Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients

The aim of this study was to evaluate the clinical, laboratory findings, and therapeutic features of patients with brucellosis. The diagnosis was made by clinical findings, positive agglutination titer. and/or the isolation of Brucella species. Three hundred and twenty-two cases were acute, 121 sub-acute, 24 chronic, and 13 asymptomatic. Symptoms of patients were malaise in 432 (90%) patients, sweating in 405 (184.4%), arthralgia in 393 (81.9%), fever in 383 (79.8%), and back pain in 281 (58.5%). The most frequent findings were fever in 187 (39%) patients, hepatomegaly in 102 (21.3%). osteoarticular involvement in 91 (19%), splenomegaly in 68 (14.2%), nervous system involvement in 31 (6.5%) patients. Lymphocytosis was determined in 328 patients, anemia in 262 patients, thrombocytopenia in 35 patients, leukopenia in 37 patients, leukocytosis in 31 patients. and elevated erythrocyte sedimentation rate in 282 patients. Cultures were positive in 194 (45%) patients and all strains were identified as Brucella melitensis. Various treatment regimens were given to patients, No therapeutic failure was observed. The time to defervescence ranged from 2 to 15 days. Relapse occurred in 26 of the 480 patients (5.4%). There was no correlation between relapse and positive culture or complications. Brucellosis can present various clinical forms in endemic areas and mimics several diseases. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserved

Predictors of Mortality in Septic Shock: Findings for 57 Patients Diagnosed on Admission to Emergency or within 24 hours of Admission to Intensive Care

Objective To identify the risk factors that influence outcome for patients who are diagnosed with septic shock in the emergency department at presentation or within 24 hours after admission to intensive care unit. Methods A retrospective study of 57 adult patients with septic shock was conducted between March 1, 2006 and August 31, 2009. Results The patients were 23 males and 34 females with a median age of 67 years (20 to 92 years). Thirty-three (58%) of 57 patients died in hospital and 24 (42%) survived. Multivariate analysis identified low blood pH (OR &lt;0.001; 95% CI &lt;0.001-0.53) and low bicarbonate level (OR 0.81; 95% CI 0.70-0.95) at emergency department or intensive care unit admission as useful predictors of 3-day in-hospital mortality. Low blood pH (OR &lt;0.001; 95% CI &lt;0.001-0.05), low bicarbonate level (OR 0.75; 95% CIs 0.61-0.91), long duration of symptoms (OR 1.49; 95% CI 1.04-2.13), high MEDS score (OR 1.56; 95% CIs 1.06-2.30), and high SOFA score (OR 1.57; 95% CI 1.12-2.20) were risk factors for 14-day in-hospital mortality. Renal failure (OR 7.58; 95% CI 1.28-44.77), lower pulmonary tract infection (OR 3.58; 95% CI 1.10-11.58), high MEDS score (OR 1.42; 95% CI 1.05-1.93) and high APACHE II score (OR 1.34; 95% CI 1.13-1.60) were risk factors for 28-day in-hospital mortality. Conclusions Several factors signaling poor short-term outcome for this patient group are low blood pH, low serum bicarbonate level, longer duration of symptoms, lower respiratory tract infection and renal failure. MEDS and SOFA scores might be helpful in the ED to stratify patients with septic shock according to mortality risk. </jats:sec

Molecular epidemiology of the Bacillus anthracis isolates collected throughout Turkey from 1983 to 2011

Doganay, Mehmet/0000-0003-3922-4901; Otlu, Baris/0000-0002-6220-0521WOS: 000309214300035PubMed: 22576652The main perspective of this study was to determine cross-transmissions amongst anthrax cases and provide detailed information regarding the genotypes of Bacillus anthracis isolates circulating in Turkey. A total of 251 B. anthracis isolates were obtained from human (93 isolates), animal (155 isolates), and environmental (three isolates) samples in various provinces of Turkey. All isolates were susceptible to quinolones, vancomycin, tigecycline, and linezolid, but not to ceftriaxone. Excluding human isolates, one of the animal isolates was found to be resistant to penicillin, erythromycin, and doxycycline. Multiple-locus variable-number tandem repeats analysis including 8 loci (MLVA8) revealed 12 genotypes, in which genotype 43 was observed at the highest frequency (41.8 %), followed by genotype 35 (25.5 %) and genotype 27 (10.4 %). Major subtype A3.a was the predominant cluster, including 86.8 % of the isolates. The MLVA25 analysis for the 251 isolates yielded 62 different genotypes, 33 of which had only one isolate, while the remaining 29 genotypes had 2 to 43 isolates, with a total of 218 isolates (86.9 %). These findings indicate very high cross-transmission rates within anthrax cases in Turkey. The genotypes diagnosed in Turkey are populated in the A major cluster. Penicillin prescribed as the first-choice antibiotic for the treatment of anthrax is still effective.Scientific and Technological Research Council of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [108 S164]This study was supported by a grant (108 S164) from the Scientific and Technological Research Council of Turkey. The authors thank Dr. Florigio Lista and Dr. Andrea Ciammaruconi from the Histology and Molecular Biology Section, Army Medical and Veterinary Research Center, Via Santo Stefano Rotondo 4, 00184, Rome, Italy, for their help and encouraging suggestions on the MLVA typing protocol

Naturally Occurring Cutaneous Anthrax: Antibiotic Treatment and Outcome

&lt;i&gt;Objectives:&lt;/i&gt; 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. &lt;i&gt;Methods:&lt;/i&gt; 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. &lt;i&gt;Results:&lt;/i&gt; 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. &lt;i&gt;Conclusions:&lt;/i&gt; 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.</jats:p

Naturally Occurring Cutaneous Anthrax: Antibiotic Treatment and Outcome

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. Copyright (C) 2012 S. Karger AG, Base

Pyogenic tenosynovitis of the flexor hallucis longus in a healthy 11-year-old boy: a case report and review of the literature

Pyogenic tenosynovitis of the flexor hallucis longus (FHL) is a rare condition in young healthy patients. We report the case of a healthy 11-year-old boy who presented with a history of fever and painful swelling below the medial malleolus of the left ankle. Imaging and laboratory findings suggested infectious tenosynovitis of the FHL. Methicillin-sensitive Staphylococcus aureus was isolated on culture following surgery. Antibiotherapy was initiated and continued until inflammatory markers returned to normal. Six months post-surgery, he resumed sport activities and inflammatory markers remained within normal limits. We review also the literature and discuss the clinical characteristics of this condition. © Springer-Verlag 2012

Update on treatment options for spinal brucellosis

AbstractWe evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular