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.
