We aimed to investigate the approaches for antifungal prophylaxis (AFP) and antifungal treatment in breakthrough invasive fungal diseases (IFDs) under AFP in high-risk hematology patients. Patients ≥ 18-years who received chemotherapy for acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL) or a conditioning regimen for allogeneic hematopoietic stem cell transplantation (AHSCT) with a duration of neutropenia (< 500 cells/mm3) ≥ 10 days were included in a prospective multicenter observational study. Patients were followed until one week after recovery from neutropenia, discharge from the hospital, or death, which comes first to define the success of AFP. A total of 230 patients were recruited from 18 centers in seven months. Posaconazole prophylaxis was used in 134 (44 of whom failed) and 96 patients received fluconazole (28 of whom failed). The survival rate at 12 weeks after the initiation of AFP was higher in patients with successful prophylaxis (96.2

Objective: The aim of this study is to investigate the epidemiology and recent incidence of HIV infection among young male candidates scheduled for military recruitment and whole young population in Turkey, a country previously known as markedly low prevalence of HIV infection. Materials and Methods: In the present study, the medical records from respective health institutions between the years 2007 and 2013 of male candidates scheduled for recruitment from recruitment offices serving under the National Defence Ministry of Turkish Republic, diagnosed with HIV infection and as such judged as unfit for service were requested. Results: While the total number of new HIV/AIDs cases in 2000 was 157, a fourfold increase (589) was recorded in the year 2010, and reaching 1,068 by the year 2012. Considering, data from the national statistics, in the year 2013 (including the month of November), a total of 7050 HIV positive cases were reported and of all the cases 4,931 (72%) consisted of males. At the same time, an important part of this group falls into the 18-45 year group category. Conclusion: As a conclusion, the prevalence of HIV infection in Turkey remains still low as compared to that of current global figures but the case numbers of HIV positive candidates of recruits and young people in the whole population are increasing alarmingly in significant manner due to every new coming year. So, programs targeted at identifying high risk groups and increasing the testing rates and preventive measures about HIV infection should be improved and developed

Fusarium is an opportunistic fungal pathogen which is emerging as a significant cause of morbidity and mortality in the immunocompromised host [1]. This disease can be localized, focally invasive or disseminated, when two or more noncontiguous sites are involved. We present a case of disseminated fusariosis in a patient with prolonged and profound neutropenia after the third allogeneic stem cell transplantation for acute lymphoblastic leukemia.

INTRODUCTION:This study aimed to identify a follow-up modality that can be used to evaluate therapeutic responses in patients receiving treatment for brucellar sacroillitis and to determine whether antibiotherapy can be stopped. METHODOLOGY:A total of 32 patients with sacroiliac joint involvement demonstrated via magnetic resonance imaging or bone scintigraphy were followed up and treated. Patients received 200 mg/day of doxycycline and 600-900 mg/day of rifampicin for 3-21 months, and 1 g/day of streptomycin for 21 days. RESULTS:The mean age of the 32 patients involved was 21.81±4.09. In total, 10/32 patients did not complete therapy, and the remaining 22 patients received combination antibiotic treatment for a mean of 8.95±4.34 months. Of the 22 patients, 15 underwent MRI, and 7 of them did not consent to MRI. Similarly, 17 patients were followed up by bone scintigraphy, and 5 patients did not have scintigraphy results. In 9/17 patients followed up with bone scintigraphy, sacroiliitis findings were found to reduce after a mean of 7.44±3.71 months, whereas in 12/15 patients on whom MRI was performed,  there were no active sacroiliitis findings for a mean of 6.95±2.83 months. CONCLUSIONS:While active involvement findings in bone scintigraphy were observed for a longer period in scintigraphy images, active sacroiliitis findings disappeared in a relatively shorter period of time with MRI. Therefore, we have demonstrated that high-resolution MRI is a very sensitive technique compared to scintigraphy.

A 79-year-old male suffering from nasal congestion was referred to our hospital. Endoscopic examination revealed a hyperemic mass obstructing the left nasal passage. The lesion's surface was smooth. The findings of imaging studies were consistent with a benign tumor despite the erosion and perforation of the septum. The lesion originated from the middle concha and was attached to it with a thin stalk. It was removed easily by endoscopic resection. Histopathology revealed significant infiltration of mononuclear inflammatory cells, mostly lymphocytes and histiocytes, into the edematous subepithelial connective tissue. High-power magnification showed numerous Leishmania amastigotes in the cytoplasm of the histiocytes. A polymerase chain reaction experiment for Leishmania also confirmed the morphological diagnosis. No relapse was observed in the 12 months after surgery and the patient was doing well.

AIMS:There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses. MATERIALS AND METHODS:This multicenter study included 507 patients with microbiologically confirmed TBM. However, 94 patients eligible for the analysis were included in this study from 24 centers. Six out of 94 patients died and the statistical analysis was performed with 88 survivors. Early and late responder groups were compared in the statistical analysis. P < 0.05 were considered to show a significant difference. RESULTS:In the multivariate analysis, the presence of vasculitis (P = 0.029, OR = 10.491 [95% CI, 1.27-86.83]) was found to be significantly associated with a delayed fever response whereas hydrocephalus was associated with altered mental status for >9 days duration (P = 0.005, OR = 5.740 [95% CI, 1.68-19.57]). According to linear regression analysis, fever was significantly persisting (>7 days) in the presence of vasculitis (17.5 vs. 7, P< 0.001) and hydrocephalus (11 vs. 7, P = 0.029). Hydrocephalus was significantly associated with persisting headache (21 vs. 12, P = 0.025), delayed recovery of consciousness (19.5 vs. 7, P = 0.001), and a delay in complete recovery (21 vs. 14, P = 0.007) in the linear regression analysis. Following institution of treatment, the complaints seemed to disappear in up to 2 weeks among TBM survivors. CONCLUSIONS:In the absence of hydrocephalus or vasculitis, one week of anti-tuberculosis treatment seems to be adequate for the resolution of TBM symptoms. Hydrocephalus and vasculitis delay the resolution of TBM symptoms in response to antimycobacterial treatment.

AIM: This study aims to compare point prevalence results which were done with one year interval in a university hospital with a 1,200-bed capacity. METHODS: The study assessed antibiotic usage among all hospitalised patients in the hospital on April 20, 2012 and April 19, 2013, using the point prevalence method. The assessment was carried out by an infectious disease specialist relying on the basic principles of antibiotic usage and current antimicrobial treatment guides. The causes of antibiotic usage were classified under three groups, namely, empirical, infection diagnosis and prophylactic. Data were transferred to computer and analysed using SPSS 15.0. We used the chi square method for comparisons of categorical variables. P values

Our country is in the median endemicity belt in terms of hepatitis B virus infection. This study was performed in the commando candidates who came from all over Turkey to a military division/brigade, between January 2007 and December 2009, 20.681 commando candidates were checked for HBsAg positivity and these data were investigated retrospectively. In our study, hepatitis B virus carriage among young men as the Turkey\'s average was 3.3%. This data was lower than those reported previously. We attribute this positive trend to the dissemination of immunization programs, the increase of births in the hospitals rather than home delivery, and the widespread use of HBsAg screening tests before marriage

Introduction: In this study, we aimed to determine the seropositivity of antiHAV IgG in young adults aged 16-24 years admitted to department of pediatrics and department of infectious diseases of a hospital in Kayseri. Material and Methods: This retrospective study was performed in a public hospital in Kayseri. In this study, the anti-HAV IgG results of 1032 patients aged 16-24 years admitted to hospital between 1st January, 2006 and 1st April, 2010 were investigated and the association between the anti-HAV IgG results and demographic features such as age and gender was analysed. Patients having immunisation history with HAV vaccine were not included in the study. The SPSS 15.0 was used for statistical analysis of data. Results: The study population were included a total of 1032 patients, 769 (74.6%) male and 263 (25.4%) female, mean age of 22.3± 2 years in male and 20.6±4 years in female. Total Anti-HAV IgG seropositivity was %61.8 (638/1032). Anti-HAV IgG results were seropositive 150 out of 263 (57.0%) in female group and 488 out of 769 (63.4%) in male group. There was no statistically significant association between seropositivity and age or gender (p>0,05). Conclusion: In this study, it was shown a lower seropositivity of anti-HAV IgG in young adults. It seems that effective precautions such as vaccination should be carried out for prevention of HAV infection and its complications which are more severe in adults.

BACKGROUND/PURPOSE:Between 5% and 10% of the vaccinated population responds less well to standard vaccination schedules irrespective of hepatitis B virus (HBV) vaccination. This manuscript aims at describing possible correlation of different major histocompatibility complex (MHC) Class-I and MHC Class-II haplotype to anti-HBV humoral responsiveness following HBV vaccination.MATERIALS AND METHODS:The study was conducted on 944 vaccinated hospital staff members and concentrated on the 38 nonresponders as defined by enzyme-linked immunosorbent assay (ELISA) results. In order to define significance of the different haplotypes from the nonresponders, their frequency was compared to the frequency of the same haplotype in 18 randomly selected responders. Human leukocyte antigen (HLA)-A and HLA-B antigens were typed among total mononuclear cells using a standard two-stage microlymphocytotoxicity test. The typing method of HLA Class-II is based on a technique that involves amplification of the second exon of different HLA Class-II genes by PCR.RESULTS:Positive correlations were found between four HLA-DR (HLA-DRB1*04X, DRB1*0401X, DRB1*11/13, and DRB1*0401X0201) haplotypes and nonresponders but there was a negative correlation with one Class-I (HLA-B13).CONCLUSION:This study suggested that certain HLA types are associated with nonresponsiveness to vaccination. The different HLA of ethnic groups should also be kept in mind when evaluating the response to hepatitis vaccination. The different HLA gene frequencies of ethnic groups should be examined in further large-scale population-based studies.

Introduction: This study aimed to review the possible sources of infection of 16 oropharyngeal tularemia hospital cases, and to document their epidemiological and demographical characteristics, laboratory findings, treatment methods, and treatment results. Methodology: Sixteen cases from a Turkish military hospital between January 2011 and December 2012 were retrospectively evaluated. The age, sex, occupation, place of residence, symptoms, duration of symptoms, laboratory results, treatment and duration, and treatment results were recorded. Tularemia was diagnosed through tularemia-specific tests once the other conditions that may have caused lymphadenopathy were excluded. Results: Twelve of the patients included in this study were males. The average age of the patients was 32.1±17.2 years. Sore throat, fatigue, and fever were the most frequent symptoms. The mean duration of symptoms was 21.6±6.9 days. All the patients had been treated for tonsillopharyngitis in primary healthcare institutions previously. However, despite the treatment, cervical lymphadenopathy had developed in these cases. Patients were given streptomycin, doxycycline, and ciprofloxacin monotherapy or in combination. Ten of the cases fully recovered, while five required surgical lymph node drainage. Spontaneous drainage occurred in the single remaining case. Conclusions: Turkey is considered to be an endemic country with regards to tularemia. Prompt diagnosis and proper treatment of the disease is imperative in providing cure. Since it can be potentially confused with tuberculous lymphadenitis, differential diagnosis is vital. Patients presenting with a condition of tonsillopharyngitis in endemic areas must be carefully monitored.

Cases of orf virus infection in human in Turkey have been reported for many years. Scab material from a man was found positive by PCR using pan-parapox-specific primers for parapoxvirus infection. The amplicon was purified and sequenced. The present study provides for the first time a phylogenetic analysis of parapoxviruses from Turkey. The partial B2L gene sequence of a Turkish orf virus from a human presented here may be useful for characterization of parapoxvirus infections in Turkey based on the phylogenetic analysis studies.

Numerous viral and bacterial pathogens have been reported causing acute respiratory tract infection (ARTI). Nasopharyngeal swab (NPS) specimens from 351 patients (278 children, 73 adults) with suspected upper and lower ARTI were submitted during the study period from Jan. 2005 to Dec. 2006. Organism-specific nucleic acids were detected using TemPlex technology (ResPlex I and II, Genaco Biomedical Products, Huntsville, AL). Amplified products were identified using a suspension array for multiplex detection performed on a Luminex 100 instrument (Luminex, Austin, TX). A total of 221 viral and bacterial respiratory agents were detected in 148 patients (135 [48.5%] of the 278 children and 13 [17.8%] of the 73 adults) with suspected ARTI. A single respiratory pathogen was detected in 89 patients [25.35%], whereas mixed infection with two or three pathogens was found in 59 [16.8%] of 351 suspected patients. S. pneumonia was the most frequently isolated strain (54 [15.3%] of 351 patients), followed by H. influenzae (37 [10.5%]), rhinoviruses (35 [9.9%]), influenza A virus (23 [6.5%]), enteroviruses (19 [5.4%]), hMPV (14 [3.9%]), PIV-1 (12 [3.4%]), PIV-3 (11 [3.1%]), RSV (10 [2.8%]), and influenza B virus (6 [1.7%]). Mixed infections were more frequent in children (56 [20.1%] of 278) than adult patients (3 [4.1%] of 73 patients). The detection rate of the bacteria peaked in the spring season (37 [40.6%] of 91 bacteria), followed by winter (24 infections), autumn (18 infections) and summer (12 infections). The prevalence of co-infection is ~40%, finding a much higher incidence of co-infection with more than one agent than that reported previously.

printing supported by . Visit Chiesi at Stand B2.10 TUESDAY, SEPTEMBER 4TH 2012 improve tolerance & patient satisfaction. Propofol, a short acting intravenous hypnotic, offers advantages over benzodiazepines/opiates. Objectives: We analyzed the feasibility, efficacy & safety profile of propofol administered by a trained nurse for outpatient bronchoscopy. Methods: A total of 276 flexible bronchoscopies performed between 2009 & 2011 using propofol sedation only without premedication were retrospectively reviewed. Patient demographics, indications, type of procedure, procedure time, medication doses, comfort level on 10cm verbal analogue scale (VAS, 0-10, 0=excellent, 10=unbearable) & adverse events were analyzed from procedure records. Results: Of the 276, two-thirds (182, 66%) patients were male with an average age of 56 years (range 18−82) & an average weight of 73 kg. Indications included diagnostic BAL (127, 46%), TBLB (68,25%), TBNA (41,15%) & EBB (22,8%). Average procedure time was 36 minutes (range 12−145). Average propofol dose was 1.86 mg.kg-1 (range 0.12−20 mg.kg-1). Minor adverse events (21, 7.6%) included hypotension (19, 7%), transient hypoxia (8, 3%) & tachycardia (5, 2%). Major adverse events (death,intubation, ICU stay, or hospitalization) occurred in 7 (2.5%), of which 3 (1%) were attributed to sedation, 2 (0.7%) to hemoptysis, & 1 each to hypoxia & bronchospasm. There were no procedure-related deaths. A majority (196, 71%) reported VAS of 4-6 with good amnesia, while 56 (20%) had VAS > 6 & 24 (8.6%) had VAS <3. Conclusions: Propofol is an easy to administer, safe, & effective procedural sedative for outpatient bronchoscopies providing acceptable comfort. P3575 Lidocaine administration to the laryngopharynx for inducing anesthesia before bronchoscopy: A comparative study of Jackson’s spray method and ultrasonic nebulization Ken-ichi Takahashi1, Emiko Yamakawa2, Kouki Tsuji2, Yukiko Kaneko2, Yoko Uraguchi2, Kaori Okubo2, Toshie Chiyomori2, Emiko Murakami2, Taeko Kameyama2, Kazuki Shima1, Yoko Hamakawa1, Shohei Kaneda1, Susumu Noguchi1, Akari Moriyama1, Yojiro Yutaka1, Hiromichi Katakura1, Naoki Sakai1, Akira Yamanaka1. 1Respiratry Diseases and Chest Surgery, Otsu Red Cross Hospital, Otsu, Japan; 2Endoscopy Center, Otsu Red Cross Hospital, Otsu, Japan Objective: To compare the degrees of pain experienced by patients and additional intraoperative amounts of lidocaine required when lidocaine is administered using Jackson’s spray and an ultrasonic nebulization. Methods: Forty patients who were given laryngopharyngeal anesthesia before bronchoscopy were divided into 2 groups of 20 patients each: group A, which was given 4% lidocaine 5 mL by using Jackson’s spray, and group B, which was given 2% lidocaine 10 mL by using an ultrasonic nebulizer. The degrees of pain in patients evaluated on the basis of examination times, amounts of lidocaine administered during bronchoscopy, rates of lidocaine use (obtained by dividing amounts of lidocaine administered during bronchoscopy by examination times), and results of a questionnaire survey consisting of a 5-point evaluation scale for 7 items were compared between the 2 groups. Results: There were no significant differences in examination times, amounts of lidocaine administered during bronchoscopy, and degrees of pain between the groups. However, the rates of lidocaine use in group B were significantly lower than those in group A (0.55±0.3 mL/min versus 0.38±0.2 mL/min; p = 0.03). An analysis based on patient age and smoking history showed that the rate of lidocaine use in group A was not significantly high in elderly persons (less than 70 years of age) and smokers (p = 0.05). Conclusion: In laryngopharyngeal anesthesia before bronchoscopy, the Jackson spray required a large amount of lidocaine at the time of bronchoscopic examination for bronchoscopy time, compared with the ultrasonic nebulizer. P3576 Incremental midazolam versus midazolame/rentanyl sedation during flexible bronchoscopy. Safety and tolerance in relation to the complexity of intervention Grigoris Stratakos, Ioannis Kokkonouzis, Penny Moraitaki, Philip Emmanouil, Nikos Koufos, Evangelia Stoubi, Dimitra Tsiboura, Filomila Zikopoulou, Fotis Sampsonas, Manos Alchanatis, Nikolaos Koulouris. 1st Department of Pulmonary Medicine, University of Athens, Sotiria Chest Hospital, Athens, Greece Background: Sedation during flexible bronchoscopy (FB) is undisputed. Although suggested, benzodiazepines and opiates combination is underused due to fear of complications. Aim: To prospectively compare safety and tolerance of FB sedation using incremental midazolam (M) versus combined midazolam/fentanyl (MF) administration. Methods: Consecutive patients referred for FB were enrolled. After administration of 2% lidocaine aerosol, sedation with midazolam (1-5 mg) alone or combined with fentanyl (0.025-.005mg) was given. Decision relied on clinical parameters (fear,anxiety,cough and restlessness) and on staff judgment regarding performed interventions.Nurses took active role estimating sedation need. Patients completed verbal analogue scales (VAS) and overall tolerance questionnaires.Bronchoscopists completed tolerance VAS and complications questionnaires. Results: 68 patients (53 males, aged 65±12) enrolled.31 received only M (mean 2.23 mg) while 37 received combined sedation (mean 2.74mg M and 0.033 mg F).No sedation related complications were reported.Increased duration of FB and interventional procedures (EBUS, TBNA, Electro-Cryotherapy) were associated with combined MF sedation and increased M dosage (p < 0.05). Patients & bronchoscopists reached high VAS scores (>8/10).Discomfort and adverse effect scores were equally minimal. Conclusion: Both regimens are safe and effective in reducing anxiety and cough while increasing FB tolerance. Selection can be based on prolonged duration and need for interventional modalities. Trained endoscopy nurses are effective in incrementing sedation during bronchoscopy in an “as needed” basis. P3577 Propofol sedation for flexible bronchoscopy: A large randomized, controlled, non-inferiority trial Peter Grendelmeier, Eric Pflimlin, Michael Tamm, Daiana Stolz. Clinic of Pulmonary Medicine, University Hospital, Basel, Switzerland Background: Propofol is a feasible and safe method for sedation in patients undergoing flexible bronchoscopy. However, there are no data comparing bolus administration versus continuous infusion of propofol for flexible bronchoscopy. Methods: 702 consecutive patients undergoing flexible bronchoscopy were randomly allocated to receive intravenous propofol using either a continuous infusion or an intermittent bolus technique. The primary endpoint was the number of any adverse event (SaO2 ≤ 90%; need for oroor nasopharyngeal airway insertion; systolic BP < 90 mmHg, minor or major bleeding, pneumothorax, need to abort bronchoscopy, ICU, intubation or death) assessed by the end of FB and at 24 hours. Results: The number of any adverse event was similar in both randomized groups (Bolus group 219 vs. 211 Infusion group, p = 0.810). There were complications in 8 (1.1%) cases (6 major bleedings, 2 intubations). There was no death. As compared to the Bolus group, the amount of propofol required was significantly higher in the infusion group (226mg ± 147 versus vs. 308 mg ± 204.8, p < 0.0001). In a linear multivariate regression model, this difference remained significant independently of duration and the interventions (e.g. TBB, EBUS) performed during flexible bronchoscopy. The duration of bronchoscopy was significantly longer in the infusion group (14 [9 24] versus 17 [12 27] minutes, p < 0.0001). Conclusion: Although propofol continuous infusion is as feasible and safe as bolus administration, it is associated with higher propofol requirements and a longer duration of the bronchoscopy. P3578 Bronchology in the Czech Republic – National surveys during last decades Vitezslav Kolek1, Miloslav Marel2, Pavel Barton3. 1Respiratory Medicine, University Hospital, Olomouc, Czech Republic; 2Respiratory Medicine, University Hospital, Motol, Praha, Czech Republic; 3Tuberculosis and Respiratory Diseases, Institute, Jevicko, Czech Republic Czech bronchology has a long tradition and its activities have been monitored for many years. Statistical analysis based on questionnaires was realised in 1977 (Hlobil), 1994 (Marel), 1996, 1999,2003 (Kolek). Increasing trends of total numbers of endoscopes, broncoscopies and especially interventional bronchological procedures were verified in this surveys. Similar questionnaire was sent electronically and via post to all Czech bronchological centres in 2009. Personal and telephone contacts were used to accelerate an adequate response,too. Questions dealt with numbers of bronchoscopists, types of bronchoscopes, diagnostic methods, interventional techniques and system of work. Results were compared with older surveys mentioned above. In 2009 there were 59 active bronchological centres, which performed 33. 282 bronchoscopies. Out of them 1.637 (4,9%) were done by rigid bronchoscope, 258 were done in children. General anaesthesia was used in 2194, fluoroscopy in 1238 procedures. Altogether 182 bronchoscopists worked with 182 flexible and 87 rigid bronchoscopes, 29 videocameras and 81 videobronchoscopes. Out of all procedures, 544 EBUS, 1724 AFO,1041 NBI and 46 EMN investigations were performed. Doctors performed 1235 laser resections, 246 electrocautheries, 121 stent insertions, 78 afterloadings, 5 plasmacoagulations, 3 cryotherapies and first endobronchial valves insertions. During last decades, the quantity of bronchological procedures (especially therapeutical and new sophisticated diagnostic methods) is increasing, vice versa the number of bronchological centres is decreasing. P3579 Bronchoscopic practice in Japan Fumihiro Asano, Motoi Aoe, Yoshinobu Ohsaki, Yoshinori Okada, Shinji Sasada, Shigeki Sato, Eiichi Suzuki, Hiroshi Senba, Shozo Fuj

AIM: We aimed to obtain the knowledge of appropriate antibiotic therapy and to make a contribution to improving treatment efficacy by conducting a microbiological study of diabetic foot ulcers. METHOD: 30 patients (18 male and 12 female) with diabetic foot ulcer applying to our center for hyperbaric oxygen (HBO) treatment in 2010 were enrolled in this study. The wounds were graded according to Meggitt-Wagner classification system. Wound cultures were obtained before starting antibiotic therapy and HBO treatment. Phoenix system (Becton Dickinson, USA) and Kirby-Bauer disk diffusion antibiotic sensitivity testing were used in order to detect the antimicrobial susceptibility of the infection agents. The number of HBO sessions, glycemic control and treatment results were assessed. RESULTS: Mean age of the patients was 61.3 years (range: 35-83). 24 patients had a good glycemic control and 6 patients had not. The patients were given 5 to 55 HBO sessions (mean: 20). Of the 30 patients 19 (63.33%) recovered from the infection but 11 (36.67%) have not responded to the treatment. 14 different infectious agents were detected in diabetic foot ulcers we examined. Gram-positive agents were isolated in 12 (40%) out of 30 wound cultures and gram-negative agents were isolated in 18 (60%) wound culture. Pseudomonas aeruginosa was predominantly isolated and the other agents isolated were enterococcus faecalis, klebsiella pneumoniae, staphylococcus aureus and escherichia coli. CONCLUSION: The outcomes can not represent the general population rates due to the restriction factors. They give only an idea about the probability of infectious agent spectrum in diabetic foot ulcers and their antibiotic susceptibility. We want to attract attention to the fact that although pseudomonas aeruginosa infections are mostly encountered in hospital, they can also be acquired from the community and it will be useful to develop appropriate antibiotic policies and treatment protocols.