[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.

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.

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.

Mucormycosis: a 10-year experience at a tertiary care center in Turkey.

BACKGROUND/AIM: Mucormycosis is a rare invasive fungal infection most commonly encountered in the immunocompromised host. We analyzed 51 adult patients treated for mucormycosis between 2003 and 2013 and recorded at a tertiary university hospital in Turkey. MATERIALS AND METHODS: We examined the following data for all patients: age, sex, predisposing disease, symptoms, treatment, surgical procedure, concomitant infections, intensive care requirement, and outcomes. RESULTS: During the study period 51 cases of mucormycosis were documented; 54.9% of the patients were female. The mean age was 44.2 ± 18.2 years. Rhinocerebral presentation was reported in 94.1% of patients. Almost all patients (88.2%) had at least one risk factor. The common predisposing factors were hematologic malignancies (52.9%), diabetes mellitus (25.5%), and solid malignancies (5.8%). The most common initial symptoms were fever, cellulitis, and facial pain. The primary medication used was liposomal amphotericin B or conventional amphotericin B. Surgery was performed in 94.1% of patients. Mortality was 52.9%. CONCLUSION: Our study revealed that mucormycosis continues to be a mortal disease in about half of the cases. Our findings indicate that treatment with L-AMB is associated with a favorable response. Also, in the case of facial pain, the low mortality rate may indicate the importance of early diagnosis.

Comparison of amphotericin B lipid complex (Abelcet) and liposomal amphotericin B (Ambisome) on rat kidney: a morphological evaluation / Comparasión de la anfotericina B complejo lipídico (Abelcet) y la anfotericina B liposomal (AmBisome) en el riñón de rata: una evaluación morfológica

The aim of our study was to compare the nephrotoxic effects of liposomal amphotericin B (Ambisome) and amphotericin B lipid complex (Abelcet) on rat kidneys at short (14 days) and long term (28 days) treatment applications. Thirty-six male Wistar rats were included and divided into six groups (n=6). Groups 1 and 4 are composed as control groups by administrating intraperitoneal (ip) 0, 9 molar Serum physiologic for a period of 14 and 28 days respectively. Group 2 and 3 are treated with 5 mg/kg Ambisome and 5 mg/kg Abelcet for 14 days respectively, group 5 and 6 are treated with same agents for 28 days respectively. Then, the rats were transcardially perfused, samples were taken from cortex and medulla regions of kidneys. The micrographs of group 1 and 4 were seen as normal. For short term treatment, some morphological changes were seen in proximal tubule cells in group 3 whereas in group 2 the graphs were observed as normal. However, after long term drug using in group 5 and 6 there were vacuolization, increased lysosomal structures and deep basal folding's into tubular cells lumen. These experiments establish that renal damage were seen in short and long term use of Abelcet and long term use of Ambisome.

El objetivo de nuestro estudio fue comparar los efectos nefrotóxicos de la anfotericina B liposomal (AmBisome) y anfotericina B en complejo lipídico (Abelcet) sobre riñones de ratas, en el tratamiento de aplicación a corto (14 días) y largo plazo (28 días). Fueron incluidas en el estudio 36 ratas Wistar machos, divididas en seis grupos (n = 6). Los Grupos 1 y 4 fueron grupos de control mediante la administración intraperitoneal (ip) de 0, 9 molar de suero fisiológico durante un periodo de 14 y 28 días respectivamente. Los Grupos 2 y 3 fueron tratados con 5 mg/kg de ambisome y 5 mg/kg abelcet durante 14 días respectivamente, y finalmente los grupos Grupos 5 y 6 tratados con los mismos agentes durante 28 días, respectivamente. Luego, las ratas fueron perfundidas vía transcardíaca, y se tomaron muestras de la corteza y la médula renal. Las micrografías de los grupos 1 y 4 se observaron normal. En el tratamiento a corto plazo, algunos cambios morfológicos se observaron en las células del túbulo proximal en el grupo 3, mientras que en el grupo 2 los gráficos se observaron normales. Sin embargo, después de utilizar la droga a largo plazo en los grupos 5 y 6 hubo vacuolización, aumento de las estructuras lisosomales y un profundo plegamiento basal de las células del lumen tubular. Estos experimentos establecen que el daño renal se produce en el uso a corto y largo plazo de Abelcet, y largo plazo de Ambisome.

Transfusion-associated graft-versus-host disease.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a relatively rare and interesting entity. Despite a range of pathophysiological and therapeutic approaches, it has a high mortality. It is possible to prevent the disease by prophylaxis only. It is possible to miss the entity in routine clinical practice and reach a different diagnosis due to its non-specific signs and symptoms. Four patients with signs and symptoms suggestive of TA-GVHD were evaluated and the literature reviewed. The transfusion history was of great importance, as was the exclusion of other conditions that may present with similar signs and symptoms (fever, skin rash, diarrhea, pancytopenia, icterus and renal failure). Confirmation of TA-GVHD was by skin biopsy. TA-GVHD must be considered as a differential diagnosis in patients who present with fever, pancytopenia, diarrhea, skin rash and icterus, and the transfusion history must be questioned. Mortality is very high despite various therapeutic approaches. This makes prophylaxis essential. TA-GVHD can be prevented by irradiation of blood products and by avoiding the use of blood transfusions from family donors.

Reference ranges of lymphocyte subsets of healthy adults in Turkey.

UNLABELLED: The aim of this study was to determine the reference ranges of lymphocyte subsets in serologically HIV-negative healthy adults in Turkey. MATERIALS AND METHODS: Blood samples from 220 healthy adults, 105 female and 115 male, collected into tubes containing EDTA were investigated for lymphocyte subsets using flow cytometry. The age range was 18-80 years (44.80 +/- 16.69). RESULTS: The mean percentage and absolute values of the lymphocyte subsets were as follows: CD3: 72.70 +/- 8.44%, 1,680 +/- 528 cells/microl; CD4: 47.37 +/- 9.10%, 1,095 +/- 391 cells/microl; CD8: 28.99 +/- 5.99%, 669 +/- 239 cells/microl; CD19: 10.96 +/- 4.44%, 254 +/- 122 cells/microl and CD56: 7.03 +/- 3.26%, 161 +/- 92 cells/microl, respectively. The ratio of CD4/CD8 was 1.68 +/- 0.43. There was no statistically significant difference in the percentages and absolute values of lymphocyte subsets between the genders (p > 0.05). CONCLUSION: Immunophenotyping has been used to establish reference values of lymphocyte subsets in normal healthy adults in Turkey.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman's disease) previously misdiagnosed as Toxoplasma Lymphadenitis.

Here we describe a case of Rosai-Dorfman Disease (RDD) in a 25-year-old female patient from Turkey who was previously misdiagnosed with Toxoplasma Lymphadenitis, and review the manifestations and treatment of this rare entity. To the best of our knowledge this is the third description of RDD [Sinus Histiocytosis with Massive Lymphadenopathy (SHML)], involving bilateral cervical lymphadenopathy and nephromegaly previously misdiagnosed as Toxoplasma Lymphadenitis. Representative clinical, radiographic and histological findings are presented. Its etiology, diagnosis and management are also reviewed. Sinus Histiocytosis with Massive Lymphadenopathy is a rare disorder of unknown etiology, usually associated with lymph node enlargement in various superficial or deep sites. The key histologic feature of SHML is the presence of various numbers of large, pale histiocytic cells that contain within their cellular borders apparently engulfed lymphocytes (emperipolesis); these distinctive large, pale cells are S-100 protein positive CD-68 positive and CD1a negative by immunostaining. According to the literature the most effective treatment found was surgical debulking.

Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study.

OBJECTIVES: To investigate fever of unknown origin (FUO) in 87 patients. METHODS: We investigated 87 (61 male) patients with FUO using the criteria of Petersdorf and Beeson [Medicine 40 (1961) 1] hospitalized between January 1994 and August 2002 at Cukurova University Hospital. RESULTS: The median age of the patients was 38.5 years (range: 14-80 years). Eleven patients (12.6%) were over 65. The mean duration of hospitalization was 22.5+/-13 days. Infectious diseases were the most common causes of FUO. Tuberculosis (n=15, 17.2%), infective endocarditis (n=6), abdominal abscess (n=6), brucellosis (n=5), urinary tract infection (n=5), visceral leishmaniasis (n=4), salmonellosis (n=3), rhinocerebral mucormycosis (n=4), atypical pneumonia, cerebral toxoplasmosis, Cytomegalovirus infection or encephalitis were diagnosed in 51 (58.6%) patients. The second most common causes of FUO were collagen vascular diseases (n=16, 18.3%) determined as vasculitis syndrome, adult Still's disease (n=4), systemic lupus erythematosus, Behçet's disease, juvenile ankylosing spondylitis. Neoplasm was found in 12 (13.7%) patients; (non-Hodgkin lymphoma, Hodgkin lymphoma, chronic myeloid leukemia, gastrointestinal tract carcinoma, glioma). Miscellaneous diseases thyroiditis, granulomatous hepatitis were diagnosed in two (2.2%) patients. On admission, six patients (6.8%) were neutropenic. CONCLUSIONS: Infectious diseases, especially tuberculosis, were the leading diagnostic category of FUO in this study. Adult Still's disease was more common than expected. An aetiological diagnosis could not be reached in six (7%) patients who were followed for 1 year. Five of these patients completely recovered, and one patient died.