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    Management of Brucella endocarditis: results of the Gulhane study
    (ELSEVIER SCIENCE BV, 2012) Koruk, Suda Tekin; Erdem, Hakan; Koruk, Ibrahim; Erbay, Ayse; Tezer-Tekce, Yasemin; Erbay, Ali Riza; Dayan, Saim; Deveci, Ozcan; Inan, Asuman; Engin, Derya Ozturk; Guner, Rahmet; Dikici, Nebahat; Doyuk-Kartal, Elif; Kurtaran, Behice; Pehlivanoglu, Filiz; Sipahi, Oguz Resat; Yalci, Aysun; Yemisen, Mucahit; Alp-Cavus, Sema; Gencer, Serap; Guzel, Gokhan; Oncul, Oral; Parlak, Mehmet; Kazak, Esra; Tulek, Necla; Ulcay, Asim; Savasci, Umit
    Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n = 18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients. (C) 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
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    Paradoxical Reactions in Tuberculosis Treatment: Mechanisms, Diagnosis and Approach
    (Bilimsel Tip Yayinevi, 2024) Buyuktuna, Seyit Ali; Kurtaran, Behice; Ozsahin, Sefa Levent; Senol, Gunes; Kilic, Aysegul Ulu; Tasbakan, Meltem
    Paradoxical reactions (PR) refer to the worsening of clinical manifestations of tuberculosis (TB) after the initiation of TB treatment, particularly occurring during the recovery of immune function in immunocompromised individuals. This syndrome is also known as immune reconstitution inflammatory syndrome and is more common in human immunodeficiency virus (HIV)-infected individuals after the initiation of antiretroviral therapy (ART). Although the mechanisms of PR are not fully understood, excessive inflammatory responses triggered by increased antigen load and rapid immune response are considered the main cause. This is associated with a strong T-cell response to antigens of Mycobacterium tuberculosis. Paradoxical reactions in HIV-positive individuals after ART initiation is characterized by a sudden and intense activation of TB-fighting immune cells. Symptoms of PR include fever, lymphadenopathy, pulmonary infiltrates, and enlargement of existing TB lesions. A major diagnostic challenge is the exclusion of TB treatment-resistant mycobacterial infections or other infections. Management of PR mainly involves the continuation of TB and HIV treatment. Anti-inflammatory drugs, such as corticosteroids, can be used in severe PR cases. By reducing inflammation, corticosteroids can relieve the symptoms of the disease and improve the quality of life. However, the use of these drugs should be carefully monitored and side effects should be considered. Enhancing our understanding of the mechanisms behind paradoxical reactions and developing effective management strategies could significantly advance the fight against TB and HIV. This review aims to explore the mechanisms, diagnosis, and management strategies of paradoxical reactions in tuberculosis treatment.