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    Brucellar pericarditis: a report of four cases and review of the literature
    (Elsevier Sci Ltd, 2013) Kaya, Safak; Eskazan, Ahmet Emre; Elaldi, Nazif
    Background: Brucellosis, a disease endemic in many countries including Turkey, is a systemic infectious disease. Cardiovascular complications are not frequent, and endocarditis is the main cardiac manifestation of brucellosis. Pericarditis in the absence of concomitant endocarditis is extremely rare. Methods: In this report, we present four patients with pericarditis caused by brucellosis in the absence of concomitant endocarditis, along with a review of the published literature on brucellar pericarditis. We also searched for clinically silent pericardial effusion among patients with brucellosis. We performed routine transthoracic echocardiography (TTE) on 72 consecutive patients with newly diagnosed brucellosis in the absence of any signs and symptoms of pericarditis over a period of 6 months. Results: Three of our patients with brucellar pericarditis recovered fully after antibiotics. The other patient received 6 days of antibiotic treatment, and her signs and symptoms regressed, but after this the patient was lost to follow-up. We did not detect pericarditis among the 72 newly diagnosed patients. Conclusions: Brucellar pericarditis is a rare clinical entity, and the morbidity and mortality in patients with brucellar pericarditis is low. Pericardiocentesis should only be performed in patients with cardiac tamponade. Moreover, the choice of antibiotics and the duration of treatment do not differ between brucellosis cases with or without isolated pericarditis. Although the prevalence of pericarditis in brucellosis is low, brucellar pericarditis should always be kept in mind in patients with acute or chronic pericarditis, especially in areas where brucellosis is endemic. (C) 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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    Brucellosis in pregnancy: results of multicenter ID-IRI study
    (Springer, 2019) Inan, Asuman; Erdem, Hakan; Elaldi, Nazif; Gulsun, Serda; Karahocagil, Mustafa K.; Pekok, Abdullah U.; Ulug, Mehmet
    Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p<0.001), vaginal bleeding (p<0.001), anemia (blood hemoglobin <11g/dL; p<0.001), high level of serum aspartate aminotransferase (>41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.
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    Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter Backbone-1 Study
    (Elsevier Science Inc, 2015) Erdem, Hakan; Elaldi, Nazif; Batirel, Ayse; Aliyu, Sani; Sengoz, Gonul; Pehlivanoglu, Filiz; Ramosaco, Ergys
    BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1). CONCLUSIONS: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available. (C) 2015 Elsevier Inc. All rights reserved.
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    Cytopenia in adult brucellosis patients
    (Medknow Publications & Media Pvt Ltd, 2018) Kaya, Safak; Elaldi, Nazif; Deveci, Ozcan; Eskazan, Ahmet Emre; Bekcibasi, Muhammed; Hosoglu, Salih
    Background & objectives: Brucellosis can lead to haematological abnormalities including cytopenia confusing with haematological malignancies. The aim of this study was to compare the main characteristics of brucellosis patients without cytopenia (Group 1) and with cytopenia (Group 2). Methods: This five-year period study which was performed in two referral hospitals in Turkey, included all adult brucellosis patients. Abnormally, low counts of leucocyte or haemoglobin or platelets in a patient were considered as cytopenia. The demographics, clinical, laboratory, treatment and outcome data were analyzed. Results: A total of 484 brucellosis patients were enrolled. Among the cases, 162 (33.5%) of them had cytopenia. One hundred and four (21.5%) had anaemia, 88 (18.8%) had thrombocytopenia, 71 (14.6%) had leucopenia and 28 (5.8%) had pancytopenia. The mean age of group 2 was 35.01 +/- 16.05 yr and it was 33.31 +/- 14.39 yr in group 1. While there was no difference between the groups in terms of duration of treatment, the median length of hospital stay (LOS) was significantly longer in group 2 (9 vs 10 days; P<0.001). The most frequently applied combination therapy consisted of doxycycline plus rifampicin and doxycycline plus streptomycin regimens. No significant difference was observed in terms of duration of treatment, LOS and restoration time of cytopenia between the patients who received either of these combinations. Interpretation & conclusions: Our findings suggested that the patients with cytopenia should be investigated for brucellosis, especially if living in, or with a history of travel to, endemic areas, in view of the increase in world travel.
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    Mortality indicators in pneumococcal meningitis: therapeutic implications
    (Elsevier Sci Ltd, 2014) Erdem, Hakan; Elaldi, Nazif; Oztoprak, Nefise; Sengoz, Gonul; Ak, Oznur; Kaya, Selcuk; Inan, Asuman
    Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.
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    Respiratory System Involvement in Brucellosis The Results of the Kardelen Study
    (Elsevier, 2014) Erdem, Hakan; Inan, Asuman; Elaldi, Nazif; Tekin, Recep; Gulsun, Serda; Ataman-Hatipoglu, Cigdem; Beeching, Nicholas
    Background: Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis. Methods: This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement. Results: Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as, 2 months), with an overall mean +/- SD duration of symptoms of 33.9 +/- 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 +/- 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients. Conclusions: Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.