Evaluation of HIV and Syphilis Co-infected Cases, Data from a University Hospital.

BACKGROUND: HIV and syphilis are sexually transmitted infections with overlapping risk factors, potentially leading to increased HIV transmission and treatment challenges. Understanding the clinical management of syphilis co-infection among people living with HIV is crucial for public health interventions. OBJECTIVE: This retrospective cohort study aimed to assess the prevalence of syphilis co-infection, clinical characteristics, treatment response, and public health implications among people living with HIV in southern Turkey. METHODS: Records of 1352 people living with HIV 18 years and older, followed at a tertiary infectious diseases clinic between 2013 and 2023, were analyzed. Data on demographics, clinical stage of syphilis and HIV/AIDS, laboratory parameters, treatment response, and co-infections were collected. Statistical analyses were performed using SPSS 20.0 software. RESULTS: Among the people living with HIV, 103 (7.6%) were diagnosed with syphilis. Most cases were male (97.1%), with a median age of 33 (IQR 28-49) years. Heterosexual transmission was predominant (60.2%), with a history of condomless sexual intercourse in 90.3% of cases. The majority (88.3%) were asymptomatic with latent syphilis. Syphilis was diagnosed concurrently with HIV in 77.7% of cases. Serological response to syphilis treatment was observed in 46.8% of patients, while 53.2% showed a serofast reaction. Neurosyphilis was rare, diagnosed in only one patient. Co-infections with hepatitis B and C were detected in 3.9% and 1.9% of patients, respectively. CONCLUSION: Syphilis co-infection among people living with HIV is a significant public health concern in southern Turkey. Routine screening for syphilis, along with comprehensive education on sexually transmitted infection prevention, is essential for early detection and optimal management. Further research is needed to improve treatment outcomes and address emerging challenges in HIV-syphilis co-infection management.

Evaluation of chronic hepatitis B patients who voluntarily discontinued oral antiviral therapy: is there an answer to the controversial topic?

OBJECTIVE: The uncertain treatment duration for nucleos(t)ide analogues (NA) used in the treatment of chronic hepatitis B (CHB) is an important problem for both patients and physicians. The aim of this study was to evaluate the determinants of virologic relapse (VR) and the optimum time of treatment discontinuation in the follow-up of CHB patients who voluntarily discontinued treatment after virological suppression was achieved under NA use. METHODS: Data from 138 patients from 11 centers were included in this registry-based study. Factors associated with VR were investigated using multivariate Cox regression analysis. RESULTS: Ninety-nine (71.7%) of the patients were HBeAg (Hepatitis B e antigen) negative. During the 24-month follow-up period after treatment discontinuation, VR occurred in 58.7% (n = 81) of all patients and 57.6% (n = 57) of HBeAg-negative patients. The duration of NA treatment was significantly shorter (cutoff 60 months) in HBeAg-negative patients who later developed VR. In addition, the duration of virologic remission achieved under NA treatment was significantly shorter (cutoff 52 months) in those who later developed VR. In the Cox multivariate regression model of HBeAg-negative patients, having less than 60 months of NA treatment (HR = 2.568; CI:1.280-5.148; P  = 0.008) and the levels of alanine aminotransferase being equal to or higher than twice the upper level of normal at the beginning of treatment (HR = 3.753; CI:1.551-9.081; P  = 0.003) were found to be statistically significant and independently associated with VR. CONCLUSION: The findings of this study may provide clinical guidance in terms of determining the most appropriate discontinuation time for NA.

Exposure to COVID-19 among unvaccinated healthcare personnel and risk for infection: a single-center retrospective study.

INTRODUCTION: Characteristics of exposure and infection risk, are important in strategy development for infection control among healthcare workers (HCWs). Our objective was to investigate the characteristics of exposure of HCWs to SARS-CoV-2 and determine the risk of COVID-19 development. METHODOLOGY: This is a retrospective single-center cohort study, conducted between March and December 2020. Unvaccinated and exposed HCWs were asked to complete a standard form, including demographic data and characteristics of exposure(s). Exposures were stratified according to national guidelines. STROBE checklist was used. RESULTS: Among a total of 4,385 healthcare workers, 1,483 HCWs (33.8%) with a total of 1,903 exposures to SARS-CoV-2 were identified. Median age was 31 (IQR: 26-40) years and 45.4% were male (N = 673). Following exposure, 78 HCWs became SARS-CoV-2-positive (attack rate: 3.9%) and secondary attack rate was 4/16. In terms of infection, exposure to SARS-CoV-2-positive HCWs posed a greater risk compared to contact with patients (8.9%, [n = 66] vs. 3.8% [n = 12], respectively, p = 0.003). PCR positivity rates were 11.5%, 6.3%, and 8.4% for low, medium, and high-risk contacts (p = 0.152). Median time to infection post-exposure was 7 (IQR: 4-13) days. CONCLUSIONS: Given the attack rates, there was no correlation between risk levels and PCR test positivity rates. There was no difference between HCWs with or without work restrictions, in terms of PCR positivity. Due to feasibility issues, prioritizing universally applied symptom screening and resource control strategies and suspending contact tracing and work restrictions, appear to be safe during high prevalence period.

Late Diagnosis in HIV with New and Old Definitions; Data from a Regional Hospital in Turkey.

Background: Late presentation for HIV care, continues to be a challenge, leading to increased morbidity, mortality, and society costs. The study aimed to determine the rates of late diagnosis (LD) and patient characteristics in Turkey, utilizing the new definition excluding recently infected. Methods: The study included patients admitted to the hospital between 1998 and 2023, with at least 1 year of follow-up. Patients without a CD4 count at their initial admission were excluded. Two definitions of presentation were used: LD, (CD4<350 cells/mL or AIDS-defining event) and advanced disease (AD), (CD4<200 cells/mL or AIDS-defining event). Individuals with recent evidence of infection were reclassified as "not late". Results: Out of the 914 patients meeting the criteria and the analysis focused on 794 treatment-naïve patients, with 90.6% being male and an average age of 36.0 ± 12.0 years. Using the previous definition, 48.9% were diagnosed as late, while the new definition identified 47.2%. A total of 183 patients (23%) were diagnosed with AD, and 25.9% of the diagnoses occurred during the COVID-19 Pandemic. The rate of LD increased during the pandemic compared to before (55.8% vs 44.2%, p=0.005), as did the rate of AD (30.1% vs 20.6%, p=0.007). There was no significant relationship between gender and LD. Patients with LD were older (median ages were 31 vs 36 in groups, p<0.001), had poorer virological response, higher mortality rates (4.8% vs 1.2%, p=0.003), and shorter survival compared to those without (log rank=0.004). Conclusion: HIV patients with LD have poorer prognosis with older age as well as disruption of health services during the pandemic as risk factors. To improve outcomes, multicenter studies should investigate missed opportunities and specific risk factors in our region, and we should screen at-risk populations, promote awareness among underdiagnosed populations, and advocate testing even in disastrous situations.

Analysis of Macular Microvasculature in Human Immunodeficiency Virus Infection.

PURPOSE: To evaluate the retinal and choroidal microvascular blood flow in patients with human immunodeficiency virus (HIV) infection using optical coherence tomography angiography (OCTA). METHODS: Macular OCTA parameters including vessel density (VD) of parafoveal superficial capillary plexus (SCP-VD) and deep capillary plexus (DCP-VD), foveal vessel density (FD), foveal avascular zone area, and flow area of choriocapillaris were analyzed in 42 HIV-positive patients, and compared with 42 healthy controls. RESULTS: The mean SCP-VD, DCP-VD and FD were significantly lower in HIV-positive group compared with controls (p < .001, p = .014, p = .026; respectively). Reduced SCP-VD was associated with higher HIV RNA plasma level (r = -0.400, p = .021) and lower CD4 + T cell count (r = 0.314, p = .046) in HIV-positive patients. CONCLUSIONS: Macular microvascular blood flow is affected by HIV infection. OCTA can detect microvascular flow abnormalities in retinal capillary plexus in HIV-positive patients.

[Comparison of Candida Polymerase Chain Reaction Method and Blood Culture in Patients with High Risk of Candidemia in Intensive Care Unit]. / Yogun Bakim Ünitesinde Takip Edilen Kandidemi Riski Yüksek Hastalarda Candida Polimeraz Zincir Reaksiyonu Yöntemi ve Kan Kültürünün Karsilastirilmasi.

Candida species are responsible for 70-90% of invasive fungal infections in the intensive care unit. Early diagnosis and treatment is important in candidemia. Improper diagnosis and treatment increases mortality and morbidity significantly. Because of the late results of blood cultures and low sensitivity of the serological tests when used alone, molecular methods should be investigated in this field. In this study, the results of the Candida real-time polymerase chain reaction (Rt-PCR) test, which was studied from blood culture and whole blood, were compared in patients with high candidemia risk who were followed in the General Surgery Intensive Care and Anesthesiology and Reanimation Unit of Cukurova University Faculty of Medicine. It was aimed to investigate the practical utility of Candida RT-PCR test, which is a rapid diagnosis method in patients with suspected candidemia. In our study, 90 patients with high risk of candidemia according to the criteria determined according to the guidelines were evaluated prospectively. Urine, perineum, axilla, tracheal aspirate culture and two sets of blood cultures were obtained from the patients. Blood sample was also drawn into an ethylenediaminetetraacetic acid (EDTA) tube and stored at -40°C for later Candida Rt-PCR study. In Candida Rt- PCR, species-specific primers were used to distinguish species. Candida score (CS) of the patients was calculated. Forty one (45.5%) of the patients were female and 49 (55.5%) were male. The median age of the patients was 61.5 years. Candida was positive in blood culture in three (3.3%) of the patients included in the study, while Candida Rt-PCR was positive in 17 (18.9%). Candida species detected in the blood culture and Rt-PCR test were compatible with each other. Rt-PCR was significantly more positive (p= 0.006). Candida Rt-PCR positivity was significantly higher in patients receiving total parenteral nutrition (p= 0.028), malignancy (p= 0.021), and history of surgery in the last three months (p=0.003). The difference in CS between patients with PCR positive and PCR negative was statistically significant (p= 0.015). Our study was conducted in a high-risk population for candidemia and the results of Candida Rt-PCR was found to be more positive than blood culture. Rt-PCR positivity and blood culture positivity were associated with high CS. In the light of these data, it was thought that it would be appropriate to use molecular methods in the diagnosis and support them with CS, especially in patients with high risk of candidemia. Considering that blood culture, which is the gold standard for the diagnosis of candidemia, gives late results and is 50% positive, using faster diagnostic methods for candidemia is important to reduce mortality and morbidity. The fast and good results of Candida PCR method have shown that it can be used in diagnosis. However, lack of standardization of primers used in PCR tests may cause false positives. Additional studies are needed in this respect.

COVID-19 patients' sera induce epithelial mesenchymal transition in cancer cells.

Covid-19 Pneumonia of SARS-CoV-2 pandemic infection, persists to have high disease burden especially in cancer patients. Increased inflammation and thromboembolic processes are blamed to influence cancer patients more than the others but due to lack of knowledge regarding the pathophysiology of the both the virus itself and the response of the host, more basic and translational disease modeling research is needed to understand Cancer-Covid-19 interaction. In this study, serum samples from the patients, who were hospitalized due to Covid-19 pneumonia, applied to different cancer cells and cytotoxicity, motility, proliferation and gene expression analysis were performed. Serum samples derived from healthy volunteers and the fetal bovine serum that is used regularly in cell culture experiments used as controls. Hospitalized Covid-19 patients who had also cancer, were retrospectively screened, and their clinical course were recorded. Overall 12 Patient (PS) and 4 healthy serums (CS) were included in the experiments. PS applied cells showed increased motility in A549 cells as well as lost cell to cell connection in MCF7 and HCT116 cells, and induced expression of VIM, ZEB1 and SNAIL2 mRNA levels. Eight cancer diagnosed patients who were hospitalized due to Covid-19 between April and September 2020 were also reviewed retrospectively, which 5 of them were dead during SARS-CoV-2 infection. Thorax CT images of the 2 patients showed increased metastatic nodules in the lungs as of January 2021. The results of the study indicate that metastasis may be one of the prolonged consequences of COVID-19 pandemic in cancer sufferers.

Low immunity against vaccine preventable diseases in Turkish HIV cohort

Background/aim: HIV infection increase the risk of serious disease resulting from common vaccine-preventable infections. Vaccinations are particularly important for HIV infected adults. We aimed to investigate the immunity rates against measles, mumps, rubella, hepatitis A, B, and tetanus in newly diagnosed HIV patients. Materials and methods: Patients who admitted to outpatient clinics of three centers with newly diagnosed HIV infection, between 1 January 2015 and 31 June 2017 were included. Measles, mumps, rubella, varicella zoster virus, hepatitis A, hepatitis B, and tetanus antibody levels were measured by commercial diagnostic kits. Demographical and laboratory data of the patients were recorded. Results: Five hundred and twenty-three patients were enrolled in the study. Of the patients 87% were male (n = 455) and the mean age was 38 ± 13 years. Serology was available for measles 74.2% (388/523), mumps 73.8% (386/523), rubella 77.8% (407/523), hepatitis A 88.5% (463/523), hepatitis B 97.7% (511/523), tetanus 8.6% (45/523), and VZV 79.9% (418/523). Seropositivity was 82% for measles, 75.6% for mumps, 92.1% for rubella. Of the patients whom all three of the components of the MMR vaccine was tested, 37.7% (127/337) were susceptible at least one and needed the vaccine. Mean age was lower in patients who are nonimmune to measles and mumps (p = 0.008). Younger patients were also nonimmune for hepatitis A, while older patients were nonimmune for hepatitis B. Conclusion: In our study we found that rates of nonimmunity can increase up to one third of the patients even though there is a national vaccination program. Nonimmune individuals should be detected and vaccinated in line with recent guidelines and response should be monitored because of the possibility of impaired immunity and possible suboptimal response. National campaigns can be launched for adult immunization and physicians should be aware of the importance of adult immunization.

Physicians' knowledge of potential covid-19 drug-drug interactions: An online survey in turkey.

OBJECTIVES: Given the many medications used to treat novel coronavirus disease (COVID-19) and its comorbidities and complications, the risk of drug-drug interactions (DDIs) and resulting patient harm is concerning. This study aimed to shed light on physicians' knowledge of potential DDIs related to COVID-19 treatment, to determine the effect of an information brief about these DDIs on their correct response rates, and to identify factors associated with higher levels of knowledge about these DDIs. METHODS: The knowledge of physicians regarding the clinical significance and intervention of 7 common potential DDIs during COVID-19 treatment was evaluated via an online survey. Using a pretest-posttest design, the physicians completed a multiple-choice questionnaire first using their existing knowledge, then received an information brief about the DDIs and completed the same questionnaire again. Pretest and posttest scores were evaluated and factors affecting correct response rates were determined using correlation, regression, and post-hoc analyzes. RESULTS: A total of 244 physicians participated in the survey, 147 (60.2%) of whom were involved in the treatment of COVID-19 patients. After the information brief, there were significant increases in the number of correct responses for both clinical significance and interventions (p < 0.0001). In comparisons of pretest knowledge, physicians involved in the treatment of COVID-19 patients showed significantly higher correct response rate for interventions compared to physicians who had not treated COVID-19 patients (p = 0.003). Post-hoc analysis to compare pretest correct intervention responses among all medical specialties revealed significant differences between infectious diseases and family practice (mean difference: 1.059; p = 0.005) and between internal medicine and family practice (mean difference: 1.771; p < 0.0001). CONCLUSION: Physicians involved in the treatment of COVID-19 patients had more knowledge regarding clinical significance and appropriate management of potential DDIs than those not involved. Therefore, it may be beneficial to organize trainings and issue guidelines about potential DDIs for physicians during the COVID-19 pandemic.

A snapshot of geriatric infections in Turkey: ratio of geriatric inpatients in hospitals and evaluation of their infectious diseases: A multicenter point prevalence study.

INTRODUCTION: The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. MATERIALS AND METHODS: Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. RESULTS: Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1±7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2-11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. CONCLUSION: This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients.

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.

Identification of Cryptococcus antigen in human immunodeficiency virus-positive Turkish patients by using the Dynamiker® lateral flow assay.

Cryptococcus neoformans causes life-threatening meningoencephalitis, particularly in human immunodeficiency virus (HIV)-positive individuals with low CD4 levels (<100 cells/µL). Although the burden of cryptococcal meningoencephalitis (CM) in Turkey is low (0.13 cases per 100 000 persons), asymptomatic individuals at risk of cryptococcosis should be screened for antigenemia to prevent the disease and/or promote early CM diagnosis. A lateral flow assay (LFA) is used to detect Cryptococcus antigen (CrAg) in cerebrospinal fluid and serum. We determined Cryptococcus antigenemia prevalence in serum samples of HIV-positive and HIV-negative adult patients by using Dynamiker® CrAg-LFA, a point-of-care dipstick test. Patients' demographic data, CD4 count, HIV-RNA levels and anti-retroviral therapy status were recorded. CrAg was detected in 28 (11%) of 254 HIV-positive patients screened but not in 100 HIV-negative control individuals; a significant difference was observed in the CrAg-LFA positivity rate between HIV-positive and HIV-negative groups (x2  = 11.970; P < .05). In CrAg-positive patients, the median CD4 level was 666 cells/µL (115-1344 cells/µL), with a median viral load of 23 copies/mL (0-3.69 × 106  copies/mL). In HIV-positive CrAg-negative patients, the median CD4 level was 633 cells/µL (31-2953 cells/µL) and the median viral load was 12 copies/mL (0-1.95 × 106  copies/mL; P > .05). Results indicate that HIV-positive patients with both low (<200 cells/µL) and high (>200 cells/µL) CD4 counts should be screened for asymptomatic cryptococcal antigenemia. HIV-associated asymptomatic cryptococcosis is not uncommon in Turkey, which warrants systematic screening. Updated strategies for CM prevention among HIV-positive patients should be used even in non-endemic countries.

The Causes of Postoperative Meningitis: The Comparison of Gram-Negative and Gram-Positive Pathogens.

AIM: To determine the microbiological etiology in critically ill neurosurgical patients with nosocomial meningitis (NM) and to show the impact of Gram-negative rods and the differences between patient characteristics and the clinical and prognostic measures in Gram-negative and Gram-positive meningitis. MATERIAL AND METHODS: In this prospective, single-center study, we reviewed all adult patients hospitalized during a 12-year period and identified pathogens isolated from post-neurosurgical cases of NM. Demographic, clinical, and treatment characteristics were noted from the medical records. RESULTS: Of the 134 bacterial NM patients, 78 were male and 56 were female, with a mean age of 46±15.9 and a median age of 50 (18-80) years. One hundred and forty-one strains were isolated; 82 (58.2%) were Gram-negative, 59 (41.8%) were Grampositive. The most commonly isolated microorganism was Acinetobacter baumannii (34.8%). Comparison of mortality data shows that the patients who have meningitis with Gram-negative pathogens have higher mortality than with Gram-positives (p=0.034). The duration between surgery and meningitis was shorter in Gram-negative meningitis cases compared to others (p=0.045) but the duration between the diagnosis and death was shorter in Gram-positive meningitis cases compared to Gram-negatives (p=0.017). Cerebrospinal fluid protein and lactate levels were higher and glucose level was lower in cases of NM with Gram-negatives (p values were respectively, 0.022, 0.039 and 0.049). CONCLUSION: In NM, Gram-negative pathogens were seen more frequently; A. baumanni was the predominant pathogen; and NM caused by Gram-negatives had worse clinical and laboratory characteristic and prognostic outcome than Gram-positives.

Reactivation rates in patients using biological agents, with resolved HBV infection or isolated anti-HBc IgG positivity.

BACKGROUND/AIMS: Tumor necrosis factor-α (TNF-α) inhibitors and ustekunimab are widely used in autoimmune diseases. It is known that these biological agents cause the reactivation of hepatitis B virus (HBV). There is no standardized strategy to prevent the reactivation in patients with evidence of a previous HBV infection. In our study, anti-HBc IgG-positive patients who received a biological agent were evaluated in terms of HBV reactivation. MATERIALS AND METHODS: Patients who were followed up for the use of biological agents in our clinic were evaluated retrospectively. Patients with isolated anti-HBc IgG positivity were included in the study. The HBV reactivation data were recorded from the patients' files retrospectively. RESULTS: Two hundred and seventy-eight patients who received biological treatment were evaluated. Twenty-nine patients with isolated anti-HBc IgG positivity or resolved HBV infection were included in the study. The HBV reactivation was seen in 5 patients (17.2%). Of these patients, 3 were using adalimumab, 1 infliximab, and 1 ustekunimab. It was controlled by antiviral therapy that was started in the early period. CONCLUSION: Drugs that block TNF-α and ustekunimab cause an increase in viral replication. In literature, the HBV reactivation rate was approximately 1% in HBsAg-negative, anti-HBC IgG-positive cases, whereas it was found to be as high as 17.2% in our study. Patients receiving the immunomodulator therapy should be evaluated for HBV serology before treatment and carefully monitored for HBV reactivation during and after treatment.

Potential Drug-Drug Interactions with Antimicrobials in Hospitalized Patients: A Multicenter Point-Prevalence Study.

BACKGROUND Improper use of antimicrobials can cause adverse drug events and high costs. The purpose of this study was to investigate the frequency and potential drug-drug interactions associated with antimicrobials among hospitalized patients. MATERIAL AND METHODS This study was conducted on the same day in 5 different hospitals in Turkey. We included patients aged ³18 years who received at least 1 antimicrobial drug and at least 1 of any other drug. The Micromedex® online drug reference system was used to control and describe the interactions. Drug interactions were classified as contraindicated, major, moderate, and minor. RESULTS Potential drug-drug interactions with antimicrobials were 26.4% of all interactions. Five (42%) of 12 contraindicated interactions and 61 (38%) of 159 major interactions were with antimicrobials. Quinolones, triazoles, metronidazole, linezolid, and clarithromycin accounted for 173 (25.7%) of 673 prescribed antimicrobials, but were responsible for 141 (92.1%) of 153 interactions. In multivariate analysis, number of prescribed antimicrobials (odds ratio: 2.3001, 95% CI: 1.6237-3.2582), number of prescribed drugs (odds ratio: 1.2008, 95% CI: 1.0943-1.3177), and hospitalization in the university hospital (odds ratio: 1.7798, 95% CI: 1.0035-3.1564) were independent risk factors for developing drug interactions. CONCLUSIONS Due to risk of drug interactions, physicians should be more cautious when prescribing antimicrobials, particularly when prescribing quinolones, linezolid, azoles, metronidazole, and macrolides.

Pooled analysis of 163 published tuberculous peritonitis cases from Turkey

Background/aim: Tuberculous peritonitis may be difficult to diagnose due to its insidious and variable clinical manifestations as well as characteristics similar to malignancy. In this study, case reports from Turkey over the last 10 years were reviewed systematically using pooled analysis. Materials and methods: Thirty-four suitable articles were found and 163 tuberculous peritonitis cases were included in the study. Results: The mean age was 34.1 years (17­79 years), and 146 (98.6%) of the patients were female and 17 (10.4%) were male. The most common complaints of these patients were abdominal pain (77.4%) and abdominal distention (73.5%). Ascites in the abdomen (75%), fever (42%), abdominal tenderness (33%), and abdominal distention (30.7%) were the most common physical examination findings. The mean adenosine deaminase level was 120.3 IU/L. In the subsets of patients with relevant data, acid-fast bacilli were found in 23.3%, culture was positive in 22.2%, and Mycobacterium tuberculosis polymerase chain reaction was positive in 20%. In abdominal imaging, ascites was reported in 92%. Elevated serum CA-125 was reported in 96.7% of the patients. Of 105 patients with data available following the antituberculous therapy prognosis, four (3.8%) died and the other 101 (96.2%) showed good treatment response. Conclusion: Tuberculous peritonitis should be kept in mind during the differential diagnosis of patients admitted with the triad of ascites, fever, and abdominal distention.

Furuncular Myiasis Caused by Dermatobia hominis in a Traveler Returning from the Amazon Jungle.

A 39-year-old man who was returning from the Amazon Jungle and had no medical history presented with a furuncular lesion on his right parietal scalp. Despite receiving appropriate antimicrobial treatment, his lesion did not heal. After surgical intervention, a Dermatobia hominis larva was extracted. The human botfly D. hominis is the most common causative agent of furuncular myiasis among travelers returning from Central and South America. Surgery is the main treatment option, and secondary bacterial infection should be kept in mind.

Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae at a Turkish centre: Is the increase of resistance a threat for Europe?

OBJECTIVES: In recent years, carbapenem-resistant Klebsiella pneumoniae (CRKP) have become an important threat to hospitalised patients. This study aimed to identify the genetic mechanisms of carbapenem resistance in CRKP isolated from patients in a Turkish centre. METHODS: During 2013-2014, a total of 98 K. pneumoniae isolated from patients at Çukurova University Balcali Hospital (Adana, Turkey) determined phenotypically as resistant to carbapenems were screened genotypically for the presence of carbapenemase enzymes by multiplex PCR. RESULTS: Of the 98 patients for whom genetic investigation was made, 93 (94.9%) were adults, 56 (57.1%) were male and 81 (82.7%) were diagnosed as infected. The mean and median age were 51.8±20.5years and 55 years (range 1-89 years), respectively. The nosocomial infection rate was 87.8% (86/98). The mortality rate was 41.8% (41/98). Fifty-eight patients (59.2%) were admitted to intensive care units. Of the 12 non-nosocomial infections, 5 (41.7%) originated from the inpatient clinic of the urology department. The mean and median hospital length of stay (LOS) were 20.7±20.8days and 17days (range 0-90 days), respectively. The most common carbapenemase gene detected was blaOXA-48 (74.5%), followed by blaVIM (45.9%) and blaSME (37.8%). The blaNDM gene was detected in 20 isolates (20.4%). The most effective antibiotics were tigecycline and colistin, with susceptibility rates of 87.5% and 74.3%, respectively. CONCLUSIONS: Multiple resistance mechanisms were present in CRKP isolates in Turkey. Most of the isolates harboured blaOXA-48, blaVIM and blaSME genes; meanwhile, the rate of 20.4% for blaNDM is alarming.

Rickettsia sibirica mongolitimonae Infection, Turkey, 2016.

In 2016, Rickettsia sibirica mongolitimonae was diagnosed for a man in Turkey. He had been bitten by a Hyalomma marginatum tick, from which PCR detected rickettsial DNA. Sequence analysis of the DNA identified R. sibirica mongolitimonae. Immunofluorescence assay of patient serum indicated R. conorii, which cross-reacts. PCR is recommended for rickettsiosis diagnoses.