CORRECTION NOTE Two corrections have been made to the original version of this article, published on February 2, 2023: In Table 3, the information ‘DOX tablet 200 mg/day, single dose, oral +’ under the headings 1)Infective Endocarditis associated with Brucella spp. and 2) Neurobrucellosis has been corrected to: ‘DOX tablet 200 mg/day, 2 doses, oral +’. Corrected article: https://doi.org/10.36519/kd.2023.4576
CORRECTION NOTE A correction has been made to the original version of this article, published as Suppl. 1 in 2019 (Ref: KLM-2890): In Table 25, the information ‘200 mg/day, single dose, oral’ for Doxycycline has been corrected to: ‘200 mg/day, 2 doses, oral’. Corrected article: https://doi.org/10.5152/kd.2019.51
Objective: Neurosyphilis is a severe manifestation of syphilis characterized by heterogeneous clinical presentations. Diagnosis and assessment of treatment response are challenging due to variable findings and limitations in interpreting serological tests. This study evaluates the clinical characteristics, laboratory findings, and treatment outcomes of neurosyphilis cases diagnosed at a single center over an 18-year period. Methods: Medical records of patients aged 18 years or older with positive syphilis serology who were diagnosed with neurosyphilis between 2005 and 2022 were reviewed in this retrospective observational study. Diagnosis and classification followed Centers for Disease Control and Prevention (CDC) criteria were applied for diagnosis and classification. Demographic data, clinical features, serological and cerebrospinal fluid (CSF) findings, treatments, and post-treatment outcomes were analyzed. Results: Of 503 patients with positive syphilis serology, 23 (4.6%) were diagnosed with neurosyphilis. Three (13%) patients were female, and 3 (13%) had human immunodeficiency virus infection. All patients were symptomatic; 7 (30.4%) had ocular involvement, and 16 (69.5%) presented with neurological manifestations. Tabes dorsalis was the most common presentation, occurring in seven patients (30.4%). Based on CDC criteria, four cases (17.4%) were classified as possible, 13 (56.5%) as probable, and 6 (26.1%) as confirmed neurosyphilis. Fifteen (65%) patients were in the tertiary stage, and eight (35%) were in the secondary stage. Serum rapid plasma reagin titers ranged from 1:1 to 1:512. The mean CSF leukocyte count was 30/mm(3), and CSF protein levels ranged from 24 to 544 mg/dL. CSF Venereal Disease Research Laboratory test results were positive in six patients, and Treponema pallidum hemagglutination assay results were positive in 15 patients. Among 22 patients with follow-up data, seven (32%) achieved full recovery, 14 (64%) developed sequelae, and 1 (4.5%) died during follow-up. Conclusion: Neurosyphilis exhibits diverse clinical features and remains challenging to diagnose. Patients with syphilis require careful evaluation for neurological and ocular involvement, and syphilis should be included in the differential diagnosis of retinitis and uveitis.
Objective: Infectious Diseases and Clinical Microbiology (IDCM) residency training in T & uuml;rkiye is structured according to the national core curriculum of the Medical Specialization Board. However, notable variations exist in its implementation across training institutions. This study evaluated the extent of curriculum implementation, educational processes, and inter-institutional differences among IDCM training clinics in T & uuml;rkiye. Methods: This cross-sectional survey included all institutions authorized to provide IDCM residency training in T & uuml;rkiye. Data were collected through face-to-face or online administration of a 52-item questionnaire to IDCM residents and early-career specialists. The questionnaire addressed demographic characteristics, academic staffing, curriculum-based educational practices, clinical infrastructure, and working conditions. Data analysis employed descriptive statistics and comparative tests. Results: One hundred participants, representing all IDCM training clinics in T & uuml;rkiye (n=87), were included. The median participant age was 30 (25-40) years, and 71% were female. Clinics had a median of 6 (1-13) faculty members and 11 (1-55) residents. In 40% of clinics (35/87), the faculty-to-resident ratio was below 1:3. No statistically significant differences were observed among hospital types regarding faculty-to-resident ratio (p=0.134) or number of residents (p=0.127). However, city hospitals had significantly more faculty members (p=0.037). Only 22% of clinics (19/87) provided a separate to rest during night shifts, and 53% (46/87) reported fewer number of computers than residents. Approximately half of the clinics lacked an in-house microbiology laboratory (44/87; 50.5%). Presentations were the most common educational activity (98.9%), while courses were least frequent (13.8%). Faculty participation as presenters during seminars or presentations was significantly higher in university and training and research hospitals (p=0.006). Conclusion: The findings indicate a need to improve residents' workload, educational quality, and working conditions. Marked differences exist among IDCM training clinics in T & uuml;rkiye regarding the implementation of the core curriculum and clinical practices. This study provides comprehensive nationwide data to monitor curriculum compliance and inform the development of residency training.
Objective: Viral agents cause the majority of gastroenteritis cases in children under five. Rotavirus and adenovirus are the most common. This study determined the frequency of rotavirus and adenovirus antigen positivity in pediatric patients with acute gastroenteritis. It also examined distribution by age, sex, and season. Methods: Data from patients aged 0-18 years admitted to the hospital between January 2013 and December 2024 with a preliminary diagnosis of acute gastroenteritis and tested for rotavirus and adenovirus antigens were retrospectively analyzed. Fresh stool samples submitted to the medical microbiology laboratory were examined using an immunochromatographic test capable of simultaneously detecting rotavirus and adenovirus antigens (TEST-IT (R) Rota-Adeno [Turklab, & Idot;zmir, Turkiye]). Data were analyzed according to age group, sex, and season. Results: Viral antigens were detected in 312 (18.1%) of the 1,725 samples analyzed. Of these, 222 (12.9%) were positive only for rotavirus, 61 (3.5%) only for adenovirus, and 29 (1.7%) for both viruses. Among the 251 patients with rotavirus positivity, 128 (51%) were male and 123 (49%) were female. Of the 90 patients with adenovirus positivity, 53 (58.9%) were male, and 37 (41.1%) were female. Antigen positivity was most frequently observed in the 3-5-year age group. Rotavirus positivity increased significantly during the spring months, defined as March through May (p<0.001), while no significant seasonal difference was observed for adenovirus positivity throughout the year (p=0.782). Conclusion: Rotavirus and adenovirus are significant contributors to the etiology of acute gastroenteritis in the pediatric population. Accurate identification of these viral agents may help reduce unnecessary antibiotic use. Increased rotavirus vaccination coverage may decrease the incidence of severe clinical presentations and hospitalizations.
Stenotrophomonas maltophilia is an uncommon cause of infective endocarditis (IE). This opportunistic pathogen poses significant therapeutic challenges due to its ability to form biofilms and its intrinsic resistance to multiple antibiotics. While trimethoprim-sulfamethoxazole (TMP-SMX) and quinolones are considered first-line therapies, prolonged targeted treatment may result in serious adverse effects. Established risk factors for S. maltophilia infection include a history of prosthetic valve surgery, presence of a central venous catheter, and prior use of broad-spectrum antibiotics. This report describes a case of successfully treated native valve endocarditis in a patient receiving hemodialysis through permanent catheter. The case is discussed in the context of the current literature to illustrate clinical experience and highlight therapeutic challenges.
Objective: Dental professionals are routinely exposed to blood and saliva, resulting in an elevated risk of blood-borne infections, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study evaluated the knowledge of dentists and dental students concerning HBV, HCV, and HIV infections, their awareness of preventive strategies, and their attitudes toward individuals living with these infections. Methods: A cross-sectional design was employed using a 30-item questionnaire distributed to dentists and dental students. The survey gathered information on demographic characteristics, infection control practices, vaccination history, knowledge of HBV, HCV, and HIV, and attitudes toward individuals with these infections. Data analysis included descriptive statistics and chi(2) tests for group comparisons. Results: The study included 122 participants, consisting of 66 dental students (54.1%) and 56 dentists (45.9%). Mask and glove use was nearly universal in both groups, while face shield use was significantly more common among students (p=0.009). Among HBV, HCV, and HIV, 83.9% of dentists and 60.6% of students correctly identified HBV as the most prevalent infection in T & uuml;rkiye (p=0.004). HBV vaccination rates were 91.1% among dentists and 65.2% among students (p=0.0006). The majority of participants (89%) indicated that treating individuals living with HIV is an ethical obligation. Over 70% of both groups reported a preference for additional protective measures, such as double masking and double gloving, when treating infected individuals. Conclusion: Dentists and dental students demonstrated knowledge gaps regarding HBV, HCV, and HIV infections and frequently employed additional protective measures with limited scientific justification. A substantial proportion of participants were unaware of HIV post-exposure prophylaxis. The relatively low HBV vaccination rate among students suggests insufficient awareness and increasing vaccine hesitancy. Enhanced education on infection control and immunization is essential to promote effective self-protection among dental professionals and to ensure access to standard dental care without discrimination for individuals with HBV, HCV, and HIV.
Actinomyces europaeus is an anaerobic, Gram-positive, branching filamentous bacterium that rarely causes human infection and is typically associated with skin and soft tissue infections. Central nervous system (CNS) involvement is extremely rare. This report presents the first CNS-localized A. europaeus case from T & uuml;rkiye. A 45-year-old male presented with severe headache and weakness in the left upper extremity, and imaging revealed a right temporal lobe abscess. Actinomyces europaeus was isolated from the abscess following surgical drainage. The patient received intravenous ampicillin for 6 weeks, followed by oral amoxicillin, completing a six-month course of therapy. Complete clinical recovery was achieved with combined surgical management and prolonged antibiotic therapy. This case highlights the importance of considering rare pathogens in the differential diagnosis of patients with chronic otologic infections.
Objective: This study aimed to examine vaccine refusal cases reported in Bilecik province between 2015 and 2024 by analyzing rejected vaccine types, vaccination status, reasons for refusal, and demographic characteristics. Methods: This cross-sectional epidemiological study evaluated 692 vaccine refusal cases reported to the Bilecik Provincial Health Directorate between 2015 and 2024. Data were obtained from official records submitted by family health centers. Recorded variables included year of refusal, age, sex, district of residence, type of vaccine rejected, vaccination status, and reasons for refusal. Vaccine refusal prevalence was calculated according to annual live birth data and age groups. Data were analyzed using IBM SPSS version 18.0; numerical variables were summarized as medians, and categorical variables as frequencies and percentages. Results: Of the cases, 50.6% were male and 49.4% were female; the median age was 1 year. Among vaccine refusal cases, 37.4% resided in the city center, whereas 62.6% lived in districts or towns. The most frequently rejected vaccines were diphtheria-acellular pertussis-tetanus-inactivated poliovirus-Haemophilus influenzae type b vaccine (DTaP-IPV-Hib), measles-mumps-rubella (MMR) vaccine, and pneumococcal conjugate vaccine (PCV). Parental decision was the most common reason for refusal (86.0%). Vaccine refusal prevalence increased from 0.3% in 2015 to >8% in 2024. The highest number of refusals occurred in the 0-4-year age group. Conclusion: Vaccine refusal cases in Bilecik province increased substantially over the study period, particularly in early childhood. These findings indicate the need for targeted local immunization strategies.
Objective: Hepatitis C virus (HCV) infection is a significant global health problem. The World Health Organization (WHO) aims for more than 90% of individuals with HCV infection to be diagnosed and more than 80% to have access to treatment. This study aimed to evaluate the impact of a patient alert system (PAS), which sends notification messages to registered phone numbers in the automation system when anti-HCV positivity is detected, on the identification of HCV-infected individuals and their access to treatment. Methods: This single-center retrospective study included individuals who underwent anti-HCV testing for any reason and received a positive result between January 2018 and March 2025. HCV RNA test request rates, access to treatment for viremic cases, and data before and after the implementation of PAS were analyzed using hospital information management system records. Findings were compared by year and age group. Results: A total of 1698 cases tested positive for anti-HCV. In 1032 (60.8%) cases, anti-HCV test positivitywas present only before the PAS, in 436 (25.7%) cases only after the PAS, and in 230 (13.5%) cases in both periods. In 963 (56.7%) cases, at least one HCV RNA test was requested, and HCV RNA positivity was found in 72 of these (7.5%). There was no difference in the rate of HCV RNA testing between individuals who tested positive for anti-HCV before and after the implementation of the PAS. When analyzed by age groups, an increase in the rate of HCV RNA testing requests was observed, particularly in individuals under 40 years of age, following the implementation of the PAS. With the integration of the system, the rate of HCV RNA testing increased from 44% to 72% in the 0-17 age group (p=0.036) and from 54% to 65% in the 18-40 age group (p=0.014). Conclusion: The positive effect of the patient alert system was observed to be more pronounced in younger age groups. Considering that this demographic segment will constitute the future adult population, PAS applications may contribute to increasing the rates of chronic HCV diagnosis and treatment. Widespread adoption of this approach may also support the achievement of WHO targets.
Objective: This study aimed to investigate phenotypic biofilm formation and the presence of biofilm-associated and virulence genes in multidrug-resistant (MDR) Acinetobacter baumannii isolates causing ventilator-associated pneumonia (VAP). Methods: Twenty-three MDR A. baumannii isolates were collected from tracheal aspirate samples of mechanically ventilated patients in the intensive care unit between 2022 and 2023. Biofilm formation was assessed using the micro-titer plate crystal violet assay. The presence of biofilm-associated and virulence genes (bap, csuE, ompA, pgaB, csgA, abaI, adeG, traT, cpaA, cnf-1, cnf-2, kpsMII, epsA, ptk, fimH, pilA, basD, bauA, and omp33-36) was determined by polymerase chain reaction (PCR). Results: All isolates demonstrated strong biofilm formation. The genes bap, csuE, ompA, and pgaB were present in all isolates, while fimH, csgA, adeG, traT, cpaA, cnf-1, cnf-2, kpsMII, pilA, bauA, and omp33-36were absent in all samples. The quorum-sensing gene abaI and the siderophore-related gene basD were detected in all isolates. Capsule-associated genes epsA and ptk were identified in 16.6% and 54.2% of isolates, respectively. Conclusion: The consistent detection of strong biofilm formation and presence of bap, csuE, ompA, and pgaB genes in VAP-associated MDR A. baumannii isolates suggests a potential association between biofilm formation and virulence. The absence of fimH and csgA genes indicates that these genes may not be the determining factors for biofilm formation in these isolates. Furthermore, the presence of abaI, basD, epsA, and ptk genes is consistent with a possible involvement in biofilm formation and antibiotic resistance mechanisms.
Syphilis is a systemic disease caused by Treponema pallidum, primarily transmitted through sexual contact and progressing in stages. Ocular involvement can occur at any stage of the disease and may affect all layers of the eye. Although uveitis is the most common manifestation of ocular syphilis, it can mimic other ocular conditions. Acute retinal necrosis (ARN) is a rapidly progressive clinical syndrome, usually caused by herpes viruses, and may lead to severe visual loss. Empirical antiviral therapy is recommended when ARN is suspected. This report presents a rare case of ocular syphilis mimicking the clinical features of acute retinal necrosis.
Objective: Measles is a highly contagious, vaccine-preventable disease caused by the measles virus. There has been a marked increase in measles cases in T & uuml;rkiye in recent years. This study aimed to evaluate the clinical and epidemiological characteristics of adult measles cases at our hospital between 2022 and 2023. Methods: This retrospective, cross-sectional study included patients 18 years and older diagnosed with measles between January 2022 and September 2023. Diagnosis was confirmed by measles immunoglobulin M (IgM) or polymerase chain reaction (PCR) testing. Researchers reviewed sociodemographic data, clinical signs and symptoms, and laboratory parameters including complete blood count (CBC), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and C-reactive protein (CRP), as well as chest radiographs. Data were extracted from the hospital information system. Descriptive statistics (mean, standard deviation, and percentage) were used. Categorical variables were summarized as frequency (n) and percentage (%). Results: A total of 162 adult measles cases were included. The first two cases appeared in 2022. The rest occurred in 2023. The number of cases peaked in May 2023 and declined afterward. Of the cases, 98 (60%) were female. Of these, 5 (5%) were pregnant. The median age was 27 years (range: 18-51). Twelve cases (0.7%) were foreign nationals. Only 17 patients (10.5%) had a history of full-dose measles vaccination. The most common symptoms were rash (100%), fever (81%), and cough (65%). Measles IgM was positive in 126 patients (78%). All 36 IgM-negative patients tested positive by PCR. Laboratory findings showed elevated aminotransferases in 86 patients (53%), leukopenia in 30 (18.5%), and thrombocytopenia in 46 (28%). Thirteen patients (0.8%) required hospitalization. All recovered with supportive care, and no deaths occurred. Conclusion: The sharp increase in measles cases shows a decline in herd immunity. Preventive measures are urgently needed. Measles should be considered in the differential diagnosis of patients with rash and fever and serological and PCR testing should be used. Public health authorities should be notified promptly and isolation precautions should be implemented to prevent outbreaks.
