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Synthetic vascular grafts are commonly used in liver transplantation. Thrombosis is a possible complication of using expanded polytetrafluoroethylene (e-PTFE) grafts. Herein, we report on 3 cases of liver recipients who died of intermittent sepsis episodes emerged concurrently with the thrombosis in synthetic vascular grafts and inferior vena cava (IVC) vein. Right lobe liver transplantation from living donors was performed for 3 patients by using e-PTFE grafts between the liver and IVC. Although heparin had been administered, thrombosis was developed in vascular graft and IVC extending to the right atrium; it was developed within 1-4 months of transplantations. All 3 patients suffered from recurrent sepsis episodes (4, 5, and 6 attacks for each patient) by different multidrug-resistant bacterial species. Treatment attempts including thrombolytic and antimicrobial drugs made, and surgical, endoscopic and radiological interventions could not resolve the clinical situation. The patients died of septic complications. We concluded that severe recurrent sepsis attacks may develop in liver transplant recipients when IVC and synthetic vascular graft were thrombosed. Removing the e-PTFE graft may be benefit for the treatment.
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OBJECTIVE: The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. METHODS: Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes. RESULTS: A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. CONCLUSION: The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.
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Infecciones por VIH/epidemiología , VIH/patogenicidad , Hepacivirus/patogenicidad , Virus de la Hepatitis B/patogenicidad , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/virología , Niño , Preescolar , Coinfección , Diagnóstico Tardío , Femenino , VIH/efectos de los fármacos , VIH/fisiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , Infecciones por VIH/virología , Hepacivirus/efectos de los fármacos , Hepacivirus/fisiología , Hepatitis B/tratamiento farmacológico , Hepatitis B/mortalidad , Hepatitis B/virología , Virus de la Hepatitis B/efectos de los fármacos , Virus de la Hepatitis B/fisiología , Hepatitis C/tratamiento farmacológico , Hepatitis C/mortalidad , Hepatitis C/virología , Heterosexualidad/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Turquía/epidemiología , Carga Viral/efectos de los fármacosRESUMEN
Pyoderma gangrenosum (PG) is a rare, but serious neutrophilic dermatosis characterized by recurrent painful cutaneous ulcerations. It is commonly associated with inflammatory bowel disease, rheumatoid arthritis, and hematological malignancies. Because laboratory evaluations and histologic features of PG are nonspecific, diagnosis is based on the clinical features of the ulcer and requires exclusion of other conditions that cause such ulceration. The disease responds to glucocorticoids, immunosuppressives, and anti-inflammatory drugs. We present a 30-year-old man with acute myelogenous leukemia (subtype M5) and bullous PG. Treatment with high-dose prednisolone was successful.
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Diagnóstico Tardío , Leucemia Mieloide Aguda/complicaciones , Piodermia Gangrenosa/diagnóstico , Adulto , Glucocorticoides/uso terapéutico , Humanos , Masculino , Prednisolona/uso terapéutico , Piodermia Gangrenosa/tratamiento farmacológico , Piodermia Gangrenosa/etiologíaRESUMEN
BACKGROUND: Bloodstream infection (BSI) is an important concern in transplant patients. Early intervention with appropriate antimicrobial therapy is critical to better clinical outcome; however, there is significant delay when conventional identification methods are used. METHODS: We aimed to determine the diagnostic performance of the FilmArray Blood Culture Identification Panel, a recently approved multiplex polymerase chain reaction assay detecting 24 BSI pathogens and 3 resistance genes, in comparison with the performances of conventional identification methods in liver transplant (LT) patients. A total of 52 defined sepsis episodes (signal-positive by blood culture systems) from 45 LT patients were prospectively studied. RESULTS: The FilmArray successfully identified 37 of 39 (94.8%) bacterial and 3 of 3 (100%) yeast pathogens in a total of 42 samples with microbial growth, failing to detect only 2 of 39 (5.1%) bacterial pathogens that were not covered by the test panel. The FilmArray could also detect additional pathogens in 3 samples that had been reported as having monomicrobial growth, and it could detect Acinetobacter baumannii in 2 samples suspected of skin flora contamination. The remaining 8 blood cultures showing a positive signal but yielding no growth were also negative by this assay. Results of MecA, KPC, and VanA/B gene detection were in high accordance. The FilmArray produced results with significantly shorter turnaround times (1.33 versus 36.2, 23.6, and 19.5 h; P < .05) than standard identification methods, Vitek II, and Vitek MS, respectively. CONCLUSIONS: This study showed that the FilmArray appeared as a reliable alternative diagnostic method with the potential to mitigate problems with protracted diagnosis of the BSI pathogens in LT patients.
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Bacteriemia/diagnóstico , Trasplante de Hígado , Reacción en Cadena de la Polimerasa Multiplex/métodos , Adulto , Bacteriemia/microbiología , Bacterias/aislamiento & purificación , Técnicas Bacteriológicas , Femenino , Hongos/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Progressive multifocal leukoencephalopathy (PML) is a lytic infection of the central nervous system caused by the reactivation of John Cunningham Virus (JCV) in severely immunosuppressed patients. Occurrence of PML after solid organ transplantations, especially after liver transplantation, is rare. If a patient has poor prognostic factors such as atypical radiological involvements or high viral load in cerebrospinal fluid (CSF), overall survival rates could be poor. Herein, we report on a patients who underwent liver transplantation three times and developed PML with unexpected radiological findings; he was also positive for JCV DNA with a high viral load. Although there are limited data about efficacy of cytarabine against JCV, it was given to the patient for five days. Despite the initiation of cytarabine and complete cessation of the immunosuppressive therapy, we lost the patient, unfortunately.
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OBJECTIVES: Cutaneous anthrax (CA) is the most common clinical presentation in human anthrax, but the duration of antibiotic therapy in naturally occurring CA is controversial. The aim of this study was to compare the clinical outcomes of patients receiving antibiotic treatment for either 3-5 days (group 1) or 7-10 days (group 2) in uncomplicated CA. METHODS: A total of 66 patients were enrolled; 29 (44%) in group 1 and 37 (56%) in group 2. Infections were classified as mild (n = 22, 33%) or severe (n = 44, 67%) CA. RESULTS: There were no significant differences between the groups in symptom resolution time, fever clearance time, healing of lesions, development and healing of eschars, requirement for surgical intervention or the development of complications. Both edema resolution time and duration of hospital stay were longer in group 2. There were no therapeutic failures, relapses or deaths in either group. Steroid therapy was used in 32% of patients with severe CA, but a beneficial effect on resolution of edema was not demonstrated. CONCLUSIONS: These results suggest that short-course antibiotic therapy is as effective as standard-duration therapy in uncomplicated CA and that steroid therapy may not be effective.
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Carbunco/tratamiento farmacológico , Antibacterianos/uso terapéutico , Adolescente , Adulto , Anciano , Amoxicilina/uso terapéutico , Carbunco/patología , Ciprofloxacina/uso terapéutico , Doxiciclina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Penicilina G Procaína/uso terapéutico , Estudios Prospectivos , Enfermedades Cutáneas Bacterianas , Resultado del Tratamiento , Adulto JovenRESUMEN
We describe the first case of isosporiasis in a liver transplant patient. Watery diarrhea due to Isospora belli was observed in a woman who had undergone liver transplantation 8 months prior. She was successfully treated with trimethoprim-sulfamethoxazole. This parasite should be taken into consideration as an opportunistic infection in transplant patients who need increased hygienic awareness.
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Isosporiasis/diagnóstico , Trasplante de Hígado/efectos adversos , Complicaciones Posoperatorias/parasitología , Adulto , Animales , Antiparasitarios/uso terapéutico , Femenino , Humanos , Huésped Inmunocomprometido , Isospora , Isosporiasis/tratamiento farmacológico , Trasplante de Hígado/inmunología , Complicaciones Posoperatorias/inmunología , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Protective effects of steroids against ischemia-reperfusion (I/R) injury are well known, but there is little information about the influence of temporary inflow occlusion on intestinal barrier function or bacterial translocation. The aim of this experimental study was to investigate the effects on liver, kidney, spleen, ileal mitochondrial stress enzymes, and bacterial translocation of methylprednisolone (MP) in rats undergoing temporary liver inflow occlusion. Twenty-seven pathogen-free Wistar albino rats were randomized into three groups: group A: I/R (n = 10); group B: I/R + MP (n = 10); and group C: sham (n = 7). Rats in groups A and B were subjected to 20 minutes of portal vein and hepatic artery occlusion with 3 mg/kg MP injected into group B animals intraperitoneally during the occlusion. Twenty-two hours later, all rats were sacrificed to measure mitochondrial oxidative stress enzymes in liver, kidney, spleen, and ileum. We evaluated intestinal bacterial counts, intestinal mucosal histopathology, bacterial translocation to mesenteric lymph nodes (MLN), liver, spleen, and kidney. Decreased levels of malondialdehyde and increased levels of glutathione were observed in all examined tissues of group B compared to those of group A rats. Statistically significant increases in the intestinal counts of Klebsiella spp and Proteus spp and of bacterial translocation to liver, kidney, spleen, and MLN were measured in group B with respect to group A.
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Traslocación Bacteriana/efectos de los fármacos , Circulación Hepática , Metilprednisolona/farmacología , Mitocondrias Hepáticas/metabolismo , Estrés Oxidativo/fisiología , Daño por Reperfusión/fisiopatología , Animales , Modelos Animales de Enfermedad , Glutatión/metabolismo , Riñón/metabolismo , Klebsiella/aislamiento & purificación , Hígado/microbiología , Ganglios Linfáticos/microbiología , Masculino , Malondialdehído/metabolismo , Óxido Nítrico/metabolismo , Proteus/aislamiento & purificación , Ratas , Ratas Wistar , Bazo/microbiologíaRESUMEN
The aim of the study was to determine the correlation of the antibacterial substance nitric oxide (NO) with dental caries in vivo. Salivary and dental plaque NO concentrations were analyzed by the Griess method in 11 subjects with high DMFT index and simplified oral hygiene index (OHI-S), 11 with low DMFT and OHI-S. Subjects with high DMFT and OHI-S had significantly higher NO concentrations in saliva (71.5 microM) and plaque (83.5 microM) than those with low DMFT and OHI-S (33.2 and 61.1 microM in saliva and plaque, respectively). Plaque NO concentrations were significantly higher than in saliva in both groups. NO production might be a host defense mechanism when dental caries increases or oral hygiene deteriorates.
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Índice CPO , Placa Dental/química , Depuradores de Radicales Libres/análisis , Óxido Nítrico/análisis , Índice de Higiene Oral , Saliva/química , Adolescente , Adulto , Cálculos Dentales/química , Caries Dental/metabolismo , Depósitos Dentarios/química , Femenino , Humanos , Masculino , Higiene BucalRESUMEN
The in vitro reduction of a bacterial population in a root canal by mechanical instrumentation using three techniques was evaluated. Root canals inoculated with a Enterococcus faecalis (E. faecalis) suspension were instrumented using hand Hedstroem files, Giromatic files, and Hero 642 rotary instruments. Irrigation was performed using sterile saline solution. Root canals were sampled before and after instrumentation. After serial dilutions, samples were plated onto Mitis-Salivarius agar and the colony forming units grown were counted. All instruments tested were able to significantly reduce the number of bacterial cells in the root canal, however, the results of this study indicated that Hedstroem files, Giromatic, and Hero 642 techniques were not significantly different in their ability to reduce intracanal bacteria.
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Instrumentos Dentales , Cavidad Pulpar/microbiología , Preparación del Conducto Radicular/instrumentación , Preparación del Conducto Radicular/métodos , Diente Premolar , Recuento de Colonia Microbiana , Aleaciones Dentales , Enterococcus faecalis , Diseño de Equipo , Humanos , Níquel , Acero Inoxidable , TitanioRESUMEN
Brucellosis, a zoonosis with worldwide distribution, is a systemic infection and still an important public health problem in Turkey. The best antimicrobial combination and schedule for the treatment of brucellosis with spondylitis has not yet been clearly determined. In a prospective and randomized study, we compared the efficacy of five antimicrobial regimens for treatment of 102 patients with lumbar brucellar spondylitis. Patients were randomly assigned to receive antimicrobial combination therapy. Twenty patients received streptomycin 1 g/day intramuscularly for 15 days and tetracycline-HCl, 500 mg every 6 h orally for 45 days (ST), 21 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days (SD), 20 patients received doxycycline 100 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (DR), 19 patients received ofloxacin, 200 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (OR), and 22 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days plus rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (SDR). Initial therapeutic failure occurred in 2 patients (10%) in the ST regimen group, 4 patients (19%) in the SD group, 3 patients (15%) in the DR group and 5 patients (26%) in the OR regimen. In addition, 2 patients (10%) in the DR group and 5 patients (26%) in the OR regimen relapsed during the follow-up period. There was no relapse in any patients in the ST, SD, and SDR groups. The response rates were 90% in the ST and 81% in the SD groups. In contrast, there was a maximum good response (100%) and no relapse in the SDR group. In conclusion, a combination of doxycycline, streptomycin, and rifampicin can be recommended as therapy for brucellar spondylitis and to reduce relapse rates.
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Antibacterianos/uso terapéutico , Brucella/patogenicidad , Brucelosis/tratamiento farmacológico , Espondilitis/tratamiento farmacológico , Adulto , Anciano , Antibacterianos/administración & dosificación , Brucelosis/microbiología , Brucelosis/patología , Doxiciclina/administración & dosificación , Doxiciclina/uso terapéutico , Farmacorresistencia Bacteriana , Quimioterapia Combinada , Inhibidores Enzimáticos/administración & dosificación , Inhibidores Enzimáticos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Rifampin/administración & dosificación , Rifampin/uso terapéutico , Espondilitis/microbiología , Espondilitis/patología , Estreptomicina/administración & dosificación , Estreptomicina/uso terapéutico , Resultado del TratamientoRESUMEN
The present study was performed to describe the incidence and risk factors for nosocomial infections (NIs) in the intensive care units of a University hospital. From January to July 2002, 454 patients from Medical and Surgical Intensive Care Unit (MICU and SICU) were observed in the active, targeted, prospective surveillance study. Risk factors for NIs were found by logistic regression analysis. Two hundred and eighteen NIs were recorded in 149 of 454 screened patients. The overall incidence rate was calculated as 33% in the ICUs. The incidence was 39% in MICU and 29% in SICU. The most frequent nosocomial infection observed in MICU, and SICU was pneumonia (42%), and surgical wound infection (31%), respectively. Extrinsic risk factors were urinary catheter, mechanical ventilation, total parenteral nutrition, entubation, antimicrobial treatment prior to the NI, nasogastric cathater and central catheter. The highest intrinsic risk factor was unconsciousness in MICU, respiratory failure in SICU. This high NI rates may be reduced by timely feedback of data for infection control activities. The recognition of risk factors for NIs is an important tool for the identification and development of interventions to minimize such risks in the ICU's.
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Infección Hospitalaria/epidemiología , Control de Infecciones/métodos , Unidades de Cuidados Intensivos , Adolescente , Adulto , Factores de Edad , Cateterismo , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nutrición Parenteral , Estudios Prospectivos , Respiración Artificial , Insuficiencia Respiratoria , Factores de Riesgo , Factores Sexuales , Turquía/epidemiología , InconscienciaRESUMEN
Extrapulmonary tuberculosis is known to be the infection in an organ with or without pulmonary involvement. The infection in extrapulmonary tuberculosis is insidious and the symptoms and signs are generally nonspecific. We describe a 56-year-old male patient complaining of weight loss, fever, and night sweats. Although there were no signs and symptoms attributable to pulmonary tuberculosis, polymerase chain reaction (PCR), microscobical and cultural examination of bone marrow aspirate revealed isolated bone marrow tuberculosis. A treatment protocol of isoniazid, rifampicin, pyrazinamide, and streptomycin was administered. After 9 months of treatment, re-examination of the bone marrow revealed no signs of tuberculosis. Tuberculosis should be kept in mind especially in endemic areas and bone marrow should be examined in case of suspected tuberculosis infection.
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Antituberculosos/uso terapéutico , Médula Ósea/patología , Fiebre/diagnóstico , Sudoración , Tuberculosis Miliar/diagnóstico , Pérdida de Peso , Diagnóstico Diferencial , Humanos , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Estreptomicina/uso terapéutico , Tuberculosis Miliar/tratamiento farmacológicoRESUMEN
Brucellosis is one of the leading diseases in the differential diagnosis of fever of unknown origin in some parts of the world. It can lead to treatment failure because of slow growth in blood cultures and late appearance of signs and symptoms in patients with febrile neutropenia who were unresponsive to empirical antibiotic treatment. During the last year in our oncology unit adjuvant chemotherapy was given to 3 patients with breast (n=1) and stomach cancer (n=2) and febrile neutropenia was seen after the first course of chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil, etoposide, Adriamycin, and cisplatin) in all 3 patients. Cefepime and amikacin were commenced but the fever continued. Prior to antifungal treatment, the patients were re-evaluated because of the history of unpasteurized milk ingestion without overt signs and symptoms. Serum agglutination tests of brucellosis were performed and were 1:640 in two patients and 1:320 in the third. Brucella melitensis was identified only in one case although multiple blood cultures were taken from all 3 patients. Empiric antibiotic treatment was stopped and streptomycin 1 g/day (10 days), doxycycline 200 mg/day (28 days), trimethoprim 320 mg and sulfamethoxazole 1600 mg/day (28 days) were given. Although neutropenia continued, fever subsided in 3 days. Due to high incidence of brucellosis in some geographic areas, especially in the Middle East, brucellosis should be kept in mind in the differential diagnosis of febrile neutropenia.