Publications by authors named "Mucahit Yemisen"

50 Publications

Prevalence and mortality of cancer among people living with HIV and AIDS patients: a large cohort study in Turkey.

East Mediterr Health J 2020 Mar 24;26(3):276-282. Epub 2020 Mar 24.

Istanbul University, Cerrahpasa Medical School, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.

Background: Cancer is responsible for elevated human immunodeficiency virus (HIV)-related mortality but there are insufficient data about cancer in HIV-positive patients in Turkey.

Aims: We aimed to investigate the prevalence and mortality of cancer among people living with HIVand AIDS patients in Istanbul, Turkey.

Methods: Between January 1998 and December 2016, people living with HIVand AIDS patients were enrolled in this study by the ACTHIV-IST Study Group, which consists of 5 centres to follow-up HIV-positive patients in Istanbul. The cancer diagnoses included AIDS-defining cancers (ADCs) and non AIDS-defining cancers (NADCs).

Results: Among 1872 patients, 37 (1.9%) were diagnosed with concurrent cancer. Eleven patients were diagnosed during follow-up; the prevalence of cancer among people living with HIVand AIDS patients was 2.6%. Among 48 cancer patients, 35 patients had ADCs, and 32 of them were diagnosed at their first hospital admission. There were 1007 late presenters and 39 of them had cancer (29 were ADCs). The most prevalent NADCs were gastrointestinal, genitourinary, and pulmonary cancers. NADCs were mostly diagnosed during follow-up of patients. The mortality of this group was significantly higher than that of patients with ADCs (53.9% vs 22.9%).

Conclusions: These results indicate the importance of cancer screening at diagnosis and during follow-up of HIV infection. A detailed physical examination contributes to diagnosis of the most prevalent ADCs (Kaposi's sarcoma and non-Hodgkin's lymphoma), especially in late presenters. For NADCs, individual risk factors should be considered.
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http://dx.doi.org/10.26719/emhj.19.030DOI Listing
March 2020

Influence of multidrug resistant organisms on the outcome of diabetic foot infection.

Int J Infect Dis 2018 May 21;70:10-14. Epub 2018 Feb 21.

Okmeydanı Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.

Objectives: We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms.

Methods: We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge.

Results: In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82-38.15, p=0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24-47.96, p=0.028), and chronic heart failure (OR: 3, CI: 1.01-9.04, p=0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p<0.001).

Conclusion: Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality.
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http://dx.doi.org/10.1016/j.ijid.2018.02.013DOI Listing
May 2018

Association between biofilm and multi/extensive drug resistance in diabetic foot infection.

Int J Clin Pract 2018 Mar 30;72(3):e13060. Epub 2018 Jan 30.

Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Purpose: We aimed to determine significant risk factors for biofilm production and to investigate the association between antimicrobial resistance profile and biofilm formation in the bacterial isolates obtained from patients with diabetic foot infection (DFI).

Methods: Demographic, clinical, laboratory and outcome data of 165 patients, prospectively recorded and followed between January 2008 and December 2015 by a multidisciplinary committee, were analysed. Standard microbiological methods were adopted. Risk factors associated with biofilm were determined by univariate and multivariate analyses.

Results: The overall rate of biofilm production among 339 wound isolates was 34%. The biofilm production rate was significantly higher in Gram-negative micro-organisms (39%) in comparison with Gram positives (21%) (P = .01). A. baumannii presented the highest biofilm production (62%), followed by P. aeruginosa (52%) and Klebsiella spp. (40%). On univariate analysis, significant factors associated with biofilm were antibiotic use within last 3 months (OR:2.94, CI: 1.5-5.75, P = .002), recurrent DFI within last 6 months (OR:2.35, CI: 1.23-4.53, P = .01), hospitalisation within last 3 months due to ipsilateral recurrent DFI (OR:2.44, CI: 1.06-5.58, P = .03), presence of amputation history (OR: 2.20, CI: 1.14-4.24, P = .01), multidrug-resistant (MDR) micro-organism (OR: 7.76, CI: 4.53-13.35, P<.001) and extensively drug-resistant (XDR) micro-organism (OR:11.33, CI:4.97-26.55, P<.001). Multivariate regression analysis revealed two variables to be significant factors associated with biofilm: MDR micro-organism (OR: 3.63, CI: 1.58-8.33, P = .002) and XDR micro-organism (OR:4.06, CI: 1.25-13.1, P = .01).

Conclusions: Multi/extensive drug resistance and previous recurrent DFIs were significantly associated with biofilm formation in patients with diabetic foot.
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http://dx.doi.org/10.1111/ijcp.13060DOI Listing
March 2018

Adherence to Antiretroviral Therapy in Turkey: Results from the ACTHIV-IST Study Group.

AIDS Res Hum Retroviruses 2017 12 11;33(12):1192-1198. Epub 2017 Oct 11.

3 Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University , Istanbul, Turkey .

Maintaining optimal adherence to antiretroviral therapy (ART) is essential for optimizing the management of HIV infection. The aim of this study is to explore ART adherence rates in Turkey. Included in this study were a total of 263 HIV-infected patients followed up by the ACTHIV-IST (ACTion against HIV in Istanbul) Study Group affiliated with four tertiary hospitals. The study population included patients 18 years of age or older who were on ART for over 12 months. Adherence was assessed by the medication possession ratio (MPR) calculated for each patient using data (a list of all drugs dispensed within the previous year for that patient) obtained from pharmacy medication records. In addition, patients completed a self-report questionnaire addressing missed doses and the AIDS Clinical Trials Group (ACTG) adherence questionnaire. The study was reviewed and approved by the Ethics Committee of Cerrahpasa Medical Faculty. Patient ages ranged from 19 to 71 years. Two hundred and thirty-one patients were male (88%). Two hundred and twenty-four patients (85%) had optimal adherence (MPR ≥95%). During the course of ART, 236 patients (90%) reported no missed doses in the past 4 days of their treatment, whereas 206 patients (78%) reported no missed doses in the past month. Simply forgetting was the most common reason for nonadherence. MPR was associated with virologic rebound. Major factors affecting adherence were being female, taking antituberculosis drugs, having an opportunistic infection, being able to take all or most of the medication as directed, and being aware of the need to take medication exactly as instructed to prevent the development of drug resistance. Adherence to ART measured by MPR and self-report surveys is relatively high in Turkey when compared with other countries, which probably led to high ART success rates.
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http://dx.doi.org/10.1089/AID.2016.0266DOI Listing
December 2017

Reactivation of Hepatitis B Virus Following Treatment of Hepatitis C Virus Infection in Coinfected Patients.

Clin Infect Dis 2017 05;64(10):1461-1462

Infectious Diseases Department, Cerrahpasa Medical School, Istanbul University, Turkey.

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http://dx.doi.org/10.1093/cid/cix211DOI Listing
May 2017

Prejudice and reality about infection risk among Syrian refugees.

Lancet Infect Dis 2016 11;16(11):1222-1223

Infection Department, Cerrahpasa Medical School, Istanbul University, Cerrahpasa 34098, Istanbul, Turkey.

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http://dx.doi.org/10.1016/S1473-3099(16)30400-5DOI Listing
November 2016

Hydrocephalus and vasculitis delay therapeutic responses in tuberculous meninigitis: Results of Haydarpasa-III study.

Neurol India 2016 Sep-Oct;64(5):896-905

Department of Infectious Diseases, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.

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.
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http://dx.doi.org/10.4103/0028-3886.190258DOI Listing
November 2018

Cat Scratch Disease in a Renal Transplant Recipient.

Prog Transplant 2016 Sep 16;26(3):227-30. Epub 2016 Jun 16.

Division of Nephrology, Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Cat scratch disease (CSD) is a disorder characterized by self-limited regional lymphadenopathy and fever. We reported a case of CSD in a kidney transplant recipient who presented with fever and lymphadenopathy. Lymph node biopsy demonstrated bacterial histiocytic lymphadenitis. The patient was diagnosed with CSD. Patient had good clinical improvement after treatment. Therefore, CSD should also be borne in mind for kidney recipients though CSD had been infrequently reported in this group.
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http://dx.doi.org/10.1177/1526924816654981DOI Listing
September 2016

Changes in HIV demographic patterns in a low prevalence population: no evidence of a shift towards men who have sex with men.

Int J Infect Dis 2016 Jul 9;48:52-6. Epub 2016 May 9.

Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

Objectives: This study aimed to examine the changes in HIV demographics over time in an exceptionally low prevalence population, with particular emphasis on men who have sex with men (MSM).

Methods: A total of 1292 newly diagnosed HIV-positive patients registered in the ACTHIV-IST Study Group database between 2000 and 2014 were included. The changes occurring over time in the characteristics of patients at the time of initial admission were examined retrospectively.

Results: A gradual increase in the total number of newly diagnosed patients was evident during the study period; however, it was not possible to show an increase in the proportion of MSM within the study population (p=0.63). There was a male predominance throughout the study (85% vs. 15%), with further increases in the proportion of males in recent years. The mean age was lower at the end of the study (p<0.05) and there was an increase in the number of unmarried patients (p<0.05).

Conclusions: Sexual preference patterns of HIV patients in extremely low prevalence populations may be different, possibly due to an early phase of the epidemic. Nevertheless, MSM still represent a target subgroup for interventions, since they account for a substantial proportion of cases and a resurgent epidemic may be expected among this group in later phases of the epidemic.
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http://dx.doi.org/10.1016/j.ijid.2016.05.006DOI Listing
July 2016

The Syrian conflict and infectious diseases.

Expert Rev Anti Infect Ther 2016 06 27;14(6):547-55. Epub 2016 Apr 27.

a Department of Infectious Diseases and Clinical Microbiology , Istanbul University, Cerrahpasa Medical School , Istanbul , Turkey.

The conflict in Syria is a big humanitarian emergency. More than 200,000 Syrians have been killed, with more than half of the population either having been displaced or having immigrated. Healthcare has been interrupted due to the destruction of facilities, a lack of medical staff, and a critical shortage of life-saving medications. It produced suitable conditions leading to the re-emergence of tuberculosis, cutaneous leishmaniasis, polio, and measles. Lebanon and Jordan reported increased rates of tuberculosis among Syrian refugees. Cutaneous leishmaniasis outbreaks were noted not only in Syria but also in Turkey, Jordan, and Lebanon. After a polio-free 15 years, Syria reported a polio outbreak. Ongoing measles outbreaks in the region was accelerated by the conflict. Iraq declared a cholera outbreak among the Syrian refugees. The healthcare facilities of the countries hosting immigrants, mainly Turkey, Lebanon, Jordan, Iraq, and Egypt, are overburdened. The majority of the immigrants live in crowded and unsanitary conditions. Infectious diseases are big challenges for Syria and for the countries hosting immigrants. More structured support from international organizations is needed for the prevention, control, diagnosis, and treatment of infectious diseases.
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http://dx.doi.org/10.1080/14787210.2016.1177457DOI Listing
June 2016

Elimination of mother-to-child transmission of hepatitis B.

Lancet Infect Dis 2016 Jan;16(1):20-21

Istanbul University, Cerrahpasa Medical School, Infectious Diseases Department, TR-34098 Istanbul, Turkey.

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http://dx.doi.org/10.1016/S1473-3099(15)00473-9DOI Listing
January 2016

More on hepatic granulomas.

Diagn Pathol 2015 Nov 19;10:203. Epub 2015 Nov 19.

Infectious Diseases Department, Cerrahpasa Medical School, Istanbul University, TR-34098, Cerrahpasa, Istanbul, Turkey.

We have read the case report of Nihon-Yanagi et al. The patient they described developed hepatic granuloma two times and the granulomatous lesion was surrounding metal staples/clips suggesting that the granuloma was due to surgical staples/clips. Hepatic granulomas (HGs) are reported in around 5% of patient who undergo a liver biopsy and caused by several diseases including sarcoidosis, tuberculosis, hydatid cyst, brucellosis, typhoid fever, chronic hepatitis B and C and primary biliary cirrhosis (PBC). Chronic hepatitis B and C infections are the most common and serious causes of liver damage in patient with renal failure. Their prevalence is a higher than people without renal failure. We have previously reported that the prevalences of HGs in patients with chronic hepatitis B and C are 1.5 and 1.3% respectively. The described patient was on hemodialysis for 12 years. The other causes of HG seem excluded; however hepatitis B and C infections and PBC should have been tested and excluded before ascribing the HGs to surgical staples/clipping material.
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http://dx.doi.org/10.1186/s13000-015-0442-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653883PMC
November 2015

Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study.

Ann Clin Microbiol Antimicrob 2015 Nov 4;14:47. Epub 2015 Nov 4.

Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey.

Background: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM.

Methods: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB).

Results: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any first-line drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0:34-13:42), respectively.

Conclusion: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing.
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http://dx.doi.org/10.1186/s12941-015-0107-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632483PMC
November 2015

Successful treatment of post-transplant hepatitis C virus cirrhosis with daclatasvir and asunaprevir.

J Gastrointestin Liver Dis 2015 Sep;24(3):393-4

Infectious Diseases Dept., Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

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September 2015

Early Changes of Mannose-Binding Lectin, H-Ficolin, and Procalcitonin in Patients with Febrile Neutropenia: A Prospective Observational Study.

Turk J Haematol 2016 Dec 6;33(4):304-310. Epub 2015 Aug 6.

İstanbul University Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey, Phone: +90 212 414 30 00, E-mail:

Objective: 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.
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http://dx.doi.org/10.4274/tjh.2014.0385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5204185PMC
December 2016

Linezolid-induced complex partial seizure in a patient without epilepsy.

Int J Infect Dis 2015 Jun 11;35:120. Epub 2015 May 11.

Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.ijid.2015.05.007DOI Listing
June 2015

Bilateral idiopathic granulomatous mastitis.

Asian J Surg 2016 Jan 2;39(1):12-20. Epub 2015 May 2.

Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. Electronic address:

Objectives: Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowledge, this study is the largest series of bilateral cases to date. The goals of this study were to present clinical features of bilateral IGM and to evaluate the results of treatments.

Materials And Methods: We performed a retrospective review of the idiopathic granulomatous mastitis database from 2010 to 2013. Ten female patients who met required histologic and clinical criteria of IGM in both breasts were included in study. Demographic data, clinical findings, medication history, and radiologic findings are presented.

Results: The mean age at onset of the disease was 38.4 ± 8.3 years (range: 29-52 years). Nine patients had no recurrence during a mean follow-up period of 21 months (range: 11-26 months). Additionally, the median time to second breast involvement was 15.6 months.

Conclusion: Bilateral IGMs have a higher rate of more relapse and greater resistance to medical therapies than do unilateral IGMs. Surgical management should be avoided unless all medical treatment options have been exhausted. Nevertheless, expectant management seems a rational option for the treatment of bilateral IGM.
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http://dx.doi.org/10.1016/j.asjsur.2015.02.003DOI Listing
January 2016

Secondary Infections in Febrile Neutropenia in Hematological Malignancies: More Than Another Febrile Neutropenic Episode.

Turk J Haematol 2015 Sep;32(3):243-50

Introduction: Febrile neutropenic episodes (FNEs) are among major causes of mortality in patients with hematological malignancies. Secondary infections develop either during the empirical antibiotic therapy or one week after cessation of therapy for a FNE. The aim of the study was to investigate the risk factors associated with secondary infections in febrile neutropenic patients.

Methods: We retrospectively analyzed 750 FNEs in 473 patients between January 2000 and December 2006.

Results: Secondary infections were diagnosed in 152 (20%) of 750 FNEs. The median time to develop secondary infection was 10 days (range 2-34 days). The duration of neutropenia over 10 days significantly increased the risk of secondary infections (p<0.001). The proportion of patients with microbiologically documented infections was found to be higher in primary infections (271/750, 36%) compared to secondary infections (43/152, 28%) (p=0.038). Age, sex, underlying disease, antibacterial, antifungal or antiviral prophylaxis, blood transfusion or bone marrow transplantation, central venous catheter or severity of neutropenia did not differ significantly between primary and secondary infections (p>0.05) While fever of unknown origin (FUO) (p=0.005) and catheter-related bacteremia (p<0.001) were less frequently observed in secondary infections, the frequency of microbiologically (p=0.003) and clinically (p<0.001) documented infections, fungal pneumonias (p<0.001), infections related with gram positive bacteria (p=0.04) and fungi (p<0.001) and 30-day mortality rate (p<0.001) were significantly higher in secondary infections (p<0.001).

Discussion And Conclusion: Secondary infections should be regarded as life-threatening complications of febrile neutropenia. Secondary infections represent a more severe and mortal complication and cannot be regarded just as another febrile neutropenic episode.
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http://dx.doi.org/10.4274/tjh.2013.0422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563200PMC
September 2015

The Changing Epidemiology of Bloodstream Infections and Resistance in Hematopoietic Stem Cell Transplantation Recipients.

Turk J Haematol 2016 Sep 4;33(3):216-22. Epub 2015 May 4.

İstanbul University Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey Phone : +90 212 414 30 95 E-mail:

Objective: Patients receiving hematopoietic stem cell transplantation (HSCT) are exposed to highly immunosuppressive conditions and bloodstream infections (BSIs) are one of the most common major complications within this period. Our aim, in this study, was to evaluate the epidemiology of BSIs in these patients retrospectively.

Materials And Methods: The epidemiological properties of 312 patients with HSCT were retrospectively evaluated.

Results: A total of 312 patients, followed between 2000 and 2011, who underwent autologous (62%) and allogeneic (38%) HSCT were included in the study. The most common underlying malignancies were multiple myeloma (28%) and Hodgkin lymphoma (21.5%). A total of 142 (45%) patients developed at least 1 episode of BSI and 193 separate pathogens were isolated from the blood cultures. There was a trend of increase in the numbers of BSIs in 2005-2008 and a relative increase in the proportion of gram-positive infections in recent years (2009-2011), and central venous catheter-related BSI was found to be most common source. Coagulase-negative staphylococci (49.2%) and Acinetobacter baumannii (8.8%) were the most common pathogens. Extended-spectrum beta-lactamase-producing strains were 23% and 22% among Escherichia coli and Klebsiella spp. isolates, respectively. Quinolone resistance was detected in 10% of Enterobacteriaceae. Resistance to carbapenems was not detected in Enterobacteriaceae, while it was seen at 11.1% and 23.5% in Pseudomonas and Acinetobacter strains, respectively.

Conclusion: A shift was detected from gram-negative bacteria to gram-positive in the etiology over the years and central lines were the most common sources of BSIs.
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http://dx.doi.org/10.4274/tjh.2014.0378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111467PMC
September 2016

Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study.

J Neurol 2015 30;262(4):890-8. Epub 2015 Jan 30.

Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey,

Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16%) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1%, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.
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http://dx.doi.org/10.1007/s00415-015-7651-5DOI Listing
January 2016

Low Prevalence of Hepatitis C Virus Infection Among HIV-Positive Patients: Data From a Large-Scale Cohort Study in Istanbul, Turkey.

Hepat Mon 2014 Aug 16;14(8):e18128. Epub 2014 Aug 16.

Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Background: Rate of coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) varies in different countries. This may be attributable to common transmission routes as well as social, economic, and cultural factors.

Objectives: The purpose of this study was to investigate the prevalence and risk factors of HCV infection among HIV-positive patients in Istanbul, Turkey.

Patients And Methods: Since January 2006 to November 2013, 949 HIV-positive patients that were enrolled in this study by ACTHIV-IST (Action Against HIV in Istanbul) Study Group, which consists of five centers to follow up HIV-positive patients in Istanbul. Epidemiologic and clinical data were collected retrospectively from medical records and were transferred to an HIV database system.

Results: Among 949 patients, 84% were men and the mean age was 37.92 ± 11.54 years (range, 17-79). The most frequent route of transmission was heterosexual intercourse (48.8%), followed by men having sex with men (30.5%). Only nine patients (0.9%) had history of injection drug use (IDU). The prevalence of HIV/HCV coinfection was 0.9% (9:949). The IDU rate was 44.4% (4:9) in patients with HIV/HCV coinfection (three of them were not Turkish citizens), whereas this rate was only 0.6% (5:881) in patients with only HIV infection (P < 0.01). Genotypes 1b, 2a/2c, and 3 were determined in five, one, and two patients, respectively. Genotype could not be determined in one patient. History of residence in a foreign country (P < 0.01) and imprisonment (P < 0.01) were also considered as risk factors in terms of HIV/HCV coinfection.

Conclusions: Prevalence of HIV/HCV coinfection is considerably low in Turkey. The extremely rare prevalence of IDU might have a role in this low prevalence.
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http://dx.doi.org/10.5812/hepatmon.18128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199144PMC
August 2014

Chronic hepatitis C successfully treated with telaprevir, pegylated interferon and ribavirin in severe aplastic anemia.

Ann Hepatol 2014 Nov-Dec;13(6):843-4

Infectious Diseases Dept. Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

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June 2015

Epidemiology of HBV subgenotypes D.

Clin Res Hepatol Gastroenterol 2015 Feb 16;39(1):28-37. Epub 2014 Jul 16.

Infectious Diseases Department, Cerrahpasa Medical School, Istanbul University, 34098 Cerrahpasa, Istanbul, Turkey.

The natural history of hepatitis B virus infection is not uniform and affected from several factors including, HBV genotype. Genotype D is a widely distributed genotype. Among genotype D, several subgenotypes differentiate epidemiologically and probably clinically. D1 is predominant in Middle East and North Africa, and characterized by early HBeAg seroconversion and low viral load. D2 is seen in Albania, Turkey, Brazil, western India, Lebanon, and Serbia. D3 was reported from Serbia, western India, and Indonesia. It is a predominant subgenotype in injection drug use-related acute HBV infections in Europe and Canada. D4 is relatively rare and reported from Haiti, Russia and Baltic region, Brazil, Kenya, Morocco and Rwanda. Subgenotype D5 seems to be common in Eastern India. D6 has been reported as a rare subgenotype from Indonesia, Kenya, Russia and Baltic region. D7 is the main genotype in Morocco and Tunisia. D8 and D9 are recently described subgenotypes and reported from Niger and India, respectively. Subgenotypes of genotype D may have clinical and/or viral differences. More subgenotype studies are required to conclude on subgenotype and its clinical/viral characteristics.
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http://dx.doi.org/10.1016/j.clinre.2014.06.005DOI Listing
February 2015

[A case of Fasciola hepatica mimicking sepsis without eosinophilia].

Turkiye Parazitol Derg 2014 Jun;38(2):131-4

Cerrahpaşa Tıp Fakültesi, Enfeksiyon Hastalıkları Anabilim Dalı, İstanbul, Türkiye.

Fasciolosis is a rare cause of hepatobiliary system infections and caused by the trematode Fasciola hepatica. It primarily infects sheeps or goats, and humans are accidental hosts. On laboratory findings, marked eosinophilia is present in most of the cases. Here, we report a case of fasciolosis without eosinophilia who was presented as sepsis and responded to therapy in second dose of triclabendazole. Sepsis like clinical presentation has been reported in few cases. Forty-eight year old female patient presented with high fever, abdominal pain, hypotension and tachycardia. The patient was considered as sepsis secondary to liver abscess, which was demonstrated on the initial abdominal ultrasonography (USG) findings. Therefore, empirical antibiotic therapy was started. Due to failure of the treatment, the image was found to be compatible with fasciolosis on control magnetic resonance imaging (MRI) and USG. On detailed anamnesis, history of eating watercress was learned and the diagnosis of fasciolosis was confirmed by serological tests.
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http://dx.doi.org/10.5152/tpd.2014.3176DOI Listing
June 2014

Blood stream infections due to OXA-48-like carbapenemase-producing Enterobacteriaceae: treatment and survival.

Int J Infect Dis 2014 Sep 3;26:51-6. Epub 2014 Jul 3.

Department of Infectious Diseases, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul 34098, Turkey.

Background: Blood stream infections (BSIs) due to carbapenem-resistant Enterobacteriaceae (CRE) are associated with high hospital mortality rates and present a tremendous challenge to clinicians. The optimal treatment remains undefined. We aimed to investigate the risk factors for mortality and the correlation between different treatment modalities and outcomes.

Methods: The clinical characteristics and treatment outcomes of a cohort of 36 patients with BSIs due to CRE were investigated and a retrospective nested case-control study of surviving and non-surviving patients was conducted.

Results: Fifty percent of the cases were male and the mean patient age was 54.9 ± 15.8 years. Klebsiella pneumoniae was the etiological agent in 26 cases (72.2%), Escherichia coli in eight (22.2%), and Enterobacter aerogenes in two (5.5%). All strains were phenotypically positive for carbapenemase activity and all except two (one E. coli and one K. pneumoniae) yielded both blaOXA-48 carbapenemases and blaCTX-M-type extended-spectrum beta-lactamases (ESBLs) in PCR products. The 14-day, 28-day, and all-cause in-hospital mortality rates were 41.6%, 50%, and 58.3%, respectively. The median time to death was 8 days (range 2-52 days). No significant differences were observed between survivors and non-survivors in terms of baseline characteristics, comorbid conditions, etiologies, or sources of bacteremia, however hematological malignancies (p=0.015) and prolonged neutropenia (p=0.044) were more common in non-survivors. Microbiological eradication and clinical response within 7 days were two major determinants of 28-day attributable mortality (p=0.001 and p=0.001, adjusted r(2)=0.845). Colistin-based dual combinations, and preferably triple combinations, were associated with significantly better outcomes when compared to non-colistin-based regimens (p<0.001). Time to active treatment had a significant effect on the course of infection (p=0.014).

Conclusion: Earlier active treatment with colistin based regimens and microbiological and clinical response within 7 days are major predictors of survival in cases of BSIs due to CRE. Rectal screening offers the advantage of earlier recognition and prompt empirical treatment.
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http://dx.doi.org/10.1016/j.ijid.2014.05.012DOI Listing
September 2014

Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery.

Surg Today 2015 Apr 4;45(4):457-65. Epub 2014 Jul 4.

Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Purpose: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It can mimic breast carcinoma clinically and radiologically, and usually affects females of childbearing age. There is no commonly accepted optimal treatment for IGM. In this study, we present the clinical and histopathological features and outcomes of the therapeutic management of IGM, as well as the clinical course of the disease when patients were treated with oral corticosteroids.

Methods: This retrospective study included 49 of 87 patients who met the required histological criteria for IGM who were followed up between January 2009 and December 2011. All patients had a disease-free follow-up period of at least 6 months. The data regarding the clinical features at presentation, laboratory values and the treatment modalities were obtained from the medical records of the patients.

Results: The mean age of the patients was 34.3 ± 4.37 years. Forty patients were treated with prednisolone, five were started on antituberculosis treatment, two received non-steroidal anti-inflammatory drugs, one received antibiotics and one underwent wide excision. All patients who received steroids responded well to the therapy.

Conclusion: Systemic therapy with corticosteroids is an effective and appropriate treatment option for IGM. It can provide complete disease resolution and prevent recurrence in the long term. A multidisciplinary approach including specialists in the fields of both general surgery and infectious diseases is essential for the diagnosis, treatment and follow-up of IGM.
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http://dx.doi.org/10.1007/s00595-014-0966-5DOI Listing
April 2015

Epidemiological profile of naive HIV-1/AIDS patients in Istanbul: the largest case series from Turkey.

Curr HIV Res 2014 ;12(1):60-4

University of Istanbul, Cerrahpasa Medical Faculty, Department of Infectious Diseases, TR-34303, Cerrahpasa, Istanbul, Turkey.

The aim of the study was to report the epidemiological profile of HIV-1 positive patients from, Istanbul, Turkey, which has one of the lowest HIV-1/AIDS prevalences in Europe. The patients were followed by ACTHIV-IST group which was established by the Infectious Diseases Departments of five teaching hospitals (three university hospitals and two public hospitals) in Istanbul, Turkey. The HIV-1 positive patients were added to the standard patient files in all of the centers; these files were then transferred to the ACTHIV-IST database in the Internet. A total of 829 naiv-untreated HIV-1 positive patients were chosen from the database. The number of male patients was 700 (84.4%) and the mean age of the patients was 37 years (range, 17-79). In our study group 348 (42%) of the patients were married and 318 (38.7%) of the patients were single. The probable route of transmission was heterosexual intercourse in 437 (52.7%) patients and homosexual intercourse in 256 (30.9%) patients. In 519 (62.6%) patients the diagnose was made due to a screening test and in 241 (29.1%) patients, the diagnose was made due to an HIV-related/non-related disease. The mean CD4+ T cell number in 788 of the patients was 357.8/mm(3) (±271.1), and the median viral load in 698 of the patients was 100,000 copies/mL (20-9,790,000). In Turkey, the number of HIV-1 positive patients is still low and to diagnose with a screening test is the most common way of diagnostic route.
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http://dx.doi.org/10.2174/1570162x12666140411111803DOI Listing
February 2015

Carbapenem resistance due to Bla(OXA-48) among ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates in a univesity hospital, Turkey.

Southeast Asian J Trop Med Public Health 2012 Sep;43(5):1178-85

Department of Microbiology and Clinical Microbiology, Istanbul Medical Faculty, Istanbul Universiy, Istanbul, Turkey.

Bacterial isolates producing Class D OXA-48 carbapenemase may be missed in routine laboratory testing, allowing them to spread undetected. The purpose of the present study was to detect bla(OXA-48) among ESBL-producing Klebsiella pneumoniae and Escherichia coli isolates collected from a university hospital, Turkey. Ninety-two ESBL-producing isolates (66 E. coli, 26 K. pneumoniae) were obtained in 2010. Antibiotic susceptibility tests were performed using the disc diffusion method and VITEK 2 system. Carbapenemase activity was screened using modified Hodge test. Beta-lactamase genes were detected by PCR and bla(OXA-48)-positive amplicons were sequenced. Genetic relatedness among K. pneumoniae isolates was investigated by pulsed-field gel-electrophoresis (PFGE). Carbapenemase activity was detected in 1 E. coli and 9 K. pneumoniae isolates and 8 of the K. pneumoniae plus the E. coli isolates were resistant to ertapenem. Three K. pneumoniae and 1 E. coli isolates were resistant to imipenem. All 10 isolates were susceptible to meropenem. bla(OXA-48) was present in all 10 isolates. Additionally, 9 isolates contained at least one beta-lactamase gene, including bla(SHV') bla(CTX-M) and bla(VEB) type. PFGE revealed different karyotypes among 9 K. pneumoniae isolates suggesting that the dissemination of bla(OXA-48) gene was not spread by a single K. pneumoniae clone. Thus OXA-48-producing isolates found in carbapenem-susceptible strains according to CLSI guidelines.
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September 2012

[Molecular Epidemiological Analysis of HIV-1 pol Gene Sequences Isolated in Istanbul, Turkey].

Mikrobiyol Bul 2013 Jan;47(1):87-97

Kocaeli University Medical Faculty Hospital, Central Laboratory, PCR Unit, Kocaeli, Turkey.

Human immunodeficiency virus (HIV) characterized by a high genetic variability includes two genotypes namely HIV-1 and HIV-2. A major proportion of the infections worldwide is caused by HIV-1 which includes four groups (M, N, O and P). Group M being responsible for the HIV pandemic is further divided into nine genetically distinct subtypes (A, B, C, D, F, G, H, J, and K). Additionally, more than 49 circulating recombinant forms (CRFs) have been recognized up to now. The aim of this study was to determine the subtype characterization and prevalence of HIV strains isolated from patients inhabiting in Istanbul, Turkey. The study was carried out between June 2009 and June 2012 and a total of 72 patients [58 male, 14 female; age range: 20-57 (median: 37) years; CD4+ T cell count range: 3-813 (median: 243)/mm3; HIV-RNA load range: 1.5+E3-1.0+E7 (median: 5.8+E5) IU/ml] were included in the study. Fortysix of the patients (64%) have acquired the infection via heterosexual and 23 (32%) via homosexual contact. Of the patients 57 were newly diagnosed and antiretroviral (ARV) therapy-naïve patients, while 15 were under different ARV therapies. For HIV-1 subtyping the most widely known algorithm (HIVdb-Stanford University Genotypic Resistance Interpretation Algoritm) was used. The population-based sequencing of the reverse transcripta ise region (pol) of HIV-1 indicated that CRFs (36/72; 50%) were the most commonly identified strains, followed by subtype B (31/72; 43%) among Turkish patients. Sub-subtypes A1 (3/72; 4.2%) and F1 (2/72; 2.8%) were also detected as low prevalent. The recombinant forms of HIV-1 circulated in Istanbul, Turkey were found as follows, respectively; CRF02_AG [%25 (18/72), West Africa, Central Africa and Middle East/North Africa origin], CRF12_BF [%12.5 (9/72), South America origin], CRF03_AB [%9.7 (7/72), Eastern Europe and Central Asia origin] and CRF01_AE [%2.8 (2/72), South-East Asia, East Asia and Central Africa origin]. Since molecular epidemiologic studies are important tools for tracking the transmission and spread patterns, and for the control of the HIV infections, HIV molecular studies should be expanded in HIV-1 infected Turkish patients. Furthermore, the determined subtypes and CRFs of HIV-1 in Turkey may be expected to contribute to global HIV surveillance systems.
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http://dx.doi.org/10.5578/mb.4099DOI Listing
January 2013