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    Brucellosis in the etiology of febrile neutropenia: Case report
    (Taylor & Francis Ltd, 2002) Sari, R; Buyukberber, N; Sevinc, A; Bayindir, Y; Buyukberber, S
    Brucellosis is one of the leading diseases in the differential diagnosis of fever of unknown origin in some parts of the world. It can lead to treatment failure because of slow growth in blood cultures and late appearance of signs and symptoms in patients with febrile neutropenia who were unresponsive to empirical antibiotic treatment. During the last year in our oncology unit adjuvant chemotherapy was given to 3 patients with breast (n=l) and stomach cancer (n=2) and febrile neutropenia was seen after the first course of chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil, etoposide, Adriamycin, and cisplatin) in all 3 patients. Cefepime and amikacin were commenced but the fever continued. Prior to antifungal treatment, the patients were re-evaluated because of the history of unpasteurized milk ingestion without overt signs and symptoms. Serum agglutination tests of brucellosis were performed and were 1:640 in two patients and 1:320 in the third. Brucella melitensis was identified only in one case although multiple blood cultures were taken from all 3 patients. Empiric antibiotic treatment was stopped and streptomycin 1 g/day (10 days), doxycycline 200 mg/day (28 days), trimethoprim 320 mg and sulfamethoxazole 1600 mg/day (28 days) were given. Although neutropenia continued, fever subsided in 3 days. Due to high incidence of brucellosis in some geographic areas, especially in the Middle East, brucellosis should be kept in mind in the differential diagnosis of febrile neutropenia.
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    Comparison of five antimicrobial regimens for the treatment of brucellar spondylitis: A prospective, randomized study
    (E I F T Srl, 2003) Bayindir, Y; Sonmez, E; Aladag, A; Buyukberber, N
    Brucellosis, a zoonosis with worldwide distribution, is a systemic infection and still an important public health problem in Turkey. The best antimicrobial combination and schedule for the treatment of brucellosis with spondylitis has not yet been clearly determined. In a prospective and randomized study, we compared the efficacy of five antimicrobial regimens for treatment of 102 patients with lumbar brucellar spondylitis. Patients were randomly assigned to receive antimicrobial combination therapy. Twenty patients received streptomycin 1 g/day intramuscularly for 15 days and tetracycline-HCl, 500 mg every 6 h orally for 45 days (ST), 21 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days (SD), 20 patients received doxycycline 100 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (DR), 19 patients received ofloxacin, 200 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (OR), and 22 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days plus rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (SDR). Initial therapeutic failure occurred in 2 patients (10%) in the ST regimen group, 4 patients (19%) in the SD group, 3 patients (15%) in the DR group and 5 patients (26%) in the OR regimen. In addition, 2 patients (10%) in the DR group and 5 patients (26%) in the OR regimen relapsed during the follow-up period. There was no relapse in any patients in the ST, SD, and SDR groups. The response rates were 90% in the ST and 81% in the SD groups. In contrast, there was a maximum good response (100%) and no relapse in the SDR group. In conclusion, a combination of doxycycline, streptomycin, and rifampicin can be recommended as therapy for brucellar spondylitis and to reduce relapse rates.
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    Serum immunoglobulin E (Ig E) levels after myocardial infarction
    (Acta Cardiologica, 1997) Buyukberber, S; Sencan, O; Buyukberber, N; Tuncer, C; Akyol, O; Turgay, M; Kocakavak, C
    The relation between cardiovascular diseases and serum immunoglobulin E (Ig E) levels has been investigated by different authors. Serum Ig E may play a direct role in The pathogenesis of cardiovascular diseases, or it may only be a marker formed during pathological mechanisms. In this study, we determined serum Ig E levels of patients with unstable angina pectoris and myocardial infarction. Serum Ig E levels of 30 patients with acute myocardial infarction and 20 patients with unstable angina pectoris were deter-mined within the first 6 and 12th hours and on 2nd, 4th, 8th days of the hospitalization and these levels were compared with the serum Ig E levels of normal subjects reserved as control group. As a result, at all measurement hours, serum Ig E levels of acute myocardial infraction group were found to be approximately fourfold increased when compared to those of unstable angina pectoris and those of control group (p<0.001). In the acute myocardial infarction group, no significant differences could he found between the levels of the first 6th and 12th hours nod on the 2nd, 4th, 8th days. Also, no statistically significant difference was found between the serum Ig E levels of unstable angina pectoris and those of control group.