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Öğe A Case of Oropharyngeal Tularemia Mimicking Lymphoma During Pregnancy(Ankara Microbiology Soc, 2022) Elaldi, Nazif; Oz, Murtaza; Kurt, Begum; Turgut, Ismail; Koc, Tulay; Turan, Meral; Buyuktuna, Seyit AliTularemia is a zoonotic bacterial infectious disease caused by a gram-negative coccobacillus namely Francisella tularensis. In humans, disease leads to several different clinical forms (ulceroglandular, glandular, oculoglandular, respiratory, typhoidal and oropharyngeal). Since the main mode of transmission of the disease to humans in Turkiye is by drinking water contaminated with F.tularensis, the oropharyngeal form is the most common clinical manifestation. Since tularemia cases with pregnancy are rare, the literature about maternal and fetal complications of tularemia is sparse. In this report, a case of oropharyngeal tularemia mimicking lymphoma during pregnancy was presented. A 33-year-old 11-week pregnant patient living in a village in Sivas province admitted to the infectious diseases and clinical microbiology outpatient clinic with the complaint of swelling in the neck region that continued for six days. The patient, who was engaged in animal husbandry stated that she consumed raw milk and admitted to the otorhinolaryngology outpatient clinic of a hospital 10 days ago with the complaints of fever, chills, and sore throat. She stated that her complaints did not regress with the amoxicillin-clavulanate treatment recommended by her doctor and she noticed the swelling in her neck on the 4th day of the treatment. Upon further questioning, it was understood that the patient had a history of consumption of unchlorinated spring water. Her vital signs were normal and physical examination revealed non-fluctuant lymph nodes with the largest of 5 x 2 cm in the right posterior cervical region, and 3 x 2 cm in the left. Laboratory tests revealed a blood leukocyte count of 13.32 x 103/mm3 (75% granulocytes), a blood hemoglobin of 11.4 g/dL, an erythrocyte sedimentation rate of 45 mm/hour, and C-reactive protein of 90 mg/L. A non-contrast MRI examination revealed wall thickening of the nasopharynx and enlarged lymph nodes which were suspicious for lymphoma with significant diffusion restriction on diffusion -weighted images. As the past medical history and clinical findings were suggestive for tularemia, the microagglutination test (MAT) was studied, but it was reported as negative with a titer at 1/80. Since the patient's complaints continued and tularemia cases were encountered in our region in the past years, the repeated MAT after two weeks was reported as positive with a titer at 1/320. An oropharyngeal form of tularemia was diagnosed and oral ciprofloxacin (2 x 750 mg) was given for three weeks by starting at the 14th gestational week. Lymphoma was excluded by histopathological examination of the fine needle aspiration biopsy performed on the patient's cervical lymph nodes, but the biopsy sample was compatible with granulomatous diseases. Histopathological findings of diagnostic biopsies of the larynx and nasopharynx were reactive. A healthy male baby, 2425 grams, 47 cm, was delivered by cesarean section from the patient who presented with labor contractions at the 37th week of pregnancy. There was no sign of congenital infection in the newborn. The patient and the baby were followed up to the end of one year and no abnormality was found. The evaluation of 17 cases reported in the literature including this case, suggest that tularemia may progress to involve serious obstetric complications during pregnancy, such as abortion, premature birth and intrauterine fetal death when appropriate and effective antibiotic treatment is not given.Öğe Antibiotic combinations in treatment of infections developed with difficult-to-treat bacterias and treatment response(Lippincott Williams & Wilkins, 2024) Ozguler, Muge; Temel, Esra Nurlu; Sahin, Ahmet; Buyutuna, Seyit Ali; Oz, Murtaza; Singil, Sarp; Senbayrak, SenihaAntimicrobial resistance is a growing threat for humanity worldwide. A new definition of resistance, defined as difficult-to-treat resistance (DTR), has been made for Gram-negative infectious agents. DTR indicates resistance to all first-line treatment options, including all beta-lactams (carbapenems and beta-lactamase inhibitor combinations) and fluoroquinolones. The aim of this study is to evaluate the antibiotic combinations used in clinical practice in the management of infections with difficult to treat microorganisms and the microbiological and clinical responses to this combination. In this study is a multicenter retrospective observational cohort study. Data were collected from 10 centers. The demographic factors, preferred combination and mortality status of patients that develops with a strain that the microorganism was found to be resistant in the antibiogram were determined. A total of 174 patients from seven different centers were included in the study. One hundred and forty-eight (85%) of the patients were hospitalized in the tertiary intensive care unit. The most common bacteria were Klebsiella spp. with a rate of 80 (45.9%). We observed an overall carbapenem resistance rate of 98.5% in Klebsiella spp., 100% both in Acinetobacter spp. and Pseudomonas spp. Conclusion: This study highlights the importance of combination treatments for DTR isolates.Öğe Comparison of the Predictive Performances of qSOFA, APACHE II, and SGS for Evaluation of the Disease Prognosis of CCHF Patients at the Emergency Department(Natl Inst Infectious Diseases, 2020) Demirtas, Erdal; Bakir, Mehmet; Buyuktuna, Seyit Ali; Oksuz, Caner; Oz, Murtaza; Cebecioglu, Kivanc; Unlusavuran, MeltemIn this study, we compared the predictive performances of quick sequential organ failure assessment (qSOFA), the acute physiology and chronic health evaluation (APACHE II) scores, and the severity grading score (SGS) for evaluation of the disease prognosis of patients with Crimean-Congo hemorrhagic fever (CCHF) at the emergency department. We recorded the qSOFA, SGS, and APACHE II scores at admission and at the 72nd and 120th hour in 97 patients admitted to the emergency department and diagnosed with CCHF. In our study, the area under a receiver operating characteristic curve values of qSOFA, SGS, and APACHE II at admission were found to be 0.640, 0.824, and 0.576, respectively. No statistical significance was found for a qSOFA score >= 2 at admission as a predictor of mortality. The use of qSOFA score for diseases with a mortal prognosis such as CCHF is insufficient in predicting the prognosis.Öğe COVID-19 Co-infection in a patient with Crimean Congo Hemorrhagic Fever: A Case Report(Ankara Microbiology Soc, 2021) Buyuktuna, Seyit Ali; Hasbek, Mursit; Oksuz, Caner; Baysal, Cihad; Oz, Murtaza; Elaldi, Nazif; Bakir, MehmetCrimean-Congo Hemorrhagic Fever (CCHF) is an acute viral zoonotic disease. Coronavirus disease-2019 (COVID-19) is a newly emerging viral disease and it is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In this article, a case diagnosed with CCHF and COVID-19 coinfection confirmed by the polymerase chain reaction (PCR) method and its management was presented. A thirty-five years old female patient admitted to the hospital with the complaint of fever for one day and common body pain. It was learned that three days before the onset of her complaints, she removed a tick adhering to the anterior abdominal wall with no precaution. Her body temperature was 38 degrees C degrees and her respiratory rate was 22 per minute. The leucocyte count was 3660/mm(3) and the platelet count was 138.000/mm(3). It was determined that prothrombin time was 15.4 seconds, international normalized ratio (INR) was 1.35 seconds, and D-dimer level was 1310 ng/ml. The patient was hospitalized with prediagnosis of CCHF. Supportive treatment was started. On the second day at the clinical follow-up of the patient, complaints of sore throat and cough without sputum started. A combined nasopharyngeal and throat swab sample was taken from the patient because of the suspicion of COVID-19. COVID-19 PCR test result was reported as positive. Favipiravir treatment was started. The CCHF-PCR test, which was studied from the serum sample sent to the Microbiology Reference Laboratories was reported as positive. From the third day of favipiravir treatment; the patient did not have a fever and her complaints regressed. On the ninth day of her hospitalization, she was discharged. In this case; it is important to show that both diseases, especially in regions where CCHF disease is endemic, can be confused due to the similarity of the clinical picture with COVID-19 and to know that they can coexist.Öğe COVID-19-associated Leukoencephalopathy Involving the Splenium of the Corpus Callosum(Galenos Publ House, 2021) Yildiz, Ozlem Kayim; Yildiz, Bulent; Hasbek, Mursit; Tatli, Gulsum Asli; Oz, Murtaza[Abstract Not Available]Öğe Development of targeted whole genome sequencing approaches for Crimean-Congo haemorrhagic fever virus (CCHFV)(Elsevier, 2024) D'Addiego, Jake; Shah, Sonal; Pektas, Ayse Nur; Bagci, Binnur Koksal; Oz, Murtaza; Sebastianelli, Sasha; Elaldi, NazifCrimean-Congo haemorrhagic fever (CCHF) is the most prevalent human tick-borne viral disease, with a reported case fatality rate of 30 % or higher. The virus contains a tri-segmented, negative-sense RNA genome consisting of the small (S), medium (M) and large (L) segments encoding respectively the nucleoprotein (NP), the glycoproteins precursor (GPC) and the viral RNA-dependent RNA polymerase (RDRP). CCHFV is one of the most genetically diverse arboviruses, with seven distinct lineages named after the region they were first reported in and based on S segment phylogenetic analysis. Due to the high genetic divergence of the virus, a single targeted tiling PCR strategy to enrich for viral nucleic acids prior to sequencing is difficult to develop, and previously we have developed and validated a tiling PCR enrichment method for the Europe 1 genetic lineage. We have developed a targeted, probe hybridisation capture method and validated its performance on clinical as well as cell-cultured material of CCHFV from different genetic lineages, including Europe 1, Europe 2, Africa 2 and Africa 3. The method produced over 95 % reference coverages with at least 10x sequencing depth. While we were only able to recover a single complete genome sequence from the tested Europe 1 clinical samples with the capture hybridisation protocol, the data provides evidence of its applicability to different CCHFV genetic lineages. CCHFV is an important tick-borne human pathogen with wide geographical distribution. Environmental as well as anthropogenic factors are causing increased CCHFV transmission. Development of strategies to recover CCHFV sequences from genetically diverse lineages of the virus is of paramount importance to monitor the presence of the virus in new areas, and in public health responses for CCHFV molecular surveillance to rapidly detect, diagnose and characterise currently circulating strains.Öğe Frequency of Hepatosteatosis and Relationship Between Laboratory Parameters and Hepatosteatosis in Chronic Hepatitis B Patients(Galenos Publ House, 2024) Cakir, Yasemin; Sungur, Mehmet Ali; Oz, Murtaza; Buyuktuna, Seyit AliObjectives: Hepatosteatosis is very common worldwide and is defined as the accumulation of lipid droplets in hepatocytes. Hepatosteatosis is often associated with metabolic factors such as obesity, insulin resistance, and hypertriglyceridemia. The relationship between chronic hepatitis B (CHB) and hepatosteatosis remains unknown. We investigated the frequency of hepatosteatosis in patients with CHB and to evaluate the relationship between hepatosteatosis and laboratory parameters. Materials and Methods: We retrospectively studied 262 patients with CHB. Patients were divided into two groups, hepatosteatosis and non-hepatosteatosis, according to liver ultrasonography findings. The groups were compared in terms of demographic characteristics and laboratory parameters. Results: A total of 262 patients with CHB were included. The mean age was 45.1 +/- 15.3 years, 136 (51.8%) of whom were male. Liver biopsy was performed in 86 (32.8%) of the patients, 20 (7.6%) had fibrosis, and 163 (62.2%) had steatosis. Among the patients with steatosis, grade 1 steatosis was observed in 30.9 (81/163), grade 2 in 26 (68/163), and grade 3 in 5.3 (14/163). Hypertension, hepatomegaly, and cirrhosis were correlated with the presence of steatosis. Patients with steatosis were older than those without. Fasting glucose levels, low-density lipoprotein levels, and triglyceride levels of patients with steatosis were higher than those of patients without steatosis. High-density lipoprotein levels were lower in the steatosis group. No correlation has been found with gender, body mass index, hepatitis delta virus co -infection, hepatitis B virus (HBV)-DNA levels, or hepatitis B e antigen status between steatosis. Conclusion: We found that hepatosteatosis is present in a significant proportion of patients with CHB. Although the presence of hepatosteatosis was associated with some metabolic parameters, the relationship between it and HBV parameters was not statistically significant.Öğe Hidden threats: Brucellosis diagnosis and co-infection patterns in Crimean-Congo Hemorrhagic Fever suspects(Elsevier Science Inc, 2025) Oz, Murtaza; Cubuk, Fatih; Kiymaz, Yasemin cakir; Oksuz, Caner; Hasbek, Mursit; Buyuktuna, Seyit Ali; Elaldi, NazifPurpose: This study aims to investigate the frequency of brucellosis in patients with Crimean-Congo Hemorrhagic Fever (CCHF). Method: In this study, 1231 patients were evaluated retrospectively, including 14 patients with CCHF and brucellosis coinfection and 25 patients with brucellosis alone. Statistical methods such as the Mann-Whitney U test and Fisher's exact test were used. Result: Of the patients with a preliminary diagnosis of Crimean-Congo Hemorrhagic Fever (CCHF), 3.2% were found to have brucellosis. In the group co-infected with brucellosis and CCHF, the time to hospital admission was shorter. Additionally, tick exposure and headache were observed more frequently in this group. Creatine kinase levels were found to be higher in the co-infected group, while lymphocyte counts and fibrinogen levels were lower compared to the group with brucellosis alone. Conclusion: Our study revealed a 3.2% rate of brucellosis in patients with a preliminary diagnosis of CCHF. Due to the similarity of symptoms and common risk factors, the differential diagnosis of brucellosis should be considered in patients diagnosed with CCHF. Additionally, the possibility of brucellosis coexisting with CCHF should always be considered. Even in patients diagnosed with CCHF, an evaluation for brucellosis must be conducted.Öğe Septhic Arthritis Caused by Myroides odoratimimus: A Case Report(Bilimsel Tip Yayinevi, 2021) Buyuktuna, Seyit Ali; Oz, Murtaza; Oksuz, Caner; Hasbek, MursitIn recent years, there has been a significant increase in the frequency of infections caused by Myroides spp. both on a case-by-case basis and in the form of minor epidemics. It is often seen as a disease factor in immunocompromised people and can sometimes be life threatening. The most common clinical presentations are bloodstream infections, skin infections and urinary tract infections. Myroides odoratus and Myroides odoratimimus are the two most common types of Myroid as infectious agents in humans. In this study, a case of septic arthritis caused by Myroides odoratimimus in a 71-year-old female patient who did not receive regular treatment for her underlying diseases was presented.
