Seroprevalence and risk factors of syphilis among HIV/AIDS patients in Istanbul, Turkey.

OBJECTIVE: Data on syphilis seroprevalence among human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS) patients are unavailable in Turkey although they have common transmission routes. Our study is oriented towards the assessment of the seroprevalence of syphilis and the related risk factors in the HIV/AIDS patients followed in our outpatient clinic. MATERIALS: Newly diagnosed HIV/AIDS cases (n = 308) who attended our outpatient clinic between January 2006 and April 2013 were included in the study. Patient characteristics, medical history, physical examination findings, CD4+ T lymphocyte count, HIV RNA level, rapid plasma reagent (RPR) and Treponema pallidum hemagglutination (TPHA) test results were analyzed retrospectively. TPHA positivity was considered indicative of syphilis-causing T pallidum exposure. RESULTS: HIV infection was transmitted through heterosexual (n = 176) or homosexual (n =131) contact (266 male, 86.3%; age 38.3 ± 11.7 years; CD4+ T lymphocyte count, 330.6 ± 15.17/mm3). 50.7% of the patients attained only primary education. Out of the 245 cases, who were asked about the number of their sexual partners, 40 patients (26 women) lived in a monogamous relationship. Condom usage was not practiced (57.2%) or was only occasional (34.4% - particularly with their legal spouses and for contraception). Physical exam revealed no signs of syphilis or other STIs. TPHA (+/- RPR) positivity was determined in 40 patients (12.9%), indicating T pallidum exposure. All patients with positive syphilis serology were male (p= 0.0026). T pallidum exposure was determined in 21.3% of homosexual and 6.8% of heterosexual cases (p = 0.0003). CONCLUSION: Since sexual contact is the most common route of transmission for both infections, syphilis seroprevalence was relatively high in our HIV/AIDS patients. Male and homosexual HIV/AIDS patients constituted a group at the highest risk for syphilis.

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults.

BACKGROUND: The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. METHODS: This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. RESULTS: In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p=0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p=0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p=0.133) significantly increased the likelihood of fatality. CONCLUSIONS: Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.

Prevalence and risk factors of osteopenia/osteoporosis in Turkish HIV/AIDS patients.

BACKGROUND: Recent studies showed a high frequency of low bone mineral density (BMD) in HIV-infected patients and no reports have been issued in Turkey. Our aim was to evaluate BMD and risk factors for osteopenia/osteoporosis in HIV-infected patients that attended an outpatient clinic in Istanbul, Turkey. METHOD: In order to determine the prevalence of BMD, 126 HIV-infected patients had been studied with dual energy X-ray absorptiometry (DEXA). The association between BMD and age, gender, body mass index (BMI), habits, 25(OH)vitamin D, HIV RNA, CD4 lymphocyte nadir, using and duration of highly active antiretroviral treatment (HAART) were investigated by using multivariate analysis. RESULTS: Median age was 40.1 years (range, 20-70); 84% were male; 35.7% patients had AIDS, 63.5% were treated with HAART. Osteopenia and osteoporosis were diagnosed in 53.9% and 23.8%, respectively. Mean plasma HIV RNA was 5.2 (SD 1.0) log10 copies/mL and CD4 lymphocyte nadir was 313.8 (SD 226.2)/mm(3). Factors associated with bone loss were high viral load (p=0.034), using (p=0.033) and duration of HAART (p=0.008). No correlation had been seen between sex and osteopenia/osteoporosis (p=0.794). However, males showed higher rates of osteoporosis than females (p=0.042). CONCLUSIONS: Our results show a very high prevalence of bone mass reduction in Turkish HIV-infected patients. This study supports the importance of both HIV and antiretroviral therapy in low BMD.

Imported Plasmodium falciparum malaria in Istanbul, Turkey: risk factors for severe course and mortality.

We describe the epidemiological, clinical features and risk factors for the morbidity and mortality of imported Plasmodium falciparum malaria cases during the last 10 years in Istanbul, Turkey. The epidemiological, clinical and laboratory data of cases in six tertiary care hospitals in Istanbul between 2002 and 2012 were analysed. Seventy patients (65 males, five females; median age 37; range: 14-84) were included. Sixty-five (93%) patients had travelled to African countries and the remaining five to other malarious countries. Seventeen (24%) had a history of previous malarial episodes; eight (13%) developed recrudescence during the first month; 22 (31%), 17 (24%), 20 (29%) and three (4%) cases had cerebral malaria, cholestatic icterus, malarial hepatitis and respiratory distress syndrome on admission, respectively. Six of 12 patients with severe falciparum malaria died. Clinically, the presence of alteration in mental status, icterus, hypoglycaemia, disseminated intravascular coagulation and malarial hepatitis were statistically significant for the development of severe malaria and mortality. Recrudescence should not be forgotten, especially in uncomplicated cases.

Isolated anti-HBc among HIV-infected patients in Istanbul, Turkey.

BACKGROUND: Isolated antibody to hepatitis B core antigen (anti-HBc) is frequent in HIV-infected patients, and it may be a marker of occult hepatitis B. We aimed to determine the prevalence and associated risk factors of isolated anti-HBc among HIV-infected patients in Turkey, which is classified as an intermediate HBV, low HIV endemic region. METHOD: HIV/AIDS patients followed by the Infectious Diseases and Clinical Microbiology Outpatient Clinic of Haseki Training and Research Hospital between January 2006 and March 2011 were included in this study. Medical records were reviewed to determine the prevalence of isolated anti-HBc and to identify the risk factors associated with isolated anti-HBc. The frequency of isolated anti-HBc in 209 HIV-infected patients was compared with 83 volunteer blood donors. RESULTS: Of 209 HIV-infected patients, 40 subjects (19.1%) had isolated anti-HBc compared with control group, which consisted of 83 volunteer blood donors who had similar age (P = .13) and sex (P = .29). In the control group, only 2 (2.4%) had isolated anti-HBc. Isolated anti-HBc was significantly more frequent in HIV-infected patients (P < .001). The characteristics such as age, gender, injecting drug use, anti-HCV seropositivity, and CD4 cell counts were not significantly different between HIV-infected patients with or without isolated anti-HBc. Only 3 (7.5%) of HIV-infected patients had occult infection. CONCLUSION: Prevalence of isolated anti-HBc in Turkish HIV-infected patients was 19.1%, which was significantly more frequent than in blood donors. Isolated anti-HBc could be associated with occult infection. Thus, all HIV-infected patients should be screened for anti-HBc before starting antiretroviral therapy.

The importance of transmission time in HIV infections and an epidemiological prospective follow-up study for 1 year in the Marmara Region of Turkey.

It is important to detect recent and new HIV/1 infections and to take preventative measures in order to prevent rapid disease progression in AIDS and to decrease the incidence of infection. We aimed to detect long standing or recent HIV infections by determining transmission times for the cases in which first-time HIV/1 seropositivity were detected. The serum samples of 323 cases which were found to be seropositive by ELISA and Western-blotting were included in this study. The discrimination between long-term and recent HIV/1 infection was made by determining transmission-time with the Aware BED-EIA, HIV-1 incidence test (IgG capture HIV-EIA) tests. Ninety-six healthy blood donors who did not have a positive anti-HIV test and a chronic infectious disease for at least 1 year were included in this study as a negative healthy control group. In the discrimination of long-term and recent HIV/1 infections, only in vitro ODn values were used. The cases with normalized optical density (OD) (OD(specimen)/OD(calibrator))<0.8 by commercial kit were accepted as recent HIV infection (155 days history or seroconversion less than 6 months). The cases with ODn >1.2 were accepted as long-term HIV/1 infections (more than 155 days history or more than 6 months). The cases with ODn between 0.8 and 1.2 were accepted as "additional tests needed" cases. We detected recent HIV/1 infections (<6 months) in 60 (18.5%) out of 323 cases and long-term HIV/1 infections (>6 months) in 263 (81.5%) out of 323 cases. The most frequently encountered transmission route in long-term and recent HIV/1 infections was heterosexual sexual intercourse as 54 (50%) and 257 (97%), respectively. 63.3% of newly infected patients were married females and 65.3% of recently infected patients were males. In conclusion, the detection of the high ratio of long-term HIV/1 infection cases (81.5%) compared to recent infections (18.5%) suggested to us, that the long standing cases may have some activities related with transmission of HIV/1 in the past. The detection of higher HIV/1-infections in individuals which had heterosexual sex and also in married males suggested that this situation poses a very great threat for the health of society.

Seroprevalence of hepatitis B: do blood donors represent the general population?

INTRODUCTION: In this study, we aimed to compare the HBV seroprevalances of voluntary blood donors and the healthy persons who required premarital screening. METHODOLOGY: HBsAg ELISA results were collected retrospectively from the records of 9,949 blood donors and 954 healthy persons who required premarital screening. RESULTS: HBsAg was detected in 182 of 9,949 (%1.8) voluntary blood donors and  32 of  954 (%3.4) healthy persons who required premarital screening. HBsAg seropositivity was significiantly higher in the healthy persons who required premarital screening than in blood donors (p = 0.0016). CONCLUSION: Premarital screening is mandatory in our country, and it may provide more accurate epidemiological data to determine HBV seroprevalence than in other selected groups such as blood donors.

[Toxoplasma gondii IgG seroprevalence in HIV/AIDS patients]. / HIV/AIDS Hastalarinda Toxoplasma gondii IgG Seroprevalansi

OBJECTIVE: Our aim was to determine the Toxoplasma gondii IgG seroprevalence in HIV/AIDS patients who applied to our outpatient clinic. METHODS: Between January 2006 and June 2010, 164 HIV/AIDS patients were tested for Toxoplasma gondii IgG antibodies by using the ELISA method. RESULTS: Of the total of 164 HIV/AIDS patients, 135 were male, 29 were female with a mean age of 36 years (range: 20-72 years). 85 (52%) of cases, T. gondii IgG was evaluated positive. In addition, positive T. gondii IgG was seen in 23 of 36 patients (64%) whose count of CD4+T cell was below 100. CONCLUSION: Life threatening clinical conditions, mostly toxoplasma encephalitis, develop in cases who are T. gondii IgG seropositive with a count of CD4+ T cell lower than 100. The presence of T. gondii IgG should be investigated in all HIV infected patients due to the high risk of reactivation.

Profile of HIV/AIDS patients in a tertiary hospital in Istanbul, Turkey.

BACKGROUND: In Turkey, the first HIV/AIDS case was reported in 1985. Although HIV/AIDS incidence has been increasing, only 3,671 cases have been documented to date in this country, with a population of 71,517,100. The aim of this study was to determine the epidemiologic and clinical features of patients with HIV infection and AIDS followed during a 3.5-year period. METHODS: A total of 136 HIV-infected patients attending Infectious Diseases and Clinical Microbiology Outpatient Clinic of Haseki Training and Research Hospital between January 2006 and June 2009 were included in the study. Epidemiologic and clinical data, such as age, gender, marital status, occupation, level of education, transmission routes, condom usage, type of screening tests, clinical findings, and CD4 T-cell counts and viral loads at diagnosis, were collected retrospectively from case records completed on admission. RESULTS: Patients with a diagnosis of HIV infection comprised a group of 136 persons (80% men, mean age 36 years [range, 20-72 years]). Six patients (8%) were university graduates. Heterosexual intercourse was the most common route of transmission (60%), followed by homosexual intercourse and intravenous drug use. Almost all women (24 out of 25; 96%) acquired the infection from their husbands. Median CD4 T-cell count at diagnosis was 302/mm3 (range, 9-1,270). On admission, CD4 T-cell count was < 200/mm3 in 39%, 200-350/mm3 in 30%, and ≯350/mL in 31%. Mean viral load at diagnosis was 1,033,871 copies/mL. Forty-four percent of the patients were admitted with obvious clinical signs and symptoms, whereas 56% were diagnosed through screening tests. CONCLUSIONS: Poorly educated individuals and men constituted the majority of the cases. Most women acquired the disease from their husbands. Considering the poor level of education among the patients we studied, effective educational programs should be developed to reduce the transmission of HIV. Although heterosexual intercourse was the most common route of transmission, 38% of the patients we studied reported male-to-male intercourse. This is markedly higher than the 9% rate of transmission by this route in Turkey.

Sensorineural hearing loss in neurobrucellosis.

Neurobrucellosis (NB) is a rare clinical presentation of brucellosis. This form is hard to diagnose because of a lack of definite diagnostic criteria, and its treatment is also hard. The clinical spectrum may cover a span between non-specific neurological symptoms to a severe meningoencephalitis. We report 3 patients with NB, whose main complaint was sensorineural hearing loss (SNHL) who were followed up at our hospital for 3 years. We diagnosed NB by positive CSF cultures in 2 patients and by a positive brucella IgG agglutination titer in blood and CSF in the third. Sensorineural hearing loss is a rare complication of NB, which has not attracted enough attention among known manifestations. Neurologists and otologists should be aware of this symptom as a probable clinical presentation of brucellosis.

Evaluation of cases admitted to a center in Istanbul, Turkey in 2003 for rabies vaccination and three rabies cases followed up in the last 15 years.

We evaluated the cases of 7,266 individuals who applied to our hospital's Center for Rabies Vaccination between January and December 2003. Among 1,831 female and 5,435 male cases, 37% were given 3 doses of vaccination, 14% were given 5 doses, and in 24% of cases a 2-1-1 vaccination schedule was applied. Antirabies serum of horse origin was given in 179 cases. Regarding the wounds, 83% were superficial and 17% were deep. Most of the cases involved dog bites (74%). Of the dogs involved, 30% were pets (with owners). Only a few (6%) of those pets had been vaccinated. Of the 2 dogs investigated for rabies in Pendik Veterinarian Research Institute, none were found to harbor the disease. In the last 15 years, 3 cases were followed up with a diagnosis of human rabies in our clinic. Domestic animals (without owners, living a somewhat wild life in cities) are still the cause of many rabies cases. As rabies carries a very high fatality risk, public health precautions and education are important as well as post-exposure prophylaxis.

[Investigation of intestinal parasites in AIDS patients]. / AIDS hastalarinda barsak parazitlerinin arastirilmasi.

In this study, enteric parasites were investigated in the stool samples of 38 AIDS patients (23 with chronic diarrhea and 15 without diarrhea) prospectively. At least three stool samples from each patient were investigated microscopically for ova or trophozoites. The samples were concentrated with formol-ether method and wet preparations stained with lugol were examined. In addition, the concentrated samples were stained with modified asid-fast (Kinyoun's), rhodamine-auramine, modified trichrom and calcoflor methods. Enteric parasites were detected in 18 (47%) of the 38 patients, 16 patients harbored a single parasite, and 2 patients were found to be infected with more than one parasite. Only one (7%) of 15 AIDS patients without diarrhea, were found to be infected with Giardia lamblia. On the other hand, 17 (74%) of 23 AIDS patients with chronic diarrhea were found to be infected with various enteric parasites. Cryptosporidium spp. was detected in 9 (39%) of these 23 patients, and in 2 of them Microsporidium spp. accompanied Cryptosporidium. In 2 (9%) of these 23 patients G. lamblia were detected, while Isospora belli, Blastocystis hominis, Entamoeba histolytica, Strongyloides stercoralis and Trichuris trichiura were detected in one patient each. As a result, the detection rate of emerging parasites, including Cryptosporidium spp, Microsporidium spp, I. belli, B. hominis, and S. stercoralis was significantly higher than conventional parasites (39% versus 13%; z=2.34, p=0.01), and CD4 T cell counts were found to be significantly lower among AIDS patients with chronic diarrhea than those without diarrhea (x2=34.33, p<0.001).