Search

Bu çalışma, 14-17 Eylül 2016 tarihleri arasında Lizbon[Portekiz]'de düzenlenen 19. Meeting of the European Society for Clinical Virology'de bildiri olarak sunulmuştur. Background: Because of their similar modes of transmission, the simultaneous infection of viral hepatitis and human immunodeficiency virus are increasingly seen as a big problem related to human health. Aims: To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1 patients in Turkey. Study Design: Retrospective cross-sectional study. Methods: The present study was conducted between 2010 and 2017. HBsAg, anti-hepatitis C virus, and anti-human immunodeficiency vim were tested with ELISA. All anti-human immunodeficiency virus positive results by ELISA were verified for anti-human immunodeficiency virus positivity by a Western blot test, and Antihuman immunodeficiency virus positive patients with HBsAg andior anti-hepatitis C virus positivity were included in the study. Subtyping and genotypic resistance analyses were performed by population sequencing of the viral protease and reverse transcriptase regions of the human immunodeficiency virus-1 pol gene. Results: We detected 3896 human immunodeficiency virus-1 positive patients whose sera were sent from numerous hospitals across the country to our polymerase chain reaction unit for detection of drug resistance mutations and whose molecular laboratory tests were completed. Viral hepatitis co-infections were detected in 4.3% (n=170) of patients. Hepatitis B virus and hepatitis C virus co-infection were observed in 3.2% and 0.5% of all human immunodeficiency virus-I infected patients, respectively. The major human immunodeficiency virus-1 subtype detected was group M, subtype B (62.9%). However, 13.5% of drug resistance mutation motifs were found in human immunodeficiency virus-1 genomes of patients included in the study. Conclusion: Due to similar transmission routes, HIV1 patients are at risk of hepatitis B and C virus co-infection. However, antiretroviral drug resistance mutation model is similar to patients with hepatitis negative. European Society for Clinical Virology

Background: Because of their similar modes of transmission, thesimultaneous infection of viral hepatitis and human immunodeficiencyvirus are increasingly seen as a big problem related to human health.Aims: To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1patients in Turkey.Study Design: Retrospective cross-sectional study.Methods: The present study was conducted between 2010 and 2017.HBsAg, anti-hepatitis C virus, and anti-human immunodeficiencyvirus were tested with ELISA. All anti-human immunodeficiencyvirus positive results by ELISA were verified for anti-humanimmunodeficiency virus positivity by a Western blot test, and Antihuman immunodeficiency virus positive patients with HBsAg and/oranti-hepatitis C virus positivity were included in the study. Subtypingand genotypic resistance analyses were performed by populationsequencing of the viral protease and reverse transcriptase regions ofthe human immunodeficiency virus-1 pol gene.Results: We detected 3896 human immunodeficiency virus-1 positivepatients whose sera were sent from numerous hospitals across thecountry to our polymerase chain reaction unit for detection of drugresistance mutations and whose molecular laboratory tests werecompleted. Viral hepatitis co-infections were detected in 4.3% (n=170)of patients. Hepatitis B virus and hepatitis C virus co-infection wereobserved in 3.2% and 0.5% of all human immunodeficiency virus-1infected patients, respectively. The major human immunodeficiencyvirus-1 subtype detected was group M, subtype B (62.9%). However,13.5% of drug resistance mutation motifs were found in humanimmunodeficiency virus-1 genomes of patients included in the study.Conclusion: Due to similar transmission routes, HIV1 patients are atrisk of hepatitis B and C virus co-infection. However, antiretroviraldrug resistance mutation model is similar to patients with hepatitisnegative.

Phlebotomy causes pain and discomfort to adults. The objective of this study was to investigate the effect of the use of Buzzy on phlebotomy satisfaction and pain relating to the phlebotomy process in healthy adult blood donors voluntarily donating blood. This was a prospective, randomised, controlled experimental study. The research sample was made up of 90 healthy adult men. These individuals were randomly assigned to an experimental group (Buzzy group), a placebo control group, and a nonintervention control group. For the individuals in the experimental group, the ice wings of the Buzzy device, frozen solid in the refrigerator, were placed approximately 5 centimeters above the intervention site from 1 minute before the procedure until the end of the needle location process. When the device was operated, it applied vibration and cold to the site: For individuals in the placebo control group, the Buzzy device was also located approximately 5 centimeters above the intervention site from 1 minute before the procedure until the end of the needle location process, but with the ice wings at room temperature (unfrozen) and with the vibration switch remaining off. For the nonintervention control group, no intervention was implemented before the procedure. Immediately after entry to the vein, pain levels and levels of phlebotomy satisfaction were assessed in individuals in all groups. A statistically significant difference was determined between the mean pain and phlebotomy satisfaction scores of individuals in the experimental and control groups (p < .05). Results indicate that use of the Buzzy device was an effective method of reducing the pain of phlebotomy and increasing phlebotomy satisfaction in healthy adult male blood donors.

Introduction Brucellosis is a public health problem that is prevalent in several developing countries. Methods The clinical and laboratory characteristics of 164 cases of brucellosis in Bursa, Turkey, were retrospectively evaluated. Results The ages of the 164 patients ranged from 15-85 years. All of the patients underwent the Rose Bengal test and 163 (99.4%) patients tested positive. 122 (74.4%) patients were diagnosed with acute brucellosis, 31 (18.9%) with subacute brucellosis and 11 (6.7%) with chronic brucellosis. Focal involvement was found in 101 (61.6%) patients. Although patients with focal involvement had a higher white blood cell count (p = 0.002), those without focal involvement had higher aspartate transaminase and alanine transaminase values, and lower platelet values (p = 0.005, 0.007 and 0.039, respectively). Spondylodiscitis was observed on imaging in 58 (66.7%) of the 87 patients who presented with back pain. Among the 118 patients who were examined within the first month of treatment, 79 (66.9%) responded to treatment. The relapse rate was 11.6% among all 164 patients. Conclusion Brucellosis should be considered as a differential diagnosis among patients who present with fever, and joint or back pain. Focal involvement should be investigated in the presence of leucocytosis, and subacute or chronic forms of brucellosis. To identify cases of spondylodiscitis, radiography should be performed in patients who present with back pain.

Introduction: There are only a few studies regarding community-acquired sepsis and its epidemiology. We aimed to evaluate the cases diagnosed as community-acquired sepsis and followed in our clinic. Patients and Methods: In this study, epidemiological and clinical features of 125 adult patients with community-acquired sepsis followed in our clinic during the period 1989-2005 were retrospectively evaluated. Results: The mean age was 52.7 years; 58 patients (46.4%) were male and 67 (53.6%) were female. Anatomic site of infections included urinary tract in 56 patients (45%), respiratory system in 23 (18%), intraabdominal in 12 (9.6%), and skin and soft tissue in 6 (5%). No anatomic site of infection was found in 28 (22.4%) patients. Of the blood culture isolates, 64% were gram-negative bacteria. In-hospital mortality was 30% in patients with sepsis. The mortality rate was found to be 4.25% in 47 patients with sepsis, while it was 35.9% in 78 patients with severe sepsis on admission (p< 0.001). Conclusion: New and large studies are needed to understand the epidemiology of community-acquired sepsis.

We present a case of multiple intracranial abscesses caused by Cryptococcus neoformans in a patient who presented with no symptoms of immunodeficiency.

Introduction: The fever of unknown origin (FUO) cases are one of the main patient group of infectious diseases departments. The reason of FUO followed in our department were evaluated in this study. Patients and Methods: Thirty-eight cases (18 male, 20 female) of FUO seen in the Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University between January 2007 and January 2009 were analyzed retrospectively. The cases within a classic definition of FUO as established by Petersdorf and Beeson were included. Results: The average age of the patients was 51 ± 19 years (20-82). The mean duration of hospitalization was 20 ± 12 (7-63) days. In 32 (84.2%) patients, the diagnosis was established, while in 6 (15.8%) patients, the cause of fever could not be explained. The etiology was infectious in 19 (50%) patients, collagen vascular diseases in 6 (15.8%), and neoplasm in 6 (15.8%), and pulmonary embolism was diagnosed in 1 (2.6%) patient. The most common infectious diseases were brucellosis, infective endocarditis and atypical pneumonia. The most frequently performed invasive procedure was the aspiration and biopsy of bone marrow. Of the 38 patients, 8 (21%) died. Conclusion: Infectious diseases were the most common causes of FUO in our study as in other studies in our country; however, it is striking that there was no tuberculosis among our cases, which is in contrast to other studies.

Antibiotic associated diarrhea may develop due to several causes. Here, we report the cases with diarrhea syndrome developed during the use of oral antibiotics for the treatment of community-acquired infections. Thirty hospitalized patients (15 male, 15 female) with bloody diarrhea were included in this study. The mean age was 40.8 years (range 16-85). Twenty-six of the cases had history of ampicillin/sulbactam usage before the onset of diarrhea, whereas remaning four cases mentioned use of amoxycilline/clavunate (2), azitromycine (1) or ampicillin/sulbactam + ornidazole (1). The time from onset of antibiotic use before the appearance of symptoms varied from 1 day to 8 days (median ± SEM, 3.73 ± 0.34 days). The frequencies of defecation were 3-9 times/day in six cases, 10-20 times/day in 15 cases and ≥ 20 times in nine cases. The presence of Clostridium difficile toxin in feces was assessed in 10 patients, and was weak positive in one patient. No enteric pathogen was isolated from feces culture. The diarrhea was regressed within two to six days (median ± SEM, 3.96 ± 0.18 days) after starting metronidazole (4 x 250 mg/day, oral, 10 days) treatment. In conclusion, cephalosporins and clindamycine, which are the most common causes of antibioticassociated colitis worldwide, were not responsible for the diarrheas observed in our cases. This may be due to the fact that ampicillin/sulbactam is commonly used for the treatment of community-acquired infections in our country.

The aim of this study was to determine and discuss the significance of fungemias developed at a tertiarycare university hospital in which almost all types of patients are followed up. Fungemia episodes, during five years period from January 1996 to December 2000 were emphasized. Approximately 24.000 patients per one year admitted to our hospital during the study period and fungemias developed among 285 of them. Candida species were responsible for 96% of episodes (275/285) and Trichosporon, Fusarium, Rhodotorula species were the other isolated fungi. There wasn’t any trend of increase or decrease with respect to the incidence of candidemia between the years but the highest ratio was significantly found at 1996 (p< 0.05). The mean value of ratio was 2.2 per 1000 admissions. Although Candida albicans was the species predominantly isolated, the total number of nonalbicans strains constituted 66% of all cases.

Pancytopenia associated with EBV is a rare complication. In this study, a case of infectious mononucleosis with pancytopenia that is resolved spontaneously was reported.

WOS: 000340538700017, PubMed ID: 24789652, The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.

This study was designed to determine the prevalence of intestinal parasites in relation to personal and environmental risk factors in Bursa province of Turkey and to compare wet mount + Lugol's iodine, formalin ethyl acetate concentration, trichrome staining and enzyme-linked immunosorbent assays (ELISA) methods used inEntamoeba histolytica/ Entamoeba dispar diagnosis. For this purpose a total of 176 faecal samples from people were randomly collected from regions of the Bursa City Centre, where crowded families of low socio-economic levels reside. All faecal samples were examined by wet mount + Lugol's iodine formalin ethyl acetate concentration, trichrome staining methods and ELISA. 66 faecal samples were infected with one or more parasite species and the overall prevalence rate was 37.5%. Nine species of intestinal parasites, including six protozoon and three helminth species were found. The most prevalent species was Blastocystis hominis (17.04%) and others were found with the following frequencies: 9.09% Enterobius vermicularis, 7.38% Giardia intestinalis, 5.68% Entamoeba coli, 2.27% E. histolytica/E.dispar, 1.13 % Entamoeba hartmani, 1.13% Taenia spp., 0.56% Hymenolepis nana. 6.2% of examined samples had mixed infections. Overall prevalence of the detected parasites did not differ significantly in different demographic groups. Except for B. hominis andG. intestinalis, there was no evidence for sex, age and other demographic-related differences in the prevalence of these parasites. Statistically, B. hominis and G. intestinalis were higher in 20 to 49 and in 1 to 19 year age groups, respectively than in any other age group. Microscopical examination and ELISA revealed that one sample (0.5%) was found to be positive using all 4 methods, and 162 samples (92%) were found to be negative with all 4 methods applied. E. histolytica/E. dispar complex was detected in 0.56% (1); in 0.56% (1), in 0.56% (1) and in 2.27% (4) of the fecal samples examined by wet mount + Lugol's iodine, formalin ethyl acetate concentration, with trichrome staining, and ELISA respectively. The wet mount + Lugol's iodine, formalin ethyl acetate and trichrome staining methods had a sensitivity of 25% each, a specificity of 94.1, 99.4 and 98.2%, compared to the results of the E. histolytica/E. dispar ELISA, respectively. Key words: Entamoeba histolytica/ Entamoeba dispar, enzyme-linked immunosorbent assays (ELISA), intestinal parasites, microscopy, prevalence.

Background Clostridium difficile (C. difficile) is a well-established cause of nosocomial diarrhea. The aim of our study was to define the incidence of nosocomial diarrhea in our hospital and to determine the role of C. difficile. Additionally, the risk factors for nosocomial diarrhea and Clostridium difficile associated diarrhea (CDAD) were investigated. Methods We included all patients, 18 years of age or more, who were admitted to the Uludag Teaching Hospital between October 1, 2004 and February 1, 2005, and developed diarrhea at least three days after hospital admission. A case-control study was performed. Results The total incidence of nosocomial diarrhea was 0.6 per 1,000 hospitalization-days and 5 per 1,000 patients’ admissions. Previous use of chemotherapy was found to be an important predisposing factor for nosocomial diarrhea. The incidence of CDAD was 0.26 per 1,000 hospitalization-days and 2.1 per 1,000 admissions, comparable with incidence rates in Europe. CDAD was diagnosed in 43% of patients with nosocomial diarrhea. No severe cases of CDAD were diagnosed. A correlation was found between CDAD and antibiotic use before admission and during admission in univariate analysis. PCR ribotyping revealed four strains of PCR ribotype 002 and 1 strain of ribotype 012 out of 5 C. difficile strains available for extensive identification. Conclusion The incidence rates of nosocomial diarrhea and CDAD are not different than the usual incidence rates in Europe. C. difficile was the causative agent in 43% of patients with nosocomial diarrhea.

Sir, The main route of human trichinosis is eating raw or undercooked pork, but there are also reports of some cases and outbreaks caused by wild boar, horse, dog, cougar, walrus, badger meat, etc., in the literature. Trichinosis is extremely rare in Turkey, because eating pork is prohibited in Islam and consumption of wild game meat is uncommon. Not to be considered in differential diagnosis may cause delays in the diagnosis and the treatment. Here we present an index case and a number of related cases which could only be diagnosed after the patient’s friends had similar complaints and explained that they had eaten wild boar meat all together. CASE REPORT

Objective - Inflammation plays a major role in the pathogenesis of atherosclerosis. Obesity is an independent risk factor for cardiovascular disease, which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue. The aim of this study is to investigate changes in the inflammatory markers interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) during weight reduction with orlistat treatment in obese patients. Methods and results - Thirty-six obese (BMI: 36.1 +/- 3.4 kg/m(2)) and II non-obese (BMI: 22.9 +/- 1.7 kg/m(2)) subjects were studied. IL-6 and hs-CRP levels were evaluated at baseline. In obese subjects after treatment of orlistat 120 mg three times daily for 6 months, IL-6 and hs-CRP levels were repeated. Levels of circulating IL-6 (p < 0.05) and hs-CRP (p < 0.01) were significantly higher in the obese group than in the non-obese group. Plasma IL-6 (r = 0.29 and p < 0.05) and CRP (r = 0.35 and p < 0.05) concentrations correlated positively with the level of obesity assessed by BMI at baseline. After 6 months of orlistat treatment in obese subjects, the mean weight of the patients decreased by 6.8 kg, the BMI by 3.2 kg/m(2). Compared with baseline, weight loss was associated with significant reductions of IL-6 (p < 0.001) and hs-CRP (p < 0.001) levels. Conclusion - In summary plasma IL-6 and hs-CRP levels were increased in obese patients. Orlistat-induced weight reduction was associated with decreasing levels of both IL-6 and hs-CRP in obese subjects. Because inflammatory mediators may be directly involved in atherogenesis, this would suggest that interventions to reduce IL-6 and CRP levels could be cardioprotective.

Objective: Brucellar spondylitis is one of the most serious complications of brucellosis. It should be considered in patients who have back pain and neurologic disorders as well as systemic symptoms and findings in or from endemic areas such as Turkey. This report describes important features of the disease. Methods: Twenty-five patients with brucellar spordylitis were retrospectively evaluated in terms of their clinical, laboratory, and radiologic features and their response to different treatment regimens. Results: The most common symptoms of brucellar spondylitis were back pain, fever, and sweating. Rose Bengal tests were positive in all of these patients. Brucella species was isolated from blood cultures of 8 (32%) patients. Magnetic resonance imaging (MRI) showed that the lumbar segment was the most frequently involved region. Different combination regimens including 2 or 3 antibiotics were used. Combination of tetracycline (especially doxycycline) and streptomycin was the most widely used therapy regimen. Trimethoprim-sulfamethoxazole, ciprofloxacin, ofloxacin, and rifampin were also included in some combination therapies. In this series, the mean duration of antimicrobial therapy was 130 +/- 45.6 days (range, 77-281 days), and 92% of patients received therapy for greater than or equal to 90 days. There were no mortalities in this study. Conclusions: Brucellar spondylitis should be considered in patients with back pain and neurologic disorders as well as systemic symptoms and findings in endemic areas. MR imaging is recommended in suspected cases. The patients can be treated effectively treated with appropriate antibiotic combinations. Follow up is important because relapses can occur.