[Show abstract][Hide abstract] ABSTRACT: Six months after new legislation in Turkey banning smoking in all public places, a national survey was carried out to assess its implementation. This paper summarizes the main findings on the public's awareness of and support for the new law. In a household interview survey of 32 972 adults representative of the Turkish adult population, a high proportion of both non-smokers and current smokers (91.4% and 67.2% respectively) strongly supported the new law. Knowledge about the health hazards of passive smoking and support for the law, however, were relatively lower among smokers than non-smokers. After controlling for smoking status, people with better knowledge about passive smoking were over 5 times more likely to support the new law. Tobacco control activities should be tailored to local needs, with afocus on increasing awareness about the health hazards of passive smoking. The study also demonstrated application of the lot quality sampling technique (LQT) for monitoring tobacco control activities in a national survey.
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ 02/2013; 19(2):141-50.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine whether vancomycin resistant Staphylococcus aureus (VRSA) and vancomycin intermediate susceptible S.aureus (VISA) strains were present among methicillin-resistant S.aureus (MRSA) strains isolated from patients hospitalised at intensive care units (ICU) of hospitals located at different regions of Turkey and to determine the minimum inhibitory concentration (MIC) values of teicoplanin, linezolid, tigecycline, quinupristin-dalfopristin and daptomycin, which are alternative drugs for the treatment of MRSA infections. A total of 260 MRSA clinical strains (isolated from 113 lower respiratory tract, 90 blood, 24 wound, 17 catheter, 13 nasal swabs, two urine and one CSF sample) were collected from nine health-care centers in eight provinces [Ankara (n= 52), Konya (n= 49), Antalya (n= 40), Istanbul (n= 7), Izmir (37), Diyarbakir (n= 15), Van (n= 12), Trabzon (n= 48)] selected as representatives of the seven different geographical regions of Turkey. Methicillin resistance was determined by cefoxitin disk diffusion in the hospitals where the strains were isolated and confirmed by oxacillin salt agar screening at the Refik Saydam National Public Health Agency. Screening for VISA and VRSA was conducted using the agar screening test and E-test. Susceptibility of the MRSA strains to other antibiotics was also determined by E-test method. None of the 260 MRSA strains were determined to be VRSA or VISA. All were susceptible to teicoplanin and linezolid, and susceptibility rates to daptomycin, tigecycline and quinupristin-dalfopristin were 99.6%, 96.9%, and 95%, respectively. Absence of VISA and VRSA among the MRSA strains surveyed currently seemed hopeful, however, continuous surveillance is necessary. In order to prevent the development of VISA and VRSA strains the use of linezolid, tigecycline, quinupristin-dalfopristin and daptomycin should be encouraged as alternative agents of treatment of MRSA infections.
[Show abstract][Hide abstract] ABSTRACT: Objective: The aim of this study was to determine the frequency of metallobeta-lactamase (MBL) enzyme in Pseudomonas aeruginosa strains resistant to carbapenem (imipenem or/and meropenem) in seven regions of Turkey and to assess the minimal inhibitory concentration (MIC) levels of drugs used in treatment such as colistin, aztreonam, polymyxin B and rifampin. Overall 186 Pseudomonas aeruginosa (P.aeruginosa) strains resistant to carbapenem from 8 provinces (Ankara, Konya, Antalya, Istanbul, izmir, Diyarbakir, Van and Trabzon) representing 7 different geographical regions of Turkey were included in the study. Material and Methods: The presence of MBL in P.aeruginosa strains resistant to carbapenem was investigated by combined disk methods with imipenem and EDTA absorbed imipenem disk. The MBL positivity was determined in the strains. Additionally, susceptibility to aztreonam, colistin, polymyxin B, and rifampin was established by the E-test method. Results: MBL enzyme positivity was detected in 58 out of 186 strains (31.2%). There was statistically significant difference between regions in terms of MBL positivity, with the highest rates in Antalya (52%), and Istanbul (50%) and the lowest in Diyarbakir (6%). Aztreonam sensitivity was detected in 134 (72%) strains; 155 (83.3%) were sensitive to colistin and 148 (79.6%) to polymixine. No strain (0%) was sensitive to rifampin. Conclusion: In conclusion, the overall mean rate of MBL positivity was 31.2%, which is quite high. Therefore, it will be beneficial to confirm the MBL positivity of strains with molecular methods, to review regional antibiotic surveillance data at certain intervals and to share the obtained data with relevant institutions in order to prevent the regional spread of these strains. Thus, it is essential to record and monitor systematically the antibiotic surveillance data.
Turkiye Klinikleri Journal of Medical Sciences 06/2012; 32(3):687-693. DOI:10.5336/medsci.2011-24972 · 0.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were; to investigate the hand hygiene compliance of the health care workers (HCWs) during their routine patient care, to determine the methicillin-resistant Staphylococcus aureus (MRSA) hand colonization of the HCWs, to investigate the effect of different hand hygiene products on MRSA colonization and to evaluate the effectiveness of chromogenic agar for detecting MRSA. HCWs were investigated during their routine patient care and hand cultures were taken before and after hand wash/hygiene. Two different techniques were used to obtain the hand cultures: fingertip method (CHROMagar MRSA containing HygiSlide); and direct swab method and then inoculation to CHROMagar MRSA media. MRSA strains grown on those cultures were confirmed with conventional methods. A total of 100 HCWs (of them 61 were female; mean age: 32.7 ± 5.2 years; age range: 25-51 years) involving physicians (n= 33), nurses (n= 38) and health care assistants (n= 29), were included in the study. MRSA was detected in 39% and 11% before hand hygiene and in 13% and 6% after hand hygiene, with HygiSlide CHROMagar media and with CHROMagar in plate media, respectively. No difference were found regarding clinics, occupations, or the type of patient handling in those HCWs who were positive (n= 13) for MRSA colonization following hand hygiene, and those who were negative (n= 26). However, the type of the hand hygiene product used exhibited a statistical difference. None of the seven HCWs who used alcohol based hand rub revealed growth in the second culture while 10 of 19 (53%) HCWs who used soap and three of 13 (23%) HCWs who used chlorhexidine were still colonized with MRSA. In terms of reduction in the MRSA counts, the most effective one was the alcohol based hand rub while the soap was the least, since seven of 19 (37%) HCWs who used soap showed no reduction at all in the MRSA counts. A high ratio of hand colonization with MRSA was detected in our hospital staff (39%). It was shown that the colonization could be reduced significantly (with a rate of 66%) with hand hygiene. Alcohol based hand rub was found to be the most effective method in hand hygiene. The fingertip technique was found to be superior to inoculation to plate media for obtaining hand cultures and CHROMagar MRSA media was found to be rapid, effective and practical for detecting the MRSA hand colonization.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the minimal inhibitory concentration (MIC) values of vancomycin, teicoplanin, tigecycline and linezolid in 100 methicillin-resistant staphylococci [21 methicillin-resistant Staphylococcus aureus (MRSA) and 79 methicillin-resistant coagulase negative staphylococcus (MR-CNS)] isolated as agents of nosocomial infection from patients at Ankara Training and Research Hospital between June 2005-March 2007. The MIC values for vancomycin, teicoplanin, linezolid and tigecycline were tested by E-test method (AB Biodisk, Sweden). For 21 MRSA strains MIC50 and MIC90 values were as follows: vancomycin 0.125 µg/ml and 1 µg/ml; teicoplanin 0.5 µg/ml and 3 µg/ml, linezolid 0.047 µg/ml and 0.19 µg/ml; tigecycline 0.094 µg/ml and 0.5 µg/ml, respectively. For 79 MR-CNS strains MIC50 and MIC90 values were as follows: vancomycin 0.5 µg/ml and 2 µg/ml; teicoplanin 2 µg/ml and 4 µg/ml; linezolid 0.125 µg/ml and 0.25 µg/ml; tigecycline 0.38 µg/ml and 0.5 µg/ml, respectively. No resistance to vancomycin, teicoplanin, tigecycline and linezolid were determined in methicillin-resistant staphylococcus strains isolated from the inpatients in our hospital. Among glycopeptides, MIC50 and MIC90 values of vancomycin were found to be lower than that of teicoplanin.
[Show abstract][Hide abstract] ABSTRACT: Objective: We aimed to retrospectively evaluate our cases followed up in department of Infectious Diseases, Medical Faculty of Yuzuncu Yil University with the diagnosis of bacterial meningitis between January 1995 and August 2008 in view of their clinical and laboratory findings. Material and Methods: Demographic features, history, physical examination and laboratory findings were achieved by screening the files. The diagnosis of bacterial meningitis in cases clinically consistent with suspected meningitis was done by microbiological, biochemical and serological tests performed on cerebrospinal fluid (CSF) samples, by radiological examinations of central nervous system (CNS) and the answers of the patients to antibacterial treatment. Results: Of 204 patients, 96 were females and 108 were males with an average age of 30.8 +/- 13.9 years. Thirty three percent of cases had acute bacterial meningitis (ABM), 44% had tuberculous meningitis (TM) and 23% brucella meningitis (BrM). Headache was the most frequent symptom in all cases with 80%, being 89.5% in ABM cases, 71% in TM cases and 74.5% in BrM cases. In CSF cultures of the patients with ABM, S. pneumonia was isolated in 13.4% of the cases, N.meningitides in 7.5% and S.aures in 3%. In patients with TM, acid-fast bacilli was seen in 20% of the cases. B. melitensis was grown from CSF in 10.6% of the patients with BrM and from blood in 17.2% of the patients. Mortality rate was 13.4% in ABM cases, 14.4% in TM cases and 2.1% in BrM cases. Conclusion: TM seems to be more frequent in our region when compared to other causes of bacterial meningitis and its high morbidity and mortality rates attract the attention. Clinical and laboratory findings of BrM are vaguer than other forms of bacterial meningitis.
Turkiye Klinikleri Journal of Medical Sciences 10/2010; 30(5):1675-1682. DOI:10.5336/medsci.2008-10238 · 0.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Depressive symptoms and myalgia are commonly seen in patients with chronic hepatitis B and chronic hepatitis C.
To investigate the efficacy of acupuncture treatment on depressive symptoms and myalgia in patients with hepatitis.
Of 44 patients with hepatitis screened for depression and myalgia, 28 were enrolled and included in the study. The main outcome measure for depressive symptoms was Beck's Depression Inventory (BDI). For pain/myalgia, patients rated their pain on a scale from 0 to 10. Patients with a score greater than the cut-off point in either score were allocated to acupuncture treatment. The Chinese method of acupuncture was used. Treatment continued for 6 weeks.
At baseline, 17/44 patients (39%) had a BDI score ≥17 and 24 (55%) had a pain score ≥5. A total of 28 patients were allocated to acupuncture treatment, forming three groups: group 1, 13 patients with high BDI and high myalgia scores; group 2, 11 patients with low BDI score but high myalgia score; group 3, 4 patients with high BDI score but low myalgia score. Adherence to treatment was good; all patients completed the sessions and there were no drop-outs. Significant improvements in end-treatment BDI and in myalgia scores compared with baseline levels was found.
Acupuncture seems to be a promising treatment for patients with hepatitis. Further studies are warranted in large populations to establish the therapeutic role of acupuncture.
Acupuncture in Medicine 09/2010; 28(3):136-9. DOI:10.1136/aim.2009.002170 · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was aimed to determine the rates of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) carriage in a neonatal intensive care unit in a Training and Research Hospital in Ankara, Turkey. A total of 135 newborns were included in the study. Following 5 days stay in intensive care unit, samples were taken from nose and umbilicus for the detection of MRSA and cultivated in mannitol-salt agar and oxacillin-resistance screening agar (ORSAB), respectively. The samples taken from rectum to screen VRE, were placed onto Enterococcosel agar which contained vancomycin and ceftazidime. The confirmation of methicillin resistance in MRSA suspected isolates was performed by oxacillin and cefoxitin disk diffusion tests according to Clinical Laboratory Standards Institute (CLSI) guidelines. Twenty eight (20.7%) of 135 newborns had nasal MRSA carriage, 30 (22.2%) of 135 had umbilical and 10 (7.4%) had both nasal and umbilical MRSA carriage. No rectal VRE carriage was found among the newborns. As a result, we suggest that periodical MRSA and VRE carriage investigation in the patients hospitalized in neonatal intensive care units is of outmost help to control and prevent nosocomial infections.
[Show abstract][Hide abstract] ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) strains which are the most frequent causes of hospital acquired infections, are also currently encountered with increasing frequency in community acquired infections. Therefore rapid and accurate identification of MRSA strains is essential in both implementation of infection control measures and prevention of the nosocomial spread of this microorganism. The aim of this study was to determine the specifisity, sensitivity, positive and negative predictive values of two commercial media, one was Oxacillin Resistance Screening Agar Base (ORSAB; Oxoid, England) and the other was chromogenic MRSA agar (BBL CHROMagar MRSA; BD, Paris, France), for the identification of MRSA strains. A total of 175 clinical S. aureus isolates, of which 45 were MRSA, and 130 were methicillin-susceptible S. aureus (MSSA), whose susceptibility to methicillin were determined by disk diffusion method using oxacillin and cefoxitin disks in Mueller-Hinton agar medium, were included in the study. When oxacillin disk diffusion test was accepted as the reference method, the specificity, sensitivity, positive and negative predictive values of ORSAB were found as 97.7%, 40%, 36.5% and 98.1%, respectively; while these values were detected as 95.5%, 37.6%, 35.7% and 96.1% for CHROMagar MRSA, respectively. These results indicated that both media may be used in laboratories where work load is high and the number of personnel is inadequate especially in screening studies together or in addition to another medium (mannitol-salt agar). However, since these methods exhibit low specifity (high false positive results), positive results should be confirmed using other methods such as disk diffusion, E-test or microdilution susceptibility testing.
[Show abstract][Hide abstract] ABSTRACT: Aim: The resistant organisms from patients and healthcare workers (HCWs) first colonized the gastrointestinal tract before causing infections in patients. In this study, presence of risk factors for vancomycin-resistant enterococci (VRE) colonization and the prevalence of rectal carriage of VRE among HCWs and hospitalized patients in the absence of an outbreak were investigated. Design: Cross-sectional study. Setting: A 600-bed training and research hospital. Materials and methods: A total of 508 intensive-care unit (ICU) patients and HCWs in these units were included. Risk factors such as previous antibiotic use, especially vancomycin and cephalosporin, the presence of invasive devices like catheters, and co-morbid diseases were investigated. Rectal smear cultures were obtained from each participant to detect VRE colonization. Results: Risk factors for VRE colonization were identified among both patients and HCWs with a significant ratio. Except for one patient, who had been transferred from another hospital, no VRE colonization was detected in patients or HCWs. Conclusion: The result was attributed to factors such as low inter-institutional transfer, HCWs' being free of VRE colonization (transmission is less likely), strict infection control strategy of the hospital, isolation of newly transferred patients suspected of having VRE colonization, isolation of VRE colonization identified patients, use of indwelling catheters only when indicated and their early removal, and low prevalence of predisposing co-morbid diseases and malignity. We want to underline that a strict hospital infection control program can prevent colonization, even in the presence of risk factors. Risk faktörlerinin bulunmasına rağmen vankomisin dirençli enterokokun (VRE) bulunmaması: bir VRE rektal taşıyıcılık surveyansı Amaç: Dirençli mikororganizmalar, hastalığa sebep olmadan önce, hastaların ve sağlık çalışanlarının ilk olarak gastrointestinal sisteminde kolonize olurlar. Bu çalışmada hastanede yatan hastalarda ve sağlık çalışanlarında vankomisine dirençli enterokok (VRE) kolonizasyonu ve taşıyıcılık için risk faktörlerinin bulunup bulunmadığının araştırılması amaçlanmıştır. Yöntem ve gereç: Çalışma 600 yataklı bir eğitim ve araştırma hastanesinde yapıldı. Özellikle yoğun bakımda yatan hastalar olmak üzere 508 yataklı hasta ve sağlık çalışanı çalışmaya dahil edildi. Antibiyotik kullanım geçmişi, katater varlığı, eşlik eden hastalık varlığı gibi risk faktörleri sorgulandı. VRE kolonizasyonu araştırılmak üzere rektal sürüntü kültürleri alındı. Bulgular: Hem hasta grubunda hem de sağlık çalışanlarında VRE kolonizasyonu için daha önceki çalışmalarda belirtilmiş olan risk faktörleri yüksek oranda saptandı. VRE kolonizasyonu başka bir hastaneden transfer edilen bir hasta hariç saptanmadı.
[Show abstract][Hide abstract] ABSTRACT: Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features.
A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications.
Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7+/-16.34 years and 69.6% of cases were aged 13-44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test+Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement.
In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 11/2009; 14(6):e469-78. DOI:10.1016/j.ijid.2009.06.031 · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease presenting with flu-like symptoms, fever, hemorrhage and petechia. The virus (CCHFV) is a member of the Nairovirus genera of Bunyaviridae family and can be transmitted to humans by Hyalomma tick-bite, by exposure to infected blood and fomites of patient with CCHF or contact with animal tissue in viremic phase. In this study we present two cases with CCHF but without history of tick bite or exposure to infected fomites, even not coming from endemic areas. The first case was a 67 years old male patient presented with fever, fatique and shortness of breath. Physical examination revealed rales in right lower segments of lung. Laboratory findings showed elevation of liver enzymes with thrombocytopenia and prolonged prothrombin time. Serological markers for viral hepatitis, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) were negative. The patient was found to be IgM and RNA positive for CCHFV by ELISA and polymerase chain reaction (PCR) methods, respectively. His history indicated a contact with livestock. The second patient was a 60 years old male dealing with husbandry. He had fever, fatique and myalgia. Physical examination revealed petechial rash on legs. Laboratory findings showed elevated liver enzymes, prolonged phrothrombin time and thrombocytopenia. Viral hepatitis markers, CMV-IgM and EBV-IgM were found negative. He was also found to be IgM and RNA positive for CCHFV in the reference laboratory. In conclusion, CCHF should be considered in the differential diagnosis of patients who contact with livestock and present with fever, fatigue, rash, elevated liver enzymes, thrombocytopenia and prolonged prothrombin time eventhough they do not reside in endemic areas for CCHF.
[Show abstract][Hide abstract] ABSTRACT: This study was aimed to investigate the prognostic value of tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), leptin and C-reactive protein (CRP) levels in newborn sepsis. A total of 57 newborns with nosocomial sepsis and 30 healthy newborns were included to the study. Serum TNF-alpha, IL-10, leptin (Biosource, Belgium) and CRP (Dade Behring, Germany) levels were investigated by ELISA methodology before the initiation of the therapy (day 0) and on the third and fifth days of therapy. Initial leptin levels were found to be high in the control group (p = 0.00) and CRP levels were found to be high in the patient group (p = 0.00). No significant difference was detected for IL-10 and TNF-alpha levels (p > 0.05). CRP levels were significantly higher in the patient group than the controls on the third day of the therapy (p = 0.001), however, no significant difference was detected for the other parameters (p > 0.05). On the fifth day of the therapy CRP (p = 0.023) and leptin (p = 0.00) levels were significantly high in the patient group and TNF-alpha in the control group (p = 0.00) while no significant difference was observed for IL-10 levels (p > 0.05). Mortality rate was 24.5%. When the mean TNF-alpha, IL-10, leptin and CRP levels on the 0th, 3rd and 5th days were analysed for alive (n = 43) and dead (n = 14) newborns with sepsis, it was observed that TNF-alpha, IL-10 and CRP levels were related with poor prognosis (p < 0.05). The ROC analysis performed for the determination of the prognostic performance of TNF-alpha and IL-10 revealed that these parameters had predictive value about mortality when their levels were above certain cut-off values (on the 5th day of therapy for IL-10 > 1.8 ng/ml and for TNF-alpha > 21.1 ng/ml). It can be concluded that besides routine laboratory parameters, serum TNF-alpha and IL-10 levels at the initiation of therapy and afterwards may help to predict prognosis and guide treatment in newborns with sepsis.
[Show abstract][Hide abstract] ABSTRACT: Micrococcus strains which are the normal flora members of skin, mucosa and oropharynx, may lead to infections associated with intravenous catheter, chronic ambulatory peritoneal dialysis, venticular shunt and prosthetic valve. In this paper, a case of peritonitis due to Kocuria rosea of Micrococcea family, in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD), was presented. Fiftysix years old female patient was admitted to the hospital by complaints of abdominal pain, nausea and fever. The patient was undergoing CAPD due to chronic renal failure for one and a half year and turbidity was detected in the peritoneal fluid during dialysis. Examination of the peritoneal fluid revealed 1800 cells/mm3, with no evidence of bacteria in Gram and Ziehl-Neelsen stained smears. No bacterial growth was detected in conventional culture media, however, bacteria was isolated from the peritoneal fluid culture on second day by Bactec (Becton Dickinson, USA) automated blood culture system. By means of API identification system (bioMerieux, USA), the causative agent was identified as Kocuria rosea. The patient was successfully treated with intraperitoneal teicoplanin (4 x 40 mg) for 14 days. In conclusion, in patients undergoing CAPD, rare pathogens should be considered in case of peritonitis and peritoneal fluid samples should be inoculated into automated culture systems.
[Show abstract][Hide abstract] ABSTRACT: Crimean-Congo hemorrhagic fever (CCHF) is a serious disease caused by the CCHF virus of the Bunyaviridae family. The disease has been reported in 30 countries in Africa, Asia, Eastern Europe, and the Middle East. It has been present in Turkey since 2002. In this study we present and discuss the epidemiological features, clinical and laboratory findings, treatment, and outcome of cases diagnosed with CCHF between 2002 and 2007 from the surveillance results of the Turkish Ministry of Health (MoH).
According to the surveillance system of the MoH, data for patients with clinical, laboratory, and epidemiological findings compatible with CCHF are recorded on case reporting forms. These forms are submitted to the General Directorate of Primary Health Care of the MoH by the city health directorates. All the surveillance data regarding CCHF were recorded on a database (SSPS 11.0) established in the Communicable Diseases Department of the MoH.
According to the surveillance reports of the Turkish MoH, between 2002 and 2007, 1820 CCHF cases occurred (150 in 2002-2003, 249 in 2004, 266 in 2005, 438 in 2006, and 717 in 2007). The crude fatality rate was calculated to be 5% (92/1820). Two thirds of the CCHF cases were reported from five cities located in the Mid-Eastern Anatolia region; 69.4% of the cases were from rural areas. The male to female ratio was 1.13:1. Of all the reported cases, 68.9% had a history of tick-bite or tick contact and 84.1% were seen in the months of May, June, and July. Of 1820 CCHF cases, three (0.16%) were nosocomial infections.
CCHF appears to be a seasonal problem in the Mid-Eastern Anatolia region of Turkey. The possible risk factors for transmission and the clinical and laboratory findings of patients with a diagnosis of CCHF were found to be similar to those reported in the literature. The mean fatality rate for Turkey is lower than the rate reported for other series from other parts of the world.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 12/2008; 13(3):380-6. DOI:10.1016/j.ijid.2008.07.021 · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Turkey is located at an endemic area for brusellosis and tuberculosis which are both important public health problems. Meningitis caused by Brucella and Mycobacterium spp. may be confused since the clinical and laboratory findings are similar. In this report, a meningitis case with Brucella and tuberculosis co-infection has been presented. A 19-years-old woman was admitted to our clinic with severe headache, fever, vomiting, meningeal irritation symptoms, confusion and diplopia. The patient was initially diagnosed as Brucella meningitis based on her history (stockbreeding, consuming raw milk products, clinical symptoms concordant to brucellosis lasting for 4-5 months), physical examination and laboratory findings of cerebrospinal fluid (CSF). Standard tube agglutination test for brucellosis was positive at 1/80 titer in CSF and at 1/640 titer in serum, whereas no growth of Brucella spp. was detected in CSF and blood cultures. Antibiotic therapy with ceftriaxone, rifampicin and doxycyclin was started, however, there was no clinical improvement and agitation and confusion of the patient continued by the end of second day of treatment. Repeated CSF examination yielded acid-fast bacteria. The patient was then diagnosed as meningitis with double etiology and the therapy was changed to ceftriaxone, streptomycin, morphozinamide, rifampicin and isoniazid for thirty days. Tuberculosis meningitis was confirmed with the growth of Mycobacterium tuberculosis on the 14th day of cultivation (BACTEC, Becton Dickinson, USA) of the CSF sample. On the 30th day of treatment she was discharged on anti-tuberculous treatment with isoniazid and rifampicin for 12 months. The follow-up of the patient on the first and third months of treatment revealed clinical and laboratory improvement. Since this was a rare case of Brucella and tuberculosis co-infection, this report emphasizes that such co-infections should be kept in mind especially in the endemic areas for tuberculosis and brucellosis.
[Show abstract][Hide abstract] ABSTRACT: The World Health Organization (WHO) reports that pertussis remains one of the least well-controlled vaccine-preventable diseases. It is supposed that the incidence of reported pertussis among adolescents, adults, and young infants has increased over the past decade. The aim of this study is to evaluate recent epidemiological data on pertussis in Turkey by regions. Data on vaccination coverage and pertussis incidence between 1986 and 2005 obtained from the Expanded Programme on Immunization national surveillance database of the Ministry of Health of Turkey were analyzed. Age and geographical distribution of the reported cases between 2000 and 2005 were evaluated. It was found that third-dose vaccination coverage increased from 1986 (45%) to 2005 (90%). In 2005, pertussis incidence tended to decrease (0.38 per 100,000) compared to 1986 (2.03 per 100,000). Even though only up to 6.5% of the cases were > or =15 years of age until 2005, 16.9% of them were included in this age group in 2005. It was observed that vaccination coverage rates steadily increased and pertussis incidence decreased by years despite some regional differences. In Turkey, pertussis incidence appears to be reaching the WHO targets, except East Anatolia. It is possible that waning immunity is responsible for the change of the age distribution of pertussis cases. However, priority should be given to strengthening available vaccination efforts throughout the country. A booster dose of pertussis vaccine in adolescence might be required in the future.
European Journal of Clinical Microbiology 05/2008; 27(5):335-41. DOI:10.1007/s10096-007-0442-x · 2.67 Impact Factor