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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.

Fusobacterium necrophorum is an anaerobic, nonspore-forming, Gram-negative bacterium that can cause localized or systemic infection. Lemierre's syndrome, postanginal sepsis and necrobacillosis are among the systemic infections caused by F. necrophorum. Lemierre's syndrome is characterized by the development of internal jugular venous thrombosis and septic emboli following classical oropharyngeal infections in healthy young adults. In this case report, we present a 26-year-old female patient with a one-week history of back pain, shoulder pain, dyspnea and fever. She was intubated and admitted to the intensive care unit with symptoms of respiratory failure on the second day. She had high fever, leukocytosis, thrombocytopenia, cholestasis, and elevated bilirubin levels. Metastatic septic embolism in the patient's lungs, internal jugular vein thrombosis and a mycotic aneurysm were detected. After planning the treatment as meropenem, gentamicin, amphotericin B, multiseptal abscess foci were found between the paravertebral muscle plans and the deep neck fascia. In addition to antimicrobial treatment, recurrent surgical procedures were implemented. Lemierre's syndrome is a rare clinical entity which has a high rate of mortality. The present case was reported with the aim of reminding such an important disease and that early diagnosis and multidisciplinary approach is life-saving. WOS:000531866700022 2-s2.0-85089125073

To evaluate the diagnostic efficacy of intravoxel incoherent motion (IVIM) parameters in hepatitis B virus (HBV)-induced hepatic fibrosis using different calculation methods and to investigate histopathologic origins. Liver biopsies from 37 prospectively recruited chronic hepatitis B patients were obtained. Twelve b-value (0–1000 s/mm2) diffusion-weighted imaging (DWI) was performed with a 1.5 T scanner and was followed by blinded percutaneous liver biopsy. All biopsy specimens were evaluated with Ishak staging, and the microvascular density (MVD) was calculated. Patients were classified as having no/mild (F0–1), moderate (F2–3), or marked (F4–5) fibrosis. Pseudodiffusion (D*), the perfusion fraction (f), and the apparent diffusion coefficient (ADC) were calculated using all b-values, while true diffusion (D) was calculated using all b-values [D0–1000] and b-values greater than 200 s/mm2 [D200–1000]. Three concentric regions of interest (ROIs) (5, 10, and 20 mm) centered on the biopsy site were used. D* was correlated with the MVD (p = 0.015, Pearson’s r = 0.415), but f was not (p = 0.119). D0–1000 was inversely correlated with Ishak stage (p = 0.000, Spearman’s rs = − 0.685) and was significantly decreased in all the fibrosis groups; however, only the no/mild and marked fibrosis groups had significantly different D200–1000 values. A pairwise comparison of receiver operating characteristic (ROC) curves of D0–1000 and D200-1000 showed significant differences (p = 0.039). D* was the best at discriminating early fibrosis (AUC = 0.861), while the ADC best discriminated advanced fibrosis (AUC = 0.964). D* was correlated with the MVD and is a powerful parameter to discriminate early hepatic fibrosis. D significantly decreased with advanced fibrosis stage when using b-values less than 200 s/mm2 in calculations.

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

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.

Aim: Community and hospital acquired urinary tract infections (UTI) are the most common bacterial infections in all age groups. In this study, the women diagnosed UTI, which complicated and uncomplicated, were referred to outpatient clinics between 2011 and 2015 were selected. The suitability of empirical antimicrobial therapy prescribed with resistance patterns of Gram negative bacteria isolated from these patients was investigated. Methods: UTI complaining and urine culture ≥10⁵ cfu / ml of bacteria that women aged 18-65 were comprised the study group. HIS (Hospital Information System Software) was scanned for these patients and uncomplicated and complicated UTI distinction was made according to the criteria set by Infectious Diseases Society of America (IDSA, 2016). Of the 2180 patients studied, 836 were complicated and 896 were noncomplicated. Identification of Gram negative isolates in urine culture; Conventional methods and Matrix-Assisted Laser Desorption and Ionization Time-Of-Flight Mass Spectrometry (MALDI-TOF MS), (Biotyper, Bruker, Germany) systems were used. The antimicrobial susceptibilities of the isolated strains from 2011 to 2014 were determined according to the Clinical Laboratory Standards Institute (CLSI) and the isolated strains in 2015 were determined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Results: The distribution of 2180 female patients (18 to 65 years old) was urology polyclinic (68%), family medicine, infectious disease and physical medicine and rehabilitation polyclinics (19.1%), and emergency medicine polyclinic (12.6%). E. coli (84%), K. pneumonia / oxytoca (7%) and Enterobacter spp (2.6%) were the most frequently detected agents in the uncomplicated UTIs, while complicated UTI E. coli (91%), K. pneumonia / oxytoca (5.7%) and P. aeruginosa (1%) were found to be the first, second and third in the patients. Quinolones were prescribed 18.2%, phosphomycin 16.7%, nitrofurantoin 15.6%, nitrofurantoin and phosphomycin combined 16.3%, second generation oral cephalosporins 9.6% and third generation oral cephalosporins 10.7%. Resistance to quinolones, the most commonly prescribed antibiotic, was found in 19% of E. coli, 21% of Klebsiella spp., 13% of Enterobacter spp. and 9% of Proteus spp. Conclusion: When these prescriptions were compared with the results of antimicrobial susceptibility, it was observed that 38 (14%) were incompatible with the sensitivity results. It was found that 42% of cefuroxime prescriptions, 28% of quinolone prescriptions and 17% of ceftriaxone prescriptions were incompatible with the antibiogram results., Amaç: Toplum ve hastane kaynaklı üriner sistem enfeksiyonları (ÜSE), tüm yaş gruplarında en sık karşılaşılan bakteriyel enfeksiyonlardır. Bu çalışmada 2011-2015 yılları arasında polikliniklere ÜSE şikayetiyle başvuran hastalardan izole edilen Gram negatif bakterilerin direnç paternleri ile bu hastalara reçetelenen ampirik antimikrobiyal tedavinin uygunluğunun araştırıldı.Yöntemler: ÜSE şikayetiyle başvuran ve idrar kültüründe ≥10⁵ kob/ml bakteri üremesi olan 18-65 yaş arası kadın hastalar çalışma grubunu oluşturdu. HBYS (Hastane Bilgi Yazılım Sistemi)’nden bu hastaların dosyası taranarak Infectious Diseases Society of America (IDSA, 2016) tarafından belirlenen kriterler doğrultusunda komplike olmayan ve komplike ÜSE ayrımları yapıldı. Buna göre 2180 hastanın 836’sı komplike ÜSE tanısı alırken, 896’sının nonkomplike ÜSE tanısı aldığı tesbit edildi. İdrar kültüründe izole edilen Gram negatif izolatların identifikasyonu; konvansiyonel yöntemler ve Matrix-Assisted Laser Desorption and İonization Time-Of-Flight Mass Spectrometry (MALDI-TOF MS), (Biotyper, Bruker, Almanya) sistemleri ile yapıldı. İzole edilen suşların antimikrobiyal duyarlılıkları 2011-2014 yılları için Clinical Laboratory Standards Institute (CLSI), 2015 yılı için ise The European Committee on Antimicrobial Susceptibility Testing (EUCAST) önerilerine göre belirlendi. Bulgular: ÜSE şikayetiyle çalışmaya alınan 18-65 yaş arası 2180 kadın hastanın poliklinik dağılımı; %68 Üroloji, %19,1 Aile Hekimliği pol., Enfeksiyon pol ve Fizik Tedavi ve Rehabilitasyon pol. ve %12,6 Acil pol. idi. Komplike olmayan ÜSE’lerde 1., 2. ve 3. sırada en çok tespit edilen etken sırasıyla E. coli (%84), K. pneumoni/oxytoca (%7) ve Enterobacter spp (%2,6) iken, komplike ÜSE’li hastalarda 1., 2. ve 3. sırada E. coli (%91), K. pneumoni/oxytoca (%5,7) ve P. aeruginosa (%1) tespit edildi. Hastalara reçete edilen antimikrobiyallere bakıldığında; kinolonların %18,2 oranında, fosfomisin %16,7, nitrofurantoin %15,6, nitrofurantoin ve fosfomisin kombine olarak %16,3 oranında, 2. kuşak oral sefalosporinlerin %9,6 ve 3. kuşak oral sefalosporinlerin ise %10,7 oranında reçetelendiği saptandı. Ayaktan tedavi edilen hastalara en sık reçete edilen antibiyotik olan kinolonlara direnç, E.coli’de %19, Klebsiella spp.’de %21, Enterobacterspp.’de %13, Proteus spp’de % 9 olarak bulundu. Sonuç: Bu reçetelerin antimikrobiyal duyarlılık sonuçları ile uyumuna bakıldığında ise, 38(%14)’inin duyarlılık sonuçları ile uyumsuz olduğu gözlendi. Sefuroksim reçetelerinin %42, kinolon reçetelerinin %28, seftriakson reçetelerinin ise %17 oranında antibiyogram sonucu ile uyumsuz olduğu saptandı.

This paper represents the third part of a series of four publications on response history analysis for new buildings. Three real-building examples designed to a prior version of the building code are chosen, having a range of target spectrum characteristics, tectonic settings, and structural systems to test the new procedure and document its appropriate implementation. This paper describes the process of determining both MCER spectra and scenario spectra for all three examples. It explores selection of appropriate recorded ground motions and the procedure for scaling and spectrally matching to a maximum direction spectrum. Global results such as drift and treatment of unacceptable response, and local results such as force-and deformation-controlled acceptance criteria checks, are shown for each example. Practical guidance is given on implementing response history analysis for engineers employing the new Chapter 16.

Objective: this study aimed to evaluate the awareness and knowledge levels of all physicians administering immunosuppressive treatment concerning hepatitis B virus (HBV) reactivation, and draw attention to the importance of the subject through evaluation. Methods: the study was carried out by infectious diseases and clinical microbiology specialists in 37 health centers, and it was performed in Turkey between January and March 2017. All specialists providing a written consent and working in the departments of Medical Oncology, Hematology, Dermatology and Venereology, Physical Medicine and Rehabilitation, and Rheumatology of each study center were included in the study. Results: a total of 430 physicians participated in the study. Their mean age was 39.87 +/- 7.42 years, and 47.9% of them were males. During their career, 39.3% of these physicians had encountered patients developing HBV reactivation while receiving immunosuppressive treatment. The rate of encountering patients who died due to HBV reactivation was 6.5%. 97% of physicians who participated, considered the risk of HBV reactivation to be important. 70.2% of physicians stated that guidelines related to HBV reactivation and antiviral treatment for these patients were discussed in the congresses they participated, regarding their specialties. The rate of performing hepatitis screening among physicians whose patients developed HBV reactivation was statistically significantly higher than those physicians who had no patients with HBV reactivation (p, NA

HIV-1 replication is rapid and highly error-prone. Transmission of a drug-resistant HIV-1 strain is possible and occurs within the HIV-1-infected population. In this study, we aimed to determine the prevalence of transmitted drug resistance mutations (TDRMs) in 1,306 newly diagnosed untreated HIV-1-infected patients from 21 cities across six regions of Turkey between 2010 and 2015. TDRMs were identified according to the criteria provided by the World Health Organization's 2009 list of surveillance drug resistance mutations. The HIV-1 TDRM prevalence was 10.1% (133/1,306) in Turkey. Primary drug resistance mutations (K65R, M184V) and thymidine analogue-associated mutations (TAMs) were evaluated together as nucleos(t)ide reverse transcriptase inhibitor (NRTI) mutations. NRTI TDRMs were found in 8.1% (107/1,306) of patients. However, TAMs were divided into three categories and M41L, L210W, and T215Y mutations were found for TAM1 in 97 (7.4%) patients, D67N, K70R, K219E/Q/N/R, T215F, and T215C/D/S mutations were detected for TAM2 in 52 (3.9%) patients, and M41L + K219N and M41L + T215C/D/S mutations were detected for the TAM1 + TAM2 profile in 22 (1.7%) patients, respectively. Nonnucleoside reverse transcriptase inhibitor-associated TDRMs were detected in 3.3% (44/1,306) of patients (L100I, K101E/P, K103N/S, V179F, Y188H/L/M, Y181I/C, and G190A/E/S) and TDRMs to protease inhibitors were detected in 2.3% (30/1,306) of patients (M46L, I50V, I54V, Q58E, L76V, V82A/C/L/T, N83D, I84V, and L90M). In conclusion, long-term and large-scale monitoring of regional levels of HIV-1 TDRMs informs treatment guidelines and provides feedback on the success of HIV-1 prevention and treatment efforts. © Copyright 2016, Mary Ann Liebert, Inc. 2016.

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.

Disseminated Nocardia infections occur particularly in immunosuppressed hosts and are most often due to Nocardia farcinica, Nocardia nova, and Nocardia cyriacigeorgica. Here, we report an unusual case of disseminated N. farcinica infection presenting as a paravertebral abscess in a patient with systemic lupus erythematosus.

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.

Objective: We aimed to describe the risk factors for fatality among the patients with Acinetobacter baumannii bacteremia. Methods: Patients with a positive blood culture for A. baumannii by BacT/Alert (bioMerieux, Durham, NC) system were selected. Surviving and nonsurviving patients were compared in terms of demographic characteristics, underlying diseases, invasive procedures, and antibiotic resistance of the microorganisms. Therapies were evaluated according to the results of antibiotic susceptibility tests, and impact of inappropriate therapies for A. baumannii bacteremia was evaluated statistically. Results: Of the 40 patients enrolled, 21 (52.5%) died due to A. baumannii bacteremia. Univariate analysis of risk factors for fatality revealed the following parameters to be significant: >50 years of age, an APACHE II score >16, and transfer from one unit to another more than once (p 16. Overall imipenem resistance in A. baumannii was 67.5%, and carbapenem resistance among fatal cases was 76%. When the antibiotic sensitivity results were assessed, it was noted that 70% of the patients had been receiving inappropriate therapy. However, the antibiotic therapy received or initiated empirically was not shown to be a significant risk factor for mortality (p>0.05). Conclusions: Knowing the risk factors that indicate mortality in such patients and ensuring early diagnosis are of critical importance with respect to prognosis. Starting appropriate therapy by making the right decisions regarding the severity of acute and un

Alpay, Yeşim (Balikesir Author), "Background: Manynoninvasive methods, including aspartateaminotransaminase (AST)/alanineaminotransaminase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), fibrosis-4 (FIB4) index, and age-platelet index (API), have been described to determine the stage of hepatic fibrosis. However, thesemethodsare developed for patients with chronic hepatitisC(CHC) andproduce conflicting results in the prediction of liver fibrosis in patients with chronic hepatitis B (CHB). Objectives: The aim of this study was to evaluate the relationship between 7 noninvasive models, including AAR, APRI, CDS, API, FIB-4, neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW)-to-platelet ratio (RPR) in patients with CHB. Methods: The study population included all patients with CHB, undergoing liver biopsy to determine HBsAg and HBV DNA positivity in more than 6 months. Results: A total of 2520 treatment-naive CHB patients from 40 different centers were included in the study. In total, 62.6% of the patients were male, and the mean age was 40.60 +/- 12.34 years (minimum, 18 years; maximum, 77 years). The Ishak fibrosis score was >= 3 in 29.8% of the patients, indicating significant fibrosis. The mean API, APRI, CDS, NLR, FIB4, and RPR scores in the noninvasive models were significantly different between the groups with significant and low fibrosis (P < 0.05). All the noninvave models (API, APRI, AAR, CDS, NLR, RPR, and FIB4) were found to be significant in the discrimination of cirrhosis (P < 0.05). In the multiple logistic regression analysis, CDS, albumin, alkaline phosphatase (ALP), total bilirubin, neutrophil count, NLR, mean platelet volume (MPV), and FIB4 were independent indices for cirrhosis. Conclusions: In the present study, the role of noninvasive tests in the prediction of liver fibrosis stage and cirrhosis was evaluated in a large cohort of CHB patients. Overall, noninvasive models are gradually becoming more promising. Accordingly, the need for liver biopsy can be reduced with a combination of noninvasive methods in the future."

We investigated 9 cases of Crimean-Congo hemorrhagic fever (1 fatal, 2 asymptomatic) among health care workers in Turkey. Needlestick injuries were reported for 4 workers. Eight received ribavirin. In addition to standard precautions, airborne infection isolation precautions are essential during aerosol-generating procedures. For postexposure prophylaxis and therapy, ribavirin should be given., NA

Crimean-Congo Hemorrhagic fever (CCHF) is a potentially fatal viral infection with reported case fatality rates of 5–30%. Humans become infected through tick bites, by contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. In this first report in the literature, we present the characteristics of three pregnant women with CCHF infection and the outcome of their babies. Transmission of the CCHF infection could be either intrauterine or perinatal. In endemic regions, CCHF infection should be considered in the differential diagnosis of HELLP syndrome (haemolytic anaemia, elevated liver enzymes, low platelet count), and obstetricians should be familiar with the characteristics of CCHF infection. In the aetiology of necrotising enterocolitis, CCHF should be considered.

Decreased fibrinolytic activity in the serosal surfaces of peritoneal tissue appears to be a major factor in the development of peritoneal fibrous adhesions. The omentum reduces peritoneal adhesion by creating a mechanical barrier and producing fibrinolytic factors. This experimental study was designed to investigate the effects of omentectomy on the peritoneal fibrinolytic system.Thirty animals were assigned randomly to a control group or an omentectomy group. On postoperative day 10, peritoneal and blood samples were collected and adhesions were graded qualitatively. We measured the concentrations of serum and peritoneal tissue plasminogen activator, peritoneal plasminogen activator inhibitor-1, tissue plasminogen activator/plasminogen activator inhibitor complex, and hydroxyproline.Adhesions were significantly increased after omentectomy. Omentectomy also resulted in a reduction of both serum and tissue "tissue plasminogen activator" levels. On the other hand, an increment in "plasminogen activator inhibitor-1" levels was observed after omentectomy. There were no differences in "tissue plasminogen activator/plasminogen activator inhibitor" complex or "hydroxyproline" levels.Omentectomy reduced peritoneal fibrinolytic activity significantly and the peritoneal plasminogen activator system showed corruption that did not resolve with the rest of the peritoneal system after omentectomy.

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.

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.

The acetabular teardrop is an important tool for the diagnosis of acetabular dysplasia. Since it was first described by Kohler its widespread use has not become established due to the relative subjectivity in classification of the types. The acetabular teardrop angle (ATA) is proposed for this purpose, and to show the teardrop's direct relation to acetabular development by correlating it with hip ultrasonography results. Patients (51 male, 53 female) included in this study received hip ultrasonography and concomitant pelvic radiography. In the 296 hips, alpha and 0 angles were measured from ultrasonography, whilst the acetabular index (AI), ATA, teardrop distance and the transverse diameter of the most upper, most widened part of the teardrop were measured from the radiographs. The enlarged, and triangle-shaped teardrop is seen later than normal ones, and the triangle-shaped-teardrop hips have a higher AI than the normal hips. The ATA is in good correlation with the widest diameter, showing this to be a reliable tool for describing the teardrop. The ATA also has a positive correlation with the P angle denoting its significance to acetabular development. High-risk babies should be followed-up primarily with ultrasonography wherever possible. The AI from radiographs and the acetabular teardrop may be used as a helper tools in decision-making, with the guides of the ATA and the transverse diameter of the most upper, most widened part of the teardrop, as proposed in this study. (c) 2004 Lippincott Williams T Wilkins. C1 Pamukkale Univ, Dept Orthoped & Traumatol, Denizli, Turkey.

Summary Atlantoaxial subluxation is a rare complication of the upper neck inflammatory processes of head and neck region. Grisel's syndrome is a non-traumatic subluxation of the atlanto axial joint. It is not associated with trauma or bone disease. It typically occurs in children after serious infection in the head and neck region. Several theories have been proposed to explain the pathogenesis of inflammatory subluxation. The primary treatment of Grisel's syndrome is medical. We report a case of atlantoaxial rotatory subluxation treated with external fixation and antibiotic therapy.

WOS: 000264945300010, PubMed ID: 19246100, Objective: The aim of this study was to evaluate the efficacy of oral ribavirin treatment in patients with Crimean-Congo haemorrhagic fever (CCHF). Methods: In 2004, all patients diagnosed with CCHF were treated with oral ribavirin, however in 2003 none of the CCHF patients had been given treatment due to Lack of confirmatory diagnostic information at that time in Turkey. In this study, patients treated with ribavirin in 2004 (n = 126) were compared with ribavirin-untreated CCHF patients (n = 92) in 2003. Patients only with a definitive diagnosis of CCHF (clinical symptoms plus the presence of specific IgM antibodies against CCHF virus and presence of viral antigen) were included in this study. Results: There was no difference in the case-fatality rate between treated and untreated patients (7.1% vs. 11.9%; P > 0.05). A Cox Proportional Hazards regression analysis revealed that altered sensorium and prolonged international normalized ratio were independent predictors of mortality. Conclusion: Our results showed that oral ribavirin treatment did not improve the survival rate in CCHF patients. Ribavirin and supportive care are the only available choices for treatment of CCHF patients, but to ascertain the efficacy of ribavirin, more laboratory and observational studies are necessary and ultimately, to elucidate these conflicting results and evaluate the efficacy undoubtedly, a multicenter randomised controlled trial will be needed. (C) 2009 The British Infection Society. Published by Elsevier Ltd. All rights reserved., Turkish Ministry of Health, We would like to thank our colleagues from the Turkish Ministry of Health for their contributions.

Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral infection that involves multiple organs, and endothelium. We described abdominal sonographic findings of the patients infected with the Crimean-Congo hemorrhagic fever virus (CCHFV) in relation to the severity of the disease. This is a prospective study performed among hospitalized patients infected with CCHF between 2005 and 2011. A total of 210 hospitalized patients with confirmed CCHF infection were included in the study. The mean age was 47 and 49.5% of the patients were female. Patients were classified as mild, moderate, or severe disease according to their clinical and laboratory findings. The relationship between the clinical severity of CCHF and the abdominal sonographic findings was analyzed. Sonographic findings of abdomen included gallbladder wall thickening (GBWT) in 44 (21%), splenomegaly in 39 (19%), hepatomegaly in 52 (25%), decrease in echo of liver parenchyma in nine (4%), increase in echo liver parenchyma in 13 (6%), intra-abdominal fluid collection/ascites in 23 (11%), and enlarged periportal lymph nodes in seven (3%) cases. GBWT was detected in 3% of mild patients, 23% of moderate patients, and 61% of severe patients (p

Introduction : The objective of this study was to determine the transmitted drug resistance mutations (TDRMs) in newly diagnosed HIV-1 positive patients in Turkey. Material and Methods : The study was carried out between 2009 and 2014 and antiretroviral naive 774 HIV-1 infected patients from 19 Infectious Diseases and Clinical Microbiology Departments in Turkey were included; gender: 664 (86%) male, median age: 37 (range; 1–77), median CD4+T-cell: 360 (range; 1–1320) count/mm 3 , median HIV-RNA load: 2.10+E6 (range; 4.2+E2–7.41+E8) IU/mL. HIV-1 drug resistance mutations were detected by population based sequencing of the reverse transcriptase (codon 41–238) and protease (codon 1–99) domains of pol gene of HIV-1, and analyzed according to the criteria by the World Health Organization 2009 list of surveillance drug resistance mutations [1]. Results : The patients had TDRMs to NRTIs (K65R, M184V), NNRTIs (K101E, K103N/S, G190A/E/S, Y181I/C, Y188H/L) and PIs (M46L, I54V, L76V, V82L/T, N83D, I84V, L90M). The prevalence of overall TDRMs was 6.7% (52/774). Resistance mutations were found to be 0.7% (6/774), 4.1% (32/774) and 2.1% (17/774) to NRTIs, NNRTIs and PIs drug groups, respectively. Three patients had NRTIs+NNRTs resistance mutations (M184V+K103N) as multi-class drug resistance. However, thymidine analogue resistance mutations (TAMs) determined two distinct genotypic profiles in the HIV-1 reverse transcriptase: TAM1: M41L, L210W and T215Y, and TAM2: D67N, K70R, K219E/Q, and T215F. The prevalence of TAM1 and TAM2 were 7.7% (60/774) and 4.3% (34/774), respectively. Conclusions : The TDRMs prevalence of antiretroviral naive HIV-1 infected patients may be suggested current situation of Turkey. These long-term and large-scale results show that the resistance testing must be an integral part of the management of HIV infection in Turkey. (Published: 2 November 2014 ) Citation: Abstracts of the HIV Drug Therapy Glasgow Congress 2014 Sayan M et al. Journal of the International AIDS Society 2014, 17(Suppl 3) :19750 http://www.jiasociety.org/index.php/jias/article/view/19750 | http://dx.doi.org/10.7448/IAS.17.4.19750

In this paper, we study coordination mechanisms through penalty schemes between manufacturing and marketing departments which enable organizations to match demand forecasts with production quantities. This research was motivated by our interactions with a leading electronics and computer manufacturer. We consider two possible organizational structures – centralized and decentralized. In the decentralized case we model a single period problem where demand is uncertain and the marketing department provides a forecast to manufacturing which in turn produces a quantity based on the forecast and the demand distribution. In the centralized case, marketing and manufacturing jointly decide on the production quantity. Among other results we show that by setting suitable penalties one can generate the same result in a decentralized system as that obtained from a centralized system. We also show that setting the correct penalty for marketing is essential for coordination. Subsequently, we analyze models where the marketing department has the ability to change the distribution of demand based on efforts (through promotion, advertising and personal relationship with customers). An interesting result indicates that it is possible to set penalties so that a coordinated decentralized system outperforms a centralized system when there are no tangible costs to the firm for the efforts expended by the marketing department.

An unusual cause of acute abdominal pain simulating acute appendicitis is presented. The patient was admitted with complaints of fever, malaise, headache, nausea, vomiting, diarrhoea, and severe bleeding. Based on the clinical and epidemiological findings, a diagnosis of Crimean Congo hemorrhagic fever virus infection was suspected, and ribavirin therapy was started. While her clinical condition was improving, she experienced a sudden pain at her right lower quadrant of the abdomen. Explorative laparotomy revealed haemorrhage within the abdominal muscles. Her CCHF IgM was found to be positive.

Background Patients infected with Crimean-Congo hemorrhagic fever (CCHF) virus present with a wide clinical spectrum. In observational studies, the effects of therapeutic agents are confounded by severity. We describe use of a clinical severity scoring index (SSI) for CCHF patients and assess the effect of ribavirin and corticosteroid therapy on the case-fatality rate, stratified by SSI. Methods The study group included hospitalized patients who received a diagnosis of CCHF at the Infectious Diseases and Clinical Microbiology Clinic of Ankara Numune Education and Research Hospital between 2004 and 2011. The SSI included platelet count, bleeding, fibrinogen level, activated partial thromboplastin time, and somnolence. The effects of ribavirin and corticosteroid on the case-fatality rate were studied by univariate and multivariate analysis, stratified by SSI. Results Two hundred eighty-one confirmed cases of CCHF were included in the study. Of 281 patients, 23 (8%) died. The mean age (±SD) of the patients was 47 ± 16 years. Forty-nine percent were female. The mean duration of stay at our clinic after onset of symptoms was 4.4 days, with a range of 1-14 days. In multivariate analysis of factors for the prediction of death, the SSI (odds ratio [OR], 3.27; 95% confidence interval [CI], 2.09-5.13) and ribavirin use (OR, 0.04; 95% CI, .004-.48) were found to be statistically significant factors. Conclusion The SSI is an accurate predictor of death and will therefore be a useful tool for case management and for drug-assessment studies. After stratification of cases by SSI, ribavirin was found to be effective in reducing the case-fatality rate, especially among moderately ill patients, whereas steroids were found to be beneficial particularly among patients with severe disease.

A total of 900 patients were screened for methicillin-resistant Staphylococcus aureus (MRSA) on hospital admission, and 11 MRSA strains (1.2%) were detected. All 11 MRSA strains were positive for the mecA and PVL genes. Eight of the 11 MRSA-positive patients (72%) had a history of hospitalization within the previous 12 months.

In this study, we endeavored to determine whether the incidence of cholelithiasis (CL) was increased in chronic renal failure (CRF) patients with secondary hyperparathyroidism on a peritoneal dialysis (PD) program. We also evaluated the factors that might have some influence on the development of CL.A total of 59 CRF patients undergoing PD were included in the study. We studied the following groups to determine whether parathyroid hormone (PTH) levels were increased in CRF-PD patients: twenty patients with secondary hyperparathyroidism (group 1) and 39 patients with normal PTH levels (group 2). PTH levels were maintained at three times the upper limit of normal. Biochemical parameters were obtained for each CRF-PD patient. All patients underwent abdominal ultrasonography to screen for the presence of cholelithiasis. For statistical analysis, chi2, t test, and logistic regression analysis were used; p0.05 was considered as significant.We found an almost ten times higher incidence (25% vs. 2.6%) of CL in group 1 patients with statistical significance (p = 0.007). When the incidence of CL according to sex, creatinine, and PTH levels were considered, female gender, creatinine, and PTH levels were higher in group 1, which was also significant statistically. No significant relationship was detected between gallbladder stone formation and the other analyzed biochemical parameters.We found that the incidence of CL in CRF-PD patients with secondary hyperparathyroidism was higher than CRF-PD patients with normal PTH levels. It was also detected that female gender, high creatinine levels, and elevated PTH levels might influence the development of CL in CRF-PD patients.

Background To investigate the immune status of health care workers (HCWs) against measles, rubella, mumps, and varicella zoster (MMRV) in Turkey and to define an appropriate vaccination program among HCWs. Methods Voluntary HCWs from a children's hospital and a general hospital were included in the study between March and May 2005. The specific IgG antibodies against MMRV viruses were screened by ELISA. Results Three hundred sixty-three HCWs participated in the study; 186 (51%) were physicians, 118 (33%) were nurses, 36 (10%) were housekeeping staff, and 23 (6%) were medical technicians. The proportion of HCWs who had antibodies against measles was 98.6%; rubella, 98.3%; mumps, 92.2%; and varicella, 98%. No association was found between the susceptibility to at least 1 of MMRV virus infections and gender, age, duration of work, profession, and department of work in analysis either among the whole study group, or each hospital. The positive predictive value for the history of varicella was 100%, whereas it was 92% for MMR. The cost of vaccination for varicella was significantly expensive without screening before vaccination. However, there was not much difference for MMR infections. Conclusion A policy based on obtaining the history of varicella infection from the staff and then screening the ones with negative history and vaccination of only seronegative HCWs was found to be appropriate.

In a prospective randomized study of plantar heel pain, 44 patients were treated with injection of 1 mL of 2% prilocaine using the peppering technique, 1 mL of 2% prilocaine combined with 2 mL of autologous blood, or 1 mL of 2% prilocaine mixed with 40 mg of methylprednisolone acetate. At 6-month follow-up, clinical improvement was evaluated by using a 10-cm visual analog scale and the rearfoot score of the American Orthopaedic Foot and Ankle Society. Results were analyzed using sample t-tests within groups and repeated-measures analyses of variance between groups. Mean +/- SD visual analog scale scores in the peppering technique, autologous blood injection, and corticosteroid injection groups improved from 6.4 +/- 1.1, 7.6 +/- 1.3, and 7.28 +/- 1.2 to 2.0 +/- 2.2 (P

We investigated the role played by cytokines in the mortality of patients with Crimean-Congo hemorrhagic fever (CCHF). Serum levels of several cytokines were measured in 3 patients with fatal CCHF and in 27 patients with nonfatal CCHF. Levels of interleukin (IL)-6 (P< or = .001) and tumor necrosis factor (TNF)-alpha (P = .004) were significantly higher in patients with fatal CCHF than in patients with nonfatal CCHF, whereas levels of IL-10 were not significantly different between the 2 groups (P = .937). Disseminated intravascular coagulation (DIC) scores were also higher in the patients with fatal CCHF (P = .023). Levels of IL-6 and TNF-alpha were positively correlated with DIC scores, whereas levels of IL-10 were negatively correlated with DIC scores. In conclusion, these findings demonstrate that proinflammatory cytokines play a major role in the mortality of patients with CCHF.

To determine cognitive and emotional changes among neurobrucellosis patients.The patients with neurobrucellosis and controls with brucellosis without neurologic involvement were included in the study. Neurobrucellosis was diagnosed by the following criteria: (i) symptoms or clinical findings compatible with neurobrucellosis, including headache, confusion, mental and emotional changes; (ii) isolation of Brucella spp. from CSF and/or demonstration of antibodies to Brucellaor = 1/4 in the CSF; (iii) the presence of lymphocytosis, increased protein and decreased glucose levels in the CSF; and (iv) clinical improvement with appropriate treatment. Two psychiatrists interviewed the patients, and performed the Hamilton Depression Rating Scale (HDRS) tests and Mini-Mental State Examination (MMSE) tests.Thirty-four neurobrucellosis cases and 30 patients with brucellosis without neurological involvement were studied. The mean age was 41 years, 12 (41%) patients were female, 13 (46%) patients were farmers, and 7 (25%) patients were housewives. Among the neurobrucellosis cases, before the antibiotic therapy, the mean MMSE test score was 21.6, one week after the therapy 22.7, and two weeks after the therapy 24.3 (p=0.024, and p0.001, respectively). At the day of admission before therapy, the mean of HDRS test was 9.9, one week after therapy it was 7.8, and two weeks after therapy it was 5 (p=0.014, and p0.001, respectively).The cognitive and emotional disturbances among neurobrucellosis patients were documented by MMSE and HDRS tests. These disorders improve by antibiotic therapy, without any anti-depressive or anti-psychotic therapy.

The Hirayama’s disease affects the neurons of the anterior horn of the spinal cord, usually C7 -T1 in young individuals, which causes weakness of the distal muscles of the upper limbs. We report a case of a 14 years old patient presented with significant left hand weakness associated with difficulty gripping objects. After performing a resonance of the cervical spine, there were few hyperintense signals in the anterior horn at the C5-C6 segment. In this situation we can differentiate this case from other conditions, making the correct diagnosis. It is important to report it due to the necessity of better methods that can perform the diagnosis.

We describe the epidemiological, clinical, and laboratory findings and the role of ribavirin therapy for 35 patients who received a diagnosis of Crimean-Congo hemorrhagic fever (CCHF). All patients had immunoglobulin M antibodies and/or PCR results positive for CCHF virus in blood or tissue specimens. Eighty-six percent of the patients were considered to have severe cases of CCHF. The overall case-fatality rate was 2.8%. Eight patients were given ribavirin, and all 8 survived. We suggest using ribavirin to treat patients with CCHF, particularly those with severe cases.

The aim of the study was to determine the risk factors for acquiring brucella infection among healthcare workers (HCWs). The study was performed in Ankara Numune Education and Research Hospital, Turkey, before the introduction of Biosafety III measures. A questionnaire was given to HCWs, who were at risk of brucella infection. Twelve HCWs with brucella infection were detected, an incidence of 8% per employee-year. A multivariate analysis of risk factors in seven of the cases and 48 control HCWs was performed. Male physicians were found to be associated with a higher risk of acquiring brucella infection [odds ratio, 25.3; confidence interval (CI), 2.3-283.7; P=0.008]. Using gloves was found to be protective (odds ratio, 0.02; CI, 0.008-0.4; P=0.017).

SummaryWe aimed to detect antibodies against Crimean-Congo hemorrhagic fever virus (CCHFV) in healthcare workers (HCWs) in an endemic region. The study was conducted in a tertiary care hospital that had cared for CCHFV infected patients in the period 2002–2003. The sera from the HCWs were collected one month after the last admitted hospital case (October 2003), and sent to the Pasteur Institute, Lyon, France to be studied for CCHF IgM and IgG by ELISA. The total number of HCWs included in the study was 75; the median age was 30, 68% of the subjects were female, and 83% of the HCWs were at risk of exposure to the body fluids of patients. Only one HCW from the group without risk of exposure was CCHF IgG positive. The adherence rate to universal precautions was high. In conclusion, a lack of CCHFV transmission from patients to HCWs was observed. This result could be related to the high rate of compliance to the universal precautions, which are sufficient to protect against CCHFV infection.