Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Herpes Zoster Infections in Solid-Organ Transplant Recipients(2023) Sari, Nuran; Erol, Cigdem; Yalcin, Tugba Yanik; Azap, Ozlem Kurt; Arslan, Hande; Karakaya, Emre; Altinel, Cemile Tugba; Sezgin, Atilla; Incekas, Caner; Haberal, Mehmet; 0000-0002-4879-7974; 37885293; AAD-5466-2021Objectives: Herpes zoster infections can be complicated and mortal in solid-organ transplant recipients. In our study, we investigated herpes zoster infections in solid-organ transplant recipients.Materials and Methods: Until June 2022, our center has performed 3342 kidney, 708 liver, and 148 heart transplants. Herpes zoster infections were investigated in 1050 adult solid-organ transplant recipients from January 1, 2011, to June 31, 2022. We studied 44 patients diagnosed with herpes zoster infections.Results: Of the 44 patients with herpes zoster, 32 had kidney, 7 had heart, and 5 had liver transplant procedures. Crude incidence rate was 5.2%.,with 9.7% being heart, 5.1% being kidney, and 3.9% being liver transplant recipients; 72.7% were male patients. The median age was 47.5 years, and 61% of patients were aged >45 years. Postherpetic neuralgia was significantly higher in patients older than 45 years (P = .006). The median duration to infection posttransplant was 16.5 months. The dermatomes of patients were 43.2% thoracic. Sacral dermatome involvement was significantly higher in heart transplant patients than in other transplant recipients (P = .015). We reviewed specific findings of the Tzanck test in 36.4% of the patients. There was concomitant infection in 15.9% of the patients, and 6.8% had pneumonia. Acute neuritis was more common in kidney transplant recipients (65.6%). The mean duration of acute neuritis/neuralgia was longest in liver transplant recipients (13.5 months; P = .047). Postherpetic neuralgia was detected as high as 24%.Conclusions: Early specific and supportive treatment is important for transplant recipients with herpes zoster infections. Appropriate antiviral prophylaxis regimens and vaccination strategies for varicella zoster (chickenpox) and herpes zoster infections should be implemented in the vaccination schedule of solid -organ transplant candidates to prevent herpes zoster infections and complications.Item Kikuchi-Fujimoto Disease in a Patient with Mediastinal Lymphadenopathy(2014) Turan, Hale; Serefhanoglu, Kivanc; Apiliogullari, Burhan; Aribas, Olgun Kadir; Ekici, Zuhal; Timurkaynak, Funda; Arslan, Hande; https://orcid.org/0000-0002-5708-7915; https://orcid.org/0000-0003-3225-2686; https://orcid.org/0000-0002-5708-7915; ABG-7034-2021; AAV-4737-2021; AAD-5602-2021; ABG-7034-2021Kikuchi-Fujimoto disease is a benign self-limited syndrome with distinct histopathologic characteristics. Clinical symptoms include cervical lymphadenopathy with tenderness, fever of medium grade, night sweats, nausea, vomiting, and a sore throat. It is a rare disease worldwide. Diagnosis is based on histopathologic findings from an excisional lymph node biopsy. We present the case of a 37-year-old male patient with a fever of 15 days' duration. Clinical examination revealed no other pathologic signs except for oral aphthous lesions and a fever of unknown origin. The patient's fever did not resolve after 15 days' follow-up, and the results of computed tomographic study of the thorax revealed several sites of mediastinal lymphadenopathy. The diagnosis of Kikuchi-Fujimoto disease (histiocytic necrotising lymphadenitis) was based on the results of pathologic examination of the biopsy specimen. The patient's signs and symptoms resolved without antibiotic therapy. This case report of a patient with a fever of unknown origin is presented because of the rare involvement of mediastinal lymphadenopathy without cervical lymphadenopathy. Kikuchi-Fujimoto disease should be considered in the differential diagnosis of the patient who presents with fever and mediastinal lymphadenopathy.Item Infections in Liver Transplant Recipients(2014) Arslan, Hande; https://orcid.org/0000-0002-5708-7915; 24635787; ABG-7034-2021Liver transplant is a life-saving procedure for many end-stage liver diseases. Despite measures such as the use of protective barriers, antimicrobial prophylaxis, and vaccination, infections still represent a major cause of morbidity and mortality after liver transplant. This article reviews major infectious concerns after liver transplant.Item Does Brucellosis Cause Arterial Stiffness and Ventricular Remodelling Through Inflammation?(2015) Togan, Turhan; Ciftci, Ozgur; Gunday, Murat; Narci, Huseyin; Arslan, Hande; 0000-0002-6636-9391; 0000-0002-5708-7915; 0000-0002-6463-6070; 26148379; L-7182-2015; ABG-7034-2021; A-7318-2017Background Like other acute and chronic infections, Brucella infection leads to endothelial dysfunction. Furthermore, it has been suggested that the chronic inflammatory state present in chronic infectious diseases leads to an acceleration in atherosclerosis. For the prediction of CAD, it is possible to use epicardial fat thickness (EFT) as an adjunctive marker beside the classical risk factors, as it is easily and non-invasively evaluated by transthoracic echocardiography. The purpose of this study was to investigate the presence of impaired myocardial performance as well as of increased arterial stiffness and EFT in patients who had been infected with brucellosis in the past. Methods Included in the study were twenty-seven brucellosis patients and twenty-six healthy volunteers. Using EFT and transthoracic echocardiography, which included Doppler echocardiography in combination with tissue Doppler imaging (TDI), all the patients were examined to measure their aortic stiffness index (AoSI), aortic distensibility (AoD), and aortic elastic modulus (AoEM) values. Results A statistically significant increase was observed in hs-CRP, aortic stiffness index, aortic elastic modulus and EFT in brucellosis patients when compared with the controls (2.46 +/- 1.40 vs 1.71 +/- 0.61, P=0.016; 9.69 +/- 6.99 vs 2.14 +/- 0.72, P < 0.001; 11.17 +/- 8.60 vs 2.18 +/- 0.90, P < 0.001; 0.76 +/- 0.08 vs 0.63 +/- 0.10, P < 0.001). On the other hand, there was a significant decrease in aortic strain and aortic distensibility (7.41 +/- 6.82 vs 18.26 +/- 5.83, P < 0.001; 1.83 +/- 1.71 vs 5.22 +/- 1.72, P < 0.001, respectively). No difference was observed between the two groups with respect to the left ventricular myocardial performance index (MPI) (0.62 +/- 0.15 vs 0.61 +/- 0.13, P=0.859). Conclusions In this study, we demonstrated for the first time in the literature that there was impaired aortic elasticity and increased EFT in patients with brucellosis, while the myocardial performance index remained unaffected. We also determined that these effects had a significant correlation with inflammation.Item Colonization of Legionella Species in Turkish Baths in Hotels in Alanya, Turkey(2015) Erdogan, Haluk; Arslan, Hande; 0000-0002-5708-7915; 0000-0002-9033-4236; 25850992; ABG-7034-2021; O-2247-2015This study evaluated the prevalence of Legionella species in water samples collected from Turkish baths in hotels in Alanya, Turkey, from August 2003 to September 2013. Water samples were collected in 100-mL sterile containers and then concentrated by filtration. Heat treatment was used to eliminate other microorganisms from the samples, which were then spread on Legionella-selective-buffered charcoal yeast extract alpha (BCYE-alpha) agar and on BCYE-alpha agar supplemented with glycine, vancomycin, polymyxin, and cycloheximide. Cysteine-dependent colonies were identified by latex agglutination. In total, 135 samples from 52 hotels with Turkish baths were evaluated. Legionella species were identified in 11/52 (21.2 %) hotels and 18/135 (13.3%) samples. The most frequently isolated species was Legionella pneumophila, with most isolates belonging to serogroups 6 (55.6 %) and 1 (22.2 %). The colony count was <100 colony-forming units (CFU) mL(-1) in nine samples, from 100 to 1000 CFU mL(-1) in six samples, and >1000 CFU mL(-1) in three samples. These findings suggest that the hot water systems of Turkish baths in hotels must be viewed as a possible source of travel-associated Legionnaires' disease, and preventative measures should be put in place.Item A Fine Line Between A Major Surgery and Medical Therapy: The Diagnosis of Sternal Tuberculosis(2014) Yesilkaya, Aysegul; Azap, Ozlem Kurt; Kilic, Dalokay; Arslan, Hande; Uner, Halit; https://orcid.org/0000-0003-0225-6416; https://orcid.org/0000-0002-3171-8926; https://orcid.org/0000-0002-5708-7915; https://orcid.org/0000-0002-5388-4183; A-8902-2013; AAK-4089-2021; H-7700-2019; ABG-7034-2021; HOH-1335-2023Tuberculosis involving the sternum is rare. The most common symptoms at the early stage are chest pain and palpable masses on the sternum. Cutaneous fistulas, spontaneous fracture of sternum and extrasternal spread may develop in cases with late diagnosis. In this article, we report a 53-year-old male case admitted with a one-month history of chest pain and two palpable masses on his lower sternal part of chest in whom the diagnosis of sternal tuberculosis was confirmed by histopathologically and rnicrobiologically. The masses were reduced in size with two-month anti-tubercular therapy. The nine-month duration of the therapy produced satisfactory results without any adverse reactions.Item In vitro Susceptibility of Tigecycline against Multidrug-Resistant Gram-Negative Strains: Etest versus Agar Dilution(2014) Ozkok, Sezen; Togan, Turhan; Yesilkaya, Aysegul; Timurkaynak, Funda; Azap, Ozlem Kurt; Arslan, Hande; https://orcid.org/0000-0003-0225-6416; https://orcid.org/0000-0002-3171-8926; https://orcid.org/0000-0002-5708-7915; 25791941; A-8902-2013; AAK-4089-2021; ABG-7034-2021Background and Aim: Tigecycline is a semi-synthetic tetracycline with activity against most multidrug-resistant (MDR) bacteria. Methods: We studied in vitro activity of tigecycline by agar dilution (AD) and Etest methods to evaluate their correlation. The study included 206 isolates of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, Klebsiella pneumoniae and MDR Acinetobacter baumannii recovered from blood cultures of patients of Baskent University between 2008 and 2010. Results: ESBL-producing E. coli had MIC50 /MIC90 values of 0.5/0.5 mu g/ml by AD and 0.25/0.5 mu g/ml by Etest. ESBL-producing K. pneumoniae had MIC50 /MIC90 values of 1/2 mu g/ml by AD and 0.75/2 mu g/ml by Etest, whereas MDR A. baumannii had MIC50 /MIC90 values of 4/4 mu g/ml by AD and 2/4 mu g/ml by Etest. The correlation between AD and Etest was weak for ESBL-producing E. coli and strong for ESBL-producing K. pneumoniae and MDR A. baumannii. Tigecycline MIC values for ESBL-producing E. coli were lower than the tigecycline concentration, while they were higher than the concentrations attainable by treatment doses for A. baumannii. Conclusion: Tigecycline is an appropriate agent in the treatment of E. coli bacteremia, but it is not for treating A. baumannii bacteremia. Tigecycline could be used for K. pneumoniae bacteremia treatment after determining its MIC value. Determining the MIC value by gold-standard methods is more appropriate due to the correlation between Etest and AD at high MIC values. (C) 2015 S. Karger AG, BaselItem Cytomegalovirus Viremia in Solid-Organ Transplant Patients in the First Year After Transplantation(2022) Erol, Cigdem; Akdur, Aydincan; Arslan, Hande; Haberal, Mehmet; https://orcid.org/0000-0002-2535-2534; https://orcid.org/0000-0002-3462-7632; 35384821; AAJ-1219-2021; AAJ-8097-2021Objectives: Cytomegalovirus infection is an important problem for transplantation. Although effective antivirals for prophylaxis or preemptive therapy have reduced the severity and consequences of infection, cytomegalovirus viremia and cytomegalovirusrelated disease are still matters for patients and for graft survival. The aim of our study was to determine the frequency of cytomegalovirus infections during the first year after transplant. Materials and Methods: In this study, we analyzed the data of 252 liver and kidney transplant patients who had procedures between May 2016 and May 2020. Demographic and laboratory data of patients were recorded retrospectively and analyzed with the SPSS version 25 statistical program. Results: Our study included 35 liver (14%) and 217 kidney transplant recipients. The ratio of male to female was 3.8, and the median age was 41 years (range, 18-71 years). In our study group, there were 32 patients (12.7%) with cytomegalovirus DNAemia, 13 patients (5%) with cytomegalovirus syndrome, and 6 patients (2.4%) with cytomegalovirus endorgan diseases. Four patients were diagnosed with gastrointestinal disease with histopathology, and 2 patients were diagnosed with cytomegalovirus pneumonia with bronchoscopy and radiology. The mortality rate was 0.8% in the first year. Conclusions: Cytomegalovirus reactivations in the first year after transplant play a critical role on graft survival in solid- organ transplant. Regular follow-up of cytomegalovirus DNAemia is crucial for modifying prophylactic and preemptive antiviral regimens.Item Rituximab Therapy and Infection Risk in Pediatric Renal Transplant Patients(2016) Gulleroglu, Kaan; Baskin, Esra; Moray, Gokhan; Ozdemir, Handan; Arslan, Hande; Haberal, Mehmet; https://orcid.org/0000-0003-1434-3824; https://orcid.org/0000-0003-4361-8508; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-5708-7915; https://orcid.org/0000-0002-3462-7632; 26742572; AAJ-8833-2021; B-5785-2018; AAE-1041-2021; X-8540-2019; ABG-7034-2021; AAJ-8097-2021Objectives: Rituximab is a monoclonal antibody directed against the CD20 molecule on pre-B and mature B cells and is used in transplant recipients for the prevention and treatment of alloantibody-mediated rejection or for the treatment of disease recurrence after transplant. In most patients, rituximab has been safe and well-tolerated, but the long-term adverse effects of rituximab are currently unknown. Materials and Methods: We retrospectively evaluated 78 pediatric renal transplant recipients for the occurrence of infectious disease. Patients who received rituximab therapy were divided into 2 groups: those who developed an infection and those who did not. The 2 groups were compared for serious infections, hospitalization, graft loss, and death rates. Results: Eighteen transplant patients received rituximab therapy for various causes. The number of rituximab courses given varied according to the cause and ranged from 1 to 8 courses. The dose at each course was 375 mg/m(2). Median age of all recipients was 16.00 years (min-max:, 5.00-22.00 y), and median follow-up time was 2.00 years (min-max:, 1.00-3.00 y). Serious infections (bacterial sepsis, tuberculosis, Cytomegalovirus infection, varicella-zoster virus infection, Polyomavirus-associated nephropathy, and acute pyelonephritis) were observed in 8 patients who received rituximab therapy. We observed that patients with antibody-mediated rejection had significantly increased infection rate. Patients who had used rituximab combined with antithymocyte globulin and higher rituximab course number and higher pretreatment CD19 and CD20 levels had higher risk of infection (P<.05). Conclusions: The combined use of rituximab with additional treatments such as antithymocyte glob ulin, intravenous immunoglobulin, and repeated plasma exchange may be associated with high risk of infectious disease. Especially for those patients who required intensive and repetitive treatment, such as antibody-mediated rejection, rituximab treatment should be used with caution. Infection risk should be closely monitored, although mainly in patients who receive T-cell-depleting agents.Item Early Postoperative Infections After Liver Transplant(2018) Soy, Ebru H. Ayvazoglu; Akdur, Aydincan; Yildirim, Sedat; Arslan, Hande; Haberal, Mehmet; 0000-0002-0993-9917; 0000-0002-8726-3369; 0000-0002-5735-4315; 0000-0002-5708-7915; 0000-0002-3462-7632; 29528013; AAC-5566-2019; AAA-3068-2021; AAF-4610-2019; ABG-7034-2021; AAJ-8097-2021Objectives: Despite surgical advances and effective prophylactic strategies in liver transplant, infection is still a major cause of morbidity and mortality. Up to 80% of liver recipients will develop at least 1 infection during the first year after liver transplant. The spectrum and manifestations of these infections are broad and variable. Their diagnosis and treatment are often delayed because immunosuppressive therapy diminishes inflammatory responses. However, if an infection is not identified early enough and treated properly, it can have devastating consequences. In addition, prophylactic approaches remain controversial. Our aim was to review our early postoperative infection management after liver transplant. Materials and Methods: We retrospectively evaluated infections that occurred during the first hospital stay of transplant patients. Infections were grouped as surgical site and nonsurgical site infections. Consequences and treatment protocols of infections were stratified according to the Clavien scale. Results: Between December 1988 and January 2017, we performed 561 liver transplants at our center (patient age range, 6 months to 64 years), which included 401 living-donor (72%) and 160 deceased-donor (28%) liver transplants. Early postoperative infections were detected in 131 patients (23.3%), comprising 67 surgical site (51%), 56 nonsurgical site (43%), and 8 combined surgical and nonsurgical site infections (6%). Although no mortalities occurred in patients with single nonsurgical or surgical site infections, there were 4 mortalities in patients with combined surgical and nonsurgical site infections. In the 4 other patients with combined infections, 3 patients required endoscopic or radiologic intervention and 1 recovered from single-organ dysfunction. Conclusions: Initiation of appropriate prophylactic and therapeutic protocols at the right time decreases morbidity and mortality due to infection in liver transplant recipients. Increased understanding and effective approaches to prevent infection are essential to improving both graft and recipient survival.