Retrospective Analysis of Serology and Radiology Results in Patients with Suspected Cystic Echinococcosis Through 3 Years Period

OBJECTIVE: Cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus sensu latu, is one of the neglected zoonotic infectious diseases and Türkiye is among the endemic countries. This study was designed to analyze serology results for patients who were diagnosed as CE by clinical symptoms and radiological methods over a three-year period. METHODS: Sera were analyzed for Anti-E. granulosus IgG by a chemiluminescence immunoassay (CLIA) (HYDATIDOSIS VIRCLIA® IgG MONOTEST, Vircell) using the VIRCLIA® (CLIA; Vircell, Granada, Spain) and results processed by the dedicated software. Cut-off for a positive test was ≥1.1 index value. Echinococcal cysts were detected based on ultrasonography, computed tomography, and magnetic resonance imaging. RESULTS: A total of 244 sera were analyzed from 109 patients, during three-year-period from January 2018 to December 2020. Anti-E. granulosus IgG was ordered twice in 89 patients, three times in 15 patients, four times in four patients, and five times in one patient. CLIA test was positive among 41 of 109 (37.6%) patients in whom 32 (76%) had only hepatic involvement, whereas in 5 (12%) hepatic and pulmonary involvement were coexisted. The mean age of seropositive patients was 39.8 (6-75±2.72) and 61.9% of them (n=26) were female. Time intervals between sequential test orders varied from 1 day to 33 months. Eight seropositive patients turned out to be negative, and one of 66 seronegative patients became seropositive. Positive test results were converted to negative in the case of therapy or cyst inactivity. CONCLUSION: We may conclude that CLIA could be used as a complementary tool for CE patient follow-up.

Cystoisospora belli infection in a renal transplant recipient: a case report and review of literature.

Cystoisospora belli is a coccidian parasite that causes prolonged watery diarrhea especially among immunocompromised patients. Herein, we report a renal transplant patient who complaints of alternating diarrhea and review of literature related to cystoisosporiasis amongst the transplant recipients.

Evaluation of the Presence and Characterization of Vancomycin-Intermediate and Heterogeneous Vancomycin-Intermediate Level Resistance Among Bloodstream Isolates of Methicillin-Resistant Staphylococcus aureus.

Aims: Heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) could be misinterpreted as "susceptible" with routine susceptibility testing procedures, and the subpopulations with reduced susceptibility to glycopeptides can lead to therapeutic failure. The aim of this study was to evaluate the presence of VISA and hVISA strains among stocked bloodstream methicillin-resistant S. aureus (MRSA) isolates of 14 years. Materials and Methods: A total of 127 nonduplicate MRSA strains isolated from blood cultures between 2001 and 2014 were investigated. Glycopeptide minimum inhibitory concentration values were detected by microbroth dilution method. Susceptibilities to other antimicrobials were determined by the disk diffusion method and interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Macrogradient test (MGT) and modified population analysis profile-area under the curve (modified PAP-AUC) methods were used to detect VISA and hVISA. Staphylococcal Cassette Chromosome mec (SCCmec), agr, and toxin gene typing were done by polymerase chain reaction. Genetic relatedness of the strains were evaluated by pulsed-field gel electrophoresis (PFGE). Results: All isolates were susceptible to glycopeptides, linezolid, and quinupristin-dalfopristin. All were resistant to tetracycline, 96% were resistant to aminoglycosides, fluoroquinolones, and rifampin. Only 58.3% of the isolates were susceptible to ceftaroline. Six isolates were suspected as hVISA by the MGT, but none could be confirmed by the modified PAP-AUC analysis. All isolates carried type-III SCCmec, sea was the most prevalent (96.9%) enterotoxin gene and agr group I locus was predominant (93.7%). PFGE analysis revealed four main and four unique patterns. Conclusion: No hVISA or VISA were detected. The resistance rate to ceftaroline seems remarkable due to its recent entry into the market in Turkey.

Visceral Leishmaniasis in A Patient Presenting with Fever of Unknown Origin: A Case Report From a Low-endemic Region of Turkey

Leishmaniasis is a neglected disease that is prevalent in tropical and subtropical regions of the world. Even though cutaneous leishmaniasis is the most common form, visceral leishmaniasis is associated with high mortality. The case presented herein is a 39 year-old bed-ridden female who presented with fever of unknown origin, tachypnea and pancytopenia. She was initially misdiagnosed as having autoimmune pancytopenia elsewhere and treated with corticosteroids and intravenous immunoglobulin. She had also received wide-spectrum antibiotics for febrile neutropenia. We performed a leishmania rK39 dipstick test which turned out to be positive along with visualisation of amastigote forms of leishmania on bone marrow biopsy. Thus, we made a diagnosis of visceral leishmaniasis and treated her with liposomal amphotericin B. Her clinical course was complicated by respiratory failure necessitating invasive mechanical ventilation. She responded well to treatment and was later extubated, shortly before being discharged. At 6 months of follow-up, no sign of recurrence was observed.