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After the declaration Global Health Sector Strategy on Viral Hepatitis by the World Health Organization in 2016, the Turkish Government defined a national strategy covering 2018-2023 to reach goals by 2030. Following a participatory decision process and a series of workshops, the strategy was built on eight separate subheadings. Apart from the official Prevention and Control Program, two separate road maps for hepatitis B and C were developed to obtain targets accessible with the cooperation of the Viral Hepatitis Society and the Turkish Association for the Study of the Liver in 2018 and 2020, respectively. Up to 2023, achievements and the current situation of the National Viral Hepatitis Prevention and Control Program and the hepatitis B virus and hepatitis C virus road maps were assessed in detail on June 28th, 2022, by the subject matter experts in Turkey. Besides the officially reported achievement rate (42\%) of the Program in 2021, participants mentioned undesirable effects of the coronavirus disease-2019 pandemic, unregulated migration, low levels of professional and public awareness, and barriers to access to anti-viral treatment. Recommendations focused on increasing the efficiency of screening and surveillance by integrating the viral carrier identity of individuals into the national health information system, simplifying the drug supplement and treatment initiation process and insisting on education to raise awareness.

Introduction: During the 2019 novel coronavirus (COVID-19) pandemic period, all cases admitted to the emergency services have been evaluated primarily for COVID-19, and therefore other infectious diseases, especially Crimean Congo Hemorrhagic Fever (CCHF), which are endemic in our region, can be overlooked. In this study, it was aimed to determine the diagnostic power of the Hitit Index, which we developed from a panel consisting of clinical and laboratory findings of the cases with and without CCHF in previous years, to distinguish CCHF cases from COVID-19 cases. Materials and Methods: The study groups consisted of the COVID-19 cases (n= 116) admitted to the emergency service and the CCHF patients (n= 110) who were followed up in the Infectious Diseases and Clinical Microbiology Clinic of the same hospital between 2015-2020. Results: Hitit Index was found to be statistically significantly higher in patients with CCHF. For Hitit Index, sensitivity and specificity were 88% and 99%, while negative predictive value (NPV) and positive predictive value (PPV) were 90% and 99%, respectively. Conclusion: The Hitit Index is an example of artificial intelligence that we can use to distinguish patients with CCHF from patients with COVID-19.

Scabies is an itchy cutaneous parasitosis caused by Sarcoptes scabiei. Leukocytoclastic vasculitis (LCV) is a common vasculitis in adults and is often idiopathic but may develop due to infection, autoimmune diseases, malignancy, or drugs. Few cases of scabies-related LCV have been reported in the literature. We present a case of LCV, which we thought to be related to scabies, in light of the literature review. A 62-year-old male patient presented with complaints of cough, sputum, fever, and itchy rash on his legs for one and a half months. Treatment targeting pneumonia was initiated. He was diagnosed as scabies with pruritic maculopapular and purpuric eruption. We learned that itchy skin lesions were present in the spouse, as well. Topical permethrin treatment was initiated on both the patient and the spouse. Skin biopsy of the vasculitic lesions was reported as leukocytoclastic vasculitis pathologically. Mass malignancy, autoimmune diseases, infectious causes were excluded. Vasculitic lesions regressed with topical treatment. Improvement of the vasculitic lesions with topical permethrin treatment, exclusion of other causes, and presence of similar complaints in the patients’ spouse have led us to the diagnosis of scabies and LCV secondary to scabies. LCV due to scabies, which is a rarely seen condition especially in itchy lesions, is a challenging diagnosis. A detailed anamnesis would facilitate diagnosing such cases.

Subskapular apse literatürde az sayıda olgu olması ve erken dönemde tanı konulup acil cerrahi müdahale gerektirmesi nedeniyle nadir ama ciddi klinik bir durumdur. Bu yazıda travma ya da cerrahi girişim olmaksızın metisiline dirençli Staphylococcus aureus septisemisine neden olan, erken dönemde tanısı konulan ve tedavi edilen spontan subskapular apse olgusu sunulmuştur Subscapular abscess is a rare but serious clinical condition due to the small number of cases in the literature requiring early diagnosis and urgent surgical intervention. We aimed to present a case of spontaneous subscapular abscess causing methicillin-resistant Staphylococcus aureus septicemia, which was diagnosed and treated early, without trauma or surgical intervention. WOS:000523303400015

Subscapular abscess is a rare but serious clinical condition due to the small number of cases in the literature requiring early diagnosis and urgent surgical intervention. We aimed to present a case of spontaneous subscapular abscess causing methicillin-resistant Staphylococcus aureus septicemia, which was diagnosed and treated early, without trauma or surgical intervention.

Introduction: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus (HCV) in the world. Aims: The aim of this study was to compare direct acting antivirals (DAAs) treatment of HCV for PWID and non-PWID in real life setting. Materials and methods: We performed a prospective, non-randomized, observational multi-center cohort study in 37 centers. All patients treated with DAAs therapy between April 1, 2017 to February 28, 2019 were included. In total, 2,713 patients were included in the study among which 250 were PWID and 2,463 were non-PWID. Besides patient characteristics, treatment response, follow-up and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: DAAs were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis.

Purpose: To investigate the frequency of MBLs in Pseudomonas and Acinetobacter species with E-test, to determine the risk factors and to evaluate the demographic and clinical features of infected patients. Materials and methods: Imipenem or meropenem resistance of Pseudomonas and Acinetobacter isolated from several clinical samples with conventional methods were evaluated with imipenem EDTA E-test and the presence of Metallo-β-lactameses MBL was examined. Several isolates were screened for VIM-1, VIM-2, IMP-1, and IMP-2 with a PCR test. Results: Of 46 carbapenem resistant Acinetobacter isolates, 41 (89%), as well as of 19 carbapenem resistant Pseudomonas isolates, 5 (26%) had MBL positivity with imipenem-EDTA E-test. A history of Intensive Care Unit stay, mechanical ventilation and cephalosporin use were found to be significant risk factors with respect to MBL production. Conclusion: Detection of MBL production in Acinetobacter and Pseudomonas species especially in ICU patients is of prime importance to control infection rapidly and effectively, which contribute to prevention of outbreaks.

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.

Early diagnosis in COVID-19 is essential in terms of treatment and prevention of contagiousness. In this study, we aimed to find an alternative diagnosis method by using fewer laboratory parameters in the early diagnosis of COVID-19 disease by creating a fast, easily accessible, cost-effective index and has a diagnostic accuracy rate of over 90%. All patients over the age of 18 who applied to Hitit University Erol Olçok Training and Research Hospital Emergency COVID Outpatient Clinic with a pre-diagnosis of COVID-19 between March and April 2020 were evaluated retrospectively. Patients were divided into two groups as COVID-19 positive and COVID-19 negative. It was aimed to create a HITIT-19 index by evaluating the cases according to the clinical and laboratory results. Between March and April 2020 (in the first peak of the pandemic), 1586 patients were applied to the Emergency COVID-19 outpatient clinic with a pre-diagnosis of COVID-19. According to COVID-19 RT-PCR, card test, and CT involvement, 285 (13%) patients were diagnosed with COVID-19. PCR was positive in 285 (18%) of 1586 patients, and PCR was negative in 1301 (82%). While 153 (53.7%) of the patients diagnosed with COVID-19 were male and the median age was 45 (28-62.75), 883 (55.7%) of the patients not diagnosed with COVID-19 were male, and the median age was 43 (31-65). Hypertension (HT) was the most common underlying disease in 10.5% of patients applied to the emergency room with a diagnosis of COVID-19, while 38.9% dyspnea and 35.1% fever were the most common symptoms. While 76% of Plaquenil and 58% azithromycin were the most frequently started treatments, 31.4% (28.4% of them were hospitalized in the service, 3% in the intensive care unit) of them hospitalized. It was to create a HITIT-19 index that is fast, easily accessible, cost-effective, and has a diagnostic accuracy rate of over 90% by using laboratory tests. However, we could not achieve this goal due to the low accuracy of the diagnostic tests and the lack of significant change in the laboratory levels of the patients at admission. Considering that the pandemic is continuing rapidly, there is still a need to develop practical diagnostic methods that are easier and cheaper in diagnosis. In this sense, we believe that our study will be a guiding study for other studies that will be designed for diagnostic index studies.

Background/aim: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) causes Middle East Respiratory Syndrome (MERS). Due to the fact that the vast majority of cases (more than 85%) are reported from Saudi Arabia, there is a pandemic potential for pilgrimage due to Hajj or Umrah. It is reported from Turkey that more than 400 thousand people went to Saudi Arabia for umrah and 61 thousand people for Hajj in 2014. Materials and methods: In this study it is aimed to investigate the patients who had just returned from Makkah for Umrah and who also applied to the Infectious Disease Clinics at the XXXX Training and Research Hospital for having respiratory tract symptoms. Their serologic situations have been determined by ELISA whether there is any risk in terms of performing the Hajj and Umrah, and contracting MERS-CoV. Between January 1st to the 31st of October 2015, 40 people were included in this study, which were admitted to our hospital with upper respiratory tract complaints and had previously been in Saudi Arabia for Umrah within the last 15 days. As a control group, 40 healthy people without any complaints and travel histories to risky areas were selected. Their serum samples were taken and searched by MERS-CoV IgG ELISA (Euroimmun AG, Lübeck, Germany). The results ≤0.8 were considered as negative, ≥1.1 were as positive, 0.8-1.1 were suspected. All suspected and positive results have been revaluated and confirmed. Results: Only two (5%) individuals from the patients’ group were found as positive for the MERS-CoV IgG antibodies, but individuals from the remaining patients’ group and also all control group members were determined as negative. Conclusion: Travels to Saudi Arabia could be a risk for exposure to MERS-CoV. Although there is no evidence, contamination could be realized by anthroponotically due to crowds.

Introduction Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease in Africa, Asia, the Balkan peninsula, the south-east of Europe and the Middle East, with mortality rates of 3–30%. Transmission can also occur through contact with infected animals or humans. Aim This observational, prospective case series aimed to investigate detectable viral genomic RNA in whole-body fluids and antibody dynamics in consecutive daily samples of patients diagnosed with CCHF until discharge from hospital. Methods We tested 18 patients and 824 swabs and sera with RT-PCR and 125 serum samples serologically. Results The longest duration until clearance of viral RNA was 18 days from serum collection and 18, 15, 13, 19 and 17 days, respectively, from nasal, oral, genital (urethral or vaginal) and faecal swab, and urine. In seven patients, viral load decreased in serum at the same time as it increased in urine or persisted at the same logarithmic values. Despite clearance in serum, viral RNA was detected in faeces and genital swabs in two and three patients, respectively. Viral clearance from body fluids occurred earlier than from serum in eight patients on ribavirin treatment. The shortest seroconversion time was 3 days after symptom onset for IgM and IgG. Seroconversion of IgG occurred until Day 14 of symptoms. Conclusion We report persistence of viral RNA in urine, faeces and genital swabs despite serum clearance. This may indicate a need for extending isolation precautions, re-evaluating discharge criteria and transmission risk after discharge, and considering oral swabs as a less invasive diagnostic alternative.

Objective: We aimed to analyze antimicrobial susceptibilities by a molecular evaluation of extended-spectrum beta-lactamase (ESBL) positive of the isolates from communityacquired complicated intra-abdominal infections (CA- IAIs) in Turkey. Method: Clinical samples were obtained during operation. Antimicrobial susceptibilities, inducible beta-lactamase and ESBL status, were determined using Clinical and Laboratory Standards Institute criteria and interpretive standards. ESBL positive and cefoxitin-resistant isolates were evaluated bla genes for CTX-M, TEM, SHV, PER-1 and plasmidic AmpC families with polymerase chain reaction (PCR). We confirmed the results by directly sequencing the bla genes (Macrogen Inc, Korea) with Mega 5.02 and BLAST programs. Results: We isolated 116 pathogens from 81 patients. Clinicians diagnosed 34 (42.1%) patients as acute appendicitis, 15 (18.5%) as cholecystitis, 14 (17.3%) as intra-abdominal abscess, 12 (14.8%) as tumor resection and six (7.3%) acute diverticulitis. Escherichia coli (E. coli) was the most common gram-negative (76%), Enterococcus spp. was the most common gram-positive (13.6%). ESBL production was 12, 3 % in all gram-negative strains; 11, 1% (9/62) in E. coli and 1, 2% (1/9) Klebsiella pneumoniae (K. pneumonia). Quinolone resistance was 22.2% and ceftriaxone resistance was 14.5% in E. coli. We detected CTX-M genes in five of nine ESBL positive isolates. CTX-M-1 group (CTX-M-1, CTX-M-3, and CTX-M-15) was in four and CTX-M-9 group (CTX-M-14) in one ESBL positive E. coli. One isolate had also AmpC, CMY-2 enzyme (1, 6 %). Conclusion: In our study, ESBL positive gram-negative pathogens were >10%. Quinolone resistance was >% 20, so that quinolones should not be the first choice for the treatment of serious IAI's in our country. Cefoxitin resistance was still low in E. coli isolates from CA-IAIs. Regular surveillance data can guide empirical antibiotic therapy in community-acquired intra-abdominal infections. It should emphasize the importance of sampling for culture to surgeons for guiding empirical therapy in the future.

Introduction Influenza subtypes vary by clinical, radiological, and prognostic courses and may go along with viral pneumonia. We aimed to identify clinical, radiological, and prognostic aspects of influenza epidemic during years 2016-2017. Materials and Methods Influenza cases reported to the Public Health Directorate in our city was assessed retrospectively. Clinical, radiological, and prognostic parameters were compared based on influenza subtypes. Result We analyzed samples from 197 cases with suspected influenza. Mean age of the subjects was 51.17 ± 26.74. We found influenza A/H1N1, influenza A/H3N2, and influenza B in 59 (30.0%), 29 (14.7%), and 3 (1.5%) cases, respectively. Comorbidity was present in 48 (24.4%) cases. Most common radiological finding was interstitial pattern. Seventy-one and 79 per cent of H1N1 and H3N2 cases were influenza pneumonia, respectively. The prevalence of overall mortality was 5.5% with a predominance in H1N1 over H3N2. Influenza vaccination had been performed in 6.8% and 3.4% of H1N1 and H3N2 cases, respectively. We detected no mortality in any vaccinated patient. We identified 6 pregnant women, 2 of which ended up with preterm birth, and another one with abortion. Conclusions Often manifested as lower respiratory tract infection, influenza may cause epidemics with increased mortality rate. Influenza should be suspected when interstitial pattern was seen on radiological images. H1N1 cases course worse. Since the prognosis is better in vaccinated patients, seasonal influenza vaccination among the community needs to be elevated. In addition, protective measures like vaccination should be taken in pregnancy to avoid preterm delivery or abortion.

The present guideline updates the Turkish recommendations for the screening, diagnosis and management of Hepatitis C virus (HCV) infection prepared by the Turkish Association for the Study of the Liver (TASL) and Viral Hepatitis Society (VHS). The aim of this guidance was to provide updates recommendations to physicians, who are interested in HCV care on the optimal screening, diagnosis and pre-treatment management for patients with HCV infection in Turkey. These recommendations, produced by panel experts, were aimed to addresses the management issues ranging from diagnosis and linkage to care, to the optimal treatment regimen in patients with HCV infection. Recommendations are based on evidence and opinions of more than 70% of the panelists. This guidance is supported by the memberships of two societies and not by pharmaceutical companies. This guidance will be updated frequently as new data become available.

Influenza subtypes vary by clinical, radiological, and prognostic courses and may go along with viral pneumonia. We aimed to identify clinical, radiological, and prognostic aspects of influenza epidemic during years 2016-2017.Influenza cases reported to the Public Health Directorate in our city was assessed retrospectively. Clinical, radiological, and prognostic parameters were compared based on influenza subtypes.We analyzed samples from 197 cases with suspected influenza. Mean age of the subjects was 51.17 ± 26.74. We found influenza A/H1N1, influenza A/H3N2, and influenza B in 59 (30.0%), 29 (14.7%), and 3 (1.5%) cases, respectively. Comorbidity was present in 48 (24.4%) cases. Most common radiological finding was interstitial pattern. Seventy-one and 79 per cent of H1N1 and H3N2 cases were influenza pneumonia, respectively. The prevalence of overall mortality was 5.5% with a predominance in H1N1 over H3N2. Influenza vaccination had been performed in 6.8% and 3.4% of H1N1 and H3N2 cases, respectively. We detected no mortality in any vaccinated patient. We identified 6 pregnant women, 2 of which ended up with preterm birth, and another one with abortion.Often manifested as lower respiratory tract infection, influenza may cause epidemics with increased mortality rate. Influenza should be suspected when interstitial pattern was seen on radiological images. H1N1 cases course worse. Since the prognosis is better in vaccinated patients, seasonal influenza vaccination among the community needs to be elevated. In addition, protective measures like vaccination should be taken in pregnancy to avoid preterm delivery or abortion.

Crimean-Congo hemorrhagic fever (CCHF) is a severe human infection caused by CCHF virus (CCHFV). Today, although the literature on CCHF pathogenesis is still limited, it is thought to be associated with immunosuppression in the early phase of infection followed by pro-inflammatory immune response that may lead to fatal outcomes. The aim of this study is to investigate the role of regulatory T-cells (T

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OZET Objectives: This study aims to determine the reasons for not being able to access treatment of chronic hepatitis C (CHC) for patients who are followed up without treatment and to serve as a resource for future studies to be conducted to find solutions. Materials and Methods: The study was planned as a multi-center observational study. Universities, training and research hospitals, and public hospitals from different regions, most of which are members of the Association to Combat Viral HepatitisAcademic Camp, participated in the study. The reasons for untreated follow-up of CHC patients followed up without treatment were investigated. Patients who were hepatitis C virus (HCV) RNA negative, who had sustained viral response, and who had been receiving treatment were excluded from the study. Results: Two hundred and ninety patients diagnosed with CHC and followed up without treatment were reviewed in detail. The median age was 58 (23-87) years, the number of female patients was 157 (54%); 241 patients were genotype 1 (83%), 12 patients were genotype 2, 3 and 4 (4%), 37 patients were of unidentified genotypes (13%); 174 patients (60%) were treatment-naive; and 14 patients (12%) out of the Amac: Bu calismada, tedavisiz izlenen kronik hepatit C (KHC) hastalarinin, tedavisiz kalma nedenlerinin ortaya konmasi ve ileriye donuk cozum onerilerinin olusturulmasi

Introduction: Tularemia is a zoonotic disease caused by Francisella tularensis. The oculoglandular form is one of the rarest forms. In this study, evaluated tularemia patients, focusing on the ocular form and the efficacy of early antibiotic therapy. Methodology: During a tularemia outbreak, the epidemiological and clinical findings, laboratory assays, and drugs used for the treatment of 48 patients were recorded prospectively. The diagnosis of tularemia was confirmed with microagglutination test (MAT) as well as clinical findings. Results: The mean age of the subject was 48.6 years; 23 (47.9%) of them were female. Thirty-six (81.25%) patients had clinical presentation compatible with oropharyngeal tularemia, seven (14.58%) with oculoglandular tularemia, and two (4.1%) with ulceroglandular tularemia. The most common symptoms were fever (91.6%) and sore throat (81.2%), and the most common findings were lymphadenopathy (91.6%) and tonsillopharyngitis (81.2%). In the oculoglandular form, fever, lymphadenopathy, periorbital edema, conjunctival injection, and chemosis were found. The most distinctive ophthalmic feature was follicular conjunctivitis and conjunctival epithelial defects. Forty-five cases had positive serological results with MAT. All the patients were treated with antibiotics considered effective against F. tularensis, and topical antimicrobial treatment was given to the patients with oculoglandular tularemia. Twenty-six (54.16%) patients, who were admitted within three weeks of the onset of symptoms, recovered without sequel. Conclusions: During tularemia outbreaks, ocular involvement should be considered carefully. The early administration of appropriate treatment will be more effective in resolving the infection and preventing complications. Along with systemic antibiotic therapy, topical treatment will help recovery.

We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p 15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.

Cryptococcus neoformans is an encapsulated yeast causing infection in patients with acquired immune deficiency syndrome (AIDS). With the introduction of highly active antiretroviral therapy (HAART), the incidence of infection due to Cryptococcus has significantly decreased. The era of HAART has not only affected the incidence ratebutalso the clinical presentation called immune reconstitution inflammatory syndrome as a consequence of the immune recovery of the host. In this paper, we presented a HIV/AIDS patient with cryptococcal sepsis and discussed clinical manifestations of cryptococcosis, diagnostic and therapeutic approach.

The most important interventions in our country that significantly affect the epidemiology of viral hepatitis are the introduction of hepatitis B vaccine into the routine vaccination program for newborns since 1998 and the introduction of catch up vaccination strategies and screening for high-risk groups. In addition, the development of our surveillance system, the introduction of hepatitis A vaccine into the routine vaccination program, and the addition of studying nucleic acid testing to serological screening in blood donors are other important interventions

editorial In this recent issue of Journal of Viral Hepatitis, Karacaer et al. (1) aimed to evaluate the percutan liver biopsy safety. Liver biopsy has currently some major roles that are diagnosis, assesment of prognosis (especially staging of parenchymal liver diseases) and deciding of therapy. It is seen as the gold standard according to current clinical practice. Because of its some restrictive and limiting features and some complications, several non-invasive methods have been developed (2)

Introduction: Vancomycin-resistant enterococci (VRE) have recently been observed as an increasingly responsible agent among nosocomial infections. In our study, we aimed to investigate the possible risk factors for VRE colonization and infection. Materials and Methods: This study was conducted prospectively in the hematology, oncology and bone marrow transplantation departments between September 2004 and April 2005. Rectal swab culture was obtained on admission day and once a week from patients who had been hospitalized in these departments. A follow-up form was completed for each patient. Stata version 8.0 was used for statistical analysis. Results: A total of 462 rectal swab samples were obtained in the seven-month period. VRE was isolated in 13 patients. All these patients were from the hematology department. Female gender, long duration of hospitalization, prolonged neutropenia, total parenteral nutrition, sucralfate usage, central venous catheterization, and duration of antibiotic usage (third- and fourth- generation cephalosporins, metronidazole, amikacin, glycopeptides, macrolides, carbapenems, quinolones) were found as risk factors with univariate analysis. In multivariate analysis, long duration of hospitalization was found as an independent risk factor. Conclusion: Establishing the risk factors for colonization and infection with VRE can contribute to the implementation of effective infection control measures.

Background. We describe the neurological involvement in brucellosis and revisited diagnostic criteria for neurobrucellosis. Methods. Patients with laboratory-confirmed brucellosis who were consequently hospitalized were observed prospectively in a brucellosis-endemic region. The neurobrucellosis was diagnosed by any one of the following criteria: (1) symptoms and signs consistent with neurobrucellosis; (2) isolation of Brucella species from cerebrospinal fluid (CSF) and/or presence of anti-Brucella antibodies in CSF; (3) the presence of lymphocytosis, increased protein, and decreased glucose levels in CSF; or (4) diagnostic findings in cranial magnetic resonance imaging or CT. Results. Lumbar puncture was performed in 128 laboratory-confirmed brucellosis cases who had neurological symptoms and signs, and 48 (37.5%) were diagnosed as neurobrucellosis. The sensitivity of tube agglutination (TA) in CSF was 0.94, specificity 0.96, positive predictive value 0.94, and negative predictive value 0.96. Brucella bacteria were isolated from CSF in 7 of 48 patients (15%). The mean age of 48 neurobrucellosis patients was 42 years (SD, 19 years), and 16 (33%) were female. The most common neurological findings were agitation (25%), behavioral disorders (25%), muscle weakness (23%), disorientation (21%), and neck rigidity (17%). Cranial nerves were involved in 9 of 48 patients (19%). One patient was left with a sequela of peripheral facial paralysis and 2 patients with sensorineural hearing loss. Conclusions. Patients with severe and persistent headache and other neurologic symptoms and signs should be considered for neurobrucellosis in endemic regions and to possibly receive longer therapy than 6 weeks. Brucella TA with Coombs test in CSF is sensitive and specific by using a cutoff of ≥1:8.

We described the predictive role of cytokines in fatality of Crimean Congo Hemorrhagic Fever Virus (CCHFV) infection by using daily clinical sera samples. Consequent serum samples of the selected patients in different severity groups and healthy controls were examined by using human cytokine 17-plex assay. We included 12 (23%) mild, 30 (58%) moderate, 10 (19%) severe patients, and 10 healthy volunteers. The mean age of the patients was 52 (sd 15), 52% were female. Forty-six patients (88%) received ribavirin. During disease course, the median levels of IL-6, IL-8, IL-10, IL-10/12, IFN-γ, MCP-1, and MIP-1b were found to be significantly higher among CCHF patients than the healthy controls. Within the first 5 days after onset of disease, among the fatal cases, the median levels of IL-6 and IL-8 were found to be significantly higher than the survived ones (Fig. 3), and MCP-1 was elevated among fatal cases, but statistical significance was not detected. In receiver operating characteristic (ROC) analysis, IL-8 (92%), IL-6 (92%), MCP-1 (79%) were found to be the most significant cytokines in predicting the fatality rates in the early period of the disease (5 days). IL-6 and IL-8 can predict the poor outcome, within the first 5 days of disease course. Elevated IL-6 and IL-8 levels within first 5 days could be used as prognostic markers. © 2017 Wiley Periodicals, Inc.

WOS: 000384856200002, PubMed ID: 27424492, Introduction: The information of discharge criteria in patients with Crimean-Congo Hemorrhagic Fever (CCHF) is limited. In this study, we aimed to determine the clinical and laboratory parameters used in discharging the patients by the experienced centers. Materials and methods: The study was done in 9 reference centers of CCHF from May 1, 2015 to December 1, 2015 and included laboratory-confirmed patients with CCHF. The study was prospective, observational and non-interventional. Results: The study included 260 patients. Mean age was 51.3 +/- 16.3 years; 158 (60.8%) were male. Mean hospital stay was 7 +/- 2.6 days. The decision of discharging was taken considering clinical and laboratory findings. On discharge, no patients had fever or hemorrhage. The patients were followed-up clinically and a repeat CCHF PCR was not studied. All centers considered the following criteria for discharge: no fever and hemorrhage, improvement in clinical findings and laboratory studies. For all patients except one, platelet count was >50,000/mm(3) and had a tendency to increase. Prothrombin time and international normalized ratio (INR) were normal in 258 (99.6%) and 254 (98.1%) patients respectively. Alanine aminotransferase (ALT) was either normal or not higher than 10-fold and had a tendency to decrease in 259 (99.6%) patients. ALT and aspartate aminotransferase (AST) levels were not taken as discharge criteria with priority. During 30 days following the discharge, complication, relapse, or secondary transmission were not reported. Conclusions: The discharging practice of the centers based on clinical and laboratory parameters seems safe considering no complications, relapses, or secondary infection thereafter. Current discharge practice of the centers composed of no fever and hemorrhage, improvement in clinical findings, platelet count of either >100,000/mm(3) or >50,000/mm(3) with a tendency to increase, and normal bleeding tests can be used as the criteria of discharge. (C) 2016 Elsevier B.V. All rights reserved.

other Rehberler, konu ile ilgili farklı uzmanlık alanlarından uzmanların her ülkenin kendi verilerini dikkate alarak hazırladıkları önerileri içerir. Ancak ülkemizde bugüne kadar intra-abdominal infeksiyonlar (İAİ) için ortak dil oluşturmak adına, önerileri kapsayan bir rehber kullanıma sunulmamıştır. Bunun en önemli nedeni klinikte İAİ'ların tanı ve tedavisi ile ilgili veya İAİ tanılı hastalardan elde edilen mikroorganizma duyarlılıklarını değerlendiren laboratuvar çalışmalarının oldukça az sayıda olmasıdır. Oysa günümüzde farklılaşan konak özellikleri ve gelişen teknolojik tedavi yöntemleri nedeniyle "ortak dil kullanmak" zorunluluk haline gelmiştir. Bu amaçla Mayıs 2015'te; Türkiye Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Uzmanlık Derneği (EKMUD)'nin önderliğinde Türk Cerrahi Derneği, Türk Kolon ve Rektum Cerrahisi Derneği, Fıtık Derneği, Türk Hepatopankreatobilier Cerrahi Derneği, Türk Hastane İnfeksiyonları ve Kontrolü Derneği üyelerinden konuya ilgi duyan toplam 15 uzman tarafından yapılan toplantılarda çalışmalar değerlendirildi. Sonuçta, erişkinler için hazırlanan bu uzlaşı raporundaki öneriler, ağırlıklı olarak Amerika İnfeksiyon Hastalıkları [Infectious Diseases Society of America (IDSA)] ve Cerrahi İnfeksiyon Derneği (Surgical Infection Society) tarafından hazırlanan erişkin ve çocuklarda komplike İAİ'ların tanısı ve yönetimi 2010 rehberi olmak üzere, ulaşılabilen rehberlerden yararlanılarak ülkemiz verileriyle hazırlandı. Öneriler; hasta ile ilk karşılaşmadan başlayarak tanısal değerlendirme ve tedavi yaklaşımı olmak üzere iki bölümde oluşturuldu. Hazırlanan uzlaşı raporu ilk kez Antalya'da EKMUD 2016 kongresinde sunuldu. Takiben bir ay süre ile derneklerin sitelerinde önerilere açıldı. Öneriler alındıktan sonra gözden geçirilerek son hali makale olarak yazıldı Guidelines include the recommendations of experts from various specialties within a topic in consideration of data specific to each country. However, to date there has not been a guideline standardizing the nomenclature and offering recommendations for intra-abdominal infections (IAIs) in Turkey. This is mainly due to the paucity of laboratory studies regarding the clinical diagnosis and treatment of IAIs or the sensitivity of microorganisms isolated from patients with IAIs. However, due to the diversification of host characteristics and advancements in technological treatment methods, it has become imperative to 'speak a common language'. For this purpose May 2015, a group of 15 experts in intra-abdominal infections, under the leadership of the Infectious Diseases and Clinical Microbiology Specialty Society of Turkey (EKMUD) and with representatives from the Turkish Surgical Association, Turkish Society of Colon and Rectal Surgery, Hernia Society, Turkish Society of Hepato-pancreato-biliary Surgery, and the Turkish Society of Hospital Infections and Control, was formed to analyze relevant studies in the literature. Ultimately, the suggestions for adults found in this consensus report were developed using available data from Turkey, referring predominantly to the 2010 guidelines for diagnosing and managing complicated IAIs in adults and children by the Infectious Diseases Society of America (IDSA) and the Surgical Infection Society. The recommendations are presented in two sections, from the initial diagnostic evaluation of patients to the treatment approach for IAI. This Consensus Report was presented at the EKMUD 2016 Congress in Antalya and was subsequently opened for suggestions on the official websites of the Infectious Diseases and Clinical Microbiology Specialty Society of Turkey and Turkish Surgical Association for one month. The manuscript was revised according to the feedback received

Objective:The risk of transmitting hepatitis B virus has been reported to continue in the blood of people with loss of HBsAg after recovery from hepatitis B virus infection. The aim of the present study was to investigate the hepatitis B virus DNA in patients with loss HBsAg after recovery from hepatitis B virus infection by using polymerase chain reaction.Materials and Methods:Total 57 cases were evaluated. Hepatitis B virus DNA was detected in 19 (43.2%) of 44 patients with loss of HBsAg after acute hepatitis B virus infection, and in 2 (15.4%) of 13 cases who had natural immunity with positive antiHBs. Results: Infectivity continued in 21 (36.8%) cases. Hepatitis B virus DNA levels were detected between 4.6 x102 with 1x105 genome / mL in these serum samples.Conclusion:In our study, hepatitis B virus DNA can positive in patients with loss of HBsAg after hepatitis B virus infection have been shown. For this reason, antiHBc screening more reliable than HBsAg was thought in the selection of blood donors. It was thought that hepatitis B virus DNA testing with polymerase chain reaction is appropriate in serum and tissues of donors with positive hepatitis B virus serology in the organ transplantation practices.

The authors describe the epidemiologic and clinical characteristics of 97 human immunodeficiency virus (HIV)—infected patients, who were followed between 1993 and 2006. Seventy-two percent of the patients were male, and median age at diagnosis was 36 years (range, 13-71 years). The mean years of survival was 3, and maximum length of life after diagnosis was 9 years. The most common professions were truck drivers, workers, and housewives. Forty-six percent of the males had a history of working abroad. Heterosexual intercourse was the most common (84%) route of transmission. Seventy-four percent of the women acquired infection from their husbands. In Turkey, less educated or uneducated and poor men are the primary target of the HIV infection usually by sexual contact with foreign women. Considering the low education status of the patients, appropriate education programs should be developed to prevent the dissemination of HIV infection. Because a significant number of patients were diagnosed at very late stages, the physicians and other health care workers should be educated on the clinical pictures of HIV/AIDS.

yapar, derya/0000-0003-3566-9751; WOS: 000369701200020 PubMed: 26577431 Introduction: We aimed to determine clinical, laboratory and demographical characteristics of tularemia on admission to Emergency Department (ED). Material and Methods: Medical data of 317 patients admitted to ED and subsequently hospitalized with suspected tularemia between January 1, 2011, and May 31, 2015, were collected. Patients were divided into 2 groups according to microagglutination test results, as tularemia (+) and tularemia (-). Results: Of the 317 patients involved, 49 were found to be tularemia (+) and 268 were tularemia (-). Mean age of the tularemia (+) patients was found to be higher than that of tularemia (-) patients. When compared to tularemia (-) patients, a significant portion of patients in tularemia (+) patients were elderly, living in rural areas and had contact with rodents. When clinical and laboratory findings of the 2 groups were compared, any statistical significance could not be determined. Conclusion: Tularemia is a disease of elderly people living in rural areas. Contact with rodents also increases risk of tularemia in suspected patients. (C) 2015 Elsevier Inc. All rights reserved.

Early diagnosis and treatment of acute brucellosis cases were targeted by screening the household members of the index cases. We also aimed to describe the causal relations of brucellosis in an endemic region. A cross-sectional study was performed among household members (29 index cases, 113 household members). Brucellosis was diagnosed on the basis of clinical findings, serum agglutinin titer of ≥1/160 in standard tube agglutination test (STA), or a positive blood culture. Index cases were defined as patients who had been admitted to the clinic on suspicion of brucellosis and then confirmed as brucellosis cases. The people who lived in the same house as the index cases were defined as household members. The risk factors for seropositivity were studied by multivariate analysis. Independent variables of gender, consuming fresh cheese, blood groups, dealing with husbandry, and contact with the placenta of infected animals were included to the model. Backward and forward selections were performed. Nineteen out of 113 (17%) screened individuals had agglutination titers ≥1/160. The mean ages of index cases and household members were 43 years (standard deviation [SD] 18) and 29 years (SD 19), respectively. In multivariate analysis, consuming fresh cheese (odds ratio [OR]=3.1, confidence interval [CI] 1.07-9.68, p=0.049), blood group A (OR=2.6, CI 1.18-5.96, p=0.018), contact with the placenta of the infected animals (OR=3.7, CI 1.42-9.68, p=0.007), and age30 years (OR=2.8, CI 1.25-6.51, p=0.13) were found to be associated with brucellosis. In univariate analysis, the individuals with blood group B were protected from brucella infection (p=0.013). In conclusion, screening of the people in brucellosis-endemic areas should be considered for early diagnosis and treatment. To our knowledge, blood groups were studied for the first time by this study. Higher prevalence of brucellosis among the individuals with blood group A and less prevalence among the individuals with blood group B should be considered for further studies on pathogenesis.

Objective. To determine the epidemiological and the clinical characteristics of bacteremic brucellosis. Methods . A prospective study, performed in the First Infectious Diseases Clinic of Ankara Numune Education and Research Hospital. All the patients had positive culture result for Brucella spp. Results . Fifty-four acute bacteremic brucellosis cases were included. The majority of patients (76%) were from rural Anatolia. Brucella melitensis serotypes were more common than Brucella abortus (83% versus 17%). Fever and arthralgia were the most common symptoms. The number of patients with back pain and arthralgia was higher in B. abortus infected group ( p =0.014 and p =0.009). Conclusions . B. melitensis is the most common subtype of Brucella infection in Turkey. The infections with B. abortus spp. are not less severe than the infections with B. melitensis.

Tuberculous peritonitis may occur by spread from adjacent intraabdominal tuberculous diseases or haematogenously spread during miliary tuberculosis. Presenting symptoms are usually fever, abdominal pain, abdominal swelling and weight loss, diarrhea is not a common symptom. We report a patient with peritoneal tuberculosis who were presented with diarrhea, fever, abdominal pain and ascites. Mycobacterium tuberculosis was isolated from ascites. Peritoneal tuberculosis should be considered in patients presenting with fever, abdominal pain, diarrhea and ascites.

In this study, the risk factors for oropharyngeal colonization in intensive care units were determined. Daily throat cultures in the first week and once a week in the following weeks were obtained from the patients admitted to intensive care units of Ankara Numune Education and Research Hospital from October 2000 to December 2000. A hundred and thirty adult patients were included, and the mean age was 53. Risk factors for oropharyngeal colonization were analysed by multivariate logistic regression analysis. The risk factors studied by multivariate analysis were length of stay > 5 days (odds ratios (OR); 5.1, confidence interval (CI); 1.9-13.2, p= 0.001), Glasgow coma scala score < 10 (OR; 4.5, CI; 1.6-12.1, p= 0.003), use of broad spectrum antibiotics (OR; 4.8, CI; 2.3-9.9, p< 0.001).

Brucellosis is a zoonosis existing worldwide. Although a variety of combinations of drugs have been used in the treatment of brucellosis, the best regimen has not been clearly determined. In our study 50 cases of acute brucellosis were examined prospectively to compare the efficacy of doxycycline plus rifampin versus rifampin plus trimethoprim-sulfamethoxazole combinations. No statistically significant difference was found between the two regimens but early clinical response was observed in rifampin plus trimethoprim sulfamethoxazole combination.