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.
