A patient presented with genital eruptions: The second case of monkeypox from Turkiye

İnsan maymun çiçeği (MPX) hastalığı, vaccinia ve variola gibi “poxviridae” ailesine ait maymun çiçeği virüsünün neden olduğu, yeniden önem kazanan zoonotik bir hastalıktır. Avrupa Hastalık Önleme ve Kontrol Merkezi [European Center for Disease Prevention and Control (ECDC)] tarafından Avrupa’da olağandışı bulaşma yollarına sahip bir MPX salgını bildirilmiştir. Bu raporda, erkekten erkeğe cinsel ilişki ilk kez insandan insana yakın bir temas yolu olarak tanımlanmıştır. Türkiye Cumhuriyeti Sağlık Bakanlığı, Türkiye’de MPX virüsü polimeraz zincir reaksiyonu [polymerase chain reaction (PCR)] ile doğrulanmış ilk olgunun 30 Haziran 2022’de bir hastanede kabul edildiğini ve izole edildiğini sosyal medya paylaşımı ile bildirmiştir. Bu bildiriden dört gün sonra merkezimize başvuran yirmi dört yaşında Türk erkek hasta lokal cerrahi işlem sonrası peniste ve skrotumda ortaya çıkan bakteriyel yumuşak doku enfeksiyonu ile kliniğimize yatırılmıştır. Öyküsünde bir hafta önce ortaya çıkan siğil benzeri lezyonlar nedeni ile dış merkezde lokal radyofrekans ablasyon tedavisi yapıldığını belirtmiştir. Yatışından bir gün sonra yüzünde, burun ucunda, vücudunda, kollarında ve parmaklarında giderek belirginleşen farklı evrelerde cilt lezyonları (makül, papül, göbekli papül) ve birkaç erüpsiyon gözlenen hasta, risk faktörleri değerlendirilerek MPX hastalığı açısından izole edilmiş ve Sağlık Bakanlığı rehberine göre MPX virüsü aranmak üzere örnekleri referans laboratuvara gönderilmiştir. Alınan örneklerde PCR ile MPX nükleik asidi saptanmıştır. Hastanın sekonder bakteriyel enfeksiyon tedavisi ve 21 günlük izolasyon süresi tamamlanarak taburcu edilmiştir. Bu olgu raporunda daha önce Türkiye’den bildirilmemiş olan MPX hastalığı, cinsel yolla bulaşan enfeksiyonlar (CYBE) ayırıcı tanısının ve tarama testlerinin önemi ve MPX hastalığı olgusuna uygulanan lokal ablasyon tedavisi sonrası gelişen yumuşak doku enfeksiyonu sunulmuştur. Yeni ve yeniden önem kazanan enfeksiyon hastalıklarına hazırlıklı olmak için güncel epidemiyolojik verilere dayalı iyi kurgulanmış sürekli eğitimin gerekliliğine vurgu yapılmıştır. Son zamanlarda, cinsel temas, MPX hastalığının yeni bulaşma yolu olarak tanımlanmaktadır ve semptom ve bulgular, “molluscum contagiousum” veya sifilis gibi diğer ülseratif cinsel yolla bulaşan enfeksiyonları (CYBE) taklit edebilir. Türkiye için ORF hastalığı da MPX hastalığı ayırıcı tanısı içindedir. Ayrıca bildirimi zorunlu olmayan CYBE ile başvuran hastalar, diğer tarama testleri yapılmadan sağlık hizmeti alabilmektedir. Kolay ulaşılabilen tanısal yeterliliği yüksek CYBE tarama merkezlerinin yaygınlaşması ile bu hastalıkların kontrol altına alınması sağlanabilir.Human monkeypox (MPX) disease is a re-emerging zoonotic infection caused by the monkeypox virus belonging to the same family as vaccinia and variola. The European Center for Disease Prevention and Control (ECDC) has documented an outbreak of MPX with atypical transmission paths throughout Europe. In this report, male-to-male sexual intercourse was first defined as a means of close human -to-human contact. The Ministry of Health of the Republic of Turkey announced via social media on June 30, 2022 that the first case confirmed by polymerase chain reaction (PCR) for the MPX virus in Turkey was admitted and isolated in a hospital. Four days after this statement, a 24-year-old Turkish man was hospitalized in our clinic with a bacterial infection of the penis and scrotum following local radiofrequency ablation therapy. A week ago, lesions resembling warts were noted in his medical history, for which a local radiofrequency ablation procedure was conducted at an external center. One day after his hospitalization, skin lesions of different stages (from macules, papules to umbilical papules) and several eruptions were detected on his face, nose tip, body, arms, and fingers, which gradually became more evident. After evaluating the risk factors, the patient was isolated with a preliminary diagnosis of MPX disease and samples were collected and sent for MPX virus detection to the reference laboratory according to the Ministry of Health guidelines. MPX virus nucleic acid was detected by PCR in samples taken from the lesion. The patient was discharged after 21 days of isolation and treatment for a secondary bacterial infection. In this case report the significance of differential diagnosis and screening tests for sexually transmitted infections (STI), a previously unreported case of MPX disease in Turkey, and a soft tissue infection that developed after local ablation treatment which was administered to a patient with MPX disease were presented. To be prepared for new and re-emerging infectious diseases, it was emphasized that well-structured continuing education based on current epidemiological data is required. Sexual contact has recently been identified as a new mode of transmission for MPX disease, and symptoms and signs may resemble those of other ulcerative sexually transmitted infections (STIs), such as "molluscum contagiousum" or syphilis. ORF disease is also in the differential diagnosis of MPX disease in Turkey. In addition, patients admitted with unreported STIs are permitted to receive health services without additional screenings. For this reason, easily accessible sexually transmitted disease centers with a high diagnostic efficiency can provide greater control over these diseases

Acinetobacterspp in Intensive Care Unit: Risk Factors Associated with Infection and Mortality

Purpose: Acinetobacter was known as a saprophytic colonizer, yet it is considered an important etiologic agent which is isolated from hospital-acquired infections. In this study, we aimed to investigate fatality rates, factors for fatality of Acinetobacter infections and relationship between combination therapies and survival.Patients and Methods: We evaluated patients with Acinetobacter infection in ICU for demographic and clinical characteristics, combination therapies and adverse effects of these therapeutic options, retrospectively.Results: Ninety-one patients with proved Acinetobacter infection were included in this study. We found that the fatality rate of Acinetobacter infection in ICU was 56%. Advanced age, carbapenem resistance and Acinetobacter isolation from respiratory secretions were significantly related with fatality.  We found that carbapenem resistance increased steadily during a 5 year period, fatality rates significantly decreased with combination therapies including aminoglycosides. There wasn’t significant relation between colistin therapy and survival in patients with Acinetobacter infections.Conclusion: The patients should be well-assessed in terms of fatality risk factors in case of Acinetobacter infections that occur in the intensive care units. The empirical antibiotic treatment started earlier based on such risk factors may decrease fatality. The antimicrobial combinations including aminoglycoside may be considered more in order to the local resistance data

Kırım Kongo kanamalı ateşine H. pylori varlığının etkisi

Background and Aims: Crimean Congo hemorrhagic fever can cause a fa- tal hemorrhagic syndrome. We aimed to investigate whether the presence of Helicobacter pylori increases the bleeding or severity of Crimean Congo hemorrhagic fever. Materials and Methods: Forty-two patients with Crime- an Congo hemorrhagic fever who had dyspepsia and were hospitalized be- tween April 2009 and July 2009 were included in the study. The patients were divided into two groups according to their fecal Helicobacter pylori an- tigen positivity. Clinical and laboratory severity criteria for Crimean Congo hemorrhagic fever were investigated in both groups. Results: We could not find any difference between the two groups with regard to severity as de- fined by clinical and laboratory criteria. Conclusion: This is the first study in the literature investigating the role of Helicobacter pylori in the severity of Crimean Congo hemorrhagic fever from a country in which both Crimean Congo hemorrhagic fever and Helicobacter pylori are endemic. Further stud- ies including a larger number of Crimean Congo hemorrhagic fever patients are necessary to recommend Helicobacter pylori screening and eradication in Crimean Congo hemorrhagic fever.Giriş ve Amaç: Kırım Kongo kanamalı ateşi ölümcül hemorajik bir sendro- ma neden olabilir. Bu çalışmada Helicobacter pylori varlığının Kırım Kongo kanamalı ateşi hastalığının şiddeti ya da kanama üzerine etkisinin olup olma- dığını araştırdık. Gereç ve Yöntem: Kırım Kongo kanamalı ateşi nedeniyle Nisan 2009-Temmuz 2009 arası hospitalize edilen kırk iki dispeptik hasta çalışmaya dahil edildi. Hastalar fekal Helicobacter pylori antijeni pozitifliği durumuna göre iki gruba ayrıldı. Her iki grupta Kırım Kongo kanamalı ate- şi'nin klinik ve labaratuvar olarak şiddet kriterleri değerlendirildi. Bulgular: Klinik ve laboratuvar kriterleri açısından iki grup arasında Kırım Kongo ka- namalı ateşi hastalık şiddeti açısından farklılık saptanmadı. Sonuç: Bu çalış- ma Helicobacter pylori'nin Kırım Kongo kanamalı ateşi'nin şiddeti üzerine etkisini araştıran ilk çalışma olması ve hem Helicobacter pylori hem de Kırım Kongo kanamalı ateşi'nin endemik olduğu bir bölgeden yapılması nedeniyle önemlidir. Ancak Kırım Kongo kanamalı ateşi hastalarında rutin Helicobac- ter pylori taranması ve eradikasyonunun önerilebilmesi için daha geniş vaka sayılı çalışmalara ihtiyaç vardır

The Frequency of Asymptomatic Bacteriuria in Patients with Diabetes Mellitus and Relation with the Duration of Diabetes

In this study we aimed to find out the frequency of asymptomatic bacteriuria (ASB), relation between bacteriuria and duration of diabetes in patients with diabetes mellitus (DM) prospectively. A total of 100 diabetic patients (75 female, 25 male) who were 19-78 years of age and 100 nondiabetic patients (75 female, 25 male) applying to the Department of Internal Medicine without having urinary tract infection (UTI) symptoms but for reasons other than infection (control subjects) were included. Two clean-catch midstream urine samples of the patients were obtained and cultured for the evaluation of ASB with an interval of twentyfour hours. ASB was defined as the same bacteria growing ≥ 105 colony forming units (cfu) per ml of both urine samples in the absence of UTI symptoms. Frequency of ASB was 26% (30.7% in women, 12.0% in men) in the diabetic patients and 7% (9% in women, 4% in men) in the control group (p 0.05). It was observed that the frequency of ASB increased significantly by increasing the duration of DM in diabetic patients (p< 0.05). In conclusion, the frequency of ASB in diabetic patients is higher than nondiabetics. For this reason, we think that the diabetic patients who are older and have longer duration of diabetes should be searched for ASB and, in order to decide for ASB treatment, further studies are necessary

Pneumococcal Meningitis in 18 Year-Old Young Pregnant Woman

Community acquired bacterial meningitis is associated with high morbidity and mortality, and the most common bacterial pathogen is Streptococcus pneumoniae. Few case reports and two small case series of pneumococcal meningitis during pregnancy have been reported in the literature. This is the first case report of pneumococcal meningitis in an 18 year-old pregnant woman from Turkey. She was admitted to our emergency department at 33rd week of gestation with the complaints of fever, nausea, vomiting and sudden onset of confusion. The diagnosis of acute bacterial meningitis was made according to the findings of lumbar puncture. Empirical treatment with ceftriaxone (2 x 2 g/day) and vancomycin (4 x 500 mg/day) were started immediately. Caesarean section was performed on the sixth day of hospitalization (34th week of gestation) because of the premature rupture of membrane. Both mother and the infant survived without any sequela. Successful results for both mother and infant can be achieved with early diagnosis and appropriate treatment in cases of pneumococcal meningitis during pregnancy

Antimicrobial Susceptibility and Frequency of Extended Spectrum Beta-Lactamase (ESBL) of Escherichia coli Strains Isolated from Community Acquired and Nosocomial Infections

Introduction: Escherichia coli is one of the most important causes of nosocomial and community acquired infections. Beta-lactam antibiotics constitute one of the major therapeutic options to treat infections caused by these microorganism. Resistance to beta-lactams antibiotics is mainly caused by extended-spectrum beta-lactamases (ESBLs). The aim of this study was to determine the production rates of ESBL of E. coli isolates causing nosocomial and community acquired infections as well as to determine their antimicrobial susceptibility patterns. Materials and Methods: Between June 2006-December 2010, 555 E. coli strains isolated from clinical specimens (256 wound, 213 urine, 42 blood, 28 respiratory truct, 16 others) of inpatients, and 3052 E. coli strains isolated from urines of outpatients admitted to Cumhuriyet University Research and Training Hospital, were included to the study. Identification of the isolates and antibiotic susceptibility testings were performed by an automatic system (BD, Phoenix, USA). The production of ESBL was done by the broth microdilution method according to Clinical and Laboratory Standards Institute guidelines. Results: The rate of ESBL producers in the nosocomial isolates was approximately three times higher than the community acquired isolates (47.7% vs. 15.8%). Ciprofloxacin and piperacillin-tazobactam resistance rate were significantly different between the nosocomial and community acquired ESBL producing E. coli isolates. Ciprofloxacin resistance was higher in community acquired strains (84.3% vs. 77.7%, p= 0.026) and piperacillin-tazobactam resistance was higher in nosocomial strains (44.5% vs. 37.1%, p= 0.046). Nitrofurantoin and fosfomycine resistance in the community acquired ESBL positive E. coli strains was quite low (4.0% vs. 0.5%), and the nosocomial isolates were not studied. All nosocomial and community acquired E. coli isolates were sensitive to carbapenems. Conclusion: These results show that ESBL production is high in nosocomial E. coli isolates, and some differences can be seen in antibiotics susceptibility of nosocomial and community acquired ESBL producing E. coli strains