Impact of the COVID-19 Pandemic on Diabetic Foot Patients: A Shift in the Infectious Agent Profile Toward Nonfermentative Gram-Negative Bacilli.

BACKGROUND: Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality. METHODS: This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]). RESULTS: During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP. CONCLUSIONS: The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.

Evaluation of interleukin-8 levels in the diagnosis of invasive pulmonary aspergillosis in patients with haematological malignancies.

This study aimed to determine the level of interleukin (IL)-8 in diagnosing of invasive pulmonary aspergillosis (IPA). We conducted this study with 50 controls and 25 IPA patients with haematological malignancies. Demographic data, haematological diagnoses, chemotherapy regimen, galactomannan level, fungal culture, and computed tomography findings of the patients were evaluated prospectively. IL-8 levels were studied with the ELISA method. The mean age of patients in the case group was 60.84 ± 15.38 years, while that of the controls was 58.38 ± 16.64 years. Of the patients, 2/25 were classified as having 'proven', 13/25 as 'probable', and 10/25 as 'possible' invasive aspergillosis (IA). Serum IL-8 levels were found to be significantly higher in the case group compared to the controls. There was a negative correlation between serum IL-8 levels and neutrophil counts and a positive correlation with the duration of neutropenia. A significant cutoff value for serum IL-8 parameter in detecting IPA disease was obtained as ≥274 ng/l; sensitivity was 72%; specificity was 64%; PPV was 50%; and NPV was 82%. In the subgroup analysis, there was no significant difference in serum IL-8 levels between the case group and the patients in the neutropenic control group, while a significant difference was found in with the patients in the non-neutropenic control group. Serum IL-8 levels in neutropenic patients who develop IPA are not adequate in terms of both the diagnosis of the disease and predicting mortality. New, easily applicable methods with high sensitivity and specificity in diagnosing IPA are still needed.

Although a significant cutoff value for serum interleukin (IL)-8 was found in the diagnosis of IPA, there was no statistical difference in serum IL-8 when subgroup analysis was performed with neutropenic control patients. Therefore, serum IL-8 is not a successful marker in diagnosing neutropenic patients with IPA.

Evaluation of risk factors for the development of bacteremia and complications in patients with brucellosis: Is it possible to predict the clinical course?

INTRODUCTION: Brucellosis is often confused with other diseases or accompanies the conditions it imitates. It causes treatment delays, failure, relapse, and complications. This study aimed to investigate bacteremia and complication predictors in Brucellosis patients. Early detection may help reduce relapse rates, length of hospital stay, and surgical intervention rates by providing appropriate treatment. METHODOLOGY: We examined 220 adult patients diagnosed with Brucellosis in our tertiary care hospital in the Black Sea Region between January 01, 2010, and January 01, 2022. Patients with and without bacteremia and complications were compared regarding demographic characteristics, clinical features, and laboratory parameters. RESULTS: The mean age was 46.4 ± 15.8 years (18-96 years), and 61% were male. Low back pain and absence of muscle pain were independent risk factors for predicting bacteremia (p = 0.049, p = 0.043, respectively). Weakness /fatigue, weight loss, and 1/320 Standard Tube Agglutination Test (STAT) or Brucella Coombs Gel Test (BCGT) titers were independent risk factors that reduced the risk of complications; in contrast, low back pain and splenomegaly were independent risk factors for development of complications. (p = 0.025, p = 0.007, p = 0.008, p = 0.003, p = 0.021 respectively). Thrombocytopenia was related to complications. When the platelet cut-off value was taken as 160,000/µL in predicting complications, the sensitivity was 31.30%, and the specificity was 97.73% (p = 0.011). CONCLUSIONS: The risk of clinical progression and complications could be predicted with symptoms and signs such as myalgia, low back pain, weakness/fatigue, weight loss, splenomegaly, and easily accessible laboratory parameters such as serum STAT/BCGT titer and platelet level.

Investigation of Anti-SARS-CoV-2-specific IgG Levels in Breast Milk after Vaccination or COVID-19 Infection.

OBJECTIVE: Newborns are vulnerable to all types of infections due to their developing immune system. To compensate for their immune immaturity, newborns rely on the passive transfer of antibodies through the placenta and own mother's breast milk (BM). In the present study, we investigated whether vaccination against SARS-CoV-2 leads to the presence of antibodies in BM. Furthermore, we compared the levels of SARS-CoV-2-specific anti-spike (anti-S) IgG antibodies in the BM of mothers who were vaccinated against Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or had coronavirus disease 2019 (COVID-19) infection naturally or were vaccinated after natural infection. STUDY DESIGN: This was a prospective cohort study conducted in the Ondokuz Mayis University Faculty of Medicine. Forty-six mothers who had at least two doses of the BNT162b2 messenger RNA-based vaccine and/or had a history of symptomatic COVID-19 infection were included in the study. BM samples were analyzed by the Abbott Architect SARS-CoV-2 IgG II Quant kit following the manufacturer's instructions. RESULTS: Forty-six mothers with an average age of 29.7 ± 5.7 years participated the study: 18 (39.1%) had COVID-19 infection + BTN162b2 vaccine, 17 (37.0%) had BTN162b2 vaccine, and 11 (23.9%) had natural infection. The highest SARS-CoV-2-specific anti-S IgG antibody titers in BM were found in mothers who were vaccinated following the infection (anti-SARS-CoV-2 IgG: 32.48 ± 57.1 arbitrary units AU/mL). However, no significant difference in anti-SARS-CoV-2 antibody levels was observed between the three groups (p = 0.641). No antibody was detected in 15.2% of BM samples. CONCLUSION: Both vaccination and natural COVID-19 infection during pregnancy leads to the passive transfer of specific anti-SARS-CoV-2 IgG antibodies to BM. These results are important to overcome vaccine hesitancy and increase vaccination levels in expectant mothers. KEY POINTS: · We investigated the levels of SARS-CoV-2 antibodies in BM after natural infection and vaccination.. · Anti-SARS-CoV-2 IgG antibodies were detected in 39 (84.8%) BM samples.. · The highest titers in BM were found in mothers who were vaccinated following natural infection..

Molecular epidemiology of Coxiella burnetii detected in humans and domestic ruminants in Turkey.

Q fever is a zoonotic disease that is known to be widespread throughout the world by many researches since its discovery in 1935 and it is important in terms of animal and public health. Coxiella burnetii, which is the etiological agent of the disease, is an obligate intracellular pathogen. While the disease generally manifests itself with abortion in animals, disease manifests as atypical pneumonia or granulomatous hepatitis in the acute form and as endocarditis in the chronic form in humans. Its presence in Turkey has been shown with a large number of studies. The aim of this study was to show the genotypic relationship with MLVA analysis of C. burnetii samples found in cattle, sheep and goat samples in Erzurum and Samsun Veterinary Control Institutes and blood samples collected from humans with atypical pneumonia findings. In the study, MLVA analyses of 100 positive samples from 50 cows, 41 sheep and 9 goats from Northeast Anatolia and Black Sea regions and C. burnetii positive samples found in 6 individuals with atypical pneumonia were performed. As a result of the study, it was found that 106 C. burnetii samples had belong to 16 genotype groups. It was found that genotype XVI was the most prevalent among these groups and it was seen in both regions. In addition to this, genotype IX profile was the second largest group with 83.3% (5/6) of human samples. In this study, the genotypes common in the regions were determined and a data source was created for possible outbreaks.

Clinical, Prognostic, and Predictive Value of Olfactory Dysfunction for COVID-19: A Prospective Controlled Study.

OBJECTIVE: To evaluate the effect of olfactory dysfunction on the course and severity of COVID-19 and its prognostic and predictive significance for COVID-19. STUDY DESIGN: Prospective case-control study. SETTING: Ondokuz Mayis University School of Medicine. METHODS: Reverse transcription polymerase chain reaction (PCR)-positive patients, patients with COVID-19-related symptoms who had a negative PCR result, and healthy controls were included in the study. Clinicodemographic characteristics, inflammatory markers, and computed tomography stages were recorded. Disease progression and intensive care unit admission were registered. The visual analog scale (0, worst; 10, best) was used to evaluate subjective olfactory, taste, and nasal breathing ability, and the Sniffin' Sticks identification (SS-ID) test was used for psychophysical olfactory assessment. RESULTS: Mean SS-ID scores were significantly lower in the positive group (8.77) than in the negative (10.43) and healthy control (12.17) groups. VAS-smell scores were significantly lower and anosmia was more prevalent in PCR-positive patients (P < .01). SS-ID and VAS-smell scores were significantly correlated (r = 0.681, P < .001). The inflammatory parameters, pulmonary infiltration stage, disease progression, and ICU admission were not associated with SS-ID scores. A cutoff SS-ID score <9 resulted in 55.56% sensitivity in predicting COVID-19 positivity, and a cutoff VAS-smell score <8 yielded 72.22% sensitivity. CONCLUSION: Olfactory dysfunction was detected objectively and subjectively in the PCR-positive group, and no difference was found in terms of taste function and nasal breathing. The severity and prognosis of COVID-19 are not exclusively dependent on olfactory dysfunction. The degree of olfactory dysfunction can be useful in predicting PCR positivity.

[CARD9 Mutation in a Patient with Candida albicans Meningoencephalitis; A Case Report]. / Candida albicans Meningoensefaliti Olan Bir Hastada CARD9 Mutasyonu; Bir Olgu Raporu.

Primary immunodeficiencies are disorders that cause clinical findings ranging from mild diseases to life-threatening diseases in a wide age range. Infections are the most common complications of primary immunodeficiencies. Caspase associated recruitment domain-9 (CARD9) is a protein that plays a role in fungal immune response. CARD9 deficiency is one of the primary immunodeficiency disorders that show autosomal recessive inheritance and can cause different clinical pictures. It has been associated with various fungal infections such as superficial or deep dermatophytosis, invasive pheohifomycosis, cutaneous mucormycosis, extrapulmonary aspergillosis, mucocutaneous or invasive candidiasis. The most common infections in CARD9 deficiency are caused by Candida spp. In this report, a case of Candida albicans meningoencephalitis due to CARD9 deficiency was presented. It was learned from the medical story that a 37 years old male patient had no known disease or drug use, but had recurrent oral candidiasis and cutaneous fungal infections since childhood, and received liposomal amphotericin B treatment with the diagnosis of C.albicans meningoencephalitis two months ago. It was learned that he was discharged with voriconazole treatment after clinical improvement, and he stopped the voriconazole treatment after discharge and did not go for follow-up. The patient, who reapplied 1.5 months after discharge with complaints of headache, vomiting and altered consciousness, did not have fever and neck stiffness, and Kerning and Bruzinski sign was negative. An external ventricular drainage (EVD) catheter was inserted after hydrocephalus was detected in the brain computerized tomography (CT). In the cerebrospinal fluid (CSF) examination, erythrocyte count was detected as 340/mm3, and no leukocytes were seen. CSF protein level was 28 mg/dl, CSF glucose level was 59 mg/dl (simultaneous blood glucose level was 104 mg/dl). There was no yeast or bacteria in CSF Gram staining and no acidfast bacteria in Ziehl-Neelsen staining. It was learned that there was no growth in the Mycobacterium tuberculosis culture made from CSF sample taken at the first admission of the patient. Serum human immunodeficiency virus antibody was negative. Upon learning of fluconazole-susceptible C.albicans growth in the control CSF culture of the patient, the EVD catheter was changed, and liposomal amphotericin B treatment was started. CSF culture was repeated. Fluconazole-susceptible C.albicans continued to grow in CSF cultures repeated in the follow-ups. No pathology in favor of abscess was detected in the brain magnetic resonance imaging. Fluconazole was added to the current liposomal amphotericin B treatment. Having a history of recurrent mucocutaneous fungal infection in the patient and his siblings, whose parents were third-degree relatives, suggested CARD9 deficiency. In the molecular test studied from blood samples, homozygous p.Q295X mutation due to CARD9 deficiency was detected in the patient and his sister. However, the patient died on the 62nd day of hospitalization due to delayed diagnosis, cerebral complications due to recurrent C.albicans meningoencephalitis, and insufficient treatment as a result of failure to receive the granulocyte colony stimulating factor (G-CSF) treatment. Persistent fungal infections that develop in CARD9 deficiency cause serious complications and mortality. Considering the frequency of CARD9 deficiency in the Turkish population and the lack of diagnostic testing in our country, it is thought that there may be many patients who cannot be diagnosed and who progress with mortality or morbidity. In conclusion, this case was presented to emphasize the consideration of CARD9 deficiency in case of persistent invasive fungal infection or recurrent invasive fungal infection after treatment despite effective antifungal treatment in children and adults who do not have known risk factors for invasive fungal infections.

Evaluation of pain in patients with COVID-19.

OBJECTIVES: A new type of coronavirus outbreak has emerged in China and caused a pandemic. World Health Organization (WHO) announced the official name of this disease 'COVID-19'. The main purpose of this study is to evaluate pain in COVID-19 patients. METHODS: Patients who were followed in the ward of an infectious diseases department because of possible or confirmed COVID-19 between May and September of 2020 were included in the study. The Turkish version of the Brief Pain Inventory (BPI) was applied. Demographic features, frequency, location, the intensity of pain, and response to analgesics were analyzed. RESULTS: A total of 178 participants were included in the study. Ninety-one (51.1%) of patients had pain complaints and the mean pain score (MPS) was 2.28±2.81 over 10. Fifty-nine (56.0%) of participants with pain required analgesic therapy and 41 (80.3%) of them showed ≥50% pain relief with simple analgesics. Twelve of the remaining 18 who did not get enough pain relief with simple analgesic were taking their analgesics pro re nata (PRN) rather than around the clock (ATC). Pain frequency and intensity and mean hospitalization duration (MHD) were similar between confirmed and possible cases. CONCLUSION: Regarding the results, we conclude that pain is not one of the challenging symptoms and easily manageable in patients with a mild-moderate intensity of COVID-19. Our results were not enough to make a correlation between pain and the clinical course of the disease. Further studies are required for the evaluation of pain including patients in intensive care units.

Clinical significance of smell and taste dysfunction and other related factors in COVID-19.

PURPOSE: The objective of this study is to evaluate smell and taste dysfunction (STD) in coronavirus disease 2019 (COVID-19) positive and negative patients, and to assess the factors associated with STD in COVID-19 positive patients. METHODS: Patients who had been tested with the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for COVID-19 were identified, and according to the RT-PCR test results, patients were separated into Positive and Negative Groups. A telephone-based assessment was applied to both groups using the American Academy of Otolaryngology-Head and Neck Surgery Anosmia Reporting Tool. Patients in Positive Group were also asked to rate STD, nasal breathing, and anxiety in three different time periods (pre-/during-/post-COVID) using the visual analog scale (VAS). RESULTS: A total of 53 COVID-19 positive and 51 negative patients completed the surveys. STD was eightfold more frequent (OR 8.19; CI 95% 3.22-20.84) in the Positive Group. Of the 53 COVID-19 positive patients, 32 reported STD and 21 did not. 'Ground-glass appearance' on chest-computed tomography was more frequent and median lymphocyte count was significantly lower in COVID-19 positive patients with STD. During-COVID STD and nasal breathing VAS scores were significantly lower than the pre- and post-COVID scores. During-COVID STD scores were significantly correlated with anxiety scores (Spearman's rho-0.404, p = 0.022) but not correlated with nasal breathing scores. CONCLUSION: STD may be related to increased inflammatory response as well as damage of olfactory neuronal pathway or non-neuronal olfactory mucosa. Understanding the exact cause of chemosensory impairment in COVID-19 can be helpful in explaining the pathophysiology of the disease.

Enterococcus hirae as a cause of bacteremic urinary tract infection: first case report from Turkey.

INTRODUCTION: Enterococcus hirae (E. hirae) constitutes less than 1% of the enterococci strains in human clinical specimens. In this article, we report the first case of urinary tract infection-related bacteremia due to E. hirae from Turkey. CASE PRESENTATION: A 74-year-old male patient with a history of coronary artery disease, hypertension, and chronic renal failure was admitted to the emergency department with abdominal pain, dysuria, and fever. The urine sample collected from the urinary catheter resulted as ampicillin-sensitive E. hirae. On the 4th day of hospitalization, E. hirae growth with the same sensitivity pattern was also reported in blood culture. Intravenous ampicillin 4×2 g/day treatment was initiated. There was no growth in subsequent blood and urine cultures. Fever resolved and general condition improved. The patient was discharged on the thirteenth day with clinical improvement after moxifloxacin treatment for four days and ampicillin treatment for nine days. DISCUSSION: The patient's medical history included risk factors for enterococcal bacteremia. There are a limited number of reports in the literature describing human infections caused by E. hirae. The reason for the rare isolation of E. hirae from clinical specimens may be the difficulty of identifying with standard diagnostic approaches. CONCLUSIONS: For diagnostic purposes, as in our case, rapid and high sensitive diagnostic methods such as Matrix-assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) and molecular techniques may be useful to guide the selection of the least toxic and optimal duration of antibiotic treatment.