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Background: The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. Methods: This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1) pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. Results: In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1) pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality. Conclusions: Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.

WOS: 000329981700003, PubMed ID: 24211227, Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.

Kikuchi-Fujimoto disease (KFD) is a self-limited disease characterized by necrotizing lymphadenitis. Although cervical lymphadenitis in young women is the most familiar clinical presentation, it may take place in the etiology of fever in cases presenting with fever of unknown origin. A 33-year-old male case admitted with fever, nausea, vomiting, weight loss, and leukopenia for one month, subsequently developing axillary lymphadenopathy during followup, diagnosed as KFD with typical histopathological findings, and showing full recovery after the excision of lymph node was presented in this report.

The natural history of hepatitis B virus infection is not uniform and affected from several factors including, HBV genotype. Genotype D is a widely distributed genotype. Among genotype D, several subgenotypes differentiate epidemiologically and probably clinically. D1 is predominant in Middle East and North Africa, and characterized by early HBeAg seroconversion and low viral load. D2 is seen in Albania, Turkey, Brazil, western India, Lebanon, and Serbia. D3 was reported from Serbia, western India, and Indonesia. It is a predominant subgenotype in injection drug use-related acute HBV infections in Europe and Canada. D4 is relatively rare and reported from Haiti, Russia and Baltic region, Brazil, Kenya, Morocco and Rwanda. Subgenotype D5 seems to be common in Eastern India. D6 has been reported as a rare subgenotype from Indonesia, Kenya, Russia and Baltic region. D7 is the main genotype in Morocco and Tunisia. D8 and D9 are recently described subgenotypes and reported from Niger and India, respectively. Subgenotypes of genotype D may have clinical and/or viral differences. More subgenotype studies are required to conclude on subgenotype and its clinical/viral characteristics.

Mucahit Yemisen1, Asli Vatan1, Ilker Balkan1, Ayse Salihoglu2, Tugrul Elverdi2, Emre Eskazan2, Bilgul Mete1, M.Cem Ar2, Seniz Ongoren2, Zafer Baslar2, Resat Ozaras1, Nese Saltoglu1, Recep Ozturk1, Teoman Soysal2 and Fehmi Tabak1, (1)Infectious Diseases, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey, (2)Internal Medicine, Hematology Section, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey

Telaprevir combination with pegylated-interferon (Peg-IFN) +ribavirin significantly improves response rates in HCV infection.1-3 However this triple regimen is particularly associated with increased rates of side effects.4 HCV infection in patients undergoing hematopoietic stem cell transplantation (HSCT) increases the risks of liver-related complications and veno-occlusive disorder.5,6 Cure of HCV before transplantation can eliminate these risks. We present a patient with severe aplastic anemia and chronic hepatitis C treated with telaprevir based triple regimen before HSCT. A 24-year-old male had been diagnosed as severe aplastic anemia and chronic HCV infection. Initial tests revealed the followings: leukocytes 2500/mm3, neutophils 570/mm3, Hb 11.5 mg/mL, platelets 42,000/mm3. HCV RNA level was 1,350,000 IU/mL and genotype 1b. Liver biopsy revealed moderate inflammation, mild fibrosis and iron deposition due to multiple transfusions. A detailed informed consent was obtained and he was given modified doses of Peg-IFN-α2a (135 mcg/week) + ribavirin (600 mg/ day) and full dose telaprevir (2,250 mg/day). His trombocytopenia has deepened (10,600/mm3) and peg-INF was reduced to 67.5 mcg/week after the first dose and was given with platelet transfusions. Hemoglobin level fell to 8.6 g/dL and required erythrocyte replacement as well as further dose reduction in ribavirin. A rash has appeared on his face and scalp in the fourth week and was evaluated as “telaprevir associated seborrheic dermatitis”. Topical steorid creams were given. HCV-RNA was negative at the end of the fourth week. HCV RNA was still negative at the end of 12th week and telaprevir was stopped. Erythrocyte and platelet replacements were given regularly due to persistent cytopenias. The treatment was continued with Peg-IFN and ribavirin combination. Neutropenia was deepened (110/ mm3) on the 14th week and peg-IFN dose was skipped. By the 16th week, he developed interferon related parapsoriasis and systemic steroid was given for 8 weeks. The treatment was completed at the end of 24th week. HCV-RNA studies at the end of treatment, 1st month follow-up, 3rd month followup and 6th month follow-up were negative. The patient was accepted as sustained virologic responder. On the 3rd month after treatment he underwent HSCT. Engraftment was achieved on the 14th day of transplantation. A telaprevir-containing triple regimen is a challenge for a patient with severe cytopenias. Ribavirin free all-oral regimens are available with high efficacy and low rates of side effects. They are recommended in updated HCV treatment guidelines.7,8 However they are neither commonly available nor reimbursed in some countries. However some patients including those with severe fibrosis or severe extrahepatic manifestations merit currently available standard of care. However HSCT with HCV infection would potentially cause new complications. Though not smooth enough; it might deserve to be recognized as a success story at the dawn of new safer and stronger all-oral regimens.

Bacterial isolates producing Class D OXA-48 carbapenemase may be missed in routine laboratory testing, allowing them to spread undetected. The purpose of the present study was to detect bla(OXA-48) among ESBL-producing Klebsiella pneumoniae and Escherichia coli isolates collected from a university hospital, Turkey. Ninety-two ESBL-producing isolates (66 E. coli, 26 K. pneumoniae) were obtained in 2010. Antibiotic susceptibility tests were performed using the disc diffusion method and VITEK 2 system. Carbapenemase activity was screened using modified Hodge test. Beta-lactamase genes were detected by PCR and bla(OXA-48)-positive amplicons were sequenced. Genetic relatedness among K. pneumoniae isolates was investigated by pulsed-field gel-electrophoresis (PFGE). Carbapenemase activity was detected in 1 E. coli and 9 K. pneumoniae isolates and 8 of the K. pneumoniae plus the E. coli isolates were resistant to ertapenem. Three K. pneumoniae and 1 E. coli isolates were resistant to imipenem. All 10 isolates were susceptible to meropenem. bla(OXA-48) was present in all 10 isolates. Additionally, 9 isolates contained at least one beta-lactamase gene, including bla(SHV') bla(CTX-M) and bla(VEB) type. PFGE revealed different karyotypes among 9 K. pneumoniae isolates suggesting that the dissemination of bla(OXA-48) gene was not spread by a single K. pneumoniae clone. Thus OXA-48-producing isolates found in carbapenem-susceptible strains according to CLSI guidelines.

Although the syndrome of spontaneous intracranial hypotension (SIH) is not an infectious disease, it is commonly involved in the differential diagnoses of meningitis and encephalitis. It is a clinical (headache, fever, even neck stiffness) and laboratory (cerebrospinal fluid (CSF) abnormalities) challenge for the physician. Considering this syndrome especially under some settings and taking care of the charactestic imaging findings would contribute to the diagnosis. We believe in that the physicians who care with these central nervous system (CNS) infections should be aware of this syndrome. Some patients under the suspicion of encephalitis have the SIH that could be diagnosed by approaches described in this chapter.

WOS: 000325802700001 PubMed ID: 24043418 We describe the epidemiological, clinical features and risk factors for the morbidity and mortality of imported Plasmodium falciparum malaria cases during the last 10 years in Istanbul, Turkey. The epidemiological, clinical and laboratory data of cases in six tertiary care hospitals in Istanbul between 2002 and 2012 were analysed. Seventy patients (65 males, five females; median age 37; range: 14-84) were included. Sixty-five (93%) patients had travelled to African countries and the remaining five to other malarious countries. Seventeen (24%) had a history of previous malarial episodes; eight (13%) developed recrudescence during the first month; 22 (31%), 17 (24%), 20 (29%) and three (4%) cases had cerebral malaria, cholestatic icterus, malarial hepatitis and respiratory distress syndrome on admission, respectively. Six of 12 patients with severe falciparum malaria died. Clinically, the presence of alteration in mental status, icterus, hypoglycaemia, disseminated intravascular coagulation and malarial hepatitis were statistically significant for the development of severe malaria and mortality. Recrudescence should not be forgotten, especially in uncomplicated cases.

WOS: 000326241700021, PubMed ID: 23663858, Background: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. Methods: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value

Fusarium spp. is an opportunistic mold that causes disseminated infections in immunocompromised patients. It is important to make a definite diagnosis because of high mortality rates. We present the case of a 27-year-old pregnant woman diagnosed with acute myeloid leukemia with a prolonged febrile neutropenic period. She developed ecthyma gangrenosum-like lesions and simultaneously had Pseudomonas bacteremia and disseminated fusariosis. Histopathological and microbiological features of skin lesions had a critical role in differential diagnosis. Ecthyma gangrenosum-like lesions due to disseminated fusariosis might be easily misdiagnosed as lesions associated with Pseudomonas unless tissue cultures and histopathological examinations are performed.None declared.Fusarium spp. immündüşkün hastalarda dissemine enfeksiyonlara neden olan oportünistik bir küf mantarıdır. Yüksek mortalite oranları nedeniyle kesin tanıya gitmek önemlidir. Sunmakta olduğumuz olguda uzamış febril nötropenik dönemde bulunan AML tanılı 27 yaşında bir gebede Pseudomonas bakteremisi ile dissemine fusariozis eşzamanlı gelişmiş ve aynı dönemde ektima gangrenozum benzeri lezyonlar ortaya çıkmıştır. Ayırıcı tanıda deri lezyonlarının histopatolojik ve mikrobiyolojik özellikleri önemli bir yer tutmuştur. Dissemine fusariozise bağlı ektima gangrenozum benzeri lezyonlar doku kültürü ve histopatolojik incelemeler yapılmazsa kolaylıkla Pseudomonas enfeksiyonu ile ilişkili lezyonlarla karıştırılabilir.

Helicobacter pylori (HP) is recognized as a common chronic human bacterial infection and is the most common cause of gastritis. Recent studies suggest an increased HP prevalence in patients with various extra-digestive inflammatory diseases. Since many respiratory diseases are characterized by chronic inflammation as well as increased immune response, and HP may enter the nasopharyngeal cavity by gastroesophageal reflux, an association between respiratory disorders and HP infection has been suggested. Several studies discover HP in clinical samples from the patients with upper respiratory system infections. Even some of them revealed a relief after the treatment directed to HP eradication. However some studies do not support this theory and whether this association means a definite proof of a causal relationship between HP and respiratory diseases needs to be clarified. In this study, we aimed to review the reports about the role of HP in upper respiratory system infections.

Infections due to Chryseobacterium indologenes (C. indologenes) are rare and generally associated with immunosupression and indwelling catheters. We report a recurrent port infection caused by C. indologenes. In the first bacteremia episode we did not remove the port and only applied antibiotherapy. However, the patient presented with bacteremia with the same bacteria and successfully treated with antibiotherapy and removal of the port.

The aim of treatment in chronic hepatitis B (CHB) is to suppress HBV replication and to prevent liver diseases, such as cirrhosis and HCC. Nucleoside (nucleotide) analogues (NA) are oral antiviral drugs used for treatment of chronic HBV infection, causing regression in liver fibrosis and allowing histological healing. The duration of treatment with oral antiviral drugs is still unclear. In this study, we investigated the frequency of relapse in patients with CHB after discontinuing NA.