[Show abstract][Hide abstract] ABSTRACT: Introduction
HIV-TR is a recently established (2012) multicentre cohort in Turkey. The aim of this study is to analyze epidemiological, immunologic and virologic data of recently diagnosed HIV patients.
Materials and Methods
Epidemiologic, clinical and laboratory data of all patients diagnosed in 2011 and 2012 were recorded by a web-based data collection system, retrospectively.
A total of 693 patients (561 male, 132 female) at 24 sites were enrolled. The median age at first presentation for HIV care was 36. The proportion of patients presenting with advanced HIV disease (CD4 count<200/mm3 or presenting with an AIDS-defining event) was 30.6%; and 52.4% of patients were late presenters (CD4 count<350/mm3 or presenting with an AIDS-defining event). Median CD4 counts at presentation and before treatment were 344 (IQR: 175–540) and 295 (IQR: 150–430), respectively. Pretreatment CD4 count was >500 copies/mL in 18.5% of patients. Of 531 patients receiving ART, initial combinations consist of tenofovir/emtricitabine (TDF/FTC) plus efavirenz (EFV) in 48.2% and TDF/FTC plus lopinavir/ritonavir (LPV/r) in 37.5% and other combinations in 14.3% of the patients. Pre-treatment HIV-RNA was over 100.000 copies/mL in 52.3% of patients. At Weeks 24 and 48, HIV-RNA were<50 copies/mL in 63,4% of 385 patients and 82% of 311 patients reported to be still on ART and had a viral load measurement, respectively. Median pretreatment CD4 count was lower for TDF/FTC+LPV/r recipients than TDF/FTC+EFV recipients (250 vs 316) (p<0.05). The median increase from baseline CD4 cell count was 230 in TDF/FTC+LPV/r group, 193 in TDF/FTC+EFV group and 216 among all treated patients. Of 531 patients receiving ART, 11 had died and 19 were lost to follow-up.
Despite 52.4% of recently diagnosed patients were late presenters; a high rate of virologic suppression was achieved in HIV-TR Cohort. A national HIV testing strategy targeting subpopulations with higher risk is urgently needed.
Full-text · Article · Nov 2014 · Journal of the International AIDS Society
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Routes of transmission and reasons for HIV testing are important epidemiologic data to analyze the epidemic and to tailor the response to AIDS. The aim of this study was to analyze reasons for testing and transmission ways of HIV among recently diagnosed HIV patients registered in the multicenter HIV-TR cohort in Turkey.
Transmission ways and reasons for testing of all patients diagnosed in 2011 and 2012 were recorded on a web-based data collection system and were analyzed retrospectively.
The study included 693 patients (561 male, 132 female) from 24 sites. Reason for HIV testing was available in 640 patients (92%). The most common reason for HIV testing was diagnostic workout for other conditions or illness followed by patient-initiated testing. The reasons for testing were listed in Table 1. The most common routes of HIV transmission were heterosexual intercourse (62.7%) and sex among men who have sex with men (MSM) (22.6%). At the time of HIV diagnosis, the mean CD4 lymphocyte cell count was 355/mm(3) (3-1433/mm(3)). Primary HIV infection was determined in 42/693 (6%) patients and 9/693 (% 1, 2) cases were considered "probable primary HIV infection." The majority of the cases presented to a clinic for follow-up right after the diagnosis. On the other hand 32/616 (5.2%) patients delayed their presentation for more than 3 months. The longest delay was 11 months.
The results of the database suggest that targeted testing is lacking in the country. The shift toward homosexual transmission during the last 2 years emphasizes the need for targeted interventions. Patients present relatively late and HIV infection could only be diagnosed when immunosuppression related findings appeared. Patient-initiated testing,an indicator of awareness, was very low suggesting a need to scale-up awareness raising interventions.
Full-text · Article · Nov 2014 · Journal of the International AIDS Society
[Show abstract][Hide abstract] ABSTRACT: Oxidative stress is defined as a disturbance of balance between free radicals and antioxidant defense system. This study investigated oxidative stress in patients with chronic hepatitis B.
Sixty nine patients with chronic hepatitis B admitted to the Department of the Infectious Diseases and Clinical Microbiology of Medical Faculty of Ondokuz Mayis University were enrolled into study. Twenty healthy persons were included as a control group. The study group was divided into three groups: healthy controls (group 1), chronic hepatitis B (group 2), and inactive hepatitis B carriers (group 3). Antioxidant status of plasma, including glutathione, glutathione peroxidase, vitamin E, and vitamin C levels were measured. Carbonyl and lipid peroxidation levels were measured as parameters of oxidative stress.
Glutathione, glutathione peroxidase, vitamin E, and vitamin C levels were found to be significantly decreased in the chronic hepatitis B group when compared with the control group (9.5 vs. 13.8, p < 0.05; 22.98 vs. 32.4, p < 0.05; 15.1 vs. 16.4, p < 0.05; 12.9 vs. 18.4, p < 0.05, respectively). Carbonyl and lipid peroxidation levels were significantly increased in the chronic hepatitis B group compared to controls (0.7 vs. 0.5, p < 0.05; 2 vs. 0.7, p < 0.05, respectively). However, whereas the glutathione and carbonyl level correlation with HBV DNA levels were mild to moderate (glutathione vs. HBV DNA, r:-0.288, p < 0.05; carbonyl vs. HBV DNA, r:0.317, p < 0.05), the lipid peroxidation levels were strongly related with HBV DNA levels in chronic hepatitis B (r:0.545, p < 0.05).
Oxidative stress was significantly increased in hepatitis B patients. Consequently, decreases were seen at the level of protective antioxidative parameters in the blood of these patients.
Full-text · Article · Jan 2012 · Clinical laboratory
[Show abstract][Hide abstract] ABSTRACT: Multidrug resistant (MDR) gram positive infectious agents can cause severe infections and monotherapy of these infections by current available antimicrobial agents can be problematic. Therefore, antimicrobial combination therapy may be needed for effective treatment. The study aimed to investigate in vitro effects of binary combinations of tigecycline (TGC), daptomycin (DPC) and teicoplanin (TP) against 4 methicillin resistant Staphylococcus aureus (MRSA), 2 vancomycin intermediate S. aureus (VISA) and 9 vancomycin resistant enterococci (VRE) species by E test method. Whilst, all binary combination of TGC, DPC and TP showed synergistic effect against standard strain of S. aureus and 50% of clinical MRSA isolates, all of the combinations except DPC-TP combination showed additive effect against VISA strains (Mu 3 and Mu 50). TGC-TP, DPC-TP and TGC-DPC combinations showed additive effect against 25, 60 and 50% of clinical VRE isolates, respectively. Synergistic effect was observed in combinations of TGC-TP and DPC-TGC against 2 and 1 VRE clinical isolates, respectively. Combinations of TP with any of TGC and DPC brought MIC values of TP below the level of sensitivity in all of TP resistant VRE and VISA isolates. Antagonistic effect was not observed in combinations of tested drugs against any strains. In conclusion, in vitro effectiveness of these drug combinations may reflect advantages in clinical practice for severe MDR gram positive bacterial infections.
Full-text · Article · Nov 2010 · African journal of microbiology research
[Show abstract][Hide abstract] ABSTRACT: In this study, in vitro activity of tigecycline (TIG) and ertapenem (ERT) against clinical isolates of Brucella melitensis and the effect of different media on in vitro test results were investigated. The in vitro effects of TIG and ERT to 38 B. melitensis isolates were comparatively investigated in brucella agar and 5% sheep blood agar. MIC value of ERT was 0.032 μg/mL in 23 of 38 and 20 of 38 isolates on blood and brucella agar, respectively. Minimum inhibitory concentration values of TIG were substantially different ranging between 0.064-0.25 μg/mL on blood agar. However, MIC values of TIG were similar on brucella agar with 0.25 μg/mL in 15 of 38 isolates and 0.5 μg/mL in 10 of 38 isolates. In conclusion, although ERT and TIG were effective against B. melitensis isolates in vitro, further studies are needed in order to determine the use of these novel drugs in treatment of brucellosis.
No preview · Article · Oct 2010 · Indian journal of medical microbiology
[Show abstract][Hide abstract] ABSTRACT: Neopterin (NT) is a compound of low molecule-based pteridine. It is secreted by macrophages as a response to the stimulation of cytokines such as interferon-gamma, interferon-1beta, tumor necrosis factor alpha or bacteria compounds such as lipopolysaccharides. Procalcitonin (PCT) levels may increase in the course of bacterial, parasitic, and fungal infections. Therefore, it can be used for the differential diagnosis of the infection, especially in cases of serious inflammation. In this study, the role of NT, and PCT in sepsis as a prognostic factor, and the relationship between the two parameters are examined.
From November 1, 2005 through December 31, 2005, fifty patients with sepsis admitted to the Department of the Infectious Diseases and Clinical Microbiology and/or Department of Anaesthesiology and Reanimation were enrolled in the study. Patients were divided in two subgroups according to their survival: group I (n=23) nonsurviving patients and group II (n=27) surviving patients.
Serum NT levels have been found to be increased in group I (median: 15 ng/mL, range: 2-69) when compared to group II (median: 5 ng/mL, range: 2-130). The difference was statistically significant (P=0.03). Other laboratory parameters and PCT levels (group I median: 0.13; group II median: 0.08; P<0.05) were not different between the two groups.
NT was found to be a prognostic factor in patients with sepsis.
Full-text · Article · Mar 2010 · Southern medical journal
[Show abstract][Hide abstract] ABSTRACT: Moraxella catarrhalis is a gram-negative, catalase and oxidase positive diplococcus. While it causes otitis media, sinusitis, bronchitis and conjunctivitis in children and adults, it has a tendency to cause lower respiratory tract infections in older ages. More severe clinical pictures with the range of sepsis to endocarditis are also seen in immunocompromised patients. In this report, a case of M. catarrhalis endocarditis in an immunocompetent host who needed valve replacement has been presented. Forty three years old female patient was admitted to our hospital with the complaints of fever, nausea, night sweating and arthralgia for 20 days. Physical examination revealed systolic murmurs on the apex, and vegetation on the atrial surface of mitral valve was detected by transthoracic echocardiography. Intravenous (IV) ampicillin (4 x 3 g/day) and gentamicin (3 x 80 mg/day) treatment was started empirically with prediagnosis of infective endocarditis. The treatment was modified to IV ceftriaxone (1 x 2 g/day) and gentamicin (3 x 80 mg/day) due to the reporting of gram-negative bacilli in blood culture (BacT/ALERT 3D, bioMérieux, France) on the next day. Gram-negative cocobacilli/diplococci were detected with Gram stain on the smear prepared from the blood culture bottle. Simultaneous subcultures to blood agar and eosin methylene blue agar yielded white colored, S-type, non-hemolytic colonies on only blood agar. Catalase and oxidase tests were positive, while beta-lactamase activity was negative. The isolate was identified as M. catarrhalis by using API NH (bioMérieux, France) identification strips. M. catarrhalis was isolated from five different blood culture specimens of the patient. The focus for bacteremia could not be detected. The patient underwent mitral valve replacement operation as an emergency since the vegetation exhibited rapid growth on the fifth day of medical treatment. Antibacterial therapy was completed for 6 weeks. Control echocardiography revealed that artificial mitral valve was open and functional, thus the patient recovered completely without sequela. In conclusion, M. catarrhalis should be considered as a possible cause of infective endocarditis even in immunocompetent patients.
No preview · Article · Oct 2009 · Mikrobiyoloji bülteni
[Show abstract][Hide abstract] ABSTRACT: Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal viral disease. In this study, the aim was to investigate the prognostic factors affecting the patient's survival and risk factors to fatality. At Ondokuz Mayis University Faculty of Medicine, a tertiary referral centre near the CCHF epidemic region, patients with typical clinical findings and indicative microbiological results for IgM and/or reverse transcriptase-polymerase chain reaction of CCHF virus were enrolled in the study, from 2004 to 2007. Patients were divided into two subgroups according to their survival outcomes; group I (n = 44) survived patients and group II (n = 6) consisted of fatal cases. The median platelet count was significantly lower in the fatal group (11000/mm(3)) when compared to the survived group (49500/mm(3)). Aspartate transferase and alanine transferase (ALT) levels were significantly higher in group II, when compared to group I. Also, the median range of serum lactic dehydrogenase (LDH) and creatinine phosphokinase (CPK) levels were much more elevated, and prothrombin time (PT) and activated partial thromboplastin time (aPTT) were prolonged in fatal cases. There was also a significant difference in median age of these two groups. Advanced age, late admission, low platelet count, increased AST, ALT, CPK and LDH levels, and prolonged PT and aPTT could be an early indicator of poor prognosis in patients with CCHF.
[Show abstract][Hide abstract] ABSTRACT: Crimean Congo haemorrhagic fever (CCHF) has been an emerging tick-borne infection in some parts of Turkey since 2002, with a number of fatalities. Many of the initial non-specific symptoms of CCHF can mimic other common infections. Additionally, the seasonal pattern of the epidemic, and the waning attention of healthcare workers to the yearly index cases caused some delays in appropriate patient care and treatment. Between March 2004 and August 2008, 140 confirmed adult cases were evaluated retrospectively for initial diagnosis and treatment delays. This study clearly demonstrated that there are particular delays (4.8 days) in the referral system to initiate effective antiviral treatment in the tertiary-care centre which significantly affect fatality rates (P>0.05). A large number of patients (n=95, 68%) received an initial misdiagnosis of various infections other than CCHF. In conclusion, continuous medical education regarding CCHF in the epidemic area is essential in order to achieve a better survival rate from this deadly infection.
No preview · Article · Aug 2009 · Epidemiology and Infection
[Show abstract][Hide abstract] ABSTRACT: Because forensic medicine workers have a greater occupational risk for infectious diseases, strict rules and measures against infections must be implemented at every stage of forensic medicine practices. In this study, we aim to evaluate the infection control implementations in forensic medicine practices in Turkey.A questionnaire survey was mailed to forensic medicine specialists and residents between April and June 2005. The questionnaire consisted of 36 questions whose designed was based on standard precautions and protective barriers against infectious risks.In all, 111 doctors from 27 different cities responded to the questionnaire. Of those doctors who responded, 43.2% reported performing external examination anywhere. The percentage of doctors performing external examinations who regularly wore gloves, masks, and gowns, and washed hands with a disinfectant were 81.5%, 24.7%, 30.9%, and 81.5%, respectively. The percentage of doctors performing autopsies who regularly wore masks, protective eye-wear, gloves, special gloves, and special boots were 59.6%, 10.6%, 98.9%, 71.3%, and 36.2%, respectively. Only 2 negative pressure rooms were reported.According to these results, precautionary measures against infectious risks in forensic medicine practice in our country are insufficient. Conditions to facilitate and to improve the compliance with infection control procedures must be prepared.
No preview · Article · Jul 2009 · The American journal of forensic medicine and pathology: official publication of the National Association of Medical Examiners
[Show abstract][Hide abstract] ABSTRACT: Crimean-Congo hemorrhagic fever (CCHF) is a disease with high fatality. To demonstrate the effectiveness of ribavirin against CCHF. The first group of 21 patients received ribavirin within 4 days of the onset of symptoms (early use of ribavirin, EUR); the second group of 20 patients received ribavirin > or =5 days after the onset of the symptoms of the disease (late use of ribavirin, LUR); and the last group of 11 patients did not receive ribavirin (no use of ribavirin, NUR). At 5-10 days from the onset of symptoms the mean platelet counts of the patients in the EUR group were significantly higher than those of the patients in LUR group, and at 7-9 days, they were significantly higher than that of the patients in the NUR group. The mean aspartate transferase levels in the EUR group were significantly lower than of the NUR group on days 8 and 9, and the mean alanine transferase level was significantly lower on day 8 after the onset of the symptoms. There is a beneficial effect of ribavirin if given at an early phase of the CCHF. We suggest ribavirin use especially in the early phase of the disease.
No preview · Article · Mar 2009 · European Journal of Clinical Microbiology
[Show abstract][Hide abstract] ABSTRACT: Pseudomonas stutzeri which is an aerobic, non-fermentative gram-negative bacillus frequently found in soil, water and hospital environment, rarely leads to serious community-acquired infections. In this report a case of community-acquired meningitis due to P. stutzeri was presented. A 73-years-old male patient was admitted to the emergency department with the complaints of nausea, vomiting, headache, dizziness, difficulties in walking and speaking and loss of consciousness. There was no history of an underlying disease or immunosuppression. Physical examination revealed nuchal rigidity, however, Kernig and Brudzinski signs were negative. The cerebrospinal fluid (CSF) analysis revealed 0.4 mg/dl glucose (simultaneous blood glucose 145 mg/dl), and 618 mg/dl protein and 640 leucocyte/mm3 (90% PMNL). No bacteria were detected in Gram stained and Ehrlich-Ziehl-Neelsen stained CSF smears. Upon the diagnosis of acute bacterial meningitis, treatment with ceftriaxone and ampicillin was initiated, however, the patient died after 16 hours of hospitalization. CSF culture yielded the growth of gram-negative oxidase-positive bacteria and the isolate was identified as P. stutzeri by Vitek-2 Compact system (bioMerieux, France). The isolate was found to be sensitive to piperacillin/tazobactam, amikacin, gentamycin, ceftazidime, cefepime, ciprofloxacin, imipenem and meropenem. Since the patient was lost due to acute respiratory and cardiac failure, it was not possible to change the therapy to agent specific therapy. In conclusion, it should always be kept in mind that uncommon agents could lead to community-acquired meningitis in elderly patients and empirical treatment protocols might fail in such cases resulting in high morbidity and mortality.
Full-text · Article · Feb 2009 · Mikrobiyoloji bülteni
[Show abstract][Hide abstract] ABSTRACT: Brucella spp. replicate and survive in lympho-proliferative tissues and cells, thus effective treatment of brucellosis requires the combined and long term use of intracellularly active antibiotics. Elimination of the microorganism largely depends on the reactive oxygen and nitrogen intermediates released by activated macrophages. In this study we aimed to determine the in vitro activity of hydrogen peroxide (H2O2; reactive oxygen intermediate) and acidified sodium nitrite (ASN; reactive nitrogen intermediate) alone and in combination with rifampicin (RIF) and tetracycline (TET) against four clinical isolates of Brucella melitensis. Initially minimal inhibitory concentrations of RIF and TET were determined by microbroth dilution susceptibility test. The activity of 2 and 5 mM H2O2 and 3 and 6 mM ASN was tested against each isolate by direct colony count from the agar plates inoculated with bacterial suspensions treated with H2O2 or ASN. The last step in the assay was to determine the combined effectiveness of RIF and TET plus H2O2 and ASN. From each three rolls of assay apparatus samples were taken at 0., 1., 6. and 24. hours and inoculated on Brucella agar. The plates were incubated at 37 degrees C for 48 hours and colonies were counted. While RIF alone or in combination with H2O2 supressed the growth of bacteria even in the first hour, TET alone did not show any effect in 24 hours. However, in combination with reactive oxygen and nitrogen intermediates TET affected bacterial growth starting from six hours. In conclusion, further explanation of the interactions between antibiotics and the substances produced by the immune system of the host during the infections caused by intracellular pathogens, might have an important impact on the determination of the treatment protocols and the measures to prevent relapses.
No preview · Article · Feb 2009 · Mikrobiyoloji bülteni
[Show abstract][Hide abstract] ABSTRACT: The in vitro antimicrobial activity of Ankaferd Blood Stopper (ABS) was assessed on 102 clinical isolates from both Gram negative and Gram positive bacteria and four standard strains, including MRSA ATCC 43300, MSSA ATCC 25923, P. aeruginosa ATCC 27853 and E. coli ATCC 35218. ABS was significantly active against all bacteria investigated.
[Show abstract][Hide abstract] ABSTRACT: Background: Crimean-Congo hemorrhagic fever (CCHF) is highly fatal tick-borne viral disease in Euroasia and seen endemically in Turkey in the recent years. In this prospective study, the aim is investigating the patient’s survival with early initiation of ribavirin and correlation of platelets count, AST and ALT levels with this early use. Methods: Consecutive patients in the epidemic season in beginning of 2004 to end of 2007 with typical clinical findings and indicative microbiological results for IgM and/or PCR for CCHF virus were enrolled in the study in Ondokuz Mayis University Faculty of Medicine Samsun-Turkey, a tertiary referral center near the CCHF epidemic region. Patients were divided in three subgroups according to initiating time of ribavirin use and; group I (n: 21) ribavirin given ≤4 days within the clinical infection, group III (n: 20) ribavirin given ≥5 days after the clinical symptoms of the disease and group II (n: 11) ribavirin not given. Results: The case fatality rate between the patients who received ribavirin earlier and the patients, who did not receive ribavirin was different, but statistically nonsignificant (p=0.067). Patient’s PLT counts, maximum daily AST and ALT values were statistically investigate for a significance, according to the onset time of symptoms (days) in each groups. PLT counts in early ribavirin group had higher daily level from 5th day to 10th day than the group who had no ribavirin treatment. Conclusions: Similar positive impacts in progression of the disease seen on AST and ALT values in 8th and 9th days in the group I and these results were calculated statistically significant. This study had a very important conclusion stating that early ribavirin use (4 days or less) has a strong positive impact for the survival rates from CCHF with positive indicators on PLT counts and AST, ALT levels
[Show abstract][Hide abstract] ABSTRACT: Here, we describe a 38-year-old male with an abrupt manifestation acute panniculitis as unusual presentation of brucellosis. Brucellosis is a reemerging disease in Turkey, and the disease is primarily transmitted from farm animals to humans. Farmers and shepherds are the major risk groups for brucellosis in Anatolia. Brucellosis may involve almost all systems and organs, including the skin, and may mimic a wide range of illness and syndromes. Although the cutaneous manifestation of brucellosis is not disease specific, but it occurs in about 6%-13% of patients with brucellosis. Some of these lesions including rashes, papules, ulcers, abscess, erythema nodosum, ecchymosed skin rash, purpura, and vasculitis may be seen frequently in brucellosis, but panniculitis is rarely described. The case confirmed by positive blood culture had manifest skin lesion as an initial finding represented by lobular panniculitis with vasculitis.
Full-text · Article · May 2008 · The American Journal of dermatopathology
[Show abstract][Hide abstract] ABSTRACT: Three pediatric and two adult Turkish patients with Crimean Congo Hemorrhagic Fever (CCHF) induced hemophagocytic syndrome (HPS) were admitted to Ondokuz Mayis University Hospital, which is in the Middle Black Sea Region of Turkey. All of them had remarkable hemophagocytosis in the bone marrow with severe bleeding symptoms along with the other known clinical and laboratory findings of CCHF. We would like to present these patients and to discuss the pathophysiology and the effect of acquired HPS on the severity of the disease.
Full-text · Article · Jan 2008 · American Journal of Hematology