Molecular epidemiology of HIV-1 strains in the south-east and east of Turkey

OBJECTIVE: To detect the subtype characterization and drug-resistant mutations in HIV-1 strains after the refugee movement from Syria to Turkey between 2011 and 2014 in south east border lines. METHODS: A total of 65 patients were included in this study, of which 57 (88%) patients were antiretroviral therapy-naive patients. HIV-1 RNA was detected and quantified by real-time PCR assay. HIV-1 subtypes and circulating recombinant forms (CRFs) were identified by phylogenetic analysis (neighbor-joining method), and drug-resistant mutations were analyzed. RESULTS: Three major HIV groups were indicated. Two of these groups were located in subtype B. The other group showed heterogeneity. Subtype B (48/65, 73.8%), followed by CRFs (12/65, 18.5%) was the most common strain. Subtype of CRFs consisted of CRF01_AE (9/65, 13.8%) and CRF02_AG (3/65, 4.6%). Subtype C (1/65, 1.5%), sub-subtypes A1 (2/65, 3.1%) and F1 (2/65, 3.1%) were also detected with low prevalence. The rate of overall primary antiretroviral resistance was 4.9% (3/61). Drug-resistant rate for non-nucleoside reverse transcriptase inhibitors was 4.9%. The thymidine analogue mutation rate was 13.1% (8/61). CONCLUSIONS: HIV molecular epidemiology studies are necessary to determine transmission patterns and spread. Subtype B and CRF01_AE, CRF02_AG are the most prevalent strains in the south-east of Turkey. However, subtype C, sub-subtypes A1 and F1 are of low prevalence but persist in the south-east of Turkey. In the near future, changing of HIV epidemiology will be possible in Turkey due to migration movement in border lines and resistance testing will play an important role in HIV management.

Laboratory-acquired brucellosis

Laboratory-acquired infections are rarely diagnosed and reported. Brucella species are highly contagious when handled in the laboratory. Therefeore, brucellosis is one of the most common laboratory-acquired bacterial infections. Laboratory workers get infected by either inhalation or by direct contact through the injured skin. We present a case of laboratory-acquired brucellosis [LAB] caused by Brucella melitensis. In conclusion, despite the enforcement of infection control measures, including the use of biosafety cabinet in the laboratory, laboratory-acquired brucellosis still maintains its importance because of infected sample handling by the workers

diagnostic value of sinus-track cultures in secondary pediatric chronic osteomyelitis

To determine and compare the diagnosis value and accuracy of culture of material from a sinus track with culture of material from bone specimens. Retrospective study. Dicle University Medical School and Batman State Hospital, Turkey. Twenty-one patients with secondary chronic osteomyelitis [COM]. Material for cultures was taken from the sinus as well as the bone specimens. Surgery for COM. The diagnostic value of sinus track cultures. The mean age of patients was 8.5 +/- 3.8 years. 15 [71.4%] were male and six [28.6%] were female. Organisms isolates from bone cultures were Staphylococcus 71.4% [15 / 21], Pseudomonas aeruginosa 9.5% [2 /21], Escherichia coli 9.5% [2 / 21], Proteus mirabilis 4.8% [1 / 21], Klebsiella pneumoniae 4.8% [1 / 21], respectively. Cultures of sinus track material and bone specimens gave identical results in 47.6% of patients. This study shows that if treatment of COM was planned according to the microbiological analysis of material from the sinus-track, it may not result in recovery every time. We found approximately 48% concordance between sinus-track and bone cultures. In other words, antimicrobial therapy guided by antibiograms of bacteria isolated from sinus-track would be inappropriate in 52% of patients with COM and result in treatment failure

efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis

To evaluate the efficacy of dexamethasone added to the treatment of adult patients with bacterial meningitis in our region. One hundred and forty-four patients were randomized prospectively and evaluated to determine the efficacy of dexamethasone treatment in adult patients with acute bacterial meningitis at Dicle University Hospital, Diyarbakir, Turkey between January 2000 and December 2004. While the first group received ceftriaxone 4 gr/day plus dexamethasone, the second group received ceftriaxone 4 gr/day only Dexamethasone was given I 10-15 minutes before the first 8 mg dose of antibiotic treatment. It was continued at 16 mg/day for 3 days. The study included 144 patients with the diagnosis of acute bacterial meningitis. Cerebrospinal fluid [CSF] was analyzed at the time of admission, after 24-48 hours [Table 1], and at the end of treatment. Accordingly, CSF leukocyte level was found to be 1710 +/- 2140/mm3 in group 1 receiving dexamethasone treatment compared to 1950 +/- 2244/mm[3] in group 2 [p=0.001]. The consciousness in the group receiving dexamethasone improved significantly more rapidly than the control group [p=0.001]. While mortality was 9.7% in the patient group receiving dexamethasone it was 16.7% in the control group, however, it was not significant [p=0.093]. The use of dexamethasone in adult patients is still under debate, and the administration of dexamethasone 10-15 minutes before antibiotherapy to unconscious patients in a poor state of health, is effective in the clinical improvement of the patient

6-year prospective surveillance study for healthcare associated infections in a neurology unit

To assess the epidemiology of healthcare-associated infections [HAIs] in a neurology unit in a university hospital. The study was carried out prospectively at Dicle University Hospital, Diyarbakir, Turkey [1050-bed] between 1st January 1999 and 31st December 2004. Active surveillance for HAIs was performed by the infection control team, using the criteria proposed by the Centers for Diseases Control and Prevention [CDC] and National Nosocomial Infections Surveillance System [NNIS] methodology. During the 6-year follow up period, 219 HAIs episodes were detected in 203 patients out of 3323 in patients. The mean length of stay of patients with HAI was 28 +/- 5 days, while that of patients without infections was 11 +/- 1 days. Eighty-two patients died with HAIs, while 1330 died in the patients without infections. The overall incidence rates [HAI/100] and incidence densities [HAI/1000 days of stay] of HAIs were 6.6% and 4.4/1,000 patients-days. The most common HAIs by primary site were urinary tract infection [44.2%] and decubitus infection [30.4%]. The most prevalent microorganisms were Escherichia coli [27%], Klebsiella species [14%], Pseudomonas aeruginosa [13%], Enterobacter species [12%], coagulase-negative Staphylococci [10%] and Staphylococcus aureus [7%]. The results may contribute to observe the magnitude and characteristics of HAIs and to plan and evaluate policies and guidelines of infection control in neurology units

Multiresistant bacterial colonization due to increased nurse workload in a neurology intensive care unit

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcet's disease. This prospective study was carried out in the Behcet's Research Clinic in Shiraz [south-west Iran] and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed. Eighteen [15 males and 3 females] out of 690 Behcet's patients [2.6%, 95% CI = 1.4-3.8%] were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet's Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes. Neuro-Behcet's disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies

Characteristics of acute bacterial meningitis in Southeast Turkey.

BACKGROUND: Acute bacterial meningitis (ABM) remains a significant worldwide cause of death in adults. Even in the antibiotic era, the mortality rate in ABM remains significant and has been reported in the range of 8-40%. AIM: The aim of this study was to assess the characteristics of epidemiology, clinical manifestations, treatment modalities and outcome of patients with ABM in Southeast Turkey. SETTINGS AND DESIGN: This retrospective study included all cases of community-acquired ABM diagnosed and treated in Dicle University Hospital between June 1996 and December 2002. METHODS AND PATIENTS: The study group consisted of 186 adult patients (110 male, 76 female) with ABM, those patients who are older than 14 years, followed up at Dicle University Hospital from June 1996 to December 2002. Patients' charts were retrospectively reviewed, clinical characteristics were recorded and final data were analyzed. STATISTICAL ANALYSIS: In statistical analyses, the Chi-square test was used for binary variables and Student's t-test for continuous variables. RESULTS: The patients' mean age was 30.2 +/- 15.3 years (range 14 to 90 years). On admission, typical symptoms of meningitis were found in most of the patients: headache in 92.5%, fever in 88.2%, and nuchal rigidity in 80.1%. The main predisposing factor for ABM was otitis media (40 patients, 21.5%) and closed head trauma (12 patients, 6.5%). Streptococcus pneumonia was the most common identified pathogen. Twenty-nine patients (15.6%) died during hospitalization period. In multivariate analyses, the significant mortality factor was found as initial level of consciousness, low cerebrospinal fluid/blood glucose ratio, high erythrocyte sedimentation rate and initial treatment by penicillin G. CONCLUSIONS: Although still remains as a serious infection, early diagnosis and effective treatment may reduce fatal outcome and improve the course of the disease in patients with ABM. Ceftriaxone should be considered as the drug of choice for initial empirical therapy, while waiting culture results and vancomycin must be withheld for patients having increased risk of penicillin resistant pneumococci strains.

Acute Bacterial Meningitis as a Complication of Otitis Media and Related Mortality Factors

The aim of this study was to evaluate the characteristics of patients with acute bacterial meningitis (ABM) developed secondary to acute and chronic otitis media (OM). Between 1991 and 2001, among 269 adult patients with ABM, 56 who were secondary to OM were included in the study. We reviewed the charts of patients who were diagnosed as ABM following acute or chronic OM. Risk factors associated with mortality were determined by using a logistic regression model. The mean age of the patients, 38 male and 18 female, was 25.8 +/- 10.8 years (range 14 - 65). Forty-four of these cases (79%) have had chronic OM, of whom 19 (43% of the 44) have also had chronic mastoiditis and 12 (27% of the 44) acute OM. Twenty-three patients (41%) died, during either hospitalization or the follow-up period. Univariate analysis revealed comatose mental status on admission, inappropriate antibiotic treatment before admission, and elevated erythrocyte sedimentation rate (ESR) as significant risk factors for mortality. In multifactorial analysis, comatose mental status (OR=42.5, CI=6.4-280.1, p=0.001) and elevated ESR (OR=1.0, CI=1.01-1.07; p=0.005) remained as significant predictors for mortality. In conclusion, the primary sources of infection leading to the development of ABM should be investigated carefully to reduce the morbidity and mortality rates. It is hoped that this study will raise awareness among general practitioners and otolaryngologists concerning the role of ABM as one of the most important complications of OM.