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1. Hydrocephalus and vasculitis delay therapeutic responses in tuberculous meninigitis: Results of Haydarpasa-III study

Author

Serpil Erol, Canan Agalar, Serkan Oncu, Seniha Senbayrak, Alper Şener, Mihai Nechifor, Gorana Dragovac, Muge Ozguler, Bahar Kandemir, Özcan Deveci, Alexandru Crisan, Rodrigo Hasbun, Nazif Elaldi, Recep Tekin, Gamze Kilicoglu, Hulya Tireli, Kadriye Kart Yaşar, Nurgul Ceran, Aysegul Ulu-Kilic, Oğuz Reşat Sipahi, Gürkan Mert, Derya Ozturk-Engin, Rok Čivljak, Branislava Savic, Katell Andre, Yasemin Cag, Mustafa Namiduru, Mustafa Sunbul, Gonul Sengoz, Oral Oncul, Hakan Erdem, Ayhan Akbulut, Serap Gencer, Selma Alabay, Ayşe Seza Inal, Mucahit Yemisen, Filiz Pehlivanoglu, Olga Dulovic, Asuman Inan, B. Lakatos, Hanefi Cem Gul, Ondokuz Mayıs Üniversitesi, Çukurova Üniversitesi, [Cag, Yasemin] Istanbul Medeniyet Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Ozturk-Engin, Derya -- Ceran, Nurgul -- Kilicoglu, Gamze -- Tireli, Hulya -- Senbayrak, Seniha -- Inan, Asuman -- Erol, Serpil] Haydarpasa Numune Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Gencer, Serap] Dr Lutfi Kirdar Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Hasbun, Rodrigo] Univ Texas Hlth Sci Ctr Houston, Sch Med, Dept Infect Dis, Houston, TX 77030 USA -- [Sengoz, Gonul -- Pehlivanoglu, Filiz] Haseki Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Crisan, Alexandru] Victor Babes Univ Med & Pharm, Dept Infect Dis, Timisoara, Romania -- [Savic, Branislava] Univ Belgrade, Inst Microbiol & Immunol, Natl Reference Lab TB, Fac Med, Belgrade, Serbia -- [Yasar, Kadriye] Bakirkoy Dr Sadi Konuk Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Inal, Ayse S.] Cukurova Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Adana, Turkey -- [Civljak, Rok] Univ Zagreb, Sch Med, Dr Fran Mihaljev Univ Hosp Infect Dis, Dept Infect Dis, Zagreb, Croatia -- [Tekin, Recep -- Deveci, Ozcan] Dicle Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Diyarbakir, Turkey -- [Elaldi, Nazif] Cumhuriyet Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Sivas, Turkey -- [Ulu-Kilic, Aysegul -- Alabay, Selma] Erciyes Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Kayseri, Turkey -- [Ozguler, Muge -- Akbulut, Ayhan] Firat Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Elazig, Turkey -- [Namiduru, Mustafa] Gaziantep Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Gaziantep, Turkey -- [Sunbul, Mustafa] Ondokuz Mayis Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Samsun, Turkey -- [Sipahi, Oguz R.] Ege Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Izmir, Turkey -- [Dulovic, Olga] Clin Ctr Serbia, Clin Infect & Trop Dis, Belgrade, Serbia -- [Sener, Alper] Onsekiz Mart Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Canakkale, Turkey -- [Lakatos, Botond] St Laszlo Hosp, Dept Infect Dis, Budapest, Hungary -- [Andre, Katell] Dax Hosp, Dept Infect Dis, Dax, France -- [Yemisen, Mucahit] Istanbul Univ, Cerrahpasa Med Sch, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Oncu, Serkan] Adnan Menderes Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Aydin, Turkey -- [Nechifor, Mihai] Gr T Popa Univ Med & Pharm, Dept Infect Dis, Iasi, Romania -- [Dragovac, Gorana] Univ Novi Sad, IPH Vojvodina, Fac Med, Dept Prevent & Control Dis, Novi Sad, Serbia -- [Gul, Hanefi C. -- Mert, Gurkan -- Erdem, Hakan] Gulhane Mil Med Acad, Dept Infect Dis & Clin Microbiol, Ankara, Turkey -- [Oncul, Oral] Istanbul Univ, Dept Infect Dis & Clin Microbiol, Istanbul Fac Med, Istanbul, Turkey -- [Kandemir, Bahar] Necmettin Erbakan Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Konya, Turkey -- [Agalar, Canan] Fatih Sultan Mehmet Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey, Inal, Ayse Seza -- 0000-0002-1182-7164, Gencer, Serap -- 0000-0002-3217-6305, GENCER, SERAP -- 0000-0002-3217-6305, Civljak, Rok -- 0000-0001-8766-7438, and Kart Yasar, Kadriye -- 0000-0003-2963-4894

Subjects
Vasculitis, medicine.medical_specialty, Pediatrics, Time Factors, Multivariate analysis, Tuberculosis, Antitubercular Agents, Gastroenterology, Tuberculous meningitis, Clinical, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Meningitis, Retrospective Studies, 030203 arthritis & rheumatology, response, business.industry, Response, meningitis, Retrospective cohort study, Prognosis, medicine.disease, Hydrocephalus, Treatment Outcome, tuberculosis, Neurology, Multicenter study, Tuberculosis, Meningeal, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

WOS: 000384527500014, PubMed ID: 27625226, Aims: There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses. Materials and Methods: This multicenter study included 507 patients with microbiologically confirmed TBM. However, 94 patients eligible for the analysis were included in this study from 24 centers. Six out of 94 patients died and the statistical analysis was performed with 88 survivors. Early and late responder groups were compared in the statistical analysis. P < 0.05 were considered to show a significant difference. Results: In the multivariate analysis, the presence of vasculitis (P = 0.029, OR = 10.491 [95% CI, 1.27u86.83]) was found to be significantly associated with a delayed fever response whereas hydrocephalus was associated with altered mental status for 9 days duration (P = 0.005, OR = 5.740 [95% CI, 1.68u19.57]). According to linear regression analysis, fever was significantly persisting (7 days) in the presence of vasculitis (17.5 vs. 7, P< 0.001) and hydrocephalus (11 vs. 7, P = 0.029). Hydrocephalus was significantly associated with persisting headache (21 vs. 12, P = 0.025), delayed recovery of consciousness (19.5 vs. 7, P = 0.001), and a delay in complete recovery (21 vs. 14, P = 0.007) in the linear regression analysis. Following institution of treatment, the complaints seemed to disappear in up to 2 weeks among TBM survivors. Conclusions: In the absence of hydrocephalus or vasculitis, one week of anti-tuberculosis treatment seems to be adequate for the resolution of TBM symptoms. Hydrocephalus and vasculitis delay the resolution of TBM symptoms in response to antimycobacterial treatment.

Published
2016
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2. Liver involvement in patients with brucellosis: results of the Marmara study

Author

D. Ozturk-Engin, H. Erdem, S. Gencer, S. Kaya, A. I. Baran, A. Batirel, R. Tekin, M. K. Celen, A. Denk, S. Guler, M. Ulug, H. Turan, A. U. Pekok, G. Mermut, M. Tasbakan, N. Tulek, Y. Cag, A. Inan, A. Yalci, C. Ataman-Hatipoglu, I. Gonen, A. Dogan-Celik, F. Bozkurt, S. Gulsun, M. Sunnetcioglu, T. Guven, F. Duygu, E. Parlak, H. Sozen, S. Tosun, T. Demirdal, E. Guclu, O. Karabay, N. Uzun, O. Gunal, H. Diktas, A. Haykir-Solay, A. Erbay, C. Kader, O. Aydin, A. Erdem, N. Elaldi, A. Kadanali, Z. Yulugkural, L. Gorenek, M. Altındis, S. Bolukcu, C. Agalar, N. Ormeci, Ozturk-Engin, D, Erdem, H, Gencer, S, Kaya, S, Baran, AI, Batirel, A, Tekin, R, Celen, MK, Denk, A, Guler, S, Ulug, M, Turan, H, Pekok, AU, Mermut, G, Tasbakan, M, Tulek, N, Cag, Y, Inan, A, Yalci, A, Ataman-Hatipoglu, C, Gonen, I, Sakarya Üniversitesi/İlahiyat Fakültesi/Temel İslam Bilimleri Bölümü, Kaya, Süleyman, [Ozturk-Engin, D. -- Inan, A. -- Bolukcu, S.] Haydarpasa Numune Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Erdem, H. -- Gorenek, L.] GATA Haydarpasa Training Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Gencer, S. -- Batirel, A. -- Cag, Y.] Lutfi Kirdar Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Kaya, S. -- Gulsun, S.] Diyarbakir Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Diyarbakir, Turkey -- [Baran, A. I. -- Sunnetcioglu, M.] Yuzuncu Yil Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Van, Turkey -- [Tekin, R. -- Celen, M. K. -- Bozkurt, F.] Dicle Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Diyarbakir, Turkey -- [Denk, A.] Firat Univ, Sch Med, Dept Infect Dis & Clin Microbiol, TR-23169 Elazig, Turkey -- [Guler, S.] Yenisehir State Hosp, Dept Infect Dis & Clin Microbiol, Kahramanmaras, Turkey -- [Ulug, M.] Private Umit Hosp, Dept Infect Dis & Clin Microbiol, Eskisehir, Turkey -- [Turan, H.] Baskent Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Konya, Turkey -- [Pekok, A. U.] Private Erzurum Sifa Hosp, Dept Infect Dis & Clin Microbiol, Erzurum, Turkey -- [Mermut, G. -- Tosun, S.] Izmir Bozyaka Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Izmir, Turkey -- [Kaya, S.] Karadeniz Tech Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Trabzon, Turkey -- [Tasbakan, M.] Ege Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Izmir, Turkey -- [Tulek, N. -- Ataman-Hatipoglu, C.] Ankara Numune Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Ankara, Turkey -- [Yalci, A.] Ankara Univ, Sch Med, Dept Infect Dis & Clin Microbiol, TR-06100 Ankara, Turkey -- [Gonen, I.] Suleyman Demirel Univ, Sch Med, Dept Infect Dis & Clin Microbiol, TR-32200 Isparta, Turkey -- [Dogan-Celik, A. -- Yulugkural, Z.] Trakya Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Edirne, Turkey -- [Guven, T.] Yildirim Beyazit Univ, Ankara Ataturk Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Ankara, Turkey -- [Duygu, F. -- Gunal, O.] Gaziosmanpasa Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Tokat, Turkey -- [Parlak, E.] Ataturk Univ, Dept Infect Dis & Clin Microbiol, Sch Med, Erzurum, Turkey -- [Sozen, H.] Sitki Kocman Univ, Sch Med, Dept Anesthesiol & Reanimat, Mugla, Turkey -- [Demirdal, T.] Katip Celebi Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Izmir, Turkey -- [Guclu, E. -- Karabay, O.] Sakarya Univ, Dept Infect Dis & Clin Microbiol, Sch Med, Sakarya, Turkey -- [Uzun, N.] Sisli Etfal Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Diktas, H.] Tatvan Mil Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Haykir-Solay, A.] Igdir State Hosp, Dept Infect Dis & Clin Microbiol, Igdir, Turkey -- [Erbay, A. -- Kader, C.] Bozok Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Yozgat, Turkey -- [Aydin, O.] Medeniyet Univ, Dept Infect Dis & Clin Microbiol, Goztepe Training & Res Hosp, Istanbul, Turkey -- [Erdem, A.] Medeniyet Univ, Dept Pathol, Goztepe Training & Res Hosp, Istanbul, Turkey -- [Elaldi, N.] Cumhuriyet Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Sivas, Turkey -- [Kadanali, A.] Umraniye Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Altindis, M.] Sakarya Univ, Sch Med, Dept Clin Microbiol, Sakarya, Turkey -- [Agalar, C.] Fatih Sultan Mehmet Training & Res Hosp, Dept Infect Dis & Clin Microbiol, Istanbul, Turkey -- [Ormeci, N.] Ankara Univ, Sch Med, Dept Gastroenterol, TR-06100 Ankara, Turkey, Gencer, Serap -- 0000-0002-3217-6305, Altindis, Mustafa -- 0000-0003-0411-9669, GENCER, SERAP -- 0000-0002-3217-6305, Elaldi, Nazif -- 0000-0002-9515-770X, and Karabay, Oguz -- 0000-0003-0502-432X

Subjects
Microbiology (medical), Adult, Male, medicine.medical_specialty, Anemia, Gastroenterology, Brucellosis, Hepatitis, Young Adult, Internal medicine, medicine, Animals, Humans, Leukocytosis, Transaminases, Retrospective Studies, Doxycycline, Leukopenia, business.industry, Bilirubin, General Medicine, Middle Aged, medicine.disease, Pancytopenia, Surgery, Anti-Bacterial Agents, Infectious Diseases, Treatment Outcome, Female, medicine.symptom, business, Rifampicin, medicine.drug
Abstract

WOS: 000336986700024, PubMed ID: 24557334, Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with a parts per thousand yen5 times of the upper limit of normal for aminotransferases, total bilirubin level a parts per thousand yen2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.

Published
2014

3. Management of Brucella endocarditis: results of the Gulhane study

Author

Saim Dayan, Hakan Erdem, Özcan Deveci, Ayşe Erbay, Esra Kazak, Sema Alp-Cavus, Ali Rıza Erbay, Elif Doyuk-Kartal, İbrahim Koruk, Rahmet Guner, Umit Savasci, Oğuz Reşat Sipahi, Behice Kurtaran, Yasemin Tezer-Tekce, Aysun Yalci, Serap Gencer, Mehmet Parlak, Derya Ozturk Engin, Necla Tulek, Mucahit Yemisen, Filiz Pehlivanoglu, Asuman Inan, Suda Tekin Koruk, Oral Oncul, Gokhan Guzel, Asim Ulcay, Nebahat Dikici, Çukurova Üniversitesi, [Koruk, Suda Tekin] Harran Univ, Sch Med, Dept Infect Dis & Clin Microbiol IDCM, Sanliurfa, Turkey -- [Erdem, Hakan -- Ulcay, Asim] Kasimpasa Hosp, Dept IDCM, Istanbul, Turkey -- [Koruk, Ibrahim] Harran Univ, Sch Med, Dept Publ Hlth, Sanliurfa, Turkey -- [Erbay, Ayse] Bozok Univ, Sch Med, Dept IDCM, Yozgat, Turkey -- [Tezer-Tekce, Yasemin] Turkiye Yuksek Ihtisas Training & Res Hosp, Dept IDCM, Ankara, Turkey -- [Erbay, Ali Riza] Bozok Univ, Sch Med, Dept Cardiol, Yozgat, Turkey -- [Dayan, Saim -- Deveci, Ozcan] Dicle Univ, Sch Med, Dept IDCM, Diyarbakir, Turkey -- [Inan, Asuman -- Engin, Derya Ozturk] Haydarpasa Numune Training & Res Hosp, Istanbul, Turkey -- [Guner, Rahmet] Ataturk Training & Res Hosp, Dept IDCM, Ankara, Turkey -- [Dikici, Nebahat] Selcuk Univ, Fac Selcuklu Med, Konya, Turkey -- [Doyuk-Kartal, Elif] Osmangazi Univ, Sch Med, Dept IDCM, Eskisehir, Turkey -- [Kurtaran, Behice] Cukurova Univ, Sch Med, Dept IDCM, Adana, Turkey -- [Pehlivanoglu, Filiz] Haseki Training & Res Hosp, Dept IDCM, Istanbul, Turkey -- [Sipahi, Oguz Resat] Ege Univ, Sch Med, Dept IDCM, Izmir, Turkey -- [Yalci, Aysun] Ankara Univ, Sch Med, Dept IDCM, TR-06100 Ankara, Turkey -- [Yemisen, Mucahit] Istanbul Univ, Cerrahpasa Med Sch, Dept IDCM, Istanbul, Turkey -- [Alp-Cavus, Sema] Dokuz Eylul Univ, Sch Med, Dept IDCM, Izmir, Turkey -- [Gencer, Serap] Dr Lutfi Kirdar Kartal Training & Res Hosp, Dept IDCM, Istanbul, Turkey -- [Guzel, Gokhan] Cumhuriyet Univ, Sch Med, Dept IDCM, Sivas, Turkey -- [Oncul, Oral] Gulhane Haydarpasa Hosp, Dept IDCM, Istanbul, Turkey -- [Parlak, Mehmet] Ataturk Univ, Sch Med, Dept IDCM, Erzurum, Turkey -- [Kazak, Esra] Uludag Sch Med, Dept IDCM, Bursa, Turkey -- [Tulek, Necla] Ankara Numune Training & Res Hosp, Dept IDCM, Ankara, Turkey -- [Savasci, Umit] Mil Hosp, IDCM Serv, Sarikamis, Turkey, Kurtaran, Behice -- 0000-0002-2081-4664, GENCER, SERAP -- 0000-0002-3217-6305, Gencer, Serap -- 0000-0002-3217-6305, Gozel, Mustafa Gokhan -- 0000-0001-5187-7388, Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı., Kazak, Esra, and AAG-8459-2021

Subjects
Congestive heart failure, Male, Turkey, Bacterial endocarditis, Antibiotics, Pericardial effusion, Leukocyte Count, Ciprofloxacin, Diagnosis, Pharmacology (medical), Gentamicin, Heart valve prosthesis, Priority journal, Aged, 80 and over, Endocarditis, Ceftriaxone, Heart, General Medicine, Middle Aged, Bacterial-endocarditis, Risk-factors, Infectious Diseases, Treatment Outcome, Doxycycline, Aortic Valve, Streptomycin, Mitral Valve, Drug Therapy, Combination, Female, Tricuspid Valve, Aorta valve, Human, medicine.drug, Microbiology (medical), Adult, medicine.medical_specialty, medicine.drug_class, Brucella endocarditis, Major clinical study, Microbiology, Article, Brucellosis, Young Adult, Pharmacotherapy, medicine, Adults, Agglutination Tests, Zoonosis, Humans, Mortality, Rifampicin, Aged, Retrospective Studies, Pharmacology & pharmacy, business.industry, Retrospective cohort study, Endocarditis, Bacterial, medicine.disease, Valvular heart disease, Brucella, Cotrimoxazole, Heart surgery, Surgery, Aminoglycosides, Therapy, Infective endocarditis, Complication, business
Abstract

WOS: 000306663800009, PubMed ID: 22727531, Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n = 18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients. (C) 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Published
2012

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