Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study.

OBJECTIVE: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION: Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.

Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter case-control study.

Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56-3.14); prior exposure to N-acetylcysteine, 0.11 (0.03-0.34) and prior surgical intervention, 1.26 (0.76-2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.

Changes in acute viral hepatitis epidemiology in the Turkish adult population: A multicenter study.

BACKGROUND/AIMS: The present study aimed to determine the changes in the epidemiology of hepatitis in recent years in an adult Turkish population. MATERIALS AND METHODS: Overall, 852 patients with acute viral hepatitis from 17 centers were included in this study. Their sociodemographic characteristics, clinical courses, treatments, and laboratory findings were retrospectively analyzed. RESULTS: The most commonly found microorganisms were the hepatitis B virus (55.2%) and hepatitis A virus (37.6%), and the types of acute viral hepatitis differed significantly according to the age group (p≤0.001). The most frequently reported symptom was fatigue (73.7%), and the most common complications were cholecystitis (0.4%) and fulminant hepatitis (0.4%). The median hospital stay was 9 days (range 1-373). In total, 40.8% patients with acute hepatitis B virus developed immunity. CONCLUSION: In Turkey, there are significantly large adolescent and adult populations susceptible to acute viral hepatitis. Therefore, larger vaccination programs covering these age groups should be implemented.

Influence of multidrug resistant organisms on the outcome of diabetic foot infection.

OBJECTIVES: We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms. METHODS: We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. RESULTS: In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82-38.15, p=0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24-47.96, p=0.028), and chronic heart failure (OR: 3, CI: 1.01-9.04, p=0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p<0.001). CONCLUSION: Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality.

Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin.

AIM: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin. MATERIALS AND METHODS: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis. RESULTS: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (CI), 1.004-1.067; p=0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p=0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality. CONCLUSIONS: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation.

Efficiency of Hyperbaric Oxygen Therapy in Iatrogenic Spinal Infections.

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: The aim of this study is to reveal the effectiveness of HBO therapy in iatrogenic spinal infections intractable to antibiotic therapy alone. SUMMARY OF BACKGROUND DATA: The efficiency of hyperbaric oxygen (HBO) therapy, which is currently being used in many areas, has been proven in infections in deep and superficial locations and in osteomyelitis. The aim of this study is to reveal effectives of HBO therapy in iatrogenic spinal infections intractable to antibiotic alone therapy. METHODS: HBO therapy was given to 19 cases of iatrogenic spinal infection between 2008 and 2013. Adjuvant HBO therapy was applied to cases that had exhibited no improvement in clinical and laboratory findings despite medical treatment for at least 3 weeks. Several parameters including demographic characteristics, surgical area, etiology and the surgical treatment modality, microbiology (culture material and causative organism), clinical and laboratory results, duration of HBO therapy, and outcome were reviewed. RESULTS: The mean age was 54.6 years (range: 32-75 years). Iatrogenic spinal infections were most frequent in the lumbar region. It occurred after spine instrumentation in 12 cases and after micro-discectomy in 7 cases. The average number of HBO therapy sessions applied was 20.1 (range: 10-40). Wound discharge and clinical and laboratory findings recovered in all cases at the end of the therapy course. No revision or removal of the instrumentation was necessary in the instrumented cases. CONCLUSION: HBO therapy is a treatment modality, which is safe and efficient as an adjuvant therapy in the treatment of infections. It was also seen to be effective in the prevention of revision procedures and instrumentation failures in iatrogenic osteomyelitis cases, which had occurred following spinal instrumentation. LEVEL OF EVIDENCE: 4.

An overview of Ebola virus disease.

Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans. Ebola virus (EBOV) is transmitted through contact with blood or body fluids of a person who contracted or died from EVD, contaminated objects like needles and infected animals or bush meat. EVD has an incubation period of 2 to 21 days, and the infection has an acute onset without any carrier status. Currently, there is no standard treatment for EVD, so it is important to avoid infection or further spreading of the virus. Although historically the mortality of this infection exceeded 80%, modern medicine and public health measures have been able to lower this figure and reduce the impact of EBOV on individuals and communities. Its treatment involves early, aggressive supportive care with rehydration. Clinicians should consider the possibility of EVD in persons with travel or exposure history with the incubation period presenting constitutional symptoms in order to promptly identify diseased patients, and prevent further spreading of the disease.

Metoclopramide-induced acute dystonic reaction: a case report.

The aim of this case report is to draw attention to the frequent occurrence of metoclopramide-induced movement disorders. We report a case of an acute dystonic reaction to metoclopramide in a patient treated for hepatitis A. Metoclopramide can cause severe adverse events, such as an acute dystonic reaction, and should be used with caution in patients with infectious diseases.

An adult onset Still's disease mimicking pneumonia.

Adult onset Still's disease is a rare systemic inflammatory disease of unknown origin. It is common to involve liver and spleen, and less often lungs. A 24-year-old man presenting with spiking fever, pulmonary infiltrations, and pleural effusion on the right side mimicking pneumonia. All serologic tests of infectious causes, antinuclear antibody, and rheumatoid factor were negative. He was diagnosed as Adult onset Still's disease according to the criteria of Yamaguchi. Adult onset Still's disease is considering in the differential diagnosis pneumonia that is unresponsive to antimicrobial treatment, negative cultures and serologically diagnostic laboratory tests, and high-level serum ferritin.

The coexistence of hepatitis A and infectious mononucleosis.

Hepatitis A is an acute, self-limited disease that spreads predominantly by the fecal-oral route. Hepatitis A characteristically has an acute, sudden influenza-like onset with a prominence of myalgia, headache, fever and malaise. Infectious mononucleosis is an acute illness characterized clinically by sore throat, fever and lymphadenopathy. The virus usually spreads from person to person by close contact with nasopharyngeal secretions. In this case the coexistence of both diseases in the same patient is found interesting.