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Viral hepatitis are infections that can cause liver damage, become chronic, lead to cirrhosis, hepatocellular carcinoma and ultimately result in death due to their ability to spread in the community through blood and infected body fluids. The aim of this study was to determine the seroprevalence of hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) transmitted through blood among individuals living in Trabzon province and to examine the factors potentially associated with seroprevalence. This cross-sectional study was conducted in Trabzon province, located in the northeast of Türkiye, including a total of 10 districts, including the central district. Since seroprevalence was calculated for HBV, HCV, and HDV in the study, the sample size was separately calculated for each, and the calculated maximum sample size of 1116 was accepted as the minimum sample size for the study. The study was completed with 1502 participants. Serological tests for HBV included HBsAg, anti-HBs, and anti-HBc IgG; for HCV, anti-HCV; and for HDV, anti-HDV were analysed. Data were evaluated for HBV risk factors using univariate analyses with Chi-square test and for multiple analyses using enter model logistic regression analysis. The mean age of the participants was 45.7 ± 16.6 years, with 767 (51.1%) being female. The prevalence of HBV seropositivity, indicating vaccination, was 23.0%, while the seroprevalence of HBV among unvaccinated adults was 27.4%. HBsAg positivity was 5.1%, and isolated anti-HBc IgG positivity was 4.2%. The proportion of individuals with HBsAg in the gray zone was 0.5%, while the positivity rates for anti-HBs and anti-HBc IgG (indicating past infection) were 17.6%. The prevalence of anti-HCV was six per thousand, while anti-HDV was not detected in the analyses. HBsAg positivity and co-infection with HCV were found in one person, and among the nine individuals positive for anti-HCV, isolated anti-HBc IgG positivity was detected in three. Increasing age, presence of a person with jaundice in the family, presence of diabetes mellitus, alcohol use and cupping therapy were identified as risk factors for HBV in the logistic regression analysis. Risk factors for HCV in univariate analyses were being over 40 years old, presence of hepatic steatosis and receiving dialysis treatment. The results of the study indicate that despite being included in our vaccination schedule and the administration of vaccines to high-risk adults, HBV still requires intensive attention as a public health problem. HCV, lacking a vaccine has been evaluated as an infectious agent that needs to be taken into consideration due to its potential risks and requires the complete implementation of individual and social precautions.

The paranasal sinus infections caused by Aspergillus spp. are usually presented clinically with mild symptoms, however they may lead to invasive disease and mortality especially in immunocompromised individuals. In this report a fatal case of sino-orbital aspergillosis developed in an immunocompetent patient has been presented. Seventy-four years old female patient was admitted to the hospital with the complaints of fever and progressively increasing headache that continued for 15 days. Due to the development of nausea, vomiting, loss of consciousness and stiff neck in the following days, cerebrospinal fluid (CSF) sample was obtained. Direct microscopic examination of the Gram and acidfast staining of the CSF sample revealed no microorganisms, no growth was detected in CSF culture and PCR amplification was negative for Herpes simplex virus and Mycobacterium tuberculosis. Since no response was achieved by empirical ceftriaxone, ampicillin and conventional anti-tuberculosis treatment and tachypnea, proptosis and progressive respiratory failure developed in the patient, she was transferred to the intensive care unit. The radiological examination revealed soft tissue lesion filling the sphenoid sinus, extending to the nasal cavity and suprasellar cistern, destruction of bones, dilated orbital vein, cavernous sinus thrombosis and infarction on left cerebral peduncule. Patient was operated and pus and fungus ball were aspirated from the openings of both sphenoid sinuses. Gomori methenamine silver, periodic acid-Schiff and haematoxylin-eosine staining of the operational material exhibited dichotomously branching hyphae. The patient was diagnosed as invasive sino-orbital aspergillosis based on the clinical, radiological and histopathological findings. Despite antifungal therapy and surgical debridement, the patient died. It should always be kept in mind that aspergillosis can develop in immuncompetent individuals. Delay in diagnosis and treatment may lead to fatality. Thus multidiciplinary approach is necessary for early diagnosis and successful treatment of aspergillus infections.

The aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical gram-negative isolates. A total of 596 clinical isolates were obtained from intensive care unit (ICU) and non-ICU patients in 10 centers over Turkey between September-December 2008. The origin of the isolates was patients with nosocomial pneumonia (42.4%), bloodstream infections (%40.4), and complicated intraabdominal infections (17.1%). Of the isolates, 51.8% were obtained from ICU patients. The study isolates consisted of Pseudomonas spp. in 49.8%, Enterobacteriaceae in 40.3%, and other gram-negative agents in 9.9%. The minimum inhibitory concentrations (MIC) for doripenem, imipenem and meropenem were determined for all isolates in each center using Etest® strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC50 of doripenem against Pseudomonas spp. Was 1 mg/L which was similar to that of meropenem and two-fold lower than imipenem. Susceptibility to carbapenems in P.aeruginosa was 64% for doripenem at an MIC level of 2 mg/L, 53.9% and 63% for imipenem and meropenem at an MIC level of 4 mg/L, respectively. Doripenem and meropenem showed similar activity with the MIC90 of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gramnegative pathogens, mostly Acinetobacter spp., MIC50 was 8 mg/L for doripenem and 32 mg/L for other two carbapenems. P.aeruginosa isolates were inhibited 84.2% with doripenem and 72.1% with meropenem at the MIC level of 8 mg/L. Doripenem generally showed similar or slightly better activity than meropenem and better activity than imipenem against pathogens collected in this study. Against Pseudomonas spp., doripenem was the most active of the three carbapenems. Doripenem and meropenem were equally active against Enterobacteriaceae and at least four-fold more active than imipenem. It was concluded that doripenem seemed to be a promising agent in the treatment of nosocomial pneumonia, blood stream infections and intraabdominal infections particularly in patients who were under risk of developing antimicrobial resistance.

Hantaviruses which are the members of Bunyaviridae, differ from other members of this family since they are transmitted to humans by rodents. More than 200.000 cases of hantavirus infections are reported annually worldwide. Hantaviruses can lead to two different types of infection in humans, namely, hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). HFRS is the most common type of hantavirus infection in Europe and Asia and the most common virus types are Dobrava, Puumala, Hantaan and Seoul. A total of 25 hantavirus suspected cases have been reported from the Western Black Sea region of Turkey and 12 of these were confirmed serologically as "Puumala" subtype. Serological tests such as indirect immunofluorescence assay (IFA), are used for diagnosis and typing of the hantaviruses, however, since cross-reactions are common between the subtypes, the results of these tests should be confirmed by other methods. In this report two cases with hantavirus infection defined serologically were presented. Two male patients, 55 and 50 years old, respectively, living in Giresun province of Eastern Black Sea region, Turkey, were admitted to the State Hospital with the complaints of fever, sweating and diarrhoea without blood or mucus. Since thrombocytopenia and renal failure were detected in these two cases, they were transferred to the University Hospital. Presence of fever, thrombocytopenia and renal failure, with no laboratory findings of a bacterial infection and no growth of microoorganisms in the clinical specimens, admittance of the patients during summer and history of being present in the fields, necessitated to rule out leptospirosis, Crimean Kongo hemorrhagic fever and hantavirus infection which were all endemic in our area. Further investigation of the serum samples at the National Reference Virology Laboratory by IFA (Hantavirus Mosaic-1, Euroimmun, Germany) revealed hantavirus IgM and IgG antibodies ≥ 1:100 titer and the results were confirmed by immunoblot test (Hantavirus Profile 1 EUROLINE IgG and IgM, Euroimmun, Germany). Hantavirus Dobrava subtype was determined in both of the cases. Reverse transcriptase real-time PCR (Hantavirus Renal Syndrome General-type I&II Real Time RT-PCR; Shanghai ZJ Bio-Tech, China) revealed negative result. The first case was discharged with complete cure, however, the second case died. These cases which were the first cases from the Eastern Black Sea Region emphasized that hantavirus infections should be taken into consideration in patients presenting with fever, thrombocytopenia and renal function disturbance.

Brucellosis is a major public health problem in Turkey and all over the world. Joint pain, night sweats, anorexia, weakness, loss of weight and headache are the basic symptoms of brucellosis and the illness can affect many organs. Genitourinary involvement is reported in 2-20% of cases, epididimoorchitis being the most frequent complication, however, prostatic involvement is far more uncommon. In this paper, a case of Brucella prostatitis misdiagnosed as prostate carcinoma has been presented. A 50-years-old man who was a microbiology laboratory staff has been admitted to our outpatient clinic with the complaints of joint pain, weakness, fever, urgency, difficulty and pain during urination. Since prostate specific antigen (PSA) was 23.6 ng/ml (normal value < 4 ng/ml) and free PSA (fPSA) was 3.89 ng/ml (normal value < 1 ng/ml), needle biopsy from the prostate was performed. Blood cultures performed by BACTEC 9200 (Becton Dickinson, Sparks, Md.) system yielded Brucella melitensis, and the pathological examination of the prostate biopsy revealed prostatic hyperplasia and prostatitis. Brucella standard tube agglutination titer was 1/320. Upon the diagnosis of Brucella prostatitis the patient was treated with a combination of 200 mg doxycycline and 600 mg rifampicin daily for 6 months. During the follow-up period no complication was detected in the patient and the PSA level decreased to 1.57 ng/ml and fPSA to 0.43 ng/ml. This case was reported to withdraw attention to prostatic involvement during brucellosis. Elevated PSA values with the signs and symptoms of brucellosis in endemic areas should be evaluated accordingly and appropriate therapy should be initiated without any delay.

Brucellosis is a significant public health problem particularly in developing countries. People are frequently infected through milk, milk products, urine and pregnancy material of animals with brucellosis. Epididymoorchitis is the most frequent genitourinary complication of brucellosis and is often unilateral. In this report, a 35 years old male patient who was diagnosed as epididymoorchitis based on clinical presentation, laboratory findings and imaging techniques, has been presented. Brucella melitensis was isolated from blood, bone marrow and ejaculate cultures of the patient. The patient was treated with rifampicine and doxycycline combination therapy for six weeks and no complication has developed in the one year follow-up period. In areas where brucellosis is endemic, such as our country, Brucella infection should be considered in the differential diagnosis of epididymoorchitis and in addition to blood and bone marrow cultures, ejaculate cultures should also be evaluated.

The genus Ruminococcus which are anaerobe Gram positive cocci, previously classified as Peptostreptococcus, may colonize the upper respiratory tract, gastrointestinal tract, vagina and skin of humans and animals. In this report a case of liver abscess and a case of infective endocarditis caused by Ruminoccocus productus, which is very rarely encountered in the clinical practice were presented. The first case was a 32 years old male who was admitted to the hospital in 2002, with the complaints of fever lasting for 20 days and pain while breathing. The abdominal ultrasonography revealed the presence of a liver abscess, and the drainage material from the abscess yielded Ruminococcus productus, identified in BACTEC 9200 (Becton Dickinson, Sparks, Md) anaerobe system. As the isolate was found to be sensitive to penicilin, the empirical gentamicin and ampicillin/sulbactam therapy was continued. The second case was a 25 years old male who was admitted to the hospital in 2005, with the signs of fever lasting for 3-4 months, chills, bone and joint pains. As multiple vegetations were detected in echocardiography, blood cultures were collected and empirical therapy with ceftriaxone and gentamicin was initiated with the preliminary diagnosis of infective endocarditis. Bacteria which were isolated from blood cultures by BACTEC 9200 system have been identified as R. productus. As this strain was also sensitive to penicillin, the empirical therapy was changed to penicilin and gentamicin. These two cases indicated that R. productus should be considered in complicated infections even if it is a rarely isolated species from the clinical samples.

In this study, the rate of blood culture contamination, bacterial pathogens and their antimicrobial susceptibilities causing nosocomial and community acquired bloodstream infections were investigated prospectively during the period February 2003 to February 2004. In the study period, among the 5994 blood culture samples obtained from 3114 patients, 1091 (18%) yielded positive results. Seventy-four of them (1.2%) were evaluated as false positive, 514 (9%) were pseudobacteremia or contamination. According to patients' clinical features, 503 (8%) blood culture samples were associated with blood stream infections, and 358 of them (71%) were primary episodes. Twohundred and ninetyfour of primary episodes (82%) were hospital acquired and 64 were community acquired bloodstream infections. Staphylococcus aureus was the most frequently isolated agent in the hospital and community acquired bloodstream infections at the rates of 16% and 20%, respectively. In hospital acquired blood stream infections, Escherichia coil (9%) and Pseudomonas aeruginosa (8%); in community acquired bloodstream infections Streptococcus spp (17%) and E. coli (15%) were the other most frequently isolated bacterial agents. Methicillin resistance of S. aureus isolates was determined as 54% in hospital acquired blood stream infections and 25% in community acquired blood stream infections.

In order to find the distinctive features of Salmonellae and Salmonella infections in Turkey, 620 Salmonellae strains, isolated from various clinical samples (481 stool, 108 blood, 12 urine, 3 bone marrow, 3 cerebrospinal fluid, 9 pus, and one from each of the bile, pleural fluid, wound, catheter samples) in 13 clinical microbiology laboratories of 10 provinces in Turkey (Ankara, Antalya, Bursa, Edirne, Eskişehir, Istanbul, Izmir, Kayseri, Konya and Trabzon) between July 1, 2000 and June 30, 2002, were serotyped. Among the patients 43% were female, 57% were male, 63.2% were from outpatient clinics and 36.8% were hospitalized patients. Seventy eight percent of the patients had gastroenteritis, 10.7% had septicemia/local infection, 9.8% had typhoid/paratyphoid fever and 1.5% were carriers. Incidence of gastroenteritis was higher in 0-5 years age group (p<0.001). Of the 620 Salmonella enterica isolates, 47.7% were S. Enteritidis, 34.7% S. Typhimurium, 6% S. Paratyphi B, 2.9% S. Typhi, 0.2% S. paratyphi A, 6.1% serogroup C1, and 2.4% serogroup C2. S. Enteritidis was the most common serotype in all provinces except for Kayseri, where S. Typhimurium was found to be the most common serotype (68.2%). Overall, the most frequently isolated serotype was S. Enteritidis, also being the most common serotype in stool and blood cultures. During the surveillance period two outbreaks have occurred, the first one by S. Enteritidis strains in Edirne, and the second one by S. Typhimurium strains in Kayseri. As a result, Salmonella infections are still a common health problem in Turkey, and active surveillance of Salmonella infections has vital importance.