Temporal Trends in the Epidemiology of HIV in Turkey.

OBJECTIVE: The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. METHODS: Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes. RESULTS: A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. CONCLUSION: The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.

Is Timely and Appropriate Antifungal Drug Enough for Survival of Adult Cases with Candidaemia? Five-year Experience.

OBJECTIVE: Candidaemia is the fourth most common cause of nosocomial bloodstream infections. The objective of this paper was to evaluate the risk factors associated with mortality in patients with candidaemia with respect to Candida species and their susceptibilities, retrospectively. METHODS: All consecutive patients who developed candidaemia at an 800-bed training and research hospital were enrolled in this retrospective, observational, single centre study during the period June 2006 to December 2011. RESULTS: A total of 97 candidaemia episodes were identified in 97 patients during the study period with an overall incidence of four episodes/10 000 admissions in adults. Crude 30-day mortality rates among patients with candidaemia were 56% (55 of 97 cases). Urinary catheterization, immunosuppressive therapy, acute physiology and chronic health evaluation (APACHE) II score (≥ 16) and hypoalbuminaemia were found to be independent risk factors for fatal candidaemia. CONCLUSIONS: Adult cases with candidaemia who have risk factors associated with mortality are more likely to have poor prognosis despite appropriate and timely initiated antifungal drug treatment. Empiric antifungal drug should be tailored according to the severity of the patients' conditions and local antifungal susceptibility.

Colistin against colistin-only-susceptible Acinetobacter baumannii-related infections: Monotherapy or combination therapy?

PURPOSE: To evaluate the outcomes of the patients who were infected with colistin-only-susceptible (COS) Acinetobacter baumannii and treated with either colistin monotherapy or colistin combined therapy. MATERIALS AND METHODS: This retrospective case-control study was conducted in the training and research hospital with an 800 beds between August 2008 and December 2011. The patients, who were infected with COS A. baumannii and received either colistin monotherapy or colistin combined therapy, were included into the study. RESULTS: In total, 51 patients fulfilling study criteria were evaluated. Colistin monotherapy was found effective as much as colistin combined therapy in terms of clinical and microbiological responses in patients with ventilator associated pneumonia (VAP) and also in patients with blood stream infections. CONCLUSION: Although there is no randomised controlled study yet, colistin monotherapy and colistin combined therapy are likely to achieve similar treatment responses rates. Heteroresistant strains can emerge in patients who receive colistin monotherapy.

Tuberculous meningitis: a report of 60 adult cases.

OBJECTIVE: This was to evaluate the history, clinical and laboratory findings, outcome and prognosis of patients with tuberculous meningitis (TBM). METHOD: Between 1998 and 2009, 60 patients with TBM were evaluated, retrospectively. RESULTS: Overall, 60 patients were selected, of which 33 (55%) were male. The patients' ages ranged from 14 to 62 years. In the majority of the patients, disease was in an advanced stage on admission (66% in stage III according to the British Research Council neurological criteria). The rate of complications was highest among patients in stages II and III with an overall mortality rate of 6.6% (n = 2 of stage II patients and n = 2 of stage III patients). CONCLUSIONS: Earlier admission of the patients with TBM could provide better outcomes with regard to sequelae and mortality. Fatal cases presented with rapid deterioration and were refractory to treatment.

Fungal pathogens and primary antifungal prophylaxis in patients with hematological malignancies: one year experience.

BACKGROUND: Febrile neutropenia (FN) is generally a complication of cancer chemotherapy in patients with hematological malignancies. OBJECTIVE: To evaluate the febrile neutropenia episodes of hematological patients and their outcomes with respect to fungal pathogens, primary antifungal prophylaxis antifungal therapy. METHODS: All consecutive patients older than 14 years of age and who developed febrile neutropenia episodes from September 2010 to November 2011 were incorporated into this study. RESULTS: In total, we retrospectively evaluated 86 consecutive patients and their 148 neutropenic episodes. Of the 86 patients, 45 were male and the mean age was 47,65±15,06 years (range: 17-82 years). The mean MASCC score was 18,72 ± 9,43. Systemic antifungal drug was initiated to 17 patients with probable fungal infection and 12 patients with possible fungal infection. Of seven patients who received posaconazole prophylaxis, five were treated with systemic fungal infection due to possible fungal infection. CONCLUSIONS: It is obvious that more studies focused on primary prophylaxis are needed and primary or secondary antifungal prophylaxis should be evaluated in terms of provided benefits and disadvantages. Timely and appropriately initiated antifungal treatment is one of the most important factors for a good prognosis for recovery from a neutropenic phase.

Pulmonary involvement of Brucellosis: a report of six cases.

BACKGROUND: Pulmonary involvement of brucellosis rarely occurs due to inhalation of infected aerosol or hematogenous overspreading. OBJECTIVE: The study aimed to reveal the pulmonary manifestations of brucellosis that occur rarely in Brucella infections in the context of six cases in this report. METHODS: Between 1998-2008, 82 patients with brucellosis treated and followed up at infectious diseases clinic have been retrospectively studied in relation to their clinical and laboratory findings and treatment results. RESULTS: Patients' (n=6) age ranged from 48 to 59 years and they showed equal gender distribution. All patients presented with fever and cough. Radiological examination showed pneumonic patches and consolidation in two cases, bilateral glass round opacity in four cases, perivascular and peribronchial thickness increase in two cases, pleural effusion in two cases, sentri-acinar emphysematous images in one patient, and athelectasis in one patient. Blood cultures of three patients grew Brucella spp. All patients responded to treatment containing doxycycline, rifampicin and streptomycin (for only one patient) within seven to 10 days and were treated for six weeks except for one patient for who was treated eight weeks due to hepatosplenic brucellosis. CONCLUSION: Pulmonary involvement of brucellosis has good prognosis with combined antimicrobial therapy.