Search

Objectives: Paritaprevir/Ritonavir/Ombitasvir/Dasabuvir (PrOD) seems to be highly effective and safe in chronic haemodialysis (CHD) patients. We presented our experiences of treatment with PrOD in CHD patients.

WOS: 000471726700008, PubMed ID: 30989418, Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

Background/aim: The aim of this descriptive article is to share the experience in Ege University, Turkey with favipiravir in the treatment of severe SARS-CoV-2 pneumonia. Materials and methods: This retrospective descriptive study included patients diagnosed with COVID-19 who presented with or developed severe pneumonia. Results: Forty patients who completed a full course (at least 5 days) of favipiravir were included in the study. At baseline, 30 (75%) patients required treatment for respiratory distress. Thirty-three patients (82.5%) were discharged from the hospital with full recovery, 6 patients (15%) died and 1 case (2.5%) was still at the intensive care unit (ICU) when this paper was written. Conclusion: This study provides relevant information for the treatment of COVID-19, suggesting that favipiravir was associated with significant clinical and laboratory improvements in the majority of the patients, is a safe drug with no serious side effects and would merit further investigation.

Background/Aims: Despite surgical advances in liver transplantation and effective prophylactic strategies, posttransplant infections are the most important cause of morbidity and mortality. Diagnosis and management of infections because of developing immunosuppression is difficult and adversely affects mortality. This study aimed to review bacterial and fungal infections in patients after liver transplantation and to reveal the resistance rates. Materials and Methods: A total of 107 patients who underwent liver transplantation between January 2017 and February 2018 were evaluated retrospectively with regard to demographic characteristics, causes of transplantation, conditions that may lead to infection, postoperative infections, pathogens, and resistance patterns. Results: of the 107 patients who underwent liver transplantation, 48 (44.8%) had an infection. Bacterial infections were detected in 41% of the patients, and fungal infections were found in 13%. When we compared living and cadaveric transplants in terms of infection development, these rates were found to be 53% and 33%, respectively (p=0.034). No statistically significant results could be obtained when evaluating conditions such as sex, presence of underlying primary disease, Model for End-Stage Liver Disease MELD score, diabetes status, total parenteral nutrition, and risk factors for infection. Conclusion: After liver transplantation, infections are often seen in the first month of the postoperative period. Knowing the most common pathogens and resistance states in this process reduces infection-related deaths by providing appropriate treatment regimens at the right time., Infect Dis & Clin Microbiol Special Soc Turkey

Objectives: the aim of this study was to compare the antibacterial activity of ceftaroline versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis in an experimental rabbit meningitis model. Methods: the antibacterial activity of ceftaroline was compared with vancomycin in the treatment of meningitis induced by MRSA strain ATCC 43300 in an experimental rabbit meningitis model. Quantitative cerebrospinal fluid (CSF) cultures were performed at the beginning of antibiotic treatment and 24 h and 73 h after the first antibiotic dose. Furthermore, in vitro time-kill data were investigated at 0, 2, 4, 6, 8, 12 and 24 h in sterile human serum. Results: the difference between the control group versus both treatment groups was significant when comparing the decrease in colony counts in CSF both at 24 h and 73 h after the first antibiotic dose (P < 0.05). At the end of the experiment, there was a significant difference in survival between both the ceftaroline-treated group and the vancomycin-treated group versus the control group, but not between the two treatment groups. Conclusion: These results suggest that the antibacterial activity of both ceftaroline and vancomycin are similar in the treatment of MRSA meningitis in an experimental rabbit meningitis model. (C) 2020 the Authors. Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy., Ege University (Izmir, Turkey)Ege University, This study was funded by Ege University (Izmir, Turkey).

Background/Aims: Ledipasvir (LDV) and sofosbuvir (SOF) as single-tablet regimen (STR) has been approved for treatment of chronic HCV infection (CHC) for treatment-naive or experienced cirrhotic or non-cirrhotic patients. Our aim was to analyse the effectiveness and safety of 12-24 weeks treatment of LDV/SOF (90mg/400 mg)+/- ribavirin in a real-life setting in Turkey. Materials and Methods: Between May-Dec 2016, 104 treatment-naive or experienced adult patients with CHC and with or without cirrhosis (including decompensated cirrhosis) were included in this observational study. Patients were administered LDV/SOF STR +/- ribavirin once daily for 12-24 weeks. SVR12 rates and effects of the baseline characteristics on SVR12 rates were assessed. Results: Out of 104 enrolled patients (61.5% female, mean age 62.0 years); 60.6% were cirrhotic, 76.0% previously used peg-IFN, 94.2% had GT1. At the end of the treatment, 77.8% (77/99, no data for 21 patients) had undetectable HCV-RNA and 98.9% (94/95) had SVR12. in the baseline characteristics subgroups, the SVR12 rates varied between 94.4% and 100%, and none of the baseline characteristics had a significant effect on the SVR12 rates. During the study, 6 (5.8%) patients died and none of the deaths was suspected to be related to the LDV/SOF. No treatment-emergent adverse event was reported. Conclusion: in conclusion, LDV/SOF +/- ribavirin yielded very high SVR12 rates, without any safety or tolerability concern in Turkey. the effectiveness of the LDV/SOF treatment was not affected by the patient demographics or medical characteristics such as fibrosis level, cirrhosis status, previous treatment status, HCV-RNA level or HCV genotype., Gilead Sciences, TurkeyGilead Sciences, This study was supported by Gilead Sciences, Turkey for editorial support in the preparation of this manuscript.

WOS: 000449010500007, PubMed ID: 30381274, Background/Aims: Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT. Materials and Methods: Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation). Results: A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring, the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally established. Conclusion: LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.

WOS: 000419586300002, The aim of this study was to screen the patients with solid organ malignancy for HBV (Hepatitis B virus) infection before the start of chemotherapy and follow up in the oncology department of our setting. All cases admitted to oncology department for chemotherapy were screened prospectively for HBV infection and reactivation between March 2013-September 2014. A total of 225 patients were included in the study and divided into 3 groups; Group I: having recovered past HBV infection: 43 patients (19.1%), Group II: isolated Anti-HBcAg total positive: 20 patients (8.9%) and Group III: chronic HBV infection with 10 patients (4.4%). HBV reactivation developed in one (5.9%) of 17 patients in group II, and two (28.6%) of seven patients in group III while under lamivudine prophylaxis. Neither hepatitis flare by HBV reactivation nor HBV-related death were observed in our study. In the moderate endemicity areas like Turkey for HBV infection, all patients must be screened for HBV before starting of chemotherapy.

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.

Introduction: Although diabetic foot infections are polymicrobial, gram-positive microorganisms comprise the majority. Daptomycin is a novel agent in treating infections due to multidrug-resistant gram-positive pathogens. In this multicenter study, the outcomes of the daptomycin treatment were evaluated retrospectively in the treatment of diabetic foot infectious without osteomyelitis. Materials and Methods: Patients with diabetic foot infection without osteomyelitis and who received daptomycin treatment were included into the study. Sociodemographic characteristics of the patients, risk factors for methicillin resistant Staphylococcus aureus (MRSA), antimicrobial treatment, and the data of microbiological and clinical outcomes of the cases were registered in a standard form by eleven centers. Clinical success was defined as a combination of end-of-treatment laboratory parameters, clinical and microbiological responses. Results: A total of 46 patients (30 males, 16 females) were clinically evaluated for the outcome of daptomycin therapy. Mean age was 61.09 ± 11.82 years (31-81) and mean diabetes duration was 13 ± 8.2 years. The number of mild, moderate and severe infections identified according to the infection scoring system of the Infectious Diseases Society of America (IDSA) were 12 (26.1%), 25 (54.3%), and 9 (19.6%) respectively. Duration of daptomycin therapy was 17.5 ± 9.3 days and overall daptomycin success rate was 82.6% (n= 38). Two patients developed side effects. Conclusion: The clinical success rate of this study which assessed the efficacy of daptomycin in diabetic foot infections was 82.6%. Daptomycin can be safely used even in severe cases having had no success with previous antibiotic therapy.

In this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 ± 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.

WOS: 000401318800009, Objectives: Interferon (IFN) treatment has many neuropsychiatric side effects such as depression and anxiety disorder. Although untreated depression is a major contributor to dosage reduction or premature discontinuation of the IFN treatment, it is found that depressive symptoms among patients undergoing hepatitis C virus (HCV) treatment are commonly overlooked during routine clinical interviews. Besides depression, anxiety disorders are shown to affect adherence to pegylated IFN (Peg-IFN) treatment in patients with hepatitis C. Despite the occurrence of neuropsychiatric side effects of IFN treatment being widely reported in patients with hepatitis C, there are few studies studying patients infected with hepatitis B virus (HBV). The aim of this prospective study was to evaluate the incidence and risk factors of depressive and anxiety disorders that occur during Peg-IFN treatment of patients with HBV. Methods: The sample consisted of volunteer patients who were diagnosed with HBV infection and who were decided to receive IFN treatment. During the study period, all consecutive patients with HBV infection and who would have IFN treatment were informed about the study and invited to participate. Thirty-seven chronic hepatitis B (CHB) patients were recruited for the study, but four of them were excluded due to psychiatric diagnosis at the initiation of the treatment. Therefore, the sample consisted of 33 patients with CHB, meeting the inclusion criteria. The participants had psychiatric assessment before the treatment and at 1st, 3rd, 6th, and 12th months. At each visit, the subjects were assessed with Clinical Global Impressions Scale, Hamilton Rating Scale for Depression (HRSD), and Hamilton Anxiety Rating Scale (HAM-A). Results: Among the 33 patients with HBV, 22 (66.7%) were men. Mean age was 35.97 +/- 10.73 years. While follow-up, 6 patients dropped out from the study. Also, 13 patients were excluded from the study as they developed depression and/or anxiety disorder. Mean baseline HRSD and HAM-A scores were smaller than the following visits' scores. The difference was not statistically significant only for the 12th month assessments. Totally 14 (42.4%) patients developed depression/anxiety disorder during 1 year follow-up. Six (42.86%) of them received the diagnosis at the 1st month, 3 (21.43%) at the 3rd, 4 (28.57%), at 6th months, and 1 (7.14%) at the 12th month. When we compared the patients who developed depression/anxiety disorder with the patients who did not develop any psychiatric disorder, we found that the mean baseline HRSD score (t = 2.303, p =.028) and female percentage (p =.017) were statistically significantly higher in the depression/anxiety disorder group. Conclusions: There is an incidence of 42.4% for depression and/or anxiety disorders during Peg-IFN treatment. Females and patients with subsyndromal depressive symptoms should be referred to a psychiatrist and closely monitored especially for the first three months of the IFN treatment.

Almost 75% of women experience vulvovaginal Candida infection at least once during their lifetime and 90% of these infections are due to Candida albicans (Marchaim et al. 2012). Both diagnosis and ...

Visceral Leishmaniasis (VL) is a parasitic disease frequently seen in Mediterranean countries, including our country, which still constitute a major public health problem. In this study, it was aimed to investigated retrospectively 20 cases diagnosed with visceral leishmaniasis (VL) among the cases referred from different clinics/centers for further examination to our department due to fever of unknown origin in terms of demographic characteristics, underlying diseases, laboratory, clinical data and treatment results between 2007-2017. Adults with chronic systemic diseases are always at risk in endemic regions and VL should be considered in differential diagnosis, particularly in cases of fever of unknown origin.

PubMedID: 30498901 Purpose: In this multicentre, retrospective, matched cohort study we aimed to evaluate the outcomes of neutropenic fever cases that were treated with daptomycin or a glycopeptide (vancomycin or teicoplanin). Methods: Data and outcomes of adult (aged > 18-years old) patients with neutropenic fever [(1) without clinical and radiological evidence of pneumonia, (2) who were treated with daptomycin or a glycopeptide (teicoplanin or vancomycin) for any reason and for at least 72 h] were extracted from the hospital databases. Matching was performed with all of the three following criteria: (1) underlying disease, (2) reason for starting daptomycin or glycopeptide (microbiologic evidence vs. microbiologic evidence, clinical infection vs. clinical infection and empirical therapy vs. empirical therapy) and (3) neutropenic status. Results: Overall 128 patients [(69/123) (56.1%) in the daptomycin cohort (D) and 59/123 (48%) in the glycopeptide cohort (G)] had a resolution of fever at the end of 72 h antibiotic treatment (p = 0.25). There was no significant difference in cured, improved and (cured + improved) rates between (D) and (G) cohorts as well as fever of unknown origin cases or microbiologically confirmed infections or clinically defined infections subgroups (p > 0.05). There was also no significant difference (p > 0.05), in terms of persistent response in the (D) versus (G) cohorts, Conclusions: These findings suggest that although not better, daptomycin efficacy is comparable to vancomycin if used as empiric therapy in the treatment of adult febrile neutropenia. We conclude that daptomycin may be used at least as a salvage therapy alternative to glycopeptides in the treatment of adult febrile neutropenia cases. A large, randomized-controlled trial may further consolidate the evidence related to this question. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

Actinomycosis is a chronic, suppurative disease caused by gram-positive anaerobic bacteria from the Actinomycetaceae family. Actinomyces israelii is the most commonly encountered cause of actinomycosis. Other Actinomyces species responsible for actinomycosis are A. odontolyticus, A. meyeri, A. naeslundii, and A. viscosus. Based on the site of involvement, the four most common forms are cervicofascial, abdominal, thoracic and pelvic actinomycosis. Purulent matter, sputum, vaginal discharge, fistulae content or tissue biopsy specimens are generally used to diagnose actinomycosis. However, it is very difficult to identify Actinomyces in these samples due to other filamentous and anaerobic bacteria. In this study, we evaluated actinomycosis cases who were followed up in Ege University Infectious Diseases and Clinical Microbiology Clinic between 2011 and 2016, retrospectively. Cases were evaluated in terms of age, gender, form of application, symptoms, underlying diseases, location of infection, diagnosis, and treatment. Six patients [five women; mean age 52.16 ± 21.21 (min 20-max 83)] were included into this study. Two patients had pelvic, two had cervicofascial, one had skin involvement and one had pulmonary, skin and brain actinomycosis. As a result, actinomycosis is a rare and serious disease. Unless considered in differential diagnosis, appropriate treatment may be delayed. This cohort is one of the largest series reported in Turkey. Being aware of risk factors and clinical forms as well as being skeptical are important fordiagnosis and treatment.

PubMedID: 29960893 Objectives: In this study we retrospectively reviewed A. baumannii meningitis cases treated with tigecycline including regimens and evaluated the efficacy of tigecycline in the therapy. Patients and Methods: Study was performed in seven tertiary-care educational hospitals from five cities of Turkey and one center from France. We extracted data and outcomes of all adult (aged >18) patients with culture proven A. baumannii meningitis treated with tigecycline including antibiotic therapy until April 2016. Results: A total of 23 patients (15 male and eight female) fulfilled our inclusion criteria. All Acinetobacter strains were carbapenem-resistant and susceptible to tigecycline. Six cases received tigecycline monotherapy while 17 received tigecycline including combination therapy (10 with colistin, 4 with netilmicin, 3 with amikacin, 4 with meropenem). Seven of 23 cases (30%) died during the tigecycline including therapy (1 in monotherapy, 4 in colistin, 2 in netilmicin, 1 amikacin, one case received tigecycline + netilmicin followed by tigecycline + colistin). Hence, overall end of treatment (EOT) success was 70%. However, since further 27% died due to additional nosocomial infections, overall clinical success (relieved symptoms at the EOT and one-month post-therapy survival without any relapse or reinfection) decreased to 43%. Conclusion: We conclude that tigecycline may be an alternative in the salvage treatment of nosocomial multidrug-resistant Acinetobacter spp. meningitis. Acinetobacter spp. Meningitis. © 2018 Elsevier B.V.

WOS: 000407294300013, Introduction: Hemophilia is a genetic disease presenting predominantly with joint hemorrhages in clinical course. Thus, its treatment requires transfusion of numerous blood and blood products. As a consequence, hemophilia patients are under high risk of many transfusion-borne infections, especially viral hepatitis and human immunodeficiency virus infection. Measures should be taken to prevent the transmission of blood-borne diseases in these patients. Vaccination against hepatitis A and B and patient education are especially crucial for prevention. The aim of this study was to evaluate hemophilia patients' knowledge on viral hepatitis and to test whether their knowledge could be improved by a two-hour training program. Materials and Methods: The study was conducted on June 6, 2015 during a full-day educational program on different topics for hemophilia patients being followed by the Department of Internal Medicine, Hematology Division at Ege University Faculty of Medicine. Twenty-four participating patients filled up pre-test questionnaires, followed by a training given by an expert. The same questionnaire was distributed as a post-test after the training session. There were 18 questions in the questionnaire, comprising six questions on socio-demographic characteristics, eight true/false questions on knowledge about hepatitis and four questions on their vaccination status. Pre-and post-tests were compared with the McNemar test. Results: The mean age of the participating 24 patients was 37.0 +/- 13.0 (20-67) years. The mean duration since the diagnosis of hemophilia was 32.7 +/- 12.8 (6-60) years. Among the participants, one had chronic hepatitis B, two had chronic hepatitis C and the rest were unaware of their viral hepatitis status. Before the training, 19 patients had heard of hepatitis B, 17 had heard of hepatitis A and C, four had heard of hepatitis D and two had heard of hepatitis E. Only two patients knew the routes of transmission of hepatitis A correctly. The patients had misconceptions on the transmission routes of hepatitis B and C. After the training, their information on the fact that hepatitis A is spread primarily through contaminated food or water, hepatitis C can be transmitted via sexual intercourse, there are vaccines to prevent hepatitis A and a vaccine against hepatitis C is not available yet, improved significantly. Conclusion: Patient education programs targeting special high-risk groups such as haemophilia patients could both increase their knowledge and render prevention of viral hepatitis possible.

Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products., Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016)., Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p, Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well.

Background Local and systemic use of azole derivatives are common in the treatment of vulvovaginal candidiasis. However, there are cases unresponsive to these agents. Herein, we present treatment and follow-up of a patient with fluconazole–itraconazole and voriconazole-resistant recurrent vaginal candidiasis. Methods A 37-year-old woman with no comorbidity used topical and oral antifungal/antibacterial medications (including fluconazole and itraconazole) in the treatment of recurrent vulvovaginitis, was hospitalized due to continuous complaints. Intense, white-colored, odorless vaginal discharge was observed on physical examination. Urine and vaginal swab samples were taken for mycological and bacteriological culture. Metronidazole (500 mg 3x1 i.v.) and high dose fluconazole (600 mg/day i.v.) were initiated empirically for the possibility of dose-dependent resistant Candida infection, but there was no clinical response. Results Candida albicans was isolated in vaginal swab culture, but response to systemic fluconazole treatment for one week was inadequate. Antifungal susceptibility test was performed by microdilution method according to CLSI M27A3 guidelines and MIC values were reported respectively; fluconazole 4 µg/mL (SDD), itraconazole 1 µg/mL (R), posaconazole 0.06 µg/mL (WT), voriconazole 0.25 µg/mL (SDD), anidulafungin ≤ 0.015 µg/mL (S), amphotericin B 0.06 µg/mL (WT). For the resistance mechanism, point mutation in the ERG11 gene and MDR1 and MDR2 from efflux pumps were investigated and only the G464S mutation was detected in the ERG11 gene. Treatment was switched to IV anidulafungin (200 mg on day 1 followed by 100 mg/day). Clinical response was achieved in the patient whose complaints were reduced, and there was no Candida in the repeated vaginal swab culture taken on day 3 of treatment. The patient was discharged after 2 weeks of treatment. She had no recurrence after 2 years follow-up. Conclusion It should be kept in mind that resistant strains may be responsible for recurrent and unresponsive vulvovaginal candidiasis cases. Although there is no case report in which anidulafungin is used for treatment and it should be kept in mind that the anidulafungin is also in the treatment as it is summarized. Disclosures All authors: No reported disclosures.

Objectives: We aimed to determine tetanus antitoxin levels and to evaluate their relationship with history of vaccination among patients applying to the outpatient clinics of a University hospital. Methods: A questionnaire including socio-demographic characteristics and tetanus vaccination status was applied and blood samples taken from 218 subjects between 1 and 30 June 2015. Participants were classified into five groups according to their vaccination timing. Results: The mean age of participants was 46.7±15.4 years and 134 (61.5%) were women. Tetanus antitoxin levels were found weak positive in 54 (24.8%) patients, positive in 44 (20.2%) and strong positive in 120 (55.0%). Tetanus antitoxin level positivity was significantly associated with vaccination timing according to history. Among 105 participants who did not remember being vaccinated or who knew they were vaccinated but did not remember the date, 16 (15.2%) remembered the vaccination time when their injury, military service and pregnancy were questioned specifically. Antitoxin levels decreased with increasing age independent of gender (0.9-fold increase/year). Conclusion: We found that the booster dose recommended every 10 years was not applied sufficiently. Tetanus vaccination history must be questioned in more detail among people who do not remember/know their vaccination history, with specific questions regarding pregnancy, military service and injury histories.

WOS: 000408336600025, PubMed ID: 29156865, Background/aim: Staphylococcus aureus is an important nosocomial pathogen and a successful antimicrobial-resistance developer. In this study we retrospectively evaluated the resistance patterns and incidence of microbiologically confirmed nosocomial bacteremia (MCNB) related S. aureus strains between 2001 and 2013. Materials and methods: Any patient in whom S. aureus was isolated in at least one set of blood cultures (sent to the bacteriology laboratory 72 h after hospital admission) was considered to have MCNB. Results: The methicillin-resistant S. aureus (MRSA) rate in 2001 was 73.8% whereas it was 36.2% in 2013. When the 2001-2003 and 2011-2013 periods were compared, resistance to oxacillin, levofloxacin, gentamicin, erythromycin, and clindamycin decreased significantly (P < 0.05). When we evaluated the total S. aureus, MRSA, and methicillin-sensitive S. aureus (MSSA) bacteremia rates per 1000 days and 1000 patients, there was an increase in the 2004-2005 period, which was followed by a slight decrease until 2013 (P < 0.05). There was a plateau in MCNB-related S. aureus rates between 2008 and 2011. Conclusion: There was a decrease in overall S. aureus and MRSA bacteremia incidence as well as MRSA rates except for a plateau between 2008 and 2011. This steady decrease in the resistance rates is most probably due to the 2003 budget application and application of antimicrobial stewardship.

WOS: 000395632600004, PubMed ID: 28263502, Background/aim: Healthcare-associated meningitis (HCAM) is a relatively rare entity with significant morbidity and mortality. The aim of this study was to systematically review the Turkish medical literature for acute nosocomial meningitis. Materials and methods: One national (ULAKBIM) and two international (www. scopus. com and www. pubmed. com) databases were searched. In addition, abstracts of four national congresses held between 2004 and 2013 were searched for reports for HCAM meningitis. Results: Data for 899 HCAM meningitis episodes were obtained from 24 reports. In terms of clinical findings, 177 of 216 (81.9%) had fever (> 38 degrees C), 55 of 64 (85.9%) had high CRP levels, 105 of 132 had leukocytosis (> 10,000/mm3), and 241 of 759 had shunt infection. Cerebrospinal fluid culture yielded a pathogen in 689 of 872 nosocomial meningitis episodes. The most common pathogen was Acinetobacter spp. (30.7%), followed by coagulase-negative staphylococci (21.2%) and Staphylococcus aureus (19%). Carbapenem resistance was reported in 18 of 48 (37.5%) Acinetobacter spp. Overall mortality was 160/593 (27%). Pathogen-specific mortality was 55.5% (30/54) for A. baumannii whereas it was 18.9% (7/37) for S. aureus and 2/17 (11,7%) for MRSA. Conclusion: Nosocomial meningitis is still a serious and highly fatal disease. More preventive measures should be sought to further decrease HCAM meningitis and the mortality/morbidity related to it.

Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital’s Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival. © 2017, Springer-Verlag Berlin Heidelberg.

Toxocariasis in man is associated with three syndromes which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this report, a case of brain abscess caused by toxocariasis was presented. A 56 years-old female patient was admitted to our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few non-specific intensities at supratentorial white matter, an approximately 13 x 12 mm lesion without contrast enhancement and a significant edema around the white matter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration. A specific agent could not be detected in the histochemical examination. Western-blot test for toxocariasis in serum and cerebrospinal fluid samples were found positive. She was transferred to the infectious diseases clinic, and albendazole therapy (400 mg, q12h) was started. Albendazole treatment was completed for a total of one month following the regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, it was noted that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semiovale. The patient was successfully treated with albendazole. There was no relapse after six month follow-up. This case was presented to withdraw attention to neurotoxocariasis which may be encountered although rarely in the etiology of encephalitis/ brain abscess.

WOS: 000336383000005, PubMed ID: 24657273, Background: Tigecycline is a relatively new glycylcycline antimicrobial, active in vitro against a variety of Gram-positive and Gram-negative organisms. In this study we evaluated the outcomes of spondylodiscitis cases treated with tigecycline-including therapies retrospectively. Methods: All adult (age > 18 years) cases with a diagnosis of spondylodiscitis, who were treated with a tigecycline-including therapy between 2007 and 2011, were included in the study. The primary efficacy outcome was clinical success with tigecycline at the end of induction, while the secondary efficacy outcome was maintenance of success through 3 months following completion of induction. Results: A total of eight spondylodiscitis cases fulfilled the study inclusion criteria. All cases had back pain, restricted mobility, magnetic resonance findings associated with spondylodiscitis, and microbiology or pathological findings related to spondylodiscitis. All had post-neurosurgical spondylodiscitis. In five cases, tigecycline was started in accordance with the antibacterial susceptibility results from intervertebral tissue biopsy cultures, whereas in three it was started empirically. All cases had received several different antibacterials with failure before receiving tigecycline. The mean duration of tigecycline treatment was 37 +/- 21 days. One case was lost to follow-up after 2 days of tigecycline. Primary and secondary success was achieved in the remaining seven cases. Conclusions: These limited data suggest that tigecycline may have a role in the treatment of refractory spondylodiscitis cases. (C) 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Background Chronic hepatitis B (CHB) is an important health concern, but there are few studies describing its management in different countries. This prospective, longitudinal, non-interventional study aimed to assess differences in CHB management in five European countries (Germany, France, Poland, Romania and Turkey). Methods Data were collected from CHB patients’ records between 2008 and 2010. Patients were stratified by treatment status at baseline (treated or untreated). The primary objective was to estimate the probability of a CHB management modification (treatment initiation or change) among patients from each country during a 2-year follow-up. Results A total of 1,267 patients were included (567 treated, 700 untreated). Baseline characteristics between countries and treatment status groups were broadly comparable. Most patients had an alanine aminotransferase measurement in the 12 months prior to baseline; proportions of patients with an HBV DNA assessment varied by country and treatment status. The Kaplan–Meier-estimated probability of any treatment modification ranged from 9.4% (Turkey) to 30.1% (Poland) at 12 months and 10.0% (Turkey) to 40.0% (Poland) at 24 months. Modifications were more common in treated than untreated patients. The most frequently reported reasons for modifying treatment were HBV-DNA-related. The majority of treated patients were treated with monotherapy; however, choice of therapy differed between countries. Conclusions This is the first longitudinal study describing CHB management in European countries. Differences were observed in treatment and monitoring between countries, but alanine aminotransferase and HBV DNA levels consistently emerged as key tests in the management of CHB in all five countries.

Objective: We aimed to determine prevalence and epidemiological characteristics of cases coinfected with hepatitis B virus (HBV)/hepatitis C virus (HCV) in Turkey. Material and Methods: The data for this study was obtained from Turk-Hepatitis Registry (HEP-NET) Project, which includes real-life cohort of hepatitis patients from 15 centers in Turkey, and is supported by Viral Hepatitis Society. In the project, 10,165 hepatitis cases were evaluated in 10 hospitals. Re- sults: According to initial visit results, HBV/HCV coinfection was detected in 99 patients. The ratio was 974/100 000. The mean age of the cases was 40.9+21.7 years, 56.6% of them were males and 43.4% were females,. The major risk factors were dental therapy, any surgical procedure, he - modialysis and blood transfusion. The mean alanine aminotransferase (ALT) levels were 70.9±49.1 IU/L in coinfected patients. In 12% of cases HBeAg was positive. The median HCV RNA level was found 0 IU/mL (minimum: 50-maximum: 2.18x107 IU/mL), and the median HBV DNA level was found 2.50x102 IU/mL (minimum: 12-maximum: 1.70x108 IU/mL). In 8.1% of the patients both HCV RNA and HBV DNA were positive, and in 87.5% of cases HCV infection was dominant. The most important risk factor was hemodialysis (25%) in this group. Conclusion: This is the most de - tailed study which evaluates the prevalence of HBV/HCV coinfection in Turkey. HBV/HCV coin - fection prevalence was not higher than HBV or HCV monoinfections. In cases where both HCV RNA and HBV DNA were positive, HCV was predominant.

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

Yamazhan T., Durusoy R., Tasbakan M.I., Tokem Y., Pullukcu H., Sipahi O.R., Ulusoy S. & Turkish Nursing Hepatitis Study Group (2011) Nursing students' immunisation status and knowledge about viral hepatitis in Turkey: a multi-centre cross-sectional study. International Nursing Review58, 181–185 Background: The aims of this multi-centre cross-sectional survey were to detect Turkish nursing students' level of knowledge on viral hepatitis, to evaluate their rates of exposure to blood and to find out their hepatitis A (HAV), hepatitis B (HBV) vaccination status. Methods: This multi-centre cross-sectional study was conducted in 14 nursing schools located in the seven geographical regions of Turkey. A questionnaire composed of 47 questions on socio-demographic factors, level of knowledge on HAV, HBV, hepatitis C (HCV) immunisation status, exposure history and attitudes was applied to the study group. Results: A total of 1491 third- and fourth-year nursing students participated with an 89% response rate. The mean age of the participating students was 21.4 ± 1.3. Their mean knowledge score was 23.7 ± 4.6 (71/100) and was significantly higher in fourth-year students than third-year students. There were significant differences in mean scores among nursing schools. Among the participants, 85.3% had received HBV vaccine and 9.1% had received HAV vaccine. The percentage of students who signify themselves at increased risk of acquiring viral hepatitis was 97.3%. Of the students, 28.1% had sustained a needle-stick injury and 5.4% had experienced conjunctival exposure to blood. Conclusions: Curriculum differences among nursing schools have a significant effect on nursing students' level of knowledge. For this reason, nursing schools should organize HBV immunisation programmes for their students to increase vaccination coverage.

Sarcoidosis is a systemic inflammatory disorder of unknown etiology characterized by the formation of noncaseating granulomas in the involved tissues and lymph nodes. It usually involves multiple organs, including the lungs, skin, bones, muscles, eyes, heart, liver, spleen and lymph nodes [1]. Although liver is an important site of sarcoidosis, isolated hepatic involvement is quite rare [2]. In this paper it is aimed to present a case of sarcoidosis with isolated liver microabscesses. A 51-year-old woman with no known prior disease admitted to our outpatient clinic with the complaints of fever persisting for 20 days and abdominal pain. In the physical examination her length was 150 cm and her weight was 65 kg. She had fever (38 C) and abdominal tenderness on palpation in the upper right quadrant. She had malaise and 8 kg weight loss within the previous month. Her main laboratory findings were: hemoglobin 9.7 g/dl, leukocyte 15.57 9 10/mm, neutrophil 80.9 %, C reactive protein 31 mg/dl and erythrocyte sedimentation rate (ESR) 104 mm/h. Abdominal ultrasonography revealed a 14 mm hemangioma in the segment 6 and a 42 9 38 mm cystic lesion nearby the gallbladder. Contrast enhanced abdominal computed tomography (CT) demonstrated diffuse hypodense infiltrative lesions in the liver representing microabscesses (Fig. 1a). At the same time liver magnetic resonance imaging (MRI) was performed to better characterize the liver lesions and revealed isointense and intermediate hyperintense signal changes on T2weighted images and iso-hypointesity on T1-weighted images. Postcontrast T1-weighted images showed diffuse hypointense lesions and rim enhancement representing microabscesses. There were nonspecific nodules with a size of max 3.5 mm at upper lobe of the left lung in chest CT, and there was no mediastinal lymphadenopathy. Blood cultures were performed. Empirical ceftriaxone and metronidazole were started. Serologic tests for Echinococcus, fasciolasis, toxoplasmosis, leishmaniasis, HIV and brucellosis were negative. Since there was no clinical response on day 5, treatment was switched to meropenem and teicoplanin combination. There was no cardiac vegetation in transthoracic and transesophageal ECHO cardiography and no pathologic finding in electrocardiography. Autoimmune markers (ANA, ASMA, LKMA, ANCA) were negative. Tumor markers were normal. Blood or urine cultures did not reveal any bacterial or mycobacterial growth. Quantiferon TB Gold test was negative, tuberculosis skin test resulted in an induration of 9 mm, and blood adenosine deaminase was 13.3 U/l. CD4/CD8 rate was normal in bronchoalveolar lavage (BAL). BAL cytology revealed 95 % macrophages, 4 % lymphocytes and 1 % neutrophils. Bacteriological or mycobacteriological cultures of BAL did not reveal any pathogen. Liver biopsy and aspiration from the cyst were performed and Entamoeba hystolytica M. I. Tasbakan (&) H. A. Erdem H. Pullukcu T. Yamazhan O. R. Sipahi B. Arda S. Ulusoy Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, Izmir, Turkey e-mail: tasbakan@yahoo.com

Clinicians have usually considered malignancies during follow up of patients who have infectious diseases as a pre-diagnosis. However, malignancy and an infectious disease are seen together more rarely, with the exception of immunosuppressed patients. This presentation is a case report followed up for fever of unknown origin. The patient was admitted to the hospital with the symptoms of fever, weight loss, abdominal pain and weakness. Anemia and hypergamaglobulinemia by biochemical analyses and splenomegaly by total body computed tomography were detected. Amastigotes were seen in bone marrow aspiration smears and promastigotes were isolated in NNN medium. At the end of the Liposomal Amphotericin B treatment, control bone marrow aspiration was applied. Leishmania amastigotes were not seen, while patient was diagnosed as diffuse B cell lymphoma pathologically.

PubMed ID: 18230687, Objectives: This study aimed to compare the antibacterial activity of moxifloxacin and ampicillin + gentamicin in the treatment of Listeria monocytogenes meningitis in a rabbit meningitis model. Methods: Meningitis was induced by direct inoculation of a clinical strain isolated from an immunocompromised patient (107 cfu/mL) into the cisterna magna of New Zealand rabbits. After 16 h of incubation, rabbits were separated into four groups: moxifloxacin (M), ampicillin + gentamicin (A), ampicillin + gentamicin 2 (A2) and control (C). Group M received 20 mg/kg moxifloxacin at the end of the incubation time and 5 h later by intravenous (iv) route. Group A received ampicillin (30 mg/kg/h) and gentamicin (2.5 mg/kg/h) by iv route with continuous infusion for 8 h in 36 mL of 0.9% NaCl, group A2 received the same dosage of gentamicin and ampicillin in two different 36 mL 0.9% NaCl solutions and group C did not receive any treatment. Cerebrospinal fluid (CSF) samples (0.1-0.25 mL) were obtained 16 and 24 h after induction of meningitis. Results: At the end of the 16 h of incubation, CSF bacterial counts were similar in all groups (P > 0.05). At the final stage of the study (24 h after induction of meningitis), bacterial counts in all treatment groups were significantly lower than the control group (P < 0.05). When the three treatment groups were compared, bacterial counts were found to be similar (P > 0.05). Conclusions: These data suggest that antibacterial activity of moxifloxacin is similar to ampicillin + gentamicin in the treatment of experimental L. monocytogenes meningitis of rabbits. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved., Ege Üniversitesi, The study was funded by Ege University.

In 2003 Turkish government released a new budget application instruction for regulating the usage of parenteral antibiotics inside and outside of the hospitals. In this study it was aimed to evaluate the effect of this instruction on the overall usage of restricted antibiotics, their cost, overall mortality, bacterial resistance patterns and nosocomial infection rates in intensive care units (ICUs) of our setting for March-October 2002 and March-October 2003 periods.Overall daily defined dose/1000 patients/day of restricted drugs decreased, whereas unrestricted drugs increased significantly after the instruction. The cost of all analysed drugs in 2003 period was 540,303USD (-19.6%) less than 2002 period. Nosocomial infection rates in ICUs decreased significantly (p0.05). When all microbiologically confirmed nosocomial bacteremia cases during the study period were analysed, amoxycilline/clavulanate, ciprofloxacin, cefuroxime, cefotaxime, piperacilline/tazobactam resistance and ESBL rate in Klebsiella pneumoniae decreased significantly (p0.05). Amikacin resistance in Escherichia coli and Acinetobacter baumannii increased significantly (p0.05).Antibiotic control is one of the most important and significant ways to save money, and to prevent antibacterial resistance.

WOS: 000219732100002, Although hand infections in diabetic patients are observed less frequently than foot infections, hand infections may cause severe problems, such as stiffness and loss of skin, nerve and bone persisting even after the infection resolves. Invasive soft tissue fungal infections are very rare among diabetes-related limb infections. In this report, we present a case of diabetic hand infection with invasive candidiasis. A 53-year-old female patient was admitted to our Ege University Diabetic Foot Council with necrosis and bullae at the tip of the third finger of her right hand. For surgical treatment, wound debridement and amputation were performed and a broad-spectrum antibiotic treatment was started. The tissue culture yielded Candida albicans and the patient was successfully treated with fluconazole. Inguinal flap operation was performed after antifungal ( fluconazole) therapy. However, purulent discharge and ischemia with superficial necrosis of the flap developed on follow up. Thereupon, surgical debridement was performed again and antibiotic treatment was started. With the treatment of infection, flap success was achieved. Routine evaluation during follow-up of the patient revealed that eight months after the operation, the wound completely healed.

Hepatit A is usually a self-limited, asymptomatic infection. However, severe manifestations of hepatitis may occur rarely in adult patients. Here, we present a case of prolonged, relapsed cholestasis secondary to acute hepatitis infection in an adult patient. A 25-year old male patient had been given symptomatic treatment for weakness, abdominal pain, loss of appetite, pruritis, nausea and generalized jaundice. A week later, he had been diagnosed with acute hepatitis A infection. He admitted to our clinic two months after the first episode with complaints of pruritis and jaundice. His laboratory results included a serum alanine aminotransferase (ALT) level of 86 U/L, aspartate transferase (AST) of 91 U/L, total bilirubin of 46.5 mg/dl and direct bilirubin of 33.9 mg/dl. ursodeoxycholic acid (UDCA) therapy was started due to protracted jaundice, severe itching and a marked elevation in bilirubin levels, which was replaced with prednisolone therapy at a dose of 1 mg/kg/day at 12 days. Most of his clinical symptoms resolved with much lower serum bilirubin levels. No clinical or biochemical deterioration was observed after discontinuation of therapy. One year later his general condition was good with no relapse. There are few case reports in literature about the use of corticosteroids for treat­ment of prolonged cholestatic jaundice in patients with hepatitis A infection. Based on our findings, we suggest that this type of therapy may be beneficial for relief of symptoms and improvement of serum biochemistry., Hepatit A kendi kendini sınırlayan, genellikle asemptomatik seyreden bir enfeksiyondur. Nadiren bazı erişkin olgularda ağır hepatit tablosu görülebilir. Burada tekrarlayan ve uzun sure kolestatik formla seyreden bir olgu sunuldu. Yirmi beş yaşında erkek hasta halsizlik, karın ağrısı, bulantı ve tüm vücutta sararma yakınmaları ile başvurdu. Başvurmadan önce semptomatik tedaviler almış ve bir hafta sonra akut hepatit A tanısı konulmuştu. İlk ataktan iki ay sonra hastanın tekrar kaşıntı ve sarılık şikayeti olduğu için bize başvurmuştu. Başvuruda serum alanin aminoasit transferaz (ALT):86 U/L, aspartat transferaz (AST):91 U/L, T. Bil:46,5 mg/dl, D. Bil:33.86 mg/dl’ idi. Uzun süren sarılık, yoğun kaşıntı ve bilirübin seviyelerinde artma nedeniyle ursodeoxycholic acid (UDCA) tedavisi verildi. Daha sonra tedavi 1 mg/kg/gün prednisolon tedavisiyle değiştirildi. Klinik semptomların çoğu kayboldu ve bilirübin düzeyleri düştü. Bir yıllık takibinde relaps görülmedi. Literatürde kortikosteroit kullanılan uzamış kolestatik tipte sarılıkla seyreden az miktarda hepatit A olguları bulunmaktadır. Bunun, bizim olgumuzda olduğu gibi semptomları giderici ve serum biyokimya değerlerini iyileştirici etkisi olduğu düşünülmektedir

WOS: 000351719300007, PubMed ID: 25788959, Background: In patients with chronic hepatitis C, triple drug regimens containing a protease inhibitor, peginterferon and ribavirin were found to significantly increase sustained virologic response rates compared to dual drug regimen containing pegylated interferon and ribavirin, especially in genotype 1. Objectives: In Turkey, telaprevir has been used since March 2013. We aimed to evaluate results of patients with chronic hepatitis C treated with telaprevir, peginterferon and ribavirin. Patients and Methods: We evaluated 28 patients with genotype 1 chronic hepatitis C infection treated with triple drug regimen containing telaprevir, in three medical centers in Turkey, retrospectively. Demographic data of patients, treatment indications, adverse events and outcomes were recorded. Results: Of 28 patients intended to treat, 25 (89.2%) patients completed the treatment. Overall, 21 (82.1%) patients had relapse and five patients were non-responder. Regarding the treatment outcomes of Telaprevir based regimen, 20/26 patients achieved sustained virological response. Pruritus, rash, dysgeusia, anorectal discomfort and anemia were main adverse effects. Blood transfusion and ribavirin dose reduction required for 7 and 11 patients, respectively. Due to several adverse effects, 10 patients were hospitalized. Conclusions: Although more frequent and severe adverse effects, telaprevir has been promising for patients with treatment-experienced hepatitis C.

Introduction: Brucellosis is a systemic infection which in volves many organs including liver. In this study, it was aimed to review the hepatosplenic findings in allcases followed up in our clinic with the diagnosis of brucellosis. Materials and Methods: Allcases, we followed up in our clinic between July 2006 and October 2014 with the diagnosis of brucellosis, were reviewed retrospectively. Cases with microbiological culture confirmation and/or Wright agglutination test positivity with a titer of 1/160 or higher were considered brucellosis. Results: There were a total of 102 cases meeting the inclusion criteria (43 female (42.2%), 59 male (57.8%), aged 47.1 ± 16). Eighty-two (80.3%) patients had a titer of 1/160 or more Wright agglutination test positivity. Three patients had negative Wright agglutination test but had anti-humanglobulin test positivity. Seventeen (16.7%) patients were diagnosed with only blood culture. The most common three symptoms were fever (63.7%), weakness (48%) and back pain (48%). Hepatomegaly and splenomegaly were determined with ultrasonography in 16 (15.8%) and 19 (18.8%) cases, respectively. About 23.8%, 24.8%, 26.8%, 36.6%, and 12.9% of the patients had elevated levels of AST, ALT, ALP, GGT and total bilirubin, respectively. Forty-two (41.2%) patients had no remarkable pathology in the liver. Mean age of the cases without a remarkable liver pathology was 51.1 ± 14.9; whereas, mean age of the rest of the cases was 44.3 ± 16.3 (p= 0.035). Liver function tests improved in all cases with treatment. There was no severe adverse drug reaction during treatment. Conclusion: Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system, and may cause liver damage. Its response to treatment is high. However, there was no pathology in ultrasonography in majority of the cases. In a brucellosis endemic country such as Turkey, it must be kept in mind that the disease may present without significant liver involvement.

Background: Toxocariasis is associated with three syndromes in human beings which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this abstract we report a case of brain abcess caused by toxocariasis. Methods & Materials: A 56 years-old female patient admitted at our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few nonspesific intensities at supratentorial white matter, and an approximately 13x12mm lesion without contrast enhancement which had a significant edema around the whitematter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration in histological examination. Results: A spesific agent could not be detected in histochemical examination.Western-blot test toxocariasis in serumand CSFwere positive. She was transferred to the infectious diseases and clinical microbiology clinic.Albendazole 400mg q12h was started. A total of onemonthduration for albendazole treatmentwasplanned after regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, we found out that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semi-ovale. There was no relapse after six month follow up. The Conclusion: The presented case suggests that although rarely neurotoxocariasismaybe encountered in the etiology of encephalitis/brain abcess. The patient was successfully treated with albendazole. To our knowledge this is the first reported case of neurotoxocariasis n Turkey.

Summary Aim The aim of this study was to compare the efficacy of piperacillin/tazobactam (P/T) and cefoperazone/sulbactam (C/S) in the empirical treatment of adult neutropenic fever. Methods Data and outcomes of low-risk adult cases with neutropenic fever and treated with P/T (4.5 g q6h) or C/S (2 g q8h) between 2005 and 2011 June were extracted from our database. Risk evaluation was made according to criteria of Multinational Association for Supportive Care in Cancer (MASCC) and a score of ≥ 21 was considered as low risk. Data were collected prospectively by daily visits and evaluated retrospectively. Primary outcome was – fever defervescence at 72 h in combination with success without modification (referring to episodes where the patient recovered from fever with disappearance of signs of infection without modification to initial empirical treatment). All-cause mortality referred to death resulting from a documented or presumed infection or unidentified reason during the treatment and 30-day follow-up period. Results A total of 172 patients (113 cases P/T and 59 cases C/S) fulfilled the study inclusion criteria. Persistent response in P/T arm was 73.5%, whereas it was 64.5% in C/S arm (p > 0.05). Rates of any modification were also similar in both treatment arms. All-cause mortality during the treatment and 30-day follow-up period was not significantly different (P/T: 4/113 vs. C/S: 2/59, p > 0.05). There was no severe adverse effect requiring antibiotic cessation in both cohorts. Conclusion In conclusion, our data suggest that C/S may be a safe alternative to P/T in the empirical treatment of adult low-risk febrile neutropenia cases.

Zygomycosis is a rapidly-progressive invasive fungal disease with high mortality rates. Mucor, Rhizopus, Rhizomucor and Absidia species classified in Mucorales order, are the main causative agents of zygomycosis. Uncontrolled diabetes, hematologic malignancies, long term corticosteroid use and immunosuppressive therapies are the main predisposing factors for mucormycosis. In this study, we aimed to evaluate the mucormycosis cases from Turkey published in national and international databases in the last 17 years by means of age, gender, co-morbidities, signs and symptoms, diagnostic methods, therapeutic modalities, and mortality rate by pooling analysis. In our study, two national (http://uvt.ulakbim.gov.tr, http://www.turkmedline.net) and two international (www.ncbi.nlm.nih.gov, http://apps.webofknowledge.com) databases were used. A total of 64 manuscript (34 from national and 30 from international databases) published between 1995 and 2012, which were eligible for the study criteria and accessible as full text were included in the study. A total of 151 mucormycosis patients (71 female, 80 male; mean age: 45.4 +/- 21.4 years) from these studies, with definitive diagnosis of invasive fungal infections according to the criteria of European Organization for Research and Treatment of Cancer (EORTC) have been evaluated. Of 151 patients 91(60%) were diagnosed as rhinocerebral, 42 (%27.8) were sinoorbital, 7 (4.6%) were pulmonary, 6 (3.9%) were disseminated, 3 (1.9%) were skin, and 2 (1.3%) were gastrointestinal mycormycosis. The most common symptoms and signs were; swelling of eye and face (n = 95, 63%), fever (n = 72, 48%), nasal obstruction (n = 60, 40%), headache (n = 58, 38%) and opthtalmoplegia (n = 48, 32%). The most common co-morbidity was diabetes (49%) followed by hematological malignancies (39.7%). Mycological cultures were performed for 82 patients, and fungal growth were detected in the clinical specimens of 51 cases. The distribution of strains isolated in culture were as follows: Mucor spp. (n = 19, 37.2%), Rhizopus spp. (n = 13, 25.5%), Zygomycetes (n = 9, 17.6%), Rhizopus oryzae (n = 4, 7.8%), Rhizopus spp. + yeast (n = 3, 5.9%), Rhizomucor spp. (n = 2, 3.9%) and Rhizosporium spp. (n = 1, 1.9%). In 133 patients, histopathological investigation and in 126 patients radiological examinations were performed for diagnosis. Both surgical debridement and antifungal therapy were employed in 115 patients. Four patients had received only surgical debridement and 30 only antifungal therapies. Classical amphotericin B (AMP-B) therapy for 77 cases, liposomal AMP-B for 60 cases, liposomal AMP-B + posaconazole for six cases and lipid complex AMP-B for two cases have been started as antifungal therapies. Total mortality rate was detected as 54.3% (82/151). In conclusion, despite new diagnostic tools and therapeutic agents, mortality rates in mucormycosis are still very high. For the management, mucormycosis should be considered early in risky patients, and surgical debridement together with effective antifungal therapy should be applied as soon as possible.