[Protozoal antigen positivity in diarrheal patients admitted to emergency service: a point prevalence study]. / Acil Servise Basvuran Ishalli Olgularda Protozoal Antijen Pozitifligi: Bir Nokta Prevalans Çalismasi

Intestinal parasites are the important etiological agents of water and food related diarrhea cases which are frequently seen during summer/early autumn seasons in developing countries. This point prevalence study was aimed to determine the protozoal antigen positivity rate in diarrhea cases admitted to the emergency service in one single day. A total of 198 diarrheal patients (90 male, 108 female; age range: 1-82 years, mean age: 29 years) who were admitted to the emergency service of Ankara Training and Research Hospital were included in the study. Macroscopic and direct microscopic examinations were performed for the stool samples of patients, and the samples which yielded pathological microscopic findings (e.g. presence of leukocytes, erythrocytes, and trophozoits) were investigated in terms of Entamoeba histolytica adhesin antigen, Giardia intestinalis cyst antigen and Cryptosporidium oocyst antigen by commercial ELISA kits (Techlab, USA). Macroscopic examination of the stool samples revealed that 60 (30%) of them had blood and mucous, 137 (69%) were watery and one sample had normal appearance. Pathologic results were obtained for 96 (48.5%) of the samples by microscopic examination: 36 (37.5%) revealed erythrocytes, 90 (93.7%) had leukocytes and 3 (1.5%) had G.intestinalis trophozoites. Since Shigella spp. were cultured in two of these 96 samples, these two cases were omitted from the study and 94 samples were investigated by ELISA assays. G.intestinalis was detected in 13 (13.8%) and E.histolytica in 2 (2.1%) samples while Cryptosporidium antigen was not detected in any of the samples by the ELISA assays. It was concluded that ELISA antigen assays were rapid and cost-effective methods for the determination of the causative agent in cases of diarrhea.

[An overlooked disease of tick bites: Lyme disease]. / Kene isiriklarinda gözden kaçan bir hastalik: Lyme hastaligi.

The exact prevalence of Lyme disease caused by Borrelia burgdorferi is unknown in Turkey. However, B. burgdorferi seropositivity ranges between 6-44% among high risk groups. B. burgdorferi is transmitted to humans by the bite of infected ticks belonging to the genus Ixodes, which may be seen throughout our country. Since the Crimean-Congo Hemorrhagic Fever (CCHF) is attracting attentions to tick bites more than ever in Turkey, the patients with tick bites are followed up more cautiously and have been referred to central hospitals. In this study 4 patients who were referred to our center with prediagnosis of CCHF but later appeared to be Lyme cases, were presented. All of the cases were women, age ranging between 25-67 years old. The patients were from areas where there is high risk of CCHF. CCHF were ruled out in these patients by agent specific polymerase chain reaction and IgM results. All of the patients were clinically diagnosed as Lyme disease since they had lesions compatible with erythema migrans. B. burgdorferi total antibodies investigated by ELISA (Zeus Scientific Inc., USA) were found positive in all patients. Since Western blot method could not be performed, positive serologic results have not be confirmed. However, the diagnosis of Lyme disease was done according to Centers for Disease Control and Prevention (CDC) criteria and all of the cases have recovered following treatment with antibiotics (cefuroxime axetil or sulbactam ampicillin or amoxicillin clavulanic acid). When the increase in the incidence of arthropod-borne infections in our country is considered, it should be noted that tick-bite cases should also be evaluated in terms of Lyme disease besides CCHF. Differential diagnosis of these infections is of critical value since early appropriate therapy is important to prevent the development of serious complications in both of the disease settings.

Growing OXA-23 type strains among carbapenem-resistant Acinetobacter baumannii and tigecycline as an alternate combination therapy.

BACKGROUND/AIM: The increasing prevalence and global spread of difficult-to-treat carbapenem-resistant Acinetobacter baumannii has become a serious problem. The aim of this study is to investigate the resistance patterns and tigecycline sensitivity of carbapenem-resistant A. baumannii strains. MATERIALS AND METHODS: Acinetobacter strains that were carbapenem-resistant and collected mainly from intensive care units were included into this study. The antibiotic sensitivity/resistance of the strains to other antibiotics and tigecycline were noted. Presence of blaOXA-23, blaOXA-48, blaOXA-58, and NDM-1 was investigated by PCR. RESULTS: In total, 44 carbapenem-resistant A. baumannii strains were detected. In addition, 57% (25/44) showed resistance to netilmicin and 2% (1/43) to tigecycline. All of the strains were susceptible to colistin. blaOXA-58 was found only in one (2%) strain while blaOXA-23 was found in 14 (32%) strains. All strains were negative for blaOXA-48 and NDM-1. CONCLUSION: blaOXA-23 was the main resistance pattern in carbapenem-resistant A. baumannii strains. blaOXA-58 was present only in one strain and no blaOXA-48 was found. Tigecycline susceptibility is high and it can be a treatment option for a possible combination therapy of carbapenem-resistant A. baumannii, especially for those for whom colistin is contraindicated because of its toxicity.

The Knowledge of the Physicians about Sepsis Bundles is Suboptimal: A Multicenter Survey.

OBJECTIVES: Sepsis is a severe condition with possible high mortality outcomes. A multicentre-survey to detect the knowledge of the physicians who are involved in sepsis management in daily work was conducted. MATERIALS AND METHODS: The study was held in October 2013. A questionnaire consisting of questions about sepsis bundles was prepared. Eight centers from different regions of the country were invited to join the survey. The questionnaires were introduced to physicians from infectious diseases, internal diseases, emergency (ER) and anaesthesiology departments. RESULTS: Two-hundred-and-twenty-three physicians from eight different centers were included. Of total 112 (50%) were male, median age was 30 years (24-59 years). Median working duration of participants was 5 years; 153 (69%) were residents, 70 (31%) were consultants. Of total 131 (59%) declared that they have enough knowledge on sepsis management. About the most important approach in sepsis, 151 (68%) voted for fluid replacement while 59 (26%) and 13 (6%) said early antibiotic use and inotropic support are the most important approaches respectively. Physicians from ER (56.5%) and anaesthesiology departments (55.4%) were more aware of the fluid replacement element of the bundle (30ml/kg, 3-hours bundle) in severe sepsis. The ID physicians, who routinely follow sepsis patients, were not aware of the fluid resuscitation (only 20% replied the element correctly) but almost all of them answered the question on early antibiotic use and blood culture sampling correctly. The knowledge of target CVP and MAP in severe sepsis were also below expectant among ID physicians. The overall knowledge of sepsis bundles of internal medicine physicians was poor. Almost all of the ER physicians knew that they have to measure lactate level upon admission but they were not aware of the threshold of the lactate level. CONCLUSION: The knowledge of the sepsis bundles of the physicians, who are in charge of sepsis patients in routine work, was suboptimal. Most of the participants were unaware of SSC and new bundles. Training of the physicians of all centers about sepsis bundles is suggested according to these results.

An investigation of pulmonary findings of Crimean-Congo haemorrhagic fever patients.

AIM: Crimean-Congo haemorrhagic fever (CCHF) generally affects many organs. In this study a retrospective evaluation of the pulmonary findings of CCHF patients was made. MATERIALS AND METHODS: The records of patients were retrospectively analysed. For each patient an evaluation was made of age, sex, occupation, place of residence, contact with ticks, smoking history, and pulmonary radiological and laboratory findings. A confirmed diagnosis of CCHF was made on determination by enzyme-linked immunosorbent assay or polymerase chain reaction. RESULTS: Of the 128 patients, 48.4% were female. Symptoms of coughing were determined in 18% of patients, sputum in 4.7%, chest pain in 3.9%, dyspnoea in 3.1%, and haemoptysis in 0.8%. The mortality rate was 7%. In terms of sex, place of residence, contact with ticks, smoking, findings of the respiratory system, and physical examination findings, no statistically significant difference was seen between the survivor and nonsurvivor groups (P > 0.05). The white blood cell count values of the survivors were determined to be significantly lower compared to those of the nonsurvivors and the alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, creatine phosphokinase, and C-reactive protein values of the nonsurvivors were significantly higher compared to those of the survivors (P < 0.05). CONCLUSION: CCHF can be fatal for the respiratory system. An early diagnosis of CCHF and referral to a specialised centre is therefore important.

[A case of malaria with uveitis, hyperglycemia, and rasha in a Turkish radiologist who went to Africa]. / Afrika'ya Giden Bir Türk Radyologda Gelisen; Üveit, Hiperglisemi Ve Döküntü Ile Seyreden Sitma, Olgu Sunumu.

Malaria is still an important health problem worldwide, particularly in Sub-Saharan Africa. In Turkey, the most common type of malaria is Plasmodium vivax, and endemic regions are South-Eastern Anatolia and Çukurova. Due to globalization and tourism, travel-associated infection due to P. falciparum is also seen more frequently in Turkey. P. falciparum malaria can be highly fatal despite optimal antimalarial treatment. We present a case of falciparum malaria in a Turkish radiologist who went to Africa for occupational reasons and come back with malaria accompanied by uveitis, hyperglycemia, and purpuric rash.