Browsing by Author "Karsen, Hasan"

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Akut Batın Tablosunu Taklit Eden Bir Bruselloz Olgusu
(2005) Akdeniz, Hayrettin; Arat, Murat Ersöz; Karsen, Hasan
GIS tutulumu ile seyrederek akut batın tablosunu taklit eden 17 yaşındaki brusellozlu olguya ait klinik bulgular sunuldu. Brucella serolojisi 1:10240 titrede pozitif bulundu. Rifampisin, doksisiklin ve sefriakson başlanan hastanın, bir hafta sonra cerrahi müdahale yapılmaksızın semptom ve bulguları düzeldi.
Apparent Vaccine-Thimerosal Induced Hypersensitivity, Myelodysplastic Syndrome and Pancytopenia
(J infection developing Countries, 2007) Karsen, Hasan; Akdeniz, Hayrettin; Karahocagil, Mustafa K.; Baran, Ali I.; Erten, Remzi
A case of hypersensitivity reaction, myelodysplastic syndrome and pancytopenia, which developed after an administration of thimerosal-containing tetanus vaccine, is presented and discussed.
Botulism Presenting With Unilateral Paralysis: First Case Report
(Aves, 2011) Karsen, Hasan; Baran, Ali Irfan; Ekin, Selami; Odabas, Faruk Omer; Duygu, Fazilet
Food-borne botulism is an acute form of food poisoning that results from ingestion of the toxin produced by Clostridium botulinum. Intoxication classically presents as an acute, symmetrical paralysis. In this study, we report a case of botulism with unilateral paralysis that was confirmed by the mouse inoculation and neutralization method.
A Brucellosis Case Presenting With Mass Formation Suggestive for Tumor in Soft Tissue
(Lippincott Williams & Wilkins, 2007) Karsen, Hasan; Akdeniz, Hayrettin; Irmak, Hasan; Buzgan, Turan; Karahocagil, M. Kasim; Kocak, Zeliha; Suennetcioglu, Mahmut
We report here a 70-year-old female patient who was diagnosed with brucellosis and presented with mass formation resembling a tumor. The mass was protuberant, 10 cut from the skin surface with a diameter of 15 cm, located at the inferior-lateral region of the left scapula. Brucella melitensis was yielded from culture of mass fluid. The patient responded to ceftriaxone, rifampin and doxycycline therapy and recovered without any sequela at the end of surgery and 3 months of medical treatment.
A Case of Brucellosis Presenting as High Titer Negative Result by Standard Tube Agglutination Test
(Ankara Microbiology Soc, 2007) Buzgan, Turan; Karsen, Hasan; Karahocagil, M. Kasim; Akdeniz, Hayrettin; Sunnetcioglu, Mahmut
Since prozone is a well known phenomenon in the serologic diagnosis of Brucella infections, it is necessary to prepare higher serum dilutions in the standard tube agglutination (STA) test for the brucellosis suspected patients. However, due to limited economical support, the serum dilutions generally last at 1/320-1/640 titers in some laboratories in Turkey. In this report, a brucellosis case whose STA test was found negative until the titer of 1/1280, has been presented. A 36-year-old female was admitted to our hospital with the complaints of fever, sweating, fatigue, generalized arthralgia and weight loss, lasting for 45 days. Hepatosplenomegaly was detected in the physical examination, and laboratory tests yielded anemia, leucopenia, elevated erythrocyte sedimentation rate and high C-reactive protein levels. Although brucellosis was suspected, Brucella STA test was found negative at 1/640 titer. On the sixth day of admission, Brucella melitensis was isolated from her blood culture. Since a positive result at 1/40 titer was detected in Brucella STA test with the use of Coombs antiserum, the patient's serum was retested at higher dilutions than 1/640, and positive result was obtained starting from 1/1280 dilution and extended to 1/5120 titer. The patient was treated with rifampin and doxycyline and discharged with complete cure. In conclusion, in countries endemic for brucellosis, STA test should be performed at 1/1280 or higher titrations in suspected patients especially in the presence of negative culture results, for the prevention of false negative results due to prozone phenomenon.
A Case of Neurobrucellosis With Coma
(Aves, 2006) Ersoz-Arat, Muret; Karsen, Hasan; Bakirci, Ayegul; Akdeniz, Hayrettin
A case of neurobrucellosis with coma. A case of brucellosis with coma, focal epileptic seizure, encephalopathy, depression, parkinsonism and pancreatic involvement is presented. The 25-year-old male patient was succesfully treated with rifampin, doxycycline and ceftriaxone.
A Case of Typhoid Fever Presenting With Multiple Complications
(Modestum Ltd, 2007) Buzgan, Turan; Evirgen, Omer; Irmak, Hasan; Karsen, Hasan; Akdeniz, Hayrettin
An 18-year old female patient was admitted to the Emergency Department with complaints of fever and fatigue beginning 15 days ago associated with headache, weakness, palpitation, abdominal pain, and diarrhea a week later. The patient who apathic confused and discordant was transferred to the Department of Infectious Diseases. There was also hypocalcemia, hypopotassemia, pancytopenia, intestinal hemorrhage, and hepatic involvement. S. typhi was grown in the blood culture. The patient was discharged with full recovery after ciprofloxacin treatment in addition to electrolyte replacement. Typhoid fever is a widespread infectious disease in our country and should be taken into consideration in differential diagnosis of many diseases because it may involve a number of systems and may present with a variety of complications.
Claw Hand Deformity Developing After Mmr Vaccination: the First Case Report
(Ortadogu Ad Pres & Publ Co, 2012) Karsen, Hasan; Hocanli, Ibrahim; Binici, Irfan; Iscan, Akin; Bayraktar, Mehmet
Measles, mumps, rubella (MMR) vaccination is included in the routine vaccination program in our country. In the past, many children died or were permanently disabled due to measles and its complications. MMR has significantly decreased with routine and widespread use of MMR vaccination. Many adverse effects such as fever, parotitis, vasculitis, pancreatitis, uveitis, subacute sclerosing panencephalitis, 3rd and 6th nerve paralysis and anaphylaxis may develop following MMR vaccination. 'Claw hand defomity' developing after MMR vaccination has not been reported up to date. Claw hand is the motor dysfunction of the ulnar nerve. This paper presents patients who developed pain, fever and local discharge at the injection area and claw hand deformity after receiving MMR vaccination to the distal part of the deltoid muscle. Claw hand deformity did not improve despite medical and surgical treatment. Thus, we suggest that claw hand deformity may be due to an immunologic reaction. There are some misunderstandings about vaccination in our country. Vaccination rates may decrease if they are not clarified.
Clinical Manifestations and Complications in 1028 Cases of Brucellosis: a Retrospective Evaluation and Review of the Literature
(Elsevier Sci Ltd, 2010) Buzgan, Turan; Karahocagil, Mustafa Kasim; Irmak, Hasan; Baran, Ali Irfan; Karsen, Hasan; Evirgen, Omer; Akdeniz, Hayrettin
Introduction: Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features. Methods: A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications. Results: Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7 +/- 16.34 years and 69.6% of cases were aged 13-44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test + Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement. Conclusions: In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis. (C) 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Comparative Analysis of Cerebrospinal Fluid Adenosine Deaminase Activity in Meningitis
(E M H Swiss Medical Publishers Ltd, 2011) Karsen, Hasan; Koruk, Suda Tekin; Karahocagil, Mustafa Kasim; Calisir, Celal; Baran, Fatma Corcu
AIM: The purpose is to determine the cut-off value of adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) of patients with tuberculous and non-tuberculous meningitis, and to assess its value in differential diagnosis. MATERIAL AND METHODS: This study was conducted in 91 patients with meningitis in two university hospitals in Turkey. 24 patients had tuberculous meningitis (TBM), 25 purulent meningitis (PM), 25 aseptic meningitis (AM) and 17 neurobrucellosis (BM). ADA activity of CSF was quantified by colorimetry. RESULTS: In our study, mean ADA values in CSF were 28.34 +/- 14.83 IU/L in TB cases, 8.71 +/- 5.83 IU/L in BM, 6.18 +/- 2.54 IU/L in PM and 3.43 +/- 3.48 U/L in AM cases. If we accept for CSF ADA an activity cut-off value of 12.5 IU/L for differential diagnosis of TBM and BM, its sensitivity was 92% and specificity was 88%. If we accept 12.35 IU/L for differential diagnosis of TBM and PM, its sensitivity was 92% and specificity was 100%. If we accept 6.45 IU/L for differential diagnosis of TBM and AM, its sensitivity was 100% and specificity was 92%. Additionally, we examined the cases after dividing them into two groups, viz. TB and non-TB. If we accept an ADA activity cut-off level of 11 IU/L for differential diagnosis of TB and non-TB by applying ROC analysis, its sensitivity was 92% and specificity was 90%. CONCLUSION: The sensitivity and specificity for CSF ADA activity are markedly high in differential diagnosis of TB from non-TB. Hence CSF ADA activity may be used as a simple, cost-effective and reliable test for early differential diagnosis of TB.
Comparison of Intramuscular and Intradermal Applications of Hepatitis B Vaccine in Hemodialysis Patients
(Taylor & Francis inc, 2006) Karahocagil, M. Kasim; Buzgan, Turan; Irmak, Hasan; Karsen, Hasan; Akdeniz, Hayrettin; Akman, Nevzat
This study compared the application of intramuscular recombinant hepatitis B vaccine in hemodialysis patients with the application of accelerated intradermal recombinant hepatitis B vaccine, which can be applied with one-tenth of the standard dose. Sixty seronegative patients for hepatitis B were randomly separated into two groups. Twenty mu g of the recombinant hepatitis B vaccine was intramuscularly applied at 0-, 1-, 2-, and 6-month intervals to the first group (32 cases). One more dose was applied at month 12 to those whose anti-HBs titers remained below 100 mIU/mL at month 7. The same vaccine was intradermally applied at 2 mu g dose six times with one-month intervals to the second group (28 cases). Vaccine applications were continued in those whose anti-HBs titers remained below 100 mIU/mL at month 7 until antibody titers reached above this value or until the dose number became 12. Measurements of antibody titers were repeated at month 13 in both groups. As a result, in the vaccination of hemodialysis patients against hepatitis B, the accelerated ID application of hepatitis B vaccine with a dose reduced to one-tenth is more cost-effective than the standard dose vaccination schedules. Especially for hemodialysis patients, the time has come for routine application of ID hepatitis B vaccine as an alternative vaccination method.
Determination of Serum Differential Carnitine Ester Levels in Hiv(+)patients: a Cross-Sectional Study
(Bentham Science Publ Ltd, 2023) Binici, Irfan; Akbay, Halil Ibrahim; Huyut, Zubeyir; Alp, Hamit Hakan; Karsen, Hasan; Koyuncu, Ismail; Celik, Hakim
Objective It has been reported that carnitine deficiency is observed in various viral infections and in the follow-up of the prognosis of some diseases. In this cross-sectional study, we aimed to determine how carnitine ester derivatives change in HIV-positive patients. Materials and Methods In this study, 25 HIV-infected patients who applied to Harran University Faculty of Medicine Education Research and Practice Hospital Infectious Diseases and Clinical Microbiology Outpatient Clinic and who did not receive any antiretroviral treatment, as well as 25 healthy volunteers were included in the study. Carnitine ester levels in serum samples were measured by Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS) method (Shimadzu North America, Columbia, MD, USA). Results While suberoylcarnitine (C8DC), myristoleylcarnitine (C14:1), tetradecadienoylcarnitine (C14:2), palmitoleylcarnitine (C16:1), and linoleylcarnitine (C18:2) levels in HIV(+) patients were quite low compared to the control group, tiglylcarnitine (C5:1) levels were high (p <= 0.05). In addition, C5:1 and C14:2 index parameters according to VIP score, and C5:1 and C14:1/C16 index parameters according to ROC analysis were determined as markers with high potential to distinguish HIV(+) patients from healthy volunteers. Conclusion This study showed that levels of acylcarnitine derivatives might be altered in HIV(+) patients, and the results obtained may contribute to a better understanding of carnitine metabolism.
Evaluation of Cerebrospinal Fluid Levels for Alox5, S100b, Defa1, and Gfap in Infectious Meningitis
(Lippincott Williams & Wilkins, 2023) Baran, Ali Irfan; Huyut, Zubeyir; Oncu, Mehmet Resit; Akbay, Halil Ibrahim; Akmese, Sukru; Karsen, Hasan; Tarcan, Tayyar
Background: The aim of this study was to determine how the levels of peptide and protein-based biomarkers in cerebrospinal fluid change in bacterial, tuberculous, and aseptic meningitis, and to determine the success of these agents in distinguishing between different types of infectious meningitis.Methods: The levels of arachidonate-5-lipoxygenase, S100 calcium-binding protein B, defensin-alpha 1, and glial fibrillary acidic protein in cerebrospinal fluid samples from 20 tuberculosis, 40 bacterial, 25 aseptic meningitis patients, and 55 control groups were measured and compared using an enzyme-linked immunosorbent assay.Results: The mean age of the patients was 37.9 +/- 14.4 years. The parameter that contributed the most to the differential diagnosis of the infectious meningitis groups was S100 calcium-binding protein B. The S100 calcium-binding protein B levels were significantly higher in the tuberculous meningitis group than in the other groups, and arachidonate-5-lipoxygenase levels were significantly higher in the tuberculous meningitis and bacterial meningitis groups (P < .05).Conclusion: This study showed that cerebrospinal fluid arachidonate-5-lipoxygenase, and S100 calcium-binding protein B levels may differ in bacterial, aseptic, and tuberculous meningitis, and the results obtained may be quite effective as important potential biomarkers in the differential diagnosis of different types of meningitis.
Hematological Complications in 787 Cases of Acute Brucellosis in Eastern Turkey
(Tubitak Scientific & Technological Research Council Turkey, 2008) Dilek, Imdat; Durmus, Ahmet; Karahocagil, M. Kasim; Akdeniz, Hayrettin; Karsen, Hasan; Baran, Ali Irfan; Evirgen, Oemer
Aim: In this paper, we present the hematological findings of 787 cases diagnosed with acute brucellosis. Materials and Methods: Records of the cases seen between 1994 and 2006 were retrospectively investigated regarding hematological changes. Results: Three hundred sixty-five (46%) patients were male and 422 (54%) were female. Mean age was 32 (range: 11-78 years). Mean hematological values were as follows: Hb 12 g/dl (4-19), Htc 36% (12-56), leukocyte 6.9 x 10(9)/L. (0.5-25) and platelets 213 x 10(9)/L (9-617). According to differential counts, 34% and 14% of patients had mononuclear cell and neutrophil dominance, respectively. Fifty-six percent of patients were found to have anemia, alone or in combination with leukopenia or thrombocytopenia. Fourteen percent of patients had thrombocytopenia, 12% leukopenia, 5% pancytopenia, 4% leukopenia + thrombocytopenia, 0.5% acute hemolysis, and 0.1% disseminated intravascular coagulation. Restoration of thrombocytopenia and leukopenia and improvement in clinical situation were seen within one week and recovery of anemia occurred within 3-4 weeks. Conclusions: Hematological complications such as anemia and leukopenia are more frequently seen in acute brucellosis cases. However, acute brucellosis should also be considered in the differential diagnosis in the presence of other hematological abnormalities such as severe thrombocytopenia, pancytopenia, acute hemolytic anemia, and disseminated intravascular coagulation.
Hepatit B İmmünizasyonunda Düşük Doz İntradermal ve Subkutan Aşı ile Klasik İntramüsküler Aşı Uygulama Sonuçlarının Karşılaştırılması
(2006) Karsen, Hasan; Karahocagil, Mustafa Kasım; Akdeniz, Hayrettin
Amaç: Klasik 20 µg hepatit B aşısının İM uygulanmasına göre sırasıyla 1/10 ve 1/4 oranında düşük doz ve maliyetle uygulanabilen alternatif intradermal (İD) ve subkutan (SK) aşı uygulama yöntemlerinin, yeterli koruyucu antikor titresi oluşturup oluşturmadığının araştırılmasıdır. Yöntem: Sağlık personeli, öğrenci ve risk gruplarından oluşan, 3 doz aşı sonrası (3. ay) antikor ölçümü yapılan 597 kişi çalışmaya alındı. 4 doz aşı sonrası (13. ay) antikor ölçümü yapılan 483 kişi çalışmayı tamamladı. İM gruba 20 µg, İD gruba 2 µg, SK gruba 5 µg rekombinant hepatit B aşısı (Euvax B) 0, 1, 2 ve 12. aylarda uygulandı. 3, ve 13. aylarda antikor ölçümleri yapıldı. Bulgular: 3. ayda koruyucu antikor (Seroproteksiyon-Sp) geliştirme oranları; İM, İD ve SK gruplar için sırasıyla %96.6, %91.9, %88.2 iken, 13. ay Sp oranları; %98.8, %95.6, %92.5 bulundu. Yan etki açısından en emin uygulama yolu SK yol olarak görünürken, en fazla lokal yan etki İD grupta, en fazla sistemik yan etki İM grupta görüldü. Yan etkilerin hiç biri aşılamayı kesmeyi gerektirmedi. Sonuç: İD hepatit B aşı uygulama yolu, klasik İM aşı uygulama yoluna alternatif ve aşı maliyetini 9/10 oranında azaltan etkili bir yöntem olup; SK yol ise uygulama kolaylığı nedeniyle, aşı maliyetini İM aşı uygulama yoluna göre 3/4 oranında azaltan etkili bir yöntem olarak gözükmektedir.
Herpes Ensefaliti, Tanı Takip ve Tedavi: Bir Olgu Sunumu
(2006) Karsen, Hasan; Karahocagil, Mustafa Kasım; Ersoz, Murat; Ekin, Selami; Akdeniz, Hayrettin; Çağaç, Aydın
Herpetik ensefalit, dünyada tüm ensefalitlerin en sık görüleni ve mortalitesi en fazla olanıdır. Tedavi edilmediği takdirde %70 oranında mortal seyretmektedir. Ancak henüz bilinç açık iken tedaviye başlanırsa başarı oranı %92 dir. Bu yazıda, bilinci kapandıktan sonra kliniğimize başvuran ve beyin omurilik sıvısında PCR ile herpes simplex virüs DNA'sı tespit edilerek ensefalit tanısı konulan bir vaka sunuldu. 21 gün süreyle asiklovir ile tedavi edilen hastada, ileri derecede motor mental sekel kaldı.
Highly Elevated Adenosine Deaminase Level in Brucellar Pleural Effusion
(Tubitak Scientific & Technological Research Council Turkey, 2008) Karahocagil, Mustafa Kasim; Akdeniz, Hayrettin; Kirikci, Aziz Dursun; Karsen, Hasan; Sertogullari, Buenyamin
Pleural involvement is a rare presentation of brucellosis. There are only a few case reports in the literature presenting with pleural involvement due to brucellosis. In this report, we present a case with exudative pleural fluid first considered as tuberculous pleurisy due to lymphocyte predominance and elevated level of pleural adenosine deaminase, but later diagnosed as brucella pleurisy with positive serologic and microbiologic test results. In conclusion, in the differential diagnosis of pleurisies, routine serologic and bacteriologic methods appear to be more important than pleural adenosine deaminase elevation, especially in regions endemic for both tuberculosis and brucellosis.
Menenjitli Bir Olguda Brucella ve Tüberküloz Koenfeksiyonu
(2008) Irmak, Hasan; Karsen, Hasan; Karahocagil, Mustafa Kasım; Demiröz, Ali Pekcan
Ülkemiz, önemli halk sağlığı sorunları olan gerek bruselloz gerekse tüberküloz için endemik bölgeler içinde yer almaktadır. Her iki etken tarafından oluşturulan menenjit tablosu ise, klinik ve laboratuvar bulguları açısından birbirine benzemekte ve karıştırılabilmektedir. Bu raporda, menenjit tanısı konulan bir hastada tespit edilen Brucella ve tüberküloz koenfeksiyonu sunulmaktadır. Hayvancılıkla uğraşan 19 yaşında bir kadın hasta, şiddetli baş ağrısı, kusma, ateş, şuur bulanıklığı, meningeal irritasyon bulguları ve diplopi yakınmalarıyla kliniğimize başvurmuştur. Başlangıçta hastaya, anamnez (hayvancılıkla uğraşma, çiğ süt ürünleri tüketimi, 4-5 aydır brusellozla uyumlu klinik bulguların varlığı), fizik muayene bulguları ve beyin omurilik sıvısı (BOS) laboratuvar bulguları ile Brucella menenjiti tanısı konulmuştur. BOS ve kan kültürlerinde Brucella spp. üremesi olmayan hastanın BOS'unda 1/80, serumunda 1/640 titrede standart tüp aglütinasyon (STA) testi ile Brucella antikor pozitifliği mevcuttur. Seftriakson, rifampisin ve doksisiklin tedavisi başlanan hastada, ikinci günün sonunda klinik düzelmenin olmaması ve ajitasyon ve şuur bulanıklığının devam etmesi üzerine tekrar alınan BOS örneğinin incelemesinde asidorezistan bakteri pozitifliği saptanmıştır. Bu bulgulara göre hastaya Brucella ve tüberküloz koenfeksiyonu ön tanısı konularak, tedavi seftriakson, streptomisin, rifampisin, izoniazid ve morfozinamid şeklinde değiştirilmiştir. Tüberküloz menenjiti tanısı, alınan BOS kültüründe (BACTEC, Becton Dickinson, ABD) 14. günde Mycobacterium tuberculosis üremesi üzerine doğrulanmıştır.Tedavinin birinci ve üçüncü aylarında yapılan kontrollerde, klinik ve BOS bulgularının düzeldiği gözlenmiş, herhangi bir şikayeti kalmayan hasta izleme alınmıştır. Olgumuz, Brucella ve tüberküloz menenjitinin bir arada görülmesi nedeniyle nadir saptanan bir olgu olup, bu enfeksiyonların endemik olduğu bölgelerde bu tür koenfeksiyonların görülebileceğinin akılda tutulması amacıyla sunulmuştur.
A Meningitis Case of Brucella and Tuberculosis Co-Infection
(Ankara Microbiology Soc, 2008) Karsen, Hasan; Karahocagil, Mustafa Kasim; Irmak, Hasan; Demiroz, Ali Pekcan
Turkey is located at an endemic area for brusellosis and tuberculosis which are both important public health problems. Meningitis caused by Brucella and Mycobacterium spp. may be confused since the clinical and laboratory findings are similar. In this report, a meningitis case with Brucella and tuberculosis co-infection has been presented. A 19 years old woman was admitted to our clinic with severe headache, fever, vomiting, meningeal irritation symptoms, confusion and diplopia. The patient was initially diagnosed as Brucello meningitis based on her history (stockbreeding, consuming raw milk products, clinical symptoms concordant to brucellosis lasting for 4-5 months), physical examination and laboratory findings of cerebrospinal fluid (CSF). Standard tube agglutination test for brucellosis was positive at 1/80 titer in CSF and at 1/640 titer in serum, whereas no growth of Brucello spp. was detected in CSF and blood cultures. Antibiotic therapy with ceftriaxone, rifampicin and doxycyclin was started, however, there was no clinical improvement and agitation and confusion of the patient continued by the end of second day of treatment. Repeated CSF examination yielded acid-fast bacteria. The patient was then diagnosed as meningitis with double etiology and the therapy was changed to ceftriaxone, streptomycin, morphozinamide, rifampicin and isoniazid for thirty days. Tuberculosis meningitis was confirmed with the growth of Mycobacterium tuberculosis on the 14(th) day of cultivation (BACTEC, Becton Dickinson, USA) of the CSF sample. On the 30(th) day of treatment she was discharged on anti-tuberculous treatment with isoniazid and rifampicin for 12 months. The follow-up of the patient on the first and third months of treatment revealed clinical and laboratory improvement. Since this was a rare case of Brucello and tuberculosis co-infection, this report emphasizes that such co-infections should be kept in mind especially in the endemic areas for tuberculosis and brucellosis.
Nörobruselloz Tanısı ile Takip Edilen Hastaların Değerlendirilmesi
(2006) Karsen, Hasan; Akdeniz, Hayrettin
2. ÖZETBruselloz, dünyanın hemen her yerinde görülebilen zoonotik bir hastalıktır.Nörobruselloz, nadir görülmesine rağmen geri kalmış ve gelişmekte olan ülkelerdesorun olarak kalmaya devam etmektedir. Bu çalışmada 1997-2006 yılları arasındakliniğimizde nörobruselloz tanısı ile takip ve tedavi edilen 16 kadın ile 14 erkekolmak üzere toplam 30 hastanın klinik ve laboratuvar parametreleri ile aldıklarıtedaviler değerlendirildi. Serumda Wright aglütinasyon testi 1/160 ve üzeri, beyinomurilik sıvısı (BOS)'nda ise Wright aglütinasyon testi 1/10 ve üzeri titrede olanlarnörobruselloz olarak kabul edildi. Serumda Wright aglütinasyon testi pozitif olupnörobruselloz kliniği olan ancak BOS'nda Wright ve/veya Coobms'lu Wrightaglütinasyon testi negatif olan hastalar da nörobruselloz olarak kabul edilip tedaviedildi.Bütün hastaların tedavilerinde rifampisin ve doksisiklin temel olmak üzereüçüncü antibiyotik olarak ise streptomisin, siprofloksasin, TMP-SMZ veyaseftriaksondan birisi eklendi. Hastalarımıza verilen tedavinin süresi en az 6 haftaen fazla 36 hafta olmak üzere ortalama 10,7 hafta idi. Hastaların tümünedeksametazon 4x8 mg/gün olarak başlanıp her hafta doz yarıya indirilerek 4haftaya tamamlandı. Hastaların 27'si şifa ile taburcu edilirken, 2 hastadabacaklarda parezi kaldı. Olgulardan biri ise kontrole gelmedi. Bu çalışmadanörobrusellozun tanı, takip ve tedavisinin bir profili çıkarıldı.Bu çalışmayla nörobrusellozun nörolojik tabloları, seyri, tanısı, takibi,tedavide kullanılan antibakteriyel ajanların kombinasyonu, kullanım süreleri vesteroid kullanımı ile ilgili daha geniş kapsamlı çalışmalara ihtiyac olduğu sonucunavarıldı2