Evaluation of case series of delayed tularaemia

Tularemia is a zoonotic disease caused by the gram-negative bacterium Francisella tularensis. Clinical suspicion is extremely important and serology is the gold standard for diagnosis. The oropharyngeal form of tularemia in Turkey takes the form of outbreaks or sporadic cases. Delay in diagnosis is the major factor in complications. Five delayed cases of tularemia in the Marmara region of Turkey are described in this paper between 2009-2015 years. All patients’ diagnoses were confirmed with serology, and all had LAP on their neck regions. The lymphadenopathies persisted despite medical treatment four being excised by Ear Nose and Throat Clinic (ENT). Tularemia must be considered in the evaluation of masses on the neck, particularly in endemic areas. The most important factor in the successful management of tularemia is early initiation of treatment. The risk of suppuration and surgical interventions increases in delayed cases

Real-Life Data of Chronic Hepatitis C Patients Treated with Direct-Acting Oral Antivirals: A Single-Center Study

Introduction:Chronic hepatitis C virus (HCV) infection is one of the important causes of liver cancer and cirrhosis all over the worldwide.Methods:The data of the patients diagnosed with chronic hepatitis C infection who applied to the Adult Infectious Diseases and Clinical Microbiology Outpatient Clinic of Erzincan Binali Yildirim University, Mengücek Gazi Training and Research Hospital were retrospectively analyzed. Accordingly, 51 patients treated with direct-acting oral antiviral drugs (DAAs) between January 2016 and May 2021 were included in the study. Patients whose treatment is still ongoing, whose treatment was completed but did not come to the 12th week after treatment, or whose control time has not yet come, were excluded from the study.Results:It was observed that 58.8% of the cases participating in the study were male, 80.4% were infected with genotype 1b, and 74.5% were treatment-naive. When the treatment regimens used in the cases were examined, glecaprevir/pibrentasvir in 7.8%, sofosbuvir (SOF)/ledipasvir (LED), SOF/LED/ribavirin, and SOF/ribavirin in 15.7%, ombitasvir (OBV)/paritaprevir (P)/ritonavir (R)/dasabuvir and OBV/P/R/ribavirin in 76.5% (n=39) appears to be used. A statistically significant difference was found between the alanine aminotransferase, aspartate aminotransferase measurements, and platelet counts of the subjects participating in the study at the beginning, at the 4th week, at the end of the treatment, and at the 12th week (p=0.001). In these cases, a sustained virological response was achieved in 100%. In the follow-up of the cases, no serious side effects that required drug discontinuation were observed.Conclusion:Our study showed that the treatment success of DAAs is 100% and their side-effect profiles are good

Molecular epidemiologic analysis on vancomycin resistant enterococci

Enterokoklar, birçok bakteri türünde bulunan virülans faktörlerine sahip olmamalarına rağmen çevre şartlarına oldukça dirençlidir. Çeşitli antibiyotiklere karşı doğal veya kazanılmış direnç göstermeleri, enterokokların son yıllarda nozokomiyal enfeksiyonlarda önemli etyolojik ajanlar arasında yer almasına neden olmuştur. Vankomisine dirençli enterokok (VRE) enfeksiyonlarının kontrolünde, bu bakteri ile kolonize olan hastaların erken tespiti ve nozokomiyal salgın ile ilişkilerinin gösterilmesi önemlidir. Nozokomiyal epidemiler sırasında izole edilen VRE suşları arasındaki klonal ilişkinin tespiti için moleküler yöntemler kullanılmalıdır. Pulsed Field Jel Elektroforezi (PFGE); nozokomiyal salgın sürveyansında, salgın suşları arasındaki ilişkinin gösterilmesi ve salgın kaynağının tespitinde ?altın standart? yöntem olarak kabul edilmektedir. Bu çalışmada hastanede yatan hastalardan izole edilen VRE suşlarının, hastane enfeksiyonları epidemiyolojisi açısından PFGE ve Arbitrarily primed-PCR (AP-PCR) yöntemleri kullanılarak klonal ilişkilerinin tespiti amaçlanmıştır.Ocak 2001 ile Aralık 2009 yılları arasında hastanede yatan hasta örneklerinden izole edilen tüm VRE türleri içinde Enterococcus faecium'un %98'lik bir oranla baskın tür olduğu saptandı. Çalışmaya 9 yıllık periyot boyunca, 5 ayrı muhtemel epidemi döneminde izole edilen suşlardan 83 adet E. faecium suşu dahil edildi. Tüm suşların yüksek düzey glikopeptit direncine sahip olduğu saptandı.PFGE yöntemiyle 2001 ile 2002 yılı epidemilerinde izole edilen birçok suş arasında anlamlı benzerlik olduğu, bu klonun varlığını uzun süre koruduğu ve bu iki epidemi döneminde baskın hale geldiği saptandı. Diğer 3 epidemi döneminde izole edilen suşların kendi içinde benzediği, ancak farklı epidemiler arasında anlamlı bir suş benzerliği olmadığı belirlendi. Özellikle 2009 yılındaki epidemi döneminde tüm suşların tek bir klonal kümede toplandığı, daha önce hasta örneklerinde izole edilmeyen yeni bir suşun tüm hastaneye yayıldığı saptandı.PFGE, ayrım gücü yüksek, tekrarlanabilirliği çok iyi, laboratuvarlar arası standardize edilebilen ve salgın sürveyansında güvenilir bilgiler sunan bir moleküler epidemiyolojik yöntem olarak değerlendirildi.Enterococci are highly resistant to environmental conditions, though they do not have the virulence factors in many bacterial species. In recent years, Enterococci have caused to take part between important etiologic agents at nosocomial infections since they have natural or acquired the resistance to various antibiotics.It is important of the early detection of patients colonized with these bacteria and the demonstration of relations with nosocomial epidemic in the control of vancomycin-resistant enterococci (VRE) infections. Molecular methods should be used to detect the clonal relationship between isolated VRE strains during epidemics of nosocomial. Pulsed Field Gel Electrophoresis (PFGE), is considered as golden standard method for demonstration of relationship between the epidemic strains and determining the source of the epidemic in the surveillance of nosocomial epidemic. In this study, it is aimed to detect clonal relationships of VRE strains isolated from the hospitalized patients by PFGE and arbitrarily primed PCR (AP-PCR) methods in terms of the epidemiology of hospital infections.Between January 2001 and December 2009, Enterococcus faecium was found to be the dominant species in all VRE isolated from hospitalized patients, which have rate of 98%. 83 strains of E. faecium were included in the study, which isolated from 5 different possible epidemic periods during 9 years. It was found that all strains have high-level glycopeptide resistance.Through PFGE method, it was determined that there was a significant similarity between many strains isolated from between 2001 and 2002 epidemics, this clone was maintained the existence for a long time and it had become the dominant in these two epidemics. It was also determined that the strains isolated in other 3 epidemic periods were similar to themselves, but there was no significant similarity to a strain between different epidemics. Especially during the 2009 epidemic period, it was found that all strains were collected in a single clonal cluster, the new strain which were not previously isolated from samples of patients was spread to all units of the hospital.It was evaluated that PFGE was a molecular epidemiological method which have high separation power, can be standardized between laboratories and provide reliable information on the epidemic surveillance

Evaluation of Portal Vein Doppler Findings in Patients with Crimean–Congo Hemorrhagic Fever

Background and objectives: In this study, we compare portal vein Doppler ultrasound (US) findings between patients with Crimean–Congo hemorrhagic fever (CCHF) and healthy persons and investigate the practicability of these findings in the prediction of disease severity. Materials and Methods: In this prospective study, portal vein Doppler US was performed in patients diagnosed with CCHF and healthy persons between March 2016 and May 2018. The patients were grouped according to mild-to-moderate and severe progression of CCHF. Liver size, portal vein diameter, portal vein flow rate, spleen volume, and splenic vein diameter were recorded in the patients and healthy controls. Results: Of the 48 patients diagnosed with CCHF, 25 were male. According to the scoring made, 38 patients were evaluated as having mild-to-moderate disease progression, and 10 were evaluated as having severe disease progression. With respect to the Doppler US findings, liver size, spleen volume, portal vein diameter, splenic vein diameter, and portal vein flow rate were significantly higher in the patient group compared with the controls. However, no significant difference was found in these parameters between the severe and mild-to-moderate progression groups. Conclusions: In the evaluation of and follow-up with patients with CCHF, portal vein Doppler US is a non-invasive and reliable tool for diagnosis

Molecular subtyping of vancomycin resistant enterococcus: A comparison of two molecular methods

Introduction: Arbitrarily Primed-Polymerase Chain Reaction (AP-PCR) and Pulsed-Field Gel Electrophoresis (PFGE) are widely used genotyping methods for investigating outbreaks of infections. The aim of this research is to compare AP-PCR with PFGE, which is known as the gold standard method, and to determine if AP-PCR is suitable for use in outbreaks.Materials and methods: Between 2001 and 2009, 664 isolated vancomycin resistant enterococcus (VRE) strains were determined at the Bacteriology Laboratory, Department of Medical Microbiology. During nine years study 5 peak periods were identified. In each peak period of 3 months, 83 VRE strains were selected from the 664 for this research. For all isolates a comparison of AP-PCR and PFGE using 83 VRE strains was performed.Results: Enterococcus faecium was found to be the dominant species in all VRE isolated from hospitalized patients. 83 strains of E. faecium were included in the study, which were isolated from 5 different possible epidemic periods over 9 years. 15 different clonal strains were collected using the AP-PCR method and 11 using PFGE.Conclusion: AP-PCR was found to be repeatable and had a better separation power than PFGE. FPGE though is a simpler, cheaper and faster method and can be used for VRE epidemics as an alternative method. In future epidemiological outbreaks the comparative molecular methods are more reliable than a single method.Sağlık Bakanlığı. Halk Sağlığı Genel Müdürlüğ

Evaluation of Laboratory, Clinical and Treatment Results in Patients with Uncomplicated Brucellosis

Introduction: Brucellosis is a zoonotic infectious disease endemic in our country and affects all systems. We aimed to evaluate clinical, laboratory findings and treatment outcomes of uncomplicated brucellosis in our study