Alphavirus chikungunya is an arbovirus transmitted by Aedes mosquitoes and typically presents with acute-onset fever and severe polyarthralgia. In a subset of patients, joint symptoms may persist beyond the acute phase, leading to prolonged functional impairment. With increasing international travel, imported chikungunya infections have become an important consideration in non-endemic countries. In this report, we present a 58-year-old woman who was diagnosed with imported chikungunya infection after returning from Cuba, presenting with fever and widespread joint pain. On initial evaluation, C-reactive protein levels were markedly elevated, while procalcitonin levels remained within normal limits. The diagnosis was confirmed by demonstrating chikungunya virus-specific IgM positivity and IgG seroconversion in sequential serum samples. Viral RNA was not detected in molecular assays. Dengue, Zika, and other arboviral infections, as well as rheumatologic diseases, were excluded during the differential diagnosis. Despite treatment with antipyretics and non-steroidal anti-inflammatory drugs, the patient's joint pain persisted and significantly limited daily activities, necessitating opioid analgesics. Based on the persistence of symptoms beyond the acute phase but for less than three months, the clinical picture was consistent with subacute (post-acute) chikungunya-associated inflammatory arthralgia. Systemic corticosteroid therapy was initiated, resulting in partial clinical improvement. Disease-modifying antirheumatic drugs were not started, as the criteria for chronic chikungunya arthritis were not met. This case highlights the importance of considering chikungunya infection in travelers returning from endemic regions who present with fever and persistent arthralgia, even in the absence of rash. Early recognition and appropriate management during the subacute phase are crucial to improve patient outcomes and prevent progression to chronic disease.
Although hepatitis C virus (HCV) infection is a curable disease with effective treatments today, gaps in the diagnostic and treatment steps remain the biggest obstacle to elimination. This study aimed to analyze the care cascade of the patients detected as positive for anti-HCV, determine linkage-to-care rates for confirmatory testing (HCV-RNA) and treatment and evaluate the attainability of microelimination targets at the provincial level.This retrospective, cross-sectional study included individuals tested for anti-HCV across all healthcare institutions in Ordu province between January 1, 2021 and December 31, 2024. Data were obtained from the Provincial Directorate of Health and a tertiary referral center and cross-analyzed. Rates of confirmatory HCV-RNA testing, viremia, treatment initiation and lost to follow-up at each step of the cascade of care were evaluated. Over the four-year period, 225.218 individuals were screened (29.2% of the provincial population) and anti-HCV seroprevalence was found to be 0.55% (n= 1241). The majority of test requests were made by surgical departments (38%) and family medicine units (26%). It was determined that only 47.5% (n= 590) of anti-HCV positive patients underwent HCV-RNA confirmatory testing; the remaining 52.5% (n= 651) were lost to follow-up in the diagnostic process. Viremia was detected in 17.2% (n=102) of the patients who underwent HCV-RNA testing. It was found that 69.6% (n= 71) of viremic patients initiated treatment, while 15.7% (n= 16) could not access treatment despite receiving a diagnosis. This study presented a comprehensive, population-based province-level HCV care cascade for the first time in Türkiye. The results demonstrate that insufficient linkage-to-care, resulting in substantial loss to follow-up during diagnostic and treatment stages, represents the primary barrier to HCV elimination. To achieve World Health Organization 2030 goals, micro-elimination strategies such as reflex testing implementation, automated alerts integrated into hospital information systems and active recall of patients lost to follow-up must be implemented.
The rise in antibiotic-resistant microorganisms poses challenges in treating infectious diseases. It is known that Taraxacum officinale (dandelion) extracts have antimicrobial effects. This study aimed to investigate the antibacterial activities of different parts of T.officinale extracted through the Soxhlet device, against bacteria with various resistance patterns that cause hospital-acquired infections. The antibacterial effects of ethanolic and methanolic extracts were tested against Staphylococcus aureus, Enterococcus spp. (Enterococcus faecalis and Enterococcus faecium), Escherichia coli and Pseudomonas aeruginosa isolates obtained from clinical samples using disc and agar well diffusion methods. Besides, the total phenolic (TPC) and flavonoid contents (TFC) of the extracts, as well as their total antioxidant capacities (TAC), were evaluated in relation to their antibacterial activities. Mean inhibition zone diameters produced by extracts ranged between 6.0-8.0 mm in the disc diffusion method and 8.0-20.6 mm in the agar well diffusion method. Antibacterial activity was more pronounced particularly against S.aureus isolates. However, inhibition zone diameters against Enterococcus spp. isolates were found to be larger compared to those against other bacteria. Ethanolic and methanolic flower extracts had higher antibacterial activity on the isolates compared to leaf and root extracts. However, the TPC, TFC, and TAC values of ethanolic leaf extracts were higher than those of the other extracts, with values of 78.09 ± 1.13 mg GAE/g extract DW, 197.20 ± 6.22 mg QE/g extract DW, and 2.65 ± 0.03 µg AAE/mL extract, respectively.This study presents preliminary data on the antibacterial potential of herbal extracts against infections caused by resistant isolates.
In recent years, Streptococcus pyogenes infections have maintained their clinical and epidemiological significance in parallel with the reported increase in invasive group A streptococcal (iGAS) disease and scarlet fever cases. This study aimed to evaluate the coverage of emm typing using a real-time polymerase chain reaction (Rt-PCR) based method which can be used as an alternative to sequencing due to its rapid and cost-effective approach in a potential S.pyogenes outbreak. In addition, determination of emm type distribution was performed to provide updated local epidemiological data and to assess vaccine coverage of the study period. Between February 2024 and May 2024, 106 S.pyogenes isolates obtained from various clinical samples were subjected to emm typing using a quadriplex Rt-PCR kit designed according to the Centers for Disease Control and Prevention protocol and the presence of 20 commonly observed emm types was investigated. To validate the emm types identified by Rt-PCR, one isolate from each emm type and 31 isolates that could not be typed by Rt-PCR were subjected to sequence analysis. Antimicrobial susceptibility testing was performed using the disk diffusion method. While 81.1% of the patients belonged to the pediatric age group, 64.8% of iGAS infections were detected in adult patients. emm types were successfully identified by Rt-PCR in 70.8% of the S.pyogenes isolates. Sequencing results obtained for representative isolates were concordant with the corresponding Rt-PCR findings. With the inclusion of sequencing data, a total of 12 different emm types were identified, with emm3 being the predominant type, followed by emm2, emm6 and emm89. Among isolates with determined emm types, the coverage of the 30-valent vaccine was calculated as 100%. All isolates were susceptible to penicillin, whereas resistance rates of 12.3% to tetracycline, 2.8% to erythromycin and 1.9% to clindamycin were observed. In conclusion, Rt-PCR-based emm typing represents a reliable, rapid and feasible alternative for S.pyogenes in centers lacking sequencing facilities. It is anticipated that optimizing primer and probe designs to adequately cover S.pyogenes isolates circulating in the country may further improve the typing performance of Rt-PCR assays. Moreover, the development of a laboratory-based active surveillance system is essential to ensure the continuity of local epidemiological data.
Hypervirulent Klebsiella pneumoniae (hvKp) is a pathotype characterized by high virulence capacity and rapid dissemination, which has gained increasing importance in recent years. It can cause invasive infections with multi-organ involvement, such as liver abscess, necrotizing fasciitis, meningitis and endophthalmitis and represents a significant public health threat due to its high mortality rates. Although numerous studies have investigated its risk factors, trauma-associated cases are extremely rare and different hypotheses have been proposed regarding their pathophysiology. The most widely accepted mechanism suggests that trauma disrupts immune barriers, facilitating pathogen entry and promoting the development of invasive infections. In this report, a case of a 71-year-old male patient with a history of diabetes mellitus who developed a liver abscess and endogenous endophthalmitis following trauma was presented. Blood, vitreous and abscess specimen cultures yielded non-extended-spectrum beta-lactamase-producing K.pneumoniae isolatessusceptible to third-generation cephalosporins, which exhibited hypermucoviscous phenotype. Polymerase chain reaction analysis demonstrated that these isolates belonged to the K1 capsular type and harbored the aerobactin gene. Despite intravenous and intravitreal therapy, high fever persisted. Ultrasonographic examination of the abdomen revealed a hepatic abscess in the right lobe and percutaneous drainage was subsequently performed. Although clinical improvement was achieved, the patient developed persistent partial vision loss. In conclusion, trauma may serve as a portal of entry for hvKp infections and severe cases with multifocal involvement can lead to permanent complications despite early and appropriate treatment. Rapid diagnosis of hypervirulent infections and early investigation of potential metastatic foci are critical for reducing morbidity and mortality.
When visceral leishmaniasis occurs alongside human immunodeficiency virus (HIV) infection, the clinical picture is more severe and the diagnosis and treatment processes are more complex. This case study presents the clinical findings, diagnostic approaches and treatment process of a patient diagnosed with concurrent indigenous visceral leishmaniasis and HIV. A 60-year-old individual who had recently been diagnosed with HIV was admitted for further investigation due to persistent pancytopenia despite receiving antiretroviral therapy. Physical examination, laboratory tests and imaging revealed no findings other than hepatosplenomegaly and generalised lymphadenopathy. Investigations failed to reveal any evidence of common opportunistic infections or HIV-associated malignancies. Upon re-evaluation of the patient's history, it emerged that he lived in a village where there were sheepdogs nearby. Peripheral blood tests revealed positive results for Leishmania IFAT (1/1024), the rK39 rapid antigen test, the Giemsa-stained smear test and polymerase chain reaction (PCR) testing. Promastigote forms were observed in NNN medium and PCR testing identified the species as L.infantum/donovani. Primary treatment with liposomal amphotericin B was administered at a total dose of 50 mg, followed by secondary prophylaxis every four weeks. No clinical or laboratory findings suggestive of relapse were detected during follow-up. The patient died four weeks after the last prophylactic dose due to a myocardial infarction, which was thought to be related to a diagnosis of congestive heart failure. This case is noteworthy for two reasons: it is the second reported case of HIV and visceral leishmaniasis co-infection in Türkiye, and it demonstrates the application of secondary prophylaxis. It makes a unique contribution to the literature in Türkiye by demonstrating the applicability of peripheral blood-based diagnostic approaches and molecular typing in cases of Leishmania co-infection with HIV.
Crimean-Congo hemorrhagic fever (CCHF) is a common tick-borne viral disease caused by viruses belonging to the genus Orthonairovirus in the family Nairoviridae and order Bunyaviridae. The aim of this study was to determine the clinical characteristics, risk factors and mortality of patients diagnosed with CCHF who were followed up and treated in Ankara or referred from external centers between January 1, 2011 and December 31, 2023. Patients who met the definitive case definition of CCHF and were followed up through the CCHF web-based information system of the Provincial Health Directorate between January 1, 2011 and December 31, 2023 were investigated retrospectively. The patients' sociodemographic and clinical characteristics, physical examination and laboratory findings, posteroanterior chest X-ray findings, treatments given, epidemiological history, CCHF IgM and CCHF IgG measured by Enzyme Linked Immunosorbent Assay for CCHF virus in blood or body fluids sent to a reference laboratory with the diagnosis of CCHF, CCHF virus RNA results of the first and second samples studied by reverse transcription polymerase chain reaction (RT-PCR), survival and death results were recorded. A total of 329 confirmed CCHF cases followed in Ankara province were included in the study. 40.4% of the cases were resident in Ankara and were infected within Ankara province and 59.6% were infected outside Ankara province. The median age of CCHF cases was 48 (minimum= 2-maximum= 86), 58.1% were male and 41.9% were female. 35.9% were farmers and livestock breeders, 1.2% were healthcare workers and 62.9% were in other occupational groups. 82.05% of CCHF cases had a history of tick bite. The highest number of CCHF cases was seen in July. The most common symptoms in CCHF cases were fatigue (92.7%), fever (82.1%) and widespread body pain (72.6%), and the most common physical examination findings were fever above 38 °C (63.5%), tachycardia (10.6%) and vaginal bleeding (11.2%). The most common laboratory findings were thrombocytopenia (86.6%), elevated aspartate aminotransferase (AST)/alanine aminotransferase (ALT) (80.5%), and leukopenia (70.8%). The CCHF case fatality rate was found to be 7.3%. In our study, most patients with CCHF were belonged to other occupational groups, reported a history of tick bites, presented with nonspecific symptoms and had thrombocytopenia, elevated AST/ALT and leukopenia. Age, impaired consciousness, gastrointestinal bleeding, and an INR value above 1.2 were factors that increased the risk of death in CCHF cases. Therefore, considering our study findings, we believe that CCHF can be considered in cases with nonspecific symptoms, thrombocytopenia, elevated AST/ALT and leukopenia, enabling early diagnosis, rapid initiation of treatment, identification of the need for intensive care, and reduction of transmission. Furthermore, factors that increase the risk of death, such as age, impaired consciousness, gastrointestinal bleeding and an INR value above 1.2, should be considered in CCHF case management.
The coronavirus disease-2019 pandemic has been shaped by successive waves of variants due to the high mutational capacity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Monitoring the genomic diversity and mutational profiles of these variants and their clinical impact is essential to inform public health measures as well as vaccine and treatment strategies. This study aimed to analyze clinical samples detected as SARS-CoV-2 positive by real-time reverse transcription polymerase chain reaction (rRT-PCR) during two different periods of the pandemic in Türkiye using next-generation sequencing to compare their genomic profiles, determine their phylogenetic positions and assess the relationship between mutations and clinical findings. A total of 39 rRT-PCR-positive respiratory samples (9 in September 2021 and 30 in March-April 2022) with cycle threshold <20 from our laboratory were included in the study.An amplicon-based Oxford Nanopore method was used for next-generation sequencing. The 22 high-quality sequences obtained were evaluated phylogenetically using MEGA software together with the sequences obtained from the Global Initiative on Sharing All Influenza Data and the reference genome in order to enrich the phylogenetic tree. Lineage and clade assignments were performed using Nextstrain and PANGO. According to the Nextstrain classification, nine of the sequences belonged to the 21J (Delta) clade and 30 to the 21L (Omicron) clade. In the PANGO analysis, sequences from the 2021 period mostly matched B.1.617.2 and its AY sublineages (AY.122, AY.46, AY.46.2, etc.), while sequences from the 2022 period mostly matched BA.2 and its sublineages (BA.2.9, BA.2.5). In the phylogenetic analysis, sequences from the two periods diverged significantly. The evolutionary distance between the reference genome and the Omicron variant was found to be greater than that to the Delta variant. In addition, the distance of Omicron to Delta exceeded its distance to the reference genome. In the phylogenetic tree including Alpha sequences from the previous predominant variant period, the Alpha variant clustered with Omicron. These results suggest that Omicron does not appear to have evolved from Delta. The mutational analysis revealed that the Omicron variant harbored a higher number of amino acid changes across multiple regions of the genome, particularly in the Spike protein; a substantial portion of these alterations included deletions in the NTD (L24/P25/P26), as well as point mutations such as S375F, E484A, Q493R, and N501Y in the receptor binding domain and H655Y and N679K in the fusion region, which are associated with host cell entry and immune evasion. In the Delta variant, substitutions P681R and L452R near the S1/S2 cleavage site of Spike and deletions Δ156/157 in the N-terminal domain predominated. Both variants retained common adaptive mutations that confer an infectious advantage, such as S:D614G, S:T478K, and ORF1b:P314L. Clinical evaluation showed that Omicron cases had a significantly milder course (p= 0.032), with similar age, comorbidity and vaccination profiles between the two groups. The results suggest that some Omicron-specific Spike mutations suppress membrane fusion by reducing TMPRSS2 usage, a feature that may contribute to the variant's low virulence. This study presents comprehensive regional genomic data from the Delta-Omicron transition period in Türkiye, including phylogenetic positions, Spike mutation profiles and clinical outcomes. The results emphasize that monitoring the molecular adaptations of variants in conjunction with clinical data is essential for early warning and control of rapidly evolving pathogens such as SARS-CoV-2.
The yellow fever vaccine containing the live attenuated 17D strain is one of the most effective methods for preventing yellow fever infection and has long been considered safe. However, rare but serious adverse events such as yellow fever vaccine-associated viscerotropic disease (YEL-AVD) have been reported. YELAVD is a life-threatening clinical condition that can mimic wild-type yellow fever infection, is associated with a high risk of mortality, and may pose diagnostic challenges, particularly in non-endemic regions. A 57-year-old male patient with no underlying comorbidities, history of immunosuppression, or thymic pathology presented with a high fever that began two days after yellow fever vaccination and had persisted for seven days at the time of admission. Physical examination revealed hypotension and jaundice; hemodynamic stability was achieved with intravenous fluid resuscitation. Laboratory findings demonstrated thrombocytopenia and hepatic dysfunction. Infectious etiologies, including malaria, dengue fever, West Nile virus infection, and Crimean-Congo hemorrhagic fever, as well as other possible causes, were comprehensively and systematically excluded; no etiological findings were identified in blood cultures or imaging studies. Although polymerase chain reaction (PCR) testing for yellow fever virus was negative, the presence of two major Brighton Collaboration criteria-hepatic involvement and thrombocytopenia-together with the systematic exclusion of alternative etiologies supported the classification of this case as consistent with level 2 diagnostic certainty for YEL-AVD. The patient fully recovered with supportive treatment without requiring intensive care. To the best of our knowledge, this is the first reported case of YEL-AVD from Türkiye. The increasing number of international travel from non-endemic to endemic regions and the expanding use of vaccination highlight the need for increased clinical awareness of rare but serious adverse events such as YEL-AVD. This case emphasizes the importance of early assessment of vaccination history in the differential diagnosis and underscores the value of case reports in global vaccine safety surveillance.
Malaria is one of the most common and fatal parasitic diseases worldwide and the increasing rate of drug resistance has made the development of new treatment alternatives an urgent necessity. The aim of this study was to evaluate the in vitro and in vivo antimalarial activities of Styrax liquidus extracts. Styrax liquidus samples were macerated to obtain extracts in ethanol, 60% ethanol, methanol, chloroform, n-butanol, hexane, dichloromethane and water. The cytotoxicity profiles of the obtained extracts were evaluated using the MTT assay on the L929 cell line. In vitro antimalarial activity was tested using the ring-stage survival assay with the Plasmodium falciparum 3D7A strain. The antimalarial activity of the extracts was evaluated and those to be used in the in vivo stage were selected based on these results. For in vivo antimalarial activity assessment, Plasmodium berghei-infected Balb/c mice were used and the experimental animals were divided into methanol extract, water extract, chloroquine (positive control) and placebo groups. The predetermined doses were administered to the experimental groups via oral gavage in accordance with Peters' four-day suppression test protocol. The treatment schedule was administered at zero, 24, 48 and 72 hours post-infection and the animals' clinical course and parasitemia levels were regularly monitored using Giemsa-stained thin smears. The chemical profiles, component identification and the characterization of the extracts were evaluated using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS) analyses. In the ring-stage survival test, the methanol and water extracts of Styrax liquidus completely inhibited P.falciparum at a concentration of 58 µg/mL. In the in vivo model, parasitemia appeared on day five in the placebo group and all animals died by day 11. In the water extract group, parasitemia was detected on day 17, and the animals died on days 24-25. In contrast, no parasitemia was observed in the methanol extract group during the 25- day follow-up period and survival was similar to that of the chloroquine group. The mean survival time was calculated as 25 days for the methanol and chloroquine groups, 24 days for the water extract group and 10 days for the placebo group. According to GC-MS and LC-MS analyses, cinnamic acid derivatives, phenolic compounds and fatty acid esters were identified as the main constituents of the methanol and water extracts. In conclusion, Styrax liquidus, particularly its methanol extract, appears to have a promising antimalarial potential. The findings indicate that further comprehensive studies are needed to evaluate this natural product as a potential alternative therapeutic agent.
Human parvovirus B19 (PVB19), the causative agent of erythema infectiosum in children, is also associated with conditions such as aplastic crisis, arthropathy, neutropenia, thrombocytopenia and fetal complications. During the coronavirus diseases-2019 pandemic, public health measures reduced the circulation of respiratory viruses as well as PVB19; however, increasing case numbers have been reported worldwide and across Europe since late 2023. This study aimed to evaluate PVB19 DNA positivity in samples submitted to our laboratory between January 2019 and April 2025, assess distributions by age, sex and clinical services, compare pre- and post-pandemic periods and investigate the recent rise in positivity. Serological testing was performed using a fully automated Enzyme-Linked Immunosorbent Assay system (Alegria® ORGENTEC, Germany). Nucleic acid extraction was carried out with the EZ12 virus mini kit v2.0 on the EZ1 Advanced XL platform, and PVB19 DNA was analyzed using the artus® Parvo B19 RG PCR kit (Qiagen, Germany) on the Rotor-Gene Q system. A total of 1445 real-time polymerase chain reaction (Rt-PCR) results from 1201 patients were retrospectively reviewed. Overall PVB19 DNA positivity was 7.4%. The PVB19 DNA positivity rate in 2024-2025 was significantly higher than that in 2019-2023 (p< 0.01). Increasing age was associated with lower DNA positivity (p< 0.01). Among PCR-positive patients with available serology, 14 were IgM+/IgG+, 32 were IgM-/IgG+ and four were IgM-/IgG-. A considerable proportion of positive cases consisted of immunosuppressed individuals and women of reproductive age. Consistent with observations from the United States and Europe, our findings indicate a resurgence of PVB19 circulation since 2024. Despite increased testing during the pandemic, low positivity rates suggest markedly suppressed viral circulation. Given that 40.4% of our study population was immunosuppressed patients, combined use of serological and molecular testing appears clinically valuable for the diagnosis and follow-up of PVB19 infection.
