Neurobrucellosis is a rare but clinically significant complication, accounting for approximately 3–5

Turkiye has reported West Nile virus (WNV) infection outbreaks since 2010. The first—and until then only—local human case in Istanbul was recorded in 2017, followed by an outbreak in 2019. We describe this first known documented outbreak of neuroinvasive WNV (NWNV) infection in the Istanbul region during the summer and autumn of 2019. Retrospective, multi-center, cohort study. Between July and September 2019, 16 cases of NWNV infection were hospitalized at six referral hospitals in Istanbul. Additionally, we included one resident case diagnosed and treated at Istanbul School of Medicine Hospital in 2017, representing the first known confirmed—but previously unreported—WNV infection in Istanbul. Among total 17 cases, 14 had meningoencephalitis, two meningitis, and one flaccid paralysis. Median age was 63 years; 65

Long COVID remains a substantial public health challenge, and the relationship between post-COVID-19 vaccination and symptom persistence remains uncertain. This prospective longitudinal study evaluated long COVID symptom trajectories according to post-COVID-19 vaccination status. Adult patients who were unvaccinated at the time of COVID-19 diagnosis were followed at 1, 3, 6, and 9 months and categorized according to vaccination status. Symptom Tool (ST) and Impact Tool (IT) scores and SARS-CoV-2 IgG antibody levels were assessed longitudinally. A total of 59 patients (mean age 43.1±14.1 years; 45.8% male) were included, of whom eight were vaccinated. The most frequently reported symptoms were memory problems, fatigue, brain fog, word-finding difficulties, and excessive sweating. Baseline characteristics were broadly comparable between groups. ST and IT scores decreased significantly over time in the overall cohort; however, no statistically significant association between vaccination status and symptom trajectories was identified. SARS-CoV-2 IgG antibody levels were higher among vaccinated participants but were not associated with symptom burden. Given the small sample size and substantial group imbalance, the study is underpowered and the findings should be interpreted cautiously. Larger prospective studies are needed to better clarify the relationship between post-COVID-19 vaccination and long COVID outcomes.

Syphilis is a re-emerging sexually transmitted infection with rising incidence worldwide, often associated with HIV infection. Ocular syphilis represents a severe manifestation that can occur at any disease stage and may result in permanent vision loss if not promptly diagnosed and treated. We conducted a retrospective comparative cohort study of 22 patients with ocular syphilis managed at Istanbul University, Istanbul Faculty of Medicine, between 2019 and 2025. Twelve patients (54.5%) were people living with HIV (PLWH). The majority were male (81.8%), with a mean age of 45.2 years. Visual loss was observed in more than half of the patients and occurred significantly more frequently in PLWH than in HIV-negative individuals (100% vs. 70%; p = 0.046). Vitritis was also significantly more frequent among PLWH (91.7% vs. 40%; p = 0.02), indicating more severe intraocular inflammation. All six cases of neurosyphilis were confined to PLWH (50% vs. 0%; p = 0.004). The most common ocular manifestations were uveitis (90.9%), predominantly panuveitis and posterior uveitis. All patients received intravenous penicillin G or ceftriaxone, and systemic corticosteroids were administered in half of the cases. Clinical improvement was observed in all patients. Our findings highlight that ocular syphilis in PLWH is associated with more severe inflammation and higher neurosyphilis risk, underscoring the importance of routine cerebrospinal fluid examination and neurosyphilis-based treatment strategies in this group.

Candida species are important causes of morbidity and mortality, with increasing antifungal resistance representing a major clinical challenge. Guideline adherence plays a critical role in optimizing outcomes. This retrospective study included adult patients hospitalized at a tertiary care center between 2022 and 2023 with Candida species isolated from blood, urine, tracheal aspirate, catheter tip, tissue, or oral swab samples. Demographic, clinical, and laboratory data were obtained from electronic records. Invasive candidiasis and colonization were defined according to the IDSA 2016 and ESCMID 2012 guidelines. The EQUAL Candida score was used to assess compliance in candidemia. A total of 316 patients were included; the mean age was 64.4 ± 18.0 years, and 54.1

Introduction: This study aimed to examine the differences between coronavirus disease 2019 (COVID-19) and non-COVID-19 patients with intensive care unit (ICU)-associated bloodstream infections (BSIs), in terms of epidemiological, clinical, microbiological, and outcome data. Methodology: All patients who were followed up in the ICU of a university hospital between 18 March 2020 and 18 April 2022, and who had developed ICU-acquired BSI, based on the study criteria, were selected and divided into 2 groups: COVID-19 and non-COVID-19. Descriptive statistics were used to analyze differences between the groups. Logistic regression analysis was applied to determine mortality risk factors in BSI patients. Results: 234 patients were treated for ICU-acquired BSI, 127 COVID-19 and 107 non-COVID-19. Respiratory sources were significantly more common in COVID-19 patients compared to non-COVID-19 patients (43.3% vs. 26%, p = < 0.01). Among the causative pathogens, Acinetobacter baumannii (24.4% vs. 5.6%, p ≤ 0.01) and Gram-negative multidrug-resistant (MDR) bacteria (81.7% vs. 61.7%, p = 0.020) were detected more frequently in COVID-19 patients than in non-COVID-19 patients. The duration of antibiotic use in the hospital before BSI was longer in COVID-19 patients than in non-COVID-19 patients, and this was also associated with BSI in which Gram-negative MDR bacteria were active (p = < 0.01). Survival times after BSI were shorter in COVID-19 patients than in non-COVID-19 patients (p = 0.032). Conclusions: We demonstrated that MDR microorganisms were prevalent in COVID-19 patients with ICU-acquired BSI, and this was partly due to antibiotic use in the hospital prior to BSI.

INTRODUCTION:The COVID-19 pandemic caused disruptions in the diagnosis, followup and treatment of non-COVID-19 patients due to the burden on the healthcare system. This may lead to missed early diagnosis opportunities in people living with HIV (PLWH). This study aimed to investigate the effects of the COVID-19 pandemic on the demographic characteristics, clinical and laboratory findings, diagnosis, follow-up, and treatment processes of PLWH, and the frequency of opportunistic infections (OIs), AIDS-defining malignancies (ADMs), and late diagnosis (LD). METHODS:In this study, 246 PLWH were identified. During the pandemic period, the mean age of PLWH was lower (p=0.025), the use of 2 nucleoside reverse transcriptase inhibitor (NRTI) + protease inhibitor (PI/r) decreased (p=0.026) and antiretroviral therapy (ART) adher-ence was higher (p=0.015). LD (48.8% vs. 47.5%) was similar for the two periods, OIs rate (22.6% vs. 18.5%) was lower and ADMs rate (4.8% vs. 6.2%) was higher in the pandemic period. Our study was designed as a retrospective cohort study. Individuals over the age of 18 years who were newly diagnosed with HIV infection in our hospital between 2018 and 2023 were included in the study. RESULTS:During the quarantine period, OIs rate (p=0.008) and hospitalization (p=0.002) decreased significantly. Compared to the pre-pandemic period, there was a decrease in primary school graduates (p=0.043) and Centers for Disease Control and Prevention (CDC) category C applicants (p=0.029) and an increase in university graduates (p=0.027) in the quarantine period. After the quarantine period, there was an increase in hospitalization (p=0.002), CDC category C admissions (p=0.021) and ART adherence (p=0.016). Other data were similar for the three periods. CONCLUSION:In summary, while the COVID-19 pandemic led to notable changes in patients' characteristics and HIV-related clinical characteristics and treatment, the incidence of LD, OIs and ADMs did not increase significantly. Continued monitoring and adaptation of healthcare services are crucial to managing PLWH effectively in the context of global health crises.

Objective: Identifying the presence and type of carbapenemases is essential to determine the treatment choices for carbapenem-resistant Gram-negative bacilli (CRB). Genotypic characterization of CRB needs technical support and experienced staff and is not an option for most laboratories due to its high cost. For this reason, especially in countries with limited resources, cheap, reliable phenotypic methods are an alternative, do not require experience, and can be easily applied in daily practice. The goal of the study was to evaluate the performance of phenotypic methods for carbapenemase production in CRB and to form a simple algorithm to differentiate carbapenemase types such as bla(OXA-48) or bla(NDM), which are common in our country. Methods: The study included 16 consecutive carbapenem-resistant, Gram-negative bacteria. Simplified carbapenem inactivation methods (sCIM) and modified Hodge test (MHT) were performed. Genes responsible for carbapenemase production (bla(OXA-48), bla(NDM), and bla(KPC)) were detected by real-time polymerase chain reaction. Temocillin resistance and ceftazidime-avibactam disc diffusion test were also applied to define carbapenemase types. Results: The carbapenemase gene was detected in 12 of the 16 strains; sCIM positivity was found in 11, and MHT was positive in 10. Sensitivity for sCIM and MHT were 91.9% and 83.3%, respectively. All Enterobacterales strains were positive for sCIM, and bla(OXA-48) was the most common carbapenemase. sCIM false negativity was detected for only one strain. High-level temocillin resistance (MIC >128 mu g/mL) was present in all strains with bla(OXA-48); it wasn't detected in the strain carrying isolated bla(NDM). Conclusion: sCIM positivity was present for all Enterobacterales, which were shown to carry the carbapenemase gene by RT-PCR. Our findings support the usage of sCIM in daily practice to screen for carbapenemase production in CRB.

Background Various studies have shown that the incidence of BSI is greater in COVID-19 patients hospitalized in the intensive care unit (ICU). Aims Our study aimed to determine the risk factors for BSI, mortality rates, and factors affecting mortality in adult COVID-19 patients hospitalized in the ICU. Methods All COVID-19 patients who met the study criteria and stayed in intensive care for more than 2 days at a tertiary university hospital during the two-year pandemic period were included in the study. Logistic regression analysis was used to determine the risk factors for BSI and mortality. Results We found that respiratory rate (RR) >= 30 breaths per minute at the time of admission [OR: 2.342 (95% CI: 1.12-4.897)] and antibiotic use in the month before admission ICU [OR: 3.137 (95% CI: 1.321-7.451)] were independent risk factors for BSI in COVID-19 patients. Subanalysis was also performed according to the doses of immunomodulators such as anakinra, tocilizumab, and corticosteroids, and it was found that they had no effect on the BSI (P > .05). The predominant causative pathogens were K. pneumoniae, A. baumannii and enterococci. The multidrug resistant rate among bacteria was 78%. Although their comorbidities and disease severity at the time of ICU admission were similar, patients with BSIs had a higher mortality rate (58.1 to 81.9%, P = .000). The SAPS-2 score at ICU admission [OR: 3.095 (95% CI: 1.969-4.865)] and mechanical ventilation requirement throughout the ICU admission [OR: 9.314 (95% CI: 3.878-22.37)] were found to be independent risk factors for mortality by multivariate analysis. BSI was not found to be a risk factor for mortality (> .05). Conclusions Antibiotic use in patients with severe COVID-19 significantly increases the risk of BSI; unnecessary antibiotic use should be avoided.

Purpose:Immunocompromised hosts are underrepresented in clinical trials. The goal of the study to search for the unmet needs in the management of CAP in immunocompromised hosts. Patients and Methods:An observational study was conducted with CAP patients documented immunocompromise or those aged over 65 who have at least one chronic visceral disease. We clinically assessed the eligible patients at the time of the presentation with a follow-up assessment on day three of admission. The data were statistically analyzed to assess the impact of variables on mortality. Results:During a 15-month study period, 140 CAP patients were observed. The overall 30-day mortality rate was 17.8%. The mortality rate was significantly higher in patients with sputum cultures positive for Pseudomonas aeruginosa, or two bacteria (p=0.049). Tachypnea was a stronger predictor of mortality. Failure to achieve a treatment response within three days of treatment identified the population with the worst outcomes. Less than half of such patients survived past one month. Conclusion:Dynamic response assessment emerged as potentially the strongest predictor of outcomes in CAP of susceptible hosts. We propose that immunocompromised CAP patients who fail to respond early to treatment face extremely high rates of mortality, identifying an unmet need.

Background We aimed to study the differences between patients with COVID-19 and non-COVID-19 ICU-associated BSIs in terms of epidemiological, clinical, microbiological and outcome data. Methods Patients who developed BSI >48 hours after admission to the ICU among patients with COVID-19 and non-COVID-19 who were followed during a two-year pandemic period at a university hospital in the ICU were selected. Descriptive statistics were used for differences between patients with COVID-19 and without COVID-19. Logistic regression analysis was used to determine mortality risk factors in BSI patients. Results Infection of the lower respiratory tract was much more common in COVID-19 patients (43.3% to 26%, p =0,000). The abundance of Acinetobacter baumanii, a microorganism causing BSI was significantly greater in COVID-19 patients than in non-COVID-9 patients (5.6% to 24.4%; p = 0.000), and the prevalence of Gram-negative MDR bacteria (61.7 to 81.7%, p = 0.020) was greater. The duration of antibiotic use in the hospital was associated with the BSI, where Gram-negative MDR bacteria are active (p = 0,000), and the appropriateness of empirical treatment (p = 0.031) was more common in the COVID-19 group. In our study, we discovered that patients with COVID-19 had lower levels of acute-phase reagents commonly used for BSI but more severe clinical symptoms during BSI. COVID-19 survivors had shorter survival times after BSI (p = 0.032) than non-COVID-19 survivors. Conclusions The increased use of antibiotics in hospitals for patients with severe COVID-19 and deficiencies in infection control measures have led to an increase in MDR microorganisms.

Objective: Multisystem Inflammatory Syndrome (MIS) is a con-dition seen in the early post-COVID-19 period and thought to develop with an impaired immune response. It has been usually reported in children but rarely in adults. Here we report the first MIS-A case series from Turkiye.Material and Methods: Six patients who met the Centers for Disease Control and Preventions MIS-A diagnostic criteria were included in the study. The demographic, clinical, laboratory, ra-diological characteristics and therapy regimes and outcomes of the patients were recorded.Results: All of our cases had a history of mild COVID-19. They presented with fever, severe fatigue and hypotension. Abnormal echocardiography findings were detected in five patients. Only one patient had multiple mucocutaneous findings. Common lab-oratory features were lymphopenia, markedly increased C-Reak-tive Protein, procalcitonin, pro-brain natriuretic peptide (pro-BNP), D-dimer, and ferritin. All patients had positive SARS-CoV-2 antibody result. Corticosteroids and/or anakinra were used in five, Intravenous immunoglobulin was used in two patients. Low-mo-lecular-weight heparin (LMWH) was used for all cases. Empirically initiated antibiotic treatments were discontinued after cultures were negative. After anti-inflammatory treatment, the hypoten-sion of the patients resolved, they did not need intensive care follow-up and no mortality was seen in our cases.Conclusions: MIS-A is a severe and mortal condition that causes various clinical pictures and can be confused with sepsis. Anakin-ra, a recombinant IL-1 receptor antagonist, is a significant agent that can be used in the treatment of MIS-A since it blocks the cytokine cascade at an early stage. The satisfactory respons-es will be obtained with early diagnosis and anti-inflammatory treatment. In this period when the pandemic is not over yet, it is necessary to increase the awareness of clinicians about MIS-A, which can be fatal.

Introduction: It was aimed to evaluate the risk factors for the development of ventilator-associated pneumonia (VAP) and clinical outcomes and prognostic predictors of VAP. Materials and Methods:This retrospective and single-center study included patients aged ≥18 years who were diagnosed with VAP in the ICU.Patients were divided into two groups with VAP or without VAP.Univariable and multivariable analyses were used to assess risk factors and prognostic predictors of VAP.Results: A total of 177 patients were evaluated.Mean length of intensive care unit (ICU) stay and the duration of mechanical ventilation was longer in patients with VAP than in patients without VAP [29 (3-107) vs. 12 (3-70) days, 22 (3-90) vs. 10 (3-45) days; p< 0.001].Rectal colonization with carbapenem-resistant Klebsiella pneumoniae (CRKp) was found to be higher in the VAP group compared to the non-VAP group (n= 41, 58% vs. n= 25, 24%, p< 0.001).Ventilation period (OR= 1.07; 95% CI 1.02-1.12,p= 0.003), smoking (OR= 3.89; 95% CI 1.68-8.9,p= 0.001), and rectal colonization with CRKp (OR= 4.93; 95% CI 2.09-11.64,p< 0.001) were detected as independent risk factors for the development of VAP.Age (OR= 1.15; 95% CI 1.03-1.28,p= 0.01), SOFA score (OR= 1.60; 95% CI 1.05-2.43,p= 0.02) and rectal colonization with CRKp (OR= 15.2; 95% CI 2.33-99.01,p= 0.004) were detected as independent risk factors for mortality in patients with VAP. Conclusion:In conclusion, decreasing the patient-related and hospital environment related risk factors, routine screening of rectal colonizations with CRKp, and continuous practicing of the universal infection control measures may significantly decrease the prevalence of ventilator-associated pneumonia.

Background: The authors aimed to determine the efficacy of frequently used antibiotics, alone or in combination, against biofilms of ventilator-associated pneumonia isolates. Materials & methods: The authors determined the MICs, minimum biofilm inhibitory concentrations and minimum biofilm eradication concentrations of meropenem, ciprofloxacin and colistin as well as their combinations against planktonic forms and biofilms of Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii clinical isolates. Results: Generally, the minimum biofilm inhibitory concentrations and minimum biofilm eradication concentrations of the antibiotics were 1000-fold higher than their MICs, and synergy was provided by different concentrations of meropenem-colistin and meropenem-ciprofloxacin combinations with checkerboard and time-kill curve methods. Conclusion: The combination of meropenem and ciprofloxacin seems to be a good candidate for the treatment of biofilm-associated infections; none of the concentrations obtained as a result of the synergy test were clinically significant.

Objectives: We aimed to compare classical methods and chromogenic media to detect carbapenem-resistant Entero-bacteriaceae (CRE) colonization among hospitalized patients and determine the risk factors causing infection in col-onized patients.Methods: Between January and August 2017, 100 patients over the age of 18 who were hospitalized in the Reanimation Intensive Care Unit and the Trauma Emergency Intensive Care Unit of a university hospital were examined. From the first day of intensive care unit (ICU) admission, rectal swabs were collected once every week and were tested for the presence of CRE by using the classical method defined by the Centers for Disease Control and Prevention (CDC), ChromID CARBA chromogenic medium, and direct inoculation into MacConkey agar plates. In addition, MIC values for imipenem, ertapenem, meropenem and colistin were determined by using the Etest.Results: Rectal BDE carriage was detected by at least one method in 46 (46%) of 100 patients included in the study. Sensitivity and specificity values of the CDC classical method, direct MacConkey inoculation, and ChromID CARBA medium in the first 24 hours were found as 78%-42%, 87%-80%, and 91%-98%, respectively. Sensitivity and specific-ity values of these methods after 72 hours were determined as 78%-100%, 87%-100%, and 91%-100%, respectively.Conclusion: We observed that, although the ChromID CARBA method performed better than classical CDC and direct MacConkey inoculation methods, direct MacConkey inoculation can still be employed, especially in areas with limited resources.

Objectives: Disease severity, previous medications and immunosuppressive agents could affect the antibody response against SARS-CoV-2. This study aimed to analyze variables affecting the humoral response to SARS-CoV-2. Methods: This prospective cohort study included adult patients who recovered from COVID-19 and were admitted to a COVID-19 follow-up unit. Eight patient groups were defined in accordance with the results of thoracic computed tomography (CT), SARS-CoV-2 PCR test, and tocilizumab or anakinra use during active disease. Anti-S IgG antibodies were determined by ELISA in serum samples. Anti-S positive and negative cases were compared. Results: A total of 518 patients were included in the study. SARS-CoV-2 IgG antibodies were positive in 82.8% of patients. SARS-CoV-2 PCR positivity, extent of lung involvement on CT, and time to antibody testing were independently associated with antibody positivity. Tocilizumab, anakinra or prednisolone use was not a factor affecting the antibody response. The rate of antibody response and sample/CO values among antibody-positive patients showed a linear relationship with the extent of lung involvement on CT. Conclusions: The use of tocilizumab, anakinra and prednisolone for COVID-19 did not affect the antibody response against SARS-CoV-2. The main driver of antibody response among patients with COVID-19 was the extent of pulmonary involvement on CT.

Introduction: Nocardiosis is an opportunistic infectious disease that involves the lungs, brain, eyes and skin and tends to occur in patients using immunosuppressive drugs (especially affecting cellular immunity) or chemotherapeutics, also in patients with diabetes mellitus, AIDS, lymphoreticular malignancies, solid cancers and architectural lung diseases such as bronchiectasis and cystic fibrosis. Here, it was aimed to present the clinical features and the risk factors of nocardiosis cases followed in a tertiary care hospital. Materials and Methods: All adult patients with a culture-proven Nocardia spp. infection at our hospital from 2013 to 2019 were analyzed in the study retrospectively. Strains were identified by conventional methods and in the case of availability, by 16SrRNA gen analysis or MADI-TOF; antimicrobil susceptibilities were defined by gradient method. Results: There were a total of 9 nocardiosis cases during the study period: 4 with disseminated (including pulmonary, brain, muscle, eye) nocardiosis, 4 with pulmonary nocardiosis and 1 case with skin nocardiosis. Corticosteroids, temozolomide, mycofenolate mofetil and cyclosoprin were used by patiensts as immunosupresive drugs in 6, 2 ,1 and 1 them, respectively. All of the patients were lymphopenic except one. Five strains identified at species level were N.cyriacigeorgica (2 strains), N.farcinicia, N.asteroides and N.abscessus, respectively. All of the 7 strains with available suceptibility test results were susceptible to co-trimoxazole. Conclusion: Nocardia spp. should always be taken into consideration in the case of pulmonary or central nervous system infections of patients with supressed cellular immunity or lymphopenia. In the case of newly defined CNS lesion in a patient with both malignancy and pulmonary nocardiosis, CNS nocardiosis should always be kept in mind in the differential diagnosis. Although chemotherapeutic agents have always been defined as risk factors for nocardiosis, temozolomide could be a stronger risk factor because of its ability to cause a deeper lymphopenia. If nocardiosis is always to be considered in the case of a compatible clinical situation in patients on temozolomide regime, the real incidence of nocardiosis and prophylactic strategies among those patients could be defined properly.