Search

Introduction: Brucellosis and Crimean-Congo Hemorrhagic Fever (CCHF) are diseases that can present with similar clinical and laboratory findings to those of COVID-19, leading to misdiagnosis or confusion by visiting multiple departments. This can delay diagnosis and increase the risk of nosocomial transmission in the case of CCHF. Although misdiagnosis of Brucellosis and CCHF, and even a case of coinfection have been reported in the literature, no case report mentioning CCHF and Brucellosis coinfection hospitalized with the pre-diagnosis of COVID-19 was found. Case Report: A 35-year-old female patient presented to the emergency service with complaints of fever and fatigue. The patient was evaluated in the emergency triage and was taken to the area where COVID-19 pre-diagnosed patients were being examined. A thorax computed tomography (CT) without intravenous contrast usage was reported as normal, and the patient was discharged after being informed about COVID-19 transmission routes. The patient re-applied to the emergency service with complaints of fever, fatigue, headache, and myalgia four days later. The laboratory findings showed a white-cell count of 1600/mm³, haemoglobin of 12.8 g/liter, platelet of 146000/mm³, urea of 21.5 mg/dl, creatinine of 0.81 mg/dl, alanine aminotransferase (ALT) of 134 U/liter, aspartate aminotransferase (AST) of 303 U/liter, lactate dehydrogenase (LDH) of 714 U/liter, creatine kinase (CK) of 1796 U/liter, C-reactive protein (CRP) of 3 mg/liter, D-dimer of 2000 µg/liter, and a thorax CT showed minimal ground-glass opacity. The patient was hospitalized with a preliminary diagnosis of COVID-19 by the chest diseases clinic. Conclusion: A patient with Brucellosis and CCHF coinfection was hospitalized with a preliminary diagnosis of COVID-19. This case highlights the importance of considering other diseases with similar clinical and laboratory findings in endemic regions of Brucellosis and CCHF to avoid misdiagnosis and delay in treatment. Early diagnosis and appropriate management are crucial for improving patient outcomes and preventing nosocomial transmission. References: 1. Zhu J, Ji P, Pang J, et al. (2020), Clinical characteristics of 3,062 COVID‐19 patients: a meta‐analysis. J Med Virol. Accepted Author Manuscript. doi:10.1002/jmv.25884 2. Özer S, Oltan N, Gencer S. Bruselloz: 33 olgunun değerlendirilmesi. Klimik Derg 1998; 11(3): 82-4. 3. Karakecili F, Cikman A, Aydin M, et al. Evaluation of epidemiological, clinical, and laboratory characteristics and mortality rate of patients with Crimean-Congo hemorrhagic fever in the North east region of Turkey. J Vector Borne Dis 2018;55:215-221. 4. Young EJ. Brucella species. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 6th ed. Churchill Livingstone, Philadelphia, 2005:2669-74. 5. Almış H, Yakıncı C. A case of brucellosis misdiagnosed as Crimean-Congo hemorrhagic fever. Mikrobiyol Bul 2012;46(3):475-9. 6. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med 2005;352(22):2325-36. 7. Uyar Y, Carhan A, Albayrak N, Altaş AB. Evaluation of PCR and ELISA-IgM results in the laboratory diagnosis of Crimean-Congo haemorrhagic fever cases in 2008 in Turkey. Mikrobiyol Bul 2010;44(1):57-64. 8. Vashakidze E, Mikadze I. Epidemiology, clinical and laboratory features of Crimean-Congo hemorrhagic fever in Georgia. Georgian Med News 2015;(247):54-8. 9. Cevik MA, Erbay A, Bodur H, et al. Clinical and laboratory features of Crimean-Congo hemorrhagic fever: predictors of fatality. Int J Infect Dis 2008;12(4):374-9. 10. Karakecili F, Cikman A, Akin H, Gülhan B, Özçiçek A. A case of brucellosis and Crimean-Congo hemorrhagic fever coinfection in an endemic area. Mikrobiyol Bul 2016; 50(2):322-7.

The coronavirus disease-2019 (COVID-19) pandemic, which affects millions of people around the world, has been affecting our country since March 2020. The fact that the symptoms such as fever, myalgia, headache, joint pain which are common in COVID-19 patients are quite similar to the symptoms of diseases such as Crimean-Congo hemorrhagic fever (CCHF) and Brucellosis. This may cause a diagnostic confusion in regions where these diseases are seen as endemic. In this report, a patient hospitalized with a pre-diagnosis of COVID-19 and diagnosed with acute Brucellosis, CCHF and COVID-19 during followup was presented. A 31-year-old female patient living in a rural area admitted to the emergency service with complaints of fever, weakness, headache, and body/joint pain. Physical examination revealed a temperature of 38.3°C, a pulse rate of 102/minute, and a peripheral capillary oxygen saturation of 97% in room air. The system examination was normal. In the laboratory findings, an increase in liver enzymes and acute phase reactants was observed and the platelet count was at the lower limit of the normal range. In terms of COVID-19, no involvement compatible with COVID-19 was detected in the thorax computed tomography (CT) of the patient whose nasopharyngeal and oropharyngeal mixed swab samples were taken.The patient was transferred to our infectious diseases service with a pre-diagnosis of COVID-19 and CCHF. Serum samples were sent to the Public Health Agency Microbiology Reference Laboratory Department (PHA-MRLD) for CCHF diagnostic tests and supportive treatment was started. Brucella Rose Bengal and Coombs' immuncapture (1/1280 titer) tests were found as positive in the patient, who was examined for brucellosis because of living in a rural area and having a history of consuming fresh dairy products. In the tests performed at PHA-MRLD, CCHF-specific IgM positivity and the presence of viral RNA were detected. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction (RT-PCR) test was negative. For Brucellosis, doxycycline and rifampicin were added to the treatment of the patient whom was given supportive therapy for CCHF. In the followup, the patient's fever was persisting and loss of taste and smell complaint developed. In this context, COVID-19 test was repeated and resulted as positive. Upon this, hydroxychloroquine sulfate treatment was started due to the recommendation of the current Ministry of Health Scientific Committee Guide. No new infiltration was detected in the chest radiography of the patient. The patient's fever subsided during follow-up and laboratory findings improved. The treatment of brucellosis was completed to eight weeks at the outpatient clinic. No problems were detected in the follow-up. This report was prepared because of a case with simultaneous brucellosis, CCHF and COVID-19 infections which could not be encountered in the literature review. As a result; in regions such as our country where both brucellosis and CCHF are seen as endemic, it is very important to keep these diseases in mind in the differential diagnosis of COVID-19 infection.

Introduction: Brucellosis is a zoonotic infectious disease endemic in our country and affects all systems. We aimed to evaluate clinical, laboratory findings and treatment outcomes of uncomplicated brucellosis in our study. Materials and Methods: Patients with uncomplicated brucellosis and with no relapse were evaluated from four different cities. Demographic data, clinical, laboratory and radiological findings of follow-up and treatment of 101 patients were recorded in forms. Clinical response (healing, treatment failure, relapse, etc.), treatment side effects, compliance and treatment discontinuation were evaluated at one-year follow-up. Results: The most common risk factors for brucellosis were detected respectively as fresh cheese/dairy product consumption (82.2%), rural area life (71.3%), brucellosis in family and surroundings (42.6%), animal husbandry (27.7%), and brucellosis in animals (24.8%). 80.2% of the patients were evaluated as acute brucellosis. Clinically, fatigue, sweating, loss of appetite, fever, body aches, arthralgia; elevated erythrocyte sedimentation rate, elevated C-reactive protein, elevated liver function tests, anemia and thrombocytopenia were the most frequent findings in laboratory examinations, respectively. In patients with brucellosis, blood culture positivity was 68%, Rose Bengal slide agglutination test was 97.1%, and tube agglutinin test positivity was 96.8%. The most preferred treatment regimen (90%) was doxycycline and rifampicin for 45 days, and treatment response was 89%. In five of the patients, treatment was changed due to doxycycline-linked gastrointestinal side effects. Relapses were seen in 4.9% of all patients. Conclusion: In brucellosis, delay in diagnosis increases the incidence of complications and the tendency to become chronic. For this reason, brucellosis must be considered in patients referred to health institutions with complaints such as fever, sweating and joint pain. Since uncomplicated brucellosis was evaluated in this study, it was seen that the majority of the patients were acute onset and had a high response rate to treatment.

To evaluate the effects of SARS-CoV-2 infection on the optic nerve, macula, and retinal vascular structures.This study included 129 participants recovering from COVID-19 and 130 healthy control subjects aged 18 to 55 years. The study was designed as observational and cross-sectional and was conducted between June 2020 and February 2021. The average thicknesses of the retinal nerve fibre layer (RNFL), ganglion cell complex (GCC), and macula also were measured using a spectral domain optical coherence tomography analysis. The vessel densities of the superficial and deep capillary plexuses of the macula, foveal avascular zone, and radial peripapillary capillary plexus of the optic disc were quantified by optical coherence tomography angiography.In all quadrants, the RNFL and GCC were thinner in patients with neurologic symptoms of COVID-19 (p0.05). None of the measurements of the Early Treatment Diabetic Retinopathy Study regions significantly differed between patients with and without COVID-19 symptoms (p0.05). The foveal avascular zone area, perimeter, circularity index, and vessel densities (%) of the global and inner and outer circles of superficial capillary plexuses and deep capillary plexus and global and superior and inferior halves of the radial peripapillary capillary plexus measurements were found to significantly differ between the symptomatic COVID-19 group and the asymptomatic COVID-19 and control groups (p0.05).RNFL and GCC thickness evaluation with optical coherence tomography and vessel density evaluation with optical coherence tomography angiography can be considered remarkable diagnostic methods for retinal neurovascular abnormalities and a biomarker for microvascular abnormalities after infection with SARS-CoV-2.

We aimed to decide which scoring system is the best for the evaluation of the course of Crimean-Congo Hemorrhagic Fever (CCHF) by comparing scoring systems such as qSOFA (quick Sequential Organ Failure Assessment), SOFA (Sequential Organ Failure Assessment), APACHE II (Acute Physiology and Chronic Health Evaluation II) and SGS (Severity Grading System) in centers where patients with CCHF were monitored. The study was conducted with patients diagnosed with CCHF in five different centers where the disease was encountered most commonly. Patients having proven PCR and/or IgM positivity for CCHF were included in the study. The scores of the scoring systems on admission, at the 72(nd) hour and at the 120(th) hour were calculated and evaluated. The data of 388 patients were obtained from five centers and evaluated. SGS, SOFA and APACHE II were the best scoring systems in predicting mortality on admission. All scoring systems were significant in predicting mortality at the 72(nd) and 120(th) hours. On admission, there was a correlation between the qSOFA, SOFA and APACHE II scores and the SGS scores in the group of survivors. All scoring systems had a positive correlation in the same direction. The correlation coefficients were strong for qSOFA and SOFA, but poor for APACHE II. A one-unit rise in SGS increased the probability of death by 12.818 times. qSOFA did not provide significant results in predicting mortality on admission. SGS, SOFA and APACHE II performed best at admission and at the 72(nd) and 120(th) hours.

Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus (HIV)-infected patients. Diagnosis and treatment of latent tuberculosis infection (LTBI) is the most important step in preventing the development of active TB. In our country where TB is moderately endemic, HIV-infected patients should be investigated for LTBI. Tuberculin skin test (TST) and interferongamma release assays (IGRA) are used in the diagnosis of LTBI but there isn't a standard practice. The aim of this study is to compare the TST and T-SPOT.TB test efficiency in the diagnosis of LTBI in HIVinfected patients. Patients who had no previous active TB infection, who were not treated for LTBI and who had no active tuberculosis infection at the time of admission were included in the study. A total of 100 HIV-infected patients who were admitted to the Infectious Diseases and Clinical Microbiology outpatient clinic between June 2015 and March 2016 were evaluated cross-sectionally. CD4+ T lymphocyte counts in the last one month were detected. All patients underwent chest radiography at the time of admission. Patients who are not considered as active TB infection with clinical and laboratory findings and who had no TST within the last one month were included in the study. TST was performed after the blood samples were taken for T-SPOT.TB test. In our study, 87% of the patients were male and the mean age was 40.2. The mean CD4+ T lymphocyte count was 605 cells/mm³ (26-1313). 16% of the patients had a history of encountring a person with tuberculosis and 81% had BCG vaccination scar. TST positivity and T-SPOT.TB positivity were 22.9% and 22%, respectively. The concordance between the two tests was found to be moderate (Kappa= 0.491). It was determined that BCG vaccination and the presence of a contact with a patient with TB did not affect TST and T-SPOT.TB test positivity (p> 0.05). There was a positive correlation between CD4+ T lymphocyte count and TST measurement values (r= 0.3, p= 0.003). Accordingly, as the number of CD4+ T lymphocytes increased, TST positivity increased (p= 0.007). T-SPOT.TB test was not affected by CD4+ T lymphocyte count (p= 0.289). Our study showed that TST was affected by CD4+ T lymphocyte count and patients' compliance with this test was also low. On the contrary T-SPOT.TB test was not affected by CD4+ T lymphocyte count. There was no statistically significant difference between T-SPOT.TB test positivity and CD4+ T lymphocyte count (p= 0.289). The concordance between the two tests was found to be moderate. It is thought that the main reason for the discordance between the tests is due to false negative or false positive results of TST. In conclusion, T-SPOT.TB was found more reliable in the diagnosis of LTBI in HIV-infected individuals. In the light of these findings, especially in HIV-infected patients with low CD4+ T lymphocyte counts, T-SPOT.TB test can be considered for LTBI diagnosis.

Amaç: Asimetrik dimetilarginin (ADMA), nitrik oksit sentazın (NOS) ana endojen inhibitörüdür. NOS, konak savunmasında ve vasküler yapının sürdürülmesinde önemli rol oynamaktadır. Yüksek ADMA düzeylerinin endoteldis fonksiyonu ile ilişkili olduğu ve çeşitli hastalıklarda rol aldığı gösterilmiştir. Brucellaspp.’nin neden olduğu zoonoz bir hastalık olan bruselloz, vaskülopati olarak kendini gösterebilmektedir. Ancak, bruselloz ile ADMA arasındaki ilişki ile ilgili yeterli veri bulunmamaktadır. Çalışmamızın amacı bruselloz hastalarında ve kontrol grubunda ADMA düzeyinin araştırılmasıdır.Yöntemler: Çalışmamıza 40 akut bruselloz hastası ve 40 sağlıklı gönüllü alındı. Bruselloz hastalarında ve sağlıklı gönüllülerde serum ADMA düzeyleri İnsan ADMA ELISA kiti ile üretici firma önerileri doğrultusunda araştırıldı. Katılımcıların fiziki muayeneleri yapılarak, cinsiyet, yaş ve ikamet adreslerini içeren demografik karakteristikleri ve laboratuvar test sonuçları kayıt altına alındı. Verilerin değerlendirilmesinde IBM SPSS 20 istatistik paket programı kullanıldı. İstatistiksel anlamlılık düzeyi (p

KARA, Murat/0000-0002-4144-2409; aydin, merve/0000-0002-1522-6083 WOS: 000473414800014 PubMed: 30745200 Background: mecA is a predefined gene causing methicillin resistance in Staphylococcus aureus (S. aureus) isolates; however, it has been shown that some methicillin-resistant S. aureus (MRSA) strains do not carry this gene. Recently, in isolates found to be MRSA-positive but mecA-negative, a new resistance gene called mecC, which is a homolog of mecA, has been reported. This study aimed to investigate the mecC and mecA genes in MRSA strains isolated from different geographic regions in Turkey. Methods: the sample of the study consisted of 494 MRSA strains isolated from seven geographical regions in Turkey between 2013 and 2016. the strains were obtained from 17 centers, comprising 13 university hospitals, three education and research hospitals, and one state hospital. Methicillin resistance in S. aureus strains was determined using the agar disk diffusion method with a cefoxitin disk and the agar dilution method with oxacillin. the mecC and mecA genes in MRSA strains was investigated by Polymerase Chain Reaction (PCR). Results: of the MRSA strains investigated, 47.9% were isolated from intensive care units. Concerning sample type, 36.7% were detected in the respiratory tract (tracheal aspirate, sputum, etc.), 24.8% in blood, 18.7% in skin and soft tissues, 9.3% in nasal swabs, 5.4% in urine, 4.1% in ears, and 1% in sterile body fluid. Using PCR, mecC was not identified in any of the S. aureus strains isolated from different clinical microbiology laboratories. mecA gene positivity was found in 315 of the MRSA strains (63.8%). Staphylococcal Cassette Chromosome mec ( SCCmec) type was identified in 232 strains (46.9%), of which 136 (58.7%) were type II, 75 (32.4%) were type IV, 12 (5.1%) were type Mb, six (2.5%) were type I, and three (1.3%) were type III. Conclusion: This is the first multi-centered study to investigate MRSA strains isolated from different regions in Turkey. the mecC gene was not detected in any of the MRSA strains. We believe that this study will constitute an important basis for monitoring possible future changes. (C) 2019 the Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. Scientific Research and Project Unit of Erzincan Binali Yildirim University [SAG-A-240215-0121] This study was financially supported by the Scientific Research and Project Unit of Erzincan Binali Yildirim University (Project No: SAG-A-240215-0121). This research was presented as a poster in the 4th National Clinical Microbiology Congress in Antalya, Turkey, 2017.

Objective: To assess viral and atypical bacterial agents using polymerase chain reaction in patients presenting with signs of acute respiratory tract infection (RTI) to Erzincan Mengucek Gazi Education and Research Hospital, Turkey. Methods: Viral and atypical bacterial agents were explored in patients presenting with RTI between February 1 and June 1, 2017. Genomic isolation was performed using a SolMag®12 fully-automated nucleic acid isolation system and SolMag® Virus Nucleic Acid Isolation Kit. Amplifications were performed using a SmartCycler-II thermocycler (Cepheid) device in accordance with the instructions provided by the manufacturer. Results: Of the 120 patients, 44 (36.6%) were found to have at least one agent. Polymerase chain reaction detected influenza viruses in 28 patients, respiratory syncytial virus in seven, cytomegalovirus (CMV) in six, Herpes simplex virus 1 (HSV1) in two, Chlamydophila pneumonia in two, Human Herpesvirus 6 in one, and Herpes simplex virus 2 in one. Also, coexistent HSV1 and CMV positivity was found in two cases. One patient had positivity in both influenza A and CMV. Among atypical bacterial agents, only two patients were found to have Chlamydophila pneumonia. There was at least one comorbid condition in 48 patients (40%). Of these subjects in whom an agent could be identified, 21 were found to have co-morbidity, while 23 were free of comorbid conditions. Antibiotherapy had been started in 109 (90.8%) of the patients after initial assessment. Sixty-four patients were admitted, and two patients died. Conclusion: Polymerase chain reaction allowed rapid detection of agents responsible for acute RTIs. We believe that this technique may contribute to appropriate use of antibiotics in patients diagnosed with atypical bacterial infection and may prevent unnecessary antibiotherapy in infections caused by viral agents.

Purpose This paper aims to determine the knowledge and attitudes of the physicians regarding human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), to emphasize that these patients exist and they will exist in the future and to raise awareness so as to prevent that their rights to treatment are revoked. Design/methodology/approach The survey was conducted via a link sent through an online system. Random physicians from 81 cities of the country were invited to the survey. The survey has 41 questions regarding knowledge and attitudes in total, including epidemiological information such as age, gender and title. Findings A total of 3,107 physicians has voluntarily participated in the study. In total, 2,195 (70.7%) are internal physicians and 912 (29.3%) are surgical physicians among the participant physicians. In total, 1,452 (46.7%) of the participants are specialist physicians, 608 (19.6%) of the participants are practising physician and the rest of it is physician assistants, academicians and dentists, respectively. Originality/value In this study, it has been found out that the physicians have a lack of knowledge on HIV/AIDS and they adopt a discriminatory attitude towards HIV-positive persons. HIV-positive patients who are exposed to discrimination and scared of being uncovered refrain from applying to hospitals for treatment, which puts public health into jeopardy due to the high viral load and these patients are faced with difficulties in coping with both medical and emotional load of the disease.

WOS:000648816400007 PMID: 33960939 Background: In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic hepatitis C in real-world clinical practice. Methods: Data from patients with chronic hepatitis C treated with SOF/LDV +/- RBV or SOF/RBV in 31 centers across Turkey between April 1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and virological outcomes were analyzed. Results: A total of 552 patients were included in the study. The mean age of the patients was 51.28 +/- 14.2, and 293 (55.8%) were female. The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at baseline in 381 patients (72.6%). SOF/LDV +/- RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes. All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect. Conclusion: The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV +/- RBV treatment in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%. WOS:000617831800002 2-s2.0-85101454721 PubMed: 33586014

Background: The hepatitis B virus (HBV) is one of the major causes of chronic liver disease. From the perspective of hospital workers (HWs), employees are at risk of hepatitis B infection because of occupational exposure. Apart from this occupational risk, health professionals may still be affected by HBV, depending on the epidemiological characteristics of the country and geographical region they live in. Objectives: This study aimed to determine HBV, HCV, and HIV seroprevalence among HWs using data obtained from 21 hospitals located in six geographical regions in Turkey and the Turkish Republic of Northern Cyprus. Methods: The study was designed as a retrospective, multicentre, descriptive study. Twenty hospitals from Turkey and one hospital from the Turkish Republic of Northern Cyprus were involved in the study. The variables of the study were vaccination status against HBV and hepatitis A and HBsAg, anti-HBs, anti-HBcIgG, anti-HAVIgG, anti-HCV, anti-HDV, and anti-HIV serology results belonging to the previous year. Results: Women constituted 58.9% (n = 5,622) of the HWs included in the study. The mean age was 36.3 +/- 9.09 years (min =18, max = 72). In terms of occupation, 42.5% (n = 4, 064) were nurses/health officers, and 24.8% (n = 2365) were physicians. HBsAg seroprevalence was found to be 1.8% (n =169; 95% CI = 1.5% - 2.0%), while anti-HBs seropositivity was 75.7% (n = 7,234). About 7.3% (n = 701) had natural immunity to hepatitis B. About 21.6% (n = 2,066) of the HWs did not receive hepatitis B vaccine. Conclusions: This study is the first study involving a large sample size from different locations of Turkey. According to the results, hepatitis B and hepatitis A vaccines should be administered to susceptible individuals and HWs. WOS:000534475500002 2-s2.0-85085751514

Background High asymmetrical dimethylarginine (ADMA) levels have been associated with endothelial dysfunction and contribute to the development of several diseases. However, data on the relationship between hepatitis B virus (HBV) and ADMA are limited. The aim of our study was to explore the relationship between ADMA and HBV by comparing the ADMA levels in patients with chronic active hepatitis B (CHB), inactive HBV carriers (carriers), and healthy volunteers (controls). Methods The participants were divided into three groups: 90 patients with CHB, 90 HBV carriers, and 90 controls. Serum ADMA levels were quantified using an ELISA kit (Cusabio, Wuhan, China). The data were analyzed using an ANOVA or the Kruskal-Wallis test as appropriate, with P

Toka, Onur/0000-0002-4025-4537; Yoruk, Gulsen/0000-0002-0357-5884; Cinar, Gule/0000-0002-7635-8848; Hakyemez, Ismail Necati/0000-0001-6133-9604; Tulek, Necla/0000-0002-3952-4982 WOS:000511173500009 Objective: Both chronic hepatitis B (CHB) and hepatosteatosis may lead to necroinflammation in liver. Therefore, the presence of hepatosteatosis might negatively affect the efficacy of antiviral therapy. We aimed to determine the effect of hepatosteatosis on virological response in patients with CHB receiving entecavir (ETV) and tenofovir (TDF) treatment. Methods: The study was designed retrospectively. All patients receiving antiviral therapy due to CHB in the departments of Infectious Diseases and Clinical Microbiology of 29 different hospitals between January 2012 and June 2017 were searched by examining medical records. Results: A total of 1069 patients were included. Six hundred and fifty of the patients had been receiving TDF and 419 of them had been receiving ETV. The rate of virological response obtained at the 48'h week of TDF was higher in patients with steatosis (p=0.029). Virological response at the 24th week and 48th week of ETV were higher in the patients without steatosis (p=0.001). TDF and ETV therapies were compared in the patients with hepatosteatosis and it was found that the virological response at 48th week was higher in the TDF group. Conclusion: Although steatosis has an effect on virological response in the short-term results of nucleos(t)ide therapy, it does not have any effect on virological response in the long-term results.

Aim: Determining Entamoeba histolyticaseroprevalence in patients with abdominal pain having no diarrhea who appliedto internal medicine policlinics was aimed in this study. Material and Method: In the study, 472 patients who applied to internalmedicine policlinics between November 2013-December 2016 with the complaint ofabdominal paint without having any diseases such as diarrhea, as the leading,acute abdominal pain, dyspepsia, cholecystopathy, acute coronary syndrome,inflammatory bowel disease, malignity, urinary tract infection, and genital andgynecological infection and 218 healthy volunteer individuals for creating thecontrol group were included recording their age and gender properties. For thestool of the patients, ELISA kit including monoclonal antibodies againstadhesin antigen specific to Entamoebahistolytica was used. Results: Number of Entamoebahistolytica positive individuals was determined as 23 (4.9%) in patientgroup, and as 3 (1.4%) in the control group, and the value was found to bestatistically significant (P=0.024). no significant difference was determinedbetween gender and ages of the individuals in statistical comparison performedbetween the groups (P>0.05). Conclusion: Obtained results indicated that Entamoeba histolytica was possible to be present in patients appliedwith the complaint of abdominal pain even without diarrhea. According to thefindings we obtained, it was possible to assume that Entamoeba histolytica could cause abdominal pain during the periodwhen it was considered to be asymptomatic. Furthermore, abdominal pain syndromecould be started to be treated diagnosing of Entamoeba histolytica early, and so that this possibilities forpreventing the chronic diseases this protozoon is possible to cause in along-term period could be provided., Amaç:Buçalışmada ishali olmadan, karın ağrısı ile iç hastalıkları polikliniğinebaşvuran hastalarda Entamoeba histolytica’nınseroprevelansının belirlemesi amaçlandı.Gereçve Yöntem: Kasım 2013 - Aralık 2016 tarihleri arasında baştaishal olmak üzere, akut karın, dispepsi, kolesistopati, akut koroner sendrom,inflamatuvar barsak hastalığı, malignite, idrar yolu enfeksiyonu, genital vejinekolojik enfeksiyon gibi, herhangi bir rahatsızlığı olmayıp, karın ağrısışikayeti ile iç hastalıkları polikliniğine başvuran 472 hasta birey ile kontrolgrubu oluşturmak için 218 sağlıklı gönüllü birey, yaş ve cinsiyet özelliklerikaydedilerek çalışmaya alındı. Hastaların dışkılarında Entamoeba histolytica’ya spesifik adezin antijenine karşımonoklonal antikorların bulunduğu ELISA kiti kullanıldı. Bulgular:Entamoeba histolytica pozitif kişisayısı hasta grubunda 23 (%4.9) iken, kontrol grubunda ise 3 (%1.4) olaraksaptandı ve istatistiksel olarak anlamlı bulundu (p=0.024). Gruplar arasıyapılan istatistiksel karşılaştırmada bireylerin cinsiyet ve yaşları arasındaanlamlı fark saptanmadı (p>0.05). Sonuç:Eldeedilen sonuçlar, karın ağrısı ile başvuran hastalarda ishal olmadan da Entamoeba histolytica bulunabileceğinigöstermektedir. Elde ettiğimiz bulgulara göre Entamoeba histolytica’nın asemptomatik olduğu varsayılandönemlerde karın ağrısına neden olabileceği varsayılabilir. Ayrıca karın ağrısı semptomu, Entamoebahistolytica’nın erken teşhis edilerek tedavi sürecinin başlatılmasınave böylece bu protozoonun uzun dönemde sebep olabileceği kronikhastalıkların önlenmesine olanak sağlayabilir.

Background & objectives : Crimean-Congo hemorrhagic fever (CCHF), an illness characterized by fever and hemorrhage, is caused by a CCHF virus (CCHFV). It is an important public health problem in Turkey. The objective of this study was to evaluate the demographic, clinical, and laboratory characteristics and mortality rates of CCHF patients in the northeast region of Turkey. Methods : A total of 206 patients, diagnosed with CCHF, from northeast region of Turkey were included and evaluated between 2011 and 2017. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) and immunofluorescence (IFA) methods were used for the diagnoses. Results : Of the patients included in the study, 77.2% were farmers/livestockers, while 22.8% had other occupations. The incidence of tick bite or tick contact with bare hands was 52.9%. About 94.2% of the patients were living in rural areas and 5.8% in city centers. However, all the patients living in city centers had a history of visit to rural areas. The disease was more common in May, June, and July months. The most common symptoms at the time of admission included fatigue, fever, and widespread body pain, while laboratory findings were thrombocytopenia, leukopenia, and anemia. Bleeding, tachycardia, and rash were the most common findings on physical examination. Of all the patients, 95.6% were identified by RT-PCR and 4.4% by IFA methods. Severe cases constituted 22.3% (46) of the included patients. Throughout the course of this study, 7 (3.4%) patients died, and the remaining 96.6% (199) patients were discharged with a full recovery. Disease severity was significantly correlated with mortality rate and duration of hospitalization (p

Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus (HIV)-infected patients. Diagnosis and treatment of latent tuberculosis infection (LTBI) is the most important step in preventing the development of active TB. In our country where TB is moderately endemic, HIV-infected patients should be investigated for LTBI. Tuberculin skin test (TST) and interferongamma release assays (IGRA) are used in the diagnosis of LTBI but there isn't a standard practice. The aim of this study is to compare the TST and T-SPOT.TB test efficiency in the diagnosis of LTBI in HIVinfected patients. Patients who had no previous active TB infection, who were not treated for LTBI and who had no active tuberculosis infection at the time of admission were included in the study. A total of 100 HIV-infected patients who were admitted to the Infectious Diseases and Clinical Microbiology outpatient clinic between June 2015 and March 2016 were evaluated cross-sectionally. CD4+ T lymphocyte counts in the last one month were detected. All patients underwent chest radiography at the time of admission. Patients who are not considered as active TB infection with clinical and laboratory findings and who had no TST within the last one month were included in the study. TST was performed after the blood samples were taken for T-SPOT.TB test. In our study, 87% of the patients were male and the mean age was 40.2. The mean CD4+ T lymphocyte count was 605 cells/mm³ (26-1313). 16% of the patients had a history of encountring a person with tuberculosis and 81% had BCG vaccination scar. TST positivity and T-SPOT.TB positivity were 22.9% and 22%, respectively. The concordance between the two tests was found to be moderate (Kappa= 0.491). It was determined that BCG vaccination and the presence of a contact with a patient with TB did not affect TST and T-SPOT.TB test positivity (p0.05). There was a positive correlation between CD4+ T lymphocyte count and TST measurement values (r= 0.3, p= 0.003). Accordingly, as the number of CD4+ T lymphocytes increased, TST positivity increased (p= 0.007). T-SPOT.TB test was not affected by CD4+ T lymphocyte count (p= 0.289). Our study showed that TST was affected by CD4+ T lymphocyte count and patients' compliance with this test was also low. On the contrary T-SPOT.TB test was not affected by CD4+ T lymphocyte count. There was no statistically significant difference between T-SPOT.TB test positivity and CD4+ T lymphocyte count (p= 0.289). The concordance between the two tests was found to be moderate. It is thought that the main reason for the discordance between the tests is due to false negative or false positive results of TST. In conclusion, T-SPOT.TB was found more reliable in the diagnosis of LTBI in HIV-infected individuals. In the light of these findings, especially in HIV-infected patients with low CD4+ T lymphocyte counts, T-SPOT.TB test can be considered for LTBI diagnosis.

Background: We aimed to determine the geographical features and seroprevalence of Borrelia burgdorferi in Erzincan, Turkey, which has a high tick population due to its geographical position and climatic conditions. Methods: From January to December 2014, 368 people living in Erzincan, northeastern Turkey were enrolled. B. burgdorferi IgG antibodies were investigated in the collected serum samples using the ELISA method in 2015. Positive and borderline results were confirmed using the Western Blot (WB) method. Results: Borrelia burgdorferi IgG positivity was found to be 4.1% by ELISA and 2.17% by WB. Of the seropositive people according to WB, 25% resided in areas within 2000m of rivers, 50% in areas with a slope of 0–5°, and 62.5% in areas with an altitude of lower than 1500 meters. Conclusion: The seroprevalence of Lyme borreliosis was high in Erzincan, particularly among people engaged in animal husbandry in rural areas. In addition, the seroprevalence of Borrelia varied according to geographical features, increasing in areas with a lower slope and altitude.

WOS: 000388326300001, PubMed: 27401586, Background: Drug resistance development is an expected problem during treatment with protease inhibitors (PIs), this is largely due to the fact that Pls are low-genetic barrier drugs. Resistance-associated variants (RAVs) however may also occur naturally, and prior to treatment with Pls, the clinical impact of this basal resistance remains unknown. In Turkey, there is yet to be an investigation into the hepatitis C (HCV) drug associated resistance to oral antivirals. Materials and methods: 178 antiviral-naive patients infected with HCV genotype 1 were selected from 27 clinical centers of various geographical regions in Turkey and included in the current study. The basal NS3 Pls resistance mutations of these patients were analyzed. Results: In 33 (18.5%) of the patients included in the study, at least one mutation pattern that can cause drug resistance was identified. The most frequently detected mutation pattern was T54S while R109K was the second most frequently detected. Following a more general examination of the patients studied, telaprevir (TVR) resistance in 27 patients (15.2%), boceprevir (BOC) resistance in 26 (14.6%) patients, simeprevir (SMV) resistance in 11 (6.2%) patients and faldaprevir resistance in 13 (7.3%) patients were detected. Our investigation also revealed that rebound developed in the presence of a Q80K mutation and amongst two V55A mutations following treatment with TVR, while no response to treatment was detected in a patient with a R55K mutation. Conclusion: We are of the opinion that drug resistance analyses can be beneficial and necessary in revealing which variants are responsible for pre-treatment natural resistance and which mutations are responsible for the viral breakthrough that may develop during the treatment. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases., Department of Scientific Research Project of Kocaeli University; Turkish Society of Clinic Microbiology and Infectious Diseases, This study was funded by Department of Scientific Research Project of Kocaeli University and Turkish Society of Clinic Microbiology and Infectious Diseases.

Amaç: Mevsimsel influenza epidemileri, dünya çapında önemli morbidite ve mortalite nedenidir. Çalışmamızda Türkiye’nin Erzincan ilinde mevsimsel influenza virüslerinin dağılımı ile influenza B salgınının klinik ve demografik özelliklerinin araştırılması amaçlanmıştır.Yöntemler: 2017 bahar döneminde Dünya Sağlık Örgütü ve Sağlık Bakanlığı’nın önerileri doğrultusunda influenza vaka yönetim şemasına uygun olarak, hastanemize başvuran 103 hasta çalışmaya dahil edildi. Özel eküvyon çubukları yardımıyla nazofarengeal sürüntü örnekleri alındı. Influenza A / Influenza B virüslerini tespit etmek için mikroişlemci kontrollü I-CORE® (Akıllı Soğutma / Isıtma Optik Reaksiyonu) modülünü temel alan entegre bir RNA çoğaltma ve algılama cihazı olan Cepheid SmartCycler Sistemi kullanıldı.Bulgular: İnfluenza ön tanısı ile başvuran tüm hastaların 28 (%27,1)’i influenza pozitif bulunurken, 23 (%22.3)’ü Influenza B, 5 (% 4,9)’i Influenza A saptandı. Influenza B pozitif saptanan hastaların 18 (%78)’i bir veya daha fazla kronik hastalığa sahip olduğu saptandı. Hastaların 15 (%65)’i kronik akciğer hastalıklarından birine, 8 (%35)’i kronik kalp hastalıklarından birine, 3 (%13)’ü diabetes mellitus tanısı alan kişilerdi. Influenza B pozitif hastalarında en sık karşılaştığımız semptomlar; myalji, öksürük, ateş ve nefes darlığıydı. Lökopeni ve trombositopeni, lökositozdan daha sık saptandı. Hastaların 7’si yatırılarak takip edildi. Takip edilen dönemde hastaların 3’ü yoğun bakım servisine alındı, bu hastaların 2’si öldü. Diğer hastalar ise şifa ile taburcu edildi.Sonuç: İnfluenza B'nin beklediğimizden daha ciddi seyrettiğini gözlemledik. Bu nedenle, İnfluenza B'ye karşı topluluğun bağışıklık düzeyinin, farklı tipte İnfluenza B alt tiplerini içeren aşılama kampanyalarıyla artırılması gerektiğini düşünüyoruz., Aim: Seasonal epidemics of influenza are responsible for significant morbidity and mortality worldwide. We aimed to investigate distribution of seasonal influenza viruses, and clinical and demographic characteristics of influenza B epidemics in Erzincan province of Turkey. Methods: A total of 103 patients who presented to our hospital in spring the season in accordance with influenza case management schema in line with the recommendations by the World Health Organization and Ministry of Health were included in this study. Cepheid SmartCycler system, which is an integrated RNA replication and detection device based on microprocessor controlled I-CORE® (Intelligent Cooling / Heating Optical Reaction) module was used in order to detect Influenza A / Influenza B viruses. Results: Influenza was positive in 28 (27.1%) of all patients who presented with suspected Influenza, with 23 (22.3%) being Influenza B and 5 (4.9%) Influenza A. Of patients with positive Influenza B, 18 (78%) had one or more chronic diseases. Of the patients, 15 (65%) were diagnosed with one of the chronic pulmonary disease, 8 (35%) one of the chronic cardiac diseases, and 3 (13%) diabetes mellitus. Leukopenia and thrombocytopenia were more common than leucocytosis. Seven patients were followed-up as inpatients. At the follow-up period, three of the patients were taken to the intensive care unit and 2 of them died. Whereas the remaining patients were discharged with recovery.Conclusion: We observed that, Influenza B progressed more seriously than we expected. For this reason, we think that immunity level of the community against Influenza B should be raised with vaccination campaigns involving different subtypes of Influenza B.

Tularemia is a zoonotic disease caused by the gram-negative bacterium Francisella tularensis. Clinical suspicion is extremely important and serology is the gold standard for diagnosis. The oropharyngeal form of tularemia in Turkey takes the form of outbreaks or sporadic cases. Delay in diagnosis is the major factor in complications. Five delayed cases of tularemia in the Marmara region of Turkey are described in this paper between 2009-2015 years. All patients’ diagnoses were confirmed with serology, and all had LAP on their neck regions. The lymphadenopathies persisted despite medical treatment four being excised by Ear Nose and Throat Clinic (ENT). Tularemia must be considered in the evaluation of masses on the neck, particularly in endemic areas. The most important factor in the successful management of tularemia is early initiation of treatment. The risk of suppuration and surgical interventions increases in delayed cases.

Brucellosis is a common zoonotic infection caused by Brucella bacteria. Brucella infections are usually presented with various clinical manifestations, and often accompanied by multiple organ involvements. In this article, we present a case of brucellosis with suppurative parotitis involvement accompanied by parotid abscess and fistula in a 60-year-old male patient. According to the literature review we conducted regarding complications of brucellosis, our case is the first case reported in the literature. Significant improvement in patient's suppurative parotitis and clinical findings was observed at the fifth week of combination antibiotic therapy. Patient's complaints resolved completely after eight weeks of treatment.