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Cysticercosis is a parasitic tissue infection caused by larval cysts of Taenia solium. Although the disease affects many tissues, it primarily affects the brain and muscles. The most common form is neurocysticercosis, a term used for human central nervous system involvement with T.solium cysts. Neurocysticercosis is an important public health problem in many parts of the world. Its prevalence is particularly high in places where T.solium tapeworms are common, such as Mexico, Central America, South America, Southeast Asia, Africa, China, India, and Nepal. Its incidence has been increasing rapidly in recent years in non-endemic countries, due to both import and local cases, while in some highly endemic areas, numbers appear to have decreased, possibly due to better sanitation and increased public awareness. It is extremely rare in Türkiye. Cysticercosis is usually caused by drinking water or eating food containing tapeworm eggs. Clinical manifestations can range from completely asymptomatic infection to severe illness or death. Although the infection can involve any part of the central nervous system, symptomatic patients mostly have spinal cord involvement, intracerebral lesion, intraventricular cyst or subarachnoid lesion. An intraparenchymal cerebral cyst typically grows slowly and causes minimal symptoms for years or decades after the onset of infection. The site of involvement and the symptoms experienced determine the diagnosis and treatment method. The current general consensus supports antihelmintic and corticosteroid therapy for viable parenchymal lesions. In this report, a neurocysticercosis case with a single brain lesion that was surgically removed and histologically examined was presented. The patient had complaints of lisp in the tongue, numbness in the lips and left face. The patient had no concomitant chronic disease. The patient did not have a travel history or a history of eating pork but had a history of contact with a dead pig two months ago. Upon detection of a central mass in the brain computed tomography examination, surgical procedure was performed on the patient. Based on the identification of a larval stage of T.solium in biopsy material neurocysticercosis was diagnosed. However, histopathologically demonstration of the parasite is not possible in most cases. The patient received an antiparasitic treatment with albendazole 1000 mg/d in combination with dexamethasone. The patient was successfully treated and is still being followed up by calling for controls.

BACKGROUND: Pentraxin-3 (PTX-3) is an important marker that plays a role in suppressing inflammation and tissue repair. The aim of this study is to investigate the diagnostic and prognostic characteristics of PTX-3 in chronic hepatitis B (CHB) patients and the relationship between PTX-3 levels and fibrosis. METHODS: A total of 52 CHB patients and 40 healthy subjects were included in the study. All of the CHB patients underwent liver biopsy and were then scored using an Ishak histologic scoring system. Blood samples were collected to evaluate the PTX-3 levels. RESULTS: Of the subjects who participated in the study, 53% were female. The PTX-3 levels were determined as 5.63 ng/mL in the control group, and as 0.88 ng/mL in the CHB patient group. PTX-3 levels were found to be 1.19 ng/mL in stage 1, 0.89 ng/mL in stage 2, 0.68 ng/mL in stage 3, and 0.55 ng/mL in stage 4. Of the CHB patients, 44.2% had significant fibrosis, while 55.7% were identified as not having significant fibrosis. The PTX-3 values were 0.64 and 1.0 ng/mL in patients with and without significant fibrosis, respectively. The cut-off value for PTX-3 in predicting the absence of significant fibrosis was estimated as 0.9 ng/mL. CONCLUSION: The CHB patients were found to have lower serum PTX-3 levels compared to the control group, and these levels decreased even further as the stage of fibrosis progressed. In addition, the significant decrease in PTX-3 levels in patients with stage 1 fibrosis compared to the control group shows that PTX-3 can be used as a non-invasive marker for the early detection of fibrosis (P < .001).

Herpes simpleks virüsü (HSV) ensefaliti sporadik, akut başlangıçlı ve mortal seyredebilen beyin parankimi enfeksiyonudur. Bu çalışmada HSV ensefaliti tanısıyla takip ettiğimiz hastalar literatür eşliğinde incelenmiştir. Çalışmaya 2013-2021 yılları arasında Fırat Üniversitesi Hastanesi Enfeksiyon Hastalıkları kliniğinde takip edilen beyin omurilik sıvısı (BOS) HSV polimeraz zincir reaksiyonu pozitifliği ile tanısı doğrulanmış 18 yaş üstü HSV ensefaliti tanılı hastalar alınmıştır. Hastaların demografik verileri, klinik belirti ve bulguları, laboratuvar sonuçları, tedavi ve prognozları incelenmiştir. Çalışmaya 16 hasta dahil edilmiştir. Hastaların dokuzu (%56.3) kadın, yedisi (%43.7) erkektir. Yaş ortalamaları 55.4±16.3’tür. Bilinç bulanıklığı, ateş, bulantı/kusma ve baş ağrısı en sık görülen klinik semptom ve bulgular olmuştur. BOS mikroskopisinde 15 (%93.8) hastada lenfositik pleositoz, 10 (%62.5) hastada eritrosit saptanmış, bir hastada ise hücre görülmemiştir. Manyetik rezonans görüntülemesi (MRG) yapılan hastaların tamamında patolojik bulguya rastlanmıştır. En sık tutulum görülen bölgeler temporal lob, frontal lob ve insular korteks olmuştur. Elektroensefalografi (EEG) yapılan 11 hastanın ikisinde (%18.2) patolojik bulguya rastlanmazken bir (%9.1) hastada periyodik lateralize epileptiform deşarj, 8 (%72.7) hastada yetersiz temel biyoelektrik aktivite üzerinde keskin dalgalar saptanmıştır. Tüm hastalara intravenöz asiklovir semptom başlangıcından sonra ortalama 3.25 (min-max: 1-13) günde başlanmıştır. İntrakranial basıncı azaltmak amacıyla bir (%6.3) hastaya kortikosteroid tedavisi, iki (%12.5) hastaya dekompresif kraniektomi uygulanmıştır. Üç (%18.8) hasta ölmüştür. HSV ensefalitinin nörolojik belirtilerinden önce gelen sistemik prodromal dönem semptomları, tanıyı zorlaştırmakta ve gecikmeye neden olabilmektedir. COVID-19 döneminde, ateş, takipne ve bilinç değişikliği gibi semptomlar, hipoksi veya COVID-19’un nörolojik komplikasyonları ile karışabilir. Klinik şüphe bulunan hastalarda BOS incelemeleri, kranial MRG ve EEG’nin beraber değerlendirilmesinin önemli tanısal ipucu sağladığı düşünülmüştür.

Aim: We aimed to determine the prognostic performance of the Glasgow Prognostic Score (GPS), systemic immune-inflammation index and early warning score (the ‘ANDC’ system) in patients with diabetes mellitus who had COVID-19. Patients & methods: Patients were divided into two groups: with and without diabetes mellitus. Results: In the diabetic patient group, the rates of in-hospital mortality, intensive care unit hospitalization and corticosteroid treatment were higher compared with the nondiabetic patient group (p

Objectives: Chronic hepatitis C (CHC) is now a more curable disease with new direct acting antivirals (DAA). Although high sustained virologic response rates, failures still occur in DAA regimens. Our objective in this study was to characterize the real-life presence of clinically relevant resistance - associated substitutions (RASs) in the HCV NS5A gene in CHC patients whose DAA regimen has failed. Methods: The study enrolled 53 CHC patients who experienced failure with DAA regimen as the prospective longitudinal cohort between 2017-2019. Genotypic resistance testing was performed via the viral population sequencing method and The Geno2pheno HCV tool was used for RAS analysis. Results: The most frequent failure category was relapse (88%) followed by non-responder (12%). For a total of 36% of patients, RASs was detected in NS5A, Y93H was the most detected RAS in GT1b infected patients (89%). Conclusions: This study establishes an HCV failure registry for Turkey in which samples were combined with clinical, virologic and molecular data of adult patients whose DAA therapy failed. RASs can occur in CHC patients with DAA treatment failures. Evaluation of RAS after DAA failure is very important before retreatment is initiated to prevent virologic failure. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. WOS:000540737100014 32302766 Q2

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: Making the differential diagnosis between central fever and infectious fever is critically important among intracerebral hemorrhage patients followed up in intensive care units (ICUs). Serum procalcitonin (PCT) has been found to be a promising biomarker for the initial diagnosis of infection, even before culturing results. OBJECTIVES: To investigate the relationship between PCT and both fever etiologies and C-reactive protein (CRP) levels among critically ill patients with suspected intracerebral hemorrhage. DESIGN AND SETTING: Cross-sectional study in a public university hospital in Elazig, Turkey. METHODS: ICU patients diagnosed with intracerebral hemorrhage and normal procalcitonin levels were included in this study. From clinical assessments and cultures, they were classified as presenting either infectious or central fever. The sensitivity and specificity of PCT and CRP for predicting infection were calculated using a receiver operating characteristic (ROC) curve. RESULTS: There were 98 ICU patients with diagnoses of intracerebral hemorrhage. The median (interquartile range) PCT levels of patients with infectious and central fever were 4 (0.9-11) and 0.1 (0.1-0.4) ng/ml, respectively, with a statistically significant intergroup difference (P < 0.001). The areas under the ROC curve for predicting infectious or central fever PCT and CRP were 0.958 (P < 0.001) and 0.816 (P < 0.001), respectively. A statistically significant positive correlation was detected between PCT and CRP levels in patients with infectious fever (rho: 0.461; P = 0.003), but not in patients with central fever. CONCLUSIONS: PCT can possibly be used as a biomarker to differentiate between infectious and central fever among ICU patients.

Gunal, Ozgur/0000-0002-7744-4123; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000490537600009 PubMed: 31580558 Objective: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. Methods: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. Results: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+

Tularemia is a zoonotic disease and endemic in the northern hemisphere. The aim of this study was to evaluate the epidemiological, clinical and laboratory characteristics of tularemia patients, and to re-analyze their lymphadenopathy during the follow-up. The patients who were diagnosed with tularemia were reviewed. They were invited for the long term, physical and radiological evaluations. 69.8% patients had lived in rural areas. 54.7% patients were associated with animal husbandry, the 18.9% had contact with rodents. The most common form was the glandular type (62.3%). The frequency of granulomatous lymphadenitis was significantly higher in patients diagnosed later than 30 days from the onset of symptoms. Lymphadenopathy was undetectable in 61.5% patients, its severity was reduced in 38.4% patients compared to its state at the admission. In rural areas, avoiding contact with wild animals can ensure the protection from the pathogen. Public communities should be made aware of the disease.

BackgroundTuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The“Thwaites’ system” and “Lancet consensus scoring system” are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown.MethodsA multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The “Thwaites’ system” and “Lancet consensus scoring system” scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The “Thwaites’ system” and “Lancet consensus scoring system” suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively.ResultsA total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P P P ConclusionBoth criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

This study was undertaken to evaluate the diagnostic and prognostic values of pentraxin-3 (PTX-3) in patients with infected diabetic foot ulcers (IDFU) as well as to assess the association between PTX-3 levels and IDFU severity. This study included 60 IDFU patients (Group 1), 45 diabetic patients without DFU (Group 2), and 45 healthy controls. Patients with IDFU were divided into mild, moderate, and severe subgroups based on classification of clinical severity. Patients who underwent amputation were also documented. Blood samples were collected to determine PTX-3 levels. PTX-3 levels in healthy controls, Group 1, and Group 2 were 5.83 (3.41-20) ng/mL, 1.47 (0.61-15.13) ng/mL, and 3.26 (0.67-20) ng/mL, respectively. A negative correlation between plasma PTX-3 and glucose levels was found. There were significant differences in terms of procalcitonin (PCT) and PTX-3 levels in the subgroup analysis of Group 1. The PTX-3 level in patients who did or did not undergo amputation was 4.1 (0.8-13.7) and 1 (0.6-15.1) ng/mL, respectively. Results suggest that PTX-3 is a particularly effective marker in patients with IDFU, both in terms of predicting disease severity and assisting in the decision to perform amputation.

Objective We aimed to investigate new biochemical indicators to predict the clinical course of patients following the diagnosis of Crimean-Congo haemorrhagic fever (CCHF). Material and methods We retrospectively evaluated patients diagnosed with CCHF. They were divided into three groups based on a scoring system known as severity grading score in order to predict severity. Red cell distribution width (RDW), mean platelet volume (MPV), creatinine phosphokinase (CPK), alkaline phosphatase (ALP), glutamyl transferase (GGT) and C-reactive protein (CRP) levels were evaluated on the first day of admission. These biochemical parameters may predict the clinical course of our three patient groups. Results In our study, there were 38 (70.4%) male and 16 (29.6%) female patients, and the mean age was 44.33±16.94 years. Based on our scoring system, 17 (31.4%), 30 (55.5%) and 7 (12.9%) patients were in group 1, 2 and 3, respectively. Statistically significant difference was observed between groups 1–3 and groups 2–3 for ALP values; however, a statistically significant difference was observed among all three groups for GGT values. Significant differences were not observed among the groups for RDW, MPW, CPK and CRP levels (p>0.05). Conclusion ALP and GGT values can be used as auxiliary indicators to predict the clinical course for patients with CCHF. However, CPK, CRP, MPV and RDW values were not observed to be important for prognosis.

Introduction: Nosocomial infections continue to be an important health problem since they seriously increase the rate of mortality and morbidity as well as hospitalization period and treatment costs. Acinetobacter spp. have an important place among the factors that cause hospital infections. Fast and accurate detection of Acinetobacter baumannii outbreaks is important in the treatment and control of epidemic infections. In our study, it was aimed to investigate the molecular similarities of carbapenem resistant A. baumannii isolates isolated as hospital infectious agents with Pulsed-Field Gel Electrophoresis (PFGE) method. Materials and Methods: This study was conducted in a medical center to examine the genetic relationship of a specific agent group detected in the non-pandemic period and is a cross-sectional study. In our study, the molecular similarities of 93 carbapenem resistant A. baumannii isolates isolated as hospital infectious agents from various clinical materials sent to Fırat University Hospital Central Laboratory and Infectious Diseases Department Laboratory between December 1, 2013 and June 30, 2014 were investigated with PFGE method. Results: A. baumannii strains showed 30 different PFGE profiles. Clonally related strains were included in seven different clusters. Eighty of 93 A. baumannii strains in total were included in any cluster. The clustering rate of the strains was found to be 86%. When the isolate dates of 55 strains in 1 cluster with the highest number of isolates were examined in our study, it was seen that this clone survived in our hospital for about five months. Conclusion: This study showed that A. baumannii strains isolated as nosocomial infection agents can survive for a long time. It was thought that carbapenem resistance spread horizontally among Acinetobacter spp. It was concluded that the necessity of training activities for infection control measures and compliance should be examined, and antibiotic use policies should be revised in terms of carbapenem resistance.

In our country, within years, despite a dramatic drop in the number of patients with malaria, a dramatic increase in the number of patients with import malaria is noteworthy. A 32-year-old male patient presented with fever, shivering, malaise, and loss of appetite. He had travelled to West Africa. Laboratory findings were as follows: hemoglobin: 8.8 g/dL and anti-HIV: positive. Microscopic examinations of thin blood smears and thick blood preparations revealed widespread trophozoites. The presence of double-dotted ring forms and banana-shaped gametocytes resulted in Plasmodium falciparum malaria being diagnosed. The patient was started treatment with oral artemether 20 mg/ lumefantrine 120 mg 2×4 tablets and trimethoprim-sulfamethoxazole. During his follow-up, hemoglobin levels regressed to 5.8 g/dL. The patient was diagnosed as having severe malaria. He visited our hematology unit, and exchange transfusion (EET) was recommended. Using an EET apheresis device, eight units of erythrocyte suspension was transfused. The cured patient was discharged. This case was found to be interesting and reminds us the possible presence of comorbid conditions associated with malaria in patients who have a history of travelling abroad. Although its effectiveness has not been proved thus far, as a striking result, EET was used as an alternative treatment in a patient with severe malaria.

Objective Malaria is an infectious disease caused by Plasmodium parasite. Sporadic cases have not been observed in Turkey since 2010, but imported malaria cases are still prevalent owing to migration. The present study aimed to evaluate Plasmodium falciparum malaria in patients hospitalized in our hospital. Methods A total of 15 adult patients (14 males and 1 female) who were diagnosed with malaria and who were managed at our clinic between January 2011 and 2017 were evaluated retrospectively for their epidemiological, clinical, and laboratory findings; treatment; and prognosis. Results Of the 15 cases, 14 (93.3%) were male and (6.7%), female. All patients had a history of travelling to endemic areas, and none of them undertook regular chemoprophylaxis. Fever (100%), splenomegaly (86.7%), hepatomegaly (26.7%), leukopenia (13.3%), thrombocytopenia (80%), elevated liver function tests (40%), and increased serum creatinine levels (13.3%) were found in the patients. Conclusions The number of import cases is increasing owing to tourism, migration, and deficiency in eradication programs. Malaria caused by P. falciparum is an import case in Turkey. The current study emphasizes on the necessity of providing proper education to Turkish individuals traveling to endemic areas for the purpose of work or travel and on the necessity of initiating chemoprophylaxis.

In the Tunceli / Dersim region, many public safety disorder and rebellion occurred from the time it was under the administration of the Ottoman Empire until the first period of the Republic. A vicious circle such as riot-suppression-riot has occurred. In order to solve the Dersim issue in the Republican era, many reports were prepared and laws towards Dersim were prepared in line with these reports. In addition, it was decided to establish a general inspectorate, a form of administration that has been implemented since the Ottoman Empire, in order to ensure the in the areas such as public order, economy, education, and health the development of the region. In order to solve the Dersim issue completely, the IV General Inspectorate was established on January 6, 1936, and was given broad authority on administrative, military, and legal matters. As an inspector, Lieutenant General Hüseyin Abdullah Alpdoğan, who knows the region and the people living there, was appointed. Thereupon, leaders in the region started to look for ways to rebel by acting together to protect their damaged interests. In this study, after examining Establishment of the IV General Inspectorate in the Dersim region, the reaction and rebellion preparations of the tribal chiefs against this situation were explained., Tunceli/Dersim bölgesinde Osmanlı Devleti’nin idaresi altında olduğu zamandan başlayarak Cumhuriyetin ilk dönemine kadar birçok asayişsizlik ve isyan hareketi meydana gelmiştir. Adeta isyan-bastırma-isyan şeklinde bir kısır döngü oluşmuştur. Cumhuriyet döneminde Dersim meselesinin çözülebilmesi için birçok rapor hazırlattırılmış ve bu raporlar doğrultusunda Dersim’e yönelik kanunlar hazırlanmıştır. Ayrıca asayişin sağlanması, ekonomi, eğitim, sağlık gibi alanlarda bölgenin kalkınması amacıyla Osmanlı Devleti’nden beri uygulanmış bir idare şekli olan umumi müfettişlik teşkilatının kurulmasına karar verilmiştir. Dersim meselesinin tamamen çözülebilmesi için IV. Umumi Müfettişlik 6 Ocak 1936’da kuruldu ve idari, askeri, hukuksal konularda oldukça geniş yetkiler verildi. Müfettiş olarak da bölgeyi ve orada yaşayan insanları iyi tanımış biri olan Korgeneral Hüseyin Abdullah Alpdoğan tayin edilmiştir. Bunun üzerine bölgedeki liderler çıkarlarını korumak için birlikte hareket ederek isyan çıkarmanın yollarını aramaya başlamışlardır. Bu çalışmada Dersim bölgesi için IV. Umumi Müfettişliğin kurulması incelendikten sonra aşiret reislerinin bu duruma karşı göstermiş oldukları tepki ve isyan hazırlıkları açıklanmıştır.

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.

Introduction: This study aimed to determine the epidemiological data, clinical and laboratory findings, morbidity, and mortality of patients with central nervous system infection (CNSI). Materials and Methods: Patients who were followed-up in our clinic with a diagnosis of CNSI between 2013 and 2018 were reviewed retrospectively. Results: A total of 55 patients with a mean age of 46±19 (19-90) years were included in the study; 58.1% of the patients were male. Acute bacterial meningitis was observed in 54.5% of the patients, aseptic meningitis in 23.6%, tuberculous meningitis in 5.5%, and meningoencephalitis in 16.4% (88.8% of these patients were defined as highly probable encephalitis). The most common symptom was fever. The prevalence of the classical triad (fever, neck stiffness, and change in mental status) in patients with acute bacterial meningitis was 36.6%. Streptococcus pneumoniae was the most common causative agent identified in cerebrospinal fluid (CSF) and blood culture. Cerebrospinal fluid acid-fast bacillus positivity in tuberculous meningitis and CSF herpes simplex virus polymerase chain reaction-1 positivity in meningoencephalitis was 33.3%. The complication rate was 18.1%. The only mortality was in one patient with acute bacterial meningitis. Conclusion: According to the results of our study, fever, change in mental status, headache, and signs of meningeal irritation are essential in predicting CNSI. However, these indicators rarely presented altogether in our patients. Therefore, patients who do not exhibit the classical triad but are suspected of CNSI should undergo lumbar puncture for CSF analysis and antimicrobial treatment should be started as soon as possible. The low mortality rate among our patients once again demonstrates the importance of this approach.

Tartar T, Sagmak-Tartar A, Sarac M, Bakal U, Akbulut A, Kazez A. Does microbial resistance profile change in community-based intra-abdominal infections? Evaluation of the culture results of patients with appendicitis. Turk J Pediatr 2018; 60: 520-526. Most common origin of intra-abdominal infections in children is appendicitis. Microorganisms responsible for community-based and hospital-acquired intra-abdominal infections vary. The aim of this study was to evaluate microbial culture outcomes and antibiotic susceptibilities of these microorganisms in samples obtained intraoperatively from pediatric patients with appendicitis, and to define the infectious microorganisms responsible for the community-based intra-abdominal infections in our region, and their antibiotic susceptibilities. This study included 231 patients between 0 and 16 years of age, operated on due to appendicitis between 2014 and 2017. Appendicular tissues were sampled intraoperatively. Antibiogram was studied in case of reproduction in tissue culture. Forms included information on the age and gender of the patients, intra-abdominal event, bacterial growth in microbial culture and antibiogram, antibiotic switch during follow-up, duration of the treatment, complications and outcomes were recorded. No microbial growth was observed following inoculation of the samples obtained from appendiceal tissue of 24.7% patients, whereas growth was positive in 75.3%. Gram negative bacteria were isolated in 94.3% of the patients, whereas gram positive bacteria was isolated in 5.7%. Polymicrobial growth was observed in 2.2% of the patients. E. coli in 79.9%, P. aeruginosa in 5.2%, Enterobacter cloacae in 3.4%, Coagulase-negative staphylococci in 3.4%, Klebsiella spp. in 1.7%, Citrobacter spp. in 1.7%, Enterococcus spp. in 1.7%, Comamonas testosteroni in 1.2% of patients produced. ESBL positivity is present in 51 (36.7%) of 139 E. coli strains reproducing in appendiceal tissue culture. ESBL was positivity detected in one of the reproduced 3 Klebsiella spp. strains. In E. coli, ciprofloxacin resistance as 20.86%, ampicillin-sulbactam resistance as 83.45%, and co-trimoxazole resistance as 41% were found. Our study clearly demonstrates that the resistance profile varies in community-based intra-abdominal infections. Empirical treatment protocols should be revised in especially the patients admitted with septic presentation and where the source control is not possible.

WOS: 000388827200008, PubMed ID: 27138335, Objective Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes. Methods Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain. Results A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000-0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.32.7, p = 0.0001) were associated with diffuse inflammation. Conclusions In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

Making the differential diagnosis between central fever and infectious fever is critically important among intracerebral hemorrhage patients followed up in intensive care units (ICUs). Serum procalcitonin (PCT) has been found to be a promising biomarker for the initial diagnosis of infection, even before culturing results.To investigate the relationship between PCT and both fever etiologies and C-reactive protein (CRP) levels among critically ill patients with suspected intracerebral hemorrhage.Cross-sectional study in a public university hospital in Elazig, Turkey.ICU patients diagnosed with intracerebral hemorrhage and normal procalcitonin levels were included in this study. From clinical assessments and cultures, they were classified as presenting either infectious or central fever. The sensitivity and specificity of PCT and CRP for predicting infection were calculated using a receiver operating characteristic (ROC) curve.There were 98 ICU patients with diagnoses of intracerebral hemorrhage. The median (interquartile range) PCT levels of patients with infectious and central fever were 4 (0.9-11) and 0.1 (0.1-0.4) ng/ml, respectively, with a statistically significant intergroup difference (P0.001). The areas under the ROC curve for predicting infectious or central fever PCT and CRP were 0.958 (P0.001) and 0.816 (P0.001), respectively. A statistically significant positive correlation was detected between PCT and CRP levels in patients with infectious fever (rho: 0.461; P = 0.003), but not in patients with central fever.PCT can possibly be used as a biomarker to differentiate between infectious and central fever among ICU patients.

Background: Brucellosis is a zoonosis that affects several systems, especially with the osteoarticular involvement. Objectives: This study aims to compare the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), mean platelet volume (MPV) and red blood cell distribution (RDW) in patients with the osteoarticular involvement and those with non-localised brucellosis and evaluate their predictive value for the diagnosis of osteoarticular brucellosis. Methods: We enrolled 140 patients with brucellosis, 70 with the osteoarticular involvement and 70 without any localised involvement. We collected patients’ data retrospectively and compared haematological parameters between both groups. In patients with osteoarticular brucellosis, a correlation of the NLR with the ESR and CRP and correlation of the MLR with the ESR and CRP were assessed. Furthermore, the predictive performance of the ESR, CRP, NLR and MLR on the osteoarticular involvement was evaluated. Results: The NLR, MLR, ESR, CRP, neutrophil and monocyte levels were higher in the patient group than the control group. Conclusion: The NLR, MLR, ESR and CRP are useful parameters to estimate the clinical course of patients with brucellosis, and the NLR and MLR are alternative to inflammatory markers in the osteoarticular involvement. Keywords: Neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, inflammatory marker.

Introduction: Production of extended-spectrum beta-lactamase (ESBL) is one of the most important resistance mechanisms. Today, community-acquired infections caused by ESBL-producing isolates are mentioned as well as nosocomial infections. Theaim of this study was to assess in vitro activity of various antimicrobials against 75 ESBL-producing Escherichia coli isolates obtained from urine samples which were determined in patients with the diagnosis of urinary tract infections. Patients and Methods: In this study, all the 75 ESBL-producing E. Coli isolates obtained from urine samples between September 2011 and February 2012 were included. ESBL production of the isolates was detected by double disk synergy test. The minimum inhibitory concentrations (MICs) of antibiotics (ertapenem, imipenem, doripenem, and cefoperazone-sulbactam) were determined by broth microdilution method according to CLSI (Clinical and Laboratory Standards Institute) guidelines. Results: While MIC50-MIC90 values were 0.125-0.25 μg/mL for ertapenem, 0.5-0.5 μg/mL for imipenem, and 0.06-0.06 μg/mL for doripenem against nosocomial E. Coli isolates (n= 57), MIC50-MIC90 values were 0.06-0.125 μg/mL for ertapenem, 0.25-0.5 μg/mL for imipenem, and 0.06-0.06 μg/mL for doripenem against community-acquired E. Coli isolates (n= 18). Statistically, no difference was determined between these two groups (p> 0.05). Cefoperazone-sulbactam MIC50-MIC90 values were 8-64 μg/mL against both nosocomial and community-acquired E. Coli isolates. Conclusion: Ertapenem, imipenem, and doripenem were more effective as in vitro than cefaperazone-sulbactam and they are antimicrobials that could be used safely in the treatment of infections caused by ESBL-producing isolates.