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Öğe A patient with HIV infection presenting with diffuse membranous glomerulonephritis in a country with a low HIV prevalence-remarkable remission with therapy(2012) Aydın, Selda; Mete, Bilgül; Yılmaz, Mesut; Yenidünya, Gülşah; Zaras, Reşat; Tunçkale, Aydın; Tabak, FehmiThe most common manifestation of HIV in the kidney is HIV-associated nephropathy (HIVAN). In this report, we describe the first documented case of membranous glomerulonephritis in an HIV-positive individual in Turkey, the country with the lowest HIV prevalence in the region. The case occurred in an HIV-positive, hepatitis C (HCV)-negative, and hepatitis B (HBV)-negative Caucasian male, who presented with nephrotic-range proteinuria. The patient had a favorable response to HAART and an angiotensin-receptor blocker.Öğe A prospective pharmacovigilance study in the infectious diseases unit of a tertiary care hospital(Journal of Infection in Developing Countries, 2019) Karaismailoğlu, Berna; Saltoğlu, Neşe; Balkan, İlker İnanç; Mete, Bilgül; Tabak, Fehmi; Öztürk, RecepIntroduction: The frequency, causality, severity, preventability and risk factors of ADRs (adverse drug reactions) in infectious disease units are not well defined in the literature. Thus, the aim of this study was to determine the characteristics of the ADRs encountered in an infectious disease unit of a tertiary teaching hospital. Methodology: The patients who were admitted to the infectious disease unit of a tertiary teaching hospital longer than 24 hours between January and December of 2016 were followed prospectively. Patients were observed and questioned for any sign of ADRs. The proportion of ADRs and patient characteristics were investigated. Causality was evaluated by the Naranjo algorithm, severity was determined using the Hartwig classification, and preventability was assessed using the Schumock and Thornton scale. Results: 210 patients were admitted to the unit during the study period, of whom 44 patients (20.9%) experienced 51 ADRs. 5.9% of ADRs were found to be serious according to the Hartwig severity classification. In addition, 88.1% of ADRs were not preventable. The most frequently detected ADR was skin and subcutaneous tissue reactions (33.3%), and systemic antimicrobials were the most common type of drugs that caused an ADR. Prolonged hospitalization (p < 0.001) and usage of an increased number of drugs (p < 0.001) were found to be significant risk factors for ADR development. Conclusions: Prolonged hospital stay and polypharmacy are significant risk factors that increase the incidence of ADRs in infectious disease units. The likelihood of unavoidable ADRs should arouse the attention of clinicians when prescribing antimicrobials.Öğe Anorectal syphilis mimicking Crohn's disease(Springer, 2011) Yılmaz, Mesut; Memişoğlu, Reşat; Aydın, Selda; Tabak, Ömür; Mete, Bilgül; Memişoğlu, Necat; Tabak, FehmiAnorectal syphilis, one of the great masqueraders in medicine, can be difficult to diagnose not only because of its variable symptoms but also because it is hard to think of unless a detailed history about sexual preferences and practices, including homosexuality, has been gathered. With increasing acceptance of sexual activity in our culture, despite moral and religious issues, various forms of sex have led to many different clinical conditions of sexually transmitted diseases. In this report, we describe a rare case of primary anorectal syphilis with clinical, endoscopic and histologic features that was misdiagnosed as Crohn's disease.Öğe Aspergillus fumigatus infection as a delayed manifestation of prosthetic knee arthroplasty and a review of the literature(Informa Healthcare, 2011) Yılmaz, Mesut; Mete, Bilgül; Özaras, Reşat; Kaynak, Gökhan; Tabak, Fehmi; Tenekecioğlu, Yüksel; Öztürk, RecepFungal infection after total joint arthroplasty is a very rare but serious complication and a challenge to the treating and consulting physicians. The literature includes little information about the treatment protocol for Aspergillus infection after total knee arthroplasty, since only 3 cases have been reported. We describe the case of a non-immunocompromised patient who lacked predisposing risk factors and presented with pain and swelling. An aspiration under sterile conditions revealed Aspergillus fumigatus. The patient was treated successfully with a 2-stage exchange reimplantation and 6-week course of liposomal amphotericin B. At 4 y after reimplantation, the patient had no evidence of infection or pain.Öğe Candida auris Fungemia and a local spread taken under control with infection control measures: First report from Turkey(NLM (Medline), 2021) Kurt, Ahmet Furkan; Kuşkucu, Mert; Balkan, İlker İnanç; Bayri Barış, Ayşe; Yazgan, Zeynep; Öz, Ayşe Şerife; İstanbullu Tosun, Ayşe; Mete, Bilgül; Tabak, Fehmi; Aygün, GökhanCandidaauris, draws attention as a new emerging antifungal resistant pathogen, leading to healthcare-associated infections and outbreaks. This is the first report of C. auris fungemia in a 81-year-old patient, confirmed by sequential analysis, from Turkey. Although the source of the isolate could not be identified, its spread in the hospital has been taken under control by effective infection control measures.Öğe Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience)(Springer, 2021) Mete, Bilgül; Yerlikaya Zerdalı, Esra; Aygün, Gökhan; Saltoğlu, Neşe; Balkan, İlker İnanç; Karaali, Rıdvan; Kaya, Sibel Yıldız; Karaismailoğlu, Berna; Kaya, Abdurrahman; Ürkmez, Seval; Can, Günay; Tabak, Fehmi; Öztürk, RecepCandidemia is a nosocomial infection mostly found in critically ill patients. Our objectives were to evaluate the change in distribution and resistance profile ofCandidaspp. isolated from candidemic patients in our intensive care unit over two 5-year periods spanning 15 years and to evaluate the risk factors. Records from the microbiology laboratory were obtained, from January 2004 to December 2008 and from January 2013 to December 2017, retrospectively. Antifungal susceptibility was performed by E-test and evaluated according to EUCAST breakpoints. A total of 210 candidemia cases occurred; 238Candidaspp. were isolated in 197 patients (58.8% male; mean age, 59.2 +/- 19.6 years). The most predominant risk factor was central venous catheter use. Species distribution rates were 32%, 28%, 17%, and 11% forC. albicans(n = 76),C. parapsilosis(n = 67),C. glabrata(n = 40), andC. tropicalis(n = 27), respectively. Resistance rate to anidulafungin was high inC. parapsilosisover both periods and increased to 73% in the second period. Fluconazole showed a remarkable decrease for susceptibility inC. parapsilosis(94 to 49%). The prevalence of MDRC. parapsilosis(6%/33%) andC. glabrata(0%/44%) increased in the second period. We observed a predominance of non-albicansCandidaspp., withC. parapsilosisbeing the most frequent andC. glabratainfections presenting with the highest mortality. High level of echinocandin resistance inC. parapsilosisand increasing prevalences of MDRC. parapsilosisandC. glabrataseem emerging challenges in our institution.Öğe Colistin nephrotoxicity increases with age(Informa Healthcare, 2014) Balkan, İlker İnanç; Doğan, Mustafa; Durdu, Bülent; Batırel, Ayşe; Hakyemez, İsmail Necati; Çetin, Birsen; Karabay, Oğuz; Gönen, İbak; Özkan, Ahmet Selim; Uzun, Sami; Demirkol, Muhammed Emin; Akbaş, Sedat; Kaçmaz, Asiye Bahar; Aras, Sükrü; Mert, Ali; Tabak, FehmiBackground: Colistin (COL) has become the backbone of the treatment of infections due to extensively drug-resistant (XDR) Gram-negative bacteria. The most common restriction to its use is acute kidney injury (AKI). Methods: We conducted a retrospective cohort study to evaluate risk factors for new-onset AKI in patients receiving COL. The cohort consisted of 198 adults admitted to 9 referral hospitals between January 2010 and October 2012 and treated with intravenous COL for >= 72 h. Patients with no pre-existing kidney dysfunction were compared in terms of risk factors and outcomes of AKI graded according to the RIFLE criteria. Logistic regression analysis was used to identify associated risk factors. Results: A total of 198 patients met the inclusion criteria, of whom 167 had no pre-existing kidney dysfunction; the mean patient age was 58.77 (+/- 18.98) y. Bloodstream infections (34.8%) and ventilator-associated pneumonia (32.3%) were the 2 most common indications for COL use. New-onset AKI developed in 46.1% of the patients, graded as risk (10%), injury (15%), and failure (21%). Patients with high Charlson co-morbidity index (CCI) scores (p = 0.001) and comparatively low initial glomerular filtration rate (GFR) estimations (p < 0.001) were more likely to develop AKI, but older age (p = 0.001; odds ratio 5.199, 95% confidence interval 2.684-10.072) was the major predictor in the multivariate analysis. In-hospital recovery from AKI occurred in 58.1%, within a median of 7 days. Conclusions: COL-induced nephrotoxicity occurred significantly more often in patients older than 60 y of age and was related to low initial GFR estimations and high CCI scores, which were basically determined by age.Öğe Comparison of cellular immunity in patients with chronic hepatitis B, inactive hepatitis B surface antigen carriers and spontaneously recovered individuals(H G E Update Medical Publishing S A, 2014) Arslan, Ferhat; Mert, Ali; Sili, Uluhan; Tabak, Fehmi; Öztürk, Recep; Özaras, ReşatDifferent clinical outcomes of acute HBV infection have been partially explained by individual differences in immune response. In this study We investigated interferon gamma (IFN-gamma) secretion of peripheral blood mononuclear cells (PBMC) in vitro against specific (Hepatitis B core antigen; recombinant HBcAg) and non-specific (CMV, EBV, Influenza peptide pool; CTL CFF peptide pool "plus") antigens using enzyme linked immunospot (ELISPOT) assay in 7 patients with chronic hepatitis B (CHB group), 8 inactive carriers of HBV (carrier group) and 8 subjects who spontaneously recovered from acute HBV infection as detected by anti-HBs positivity (immune group). Phytohemaglutinin served as the positive test control. Response against recombinant HBcAg was 88 +/- 35, 50 +/- 110, 105 +/- 150 spot forming cell (SFC) /10(5) PBMC, in CHB, carrier and immune groups, respectively. HBeAg-specific T-cell response was slightly higher in the immune group; however, statistically there was no significant difference between the groups. Assessment of cellular immunity by IFN-gamma ELISPOT was not sufficient to explain the various outcomes of HBV infection such as resolution, chronicity and carriership.Öğe Early changes of mannose-binding lectin, H-ficolin, and procalcitonin in patients with febrile neutropenia: A prospective observational study(Galenos Yayıncılık, 2016) Mutcali Islak, Sibel; Saltoğlu, Neşe; Balkan İnanç, Ilker; Özaras, Reşat; Yemişen, Mücahit; Mete, Bilgül; Tabak, Fehmi; Mert, Ali; Öztürk, Recep; Öngören, Seniz; Başlar, Zafer; Aydın, Yıldız; Ferhanoğlu, Burhan; Soysal, TeomanObjective: The significance of mannose-binding lectin (MBL) and H-ficolin deficiency in febrile neutropenic (FN) patients and the correlation of these markers along with consecutive C-reactive protein (CRP) and procalcitonin (PCT) levels during the infectious process are investigated. Materials and Methods: Patients with any hematological malignancies who were defined to have "microbiologically confirmed infection", "clinically documented infection", or "fever of unknown origin" were included in this single-center prospective observational study. Serum levels of CRP, PCT, MBL, and H-ficolin were determined on 3 separate occasions: at baseline (between hospital admission and chemotherapy), at the onset of fever, and at the 72nd hour of fever. Results: Forty-six patients (54% male, mean age 41.7 years) with 61 separate episodes of FN were evaluated. Eleven patients (23.9%) had "microbiologically confirmed infection", 17 (37%) had "clinically documented infection", and 18 (39.1%) had "fever of unknown origin". Fourteen (30.4%) patients had low (<500 ng/mL) initial MBL levels and 7 (15.21%) had low (<12,000 ng/mL) H-ficolin levels. Baseline MBL and H-ficolin levels did not significantly change on the first and third days of fever (p=0.076). Gram-negative bacteremia more frequently occurred in those with low initial MBL levels (p=0.006). PCT levels were significantly higher in those with microbiologically documented infections. Mean and median PCT levels were significantly higher in cases with bacteremia. There was no significant difference between hemoculture-positive and-negative patients in terms of CRP levels. Conclusion: Monitoring serum H-ficolin levels was shown to be of no benefit in terms of predicting severe infection. Low baseline MBL levels were correlated with high risk of gram-negative bacteremia; however, no significant correlation was shown in the follow-up. Close monitoring of PCT levels is warranted to provide more accurate and specific data while monitoring cases of bacteremia.Öğe Epidemiological, clinical, and prognostic features of infective endocarditis: A retrospective study with 90 episodes(İstanbul University-Cerrahpaşa, 2021) Kaçmaz, Asiye Bahar; Balkan, İlker İnanç; Sinan, Ümit Yaşar; Mete, Bilgül; Saltoğlu, Neşe; Tabak, Fehmi; Mert, Ali; Küçükoğlu, Mehmet Serdar; Öztürk, RecepTo evaluate the epidemiological, clinical, microbiological, and echocardiographic features, as well as the prognosis and long- term outcome of patients with infective endocarditis. Methods: The clinical records and follow-up data of 90 endocarditis episodes in 86 patients diagnosed with definite and possible infec- tive endocarditis according to the modified Duke criteria in a tertiary university hospital, between 1998 and 2016, were reviewed. Results: Fifty-six patients were male (65.1%), and the mean age was 49.9 ± 14.3. Native valve endocarditis constituted 62.2% of the cases, while the remaining patients had prosthetic valve endocarditis. The aortic (34.4%) and mitral (24.4%) valves were infected more frequently. Streptococci (27.7%) and staphylococci (24.4%) were the most frequently isolated microorganisms. Embolic complications (35.5%) were the leading cause of morbidity, followed by valve insufficiency (28.8%) and heart failure (21.1%). Valve replacement surgery was performed in 28 patients (31%). The in-hospital mortality rate was 15.1% (n = 13). Chronic renal failure (P = .042) and degenerative valves (P = .036) were significantly associated with mortality. Among 43 of the 73 cases available for telephonic survey, 36 (83.7%) patients were alive and without disease, with a median follow-up of 52.9 (4-163) months. Twenty-five (69.4%) of these patients were younger than 55 years, and 24 (66.6%) had native valve endocarditis. Conclusion: Underlying cardiac conditions and chronic renal failure increase mortality in infective endocarditis, regardless of the patho- gen. Long-term survival seems promising in cases with native valve endocarditis and in younger patients with low rates of comorbidities.Öğe HCV-specific lymphocyte responses in individuals with positive anti-HCV but negative HCV-RNA(Elsevier Science, 2015) Sili, Uluhan; Kaya, Abdurrahman; Aydın, Selda; Hondur, Nur; Mert, Ali; Tabak, Fehmi; Özaras, Reşat; Öztürk, RecepBackground: Hepatitis C virus (HCV) status cannot be reliably predicted in anti-HCV positive/HCV-RNA negative individuals who may either have recovered spontaneously or have a false-positive test due to antibody cross-reaction. Investigating T lymphocyte responses in individuals with different HCV status may help understand the cellular immune mechanisms underlying spontaneous recovery, treatment response, and chronicity. Objective: We aimed to determine whether anti-HCV positive, HCV-RNA negative individuals are truly spontaneous recoverers from acute HCV infection. Study design: We used enzyme-linked immunosorbent spot (ELISPOT) assay to compare HCV-specific lymphocyte response among anti-HCV positive/HCV-RNA negative individuals, patients with sustained virological response to interferon-gamma/ribavirin treatment, and patients with chronic HCV infection. Results: We found that 83% of anti-HCV positive/HCV-RNA negative individuals without a past medical history of acute icteric hepatitis had an HCV-specific T lymphocyte response in peripheral blood. Lymphocyte responses in these individuals were similar in magnitude to treatment responders unlike patients with chronic HCV whose virus-directed immunity was significantly suppressed. Conclusions: Detection of HCV-specific T lymphocyte responses using ELISPOT is a feasible method to ascertain past asymptomatic acute HCV infection.Öğe Pelvic and retroperitoneal hydatid cysts superinfected with Brucella sp and review of infected hydatid cysts(Malaysian Soc Parasitology Tropical Medicine, 2013) Arslan, Ferhat; Zengin, Kağan; Mert, Ali; Özaras, Reşat; Tabak, FehmiHydatid disease is a zoonotic infection resulting from the tissue infestation of the larval stage of the parasite Echinococcus granulosus. Hydatid cysts superinfected with pyogenic organisms have been reported previously. Brucellosis is more prevalent in people with close contact to animals and those consuming fresh milk or fresh milk products. Although these two disorders have some similar epidemiological features, we did not encounter any hydatid cyst cases superinfected with Brucella species (sp.) in a search of medical literature (Pubmed). Here, we present a case of hydatid cyst disease superinfected with Brucella and review the literature on other hydatid cyst cases superinfected with pyogenic organisms. We conclude that in regions where brucellosis and hydatid cysts are endemic, cysts may be infected with Brucella sp.Öğe Plasma and breast milk pharmacokinetics of tenofovir disoproxil fumarate in nursing mother with chronic hepatitis B-infant pairs(American Society for Microbiology, 2021) Ertürk, U. S.; Mete, Birgül; Özaras, Reşat; Saltoğlu, Neşe; Balkan, I. I.; Mert, Ali; Kaçmaz, Bahar; Sağlam, Onursal; Güney, B.; Sayman, O. A.; Tabak, FehmiTenofovir use is associated with lower risk of mother-to-infant transmission of the virus, and discontinuation of the treatment is not safe. However, the safety of the drug during pregnancy and breastfeeding is not clear. In this study, we aimed to determine the tenofovir concentration in plasma of mother-infant pairs along with breast milk in chronic hepatitis B patients during the lactation period. A total of 11 mother-infant pairs were enrolled in the study. All the mothers received tenofovir disoproxil fumarate (TDF) 245mg/day for at least 1 month because of chronic hepatitis B infection. Maternal blood, breast milk, and infant blood samples were obtained concomitantly. Tenofovir concentrations were determined by liquid chromatography-tandem mass spectrometry. The median concentrations of tenofovir in maternal plasma and breast milk samples were 88.44 (interquartile range [IQR], 62.47 to 116.17) ng/ml and 6.69 (IQR, 4.88 to 7.03) ng/ml, respectively. Tenofovir concentrations were undetectable (,4ng/ml) in all of the infant plasma samples. The ratio of tenofovir concentration in breast milk to that in maternal plasma was 0.07. Tenofovir disoproxil fumarate passes through the breast milk in a small amount. Infants had no detectable tenofovir level in their plasma. Our study suggests that tenofovir disoproxil fumarate treatment is safe during the breastfeeding period in chronic hepatitis B patients.Öğe The determination of tenofovir level in breast milk of nursing mothers under tenofovir therapy(Wiley, 2018) Ertürk, Ümran Sümeyye; Mete, Bilgül; Özaras, Reşat; Saltoğlu, Neşe; Balkan, İlker İnanç; Mert, Ali; Kaçmaz, Bahar; Sağlam, Onursal; Güney, Berrak; Sayman, Özden Aksu; Tabak, FehmiIn this study, we aimed to determine of tenofovir concentration in maternal plasma, breast milk and plasma of infants and factors affecting drug levels in chronic hepatitis B (CHB) patients using tenofovir disoproxil fumarate (TDF) during breastfeeding period.Öğe The effect of the administration of interferon and steroids on regulatory t-cells in the liver, spleen, and bone marrow of mice(Galenos Publishing House, 2022) Zerdali, Esra; Özpınar, Esra; Akdoğan, Ecem; Mete, Bilgül; Saltoğlu, Neşe; Tabak, Fehmi; Özaras, ReşatObjectives: Regulatory T-cells (T-regs) maintain immune tolerance by affecting other cells of the immune system. They play an important role in autoimmune diseases and the prevention of graft rejection. Steroids suppress the immune system, especially inhibiting cytokine secretion of T-lymphocytes, initiation of the cell- mediated immune response, and stimulation of T-regs. Interferons (IFN) also have immunomodulatory, antiviral, and anti-proliferative effects. They activate macrophages and cytotoxic T-cells and stimulate the differentiation of T-regs. The aim of this study was to evaluate the effects of IFN and steroids on T-regs in the liver, spleen, and bone marrow in a mouse model, and to determine if they exert their immunosuppresive/immunomodulatory effects through T-regs. Materials and Methods: A total of 24 mice were randomly separated into 3 groups and administered an intraperitoneal injection for five days. The control group received 0.1 mL saline every day, the IFN group received IFN-alpha-2b 20,000 IU on the first, third, and fifth days, and only 0.1 mL saline on the other days, and the steroids group received 5 mg/kg dexamethasone in 0.1 mL saline every day. Two days after the end of therapy, each mouse was anesthetized, the portal vein was explored via laparotomy, and 5 mL bovine serum albumin (BSA) was administered through the portal vein. The inferior vena cava was cut to allow BSA perfusion of the liver, and then the mice were sacrificed. The liver, spleen, and bone marrow were removed for analysis. T-regs were identified and counted using flow cytometry. Results: The flow cytometry count results showed no significant difference between the IFN, steroid, and control groups. Conclusion: IFN and steroid use do not seem to affect the quantity of T-regs.
