Profiling infectious diseases in Turkey after the influx of 3.5 million Syrian refugees

Background

Since 2011, the conflict in Syria has led to over five million refugees. Turkey hosts the highest number of Syrian refugees in the world. By February 2019 over 3.6 million people had fled to Turkey to seek safety. Only 6.1% of Syrian refugees live in temporary shelters. Owing to the disrupted healthcare services, many children coming from the conflict zones are less likely to have received vaccination. In temporary shelters immunization coverage is >95% and the refugee population is receptive to vaccination.

Aims

The objective of this study was to review the infectious diseases situation among Syrian refugees in Turkey.

Sources

We have reviewed the reports and studies provided by the governmental and non-governmental organizations and obtained more detailed data from the Ministry of Health in Turkey.

Content

Between 2012 and 2016, 1 299 209 cases of respiratory tract infection and 158 058 episodes of diarrhoea with 59 bloody diarrhoeas were reported; 1354 hepatitis A cases and 108 active tuberculosis cases were detected and treated in the temporary shelters for Syrian refugees. Overall in Turkey, 7794 cutaneous leishmaniasis have been reported.

Implications

Since the influx of Syrian refugees, there has been an increase in cases of leishmaniasis and measles. No significant increase was detected for tuberculosis, other vector-borne infections, and healthcare associated or sexually transmitted infections. The Syrian refugees can be considered as a vulnerable group in Turkey due to their living and working conditions. Based on available data and our detailed analysis, the numbers show a stable situation regarding infectious diseases.

An unusual presentation of sirolimus associated cough in a renal transplant recipient

Sirolimus-associated pulmonary problems are rare but life threatening. Pulmonary problems due to sirolimus treatment are interstitial pneumonitis, bronchiolitis obliterans organizing pneumonia (BOOP), and alveolar hemorrhage. We present a case of sirolimus-related cough in the absence of any pulmonary radiological findings. A 55-year-old man with a history of 4 years of hemodialysis therapy because of end-stage renal disease of unknown etiology underwent cadaveric renal transplantation in June 2006. Three days following the initiation of sirolimus therapy he complained of dry cough and fever. There were no clinical or laboratory findings compatible with specific pulmonary disease. After switching sirolimus to tacrolimus, the cough improved within 1-2 days and resolved in 5 days. Sirolimus should be considered in the differential diagnosis of pulmonary problems in the early posttransplantation period even in the absence of radiological findings.

Soluble interleukin-2 receptor and interleukin-10 levels in patients with chronic hepatitis B infection

BACKGROUND/AIMS

In the current investigation, we evaluated patients with hepatitis B infection to determine whether serum soluble interleukin-2 receptor and interleukin-10 levels were changed and whether the degree of these changes in serum levels correlated with histologic severity of hepatitis related liver injury.

METHODOLOGY

25 patients diagnosed of chronic active B hepatitis, 25 asymptomatic hepatitis B carriers, 25 healthy people with antibody to hepatitis B surface antigen and 20 healthy people without any hepatitis marker positivity were included in the study. Serum interleukin-10 and soluble interleukin-2 receptor levels were measured. The association between liver pathology, HBV DNA, serum transaminase values and these parameters were researched.

RESULTS

Serum soluble interleukin-2 receptor and interleukin-10 levels were significantly higher in chronic hepatitis cases and asymptomatic carriers than that of others (P < 0.01). Serum interleukin-10 levels correlated with histological activity index and HBV DNA values (r = 0.7, P < 0.01) but not with soluble interleukin-2 receptor levels and transaminase values.

CONCLUSIONS

Our results support the observation that interleukin-10 and soluble interleukin-2 receptor may play an important role in the inappropriate regulation of immune response in patients with chronic hepatitis B virus infection and interleukin-10 may be responsible for chronicity.

Circulating ICAM-1 levels in bronchial asthma and the effect of inhaled corticosteroids

BACKGROUND

Even mild asthma has an inflammatory component. Intercellular adhesion molecule-1 (ICAM-1) plays an important role in inflammation. Higher levels of circulating ICAM-1 (cICAM-1) in sera may reflect the upregulation of ICAM-1 expression in allergic inflammation.

OBJECTIVE

The aim of this study was to assess cICAM-1 levels in children with atopic bronchial asthma and to determine the effects of inhaled glucocorticoids on cICAM-1 levels.

METHODS

The study group consisted of 25 children with moderate atopic bronchial asthma with a mean age of 9.9 +/- 4.2 years, and the control group consisted of 18 healthy children with a mean age of 9.6 +/- 2.6 years. Serum cICAM-1 levels and pulmonary function tests were measured. The patients were treated 2 months with inhaled budesonide 400 to 800 microg (mean 440 microg) per day. After this treatment, cICAM-1 levels and pulmonary function tests were compared with pretreatment levels. The pretreatment cICAM-1 values were compared with healthy control group.

RESULTS

The initial cICAM-1 levels of the patient group were significantly higher than the cICAM-1 levels of the control group (P = .001). The post-treatment cICAM-1 levels of the patient group were significantly lower than the pretreatment values (P = .007). Pulmonary function test results (FEV1, FEF25-75, and PEFR) rose significantly with the treatment in patients (P < .05).

CONCLUSION

This study revealed the presence of inflammation in children with even moderate atopic asthma as reflected with elevated levels of cICAM-1 levels, which decreased following corticosteroid treatment as a result of decreased inflammation.

The early effect of specific immunotherapy on lymphocyte response to PHA and allergens in atopic patients with allergic rhinitis

In the first part of this study, peripheral lymphocyte subpopulations and their proliferative response to PHA and allergens were investigated in the 30 patients with allergic rhinitis compared to 20 healthy non-atopic individuals. Data obtained employing a PHA-induced lymphoproliferative response assay revealed that the allergic rhinitis generated significantly less activity than did the normal control group. Significantly decreased ration of CD4+/CD8+ T cells was noted in the patients with allergic rhinitis. Mean values of stimulation indices by allergen extracts were higher in the patients sensitive to same antigen than others especially in concentration of 1000 SQU/ml. Stimulation of active lymphocytes revealed no statistically significant group differences between allergens. In the second part of the study, the early effect of immunotherapy on T cell subsets and lymphocyte proliferative response to PHA and allergens were examined in the peripheral blood lymphocytes of patients. A significant increase in PHA-induced and in allergen induced lymphoproliferative response were observed in all patients after sixth months of immunotherapy. It is concluded that there may be an association between allergic rhinitis and deficiency of circulating CD4+ cells but further studies are required to substantiate this hypothesis.

Hepatotoxicity of antituberculosis therapy (rifampicin, isoniazid and pyrazinamide) or viral hepatitis

SETTING

Department of Chest Diseases, Gazi University Faculty of Medicine and Atatürk Chest Diseases Hospital, Ankara, Turkey.

OBJECTIVE

The primary purpose of this study was to assess the contributory role of viral hepatitis in antituberculosis drug hepatotoxicity.

DESIGN

Serologic markers for viral hepatitis were studied in 57 patients who developed acute hepatitis during antituberculosis therapy with rifampicin and isoniazid.

RESULTS

Among 705 adult tuberculous patients, 57 (8.1%) developed acute hepatitis during therapy with rifampicin and isoniazid. Serologic markers confirmed the presence of hepatitis B in 6 (10.5%) and hepatitis C in 4 (7%) of the 57 patients. Acute hepatitis A was not diagnosed in any of the patients.

CONCLUSION

Hepatitis occurring during antituberculosis therapy may not be drug-induced in all patients. Apart from the other factors mentioned above the endemicity of viral hepatitis in developing countries could be responsible for the higher incidence of antituberculosis-drug hepatitis.

[Isolation of Gardnerella vaginalis from vaginal discharge specimens]

In this study specimens taken from 93 patients who admitted to outpatient clinics of SSK Ankara Gynaecology and Obstetrics Hospital with vaginal discharge were examined for G. vaginalis, T. vaginalis, C. albicans and N. gonorrhoeae. We evaluated the smell, pH, direct microscopic examinations, stained preparations and specific culture results of the discharges which were taken from posterior fornix. We isolated G. vaginalis from 13 patients (13.9%), T. vaginalis from 5 patients (5.3%) and C. albicans from 19 patients (20.4%). N. gonorrhoeae could not be isolated from any of the specimens. In our control study, we isolated G. vaginalis in three out of 50 patients (6%) without vaginal discharge. We observed T. vaginalis in specimens of 3 control patients. C. albicans and N. gonorrhoeae could not be isolated in this study in this study.

[Prevalence of hepatitis C virus antibodies in hospital personnel]

In this study, 416 hospital staffs from different departments and profession were screened for Hepatitis C virus (HCV) antibody by Enzyme Immune Assay method. Two hundred fifty blood bank donors were tested as a control group. Anti HCV positivity were found in four of hospital staffs (0.9%) and in four of donors (1.6%). According to our results, generally we didn't find any data about transmission of hepatitis C virus from hospital but it is interesting that all of the positive cases were from intensive care units.