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Twohundred Intensive Care Unit (ICU) patients are consulted by our department in between October1997 to December1998 for infectious diseases. A prospective study is performed for the reasons of hospitalization, underlying diseases, risk factors, etiology, antibiotic susceptibility, type of infection and prognosis. Patients were consisted of 44% females and 56% males with a mean age of 42.2. Sixty five percent of the patients were directly admitted to the ICU where as 35% were transferred either from clinics or hospitals. 55% of the patients already had primary infections before admitted to the ICU; however, 64% of these patients were transferred to the ICU either from another clinic or hospital. In 39% of the patients, infection has developed while hospitalization in the ICU. The most common pathogens isolated from ICU patients were Staphylococcus aureus (32%), Acinetobacter spp. (16%) , coagulase negative Staphylococcus (13%), Pseudomonas spp (13%), Klebsiella spp. (10%), Escherichia coli (9%), Enterococcus spp. (5%), Candida spp. (4%), Streptococcus pneumoniae (3.7%) and Enterobacteriaceae spp. (2.6%). However for nosocomial ICU infections (n= 78) the most common pathogens were Acinetobacter spp. (25.6%), S. aureus (21.7%) and Pseudomonas spp. (%16.6). In the patients with community acquired infection (n= 40), pathogens were described as S. aureus (37.5%), E. coli (22.5%) and S. pneumoniae (12.5%). In patients transferred from another clinics or hospitals (n= 70), the most common pathogens were S. aureus (40%), coagulase negative staphylococci (18.5%) and Acinetobacter spp. (15.7%). Rate of meticillin resistant S. aureus isolated from ICU infections was 90%. Vancomcyin was the most effective antibiotic for Staphylococcus (100%) in this study, followed by trimethoprim-sulphamethoxazole. Imipenem (85%) and amikacin (60%) were the most effective antibiotics for Acinetobacter spp. Whereas ceftazidime (70%) and imipenem (60%) were the most effective agents for Pseudomonas spp. Nosocomial infection types of our patients were as follows; respiratory tract infections (27%), urinary tract infections (24.3%), bacteremia (20.5%), post-operative surgical infections (13%) and others (15%). Mortality rate for ICU patients was 44% (n= 88). It is observed that the mortality rate was significantly high for the patients having more than 20 days of hospitalization time and for the patients with APACHE II score > 15 (p < 0.05).

In this study, 130 patients with community-acquired pneumonia were prospectively investigated between January 1996 and February 1999. The aim of this study was to determine the initial treatment according to the causative agents and prognostic factors. The study group included 78 (60%) men, 52 (40%) women with a mean age of 40.5 ± 13.6 years (range 14-75 years). Underlying diseases were found in 45 (35%) cases. The major underlying diseases were chronic obstructive lung disease (16%) and diabetes mellitus (10%). The cause of pneumonia was diagnosed in 57 (44%) cases, and the most common pathogen was Streptococcus pneumoniae (17%), followed by gram negative enteric rods (8%), Mycoplasma pneumoniae (7%), Chlamydia pneumoniae (5%), Staphylococcus aureus (4%) and Legionella pneumophila (3%). The overall death rate was 3%. Fifthy two (40%) patients were hospitalized. In patients with community-acquired pneumonia, antibiotic chemotherapy was carried out according to the etiologic agents and the guidelines of the American Thoracic Society and the Turkish Thoracic Society. Community-acquired pneumonia remains a major health-care issue. The development of country-specific guidelines is an attemp to standardize initial management. But ideally, all such guidelines should be validated by appropriate prospective studies. Further studies are also required to provide data on community-acquired pneumoniae in patients who do not require admission to hospital.

The number of nosocomial infections caused by Acinetobacter spp. has increased in recent years. In this study, we evaluated 80 patients (male 70% and, mean age of all patients 38.8 ± 12) with nosocomial acinetobacter infections. Fifty three (66.3%) of 80 strains identified by Sceptor were found to be as Acinetobacter baumannii and 27 (33.7%) strains to be as A. lwoffii. All Acinetobacter spp. were multidrug resistant. Quinolone and carbapenem resistance were 60.4% and 15.1% for A. baumannii, and 44.4% and 22.2% for A. lwoffii, respectively. Nosocomial Acinetobacter infections occurred after a mean (± SD) hospitalization of 14 ± 8.8 days. Most of infections (61.3%) were acquired in an intensive care and oncology ward. Of all patients, 76 (95%) had multiple risk factors. Nosocomial infections were as follows: pneumonia in 32 (40.8%), urinary tract infection in 16 (20%), wound infection in 14 (17.5%), bacteremia in 8 (10%), meningitis in 5 (6.3%), catheter infection in 3 (3.8%) and peritonitis in 2 (2.5%) of the patients. Acinetobacter infections caused or contributed to death of 13 (16.3%) patients.

Streptococcus pneumoniae is the most common pathogen in adult bacterial meningitis. The resistance of S. pneumoniae to penicillin and other antimicrobial agents is increasing worldwide. This case report documents failure of a third generation cephalosporin in the treatment of meningitis caused by multiple drug resistant S. pneumoniae. The isolated S. pneumoniae had a minimal inhibitory concentration of >2 µg/mL for penicillin, ≥8 µg/mL for erythromycin, >8 µg/mL for imipenem and 0.5 µg/mL for ceftriaxone. Ceftriaxone (4g/day IV) was given for the treatment but, on the sixth hospital day the patient showed no clinical improvement and no improvement in laboratory parameters. Vancomycin was added to the therapy and the patient improved on the third day of combination therapy. The treatment options of resistant pneumococcal meningitis were discussed.

The rate of intrafamilial transmission of the hepatitis C virus (HCV) was investigated in 90 family members of 41 index patients with type C chronic liver disease. Antibody to HCV (anti-HCV) was detected by the EIA method (Abbott-Axsym Sys) and Hepatitis C virus RNA, by the polymerase chain reaction (Nested PCR). We also investigated the presence of anti-HCV in 350 healthy persons (control group). The subjects in the study included 38 spouses, 45 children and others (1 relative and 6 parents). Four family members including 3/38 (7.8%) spouses and 1 sister were found to be positive for anti HCV antibodies but none had HCV RNA. Anti-HCV was not detected in the children of index patients. The prevalence of anti-HCV in the families of index patients was significantly higher than in the controls (4.3% versus 0.85%) (p = 0.0355). We concluded that the intrafamilial transmission of HCV is possible but occurs at a low rate.

In this study, 54 cases with fever of unknown origin (FUO) were analysed prospectively in Infectious Disease Department at Çukurova Medical Faculty between the years 1994-1997. Among the 54 cases included in this study 49 of them(90.7%) were determined as classic FUO whereas 5 of them (9.2%) were determined as neutropenic FUO. Infections (51.8%) were the most common causes of FUO in this series. Tuberculosis constituted the most common infectious reason (32.1%). Other FUO reasons were abdominal abcess, brucellosis, infective endocarditis, cytomegalovirus infection, rhinocerebral mucormycosis and cerebral toxoplasmosis. Non infectious reasons of FUO were neoplastic diseases found in 9 cases (16.6%), collagen vascular diseases found in 16 cases (16.6%) and other diseases diagnosed in 2 cases (3.7%). On the other hand, in 6 (11.6%) of the FUO cases no diagnosis could be reached. While the reasons of cases of neutropenic FUO were lymphoma, splenic abcess, brucellosis, sytemic lupus erytematosus only in one case no diagnosis could be reached. In undiagnosed cases of FUO, 5 of them (83.3%) completely recovered and only one of them (16.6%) died. Among these cases two of them (lymphoma and the undiagnosed) were neutropenic

Adult tuberculous meningitis is an extra-pulmonary form of tuberculosis which, because of a rapid course and neurological sequela, leads to high morbidity and mortality. For this reason, an early diagnosis is important but is not always possible. The aim of this study, which was carried out between 1991-1995, was to evaluate the factors affecting the prognosis of diseases in patients which had been diagnosied as tuberculous meningitis using the patients history, clinical picture, and laboratory and radiological findings. Fifty nine percent of the patients were between 25-45 years of age. The rate of mortality in these patients 47% and when they were admitted to the hospital, 62.5% were in the second stage of the disease. In 15 (88.2%) of all patients, the symptoms had occurred 2 weeks or more before hospitalization. In the microscobic examination of CSF of 5 (29.4%) of the patients, acid fast bacilli were seen. However, M. tuberculosis grew in the cultures of CSF of only 2 of these. Evidence of active or previous pulmonary tuberculosis was found in 4 (23.5%) of our patients. Ventriculoperitoneal shuts were placed in 3 out of 8 patients who developed hydrocephalus. Multipl tüberculomas which decreased with antituberculous treatment were detected in 2 patients during treatment. In conclusion, in patients with tuberculous meningitis, the most important factors affecting the prognosis is the time between the development of symptoms and treatment as well as the neurologic phase.

PubMedID: 15008944 The objective of this study was to determine prognostic factors related to death from adult tetanus. Fifty-three cases of tetanus, 25 females and 28 males, were treated in Çukurova University Hospital during 1994-2000. The mean age was 46.6 years. Forty-one (77.7%) patients came from rural areas. Most (64.1%) cases had minor trauma, but 19 (35.8%) had deep injuries. The mean incubation period was 11.5 days. Mortality was high (52.8%), caused by cardiac or respiratory failure or complications, and was related to the length of the incubation period. In cases with an incubation period ?7 days, the mortality rate was 75% (p 0.07). Mortality was significantly associated with generalised tetanus (p < 0.05), fever of ?40 °C, tachycardia of >120 beats/min (p < 0.05), post-operative tetanus (p 0.03), and the absence of post-traumatic tetanus vaccination (p 0.068). Patients who were given tetanus human immunoglobulin or tetanus antiserum (p > 0.05) had similar outcomes. Patients who were given penicillin had a mortality rate similar to patients who were given metronidazole (p 0.15). The mortality rate was higher (92%) in patients with severe tetanus than in patients with moderate disease (53%). By multivariate analysis, the time to mortality caused by tetanus, and also the mortality rate, were both related significantly to age and tachycardia. © 2004 Copyright by the European Society of Clinical Microbiology and Infectious Diseases.

PubMedID: 14667795 Objectives. To investigate fever of unknown origin (FUO) in 87 patients. Methods. We investigated 87 (61 male) patients with FUO using the criteria of Petersdorf and Beeson [Medicine 40 (1961 ) 1] hospitalized between January 1994 and August 2002 at Cukurova University Hospital. Results. The median age of the patients was 38.5 years (range: 14-80 years). Eleven patients (12.6%) were over 65. The mean duration of hospitalization was 22.5 ± 13 days. Infectious diseases were the most common causes of FUO. Tuberculosis (n = 15, 17.2%), infective endocarditis (n = 6), abdominal abscess (n = 6), brucellosis (n = 5), urinary tract infection (n = 5), visceral leishmaniasis (n = 4), salmonellosis (n = 3), rhinocerebral mucormycosis (n = 4), atypical pneumonia, cerebral toxoplasmosis, Cytomegalovirus infection or encephalitis were diagnosed in 51 (58.6%) patients. The second most common causes of FUO were collagen vascular diseases (n = 16, 18.3%) determined as vasculitis syndrome, adult Still's disease (n = 4), systemic lupus erythematosus, Behçet's disease, juvenile ankylosing spondylitis. Neoplasm was found in 12 (13.7%) patients; (non-Hodgkin lymphoma, Hodgkin lymphoma, chronic myeloid leukemia, gastrointestinal tract carcinoma, glioma). Miscellaneous diseases thyroiditis, granulomatous hepatitis were diagnosed in two (2.2%) patients. On admission, six patients (6.8%) were neutropenic. Conclusions. Infectious diseases, especially tuberculosis, were the leading diagnostic category of FUO in this study. Adult Still's disease was more common than expected. An aetiological diagnosis could not be reached in six (7%) patients who were followed for 1 year. Five of these patients completely recovered, and one patient died. © 2003 The British Infection Society. Published by Elsevier Ltd. All rights reserved.

The aim of this study was to determine the reference ranges of lymphocyte subsets in serologically HIV-negative healthy adults in Turkey. Materials and Methods: Blood samples from 220 healthy adults, 105 female and 115 male, collected into tubes containing EDTA were investigated for lymphocyte subsets using flow cytometry. The age range was 18–80 years (44.80 ± 16.69). Results: The mean percentage and absolute values of the lymphocyte subsets were as follows: CD3: 72.70 ± 8.44%, 1,680 ± 528 cells/µl; CD4: 47.37 ± 9.10%, 1,095 ± 391 cells/µl; CD8: 28.99 ± 5.99%, 669 ± 239 cells/µl; CD19: 10.96 ± 4.44%, 254 ± 122 cells/µl and CD56: 7.03 ± 3.26%, 161 ± 92 cells/µl, respectively. The ratio of CD4/CD8 was 1.68 ± 0.43. There was no statistically significant difference in the percentages and absolute values of lymphocyte subsets between the genders (p > 0.05). Conclusion: Immunophenotyping has been used to establish reference values of lymphocyte subsets in normal healthy adults in Turkey.

Purpose: There is a continuing increase in resistance to penicillin which is commonly used in treatment of Streptococcus pneumoniae infections. This study was carried out in order to determine the rate of resistance to penicillin in S. pneumoniae isoleted in our hospital. Methods: Colonies on blood agar which resembled pneumonoccoccal colonies were tested with optochin disks. Identification of the bacteria was made using Sceptor system panels each of which contain 24 biochemical test including bile solubility and bile esculin as well as antibiotic susceptibility tests. Results: Between October 1993 and June 1995, 231 Streptococcus pneumoniae strains were isolated from various specimens from hospitalized patients and outpatients. Forty five (19%) of these strains were found to be resistant to penicillin (MIC > 1 µg/ml); 68 (29%), moderately resistant (MIC 0.1-1 µg/ml); and 118 (51%), susceptible (MIC < 0.06 µg/ml). The highest rates of penicillin resistance were detected in S.pneumoniae isolated from wound infections, spinal fluid, and blood (31%, 26%, 23%, respectively). There was no resistance to vancomycin. Conclusion: The results of this study indicated that S.pneumoniae infections should not be treated with penicillin or other antibiotics without confirmation of sensitivity with susceptibility tests.

PubMedID: 9610133 We report three cases with rhinocerebral zygomycosis in two diabetic persons and one otherwise healthy person. The diagnosis was established by histopathological appearance and computerized tomography (CT) and/or magnetic resonance imaging (MRI) scans. These cases were successfully treated by a combination of surgery and liposomal amphotericin B.