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Gökengin D, Noori T, Alemany A, Bienkowski C, Liegon G, İnkaya AÇ, Carrillo J, Stary G, Knapp K, Mitja O, Molina JM. Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe. Lancet Reg Health Eur 2023; 34:100738. [PMID: 37927439 PMCID: PMC10625023 DOI: 10.1016/j.lanepe.2023.100738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.
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Affiliation(s)
- Deniz Gökengin
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkiye
- Ege University HIV/AIDS Practice and Research Center, Izmir, Turkiye
| | - Teymur Noori
- European Centre for Disease Prevention and Control STI, Blood-Borne Viruses and TB DPR, Stockholm, Sweden
| | - Andrea Alemany
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carlo Bienkowski
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Poland and Hospital for Infectious Diseases in Warsaw, Poland
| | - Geoffroy Liegon
- Section of Infectious Diseases and Global Health University of Chicago Medicine Chicago, Illinois, United States
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine Department of Infectious Diseases Ankara, Turkey
| | - Jorge Carrillo
- IrsiCaixa AIDS Research Institute, Campus Can Ruti, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBERINFEC, Instituto de Salud Carlos IIII, Madrid, Spain
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Katja Knapp
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Oriol Mitja
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jean-Michel Molina
- University of Paris Cité and Department of Infectious Diseases Saint-Louis and Lariboisiére Hospitals, APHP, Paris, France
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Hilmi Çekin A, Güner R, Çağkan İnkaya A, Oğuz D, Özdemir O, Fehmi Tabak Ö. Modeling the Health Economic Burden of Hepatitis C Virus Infection in Turkey: Cost-Effectiveness of Targeted Screening. Turk J Gastroenterol 2023; 34:1062-1070. [PMID: 37565793 PMCID: PMC10645295 DOI: 10.5152/tjg.2023.22749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/29/2022] [Indexed: 08/12/2023]
Abstract
BACKGROUND/AIMS In 2016, World Health Organization introduced global goals to eliminate hepatitis C virus by 2030. The aim of this study is to analyze the epidemiologic and economic burden of hepatitis C virus in Turkey and compare current practice (regular care) with a hypothetical active screening and treatment approach (active scenario). MATERIALS AND METHODS A Markov model was used to analyze and compare regular care with a scenario developed by experts including the screening and treatment of all acute and chronic hepatitis C virus infections between 2020 and 2050. General and targeted populations were focused. The model reflected the natural history of the disease, and the inputs were based on a literature review and expert opinions. Costs were provided by previous studies and national regulations. RESULTS The active scenario resulted in higher spending for all groups compared with regular care in the first year. Cumulative costs were equalized in the 8th, 12th, 13th, and 16th year and followed by cost-savings of 49.7 million, 1.1 billion, 288.6 million, and 883.4 million Turkish liras in 20 years for prisoners, refugees, people who inject drugs (PWID), and all population, respectively. In all groups, the mortality was found to be lower with the active scenario. In total, 62.8% and 50.6% of expected deaths with regular care in 5 and 20 years, respectively, were prevented with the active scenario. CONCLUSIONS An active screening and treatment approach for hepatitis C virus infection could be cost-effective for PWID, prisoners, and refugees. Almost two-thirds of deaths in regular care could be prevented in 5 years' time with this approach.
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Affiliation(s)
- Ayhan Hilmi Çekin
- Department of Gastroenterology, Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilek Oğuz
- Department of Gastroenterology, Güven Hospital, Ankara, Turkey
| | - Oktay Özdemir
- Department of Medical Education, İstanbul Health and Technology University, İstanbul, Turkey
| | - Ömer Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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Ayaz ÇM, Karakaplan ND, İnkaya AÇ, Çakır B, Ünal S, Zarakolu P. [Investigation of the Frequency of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in Men Living with HIV in Terms of Sociodemographic Characteristics and Behavioral Risk Factors]. MIKROBIYOL BUL 2023; 57:378-389. [PMID: 37462302 DOI: 10.5578/mb.20239931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
The aim of this study was to investigate the frequency of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in men living with HIV in terms of sociodemographic characteristics and behavioral risk factors. In this cross-sectional, single center study, all HIV-infected male patients, aged ≥ 18 years, including those being followed-up (n= 142) and the new admissions (n= 16) at Hacettepe University, Department of Infectious Diseases between March 1st, 2017 and May 1st, 2018 were included. After obtaining the informed consent form; age, follow-up days in STI-clinic, marital status, education, employment status; STI-related sign and symptoms, prior STI diagnosis, multiple sexual partners during the last year, exchanging sex for money, sexual orientation, drug use, condom use with regular and casual partner and also risk factors regarding partners were inquired as behavioural risk factors. A sample of first-voided urine of each participant was tested for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium by using nucleic acid amplification test (NAAT) (BD-MAX system, BD Diagnostics, USA) and BD MAX Mycoplasma-Ureaplasma-OSR for BioGX, (BD Diagnostics, The Netherlands). All participants living with HIV, men who have sex with men (MSM) and heterosexual men were grouped as STI-positive and STI-negative and compared. For all statistical analysis, SPSS 24 software was used. During the period of 14 months; the data was determined as follows: median follow-up time was 1138 (IQR= 159.5- 1494.5) days, median age was 35 (IQR= 28-42) years, 73.3% were single, 68.3% were at least college graduates or had higher educational attainment, 78.1% were currently employed. Of the participants, 26.9% reported STI-related sign and symptoms, 50.0% at least one STI episode in the past. Nine (5.6%) M.genitalium, five (3.1%) N.gonorrhoeae, and four (2.5%) C.trachomatis were detected in the urine samples of 17 (10.7%) individuals. N.gonorrhoeae and C.trachomatis were detected simultaneously in only one patient's urine sample. STI-positive patients (n= 17) were determined to be younger compared to STI-negative group [(p= 0.02; 27 years (IQR= 24-37) vs 35 years (IQR= 28-42)], had prominent STI-related signs and symptoms (p< 0.001) and had more multiple sexual partners (p= 0.03). The median CD4+ T lymphocyte count were relatively lower (p= 0.03) in STI-positive patients and plasma HIV RNA level was higher compared to the STI-negative participants (p= 0.05). STI-positive MSM group were younger [p= 0.01; 26 years (IQR= 23.5-29) vs 33 years, (IQR= 28-40)], STI-related signs and symptoms were more prominent (p= 0.02), the frequency of exchanging sex for money/drugs among their partners (p= 0.03) was higher compared to their STI-negative counterparts. Among STI-positive heterosexual patients, the presence of STI-related signs and symptoms (p= 0.04), drug use among their partners (p= 0.04) and plasma HIV RNA level (p<0.01) were significantly higher. STI was identified as an important health problem in this series of men living with HIV, 63.0% of whom had MSM and had a relatively high education level and socioeconomic status. Young age, having multiple partners, drug use, exchanging sex for money/drugs were prominent among the participants and their partners. Public health studies should focus on preventing STIs in young people living with HIV who have behavioral risk factors.
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Affiliation(s)
- Çağlayan Merve Ayaz
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | | | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Banu Çakır
- Hacettepe University Faculty of Medicine, Department of Public Health, Ankara, Türkiye
| | - Serhat Ünal
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Pınar Zarakolu
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
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Başaran NÇ, İdilman İ, Tokuçoğlu HA, Onur MR, Sönmezer MÇ, Özışık L, Karçaaltıncaba M, İnkaya AÇ, Ünal S. Detection of Non-Alcoholic Fatty Liver Disease with Non-invasive Tools in Turkish People Living with HIV and with Apparently Normal Liver Function. Curr HIV Res 2023; 21:192-201. [PMID: 37455457 DOI: 10.2174/1570162x21666230714122716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has become a significant cause of mortality and morbidity in people living with HIV. OBJECTIVE We aimed to investigate NAFLD presence by magnetic resonance imaging (MRI) methods, including MRI-derived proton density fat fraction (MRI-PDFF) and MRE, and ultrasound elastography among Turkish people living with HIV (PLWH), and identify factors correlated with fatty liver. METHODS We included 57 PLWH attending outpatient clinics on antiretroviral therapy (ART) for more than six months, without HBV/HCV co-infection, significant alcohol consumption, active opportunistic infection, previously diagnosed hepatobiliary disease, T2DM, and hyperlipidemia. We performed MRI, MRE, and US elastography on all participants. RESULTS The mean age of the participants (M/F, 47/10) was 41.7± 12 years. The median duration of HIV infection was 3 (0.5-19 years) years. The mean MRI-PDFF was 4.4 ± 3.8 %, and 11 had fatty liver. The mean MRE value was 2.27 ± 0.6 kPa, inflammation was present in 16, and 4 participants had values consistent with fibrosis. The mean US elastography of the study population was 4.1±2.4 kPa. The mean right and left CCA intima-media of the study population was 0.65± 0.23 mm and 0.66± 0.25 mm; 16 had increased intima-media thickness. In patients with fatty liver, a significant positive correlation was present between MRE and CCA intima-media thickness (rs=0.82, p:0.006 for MRE-left CCA; r=0.68, p=0.042 for MRE-right CCA). CONCLUSION We demonstrated that even a significant proportion of PLWH individuals with normal transaminase levels have fatty liver. Future prospective trials are warranted to understand and mitigate the risk factors, course of NAFLD, and accurate non-invasive tests, predicting fibrosis in people living with HIV.
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Affiliation(s)
- Nursel Çalık Başaran
- Division of General Internal Medicine, Internal Medicine Department, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - İlkay İdilman
- Department of Radiology, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Hayriye Altunay Tokuçoğlu
- Infectious Diseases and Clinical Microbiology Department, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Meliha Çağla Sönmezer
- Infectious Diseases and Clinical Microbiology Department, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Lale Özışık
- Division of General Internal Medicine, Internal Medicine Department, Medical Faculty, Hacettepe University, Ankara, Turkey
| | | | - Ahmet Çağkan İnkaya
- Infectious Diseases and Clinical Microbiology Department, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Serhat Ünal
- Infectious Diseases and Clinical Microbiology Department, Medical Faculty, Hacettepe University, Ankara, Turkey
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Canbaz H, İdiz UO, Cankar Dal H, Kaçıroğlu F, Taş S, Çubukçu HC, Beştemir A, Gülşen M, Polat İT, Laloğlu A, Tör İH, Akkurt HE, Ateş U, Reisli İ, Koç E, İnkaya AÇ, Karakükçü M, Ceylan M, Haznedaroğlu İC, Akın H. The Effectiveness of Mesenchymal Stem Cell Therapy on COVID-19 Patients at Intensive Care Unit: Case Control Study. Turk J Haematol 2022; 39:222-229. [DOI: 10.4274/tjh.galenos.2022.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Şahin EA, Mavi D, Kara E, Sönmezer MÇ, İnkaya AÇ, Ünal S. Integrase inhibitor-based regimens are related to favorable systemic inflammatory index and platecrit scores in people living with HIV (PLWH) up to 2 years. Postgrad Med 2022; 134:635-640. [PMID: 35671079 DOI: 10.1080/00325481.2022.2085931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Despite the advances in antiretroviral treatment (ART), persistent inflammation remained a challenge. We analyzed the inflammatory-score changes through 2-years in people living with HIV (PLWH) treated with different antiretroviral regimes. METHODS This study was conducted in Hacettepe University HIV/AIDS Treatment and Research Center. PLWH diagnosed between 2014 and 2020 were included. Inflammatory and metabolic markers (CD4/CD8 ratio, C-reactive protein (CRP), Systemic Inflammatory Index (SII), Neutrophil-Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV), Platecrite (PCT), and Low-Density Lipoprotein/High-Density Lipoprotein (LDL/HDL), Platelet-to-Lymphocyte Ratio (PLR) and ARTs were captured from database through 2-years from the diagnosis. The 2-year change (Δ) in markers was calculated and compared by ART type (backbone and 3rd agent). Mann-Whitney-U test and T-test were used for statistical analysis. RESULTS This study included 205 PLWH; 175 (85.4%) were male, and the mean age was 38.98 (±10.88) years. The number of PLWH with suppressed viremia (<40 HIV-RNA copies/ml) was 164 (80%) at the end of the second year. MPV increased significantly higher among PLWH receiving ABC/3TC compared to PLWH receiving TDF/FTC (p < 0.05). The CD4:CD8 ratio increased, and SII, NLR, LDL/HDL ratios decreased significantly among PLWH treated with integrase strand transfer inhibitors (INSTI) compared with protease inhibitors (PI) and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (p < 0.05). CONCLUSIONS Integrase inhibitor treatment is related to favorable inflammatory marker profile among PLWH in the 2-year follow-up. A favorable inflammatory profile may, in turn, contribute to the prevention of non-communicable diseases (NCD) among PLWH. This study showed that simple, easy-to-calculate markers could be implemented to define ongoing inflammation among PLWH under suppressive ART.
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Affiliation(s)
| | - Deniz Mavi
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emre Kara
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, Ankara, Turkey
| | - Meliha Çağla Sönmezer
- Faculty of Medicine, Department of Infectious Diseases, Hacettepe University, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Faculty of Medicine, Department of Infectious Diseases, Hacettepe University, Ankara, Turkey
| | - Serhat Ünal
- Faculty of Medicine, Department of Infectious Diseases, Hacettepe University, Ankara, Turkey
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Çalık Başaran N, Tan Ç, Özışık L, Özbek B, İnkaya AÇ, Alp Ş, Ersoy EO, Ayvaz DÇ, Tezcan İ. Evaluation of the peripheral blood T and B cell subsets and
IRF
‐7 variants in adult patients with severe influenza virus infection. Health Sci Rep 2022; 5:e492. [PMID: 35229048 PMCID: PMC8865064 DOI: 10.1002/hsr2.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/03/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022] Open
Abstract
Background and Aims Influenza virus is one of the leading infections causing death among human being. Despite known risks, primary immune deficiency due to Interferon Regulatory Factor‐7 (IRF7) gene defect was reported as a possible cause of the risk factors for complicated influenza. We aimed to investigate the changes in peripheral T and B cell subsets in adult patients with severe seasonal influenza virus infection and the investigation of variants of IRF7 gene. Methods In this study, 32 patients, hospitalized due to influenza infection‐related acute respiratory failure were included. Results The median age of the patients was 76 years (26‐96), and 13/32 (40.6%) were in the intensive care unit. Central memory Th, effector memory Th, TEMRA Th, cytotoxic T lymphocytes (CTL), central memory CTL of the patients were found to be increased, naive CTL were decreased. There was a significant increase in the percentage of effector memory Th, and a decrease in the percentage of naive CTL in patients ≥65 years‐old compared to patients <65 years old (P = .039, and P = .017, respectively). IRF7 gene analysis revealed two different nucleotide changes in three patients; c.535 A > G; p.Lys179Glu (K179E) and c584A > T; p.His195Leu (H195L), located in the fourth exon of the IRF7 gene. Discussion The increases in central and effector memory Th, central memory CTL and decrease of naive CTLs may be secondary to the virus infection. K179E (rs1061502) and H195L (rs139709725) variants were not reported to be related with susceptibility to an infection yet. It is conceivable to investigate for novel variants in other genes related to antiviral immunity.
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Affiliation(s)
- Nursel Çalık Başaran
- Faculty of Medicine, Department of Internal Medicine, General Internal Medicine Division Hacettepe University Ankara Turkey
| | - Çağman Tan
- Faculty of Medicine, İhsan Doğramacı Children's Hospital, Section of Pediatric Immunology Hacettepe University Ankara Turkey
| | - Lale Özışık
- Faculty of Medicine, Department of Internal Medicine, General Internal Medicine Division Hacettepe University Ankara Turkey
| | - Begüm Özbek
- Faculty of Medicine, İhsan Doğramacı Children's Hospital, Section of Pediatric Immunology Hacettepe University Ankara Turkey
| | - Ahmet Çağkan İnkaya
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology Hacettepe University Ankara Turkey
| | - Şehnaz Alp
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology Hacettepe University Ankara Turkey
| | - Ebru Ortaç Ersoy
- Faculty of Medicine, Department of Internal Medicine, Intensive Care Division Hacettepe University Ankara Turkey
| | - Deniz Çağdaş Ayvaz
- Faculty of Medicine, İhsan Doğramacı Children's Hospital, Section of Pediatric Immunology Hacettepe University Ankara Turkey
| | - İlhan Tezcan
- Faculty of Medicine, İhsan Doğramacı Children's Hospital, Section of Pediatric Immunology Hacettepe University Ankara Turkey
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Uyaroğlu OA, Şener YZ, Özdede M, Başaran NÇ, Özışık L, Şahin TK, Canpolat U, Çağkan İnkaya A, Yorgun H, Güven GS, Aytemir K. Evaluation of Corrected QT Intervals of 74 COVID19 Patients Treated with Hydroxychloroquine in Combination with or without Azithromycin and/or Favipiravir. Eur J Ther 2022. [DOI: 10.5152/eurjther.2021.21022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Oral H, Sönmezer MÇ, Yıldız AE, Hazırolan G, Metan G, İnkaya AÇ. Disseminated Brucella melitensis infection following canakinumab treatment. Travel Med Infect Dis 2021; 45:102227. [PMID: 34856407 DOI: 10.1016/j.tmaid.2021.102227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Hakan Oral
- Hacettepe University, Department of Internal Medicine, Ankara, Turkey
| | - Meliha Çağla Sönmezer
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | | | - Gülşen Hazırolan
- Hacettepe University, Department of Microbiology, Ankara, Turkey
| | - Gökhan Metan
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
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Sarohan AR, Kızıl M, İnkaya AÇ, Mahmud S, Akram M, Cen O. A novel hypothesis for COVID-19 pathogenesis: Retinol depletion and retinoid signaling disorder. Cell Signal 2021; 87:110121. [PMID: 34438017 PMCID: PMC8380544 DOI: 10.1016/j.cellsig.2021.110121] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 02/08/2023]
Abstract
The SARS-CoV-2 virus has caused a worldwide COVID-19 pandemic. In less than a year and a half, more than 200 million people have been infected and more than four million have died. Despite some improvement in the treatment strategies, no definitive treatment protocol has been developed. The pathogenesis of the disease has not been clearly elucidated yet. A clear understanding of its pathogenesis will help develop effective vaccines and drugs. The immunopathogenesis of COVID-19 is characteristic with acute respiratory distress syndrome and multiorgan involvement with impaired Type I interferon response and hyperinflammation. The destructive systemic effects of COVID-19 cannot be explained simply by the viral tropism through the ACE2 and TMPRSS2 receptors. In addition, the recently identified mutations cannot fully explain the defect in all cases of Type I interferon synthesis. We hypothesize that retinol depletion and resulting impaired retinoid signaling play a central role in the COVID-19 pathogenesis that is characteristic for dysregulated immune system, defect in Type I interferon synthesis, severe inflammatory process, and destructive systemic multiorgan involvement. Viral RNA recognition mechanism through RIG-I receptors can quickly consume a large amount of the body's retinoid reserve, which causes the retinol levels to fall below the normal serum levels. This causes retinoid insufficiency and impaired retinoid signaling, which leads to interruption in Type I interferon synthesis and an excessive inflammation. Therefore, reconstitution of the retinoid signaling may prove to be a valid strategy for management of COVID-19 as well for some other chronic, degenerative, inflammatory, and autoimmune diseases.
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Affiliation(s)
- Aziz Rodan Sarohan
- Department of Obstetrics and Gynecology, Medicina Plus Medical Center, 75. Yıl Mah., İstiklal Cad. 1305 Sk., No: 16 Sultangazi, İstanbul, Turkey.
| | - Murat Kızıl
- Department of Chemistry, Faculty of Science, Dicle University. Diyarbakır, Turkey
| | - Ahmet Çağkan İnkaya
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06230, Turkey
| | - Shokhan Mahmud
- Department of Pharmacognosy, College of Pharmacy, Hawler Medical University, Erbil, Kurdistan Region, Iraq
| | - Muhammad Akram
- Department of Eastern Medicine Government College, University Faisalabad, Pakistan
| | - Osman Cen
- Department of Microbiology and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America; Department of Natural Sciences and Engineering, John Wood College, Quincy, IL, United States of America
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İnkaya AÇ, Kara E, Başaran NÇ, Şahin TK, Uyaroğlu OA, Uzun Ö, Ünal S. Pretreatment serum uric acid level is not a surrogate marker for the outcome of favipiravir treatment in COVID-19 patients. Turk J Med Sci 2021; 51:2786-2788. [PMID: 34392669 DOI: 10.3906/sag-2102-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 08/15/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ahmet Çağkan İnkaya
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emre Kara
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Nursel Çalık Başaran
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Taha Koray Şahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Oğuz Abdullah Uyaroğlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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12
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Irmak İ, Damadoğlu E, Karadeniz Güven D, Hüseynova X, İnkaya AÇ, Er B, Sığ AK, Gülmez D, Arıkan-Akdağlı S, Ademhan Tural D, Doğru Ersöz D, Özçelik HU, Kiper EN, Kalyoncu AF. Clinical implications of fungal isolation from sputum in adult patients with cystic fibrosis. Turk J Med Sci 2021; 51:1191-1200. [PMID: 33433970 DOI: 10.3906/sag-2006-94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/12/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Cystic fibrosis is an autosomal recessive disease with a defect in mucociliary activity that is characterized by recurrent pulmonary infections. Bacterial agents frequently implicated in airway colonization are Haemophilus influenzae, Staphylococcus spp., and Pseudomonas spp. Fungal isolation from sputum is common in adults. However, growth of fungal agent only in sputum culture in patients with cystic fibrosis is insufficient for the diagnosis of fungal diseases. There is limited data about the clinical significance of fungal isolation in sputum cultures. The aim of the study was to investigate the clinical outcomes andsignificance of fungal isolation from sputum samples in adult CF. Materials and methods This retrospective study included patients who have been admitted between October 2017 and January 2019 in an adult cystic fibrosis unit. Patients were grouped according to fungal pathogenicity as; fungal disease group, colonization group, and nonisolated group. The data of the last one year, including demographics, clinical data, laboratory, treatment modalities, results of cultured bacteria and fungus from sputum samples, respiratory function parameters, frequency of exacerbation, and hospitalizationwere compared between groups. Results A total of 330 sputum samples from 88 adult patients with CF were collected. Patients were divided into 3 groups, the fungal disease group (n = 10, 11.4%), colonization group (n = 49, 55.7%), and nonisolated group (n = 29, 32.9%). Presence of pulmonary exacerbation, number of admissions to emergency department, and the number of positive cultures for bacteria from sputum were higher in the fungal disease group (p = 0.03, p = 0.01 and p < 0.001). The fungal disease group had higher rate of antibiotics by parenteral routethan other groups (p = 0.001) whereas lung functions were similar. Use of nutritional supplementation and parenteral antibiotherapy were the factors associated with elevated risk of fungal isolation. Conclusion Frequent use of parenteral antibiotics and use of nutritional supplementation were found to be independent risk factors for fungal isolation from sputum in adult CF.
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Affiliation(s)
- İlim Irmak
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Damadoğlu
- Department of Allergy and Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Damla Karadeniz Güven
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Xursud Hüseynova
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Berrin Er
- Medical Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Korhan Sığ
- Department of Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dolunay Gülmez
- Department of Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sevtap Arıkan-Akdağlı
- Department of Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Doğru Ersöz
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hayriye Uğur Özçelik
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emine Nural Kiper
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Department of Allergy and Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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13
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Kaya F, İnkaya AÇ, Aksoy S, Abbasoğlu O, Ertenli Aİ, Büyükaşık Y, Arıkan Akdağlı S, Akyön Y, Ergüven S. Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital. Turkiye Parazitol Derg 2021; 45:39-44. [PMID: 33685067 DOI: 10.4274/tpd.galenos.2020.6819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective Immunocompromised patients are at a greater risk of developing intestinal parasite infections. In this study, we examined the presence of Enterocytozoon bieneusi, Encaphalitozoon intestinalis and other intestinal protozoa in stool samples of immunosuppressed patients. Methods A total of 100 stool samples were obtained from patients receiving chemotherapy because of solid organ tumour with haematological malignancies and those receiving immunosuppressive treatment because of rheumatic diseases, organ transplant patients and patients receiving treatment for HIV-related infections. Stool samples were examined by using the native-lugol method in which the stool concentration, modified Kinyoun acid-fast and trichrome staining methods and parasite presence were analysed. The stool samples were also examined for the presence of Enterocytozoon bieneusi and Encephalitozoon intestinalis using an indirect fluorescent antibody method. Results Intestinal parasites were detected in 12% of all patients. The distribution of intestinal parasites in patients were 7% Blastocystis spp., 2% Blastocystis spp. + Dientamoeba fragilis, 1% Blastocystis spp. + Entamoeba coli, 1% Blastocystis spp. + Giardia intestinalis and 1% G. intestinalis. Microsporidia spp. were detected in 4% of all patients by the IFAT method and in 8% of all patients by calcoflour staining method. Conclusion In our study, the most prevalent parasite detected in the immunosuppressed patients was Blastocystis spp. The pathogenesis of Blastocystis spp. remains to be controversial, and their role in immunocompromised patients continues to remain unknown. Although these rates detected in our study are similar to the prevalence in the normal population, it is important to study these microorganisms in immunocompromised patients in terms of the associated decreasing morbidity and mortality rates.
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Affiliation(s)
- Filiz Kaya
- Ankara Training and Research Hospital, Clinic of Medical Microbiology, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Ankara, Turkey
| | - Sercan Aksoy
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Osman Abbasoğlu
- Hacettepe University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
| | - Ali İhsan Ertenli
- Hacettepe University Faculty of Medicine, Department of Internal Diseases Rheumatology Subdivision, Ankara, Turkey
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Internal Diseases Hematology Subdivision, Ankara, Turkey
| | - Sevtap Arıkan Akdağlı
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Yakut Akyön
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Sibel Ergüven
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
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14
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Özmen-Çapın BB, Gürsoy G, Tortop S, Jabrayilov J, İnkaya AÇ, Ergüven S. Cystoisospora belli infection in a renal transplant recipient: a case report and review of literature. J Infect Dev Ctries 2021; 15:599-602. [PMID: 33956664 DOI: 10.3855/jidc.12407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/19/2020] [Indexed: 10/31/2022] Open
Abstract
Cystoisospora belli is a coccidian parasite that causes prolonged watery diarrhea especially among immunocompromised patients. Herein, we report a renal transplant patient who complaints of alternating diarrhea and review of literature related to cystoisosporiasis amongst the transplant recipients.
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Affiliation(s)
- Büşra Betül Özmen-Çapın
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Gamze Gürsoy
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sema Tortop
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Jabrayil Jabrayilov
- Department of Internal Diseases, Nephrology Subdivision, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sibel Ergüven
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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15
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UyaroĞlu OA, BaŞaran NÇ, ÖziŞik L, Dİzman GT, EroĞlu İ, Şahİn TK, TaŞ Z, İnkaya AÇ, TanriÖver MD, Metan G, GÜven GS, Ünal S. Thirty-day readmission rate of COVID-19 patients discharged from a tertiary care university hospital in Turkey: an observational, single-center study. Int J Qual Health Care 2021; 33:5940459. [PMID: 33104780 PMCID: PMC7665548 DOI: 10.1093/intqhc/mzaa144] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background The 30-day readmission rate is an important indicator of patient safety and hospital’s quality performance. In this study, we aimed to find out the 30-day readmission rate of mild and moderate severity COVID-19 patients discharged from a tertiary care university hospital and to demonstrate the possible factors associated with readmission. Methods This is an observational, single-center study. Epidemiological and clinical data of patients who were hospitalized with a diagnosis of COVID-19 were retrieved from a research database where patient information was recorded prospectively. Readmission data was sought from the hospital information management system and National Health Record System to detect if the patients were readmitted to any hospital within 30 days of discharge. Adult patients (≥18 years-old) hospitalized in COVID-19 wards with a diagnosis of mild or moderate COVID-19 between March 20, 2020 (when the first case was admitted to our hospital), and April 26, 2020 were included. Results From March 26 to May 1, there were 154 mild or moderate severity (non-critical) COVID-19 patients discharged from COVID-19 wards, of which 11 (7.1%) were readmitted The median time of readmission was 8.1 days (IQR=5.2). Two patients (18.1%) were categorized to have mild disease and the remaining 9 (81.9%) as moderate disease. Two patients who were over 65 years of age and had metastatic cancers and hypertension developed sepsis and died in the hospital during the readmission episode. Malignancy (18.7% vs 2.1%, P = 0.04) and hypertension (45.5% vs 14%, P = 0.02) were more common in those who were readmitted. Conclusions This is one of the first studies to report on 30-day readmission rate of COVID-19 in the literature. More comprehensive studies are needed to reveal the causes and predictors of COVID-19 readmissions.
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Affiliation(s)
- Oğuz Abdullah UyaroĞlu
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Nursel Çalik BaŞaran
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Lale ÖziŞik
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Gülçİn Tellİ Dİzman
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - İmdat EroĞlu
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Taha Koray Şahİn
- Faculty of Medicine, Department of Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Zahİt TaŞ
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Ahmet Çağkan İnkaya
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Mıne Durusu TanriÖver
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Gökhan Metan
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Gülay Saİn GÜven
- Faculty of Medicine, Department of Internal Medicine, Section of General Internal Medicine, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
| | - Serhat Ünal
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sıhhiye, Ankara, 06430, Turkey
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16
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Jaiteh MB, İnkaya AÇ, Üner A, Elçin G, Ergüven S, Kurtulan O, Harxhi A, Akova M. Persistent dermal lesions in a patient with previous history of visceral leishmaniasis. Parasitol Int 2020; 80:102197. [PMID: 32920054 DOI: 10.1016/j.parint.2020.102197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/26/2022]
Abstract
Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) that most frequently occurs after an episode of VL caused by Leishmania donovani. In this case report, we present a 21-year-old male patient with persistent skin lesions and recurrent visceral leishmaniasis (VL) due to Leishmania infantum. The patient did not respond to multiple lines of anti-leishmanial treatment (including Liposomal amphotericin B and miltefosine) and later died from cerebral lesions presumed to be secondary to persistent VL.
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Affiliation(s)
- Muhammed B Jaiteh
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Ahmet Çağkan İnkaya
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ayşegül Üner
- Department of Medical Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gonca Elçin
- Department of Dermatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sibel Ergüven
- Parasitology Unit, Department of Medical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Olcay Kurtulan
- Department of Medical Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Arjan Harxhi
- Department of Infectious Disease and Dermatology, Faculty of Medicine, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
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17
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Karataş A, İnkaya AÇ, Demiroğlu H, Aksu S, Haziyev T, Çınar OE, Alp A, Uzun Ö, Sayınalp N, Göker H. Prolonged viral shedding in a lymphoma patient with COVID-19 infection receiving convalescent plasma. Transfus Apher Sci 2020; 59:102871. [PMID: 32694044 PMCID: PMC7333597 DOI: 10.1016/j.transci.2020.102871] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 01/01/2023]
Abstract
Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China; and spread all over the world. Reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 usually returns to negative in 20 days post-infection, but prolonged positivity has been reported up to 63 days. A case whose viral shedding lasted 60 days is reported from China. Herein we report a patient with a history of autologous stem cell transplantation (ASCT) for lymphoma whose RT-PCR test remained positive for SARS-CoV-2 for 74 days. The prolonged RT-PCR positivity, despite convalescent plasma infusion, may suggest that the given antibodies may be ineffective in terms of viral clearance. In patients with hematological malignancies or immunosuppression, such as ASCT, may lead to prolonged viral shedding, and strict isolation is warranted for long-term SARS-CoV-2 infection control.
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Affiliation(s)
- Ayşe Karataş
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Ankara, Turkey
| | - Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Ankara, Turkey
| | - Salih Aksu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Ankara, Turkey
| | - Tahmaz Haziyev
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Ankara, Turkey
| | - Olgu Erkin Çınar
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Ankara, Turkey
| | - Alpaslan Alp
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Ömrüm Uzun
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Ankara, Turkey
| | - Nilgün Sayınalp
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Ankara, Turkey
| | - Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Ankara, Turkey.
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18
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Çınar OE, Sayınalp B, Aladağ Karakulak E, Avşar Karataş A, Velet M, İnkaya AÇ, Ersoy Ortaç NE, Öcal S, Aksu S, Haznedaroğlu İC, Sayınalp N, Özcebe Oİ. Convalescent (immune) plasma treatment in a myelodysplastic COVID-19 patient with disseminated tuberculosis. Transfus Apher Sci 2020; 59:102821. [PMID: 32487513 PMCID: PMC7258803 DOI: 10.1016/j.transci.2020.102821] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022]
Abstract
During the ongoing COVID-19 pandemic due to the SARS-CoV-2 virus of which evidence-based medical paradigms cannot be easily applied; difficult clinical decisions shall be required particularly in the 'difficult-to-treat' cases of high risk group with associated comorbidities. Convalescent immune plasma therapy is a promising option as a sort of 'rescue' treatment in COVID-19 immune syndrome, where miraculous antiviral drugs are not available yet. In this report, we aim to convey our experience of multi-task treatment approach with convalescent immune plasma and anti-cytokine drug combination in a COVID-19 patient with extremely challenging comorbidities including active myeloid malignancy, disseminated tuberculosis and kidney failure.
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Affiliation(s)
- Olgu Erkin Çınar
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey.
| | - Başak Sayınalp
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Turkey
| | - Elifcan Aladağ Karakulak
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | - Ayşe Avşar Karataş
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | - Mustafa Velet
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Turkey
| | - Nazmiye Ebru Ersoy Ortaç
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Intensive Care Unit, Turkey
| | - Serpil Öcal
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Intensive Care Unit, Turkey
| | - Salih Aksu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | | | - Nilgün Sayınalp
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
| | - Osman İlhami Özcebe
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Hematology Unit, Turkey
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19
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Jaiteh MB, Çalık Başaran N, Özışık L, Akman O, Hasanlı N, Tortop S, Özmen Çapın BB, Hüseyinova S, Üner A, İnkaya AÇ. Visceral Leishmaniasis in A Patient Presenting with Fever of Unknown Origin: A Case Report From a Low-endemic Region of Turkey. Turkiye Parazitol Derg 2020; 43:210-212. [PMID: 31865658 DOI: 10.4274/tpd.galenos.2019.6362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Leishmaniasis is a neglected disease that is prevalent in tropical and subtropical regions of the world. Even though cutaneous leishmaniasis is the most common form, visceral leishmaniasis is associated with high mortality. The case presented herein is a 39 year-old bed-ridden female who presented with fever of unknown origin, tachypnea and pancytopenia. She was initially misdiagnosed as having autoimmune pancytopenia elsewhere and treated with corticosteroids and intravenous immunoglobulin. She had also received wide-spectrum antibiotics for febrile neutropenia. We performed a leishmania rK39 dipstick test which turned out to be positive along with visualisation of amastigote forms of leishmania on bone marrow biopsy. Thus, we made a diagnosis of visceral leishmaniasis and treated her with liposomal amphotericin B. Her clinical course was complicated by respiratory failure necessitating invasive mechanical ventilation. She responded well to treatment and was later extubated, shortly before being discharged. At 6 months of follow-up, no sign of recurrence was observed.
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Affiliation(s)
- Muhammed B. Jaiteh
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Nursel Çalık Başaran
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Lale Özışık
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Orkun Akman
- Hacettepe University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Nasib Hasanlı
- Hacettepe Univesity Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Sema Tortop
- Hacettepe University Faculty of Medicine, Department of Microbiology, Ankara, Turkey
| | | | - Sabine Hüseyinova
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Ayşegül Üner
- Hacettepe University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe Univesity Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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20
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Özmen Çapın BB, Sönmezer MÇ, Tortop S, Ünalan T, Bölek H, Altıntop SE, İnkaya AÇ, Metan G, Ergüven S. [The Importance of Awareness for Malaria Regarding Prophylaxis and Early Diagnosis: Two Imported Malaria Cases in Turkey]. MIKROBIYOL BUL 2019; 53:472-479. [PMID: 31709945 DOI: 10.5578/mb.68419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In spite of the fact that Plasmodium vivax is the leading causative agent of malaria in our country, imported malaria cases have been reported, recently. In this report, two malaria cases originated from sub-Saharan Africa, and their diagnostic and therapeutic approaches were aimed to be presented. First case, 45-year-old male, who has been working in Republic of Ghana, was admitted to Hacettepe University Hospitals Emergency Service with complaints of fever, sweating and shivering, after returning to Turkey. On admission, his general condition was fine and his physical examination revealed no pathological finding. After his admission, a fever episode occured and his blood tests revealed anemia, trombocytopenia and increased alkaline phosphatase level. Second case, 39-year-old-male admitted to the emergency service with the complaints of fever, shivering and myalgia. His physical examination revealed decreased breath sounds and splenomegaly, his laboratory tests resulted in pansitopenia and elevated liver enzymes. In the thick blood smears of the patients ring formed young trophozoites are detected and in the thin films multiple ring forms demonstrated in one erythrocyte with the absence of mature trophozoites and schizont forms, which were compatible with falciparum malaria. The rapid antigen test (Digamed, Belgium) of the second case found to be positive for both Plasmodium falciparum and P.vivax and this patient followed-up in intensive care unit due to his deterioration of general condition, respiratory distress, hematuria and change of consciousness. Neither cases were commenced on malaria prophylaxis. Both patients have been in countries which chloroquine resistance is commonly seen, they were treated with artemether/lumefantrine as current World Health Organization recommended. Targeting hypnozoites of P.vivax, primaquine was added to the therapy of the second patient. Both patients resulted in cure. In conclusion, while travelling to endemic countries, people should be informed about the importance of malaria prophylaxis and prophylaxis should be commenced immediately and continued appropriately. Additionally, malaria should always be considered in the differential diagnosis of high fever for the patients who admitted to the hospital with a travelling history to these countries.
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Affiliation(s)
- Büşra Betül Özmen Çapın
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Meliha Çağla Sönmezer
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Sema Tortop
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Tuğçe Ünalan
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Hatice Bölek
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Sabri Engin Altıntop
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Gökhan Metan
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Sibel Ergüven
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
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İnkaya AÇ, Örgül G, Halis N, Alp Ş, Kara A, Özyüncü Ö, Yurdakok M, Ünal S, Beksaç MS. Perinatal outcomes of twenty-five human immunodeficiency virus-infected pregnant women: Hacettepe University experience. J Turk Ger Gynecol Assoc 2019; 21:180-186. [PMID: 31564083 PMCID: PMC7495123 DOI: 10.4274/jtgga.galenos.2019.2019.0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate perinatal outcomes in human immunodeficiency virus (HIV) infected pregnant women in Turkey. Material and Methods: Maternal characteristics, pregnancy complications, laboratory findings including HIV load, CD4 cell count, CD4/CD8 ratio, neonatal features and final HIV status of the baby were retrospectively analyzed. Results: The sample included 26 singleton pregnancies, from 25 HIV-infected women. The ethnicities were Turkish (n=18), East European (n=4), Asian (n=2) and African (n=2). The majority (76.9%) was aware of their HIV status before becoming pregnant. Four cases (15.3%) were diagnosed during pregnancy and two (7.8%) at the onset of labor. The results for median HIV viral load, CD4 count, and CD4/CD8 ratio at birth were 20 copies/mL (0-34 587), 577/mm3 (115-977), and 0.7 (0.1-1.9), respectively. The HIV viral load rate was 5.5% in eighteen women taking anti-retroviral treatment. The rates of gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction, and preterm delivery were 3.8%, 3.8%, 7.6%, and 8% (numbers are 1;1;2;2), respectively. The mean gestational week at birth was 38 weeks and mean birthweight is 2972±329 g. Two babies were congenitally infected with HIV (infection rate of 8.3%). There was one needle-related accident during surgery. Conclusion: Timely diagnosis of HIV infection during pregnancy is important for preventing mother to child transmission. HIV infected women may give birth to HIV negative babies with the help of a multidisciplinary team, composed of perinatology, infectious diseases, and pediatrics specialists.
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Affiliation(s)
- Ahmet Çağkan İnkaya
- Department of Infection Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gökçen Örgül
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nurhayat Halis
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Şehnaz Alp
- Department of Infection Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ateş Kara
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özgür Özyüncü
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Yurdakok
- Department of Child Health and Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serhat Ünal
- Department of Infection Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M. Sinan Beksaç
- Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Zarakolu P, Çetik S, İnkaya AÇ, Ünal S. [Comparison of immunochromatographic (IC) and real-time polymerase chain reaction (Rt-PCR) tests for screening Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma spp. in HIV-infected men]. MIKROBIYOL BUL 2019; 53:37-42. [PMID: 30683037 DOI: 10.5578/mb.67694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laboratory testing is critical for sexually transmitted infections (STIs) as most of the infected people usually have no symptoms. It is known that having HIV and STI coinfection increases the risk of HIV transmission. Sensitive tests are required for the infection control. The aim of this study was to compare the 2 different diagnostic tests-an immunochromatographic (IC) test and a real-time polymerase chain reaction (Rt-PCR) assay-for screening Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma spp. and Mycoplasma spp. in HIV-infected men. The tests were evaluated in terms of sensitivity, specificity, rapidity, sample types and cost per test. Eighty HIV-infected adult men who were admitted to Hacettepe University Faculty of Medicine Hospital STIs Outpatient Clinic between October 2017-April 2018 were included in the study. Urine and urethral swab samples were collected from each patient. Urine samples were tested by BDMAX (Becton-Dickinson, Canada) assay, Chlamydia antigen cassette test (Monlab, Spain) and Mycoview test (Zeakon, France). Urethral swabs were tested by Gonorrhoeae cassette test (Monlab, Spain). In 18 (22.5%) of the 80 HIV-infected individuals, the presence of at least one of the four agents was detected by Rt-PCR method. A total of 23 agents were reported as one N.gonorrhoeae (1/80), two C.trachomatis (2/80), seven Mycoplasma spp. (7/80), 13 Ureaplasma spp. (13/80). In five (27.7%) patients, Ureaplasma spp. and Mycoplasma spp. were detected simultaneously. Twelve of 23 bacteria detected by Rt-PCR were also detected by IC tests; however, the remaining 11 bacteria (one N.gonorrhoeae, two C.trachomatis, four Ureaplasma spp., four Mycoplasma spp.) were not detected. When IC tests were compared to the gold standard test Rt-PCR, the sensitivity was 47.8% (11/23) and the positive-predictive value was 100% (11/11). Sixteen patients had STI-related signs and symptoms whereas 64 were asymptomatic. Only two of the 18 men with positive-Rt-PCR test results had STI-related symptoms. It was concluded that all individuals with risky behaviours should undergo STIs screening regardless of their symptoms. As obtaining urethral samples could create difficulty for the patients as well as for the physicians, using urine samples determined to be more convenient. In our study the sensitivity of IC tests found to be insufficiently low. It was concluded that in STI screening the use of Rt-PCR method, which has high sensitivity, specificity and ability to give results on the same day although a high cost test could be preferred on high risk groups such as HIV-infected individuals with no signs of infection.
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Affiliation(s)
- Pınar Zarakolu
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Sıla Çetik
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Serhat Ünal
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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23
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Kaya F, İnkaya AÇ, Maçin S, Akyön Y, Ergüven S. Refractory Giardiasis in an Immunosuppressed Patient in Turkey. J Infect Dev Ctries 2018; 12:204-207. [DOI: 10.3855/jidc.9669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/17/2018] [Indexed: 10/31/2022] Open
Abstract
Giardiasis is an infection of the small intestine caused by the protozoan parasite Giardia duodenalis. In immunocompetent patients the infection is usually self-limited and no treatment may be needed. Immunodeficiency, however, is a predisposing factor for the development of severe Giardia infection. In this report, a case of recurrent giardiasis refractory to nitroimidazoles and nitazoxanides presented. A 28-year-old male patient with hypogammaglobulinemia admitted to our hospital because of chronic diarrhoea. Microscopic examination of stool revealed a high number of Giardia trophozoites and cysts. Treatment with higher doses and a longer course of metronidazole, trimethoprim-sulfamethoxazole, ornidazole and albendazole failed. Administration of nitazoxanide, which has been reported to be effective against Giardia duodenalis refractory to nitroimidazoles, was commenced, but his symptoms persisted and stool samples demonstrated Giardia trophozoites and cysts again.
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24
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Doğan Ö, İnkaya AÇ, Gülmez D, Uzun Ö, Akova M, Arıkan Akdağlı S. [Evaluation of PNA-FISH method for direct identification of Candida species in blood culture samples and its potential impact on guidance of antifungal therapy]. MIKROBIYOL BUL 2017; 50:580-589. [PMID: 28124963 DOI: 10.5578/mb.27948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early antifungal therapy has a major influence on survival in candidemia. Rapid identification of the species has importance for the treatment, prediction of the species-specific primary resistance and variable antifungal susceptibility. Recently, molecular-based methods attempt to reduce the time between the positive signal of a blood culture and identification of the fungus. PNA-FISH (Peptide nucleic acid fluorescence in situ hybridization) assay distinguishes a number of frequently isolated Candida species in groups following the growth in blood culture. The aim of this study was to investigate the correlation of the species identified by PNA-FISH with conventional identification methods in yeast positive blood cultures and its influence on the selection of antifungal therapy. Specimens of adult patients diagnosed as yeast with Gram stain in signal-positive blood cultures between August to December 2013, were included in the study. The strains were concomitantly cultivated by subculturing from the blood culture bottles onto solid media and identified by conventional methods (germ tube test, ID32C and morphology on cornmeal Tween 80 agar). Rapid species identification was performed by Yeast Traffic Light PNA-FISH, which generates green flourescence for Candida albicans and Candida parapsilosis, yellow for Candida tropicalis, and red for Candida krusei and Candida glabrata. C.tropicalis was identified as a single species whereas the others were identified in pairs. The time points when the yeast positive blood culture bottle was received by the mycology laboratory and reporting of the species identification results by PNA-FISH and the conventional methods were recorded. Seven C.albicans, six C.glabrata, three C.parapsilosis, one C.tropicalis, one C.krusei, one Cryptococcus neoformans, one Saprochaete capitata (Blastoschizomyces capitatus), one C.albicans and Candida dubliniensis, one C.krusei and C.dubliniensis, and one C.glabrata and C.parapsilosis were identified by conventional methods in 23 specimens. Results of PNA-FISH and conventional methods were in full agreement in 19 of the 23 specimens (82.6%). Two specimens were negative by PNA-FISH and yielded S.capitata and C.neoformans which were not included in the test panel. In three specimens that were infected with multiple species, PNA-FISH detected only one of the species. On the other hand and in one specimen, PNA-FISH detected a second species (C.glabrata or C.krusei) that could not be isolated and identified conventionally. Species identification were obtained 72 hours (mean) earlier with PNA-FISH. PNA-FISH provided accurate species identification that were consistent with conventional methods. However and expectedly, it failed to detect species that were not included in the test panel. During the study period, 13 of the 23 patients have passed away. Apart from six patients died prior to blood culture positivity and the one that could not get any antifungal therapy during hospital stay, 16 patients received antifungal treatment. Of sixteen patients who received antifungal therapy, initial antifungal treatment was fluconazole for five and echinocandin for 10 patients. Fluconazole and amphotericin B combination was preferred for one patient. In this study, PNA-FISH result had an influence on the modification of the antifungal treatment of only for one patient in accordance with the clinical findings. We conclude that the utility of PNA-FISH method appeared to be limited in our center since the assay cannot differentiate C.albicans and C.parapsilosis, the two commonly isolated species among our candidemia isolates. However, advantages of the assay might be more pronounced for the centers where C.glabrata is a relatively more frequent species.
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Affiliation(s)
| | | | - Dolunay Gülmez
- Hacettepe University Medical School, Department of Medical Microbiology, Ankara, Turkey.
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25
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Abstract
Actinomyces spp. are located without displaying any pathogenic effect in the oral flora. However, the disruption of oral microenvironmental balance, mucosal tissue integrity, and defense system can cause microorganisms to settle on deep periodontal tissues and to induce pathologic reactions. The present case report describes erythematous and desquamative lesions with pseudomembrane limited to the gingiva. In the histopathologic examination, Actinomyces colonies were isolated from the gingiva. On the basis of histopathologic and laboratory findings, the lesions were diagnosed as Actinomyces- associated lesions of the gingiva. No condition that caused immuno suppression was present in the patient. Nevertheless, local effect of the chlorhexidine mouthwash usage for a period may induce irritation of the oral keratinized tissue. The localized form of actinomycotic lesions occurs seldom in the gingival tissues. In rare cases like this, the practice of differential diagnosis with a multi-disciplinary approach is very important for the accurate diagnosis and appropriate treatment planning.
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Affiliation(s)
- Buket Acar
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Feriha Çağlayan
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Ahmet Çağkan İnkaya
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Olcay Kurtulan
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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26
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Macin S, İnkaya AÇ, Tuncer Ö, Ünal S, Akyön Y. Infections related to Granulicatella adiacens: Report of two cases and review of literature. Indian J Med Microbiol 2017; 34:547-550. [PMID: 27934842 DOI: 10.4103/0255-0857.195377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Infections due to nutritionally variant streptococci are diagnosed rarely due to difficulties encountered during identification and isolation. Mortality rate in these infections is high therefore appropriate supplemented media and reliable detection systems should be implemented to isolate these fastidious organisms. Here, we describe two cases of Granulicatella adiacens infections. All microbiologic identifications were made with MALDI-TOF Vitek MS (BioMerieux, France), and the results confirmed by 16S ribotyping.
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Affiliation(s)
- S Macin
- Department of Medical Microbiology, Microbiology Laboratory, Şrnak State Hospital, Şırnak, Turkey
| | - A Ç İnkaya
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ö Tuncer
- Department of Medical Microbiology , Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - S Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Y Akyön
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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27
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İnkaya AÇ, Kaya F, Yıldız İ, Uzun Ö, Ergüven S. [Plasmodium falciparum malaria: evaluation of three imported cases]. MIKROBIYOL BUL 2016; 50:328-32. [PMID: 27175507 DOI: 10.5578/mb.23159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Among Plasmodium species the causative agent of malaria in Turkey is P.vivax, however the incidence of imported falciparum malaria cases is steadily increasing. P.falciparum may cause severe malaria with the involvement of central nervous system, acute renal failure, severe anemia or acute respiratory distress syndrome. Furhermore most of the casualties due to malaria are related with P.falciparum. There is recently, a considerable increase in malaria infections especially in tropical areas. In this report, three cases, who have admitted to our hospital with three different clinical presentations of falciparum malaria, and all shared common history of travelling to Africa were presented. First case was a 27 years old, male patient who returned from Malawi seven days ago where he stayed for two weeks. He admitted to our hospital with the complaints of sensation of cold, shivering and fever. In physical examination his body temperature was 37.9°C, C-reactive protein level was high, and the other systemic results were normal. The second case was a 25 years old, male patient who returned from Gambia two weeks ago. He was suffering from fever, headache, shivering and unable to maintain his balance. The patient's body temperature was 38°C. Laboratory tests revealed hyperbilirubinemia and thrombocytopenia. Parasitological examination of the Giemsa-stained peripheral blood smear of these two patients demonstrated ring forms compatible with P.falciparum. Treatment was commenced with arthemeter plus lumefantrine, resulting with complete cure. Third case was a 46 years old, male patient who had been working in Uganda, and returned to Turkey two weeks ago. He had sudden onset of fever, headache, nausea and vomiting and impaired consciousness. His peripheral blood smear revealed ring-formed trophozoites and banana-shaped gametocytes of P.falciparum. Arthemeter plus lumefantrine therapy was started, however, he developed severe thrombocytopenia and jaundice under treatment. His general condition was detoriated and the patient lost his consciousness. As the patient's clinical signs were compatible with sepsis ceftriaxone plus clindamycin were added to the antiparasitic treatment emprically. Due to the development of acute tubular necrosis, the patient have undergone hemodialysis. On the 9th day of therapy the complaints and laboratory findings of the patient have improved, so he was discharged. However, visual defects due to retinopathy and severe neurocognitive impairment that were thought to be the complications of malaria continued in his follow-ups. As a result, it should be keep in mind that both the African students who have come to our country for education from endemic regions and as well as the returned citizens of our country who have gone to work in endemic areas, are under risk of malaria and it is very important to consider malaria in the distinctive diagnosis of patients with the complaints of fever, headache, nausea, vomiting and muscle pain.
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Affiliation(s)
- Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
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Abstract
The first HIV/AIDS case has been reported in 1985 in Turkey, and since then 8238 cases have registered until June 2014 according to the records of Turkish Ministry of Health. The aim of this retrospective study was to evaluate the epidemiological data and clinical features of HIV/AIDS patients admitted to our center. A total of 255 HIV-infected patients admitted to our clinic between January 1986 and January 2013, whose data obtained from file records, were included in the study. Most of the patients were male (193/255, 75.6%) and Turkish citizens (216/255, 84.7%), with the mean age of 38.0 ± 11.6 (age range: 19-80) years. Approximately 25.4% (46/181) were university graduates. The most frequent route of transmission was through a heterosexual intercourse (161/255, 63.1%). In our study group, there were 34 men who had sex with men, and the majority of these cases (n= 26, 76.5%) were diagnosed in or after the year 2006, while 23.5% (n= 8) before 2006. This difference was found statistically significant (p< 0.05). The reasons that led patients for diagnosis were the presence of clinical symptoms such as diarrhea, lymphadenopathy and fever in 30.7%, and personal curiosity because of unprotected/risky sexual intercourse in 21.3% of the cases. Initial CD4(+) T lymphocyte counts could be reached for 237 cases, and the median value was calculated as 260 (range: 3-1183) cells/mm(3). Among these patients, CD4(+) T cell count was below 200/mm3 in 40.1% (95/237), and above 500/mm3 in 22.8% (54/237). The mean CD4(+) lymphocyte count on first admission was 240/mm(3) for those admitted before the year 2006 (n= 107) and 375/mm3 for those admitted after 2006 (n= 130) (p< 0.005). HIV-RNA loads could be reached for 203 cases on admission, and the median value was calculated as 67.200 copies/ml. Nearly half of the cases (91/203, 44.8%) had high viral load (≥ 100.000 copies/ml). The disease could be categorized in 246 cases, 54.1% were HIV-positive and 45.9% were in AIDS stage. Patients diagnosed after 2006 had lower rate of AIDS when compared to the patients diagnosed before 2006 (33.6% vs. 60.7%, respectively; p< 0.005). Two hundred patients were followed up more than three months (median: 41 months), and 138 patients (of them 79 were HIV-positive, and 59 were in AIDS stage) were still in follow up at the end of study period. Throughout the follow-up, 29 cases (29/255, 11.4%) had died. It was concluded that, the surveillance of data from HIV/AIDS patients would be beneficial to determine and predict the complications of the disease.
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Affiliation(s)
- Pamir Çerçi
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey.
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Adam M, Balcı M, Bayhan HA, İnkaya AÇ, Uyar M, Gürdal C. Conjunctival Flora in Diabetic and Nondiabetic Individuals. Turk J Ophthalmol 2015; 45:193-196. [PMID: 27800231 PMCID: PMC5082240 DOI: 10.4274/tjo.33230] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/29/2014] [Indexed: 02/06/2023] Open
Abstract
Objectives: To evaluate the conjunctival bacterial flora in diabetic patients and nondiabetic subjects. Materials and Methods: Fifty-three diabetic patients and 43 nondiabetic healthy individuals were included in the study. A specimen was taken from each participant for the study by rubbing a sterile cotton-tipped swab on the inferior palpebral conjunctiva of the right eye. Samples were incubated in blood agar, chocolate agar, eosin methylene-blue lactose sucrose agar and sabouraud 4% dextrose agar. Isolated microorganisms were identified using routine microbiological methods. Results: Rates for bacterial isolations were determined as 38.5% in diabetic patients and 34.9% in nondiabetic controls. Staphylococcus aureus was isolated in 30% of cases in the diabetic patient group, while 20% tested positive for Escherichia coli, 10% for coagulase-negative Staphylococcus, 10% for Klebsiella pneumoniae and 30% for multiple bacteria. In the non-diabetic group, 53.3% of patients were positive for Staphylococcus aureus while coagulase-negative Staphylococcus was isolated in 26.7%, Klebsiella pneumoniae in 6.7% and multiple bacteria in 13.3% of patients. Although there was no statistically significant difference in the number of isolated bacteria between the diabetic and nondiabetic groups, gram-negative bacterial colonization was significantly higher in diabetic patients (χ2=0.129, p=0.719 and χ2=5.60, p=0.018, respectively). Conclusion: Gram-negative bacteria are more common in the conjunctival flora of diabetic patients. This should be considered by clinicians when treating ocular infections in diabetic patients.
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Affiliation(s)
- Mehmet Adam
- Bozok University Faculty of Medicine, Department of Ophthalmology, Yozgat, Turkey
| | - Mehmet Balcı
- İzzet Baysal State Hospital, Clinic of Infectious Disease and Microbiology, Bolu, Turkey
| | - Hasan Ali Bayhan
- Bozok University Faculty of Medicine, Department of Ophthalmology, Yozgat, Turkey
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
| | - Mehmet Uyar
- Necmettin Erbakan University Faculty of Medicine, Department of Public Health, Konya, Turkey
| | - Canan Gürdal
- Bozok University Faculty of Medicine, Department of Ophthalmology, Yozgat, Turkey
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Demir NA, Kölgelier S, Demir LS, Özçimen S, İnkaya AÇ. Knowledge Level of Hepatitis B and its Prevalance in Policemen Working in Adiyaman. Electron J Gen Med 2015. [DOI: 10.15197/sabad.1.12.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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31
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Aktuğ Demir N, Çelik M, Kölgelier S, Sümer S, Aksöz S, Demir LS, İnkaya AÇ. [Comparison of the level of depression and anxiety in inactive hepatitis B carriers and chronic hepatitis B patients]. Turk Psikiyatri Derg 2013; 24:248-252. [PMID: 24310091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the relative contribution of chronic illness and the physical effects such illness on the mental status of chronic hepatitis B patients by comparing them to inactive hepatitis B carriers, based on Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) scores. MATERIALS AND METHODS The study included 444 participants: 249 HBsAg-positive inactive carriers (IC group) and 195 chronic hepatitis B patients (CH group) that were undergoing follow-up at Adiyaman University Research and Education Hospital, Department of Infectious Diseases Department. HBV carrier status and chronic hepatitis B were diagnosed based on European Association for the Study of Liver (EASL) guidelines. The HDRS and HARS were administered to all the participants via psychiatric interview. RESULTS The overall mean HDRS score was 6.2 ± 8 and the overall mean HARS score was 6.0 ± 7.1. Mean HDRS score in the IC group was 7.5 ± 5.8, versus 8.8 ± 6.6 in the CH group; the difference was significant (P = 0.037). Mean HARS score were similar in both groups (P > 0.05). There wasn't a difference in anxiety or depression scores based on participants'gender or age (P > 0.05). Additionally, there wasn't a correlation between duration of illness, and family history of hepatitis or cirrhosis, or anxiety or depression scores (P > 0.05). Anxiety scores were higher among the participants with comorbidity, in both CHB and IC groups (P= 0.005 and P = 0.001, respectively). Depression scores were higher among the IC group participants with comorbidity (P= 0.003). that can occur during the treatment and follow-up of chronic hepatitis patients. The presence of comorbidity in chronic hepatitis patients increases the risk of psychiatric complications. CONCLUSION Psychiatric comorbidity, particularly anxiety and depression, are important problems.
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