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Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study
(Biomed Central Ltd, 2015) Senbayrak, Seniha; Ozkutuk, Nuri; Erdem, Hakan; Johansen, Isik Somuncu; Civljak, Rok; Inal, Ayse Seza; Kayabas, Uner
Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM. Methods: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB). Results: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any firstline drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0: 34-13: 42), respectively. Conclusion: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing.
BK virus-induced acute motor-axonal polyneuropathy in a renal transplant patient
(Springer Japan Kk, 2016) Taskapan, Hulya; Kayabas, Uner; Otlu, Baris; Kamisli, Ozden; Yaprak, Cisel Yilmaz; Sahin, Fatma Terzioglu
Neurological complications are not uncommon in patients with renal transplantation, mostly affecting the central nervous system, and less frequently the peripheral nerves. BK virus infection is relatively common in transplant recipients and in some cases may lead to neurological complications. In this report, we present an interesting case of a patient who developed acute axonal motor polyneuropathy in the course of BK virus infection 3 months after kidney transplantation. After BK virus clearence in blood, a significant improvement was noted in her polyneuropathy. In patients with acute axonal motor polyneuropathy after transplantation BK virus-induced polyneuropathy should be excluded.
Brucella and peritoneal dialysis related peritonitis: case report and review of literature
(Dustri-Verlag Dr Karl Feistle, 2014) Koz, Suleyman; Sahin, Idris; Kayabas, Uner; Kuzucu, Cigdem
Isolated case reports of peritonitis due to Brucella spp. during peritoneal dialysis (PD) continue to surface in the medical literature. However, the optimal treatment regimen for these patients, in particular with regards to the fate of PD catheter, is still largely unknown. We report a case of brucella peritonitis successfully treated with intraperitoneal administration of amikacin, along with oral rifampicin and doxycycline but without catheter removal. Furthermore, we have reviewed the literature up until present day.
Cerebrospinal Fluid Viscosity: A Novel Diagnostic Measure for Acute Meningitis
(Lippincott Williams & Wilkins, 2010) Yetkin, Funda; Kayabas, Uner; Ersoy, Yasemin; Bayindir, Yasar; Toplu, Sibel Altunisik; Tek, Ibrahim
Introduction: Early diagnosis of acute meningitis has paramount importance in clinical practice because of mortality and morbidity of the disease. Examination of cerebrospinal fluid (CSF) has critical value for the diagnosis of acute meningitis and discrimination of bacterial and aseptic meningitis. It has been previously reported that plasma viscosity can be used as an inflammatory marker. In this study we aimed to evaluate the role of CSF viscosity as a complementary measure for diagnosis of meningitis in suspected patients. Methods: Forty-one consecutive patients who underwent lumbar puncture to rule out meningitis were studied prospectively. Twenty-seven patients were diagnosed with meningitis, of whom 13 patients had aseptic meningitis and 14 patients had bacterial meningitis. Meningitis was ruled out in 14 patients. Results: CSF protein and CSF viscosity were significantly higher in patients with meningitis compared to nonmeningitis. Receiver operator characteristic (ROC) analysis revealed that CSF viscosity was highly sensitive (100%) and specific (93%); measures for the diagnosis of meningitis in the study population was comparable to those of CSF protein. Additionally, patients with meningitis were also divided into two groups as having bacterial and aseptic meningitis. CSF viscosity also significantly differed between bacterial and aseptic meningitis. Conclusion: The CSF viscosity is a simple and easy method and can be used as an adjunctive measure for the diagnosis of meningitis. With the support of further and larger clinical studies, CSF viscosity may have a role in the discrimination of bacterial versus aseptic meningitis.
Ciprofloxacin-induced urticaria and tenosynovitis: A case report
(Karger, 2008) Kayabas, Uner; Yetkin, Funda; Firat, Ahmet K.; Ozcan, Hamdi; Bayindir, Yasar
Background: Tendon disorders are rare events associated with fluoroquinolone congestion. Skin reactions are more frequent than tendon disorders. We reported this case as the combination of ciprofloxacin-induced urticaria and tenosynovitis has been unreported in young women. Case: A 28-year-old woman without underlying disease developed urticarias and tendinopathy 4 days after the initiation of ciprofloxacin treatment for urinary infection. MRI of the left foot revealed increased synovial fluid surrounding the tendon of the flexor hallucis longus muscle representing tenosynovitis. Ciprofloxacin was ceased due to the possibility of ciprofloxacin-induced tendinopathy and urticaria. Complete resolution of her symptoms and findings occurred 3 days after discontinuation of ciprofloxacin without any additional treatment. Conclusion: Early discontinuation of fluoroquinolone therapy when tendinopathy is suspected is the basis of therapy. So, it should be kept in mind that fluoroquinolone-induced tendinopathy may occur in an otherwise healthy young patient with no risk factors and in a site other than the Achilles tendon. Copyright (C) 2008 S. Karger AG, Basel.
Device-associated nosocomial infection surveillance in the neurosurgery intensive care unit of the Inonu University Turgut Ozal Medical Center
(Doc Design Informatics Co Ltd, 2008) Yetkin, Funda; Ersoy, Yasemin; Karaman, Perihan; Kayabas, Uner; Bayindir, Yaflar; Kocak, Ayhan
Patients in the intensive care units (ICUs) have a high risk of infection due to the severity of illness of the patients treated and the high number of medical devices used. For patients requiring neurosurgical intensive care there are certain risk factors (e.g. altered consciousness, impaired protective reflexes, head injury) of acquiring nosocomial infections (NIs). In this study, we prospectively investigated NIs, device utilization ratios and device-associated infection rates, isolated agents and their antimicrobial susceptibilities in the neurosurgery intensive care unit of the Inonu University Turgut Ozal Medical Center between May 2006-April 2007. 613 patients with a total of 3561 patient days were enrolled. The overall incidence of NIs was 13.9% per 100 patients and the incidence density 23.8 per 1,000 patient days. Pneumonia (65.8%), bloodstream infections (16.5%), and urinary tract infections (15.3%) were the most frequent NIs recorded. The rate of ventilator-associated pneumonia was 67.2 infections per 1,000 ventilator-days, the rate of catheter-associated bloodstream infection was 8.1 per 1,000 central line-days, and the rate of catheter-associated urinary tract infection was 3.9 infections per 1,000 urinary catheter-days. Of the bacteria determined 56.8% were Gram-negative. In this group Pseudomonas aeruginosa was the most frequently isolated (25%). Staphylococcus aureus (20.4%) was the most frequently found Gram-positive bacteria (38.6%). We aim to investigate the causes of ventilator-associated pneumonia and catheter-associated bloodstream infections and to determine necessary preventive measures in an observative and multidisciplinary studies.
Evaluation of 23 cutaneous anthrax patients in eastern Anatolia, Turkey: diagnosis and risk factors
(Wiley, 2008) Ozcan, Hamdi; Kayabas, Uner; Bayindir, Yasar; Bayraktar, Mehmet R.; Ay, Selma
Background Anthrax is a potentially fatal zoonotic disease. The diagnosis of cutaneous anthrax (CA) may be very difficult, particularly in atypical presentations and nonendemic regions. Aim To evaluate the clinical features and diagnostic difficulties of 23 anthrax cases seen between May 2004 and September 2006. Methods Twenty-three patients with CA were included in this study. The diagnosis of CA was based on clinical findings and/or microbiologic procedures. Results All patients with a diagnosis of CA were followed up. One patient experienced toxemic shock. Twenty-two patients had a history of animal contact. Only one patient did not recall any history of suspicious contact. The clinical presentation of CA was typical in 20 patients (87%). Two patients were initially misdiagnosed with insect bites and one patient with angioedema. Cultures from the lesions were positive for Bacillus anthracis in seven cases (30.4%). Gram stain from the lesions revealed Gram-positive rods in eight cases (34.8%). Fifteen patients (65.2%) were diagnosed by clinical presentation and a history of contact with sick animals and/or contaminated animal products. Conclusions CA is a very contagious and important infectious disease worldwide. Early and accurate diagnosis dramatically affects the prognosis of the disease. The diagnosis of CA may be difficult, especially in atypical presentations and nonendemic areas. Thus, CA should be kept in mind, especially in these situations.
Evaluation of Culture-confirmed Extrapulmonary Tuberculosis Cases in a University Hospital
(Galenos Yayincilik, 2019) Toplu, Sibel Altunisik; Kayabas, Uner; Otlu, Baris; Bayindir, Yasar; Ersoy, Yasemin; Memisoglu, Funda
Introduction: Tuberculosis (TB) is caused by Mycobacterium tuberculosis and can involve any organ, especially the lungs. In recent years, especially in developed countries, the incidence of TB has increased due to the growing number of people with acquired immunodeficiency. This has led to an increase in the incidence of extrapulmonary TB (EPTB). This study examined patients with EPTB confirmed by positive M. tuberculosis culture in Inonu University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Molecular Microbiology Laboratory. Materials and Methods: Patients with positive M. tuberculosis culture in the molecular microbiology laboratory of our hospital between January 1, 2004 and December 31, 2014 were retrospectively evaluated according to culture-confirmed site of involvement, acid-fast bacillus (AFB), polymerase chain reaction (PCR) positivity, drug resistance, and mortality. Results: The study included 132 patients; 41 (31.1%) were male and 91 (68.9%) were female. The mean age was 46.4 +/- 18.5 (17-86) years. Extrapulmonary TB types were TB lymphadenitis in 48 patients (36.4%), musculoskeletal TB in 23 (17.4%), disseminated TB in 17 (12.9%), urinary TB in 11 (8.3%), abdominal TB in 11 (8.3%), TB meningitis in eight (6.1%), pleural TB in six (4.5%), genital TB in five (3.8%), and cutaneous TB in three patients (2.3%). Acid-fast bacillus positivity rates were 21.7% in musculoskeletal samples, 16.6% in pleural samples, 12.5% in cerebrospinal fluid, 9% in urinary tract samples, and 6.2% in lymph nodes. Polymerase chain reaction positivity was not detected in cerebrospinal fluid or skin samples. The rate of resistance to at least one anti-tuberculous drug was 20%. Mortality was 16.1% (n=9) in the 56 patients (42.4%) with available data. Conclusion: Lymphatic TB was the most common form in our patients. According to national data, pleural TB is among the common forms of EPTB in Turkey. However, the rate of pleural TB was low in our study due to the lack of pleural biopsy in our hospital during the study period. In TB-endemic regions such as Turkey, it is important to consider EPTB in the differential diagnosis of patients with relevant clinical findings and to confirm the diagnosis with TB culture primarily, as well as methods such as AFB staining and PCR.
Evaluation of Nosocomial Infections after ABO-Compatible and Incompatible Liver Transplantations
(Galenos Yayincilik, 2018) Bayar, Filiz Surucu; Bayindir, Yasar; Isik, Burak; Ozgor, Dincer; Kayabas, Uner; Kuzucu, Cigdem; Yilmaz, Sezai
Introduction: Liver transplantation is currently the only treatment option in acute hepatic failure and end-stage liver disease. In spite of their complications, ABO-incompatible liver transplantations are performed due to the shortage of suitable donors and the urgent need for organs. Despite developments in surgical techniques and improvements in antimicrobial prophylaxis strategies, infection is still an important complication and continues to be a major cause of death. In this study, ABO-compatible and ABO-incompatible liver transplant recipients were compared retrospectively in terms of infections and survival. Materials and Methods: Sixteen ABO-incompatible liver transplant recipients whose transplant surgeries were performed by the Liver Transplant Team between March 2002 and January 2011 were included in the study. ABO-compatible liver transplant recipients whose surgeries were undergone before and after the ABO-incompatible transplantation were selected as control group (total 32 patients). Patients' postoperative one year data were obtained from hospital records in both groups. Results: In the first postoperative year after liver transplantation, 12 (75%) of the ABO-incompatible recipients and 21 (65.6%) of the ABO-compatible recipients experienced at least one infection attack (p=0.509). The infection attack rate was 175% in the ABO-incompatible group and 113% in the ABO-compatible group (p=0.262). Eight (50%) of the 16 ABO-incompatible recipients and nine (28.1%) of the 32 ABO-compatible recipients died within one year of transplantation (p=0.135). There were no statistically significant differences between the groups in terms of mortality or infection rates. Pseudomonas aeruginosa was the most common isolate in both ABO-compatible and incompatible recipients. Conclusion: The findings of the study showed that ABO-incompatible transplants were comparable to ABO-compatible transplants in terms of infection rates and survival. It should be kept in mind that ABO-incompatible liver transplantation may be an option, especially in emergencies and in selected cases, despite differences in complications between centers and patient groups and concerns about greater complications in ABO-incompatible patients. However, further studies are needed on this topic.
Evaluation of nosocomial ınfections after abo-compatible and ıncompatible liver transplantations
(Galenos yayıncılık, erkan mor, molla guranı cad 21-1, fındıkzade, ıstanbul 34093, turkey, 2018) Bayar, Filiz Surucu; Bayindir, Yasar; Isik, Burak; Ozgor, Dincer; Kayabas, Uner; Kuzucu, Cigdem; Yilmaz, Sezai
Introduction: Liver transplantation is currently the only treatment option in acute hepatic failure and end-stage liver disease. In spite of their complications, ABO-incompatible liver transplantations are performed due to the shortage of suitable donors and the urgent need for organs. Despite developments in surgical techniques and improvements in antimicrobial prophylaxis strategies, infection is still an important complication and continues to be a major cause of death. In this study, ABO-compatible and ABO-incompatible liver transplant recipients were compared retrospectively in terms of infections and survival. Materials and Methods: Sixteen ABO-incompatible liver transplant recipients whose transplant surgeries were performed by the Liver Transplant Team between March 2002 and January 2011 were included in the study. ABO-compatible liver transplant recipients whose surgeries were undergone before and after the ABO-incompatible transplantation were selected as control group (total 32 patients). Patients' postoperative one year data were obtained from hospital records in both groups. Results: In the first postoperative year after liver transplantation, 12 (75%) of the ABO-incompatible recipients and 21 (65.6%) of the ABO-compatible recipients experienced at least one infection attack (p=0.509). The infection attack rate was 175% in the ABO-incompatible group and 113% in the ABO-compatible group (p=0.262). Eight (50%) of the 16 ABO-incompatible recipients and nine (28.1%) of the 32 ABO-compatible recipients died within one year of transplantation (p=0.135). There were no statistically significant differences between the groups in terms of mortality or infection rates. Pseudomonas aeruginosa was the most common isolate in both ABO-compatible and incompatible recipients. Conclusion: The findings of the study showed that ABO-incompatible transplants were comparable to ABO-compatible transplants in terms of infection rates and survival. It should be kept in mind that ABO-incompatible liver transplantation may be an option, especially in emergencies and in selected cases, despite differences in complications between centers and patient groups and concerns about greater complications in ABO-incompatible patients. However, further studies are needed on this topic.
HBsAg Screening in the Family Members of the Patients with Chronic Hepatitis B
(Galenos Yayincilik, 2007) Kayabas, Uner; Bayindir, Yasar; Yologlu, Salim; Akdogan, Dogan
Hepatitis B is one of the most common viral infections around the world. It is estimated that two billion people have been infected with hepatitis B virus and higher than 350 million have chronic hepatitis B. The aim of this study was to determine HBsAg positivity in the family members of index cases with chronic hepatitis B. Totally 375 subjects who were admitted to our outpatient clinic of Infectious Diseases between 2000 and 2003, were included in this study. Eighty-eight of them were index cases that were detected as HBsAg positive while 287 of them were the family members of the index cases. Thirty (34.1%) of the index cases were female and 58 (65.9%) were male. One hundred and fifty eight (55.1%) of the family members were female, 129 (44.9) were male. There were 36 HBsAg positive family members, 20 (55.5%) of them were male, 16 (44.5%) of them were female (p>0.05). The mean age of HBsAg positive family members and HBsAg negative family members were 26.5 +/- 14.7 (6-58) and 20.1 +/- 14.2 (range 1-60) (p=0.01), respectively. HBsAg positivity of fathers was higher than mothers (p=0.0003). HBsAg positivity was higher in off-springs of families that both parents have HBsAg positivity than families with mother-negative but father-positive HBsAg positivity (p<0.0001). In conclusion, intra-familial transmission is very important for HBV, therefore the family members of HBsAg positive index cases should be screened for HBsAg and if necessary they should be vaccinated.
A Heart Transplant Recipient Lost Due to Pneumocystis jiroveci Pneumonia Under Trimethoprim-Sulfamethoxazole Prophylaxis: Case Report
(Baskent Univ, 2010) Celik, Tuncay; Gedik, Ender; Kayabas, Uner; Bayindir, Yasar; Gulbas, Gazi; Firat, Ahmet Kemal; Togal, Turkan
Infections in solid-organ transplant recipients are the most important causes of morbidity and mortality. A primary goal in organ transplant is the prevention or effective treatment of infection, which is the most-common life-threatening complication of long-term immunosuppressive therapy. A 21-year-old woman who underwent heart transplant 3 years previous owing to dilated cardiomyopathy was referred to our hospital with symptoms of high fever and cough. The patient's history revealed that she had received a trimethoprim-sulfamethoxazole double-strength tablet each day for prophylactic purposes. On chest radiograph, pneumonia was detected, and in broncho-alveolar lavage sample, Pneumocystis jiroveci cysts were found. After diagnosing P. jiroveci pneumonia, trimethoprim-sulfamethoxazole was initiated at 20 mg/kg/d including intravenous trimethoprim in divided dosages every 6 hours. On the sixth day of therapy, she died in intensive care unit. In solid-organ transplant recipients, although antipneumocystis prophylaxis is recommended within the first 6 to 12 months after transplant, lifelong prophylaxis is also used in several settings. In addition, the physician should keep in mind that P. jiroveci pneumonia may develop in solid organ recipients, despite trimethoprim-sulfamethoxazole prophylaxis.
Immune Response in the Liver under Conditions of Infection, Malignancy, and Transplantation
(Hindawi Ltd, 2014) Kayhan, Basak; Ozdamar, Sukru Oguz; Padberg, Winfried; Kayabas, Uner; Aharoni, Rina; Mirshahidi, Saied
[Abstract Not Available]
Increased membrane turnover in the brain in cutaneous anthrax without central nervous system disorder: A magnetic resonance spectroscopy study
(Churchill Livingstone, 2012) Bayindir, Yasar; Firat, Ahmet K.; Kayabas, Uner; Alkan, Alpay; Yetkin, Funda; Karakas, Hakki M.; Yologlu, Saim
Cutaneous anthrax, caused by Bacillus anthracis contacting the skin, is the most common form of human anthrax. Recent studies implicate the presence of additional, possibly toxin-related subtle changes, even in patients without neurological or radiological findings. In this study, the presence of subtle changes in cutaneous anthrax was investigated at the metabolite level using magnetic resonance spectroscopy. Study subjects were consisted of 10 patients with cutaneous anthrax without co-morbid disease and/or neurological findings, and 13 healthy controls. There were no statistical differences in age and gender between two groups. The diagnosis of cutaneous anthrax was based on medical history, presence of a typical cutaneous lesion, large gram positive bacilli on gram staining and/or positive culture for B. anthracis from cutaneous samples. Brain magnetic resonance imaging examination consisted of conventional imaging and single-voxel magnetic resonance spectroscopy. Magnetic resonance spectroscopy was performed by using point-resolved spectroscopy sequence (TR: 2000 ms, TE: 136 ms, 128 averages). Voxels of 20 mm x 20 mm x 20 mm were placed in normal-appearing parietal white matter to detect metabolite levels. Cerebral metabolite peaks were measured in normal appearing parietal white matter. N-acetyl aspartate/creatine and choline/creatine ratios were calculated using standard analytical procedures. Patients and controls were not statistically different regarding parietal white matter N-acetyl aspartate/creatine ratios (p = 0.902), a finding that implicates the conservation of neuronal and axonal integrity and neuronal functions. However, choline/creatine ratios were significantly higher in patient groups (p = 0.001), a finding implicating an increased membrane turnover. In conclusion, these two findings point to a possibly anthrax toxins-related subtle inflammatory reaction of the central nervous system at the cellular level. (C) 2012 Elsevier Ltd. All rights reserved.
Investigation and analysis of a human orf outbreak among people living on the same farm
(Edizioni Int Srl, 2011) Bayindir, Yasar; Bayraktar, Mehmet; Karadag, Nese; Ozcan, Hamdi; Kayabas, Uner; Otlu, Baris; Durmaz, Riza
Human orf is a viral zoonotic infection caused by Parapoxvirus. The skin lesions of human orf can be misdiagnosed as cutaneous anthrax leading to overtreatment and also fear This study was conducted to analyze an outbreak which led to deaths among kids and lambs in the same flock, and skin lesions in some persons who were living on the same farm that were initially diagnosed as cutaneous anthrax by a practitioner. Eight patients with skin lesions and eleven persons who had no skin lesion were considered as patients and control groups, respectively The cultures obtained from the lesions of all patients were negative for Bacillus anthracis. The diagnosis of skin lesions was done by clinical findings, histopathological examination and PCR as human if. To be under 20 years of age, direct contact with the animals, and contact with flayed skin of sick animals were the risk factors for human if (Odds Ratio 7.5; 95% Confidence Interval 1.02-54.54, OR 12.25; 95% CI:1.3-100.9, OR 16.67; 95% CI:1.65-148.20, respectively). Orf should be kept in mind in the differential diagnosis of skin lesions resembling anthrax. For control and prevention of orf, transmission routes should be known; good hand hygiene and other personal protective measures have to be implemented.
Is airborne transmission of Acinetobacter baumannii possible: A prospective molecular epidemiologic study in a tertiary care hospital
(Mosby-Elsevier, 2016) Yakupogullari, Yusuf; Otlu, Baris; Ersoy, Yasemin; Kuzucu, Cigdem; Bayindir, Yasar; Kayabas, Uner; Togal, Turkan
Background: Understanding the dynamics of aerial spread of Acinetobacter may provide useful information for production of effective control measurements. We investigated genetic relationships between air and clinical isolates of Acinetobacter baumannii in an intensive care unit (ICU) setting. Methods: We conducted a prospective surveillance study in a tertiary care hospital for 8 months. A total of 186 air samples were taken from 2 ICUs. Clonal characteristics of air isolates were compared with the prospective clinical strains and the previously isolated strains of ICU patients over a 23-month period. Results: Twenty-six (11.4%) air samples yielded A baumannii, of which 24 (92.3%) isolateswere carbapenemresistant. The Acinetobacter concentrationwas the highest in bedside sampling areas of infected patients (0.39 CFU/m(3)). Air isolateswere clustered in 13 genotypes, and 7 genotypes (including 18 air strains) were clonally related to the clinical strains of 9 ICU patients. One clone continued to be cultured over 27 days in ICU air, and air isolates could be clonally related to 7-week retrospective and approximately 15-week prospective clinical strains. Conclusions: The results of this study suggest that infected patients could spread significant amounts of Acinetobacter to ICU air. These strains could survive in air for some weeks and could likely still infect new patients after some months. Special control measurements may be required against the airborne spread of Acinetobacter in ICUs. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Magnetic resonance spectroscopy features of normal-appearing white matter in patients with acute brucellosis
(Elsevier Ireland Ltd, 2008) Kayabas, Uner; Alkan, Alpay; Firat, Ahmet Kemal; Karakas, Hakki Muammer; Bayindir, Yasar; Yetkin, Funda
We aimed to evaluate whether the subtle metabolic cerebral changes are present in normal-appearing white matter on conventional MRI, in patients with acute brucellosis, by using MR spectroscopy (MRS). Sixteen patients with acute brucellosis and 13 healthy control subjects were investigated with conventional MRI and single-voxel MRS. Voxels were placed in normal-appearing parietal white matter (NAPWM). N-Acetyl aspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were calculated. There was no significant difference between the study subjects and the control group in NAA/Cr ratios obtained from NAPWM. However, the Cho/Cr ratios were significantly higher in patients with acute brucellosis compared to controls (p=0.01). MRS revealed metabolic changes in normal-appearing white matter of patients with brucellosis. Brucellosis may cause subtle cerebral alterations, which may only be discernible with MRS. Increased Cho/Cr ratio possibly represents an initial phase of inflammation and/or demyelination process of brucellosis. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
Mucormycosis Presented with Facial Pain in a Renal Transplant Patient: A Case Report
(Elsevier Science Inc, 2019) Berktas, Bayram; Taskapan, Hulya; Bayindir, Tugba; Kayabas, Uner; Yildirim, Ismail Okan
Introduction. Mucormycosis is a severe infection in renal transplant recipients. Here, we report a case of maxillary sinus mucormycosis in a patient who presented with a facial pain complaint. Case. A 51-year-old female patient with renal transplantation due to autosomal dominant, polycystic kidney disease and diabetic nephropathy was admitted to our hospital with facial pain and minimal edema of the left half of her face on the 8th month of transplantation. On physical examination, there was only tenderness and slight edema on the left half of the face. On the paranasal computed tomography, extensive soft tissue densities involving septations, filling the left maxillary sinus, extending to the nasal cavity, and obliterating the left osteometeal unit were observed. Because facial pain was not relieved by antibiotics and several, potent analgesic drugs on the second day, mucormycosis infection with bone involvement was suspected. A left maxillary sinus excision was performed. Microscopic examination of the debridement specimen revealed necrotic bone interspersed with fungal hyphae, and culture isolated Rhizopus oiyzae. Liposomal amphotericin B was started. The patient was on tacrolimus, prednisolone, and mycophenolate mofetil. Tacrolimus was switched to cyclosporine to regulate serum glucose levels. The left maxillary sinus was washed with liposomal amphoterin B daily and curetted with intervals. The patient started dialysis because of severe renal function loss. The patient was discharged on the 96th day of liposomal amphotericin B. Conclusion. It should be kept in mind that mucormycosis may be present in the sinuses even if there is no evidence for nasal, oral, and dental examination in renal transplant patients with facial pain.
Mystery of Immune Response in Relapsed Brucellosis: Immunophenotyping and Multiple Cytokine Analysis
(Galenos Yayincilik, 2016) Kayhan, Basak; Kayabas, Uner; Kolgelier, Servet; Otlu, Baris; Gul, Mehmet; Kurtoglu, Elcin Latife; Bayindir, Yasar
Introduction: Brucella spp. are intracellular bacteria that may cause acute, subacute and chronic infections. Despite optimum antibiotic treatment, relapse of brucellosis occurs in some patients. There is less amount of knowledge about immune response in relapse of brucellosis. Materials and Methods: Twenty patients with acute brucellosis, 16 patients with relapsed brucellosis and as a control group 20 healthy volunteers were enrolled in this study to explore the immune response variation during relapse of brucellosis. The distribution of peripheral blood mononuclear cells was investigated by flow cytometry and level of various cytokines involved in inflammatory and anti-inflammatory response were measured by enzyme-linked immunosorbent assay in serum samples. Results: The most prominent data in phenotyping examination was the significant reduction (1.45 times) in the percentage of activated T cell (CD3(+) human leukocyte antigen-DR+) population in the relapse group in comparison to the acute brucellosis group. However, percentage of activated T cell population in the relapse group was 2.59 times higher than in healthy controls (p< 0.01). We observed a significant reduction in inflammatory cytokines interleukin (IL)-6, IL-18, interferon-gamma and IL-17 in relapsed patients in comparison to patients with acute brucellosis. While there was no significant difference in IL-15 and tumor necrosis factor-alpha levels between relapse and acute brucellosis groups, the levels of these two cytokines were significantly higher in the relapse group than in healthy subjects. In case of anti-inflammatory cytokines, while IL-4 levels increased significantly only in relapse group, IL-10 levels increased both in acute and relapse brucellosis group in comparison to healthy controls. Interestingly, we observed 2.87 times elevation in IL-4 levels in the relapse group in comparison to acute brucellosis (p< 0.01). Similarly; IL-10 levels increased 2.09 times in patients with relapsed brucellosis patients in comparison to acute brucellosis (p< 0.01). Conclusion: Elevation of regulatory cytokines in systemic immune system and reduction of activated T cell frequency occur during the relapse of brucellosis. These results may contribute to understanding the immunopathology in the systemic circulation during relapse of brucellosis.
An outbreak of Pseudomonas aeruginosa because of inadequate disinfection procedures in a urology unit
(Mosby-Elsevier, 2008) Kayabas, Uner; Bayraktar, Mehmet; Otlu, Baris; Ugras, Murat; Ersoy, Yasemin; Bayindir, Yasar; Durmaz, Riza
Background: Pseudomonas aeruginosa is an opportunistic pathogen causing nosocomial infections in many hospitals. We aimed to investigate the source of urinary tract infections by determining clonal relationship of Pseudomonas aeruginosa strains with pulsed-field gel electrophoresis (PFGE). Methods: During a 2-month period, all postoperative infections because of P aeruginosa were investigated in the Urology Department. Patient data were collected from medical records. Surveillance samples were obtained from various places in urological operating rooms. PFGE typing was performed for all P aeruginosa isolates. Results: A total of 14 P aeruginosa strains (12 from patients and 2 from environmental samples) were isolated. PFGE typing of these 14 strains yielded 2 possibly related clones, which differed from each other by 4 major bands. Ten of the patient isolates were clonally identical with the strains of 2 forceps. Conclusion: Typing results confirmed that inadequately disinfected surgical devices can be the source of outbreak. After institution of infection control measures and education,. no further clusters of P aeruginosa infection were detected in the Urology Department.

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