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Al-Khurma haemorrhagic fever (AHF) is an emerging infectious disease described initially in Saudi Arabia and considered among major health risks to the pilgrims during Hajj and Umrah. The first case was diagnosed in a butcher who became sick after he slaughtered a sheep originated from al-Khurma, a small settlement near Taif. The causative agent, al-Khurma haemorrhagic fever virus (AHFV), is a variant of Kyasanur Forest disease virus, a member of the mammalian tick-borne virus subgroup of the genus Flavivirus, family Flaviviridae. It has been isolated from adult soft and hard ticks collected in both western and southern Saudi Arabia. Clinical cases have been linked to handling sheep, goats and camels and to drinking raw camel milk. Seropreva- lence in Saudi Arabia seems as 1%. Confirmation of AHFV infection in tourists visiting southeastern Egypt near the Sudanese border extended its geographical spread. Incubation period is 2-4 days after tick exposure. Most patients present with a nonspecific clinical picture difficult to distinguish from other similar febrile illnesses. Haemorrhagic manifestations together with gastrointestinal, hepatic and neurologic involvement are clinical hallmarks in severe forms in common with other viral haemorrhagic fevers. Major laboratory abnormalities in hospitalized patients are thrombocytopenia, leukopenia, elevated levels of liver enzymes, creatine kinase and lactate dehydrogenase. Rapid laboratory confirmation depends principally on real-time RT-PCR to detect viral RNA in the plasma and serum during viremic phase of illness. Virus isolation in cell culture or suckling mice is not routinely performed since AHFV is classified as biosafety level 3 or 4 agent. Caution is required in interpretation of serological tests because of antigenic cross-reactivity between related viruses. An overall case fatality rate appears to be 1-2% according to recent observations in contrast to much higher initial data. Although no person-to-person transmission are reported, standard precautions should be taken by healthcare workers involved in the management of AHF cases. People processing meat from freshly slaughtered animals are advised to wear gloves. There is no immunoprophylactic measure and no specific treatment for AHF at present. [ABSTRACT FROM AUTHOR]

Objective: Identifying the presence and type of carbapenemases is essential to determine the treatment choices for carbapenem-resistant Gram-negative bacilli (CRB). Genotypic characterization of CRB needs technical support and experienced staff and is not an option for most laboratories due to its high cost. For this reason, especially in countries with limited resources, cheap, reliable phenotypic methods are an alternative, do not require experience, and can be easily applied in daily practice. The goal of the study was to evaluate the performance of phenotypic methods for carbapenemase production in CRB and to form a simple algorithm to differentiate carbapenemase types such as blaOXA-48 or blaNDM, which are common in our country. Methods: The study included 16 consecutive carbapenem-resistant, Gram-negative bacteria. Simplified carbapenem inactivation methods (sCIM) and modified Hodge test (MHT) were performed. Genes responsible for carbapenemase production (blaOXA-48, blaNDM, and blaKPC) were detected by real-time polymerase chain reaction. Temocillin resistance and ceftazidime-avibactam disc diffusion test were also applied to define carbapenemase types. Results: The carbapenemase gene was detected in 12 of the 16 strains; sCIM positivity was found in 11, and MHT was positive in 10. Sensitivity for sCIM and MHT were 91.9% and 83.3%, respectively. All Enterobacterales strains were positive for sCIM, and blaOXA-48 was the most common carbapenemase. sCIM false negativity was detected for only one strain. High-level temocillin resistance (MIC >128 μg/mL) was present in all strains with blaOXA-48; it wasn't detected in the strain carrying isolated blaNDM. Conclusion: sCIM positivity was present for all Enterobacterales, which were shown to carry the carbapenemase gene by RT-PCR. Our findings support the usage of sCIM in daily practice to screen for carbapenemase production in CRB. [ABSTRACT FROM AUTHOR]

Human pegivirus (HPgV) is transmitted through sexual or parenteral exposure and is common among patients receiving blood products. HPgV is associated with lower levels of human immunodeficiency virus (HIV) RNA and better survival among HIV-infected patients. This study aimed to investigate the prevalence of HPgV and determine its subtypes in HIV-infected individuals living in Istanbul, which has the highest rate of HIV infection in Türkiye. Total RNA extraction from plasma, cDNA synthesis, and nested PCR were performed for HPgV on plasma samples taken from 351 HIV-1-infected patients. The HPgV viral load was quantified on HPgV-positive samples. HPgV genotyping was performed by sequencing the corresponding amplicons. In the present study, the overall prevalence of HPgV RNA in HIV-infected patients was 27.3%. HPgV subtypes 1, 2a, and 2b were found, with subtype 2a being the most frequent (91.6%). Statistical analysis of HIV-1 viral load on HPgV viral load showed an opposing correlation between HIV-1 and HPgV loads. In conclusion, these data show that HPgV infection is common among HIV-positive individuals in Istanbul, Türkiye. Further comprehensive studies are needed to clarify both the cellular and molecular pathways of these two infections and to provide more information on the effect of HPgV on the course of the disease in HIV-infected individuals. [ABSTRACT FROM AUTHOR]

Objective: Multisystem Inflammatory Syndrome (MIS) is a condition seen in the early post-COVID-19 period and thought to develop with an impaired immune response. It has been usually reported in children but rarely in adults. Here we report the first adult MIS (MIS-A) case series from Turkiye. Material and Methods: Six patients who met the Centers for Disease Control and Prevention’s MIS-A diagnostic criteria were included in the study. The demographic, clinical, laboratory, radiological characteristics and therapy regimes and outcomes of the patients were recorded. Results: All of our cases had a history of mild COVID-19. They presented with fever, severe fatigue and hypotension. Abnormal echocardiography findings were detected in five patients. Only one patient had multiple mucocutaneous findings. Common laboratory features were lymphopenia, markedly increased C-Reaktive Protein, procalcitonin, pro-brain natriuretic peptide (pro-BNP), D-dimer, and ferritin. All patients had positive SARSCoV-2 antibody result. Corticosteroids and/or anakinra were used in five, and intravenous immunoglobulin was used in two patients. Low-molecular-weight heparin (LMWH) was used for all cases. Empirically initiated antibiotic treatments were discontinued after cultures were negative. After anti-inflammatory treatment, the hypotension of the patients resolved, they did not need intensive care follow-up and no mortality was seen in our cases. Conclusions: MIS-A is a severe and mortal condition that causes various clinical pictures and can be confused with sepsis. Anakinra, a recombinant IL-1 receptor antagonist, is a significant agent that can be used in the treatment of MIS-A since it blocks the cytokine cascade at an early stage. The satisfactory responses will be obtained with early diagnosis and anti-inflammatory treatment. In this period when the pandemic is not over yet, it is necessary to increase the awareness of clinicians about MIS-A, which can be fatal. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to compare classical methods and chromogenic media to detect carbapenem-resistant Enterobacteriaceae (CRE) colonization among hospitalized patients and determine the risk factors causing infection in colonized patients. Methods: Between January and August 2017, 100 patients over the age of 18 who were hospitalized in the Reanimation Intensive Care Unit and the Trauma Emergency Intensive Care Unit of a university hospital were examined. From the first day of intensive care unit (ICU) admission, rectal swabs were collected once every week and were tested for the presence of CRE by using the classical method defined by the Centers for Disease Control and Prevention (CDC), ChromID CARBA chromogenic medium, and direct inoculation into MacConkey agar plates. In addition, MIC values for imipenem, ertapenem, meropenem and colistin were determined by using the Etest. Results: Rectal BDE carriage was detected by at least one method in 46 (46%) of 100 patients included in the study. Sensitivity and specificity values of the CDC classical method, direct MacConkey inoculation, and ChromID CARBA medium in the first 24 hours were found as 78%-42%, 87%-80%, and 91%-98%, respectively. Sensitivity and specificity values of these methods after 72 hours were determined as 78%-100%, 87%-100%, and 91%-100%, respectively. Conclusion: We observed that, although the ChromID CARBA method performed better than classical CDC and direct MacConkey inoculation methods, direct MacConkey inoculation can still be employed, especially in areas with limited resources. [ABSTRACT FROM AUTHOR]

Introduction: Co-receptors involved in cell entry of the human immunodeficiency virus (HIV) and mutations in genes encoding their ligands may play a role in the susceptibility to infection and resistance to the progression of the infection. The best studied mutations that can exist in these genes are the CCR5-Δ32, CCR2-64I and SDF1-3'A mutations. The frequency of these mutations vary from continent to continent and even from region to region. However, there is limited information on their distribution throughout the Turkish population. Istanbul is the city with the highest number of documented HIV-infected patients in Turkey, which can be attributed to the population size. The aim of this study was to determine the distribution of three AIDS-related gene variants among HIV-infected and uninfected population in Istanbul, Turkey and to estimate the contribution of these variants to susceptibility or resistance to HIV. Methodology: A total of 242 healthy individuals and 200 HIV-positive patients were included in the study. CCR5 polymorphisms were genotyped by polymerase chain reaction. CCR2 and SDF1 polymorphisms were genotyped using PCR restriction fragment length polymorphism (PCR-RFLP). Results: The allelic frequencies for CCR5-Δ32, CCR2-64I and SDF1-3'A were 4.07%, 19.8% and 28.7%, respectively. No individual was found to carry the homozygous CCR5-Δ32 mutation in either cohort. No polymorphism was found to be significantly elevated in the HIVinfected cohort compared to the healthy group. Conclusions: The distribution of CCR5-Δ32, CCR2-64I, and SDF1-3'A variants does not differ between HIV-infected and uninfected patients. CCR2-64I and SDF1-3'A frequencies are relatively high where as the frequency of CCR5-Δ32 is low. [ABSTRACT FROM AUTHOR]

Objective: Skull base osteomyelitis (SBO) is a rare, life-threatening infection and frequently followed and treated by otolaryngologists previously. In this study, we analyzed the diagnosis, treatment and long-term outcomes of SBO from the perspective of infectious diseases and clinical microbiology (IDCM). Methods: Hospitalized patients with SBO between 2012-2019 were evaluated retrospectively. Epidemiological, clinical, laboratory data of the patients were recorded. The patients who recovered with and without sequelae were compared. Results: The mean age of 16 SBO cases was 66 years, 75% of them were male and 87.5% had diabetes mellitus (DM). Cranial nerve and vascular/dural involvement were present in 75% and 56.3% of them, respectively. The most common isolated microorganism were P. aeruginosa, staphylococci and Candida spp. 81.2%, 43.7%, and 56% of the patients received anti-pseudomonal antibiotics, additional glycopeptide and additional antifungal drugs, respectively. The sequelae rate was 46.7% in a 24-month follow-up. Hypertension (p=0.041), duration of complaints (p=0.003), bilateral involvement of skull base (p=0.001), vascular thrombosis/inflammation or dural involvement (p=0.007), previous surgical intervention (p=0.041) and elevated ESR at the end of treatment (p=0.014) were defined as risk factors for permanent sequelae. There was no in-hospital mortality. Conclusions: SBO mainly affects older male patients with DM and causes significant sequelae in half of them. In the cases unresponsive to anti-pseudomonal agents, the addition of antifungal therapy empirically may provide a clinical response. Permanent sequelae are more common in cases with delayed diagnosis/treatment, bilateral, vascular or dural involvement, and elevated ESR at the end of treatment. ESR can be used to determine the treatment response and duration. The follow-up and treatment of SBO cases by IDCM with the support of experienced surgeons may contribute to the positive clinical results. [ABSTRACT FROM AUTHOR]

[Display omitted] • Tocilizumab, anakinra and prednisolone did not affect the antibody response to SARS-CoV-2. • The antibody response correlated with and could be predicted by involvement on thoracic CT. • The antibody level also correlated with the level of lung involvement on thoracic CT. Disease severity, previous medications and immunosuppressive agents could affect the antibody response against SARS-CoV-2. This study aimed to analyze variables affecting the humoral response to SARS-CoV-2. This prospective cohort study included adult patients who recovered from COVID-19 and were admitted to a COVID-19 follow-up unit. Eight patient groups were defined in accordance with the results of thoracic computed tomography (CT), SARS-CoV-2 PCR test, and tocilizumab or anakinra use during active disease. Anti-S IgG antibodies were determined by ELISA in serum samples. Anti-S positive and negative cases were compared. A total of 518 patients were included in the study. SARS-CoV-2 IgG antibodies were positive in 82.8% of patients. SARS-CoV-2 PCR positivity, extent of lung involvement on CT, and time to antibody testing were independently associated with antibody positivity. Tocilizumab, anakinra or prednisolone use was not a factor affecting the antibody response. The rate of antibody response and sample/CO values among antibody-positive patients showed a linear relationship with the extent of lung involvement on CT. The use of tocilizumab, anakinra and prednisolone for COVID-19 did not affect the antibody response against SARS-CoV-2. The main driver of antibody response among patients with COVID-19 was the extent of pulmonary involvement on CT. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence on the modification or stopping of antiretroviral therapy (ART) regimens, including novel antiretroviral drugs. The aim of this study was to evaluate the discontinuation of first ART before and after the availability of better tolerated and less complex regimens by comparing the frequency, reasons and associations with patient characteristics. Methods: A total of 3019 ART-naive patients registered in the HIV-TR cohort who started ART between Jan 2011 and Feb 2017 were studied. Only the first modification within the first year of treatment for each patient was included in the analyses. Reasons were classified as listed in the coded form in the web-based database. Cumulative incidences were analysed using competing risk function and factors associated with discontinuation of the ART regimen were examined using Cox proportional hazards models and Fine-Gray competing risk regression models. Results: The initial ART regimen was discontinued in 351 out of 3019 eligible patients (11.6%) within the first year. The main reason for discontinuation was intolerance/toxicity (45.0%), followed by treatment simplification (9.7%), patient willingness (7.4%), poor compliance (7.1%), prevention of future toxicities (6.0%), virologic failure (5.4%), and provider preference (5.4%). Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based (aHR = 4.4, [95% CI 3.0–6.4]; p < 0.0001) or protease inhibitor (PI)-based regimens (aHR = 4.3, [95% CI 3.1–6.0]; p < 0.0001) relative to integrase strand transfer inhibitor (InSTI)-based regimens were significantly associated with ART discontinuation. ART initiated at a later period (2015-Feb 2017) (aHR = 0.6, [95% CI 0.4–0.9]; p < 0.0001) was less likely to be discontinued. A lower rate of treatment discontinuation for intolerance/toxicity was observed with InSTI-based regimens (2.0%) than with NNRTI- (6.6%) and PI-based regimens (7.5%) (p < 0.001). The percentage of patients who achieved HIV RNA < 200 copies/mL within 12 months of ART initiation was 91% in the ART discontinued group vs. 94% in the continued group (p > 0.05). Conclusion: ART discontinuation due to intolerance/toxicity and virologic failure decreased over time. InSTI-based regimens were less likely to be discontinued than PI- and NNRTI-based ART. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the comorbidities, antiretroviral therapy (ART) switches, and drug side-effects in HIV-infected patients who were followed in the Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University. Methods: This study was designed as a retrospective cohort study. Files of HIV-infected patients admitted to the outpatient clinic between years 2002 and 2018 were evaluated. Among them, 210 patients over 18 years of age, whose HIV/AIDS diagnosis was confirmed with ELISA and Western Blot test, without loss to follow up longer than six months, and using ART for at least 6 months were included in the study. Their demographic and clinical features, laboratory results, initial ART regimen, and its side-effects, reasons for ART switches, and subsequent ART regimen were recorded. Results: 165 (78.5%) out of 210 patients were men, and 45 (21.4%) patients were women. Mean age of the patients was 40.4±12.373. 152 (72.4%) patients identified themselves as heterosexual, and 39 (18.6%) were men who had sex with men. Comorbidities of patients during their follow-up were hyperlipidemia in 42 (20%), hypertension in 22 (10.4%), cardiovascular disease in 13 (6.1%), type 2 diabetes mellitus in 12 (5.7%), renal dysfunction in 9 (3.8%), osteopenia/osteoporosis in 8 (3.8%) patients. Although two most common regimens in the first step therapy were tenofovir disoproxil fumarate/emtricitabine + lopinavir/ritonavir, and tenofovir disoproxil fumarate/ emtricitabine + elvitegravir/cobisistate, the second step therapy was detected as an interchange in the order of these two regimens. ART switch was detected in 71 (33.8%) patients. Leading reasons of ART switch were intolerance/toxicity in 22 (30.9%) patients, and simplification of regimen in 19 (26.7%) patients. Frequency of disorders developed after ART were 5 (2.3%) diabetes mellitus, 4 (1.9%) renal diseases, 5 (2.3%) cardiovascular events, 4 (1.9%) osteopenia, and 4 (1.9%) osteoporosis. Conclusions: HIV infection is controlled with ART and life expectancy is prolonged. Patients must be evaluated carefully for metabolic risk factors in the beginning of the treatment and treatment regimen should be selected by considering these situations. The side-effects such as hyperlipidemia, diabetes mellitus, cardiovascular diseases, bone metabolic disorders, osteopenia ve osteoporosis may also develop during the treatment. Therefore, patients must be closely monitored for the possible side-effects, and physicians must work in cooperation with the related specialties, and ART switch must be performed when required. Klimik Dergisi 2020; 33(3): 241-7. [ABSTRACT FROM AUTHOR]

Objective: In order to manage the antimicrobial treatment of patients with cholangitis/cholecystitis properly, it is very important to predict the potential causative pathogens and their antimicrobial resistance patterns. The aim of this study is to provide data for empirical treatment approaches by identifying the causative agents of biliary tract infections and their antimicrobial susceptibilities, and the risk factors in patients infected with drug-resistant microorganism. Methods: Hospitalized patients with cholangitis/cholecystitis developed primarily or secondary to a biliary tract intervention, and whose bile samples for culture could be obtained, were included in the study during a 9-month period. Bile cultures were incubated in an aerobic environment, and antimicrobial susceptibilities were tested by disk diffusion method. Isolated strains that were resistant to at least two major antimicrobial groups were regarded as "drug-resistant". Risk factors for development of infection with a drug-resistant pathogen were evaluated by univariate analysis. Results: A total of 76 bacteria were isolated from 58 bile samples obtained from patients with biliary tract infections. While 30 (39.5%) bacteria were in the drug-resistant group, patients infected with these agents were found to be 26 (44.8%). All drugresistant strains of Escherichia coli were producing extendedspectrum β-lactamases, and carbapenem resistance was seen among Pseudomonas aeruginosa strains only. Antimicrobial usage during last 3 months before diagnosis (p=0.01) and duration of hospital stay before the infective episode (p=0.03) were found to be risk factors for cholangitis due to drug-resistant agents. Conclusions: In order to guide the empirical treatment of patients with cholangitis/cholecystitis properly, antimicrobial susceptibility patterns of causative agents should be monitored closely and drug-resistant pathogens should be considered in patients with a history of antimicrobial usage during the last 3 months or who have been hospitalized for a long time before the infective episode. closely and drug-resistant pathogens should be considered in patients with a history of antimicrobial usage during the last 3 months or who have been hospitalized for a long time before the infective episode. [ABSTRACT FROM AUTHOR]

Objective: Methicillin-sensitive Staphylococcus aureus (MSSA) is frequent cause of bacteraemias and associated with substantial mortality. We defined risk factors for mortality among patients with either community-acquired (CA) or healthcare-associated (HCA) MSSA bacteraemia with special emphasis on treatment options including cefazolin and other antimicrobials (mainly ampicillin- sulbactam). Material and Method: All adult patients who were hospitalized and whose blood cultures were positive for MSSA between 2009 and 2014 were included. Patients with CA and HCA MSSA bacteraemia were compared. Results: 83% of the 127 patients with MSSA bacteraemia had HCA. The mortality rate of patients was 20.5% and this did not differ between patients with either CA or HCA MSSA bacteraemia. In the multivariate analysis, higher comorbidity index (HR 1.557), presence of metastatic foci (HR 2.883), and requirement for ICU support (HR 16.239) were found as independent risk factors for mortality, and cefazolin use was found to be protective against mortality (HR 0.178). Conclusion: Patients with MSSA bacteraemia should be treated with cefazolin instead of other antimicrobial options, especially in countries where anti-staphylococcal penicillins are not available or in patients who cannot tolerate anti-staphylococcal penicillins, as cefazolin was found to be protective against mortality. [ABSTRACT FROM AUTHOR]

Objective: Recommended combination for the treatment of serious Stenotrophomonas maltophilia infections is ticarcillinclavulanate and co-trimoxazole (SXT). However, first agent is not available in our country, and the second component may be a matter of antimicrobial resistance or intolerance. Therefore, we aimed to evaluate antimicrobial susceptibility testing results of S. maltophilia and in vitro activity of ceftazidime and moxifloxacin as a potential therapeutic alternative. Methods: S. maltophilia strains isolated from clinical samples in Infectious Diseases and Clinical Microbiology Laboratory between 1 October 2007-23 November 2017 were included in the study. Disk diffusion antimicrobial susceptibility test results of the strains were evaluated retrospectively. The in vitro activity of combination of ceftazidime and moxifloxacin against 24 of these strains was investigated by Etest®. Results: During the study period, 649 S. maltophilia strains were isolated from 649 different patients, and 94%, 93%, 92%, 81%, 60%, 55%, 45%, 41%, 38% of the strains were susceptible to tigecycline, moxifloxacin, SXT, ciprofloxacin, cefoperazonesulbactam, ceftazidime, netilmicin, gentamicin and amikacin, respectively. For the 24 strains included in the combination study, the moxifloxacin minimal inhibitory concentration (MIC)50/MIC90 values were defined as 0.064/0.125 µg/mL (MIC range 0.023-4 µg/mL) and ceftazidime MIC50/MIC90 values were defined as 32/256 µg/mL (MIC range 1.5-256 µg/mL). According to the results of fractional inhibitor concentration (FIC) index; ceftazidime and moxifloxacin combination displayed synergism, additivity and indifference for 1 (4%), 18 (75%) and 5 (21%) strains, respectively and there was no antagonism. The FIC50/ FIC90 value is calculated as 0.75/1.01 (FIC range 0.5-1.01). Conclusions: SXT resistance in S. maltophilia strains is below 10%, but it should be closely monitored because of the limited treatment options. Tigecycline and moxifloxacin can be among the treatment alternatives because of their high sensitivity rates similar to SXT. The combination of moxifloxacin plus ceftazidime demonstrated in vitro synergism or additivity against majority of the strains. So, this combination may be used as an alternative for the treatment of patients with S. maltophilia infections if there is resistance or side effects to the antibiotics used as the first option. [ABSTRACT FROM AUTHOR]

Objective: We aimed to find the incidence and risk factors of hematologic adverse effects of piperacillin-tazobactam (TZP). Materials and Methods: Adult patients who used TZP for more than 10 days were included in the study. Results: The incidence of leukopenia, neutropenia, and eosinophilia in 110 TZP therapy episodes was found to be 16.3%, 10%, and 10%, respectively. Lower Charlson Comorbidity Index score, lower initial leukocyte count, combination of TZP with another antibiotic, and total duration of TZP therapy were found to be independent risk factors for leukopenia, while initial higher eosinophil count (IHEC) and usage of TZP for >20 days were independent risk factors for neutropenia and IHEC and total duration of TZP therapy were independent risk factors for eosinophilia. Conclusion: Longer duration of therapy, combination with other antibiotics, younger age with fewer comorbidities, and IHEC could result in hematologic adverse effects in patients treated with TZP. Patients with IHEC may be more prone to allergic reactions, so immunological mechanisms may facilitate the development of hematological adverse effects of TZP. [ABSTRACT FROM AUTHOR]

Objectives We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms. Methods We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. Results In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19–90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82–38.15, p = 0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24–47.96, p = 0.028), and chronic heart failure (OR: 3, CI: 1.01–9.04, p = 0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p < 0.001). Conclusion Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality. [ABSTRACT FROM AUTHOR]

Objective: Plasmodium falciparum acquired abroad, has become the main causative malaria agent in Turkey due to the elimination of endemic P. vivax in recent years. By describing clinical, laboratory and treatment features of imported malaria cases caused by P. falciparum, we aimed to distinguish it from other infectious diseases with similar epidemiological and clinical features, such as viral haemorrhagic fevers, and therefore to ensure the recognition of this kind of deadly malaria earlier. Methods: All cases hospitalized in Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University with a diagnosis of malaria between 2000 and 2016 were included in the study. Epidemiological, clinical, laboratory features and antimalarial drugs used either for prophylaxis or treatment of the cases were retrieved from the hospital database retrospectively. Results: A total of 16 patients diagnosed as having malaria caused by P. falciparum were followed our clinic during the study period. Apart from one patient who had visited Afghanistan, all of the cases acquired the infection during an Africa visit. Except two patients who received irregular prophylaxis, none of the patients had used prophylactic drugs for prevention of malaria. All of the patients had fever and shaking chills. The most frequently encountered pathologic laboratory findings were thrombocytopenia and elevated serum LDH levels. Of the patients, 50% had severe malaria and 31% were followed in intensive care unit. Artemether-lumefantrine was the most frequent (44%) regimen for treatment. All patients were discharged with full recovery except one lost due to cerebral malaria. Conclusions: Patients who acquired malaria abroad are most likely to acquire a more severe form of the disease because of the lack of the antibodies resulting from previous exposure. To avoid this severe disease, it is important to give more attention to appropriate prophylaxis against malaria among persons who plan to visit endemic areas. [ABSTRACT FROM AUTHOR]

Previously a consensus report about management of hepatitis C virus (HCV) infection, a major health problem all over the world had been prepared by Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases. It was first published in the Klimik Journal in 2014. Recently, we needed to update this report considering the new developments in treatment of chronic hepatitis C (CHC). This new consensus report is based on review of current literature and international guidelines. Agreed recommendations are presented at the end of each section such as epidemiology and natural history of HCV infection, diagnosis of acute hepatitis C (AHC) and CHC, treatment of AHC, goals of CHC therapy and pre-therapeutic assessment of CHC therapy, indications for treatment, contraindications to therapy, direct-acting antivirals (DAA) in the treatment of CHC and drug-drug interactions in the treatment of DAA, resistance problem in DAA treatment and clinical assesment of resistance, monitoring and managing treatment safety and side effects, post-treatment follow-up of patients who achieve a sustained virological response (SVR), follow-up of patients who didn't achieve an SVR and prevention of HCV infection. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to compare the efficacy of catheter lock solutions of novel antibiotics with anticoagulants against methicillin-resistant Staphylococcus aureus (MRSA) embedded in biofilm. Methods: Biofilm was formed in vitro on silicone Hickman catheter segments by 10 MRSA isolates. Catheter segments were exposed to 2 mg/ml vancomycin, teicoplanin, daptomycin, linezolid, tigecycline, and rifampin solutions for 24 hours. To evaluate the antimicrobial activities of antibiotics against MRSA, bacterial colonies were counted after catheters were vortexed in 0.9% saline. Additionally, as in antibiotic lock therapy, catheter segments were exposed to combination of vancomycin, teicoplanin, daptomycin, linezolid, and tigecycline with 1000 IU/ ml heparin daily four hours for consecutive five days. Antimicrobial efficacy was assessed daily. Results: After 24 hours of exposure, the most effective antibiotic was detected as daptomycin on the Hickman catheter segments. Both daptomycin and tigecycline decreased significantly the bacterial colony counts on the third day of 4-hour daily exposures (all p values were <0.01). There was no significant difference between these two antibiotics (p=0.993). Conclusions: Both daptomycin and tigecycline are promising antimicrobial agents that can be used in antibiotic lock solution for the treatment of central line-associated bloodstream infections due to MRSA. This study provides encouraging data which should be validated in clinical settings. [ABSTRACT FROM AUTHOR]

A case of infective endocarditis (IE) presented with fatigue, lowgrade fever, painful nodular lesions and intracranial haemorrhage and diagnosed after 16 months is reported. A 35-year-old woman without any previous disease was investigated at different medical departments during these 16 months. Despite the detection of an underlying valvular heart disease by echocardiography, the patient was thought to have vasculitis because of absence of vegetations and presence of autoantibodies including rheumatoid factor, perinuclear and cytoplasmic antineutrophil cytoplasmic antibodies. IE was suspected because of multiple cerebral mycotic aneurysms revealed in magnetic resonance imaging, and subsequent blood cultures yielded Gram-positive diphtheroid rods after three days of incubation. Although the organism was identified as Listeria sp. by biochemical identification tests, 16S rRNA analysis revealed that it was Streptococcus mutans. It is concluded that several autoantibodies could be positive in IE cases and vegetation could not be seen by echocardiography and S. mutans could be seen as diphtheroids in blood cultures. [ABSTRACT FROM AUTHOR]

Objective: It was aimed to evaluate clinical and laboratory differences and characteristic aspects between cases that were classified in three subgroups as tuberculous spondylodiscitis (TS), pyogenic spondylodiscitis (PS) and brucellar spondylodiscitis (BS). Methods: Adult patients with spondylodiscitis diagnosis were evaluated retrospectively. Patients who had compatible epidemiological data with brusellosis and had Brucella tube agglutination test ≥1/160 or 4-fold increased titer two weeks later were diagnosed as BS. Cases with M. tuberculosis growth in the tissue samples and/or chronic granulomatous inflammation were diagnosed as TS. Cases in which diagnostic evaluation could not be made and clinical response was elicited with antituberculous treatment were also defined as TS. Cases in which pyogenic bacteria were isolated in samples or culture-negative cases that cured with antibiotic treatment were diagnosed as PS. Results: Among 103 patients there were 46 patients in TS, 37 in PS and 20 in BS groups. TS cases were younger (p=0.011) and had longer duration of complaints (p=0.044). Localized warmth and redness were observed more often and leukocyte counts, neutrophil counts, C-reactive protein levels and erythrocyte sedimentation rates were higher in PS (p<0.05). The thoracal involvement was most common in TS (41.3%) and lumbar in PS (67.6%). Sensitivity of determining causative organism was 56.7% for computerized tomography-guided percutaneous biopsy. Abscess formation was most frequent in TS and least in BS. Conclusions: Cervical or thoracal involvement with abscess formation and paravertebral spread in magnetic resonance imaging should be primarily considered as TS. Patients with previous spine surgery, localized warmth and redness on spine, elevated acute phase reactants and lumbar involvement should be considered as PS. [ABSTRACT FROM AUTHOR]

Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases convened a meeting to develop a consensus report on management of chronic hepatitis C virus (HCV) infection, a global public health problem, affecting nearly 170 million people worldwide. Relevant literature and international guidelines were reviewed, and recommendations agreed are presented at the end of each section such as epidemiology and natural history of HCV infection, economic burden of chronic hepatitis C (CHC), diagnosis of acute hepatitis C (AHC) and CHC, treatment of AHC, goals, endpoints, stopping rules and pre-therapeutic assessment of CHC therapy, indications for treatment, treatment of CHC, monitoring and managing treatment safety and side effects, measures to improve treatment adherence, posttreatment follow-up of patients who achieve a sustained virological response, contraindications to therapy, retreatment of non-sustained virological responders, follow-up of untreated patients and of patients with treatment failure, and prevention of HCV infection. Examples of some selected recommendations are as follows: [1] It should be kept in mind that approximately 75-85% of people who become infected will develop chronic HCV infection, up to 20% of them develop cirrhosis within 20 years, and the average annual risk of hepatocellular carcinoma among them is 1-4%. [2] In addition to the HCV RNA quantification, the HCV genotype should be assessed to provide relevant information with respect to treatment duration and different response rates prior to treatment initiation. [3] If predicted response rate is not appropriate to any of the existing regimens, the patient should be kept waited until alternative therapeutic options become available. [ABSTRACT FROM AUTHOR]

The article presents a case study on the first case of chronic Q fever endocarditis and aortitis in Turkey. It cites the case of a 29-year-old woman who was admitted to the hospital with fever, weakness, and rash on her legs. It also mentions the examination of the patient that lead to her diagnosis of Q fever endocarditis.

Rothia mucilaginosa, previously known as Stomatococcus mucilaginosus, is a Gram-positive coccus and belongs to the family Micrococcaceae. It is considered as normal flora of oropharynx and upper respiratory tract, and rarely causes pneumonia. In this report, we present a case of nosocomial pneumonia caused by R. mucilaginosa, in a patient who recently had neoadjuvant chemotherapy and radiotherapy for lung cancer. [ABSTRACT FROM AUTHOR]

Introduction Routes of transmission and reasons for HIV testing are important epidemiologic data to analyze the epidemic and to tailor the response to AIDS. The aim of this study was to analyze reasons for testing and transmission ways of HIV among recently diagnosed HIV patients registered in the multicenter HIV-TR cohort in Turkey. Methods Transmission ways and reasons for testing of all patients diagnosed in 2011 and 2012 were recorded on a web-based data collection system and were analyzed retrospectively. Results The study included 693 patients (561 male, 132 female) from 24 sites. Reason for HIV testing was available in 640 patients (92%). The most common reason for HIV testing was diagnostic workout for other conditions or illness followed by patient-initiated testing. The reasons for testing were listed in Table 1. The most common routes of HIV transmission were heterosexual intercourse (62.7%) and sex among men who have sex with men (MSM) (22.6%). At the time of HIV diagnosis, the mean CD4 lymphocyte cell count was 355/mm3 (3-1433/mm3). Primary HIV infection was determined in 42/693 (6%) patients and 9/693 (% 1, 2) cases were considered 'probable primary HIV infection.' The majority of the cases presented to a clinic for follow-up right after the diagnosis. On the other hand 32/616 (5.2%) patients delayed their presentation for more than 3 months. The longest delay was 11 months. Conclusions The results of the database suggest that targeted testing is lacking in the country. The shift toward homosexual transmission during the last 2 years emphasizes the need for targeted interventions. Patients present relatively late and HIV infection could only be diagnosed when immunosuppression related findings appeared. Patient-initiated testing,an indicator of awareness, was very low suggesting a need to scale-up awareness raising interventions. [ABSTRACT FROM AUTHOR]

Introduction HIV-TR is a recently established (2012) multicentre cohort in Turkey. The aim of this study is to analyze epidemiological, immunologic and virologic data of recently diagnosed HIV patients. Materials and Methods Epidemiologic, clinical and laboratory data of all patients diagnosed in 2011 and 2012 were recorded by a web-based data collection system, retrospectively. Results A total of 693 patients (561 male, 132 female) at 24 sites were enrolled. The median age at first presentation for HIV care was 36. The proportion of patients presenting with advanced HIV disease (CD4 count<200/mm3 or presenting with an AIDS-defining event) was 30.6%; and 52.4% of patients were late presenters (CD4 count<350/mm3 or presenting with an AIDS-defining event). Median CD4 counts at presentation and before treatment were 344 (IQR: 175-540) and 295 (IQR: 150-430), respectively. Pretreatment CD4 count was >500 copies/mL in 18.5% of patients. Of 531 patients receiving ART, initial combinations consist of tenofovir/emtricitabine (TDF/FTC) plus efavirenz (EFV) in 48.2% and TDF/FTC plus lopinavir/ritonavir (LPV/r) in 37.5% and other combinations in 14.3% of the patients. Pre-treatment HIV-RNA was over 100.000 copies/mL in 52.3% of patients. At Weeks 24 and 48, HIV-RNA were<50 copies/mL in 63,4% of 385 patients and 82% of 311 patients reported to be still on ART and had a viral load measurement, respectively. Median pretreatment CD4 count was lower for TDF/FTC+LPV/r recipients than TDF/FTC+EFV recipients (250 vs 316) (p<0.05). The median increase from baseline CD4 cell count was 230 in TDF/FTC+LPV/r group, 193 in TDF/FTC+EFV group and 216 among all treated patients. Of 531 patients receiving ART, 11 had died and 19 were lost to follow-up. Conclusion Despite 52.4% of recently diagnosed patients were late presenters; a high rate of virologic suppression was achieved in HIV-TR Cohort. A national HIV testing strategy targeting subpopulations with higher risk is urgently needed. [ABSTRACT FROM AUTHOR]