Difficult Diagnosis Easy Treatment: Actinomycosis

Actinomycosis is a chronic, suppurative disease caused by gram-positive anaerobic bacteria from the Actinomycetaceae family. Actinomyces israelii is the most commonly encountered cause of actinomycosis. Other Actinomyces species responsible for actinomycosis are A. odontolyticus, A. meyeri, A. naeslundii, and A. viscosus. Based on the site of involvement, the four most common forms are cervicofascial, abdominal, thoracic and pelvic actinomycosis. Purulent matter, sputum, vaginal discharge, fistulae content or tissue biopsy specimens are generally used to diagnose actinomycosis. However, it is very difficult to identify Actinomyces in these samples due to other filamentous and anaerobic bacteria. In this study, we evaluated actinomycosis cases who were followed up in Ege University Infectious Diseases and Clinical Microbiology Clinic between 2011 and 2016, retrospectively. Cases were evaluated in terms of age, gender, form of application, symptoms, underlying diseases, location of infection, diagnosis, and treatment. Six patients [five women; mean age 52.16 ± 21.21 (min 20-max 83)] were included into this study. Two patients had pelvic, two had cervicofascial, one had skin involvement and one had pulmonary, skin and brain actinomycosis. As a result, actinomycosis is a rare and serious disease. Unless considered in differential diagnosis, appropriate treatment may be delayed. This cohort is one of the largest series reported in Turkey. Being aware of risk factors and clinical forms as well as being skeptical are important fordiagnosis and treatment

Candida dubliniensis Infectious: Retrospective Evaluation

Introduction: Candida dubliniensis is morphologically similar to C. albicans, but it can be an important yeast because of resistance to fluconazole. In this study, patients who had C. Dubliniensis infection were evaluated in terms of risk factors, underlying diseases, and responses to treatment. Patients and Methods: Fifteen patients identifi ed with C. dubliniensis as an infection factor in any microbiological sample were evaluated retrospectively between 2004-2013 in our hospital. Blood cultures of seven patients, respiratory samples of six patients with a high Candida score or consideration of invasive fungal infection, esophageal biopsyspecimen of a patient and urinec ulture of a patient were positive. The most frequent underlying diseases were malignancy, heart failure, and immunosupsession, respectively. Intensive care hospitalization, central venous and urinary catheter and total parenteral nutrition were found as risk factors as they are in other Candida infections. Fluconazole for seven patients, caspofungin for three patients, voriconazole for two patients, amphotericin B for two patients, and anidulafungin for one patient were given as antifungal treatment. Seven patients with severe underlying diseases died. Results: Blood cultures in seven patients, respiratory samples in six patients with a high candida score or consideration of invasive fungal infection, esophageal biopsy specimen in a patient and urine culture in a patient were positive. The most frequent underlying diseases were malignancy, heart failure, and immunosupsession. Intensive care hospitalization, central venous and urinary catheter, and total parenteral nutrition were found as risk factors similar to those in other candida infections risk factors. Fluconazole in seven patients, caspofungin in three patients, voriconazole in two patients, amphotericin B in two patients, and anidulafungin in one patient were given as antifungal therapy. Seven patients with severe underlying diseases died. Conclusion: This is the first report in our country, which evaluated patients infected with C. dubliniensis. C. dubliniensis can cause invasive infections in patients with underlying disease or risk factors and fl uconazole resistance andmortality should be kept in mind

Evalution of Risky Contacts in Terms of HBV in Health Personnel and the Prophylaxis Applied

Introduction: Despite global vaccination studies, healthcare personnel worldwide is infected with hepatitis B virus (HBV) during medical practices related to health care. In addition to insufficient infection control measures, healthcare personnel’s organizational and personal negligence related to HBV vaccination causes serious economic losses and threatens personal wellbeing, as well. This study aimed to analyze the data of health personnel for whom HBV hyperimmunoglobulin and vaccine were applied after they were exposed to HBV occupationally and to increase their responsiveness toward vaccine applications after their post-prophylaxis antibody levels were monitored. Materials and Methods: Healthcare personnel who were unimmunized to HBV and had occupational injury/exposure were screened retrospectively between January 2011 and November 2016 in terms of injury types and the efficacy of HBV hyper-immunoglobulin (10 IU/mL/kg) and vaccine (at 0.1 and 6 weeks). Results: In this study, 88 patients were included (39 female, 49 male; mean age (34.3 ± 9.1 years). Of these, 45 were nurses, one was a medical faculty student, and 42 were auxiliary healthcare workers. The hands of 76 personnel and the legs of two were injured by the injectors with unknown source; a contact had occurred in seven personnel as a result of percutaneous needlestick injury through an injector used in a patient who was diagnosed with chronic hepatitis B. In five personnel, mucosal contact occurred due to the fact that the blood of a patient who received HBV diagnosis was splashed to eyes. It was found that 83 of the 88 personnel were sensitive to HBV and five of them had insufficient antibody response (anti-HBsAg 10 IU/mL in all. Six-month antibody responses were not controlled in 20 personnel (32%) and anti-HBsAg levels of all personnel were found above the protective level. In one personnel, anti-HBs was negative at 6 months. Conclusion: Despite all the efforts of the Turkish Ministry of Health and Personnel Health Centers, the presence of personnel sensitive to HBV is worrisome. The fact that a few of health personnel can deal with their HBV antibody levels is another problem

Evaluation of Microbiological Culture Results of Peripheral Stem Cell Samples Collected Before Bone Marrow Transplantations

Microbiological follow up is a part of quality control in peripheral stem cell procedures. Bacterial contamination of peripheral blood hematopoietic cells collected for autologous bone marrow transplantation, is encountered sporadically. The aim of this study was to evaluate bacterial culture results of peripheral stem cell samples, collected before bone marrow transplantations between 01 January 1999 and 31 December 2006. The culture results were obtained from database of the bacteriology laboratory, retrospectively. There were bacterial growth in 151 (5.5%) of 2759 samples. Coagulase-negative staphylococci were the most commonly isolated microorganisms (66.2%). As a result, the positivity rate of the routine cultures of hematopoietic progenitor cells is low. Although bone marrow and peripheral blood progenitor cells are collected safely, better standards for monitorization of collection, proceesing, cryo-preservation, thawing and transplantation seem to be necessary

A Rare Cause of Bacteremia in a Neutropenic Fever Case: Achromobacter xylosoxidans

Achromobacter xylosoxidans is a gram-negative bacteria that may cause invasive infections in immunosuppressive patients. In this article the first A. xylosoxidans bacteremia case reported from Turkey, is presented

A Rare Agent in the Etiology of Complicated Skin and Soft Tissue Infection: Raoultella Planticola

Raoultella species are gram-negative, non-motile bacilli primarily considered to be environmental bacteria. R. planticola is a rare cause of human infections. Here in we report a case of complicated skin and soft tissue infection, necrotizing fasciitis with a rare etiologic agent R. planticola, treated with tigecycline. A 32-year-old male admitted to the emergency service with complaints of swelling in the neck, pain and a purulent wound on the mandible. He also had toothache for the last three weeks for which he was prescribed metronidazole and non-steroid anti-inflammatory drug by another doctor. He was internalized in the Plastic and Reconstructive Surgery clinic and debridement was performed and empirical antibiotic was started. Bacteriological culture revealed Acinetobacter baumannii and R. planticola. The case was successful treated with tigecycline. Necrotizing fasciitis may be fulminant and invasive in the diabetic host. To our knowledge this was the first R. planticola case treated successfully treated with tigecycline. In addition, it emphasizes once again the importance of bacteriological sampling in the management of necrotizing fasciitis and complicated soft tissue infection

Is Having Diabetic Foot Infection a Risk Factor for Hepatitis C?

Introduction: This study aimed to evaluate the prevalence of hepatitis C virus (HCV) in patients followed up with the diagnosis of diabetic foot infection (DFI) in the Department of Infectious Diseases and Clinical Microbiology of Ege University Faculty of Medicine between 2016-2023. Materials and Methods: Patients who were followed up with the diagnosis of DFI between 2016-2023 were investigated retrospectively for anti-HCV test positivity via electronic patient files. Demographic data, HCV-RNA test results, and treatment status of the patients with positive anti-HCV tests were recorded. The obtained data were entered into the Excel statistical analysis software. Statistical analysis was performed using the Chi-square test, and a p-value of <0.005 was considered significant. Results: A total of 660 diabetic foot infection patients were included in the study. The number of patients who were diagnosed with DFI and tested for anti-HCV was 361 (262 males, 99 females, mean age 63.7 ± 11.8 years). Anti-HCV positivity was present in eight patients, HCV-RNA was positive in four of these patients, and the HCV-RNA positivity rate was 4/361 (1.1%). In two patients with HCV-RNA positivity, sustained viral response was observed after treatment. Among those who tested positive, one patient remained on antiviral treatment. Antiviral treatment was planned for one patient who tested positive. It was determined that another patient with a positive test did not receive any treatment and did not come for follow-up, and this patient was contacted and his treatment started. It was found that the seroprevalence of HCV in our patient group with diabetic foot infection was eight out of 361 (2.2%). This rate was approximately 7.3 times higher than the risk observed in the general population. Conclusion: IIn order to achieve success in HCV elimination, risky groups must be screened and treated. Hepatitis C virus infection is a disease with a risk of parenteral transmission. Therefore, patients with diabetic foot infection (DFI) should be regarded as a high-risk group due to factors such as advanced age, frequent hospital admissions, history of multiple surgeries, frequent blood transfusions, parenteral treatment interventions, or procedures like hemodialysis. Consequently, it is recommended that this patient group undergo screening for HCV

Fourth Year Medical Students’ Level of Knowledge on Adult Immunization

Introduction: Health care workers have a higher risk of acquiring infections principally transmitted by blood and blood products than the normal population. Some of these infections are vaccine preventable diseases. Within this context, health care workers should be immunized against the vaccine-preventable diseases. This study was designed to evaluate the level of knowledge of medical students as future health professionals regarding adult immunization. Materials and Methods: In the 2012-2013 academic year, a questionnaire was conducted with the fourth year students of Ege University Medical School during their infectious diseases rotation. The questionnaire consisted questions on socio-demographics, resources of scientific information, and nine knowledge questions with a list of 20 infectious agents as choices. Correct answers (marking or unmarking each infectious agent) were based on international guidelines and each correct answer scored one point. The number of maximum possible scores for each question and each agent were calculated and each student’s number of correct answers were converted to percentages over these maximum scores. Results: A total of 238 students (58% male, mean age 22.3 ± 0.2) participated in the study with (82%) coverage. The students described their level of knowledge on adult immunization as 2.8% very bad, 21.9% bad, 60.9% moderate, 13.5% good, and 0.9% very good. Students had the highest scores for HPV, polio, Haemophilus influenzae type b, and rabies (91.9%, 85.5%, 84.5%, and 84.5% respectively) while they had the lowest scores for rubella, mumps, rubeola, and varicella (43.2%, 41.6%, and 24.1% respectively). Conclusion: Fourth year medical students’ level of knowledge on adult immunization is considered good. However, their level of knowledge about the vaccination program and vaccines for health care professionals are lower and need to be improved

Various Specialist Approaches for the Management of Candiduria: A Questionnaire Study

Introduction: Management of candiduria remains controversial, mainly due to uncertainties of clinicians about diagnosis and treatment. In this study, we aimed to investigate diagnostic and therapeutic approaches of different specialists for candiduria. Materials and Methods: An interview survey composed of 10 questions on candiduria was applied interactively to 429 randomly selected clinicians in six different tertiary care hospitals. We compared the answers of infectious diseases (ID) specialists with the others. Data were evaluated by Statistical package for Social Sciences version 11. In Independent samples, t-test and chi square test were performed for data analysis. Results: Out of the 429 participants, 91 (21.2%) were ID and 338 (78.8%) were specialists from other fi elds. For asymptomatic patients with candiduria, 213 (49.6%) participants stated that a second culture was required. Compared to others, a higher number of ID specialists [76 (83.5%)] asked for a second culture. It was determined that ID specialists joining this study, whose mean length of experience after specialization was longer than the others, encountered a signifi cantly higher number of candiduria cases and referred current guidelines to use frequently compared to others. Conclusion: Clinicians can treat candiduria largely, but have diffi culty in diagnosing. The fact that only 49.6% of all specialists included into the study order a second urine culture test shows that without differentiating colonization and contamination, half of them start therapies, which are likely to be unnecessary

Clinical Evaluation of Fifteen Cases of Hydatid Disease

Introduction: Hydatid disease is a zoonotic infection caused by the cestode Echinococcus spp. It is transmitted by ingestion of infectious cestode eggs, especially through dog feces. The two organs most commonly affected are the liver and the lung. In this paper, a series of 15 cases with symptomatic hydatid cysts hospitalized in our clinic and evaluated via consultations are presented. Materials and Methods: Patients, who were treated with hydatid disease between April 2006 and June 2015, were included in the study. Demographic characteristics, symptoms (fever, abdominal pain, pruritus, weakness, icterus, cough, sputum, nausea-vomiting), signs (hepatomegaly, splenomegaly), radiological-laboratory findings, complications, involvements of other body parts and treatment modalities were evaluated retrospectively. Results: Ten (66.7%) of the patients were female. The mean age of the patients was 52.3±18.3 year. Twelve (80%) patients had at least one cystic lesion in the liver. Four cases were complicated with a lung cyst, three with spondylodiscitis, three with splenic cyst, two with renal cyst, two with amoebic liver abscess, one with intraabdominal dissemination and one case was complicated with anaphylactic shock. Seven patients (46.7%) had leukocytosis and three (20%) had eosinophilia. All patients received treatment with albendazole p.o 2x400 mg tablets. The mean duration of treatment was 27.4±18.5 weeks. Conclusion: Hydatid cyst is an infectious disease that may cause severe organ involvement. Patients with hydatid cyst in any part of the body should be checked carefully for other system involvement, including the liver, abdominal and/or retroperitoneal organs