who had no predisposing factor and discuss its clinical manifestations and the best therapeutic choice for this potential life threatening disease, together with a review of the literature. [ABSTRACT FROM AUTHOR]

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