Bülent Eser

Publications of Bülent Eser

• What is the role of the (1→3)-β-d-glucan assay in the screening of patients undergoing autologous haematopoietic stem-cell transplantation?

  Authors: Gökhan Metan, A N Koç, Leyla G Kaynar, Altay Atalay, Ahmet Oztürk, Bülent Eser, Mustafa Cetin

  Mycoses. 04/2012;

  The aim of this study is to determine the clinical contribution of (1→3)-β-d-glucan (BDG) screening in the case of patients undergoing autologous haematopoietic stem-cell transplantation (HSCT). TheThe aim of this study is to determine the clinical contribution of (1→3)-β-d-glucan (BDG) screening in the case of patients undergoing autologous haematopoietic stem-cell transplantation (HSCT). The records at our stem-cell transplantation centre were reviewed to identify the patients who underwent autologous HSCT between April 2009 and December 2010. Patients were classified as having proven invasive aspergillosis (IA), probable IA, or possible IA on the basis of the criteria established by the European Organization for Research and Treatment of Cancer and Mycoses Study Group (independent of the BDG results). During the study period, the patients were screened for BDG twice a week from transplant (day 0) until engraftment. Three patients were diagnosed with probable IA and five were diagnosed with possible IA. A total of 354 serum samples from79 patients who met the study inclusion criteria were used for statistical analysis. At the cut-off value of 80 pg ml(-1) , the sensitivity was 27.2% [95% confidence interval (CI); 7.3-60.6]; specificity, 94.4% (95% CI; 91.3-96.5); positive predictive value, 6.2%; and negative predictive, 93.7%. The clinical contribution of the BDG assay as a screening test was relatively limited in this cohort of patients undergoing autologous HSCT.

• What should be the optimal cut-off of serum 1,3-β-d-glucan for the detection of invasive pulmonary aspergillosis in patients with haematological malignancies?

  Authors: Gökhan Metan, A Nedret Koç, Altay Atalay, Leyla Gül Kaynar, Ahmet Ozturk, Emine Alp, Bülent Eser

  Scandinavian journal of infectious diseases. 12/2011;

  Abstract Background: The detection of 1,3-β-d-glucan (BDG), a cell wall component of several medically important fungi, is a promising tool for the diagnosis of invasive pulmonary aspergillosis. TheAbstract Background: The detection of 1,3-β-d-glucan (BDG), a cell wall component of several medically important fungi, is a promising tool for the diagnosis of invasive pulmonary aspergillosis. The aim of this study was to evaluate the diagnostic accuracy of the BDG test in invasive pulmonary aspergillosis (IPA) by focusing on the optimal cut-off value. Methods: The records of the Infection Control Committee were reviewed to identify patients with haematological malignancies and stem cell transplantation who had at least 1 BDG (Fungitell kit) measurement during the period January 2008 through April 2011. The European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG) criteria (independent of BDG results) were used to categorize the patients with IPA. Patients with possible IPA were not included in the study. Results: A total of 128 patients (50 with proven or probable IPA) were included in the study. At the manufacturer's recommended cut-off value of 80 pg/ml, the sensitivity of BDG was 66% (95% CI 51.2-78.7), specificity 75.6% (95% CI 64.6-84.5), positive predictive value (PPV) 63.4%, and negative predictive value (NPV) 77.6%. A receiver operating characteristic (ROC) curve was constructed to define the optimum serum BDG cut-off for the diagnosis of IPA. At a cut-off value of 181 pg/ml, the sensitivity was 52% (95% CI 37.4-66.3), specificity 94.8% (95% CI 87.4-98.6), PPV 86.7%, and NPV 75.5%. Conclusions: Although higher cut-off levels increased the specificity of the BDG test, sensitivity decreased to an unacceptable level; the commercially recommended cut-off value appears to be appropriate for screening purposes.

• Can bacteraemia lead to false positive results in 1,3-beta-d-glucan test? Analysis of 83 bacteraemia episodes in high-risk patients for invasive fungal infections.

  Authors: Gökhan Metan, A Nedret Koç, Ciğdem Ağkuş, Leyla Gül Kaynar, Emine Alp, Bülent Eser

  Revista iberoamericana de micologia : organo de la Asociacion Espanola de Especialistas en Micologia. 08/2011;

  BACKGROUND: Although bacteraemia has been reported to be related to false positive results in the 1,3-beta-d-glucan (BDG) test, the evidence for this interaction is limited. The purpose of this studyBACKGROUND: Although bacteraemia has been reported to be related to false positive results in the 1,3-beta-d-glucan (BDG) test, the evidence for this interaction is limited. The purpose of this study was to investigate the association between bacteraemia and the BDG test. PATIENTS AND METHODS: Records of the Infection Control Committee were reviewed to identify bacteraemia patients who were hospitalized in the haematology ward and stem cell transplantation unit. Patients who had undergone the BDG test at least once within 5 days of a positive blood culture were included in the study. BDG levels in the sera were assayed using the Fungitell kit (Associates of Cape Cod, East Falmouth, MA) according to the manufacturer's specifications. The cutoff for BDG positivity was 80pg/mL. RESULTS: Eighty-three bacteraemic episodes were identified in 71 patients. BDG positivity was detected in 14 patients with bacteraemia, and only 1 patient with Escherichia coli bacteraemia had high BDG levels (over 80pg/mL) despite having no evidence of invasive fungal infection (IFI). CONCLUSION: Our study suggests that the cross-reactivity of the BDG test with a concomitant or recent bacteraemia is a very rare condition. Patients with risk factors for IFI should be evaluated cautiously when a positive BDG test is reported.

• Prevalence of anti-toxoplasma Gondii antibodies in Turkish blood donors.

  Authors: Süleyman Yazar, Bülent Eser, Mehmet Yay

  Ethiopian medical journal. 08/2006; 44(3):257-61.

  OBJECTIVE: Toxoplasmosis is caused by an obligate intracellular protozoan parasite, Toxoplasma gondii. Most of these infections are asymptomatic or benign, but may cause severe or fatal consequencesOBJECTIVE: Toxoplasmosis is caused by an obligate intracellular protozoan parasite, Toxoplasma gondii. Most of these infections are asymptomatic or benign, but may cause severe or fatal consequences in immunodeficient patients, transplant recipients, and in the fetus. Transmission may occur by eating uncooked meat, contaminated vegetables, blood transfusion, organ transplantation, and across the placenta from the mother to the fetus. IgG antibodies to T. gondii may persist in the serum at high titers for years. In the present study, our aim was to determine prevalence of anti- T. gondii IgG and IgM antibodies in Turkish blood donors. METHODS: A total samples from 385 healthy blood donors from Kayseri, Turkey were examined for anti- T. gondii antibodies by indirect fluorescent antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA). RESULTS: The seroprevalence of the anti- T. gondii IgG and IgM antibodies was 19.5%, 2.33% respectively by IFAT and 20.25%, 2.33% by ELISA. CONCLUSION: It is suggested that all blood donors should be screened for toxoplasmosis before transfusion

• Importance of anticoagulant proteins in chronic liver diseases.

  Authors: Sebnem Gürsoy, Mevlüt Başkol, Edip Torun, Alper Yurci, Işin Soyuer, Bülent Eser, Kadri Güven, Omer Ozbakir, Mehmet Yücesoy

  The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology. 10/2005; 16(3):129-33.

  BACKGROUND/AIMS: This study was conducted to elucidate the importance of anticoagulant proteins in chronic liver disease and their possible role as markers in determining the severity of the liverBACKGROUND/AIMS: This study was conducted to elucidate the importance of anticoagulant proteins in chronic liver disease and their possible role as markers in determining the severity of the liver disease. METHODS: This study was conducted on 35 patients with cirrhosis, 15 patients with chronic active hepatitis and 10 healthy controls. Coagulation inhibitor proteins such as protein C, protein S and antithrombin, as well as D-dimer level and thrombin time, which reflect fibrin degradation products, were measured. Cirrhotic patients were categorized as Child A, B and C and chronic active hepatitis patients as mild or moderate activity according to the modified Knodell histopathologic classification. The parameters were compared between patient groups and healthy controls. RESULTS: In comparison with controls, the cirrhotics had significantly decreased protein C, protein S, antithrombin levels and increased D-dimer levels. The Child B and Child C patients differed significantly with respect to protein C and antithrombin levels only. In the chronic active hepatitis patients, protein S, protein C and fibrinogen were within normal limits, whereas antithrombin was low. CONCLUSIONS: In chronic active hepatitis, the antithrombin level may be used as an early marker of hepatocellular damage. In cirrhotics, protein C and antithrombin may be useful for assessment of hepatocellular damage, whereas D-dimer may be important for the transition to decompensation.

• Severe thrombotic microangiopathy associated with brucellosis: successful treatment with plasmapheresis.

  Authors: Fevzi Altuntas, Bülent Eser, Ismail Sari, Orhan Yildiz, Mustafa Cetin, Ali Unal

  Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 02/2005; 11(1):105-8.

  Brucellosis is a disease that may lead to changes in hematologic parameters such as anemia, neutropenia, and thrombocytopenia; however, thrombotic microangiopathy (TMA) is a rare finding. Severe TMABrucellosis is a disease that may lead to changes in hematologic parameters such as anemia, neutropenia, and thrombocytopenia; however, thrombotic microangiopathy (TMA) is a rare finding. Severe TMA may be associated with life-threatening hematologic, renal, and neurologic disorders. To prevent this mortality caused by brucellosis, prompt recognition of this complication and prompt therapy are essential. A patient with TMA associated with Brucella melitensis is presented who initially presented with fever, skin purpura, epistaxis, confusion, microangiopathic hemolytic anemia, and thrombocytopenia. TMA was treated with plasmapheresis with cryosupernatant plasma replacement, energetically. A rapid improvement in platelet count, lactate dehydrogenase level, hemolytic anemia, and neurologic symptoms was observed with this treatment. For cases with infection-induced thrombotic microangiopathy, short-term plasmapheresis may be applied as an urgent therapy in addition to antimicrobial therapy.

• Catheter-related bacteremia due to Kocuria rosea in a patient undergoing peripheral blood stem cell transplantation.

  Authors: Fevzi Altuntas, Orhan Yildiz, Bülent Eser, Kürsat Gündogan, Bulent Sumerkan, Mustafa Cetin

  BMC infectious diseases. 01/2005; 4(1):62.

  BACKGROUND: Micrococcus species may cause intracranial abscesses, meningitis, pneumonia, and septic arthritis in immunosuppressed or immunocompetent hosts. In addition, strains identified asBACKGROUND: Micrococcus species may cause intracranial abscesses, meningitis, pneumonia, and septic arthritis in immunosuppressed or immunocompetent hosts. In addition, strains identified as Micrococcus spp. have been reported recently in infections associated with indwelling intravenous lines, continuous ambulatory peritoneal dialysis fluids, ventricular shunts and prosthetic valves. CASE PRESENTATION: We report on the first case of a catheter-related bacteremia caused by Kocuria rosea, a gram-positive microorganism belonging to the family Micrococcaceae, in a 39-year-old man undergoing peripheral blood stem cell transplantation due to relapsed Hodgkin disease. This uncommon pathogen may cause opportunistic infections in immunocompromised patients. CONCLUSIONS: This report presents a case of Kocuria rosea catheter related bacteremia after stem cell transplantation successfully treated with vancomycin and by catheter removal.

• Investigation of anti-Toxoplasma gondii antibodies in patients with neoplasia.

  Authors: Süleyman Yazar, Ozan Yaman, Bülent Eser, Fevzi Altuntas, Fatih Kurnaz, Izzet Sahin

  Journal of medical microbiology. 01/2005; 53(Pt 12):1183-6.

  This study aimed to determine the prevalence of anti-Toxoplasma gondii antibodies in patients with neoplasia. One hundred and eight patients with neoplasia and 108 healthy controls were studied forThis study aimed to determine the prevalence of anti-Toxoplasma gondii antibodies in patients with neoplasia. One hundred and eight patients with neoplasia and 108 healthy controls were studied for the presence of anti-T. gondii antibodies using a micro ELISA and peroxidase-labelled anti-human IgG (rabbit) and IgM (goat). Anti-T. gondii IgG antibodies were detected in 68 (63.0 %) patients and in 21 (19.4 %) of the controls, which was a statistically significant difference. In addition, anti- T. gondii IgM antibodies were detected in seven (6.5 %) patients and in one (0.9 %) control. A high percentage of positivity for Toxoplasma antibodies in patients with neoplasia was detected. Therefore, parasitological surveys of this patient group should be periodically performed.

• The effect of plasmapheresis on plasma cholinesterase levels in a patient with organophosphate poisoning.

  Authors: Muhammet Güven, Murat Sungur, Bülent Eser

  Human & experimental toxicology. 08/2004; 23(7):365-8.

  OBJECTIVE: To describe the role of plasmapheresis in management of organophosphate poisonings. DESIGN: Case report. SETTING: A medical intensive care unit of a medical faculty. PATIENT: A patientOBJECTIVE: To describe the role of plasmapheresis in management of organophosphate poisonings. DESIGN: Case report. SETTING: A medical intensive care unit of a medical faculty. PATIENT: A patient with organophosphate poisoning whose cholinesterase levels continuously decline and then increase up to a normal level after plasmapheresis is performed for his sepsis. INTERVENTIONS: Plasmapheresis with fresh frozen plasma. MEASUREMENTS AND MAIN RESULTS: Baseline plasma cholinesterase (ChE) level was 4001 IU/L (normal values: 4000-10000 IU/L). Aspiration pneumonia was developed on day 3, and sepsis occurred on day 5. During this period, ChE levels gradually decreased. On day 5, plasmapheresis was performed for sepsis. Interestingly, plasma ChE levels increased from 2101 IU/L to 6144 IU/L after plasmapheresis. Atropine and pralidoxime were stopped, and a high level of ChE continued during hospitalization. The patient was successfully weaned from mechanical ventilation 3 days after plasmapheresis. CONCLUSION: Plasma exchange therapy may be considered for patients with organophosphate poisoning unresponsive to atropine and pralidoxime.

• The effects of fresh frozen plasma on cholinesterase levels and outcomes in patients with organophosphate poisoning.

  Authors: Muhammet Güven, Murat Sungur, Bülent Eser, Ismail Sari, Fevzi Altuntaş

  Journal of toxicology. Clinical toxicology. 02/2004; 42(5):617-23.

  OBJECTIVE: The aim of this study is to determine the effects of fresh frozen plasma, as a source of cholinesterase, on butyrylcholinesterase (BuChE; plasma or pseudo cholinesterase) levels andOBJECTIVE: The aim of this study is to determine the effects of fresh frozen plasma, as a source of cholinesterase, on butyrylcholinesterase (BuChE; plasma or pseudo cholinesterase) levels and outcomes in patients with organophosphate poisoning. MATERIALS AND METHODS: This prospective study was performed at the Department of Intensive Care of Erciyes University Medical School. Over 2 yrs, patients admitted to the ICU for OP poisoning were entered into the study. OP poisoning was diagnosed on the basis of history and BuChE levels. All patients received atropine. Fresh frozen plasma was given to 12 patients. The study was approved by the Ethical Committee, and verbal informed consent was obtained. RESULTS: Thirty-three patients were included in the study. BuChE levels measured at admission and the pralidoxime and atropine doses administered were not different between groups (p>0.05). Although intermediate syndrome developed in 28.6% of patients receiving pralidoxime, there were no intermediate syndrome cases in patients receiving plasma prior to developing intermediate syndrome. The mortality rates were 14.3% in the pralidoxime group and 0% in the plasma+atropine+pralidoxime group. Two patients received plasma after developing the intermediate syndrome, and one patient who received only atropine died. BuChE levels of fresh frozen plasma were 4069.5 +/- 565.1 IU/L. Every two bags of plasma provided an increase in BuChE levels of approximately 461.7 +/- 142.1 IU/L. CONCLUSION: Fresh frozen plasma therapy increases BuChE levels in patients with organophosphate poisonings. The administration of plasma may also prevent the development of intermediate syndrome and related mortality. Plasma (fresh frozen or freshly prepared) therapy may be used as an alternative or adjunctive treatment method in patients with organophosphate pesticide poisoning, especially in cases not given pralidoxime. Further randomized controlled and animal studies are required to infer a definitive result.

• A case of pulmonary Microsporidiasis in an acute myeloblastic leukemia (AML) - M3 patient.

  Authors: Süleyman Yazar, Bülent Eser, Saban Yalçin, Izzet Sahin, A Nedret Koç

  Yonsei medical journal. 03/2003; 44(1):146-9.

  Reported here is a case of microsporidiasis that occurred in an acute myeloblastic leukemia (AML)-M3 patient who underwent chemotherapy. Fever, cough, expectorate and dyspnea were observed during theReported here is a case of microsporidiasis that occurred in an acute myeloblastic leukemia (AML)-M3 patient who underwent chemotherapy. Fever, cough, expectorate and dyspnea were observed during the therapy. Since this case was considered as adult respiratory distress syndrome due to the chest X-ray and arterial blood gas findings, the male patient was bounded to a mechanical ventilator. As coagulation tests showed compatible findings with disseminate intravascular coagulation (DIC), it was thought to be a case of sepsis originating from the lungs and DIC. Pseudomonas aeruginosa and Staphylococcus aureus were found in the sputum of the patient. Although he was given combined antibiotic therapy, there was no reduction in the fever. A bronchoalveolar lavage (BAL) sample was taken and Microsporidia sp. was found upon staining with Giemsa. The patient died due to sepsis and DIC just before receiving therapy for microsporidiasis. Pulmonary infection with Microsporidia, although classically occurring in patients with HIV infection, may occur rarely in leukemia patients, especially if previously treated with systemic immune suppression. This case reinforces the need to consider Microsporidia as a possible pathogen in immunocompromised patients with pulmonary infections.