[Distribution of the Prevalence of Human Leukocyte Antigen (HLA)-B*57:01 Positivity in HIV-1 Infected Individuals and Its Effects on Treatment: Türkiye Map-Buhasder Working Group]. / HIV-1 Enfekte Bireylerde Insan Lökosit Antijeni (HLA)-B*57:01 Pozitifligi Prevalansinin Dagilimi ve Tedavi Üzerine Etkileri: Türkiye Haritasi-BUHASDER Çalisma Grubu.

Human immunodeficiency virus (HIV)/acquired immundeficiency syndrome (AIDS) is a critical global public health problem that significantly affects both life expectancy and the overall quality of life of individuals in all age groups. The landscape of HIV infection has changed significantly in recent years due to the introduction of effective combination antiretroviral therapies (ART). A key component of first-line ART regimens for HIV treatment is abacavir, a nucleoside HIV reverse transcriptase inhibitor. Although abacavir is effective in suppressing viral replication and managing disease, its clinical utility is overshadowed by the potential for life-threatening hypersensitivity reactions in HLA-B*57:01-positive patients. In our country, local data obtained from various centers regarding the prevalence of HLA-B*57:01 in HIV-1-infected patients are available. In this study, it was aimed to determine the prevalence of the HLA-B*57:01 genotype in HIV-infected patients who were followed up and treated in many regions of our country. This retrospective study consists of the data of the patients aged 18 years and over diagnosed with HIV-1 infection between 01.01.2019 and 31.07.2022. Age, gender, place of birth, mode of transmission of the disease, death status, CD4+ T cell count and HIV RNA levels at the first clinical presentation, HLA-B*57:01 positivity, and the method used, clinical stage of the disease, virological response time with the treatment they received were recorded from the patient files. Data were collected from 16 centers and each center used different methods to detect HLA-B*57:01. These methods were sequence-specific oligonucleotide probe hybridization (SSOP), DNA sequence-based typing (SBT), single-specific primer-polymerase chain reaction (SSP-PCR), allele-specific PCR (AS-PCR) and quantitative PCR (Q-PCR). A total of 608 HIV-infected individuals, 523 males (86%) and 85 females (14%), were included in the study. The mean age of the patients was 36.9 ± 11.9 (18-73) years. The prevalence of HLA-B*57:01 allele was found to be 3.6% (22 patients). The number of CD4+ T lymphocytes in HLA-B*57:01 allele-positive patients was > 500/ mm3 in 10 patients (45.5%), while the number of CD4+ T lymphocytes in HLA-B*57:01 negative patients was > 500/mm3 in 216 patients (36.9%) (p> 0.05). Viral load at the time of diagnosis was found to be lower in patients with positive HLA-B*57:01 allele but it was not statistically significant (p> 0.05). Although different treatment algorithms were used in the centers following the patients, it was observed that the duration of virological response was shorter in HLA-B*57:01 positive patients (p= 0.006). Although the presence of the HLA-B*57:01 allele has a negative impact due to its association with hypersensitivity, it is likely to continue to attract interest due to its association with slower progression of HIV infection and reduced risk of developing AIDS. In addition, although the answer to the question of whether it is cost-effective to screen patients for HLA-B*57:01 before starting an abacavir-containing ART regimen for the treatment of HIV infection is being sought, it seems that HIV treatment guidelines will continue to recommend screening to identify patients at risk in this regard.

Brucellosis-associated hepatitis.

AIM: Brucellosis is a zoonotic infection that can affect almost every organ. A mild elevation of aminotransferase levels is usually observed in liver involvement. However, the development of clinical hepatitis is rare. In this study, we aimed to present the hospitalized cases with brucellosis hepatitis in our clinic in a 13-year period. METHODS: A hundred and three patients with significant hepatobiliary involvement, diagnosed by microbiological analysis, were included in the study. For the presence of hepatitis, it was required that the aminotransferases must be ≥ 5 times more than the upper limit and/or the total bilirubin level must be ≥ 2 mg/dl and/or the local hepatic lesion must be demonstrated. RESULTS: Of the cases, 35.9%, 17.5%, and 46.6% had clinical hepatitis, cholestatic hepatitis, and both clinical and cholestatic hepatitis, respectively. The most frequent symptom was fever (85.4%) while the most preferred treatment options were combinations containing aminoglycosides. It was observed that the mean time-interval to decrease to normal values of ALT, AST, and bilirubin values was 15.2 ± 7.8 days while the patients having their treatment regimens. In our study, which focused on liver involvement, it was found that a chronic liver disease did not develop in any of the cases. CONCLUSION: Our study showed that, even in the presence of hepatitis, clinical response and laboratory improvement were high with appropriate treatment. It was observed that the improvement in aminotransferases and total bilirubin values delayed in the cases with blood culture positivity, secondary organ involvement, and alanine aminotransferase/aspartate aminotransferase > 1.

Evaluation of cerebrospinal fluid levels for ALOX5, S100B, DEFA1, and GFAP in infectious meningitis.

BACKGROUND: The aim of this study was to determine how the levels of peptide and protein-based biomarkers in cerebrospinal fluid change in bacterial, tuberculous, and aseptic meningitis, and to determine the success of these agents in distinguishing between different types of infectious meningitis. METHODS: The levels of arachidonate-5-lipoxygenase, S100 calcium-binding protein B, defensin-α 1, and glial fibrillary acidic protein in cerebrospinal fluid samples from 20 tuberculosis, 40 bacterial, 25 aseptic meningitis patients, and 55 control groups were measured and compared using an enzyme-linked immunosorbent assay. RESULTS: The mean age of the patients was 37.9 ±â€…14.4 years. The parameter that contributed the most to the differential diagnosis of the infectious meningitis groups was S100 calcium-binding protein B. The S100 calcium-binding protein B levels were significantly higher in the tuberculous meningitis group than in the other groups, and arachidonate-5-lipoxygenase levels were significantly higher in the tuberculous meningitis and bacterial meningitis groups (P < .05). CONCLUSION: This study showed that cerebrospinal fluid arachidonate-5-lipoxygenase, and S100 calcium-binding protein B levels may differ in bacterial, aseptic, and tuberculous meningitis, and the results obtained may be quite effective as important potential biomarkers in the differential diagnosis of different types of meningitis.

Blood prestin levels in COVID-19 patients.

BACKGROUND: Many studies have found that viral infections affect different tissues, including the inner ear. Coronavirus disease 2019 (COVID-19), a viral infection, is a significant health problem worldwide. Prestin is a motor protein with important functions both in the outer hair cells of the inner ear and in cardiac tissue. In addition, prestin is promising as an early biomarker in the detection of ototoxicity. To determine the severity of infection in COVID-19 patients and to determine whether other tissues are affected by the infection, lactate dehydrogenase (LDH), C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase MB (CK-MB), biochemical markers such as ferritin and D-dimer are used. This study aimed to compare prestin levels in patients with COVID-19 and healthy volunteers. METHODS: In blood samples taken from 45 patients diagnosed with COVID-19 and 40 healthy volunteers, prestin levels were determined with the kit that used an enzyme-linked immunosorbent assay method and was commercially available. At the same time, LDH, CRP, ALT, AST, CK-MB, ferritin, and D-dimer levels were also detected in both patients and healthy control groups and correlations with prestin levels were examined. RESULTS: The main result of our study is that serum prestin levels in COVID-19 patients are significantly higher than in healthy controls ( p < 0.001). In addition, a statistically significant strong positive correlation was found between prestin-LDL ( r = 0.537, p = 0.001), prestin-CRP ( r = 0.654, p = 0.001), and prestin-D-dimer ( r = 0.659, p = 0.001). CONCLUSION: The levels of prestin, a motor protein in inner ear outer hair cells and cardiac myocytes, were found to be higher in COVID-19 patients than in healthy volunteers. It also showed a positive correlation with CRP and D-dimer. This may be associated with systemic dysfunction.

[Evaluation of Infections in Intensive Care Units: A Multicentre Point-Prevalence Study]. / Yogun Bakim Ünitelerindeki Enfeksiyonlarin Degerlendirilmesi: Çok Merkezli Nokta Prevalans Çalismasi.

Infection control is a top priority for hospitals, especially in intensive care units (ICU). In intensive care units, prevalence of infection is estimated to be 30% worldwide, which is a major cause of morbidity and mortality. Many factors are known to increase the risk of infection in ICU patients. Since each of these may lead to different infections, it is important to recognize and identify predisposing factors for early diagnosis and treatment. The regional health care-associated infections (HCAI) prevalence and distribution of risk factors are important strategies in infection control. In this regard, the aim of this point prevalence study was to obtain data related to infections, the prevalence of HCAI among these infections, the epidemiology, agents and antibiotics used among adult ICU patients in the university hospitals, training and research hospitals and public hospitals located in eight of the cities of our region. In the light of these data, we aimed to review and emphasize the guidelines on HCAI prevention. The study included adult ICU patients followed up in nine hospitals in the Eastern and South-eastern Anatolia Regions of eight different cities (Sivas, Erzurum, Mardin, Batman, Diyarbakir Elazig, Van, Adiyaman) in Turkey. Of the hospitals six were university hospitals, one was training and research hospital, and two were public hospitals. The number of beds ranged from 358 to 1418. A specific day was determined on which the researchers concurrently carried out a prospective surveillance in all adult intensive care unit patients. The researchers collected data and recorded the demographic characteristics (age, gender), underlying diseases, length of hospital stay, presence of invasive intervention (urinary catheter, central venous catheter, external ventricular drainage, mechanical ventilator, presence of risk factors such as burn, trauma and surgery, number of infection cases, type of infection (hospital-acquired, community-acquired), type of microorganisms and whether polymicrobial or monomicrobial, which antibiotics were administered, and duration of antibiotic treatment. Our study assessed data of 429 inpatients in the adult ICU of nine hospitals in eight different cities. There were a total of 881 intensive care beds in these hospitals, and 740 (84%) beds were occupied. Of the study group 49.7% was male with a mean age (min-max) of 64.08 ± 18.78 (2-97) years. The point prevalence of HCAI was 21.7% (n= 93). Of the patients who were followed-up 182 (42.4%) presented infections. Of these infections, 21.4% were diagnosed as community-acquired pneumonia, 18.6% were ventilator-associated pneumonia (VAP), 16.3% were communityacquired urinary tract infection (UTI), and 16.3% were bloodstream infection. In addition, the most commonly administered antibiotics in the study group were piperacillin/tazobactam, carbapenem, quinolone and ceftriaxone, respectively. The most common types of HCAI were community-acquired pneumonia (10.7%), ventilator-associated pneumonia (8.9%) and bloodstream infections (8.2%). The mean length of hospital stay was 32.05 ± 66.85 (1-459) days and the mean duration of antibiotic therapy in patients with HCAIs was 7.76 ± 7.11 (1-41) days. The most widely accepted method to handle infection is to carry out active, prospective and patient-based surveillance studies on a regular basis, and to take control measures and arrange appropriate treatment in the light of the data obtained. We attribute the high prevalence of HCAI in our region to lack of personnel, lack of materials, inappropriate use of antibiotics, insufficiency of physical conditions, and little support for infection control committees. In conclusion, we emphasize that it is of importance to work closely with the hospital administration to take measures and that necessary assistance is provided.

Measurement of Spleen Stiffness by Shear-Wave Elastography for Prediction of Splenomegaly Etiology.

OBJECTIVE: The aim of this study was to evaluate the reproducibility of measurement of spleen stiffness at the time of the initial detection of splenomegaly, whether it is found incidentally or not, in determining the etiology of splenomegaly. METHODS: The pathologies that brought about the diffuse splenomegaly were evaluated in 3 main groups as follows: hepatoportal, myeloproliferative, and infectious causes. In addition, 17 healthy control patients were recruited. All patients were examined with acoustic radiation force impulse imaging with VTQ. RESULTS: The difference between the splenic parenchymal elasticity values in the hepatoportal group (3.27 ± 0.36 m/s), in the myeloproliferative disease group (2.98 ± 0.33 m/s), in the infectious disease group (2.44 ± 0.21 m/s), and in the control group (2.08 ± 0.19 m/s) was found to be statistically significant (P = 0.001). The intraclass correlation coefficient for shear wave velocity measurement between hepatoportal causes and myeloproliferative causes was 71.2% (95% confidence interval [CI], 54.9%-87.4%), between hepatoportal causes and infective causes was 99.7% (95% CI, 98.6%-100.0%), and between myeloproliferative causes and infective causes was 83.3% (95% CI, 68.8%-97.9%). In the same patient groups, spleen volumes were measured as 64.08 ± 9.66, 78.18 ± 18.52, and 51.57 ± 7.44 cm, respectively; in the control group, it was 26.75 ± 6.57 cm. The difference between spleen volumes was found to be statistically significant (P = 0.001). CONCLUSIONS: Distinguishing the causes of splenomegaly is important because the disorders require different management strategies. In diseases that cause splenomegaly, tissue content may change according to pathogenesis. Such changes in the spleen are mechanical properties that can be quantified by elastography.

Delftia acidovorans pneumonia with lung cavities formation.

CASE DESCRIPTION: A 52-year-old female patient was admitted to our clinic with complaints of cough, sputum, fever and fatigue. The patient has been receiving immunosuppressive therapy for thrombocytopenic purpura for 5 years. CLINICAL FINDING: Inspiratory crackles were heard on both hemithorax. Oxygen saturation measured with the pulse oximeter was 97%. Chest X-ray showed diffuse reticular opacities that were more prominent in the upper zones of both lungs. WBC counts were 17,600 mm3 and Platelet counts were 29,000 mm3. Thorax CT showed that there were many thin-walled cavities and millimetric nodules accompanied by ground-glass infiltrates in the upper and middle lobes. Gram staining of bronchial fluid, taken by bronchoscopy, revealed Gram-negative bacilli and intense polymorphonuclear leukocytes. The bacteria were defined as Delftia acidovorans by BD Phoenix automated system. TREATMENT AND OUTCOMES: The patient was hospitalized with suspicion of opportunistic pulmonary infections and cavitary lung disease. After the empirical treatment of intravenous piperacillin-tazobactam and oral clarithromycin, her clinical and radiological findings significantly regressed, and she was discharged with outpatient follow-up. CLINICAL RELEVANCE: This is the first example of cavitary pneumonia due to Delftia acidovorans in an immunocompromised patient. We would like to emphasize that Delftia pneumonia should be considered in the differential diagnosis of pulmonary cavitary involvement in such patients.

DESCRIPCIÓN DEL CASO: Una mujer de 52 años llegó a la clínica con tos, esputo, fiebre y fatiga. El paciente estuvo recibiendo terapia inmunosupresora durante 5 años para el tratamiento de la púrpura trombocitopénica. HALLAZGO CLÍNICO: se escucharon crepitaciones inspiratorias en ambos hemitórax. La saturación de oxígeno fue del 97%. La radiografía de tórax mostró opacidades reticulares difusas que eran más prominentes en las zonas superiores de ambos pulmones. Los recuentos de leucocitos fueron de 17,600 mm3 y los recuentos de plaquetas fueron de 29,000 mm3. La TC de tórax mostró muchas cavidades de pared delgada y nódulos milimétricos acompañados de infiltrados vitrales en los lóbulos superior y medio. La tinción de Gram del líquido bronquial reveló bacilos gramnegativos y leucocitos polimorfonucleares. Las bacterias fueron identificadas como Delftia acidovorans. TRATAMIENTO Y RESULTADOS: La paciente fue hospitalizado con una sospecha de infección oportunista pulmonar y enfermedad pulmonar cavitaria. Después del tratamiento empírico de piperacilina-tazobactam intravenosa y claritromicina oral, los síntomas y signos retrocedieron significativamente, y fue dada de alta con seguimiento ambulatorio. RELEVANCIA CLÍNICA: este es el primer registro de neumonía cavitaria causado por Delftia acidovorans en una paciente inmunocomprometida. Enfatizamos que la neumonía por Delftia debe considerarse en el diagnóstico diferencial de la afectación de la cavidad pulmonar en tales pacientes.

Evaluation of 257 extra pulmonary tuberculosis cases at the Tuberculosis Control Dispensary, Van, Turkey.

OBJECTIVE: To determine whether there were any changes in demographic and clinical features of extrapulmonary tuberculosis cases. METHODS: This retrospective study was conducted at Yuzuncu Yil University, Van, Turkey, and comprised records of extrapulmonary tuberculosis patients treated between January 2009 and July 2014 at the tuberculosis control dispensary. Descriptive and clinical data, including age, gender, site of involvement, diagnostic method and coexisting systemic diseases, were noted. Any changes in terms of these parameters were investigated on a year-on-year basis. SPSS 20 was used for data analysis. RESULTS: There were 257 cases detected. Of them, 50(19.45%) related to 2009, 61(23.75%) to 2010, 24(9.33%) to 2011, 50(19.45%) to 2012, 47(18.28%) to 2013 and 25(9.72%) to 2014. Although lymph nodes were by far most frequently affected in 2009, 2010, 2011 and 2013; pleura was most commonly involved in 2012 and 2014. Age and gender distribution displayed no changes between 2009 and 2014 (p>0.05). However, diagnostic method of choice and frequency of co-existent systemic disorders displayed remarkable alterations in this period (p<0.05). CONCLUSIONS: Improved insight of clinicians for atypical demographic and clinical features at presentation may provide reduction of rates of morbidity and mortality due to extrapulmonary tuberculosis.

Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study.

OBJECTIVE: Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes. METHODS: Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain. RESULTS: A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000-0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.3-2.7, p = 0.0001) were associated with diffuse inflammation. CONCLUSIONS: In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study".

BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1). CONCLUSIONS: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available.

Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases.

BACKGROUND: Tuberculosis is a disease that can involve every organ system. While pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis (EPT) is also an important clinical problem. The current study aimed to outline and compare the demographic and clinical features of pulmonary and extrapulmonary tuberculosis cases in adults. METHODS: Medical records of 411 patients (190 women, 221 men) treated between January 2010 and July 2014 in provincial tuberculosis control dispensary was retrospectively reviewed. Demographic and clinical characteristics were compared for pulmonary and extrapulmonary tuberculosis cases. RESULTS: Of these 411 cases, 208 (50.6%) had pulmonary tuberculosis (PTB) and 203 were diagnosed with extrapulmonary tuberculosis (EPTB) (49.4%). The average ages for PTB and EPTB groups were 33.00-27.00 and 31.00-29.75, respectively (p = 0.513). Men were more frequently affected by PTB (59.6%), while EPTB was more commonly detected in women (52.2%) (p = 0.016). Main diagnostic modalities for PTB were sputum/smear analyses (72.7%), clinical-radiological data (21.7%) and biopsy (6.1%); while biopsy (71.5%), sputum/fluid analysis (18.8%) and clinical-radiological data (4.9%) were used for confirming EPTB (p < 0.0019). The most common sites of EPTB involvement were lymph nodes (39.4%), followed by pleura (23.6%), peritoneum (9.9%) and bone (7.4%). CONCLUSIONS: Extrapulmonary involvement of tuberculosis is common and females are more likely to be affected. Increased clinical awareness is important since atypical presentations of the disease may constitute diagnostic and therapeutic challenges.

Clinical and laboratory features of adult measles cases detected in Van, Turkey.

OBJECTIVE: To evaluate adult measles patients with respect to their clinical and laboratory findings as well as complications. METHODS: The retrospective study was conducted at YuzuncuYil University, Van, Turkey, between December 2012 and June 2013, and comprised cases diagnosed with measles. The diagnosis was based on clinical findings and all were serologically confirmed with the presence of Anti-measles Immunoglobulin M antibodies. RESULTS: Of the 50 records studied, 41(84%) related to women. Overall mean age was 25.52±4.07 years. The most common symptoms were fever and rash 50(100%), malaise 49(98%), cough 48(96%), headache 44(88%) and sore throat 36(72%). The presence of Koplik spots, lymphadenopathy and hepatomegaly were observed in 3(6%), 6(12%) and 2(4%) patients respectively. Thrombocytopenia and elevated liver enzymes were detected in 26(52%) and 22(44%)patients. Pneumonia was the most common complication in 9(18%) patients. Other respiratory complications were bronchitis 5(10%) and laryngotracheitis 6(12%). Of the cases, 9(18%) exhibited otitis media. Premature delivery and spontaneous abortus occurred in 2(4%) and 3(6%) patients of the 15(30%) pregnant women. CONCLUSIONS: Measles continues to be an important health problem in Turkey and needs an effective elimination programme.

Tuberculous and brucellosis meningitis differential diagnosis.

BACKGROUND: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM. METHOD: BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups. RESULTS: The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently. CONCLUSIONS: When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries.

[Urogenital Myiasis Caused by Psychoda albipennis (Diptera: Psychodidae) in a Woman in Siirt]. / Siirt'te Bir Kadin Hastada Psychoda albipennis (Diptera: Psychodidae)Kaynakli Ürogenital Miyaz.

Urogenital myiasis cases occurring with the settlement of larvae of flies belonging to the order Diptera are facultative and are rarely encountered in humans. In this study, urogenital myiasis caused by Psychoda albipennis in a 20-year-old female patient was presented. The patient was admitted to our hospital with complaints of nausea, vomiting, and dysuria and claimed that she saw motile larvae in her urine. Five larvae collected from the patient's urine were microscopically examined, and they were identified as fourth-stage larvae of Psychoda albipennis. Complaints of the patient ceased after the application of an antibiotic and urinary antiseptic. It was concluded that myiasis should be considered in patients with urogenital complaints.

Asymmetric dimethylarginine levels in patients with cutaneous anthrax: a laboratory analysis.

BACKGROUND: Asymmetric dimethylarginine (ADMA), the main endogenous inhibitor of nitric oxide synthase, is considered to be associated with endothelial dysfunction. High ADMA levels have been shown to be related with disorders causing vascular inflammation such as hypertension, hypercholesterolemia, atherosclerosis, chronic heart failure, stroke and sepsis. Cutaneous anthrax (CA) is a serious infectious disease which may cause vasculitis. The aim of the study was to investigate the serum ADMA levels in patients with CA. METHODS: A total of 35 serum samples of the patients with CA and 18 control sera were tested for ADMA levels using ADMA ELISA kit (Immunodiagnostik AG, Bensheim, Germany). RESULTS: ADMA levels were found to be significantly higher in the patients group than the controls (p < 0.001). In addition, ADMA levels were found to be positively associated with sedimentation rates (R = 0.413; p = 0.026), and inversely associated with international normalized ratio (INR) levels (R = -0.46; p = 0.011). A cut-off value of 0.475 of ADMA had a sensitivity of 74.3%, specificity of 77.8%, and accuracy of 75.5% in the diagnosis of CA. CONCLUSION: Although the exact mechanism still remains unclear, ADMA levels could be related to immune activation in CA. In addition, these data might suggest the higher ADMA levels in patients could be due to the perivascular inflammation and vasculitis in CA.

High asymmetric dimethylarginine (ADMA) levels in patients with brucellosis.

Asymmetric dimethylarginine (ADMA) is the main endogenous inhibitor of nitric oxide synthase and is considered to be associated with endothelial dysfunction. Brucellosis, a zoonotic disease caused by Brucella spp., can manifest as vasculopathy. The present study was performed to investigate the relationship between ADMA and brucellosis. Serum samples from 39 patients with an accurate diagnosis of brucellosis and from 18 healthy control individuals were included in this study. ADMA levels were significantly higher in the patient group than the controls (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that ADMA level ≥ 0.61 had a sensitivity of 79.5 %, specificity of 88.9 %, positive predictive value of 93.9 %, and negative predictive value of 66.7 %. This is the first report of an association between brucellosis and high levels of ADMA. In conclusion, ADMA levels should be tested in brucellosis cases and that further studies to clarify the mechanism underlying the association between ADMA and brucellosis are required.

Severe thrombocytopenia and hemorrhagic diathesis due to brucellosis.

BACKGROUND: We aimed to examine cases of brucellosis that presented with severe thrombocytopenia and hemorrhagic diathesis. METHODS: A total of 10 brucellosis cases with severe thrombocytopenia were included in this case-series study. Patients' files were reviewed for their clinical and laboratory findings, as well as clinical outcomes and complications. Platelet counts of < 20,000/mm³ were diagnosed as severe thrombocytopenia. RESULTS: The lowest thrombocyte count was 3000/mm³ while the highest was 19,000/mm³ (mean: 12,000/mm³). Patients had the following symptoms: epistaxis (7 cases), petechia with epistaxis (4 cases), bleeding gums (3 cases), ecchymosis with epistaxis (2 cases), melena and renal failure (2 cases), and hematuria (1 case). Patients were given rifampicin and doxycycline along with supportive hematological therapy. All were treated successfully with no evidence of recurrence at follow-up visits. CONCLUSION: Since brucellosis is endemic in developing countries, it must be considered in the differential diagnosis of cases that present with severe thrombocytopenia and hemorrhagic diathesis.

Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature.

INTRODUCTION: Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features. METHODS: A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications. RESULTS: Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7+/-16.34 years and 69.6% of cases were aged 13-44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test+Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement. CONCLUSIONS: In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis.

[Case report: two Plasmodium vivax malaria cases in the Van Province]. / Olgu Sunumu: Van Ilindeki Plasmodium vivax Sitmasi.

Malaria is an important parasitic infection which is endemic in the Eastern Mediterranean and Southeastern Anatolia regions and sporadic in other regions of Turkey, while Plasmodium vivax is the most common cause. Two patients who were admitted to our hospital in October with complaints of high fever, chills, nausea-vomiting, generalized body pain and fatigue and diagnosed as P. Vivax malaria are presented, because they were two brothers with no history of travel outside of Van city.