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    A challenging coexistence: community-acquired methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis
    (Springer, 2024) Afsin, Emine; Sumbul, Asli; Gulozer, Adem Emre
    Background Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) usually emerges after a viral infection and causes severe disease in immunocompetent individuals. Concurrent infection with tuberculosis (TB) is generally very rare in immunocompetent patients. Our case is the first report of the coexistence of CA-MRSA and TB in an immunocompetent patient. Case presentation A 24-year-old male patient of African origin, who has been living in Turkey for a year, was admitted to our hospital 3 months ago with fever, cough, and sputum complaints, which developed following symptoms of influenza infection. More intense bilateral infiltration and cavitary appearance were observed on the left in the chest radiography of the patient who did not respond to amoxicillin and gemifloxacin treatments. The patient's sputum culture showed MRSA growth, and his sputum acid-resistant bacteria (ARB) was reported as three positive. Vancomycin, isoniazid, rifampicin, pyrazinamide, and ethambutol treatments were started. Subsequently, Mycobacterium Tuberculosis growth was also detected in the mycobacteria culture. Vancomycin treatment was completed in 14 days. There was no growth in the control sputum culture. When the patient, who gave clinical and laboratory response, was admitted with increased shortness of breath complaint two months after discharge, it was observed that minimal spontaneous pneumothorax developed in the left lung, and it was decided to follow up without intervention. In the second month of tuberculosis treatment, sputum ARB and mycobacteria culture became negative, and the patient was switched to dual antituberculosis treatment (isoniazid, rifampicin), and his treatment is still ongoing. Conclusions Mixed infections should be considered in case of non-response to treatment in patients with pneumonia. Mixed infections should also be followed closely as they may be more complicated.
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    DNA investigation in the exhaled breath condensate (EBC) in non-small cell lung cancer
    (2022) Afsin, Emine; Polatli, Mehmet; Bozkurt, Gokay
    Aim: Exhaled breath condensate (EBC), one of the materials which is used to detect mutations in the early\rperiod, is collected by completely non-invasive a technique which has no risk for the patient. We aimed to\rinvestigate whether EBC samples are suitable for the detection of DNA or not in non-small cell lung cancer\r(NSCLC) and control patients.\rMethods: 26 patients with NSCLC and 20 patients without lung cancer were included in the study. EBC\rprocedure was performed by the help of Eco Screen- Jaeger device in 10-15 minutes during breathing at the\rtidal volume. DNA was isolated using tissue spin-column DNA isolation kit in the collected EBC.\rResults: DNA amount was twofold high in the NSCLC group than non-cancer patients in spite of short time\r(p>0.05). However, in cancer group DNA amount was found lower in patients with endobronchial lesions than\rwithout endobronchial lesions (p>0.05). Although, there was no relationship between DNA amount and all of\rEBC collection time, collected sample amount and expiration air volume in the cancer group, a positive\rrelations was detected between DNA amount and EBC collection time in the non-cancer group.\rConclusıon: This may be explained by the pathological changes which occur at the cellular level in the lungs\rduring cancer development process. However, it may also result from relative decrease which develops from\rredundancy of EBC volume in the non-cancer group. The source of DNA in EBC may be considered to be\rpathological changes resulting from the systemic inflammatory response, apart from the localized lesion in the\rlungs.
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    A rare and late complication of lung cancer: bronchial rupture
    (Springer, 2024) Afsin, Emine; Koscu, Ozge; Kucuk, Furkan; Haktanir, Muhammed Yavuz; Ozer, Hamza; Kilicgun, Haciali
    Background Tracheobronchial injuries generally occur due to iatrogenic or traumatic causes. Although bronchial rupture due to teratoma and germ cell tumors has been reported in the literature, no cases related to lung cancer have been determined. Our case is presented because of the refusal to be examined for the mass in the lung and the detection of bronchial rupture afterward when he presented with massive hemoptysis.Case presentation A 65-year-old male patient was admitted to the emergency department with the complaint of massive hemoptysis. Six months ago, bronchoscopy was recommended due to the 8 x 7 cm cavitary lesion obliterating the bronchus in the anterior upper lobe of the right lung on chest computed tomography, but the patient refused. The sputum sample, requested 3 times, was negative for acid-resistant bacteria, and no growth was detected in the mycobacterial culture. In the new pulmonary CT angiography, a progressive cavitary lesion invading the right main bronchus, carina, and vena cava superior was observed. Following tranexamic acid treatment and bronchial artery embolization, hemoptysis significantly decreased in the follow-up. In the flexible bronchoscopy performed for diagnostic purposes, the carina was pushed to the left and invaded, and there was damage to the right main bronchus. A biopsy was not performed due to the risk of bleeding, and lavage was performed. Lavage was negative for ARB, there was no growth in the mycobacteria culture, and cytology did not reveal malignant cells. The patient, diagnosed with right main bronchial rupture, was considered inoperable and died 1 month later due to respiratory failure.Conclusions Examinations should be initiated as soon as malignancy is suspected. When diagnosis and treatment are delayed, complications that would be challenging to intervene may develop.