Frequency of lyme disease in patients with tick contact and identification of ticks from Bolu province of Turkey.

BACKGROUND OBJECTIVES: Lyme disease is a multisystemic disease caused by the bacteria in the Borrelia burgdorferi sensu lato complex, which is transmitted by ticks of Ixodes genus. Although there are seroprevalence studies and case reports of Lyme disease from various regions in Turkey, there is no widespread epidemiological research. This study aimed to determine the frequency of Lyme disease in the cases followed-up after tick contact and to examine the isolated ticks to reveal tick population from Bolu province. METHODS: The cases who applied to the emergency department due to tick contact between April and September 2020 were firstly evaluated in our infectious diseases and clinical microbiology outpatient clinic on the third day of exposure and antibodies against Lyme disease were investigated with IFA method to exclude the patients who were previously exposed to B. burgdrorferi. Thereafter, patients were requested to continue outpatient visits at the 1st and 3rd month control. At these controls serum samples were taken to study B. burgdorferi antibodies with ELISA method which was stored at -20°C until the study day. RESULTS: Out of 123 patients who came to first control, 69 patients continued later to at least one of the two controls (either at first or third month). Of these 69 patients, only one (1.4%) was diagnosed with Lyme borreliosis according to clinical and laboratory features. Erythema migrans did not occur in any of the cases. Serum samples were assessed by ELISA method. Asymptomatic infection was detected in 22 cases (30.5%). In addition, we could obtain 46 ticks from our cases and two genera were identified. Forty-two (91.3%) were Ixodes spp, and two (4.3%) were Hyalomma spp. INTERPRETATION CONCLUSION: In this study, which was carried out for the first time in the province of Bolu, it was concluded that the cases presenting with a history of tick contact were most frequently exposed to Ixodes spp ticks and the probability of developing Lyme borreliosis was low (1.4%) during the three-month follow-up. Further studies with a greater number of cases and more extended follow-up period are needed.

Multi-inflammatory Index as a Novel Mortality Predictor in Critically Ill COVID-19 Patients.

AIM: Systemic inflammation has a crucial role in the pathogenesis and mortality of Coronavirus disease 2019 (COVID-19). Multi-inflammatory index (MII) is a novel index related with systemic inflammation. In this study, we investigated the relationship between MII and in-hospital mortality in COVID-19 patients admitted to the intensive care unit (ICU). METHODS: We retrospectively analyzed the medical records of COVID-19 patients followed-up in the ICU of our institution between 01.04.2020 and 01.10.2021. Patients were classified into two groups according to mortality status as survivors and non-survivors. Various inflammatory parameters of the groups were compared and their efficacy in predicting mortality was investigated. RESULTS: Out of 348 study patients, 86 cases (24.7%) were in the survived group and 262 cases (75.3%) were in the dead group. The median age of the mortal group was significantly higher than that of the survived group (65.5 vs 76, P < .001). Multiple logistic regression analysis revealed that among all the included inflammatory parameters, MII showed the best efficacy for predicting mortality (OR: 0.999; 95% CI: 0.9991-0.9998; P = .003). CONCLUSION: MII, a new combination of Neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP), is a simple and practical biomarker that can help us in the prediction of mortality in COVID-19 patients followed-up in the ICU.

C-reactive protein and neutrophil-lymphocyte ratio as predictors of mortality in coronavirus disease 2019

SUMMARY OBJECTIVE: This study investigates whether C-reactive protein, platelet-lymphocyte ratio, and neutrophil-lymphocyte ratio could be useful to predict mortality in COVID-19. METHODS: Data of 635 patients with COVID-19 followed up in Sinop Ataturk State Hospital from February to May 2020 were evaluated retrospectively. Diagnosis of COVID-19 was made according to the interim guidance of the World Health Organization. Patients were grouped into two groups based on mortality as survived and non-survived patients. Age, gender, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and C-reactive protein of the groups were investigated and compared. RESULTS: The mean age of the participants was 55.8±22.3 years. Among the patients, 584 survived and 51 patients died. Age was significantly different between the groups, 54.2±22.3 in the survived group and 75.6±11.1 in the dead group (p=0.000). In addition, neutrophil, C-reactive protein, and neutrophil-lymphocyte ratio values were significantly higher in the dead group (p=0.000). platelet-lymphocyte ratio was slightly higher in the dead group, but this difference was not significant (p=0.42). The area under the curve values for age, lymphocyte, platelet, C-reactive protein, and neutrophil-lymphocyte ratio are 0.797, 0.424, 0.485, 0.778, and 0.729, respectively. CONCLUSIONS: Our results showed that neutrophil-lymphocyte ratio and C-reactive protein are significantly higher in patients leading to death and could be effective biomarkers in predicting COVID-19 fatality. Furthermore, C-reactive protein could be used as an independent biomarker to predict death in patients with COVID-19, regardless of gender and age (p=0.000).

Factors Affecting Cervical Lymph Node Suppuration in Oropharyngeal Tularemia Cases.

OBJECTIVE:  To determine the factors associated with cervical lymph node suppuration in oropharyngeal tularemia. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY:  Departments of Infectious Diseases and Clinical Microbiology, Faculties of Medicine, Duzce University and Bolu Abant Izzet Baysal University Turkey, between January 2016 and August 2019. METHODOLOGY: Tularemia was diagnosed in clinically compatible cases by micro-agglutination test (≥1/160 titres). Positive cases were divided into two groups according to development of suppurated and discharging lymph nodes. If the cases did not develop suppuration and discharge lymph nodes, they were defined as completely healed. If they did, they were defined as "suppurated and drained lymph node group." Demographic and clinical characteristics and acute phase reactants of these groups were compared as to investigate any significant difference between the groups. RESULTS: There were 88 tularemia cases in the current study. Of these, 60 cases were completely healed (68.2%) and 28 cases had suppurated and drained lymph nodes (31.8%). Tonsillopharyngitis was found significantly lower in suppurated and drained lymph node group compared to the completely healed group (p= 0.016). However, late presentation (>14 days) was found significantly more frequent in suppurated and drained lymph node group compared to the completely healed group (p=0.033). CONCLUSION: In order to prevent suppurative lymphadenitis in oropharyngeal tularemia, it is advisable to start appropriate antimicrobials within 14 days after the appearance of symptoms. Key Words: Oropharyngeal tularemia, Cervical lymph node suppuration, Antibiotic initiation time.

C-reactive protein and neutrophil-lymphocyte ratio as predictors of mortality in coronavirus disease 2019.

OBJECTIVE: This study investigates whether C-reactive protein, platelet-lymphocyte ratio, and neutrophil-lymphocyte ratio could be useful to predict mortality in COVID-19. METHODS: Data of 635 patients with COVID-19 followed up in Sinop Ataturk State Hospital from February to May 2020 were evaluated retrospectively. Diagnosis of COVID-19 was made according to the interim guidance of the World Health Organization. Patients were grouped into two groups based on mortality as survived and non-survived patients. Age, gender, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and C-reactive protein of the groups were investigated and compared. RESULTS: The mean age of the participants was 55.8±22.3 years. Among the patients, 584 survived and 51 patients died. Age was significantly different between the groups, 54.2±22.3 in the survived group and 75.6±11.1 in the dead group (p=0.000). In addition, neutrophil, C-reactive protein, and neutrophil-lymphocyte ratio values were significantly higher in the dead group (p=0.000). platelet-lymphocyte ratio was slightly higher in the dead group, but this difference was not significant (p=0.42). The area under the curve values for age, lymphocyte, platelet, C-reactive protein, and neutrophil-lymphocyte ratio are 0.797, 0.424, 0.485, 0.778, and 0.729, respectively. CONCLUSIONS: Our results showed that neutrophil-lymphocyte ratio and C-reactive protein are significantly higher in patients leading to death and could be effective biomarkers in predicting COVID-19 fatality. Furthermore, C-reactive protein could be used as an independent biomarker to predict death in patients with COVID-19, regardless of gender and age (p=0.000).

Urosepsis caused by Kluyvera Ascorbata in a Pregnant Woman.

Among the Kluyvera species, K. ascorbata has been isolated from only a few adult cases. Furthermore, there is little or no information in the literature as to whether the species of Kluyvera can cause a clinically significant infection in pregnant women. We report a case of urosepsis caused by K. ascorbata in a 23-year pregnant woman at 26 weeks of gestation who presented with left flank pain. Ultrasonography showed left grade 3 hydronephrosis, ureteral dilatation, and a 10-mm distal ureteral stone. The patient underwent laser lithotripsy and JJ placement. Ten days later, she was readmitted with urosepsis and empirical antibiotherapy and aggressive hydration were initiated. On the third day, K. ascorbata growth was detected in the urine culture. Based on the clinical status of the patient and the antimicrobial susceptibility testing, the treatment was switched to ertapenem 1×1 g/day and was continued for 14 days. Among the Kluyvera species, K. ascorbata is the most frequent pathogen which may be isolated from pregnant women and can cause urosepsis. To the best of authors' knowledge, this is the first report showing the isolation of K. ascorbata in a pregnant woman which caused urosepsis.