RESUMEN
BACKGROUND/AIM: In this observational study, the effects of oral ribavirin on clinical and laboratory parameters and blood products use in patients with Crimean-Congo hemorrhagic fever (CCHF) were evaluated. MATERIALS AND METHODS: CCHF patients (n = 100) who were hospitalized between 2007 and 2010 were included. Oral ribavirin was administered to 56 patients with symptom duration less than 5 days. Forty-four patients did not receive ribavirin (control group). The patients that received ribavirin in the first 3 days following the initiation of symptoms were designated as Group 1 (n = 29) and the others were designated as Group 2. RESULTS: Ribavirin-treated and untreated groups were similar in terms of demographic and most clinical characteristics. Leukocyte and platelet counts were lower in the ribavirin group than in the control group, but values of prothrombin time, activated partial thromboplastin time, aspartate aminotransferase, creatinine phosphokinase, and lactate dehydrogenase were higher (P = 0.011, P = 0.015, P = 0.001, P = 0.001, P = 0.021, P = 0.019, P = 0.004, respectively). Platelet concentrates use was greater in the ribavirin group (P = 0.01). CONCLUSION: No positive effects of oral ribavirin on blood products use or clinical or laboratory parameters of CCHF patients were observed. Moreover, no difference was shown between early and late initiation of ribavirin.
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Virus de la Fiebre Hemorrágica de Crimea-Congo , Administración Oral , Antivirales , Humanos , Ribavirina , TurquíaRESUMEN
OBJECTIVE: Due to lack of effective treatment for rabies, post-exposure prophylaxis becomes very important. In this study, we investigated side effects developed in patients following administration of rabies post-exposure prophylaxis. METHODS: A total of 1685 patients were vaccinated. 265 patients (15.7%) administered the Essen regimen with equine rabies immunoglobulin and 1420 patients (84.2%) administered Zagreb regimen. 761 (45.2%) patients were vaccinated with a verocell vaccine; Verorab and 924 patients (54.8%) were vaccinated with Abhayrab. RESULTS: All side effects were higher in female patients than those of males. The patients with chronic illness also had significantly, increased side effects; headache (12.4%), pain at site of administration (11.3%), and arthralgia (10.5%) compared to the patients without chronic illness. We grouped the patients in three as; 0-15 years, 15-60 years, and 60 years and above. In the first group; fever (21.2%), vomiting (2.4%) and coughing (2.1%); in the second group (15-60 years), headache (8.8%), arthralgia (6.7%) were significantly increased compared to the other groups. Side effects are significantly higher with schema of 2-1-1 and Abhayrab trade mark vaccine, particularly following the first doses. DISCUSSION: Second generation rabies vaccines are safe, effective and cheaper than HDCV. When fatality of rabies disease is considered, occurring side effects can be tolerated.
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Vacunas Antirrábicas/efectos adversos , Rabia/prevención & control , Adolescente , Adulto , Animales , Mordeduras y Picaduras/virología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Profilaxis Posexposición/métodos , Rabia/epidemiología , Vacunas Antirrábicas/administración & dosificación , Distribución por Sexo , Encuestas y Cuestionarios , Resultado del Tratamiento , Turquía/epidemiología , Adulto JovenRESUMEN
Parallel to the developments in the field of diagnosis and treatment, an increase in the incidence of fungal infections and the number of patients who are in the risk group for the development of opportunistic fungal infections have been observed in the recent years. Among the hospitalized patients, those most at risk in terms of fungal infections are intensive care unit (ICU) patients. The rate of Candida colonization of mucous membranes in hospitalized patients may reach to 80%, and this may predispose to the establishment of severe infections especially in patients under risk. The aim of this study was to evaluate the rate of Candida colonization and to use Candida colonization index in the intensive care unit patients in Ankara Training and Research Hospital, Ankara, Turkey. A total of 100 adult patients (46 female, 54 male; age range: 18-93 years, mean age: 65.28 ± 17.53 years) who were hospitalized for ≥ 7 days in the neurology (n= 56), anesthesia-reanimation (n= 24) and neurosurgery (n= 20) intensive care units between September 2008 to February 2009, were included in the study. Throat, nose, skin (axilla), urine, rectal swab cultures and additionally when necessary tracheal aspirates, drain and central vascular catheter cultures were taken weekly from each patient. Candida colonies were identified by using germ tube test, CHROMagar Candida Medium (Becton Dickinson, Germany) and ID 32 C (BioMeriux, France) yeast identification kit. Candida colonization index (CI) was calculated for each patient, and CI was defined as the ratio of the number of culture-positive distinct body sites to the total number of body sites cultured. Patients with CI > 0.2 were considered as Candida colonized. In our study, Candida colonization was found in 42 of 100 (42%) patients, of them 8 were heavily colonized (CI ≥ 0.50), and 34 were slightly colonized (C I < 0.50). The highest Candida colonization was detected in throat, urine and rectal swab samples, while none of the tracheal aspirate samples yielded Candida spp. growth. Invasive Candida infections subsequently developed in 21.4% (9/42) of the colonized patients, namely candidemia in five and Candida associated urinary tract infections in four cases. Our data indicated that, the number of colonized patients were higher in the surgical (anesthesia-reanimation and neurosurgery) intensive care units (p< 0.05), in patients staying in the ICU for longer periods (p= 0.000) and in patients with higher number of application of invasive instruments (p< 0.05) compared to those of non-colonized cases. Additionally Candida colonization emerged more often in patients with bacterial sepsis and in those exposed to broad spectrum antibiotics (p< 0.05). Use of broad spectrum antibiotics in the ICU, length of stay in the ICU and having central venous catheter were found as independent risk factors for Candida colonization. The sensitivity, specificity, positive and negative predictive values of colonization index for the detection of developing Candida infections in colonized patients were estimated as 100%, 64%, 21% and 100%, respectively. In conclusion, Candida colonization and Candida colonization index may be used as useful parameters to predict invasive Candida infections.
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Candidiasis/epidemiología , Infecciones Oportunistas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Catéteres Venosos Centrales/efectos adversos , Femenino , Humanos , Incidencia , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Faringe/microbiología , Recto/microbiología , Factores de Riesgo , Turquía/epidemiología , Orina/microbiología , Adulto JovenRESUMEN
Nosocomial infections due to candida species are increasingly gaining importance. In this study, we aimed to determine the risk factors associated with nosocomial candida infections and also to determine the species and antifungal sensitivity of candida strains. Candida spp. strains isolated from the clinical specimens of 92 patients who were hospitalized in Ankara Research and Training Hospital between May 2008 and September 2009 were prospectively included in the study. The demographic features, clinical and laboratory findings of the patients were recorded. Identification and antifungal sensitivities of the candida species were determined by VITEC 2 Compact System (BioMeriéux, France). Invasive candida infection was determined in 79 (85.9%) and candida colonization was found in 13 (14.1%) of the patients. Types of candida infections were as follows; urinary tract infection in 57 (72.1%), candidemia in 26 (32.9%), surgical site infection in 6 (7.5%) and intraabdominal infection in 3 (%3.8) patients. According to the univariate analysis, being female gender, duration and rate of hospitalization in the intensive care unit, use of linezolid, prolonged duration of urinary catheterization and total parenteral nutrition and the duration of central venous catheterization were found significantly higher in the urinary tract infection group. In candidemia group, carbapenem use, rates and periods of central venous catheterization and total parenteral nutrition were detected higher which were statistically significant. In multivariate analysis for urinary tract infections female gender (Odds ratio: 3; 95% CI: 1.25-7.17) and prolonged stay (p= 0.031) in intensive care unit; for candidemia use of total parenteral nutrition (OR: 16.25; 95% CI: 2.07-127.35) were found as independent risk factors. A total of 114 Candida spp. Strains were isolated from the clinical specimens. The most common isolated species were C.albicans (n= 62, 54.4%), C.glabrata (n= 16, 14%) and C.tropicalis (n= 13, 11.4%). While the resistance rates of Candida spp. To fluconazole and flucytosine were 2.6% and 1.7% respectively, there was no resistance to voriconazole. The rate of isolates with amphotericin B MIC values > 1 µg/ml was 4.4%. Consequently, the restricted use of central venous catheter and shortening the length of stay in intensive care unit may prevent the development of invasive candida infections. The local surveillance of antifungal resistance in candida strains might aid to the decision of empirical antifungal therapy.
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Candida/clasificación , Candidemia/epidemiología , Candidiasis/epidemiología , Infección Hospitalaria/epidemiología , Infecciones Urinarias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/farmacología , Candida/efectos de los fármacos , Candidemia/microbiología , Candidiasis/microbiología , Cateterismo Venoso Central , Infección Hospitalaria/microbiología , Femenino , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Nutrición Parenteral Total , Estudios Prospectivos , Factores de Riesgo , Turquía/epidemiología , Cateterismo Urinario , Infecciones Urinarias/microbiología , Adulto JovenRESUMEN
The majority of catheter-related bloodstream infections (CR-BSI) are associated with central venous catheters (CVCs) and most of them develop in patients staying at intensive care units (ICUs). The aim of this study was to assess the performance of different methods for the diagnosis of CR-BSI in neurology and neurosurgery ICUs of our hospital. This prospective study was carried out between January 2007 and January 2008 and all of the patients were followed daily for CR-BSI after the insertion of CVCs. Blood cultures were taken simultaneously from the catheter lumen and from at least one peripheral vein when there was a suspicion of CR-BSI. Additionally, from patients whose CVCs were removed, catheter tip cultures were taken and from patients with exit site infection, cultures of the skin surrounding the catheter entrance were taken. Catheter tip cultures were done by using quantitative and semiquantitative culture methods. Blood cultures taken from the catheter lumen and peripheral vein were incubated in the BACTEC 9050 (Becton Dickinson, USA) automated blood culture system. Gram and acridine orange (AO) staining were used for the smears prepared from the catheter tips and blood cultures. To evaluate the value of culture and staining methods in the diagnosis of CR-BSI; sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of each method were determined. A total of 148 patients (66 male, 82 female; age range: 1-94 years, mean age: 58.7 ± 21.8 years) were included in the study, of whom 67 (45.3%) were from neurology and 81 (54.7%) were from neurosurgery ICUs. One hundred ninety-nine CVC application performed in 148 patients were evaluated. Mean duration of catheterization was 8.5 ± 5.2 days. Thirty-two episodes of CR-BSI among 199 catheterizations (16%) in 29 patients among a total of 148 patients (19.6%) were determined. The most frequently isolated microorganisms were methicillin-resistant coagulase-negative staphylococci (8/32; 25%), penicillin-resistant Enterococcus spp. (8/32; 25%) and Candida albicans (4/32; 12.5%). Sensitivity, specificity, PPV and NPVs of the quantitative and semiquantitative culture methods of the catheter tip and the differential time to positivity (positive result obtained at least two hours earlier in blood cultures drawn through the catheter than the peripheral blood cultures which were taken simultaneously) between blood cultures drawn through the catheter and those drawn from the peripheral vein were 100% for the diagnosis of CR-BSI. Sensitivity and NPV of the isolation method of the same microorganism from blood culture drawn through the catheter and drawn from the peripheral vein were 100%, specificity was 85% and PPV was 88% for the diagnosis of CR-BSI. Sensitivity, specificity, PPV and NPVs of Gram and drawn simultaneously from the peripheral vein and quantitative and semiquantitative cultures of the catheter tip in patients with removed catheter, were important factors in terms of diagnosis of CR-BSI. It was also concluded that AO staining could provide additional benefit in the diagnosis of CR-BSI since it has higher sensitivity, specificity, PPV and NPVs for peripheral blood cultures and catheter tip cultures compared to Gram staining.
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Infecciones Relacionadas con Catéteres/diagnóstico , Cateterismo Venoso Central/efectos adversos , Catéteres de Permanencia/microbiología , Sepsis/diagnóstico , Naranja de Acridina , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Candida albicans/aislamiento & purificación , Infecciones Relacionadas con Catéteres/microbiología , Niño , Preescolar , Enterococcus/aislamiento & purificación , Femenino , Colorantes Fluorescentes , Violeta de Genciana , Humanos , Lactante , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Fenazinas , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Sepsis/microbiología , Staphylococcus/aislamiento & purificación , Adulto JovenRESUMEN
The fatality rate of Crimean-Congo haemorrhagic fever (CCHF) disease has been reported as 5.4-80%. In this prospective study our aim was to evaluate the clinical and laboratory predictors of fatality in patients with CCHF. Among probable CCHF patients admitted to our clinic between 2005 and 2008, patients with positive IgM antibodies and/or polymerase chain reaction for CCHF virus were included in the study. To determine the predictors of fatality, we compared epidemiological, clinical and laboratory findings of the fatal cases with survivors. Ninety-three confirmed CCHF patients were included in the study; 56 (60.2%) of them were female. Mean patient age was 48.4+/-17.7 y and mean hospital stay was 7.9+/-3.0 days. Five patients died (5.4%). The rates of haemorrhage, diarrhoea and confusion were higher in fatal cases compared with non-fatal cases (p<0.05). Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, lactate dehydrogenase (LDH), and C-reactive protein levels were higher in fatal cases; the international normalized ratio (INR) and activated partial thromboplastin time (aPTT) were longer and mean platelet counts were lower (p<0.05). By multivariate analysis, diarrhoea, melena, haematemesis, haematuria, elevated ALT and LDH, and prolongation of aPTT were independent clinical and laboratory predictors associated with fatality. We suggest that for patients who have diarrhoea, melena, haematemesis, haematuria, elevated AST and LDH, and a prolonged aPTT, physicians should be aware of the high fatality risk.
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Virus de la Fiebre Hemorrágica de Crimea-Congo/aislamiento & purificación , Fiebre Hemorrágica de Crimea , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diarrea , Femenino , Hemorragia , Virus de la Fiebre Hemorrágica de Crimea-Congo/genética , Fiebre Hemorrágica de Crimea/sangre , Fiebre Hemorrágica de Crimea/diagnóstico , Fiebre Hemorrágica de Crimea/epidemiología , Fiebre Hemorrágica de Crimea/mortalidad , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Turquía/epidemiologíaRESUMEN
BACKGROUND: Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is one of the complications. METHODS: In this study, we describe our experience in the diagnosis, treatment, and the final outcomes of 20 patients with neurobrucellosis out of 305 patients with brucellosis, within a five-year period between January 1999 and June 2004. RESULTS: The rate of neurobrucellosis was 6.6%. Twelve males and eight females with a mean age of 37.4 years were investigated. Fever, headache, confusion, and gait disorders were the main complaints. The duration of their complaints varied between one week and six months. On physical examination, 13 patients had fever, six had neck stiffness and confusion, three had motor deficit on either their upper or lower extremities, and four of them had diplopia. The Rose-Bengal test and standard tube agglutination tests were positive in all of the patients. Brucella melitensis was isolated from the blood of six of the 20 (30%) patients. Cerebrospinal fluid (CSF) was analyzed in 18 patients. Pleocytosis with a mean value of 244x10(6)cells/L, and high protein levels were detected in all. A low glucose level in the CSF was detected in ten patients. Patients were treated medically and a complete resolution was achieved in all. CONCLUSION: Patients with a Brucella infection occasionally manifest central nervous system involvement. Clinicians, especially serving in endemic areas or serving patients coming from endemic areas should consider the likelihood of neurobrucellosis in the patients with unexplained neurological and psychiatric symptoms, and should perform the necessary tests on blood and CSF.
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Brucelosis/complicaciones , Enfermedades del Sistema Nervioso Central , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Brucella melitensis/aislamiento & purificación , Brucelosis/epidemiología , Proteína C-Reactiva/líquido cefalorraquídeo , Enfermedades del Sistema Nervioso Central/diagnóstico , Enfermedades del Sistema Nervioso Central/tratamiento farmacológico , Enfermedades del Sistema Nervioso Central/epidemiología , Enfermedades del Sistema Nervioso Central/etiología , Confusión/patología , Diplopía/patología , Femenino , Cefalea/patología , Hospitales Urbanos , Humanos , Leucocitosis/líquido cefalorraquídeo , Masculino , Persona de Mediana Edad , Músculos del Cuello/patología , Estudios Prospectivos , Resultado del Tratamiento , Turquía/epidemiologíaRESUMEN
Results obtained by standard tube agglutination (STA) test which is the most widely used serological method for brucellosis, are often evaluated together with the clinical and microbiological findings, and the titers of > or = 1/160 are generally accepted as an indicator of acute infection. However, cross reactions with some other bacteria may lead to false positive results in this test. In this study, the performance of STA test in the diagnosis of brucellosis has been evaluated by using serum samples obtained from 40 culture positive brucellosis patients, 54 patients with bacterial infections other than brucellosis and 40 healthy blood donors. The distribution of infections and number of patients were as follows; urinary infection (n: 16), salmonellosis (n: 15), bacterial meningitis (n: 5), tuberculosis (n: 4), pneumoniae (n: 3), osteomyelitis (n: 3), infective endocarditis (n: 2), peritonitis (n: 2), diabetic foot infection (n: 2), acute cholecystitis (n: 1), and catheter infection (n: 1). STA were positive in all of the brucellosis patients between the titers of 1/160-1/1280 (mean: 1/640), whereas STA were found negative in all of the healthy subjects. Nevertheless two patients whose stool cultures yielded Salmonella spp., one patient whose urine culture yielded E. coli, one patient whose diabetic foot lesion culture yielded group A beta-hemolytic streptococci, exhibited STA positivity at the titers of 1/160. There was no history of brucellosis or presence of co-infections in the patients with non-brucellosis infections and blood donors. In conclusion, cross reactions due to the presence of other bacterial infections should be considered for the evaluation of Brucella STA test results, together with the endemicity of the country of interest and seropositivity rate of the population.