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    Paradoxical Reactions in Tuberculosis Treatment: Mechanisms, Diagnosis and Approach
    (Bilimsel Tip Yayinevi, 2024) Buyuktuna, Seyit Ali; Kurtaran, Behice; Ozsahin, Sefa Levent; Senol, Gunes; Kilic, Aysegul Ulu; Tasbakan, Meltem
    Paradoxical reactions (PR) refer to the worsening of clinical manifestations of tuberculosis (TB) after the initiation of TB treatment, particularly occurring during the recovery of immune function in immunocompromised individuals. This syndrome is also known as immune reconstitution inflammatory syndrome and is more common in human immunodeficiency virus (HIV)-infected individuals after the initiation of antiretroviral therapy (ART). Although the mechanisms of PR are not fully understood, excessive inflammatory responses triggered by increased antigen load and rapid immune response are considered the main cause. This is associated with a strong T-cell response to antigens of Mycobacterium tuberculosis. Paradoxical reactions in HIV-positive individuals after ART initiation is characterized by a sudden and intense activation of TB-fighting immune cells. Symptoms of PR include fever, lymphadenopathy, pulmonary infiltrates, and enlargement of existing TB lesions. A major diagnostic challenge is the exclusion of TB treatment-resistant mycobacterial infections or other infections. Management of PR mainly involves the continuation of TB and HIV treatment. Anti-inflammatory drugs, such as corticosteroids, can be used in severe PR cases. By reducing inflammation, corticosteroids can relieve the symptoms of the disease and improve the quality of life. However, the use of these drugs should be carefully monitored and side effects should be considered. Enhancing our understanding of the mechanisms behind paradoxical reactions and developing effective management strategies could significantly advance the fight against TB and HIV. This review aims to explore the mechanisms, diagnosis, and management strategies of paradoxical reactions in tuberculosis treatment.
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    Risk factors for infection with colistin-resistant gram-negative microorganisms: a multicenter study
    (K FAISAL SPEC HOSP RES CENTRE, 2016) Yilmaz, Gul R.; Dizbay, Murat; Guven, Tumer; Pullukcu, Husnu; Tasbakan, Meltem; Guzel, Ozlem Tunccan; Tekce, Yasemin T.; Ozden, Mehmet; Turhan, Ozge; Guner, Rahmet; Cag, Yasemin; Bozkurt, Fatma; Karadag, Fatma Yilmaz; Kartal, Elif Doyuk; Gozel, Gokhan; Bulut, Cemal; Erdinc, Sebnem; Keske, Siran; Acikgoz, Ziya Cibali; Tasyaran, Mehmet A.
    BACKGROUND: Knowing risk factors for colistin resistance is important since colistin is the only remaining choice for the treatment of infections caused by multi-drug resistant microorganisms. OBJECTIVE: Evaluate risk factors associated with infection by colistin-resistant microorganisms. DESIGN: Retrospective study. SETTINGS: Tertiary healthcare centers. PATIENTS AND METHODS: An e-mail including the title and purpose of the study was sent to 1500 infectious disease specialists via a scientific and social web portal named "Infeksiyon Dunyasi (Infection World)". Demographic and clinical data was requested from respondents. MAIN OUTCOME MEASURE(S): Colistin-resistance. RESULTS: Eighteen infectious disease specialists from twelve tertiary care centers responded to the invitation. Data was collected on 165 patients, 56 cases (39.9%) and 109 (66.0%) age-and sex-matched controls. The colistin-resistant microorganisms isolated from cases were 29 Acinetobacter baumannii (51.8%), 18 Pseudomonas aeruginosa (32.1%) and 9 Klebsiella spp. Colistin, carbapenem, and quinolone use in the last three months were risk factors for colistin resistance in the univariate analysis. Previous quinolone use in the last three months (P=.003; RR: 3.2; 95% CI: 1.5-6,7) and previous colistin use in the last three months (P=.001; RR: 3.6; 95% CI: 1.63-7.99) were significant risk factors in the multivariate analysis. CONCLUSION: Clinicians should limit the use of quinolones and remain aware of the possibility of resistance developing during colistin use. LIMITATIONS: The lack of a heteroresistance analysis on the isolates. No data on use of a loading dose or the use of colistin in combination.