The study shows that the implementation of the new policy resulted in a significant reduction in the prescription of antimicrobials.

Brucellosis is a systemic infectious disease with a broad spectrum of clinical manifestations. Arthritis is frequently observed in its course and may be one of the main presenting clinical features of the disease. We report a case of brucellar monoarthritis of the knee with a prolonged clinical course despite efficient antibiotic treatment.

IntroductionThe chikungunya virus (CHIKV) is a single-stranded, positive sense RNA virus that is a member of the genus Alphavirus of the family Togaviridae. The CHIKV is transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes (1). CHIKV infection led to more than 6 million confirmed cases worldwide (2). CHIKV has a wide geographic distribution including North and South America, Europe, Asia, the Pacific Islands, and Africa since the virus was first described in Tanzania in 1952 (3,4). A female patient who came from India to Turkey with symptoms of fever, arthralgia, and rashes was the first case of laboratory-confirmed CHIKV infection in Turkey (5). Clinical symptoms of CHIKV infection include high fever, fatigue, backache, headache, and polyarthralgia. Polyarthralgia is the most characteristic and common symptom of infection and also the origin of the name of the disease "chikungunya, " a local term in the Makonde language that means "disease that bends up the joints". In addition to these clinical manifestations, tenosynovitis, swollen joints, macular or maculopapular skin rashes, myalgia, nausea, vomiting, and diarrhea can be observed in CHIKV-infected patients (3,6). Differential diagnosis of CHIKV infection from dengue virus infection could be based on clinical manifestations and laboratory features. Fever (over 39 °C), arthritis, arthralgia, rash, and lymphopenia are more significant in a CHIKV infection. While hemoconcentration does not occur in CHIKV infection, it is present in 70%-100% of dengue virus-infected patients (2). Diagnosis of CHIKV infection is based on molecular detection of a viral genome and/or serological detection of virus-specific antibodies. RT-PCR and real-time RT-PCR (7-9) can be used for molecular detection while serological diagnostic tests include ELISA, immunofluorescence assay, and rapid immunochromatographic test (10-13). The aim of this study was to screen for possible exposure to CHIKV infections in humans using ELISA and IIFT in the city of Kırıkkale, which is located in the central Anatolia region of Turkey. Materials and methods SamplesBlood samples were taken from 500 healthy, randomly selected volunteer blood donors who live in Kırıkkale (39°50ʹN; 33°31ʹE; altitude 700 m) through July-November Background/aim: The chikungunya virus (CHIKV) is a mosquito-borne disease and has recently been causing explosive outbreaks. The CHIKV has spread throughout all continents. Although the first chikungunya case imported from India to Turkey was reported in 2012, there is no detailed epidemiologic study in Turkey yet. The aim of this study was to investigate the seroprevalence of the CHIKV in Turkey.Materials and methods: ELISA was used to screen 500 random serum samples of healthy people collected from Kırıkkale, which is located in central Anatolia in Turkey. The results were verified by indirect immunofluorescence test (IIFT). Results:The results showed that 0.4% samples were positive for CHIKV. In the verification study with IIFT, CHIKV IgG type antibodies were defi...

Infection is a serious complication of breast augmentation and tissue expansion with inflatable devices. Several reports have shown that fungi may be able to survive, colonize, and even cause infection in saline-filled devices. The mechanism of how they penetrate, spread, and colonize inside the inflatable implants is not exactly understood. The authors assessed both the expander membrane and the port in terms of leakage and penetration of Candida albicans and Aspergillus niger in an in vitro model. Thirty saline-filled expanders connected to the injection port were placed in sterile containers filled with tryptic soy broth culture medium to simulate the clinical situation in phases I and II. Intact and multipunctured ports were used in the first and second phases of the study, respectively. Either the container or the implant was inoculated with one of these fungi, and six implants in containers without fungal inoculation served as controls. As a third phase, intraluminal survival of fungi was investigated in saline-filled containers (n = 12) in 21 days. The silicone membrane, with its intact connecting tube and port, was impermeable to these fungi, whereas both fungi were able to diffuse inside-out or outside-in through the punctured ports. C. albicans did not survive beyond 18 days in saline, whereas A. niger continued to multiply at day 21. Chemical analyses of the implant fluids revealed that the contents of the culture medium diffused into the implants in phases I and II. The data show that an intact silicone membrane is impermeable to fungi, and punctured ports allow translocation of fungi into the implants. Fungi can grow and reproduce in a saline-only environment, and their survival periods differ among the species. Furthermore, their survival may be enhanced by the influx of substances through the implant shell.

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In March 2023, 34 associated cases of iatrogenic botulism were detected in Germany (30 cases), Switzerland (two cases), Austria (one case), and France (one case). An alert was rapidly disseminated via European Union networks and communication platforms (Food- and Waterborne Diseases and Zoonoses Network, EpiPulse, Early Warning and Response System) and the International Health Regulation mechanism; the outbreak was investigated in a European collaboration. We traced sources of the botulism outbreak to treatment of weight loss in Türkiye, involving intragastric injections of botulinum neurotoxin. Cases were traced using a list of patients who had received this treatment. Laboratory investigations of the first 12 German cases confirmed nine cases. The application of innovative and highly sensitive endopeptidase assays was necessary to detect minute traces of botulinum neurotoxin in patient sera. The botulism notification requirement for physicians was essential to detect this outbreak in Germany. The surveillance case definition of botulism should be revisited and inclusion of cases of iatrogenic botulism should be considered as these cases might lack standard laboratory confirmation yet warrant public health action. Any potential risks associated with the use of botulinum neurotoxins in medical procedures need to be carefully balanced with the expected benefits of the procedure.

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Objectives: Methicillin resistant Staphylococcus strains still remain as an important reason of hospital acquired infections. The aim of this study to see the antimicrobial sensitivity patterns of these strains for effective empirical therapy Material and methods: Antibiotic susceptibility results of staphylococcus strains were investigated retrospectively from tertiary reference hospital. 276 methicillin resistant staphylococcus species, which were isolated from Kırıkkale University Faculty of Medicine Department of Infectious Disease and Clinical Microbiology laboratory between November 2009-2010 were enrolled in this study. Identification and antibiotic susceptibilities of the strains were evaluated by using Vitek automated systems (bioMerieux).Results: Most of these strains were isolated from blood (49%) and wound (40 %) samples. There was no glycopeptide resistance established from 276 strains. Susceptibility percents of these strains to linezolid and erythromycin were 97% and 16% respectively.Conclusions: we believe that, informing physicians about antibiotic susceptibility patterns of methicillin resistant staphylococcus species will be helpful for effective treatment and control the spread of these infections. GİRİŞStaphylococcus çok sayıda tür içeren, deri ve mukozalarda kolonize olabilen, değişik türleri ile farklı hastalıklar yapan önemli bir cinsdir. Bu cins içinde Staphylococcus aureus çok sayıdaki virulans faktö-rü ile çeşitli doku ve organlarda ciddi infeksiyonlar oluşturabilen en önemli türdür. S.aureus dışında kalan koagülaz negatif stafilokok (KNS) türleri ise, geçmişte sadece flora elemanı olarak kabul edilirken, günümüzde özellikle hastane kaynaklı infeksiyon etkenleri arasında yer almakta ve önemleri giderek artmaktadır.