Antiretroviral Theraphy: towards 2000

Antiretroviral theraphy is now approaching its 10-year anniversary. Zidovudine and other nucleoside analogues have been the cornerstone of this theraphy until recently. Now, protease inhibitors are the most promising agents and the antiretroviral theraphy in 2000s will be based on combinations of inhibitors of both reverse transcriptase and viral protease

Cyclospora cayetanensis in Two Immunocompetent Patients in Istanbul

Cyclospora cayetanensis is a frequently reported microorganism which causes diarrhea in both immunocompromised and immunocompetent patients. Despite new information on this emerging pathogen, significant gaps remain in our knowledge. There is a need to accurately diagnose and get information because the coccidian parasites are nearly never diagnosed, even upon the clinician’s request. Two immunocompetent patients with Cyclospora cayetanensis infections were presented and literatur was reviewed in this manuscript

A Therapeutic Approach to the Varicella-Zoster Virus Pneumonia: A Report of Two Cases

Varicella is an infection of childhood, caused by varicella-zoster virus. ›t is very rare in the adult, but more frequently complicated. We report two cases of varicella, complicated by pneumonia and review the treatment of VZV pneumonia in the literature. One of the cases was pregnant and we used acyclovir only in this case, not in the other. We observed clinical recovery in both cases. As seen in these cases, adult varicella cases should be investigated for complications, especially pneumonia. Each patient should be evaluated for antiviral theraphy

Nosocomial respiratory syncytial virus infections in three cases in a bone marrow transplantation unit

Bu raporda, hematolojik hastalığı nedeni ile erişkin kan kök hücre nakli (KKHN) ünitesinde yatmakta olan üç hastada solunum sinsityal virus (RSV) enfeksiyonunun yayılımı ve nakil sonrası sonuçlara etkisi sunulmaktadır. Hastalar, hazırlama rejiminin (yüksek doz kemoterapi) uygulanacağı aşamada tek kişilik HEPA filtreli odalarda tersine koruma önlemlerinin alındığı KKHN ünitesine yatırılmıştır. Birinci olgu, yüksek doz steroid içeren rejimlerin olduğu birden çok tedaviye dirençli ilerlemiş multipl miyeloma (MM)'sı olan ve sekonder akut miyeloid lösemi (AML) gelişmiş olan 62 yaşında bir erkek; ikinci olgu ikinci basamak tedavisi ile iyi yanıt elde edildiği halde yüksek doz kemoterapiyi takiben otolog kök hücre infüzyonu yapılan MM'lu 45 yaşında bir erkek; üçüncü olgu ise birden çok tedavi basamağına dirençli kalmış AML tanısı ile akraba dışı vericiden nakil yapılmış olan 52 yaşında bir erkek hastadır. Hastalardan alınan nazofaringeal aspirat sıvısı örneklerinde RSV varlığı, birinci hastada "in-house nested" polimeraz zincir reaksiyonu (PCR) ile, diğer hastalarda ise direk antijen tespiti (Monofluoscreen RSV-Biorad, Fransa) ile araştırılmıştır. Birinci olguda RSV enfeksiyonu kliniği, yüksek doz kemoterapi verildikten sonra KKHN'nin yapıldığı gün ortaya çıkmıştır. RSV-RNA pozitifliğinin saptanması sonucunda oral olarak ribavirin tedavisi başlanmış, engrafman gerçekleşmemiştir. Hastada ciddi solunum yetersizliği ile mekanik ventilasyon ihtiyacı ortaya çıkmış ve olgu kaybedilmiştir. Bu hastada RSV pozitifliğinin saptanması nedeniyle, ünitede yatmakta olan diğer beş hastada haftalık RSV taraması başlatılmıştır. Birinci olguyu takiben sırasıyla dokuz ve 17 gün sonra iki hastada da RSV pozitifliği saptanmıştır. İkinci RSV olgusunda solunum yolu enfeksiyonu kliniği ortaya çıkmış olmasına rağmen üçüncü RSV olgusu asemptomatik kalmıştır. Son iki olguya RSV taramasının ilk pozitif tespitini takiben hemen ribavirin başlanmış ve bu olgularda RSV enfeksiyonu düzelmiştir. Akraba dışı vericiden nakil yapılmış olan üçüncü olguda engrafman gelişmemiş ve ikinci KKHN yapılmıştır. Sonuç olarak KKHN yapılan hastalarda RSV enfeksiyonunun PCR ile erken tanısı, planlanmış immünosüpresif tedavinin ertelenmesi ve tedavi yaklaşımının belirlenmesine fırsat tanıyacaktır.Here we report the spread of respiratory syncytial virus (RSV) infection among three patients, who were hospitalized in an adult hematopoetic stem cell transplantation (HSCT) unit because of hematologic diseases, and effects of RSV infection on post-transplant outcome. The patients were placed into reverse isolation for administration of preparative regimens (high dose chemotherapy) in HSCT unit with high-energy particulate air (HEPA)-filtered single rooms. First case was a 62 years-old man with advanced multiple myeloma, which was refractory to multiple line treatment with high dose steroid including regimens and with secondary acute myelogenous leukaemia (AML); second case was a 45 years-old male patient with multiple myeloma, who had undergone autologous HSCT following high dose chemotherapy; third case was a 52 years-old man with AML that was refractory to multiple line treatment and had undergone allogeneic HSCT from a HLA-matched unrelated donor. Nasopharyngeal aspirate samples were collected from the patients in order to search for RSV positivity. RSV was investigated by in-house nested polymerase chain reaction (PCR) in the first patient and by direct antigen detection method (Monofluoscreen RSV-Biorad, France) in the others. First case had clinical picture of RSV infection just on the HSCT day when high dose chemotherapy has already been given. As RSV-RNA analysis yielded positive result, peroral ribavirin was initiated. Engraftment did not occur in this patient. He developed severe respiratory failure which necessitated mechanical ventilatory support, however, he has succumbed. After the detection of RSV positive index case, weekly screening of RSV in other five patients in the same unit had been performed. Following the first case, after nine and 17 days, respectively, RSV positivity was detected in two more patients. While clinical signs and symptoms of RSV infection developed in second case, third case remained asymptomatic. Both of the following patients had received ribavirin very early at first RSV positivity and recovered from RSV infection. Engraftment did not occur in the last patient who had undergone allogeneic HSCT from a HLA-matched unrelated donor and a second HSCT was performed. As a result, in HSCT patients, early diagnosis of RSV infection by PCR analysis may provide support to postpone immunosupressive treatment and help assesment of the management