A Case of Brucellosis Presenting with Multiple Hypodense Splenic Lesions and Bilateral Pleural Effusions

Brucellosis is a zoonotic infectious disease, which mainly present with lymphoreticular system invovement. However any organ system can be attacked by the microorganism. In this paper we present a 52-year-old female patient who was admitted to the Infectious Diseases Department with complaints of fatigue, arthralgias, fever, and weight loss. In the medical examination and radiological analysis bilateral pleural effusions and hepatosplenomegaly were detected. Serum transaminase levels were two times higher than the upper limits of normal. Abdominal ultrasound revealed sludge in the gallbladder and multiple hypodense splenic lesions (the largest was 1 cm in diameter). Brucella melitensis was isolated from the blood culture of the patient. Rifampicin (600 mg/day) and doxycycline (200 mg/day) therapy was started. Follow-up chest radiography and ultrasonography revealed the absence of pleural effusion. Splenic lesions and hepatosplenomegaly were totally regressed. The patient has been followed for 3 months after 6 week antibiotic regimen without recurrence. Brucellosis was expected to be the cause of all pathological signs

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

<p>Abstract</p> <p>Background</p> <p>Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.</p> <p>Methods</p> <p>A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.</p> <p>Results</p> <p>A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.</p> <p>Conclusions</p> <p>The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.</p

Pre-exposure Prophylaxis Against Human Immunodeficiency Virus

According to the Center for Disease Control and Prevention (CDC), there were 2.1 million new human immunodeficiency virus (HIV) cases reported worldwide in 2015, which shows that siginificant work needs to be done to prevent the transmission of HIV. Research to date has focused mainly on high-risk men who have sex with men, but many women around the world are also at a high risk for HIV transmissions. In studies conducted, the incidence of HIV infection in high-risk individuals decreases over 90% when high-risk individuals use pre-exposure prophylaxis (PreP) HIV, tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) safely. Current data and studies on pre-exposure prophylaxis were discussed in this review

Serum TNF-alpha, Soluble TNF-Receptor I and II levels in Patients with Brucellosis

9th Annual Meeting of the Federation-of-Clinical-Immunology-Societies -- JUN 11-14, 2009 -- San Francisco, CABirengel, Serhat/0000-0002-5599-6488WOS: 000266342300378…Federat Clin Immunol So

Lyme Seropositivity in Healthy Persons and Some Disease Groups

In this study, we aimed to investigate the prevalence of antibodies specific to Lyme disease in healthy subjects and in defined patients in Ankara and suburban areas near Ankara in the years 1995 and 1996. One hundered and fifty four individuals comprised to the study: 54 patients with probable Lyme disease symptoms and/or signs, and admitted to the Ankara University Faculty of Medicine, ‹bn-i Sina Hospital, (patients group); 50 subjects (i.e. farmers) living at two different suburban areas near Ankara (group at risk); and 50 healthy subjects living at urban area (control group). To search the antibodies we used a commercial ELISA kit, (combined purified Borrelia burgdorferi-B31 strain cell lysate and the recombinant P39 protein, as antigen). The seropositivity was detected as 13% (7/54) at the patients group, 6% (3/50) at the risk group, and 4% (2/50) at the healthy control group. There was no statistically significant difference inbetween the groups for the seropositivity rates. Positive test results were detected in 40% of the patients with erythema migrans-like skin lesions, 20% of the patients with cardiac involvements, 14.3% of the patients with rheumatologic disorders, and 6.25% of the patients with neurologic disorders. As the result, this study yielded that probability of the exposure to the Lyme disease agent, B. burgdorferi, in our region was similar to the other investigations done previously in different regions of our country

Serum Neopterin Level In Patients With Lung Cancer And Case Of Pneumoniae

Amaç: Neopterin, hücre aracılıklı immün yanıtı gösteren duyarlı bir belirteçtir. Bu nedenle T hücreleri ve makrofaj- ların rol oynadığı çeşitli infeksiyon hastalıklarında vücut sıvılarında neopterin düzeylerinin belirlenmesi hücre aracı- lıklı immün yanıt hakkında bilgi sağlar. Kanser ve pnömoni hastalarında serum neopterin düzeylerinin yüksek oldu- ğu bildirilmiştir. Bu çalışmanın amacı, akciğer kanseri olan hastalar ve pnömonili hastalarda serum neopterin düzey- lerinin tanısal değerinin araştırılmasıydı. Yöntem ve Gereçler: Bu çalışmada, 24 pnömonili hasta (10 K, 14 E) , 20 akciğer kanserli hasta (20 E) ve 16 sağ- lıklı gönüllüde (5 K, 11 E) serum neopterin düzeyleri istatistiksel olarak karşılaştırıldı. Neopterin düzeyleri üretici firmanın önerilerine göre ELISA yöntemiyle belirlendi. İstatistiksel değerlendirmede SPSS 11.5 programı kullanıldı. İstatistiksel analizlerde, univarite varyans analizi, kovaryans analizi ve Student T testler kullanıldı. p ? 0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Serum neopterin düzeyleri ortalaması sırasıyla; akciğer kanserli hastalarda 22.21 ± 8.60 nmol/l, pnömonili hastalarda 21.18 ± 8.76 nmol/l, kontrol grubunda ise 9.03 ± 4.15 nmol/l olarak belirlendi. Serum neopterin düzey- leri akciğer kanseri ve pnömoni hastalarında kontrol grubundan istatistiksel olarak anlamlı oranda yüksek saptandı. Serum neopterin düzeyleri kanserli hastalar ve pnömonili hastalar arasında istatistiksel olarak anlamlı farklılık gös- termedi. Sonuç: Serum neopterin düzeylerinin akciğer kanseri ve pnömonili hastalarda tanıda yardımcı test olarak kullanıla- bileceği, ancak; bu iki hastalığın birbirinden ayrımında kullanılamayacağı sonucuna varıldı.Aim:Neopterin is a sensitive marker for cell-mediated immune response. Because of this, the neopterin levels of body fluids show cell-mediated immune response in different infectious diseases which involve T cells and macrophages. It is reported that serum neopterin levels were found to be higher in patients with pneumoniae and patients with can- cer. The aim of this study was to investigate that the diagnostic value of neopterin in patients with lung cancer and pneumoniae. Material And Methods:In the present study, serum neopterin levels were compared between , 24 patients with pneu- moniae (10 female, 14 male) , 20 patients with lung cancer (20 male) and 16 healthy volunteers (5 female, 11 male). Neopterin concentrations were measured by ELISA method according to the protocol of manufacturer. In statistical evaluation, SPSS 11.5 programme was used.Univariate analysis of variance, covariance analysis and Student t tests were used in statistical analysis. p value &#8804;0.05 and p &#8804;0.001 was accepted as statistical significant. Results:Serum neopterin levels were found to be 22.21 ± 8.60 nmol/l, 21.18 ± 8.76 nmol/l, and 9.03 ± 4.15 nmol/l in patients with lung cancer, pneumoniae and control groups, respectively. Serum neopterin levels were established to be significantly higher in patients with lung cancer and patients with pneumoniae than in control groups. Serum neopterin levels were not significantly different between patients with lung cancer and patients with pneumoniae. Conclusion:It is our suggestion that serum neopterin levels may be used as a supplementtary test in diagnosis in pa- tients with lung cancer and patients with pneumoniae but it can not be used in in differential diagnosis of these two diseases

Evaluation of quantiferon-TB gold and tuberculin skin test in patients with tuberculosis, close contact of patients, health care workers and tuberculosis laboratory personnel

Birengel, Serhat/0000-0002-5599-6488; Annakkaya, Ali Nihat N/0000-0002-7661-8830WOS: 000284385400003PubMed: 21063967Tüberkülin cilt testi (TCT), uzun bir süredir duyarlılık ve özgüllük değerlerindeki sınırlamalara rağmen etkin bir şekilde kullanılmaktadır. Aktif tüberkülozu olmaksızın TCT pozitif olan hastalar, latent tüberküloz enfeksiyonu (LTBE) olarak tanımlanır. LTBE olan hastaların TCT ile tanımlanması, hastalığın kontrolünde önemli bir aşamadır. Plazma interferon gamma (IFN-γ) düzeyini belirleyen Quantiferon-TB Gold Testi (QTG, Cellestis, Austuralya) latent tüberküloz (TB) enfeksiyonu tanısında TCT’ye göre avantajları olan in vitro tanısal bir testtir. Bu test Mycobacterium tuberculosis’e özgül ESAT-6 ve CFP-10 antijenlerini içerir. Bu çalışmanın amacı, TB’li hastalar, yakın temaslıları, sağlık çalışanları ve TB laboratuvarı personelinde QTG ve TCT testi sonuçlarının karşılaştırılmasıdır. Çalışmaya, 26 aktif akciğer TB’li hasta, 6 hasta yakını, 11 hasta teması olan sağlık çalışanı ve 8 TB laboratuvarı personeli dahil edilmiştir. TCT uygulanmadan önce QTG testi için kan örnekleri alınmıştır. Tüm bireyler BCG aşılaması yönünden sorgulanmış ve BCG skarı yönünden incelenmiştir. Çalışmaya katılanların tümünde BCG aşılaması öyküsü ve muayenede BCG skarı tespit edilmiştir. QTG testi plazma örneklerinde üretici firmanın önerileri doğrultusunda çalışılmıştır. TCT ile QTG testi arasındaki uyum kappa istatistiği ile ölçülmüştür. Aktif TB’li hastalarda (gerçek enfekte bireyler) TCT (PPD) pozitifliği %34.6 (9/26), QTG pozitifliği %65.3 (17/26) olarak belirlenmiş; pozitiflik oranı QTG testinde daha yüksek tespit edilmiş olmasına rağmen aradaki fark istatistiksel olarak anlamlı bulunmamıştır (p> 0.001). Diğer çalışma gruplarına bakıldığında; sağlık çalışanları, TB’li hastanın yakın temaslıları ve TB laboratuvarı çalışanlarında TCT ve QTG pozitiflik oranları sırasıyla; %36 (4/11) ve %27 (3/11); %16.6 (1/6) ve %83 (5/6); %37.5 (3/8) ve %75 (6/8) olarak tespit edilmiştir. PPD testi sonucu, QTG negatif grupta ortalama 11 mm iken, QTG pozitif grupta ortalama 14 mm olarak saptanmış ve aradaki fark istatistiksel olarak anlamlı bulunmuştur (p 0.001). TST and QTG positivity rates for health care workers, close house contact of TB patients and TB laboratory staff were as follows, respectively; 36% (4/11) and 27% (3/11); 16.6% (1/6) and 83% (5/6); 37.5% (3/8) and 75% (6/8). The mean PPD diameter was 11 mm in QTG negative group and 14 mm in QTG positive group with a statistically significant difference (p= 0.05) and gender (p< 0.001). In conclusion, QTG assay was superior to TST in its ability to detect LTBI and active TB infection, not to be affected with BCG vaccination, to discriminate responses due to non-tuberculous mycobacteria, and to avoid variability and subjectivity associated with application and reading the TST. Besides, QTG assay needs only one visit to the test unit. However, its being expensive than TST and requirement for special equipments and skilled laboratory personnel, are among the disadvantages of QTG assay

SARS-CoV-2 Infection may be Prevented with Cytochrome Inhibitors: Cobicistat and Ritonavir

Objective:&nbsp;Highly contagious character of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the lack of specific drugs have led many scientists worldwide to re-evaluate the molecules currently in use for other diseases/viruses. Thus, high-throughput screening with docking studies has the rationale to identify potential therapeutics from existing drug molecules. Conflicting results of the studies, including SARS-CoV-2 and human immunodeficiency virus (HIV) coinfected population, suggested a possible preventive effect of antiretroviral regimens they have been receiving.&nbsp;Materials and Methods:&nbsp;Interactions between the widely used antiretroviral molecules, in particular; abacavir, cobicistat, dolutegravir, elvitegravir, emtricitabine, lamivudine, raltegravir, and tenofovir, and the main proteins on SARS-CoV-2 that may be targeted for SARS-CoV-2 infection were analyzed using molecular docking studies.&nbsp;&nbsp;Results:&nbsp;Analysis of the compounds strikingly revealed that not the antiretroviral drugs but cobicistat and ritonavir, the inhibitors of cytochrome P450, had strong interactions with the main protease active site and RNA polymerase on SARS-CoV-2, as well as the active site of angiotensin-converting–enzyme 2, the protein that enables the entry of the virus into human cells.&nbsp;&nbsp;Conclusion:&nbsp;Our results suggest cobicistat and ritonavir may be used to prevent SARS-CoV-2 infection.&nbsp;Keywords:&nbsp;antiretroviral therapy, cobicistat, ritonavir, SARS-CoV-2</p

Urinary tuberculosis: A cohort of 79 adult cases

WOS: 000361339400015PubMed ID: 26123266We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 +/- 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 +/- 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 +/- 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure