Surveillance and impact of occult hepatitis B virus, SEN virus, and torque teno virus in Egyptian hemodialysis patients with chronic hepatitis C virus infection.

OBJECTIVES: Egypt ranks first regarding the prevalence of hepatitis C virus (HCV) infection. Many patients have concomitant diseases like kidney disorders requiring hemodialysis, a procedure carrying the hazard of transmitting other hepatitis viruses. The purpose of this study was to investigate for occult hepatitis B virus (HBV), SEN virus (SENV), and torque teno virus (TTV) among chronic HCV patients on maintenance hemodialysis to identify their impacts. METHODS: A total of 325 hemodialysis patients were enrolled and divided into two groups based on HCV RNA testing results. Blood samples were collected before hemodialysis. Sera were tested for hepatitis B core antibodies (anti-HBc) and hepatitis B surface antibodies (anti-HBs) using ELISA. HBV, SENV, and TTV DNA were detected by PCR. The serum alanine aminotransferase (ALT) level was measured. RESULTS: Anti-HBc and HBV DNA were detected in 73.1% and 50.8% of group 1 versus 36.4% and 22.6% of group 2. The serum ALT level was higher in group 1 than group 2. SENV was detected in 11.5% of group 1 versus 8.2% of group 2. TTV was detected in 29% of group 1 versus 27% of group 2. CONCLUSIONS: There is an increased prevalence of occult HBV in our locality among chronic HCV patients undergoing hemodialysis. The existence of SENV and TTV viremia has no clinical impact.

Changes in hepatitis C virus genotype distribution in chronic hepatitis C infection patients.

PURPOSE: Identification of hepatitis C virus (HCV) genotypes is very important in the selection of antiviral treatment, dose adjustment of antiviral agents, determining the treatment duration and following-up of treatment response. We aimed to determine the distribution pattern of HCV genotypes in chronic hepatitis C infection (CHC) patients. MATERIALS AND METHODS: We have included 106 CHC patients who were positive in the anti-HCV and HCV-RNA tests performed in our hospital during the 16-month period. Anti-HCV assays were performed on device using a chemiluminescent microparticle immunoassay, while HCV-RNA tests and HCV genotyping assays were performed by real-time polymerase chain reaction. RESULTS: Of the 106 cases; genotype 1b was detected in 67.0%, genotype 3 was detected in 16.0%, genotype 1a was detected in 14.2% and genotype 2 was detected in 2.8% patients. Genotypes 4, 5 and 6 were not detected in our study group. There were no statistically significant differences between the gender and age groups according to the HCV genotype distribution. The genotype 3 detection rate (16%) was the highest rate among the studies compared with the other studies in our country. CONCLUSIONS: Events that cause social changes such as war and immigration and intense commercial and touristic activities affect and alter the HCV genotype distribution in HCV-infected patients. For this reason, further multicentre studies are required reflecting all the regions in order to determine the genotype distribution in HCV-infected patients at regular intervals.

Risk factors for recurrences in patients with hepatitis C virus after achieving a sustained virological response: a multicentre study from Turkey.

In this study, we aimed to determine the late relapse rate in hepatitis C patients with sustained virological response after interferon-based regimens, and evaluated the predictors of late relapse while comparing the real-life data of our country with that of others. A multicenter retrospective study was performed to investigate the data of patients infected with HCV who obtained sustained virological response after classical or pegylated interferon alpha (PegIFNα) and ribavirin (RBV) for 48 weeks. Sustained virological response was based on negative HCV RNA level by PCR at the end of six months after the therapy. The information of patients enrolled in the study was retrieved from the hospital computer operating system and outpatient follow-up archives. We evaluated the age, gender, HCV RNA levels, HCV genotype, six-month and further follow-up of patients with sustained virologic response, presence of cirrhosis, steatosis and relapse. In all, 606 out of 629 chronic hepatitis C patients (mean age was 53±12 years; 57.6% of them were female) with sustained virological response were evaluated. We excluded 23 patients who relapsed within six months after the end of treatment (EOT). The mean follow-up period of the patients was 71 months (range: 6-136) after therapy. Late relapse rate was 1.8% (n=11) in all patients. Univariate Cox proportional hazard regression models identified that cirrhosis and steatosis were associated with the late relapse [(p = 0.027; Hazard Ratio (HR) 2.328; 95% confidence interval (CI): 1.309-80.418), (p = 0.021; HR 1.446; 95% CI: 1.243-14.510, respectively]. In multivariable Cox regression analysis, steatosis was the only independent risk factor for late relapse (p = 0.03; HR 3.953; 95% CI: 1.146-13.635). Although the late relapse rate was approximately 2% in our study, clinicians should consider that pretreatment steatosis may be an important risk factor for late relapse.

A Rare Ocular Manifestation of Adult Onset Still's Disease: Purtscher's-like Retinopathy.

Adult-onset Still's disease (AOSD) is a rare multisystemic immune-mediated disease of unknown etiology with quotidian spiking fever, evanescent rash, arthralgia, and multiple organ involvement. The few AOSD cases that have been reported developed Purtscher's-like retinopathy associated with thrombotic microangiopathy (TMA). Here, we report Purtscher's-like retinopathy without TMA in a patient with AOSD. A 29-year-old-man who presented for evaluation of blurred vision was diagnosed with AOSD based on Yamaguchi criteria. He had Purtscher's-like retinopathy in his right eye. Lesions improved after steroid treatment. Although almost all reported AOSD cases with Purtscher's-like retinopathy are associated with TMA, in this case such a complication was not encountered.

Epstein-Barr virus-associated haemophagocytic lymphohistiocytosis presenting with acute sensorineural hearing loss: a case report and review of the literature.

Epstein-Barr virus-associated haemophagocytic lymphohistiocytosis (EBV-HLH) is a life-threatening catastrophic and rarely seen complication of EBV infection especially in adults. While typical presentation of EBV infection is easily diagnosed as mononucleosis syndrome in teenagers and adults, some atypical clinical presentations may be challenged. We did not encounter any patient presenting with sudden sensorineural hearing loss associated with EBV infection in our English medical literature research (1966-2016). In this study, we report an adult patient who was complicated with EBV-HLH under high dose steroid therapy after diagnosis as sensorineural hearing loss. Our aim is to emphasise the atypical presentation of EBV infection and to discuss steroid therapy complication in sensorineural hearing loss that had been simply defined as idiopathic.

[Erratum: An unnoticed origin of fever: Periapical tooth abscess - Three case reports and literature review].

Erratum Following publication of the Original article An unnoticed origin of fever: Periapical tooth abscess - Three case reports and literature review (Infez. Med., volume 24, issue 1, pages 67-70, year 2016) We became aware that some authors were missing from the title page The correct list of the authors and affiliations is the following An unnoticed origin of fever: Periapical tooth abscess - Three case reports and literature review Ferhat Arslan1, Ergenekon Karagöz2, Mesut Yilmaz1, Ayse Batirel3, Birsen Yigit Arslan4, Nedim Ozer5, Nadir Alpay6, Ali Mert1 1Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital, Istanbul, Turkey 2Department of Infectious Diseases and Clinical Microbiology, Van Military Hospital, Van, Turkey 3Department of Infectious Diseases and Clinical Microbiology, Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey 4Department of Anesthesiology and Reanimation, Esenyurt State Hospital, Istanbul, Turkey 5Department of Dentistry, Istanbul Medipol University Hospital, Istanbul, Turkey 6Department of Internal Medicine, Istanbul Medipol University Hospital, Istanbul, Turkey.

Wartime infections and tragedies at the beginning of the 20th century in the Eastern part of Turkey.

In the early 20th century, Europe and the Ottoman Empire as a whole experienced a large number of epidemic diseases, and several wars. During World War I (WW1) a general mobilization of the medical services under Ottoman Empire rule was enacted. However, shortages of food and water, unfavourable weather and poor sanitary conditions resulted in numerous diseases at the battle fronts. Indeed, during the Ottoman-Russian war on the Eastern Front, the Turks suffered massive loss of life. This article therefore emphasises that during WW1, such loss of life in the Ottoman Army on the Eastern Front, which was one of the key fronts of the war, was mainly due to epidemic diseases rather than battles.

Clinical usefulness and performance of acoustic radiation force impulse in patients with chronic hepatitis B.

AIM: The aim of this study was to evaluate the performance of acoustic radiation force impulse (ARFI) compared with liver biopsy in quantifying fibrosis levels in patients with chronic hepatitis B (CHB). PATIENTS AND METHODS: The study was approved by the institutional review board at our hospital. One hundred CHB patients and 30 healthy controls (130 individuals) were included in the study. ARFI measurements were performed on all of these cases. CHB was diagnosed when serum hepatitis surface antigen was positive for more than 6 months and when persistent or intermittent elevations in alanine aminotransferase and aspartate aminotransferase levels and histopathological changes in liver biopsy were present. Liver biopsies were taken as a reference standard for 100 CHB patients. Liver biopsy samples were examined using the Ishak scoring system and compared with ARFI velocity values. RESULTS: Of the 130 participants, 107 (82.3%) were men and 23 (17.7%) were women. Thirty of these participants were healthy controls and their fibrotic score was evaluated as an Ishak fibrosis score of 0. A gradual increase in the mean velocity value was obtained for fibrosis scores F0-F6 (Ishak fibrosis score) in our study. A strong positive correlation was found between the mean velocity values and fibrosis scores of liver biopsy that were performed on liver segment 8. The area under the receiver operating characteristic curve was used to detect the best cutoff velocity values, and no or mild fibrosis (F≤2), significant fibrosis (F≥3), and severe fibrosis (F≥5) were calculated to be 0.95, 1.75, and 2.55 m/s, respectively. When a cutoff value of 1.75 m/s was used, ARFI had a sensitivity of 83% and a specificity of 98% in differentiating patients with fibrosis score F≤2 versus F≥3. CONCLUSION: ARFI elastography in patients with CHB can be considered an easy-to-use and accurate noninvasive tool to evaluate the severity of liver fibrosis.

A Comparative Study of the Effects of Intravitreal Anidulafungin, Voriconazole, and Amphotericin B in an Experimental Candida Endophthalmitis Model.

PURPOSE: To compare the safety and efficacy of intravitreal anidulafungin injection with voriconazole and amphotericin B (Amp B) in an experimental Candida endophthalmitis (CE) model. METHODS: Intravitreal 1 × 105 CFU/0.1 ml Candida albicans was injected into the right eyes of 24 New Zealand rabbits, which were divided into 4 groups. Voriconazole 50 µg/0.1 ml, Amp B 10 µg/0.1 ml, and Anidulafungin 50 µg/0.1 ml were injected by intravitreal injection 72 h after inoculation. The control group was injected with 0.1 ml 0.9% NaCl. Clinical scoring was performed by assessing the cornea, conjunctiva, iris, and vitreous on days 3 and 7 of therapy. At the end of the study, the right eyes of all rabbits were enucleated and histopathological evaluation was performed. Therapy groups were compared according to the clinical, histopathological, and microbiological analysis scores. RESULTS: Total clinical scores were significantly different between treatment groups and the control group (p < 0.05). On day 7 of the therapy, clinical scores of the anidulafungin group were found to be significantly lower when compared with the other therapy groups, while a significant improvement was observed in the eyes of rabbits in the anidulafungin group (p < 0.05). Also, microbiological scores of the anidulafungin group were lower than those of the control group (p < 0.05). Histopathological scores of the anidulafungin treatment group were significantly better than the voriconazole and control groups. Inflammation was evidently suppressed and marked retinal toxicity was not observed with anidulafungin. CONCLUSIONS: This is the first study comparing the efficacy of anidulafungin with other antifungal agents. In this CE model, an intravitreal single dose of anidulafungin was shown to be noninferior to voriconazole and Amp B. As an alternative to Amp B or voriconazole, intravitreal anidulafungin is suggested as an effective antifungal agent for the treatment of CE.

Comparison of the Elecsys HBsAg II Assay and the Architect Assay for Quantification of hepatitis B surface antigen in patients with chronic hepatitis B.

Quantitative hepatitis B surface antigen (HBsAg) is a valuable tool in hepatitis B virus (HBV) disease diagnosis and management for evaluating the effectiveness of antiviral therapy. The aim of the current research was to compare the performances of the Elecsys HBsAg II and Abbott Architect HBsAg assays in chronic hepatitis B (CHB) patients. Between May 2014 and December 2014, 72 CHBs were tested using Abbott Architect HBsAg QT and Roche Elecsys HBsAg II assay. After transformation to log (10) IU/mL, the results of the two assays were compared using the interclass correlation test, the Pearson correlation test and Bland-Altman analyses. We also analyzed all the parameters in on-treatment patients and naive patients with Pearson correlation test. There was a significant overall correlation between the Elecsys and Architect assays. We also analyzed all the parameters in naive and on-treatment patients. There was a significantly good correlation between the two assays in untreated patients and on-treatment patients. In this study, there was a significant correlation between the results of the Elecsys HBsAg II and Abbott Architect HBsAg assays in the overall and naive/on-treatment CHB patients. Additionally, we found that mean HBsAg levels resulting from the Architect assay were higher than those obtained by Elecsys assay.

Distribution of Parasites Detected in Stool Samples of Patients Admitted to Our Parasitology Laboratory during a Three-Year Period between 2012 and 2014.

OBJECTIVE: Parasitic diseases are among the major public health issues worldwide. A number of tests are available for diagnosis, but the sentivity and specifity of these tests are assumed to be insufficient. Nevertheless, the most common diagnostic method is microscopic examination. In this study, we aimed to introduce the distribution of parasites detected in stool samples of patients admitted to our laboratory on the basis of parameters such as, age, and gender during a 3-year period between 2012 and 2014. METHODS: In total, 6757 stool samples were included in the study. After macroscopic examination, wet mounts of all samples were examined under a light microscope using ×100 and ×400 magnification lenses. Wet mounts were prepared with physiological saline and Lugol's iodine. RESULTS: Parasites were detected in 3.7% (252) of the samples, while no parasites were detected in 96.3% (6505) of the samples. The distribution of intestinal parasites was as follows: Blastocystis hominis (63.5%), Giardia intestinalis (26.2%), Taenia sp. (4.8%), Enterobius vermicularis (2.4%), Entamoeba histolytica/dispar (1.6%), and Hymenolepis nana (1.6%). CONCLUSION: When the burden of intestinal parasites on public health is considered, they are still a major health issue in Turkey. The frequency of parasitic diseases can be reduced by the education of individuals and implementation of effective diagnostic methods, treatments, and preventive measures.

Tick-related facial cellulitis caused by Francisella tularensis.

Tick-borne illnesses have diverse biological and clinical features that make recognition and appropriate treatment challenging. Arthropod-transmitted (ticks, fleas and deer flies) tularaemia remains a concern worldwide. Generally, two kinds of tularaemia manifestations, namely ulceroglandular and glandular infections, can arise from the bite of an infected arthropod vector. If the ulceroglandular or glandular form is not treated, suppuration can arise from the gland. In addition, cellulitis is rarely observed around the ulcers. In our case, with the knowledge of tick exposure to the scalp, tularaemia was not initially considered for facial cellulitis without regional lymphadenopathy and also due to apparent failure to respond to doxycycline and gentamicin therapy. Serological confirmation in the late stages of the disease suggests the importance of clinical suspicion in such rare conditions.

An unnoticed origin of fever: periapical tooth abscess. Three case reports and literature review.

Dental infections may lead to severe local or systemic infections such as endocarditis, brain abscesses and mediastinitis. Fever may be the only symptom. We aim to highlight dental/odontogenic abscesses as the occult source of unexplained fever by reporting on three cases and reviewing the relevant literature. Early dental evaluation and referral of patients with persistent fever (even without any oral symptoms) to a dentist plays a critical role in preventing unnecessary, time-consuming and high-cost further diagnostic tests and invasive procedures. A simple panoramic dental radiography may suffice to establish the diagnosis.