Tetanus in adults: results of the multicenter ID-IRI study

Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital's Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival.

The outcome of non-carbapenem-based empirical antibacterial therapy and VRE colonisation in patients with hematological malignancies

BACKGROUND

Febrile neutropenia (FN) is generally a complication of cancer chemotherapy.

OBJECTIVES

We retrospectively evaluated the febrile neutropenia episodes and their outcomes with respect to modification rates of non-carbapenem-based empirical antibacterial therapy and vancomycin-resistant enterococcus (VRE) colonisation that caused to VRE bacteremia in patients with hematological malignancies.

METHODS

All consecutive patients, who were older than 14 years of age and developed febrile neutropenia episodes due to hematological malignancies from September 2010 to November 2011 at the hematology department were included into the study.

RESULTS

In total, 86 consecutive neutropenic patients and their 151 febrile episodes were evaluated. The mean MASCC prognostic index score was 18,72 ± 9,43. Among 86 patients, 28 patients experienced a total of 30 bacteremia episodes of bacterial origin. Modification rates of both, empirical monotherapy and combination therapies, were found similar, statistically (P = 0,840).

CONCLUSIONS

Our results suggest that initiating of non-carbapenem based therapy does not provide high response rates in the treatment of febrile neutropenia attacks. Furthermore, non-carbapenem-based empirical therapy provides benefit in regard to cost-effectiveness and antimicrobial stewardship when local antibiotic resistance patterns of gram-negative bacteria are considered. Patients who are colonized with VRE are more likely to develop bacteremia with VRE strains as a result of invasive procedures and severe damage of mucosal barriers observed in this group of patients.

Tuberculous meningitis: a report of 60 adult cases

OBJECTIVE

This was to evaluate the history, clinical and laboratory findings, outcome and prognosis of patients with tuberculous meningitis (TBM).

METHOD

Between 1998 and 2009, 60 patients with TBM were evaluated, retrospectively.

RESULTS

Overall, 60 patients were selected, of which 33 (55%) were male. The patients' ages ranged from 14 to 62 years. In the majority of the patients, disease was in an advanced stage on admission (66% in stage III according to the British Research Council neurological criteria). The rate of complications was highest among patients in stages II and III with an overall mortality rate of 6.6% (n = 2 of stage II patients and n = 2 of stage III patients).

CONCLUSIONS

Earlier admission of the patients with TBM could provide better outcomes with regard to sequelae and mortality. Fatal cases presented with rapid deterioration and were refractory to treatment.

Fungal pathogens and primary antifungal prophylaxis in patients with hematological malignancies: one year experience

BACKGROUND

Febrile neutropenia (FN) is generally a complication of cancer chemotherapy in patients with hematological malignancies.

OBJECTIVE

To evaluate the febrile neutropenia episodes of hematological patients and their outcomes with respect to fungal pathogens, primary antifungal prophylaxis antifungal therapy.

METHODS

All consecutive patients older than 14 years of age and who developed febrile neutropenia episodes from September 2010 to November 2011 were incorporated into this study.

RESULTS

In total, we retrospectively evaluated 86 consecutive patients and their 148 neutropenic episodes. Of the 86 patients, 45 were male and the mean age was 47,65±15,06 years (range: 17-82 years). The mean MASCC score was 18,72 ± 9,43. Systemic antifungal drug was initiated to 17 patients with probable fungal infection and 12 patients with possible fungal infection. Of seven patients who received posaconazole prophylaxis, five were treated with systemic fungal infection due to possible fungal infection.

CONCLUSIONS

It is obvious that more studies focused on primary prophylaxis are needed and primary or secondary antifungal prophylaxis should be evaluated in terms of provided benefits and disadvantages. Timely and appropriately initiated antifungal treatment is one of the most important factors for a good prognosis for recovery from a neutropenic phase.

Pulmonary involvement of Brucellosis: a report of six cases

BACKGROUND

Pulmonary involvement of brucellosis rarely occurs due to inhalation of infected aerosol or hematogenous overspreading.

OBJECTIVE

The study aimed to reveal the pulmonary manifestations of brucellosis that occur rarely in Brucella infections in the context of six cases in this report.

METHODS

Between 1998-2008, 82 patients with brucellosis treated and followed up at infectious diseases clinic have been retrospectively studied in relation to their clinical and laboratory findings and treatment results.

RESULTS

Patients' (n=6) age ranged from 48 to 59 years and they showed equal gender distribution. All patients presented with fever and cough. Radiological examination showed pneumonic patches and consolidation in two cases, bilateral glass round opacity in four cases, perivascular and peribronchial thickness increase in two cases, pleural effusion in two cases, sentri-acinar emphysematous images in one patient, and athelectasis in one patient. Blood cultures of three patients grew Brucella spp. All patients responded to treatment containing doxycycline, rifampicin and streptomycin (for only one patient) within seven to 10 days and were treated for six weeks except for one patient for who was treated eight weeks due to hepatosplenic brucellosis.

CONCLUSION

Pulmonary involvement of brucellosis has good prognosis with combined antimicrobial therapy.

The effect of thermocycling on peel strength of six soft lining materials

The bond strength of two heat-cured and four cold-cured soft lining materials was compared using a peeling test method before and after thermocycling. Tested soft lining materials were Molloplast B, Mollosil, Ufigel P, Ufigel C, Permaquick and Permaflex. Six specimens, 6.5 x 2 x 0.3 cm, for each group were prepared according to the manufacturers' instructions. Control groups were stored in a humidor for 24 h, whereas the others were thermocycled in a water bath between the 5 and 55 degrees C for 5000 cycles. Peel strength of samples were measured using an Instron Universal testing machine at a cross-head speed of 5 mm min-1. The types of failure were observed using an electron microscope. The highest peel bond strength values were calculated for Permaflex and Permaquick before and after thermocycling, respectively. Molloplast B, Mollosil, Ufigel P and Permaquick demonstrated an increase in peel strength after thermocycling, with Permaquick lining material having statistically significant increase. However, decrease in peel strength was observed for Ufigel C and Permaflex after thermocycling. Failure mode within the control groups was cohesive for Molloplast B, Permaquick and Permaflex, whereas adhesive for Ufigel P and Ufigel C. Mollosil demonstrated a mixed mode of failure for both thermocycled and control groups.