Introduction: The incidence of Gram-negative bacterial meningitis (GNBM) has increased with the growing number of neurosurgical procedures. Concurrently, global antimicrobial resistance, particularly among Gram-negative pathogens causing healthcare-associated infections, has contributed to high morbidity and mortality. This study aimed to identify clinical and laboratory parameters associated with mortality in post-neurosurgical GNBM (PN-GNBM). Methodology: This retrospective study included adult patients who developed GNBM at least 48 hours after a neurosurgical procedure in the intensive care unit of a tertiary hospital between January 2019 and March 2024. Clinical findings and laboratory results before and at the time of diagnosis were obtained from the hospital information system. The factors associated with all-cause 28-day mortality were evaluated. Statistical analyses were performed using SPSS version 19, with p < 0.05 considered statistically significant. Results: A total of 21 PN-GNBM patients were included. The 28-day mortality rate was 60%. Evaluation of peripheral blood leukocyte ratios at the time of diagnosis revealed that a low lymphocyte-to-platelet ratio (LPR) significantly predicted mortality on days 7, 14, and 21 (p = 0.046, 0.003, and 0.005, respectively), whereas a high neutrophil-to-lymphocyte ratio (NLR) predicted 14-day mortality (p = 0.035). Acinetobacter baumannii was the most frequently isolated pathogen with 81.81% carbapenem resistance rate. Conclusions: NLR and LPR are inexpensive and readily accessible biomarkers that may support early mortality prediction and risk stratification in PN-GNBM. These preliminary findings should be validated in larger multicenter studies.

BackgroundThe gastrointestinal tract serves as a major viral reservoir in HIV infection, and persistent gut dysbiosis contributes to systemic inflammation and immune dysfunction despite effective antiretroviral therapy (ART). Integrase strand transfer inhibitor (INSTI)–based regimens are now preferred for their efficacy and tolerability; however, their impact on gut microbial restoration remains underexplored.MethodsThis study analyzed fecal microbiota composition in 30 HIV-positive adults—10 ART-naïve, 7 receiving INSTI-based ART for <2 years, and 13 receiving INSTI-based ART for 2–5 years. 16S rRNA gene sequencing of stool samples (V3–V4 regions) was performed to evaluate bacterial diversity and taxonomic shifts. Microbial composition was compared across groups and correlated with CD4+ T cell counts.ResultsAlpha diversity showed a non-significant yet progressive increase from ART-naïve to long-term INSTI-treated patients, suggesting partial restoration of microbial diversity. At the phylum level, Firmicutes increased and Bacteroidetes decreased in treated groups, indicating a shift toward eubiosis. Long-term INSTI therapy enriched beneficial taxa such as Faecalibacterium prausnitzii, Lactobacillus ruminis, Eubacterium biforme, and Bifidobacterium longum, while reducing pro-inflammatory Bacteroides fragilis and Haemophilus parainfluenzae. Moreover, higher CD4+ T cell counts showed a positive correlation with the abundance of short-chain fatty acid–producing bacteria and with an increased Firmicutes/Bacteroidetes ratio, indicating improved mucosal integrity and immune homeostasis.ConclusionIntegrase inhibitor–based ART promotes partial normalization of gut microbiota composition in HIV-infected patients, enhancing beneficial taxa linked to immune recovery. These findings underscore the potential of microbiota-targeted adjunctive interventions—such as probiotics or dietary modulation—to support mucosal immunity and long-term health in people living with HIV.

Background/Aims: The roles of inflammatory and fibrogenic biomarkers in chronic hepatitis B (CHB) infection and hepatitis B virüs (HBV)-related cirrhosis remain incompletely understood. The current study investigated the diagnostic and discriminative ability of amphiregulin (AREG), interleukin-6 (IL-6), and neuropilin-1 (Nrp-1) as biomarkers of HBV-related cirrhosis. Materials and Methods: This cross-sectional analytical study included 70 patients with CHB (43 without cirrhosis and 27 with HBVrelated cirrhosis) and 60 healthy controls. Clinical and laboratory data were obtained from hospital records. Serum IL-6, Nrp-1, and AREG levels collected during outpatient visits were measured using enzyme-linked immunosorbent assay. Group differences were analyzed using the Kruskal–Wallis test, discriminative performance was evaluated using receiver operating characteristic (ROC) analysis, and factors independently associated with cirrhosis were identified using logistic regression. Results: IL-6 and Nrp-1 levels were higher in patients with noncirrhotic and HBV-related cirrhotic CHB than in healthy controls (P < .001), with no significant difference between the patient subgroups. AREG levels were lower in the overall CHB cohort than in controls (P < .001) but higher in patients with cirrhosis than in those without cirrhosis (P = .001). ROC analysis showed that AREG had moderate discriminative ability for HBV-related cirrhosis (area under the curve (AUC) = 0.749). The optimal Youden-derived cutoff value was 2.29 ng/mL, with a sensitivity of 74% and a specificity of 65%. In logistic regression, AREG was independently associated with HBV-related cirrhosis (P = .012). Addition of ln-transformed AREG to age- and sex-adjusted aspartate aminotransferase-to-platelet ratio index (APRI)- and Fibrosis-4 index (FIB-4)-based models increased the AUC from 0.923 to 0.970 and from 0.938 to 0.980, respectively. Conclusion: AREG may serve as a complementary biomarker with moderate discriminative value for HBV-related cirrhosis but is unlikely to be useful as a standalone diagnostic or prognostic marker. Although IL-6 and Nrp-1 reflected underlying inflammatory activity, their ability to distinguish cirrhosis was limited. Cite this article as: Karakoc Ozudogru F, Karaca B, Turker N, et al. Discriminative role of interleukin-6, neuropilin-1, and amphiregulin for cirrhosis in patients with chronic hepatitis B infection. Turk J Gastroenterol. Published online July 9 2026. doi:10.5152/tjg.2026.26143.

Introduction: This study aimed to assess the prevalence of anti-hepatitis C virus positivity among individuals monitored for alcohol and tertiary healthcare institution. The factors associated with referral rates to the infectious diseases (ID) clinic were evaluated. Materials and Methods: This single-center, retrospective, observational study retrospectively evaluated the data of cases monitored for alcohol and drug addiction at the AMATEM outpatient clinic of a tertiary healthcare institution between January 1, 2021, and Results: A total of 9974 cases visited the AMATEM clinic, but anti-HCV testing was requested for only 495 (4.96%) of these cases. Among them, 53 (10.7%) tested positive for anti-HCV. It was observed that consultation with the ID department was requested for 24 (45.28%) of the 53 patients, but only 10 (18.86%) presented to the ID outpatient clinic. Among the referred cases, four individuals (40%) were found to be HCV RNA positive, and only one of these patients completed an eight-week course of glecaprevir-pibrentasvir treatment and achieved sustained virological response. The referral rate to the ID outpatient clinic was significantly higher in cases where a formal ID consultation was requested compared to those where no consultation was requested. Using a logistic regression prediction model, it was estimated that if all 53 patients who tested positive for anti-HCV had presented to the ID clinic, the number Conclusion: Enhancing the awareness and knowledge of AMATEM clinicians regarding HCV and facilitating patient referrals to the ID department are crucial. Establishing specialized units to monitor HCV treatment adherence in this high-risk, challenging population and, when necessary, administering treatment under direct supervision will accelerate progress toward national HCV elimination goals.

The risk of thromboembolic pathologies increases in COVID-19 cases who have risk factors for poor prognosis and are prone to have a severe clinical course. Few cases of cerebral sinus vein thrombosis (CSVT) accompanying COVID19 have been reported. We present a patient who developed CSVT during COVID-19 without a known risk factor for thrombosis but was found to have a genetic mutation of the prothrombin 20210 G/A gene, which is a congenital thrombophilia risk factor. We aim to emphasize the importance of investigating additional pathologies in thromboembolic events during COVID-19 in cases without known comorbidities.

Background and Aim: Cardiovascular diseases are the leading cause of death worldwide.We evaluated dyslipidemia and cardiovascular risks in human immunodeficiency virus (HIV)-positive patients. Materials and Methods:We enrolled patients in this study between January 1, 2018, and December 31, 2022, at the infectious diseases outpatient clinic.A total of 189 HIV-positive cases and 199 cases with normal examination findings within the same timeframe were compared in terms of cardiovascular risk factors. Results:The study included 388 individuals, of whom 189 were HIV-positive patients and 199 were in the control group.The mean age of the HIV-positive group was 47.8 ± 11.5; 64.9% were men.Framingham's risk score was found to be statistically higher in the HIV-positive patient group (P = 0.001).Total cholesterol, low-density lipoprotein, and triglyceride levels were higher in the HIV-positive group (P < 0.001, P < 0.001, and P = 0.023).A higher proportion of patients in the moderate-and high-risk categories were HIV positive. Conclusion:In HIV-positive patients on antiretroviral therapy, an increase in lipid profiles was observed in those categorized as moderate and high cardiovascular risk groups compared with the control group.

Aim: In this study, we aimed to examine the prognostic factors for infection and the approach and demographic data of patients admitted to the emergency department of a university training and research hospital with signs and symptoms of urinary tract infection. Materials and Methods: In this retrospective observational study, using the hospital data management system, we analyzed the demographic data, presenting complaints, type of urinary tract infection, comorbid diseases, culture positivity, other laboratory results, imaging reports, and mortality rates of 115 patients admitted to the emergency department of a tertiary care university hospital with symptoms of urinary tract infection. Results: Pyelonephritis and cystitis rates were 47.8% and 52.1%, respectively. Of all patients admitted with pyelonephritis and cystitis, 28.6% were hospitalized. We observed that 18% of the hospitalized cases were admitted to the intensive care unit. The urine culture positivity rate of all cases was 24.3%. The most common microorganisms grown in urine culture were Escherichia coli (E. coli) (50%), Klebsiella pneumoniae (K. pneumoniae) (17.8%), and Enterococcus faecalis (E. faecalis) (10.7%). In blood culture results, the blood culture positivity rate was 6% and the isolated microorganisms were E. coli (42.8%), and coagulase-negative staphylococci (28.5%). Extended-spectrum beta-lactamase was detected in 50% of E. coli and 40% of K. pneumoniae. The total mortality rate was calculated as 1.7% in the whole study group. Conclusion: Urinary tract infections are common in the community and may be fatal when complicated or involving the upper urinary tract. These cases should be evaluated carefully and rapidly in the emergency department.

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Abstract Objectives There are limited data about nosocomial coinfections of COVID-19 cases monitored in the intensive care unit. This study aims to investigate coinfections in COVID-19 patients followed in an intensive care unit of a university hospital. Methods This study analyzed retrospectively the data of coinfections of 351 COVID-19 patients in the period 28.02.2020–15.01.2021 in a tertiary care intensive care unit in a university hospital. Results Bacterial coinfections were present in 216 of the 351 cases. One hundred and thirty of these cases were evaluated as nosocomial infections. On the third day the Sequential Organ Failure Assessment Score, usage of invasive mechanical ventilation and presence of septic shock were significantly higher in the coinfected group. The neutrophil/lymphocyte ratio, polymorphonuclear leukocyte count, procalcitonin, ferritin, and blood urea nitrogen values were significantly higher in the coinfection group. White blood cells (WBC) (OR: 1.075, 95% CI 1.032–1.121, p = 0.001) and ICU hospitalization day (OR: 1.114, 95% CI 1.063–1.167, p < 0.001) were found to be independent risk factors for coinfection in the multivariate logistic regression analysis. The rates of hospitalization day on the day of arrival, the 21st day, as well as total mortality (p = 0.004), were significantly higher in the coinfected group. Conclusion Bacterial coinfections of COVID-19 patients in the intensive care unit remain a problem. Identifying the infectious agent, classifying colonizations and infections, and using the proper treatment of antibiotics are of great importance in the case management of COVID-19 patients in the intensive care unit.

Diabetic foot infections are one of the complications of diabetes mellitus resulting in extremity amputation and mortality. This study aimed to examine the predictive value of the C-reactive protein (CRP) to albumin ratio (CAR) for amputation risk in diabetic foot infection. Data from 178 patients were retrospectively examined. We found the cut point value of 15.45 according to the receiver operating characteristic (ROC) curve to show the predictive value of CAR for amputation risk in the overall population. We then divided the patients into two groups low (<15.45, n = 96) and high risk (≥15.45, n = 82) according to their CAR value. Matching based on propensity scores produced 64 patients in each group and showed that the amputation rate was high in the high-risk groups (50 vs 25%, P = .003). In the multivariate analysis in the matching group, previous amputation, antibiotic therapy in the last 3 months, and CAR (Odds ratio [OR]: 1.30, 95%Confidence interval [CI]: 1.01-1.45, P < .001) were independent predictors of amputation. These parameters may be useful to predict amputation risk in these patient groups.

BACKGROUND:Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). MATERIALS/METHODS:This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. RESULTS:Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p < 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). CONCLUSIONS:Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.

BACKGROUND In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic hepatitis C in real-world clinical practice. METHODS Data from patients with chronic hepatitis C treated with SOF/LDV ± RBV or SOF/RBV in 31 centers across Turkey between April 1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and virological outcomes were analyzed. RESULTS A total of 552 patients were included in the study. The mean age of the patients was 51.28 ± 14.2, and 293 (55.8%) were female. The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at baseline in 381 patients (72.6%). SOF/LDV ± RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes. All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect. CONCLUSION The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV ± RBV treatment in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.

Objective: This study aimed to evaluate the awareness and knowledge levels of all physicians administering immunosuppressive treatment concerning hepatitis B virus (HBV) reactivation, and draw attention to the importance of the subject through evaluation. Methods: The study was carried out by infectious diseases and clinical microbiology specialists in 37 health centers, and it was performed in Turkey between January and March 2017. All specialists providing a written consent and working in the departments of Medical Oncology, Hematology, Dermatology and Venereology, Physical Medicine and Rehabilitation, and Rheumatology of each study center were included in the study. Results: A total of 430 physicians participated in the study. Their mean age was 39.87 +/- 7.42 years, and 47.9% of them were males. During their career, 39.3% of these physicians had encountered patients developing HBV reactivation while receiving immunosuppressive treatment. The rate of encountering patients who died due to HBV reactivation was 6.5%. 97% of physicians who participated, considered the risk of HBV reactivation to be important. 70.2% of physicians stated that guidelines related to HBV reactivation and antiviral treatment for these patients were discussed in the congresses they participated, regarding their specialties. The rate of performing hepatitis screening among physicians whose patients developed HBV reactivation was statistically significantly higher than those physicians who had no patients with HBV reactivation (p<0.05). Physicians who used the guidelines related to HBV reactivation in their specialties performed screening for the HBV infection much more often than physicians who did not use the guidelines (p=0.002). Conclusions: According to the results obtained in our study, the rates of conducting screening and awareness of HBV reactivation among physicians administering immunosuppressive treatment were higher compared with similar studies; however, their awareness that HBV DNA and anti-HBc should be utilized much more frequently among the serological tests they use for screening of HBV infection, should be increased.

Background: Hepatitis B virus (HBV) has a high mutation rate due to its unusual replication strategy leading to the production of a large number of virions with single and double mutations. The mutations, in turn, are associated with the development of drug resistance to nucleos(t)ide analogs (NUCs) in patients before and during NUCs therapy. Objectives: The current study aimed at investigating the molecular characterization of HBV in Turkish patients with chronic hepatitis B (CHB) infection. Methods: Polymerase chain reaction (PCR) amplification and direct sequencing procedures were used to analyze mutations. The detected drug resistance mutations were divided into the nucleos(t) ide analogs primary, partial, and compensatory resistance groups. The amino acid substitutions of hepatitis B surface antigen (HBsAg) were categorized into antiviral drug - associated potential vaccine-escape mutations (ADAPVEMs) and typical HBsAg amino acid substitutions, which included hepatitis B hyperimmunoglobulin (HBIg) - selected escape mutation, vaccine escape mutation, hepatitis B misdiagnosis, and immune - selected amino acid substitutions. Results: The number of patients included in the study was 528 out of which 271 (51.3%) were treatment - naive and 351 (66.3%) were hepatitis B e antigen (HBeAg) - negative. Moreover, 325 (61.6%) were males with a mean age of 38 years (range: 18 - 69). Primary, partial, and compensatory resistance to NUCs was reported in 174 (32.9%) patients. Six different ADAPVEM motifs were determined in both treatment - naive and treatment - experienced patients, namely, sF161L/rtI169X, sE164D/rtV173L, sL172L/rtA181T, sL173F/rtA181V, sS195M/rtM204V, and sS196L/rtM204I. The prevalence of ADAPVEMs and typical HBsAg escape mutations was 5.3% (n = 28) and 34.8% (n = 184), respectively. Conclusions: The analysis of drug resistance should constitute a fundamental part of the follow - up period of patients with CHB undergone treatment with NUCs. The surveillance of development of drug resistance mutations, while receiving treatment for hepatitis B is of paramount importance to monitor and control the emerging resistance.

Introduction: The primary aim of this study was to evaluate whether there was a difference between outpatient parenteral antibiotic therapy (OPAT) and inpatient parenteral antibiotic therapy (IPAT) costs of ertapenem for urinary tract infections (UTI"s) due to extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli, and to discuss suitability of ertapenem for OPAT programme of Turkey for the near future. Materials and Methods: A total of 53 patients hospitalized with the diagnosis of UTI and treated with ertapenem were retrospectively evaluated. The cost of ertapenem treatment as IPAT was actual costs retrieved from the hospital records. The estimated cost of the same antibiotic for the same patients as an OPAT programme was then calculated and the costs were compared. Results: The cost difference between IPAT and OPAT was 12.305 (€ 5783). Outpatient parenteral antibiotic therapy programme would provide an estimated 20% reduction in treatment costs. The estimated number of bed days saved, if the patients had received the treatment as OPAT, was calculated to be 583 days, which constitutes about 5% of the total number of hospitalization days. Conclusion: Applying ertapenem therapy through OPAT programme for UTIs caused by ESBL-producing Gram-negative bacilli will decrease the financial burden of health expenditures and the number of inpatient bed days in Turkey.

In this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 ± 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.

Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases set up a task force to develop a consensus report focused on chronic hepatitis B in pregnancy, a complex issue for both the mother with an advanced liver disease and the unborn child who is under the risk of hepatitis B virus (HBV) transmission. Relevant literature and international guidelines were reviewed, and recommendations agreed are presented in the report. An algorithm adapted from actual publications is also proposed for management of chronic hepatitis B in the pregnant patient. Since many women of childbearing age are in the immune tolerant phase of infection, there is generally no need for therapy and no indication to start therapy during the early stages of pregnancy. Initiation of antiviral therapy in the beginning of the third trimester in highly viremic (HBV DNA > 200 000 IU/mL) pregnant women can prevent mother-to-child-transmission of HBV despite postnatal passive and active immunoprophylaxis provided. Given its potency and its high genetic barrier to resistance, tenofovir might be an appropriate option for mothers who might need to continue their treatment for active hepatitis B after delivery.

In this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 ± 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.

Background/aim: The aim of this study was to determine the prevalence and associated factors of thrombocytopenia in human immunodeficiency virus (HIV)-infected patients. Materials and methods: A cross-sectional study was conducted in a tertiary care hospital in İzmir, Turkey. All HIV-infected patients admitted to the Department of Infectious Diseases and Clinical Microbiology between 2006 and 2011 were recruited. Patients with thrombocytopenia at any time point were defined as the case group and the remaining patients were defined as the control group. Results: The frequency of thrombocytopenia was 35.8%. Thrombocytopenia was more frequent in patients with acquired immune deficiency syndrome (AIDS) than in patients without AIDS (P < 0.05) and in antiretroviral-naive patients than in patients on combination antiretroviral therapy (cART) or those who had ever used cART in the past (P < 0.05). Additionally, rates of tuberculosis infection, prophylactic use of trimethoprim-sulfamethoxazole (TMP/SMX), and being anti-HCV seropositive at any time point were higher in patients with thrombocytopenia than in the control group (P < 0.05), and the case group had lower CD4+ T lymphocytes at first admission (P < 0.05). Conclusion: The main finding was the clear association between thrombocytopenia and advanced and uncontrolled HIV infection. Tuberculosis and HCV coinfections were also identified as associated factors for thrombocytopenia.

Atypical measles has been described in persons who were exposed to wild measles virus several years after they were immunized with killed measles vaccine. Occasionally, it can be caused by live measles vaccines also. It is a clinical picture different from typical measles. In this report, an adult patient with a history of immunization, who presented with high fever, maculopapular rash starting at the palms and soles, and pneumonia, is presented. Atypical measles that was first reported in the 1970s in mostly kids should be considered for differential diagnosis in adult cases presenting with high fever, atypical rash and pneumonia even if patients have a history of immunization.