An unexpected tetanus case Ergonul, Onder, Prof; Egeli, Demet, MD; Kahyaoglu, Bulent, MD ...
The Lancet infectious diseases,
06/2016, Volume:
16, Issue:
6
Journal Article
Peer reviewed
Summary 1 million cases of tetanus are estimated to occur worldwide each year, with more than 200 000 deaths. Tetanus is a life-threatening but preventable disease caused by a toxin produced by ...Clostridium tetani —a Gram-positive bacillus found in high concentrations in soil and animal excrement. Tetanus is almost completely preventable by active immunisation, but very rarely unexpected cases can occur in individuals who have been previously vaccinated. We report a case of generalised tetanus in a 22-year-old woman that arose despite the protective antitoxin antibody in her serum. The patient received all her vaccinations in the USA; her last vaccination was 6 years ago. The case was unusual because the patient had received all standard vaccinations, had no defined port of entry at disease onset, and had symptoms lasting for 6 months. Tetanus can present with unusual clinical forms; therefore, the diagnosis and management of this rare but difficult disease should be updated. In this Grand Round, we review the clinical features, epidemiology, treatment, and prognosis of C tetani infections.
D–optimal mixture design approach was used for optimisation of wall material composition including whey protein concentrate (WPC), maltodextrin, and gum arabic to effectively encapsulate cold–pressed ...pumpkin seed oil (CPPSO) by freeze–drying. Interaction and/or synergistic effects of these wall materials on the rheological and physical properties of oil–in–water emulsions and some physicochemical characteristics of microcapsules were examined. Rather than individual effects of each wall material component, effects of their interactions were dominant on the quality attributes of emulsions and microcapsules. Microencapsulation by freeze–drying decreased α–, γ– and total tocopherols and total phenolic contents (TPC) of CPPSO. Two wall material compositions (12.28% WPC + 5% maltodextrin +2.70% gum arabic or 10% WPC + 5% maltodextrin +5% gum arabic) with increased emulsion stability, encapsulation efficiency, solubility, total polyunsaturated fatty acids (PUFA) content and decreased wettability time and total saturated fatty acids (SFA) content were predicted by optimisation tool.
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•Characteristics of the emulsions were controlled by wall material composition.•Wettability, and encapsulation efficiency could be controlled by wall formulation.•Total SFA and PUFA contents were mainly affected by wall material composition.•TPC and tocopherols decreased due to microencapsulation process.•Optimum wall material compositions were predicted in line with specified objectives.
We aimed to describe the increased rate of Acinetobacter baumannii infections during the COVID-19 pandemic and define its significance within the last five years. This study was performed in a ...tertiary hospital with 280 beds and included all patients infected with A. baumannii in the intensive care unit between January 1, 2018, and June 30, 2022. A. baumannii-infected patients in the intensive care unit 27 months before the pandemic and 27 months during the pandemic were included. Pulsed-field gel electrophoresis was performed to assess clonal relatedness. The infection control measures were specified based on the findings and targeted elimination. In total, 5718 patients were admitted to the intensive care unit from January 1st, 2018, to June 30th, 2022. A. baumannii infection was detected in 81 patients. Compared to the pre-pandemic era, the rate of A. baumannii infection during the pandemic was 1.90 times higher (OR: 1.90, 95% CI: 1.197, 3.033). Clonality assessment of multidrug-resistant A. baumannii samples revealed eight clusters with one main cluster comprising 14/27 isolates between 2021 and 2022. The case fatality rate of the pre-pandemic and pandemic era was not different statistically (83.33% vs. 81.48%, p = 0.835). Univariate analysis revealed the association of mechanical ventilation (p = 0.002) and bacterial growth in tracheal aspirate (p = 0.001) with fatality. During the COVID-19 pandemic, potential deficits in infection control measures may lead to persistent nosocomial outbreaks. In this study, the introduction of enhanced and customized infection control measures has resulted in the containment of an A. baumannii outbreak.
Crimean-Congo haemorrhagic fever (CCHF) is one of the most widely seen viral haemorrhagic fever in the world. The CCHF virus is transmitted by the infected ticks or blood and body fluids of infected ...humans and animals. In therapy, besides the fluid and blood products, ribavirin as an antiviral should be considered. Ribavirin was reported to be the most effective antiviral among the alternatives against CCCF virus in vitro. Observational studies reported the beneficial effect of ribavirin. Placebo controlled randomized studies cannot be performed according to Helsinki declaration. Ribavirin was reported to be effective if it was given at the earlier days of the disease. In later phase, steroid therapy was suggested. Severity scoring was suggested before starting the ribavirin treatment. Convalescent immune globulin use was not found to be beneficial. Post-exposure prophylaxis (PEP) with ribavirin is strongly suggested for healthcare workers with high-risk exposure. No fatality was reported after PEP with ribavirin. Using ribavirin for PEP effectively is consistent with using it for therapy at the early phase of the disease. Klimik Dergisi 2016; 29(1): 2-9. Key Words: Crimean-Congo haemorrhagic fever virus, viral haemorrhagic fevers, ribavirin. Kirim-Kongo kanamali atesi (KKKA), dunyada en yaygin olarak gorulen viral kanamali ateslerin basinda gelir. KKKA virusu kene araciligiyla veya infekte insan veya hayvanlarin kan ve vucut sivilarina temas sonucunda bulasir. Tedavide sivi replasmani ve kan urunleri kullaniminin yani sira antiviral ilac olan ribavirin kullanimi degerlendirilmelidir. Antiviral alternatifler arasinda ribavirin, in vitro calismalarda KKKA virusuna karsi en etkili olan ilactir. Ribavirin, gozlemsel calismalarda yararli bulunmustur. Plasebo kontrollu randomize kontrollu calismalar Helsinki deklarasyonuna gore etik disidir. KKKA'da ribavirin ozellikle erken donemde verildigi zaman etkilidir. Erken donemden sonra steroid kullaniminin da yararli olabilecegi ileri surulmustur. Ribavirin baslanirken ciddiyet skorlamasi yapilmasi onerilmektedir. Konvalesan immun globulin uygulamasinin yarari gosterilememistir. Saglik calisanlarinda KKKA ile yuksek riskli temas olmasi durumunda mutlaka ribavirinle profilaksi yapilmasi onerilir. Bugune kadar temas sonrasi ribavirin baslananlarda olum gorulmemistir. Ribavirinin temas sonrasi profilakside yararli oldugunu kabul etmek, ilacin hastaligin erken doneminde de etkili oldugunu kabul etmek anlamina gelmektedir. Klimik Dergisi 2016; 29(1): 2-9. Anahtar Sozcukler: Kirim-Kongo kanamali atesi virusu, viral kanamali atesler, ribavirin.
We aimed to describe the mechanisms of colistin resistance in
.
Twenty-nine patients diagnosed with colistin-resistant
infection were included to the study. The mutations in
,
,
, and
genes, ...expression of
, carbapenemases, and
positivity were studied.
Twenty-seven (93%) of the patients received IV colistin therapy during their stay, and the case fatality rate was 45%. All mutations in
and
were found to be accompanied with a mutation in
. The most common mutations were I42V and L150F in
(65%), E117K in
(65%), and A138T in
(58.6%). The colistin minimum inhibitory concentrations (MICs) of the isolates having any of these four mutations were higher than the isolates with no mutations (
< 0.001). The two most common mutations in
(I42V and L150F) were found to be associated with higher expressions of
and
and higher colistin MIC values (
= 0.010 and 0.031). All isolates were
positive.
Coexistence of the
mutation along with mutations in
indicates synergistic function of these genes in development of colistin resistance in
.
Background. We describe the neurological involvement in brucellosis and revisited diagnostic criteria for neurobrucellosis. Methods. Patients with laboratory-confirmed brucellosis who were ...consequently hospitalized were observed prospectively in a brucellosis-endemic region. The neurobrucellosis was diagnosed by any one of the following criteria: (1) symptoms and signs consistent with neurobrucellosis; (2) isolation of Brucella species from cerebrospinal fluid (CSF) and/or presence of anti-Brucella antibodies in CSF; (3) the presence of lymphocytosis, increased protein, and decreased glucose levels in CSF; or (4) diagnostic findings in cranial magnetic resonance imaging or CT. Results. Lumbar puncture was performed in 128 laboratory-confirmed brucellosis cases who had neurological symptoms and signs, and 48 (37.5%) were diagnosed as neurobrucellosis. The sensitivity of tube agglutination (TA) in CSF was 0.94, specificity 0.96, positive predictive value 0.94, and negative predictive value 0.96. Brucella bacteria were isolated from CSF in 7 of 48 patients (15%). The mean age of 48 neurobrucellosis patients was 42 years (SD, 19 years), and 16 (33%) were female. The most common neurological findings were agitation (25%), behavioral disorders (25%), muscle weakness (23%), disorientation (21%), and neck rigidity (17%). Cranial nerves were involved in 9 of 48 patients (19%). One patient was left with a sequela of peripheral facial paralysis and 2 patients with sensorineural hearing loss. Conclusions. Patients with severe and persistent headache and other neurologic symptoms and signs should be considered for neurobrucellosis in endemic regions and to possibly receive longer therapy than 6 weeks. Brucella TA with Coombs test in CSF is sensitive and specific by using a cutoff of ≥1:8.
We aimed to develop a prospective prediction tool on Crimean–Congo haemorrhagic fever (CCHF) to identify geographic regions at risk. The tool could support public health decision-makers in ...implementation of an effective control strategy in a timely manner.
We used monthly surveillance data between 2004 and 2015 to predict case counts between 2016 and 2017 prospectively. The Turkish nationwide surveillance data set collected by the Ministry of Health contained 10 411 confirmed CCHF cases. We collected potential explanatory covariates about climate, land use, and animal and human populations at risk to capture spatiotemporal transmission dynamics. We developed a structured Gaussian process algorithm and prospectively tested this tool predicting the future year's cases given past years' cases.
We predicted the annual cases in 2016 and 2017 as 438 and 341, whereas the observed cases were 432 and 343, respectively. Pearson's correlation coefficient and normalized root mean squared error values for 2016 and 2017 predictions were (0.83; 0.58) and (0.87; 0.52), respectively. The most important covariates were found to be the number of settlements with fewer than 25 000 inhabitants, latitude, longitude and potential evapotranspiration (evaporation and transpiration).
Main driving factors of CCHF dynamics were human population at risk in rural areas, geographical dependency and climate effect on ticks. Our model was able to prospectively predict the numbers of CCHF cases. Our proof-of-concept study also provided insight for understanding possible mechanisms of infectious diseases and found important directions for practice and policy to combat against emerging infectious diseases.
We described the predictive role of cytokines in fatality of Crimean Congo Hemorrhagic Fever Virus (CCHFV) infection by using daily clinical sera samples. Consequent serum samples of the selected ...patients in different severity groups and healthy controls were examined by using human cytokine 17‐plex assay. We included 12 (23%) mild, 30 (58%) moderate, 10 (19%) severe patients, and 10 healthy volunteers. The mean age of the patients was 52 (sd 15), 52% were female. Forty‐six patients (88%) received ribavirin. During disease course, the median levels of IL‐6, IL‐8, IL‐10, IL‐10/12, IFN‐γ, MCP‐1, and MIP‐1b were found to be significantly higher among CCHF patients than the healthy controls. Within the first 5 days after onset of disease, among the fatal cases, the median levels of IL‐6 and IL‐8 were found to be significantly higher than the survived ones (Fig. 3), and MCP‐1 was elevated among fatal cases, but statistical significance was not detected. In receiver operating characteristic (ROC) analysis, IL‐8 (92%), IL‐6 (92%), MCP‐1 (79%) were found to be the most significant cytokines in predicting the fatality rates in the early period of the disease (5 days). IL‐6 and IL‐8 can predict the poor outcome, within the first 5 days of disease course. Elevated IL‐6 and IL‐8 levels within first 5 days could be used as prognostic markers.
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