BackgroundCrimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers.AimEvaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia.MethodsA cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016.ResultsTwenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23).ConclusionsStaff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP&C practice at individual units in endemic areas, as part of national quality assurance programs.

Purpose The objective of this study is to evaluate smell and taste dysfunction (STD) in coronavirus disease 2019 positive and negative patients, and to assess the factors associated with STD in COVID-19 positive patients. Methods Patients who had been tested with the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for COVID-19 were identified, and according to the RT-PCR test results, patients were separated into Positive and Negative Groups. A telephone-based assessment was applied to both groups using the American Academy of Otolaryngology-Head and Neck Surgery Anosmia Reporting Tool. Patients in Positive Group were also asked to rate STD, nasal breathing, and anxiety in three different time periods (pre-/during-/post-COVID) using the visual analog scale (VAS). Results A total of 53 COVID-19 positive and 51 negative patients completed the surveys. STD was eightfold more frequent (OR 8.19; CI 95% 3.22-20.84) in the Positive Group. Of the 53 COVID-19 positive patients, 32 reported STD and 21 did not. 'Ground-glass appearance' on chest-computed tomography was more frequent and median lymphocyte count was significantly lower in COVID-19 positive patients with STD. During-COVID STD and nasal breathing VAS scores were significantly lower than the pre-and post-COVID scores. During-COVID STD scores were significantly correlated with anxiety scores (Spearman's rho-0.404, p = 0.022) but not correlated with nasal breathing scores. Conclusion STD may be related to increased inflammatory response as well as damage of olfactory neuronal pathway or non-neuronal olfactory mucosa. Understanding the exact cause of chemosensory impairment in COVID-19 can be helpful in explaining the pathophysiology of the disease.

Background Data describing the coagulopathy of Crimean-Congo haemorrhagic fever are scarce. We did rotational thromboelastometry (ROTEM) and conventional coagulation testing in patients with Crimean-Congo haemorrhagic fever to increase our understanding of the coagulopathy of this infectious disease. MethodsWe did a prospective observational cohort study of adults aged 18 years and older and admitted to hospitals with PCR-confirmed Crimean-Congo haemorrhagic fever in Samsun and Tokat, Turkey. Demographic, clinical, and laboratory data were collected and blood samples for ROTEM analysis and coagulation testing were drawn at admission and during hospital admission and convalescence (up to 30 days after onset of illness). For the ROTEM analysis we recorded the following extrinsically activated ROTEM (EXTEM S) variables, with normal ranges indicated: clotting time (38-79 s), clot formation time (34-159 s), amplitude at 10 min after clotting time (43-65 mm), maximum clot firmness (50-72 mm), and maximum lysis (>15% at 1 h). The following fibrin-specific ROTEM (FIBTEM S) variables were also recorded: amplitude at 10 min after clotting time (normal range 7-23 mm) and maximum clot firmness (9-25 mm). Disease severity was assessed by Swanepoel criteria, severity grading score (SGS), and the severity scoring index (SSI), with mild disease defined as meeting no Swanepoel criteria, graded mild by SSI, and graded low risk by SGS. Findings Between May 27, 2015, and Aug 2, 2015, 65 patients with confirmed Crimean-Congo haemorrhagic fever were recruited and had blood taken at 110 time points. Most were male (40 [62%] of 65) with mild disease (49 [75%] of 65). Haemorrhage occurred in 13 (20%; 95% CI 11•1-31•8) of 65 patients and 23 (35%) of 65 received blood products (15 received fresh frozen plasma and eight received red blood cell concentrates), and 21 patients received platelet transfusions. At admission, the following EXTEM S variables differed significantly between mild cases and moderate to severe cases: median clotting time 56 s (range 42-81; IQR 48-64) versus 69 s (range 48-164; IQR 54-75; p=0•01); mean amplitude at 10 min after clotting time 45•1 mm (SD 7•0) versus 33•9 mm (SD 8•6; p<0•0001); median clot formation time 147 s (range 72-255; IQR 101-171) versus 197 s (range 98-418; IQR 156-296; p=0•006); and maximum clot firmness 54•4 mm (SD 7•2) versus 45•1 mm (SD 12•5; p=0•003). The EXTEM S variables were compared at different time points; maximum clot firmness (p=0•024) and amplitude at 10 min after clotting time (p=0•090) were lowest on days 4-6 of illness. We found no significant differences in FIBTEM variables between mild and moderate to severe cases (median amplitude at 10 min, 13 mm [range 8-20; IQR 11-15] vs 12 mm [range 6-25; IQR 10-15; p=0•68]; and median maximum clot firmness, 15 mm [range 9-60; IQR 13-21] vs 17 mm [range 7-39; IQR 13-23; p=0•21]); and no hyperfibrinolysis (maximum lysis >15%).Interpretation Coagulopathy of Crimean-Congo haemorrhagic fever is related to defects in clot development and stabilis...

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Introduction: Enterococcus hirae (E. hirae) constitutes less than 1% of the enterococci strains in human clinical specimens. In this article, we report the first case of urinary tract infection-related bacteremia due to E. hirae from Turkey. Case Presentation: A 74-year-old male patient with a history of coronary artery disease, hypertension, and chronic renal failure was admitted to the emergency department with abdominal pain, dysuria, and fever. The urine sample collected from the urinary catheter resulted as ampicillin-sensitive E. hirae. On the 4th day of hospitalization, E. hirae growth with the same sensitivity pattern was also reported in blood culture. Intravenous ampicillin 4×2 g/day treatment was initiated. There was no growth in subsequent blood and urine cultures. Fever resolved and general condition improved. The patient was discharged on the thirteenth day with clinical improvement after moxifloxacin treatment for four days and ampicillin treatment for nine days. Discussion: The patient's medical history included risk factors for enterococcal bacteremia. There are a limited number of reports in the literature describing human infections caused by E. hirae. The reason for the rare isolation of E. hirae from clinical specimens may be the difficulty of identifying with standard diagnostic approaches. Conclusions: For diagnostic purposes, as in our case, rapid and high sensitive diagnostic methods such as Matrix-assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) and molecular techniques may be useful to guide the selection of the least toxic and optimal duration of antibiotic treatment.

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Brucellosis is a common zoonotic disease in endemic areas like Turkey. It is an infection that can be manifested by extensive clinical findings, for this reason it can be difficult to diagnose. In humans, treatment of the disease requires long-lasting combined antibiotics and appropriate treatment regimens, but it is often difficult to achieve this success in countries with limited resources. Therefore, this may be an important economic burden in terms of both cost of treatment and potential loss of labor in individuals affected by brucellosis. A 23-year-old male patient who was presented with fever, pancytopenia and hepatitis, was hospitalized with the aim of investigating the etiology of fever. On laboratory findings supporting the Brusella disease, we started treatment with the combination of gentamycin and doxycycline to avoid drug-induced hepatotoxic effect. Laboratory findings were successfully improved while clinical complaints decreased. Brucella disease should be kept in mind in in endemic areas, concerning patients with abnormal laboratory findings of the hematopoietic or hepatobiliary system. Taking into consideration the side effects of the medicines used in the treatment of the disease, effective and least toxic combinations should be selected.

Abstract:Background: Epstein-Barr Virus, frequently referred to as EBV, is a member of the herpesvirus family and one of the most common human viruses. The virus occurs worldwide, and most people become infected with EBV sometime during their lives. Objectives: The purpose of this study was to investigate the serological profi les of specifi c antibodies among the sera of suspected EBV infection patients along with VCA-IgG avidity. Methods: A total of 522 patient's sera were sent to The Clinical Microbiology Laboratory for EBV specifi c antibody detection and were studied by IFA method during a two year period. The serum samples were tested for EBV specifi c VCA IgG, VCA IgM, EA, EBNA antibodies and VCA IgG aviditity. Results: Among 33 patients those who had low avidity for VCA IgG, 27 (81.8 %) of them had a serologic profi le as follows; positive VCA IgG, negative VCA IgM, negative EA and negative EBNA. Conclusion: While this profi le is considered as a primary infection, the frequency of the coexistence of VCA IgG low avidity with this profi le is interepreted that avidity may lead to detect primary infection (Tab. 2, Ref. 25 Abbreviations: IFA -indirect fl uorescent antibody, EBV -Epstein-Barr virus, EA -early antigen,VCA -viral capsid antigen, EBNA -epstein-barr nuclear antigen.Epstein-Barr virus, commonly referred to as EBV, is a human specifi c member of the herpesvirus family and is a B-cell lymphotropic virus. An EBV infection occurs by close contact with EBV presented in oral secretions. The virus initially wells in the oropharyngeal epithelial cells and causes persistent infections. Seroepidemiologic studies indicate that EBV infections are common in all communities and occur worldwide, and most people become infected with EBV sometime during their lives. In Europe including Turkey, as many as 70-80 % of adolescents and 80-90 % of adults are reported to be seropositive for EBV (1).The course of EBV infection can vary with regard to the age and health status of the person. In young children host-virus infection can take place with no apparent symptoms. By contrast, in 30-50 % of the adult patients EBV infection can cause diffuse lymphadenopathy, hepatomegaly, splenomegaly, and tonsillitis. In some cases exanthematous reactions triggered by EBV can be mistaken with an eruption of rubella (2). Moreover, EBV infection is shown to be associated with lymphoproliferative disorders in patients who are suffering from immunodefi ciency, Burkitt lymphoma, and nasopharyngeal carcinoma (3,4). Infectious mononucleosis is also caused by infection of B cells by EBV and is generally diagnosed by serological methods. EBV serology is utilized to help distinguish EBV reactivation infections from primary EBV infections and to demonstrate acute EBV infections. During this process, it is critically important to perform the tests at the same time for the presence of EBV-VCA IgM, EBV-VCAIgG, anti-EBV-EA, anti EBV-EBNA and VCA IgG avidity (2).The spectrum of antibody assays comprises unspecifi c tests, such as the long-known te...