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Ralstonia insidiosa, a gram-negative waterborne bacteria able to survive and grow in any type of water source, can cause nosocomial infections, and are considered emerging pathogens of infectious diseases in hospital settings. In this study, we report an outbreak of R. insidiosa at our center related to contaminated heparinized syringes.The present study was conducted in a tertiary care university hospital in Turkey. An outbreak analysis was performed between September 2021 and December 2021. Microbiological samples were obtained from environmental sources and from patient blood cultures. Species identification was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). To investigate the clonality of strains, all confirmed isolates were sent to the National Reference Laboratory and pulsed-field gel electrophoresis (PFGE) was used to perform molecular typing.Seventeen R. insidiosa isolates were identified from the blood cultures of 13 patients from various wards and intensive care units. Isolates from seven patient blood cultures and two heparinized blood gas syringes were characterized by PFGE. All isolates were found to belong to the same clone of R. insidiosa.R. insidiosa was identified as the cause of a nosocomial infection outbreak in our hospital, which was then rapidly controlled by the infection-control team. When rare waterborne microorganisms grow in blood or other body fluid cultures, clinicians and the infection-control team should be made aware of a possible outbreak.

This study aimed to evaluate the influencing variables for outcomes in patients with septic shock having culture-proven carbapenem-resistant Gram-negative pathogens. It included 120 patients (mean age 64.29 ± 1.35 years and 58.3% female). The mean Sequential Organ Failure Assessment score during septic shock diagnosis was found to be 11.22 ± 0.43 and 9 ± 0.79 among the patients with mortality and among the survivors, respectively (P = 0.017). The logistic regression analysis showed that empirical treatment as mono Gram-negative bacteria-oriented antibiotic therapy (P = 0.016, odds ratio (OR) = 17.730, 95% confidence interval (CI): 1.728-182.691), Charlson Comorbidity Index2 (P = 0.032, OR = 7.312, 95% CI: 5.7-18.3), and systemic inflammatory response syndrome score 3 or 4 during septic shock diagnosis (P = 0.014, OR = 5.675, 95% CI: 1.424-22.619) were found as independent risk factors for day 30 mortality. Despite early diagnosis and effective management of patients with septic shock, the mortality rates are quite high in CRGNP-infected patients.

Background CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. Methods This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 mu g inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0.5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. Findings Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65.1%] in the vaccine group and 3568 [34.9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65.4%] and 3470 [34.6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31.7 cases [14.6-59.3] per 1000 person-years) and 32 cases were reported in the placebo group (192.3 cases [135.7-261.1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83.5% (95% CI 65.4-92.1; p, TUSEB, We are grateful to all participants who volunteered to be part of this study and to all members of the clinical research teams of the participating sites. We thank TUSEB for funding the study and Omega-CRO for the statistical analyses and production of figures, and providing the study protocol. We also thank the members of the data and safety monitoring board for their contributions in the safe execution of this study.

The potential role of interleukin-6 (IL-6) in coronavirus disease 2019 (COVID-19) pneumonia provides the rationale for investigating IL-6 signaling inhibitors.To evaluate and report treatment responses to tocilizumab (TCZ) in COVID-19 patients and compare mortality outcomes with those of standard care.Patients hospitalized with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, diagnosed with reverse transcription polymerase chain reaction (RT-PCR) between March 2020 and April 2021, were enrolled in this single-center retrospective cohort study. Propensity score matching was performed in order to reduce confounding effects secondary to imbalances in receiving TCZ treatment.A total of 364 patients were included in this study. Two hundred thirty-six patients received standard care, while 128 patients were treated with TCZ in addition to standard care (26 (20.3%) patients received a dose of 400 mg intravenously once, while 102 (79.7%) patients received a total dose of 800 mg intravenously). In the propensity score-matched population, less noninvasive mechanical ventilation (p = 0.041) and mechanical ventilation support (p = 0.015), and fewer deaths (p = 0.008) were observed among the TCZ-treated patients. The multivariate adjusted Cox regression model showed a significantly higher survival rate among TCZ patients compared to controls (hazard ratio (HR): 0.157, 95% confidence interval (95% CI): 0.026-0.951; p = 0.044). The hazard ratio for mortality in the TCZ group was 0.098 (95% CI: 0.030-0.318; p = 0.0001 using log-rank test).This study determined that TCZ treatment in COVID-19 patients was associated with better survival, reduced need for mechanical ventilation and reduced hospital-associated mortality.

Coronavirus disease 2019 pandemic was expected to have traumatic effects and increase the anxiety levels of inflamma- tory bowel disease patients.We aimed to investigate the psychosocial effects of the coronavirus disease 2019 pandemic on patients with inflammatory bowel disease by revealing the risk perception for present disease, coping strategies, follow-up characteristics, and treatment adher- ence. This is a cross-sectional, web-based survey study including 798 inflammatory bowel disease patients who were followed at our outpatient clinic and 303 volunteer who did not have any known chronic diseases and were not health professionals were included as the control group.In this study, 281 of the patients were diagnosed with Crohn's disease and 215 with ulcerative colitis. The mean age of patients with Crohn's disease, ulcerative colitis, and the control group were 40.9 ± 13.1, 42.3 ± 12.7, and 39.9 ± 11.6, respectively. Here, 119 (42%) of the Crohn's disease cases, 116 (54%) of the ulcerative colitis cases, and 170 (56%) of the control group were male. Among the 3 groups, coronavirus disease 2019-related post-traumatic stress disorder rates (Impact of Event Scale-Revised33) and State-Trait Anxiety Inventory of current status of anxiety-related anxiety rates were not statistically different while State-Trait Anxiety Inventory of anxiety tendency-related constant anxiety was higher in inflammatory bowel disease patients than the control group (P.017).Inflammatory bowel disease patients with anxiety have a lower quality of life, and this may worsen the clinical course of the disease. Coronavirus disease 2019 is a major source of stress for such a vulnerable population. During the pandemic, psychological support and mental health awareness should be made accessible to all individuals.

SUMMARY OBJECTIVE: In coronavirus disease 2019, a rapidly progressive inflammatory process is considered to be the main cause of organ damage and mortality. Therefore, the importance of anti-inflammatory treatments such as tocilizumab is increasing. METHODS: A total of 107 patients who received tocilizumab between March 2020 and March 2021 were included in the study. The primary termination point was mortality. We compared surviving and deceased patients by the stage of the disease and where the drug was given (service or intensive care unit). RESULTS: The mean age was 60.8±14.6 years (minimum 29 years, maximum 96 years). According to the WHO staging system, 16 (15%) patients had moderate, 47 (43.9%) patients had severe, 44 (41.1%) patients had a critical illness. Although all patients were admitted to the service, 26 (24.3%) patients received tocilizumab in the intensive care unit. Of 107 patients, 80 (74.7%) survived and 27 (25.2%) died. Mortality was found to be significantly higher in critical patients (96.3%), severe patients (3.7%), and moderate patients (0%) (p

The Coronavirus disease-2019 (COVID-2019) pandemic is a major global healthcare problem nowadays, and because of the high numbers of infected patients, it is vitally important to distinguish this from other types of viral pneumonia caused by influenza or adenovirus, which may have similar signs and symptoms. We conducted a narrative literature review and performed a PubMed and Scopus search for studies published up to November 18, 2020, using the following medical subject headings terms: [“comparison,” “comparisons” AND “severe acute respiratory syndrome coronavirus 2,” “ncov,” “2019 ncov,” “covid 19,” “sars cov 2,” “coronavirus,” “cov” AND (“influenzas,” “influenza,” “influenzae,” “human influenza” OR “adenoviridae,” “adenovirus,” “adenoviridae infections”)]. This narrative review aims to compare pneumonia caused by severe acute respiratory syndrome coronavirus-2, influenza, and adenovirus in terms of clinical, laboratory, and radiological characteristics. In conclusion, although these viral pneumonia clinics share the similar patterns of symptoms and laboratory findings; we believe that there have some distrinctions especially in radiological findings.

Background: Determination of the prognostic factors which affects the mortality and morbidity in COVID-19 patients, has an importance in terms of planning the treatment and follow-up strategy. Material and Method: Patients who had COVID-19 diagnosis via microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were recorded retrospectively. Only adult patients (≥18 years) with clinical spectrum of moderate, severe and critical illness were included in the study according to National Institutes of Health (NIH) guideline. A p value of less than 0.05 was considered significant. Ethical committee approval was given from the Uludag University with decision number 2020-22/11. Also, the permission from Republic of Turkey, Ministry of Health was given. Results: A total number of 257 patients were included in the study. 30-day mortality rate was recorded as 14.4%. In univariate analysis; age, chronic renal failure, malignancy, cerebrovascular disease, number of comorbidities >2, dyspnea, cough, NIH severe and critical illness, oxygen saturation, respiratory rate, systolic and diastolic blood pressure, qSOFA, GCS, MEWS, SOFA, CURB-65, CCI, CRP, procalcitonin, CK, D-dimer, lymphocyte and thrombocyte levels, neutrophile-to-lymphocyte ratio, AST, albumin, hemoglobin, CK-MB, fibrinogen, LDH and potassium levels were found as statistically significant (p

In this study, we aimed to investigate retrospectively the patients with carbapenem-resistant Enterobacteriaceae urinary tract infections (UTIs) in the terms of demographic findings, antibiotic sensitivity patterns and clinical features along with the treatment options. This study was performed at a tertiary-care educational university hospital. Adult (>18 years old) patients diagnosed with culture proven UTI due to carbapenem-resistant Klebsiella pneumoniae (between December 2016 to December 2017) were included in the study. Antimicrobial susceptibility testing of the isolates was performed with the VITEK 2 system (bioMerieux). Resistance to imipenem, ertapenem, and meropenem was tested by E-test (bioMerieux). the results were interpreted according to the EUCAST criteria. A total number of 100 patients (34% female, mean age 61.69 +/- 1.65 years) were included in this study. One month all-cause mortality rate was 19%. Microbiologic eradication rate was 88.7% while it was significantly higher in combination therapy (65/70 vs. 14/19, p = 0.019) and carbapenem long-lasting (4 h) infusion subgroups (54/56 vs. 2/56, p = 0.005). Relapse and reinfection rates were 61.7 and 29.7%, respectively. Logistic regression analysis for mortality risk factors resulted as history of ertapenem usage (OR: 4.74, 95% CI: 0.678-33.201, p = 0.117), lack of microbiologic eradication (OR: 21.7, 95% CI: 1.906-247.375, p = 0.013) and ICU stay (OR: 54.8, 95% CI: 4.145-726.324, p = 0.002). Combination, carbapenem long-lasting infusion and double carbapenem therapies seem to result in higher microbiologic eradication rates and thus may effect the mortality rates of these group of patients. Randomized-controlled studies should be performed in this critical patient group to confirm these results.

A systematic review was conducted with the aim of describing the demographical data, features and outcomes of patients with Lyme disease (LD), reported from Turkey. Three international database (electronic PubMed, Web of Science and Scopus) and two national database (Ulakbim and Turkmedline) searches were performed using the following keywords ([‘Lyme’ or ‘Borrelia burgdorferi’ or ‘Borrelia’ or ‘Borreliosis’] and ‘Turkey [and/country]’). National Notifiable Diseases Surveillance System (NNNDS) of Centers for Disease Control and Prevention (CDC) criteria were used for classification. A PRISMA-based algorithm was used for systematic review. There were a total of 75 LD cases in 36 different reports. Studies related to LD are confined to case reports. We believe that LD is an important healthcare problem in Turkey and to our knowledge this is the first systematic review from this country.

Objective: Sexually transmitted infections are frequently seen and significant infections for public health. Prevention, early diagnosis and treatment of sexually transmitted infections have an important role in controlling the transmission of Human Immunodeficiency Virus (HIV). The investigation of the frequency of other sexually transmitted pathogens in asymptomatic HIV- positive individuals was aimed in the present study. Method: Vaginal and urethral swab samples were collected by 90 HIV- positive asymptomatic individuals themselves aged between 20-69 (median=36, SD=10.48) years, between September 2015 and April 2016. The samples were assessed for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, Herpes simplex virus type 1 and 2, and Human papillomavirus using real-time polymerase chain reaction (PCR) method. Results: At least one or more than one sexually transmitted pathogen was identified in 49 (54.4%) of 90 HIV-positive individuals. Human Papillomavirus was found in 31 (34.4%), Ureaplasma urealyticum in 20 (22.2%), Ureaplasma parvum in 15 (16.6%), Mycoplasma genitalium in 8 (8.8%), Mycoplasma hominis in 8 (8.8%), Neisseria gonorrhoeae in 5 (5.5%) and Chlamydia trachomatis in 2 (2.2%) individuals. Trichomonas vaginalis, Herpes simplex virus type 1 and 2 were not detected in any of the clinical specimens. Conclusion: Approximately 55% of 90 HIV- positive individuals were found to be positive for sexually transmitted pathogens, and . Human Papillomavirus was the most frequently detected pathogen. This condition reveals the necessity of screening even asymptomatic individuals for the presence of this pathogen. Studies are needed to increase awareness in our country on this issue.

WOS: 000427391500004, Brucellosis and fascioliasis are zoonoses which induce different type of cell-mediated immune responses and rarely cause hepatitis with together. Brucellosis induces T helper type 1 (Th1) immune response whereas Fasciola hepatica induces T helper type 2 (Th2) immune. It may be speculated that chronic fascioliasis can predispose to brucellosis by suppression of Th1 response against brucellosis. In this paper, we present a patient who was diagnosed with brucellosis as well as chronic fasciolasis on the basis of parasite that was seen incidentally during the abdomen ultrasonography. To our knowledge, this case is one of the few cases in the literature that showing the co-infection of the liver by both fascioliasis and brucellosis.

In this study, we aimed to investigate retrospectively the patients with carbapenem-resistant

WOS: 000446000200057, PubMed ID: 30256855, Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.

In this paper, we present a 69 years old diabetic patient with mucormycosis who was succesfully treated with liposomalamphotericin B (LAMB), posaconazole and deferasirox despite having no adequate surgery. There was no relapse on6 month post-treatment follow-up. We conclude that combination of antifungal antibiotics with deferasirox may besuccessful in the salvage therapy of mucormycosis especially in diabetic patients. J Microbiol Infect Dis 2016;6(1): 32-35

Background In this study it was aimed to compare the effects of qSOFA (Quick Sequential Organ Failure Assessment) score with modified qSOFA score (PLoS One. 2018 Sep 26;13(9):e0204608) for predicting one month survival in patients with diagnosed septic shock (SS) in a tertiary-care educational university hospital in a developing country. Methods Modified qSOFA was created by adding age factor (>50 years=1 point) to patients with qSOFA scale 1 or 2 or 3 who had SS (sepsis+hypotension+adrenergic agent) and consulted by Infectious Diseases consultants between December 2013-December 2018. Arterial lactate level of >2 mmol/L criterion was added as an including criteria for SS according to 3rd International Sepsis and Septic Shock Consensus Statement after 23rd February 2016. Statistical analysis was performed via Chi-square test and a p-value Results The number of patients with qSOFA score of 1 or 2 or 3 from 527 patients are in Table1 [some of the cases were diagnosed as septic shock according to elder definition (without lactate criterion) and there was a subgroup with qSOFA score 1]. Among the >50-year aged group, the 30-day survival rate was lower in patients with qSOFA3 vs. qSOFA 2 vs. qSOFA 1 (Table1, 3x2 Chi Square test, P = 0.0057). Among the 50 years (table, Chi-square test, 12/21 vs. 39/97 P = 0.224, 11/29 vs. 75/244 P = 0.526, 3/25 vs. 22/111 P = 0.572). Conclusion In terms of survival at one month, there was a significant difference between qSOFA score 1, 2, 3 and 4 subgroups. In patients with qSOFA score of 1 or 2 or 3, being under 50 years did not have a significant effect on one-month survival. Modified qSOFA may be beneficial to foresee the probable mortality but these findings need to be validated in larger cohorts Disclosures All authors: No reported disclosures.

In this paper, we present a 69 years old diabetic patient with mucormycosis who was succesfully treated with liposomal amphotericin B (LAMB), posaconazole and deferasirox despite having no adequate surgery. There was no relapse on 6 month post-treatment follow-up. We conclude that combination of antifungal antibiotics with deferasirox may be successful in the salvage therapy of mucormycosis especially in diabetic patients. J Microbiol Infect Dis 2016;6(1): 32-35 Key words: mucormycosis, treatment, diabetes mellitus, mucorales

İnsanlarda nadiren enfeksiyona sebep olan Pseudallescheria boydii, toprakta bulunan saprofitik mikroorganizmalardır. Bu yazıda P. boydii nedenli sol tibia ön yüzde deri yumuşak doku enfeksiyonu olan böbrek nakilli bir hasta sunulmaktadır. Doku biyopsisi alınan hastada patolojik incelemede hifler ve fungal sporlar ile birlikte mikolojik kültürde P. boydii üremesi saptandı. Aynı zamanda üreyen mantar moleküler yöntemler kullanılarak da tanımlandı. Flukonazol ile topical izokonazol nitrat tedavileri antifungal duyarlılık sonuçları elde edilene dek uygulandı. Duyarlılık sonuçları ile birlikte flukonazol, itrakonazol olarak değiştirildi. Bir ay sonra kontrolde klinik olarak yanıt alındığı görüldü. P. boydii için uygun antifungal tedavi seçimi ve tedavi süresi hakkında yeterli veri bulunmamasından dolayı patojenin tanımlanması ve antifungal duyarlılık sonuçlarının alınması çok önemlidir, Pseudallescheria boydii, a rare cause of infection in humans, are saprofitic microorganisms which are found in soil. In this report, we describe a renal transplant patient who had a skin-soft tissue infection at the anterior side of her left tibia due to P. boydii. Tissue biopsy was taken from her tibial lesion. Pathologic examination revealed hyphae plus fungal spores and mycological cultures were positive for P. boydii. The fungus was also identified by molecular methods. Fluconazole and topical isoconazole nitrate were given to the patient until the antifungal susceptibility results were seen. Fluconazole was changed to itraconazole via susceptibility results. Clinical response was seen at the 1 month control.Because of limited data regarding the optimal antifungal drug choice and duration of treatment for P. boydii infections, the proper identification of pathogen and antifungal susceptibility tests have vital importance. J Microbiol Infect Dis 2015;5(4): 176-179

Tüberküloz peritonit, ekstrapulmoner tüberküloz formları arasında nadir görülen bir formdur. Tanı genellikle periton biyopsisinin patolojik incelemesi veya kültürde üreme olması ile koyulmaktadır. Bu yazıda tüberküloz peritonit tanısı alan serum CA-125 düzeyleri yüksek beş olgu sunulmaktadır. Yaşları sırası ile 63, 41, 25, 72 ve 73 olan beş kadın hasta kliniğimize üç aydan fazla süren karın ağrısı şikayeti ile başvurmuştur. Olguların hepsi malignansi araştırılan hastalar olup CA-125 düzeyleri biyopsi öncesinde yüksek saptanmıştır. Dört hastaya periton biyopsisi ve bir hastaya parasentez yapılmıştır. Beş hastanın üçüne ait örneklerde Ehrlich Ziehl Neelsen (EZN) boyaması, kültür ve polimeraz zincir reaksiyonu (PCR) test sonuçları negatif olarak saptanmış fakat klinik ve patolojik sonuçlar ile tüberküloz peritonit düşünülmüş ve tüberküloz tedavisi ile klinik olarak yanıt alınmıştır. Bir hastanın doku kültüründe ve diğer bir hastanın da PCR testi sonucunda Mycobacterium tuberculosis pozitifliği saptanmıştır. Yüksek CA-125 düzeyleri epitelyal over kanseri için bir tümör belirteci olarak kullanılmasına rağmen tüberküloz peritonit gibi inflamatuvar hastalıklarda da görülebilmektedir. Yüksek CA-125 değerleri görüldüğünde tüberküloz peritonit de dışlanmalıdır, Peritoneal tuberculosis is an uncommon site of extrapulmonary infection. It is usually diagnosed after pathological examination or mycobacterial culture of peritoneal biopsy. In this paper, we present five patients with elevated serum CA-125 levels who were diagnosed with tuberculosis peritonitis. Five female patients (63, 41, 25, 72 and 73-year old) admitted to our clinic with the main complaint of abdominal pain for at least three months. All of them were investigated for malignancy and their CA-125 levels were high before the biopsy was considered. Peritoneal biopsies were performed to four patients and one patient had paracentesis. For peritoneal biopsies of three of the five patients; Ehrlich Ziehl Neelsen (EZN) stainings, mycobacterial cultures and polimerase chain reaction (PCR) tests were negative. However, clinical and pathological findings pointed us towards peritoneal tuberculosis and clinical improvement was seen after tuberculosis treatment. One of the patients’ biopsy tissue culture was positive and another’s PCR was positive for Mycobacterium tuberculosis. Although high CA-125 level is used as a tumor marker of epithelial ovarian cancer, it can be elevated because of inflamatory diseases such as tuberculous peritonitis. Tuberculous peritonitis should also be ruled out when high levels of CA-125 were seen