Tularemia seroprevalence in humans in the region of the Hittite-Arzawa War (Inner Aegean Region), where the first biological weapon was used 3300 years ago.

BACKGROUND: : According to Egyptian records, tularemia emerged in the Canaan region, where it was first identified and spread to Anatolia over the Euphrates. It was used as an active biological weapon for the first time in the Hittite-Arzawa War in 1320-1318 BC. This study aimed to investigate the seroprevalence of tularemia in the Inner Aegean Region, which is thought to be the region where this war was fought 3300 years ago. METHODS: Tularemia seropositivity in humans was investigated in 27 villages/neighborhoods in 3 districts in each of Manisa, Kütahya, and Usak provinces. Before the study, the participants were informed about the disease via posters, and their blood samples were taken following filling out the questionnaire. Microagglutination tests were performed using in-house tularemia antigen and V plate for serological experiments. Rose-Bengal test was also performed on seropositive sera. RESULTS: Of the total of 410 people, 226 (55.12%) were male. The mean age of the volunteers was 43.72 years. The highest participation was from Kütahya Province. According to the results of the tularemia microagglutination test, seropositivity was detected in 6 cases. It was determined that all of the seropositive volunteers were in Kütahya. When the tularemia antibody titers were examined, seropositivity was determined at 1/20-1/160 titers. No positivity was detected in the Rose-Bengal test for cross-reaction. DISCUSSION: Kütahya has been identified as a risky region in terms of tularemia in the Inner Aegean Region. In order to use the resources in the country economically, first of all, the risk areas in terms of tularemia should be determined by serological studies in all regions. In order to increase awareness about the disease, physicians and filiation teams should be trained in risky areas. Surveillance studies should be conducted to identify and monitor possible sources in areas identified as risky.

Mortality predictors on the day of healthcare-associated Acinetobacter baumanni bacteremia in intensive care unit.

INTRODUCTION: Mortality of healthcare-associated Acinetobacter baumannii bacteremia can be 50-60% in intensive care units (ICUs). We aimed to determine the risk factors for 28-day mortality in patients with sepsis due to A. baumannii bacteremia during their ICU follow-up. METHODOLOGY: Demographic characteristics, disease severity scores on admission and bacteremia day (BD), resistance status, invasive interventions, and laboratory values showing the infection and severity of the BD, were compared between groups with and without mortality as a retrospective cohort study in the ICU of a tertiary hospital. RESULTS: Of a total of 2411 patients, there were 192 cases of bacteremia. After applying the exclusion criteria, 39 patients were recruited for the study, 25 of whom died (mortality rate 64.1%). Higher age, Simplified Acute Physiology Score II (SAPS II) on admission and high Sequential Organ Failure Assessment Score (SOFA), Red Blood Cell Distribution Width (RDW) (p < 0.001), and C-Reactive Protein (CRP) (p = 0.002) on the BD and invasive intervention in follow-up were associated with mortality. When CRP and RDW were both positive, sensitivity was 72%, specificity was 100%, negative predictive value was 33%, and positive predictive value was 100% for the 28-day mortality after BD. Based on multivariate analysis, CRP and RDW values on the BD were independent risk factors for mortality. CONCLUSIONS: It is critical to monitor SOFA, RDW, and CRP values in older ICU patients with SAPS II scores and who undergo invasive intervention in follow-up. Increases in these parameters may indicate bacteremia with high mortality due to A. baumannii.