Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study.

OBJECTIVE: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.

Corneal and Anterior Chamber Morphology in Human Immunodeficiency Virus-1-Infected Patients Without Opportunistic Infections.

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<0.001), ACD (r=-0.471, P=0.002), and corneal density (r=0.424, P=0.006) in the study group, whereas it did not show a significant correlation with any ocular parameters in the control group (Pearson correlation). CONCLUSION: Corneal density, CECD, ACV, and ACD showed significant correlation with age in HIV-1-infected patients. Further studies are needed to show whether ocular parameters may serve as useful tools to monitor HIV-related accelerated aging.

Seroprevalence of human cystic echinococcosis and risk factors in animal breeders in rural communities in Denizli, Turkey.

INTRODUCTION: Cystic echinococcosis (CE) is a serious public health problem in sheep-raising regions of Turkey. The aim of this study was to determine the prevalence and associated risk factors of echinococcosis in rural regions of Denizli in Turkey. METHODOLOGY: This study was undertaken in four townships in Denizli County between May 2009 and July 2009. Family members were interviewed to assess possible risk factors for infection and tested for anti-E. granulosus antibodies by enzyme-linked immunosorbent assay (ELISA). RESULTS: Of the 1,133 individuals included in the study, 78 (6.9%) were found to be anti-EG seropositive. Multivariate analysis showed that the 30-39 year age group (odds ratio [OR]: 3.29; 95% confidence interval [CI]: 1.30 ± 8.33; p = 0.01), the ≥ 60 year group (OR: 4.08; 95% CI: 1.57 ± 10.61; p = 0.004), and the group that reported sometimes or never getting veterinary care for their animals (OR: 1.75; 95% CI: 1.05 ± 2.93; p = 0.032) had higher rates of seropositivity. Multivariate analysis showed that education was not significantly associated with seropositivity. Furthermore, no significant correlation with location, occupation, dog ownership or contact with dogs, or with cattle and/or sheep/goat ownership was found. Regular veterinary care and education had significant effects on lowering the prevalence of CE. CONCLUSIONS: Our results suggest that preventive measures, such as regular veterinary care for animals and educative and supportive activities oriented to the people working in farming and animal husbandry should be taken to decrease the prevalence of human CE in Turkey.

Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in a diabetic outpatient population: a prospective cohort study.

BACKGROUND: Diabetes mellitus is a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection. We attempted to determine the prevalence and risk factors for MRSA colonization in a population of outpatients with diabetes. METHODS: This prospective cohort study enrolled patients with diabetes. Anterior nares cultures were obtained from patients with diabetes admitted to outpatient endocrinology and metabolism clinics, and risk factors for MRSA colonization were analyzed. RESULTS: Out of the 304 patients evaluated, 127 (41.9%) were colonized with S aureus and 30 (9.9%) were colonized with MRSA. Overall, 23.6% of all S aureus isolates were MRSA. In multivariate analysis, factors independently associated with an increased risk of MRSA colonization included the presence of connective tissue disease (odds ratio, 7.075; 95% confidence interval, 2.157-23.209; P = .001) and insulin therapy (odds ratio, 3.910; 95% confidence interval, 1.652-9.251; P = .002). CONCLUSIONS: The prevalence of MRSA colonization in our sample of diabetic outpatients was 9.9%. Independent risk factors for MRSA colonization were the presence of connective tissue disease and insulin use. A better understanding of the epidemiology and risk factors for nasal MRSA colonization in the persons with diabetes may have significant implications for the treatment and prevention of MRSA infections.

Application of ATC/DDD methodology to evaluate perioperative antimicrobial prophylaxis.

OBJECTIVE: To evaluate quality of perioperative antibiotic prophylaxis (PAP) and to calculate the cost per procedure in a Turkish university hospital. SETTING: A 352-bed teaching hospital in Denizli, Turkey. METHOD: An prospective audit was performed between July and October 2010. All clean, clean-contaminated and contaminated elective surgical procedures in ten surgical wards were recorded. Antimicrobial use was calculated per procedure using the ATC-DDD system. The appropriateness of antibiotic use for each procedure was evaluated according to international guidelines on PAP. In addition, the cost per procedure was calculated. RESULTS: Overall, in 577 of the 625 (92.3%) of the studied procedures, PAP was used. PAP was indicated in 12.5% of the group where it was not used, and not indicated in 7.1% of the group where it was used. Unnecessarily prolonged antimicrobial prophylaxis was observed in 56.9% of the procedures, mean duration was 2.6 ± 2.7 days. The most frequently used antimicrobials were cefazolin (117.9 DDD/100-operation) and sulbactam/ampicillin (102.2 DDD/100-operation). The timing of the starting dose was appropriate in 545 procedures (94.5%). In the group that received PAP, only 80 (13.7%) of the procedures were found to be fully appropriate and correct. The density of antimicrobial use per operation was 2.8 DDD. The mean cost of the use of prophylactic antimicrobials 18.6 per procedure. CONCLUSION: The density of antimicrobial use in PAP was found to be very high in our hospital. Antibiotic overuse extended into the postoperative period.

Community-acquired Streptococcus mitis meningitis: a case report.

BACKGROUND: Streptococcus mitis is prevalent in the normal flora of the oropharynx, the female genital tract, gastrointestinal tract, and skin. Although it is usually considered to have low virulence and pathogenicity, Streptococcus mitis may cause life-threatening infections, particularly endocarditis. Meningitis with S. mitis is rare, but has been described in individuals with previous spinal anesthesia, neurosurgical procedure, malignancy, or neurological complications of endocarditis. CASE REPORT: A 58-year-old, alcoholic male patient with a high fever, headache, and changes in mental status was admitted to hospital with the diagnosis of meningitis. S. mitis, isolated from cerebrospinal fluid, was sensitive to penicillin. He was given a 14-day course of ampicillin and made a full clinical recovery. CONCLUSIONS: The purpose of this report is to emphasize the importance of the occurrence of S. mitis meningitis in patients with concomitant factors such as older age (>50 years), alcoholism, poor oral hygiene, and maxillary sinusitis.

[The value of the immunoglobulin G avidity test for the serologic diagnosis of brucellosis]. / Brusellozisin serolojik tanisinda immünoglobulin G avidite testinin degeri.

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 brucellosis < or = 6 months, and group 2 included 16 patients with the history of brucellosis > 6 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.