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.

Sümer, Betuel; Barkay, Orcun; Binay, Umut Devrim; Karakeçili, Faruk

Objective: Crimean-Congo hemorrhagic fever (CCHF) is one of the common zoonotic diseases in our country, and clinical course can result in mortality. CCHF virus is transmitted by ticks or contact with infected humans or animals' blood and body fluids. We present a case who didn't have a tick contact history and was not engaged in animal husbandry but had a history of sexual contact with a primary case who had a recent CCHF diagnosis. We report this case to emphasize that sexual contact should be kept in mind as a possible risk factor for CCHF transmission.

Tekin, Suda; Çinar, Gule; Barkay, Orcun; Çelik, Ilhami

Coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in human immunodeficiency virus (HIV) infected individuals results in increased hepatic complications. HBV and HIV viruses are transmitted by blood and unprotected sexual intercourse. People with HIV and HBV coinfection are at increased risk for liver-related morbidity and mortality. HCV-related liver injury progresses more rapidly among people coinfected with HIV. HCV coinfection may also affect the management of HIV infection. This review aims to go over the management of HIV-HCV and HIV-HBV coinfections.

Barkay, Orcun; Binay, Umut Devrim; Gül, Ozlem; Karakeçili, Faruk

Dizili-Yelgin, Canan; Çikman, Aytekin; Karakeçili, Faruk; Gülhan, Baris; Aydin, Merve

Objective: In this study, we aimed to assess sharps injuries occuring in a training and research hospital retrospectively and to clarify the current situation in order to reach conclusions and suggestions about the subject. Methods: The data was obtained from the notification forms with 18 questions filled by 124 health workers who were exposed to sharps injuries and applied to the infection control committee unit at the relevant dates. The data was statistically analysed with a p value of <0.05 being considered as significant. Results: At the end of the study, it was found out that 63.7% of the workers exposed to injuries were <30 years old and the average age was 27.9. A statistically significant correlation was found between the relevant age groups and injury prevalence. Injuries in the 16-30 age group were more frequent in clinical services, emergency services and blood sampling unit whereas injuries in >30 age group were mostly observed in clinic services (internal and surgical units) and operating rooms. It was found that hand injuries were the most common and needle sticks were the most frequent (91.1%) cause of injury. Conclusions: The primary way to prevent the sharps injuries is to improve safety and to develop effective employee safety policies. Additionally, taking universal precautions, regular trainings, reducing staff workload and provision of safe and useful materials can be among the suggestions that can prevent injuries.

Davarci, Ismail; Koçoglu, Mucahide Esra; Zengin, Ferhat

Objective: Carbapenem-resistant Enterobacteriaceae are reported increasingly everywhere throughout the world. Rapid and simple detection of carbapenemase-producing strains has become imperative because of the use of carbapenems in the treatment of extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae infections. In this study, we aimed to compare the diagnostic value of modified Hodge test and carbapenem inactivation test for Klebsiella pneumoniae isolates producing carbapenemase, verified by molecular method, and to evaluate their use in routine laboratory practice. Methods: 64 K. pneumoniae strains which have shown resistance gene causing carbapenem resistance by the polymerase chain reaction, and 40 ESBL-negative and carbapenem-susceptible K. pneumoniae strains have been included in this study. Meropenem, imipenem and ertapenem were studied separately in modified Hodge test and carbapenem inactivation test was performed for all strains. Carbapenem inactivation test was evaluated at the 6th hour for preliminary decision and at the 24th hour for the final decision. Results: The sensitivity of the modified Hodge test using meropenem, imipenem and ertapenem for detecting presence of carbapenemase was 60.9%, 62.5% and 68.8%, respectively. In the carbapenem inactivation test with meropenem, imipenem and ertapenem, sensitivity to determine carbapenemase production was 32.8%, 75% and 96.9% after 6 hours, and 64.1%, 84.4% and 96.9% after 24 hours, respectively. There were no positive results in modified Hodge and carbapenem inactivation tests with K. pneumoniae strains that were ESBL-negative and carbapenem-susceptible. Conclusions: As a result, molecular tests are essential to detect carbapenem encoding genes. However, we believe that the carbapenemase inactivation test is a better alternative to the modified Hodge test to detect carbapenemase production in laboratories without adequate infrastructure.

Karavas, Erdal; Karakeçili, Faruk

Objective: The aim of this study was to perform common carotid, internal carotid and vertebral artery Doppler ultrasound imaging of patients with Crimean-Congo haemorrhagic fever (CCHF), to compare the results with those of healthy individuals, and to determine the value of radiological findings in the prediction of disease severity in the early period. Methods: Bilateral common carotid, internal carotid and vertebral artery Doppler ultrasound (US) imaging was performed in CCHF patients and a healthy control group between March 2016 and September 2017. Patients were grouped as mild-moderate or severe cases according to the scoring system of Bakir et al. to determine disease severity. The peak systolic and diastolic rates together with the resistive and pulsatility indexes were examined in the common carotid, internal carotid, and vertebral arteries bilaterally. The flow volumes in the internal carotid and vertebral arteries were also measured bilaterally. Results: Total 35 CCHF patients comprised 14 males and 21 females with a mean age of 52 years. 7 patients were evaluated as severe and 28 as mild-moderate. On Doppler US, the peak systolic and diastolic end flow rates in vertebral arteries bilaterally were found to be statistically significantly higher in the patient group compared to the control group (p<0.05). The internal carotid artery and vertebral artery flow volumes bilaterally were determined to be statistically significantly higher in the patient group (p=0.032). When the relationship between flow volume and disease course was examined, volume was 1.11 L/min in mild-moderate cases and 2.23 L/min in severe cases. Conclusions: Early diagnosis of CCHF is extremely important for the initiation of supportive treatment, prediction of disease severity, and precautions to be taken. The noninvasive radiological findings determined in this study can be considered to contribute to the prediction of the clinical course and severity of CCHF in the early stages.

Karakeçili, Faruk; Çikman, Aytekin; Karagöz, Alper

Objective: We aimed to present clinical and laboratory findings of patients and the molecular analysis of strains isolated in a Salmonella typhimurium outbreak associated with food served at a wedding reception. Methods: A total of 108 patients admitted to the hospital after eating food served at a wedding reception were included in the study. The patients whose symptoms continued even after supportive care were hospitalized for further treatment. Two sets of blood and stool cultures were obtained from all the hospitalized patients, and samples were taken from the implicated food source as well. The VITEK (R) 2 Compact (bioMerieux, Marcy l'Etoile, France) automated microbiology system was used together with conventional methods to identify the isolates and determine their antibiotic susceptibility. Serotyping was performed according to the Kauffmann-White scheme using the slide agglutination method. The molecular epidemiology of the isolates was determined by pulsed-field gel electrophoresis using the XbaI enzyme. Results: All the patients presented with common complaints such as fatigue, abdominal pain, fever, diarrhea, nausea, and vomiting that had started 8 to 16 hours after the consumption of the food served. 45 patients were treated in the hospital whereas 63 patients were followed in an ambulatory setting after 4-6 hours of supportive care. Their hospitalization period varied between 1 and 5 days, and all patients were discharged with full recovery. S. typhimurium was isolated from stool cultures of 14 patients, and two of them were also blood culture-positive. All the isolates revealed a single clonal cluster in molecular analysis. All of them were susceptible to ampicillin, ceftriaxone, and ciprofloxacin, but resistant to amikacin. Conclusions: Despite the developments in the food industry in Turkey and across the world, food-borne disease outbreaks still occur. Hygiene rules should be strictly followed and appropriate inspections should be undertaken in the food sector to prevent food-borne outbreaks.