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- ArticleAçık Erişim2026Diagnosis, management, and prevention of Crimean-Congo haemorrhagic fever: a Delphi-based consensus study in Türkiye
Ergönül, Önder; Güllü, Deniz; Yigci, Defne; Çelikbaş, Aysel Kocagül; Alay, Handan; Gök, Şebnem Eren; Yapar, Derya; Can, Fatma Kesmez; Kader, Çiğdem; Akdoğan, Özlem
Background: Crimean-Congo haemorrhagic fever (CCHF) is a widely distributed viral haemorrhagic fever with expanding geographic range. As new regions encounter the disease, clinicians must make high-stakes decisions despite limited standardised management frameworks. Methods: In this multicentre, modified Delphi study, infectious diseases specialists were recruited from 19 centres in Türkiye via an open call through the professional communication channels of the Turkish Society of Clinical Microbiology and Infectious Diseases (known as KLİMİK). Eligibility was determined based on self-reported clinical experience. Eligible participants reported managing more than ten patients with CCHF as primary physicians, with no additional demographic or professional exclusion criteria applied. The Delphi process included three sequential rounds of anonymous online surveys (between Sept 26 2025, and Jan 1, 2026) and an interim structured clarification meeting (Nov 28–29, 2025), to map areas of agreement and heterogeneity across diagnosis, monitoring, therapeutics, and exposure management. Statements were analysed using Likert-scale methodology. Responses were summarised using medians, interquartile ranges, and proportions of agreement. Consensus levels were defined a priori. Findings: Of 45 ID specialists invited to participate in Round 1, 35 completed the questionnaire and were included in the analysis (78% response rate). All 35 eligible participants were invited to Round 2, and 32 (91%) completed the questionnaire. All 32 participants completed Round 3, with no attrition between Rounds 2 and 3. All participants reported experience of managing more than ten patients with CCHF; ∼85% of participants reported managing at least 50 confirmed cases. In total, 146 candidate statements were evaluated, of which 72 achieved early consensus in Round 1. Following iterative refinement, 39 of 56 statements (69.6%) met predefined consensus criteria in the final round, including eight with very high agreement and 22 with high agreement. Strong convergence was observed for early molecular testing and risk-based hospitalisation, ribavirin initiation within 4 days of symptom onset in confirmed cases, risk-adapted transfusion strategies guided by bleeding severity, and post-exposure prophylaxis after high-risk occupational exposure. Persistent heterogeneity remained regarding ribavirin initiation beyond the early symptomatic window, immunomodulatory therapies, and transfusion de-escalation strategies in selected scenarios. Interpretation: These findings should not be interpreted as formal guidelines. By transparently quantifying expert agreement and non-consensus, this study synthesises specialist clinical experience from a high incidence country and delineates areas of convergence and ongoing uncertainty relevant to both endemic and newly affected regions. Prospective studies are needed to validate key therapeutic and management strategies identified in this work. Funding: None. The Authors
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2026Modified mRNA Encoding the Crimean-Congo Hemorrhagic Fever Virus Nucleocapsid Protein Confers Robust Protection Against Lethal Challenge in Mice
Keskin, Sercan; Pavel, Shaikh Terkis Islam; Sak, Rabia; Bahadori, Fatemeh; Aslan, Ahmet Furkan; Aktaş, Münir; Karakeçili, Faruk; Kalkan, Ahmet; Özdarendeli, Aykut; Doymaz, Mehmet Ziya
The Crimean-Congo Hemorrhagic Fever Virus (Orthonairovirus haemorrhagiae) causes a hemorrhagic fever with mortality rates reaching up to 40%. For years, this virus has maintained its position among the top priority pathogens identified by the World Health Organization (WHO). This is due to its endemic presence across a vast region—from Africa and Spain to the Balkans, the Middle East, and throughout Asia—its potential for human-to-human transmission, and the lack of an effective and approved vaccine or treatment. Therefore, the development of an effective vaccine against CCHFV is of critical importance. Building on the success of mRNA-based vaccines during the Coronavirus Disease 2019 (COVID-19) pandemic, this study reports the development of a messenger ribonucleic acid (mRNA) vaccine candidate expressing the nucleocapsid protein (NP) of CCHFV. The CCHFV NP in vitro transcript (IVT) was designed with pseudouridine (Ψ) nucleoside modification. As part of the preclinical characterization of the IVT vaccine candidate, the biochemical and immunological properties of NP were confirmed in Huh-7 cells transfected with IVT NP-ΨmRNA. Afterwards, the efficacy of IVT NP-ΨmRNA immunization was evaluated in immunocompetent BALB/c and transiently immunosuppressed (IS) C57BL/6 mice. In CCHFV challenge studies, IS C57BL/6 mice were used. IS C57BL/6 mice were immunized intramuscularly with 2 doses of IVT NP- ΨmRNA, either naked or encapsulated in Poly(lactic-co-glycolic acid) (PLGA) nanoparticles, administered 14 days apart. High levels of CCHFV NP-specific humoral (IgM and IgG) and cellular (cytokine and lymphoproliferative) responses were demonstrated in BALB/c mice immunized with IVT NP- ΨmRNA. In challenge experiments, 100% survival was observed with both the naked and PLGA-encapsulated IVT NP-ΨmRNA immunizations. These findings demonstrate 100% survival following lethal CCHFV challenge under the experimental conditions tested in this mouse model and support the potential of NP-encoding pseudouridine-modified mRNA vaccines. Additionally, 100% survival was observed in mice immunized with inactivated CCHFV, whereas only 20% survival was detected in the unmodified IVT NP-mRNA vaccinated animals. In the protected mice, viral clearance was observed in the spleen, liver tissues, and blood on day 14 post-challenge. This study demonstrates that NP, the most abundant protein of the virus, is capable of providing significant survival benefits in the tested mouse model. Furthermore, our report represents a significant step in identifying a potential vaccine candidate and provides a solid foundation for further preclinical studies necessary to support future clinical development.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2026Meta-analysis of Maternal and Fetal Outcomes of Crimean-Congo Hemorrhagic Fever during Pregnancy
Donk, Bahar; Güllü, Deniz; Cırık, Ahmet Mirhan; Alay, Handan; Karakeçili, Faruk; Özden, Kemalettin; Can, Fatma Kesmez; Barkay, Orçun; Pshenichnaya, Natalia; Ergönül, Önder
Crimean-Congo hemorrhagic fever (CCHF) during pregnancy is associated with severe maternal and fetal complications, but evidence remains limited to heterogeneous case reports. We synthesized patient-level data from published and unpublished cases identified through systematic database searches and direct collaboration with centers in CCHF-endemic areas. We harmonized patient-level clinical, laboratory, obstetric, treatment, and outcome data for 55 pregnancies. The maternal mortality rate was 28.8% (15/52), and fetal loss occurred in 57.4% (31/54) of cases. Maternal mortality rates increased with advancing gestation, reaching 31.3% in the third trimester, but fetal loss was highest (85.7%) in the first trimester. Ribavirin treatment during the third trimester was associated with lower observed maternal mortality rates (odds ratio 0.33, 95% CI 0.13–0.84; p = 0.031). Our findings highlight gestational age–specific risks of CCHF and support the need for standardized management protocols and strengthened CCHF surveillance during pregnancy in endemic regions.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2026Performance of Serum-Based Non-Invasive Fibrosis Scores Compared with Liver Biopsy in Patients with Chronic Hepatitis B
Binay, Umut Devrim; Karakeçili, Faruk; Barkay, Orçun; Kuru, Betül
Background and Objectives: Accurate assessment of liver fibrosis is essential for treatment decisions in patients with chronic hepatitis B (CHB). Although liver biopsy is considered the reference standard, its invasive nature limits routine use. Serum-based non-invasive fibrosis scores have been proposed as alternatives; however, their diagnostic performance in CHB remains variable. This study aimed to compare multiple serum-based non-invasive fibrosis scores with liver biopsy findings and to evaluate their association with histological activity. Materials and Methods: This retrospective cross-sectional study included 219 adult patients with CHB who underwent liver biopsy with simultaneous laboratory evaluation. Patients with viral co-infections (HIV, HCV, or HDV), metabolic syndrome, diabetes mellitus, hepatic steatosis, or incomplete data were excluded. Non-invasive fibrosis scores—including APRI, FIB-4, AST/ALT ratio (AAR), age–platelet index (API), GGT-to-platelet ratio (GPR), Lok index, modified Forns index, Albumin–Bilirubin (ALBI) score, and red cell distribution width (RDW)-based indices—were calculated using routine laboratory parameters. Histopathological fibrosis staging served as the reference standard. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and areas under the curve (AUC) were compared using the DeLong test. Associations with histological activity index (HAI) were assessed using Spearman correlation. Results: For the prediction of significant fibrosis (≥F2), FIB-4 demonstrated the highest AUC, followed by ALBI and APRI. For advanced fibrosis (≥F3), FIB-4 again showed the highest AUC, followed by APRI and GPR. For significant fibrosis (≥F2), DeLong analysis revealed no statistically significant differences between FIB-4 and the other serum-based scores (p > 0.05). APRI (r = 0.556, p < 0.001) and FIB-4 (r = 0.463, p < 0.001) showed the strongest correlations with HAI. In ROC analysis for moderate-to-severe histological activity (HAI ≥ 4), APRI demonstrated the highest diagnostic accuracy (AUC = 0.677). Conclusions: Serum-based non-invasive fibrosis scores demonstrate comparable but overall modest diagnostic performance for biopsy-confirmed fibrosis in patients with chronic hepatitis B. Indices such as FIB-4 and APRI demonstrated relatively better discrimination and may be considered as screening or rule-out tools in selected clinical contexts. APRI and FIB-4 also show associations with histological activity; however, their clinical application should be interpreted with caution, given their moderate discriminatory capacity.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2026Comparison of clinical outcomes associated with RSV and influenza infections in adults: a multicenter study from Türkiye (for AP-TR)
Akdemir, İrem; Selçuk Özger, Hasan; Hocagil, Tuğba Akkaya; Kayaaslan, Bircan; Alay, Handan; Top, Özge Özgen; Kazak, Esra; Kalın Ünüvar, Gamze; Erbay, Ayşe; Çınar, Güle
Objectives Respiratory syncytial virus (RSV) is an increasingly recognized cause of serious respiratory illness in adults, yet data from middle-income countries remain scarce. This study aimed to compare clinical outcomes of RSV and influenza virus infections in hospitalized and outpatient adults in Türkiye. Methods This retrospective multicenter study included 3299 adult patients (≥18 years) with polymerase chain reaction-confirmed RSV (n = 628) or influenza (n = 2671) from 21 centers across Türkiye between January 2022 and March 2024. The primary outcome was viral infection–related hospitalization. The secondary composite outcome was intensive care unit (ICU) admission and/or 30-day mortality among hospitalized patients. Propensity score–based overlap weighting was used to adjust for baseline differences including age, risk group, clinical severity, co-infection status, and study center. Results After overlap weighting, RSV infection was not significantly associated with increased hospitalization risk compared to influenza (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.77-1.20, P = 0.705). Similarly, no significant difference was observed in the composite outcome of ICU admission or 30-day mortality (OR: 1.40, 95% CI: 0.95-2.05, P = 0.088). Age ≥60 years, high-risk comorbidities, and severe acute respiratory infection presentation were the primary independent predictors of both hospitalization and worse outcomes. Bacterial or fungal co-infections and secondary infections were observed in 12.9% and 7.3% of hospitalized patients, respectively, with no significant difference between RSV and influenza groups. Conclusion After adjustment for baseline characteristics, RSV and influenza were associated with comparable risks of hospitalization and severe clinical outcomes in adults. Host-related factors, particularly older age and underlying comorbidities, were the dominant determinants of adverse outcomes. These findings from a largely unvaccinated, middle-income country cohort highlight the need to expand RSV and influenza vaccination programs targeting high-risk adult populations.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2025Rapid Detection of Pathogens and Resistance Genes Grown in Blood Cultures with Two Multiplex Tandem Real-Time PCR Kits
Gülhan, Barış; Çıkman, Aytekin; Aydın, Merve; Hasbek, Mürşit; Özekinci, Tuncer; Akyüz, Sümeyye; Karakeçili, Faruk
Objective: In this study, two multiplex tandem real-time PCR kits were used to rapidly diagnose common Gram-positive cocci and Gram-negative bacilli, detect their commonly seen antibiotic resistance genes, and evaluate the two kits’ performance. Materials and Methods: Gram-positive 12 (GP-12) kit (AusDiagnostics, Australia) and Gram-negative 12 (GN-12) kit (AusDiagnostics, Australia) were used in the study. Seventy-eight Gram-negative bacilli and 54 Gram-positive cocci grown in blood culture vials were applied to GN-12 and GP-12 panels. At the same time, the passages of the samples were made and incubated. After that, identification and antibiograms were made in the Phoenix™ automated system (Becton, Dickinson and Company, USA) and VITEK 2 Compact automated system (bioMérieux, France). Results: Twenty-one Staphylococcus aureus, twelve coagulase-negative staphylococci (CoNS), two Streptococcus pneumoniae, two Enterococcus faecium, and three Enterococcus faecalis were found to match the results from the automated GP-12 Kit. Pathogens present in the panel were successfully identified using the GN-12 kit. Both panels were found to be more effective in diagnosing polymicrobial infections. Conclusion: These evaluated kits were rapid (approximately three hours) and valuable in identifying common sepsis pathogens and resistance genes. Thus, these tests can easily be used in the diagnosis of sepsis.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2025Key predictors of mortality in Crimean-Congo haemorrhagic fever: a retrospective multicentre cohort study
Güllü, Deniz; Yigci, Defne; Baykam, Nurcan; Çelikbaş, Aysel Kocagül; Yapar, Derya; Akdoğan, Özlem; Özden, Kemalettin; Sarıkaya, Rukiye İnan; Hasanoğlu, İmran; Güner, Rahmet
Objective This study aimed to identify key predictors of mortality in patients with Crimean-Congo haemorrhagic fever (CCHF). Our specific goals included characterizing the demographic and clinical features of hospitalized CCHF patients in Türkiye, determining the factors associated with mortality among these patients, and evaluating the impact of early ribavirin administration. Methods A retrospective study was conducted on 1103 CCHF patients across 18 hospitals in Türkiye from 1 January 2019 to 20 November 2024. All data were obtained via an online data collection system by the designated physician at each centre. Patients with laboratory-confirmed CCHF infection who were hospitalized were included in the study. Univariate analyses and time-dependent Cox regression were conducted. Results Of the 1103 patients, 65.7% (725/1102) were men; 87.2% (962/1103) resided in rural areas; and the mean age was 53 years. Ticks were identified as the transmission route in 68.4% (755/1103) of the cases. Comorbidities included diabetes mellitus, chronic heart disease, and hypertension; 4.6% (51/1103) of the patients developed healthcare-related infections. Intensive care unit admission was required in 8.0% (88/1103) of the patients, and the overall mortality rate was 5.1% (56/1103). In univariate analyses, age ≥50 years (odds ratio [OR], 3.1; 95% CI, 1.58–6.08; p < 0.001) and diabetes mellitus (OR, 4.49; 95% CI, 2.20–9.18; p < 0.001) were associated with increased mortality. Both variables remained statistically significant predictors in the multivariate analysis. Although early ribavirin administration, ≤96 hours from symptom onset, did not reach statistical significance in univariate analysis (OR, 0.52; 95% CI, 0.26–1.05; p = 0.065), it was significantly associated with reduced mortality in time-dependent Cox regression (adjusted hazard ratios, 0.21; 95% CI, 0.07–0.69; p = 0.010). Discussion Key factors such as age and comorbidities can predict mortality in CCHF patients. Timely identification of these predictors, along with early administration of ribavirin, may contribute to improved survival and better clinical outcomes.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2025Rapid, sensitive, and species-independent detection of Crimean Congo hemorrhagic fever virus nucleoprotein and GP38 antibodies
Karaaslan, Elif; Chiang, Cheng-Feng; Kurutaş, Gülter Öncü; Barkay, Orçun; Çetin Güler, Nesibe Selma; Kalkan, Merve Yazıcı; Karakoç Parlayan, Hanife Nur; Akdoğan, Özlem; Çelikbaş, Aysel Kocagül; Aksoy, Firdevs
Background: Crimean-Congo hemorrhagic fever virus (CCHFV), a zoonotic agent in the Nairoviridae family (genus Orthonairovirus), is a high-priority pathogen. CCHFV infection causes Crimean-Congo hemorrhagic fever (CCHF), a human disease with case fatality rates of up to 40%. Serological surveillance of CCHFV in animals and humans is crucial for ecological studies and public health. Methods: We developed CCHFV mix-and-read assays utilizing split-NanoLuc technology (NanoBiT) to detect anti-CCHFV antibodies against the nucleoprotein (NP) stalk region and the GP38 glycoprotein. These species- and isotype-agnostic assays provide results in ∼30 min. Using serum samples from RT-PCR-confirmed CCHF cases collected during and after hospitalization, we investigated anti-NP and anti-GP38 antibody development. The performance of the mix-and-read assays was compared to the NP-based IDScreen® CCHF commercial assay using human sera, and cross-reactivity potential was evaluated using a diverse panel of anti-orthonairovirus antisera raised in mice. Findings: In human convalescent cases (n = 21), mix-and-read assay concordance between anti-GP38 and anti-NP antibody detection was 100%. Both mix-and-read assays and IDScreen® CCHF demonstrated identical sensitivity of 95.2% in convalescent patients. The specificity of the NP assay was 98.9%, and that of GP38 was 99.7%, both comparable to IDScreen® CCHF (specificity: 99.7%). Cross-reactivity against CCHF NP and GP38, regardless of assay type, was primarily observed in antisera raised against other orthonairoviruses within the Nairobi sheep disease genogroup. Interpretation: The simplicity and robust performance of the CCHFV mix-and-read assays make them ideal tools for supporting serological surveillance in humans and animals. Furthermore, the inclusion of the GP38 antigen alongside NP enhances the precise identification of retrospective CCHF cases, further strengthening broad surveillance efforts. Funding: CDC Emerging Infectious Disease Research Core Funds, funding for reagent, CDC personal, travel. Defence Threat Reduction Agency (HDTRA12210007): E.K. salary. Oak Ridge Institute for Science and Education (ORISE): E.K. salary and travel. National Institute of Allergy and Infectious Diseases (1R01AI180125-01A1): sample acquisition. Funding sources did not have a role in the writing or decision to submit the publication.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2025Evaluation of Treatment Response in Chronic Hepatitis C Patients Receiving Sofosbuvir/Velpatasvir/Voxilaprevir: A Multicenter Real-World Experience from Türkiye
Binay, Umut Devrim; Karakeçili, Faruk; Aygen, Bilgehan; Kılınç Toker, Ayşin; Çelik, İlhami; Demirtürk, Neşe; Şimşek Bozok, Tuğçe; Dursun, Leyla; Akgül, Fethiye; Çınar, Güle
The combination of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) is recommended as a salvage therapy for treatment-experienced chronic hepatitis C (CHC) patients. However, it is used in our country for treatment-naïve and treatment-experienced patients. This study aims to present real-world data from Türkiye on CHC patients treated with SOF/VEL/VOX. The present study was conducted by the Viral Hepatitis Study Group of the Turkish Society of Clinical Microbiology and Infectious Diseases (KLİMİK). It was a multicenter, retrospective, observational study. The data were collected from patients receiving SOF/VEL/VOX therapy at 12 medical centers in Türkiye between 1 June 2022 and 31 December 2024. The patients had received the treatment for 8 to 12 weeks. Of the 139 patients enrolled, 63.3% (n = 88) were male, with a mean age of 54.4 years. Most patients were non-cirrhotic (94.2%, n = 131) and treatment-naïve (92%, n = 128); 49.6% (n = 69) were infected with genotype 1b. Early virologic response (EVR) could be assessed in 126 patients, with an EVR rate of 82.5% (n = 104). End-of-treatment data were available for 113 patients, all achieving an end-of-treatment response. Among the 80 patients for whom week-12 post-treatment data were available, 97.5% sustained virologic response at week 12 (SVR12). Significant improvements were observed in AST, ALT, and platelet levels, along with reductions in APRI and FIB-4 scores (p = 0.001).” No serious adverse events leading to treatment discontinuation were reported. Mild adverse events included pruritus (2.1%, n = 3), fatigue (2.1%, n = 3), and nausea (1.4%, n = 2). The SOF/VEL/VOX combination is a highly effective and well-tolerated treatment option in treatment-naïve CHC patients, achieving an SVR12 rate of 97.5%.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2024Blood Group: One of the Indicators of Poor Prognosis in Crimean-Congo Hemorrhagic Fever?
Karakeçili, Faruk; Barkay, Orçun
Introduction: Crimean-Congo Hemorrhagic Fever (CCHF) is a severe zoonotic disease characterized by a spectrum of clinical manifestations, including fever and organ bleeding. Specific endemic regions, such as Türkiye's Kelkit Valley, have established prognostic classification systems that notably exclude considerations of blood groups. This study aims to contribute to this evolving field by assessing whether blood groups play a significant role in the course of CCHF. Methods: The study involves 368 patients who were followed up at our clinic between 2011-2023. Statistical analyses were conducted to evaluate the relationships between demographic characteristics, blood groups, severe case presentations, and mortality rates. The relationships between blood group, gender, age, severe case status, and death status were assessed. Results: Our findings indicate that individuals with blood group A (+) exhibited a significantly higher rate of severe CCHF cases. However, blood group did not significantly affect mortality rates. Notably, advancing age was identified as a risk factor for mortality. Discussion and Conclusion: This study contributes valuable insights into the interplay between blood groups and CCHF outcomes, suggesting that blood group A (+) may be associated with an elevated risk of severe disease. Understanding the role of blood groups in CCHF may inform risk assessment and potential personalized therapeutic interventions in the future.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2024A Case of Mediterranean Spotted Fever with Cerebral Infarction
Binay, Umut Devrim; Barkay, Orçun; Karakeçili, Faruk; Gül, Özlem; Tanoğlu, Ceyda; Sümer, Betül
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2024Determining Diagnostic Sensitivity: A Comparison of Rose Bengal Test, Coombs Gel Test, ELISA and Bacterial Culture in Brucellosis Diagnosis—Analyzing Clinical Effectiveness in Light of Inflammatory Markers
Barkay, Orçun; Karakeçili, Faruk; Binay, Umut Devrim; Akyüz, Sümeyye
Background: Brucellosis is a zoonotic infectious disease. It is estimated that the number of cases reported today is much less than the actual number. We still have difficulty in diagnosing the disease and its organ involvement. In this sense, new approaches that can be useful in clinical practice are required, and we aimed to evaluate this situation in our study. Methods: 171 of 213 patients followed in our center between January 2021 and April 2024 were included in the study. A total of 150 patients were included in the study as a control group. Rose Bengal test (RBT), Coombs gel test (CGT), enzyme-linked immunosorbent assay (ELISA), and automated blood culture were used for diagnosing brucellosis. Complete blood count, sedimentation, C-reactive protein, and biochemical parameters were obtained. Inflammation markers such as neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index were calculated. Results: The most successful results in the diagnosis were ELISA (89.4%), RBT (88.3%), CGT (83%), and blood culture (34.8%). For diagnosing sacroiliitis and spondylodiscitis, instead of resorting to expensive methods like magnetic resonance, a combination of ELISA positivity with elevated acute phase reactants and inflammatory markers could be significantly instructive. Conclusions: Optimizing diagnostic algorithms and exploring novel diagnostic approaches, such as inflammatory markers, hold promise for improving diagnosis and management.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2024Hypochloremia: A Potential Indicator of Poor Outcomes in COVID-19
Barkay, Orçun; Karakeçili, Faruk
Background: Coronavirus Disease-2019 (COVID-19) has posed formidable challenges to healthcare systems. Exploring novel biomarkers that can provide valuable prognostic insights, particularly in critically ill patients, has a significant importance. Against this backdrop, our study aims to elucidate the associations between serum chloride levels and clinical outcomes. Methods: A total of 499 patients were enrolled into the study. The serum chloride levels of patients upon hospital admission were recorded and then categorized into three groups (hypochloremia, normochloremia, and hyperchloremia) for the evaluation of clinical outcomes. Additionally, serum C-reactive protein, procalcitonin, and D-dimer measurements were recorded for further evaluation. Results: A total of 390 (78.1%) patients tested positive for COVID-19 via polymerase chain reaction testing. Non-contrast thorax computed tomography scans were indicative of COVID-19 compatibility for all patients. A total of 210 (42%) patients were female and 289 (58%) were male. A total of 214 (42.8%) patients necessitated tocilizumab intervention; 250 (50.1%) were at an intensive care unit (ICU), with 166 (66.4%) of them receiving tocilizumab. A total of 65 (13%) patients died, 40 (61.5%) of whom received tocilizumab; 41 (63%) were in the ICU. Serum chloride levels upon admission were markedly lower and elevated D-dimer levels were apparent in tocilizumab users, patients requiring ICU care, and patients who died. Conclusions: our findings provide robust evidence supporting the value of serum chloride levels as a prognostic biomarker in critically ill COVID-19 patients.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2024Invasive Aspergillosis with Cavernous Sinus Thrombosis Following High-Dose Corticosteroid Therapy: A Challenging Case of Rhino-Orbital-Cerebral Mycosis
Karakeçili, Faruk; Barkay, Orçun; Sümer, Betül; Binay, Umut Devrim; Memiş, Kemal Buğra; Yapıcıer, Özlem; Balcı, Mecdi Gürhan
Invasive aspergillosis is a rare but severe fungal infection primarily affecting immunocompromised individuals. The Coronavirus Disease-2019 (COVID-19) pandemic has introduced new complexities in managing aspergillosis due to the widespread use of corticosteroids for treating COVID-19-related respiratory distress, which can increase susceptibility to fungal infections. Here, we present a challenging case of progressive cerebral aspergillosis complicated by cavernous sinus thrombosis (CST) in a 67-year-old male with a history of COVID-19. The patient, initially misdiagnosed with temporal arteritis, received pulse corticosteroid therapy twice before presenting with persistent left-sided headaches and vision loss. Cranial imaging revealed findings consistent with fungal sinusitis, Tolosa–Hunt syndrome, and orbital pseudotumor, which progressed despite initial antifungal therapy. Subsequent magnetic resonance imaging indicated an invasive mass extending into the left cavernous sinus and other intracranial structures, raising suspicion of aspergillosis. A transsphenoidal biopsy confirmed Aspergillus infection, leading to voriconazole therapy. Despite aggressive treatment, follow-up imaging revealed significant progression, with extension to the right frontal region and left cavernous sinus. The patient then developed visual impairment in the right eye and was diagnosed with CST secondary to fungal sinusitis. Management included a combination of systemic antifungals and antibiotics; however, the patient declined surgical intervention. This case underscores the diagnostic challenges and rapid progression associated with cerebral aspergillosis in post-COVID-19 patients treated with corticosteroids. This report highlights the need for heightened clinical suspicion and prompt, targeted interventions in similar cases to improve patient outcomes. Further research is required to understand the optimal management of invasive fungal infections.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2024The Efficacy of Glecaprevir/Pibrentasvir in Chronic Hepatitis C Patients and the Impact of the COVID-19 Pandemic: Multicenter Real-Life Data
Gürbüz, Yunus; Kocagül-çelikbaş, Aysel; Öztoprak, Nefise; Aygen, Bilgehan; Batırel, Ayşe; Habiloğlu, Arif Doğan; Aktuğ-Demir, Nazlım; Çeken, Sabahat; Demirtürk, Neşe; Ceylan, Mehmet Reşat
Objective: This study aimed to demonstrate the real-life efficacy and safety of glecaprevir / pibrentasvir in the treatment of chronic hepatitis C, as well as to identify the problems caused by the COVID-19 pandemic in the follow-up and treatment of patients. Materials and Methods: The study was conducted retrospectively with the participation of researchers from universities or training and research hospitals. It included patients with chronic hepatitis C who were over 18 years of age, treatment-naïve or treatment-experienced, had detectable HCV RNA and were receiving glecaprevir/pibrentasvir treatment Results: Only 188 of the 385 patients who participated in the study came to the follow-up visit 12 weeks after treatment, and all of them had a sustained virological response. It was thought that a significant portion of the 177 patients who did not come to the follow-up visit at 12 weeks after treatment refrained from coming to the hospital due to the COVID-19 pandemic. None of the patients who attended the follow-up visits required treatment discontinuation due to adverse events. Conclusion: Glecaprevir/pibrentasvir is a highly effective and relatively safe drug in the treatment of chronic hepatitis C. The COVID-19 pandemic has negatively affected the follow-up and treatment processes of patients. New measures are needed for the follow-up and treatment of patients with chronic hepatitis C during pandemics.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Antibiotic Resistance of Staphylococcus aureus Strains Isolated from Wound Specimens of Patients Admitted to the Orthopedics and Traumatology Department of a Tertiary Care Hospital
Karakeçili, Faruk; Gür, Volkan; Çıkman, Aytekin; Kockara, Nizamettin; Yapici, Furkan; Gülhan, Barış; Subaşı, Özay; Gökgöz, Mehmet Burak
Objective: Staphylococcus aureus is a critical infectious agent in orthopedics and traumatology clinics. Treatment of S. aureus infec- tion is a problem, mainly due to the increased incidence of methicillin-resistant strains. This study aims to determine the antibiotic resistance of S. aureus strains isolated from wound samples of patients admitted to a tertiary care hospital’s orthopedics and trau- matology clinic. Methods: Patients admitted to our hospital’s orthopedics and traumatology clinic between January 2012 and November 2018 were included in this study and studied retrospectively. Participants in the study were required to have S. aureus strains present within their wounds. In addition to more traditional approaches, an automated microbiologic agent detection system known as VITEK® 2 Compact (bioMérieux, Marcy l’Etoile, France) was utilized in this study to identify S. aureus and determine its level of antibiotic resistance. Results: S. aureus was identified in 64 out of 298 wound samples, with a detection rate of 21.5%. Fifty-one S. aureus strains (79.7% of the total) were taken from the inpatient clinic, and the remaining 13 (20.3%) were obtained from the outpatient clinic. S. aureus strains were categorized as either methicillin-resistant S. aureus positive (19 patients, 29.7%) or methi cillin-susceptible S. aureus positive (45 patients, 70.3%), with the majority being methicillin-susceptible S. aureus positive. Conclusion: We found out that among methicillin-resistant S. aureus positive patients, vancomycin, teicoplanin, linezolid, tigecy- cline, and daptomycin were effective antibiotic agents for the treatment. Also, methicillin-resistant S. aureus positive patients were resistant to penicillin, rifampicin, tetracycline, and erythromycin. This study detected methicillin resistance as a significant issue, and S. aureus strains antibiotic resistance in our study population was comparable to previous research.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Management of Chronic Hepatitis B in Special Patient Groups: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases-2023
Tekin, Sueda; Karakeçili, Faruk; Binay, Umut Devrim; Çelik, Ilhami; Tülek, Necla; Tütüncue, Ediz; Yildiz, Orhan; Yilmaz, Emel; Demirtürk, Nese
Turkish Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Working Group updated the consensus report on the management of chronic hepatitis B (CHB) in private hosts and special situations. Relevant literature and international guidelines are reviewed, and agreed recommendations are presented at the end of each chapter. In the report, treatment of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection, management of HBV and hepatitis C virus (HCV) coinfection, management of CHB in severe COVID-19 patients, non-transplant immunocompromised patients.
RDL Kalıcı Kaydıİncele - Conference ObjectAçık Erişim2023Real-Life Data of Chronic Hepatitis C Patients Treated with Direct-Acting Oral Antivirals: A Single-Center Study
Binay, Umut Devrim; Karakeçili, Faruk; Barkay, Orcun; Gül, Özlem
Introduction: Chronic hepatitis C virus (HCV) infection is one of the important causes of liver cancer and cirrhosis all over the worldwide. Methods: The data of the patients diagnosed with chronic hepatitis C infection who applied to the Adult Infectious Diseases and Clinical Microbiology Outpatient Clinic of Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital were retrospectively analyzed. Accordingly, 51 patients treated with direct-acting oral antiviral drugs (DAAs) between January 2016 and May 2021 were included in the study. Patients whose treatment is still ongoing, whose treatment was completed but did not come to the 12th week after treatment, or whose control time has not yet come, were excluded from the study. Results: It was observed that 58.8% of the cases participating in the study were male, 80.4% were infected with genotype 1b, and 74.5% were treatment-naive. When the treatment regimens used in the cases were examined, glecaprevir/pibrentasvir in 7.8%, sofosbuvir (SOF)/ledipasvir (LED), SOF/LED/ribavirin, and SOF/ribavirin in 15.7%, ombitasvir (OBV)/paritaprevir (P)/ritonavir (R)/dasabuvir and OBV/P/R/ribavirin in 76.5% (n=39) appears to be used. A statistically significant difference was found between the alanine aminotransferase, aspartate aminotransferase measurements, and platelet counts of the subjects participating in the study at the beginning, at the 4th week, at the end of the treatment, and at the 12th week (p=0.001). In these cases, a sustained virological response was achieved in 100%. In the follow-up of the cases, no serious side effects that required drug discontinuation were observed. Conclusion: Our study showed that the treatment success of DAAs is 100% and their side-effect profiles are good.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Significance of Differential Diagnosis for Febrile and Fatigued Patients in an Endemic Area During The COVID-19 Pandemic: Consideration of COVID-19, Brucellosis, and Crimean-Congo Hemorrhagic Fever
Barkay, Orcun; Karakeçili, Faruk; Binay, Umut Devrim; Sümer, Betul
Brucellosis and Crimean-Congo Hemorrhagic Fever are diseases that can present with similar clinical and laboratory findings to those of COVID-19. This can delay diagnosis and increase the risk of nosocomial transmission in the case of Crimean-Congo Hemorrhagic Fever. Although misdiagnosis of Brucellosis and Crimean-Congo Hemorrhagic Fever, and even a case of coinfection have been reported in the literature, no case report mentioning Crimean-Congo Hemorrhagic Fever and Brucellosis coinfection hospitalized with the pre-diagnosis of COVID-19 was found. A 35-year-old female patient presented to the emergency service with complaints of fever and fatigue. The patient was evaluated in the emergency triage and was taken to the area where COVID-19 pre-diagnosed patients were being examined. A thorax computed tomography without intravenous contrast usage was reported as normal, and the patient was discharged after being informed about COVID-19 transmission routes. The patient re-applied to the emergency service with complaints of fever, fatigue, headache, and myalgia four days later. The laboratory findings showed a white-cell count of 1600/mm(3), haemoglobin of 12,8 g/liter, platelet of 146000/mm(3), urea of 21,5 mg/dl, creatinine of 0,81 mg/dl, alanine aminotransferase of 134 U/liter, aspartate aminotransferase of 303 U/liter, lactate dehydrogenase of 714 U/liter, creatine kinase of 1796 U/liter, C-reactive protein of 3 mg/liter, D-dimer of 2000 mu g/liter, and a thorax computed tomography showed minimal ground-glass opacity. The patient was hospitalized with a preliminary diagnosis of COVID-19 by the chest diseases clinic. This case highlights the importance of considering other diseases with similar clinical and laboratory findings in endemic regions of Brucellosis and Crimean-Congo Hemorrhagic
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Evolution of Public Responses to COVID-19: Comparing Changes in People's Emotions, Behaviors, and Precautions at the Onset and End Stage of the Pandemic
Barkay, Orcun; Binay, Umut D.; Karakeçili, Faruk
Introduction The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on global public health, with profound changes in people's psychological and behavioral responses to the virus. Our aim is to evaluate the evolution of people's responses to COVID-19. Methods This observational study compares two groups of YouTube videos (495 videos in the first group and 620 videos in the second group) posted during different periods of the pandemic to examine the evolution of people's emotions, behaviors, and precautions toward COVID-19. We analyzed the titles of these videos to gain insights into the evolving public responses to the pandemic and how they may impact future public health interventions. Results Our results show a shift in focus from basic prevention measures to a more nuanced approach to prevention and management, characterized by a greater emphasis on vaccination and travel-related precautions in the second group of videos. These findings can inform public health policies and interventions aimed at mitigating the impact of COVID-19 and other pandemics. Furthermore, this study highlights the potential of social media platforms, such as YouTube, as a tool for monitoring and understanding public responses to pandemics and other health crises. Conclusion Continued analysis of public responses and behaviors can help inform effective public health interventions and policies as the COVID-19 pandemic continues to evolve.
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