Ayper Somer

Istanbul University, İstanbul, Istanbul, Turkey

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Publications (82)157.49 Total impact

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    ABSTRACT: Background We aimed to determine the frequency of vancomycin-resistant enterococci (VRE) infection occurrence in previously VRE-colonized children in a pediatric intensive care unit (PICU) and to identify associated risk factors. Methods Infection control nurses have performed prospective surveillance of health care–associated infections and rectal VRE carriage in PICUs from January 2010-December 2014. This database was reviewed to obtain information about VRE-colonized and subsequently infected patients. A case-control study was performed to identify risk factors associated with VRE infection development in previously VRE-colonized patients. Results Out of 1,134 patients admitted to the PICU, 108 (9.5%) were found to be colonized with VRE throughout the study period. Systemic VRE infections developed in 11 VRE-colonized patients (10.2%), and these included primary bloodstream infection (n = 6), urinary tract infection (n = 3), meningitis and bloodstream infection (n = 1), and meningitis (n = 1). Logistic regression analysis indicated long hospital stay (≥30 days) and glycopeptide use after detection of VRE colonization as risk factors for developing VRE infection in VRE-colonized patients (odds ratio [OR], 5.76; 95% confidence interval [CI], 1.6-15.8; P = .017 and OR, 12.8; 95% CI, 1.9-26.6; P = .012, respectively). Conclusions VRE colonization has important consequences in pediatric critically ill patients. Strict infection control measures should be implemented to prevent VRE colonization and thereby VRE infections. Furthermore, irrational antibiotic use and particularly glycopeptide use in VRE-colonized patients should be restricted.
    No preview · Article · Jan 2016 · American Journal of Infection Control
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    ABSTRACT: Abstract OBJECTIVE: To determine incidence of vancomycin resistan enterococcus (VRE) colonization in our neonatal intensive care unit (NICU) over five-year period, rate of progression to VRE infection and associated risk factors. METHODS: A retrospective analysis of a prospective surveillance for VRE colonization and health care associated infections was made. Contact precautions were taken against colonization, although the application varied over the years due to repairs in the unit. RESULTS: VRE rectal colonization was detected in 200/1671 neonates (12%) admitted to NICU. It showed great interannual variability from 1.9% to 30.3%. Sytemic VRE infection developed in 6/200 VRE colonized patients (3%) within a median of 9 days (range:3-58 days). The risk factors for VRE infection development identified in the univariate analysis were long hospital stay (≥30 days), necrotizing enterocolitis, surgical procedure, extraventricular drainage, receipt of amphotericin B and receipt of glycopeptides after detection of VRE colonization. Crude in-hospital mortality was higher in neonates who developed a systemic VRE infection (p<0.001). CONCLUSION: Maintaining physical conditions in the unit favorable for infection control and rational use of antibiotics are essential in control of VRE colonization and resultant infections. Special attention should be directed to VRE colonized babies carrying the risk factors.
    No preview · Article · Jan 2016 · Journal of Maternal-Fetal and Neonatal Medicine
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    ABSTRACT: Aim: In our study, we aimed to clinically and epidemiologically evaluate respiratory tract infections the viral agents of which were detected by molecular methods and to compare influenza and other respiratory tract viruses in this context. Material and Methods: The records of 178 patients aged above 2 years who presented to pediatric emergency outpatient clinic with fever and respiratory tract infection findings between December 2013 and April 2014 were examined retrospectively. Results: At least one respiratory tract pathogen was detected by polymerase chain reaction in 78.6% (n=140) of the patients: influenza A 33.5%, influenza B 16.4%, respiratory syncytial virus 9.2%, adenovirus 7.8%, rhinovirus 7.1%, coronavirus 7.1%, human metapneumovirus 5.7%, human bocavirus 5.7%, parainfluenza virus 3.5%, coinfection 2.8%. The mean age of the patients was 6.3±3.6 years. Sixty-nine patients (49.2%) were aged between 2 and 5 years. Seventy-one patients (50.7%) were aged 5 years and above. Upper respiratory tract infection was found with a rate of 65.7% and lower respiratory tract infection was found with a rate of 34.2%. It was observed that the distribution of respiratory tract viruses showed variance by age groups. Influenza A infection was observed with the highest rate in both age groups. Influenza B was the second leading agent (p=0.008) above the age of 5 years and respiratory syncytial virus was the second leading agent in the 2-5 year age group (p=0.003). Influenza viruses were detected in 55.9% of 118 patients who were found to be compatible with the definition of “influenza-like illness” specified in the Center for Disease Control and Prevention guidelines and other viral agenst were detected in 44%. No difference could be found between the clinical pictures and radiological findings caused by influenza and other respiratory tract viruses. Conclusions: In this study, it was concluded that influenza and other respiratory viruses can not be differentiated definitely by clinical and radiological findings, though there are some differences.
    Full-text · Article · Nov 2015 · Turk Pediatri Arsivi
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    ABSTRACT: Background/Objectives: Invasive fungal infection (IFI) of the CNS is life-threatening disease in patients with malignancies.We report three IFI cases during chemotherapy. Design/Methods: Case 1: Ten-year-old male patient was diagnosed T-cell ALL. At the nineteenth day of the chemotherapy, the thoracicCT revealed nodular lesions, Liposomal amphotericin B(LipAmpB)was given. At the thirty third day ofthe fungotherapy, patient had consciousness andconvulsion. The cranialMRI demonstrated several lesions localized on temporal lobe.The voriconazole was added to the therapy.In the follow up, the patient developed convulsion. The cerebrospinal fluid examination demonstrated fungal hyphes. The stereotaxic biopsy was done.The third antifungal, flucytosine, was added to dual therapy. The minimal regression on cranialMRI was observed after one month.However, bone marrow relapse occurred withinfour month and patient died.Case 2: Elevenyear-old female patient was diagnosed CommonB-ALL. At thirty sixth day LipAmpBwas given as galactomannan test positive.At the eighteen dayof the fungotherapy, abscess detected.LipAmpB was ceased, voriconazole started. During follow-up, regression of lesion demonstrated. Patient continues chemotherapy and is now onfifth month of treatment. Case 3: Fiveyear-old male patient was diagnosedCommonB-ALL. Patient developed headache at twentieth day of chemotherapy. The cranial MRI showed abscess on frontal region.LipAmpB was given. Patient developed consciousness and intracranial bleeding was detected and patient undergone urgent neurosurgical intervention. As progression of lesion was shown, the voriconazole was added to the treatment. As lesion culture demonstrated tricoderma species with characteristics of resistance to amphotericinB and sensitive to voriconazole.We began caspofungin with voriconazole administered together.Patient continues his therapy with severe neurological sequel. Results: One of the patients performed combination therapy was died due to progressive disease, the other lives with severe neurological sequel.Our one case responded to antifungal therapy well and is followed-up regularly.Two patient undergone stereotaxic biopsy.The early stage surgical intervention could not be performed in our cases and 2 patients undergone surgery when they had hydrocephaly and intracranial bleeding respectively. Conclusion: The Intracranialfungal infections show highmortality in patients receiving chemotherapy. There aresome studies showing positive effect of early surgical intervention on prognosis beside antifungal therapy.The combined antifungal therapy is still controversial.
    Full-text · Article · Nov 2015 · Pediatric Blood & Cancer

  • No preview · Article · Oct 2015 · Clinical Pediatrics
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    ABSTRACT: Mother-to-child transmission of human immunodeficiency virus (HIV) can be prevented by prenatal, perinatal and postnatal interventions. Although the incidence of HIV infection in Turkey is low, the number of cases are increasing in years. The aim of this study was to evaluate the characteristics of infants with HIV-positive mothers followed in a pediatric HIV center in Istanbul, Turkey and to describe the vertical transmission of HIV infection among the cases. Clinical and laboratory features of HIV-infected mothers and their exposed infants, followed in our department between June 2007 and February 2015 were retrieved from medical records retrospectively. The data about HIV infection and pregnancy course were confirmed with medical records when possible otherwise based on mothers' self-reports. Clinical and laboratory data about the birth and after birth of the babies in the other centers were obtained from the related centers. A total of 32 HIV-exposed infants (18 female, 14 male) were followed in eight years. HIV infection could be diagnosed in 15 (46.9%) mothers before pregnancy, in 10 (31.3%) during pregnancy and in seven (21.8%) during delivery. Nine of the mothers (28.1%) did not receive antiretroviral therapy during pregnancy. The median age for the patients at the admission were 13.5 days in which the earliest was a day and the latest was 420 (14 months) days. Three of the infants were fed with breast milk. Four infants (12.5%) did not receive antiretroviral prophylaxis. Cotrimoxazol prophylaxis were given approximately to 60% (n= 19) of the infants starting from 4-6 weeks. HIV viral load could be tested within the first 48 hours among 20 infants and except one, all was found as negative. A total of two infants (6.2%) were infected with HIV and their initial viral loads were 89.500 and 87.500 copies/ml, respectively. One of the infant was delivered vaginally and his mother's HIV status was detected during delivery. The mother of other infected infant was diagnosed only three weeks before birth and delivered with cesarean section. Both mothers had high viral loads just before delivery (> 102.000 and 67.000 copies/ml, respectively). One of the infants infected with HIV died in the 4th month due to pulmonary infection and sepsis. This study reveals a high rate of perinatally transmitted HIV infection and mortality. The limited number of cases involved in this one-center study should be taken into account while interpreting this result. All pediatric HIV centers in Turkey should work as partners for more precise national results. Nevertheless, our results draw attention to the lack of prenatal follow-up evaluation in women. In particular, the prompt diagnosis of HIV infection in pregnancy should be provided or not to be missed and follow-up of pregnant women with HIV should be carried out by specialist centers.
    Full-text · Article · Oct 2015 · Mikrobiyoloji bülteni
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    ABSTRACT: A 4-year-old, otherwise healthy boy presented with an axillary temperature of up to 39.5ºC for the previous 3 weeks. His medical history revealed an occasional increase in body temperature up to 38.5ºC for the last 6 months. Physical examination revealed coarse breath sounds on the basal lung area. Chest X-ray showed mediastinal lymphadenomegaly and computed tomography revealed paratracheal conglomerated lymph nodes and a groundglass appearance on the right lung. There were multiple contrast-enhanced, hypoechoic nodules with central necrosis in the liver parenchyma on abdominal magnetic resonance imaging. Open liver biopsy yielded chronic granulomatous inflammation compatible with pathological findings of tuberculosis infection. The culture specimen was positive for Mycobacterium tuberculosis. The patient improved rapidly after antituberculous therapy was initiated. Tuberculosis, especially in its disseminated form, poses a distinct diagnostic challenge in cases of prolonged fever with unproven etiology, and thus persistence should be exercised in disclosing the cause of such fevers.
    No preview · Article · Sep 2015 · The Turkish journal of pediatrics
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    ABSTRACT: : Öksüz L, Hançerli S, Somer A, Salman N, Gürler N. Pertussis in children in the İstanbul Faculty of Medicine: results for four years. Turk J Pediatr 2014; 56: 632-637. We investigated the frequency of pertussis among children in the İstanbul Faculty of Medicine Hospital during a period of four years. Clinical specimens were obtained from children who exhibited symptoms of whooping cough; a portion of the cases were confirmed microbiologically by PCR as pertussis. A total of 410 nasopharyngeal aspirates were taken for detection of Bordetella pertussis/parapertussis. The age groups of the patients were 0-4 months (n=201), >4-12 months (n=49), 1-4 years (n=79), 5-9 years (n=46), 10-14 years (n=27) and >15 years (n=8). 106 (26%) of all samples were positive for B. pertussis/parapertussis by the PCR method. The Bordetella PCR positivity rates were 36% in 2010, 29% in 2011, 15% in 2012 and 15% in 2013. Due to administration of the DTaP-IPV vaccination at seven years of age starting in 2010, pertussis was not detected in the 5–9 age group after that year. According to this result, the five doses of pertussis vaccination administered as the national vaccine scheme are effective in protecting against the infection. A booster dose for adolescents at 14 years of age as well as a cocoon strategy might also be considered in our country.
    Full-text · Article · Sep 2015 · The Turkish journal of pediatrics
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    ABSTRACT: Post-herpes simplex virus encephalitis relapses have been recently associated with autoimmunity driven by autoantibodies against N-methyl-d-aspartate (NMDA) receptors. Because it offers different treatment options, determination of this condition is important. Between 2011 and 2014, 7 children with proven diagnosis of herpes simplex virus encephalitis were identified in a university hospital of Istanbul. Two patients had neurologic relapse characterized mainly by movement disorders 2 to 3 weeks after initial encephalitis. The first patient received a second 14 days of acyclovir treatment together with antiepileptic drugs and left with severe neurologic sequelae. The second patient was found to be NMDA receptors antibody positive in the cerebrospinal fluid. She was treated with intravenous immunoglobulin and prednisolone. She showed substantial improvement, gradually regaining lost neurologic abilities. Post-herpes simplex virus encephalitis relapses may frequently be immune-mediated rather than a viral reactivation, particularly in children displaying movement disorders like choreoathetosis. Immunotherapy may provide benefit for this potentially devastating condition, like the case described in this report. © The Author(s) 2015.
    No preview · Article · Jul 2015 · Journal of child neurology
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    ABSTRACT: The aim of study was to evaluate various risk in patients who were hospitalized with moderate to severe virus-induced wheezing. Infants hospitalized with virus-induced wheezing were enrolled in the study. Respiratory viruses were detected in nasopharyngeal swab and total IgE levels and skin prick tests were performed in all patients.The mean age of the patients was 11.2±9 months. The most common detected viral agents were Respiratory Syncytial Virus, (33.6%), Influenza virus (16.3.%). Children with positive family history of atopy had their first virus-induced wheezing at an earlier age (9.0 ±7.8 months) than the others (14.2±10.8 months), (p=0.007). Atopy and viral etiology did not significantly influence clinical severity of the disease. Although children with positive parental history of atopy experience first virus-induced wheezing at an earlier age, personal atopy was not found as a risk factor for predicting the severity of the first virus-induced wheezy episode. Key words: atopy, respiratory virus, children, virus-induced wheezing. 427
    Full-text · Article · Jul 2015 · The Turkish journal of pediatrics
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    ABSTRACT: Brucellosis is considered the most widespread zoonosis in the world. In endemic regions of brucellosis, childhood brucellosis includes up to one-third of all cases of human brucellosis. Brucellosis constitutes a public health problem in Turkey. A boy aged 12 yr who had PFIC2 had undergone deceased-donor liver transplantation in 2008 at the age of seven. The boy presented with fatigue, fever, and pain in the right leg and hip and was admitted to the hospital. Brucella melitensis grew in the blood culture, and the SAT was positive at a titer of 1:640. The patient was treated with oral doxycycline and rifampicin for eight wk. After treatment, the patient recovered and his blood cultures became negative. The patient's mother also had a high Brucella agglutination titer of 1:320 positive and was treated in the internal medicine department with spiramycin and doxycycline. Brucella infection should be suspected in liver transplant recipients with fever of unknown origin, especially in recipients who live in an endemic area. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Full-text · Article · Jul 2015 · Pediatric Transplantation
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    ABSTRACT: Varicella in previously immunized individuals, known as "breakthrough varicella". While the majority of breakthrough cases are mild, some may be severe, requiring hospitalization in previously healthy children or children with an underlying condition. This report, as a part of the prospective national pediatric varicella hospitalizations study (including 29 centers, represent 50% of pediatric population) in Turkey, is aimed to evaluate breakthrough varicella infection requiring hospitalization before the routine use of single-dose live varicella vaccine in national program from 2008 to 2013 (<10% of the pediatric age group received a single-dose vaccine). In the time period, 1939 children were hospitalized due to varicella infection in Turkey; 36 children (20 boys, 16 girls, mean age 68.0+37.6 months, all received single dose live varicella vaccine) with breakthrough varicella infection. Breakthrough varicella infection might be severe in previously healthy children (61.1%) and children with immune-compromising conditions (38.9%). The time elapsed between vaccination and hospitalization was approximately 5 years, and neurological complications, mainly encephalitis and meningitis, were the most common reason for hospitalization in previously healthy children. Pediatric breakthrough varicella requiring hospitalization have been seen in Turkey, is mainly observed in previously healthy children at 5 years after a single-dose varicella vaccine. The varicella vaccine has been implemented as part of the National Immunization Program in Turkey in 2013 (a single dose at age 12 months). Further surveillance in the same settings could evaluate the effectiveness of national immunization with single-dose varicella vaccine at 12 months of age and potential need for second dose of vaccine. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Jun 2015 · Vaccine
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    ABSTRACT: Süt çocuklarında suçiçeği enfeksiyonu genellikle kendini sınırlayan bir hastalıktır. Nadiren bazen ciddi komplikasyonlara yol açarak ölüme neden olabilir. Hastaneye yatış gerektiren komplikasyonlar arasında deri-yumuşak doku enfeksiyonları, kemik-eklem enfeksiyonları, sepsis, pnömoni, trombositopeni ve dehidratasyon en çok saptananlardır. Suçiçeği aşısı şiddetli suçiçeği önlenmesinde son derece etkili olup Amerika u çiçeği sıklığını, hastaneye yatış ve mortaliteyi anlamlı düzeyde azaltmıştır. Burada, suçiçeği enfeksiyonuna bağlı sepsis ve purpura fulminans gelişen on aylık kız hasta sunuldu. Hastane yatışının 1. ayında sol dirsekte ağrı, şişlik ve hareket kısıtlılığı saptanan hastaya osteomyelit tanısı konularak başarı ile tedavi edildi.
    Full-text · Article · May 2015 · Cocuk Enfeksiyon Dergisi
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    ABSTRACT: Background Human bocavirus (HBOV) has been reported as a worldwide distributed respiratory pathogen. It has also been associated with encephalitis recently by detection of the virus in cerebrospinal fluid of patients presented with encephalitis. This retrospective study aimed to present clinical features of HBOV infections in children with respiratory symptoms and describe unexplained encephalopathy in a subgroup of these patients.Methods Results of 1143 pediatric nasal samples from mid-December 2013 to July 2014 were reviewed for detection of HBOV. A multiplex real time polymerase chain reaction assay was used for viral detection. Medical records of the patients were retrospectively analyzed.ResultsHBOV was detected in 30 patients (2.6%). Median age was 14 months (5-80). Clinical diagnoses were upper respiratory tract infection (n = 10), bronchopneumonia (n = 9), acute bronchiolitis (n = 5), pneumonia (n = 4), acute bronchitis (n = 1) and asthma execarbation (n = 1). Hospitalization was required in 16 (53.3%) patients and 10 (62.5%) of them admitted to pediatric intensive care unit (PICU). Noninvasive mechanical ventilation modalities was applied to 4 patients and mechanical ventilation to 4 patients. Intractable seizures developed in 4 patients while mechanically ventilated on the 2nd-3rd days of PICU admission. No specific reason for encephalopathy was found after a thorough investigation. No mortality was observed, but 2 patients were discharged with neurological sequela.ConclusionHBOV may lead to respiratory infections in a wide spectrum of severity. This report indicates its potential to cause severe respiratory infections requiring PICU admission and highlights possible clinical association of HBOV and encephalopathy, which developed during severe respiratory infection. This article is protected by copyright. All rights reserved
    No preview · Article · May 2015 · Journal of Medical Virology
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    Full-text · Article · Apr 2015
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    ABSTRACT: Background: Tuberculosis (TB) is an important worldwide ongoing health issue. To be able to control TB, one should not only cure active TB but also identify childhood TB patients who have the possibility to develop active disease in the future. The aim of this study was to compare a century-old tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT) test, developed as an alternative to TST and which has been claimed to be superior to TST in several ways, in the diagnosis of childhood TB. Methods: Fifty-three children with TB between 5 months and 17.5 years of age and 92 healthy children from the same age group with no risk factors for TB were recruited into the study. All children underwent TST and QFT-GIT test and their demographic, clinic and laboratory data were recorded. Data were analyzed using SPSS 14. Results: A total of 53 patients were diagnosed with TB. Mean patient age was 8.5 ± 4.3 years (range, 5 months-17.5 years). A total of 41.7% of the patients were female. Sixteen of 53 patients had confirmation on culture. QFT-GIT test was positive in 16 and TST was positive in 15 among 16 children with culture-confirmed TB. The sensitivity of TST and QFT-GIT were 93.8% and 100.0%, and the specificity of TST and QFT-GIT were 100.0% and 97.8%, respectively. With regard to the 53 TB children including those without bacteriological confirmation, QFT-GIT was positive in 33 children, and TST was positive in 44 children. The sensitivity of TST and QFT-GIT was then 83.0% and 62.3%, and the specificity, 100.0% and 97.8%, respectively. Conclusion: Although positive QFT-GIT test is very significant for TB, negative results will not exclude TB infection. TST and QFT-GIT used together may provide more efficient results.
    Full-text · Article · Apr 2015 · Pediatrics International

  • No preview · Article · Apr 2015
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    Full-text · Dataset · Mar 2015
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    ABSTRACT: Tuberculosis (TB), caused by Mycobacterium tuberculosis (M.tb) and a few related mycobacteria, is a devastating disease, killing more than a million individuals per year worldwide. However, its pathogenesis remains largely elusive, as only a small proportion of infected individuals develop clinical disease either during primary infection or during reactivation from latency or secondary infection. Subacute, hematogenous, and extrapulmonary disease tends to be more frequent in infants, children, and teenagers than in adults. Life-threatening primary TB of childhood can result from known acquired or inherited immunodeficiencies, although the vast majority of cases remain unexplained. We review here the conditions conferring a predisposition to childhood clinical diseases caused by mycobacteria, including not only M.tb but also weakly virulent mycobacteria, such as BCG vaccines and environmental mycobacteria. Infections with weakly virulent mycobacteria are much rarer than TB, but the inherited and acquired immunodeficiencies underlying these infections are much better known. Their study has also provided genetic and immunological insights into childhood TB, as illustrated by the discovery of single-gene inborn errors of IFN-γ immunity underlying severe cases of TB. Novel findings are expected from ongoing and future human genetic studies of childhood TB in countries that combine a high proportion of consanguineous marriages, a high incidence of TB, and an excellent clinical care, such as Iran, Morocco, and Turkey. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Full-text · Article · Mar 2015 · Immunological Reviews
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    ABSTRACT: To contribute to the diagnosis and treatment of pediatric abdominal tuberculosis cases by assessing the clinical, laboratory, and radiological features of patients who presented at our clinic and were diagnosed with abdominal tuberculosis. Clinical, laboratory, and radiological features were reviewed retrospectively for 35 patients diagnosed with abdominal tuberculosis and followed up at the Pediatric Infectious Diseases Clinic between January 1987 and August 2012. The study group included 16 female (45.7%) and 19 male (54.3%) patients with an age range of 6 months to 16 years (mean: 9.77±4.36 years). Twenty-nine patients were diagnosed with tuberculosis peritonitis, five patients with intestinal tuberculosis, and one patient with pelvic tuberculosis. The most common signs and symptoms were ascites, abdominal pain, abdominal distention, weight loss, and fever. Mean duration of the complaints was 109 days (range: 10 days to 3 years). Abdominal tuberculosis is a disease with an insidious course without disease-specific clinical and laboratory signs. When the disease is suspected, laparoscopy or laparotomy could be helpful in diagnosis. Employing ultrasound and computed tomography signs, abdominal tuberculosis should be included in differential diagnoses in regions with a high incidence of tuberculosis when there is abdominal pain, weight loss, ascites, history of contact with individuals with tuberculosis, and positive tuberculin skin test when patients have not been Bacillus Calmette Guerin BCG vaccinated.
    Full-text · Article · Mar 2015 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology

Publication Stats

902 Citations
157.49 Total Impact Points

Institutions

  • 1995-2016
    • Istanbul University
      • • Department of Family Medicine (Istanbul Medical Faculty)
      • • Department of Infectious Diseases
      • • Department of Social Pediatrics
      İstanbul, Istanbul, Turkey
  • 2014
    • University of Cologne
      Köln, North Rhine-Westphalia, Germany
  • 2006
    • Istanbul Medical University
      İstanbul, Istanbul, Turkey
  • 1997
    • Istanbul Occupational Diseases Hospital
      İstanbul, Istanbul, Turkey