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Tularemia is a zoonosis caused by Francisella tularensis. Oropharyngeal tularemia is due to bacteria penetrating the oral mucosa during intake of contaminated water and food and is the common form seen in our country. A case of oropharyngeal tularemia associated with erythema multiforme is reported herein. Physicians should recognize the cutaneous lesions of tularemia and consider tularemia in patients with eruptions having an epidemiological history.

Introduction: This study was planned to determine the rate of surgical site infection and to evaluate related risk factors and the effect on cost following surgical procedures in the Departments of Surgery and Orthopedics and Traumatology. Materials and Methods: Six hundred and twenty nine patients who underwent surgery were enrolled into the study. Incidence rates of clean, clean-contaminated, contaminated, and dirty-infected wounds were 3.2%, 16.4%, 32.7%, and 40.9%, respectively. Results: Older age, wound classification, malignancy, diabetes mellitus, cardiovascular system disease, bleeding from wound, preoperative antibiotic usage, urgent surgery, secondary surgical operation, number and duration of drainage catheters, and shaving with blade prior to operation were risk factors significantly related with the occurrence of surgical site infection. Duration of hospitalization (28.6 ± 20.1 days) was significantly longer in patients with surgical site infection compared to the non-surgical site infection group (11.4 ± 8.1 days) (p< 0.001). The mortality rate was 12.7%, and it was higher in patients with surgical site infection compared to the non-surgical site infection group (1.3%) (p< 0.001). The mean cost was 5038 ± 4237 American dollars and 1305 ± 1249 American dollars for the groups with and without a history of surgical site infection, respectively (p< 0.001). Conclusion: To minimize the incidence of surgical site infection, possible risk factors related with the patient should be considered.

Introduction: Fever of unknown origin is first defined in 1961 as a temperature higher than 38.3°C lasting longer than 3 weeks, with a diagnosis that remains uncertain after 1 week of investigation. In this study, it’s aimed to evaluate etiology of fever of unknown origin cases hospitalized in department of infectious diseases and clinical microbiology. Patients and Methods: Fifty three fever of unknown origin cases hospitalized at our department between January 2002-August 2007 were evaluated retrospectively. Fever of unknown origin was diagnosed according to the criteria described by Petersdorf and Beeson. Patients with a history of immunosuppressive disease and nosocomial fever were excluded. Results: Median days with fever was 15.8 days (20-160 days), median days for diagnosis was 4.8 days (3-120 days). Seventeen (32.1%), 10 (18.9%) and 5 (9.4%) of the 53 cases were diagnosed as infection, collagen vascular disease and malignancy respectively. Eight (15.1%) of all cases were diagnosed as other diseases such as thyroiditis, pheochromocytoma, ulcerative collitis, and familial mediterrenean fever. Origins of the fever was not defined for 13 (24.5%) of the patients. Fever decreased spontaneously in 61.5% of undiagnosed patients at follow up. Invasive procedures were performed at 20.8% of whole cases. Conclusion: As a result infectious diseases are the leading causes of fever of unknown origin. For diagnosis routine tests should be performed first and then if necessary, more complicated or invasive tests may be performed. Endemic, regional infectious diseases should be considered primarily.

Medical students are exposed to the risk of occupational infections due to accidental exposures such as needlestick injuries, sharps injuries and mucosal exposure of contaminated blood or body fluids. A questionnaire was devised to determine occupational exposures (OEs) they had experienced, behaviours following OE, their knowledge and compliance on universal precautions. One hundred and fourteen medical students filled out the questionnaire. 31.6% were in 3rd, 22.8% in 4th, 35.1% in 5th, and 10.5% in 6th class. 61.4% of students had history of occupational injuries at least once. Rate of sharps injuries, needlestick injuries and mucosal exposure were 30%, 82.9%, 35.7% respectively. Rate of OEs was higher and statistically significant in 5th, 6th classes compared to 3rd, 4th.The most common way for exposure was recapping the needle. Rate of underreporting was 74.2%. 53.5% of the participants were vaccinated with complete dose of hepatitis B virus vaccine. 28.9% declared they always wore gloves prior to any percutaneus procedures. Medical students should be educated for the risk and encouraged to report OEs for their own safety.

Health care workers (HCWs) are exposed to the risk of occupational infections due to accidental exposures such as needlestick injuries, sharp injuries and mucosal exposure of contaminated blood or body fluids. A questionnaire was devised to determine occupational exposures (OEs) they had experienced, behaviours following OE, condition of hepatitis B virus immunization, their knowledge and compliance on universal precautions. One hundred and thirty HCWs filled out the questionnaire. One hundred and three (79.2%) of participants determined at least one or more occupational exposure during last one year. Eighteen (17.5%) of participants exposed to accidental exposure during last one year reported these exposures. One hundred and nine (83.8%) of participants had history of hepatitis B virus vaccination. Results showed that only 30 (23.1%) followed universal precautions completely.

Infective endocarditis is a life threatening disease of endocardium of the heart. Viridans streptococci are the most common reported isolates among patients with infective endocarditis. Abiotrophia and Granulicatella species form part of the normal flora of the oral cavity. They are infrequently isolated in patients with infective endocarditis. We report a case of native valve endocarditis attributed to Granulicatella elegans. We isolated G. elegans in two blood samples of the patient. Patient was successfully treated with ceftriaxone and gentamycin.

In this study, the clinical and epidemiologic spectrum of 200 cases of complicated upper urinary tract infection which treated at a university hospital were evaluated, retrospectively. The mean age was 62.9 years and female/male ratio was 118/82. The most common complaints were fever (n= 131) and disuria (n= 71). Bacteriuria was detected in 119 patients and bacteremia was detected in 20 patients. The most common etiologic agent was Escherichia coli (%63). Advanced age, recent antimicrobial usage and diabetes mellitus were found as common complicating factors. Fourty-six patients had urosepsis and 17 patients were died. The rates of susceptibility of E. coli isolated from urine samples were detected as 100% to imipenem, meropenem & fosfomycin, 98% to amicasin, 70% to gentamycin, 73% to ciprofloxacin, to ofloxacin 56%, to nitrofurantoin 93%, to ceftriaxone 88% and to piperacilin-tazobactam 86%. Trimethoprim/sulfamethoxazole and ampicilin demonstrated the fewest susceptibility (46% and 47%, respectively). Consequently, the patients with complicated upper urinary tract infections should be treated in hospital. A third generation cephalosporin or fluoroquinolones may be suitable choices for ampiric treatment of the patients without urosepsis; and a third generation cephalosporin or beta-lactam with beta-lactamase inhibitor combined with aminoglycosides and carbapenemes may be suitable choices for the patients with urosepsis.

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lympadenitis, is an uncommon clinical and patological autolimited feature of bening prognosis that may mimic many other diseases diagnosed chiefly in young adults. It is clinically significant because of possible misdiagnosis of other diseses such as malignant lymphoma or tuberculosis. Thus, an early biopsy is instrumental in making definite diagnosis and preventing unnecessary investigation. We described a case of Kikuchi-Fujimoto disease in a 22-year-old woman who presented with swollen lymph nodes and a fever. A rapid clinical improvement after lymph nodes excisional biopsy was remarkable. No treatment was given, and a full recovery was achived within six weeks. In this case had emphasized the clinical, histologic features, and outcome of Kikuchi-Fujimoto disease.

Ocular toxoplasmosis is one of the causes of severe visual loss in young people. We reviewed the records of 15 patients with ocular toxoplasmosis who were examined between 2003 and 2005. The diagnosis of ocular toxoplasmosis was established by detecting morphologically characteristic toxoplasmic fundus lesions in either eye by ophthalmologist. A positive serologic test for toxoplasmosis was used to support the diagnosis. All patients were treated. Our treatment protocol included the combination of primethamine and trimethoprim-sulfamethoxazol (TMP-SMX) or clindamicin and TMP-SMX or spiramycin and TMP-SMX with corticosteroid. Duration of treatment was average of four-six weeks. There were active lesions in 11 of the patients. There was also inflammation accompanied with chorioretinitis scars in four patients. Macular involvement were seen in three patients. Fourteen patients had unilateral and one had bilateral involvement. Retinochroidal lesions of 12 patient showed full regression. Relaps was seen in four patients. In conclusion, ocular toxoplasmosis seriously impairs vision acuity. Patients who have active choroidoretinitis of T. gondii should be treated and followed to avoid late compllications.

Involvement of systems in cases with brucellosis in a five year period were evaluated retrospectively. Sixty-eight cases with at least one manifestation of involvement of systems were included. Rates of involvement of systems was found; hematologic system 72%, osteoarticular system 49%, hepatobiliary system 37%, neurologic system 7%, respiratory system, genitourinary system, cutaneous 3% and cardiovascular system 1%. Anemia (60%) was found as the most frequent manifestation of involvement of hematologic system and peripheric arthritis (40%) was found as the most frequent involvement of osteoarticular system. Forty-eight patients had one system involvement. Twenty patients had more than one system involvement (17 patients had two, 16 patients had three, eight patients had four). Anemia and arthritis were found as the most frequent manifestations seen together. Surgical treatment was required in three (4.4%) patients with complications (two patients with radiculoneuritis, one with endocarditis). There was not any important complication related with system involvement of brucellosis except two cases with neurobrucellosis related paraplegia. Relaps rate was 4.7%.

In this article, a patient in whom cochlear implant was administered following hearing loss associated with acute bacterial meningitis is presented. The 57-year-old male patient presented due to fever, ear pain and hearing loss for the past three days. On physical examination, the patient was conscious, had a moderate general condition, and fever of 37.7°C. There was total hearing loss and aphasia. Neck stiffness was positive during neurological examination. During non-stained microscopic examination of the cerebrospinal fluid, 1900 cells/mm3 (89% PMNL, 11% lymphocyte) were detected. During gram staining, gram-positive diplococcus was seen. Ceftriaxone was started with the diagnosis of acute bacterial meningitis. On day 2 of the treatment, his fever decreased, but hearing loss and speech and balance disorder continued. On day 4 of the treatment, vancomycin was added due to newly developed fever. Response to fever was achieved on day 2 of the combination treatment. During audiological examination of the patient with ongoing hearing loss, very severe bilateral sensorineural hearing loss was detected. 1 mg/kg prednisolone was started for the patien,t and cochlear implant was planned by the otorhinolaryngology department. Cochlear implant was performed as the patient’s complaint did not regress after one month of prednisolone treatment. Monitoring of the patient is ongoing. In conclusion, hearing loss developing in acute bacterial meningitis should be detected promptly, and rehabilitated as required.

In this study, the efficacy of intradermal Hepatitis B vaccination was compared with intramuscular route. Students of medical faculty were included to the study. Vaccine was administered in two different forms. In the classical schedule 20 µg hepatitis B vaccine was administered on 0, 1 and 6th months by intramuscular (IM) route. In the comparative low dose schedule 2 µg hepatitis B vaccine was administered on 0, 1, 2 and 12th months by intradermal (ID) route. Twohundred and fortysix students received the first schedule and sixtyfive students received the second schedule. The immune response to vaccination was measured quantitatively by enzyme immune assay (EIA). AntiHBs antibody levels was measured after 20th day of second vaccination in the first schedule. AntiHBs antibody levels were measured after 20th day of third and fourth vaccination in the second schedule. AntiHBs antibody levels were found higher in the first group than the second group who received low dose intradermal vaccination schedule. However ID vaccination was found as effective as classical IM schedule at the end of vaccination. Smoking was found as a negative factor to the response to Hepatitis B vaccination. The most frequent adverse effect was pain on the injection site. In conclusion, low dose ID vaccination schedule seems to be useful for vaccination of large groups because of it’s economical benefits. But it requires further investigations.

Rash is a rare finding in meningitis except N. menengitidis cases. In this report, a case of Streptococcus pneumoniae meningitis with rash in a patient with multiple myeloma was presented and the related literature was evaluated.

Brucellosis is a zoonosis, and transmitted by direct or indirect exposure. Direct invasion of the central nervous system occurs in fewer than 5% of cases. Neurobrucellosis includes meningitis, encephalitis, myelitisradiculoneuronitis, brain abscess, intra-medullary spinal cord abscess, epidural abscess, granuloma, and demyelinating and meningovascular syndromes. We report a case of meningitis caused by Brucella melitensis in a patient with ventriculoperitoneal shunt.

There exists a wide spectrum of clinical signs in brucellosis. Hearing loss is one of these signs but there are a few reports in literature about it. This study was planned to determine the frequency of hearing loss in brucellosis. Sixty patients diagnosed as brucellosis according to clinical and serological findings in our clinic were included to the study. Forty-one patients submitted to our clinic with different complaints and without any evidence for brucellosis were accepted as control group. Hearing loss was determined by odiometric examinations in both groups. Hearing loss was found in 28 (46.6%) of cases from the study group and in 8 (19.5%) cases from the control group (p < 0.01). There wasn’t any difference between the groups according to sexuality. Hearing loss was found more frequent in the patients over 30 years old. According to the results of this study we think that it will be useful to evaluate the hearing functions before, the treatment, particularly in areas where Brucella infections are endemic.

WOS: A1993LF33200006, PubMed ID: 8508689, The efficacy of prophylactic and early fluconazole treatment on experimental systemic candidiasis was investigated in neutropenic rabbits. Fifteen rabbits were used and divided into three groups: fluconazole was started 24 h before the inoculation of Candida albicans in the first group, and 24 h after the inoculation in the second group. The third group was the control group without antifungal therapy. Prophylactic and early fluconazole treatment for 7 days after C. albicans inoculation did not reduce the mortality and tissue culture positivity in the rabbits significantly. Four of the five rabbits survived 7 days both in the prophylactic and early treatment groups. However, only one rabbit survived for 7 days in the control group. In diagnostic procedures, histopathological examination and evaluation with periodic acid-Schiff stain was found to be the most sensitive. In this study, prophylactic and early fluconazole treatment were found to be insufficent for treatment of systemic candidiasis in neutropenic rabbits.