A View of Isosporiosis with an Immunocompromised Patient

Because chronic diarrhea in patients infected with human immunodeficiency virus (HIV) results in a significant morbidity and mortality, the early detection and proper treatment of patients with AIDS and concomitant diarrhea is very important in preventing complications and prolonging a healthy life. Diarrhea due to Isospora belli is reviewed by evaluating a 29 year-old HIV infected patient diagnosed in our clinic. Isosporiasis should be suspected in HIV infected patients from tropical and subtropical countries with either acute or chronic watery diarrhea and weight loss

Hepatit C tedavisinde karşılaşılan telaprevir ilişkili DRESS sendromu

Kronik hepatit C tedavisinde telaprevir yüksek kalıcı viral yanıt ve kısa süreli tedavi özelliğiyle dikkat çekmektedir, ancak özellikle çeşitli cilt yan etkileri olmak üzere yeni yan etkilerle ilişkilidir. Biz telaprevir bazlı hepatit C tedavisi esnasında sistemik semptomlar ve eozinofilinin eşlik ettiği ilaç reaksiyonu gelişen 66 yaşında bir kadın hasta sunduk. Hastanın tüm antiviralleri kesildi ve destek tedavi verildi. Takibinde sistemik ve cilt bulguları düzeldi. Nadir olmasına rağmen telaprevir bazlı tedavi esnasında ciddi cilt reaksiyonları akılda tutulmalıdırIn chronic hepatitis C patients telaprevir attracts attention with high sustained virologic response and short term treatment however it is associated a new spectrum of adverse events, especially several cutaneous manifestations. We report a 66-year-old female patient developed drug reaction with eosinophilia and systemic symptoms during telaprevir based hepatitis C treatment. All antivirals were discontinued and she was treated with supportive care. Systemic and cutaneous symptoms resolved in follow-up. Although rare, clinicians should be aware of potentially severe cutaneous skin reactions during telaprevir -based therapy. J Microbiol Infect Dis 2015;5(1): 36-3

Toxoplasma encephalitis: an HIV/AIDS patient with cerebral mass

Toksoplazma ensefaliti CD4+ T lenfosit sayısı azalmış olan hastalarda, Toxoplasma gondii’nin latent halde bulunan doku kistlerinin reaktivasyonu ile ortaya çıkan fırsatçı bir enfeksiyondur. Toksoplazma ensefaliti, insan immün yetmezlik virüsü enfeksiyonu ve kazanılmış immün yetmezlik sendromu olan hastalarda, santral sinir sistemi tutulumunun başta gelen nedenlerindendir. Bu yazıda , ateş ve nörolojik bulgularla başvuran, radyolojik incelemeler sonucunda saptanan serebral kitlenin etiyolojisi araştırılırken immün yetmezlik virüsü enfeksiyonu tanısı konan ve antiretroviral ve antiprotozoal tedavi ile tam iyileşme sağlanan bir toksoplazma ensefaliti olgusu sunulmuştur.Toxoplasmic encephalitis is an opportunistic infection, which develops as a result of reactivation of the latent tissue cysts of Toxoplasma gondii in patients with reduced CD4+ T lymphocytes. Amongst patients with human immunodeficiency virus or acquired immunodeficiency syndrome, toxoplasmic encephalitis is one of the leading causes of the intracerebral involvement. In this report, we present a toxoplasmic encephalitis case, who has admitted with neurological symptoms and fever. The patient was identified human immunodeficiency virus positive while he was under investigation for cerebral mass lesion, The patient has fully recovered by antiprotozoal and antiretroviral therapy

Sudden respiratory failure and eosinophilic pneumonia in patients treated with daptomycin: a report of five cases

Daptomisin, dirençli gram pozitif enfeksiyonların tedavisinde kullanıma giren siklik lipopeptidlerin ilk üyesidir. Gram pozitif bakteriler ile oluşan ciddi enfeksiyonların tedavisinde iyi bir seçenek olabileceği çeşitli çalışmalarda gösterilmiştir. Eozinofilik pnömoni daptomisin kullanımı sırasında nadiren gelişebilir. Bu yazıda daptomisin ilişkili eozinofilik pnömoni düşünülen 5 olgu sunulmuştur. Hastalarda ani gelişen solunum yetmezliği, takipne, taşikardi görülmüş, bir olguda periferik eozinofili saptanmıştır. Destek tedavisi ve ilacın kesilmesiyle genellikle semptomlar kontrol altına alınmış, ancak bazı hastalarda steroid ve mekanik ventilasyon ihtiyacı olmuştur. Daptomisin kullanımı esnasında ani gelişen solunum yetmezliğinde eozinofilik pnömoni akılda tutulmalıdır.Daptomycin is the first member of cyclic lipopeptides came into use in the treatment of resistant gram-positive infections. It is shown to be a good option in the treatment of serious infections caused by gram-positive bacteria. Eosinophilic pneumonia may occur rarely during the use of daptomycin. In this paper we described 5 cases of daptomycin-associated eosinophilic pneumonia. Sudden onset of respiratory failure with tachypnea, tachycardia was observed, peripheral eosinophilia was detected in one patient. The symptoms usually resolved with supportive treatment and after discontinuation of the drug, but steroid treatment and mechanical ventilation was required in some patients. Eosinophilic pneumonia in the sudden onset of respiratory failure should be kept in mind during daptomycin treatment

Treatment approach in chronic hepatitis C infection

Amaç: Kliniğimizde kronik hepatit C nedeni ile izlenen hastaların tedavi sonuçlarının retrospektif olarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde 2003-2015 yılları arasında kronik hepatit C tanısı ile tedavi gören 109 hastanın tedavi sonuçları değerlendirildi. Bulgular: Hastaların %52.3'ü erkek, ortalama yaş 52.3, ortalama ALT değeri 58.3 IU/ml ve ortalama HCV-RNA düzeyi 3,7x106 IU/ml idi. Hastaların 47'sinde (%43) önceden tedavi öyküsü mevcuttu. Seksen bir hasta (%74,3) pegileinterferon ve ribavirin (PegIFN/R), 28 (%25.7) hasta ise pegileinterferon, ribavirin ve telaprevir (PegIFN/R/T) kombinasyonu aldı. Erken virolojik yanıt 109 hastanın 99'unda (%90.8) alındı. Erken virolojik yanıt alınan hastalarda erken virolojik yanıt alınmayan hastalara göre kalıcı viral yanıt anlamlı oranda yüksekti. Kalıcı viral yanıt PegIFN/R alanlarda %74.1 ve PegIFN/R/T alanlarda ise %76.9 idi. PegIFN/R/T alan tüm hastalarda döküntü, kaşıntı, tat bozukluğu ve anorektal ağrı yakınmalarından en az biri görüldü. Tüm hastalarda anemi en sık görülen hematolojik yan etkiydi. Hastaların %19'unda depresif yakınmalar izlendi. Sonuç: Ülkemizdeki tedavi seçenekleri ile kalıcı viral yanıt elde edilemeyen hastalar mevcuttur. Tedavi edemediğimiz genotip 1 ile enfekte hastalar için dünyada kullanılmakta olan ve başarılı sonuçlar veren yeni antivirallere ihtiyaç duyulmaktadır.Purpose: We aimed to evaluate retrospectively the results of treatment of patients with chronic hepatitis C in our clinic. Material and Methods: We evaluated the treatment results of 109 patients who treated with the diagnosis of chronic hepatitis C between the years of 2003-2015 in our clinic. Results: The 52.3% of the patients were male, the mean age was 52.3, mean ALT value 58.3 IU/ml and average HCV-RNA levels was 3,7x106 IU/ml. Previous treatment history in 47 patients (43%) was available. Eigthy-one patients (74.3%) received treatment of pegylated interferon and ribavirin and 28 patients(25.7%) received combination of pegylated interferon, ribavirin and telaprevir. Early virologic response were obtained in 99(90.8%) of 109 patients. Sustained virologic response was more higher in patients who achieved early virologic response. Sustained viralogic response in group of PegIFN/R was %74.1 and in group of PegIFN/R/T was 76.9%. At least one of complaints as rash, itching, taste disorder and anorectal pain were observed in PegIFN/R/T group. All patients had anemia as the most common hematologic side-effect. Depressive symptoms were observed in 19% of patients. Conclusion: With available treatment options in our country, patients who can not be achieved to SVR rates are available. There is a need for new antiviral drugs that used in the world for the patients infected with genotype 1 who had unsuccessful treatment

Effects of mannose-binding lectin and mannose-binding lectin polymorphisms on treatment response in patients with chronic hepatitis C

Background/Aims: The natural course and clinical outcome of hepatitis C virus (HCV) infection is related to the interaction between HCV and the immune response of the host. Only a limited number of studies have investigated the role of mannose-binding lectin (MBL) levels in HCV infection. The aim of the present study was to explore the relationship between MBL levels and gene polymorphisms on treatment response in patients with chronic hepatitis C (CHC).Materials and Methods: Serum MBL levels from 50 CHC patients who completed treatment at least 24 weeks before the present study and 75 healthy HCV-negative controls were measured. In addition, the presence of codon 54 mutations was investigated. Correlational analyses were performed to determine relationships between MBL levels and treatment response.Results: In patients, mean serum MBL levels were lower and the rate of codon 54 mutations was higher. However, these differences were not statically significant. In both patients and controls, serum MBL levels were significantly lower in individuals with codon 54 mutations. Moreover, serum MBL levels and the rate of the codon 54 mutation were similar in patients regardless of treatment response.Conclusion: Our findings suggest that low MBL levels do not increase the susceptibility for HCV infection. Furthermore, MBL levels were not found to have a significant effect on the course of the disease or treatment response.Background/Aims: The natural course and clinical outcome of hepatitis C virus (HCV) infection is related to the interaction between HCV and the immune response of the host. Only a limited number of studies have investigated the role of mannose-binding lectin (MBL) levels in HCV infection. The aim of the present study was to explore the relationship between MBL levels and gene polymorphisms on treatment response in patients with chronic hepatitis C (CHC).Materials and Methods: Serum MBL levels from 50 CHC patients who completed treatment at least 24 weeks before the present study and 75 healthy HCV-negative controls were measured. In addition, the presence of codon 54 mutations was investigated. Correlational analyses were performed to determine relationships between MBL levels and treatment response.Results: In patients, mean serum MBL levels were lower and the rate of codon 54 mutations was higher. However, these differences were not statically significant. In both patients and controls, serum MBL levels were significantly lower in individuals with codon 54 mutations. Moreover, serum MBL levels and the rate of the codon 54 mutation were similar in patients regardless of treatment response.Conclusion: Our findings suggest that low MBL levels do not increase the susceptibility for HCV infection. Furthermore, MBL levels were not found to have a significant effect on the course of the disease or treatment response

A Case of Adult Still’s Disease

Erişkin Still hastalığı (ESH); akut, inflamatuar, febril bir hastalıktır. Yüksek ateş, artralji, miyalji, art- rit, boğaz ağrısı, makülopapüler raş, lenfadenopati, hepatosplenomegali ve lökositoz belirgin kli- nik bulgulardır. Laboratuvar tetkiklerinde çok yüksek ferritin değerleri, en patognomik bulgudur. Tanı genellikle diğer hastalıklar dışlandıktan sonra Yamaguchi kriterleri kullanılarak konulur. Bu çalışmada nedeni bilinmeyen ateş (NBA) etiyolojisi araştırılmak üzere yatırılan ve ESH tanısı konan bir olgunun sunulması amaçlanmıştır.Adult-onset Still’s disease (AOSD) is an acute, inflammatory, febrile disorder. Its significant clinical findings are high fever, arthralgia, myalgia, arthritis, sore throat, maculopapular rash, lymphadenopathy, hepatosplenomegaly, and leukocytosis. The most pathognomonic laboratory test finding is very high ferritine levels. Diagnosis is usually made using Yamaguchi criteria after excluding other diseases. In this study, we aimed to present an AOSD case that was hospitalized to investigate the etiology of fever of unknown origin (FUO)

Mucormycosis: a 10-year experience at a tertiary care center in Turkey

Background/aim: Mucormycosis is a rare invasive fungal infection most commonly encountered in the immunocompromised host. We analyzed 51 adult patients treated for mucormycosis between 2003 and 2013 and recorded at a tertiary university hospital in Turkey. Materials and methods: We examined the following data for all patients: age, sex, predisposing disease, symptoms, treatment, surgical procedure, concomitant infections, intensive care requirement, and outcomes. Results: During the study period 51 cases of mucormycosis were documented; 54.9% of the patients were female. The mean age was 44.2 ± 18.2 years. Rhinocerebral presentation was reported in 94.1% of patients. Almost all patients (88.2%) had at least one risk factor. The common predisposing factors were hematologic malignancies (52.9%), diabetes mellitus (25.5%), and solid malignancies (5.8%). The most common initial symptoms were fever, cellulitis, and facial pain. The primary medication used was liposomal amphotericin B or conventional amphotericin B. Surgery was performed in 94.1% of patients. Mortality was 52.9%. Conclusion: Our study revealed that mucormycosis continues to be a mortal disease in about half of the cases. Our findings indicate that treatment with L-AMB is associated with a favorable response. Also, in the case of facial pain, the low mortality rate may indicate the importance of early diagnosis.Background/aim: Mucormycosis is a rare invasive fungal infection most commonly encountered in the immunocompromised host. We analyzed 51 adult patients treated for mucormycosis between 2003 and 2013 and recorded at a tertiary university hospital in Turkey. Materials and methods: We examined the following data for all patients: age, sex, predisposing disease, symptoms, treatment, surgical procedure, concomitant infections, intensive care requirement, and outcomes. Results: During the study period 51 cases of mucormycosis were documented; 54.9% of the patients were female. The mean age was 44.2 ± 18.2 years. Rhinocerebral presentation was reported in 94.1% of patients. Almost all patients (88.2%) had at least one risk factor. The common predisposing factors were hematologic malignancies (52.9%), diabetes mellitus (25.5%), and solid malignancies (5.8%). The most common initial symptoms were fever, cellulitis, and facial pain. The primary medication used was liposomal amphotericin B or conventional amphotericin B. Surgery was performed in 94.1% of patients. Mortality was 52.9%. Conclusion: Our study revealed that mucormycosis continues to be a mortal disease in about half of the cases. Our findings indicate that treatment with L-AMB is associated with a favorable response. Also, in the case of facial pain, the low mortality rate may indicate the importance of early diagnosis