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Öğe Brucellosis is a major problem: A five years experience(Acta Medica Mediterranea, 2013) Dal T.; Celen M.K.; Ayaz C.; Dal M.S.; Kalkanli S.; Mert D.; Yildirim N.Brucellosis is a chronic granulomatous infection which is endemic in Mediterranean countries and Turkey. The aim of this study is to analyze the clinical, laboratory findings and therapeutic features in patients with brucellosis. A retrospective study was conducted with 91 patients who developed brucellosis between 2005 to 2009. The diagnosis was based on clinical findings compatible with brucellosis, serological tests positive, and/or isolation of Brucella species from blood, or other tissues. The mean age was 33 years (16-67 years). Sixty-threes of patients (69.2%) were male. Forty (44%) cases had an occupational history relevant for Brucella exposure and 85 (93%) cases consumption with contaminated animal product. The mean diagnostic delay was 15 days, much longer in focal brucellosis. A total of 77 (85 %) cases had acute brucellosis. The focal brucellosis complications were observed in 39 (42.8%) cases: osteoarticular involvement 32 (82%), epididymo-orchitis 4 (10%), and central nervous system involvement 3 (8%). Chronic brucellosis occurs in 3 (3.3%) cases. Clinical manifestations included non-specific symptoms such as fever (95%), sweats (90%), arthralgia and lower back pain (63%). Of the patients 84 (92%) had serological titre =1/160 and 28 (31%) blood cultures were positive. All of the patients were cured by antibiotic therapy (Doxycycline+rifampicin/streptomycine, streptomycine+rifampicin/Doxycycline, ceftiraxone/rifampicin). Relapse was observed in 5 (5.4%) patients. Brucellosis is an infection with multiple presentations. Its early diagnosis was mandatory to avoid severe complications.Öğe A case of meningitis caused by Streptococcus pyogenes in a previously healthy woman(2009) Uluğ M.; Ulug N.C.; Celen M.K.; Geyik M.F.; Ayaz C.Background: Streptococcus pyogenes is a well-known cause of a variety of clinical infections including local symptoms such as tonsillopharyngitis, cervical lymphadenitis, otitis media, cellulites, erysipelas, as well as more severe diseases such as scarlet fever, osteomyelitis, necrotizing fasciitis, sepsis, and toxic shock syndrome. However, acute bacterial meningitis caused by this pathogen is unusual. Objective: We report a case of group A streptococcus (GAS) meningitis in a previously healthy woman with a dramatically rapid course and fatal outcome. Case: A 41-year-old previously healthy woman presented a history of fever, headache, vomiting, and sore throat of three days' duration. Neurological examination revealed diminished consciousness and neck rigidity. The cerebrospinal fluid (CSF) was turbid with 10,000 leukocytes/mm3. Direct examination of CSF showed Gram-positive cocci in chains, and cultures yielded S. pyogenes. Blood cultures yielded growth of S. pyogenes. The patient was treated initially with ceftriaxone (4 g/day) and the control CSF examination was not changed on the third day, so vancomycin (2 g/day) was added to the treatment; however, she died on the fourth day of the treatment. Conclusion: S. pyogenes meningitis is uncommon and the incidence seems to be persistently low; nevertheless, clinicians should be aware that sporadic cases may occur and may have a fulminant course with a relevant neurological sequel. Copyright © 2009 Ulug et al.Öğe Characteristics of acute bacterial meningitis in Southeast Turkey(2004) Ayaz C.; Geyik M.F.; Hosoglu S.; Celen M.K.; Akalin S.; Kokoglu O.F.BACKGROUND: Acute bacterial meningitis (ABM) remains a significant worldwide cause of death in adults. Even in the antibiotic era, the mortality rate in ABM remains significant and has been reported in the range of 8-40%. AIM: The aim of this study was to assess the characteristics of epidemiology, clinical manifestations, treatment modalities and outcome of patients with ABM in Southeast Turkey. SETTINGS AND DESIGN: This retrospective study included all cases of community-acquired ABM diagnosed and treated in Dicle University Hospital between June 1996 and December 2002. METHODS AND PATIENTS: The study group consisted of 186 adult patients (110 male, 76 female) with ABM, those patients who are older than 14 years, followed up at Dicle University Hospital from June 1996 to December 2002. Patients' charts were retrospectively reviewed, clinical characteristics were recorded and final data were analyzed. STATISTICAL ANALYSIS: In statistical analyses, the Chi-square test was used for binary variables and Student's t-test for continuous variables. RESULTS: The patients' mean age was 30.2 ± 15.3 years (range 74 to 90 years). On admission, typical symptoms of meningitis were found in most of the patients: headache in 92.5%, fever in 88.2%, and nuchal rigidity in 80.1%. The main predisposing factor for ABM was otitis media (40 patients, 21.5%) and closed head trauma (12 patients, 6.5%). Streptococcus pneumonia was the most common identified pathogen. Twenty-nine patients (15.6%) died during hospitalization period. In multivariate analyses, the significant mortality factor was found as initial level of consciousness, low cerebrospinal fluid/blood glucose ratio, high erythrocyte sedimentation rate and initial treatment by penicillin G. CONCLUSIONS: Although still remains as a serious infection, early diagnosis and effective treatment may reduce fatal outcome and improve the course of the disease in patients with ABM. Ceftriaxone should be considered as the drug of choice for initial empirical therapy, while waiting culture results and vancomycin must be withheld for patients having increased risk of penicillin resistant pneumococci strains.Öğe Comparison of lamivudine and alpha-interferon combination with alpha-interferon alone in the treatment of HBeAg-positive chronic hepatitis B(2006) Ayaz C.; Celen M.K.; Colak H.; Hosoglu S.; Geyik M.F.Aim: To compare the efficacy of a combination of a-interferon (IFN-a) and lamivudine with IFN-a alone in the treatment of patients with HBeAg-positive chronic hepatitis B (CHB). Methods: Sixty-eight treatment-naove patients with HBeAg-positive CHB were randomized to receive either 9 MU of IFN-a2a three times a week and lamivudine 100 mg daily (Group 1), or IFN-a2a alone in the same dosage (Group 2), for 12 months. Serum ALT, HBeAg, anti-HBe and HBV DNA were tested at the end of treatment and 6 months later. Complete response was defined as normal ALT, negative HBeAg and negative HBV DNA, six months after stopping treatment. Results: Of the 68 patients, 64 completed the study. In Group 1 (n=31), mean (SD) ALT levels decreased from 124 (59) IU/L to 39 (18) IU/L at 12 months; corresponding values in Group 2 (n=33) were 128 (57) and 56 (11) IU/L (p<0.05). Absence of HBV DNA at the end of treatment was more common in Group 1 (28/31) than in Group 2 (22/33; p<0.022). The number of patients with seroconversion to anti-HBe (4/31 [13%] vs. 4/33 [12%], respectively; p>0.05), as also those with complete response (4/31 [13%] and 4/33 [12%], respectively; p>0.05) six months after completion of treatment was similar in Group 1 and Group 2 . Conclusion: Combination treatment with IFN-a and lamivudine was better than IFN-a monotherapy in normalization of ALT and clearance of HBV DNA; however, it did not have a better sustained response rate than IFN-a alone. © 2004 Indian Journal of Gastroenterology.Öğe The evaluation of exposure to hepatitis A virus in HBsAg-positive persons: A multicentre study from Turkey(Journal of Pure and Applied Microbiology, 2014) Celen M.K.; Turker K.; Oztoprak N.; Sener A.; Tuna N.; Ince N.; Erdem I.Chronic hepatitis B is a major public health problem in our country. Hepatitis A vaccination in HBV carriers who did not encounter with Hepatitis A virus is also significant. We aimed to evaluate the rate of exposure to HAV in HBsAg-positive persons, and the distribution of seronegative individuals according to age groups. Medical records of 4793 patients from 14 centers who were positive for hepatitis B surface antigen (HBsAg). A total 3514 cases (73.3%) were male and 1279 (26.7) were female. The HBsAg positive patients who were previously tested for HAV IgG at the time of firstly admitted to a center. HBsAg positive patients who were previously not tested for HAV IgG were tested and these . patients were confirmed serologically for HAV. The distribution of cases according to age were determined. In this study, 4793 HBsAg-positive patients were evaluated. The ratio of testing of anti-HAV IgG was very low during the first visit (54.2%). Seronegativity was highest in the age group under 19 years of age (26.2%) followed by 20-25 age group (15.5%) and 26-29 age group (12.5%). Testing of HAV serology should not be ignored in especially HBsAg-positive young adults and seronegative young adults should be vaccinated.Öğe Four-year study of entecavir efficacy and safety in nucleos (T)ide-naïve HBeAg positive chronic hepatitis B patients(Klinicka Bolnica Sestre Milosrdnice, 2014) Celen M.K.; Dal T.; Ayaz C.; Bayan K.; Mert D.; Deveci O.; Oruc E.K.Entecavir is a guanosine analogue with activity against hepatitis B virus. The aim of this 4-year trial was to evaluate entecavir treatment in nucleos(t)ide-naïve HBeAg-positive chronic hepatitis B patients. Forty-nine patients received entecavir and nine of them withdrew from the trial at the end of week 96. The initial mean value of alanine aminotransferase was 79.4±41.5 IU/L, and at the end of the 4-year study period, 90% of patients had alanine aminotransferase values within the normal range. At week 96, 91.7% of patients had HBV DNA <300 copies; at month 48, 90% of patients had HBV DNA <50 IU/mL. HBeAg loss was recorded in 7.1% of patients at week 96 and in 12.5% at month 48. The rate of HBeAg seroconversion was 4.8% at week 96 and 7.5% at month 48. The rate of HBsAg seroconversion was 2.1% at week 96 and 2.5% at month 48. Entecavir as a potent and safe agent leading to continuous viral suppression proved to be safe and well tolerated therapy.
