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Öğe Acute hepatitis: a rare complication of Epstein-Barr virus (EBV) infection(J Infection Developing Countries, 2010) Ulug, Mehmet; Celen, Mustafa Kemal; Ayaz, Celal; Geyik, Mehmet Faruk; Hosoglu, SalihInfectious Mononucleosis (IM), a benign lymphoproliferative disease, is the best known clinical syndrome caused by Epstein-Barr Virus (EBV). It usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. In this report we describe a patient with acute hepatitis following EBV-IM in a previously healthy woman. A 26-year-old woman who presented with fever, generalized weakness, nausea, sore throat, yellowing of skin, and a generalized skin rash was admitted to our clinic. Tonsillar enlargement, pharyngeal erythema, palatal petechiae, lymphadenopathy, and jaundice were noted. Significant atypical lymphocytes (> 10%) were seen on the peripheral blood smear. Liver function tests such as ALT: 303 U/L, AST: 172 U/L, ALP: 193 U/L and total bilirubin: 7.3 mg/dl were elevated. Serological tests for EBV infection were consistent with acute infection (EBV virus capsid antigen was reactive with IgM and IgG antibodies). The Monospot test was also positive. On the seventh day, liver function tests and bilirubin had risen to peak level and platelets were decreased. The patient was managed supportively and her critical condition improved and was finally stabilized. Although the prognosis for IM is very favorable, a variety of acute complications may occur.Öğe Are sinus-track cultures reliable for identifying the causative agent in chronic osteomyelitis?(Springer, 2009) Ulug, Mehmet; Ayaz, Celal; Celen, Mustafa Kemal; Geyik, Mehmet Faruk; Hosoglu, Salih; Necmioglu, SerdarThe infection of bone that contains bone marrow called osteomyelitis, and is caused by different microorganisms. In this study, we aimed to determine the diagnostic value and accuracy of cultures of material from a sinus track compared with those of cultures of bone specimens that have been controversial. Prospective study was conducted at Hospital University of Dicle, a 1,090-bed university-based hospital located in DiyarbakA +/- r, Turkey. Between May 2005 and September 2006, sinus-track cultures were compared with those of bone cultures from 43 patients with chronic osteomyelitis. The patients' mean age was 30.6 +/- A 3.6 years, and 29 (67%) male and 14 (33%) female. Organisms isolated from bone cultures were Staphylococcus 69% (29/42), Escherichia coli 9.5% (4/42), Pseudomonas aeruginosa 9.5% (4/42), Proteus mirabilis 7% (3/42), respectively. Cultures of sinus track and bone specimens gave identical results in 38% of patients. The value of bone culture in the therapy of osteomyelitis must be emphasized; it is the only reliable means of determining the responsible agent, up on which the antibiotic therapy is based. The correlation between sinus track and bone cultures was 38%, i.e., failure in the treatment for 6 patients out of 10.Öğe Brucellar epididymo-orchitis in southeastern part of Turkey: an 8 year experience(Elsevier Brazil, 2010) Celen, Mustafa Kemal; Ulug, Mehmet; Ayaz, Celal; Geyik, Mehmet Faruk; Hosoglu, SalihObjective: the different clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis (BEO) reporting to the reference hospital in Southeastern Anatolia of Turkey. Material and methods: in this study, 27 male patients with brucellosis, who presented with epididymitis or epididymo-orchitis (EO) at the university hospital in Diyarbakir from 1998 to 2006, were included. They were compared with the other male patients. Positive blood culture or high agglutination titers of >= 1/160 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Results: fourteen patients had unilateral EO. Leukocytosis was present in 10 patients; all of them had initial agglutination titers of >= 1/160 and 10 patients had a positive blood culture. All patients received combined therapy with streptomycin for the first 21 days (or oral rifampicin for 6-8 weeks) with doxycycline or tetracycline for 6-8 weeks. All showed improvement, fever subsided in 3-7 days, and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. Conclusion: in brucellosis-endemic areas, clinicians encountering EO should consider the likelihood of brucellosis. In this study, young age was the most common risk factor, and leukocytosis and high CRP level were the most common laboratory findings. Most cases were unilateral. All patients responded to medical management very well. Conservative management with combination antibiotic therapy was adequate for managing BEO. Conclusively, brucellosis must be considered as a cause of orchitis, especially in endemic regions like Turkey.Öğe 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, MehmetBrucellosis 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.Öğe A Case of Necrotizing Fasciitis due to Intramuscular Injection and Review of the Literature(Aves, 2009) Ulug, Mehmet; Celen, Mustafa Kemal; Geyik, Mehmet Faruk; Hosoglu, Salih; Ayaz, CelalNecrotizing fasciitis is a life-threatening soft-tissue infection characterized by progressive necrosis of the skin, subcutaneous tissue, and fascia. A twenty-three year-old female patient presented with erythema and pain in the left thigh; both had started 15 days previously. Physical examination revealed swelling, warmth in the left thigh and pain related to passive movement. During follow up, the area involved developed echymotic bullous lesions which shortly spread to the perineal region. Despite appropriate antibiotic therapy and supportive management, the lesions progressed and surgical debridement was carried out. Deep wound and blood cultures revealed Staphylococcus aureus. Clearly, the mortality and morbidity can be decreased with clinical awareness, early diagnosis, effective surgical debridement, and intensive supportive care. In this study, we present a rare case of necrotizing fasciitis in an adult who had no predisposing factor and discuss its clinical manifestations and the best therapeutic choice for this potential life threatening disease, together with a review of the literature.Öğe A Case of Salmonellosis Caused by a Multidrug-Resistant Strain of Salmonella typhimurium(Doc Design Informatics Co Ltd, 2009) Ulug, Mehmet; Celen, Mustafa Kemal; Ayaz, CelalSalmonellosis occurs both in epidemic and endemic forms and remains a public health problem in developing countries. Non-typhoidal Salmonella are important foodborne pathogens that cause gastroenteritis, bacteremia, and subsequent focal infection. Resistant bacteria are especially problematic in a wide variety of immunocompromised individuals, including patients with malignancy, and those receiving corticosteroid therapy or treatment with other immunotherapy agents. In this study, a 21 year old female patient with tuberculous meningitis who developed salmonellosis due to Salmonella typhimurium was presented.Öğe A case report and literature review: osteomyelitis caused by community-associated methicillin resistant Staphylococcus aureus(J Infection Developing Countries, 2011) Ulug, Mehmet; Ayaz, Celal; Celen, Mustafa KemalOsteomyelitis in adolescents is a serious disease with the potential for lifelong disability. The key to successful management is early diagnosis, including bone sampling for microbiological and pathological examination to allow targeted and long-lasting antibiotic therapy. Staphylococcus aureus is the most frequently isolated microorganism in these patients. Methicillin-resistant S. aureus (MRSA) is usually considered a nosocomial pathogen, but increasingly it is acquired in the community. We present a case of acute osteomyelitis caused by community-associated MRSA (CA-MRSA) who had never been hospitalized and had no other known risk factors for MRSA. The changing epidemiology of MRSA became evident when infections occurred in previously healthy patients without established risk factors. MRSA infections have been increasingly reported in pediatric patients, but they are uncommon in adults. Skin and soft tissue infections remain the most common manifestations of CA-MRSA infections. Glycopeptides can be used as initial therapy and oral trimetoprim-sulfamethoxazole as sequential therapy for these patients.Öğe The Diagnostic Value of Sinus-Track Cultures in Secondary Pediatric Chronic Osteomyelitis(Kuwait Medical Assoc, 2011) Ulug, Mehmet; Ayaz, Celal; Celen, Mustafa Kemal; Necmioglu, SerdarObjective: To determine and compare the diagnostic value and accuracy of culture of material from a sinus track with culture of material from bone specimens Design: Retrospective study Setting: Dicle University Medical School and Batman State Hospital, Turkey Subjects: Twenty-one patients with secondary chronic osteomyelitis (COM). Material for culture was taken from the sinus as well as the bone specimens Interventions: Surgery for COM Main outcome measures: The diagnostic value of sinus track culture Results: The mean age of patients was 8.5 +/- 3.8 years. 15 (71.4%) were male and six (28.6%) were female. Organisms isolated from bone cultures were Staphylococcus 71.4% (15 / 21), Pseudomonas aeruginosa 9.5% (2 / 21), Escherichia coli 9.5% (2 / 21), Proteus mirabilis 4.8% (1 / 21), Klebsiella pneumoniae 4.8% (1 / 21), respectively. Cultures of sinus track material and bone specimens gave identical results in 47.6% of patients. Conclusion: This study shows that if treatment of COM was planned according to the microbiological analysis of material from the sinus-track, it may not result in recovery every time. We found approximately 48% concordance between sinus-track and bone cultures. In other words, antimicrobial therapy guided by antibiograms of bacteria isolated from sinus-track would be inappropriate in 52% of patients with COM and result in treatment failure.Öğe The efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis(Riyadh Armed Forces Hospital, 2008) Ayaz, Celal; Celen, Mustafa K.; Geyik, Mehmet F.; Ulug, MehmetObjectives: To evaluate the efficacy of dexamethasone added to the treatment of adult patients with bacterial meningitis in our region. Methods: One hundred and forty-four patients were randomized prospectively and evaluated to determine the efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis at Dicle University Hospital, Diyarbakir, Turkey between January 2000 and December 2004. While the first group received ceftriaxone 4 gr/day plus dexamethasone, the second group received ceftriaxone 4 gr/day only. Dexamethasone was given 10-15 minutes before the first 8 mg dose of antibiotic treatment. It was continued at 16 mg/day for 3 days. Results: The study included 144 patients with the diagnosis of acute bacterial meningitis. Cerebrospinal fluid (CSF) was analyzed at the time of admission, after 24-48 hours (Table 1), and at the end of treatment. Accordingly, CSF leukocyte level was found to be 1710 2140/mm(3) in group 1 receiving dexamethasone treatment compared to 1950 +/- 2244/mm(3) in group 2 (p=0.001). The consciousness in the group receiving dexamethasone improved significantly more rapidly than the control group (p=0.001). While mortality was 9.7% in the patient group receiving dexamethasone it was 16.7% in the control group, however, it was not significant (p=0.093). Conclusion: The use of dexamethasone in adult patients is still under debate, and the administration of dexamethasone 10-15 minutes before antibiotherapy to unconscious patients in a poor state of health, is effective in the clinical improvement of the patient.Öğe The evaluation of bacteriology in perianal abscesses of 81 adult patients(Contexto, 2010) Ulug, Mehmet; Gedik, Ercan; Girgin, Sadullah; Celen, Mustafa Kemal; Ayaz, CelalObjective: Treatment of perianal abscesses requires prompt surgical drainage and antimicrobial therapy. However, we should encourage the selective use of antimicrobial agents on a case-by-case basis, especially because there is no evidence that uncomplicated perianal abscesses can be safely treated only with drainage. For this reason, it is important to identify the causative organisms; therefore, we accessed the microbiological analysis of these patients. Patients and methods: In this study, 81 consecutive adult patients with perianal abscesses, who presented at a university hospital in Diyarbakir from January 2004 to December 2006, were included. Clinical and laboratory data, and results of microbiological analysis were recorded. Results: All specimens, except seven, yielded bacterial growth. Escherichia coli, Bacteriodes spp., coagulase-negative Staphylococci, and Staphylococcus aureus were the most common isolated organisms. Conclusion: In contrast to other investigators, this study demonstrated that aerobic organisms are the predominant isolates in these infections.Öğe THE EVALUATION OF GERIATRIC INFECTIONS DICLE EXPERIENCE(Nobel Ilac, 2010) Ulug, Mehmet; Celen, Mustafa Kemal; Geyik, Mehmet Faruk; Hosoglu, Salih; Ayaz, CelalObjective Although successes have been achieved in the treatment of the infectious diseases with antibiotics in nowadays infectious diseases are still serious problem in the elderly This study was conducted in order to determine the pattern of clinical infectious diseases in hospitalized elderly Patients C. Material and Method In this study the data of all elderly patients aged 65 and older were hospitalized to our clinic between May 2000 and May 2005 were evaluated retrospectively We reviewed 301 patients for diagnostic studies risk factors isolated microorganisms and morbidity and mortality rates Results Infections as a cause of hospitalization were identified as the following frequency sepsis (19 2%) pneumonia (17 9%) acute gastroenteritis (16 9%) acute bacterial meningitis (5 3%) and urinaty tract infection (3 6%) respectively E colt was the most isolated microorganism in these patients Hypertension chronic obstructive pulmonary disease and diabetes were seen as risk factors in our patients Seventy three patients died during hospital stay due to their infection and chronic diseases Conclusion Under diagnosis of the elderly diseases is very common due to many factors related to elderly family members and health workers Prognosis is rather worse especially in sepsis due to pneumonia and urinary tract infectionsÖğe The evaluation of microbiology and Fournier's gangrene severity index in 27 patients(Elsevier Sci Ltd, 2009) Ulug, Mehmet; Gedik, Ercan; Girgin, Sadullah; Celen, Mustafa K.; Ayaz, CelalObjectives: The objectives of this study were to identify the causative microorganisms and factors associated with survival in patients with Fournier's gangrene and to determine the accuracy of the Fournier's gangrene severity index. Materials and methods: We retrospectively evaluated 27 patients with Fournier's gangrene who were treated and followed up at our hospital between January 2005 and December 2006. Biochemical, hematologic, and bacteriologic study results at admission and at the final evaluation, etiologic and predisposing factors at admission, physical examination findings, the timing and extent of surgical debridement, and antibiotic therapy used were all recorded. Results: The admission laboratory parameters that were significantly correlated with outcome included urea, creatinine, sodium, and potassium; at the final evaluation, in addition to these parameters, hematocrit, albumin, and bicarbonate levels were also significantly associated with outcome. The mean Fournier's gangrene severity index score (FGSIS) at admission for survivors was 5.04 + 2.49 compared with 13.6 + 4.61 for non-survivors. There was a strong correlation between the FGSIS and mortality (p < 0.0001). Escherichia coli and Pseudomonas aeruginosa were the most commonly isolated microorganisms. Conclusions: Patient metabolic status and predisposing factors are important in the prognosis of Fournier's gangrene. Hence, we believe that the FGSIS should be used clinically to evaluate therapeutic options and assess results. (C) 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Öğe The Evaluation of Nasal Cultures in Patients with Hematological Malignancies During Febrile Neutropenic Episodes(Galenos Yayincilik, 2012) Ulug, Mehmet; Ayaz, Celal; Celen, Mustafa KemalAim: Febrile neutropenia is a common complication in patients receiving cancer treatment. According to the results of several investigations, bacterial infections are the most common causes of morbidity and mortality in these patients. In this study, we aimed to determine the prevalence of nasal carriage of S. aureus in patients with febrile neutropenia, to assess the frequency of methicillin resistant S. aureus, and to compare the blood and nasal cultures in these patients. Methods: Nasal and blood cultures were performed in 51 patients with hematological malignancies during febrile neutropenic episodes. Antimicrobial susceptibilities of all S. aureus and Gram-negative strains were evaluated by disc diffusion method according to the National Committee for Clinical Laboratory Standards (NCCLS) for oxacillin and several other antibiotics. Results: In this study, blood and nasal cultures obtained between March 2006 and September 2006 were evaluated retrospectively. The overall nasal S. aureus carriage rate was 23.5%. On the other hand, of all blood cultures performed in 51 patients, nine (17.5%) were positive and the bacteria were not isolated in 87.5% of patients. The overall compliance rate of strains isolated from both blood and nasal cultures was 17.5%, while it was 11.7% when considering the status of strains resistant to antibiotics studied. Conclusion: It is concluded that, the surveillance cultures made occasionally in patients with febrile neutropenia may give an idea to the physicians in cases in which the causative pathogen cannot be determined.Öğe Laboratory-Acquired Brucellosis(Kuwait Medical Assoc, 2013) Ulug, Mehmet; Ayaz, Celal; Celen, Mustafa KemalLaboratory-acquired infections are rarely diagnosed and reported. Brucella species are highly contagious when handled in the laboratory Therefeore, brucellosis is one of the most common laboratory-acquired bacterial infections. Laboratory workers get infected by either inhalation or by direct contact through the injured skin. We present a case of laboratory-acquired brucellosis (LAB) caused by Brucella melitensis. In conclusion, despite the enforcement of infection control measures, including the use of biosafety cabinet in the laboratory, laboratory-acquired brucellosis still maintains its importance because of infected sample handling by the workers.Öğe NASOPHARYNGEAL CARCINOMA IN THE ETIOLOGY OF FEVER OF UNKNOWN ORIGIN(Nobel Ilac, 2010) Ulug, Mehmet; Celen, Mustafa Kemal; Geyik, Mehmet Faruk; Tekin, Recep; Ayaz, CelalFever of unknown origin is defined as a temperature higher than 38.3 degrees C lasting three weeks or longer and not beind diagnosed even after one week of study in-hospital settings. Infections and malignancies had been the most common causes of fever of unknown origin overall. Nasopharyngeal carcinoma,constituting less than 0.03% of all malignant tumors and only 2% of all head and neck cancer. Ebstein Barr virus infection consumption of smoked and salted fish and vitamin-C deficient diet have been blamed in its etiology. In this study,we present two cases who were admitted to our clinic with fever of unknown origin initially and later diagnosed with nasopharyngeal carcinoma atypically progressing.Öğe The Prevalence of Anti-HDV in Chronic Hepatitis B Patients(Galenos Yayincilik, 2006) Celen, Mustafa Kemal; Geyik, Mehmet Faruk; Ulug, Mehmet; Hosoglu, SalihIn spite of chronic hepatitis B infection was seen at high ratio in region of Southeast of Anatolia, our data's does not enough about hepatitis delta infection. Because of this reason we investigated the frequency of anti-HDV in chronic active hepatitis B patients. Anti-HDV was looked into 120 patients with chronic active hepatitis B. The relation between anti-HDV positive patients and age, sex, carrying time of HBsAg and positively of HBeAg was evaluated. Positively of anti-HDV was determined in 33/120 (27.5%). The relation between carrying time of HBsAg and positively of anti-HDV was found meaningful statistically (p= 0.001). But the relation between age, sex and positively of HBeAg with positively with anti-HDV was not found meaningful (p> 0.05). Positively of anti-HDV was found at high ratio (27.5%) in chronic hepatitis B patients so that they were evaluated surely about HDV infection.Öğe Pyogenic liver abscess caused by community-acquired multidrug resistance Pseudomonas aeruginosa(Contexto, 2010) Ulug, Mehmet; Gedik, Ercan; Girgin, Sadullah; Celen, Mustafa Kemal; Ayaz, Celal[Abstract Not Available]Öğe The Results of the Poll Which is about Rank of Knowledge of Viral Hepatitis at High School Students(Galenos Yayincilik, 2005) Celen, Mustafa Kemal; Ayaz, Celal; Geyik, Mehmet Faruk; Hosoglu, Salih; Acemoglu, Hamit; Ulug, MehmetViral hepatitis is an infectious diseases which is accepted liver, has five type A, B, C, D and E. Both sewer system's in sufficiency and hygiene rules does not adjust in our region because of this reason students were needed to know against methods for viral hepatitis especially. For this reason the poll which is about students rank of knowledge of hepatitis B, was taken in Anatolia Industry Vocational High School at Diyarbakir. 2003-2004 education years high school students (n=452) were included in this study. Poll forms which have got rady before, was dialed before thirty minutes, the seminar whose topic is against for viral hepatitis, began. 16 questions were asked to students in the poll than their rank of knowledge was investigated in three groups: good, medium and bad; according to their answes. 352 students (197 male, 155 female, mean age 15.8 +/- 1.2 years) were paticipated in this poll. These students were in high school class 1 (52%), class 2 (29%), class 3 (19%). Inspite of viral hepatitis topic involves in curriculum of The Ministry of Education, students (92%) were wanted to give them information about viral hepatitis at lessons in their school. Students answered questions of the poll medium level (63.4%), good (20.5%) and bad ( 16.2%). The relationship between parents of student's rank of knowledge about hepatitis B was meaningful by the statistical analysis which is done (p<0.01). Also the relationship between student's socioeconomic level and student's ranke of knowledge about for students from the cooperation between The Ministry of Education and Health an order to complete high school students lack of knowledge and to illuminate their neighborhood about hepatitis B, should be suitable.Öğe Sacroiliitis caused by Salmonella typhi(J Infection Developing Countries, 2009) Ulug, Mehmet; Celen, Mustafa Kemal; Geyik, Mehmet Faruk; Hosoglu, Salih; Ayaz, CelalAlthough the commonest manifestation of Salmonella infection is acute gastroenteritis, infection may spread to the blood-stream may and the illness can present with focal lesions in almost any organ with or without septicemia. We describe here a case of Salmonella typhi infection of a sacroiliac joint that was cured with ciprofloxacin therapy for six weeks. The patient was immunologically normal. Salmonella etiology was not suspected in this case, and the diagnosis was made only after bacterial isolation. Physicians should be aware of this rare manifestation of Salmonella infection, especially in endemic areas.Öğe Stevens-johnson syndrome caused by combined use of lamotrigine and fluoxetine and review of the literature(Versita, 2010) Ulug, Mehmet; Ulug, Nuray Can; Celen, Mustafa Kemal; Geyik, Mehmet Faruk; Ayaz, CelalStevens-Johnson syndrome (SJS) is a rare, life-threatening acute allergic drug reaction presenting with target lesions and blebs of epidermis. Although a variety of etiologies such as infections and underlying malignancies have been implicated as potential causes of SJS, drugs remain the predominant inciting agent. This report presents a SJS case due to combined use of lamotrigine and fluoxetine. A 41-year-old man was admitted to our clinic with fever, skin eruptions (especially on the face and trunk) and lesions around the mouth. The patient's history revealed lamotrigine and fluoxetine use during the previous three weeks for major depression. Dermatological examination revealed a typical clinical picture of SJS; his psychotropic medications were all stopped. While topical and ocular prednisolone (1mg/kg/day) cares were initiated, steroid dosage was reduced within 15 days. The condition of patient rapidly improved through this treatment. Effective management of SJS begins with prompt recognition of the entity, combined with attention to each of the major organs that may be affected, potential comorbidities and withdrawal of all potentially causative drugs. Clinicians should bear in mind the possibility that drugs with potential risk in developing SJS must be used carefully.
