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Human mpox (formerly monkeypox) disease has recently been reported in a number of European countries among individuals with no history of international travel or animal contact, causing global epidemic concerns. We describe the demographic, clinical characteristics, and laboratory data of four male patients with mpox disease, three of whom were human immunodeficiency virus (HIV)-positive, and one who was HIV-negative but had type 1 diabetes mellitus and a recent history of urological surgery. The HIV-negative patient attracted interest because he had no history of suspected sexual contact; however, he used shared bathrooms and towels at work, which could explain the potential transmission route. The remaining three male patients engaged in sexual activity with men recently. All four patients had prodromal symptoms such as short-term fever, myalgia, or fatigue, followed by a vesicular-pustular rash that began in the genital area, and two also had lesions on other parts of their bodies. Mpox is not generally considered in the differential diagnosis intitally because it is rare in Turkey; however, the diagnosis should be considered in patients with pustular umbilicated lesions and a history of risky sexual behavior. Keywords: mpox, outbreak, lesion, rash, HIV, infection

Introduction: Tularemia has reemerged and spread throughout Turkey, and the number of cases has increased. In this study, we report on a waterborne outbreak of tularemia in the spring of 2013 in a region which was previously disease-free, and we investigated the reasons for the outbreak. Methodology: The index case, a 17-year-old male, was diagnosed with oropharyngeal tularemia. An outbreak investigation was initiated after receiving information from other patients with similar symptoms from the same village along with Balkıca, Tavas, and Denizli. An epidemiological and environmental investigation was conducted. Tonsil swab specimens/lymph node aspirates collected from patients, and water samples collected from unchlorinated drinking water sources, were cultured. Additionally, a real-time polymerase chain reaction (RT-PCR) was performed on these samples. Serum samples from patients were analyzed for antibody response. Results: A total of 7 patients were found in this outbreak investigation. The attack rate was found to be 1% among the people of the village and 25% among patients’ family members. The drinking-water system was contaminated with F. tularensis during this outbreak. Conclusions: Lack of appropriate water infrastructure and sanitation was the primary reason for this tularemia outbreak in Turkey. Improving the water source infrastructure and sanitation should be the primary approach to preventing tularemia outbreaks.

Giriş ve Amaç: Son yıllarda yeni ajanların da kullanıma girmesiyle birlikte antifungal tüketimi giderek artmıştır. Bu durum, direnç gelişimi konusunda endişelere neden olmaktadır. Ülkemizde antifungal tüketimine ait veriler oldukça sınırlıdır. Bu çalışmada, Türkiye’nin batısındaki yedi üniversite hastanesinde yatan hastalarda antifungal kullanımının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Çalışma ekibi tarafından hazırlanan antifungal kullanım formu, tüm merkezler tarafından, aynı gün içinde, antifungal kullanan tüm hastalar için, nokta prevalans yöntemi ile dolduruldu, elde edilen veriler SPSS programı ile değerlendirildi.Bulgular: Toplam hasta sayısı 4969 idi. Hastaların 112(%2.2) ’si antifungal tedavi almaktaydı. Bu 112 hastanın verileri değerlendirildiğinde; antifungal kullanan hastaların 56 (%50)’sı hematoloji-onkoloji, 20 (%17,8)’si yoğun bakım (YB), 23 (%20,5)’ü dahili bilimler ve 13 (%11,6)’ü cerrahi bilimlerde izlenmekteydi. En sık kullanılan antifungal flukonazol [44(%39,3)] olup %34.1’i profilaksi amacı ile kullanılmaktaydı. Tedavilerin %38’i hedefe yönelik, %26.8’i ampirik ve %18,8’i preemptif olarak tanımlanmıştı. Yattığı kliniğe göre tedavi endikasyonları değerlendirildiğinde en çok pre-emptif antifungal kullanımı hemato-onkoloji kliniğinde %71.4 (15/21) görülürken ampirik tedavi en çok yoğun bakımlarda %50 olmuştur.Sonuç: Çalışmamızda antifungal tüketim oranı %2.2 olup, antifungal ajanlar daha çok hematoloji ve dahili birimlerde kullanılmıştır. Antifungal tedaviye başlama nedeni en fazla 'kanıtlanmış mantar infeksiyonu' olarak gözlenmiştir. En sık izole edilen patojenler Candida türleri olmasına rağmen, antifungal ajan seçimi hastanın yattığı kliniğe bağlıdır. Antifungal tüketim açısından yedi merkez arasında anlamlı fark gözlenmemiştir. Bu durum ülkemizdeki antifungal kullanımı politikası ile açıklanabilir. Bu sonuçlara bağlı olarak her hastane kendi verilerini izlemelidir ve izole edilen fungal patojenlere göre antifungal tedavi politikası geliştirilmelidir., Objective: Antifungal consumption has increased in recent years due to new agents on the market. This increase leads to concern about drug resistance. Data about antifungal prescription in our country is limited. The aim of this study is to evaluate antifungal consumption in seven university hospital.Materials and Methods: A form was designed to record patients’ data. The antifungal consumption at the west side of Turkey in seven University Hospital were evaluated by point prevalence. Hospitalized patients with antifungal treatment were determined and the designed forms were filled at the scheduled day. SPSS was used to determine significance of data.Results: There were 4969 hospitalized patients totally and 112 (2.2%) of them were treated with antifungal agents at the day of point-prevalance. Out of 112 patients 56 (50%) were in hematology-oncology, 20 (17.8%) in ICU (intensive care unit), 23 (20.5%) in internal medicine and 13 (11.6%) in surgery clinics. Fluconazole [44 (39.3%)] was the most used antifungal agent, 34% of them had been using oral fluconazole for prophylaxis. All of the treatments, 38% were defined as targeted, 26.8% as empirical and 18.8% as pre-emptive. When the treatment indications were evaluated according to the clinic, the most pre-emptive antifungal usage was in the hemato-oncology clinic, 71.4% (15/21), while the empirical treatment was mostly used as 50% in the intensive care units.Conclusion: In this study antifungal consumption rate was 2.2%. Antifungal agents were mostly used in hematology and internal medicine clinics. The reason of starting an antifungal treatment was ‘proven fungal infection’ mostly. Although the most frequent isolated pathogens were Candida species, the choice of antifungal agent depended on the clinic where the patient was hospitalized. There was no significantly difference between the university hospitals according to antifungal consumption. This may be explained by the antifungal prescription policy in our country. Depending on this results the hospitals should monitor their own fungal pathogens. And according to isolated fungal pathogens antifungal treatment policy should be improved

Candidemia may present as severe and life-threatening infections and is associated with a high mortality rate. This study aimed to evaluate the risk factors associated with 30-day mortality in patients with candidemia. A multi-center prospective observational study was conducted in seven university hospitals in six provinces in the western part of Turkey. Patient data were collected with a structured form between January 2018 and April 2019. In total, 425 episodes of candidemia were observed during the study period. Two hundred forty-one patients died within 30 days, and the 30-day crude mortality rate was 56.7%. Multivariable analysis found that SOFA score (OR: 1.28, CI: 1.154–1.420, p < 0.001), parenteral nutrition (OR: 3.9, CI: 1.752–8.810, p = 0.001), previous antibacterial treatment (OR: 9.32, CI: 1.634–53.744, p = 0.012), newly developed renal failure after candidemia (OR: 2.7, CI: 1.079–6.761, p = 0.034), and newly developed thrombocytopenia after candidemia (OR: 2.6, CI: 1. 057–6.439, p = 0.038) were significantly associated with 30-day mortality. Central venous catheter removal was the only factor protective against mortality (OR: 0.34, CI:0.147–0.768, p = 0.010) in multivariable analysis. Candidemia mortality is high in patients with high SOFA scores, those receiving TPN therapy, and those who previously received antibacterial therapy. Renal failure and thrombocytopenia developing after candidemia should be followed carefully in patients. Antifungal therapy and removing the central venous catheter are essential in the management of candidemia. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Objective: Acute HIV infection (AHI) is a stage with a rapid decrease in CD4+ T lymphocyte count, high viremia, and high transmissibility. Early diagnosis of AHI represents an opportunity for treatment and prevention of transmission. Therefore, we aimed to determine the clinical and laboratory findings in patients with acute HIV infection. Methods: Patients diagnosed with AHI among newly diagnosed HIV-infected patients were evaluated in the study. AHI diagnosis was defined as an HIV RNA result of at least 10,000 copies/ml with one of the following criteria: a negative or indeterminate HIV antibody test result in a person with a reactive Ag/Ab test result or a patient with a negative Ag/Ab test result has HIV RNA detected in serum or plasma or HIV serology positivity in a patient with signs and symptoms of AHI starting 2-6 weeks after high-risk HIV exposure. In addition, the history, clinical, and laboratory findings of patients with AHI were analyzed retrospectively. Results: One hundred six patients had a new HIV diagnosis during the study period. Of those, 12 (11.3%) were AHI. 10 (83.3%) of the patients with AHI were male, and seven were men who had sex with men. The mean age of the patients was 30 (21-50) years. Fourth-generation ELISA was negative in one patient initially; the repeated test was positive ten days later. While the 4th generation ELISA test of two patients was positive at the time of diagnosis, the confirmation test result was indeterminate. The 4th generation ELISA test was positive in nine patients with AHI symptoms starting 10-30 days after unprotected sexual intercourse. The duration of the patient’s complaints until the admission was found to be 13 (7-30) days. The most common findings were fever, diarrhea, fatigue, sore throat, lymphadenopathy, rash, nausea, and vomiting. Conclusion: The AHI rate was 11.3% in newly diagnosed cases of HIV infection. Awareness of AHI’s signs and symptoms to initiate early diagnosis and treatment. Thus, a better HIV infection course and reduced HIV transmission can be achieved. © 2022, DOC Design and Informatics Co. Ltd.. All rights reserved.

Introduction: Fungal infections are vital problems worldwide and their incidence have increased along with changing patient profile. Particularly candida species is still the most commonfungal agent, and the significance of non-albicans candida species have gained importance in recent years. In the present study, it was aimed to evaluate retrospectively the risk factors and distribution of candida species in patients with invasive candida infections, who were treated with anidulafungin., Materials and Methods: In the first three years (1 January 2012 to 31 December 2014) when anidulafungin came out in our country, we retrospectively evaluated the data of the patients with invasive candida infections who were treated by anidulafungin for more than 48 hours in seven university hospitals. Data were recorded to the case report forms., Results: Two hundreds and fifty-seven patients were included into the study. Fifty-six percent of the patients were male and mean age was 58.57 +/- 19.5 years. Two hundreds and three patients (79%) were hospitalized in intensive care units, 37 (14.3%) in internal medicine services, and 17 (0.07%) in surgery services. As previously described, we detected antibiotic usage in the last month (%96.9), presence of urinary catheter (90.3%) and presence of central venous catheter (82.1%) as risk factors for invasive candida infections. More than half of the patients (57.1%) with central venous catheter had candidemia. Sixty-six (47.7%) of the blood isolates were Candida albicans, 33 (23.7%) were Candida parapsilosis, 17 (12.2%) were Candida tropicalis and 13 (9.4%) were Candida glabrata. During follow up, 64.5% of 124 patients whose catheters couldn't be taken off and 47.6% of 86 patients whose catheters could be taken off died. During anidulafungin treatment, one anaphylaxis, one skin eruption and one thrombocytopenia were seen as side effects., Conclusion: In our study, we found that removal of central venous catheter of the patients with candidemia was a positive effect on mortality. We suggest that patients with candidemia, insisting on catheter removal besides antifungal treatment is necessary. We observed that anidulafungin is an effective and safe choice in invasive candida infections.

Introduction: In the presence of asymptomatic bacteriuria (ASB) before the urological procedure, the duration of antimicrobial treatment is controversial. This study aims to evaluate whether a short course of antimicrobial therapy is safe and effective in cases with ASB before urological procedures. Methodology: We retrospectively reviewed adult patients who had ASB before undergoing several urological procedures between 2011 and 2019. The patients received a single dose of an appropriate parenteral antibiotic, determined by antimicrobial sensitivity testing, 30 to 60 minutes before the urological procedure. If a urinary catheter was placed post-procedure, a second dose was given. Results: A total of 293 patients who had ASB before undergoing several urological procedures were included in the study. The total number of procedures was 328. Female/male ratio was 92 (31.4%)/201 (68.6%). The mean age was 63.7 ± 14.9 years. The most common isolated microorganisms were Escherichia coli (155 [47%]), Klebsiella pneumoniae (38 [11.6%]), and Pseudomonas aeruginosa (28 [8.5%]). The most common antimicrobial used was ertapenem. A second dose antimicrobial was given for 290 procedures due to a urinary catheter after a urological procedure. The mean hospitalization time was 3.97 ± 3.42 days. None of the patients developed infectious complications. Conclusions: This study has demonstrated that a single dose of parenteral antimicrobial drug administered 30-60 minutes before the urologic procedures and a second dose in the presence of a post-procedure catheter, was adequate to prevent post-procedure septicemia and urinary tract infection.

Cryptococcus neoformans is a basidiomycetous encapsulated yeast that can cause life-threatening infections in immunosuppressed humans and animals. C.neoformans/Cryptococcus gattii infections are considered to be acquired via inhalation of aerosolized particles from the environment. Avian guano, decaying tree hollows and soil are known as environmental niches. In recent years, colonization of the woody structures of different trees such as Eucalyptus camaldulensis, Tamarix hispida, Platanus orientalis and Punica granatum has been reported in the environmental study of the western Anatolian region. Based on the results of previous studies, our country may have intensive Cryptococcus colonization niches in the western regions. The aim of this study was to investigate the presence of the colonization of C.neoformans niche in chestnut (Castanea spp.) trees on higher altitudes. In the study, the colonization of C.neoformans was screened on chestnut trees (Castanea spp.) in Aydin-Odemis-Denizli geographical area. This area consists of mountainous terrain between the fertile plain formed by two major rivers.This region is one of the widespreading areas of chestnut farming in Anatolia. Two hundred and fourteen chestnut trees that had deep fissures or trunk hollows were screened during mid-summer 2017. A swabbing technique was used, and all samples were cultured on Staib agar medium containing biphenyl and antibiotics. Cultures were checked for ten days for suspicious brown colonies. Suspicious yeast colonies were tested for the identification of pathogenic Cryptococcus by conventional methods and canavanine-glycine-bromothymol agar reactions. ITS 1-4 primers were used for strain PCR tests. We determined the mating type and serotypes by PCR analysis of the STE20 genes using STE20 (Aa), STE20 (Aα), STE20 (Da), and STE20 (Dα) primers. V8 agar medium was used for mating cultivation. Only one (0.47%) strain of C.neoformans was isolated from 214 screened trees. This strain was confirmed by ITS 1-4 sequencing. The serotype A MATα mating type was observed. Basidium, basidiospores and clamp connections in hyphal structure were noted with MATα mating on V8 agar medium. In this study, the first C.neoformans isolate from a chestnut tree (Castanea sativa) was determined from Denizli region. Further studies of distribution of human pathogenic Cryptococcus will be helpful to determine the risk areas for the living organisms in our region.

Introduction: Candida species are important nosocomial bloodstream infections that cause high mortality rates and prolonged hospitalization.In this study, we aimed to determine risk factors for candidemia and the distribution of Candida species causing bloodstreaminfections.Materials and Methods: The study was conducted as case-control study at an 810-bed tertiary care teaching hospital between April2014 and April 2017.Results: A total of 75 candidemia episodes were identified during the study period. Candida albicans was the most-frequent species(68%), followed by Candida glabrata (9.3%), and Candida tropicalis (6.7%). The rate of candidemia was higher in intensive care unitsthan in other units. Prior antibiotic use [Odds Ratio (OR)= 15.52; 95% confidence interval (CI) 6.025-39.99; p< 0.0001], durationof hospitalization (OR= 1.043; 95% CI 1.007-1.08; p= 0.019), and total parenteral nutrition (OR= 1.181; 95% CI 1.032-1.353;p= 0.016) were found to be independent risk factors for candidemia.Conclusion: A better understanding of the risk factors for candidemia among hospitalized patients may have significant implicationsfor prevention.

Not Available

Cryptococcus neoformans is a basidiomycetous encapsulated yeast that can cause life-threatening infections in immunosuppressed humans and animals. C.neoformans/Cryptococcus gattii infections are considered to be acquired via inhalation of aerosolized particles from the environment. Avian guano, decaying tree hollows and soil are known as environmental niches. In recent years, colonization of the woody structures of different trees such as Eucalyptus camaldulensis, Tamarix hispida, Platanus orientalis and Punica granatum has been reported in the environmental study of the western Anatolian region. Based on the results of previous studies, our country may have intensive Cryptococcus colonization niches in the western regions. The aim of this study was to investigate the presence of the colonization of C.neoformans niche in chestnut (Castanea spp.) trees on higher altitudes. In the study, the colonization of C.neoformans was screened on chestnut trees (Castanea spp.) in Aydın-Ödemiş-Denizli geographical area. This area consists of mountainous terrain between the fertile plain formed by two major rivers.This region is one of the widespreading areas of chestnut farming in Anatolia. Two hundred and fourteen chestnut trees that had deep fissures or trunk hollows were screened during mid-summer 2017. A swabbing technique was used, and all samples were cultured on Staib agar medium containing biphenyl and antibiotics. Cultures were checked for ten days for suspicious brown colonies. Suspicious yeast colonies were tested for the identification of pathogenic Cryptococcus by conventional methods and canavanine-glycine-bromothymol agar reactions. ITS 1-4 primers were used for strain PCR tests. We determined the mating type and serotypes by PCR analysis of the STE20 genes using STE20 (Aa), STE20 (Aα), STE20 (Da), and STE20 (Dα) primers. V8 agar medium was used for mating cultivation. Only one (0.47%) strain of C.neoformans was isolated from 214 screened trees. This strain was confirmed by ITS 1-4 sequencing. The serotype A MATα mating type was observed. Basidium, basidiospores and clamp connections in hyphal structure were noted with MATα mating on V8 agar medium. In this study, the first C.neoformans isolate from a chestnut tree (Castanea sativa) was determined from Denizli region. Further studies of distribution of human pathogenic Cryptococcus will be helpful to determine the risk areas for the living organisms in our region.

Bazidiomiçet bir maya mantarı olan Cryptococcus neoformans hayvanlar ve bağışık sistemi baskılı insanlarda hayatı tehdit eden enfeksiyonlara neden olabilmektedir. Çevresel ortam havasında bulunan aerosolizepartiküllerin solunması ile C.neoformans/Cryptococcus gattii enfeksiyonlarının oluştuğu düşünülmektedir. Bilinen çevresel kolonizasyon odakları; kanatlı çıkartıları, ağaçlar içindeki çürüyen oyuklar ve topraktır. Son yıllarda Anadolu’nun batı bölgelerinde yapılan çevresel taramalarda Eucalyptus camaldulensis, Tamarix hispida,Platanus orientalis ve Punica granatum gibi farklı ağaçların odunsu yapılarında C.neoformans kolonizasyonubildirilmiştir. Eldeki verilere göre yapılan tahminler ülkemizin batı bölgelerinde yoğun Cryptococcus kolonizasyon odaklarının olabileceğini öngörmektedir. Bu çalışmada, yüksek rakımlı bölgelerde bulunan kestane(Castanea spp.) ağaçlarında C.neoformans kolonizasyonu varlığını araştırmak amaçlanmıştır. Bu amaçla, Aydın-Denizli-Ödemiş bölgesinde bulunan kestane (Castanea spp.) ağaçlarında C.neoformans kolonizasyonuaraştırılmıştır. Çalışma, iki büyük nehir arasında kalan verimli, yüksek rakımlı dağlık arazide yapılmıştır. Bubölge Anadolu’da yaygın kestane tarımı yapılan bölgeler arasında yer almaktadır. Bu alanda, 2017 yılınınyaz aylarında, üzerinde derin yarık veya gövdesinde büyük oyuk bulunan 214 kestane ağacından örnekalınmıştır. Eküvyon tekniği ile alınan örnekler bifenil ve antibiyotik içeren Staib agar besiyerine ekim yapılmıştır. Kültürler on gün süre ile kahverengi koloni kontrolü yapılarak takip edilmiştir. Patojen Cryptococcusizolatlarını tanımlamak için şüpheli koloniler konvansiyonel yöntemler ve kanavanin glisin bromtimol agarreaksiyonu ile incelenmiştir. İzolatın polimeraz zincir reaksiyonu (PCR) tanısı için ITS 1-4 primerleri kullanılmıştır. Bu amaçla, STE20 (Aa), STE20 (Aα), STE20 (Da) ve STE20 (Dα) primerlerini içeren STE20 PCR paneli ile serotip ve eşeyli şekil saptanmıştır. V8 agar besiyeri eşeyli çaprazlama kültürleri için kullanılmıştır.Çalışmada incelenen 214 ağacın yalnızca bir tanesinde (%0.47) C.neoformans izolasyonu gerçekleşmiştir.Bu izolat ITS 1-4 dizi analizi ile doğrulanmıştır. İzolatın A serotipinde MATα şeklinde olduğu saptanmıştır.V8 agarda MATα yapısına ait bazidiyum, bazidiyosporlar ve hif yapılarındaki kelepçe “klamp” bağlantılarıgörülmüştür. Bu çalışmada, Denizli’de Anadolu kestane (Castanea sativa) ağacından C.neoformans’ın ilkdefa izolasyonu gösterilmiştir. İnsan patojeni kriptokokların çevresel dağılımı ile yapılacak ileri araştırmalar,bölgemizdeki canlılarda risk oluşturan alanların saptanmasında yardımcı olacaktır.

Background/aim: Community-onset urinary tract infections (UTIs) caused by extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli have increased in many parts of the world. This study aimed to determine the prevalence and risk factors for community-onset UTI caused by ESBL-producing E. coli. Materials and methods: This prospective cohort study was conducted between January 2012 and March 2014 in cases of community-onset UTI caused by E. coli. Patients with UTI due to ESBL-producing E. coli and patients with UTI due to non-ESBL-producing E. coli were compared to identify risk factors for ESBL-producing E. coli in the community. Results: A total of 305 patients (116 males [46.4%]; mean age: 57.76 ± 18.06 years) were included in the study. Among these patients, 154 (50.5%) were infected with ESBL-producing E. coli. In multivariate analysis, the healthcare-associated UTI (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.02–3.18; P = 0.041), upper urinary tract infection (OR: 3.05; 95% CI: 1.76–5.29; P < 0.0001), use of antibiotics in the preceding 6 months (OR: 2.28; 95% CI: 1.21–4.30; P = 0.011), and having two or more risk factors (OR: 4.03; 95% CI: 1.73–9.35; P = 0.001) were the significant factors associated with increased risk of community-onset UTIs due to ESBL-producing E. coli. Conclusion: The increasing prevalence of ESBL-producing E. coli makes it difficult to decide the empirical therapy in UTIs, especially in patients with two or more of the risk factors. A better understanding of the epidemiology and risk factors associated with community-onset UTIs due to ESBL-producing E. coli may have significant implications in decision-making for empirical antimicrobial treatment. © TÜBİTAK.

Purpose:To evaluate choroidal, macular, peripapillary retinal nerve fiber layer (RNFL) thicknesses and retinal vascular caliber alterations in HIV-1-infected patients without opportunistic infections.Methods:This cross-sectional study included 45 HIV-1-infected patients and 47 healthy subjects. Spectral domain optical coherence tomography was used for assessment of choroidal, macular, peripapillary RNFL thicknesses and retinal vascular caliber alterations.Results:The mean CD4 count was 426 ± 226 cells per milliliter and the mean HIV-1 RNA level was 1.8 × 105 ± 3.6 × 105 copies/mL in HIV-infected group. Central inner plexiform, superior photoreceptor, superior and nasal retinal pigment epithelium layers were thinner in HIV-infected patients compared with control subjects (P < 0.05). The differences in sectoral retinal thicknesses lost their significance after Bonferroni correction (P < 0.01). The average thickness of pericentral retina within 3 mm was thinner in the photoreceptor layer in HIV-infected patients compared with control subjects (P = 0.033). The differences in peripapillary RNFL thickness, choroidal thickness, and retinal vascular caliber were not significant between the groups. Choroidal thickness and pericentral outer plexiform were thinner, whereas peripapillary RNFL was thicker in newly diagnosed cases (16 patients) compared with patients having treatment for at least 4 months or longer (27 patients, P < 0.05, Mann-Whitney U test). HIV-1 RNA showed negative correlation with choroidal thickness (r =-0.435, P = 0.003) and positive correlation with peripapillary RNFL in central (r = 0.323, P = 0.032) and superonasal (r = 0.369, P = 0.014) sectors.Conclusion:Choroidal thickness was thinner in newly diagnosed patients compared with patients on treatment. Viral load showed negative correlation with choroidal thickness. Retinal segmental alterations occurred in HIV-infected patients compared with control subjects. © 2019 by Ophthalmic Communications Society, Inc.

Giriş: Tüm dünyada fungal infeksiyonlar önemli bir sorun olup değişen hasta profili ile birlikte sıklığı artmıştır. Özellikle kandida halen ensık karşılaşılan fungal etken olup son yıllarda albikans dışı kandidaların önemi artmıştır. Bu çalışmada, invaziv kandida infeksiyonu nedeniyletedavi edilen hastaların gerçek yaşam verileriyle anidulafunginin etkinliğinin ve yan etkilerinin retrospektif olarak değerlendirilmesiamaçlanmıştır. İkincil amaç hastaların risk faktörlerinin değerlendirilmesidir.Materyal ve Metod: Yedi üniversite hastanesinde 1 Ocak 2012-31 Aralık 2014 tarihleri arasında invaziv fungal infeksiyon tanısı ile 48saatten daha uzun süre anidulafungin tedavisi alan hastaların verileri retrospektif olarak değerlendirildi. Veriler oluşturulan formlarakaydedildi.Bulgular: Çalışmaya yedi merkezden toplam 257 hasta dahil edilmiştir. Hastaların 144 (%56)’ü erkek, yaş ortalaması 58.6 ± 19.5 yıldı.Hastaların 137 (%53.3)’si dahili bölümlerde [100 (%72.9)’ü yoğun bakım], 120 (%46.7)’si cerrahi bölümlerde [103 (%85.3)’ü yoğunbakım] idi. Hastalarda tanımlanmış risk faktörü olarak son bir ayda antibiyotik kullanımı, üriner kateterizasyon ve santral venöz katetervarlığı saptanmıştır. Santral venöz kateter 210 (%82.7) hastada vardı. Santral venöz kateteri olan hastaların 120 (%57.1)‘sinde kankültürü pozitifti. Kateteri çekilen 86 hastanın 41 (%47.6)’inin, çekilmeyen 124 hastanın 80 (%64.5)’inin mortalite ile sonuçlandığı görülmüştür.Kan kültüründe üreyen etkenlerin %47.7’si Candida albicans , %23.7’si Candida parapsilosis, %12.2’si Candida tropicalis idi.Anidulafungin tedavisi boyunca bir hastada anafilaksi, bir hastada cilt erüpsiyonu, bir hastada ise trombositopeni yan etkisi görülmüştür.Sonuç: Çalışmamızda kateter kaynaklı kandidemi olgularında kateterin çıkarılmasının gerekliliği vurgulanmaktadır. Ayrıca anidulafungininetkin ve yan etkilerinin az olduğu izlenmekle birlikte diğer ekinokandinlerle karşılaştırmalı prospektif çalışmalara ihtiyaç duyulmaktadır.

Background/aim: Community-onset urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producingEscherichia coli have increased in many parts of the world. This study aimed to determine the prevalence and risk factors for communityonset UTI caused by ESBL-producing E. coli.Materials and methods: This prospective cohort study was conducted between January 2012 and March 2014 in cases of communityonset UTI caused by E. coli. Patients with UTI due to ESBL-producing E. coli and patients with UTI due to non-ESBL-producing E. coliwere compared to identify risk factors for ESBL-producing E. coli in the community.Results: A total of 305 patients (116 males [46.4%]; mean age: 57.76 ± 18.06 years) were included in the study. Among these patients, 154(50.5%) were infected with ESBL-producing E. coli. In multivariate analysis, the healthcare-associated UTI (odds ratio [OR]: 1.80; 95%confidence interval [CI]: 1.02–3.18; P = 0.041), upper urinary tract infection (OR: 3.05; 95% CI: 1.76–5.29; P < 0.0001), use of antibioticsin the preceding 6 months (OR: 2.28; 95% CI: 1.21–4.30; P = 0.011), and having two or more risk factors (OR: 4.03; 95% CI: 1.73–9.35;P = 0.001) were the significant factors associated with increased risk of community-onset UTIs due to ESBL-producing E. coli.Conclusion: The increasing prevalence of ESBL-producing E. coli makes it difficult to decide the empirical therapy in UTIs, especially inpatients with two or more of the risk factors. A better understanding of the epidemiology and risk factors associated with communityonset UTIs due to ESBL-producing E. coli may have significant implications in decision-making for empirical antimicrobial treatment.

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.

Objective: The aim of this prospective case control study was to describe the risk factors for bacteremia due to Acinetobacter species among hospitalized patients. Methods: The study was conducted prospectively from July 2012 to January 2014, and one case group and two control groups were created. Case group comprising patients with Acinetobacter bacteremia and control group 1 comprising patients with bacteremia due to other agents and control group 2 comprising non-bacteremic patients were compared in terms of demographic characteristics, underlying diseases, invasive procedures, and antibiotic use. Results: The study group (n=23) and control groups (n=46) were compared with univariate analysis and significant risk factors for Acinetobacter bacteremia were as follows: total parenteral nutrition, chemotherapy, use of broad spectrum antibiotics including β-lactam and β-lactamase inhibitors, carbapenems, teicoplanin, and antifungals (p

Botulism is a neurological disease caused by the heat-labile toxin of Clostridium botulinum. Botulism should be kept in mind in the presence of neurological findings and suspicious food intake in patients without fever and altered mental status. In this report, an outbreak of botulism occurring with somewhat different clinical pictures in three members of the same family after consumption of a home made canned tomato sauce was presented. © 2018, AVES. All rights reserved.

In this case report, we present a patient with meningitis, cerebral and paravertebral abscess and arthritis in addition to prosthetic valve endocarditis treated surgically and medically due to Streptococcus equi accepted as S. equi subsp. zooepidemicus with its epidemiological and clinical features despite it could not be identified to subspecies level. © 2018, AVES İbrahim KARA. All rights reserved.

Introduction: Brucellar spondylodiscitis is a frequent and serious complication of brucellosis. The aim of this study is to describe the brucellosis patients with spondylodiscitis and the predictive factors related to spondylodiscitis in brucellosis. Methodology: Laboratory-confirmed brucellosis patients from a low- to medium-endemic region were enrolled in the study and distributed into two groups. Group I consisted of patients with spondylodiscitis and Group II patients had no complications. Both groups were compared for predictive factors of spondylodiscitis. Results: A total of 219 patients with active brucellosis were included in the study. We determined at least one complication in 91 (41.6%) patients. The most frequent complication was spondylodiscitis [n = 59 patients (26.9 %)]. In univariate analysis, age, time from symptom onset to diagnosis, presence of low back pain, increased levels of erythrocyte sedimentation rate, and alkaline phosphatases were the most significant predictive factors for spondylodiscitis among brucellosis cases. Presence of headache and thrombocytopenia were less frequent in patients with spondylodiscitis when compared to patients without complications (p = 0.024, p = 0.006 respectively). In multivariate analysis, old age (odds ratio [OR] 1,063; 95% confidence interval [CI] 1.026-1.101; p < 0.001), prolonged time between symptoms onset before diagnosis (OR 1.008; 95% CI 1.001-1.016; p = 0.031), and presence of low back pain (OR 12.886; 95% CI 3.978-41.739; p < 0.001) were indepedently associated with an increased risk of spondylodiscitis. Conclusions: Spondylodiscitis is the most frequent complication of systemic brucellosis. Patients with low back pain, older age, and longer duration of symptoms should be considered as candidates of potential spondylodiscitis in brucellosis.

OBJECTIVES: To evaluate corneal and anterior chamber morphology as measured by Pentacam HR in human immunodeficiency virus (HIV)-infected patients without opportunistic infections and to search for signs of accelerated aging. METHODS: This prospective study included 41 eyes of 41 HIV-1-infected patients (study group) and 50 eyes of 50 healthy subjects (control group). Specular microscope and Pentacam HR were used for corneal and anterior chamber morphology evaluation. Corneal endothelial cell density (CECD), hexagonal cell ratio, coefficient of variation, corneal thickness, density and volume, maximum keratometry, anterior chamber volume (ACV), and anterior chamber depth (ACD) measurements were recorded for analysis. RESULTS: The mean CD4 count was 428.3±231.9 (36-950) cells/mL, and the time since diagnosis was 27.5±34.1 months in the study group. The difference in anterior segment parameters was not significantly different between the study and the control groups (P>0.05). Age significantly correlated with CECD (r=-0.436, P=0.004), ACV (r=-0.570, P

Introduction: There is limited data in the literature about brucellosis related to an intracellular pathogen and anti-tumor necrosis factor alpha (anti-TNFα) medication. The aim of this study was to evaluate acute Brucella infections in mice receiving anti-TNFα drug treatment. Methodology: Anti-TNFα drugs were injected in mice on the first and fifth days of the study, after which the mice were infected with B. melitensis M16 strain. Mice were sacrificed on the fourteenth day after infection. Bacterial loads in the liver and spleen were defined, and histopathological changes were evaluated. Results: Neither the liver nor the spleen showed an increased bacterial load in all anti-TNFα drug groups when compared to a non-treated, infected group. The most significant histopathological findings were neutrophil infiltrations in the red pulp of the spleen and apoptotic cells with hepatocellular pleomorphism in the liver. There was no significant difference among the groups in terms of previously reported histopathological findings, such as extramedullary hematopoiesis and granuloma formation. Conclusions: There were no differences in hepatic and splenic bacterial load and granuloma formation, which indicate worsening of the acute Brucella infection in mice; in other words, anti-TNFα treatment did not exacerbate the acute Brucella spp. infection in mice.

Summary Bartonella henselae infections are usually detected among people who have close contact with animals. Veterinarians and cattle breeders, in particular, are considered as the risk groups for B. henselae infections. In this study, the seroprevalence of antibodies to B. henselae was investigated in these two groups of subjects in the two cities of Aydin and Denizli, which are located in the same region in the southwest of Turkey. Total antibodies to B. henselae were evaluated by indirect immunofluorescence assay in serum samples taken from 63 cattle breeders and 27 veterinarians. Twenty samples (22.2%) were found to react on 1/64 titre with B. henselae antigens. Bartonella henselae seroprevalence was found to be significantly related to age (P = 0.033) and higher in those living in Aydin (P = 0.047). Age was the only independent factor in multivariate analysis (P = 0.008). Seroprevalence was found to be 2-fold higher in those people who had had tick contact (P = 0.093). In conclusion, the physicians in the region should consider B. henselae infection among veterinarians and breeders in their differential diagnosis list of fever of unknown origin.

Suppressing viral replication is the main intervention for prevention of hepatocellular carcinoma (HCC) development, which is one of the purposes of treatment of chronic hepatitis B. We report a case of HCC in a 73-year-old woman with chronic hepatitis B who was treated and whose viral replication was successfully suppressed with antiviral therapy. The patient had anti-HBe positivity and her viral load was 1.01×106 IU/mL. Telbivudine treatment led to a decrease of HBV DNA below the detection limit on the second month of the treatment. But her ?-fetoprotein level increased (121 ng/L) on the 30th month of the treatment. Magnetic resonance imaging showed a mass compatible with HCC on the liver and a biopsy revealed HCC. She was treated with chemo-embolization. Although viral suppression is achieved in patients with chronic hepatitis B, followup and HCC screening should be done regularly in patients who have HCC risk factors such as thrombocytopenia and older age, as in this case. © 2016, AVES Ibrahim Kara. All rights reserved.

Solid organ transplantation (SOT) is a treatment method that improves quality of life and survival of patients with end-stage organ failure. Immunosuppressive treatments given to these patients may predispose to the development of invasive fungal infections (IFI). The incidence of IFI in SOT recipients, which is between 5% and 42%, depends on the organ to be transplanted. Although Candida spp., followed by Aspergillus spp. are the most common microorganisms, among fungal pathogens, this situation varies according to transplant type. The mortality rate associated with these IFI can be high. Therefore, antifungal prophylaxis may be necessary for SOT recipients. Many transplantation centers employ antifungal strategies according to their own experience because of the lack of randomized controlled studies. If the antifungal prophylaxis is given to all patients, antimicrobial resistance and drug-drug interactions may occur. Therefore, it is important to identify patients at a high risk of developing IFI. In this paper, epidemiology, risk factors, literature data and antifungal prophylaxis associated with IFI in liver, kidney, small intestine, pancreas, heart, and lung transplant recipients are reviewed.

Summary Objectives We aimed to determine the seroprevalence of Crimean-Congo hemorrhagic fever (CCHF) virus, Brucella spp , and Coxiella burnetii among veterinarians in a highly endemic and a non-endemic region for these infections in Turkey. Methods The antibody levels against these three infections were surveyed. Eighty-three veterinarians were included from two distinct geographic regions. Results CCHF IgG positivity (3% vs. 0%) and Brucella agglutination titer of ≥1/160 (33% vs. 5%) were more common in the endemic region, whereas the rates of Coxiella burnetii antibodies were similar (7% and 8%). A history of tick bite was significantly more common in the endemic region (35% vs. 12%, p =0.011). A multivariate analysis was performed among the veterinarians living in the endemic area, and percutaneous injuries were found to be associated with Brucella infection (OR 1.8, CI 1.09–3, p =0.022). Conclusions Veterinarians should protect themselves against tick bites, and should use masks to prevent transmission by inhalation of zoonotic infections in endemic countries.

Mucormycosis is increasingly common in patients with risk factors such as diabetes mellitus, neutropenia, and corticosteroid therapy. However, mucormycosis seems to be less common in patients with human immunodeficiency virus (HIV) infection compared to patients with other risk factors. Despite their lower virulence, Lichtheimia species should be regarded as emerging pathogens among Mucoralean fungi. We report a fatal case of pulmonary mucormycosis due to Lichtheimia ramosa in a 52-year-old man with an end-stage HIV infection. He had a cachectic appearance and his CD4 count was 8 cells/mm3. The fungal infection was diagnosed based on a positive sputum culture with histopathologic confirmation. The fungus was resistant to caspofungin, anidulafungin, and voriconazole [minimum inhibitory concentration (MCI) >32 µg/ml], whereas the E test MIC values of itraconazole, posaconazole, and amphotericin B were 0.38, 0.38, and 0.5 µg/ml, respectively. Although intravenous drug use is the main risk factor for the development of mucormycosis in HIV-infected patients, it may also develop in patients with low CD4 count, opportunistic infections and/or additional diseases, such as Kaposi's sarcoma or severe immunodeficiency, as in our case. © 2014 Springer Science+Business Media Dordrecht.

Ergonul, Onder/0000-0003-1935-9235 WOS: 000346883000006 PubMed: 25132061 Veterinarians and veterinary technicians are at risk for occupational brucellosis. We described the risk factors of occupational brucellosis among veterinary personnel in Turkey. A multicenter retrospective survey was performed among veterinary personnel who were actively working in the field. Of 712 veterinary personnel, 84(11.8%) had occupational brucellosis. The median number of years since graduation was 7 (interquartile ranges [IQR], 4-11) years in the occupational brucellosis group, whereas this number was 9 (IQR, 4-16) years in the non-brucellosis group (p < 0.001). In multivariable analysis, working in the private sector (odds ratio [OR], 2.8; 95% confidence interval [95% CI], 1.55-5.28, p = 0.001), being male (OR, 4.5; 95% CI, 1.05-18.84, p = 0.041), number of performed deliveries (OR, 1.01; 95% CI, 1.002-1.02, p = 0.014), and injury during Brucella vaccine administration (OR, 5.4; 95% CI, 3.16-9.3, p < 0.001) were found to be risk factors for occupational brucellosis. We suggest that all veterinary personnel should be trained on brucellosis and the importance of using personal protective equipment in order to avoid this infection. (C) 2014 Elsevier B.V. All rights reserved.

Scedosporium apiospermum is an emerging opportunistic pathogen that may lead to life-threatening infections especially in immunosuppressive individuals. In this report, S.apiospermum infection in a 62 year old male patient with acute myeloid leukemia was presented. During remission-induction chemotherapy, piperacillin-tazobactam therapy was started for febrile neutropenia. Since fever had continued, treatment was switched to imipenem and also amphotericin B deoxycholate was added to the treatment protocol. Because of allergic reaction to amphotericin B, caspofungin was started at the fifth day of neutropenic fever. Following imaging studies with high resolution computerized thorasic tomography, antifungal therapy was changed to voriconazole due to findings suggestive of invasive aspergillosis. Since galactomannan antigen was found negative at the first day of voriconazole therapy, bronchoalveolar lavage material from apical segment of the left lower lobe was cultured onto various microbiologic media. S.apiospermum (Teleomorph: Pseudallescheria apiosperma) was isolated on the fourth day of cultivation. According to CLSI M38-A2 microdilution procedure, minimum inhibitory concentrations (MIC) of voriconazole, caspofungin, amphotericin B and posaconazole were found as 0.06, 2, 8 and 4 µg/ml, respectively. Since neutropenia was resolved, the patient was discharged with continued voriconazole therapy. It was concluded that antifungal susceptibility tests should be performed for Scedosporium species and the results should be compared to the clinical response. The determination of MIC breakpoints may provide useful information for the recommendation and use of optimal choices for the treatment of Scedosporium infections.

Pregnant women are one of the major risk groups for disease related morbidity and mortality from influenza A (H1N1, swine flu) pandemic. Healthy pregnant women are supposed to have 4 to 5 fold increased rate of serious illness and hospitalization compared to non-pregnant subjects. Herein, the clinical course of novel influenza A (H1N1) infection in two pregnant women was presented. One woman expired due to delay in treatment, while the other one was discharged on day six after prompt treatment. We would like to emphasize that obstetricians should be aware of the clinical and radiological manifestations of influenza A for prompt diagnosis and treatment. Obstetricians also should prepare themselves to provide adequate care for pregnancy related complications encountered by pregnant women with H1N1 infection.Gebe kadınlar influenza A (H1N1) pandemisinde hastalığa bağlı morbidite ve mortalitede major risk grubudur. Sağlıklı gebe kadınların gebe olmayanlara göre ciddi hastalık geçirme ve hasteneye yatırılma oranlanın 4–5 kat daha fazla olduğu tahmin edilmektedir. Bu çalışmada, influenza A virüsünün iki gebe kadında gösterdiği klinik seyrin sunulması amaçlandı. Bir kadın tedavideki geçikmeye bağlı kaybedilirken, diğeri tedavinin hemen başlanması sayesinde altıncı gün taburcu edildi. Çalışmada obstetrisyenlerin influenza A’nın hızlı tanı ve tedavisi için hastalığın klinik ve radyolojik bulgularının farkında olmalarının önemi vurgulamak istedik. Obstetrisyenler tanının yanısıra, H1N1 enfekte gebede gelişebilecek gebeliğe bağlı komplikasyonların tedavisi için de hazırlıklı olmalıdır.

In order to investigate the value of immunoglobulin G (IgG) avidity test for the serological diagnosis of Brucella infections, a total of 118 patients (74 male, 44 female; mean age: 43 +/- 18.7 years) were included into the present study. The patients have been diagnosed with the characteristic clinical findings,or = 1/160 antibody titers in standard tube agglutination (STA) test and/or blood culture positivities. Brucella spp. have been grown in blood cultures of 78 patients, and STA test results were found positive (or = 1/160 titers) in 117 patients. The diagnosis of a patient with 1/80 STA titer was based on the blood culture positivity. By enzyme immunoassay (ELISA), 3 patients (2.5%) were found positive for IgM, 14 (11.9%) were positive for IgG, and 101 (85.6%) were positive for both IgM and IgG. The patients who were found IgG positive have been grouped according to their duration of complaints. Group 1 included 99 patients with the history of brucellosisor = 6 months, and group 2 included 16 patients with the history of brucellosis6 months. IgG avidity test was performed by ELISA in 115 IgG positive serum samples, with the denaturation substance (8 M urea). The cut-off value for IgG avidity index (AI) was accepted as 40%, and the avidity maturation period was defined as 6 months. As a result, the rates of patients who had low IgG AI in group 1 and 2 were found as 91.9% and 43.7%, respectively, while these rates were 8.1% and 56.3% for the presence of high IgG AI, respectively. The rate of low AI in group 1 was an expected result, while the rate was more than expected in group 2, indicating that Brucella antibodies with low avidity indices would not be helpful for the diagnosis of a recent infection, while Brucella antibodies with high avidity indices would be useful for the elimination of a recent infection.

102 8. ÖZET Babalık davaları üzerine yaptığımız bu çalışmada konunun Türk hukuk sistemi içerisindeki yeri ve adli tıbbi yönü incelenmiştir. Türk hukukunda sonuçları itibariyle birbirinden farklı iki tûr babalık davası bulunmaktadır. Şahsi hal sonuçlu babalık hükmü babaya mirasçı olmak, soyadını taşımak ve vatandaşlığını kazanmak yönünden tabii (mali sonuçlu) babalık hükmüne göre üstünlük taşımaktaydı. Çocuk ve kadın haklarındaki gelişmeler ve mukayeseli hukukta yapılan iyileştirmeler Anayasa Mahkemesi kararları ve Yargıtay içtihatları ile bizim hukukumuza da yansımaktadır. Bu gelişmeler sonucu çocuğun, tabii (mali sonuçlu) babalık hükmü ile de babaya ve hısımlarına mirasçı olabilme hakkı tanınmıştır. İncelemelerimiz sırasında, tabii babalık hükmünün babanın vatandaşlığının kazanılmasında da bir engel oluşturmadığını görmüş bulunmaktayız. Bu çalışmamızda ayrıca doktrinde pek değinilmeyen babalık davalarında kan muayenesi konusuna girildiği gibi doktrinde hiç değinilmeyen muhakemenin iadesi konusu da incelenmiş bulunmaktadır.103 Babalığın ispatında da bilimdeki ilerlemelerle daha çabuk ve daha güvenilir sonuçlar alınabilmektedir. Bu konuda dünya standartlarına uygun teknolojik imkanlar ülkemizde de bulunmakta olup babalık tayinlerinde kullanılmaktadır. 104 8.1. SUMMARY In this thesis which is carried out about paternity suits, applications and developments of the subject in Turkish legal system and the aspects of forensic medicine is studied. In Turkish legal system there are two kinds of paternity suits which are differ from each other in consideration of their results. Filiation to legal fatherhood had some superiorities according to the filiation to natural fatherhood such as acquiring paternal heirship, paternal surname and paternal nationality. Developments in the field of children and women rights, improvements in comparative law are reflecting to our law by way of judgments of the Constitutional Court and the Supreme Court of Appeals. As a result of these developments, in our law, by filiation to natural fatherhood the right of the paternal heirship of the child has accepted. In this research it is seen that filiation to natural fatherhood has no prevention acquiring the paternal nationality. Furthermore, in this thesis blood examinations in paternity suits are studied which are not touched more105 in doctrine and the renewing of trial subject which is never touched in doctrine is studied as well. Faster and more confidential results can obtained proving of paternity by scientific developments. In our country the most advanced technologies in the world are used for determination of paternity. 113

WOS: 000390014100018, The Nevsehir Castle region located in the middle of Cappadocia with approximately cone shape is investigated for the existence of an underground city using the geophysical method of electrical resistivity tomography. Underground cities are commonly known to exist in Cappadocia. The current study has obtained important clues that there may be another one under the Nevsehir Castle region. Several 2.5-D resistivity profiles totaling approximately 4 km in length surrounding the Nevsehir Castle are measured to determine the distribution of electrical resistivities under the study area. Several high resistivity anomalies with a depth range 8-20 m are discovered to associate with a systematic void structure beneath the Nevsehir Castle. Because of the high-resolution resistivity measurement system currently employed, we were able to isolate the void anomalies from the embedding structure. Using 3-D visualization techniques, we show the extension of the void structure under the measured profiles.