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    Acute Acalculous Cholecystitis: A Rare Presentation of Primary Epstein-Barr Virus Infection in Adults-Case Report and Review of the Literature
    (HINDAWI LTD, 2017) Yesilbag, Zuhal; Karadeniz, Asli; Kaya, Fatih Oner
    Primary Epstein-Barr virus (EBV) infection is almost always a self-limited disease characterized by sore throat, fever, and lymphadenopathy. Hepatic involvement is usually characterized by mild elevations of aminotransferases and resolves spontaneously. Although isolated gallbladder wall thickness has been reported in these patients, acute acalculous cholecystitis is an atypical presentation of primary EBV infection. We presented a young women admitted with a 10-day history of fever, nausea, malaise who had jaundice and right upper quadrant tenderness on the physical examination. Based on diagnostic laboratory tests and abdominal ultrasonographic findings, cholestasis and acute acalculous cholecystitis were diagnosed. Serology performed for EBV revealed the acute EBV infection. Symptoms and clinical course gradually improved with the conservative therapy, and at the 1-month follow-up laboratory findings were normal. We reviewed 16 adult cases with EBV-associated AAC in the literature. Classic symptoms of EBV infection were not predominant and all cases experienced gastrointestinal symptoms. Only one patient underwent surgery and all other patients recovered with conservative therapy. The development of AAC should be kept in mind in patients with cholestatic hepatitis due to EBV infection to avoid unnecessary surgical therapy and overuse of antibiotics.
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    Acute Hepatitis Due to Epstein Barr Virus with Cross-Reacting Antibodies to Cytomegalovirus
    (MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2018) Karadeniz, Asli; Yesilbag, Zuhal; Kaya, Fatih Oner; Akgun, Feride Sinem
    Epstein Ban virus (EBV) is the cause of systemic infection known as infectious mononucleosis with classic presentation of fever, oropharyngitis and lymphadenitis. EBV rarely causes acute hepatitis. in this report, we present a 19-year-old patient presented with nausea, fatigue and jaundice. Her physical examination and laboratory tests revealed the diagnosis as acute hepatitis due to EBV with cross-reacting antibodies to cytomegalovirus.
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    Are physicians aware of current HIV / AIDS diagnostic practices? A study from a tertiary centre in Turkey
    (J INFECTION DEVELOPING COUNTRIES, 2018) Alasehir, Elcin Akduman; Yesilbag, Zuhal; Karadeniz, Asli; Yaman, Gorkem
    Introduction: Early diagnosis of HIV infection is essential for the reduction of morbidity/mortality rates, health expenditures and the prevention of infection spread. In this study we aimed to test the knowledge of physicians regarding HIV risk groups, AIDS indicator diseases and their current practices about screening. Methodology: A questionnaire was used to collect data from physicians working in a multidisciplinary 170-bed tertiary university hospital in Istanbul, Turkey. The questionnaire measured physician knowledge of the above-mentioned points. Results: Ninety-six physicians replied to the questionnaire. "Preoperative screening" was found to be the most common (65.6%) indication for HIV testing. A large portion of physicians (72.9%) felt comfortable with an HIV test and 71.9% of the physicians had no impeding condition for HIV testing. Physicians were mostly (67.7%) unaware of the current guidelines for HIV testing. Conclusions: Teaching programs are essential to increase knowledge of HIV screening for physicians as this is an essential part of early diagnosis and therefore important for decreasing morbidity and mortality.
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    Is There a Relationship Between Rectal Colonization and Nosocomial Infection of Patients in Intensive Care Unit?
    (ANKARA MICROBIOLOGY SOC, 2015) Yesilbag, Zuhal; Cagatay, Arif Atahan; Karadeniz, Asli; Basaran, Seniha; Orhun, Gunseli; Ergin Ozcan, Perihan; Ozsut, Halit; Eraksoy, Haluk
    Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a major problem in intensive care units (ICUs) with high mortality and morbidity rates and the prior colonization is an important risk factor for these infections. The aim of this study was to investigate the prevalence of rectal colonization of MDR microorganisms and the association between the microorganisms that caused colonization and infection in the patients with nosocomial infections in ICUs. Rectal swabs were obtained on the day of 0, 3, 7, 14, 21 and weekly thereafter from 80 patients over 18 years of age hospitalized in ICU for more than 48 hours, and cultured for vancomycin-resistant enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)- producing gram-negative bacilli (GNB) and carbapenem-resistant enteric and nonenteric bacilli. Patients whose rectal swabs were not obtained on admission (on the day of 0), were excluded even they were hospitalized more than 48 hours. Bile esculin agar containing 64 mu g/mL ceftazidime and 6 mu g/mL vancomycin, chromogenic MRSA agar and blood agar media, MacConkey agar containing 1 mg/L cefitazidime and ceftriaxone, and 5 mL tryptic soy broth media containing 10 mu g imipenem and meropenem discs were used for identification. Identification of GNB was determined by conventional methods and ESBL production was determined by double-disc synergy test. Patients have been followed up for nosocomial infections. Bacterial identification and antibiotic susceptibility tests were performed with standard microbiological methods. In 37 (46%) of the 80 patients, at least one MDR microorganism was isolated in rectal swab cultures on the day of 0. The most common microorganisms were ESBL-positive E.coli (19%), followed by ESBL-positive K.pneumoniae (13%), carbapenem-resistant P.aeruginosa (10%), ESBL-positive K.oxytoca (3%), MRSA (1%), VRE (1%), carbapenem-resistant Acinetobacter sp. (1%) and carbapenem-resistant K.pneumoniae (1%), respectively. The number of microorganisms isolated from rectal swab cultures on the following days have increased, and on the 7th day, the rate of the patients with rectal colonization ascended to 72%. Out of 80 patients, 52 (65%) had nosocomial infections in the follow-up and the mean duration of infection development was 11.8 +/- 9.9 days in these patients. Patients with and without rectal colonization were compared in terms of subsequent nosocomial infection rates. While no statistically significant difference has been detected between two groups on the day of 0, patients with rectal colonization detected on the day of 3 and 7, had a significantly higher incidence of nosocomial infections (p= 0.02, p= 0.01). Among the patients with ESBL-positive GNB, carbapenem-resistant K.pneumoniae, carbapenem-resistant P.aeruginosa and VRE infections, the same microorganisms have been isolated in the rectal swab cultures taken before the development of infection. This result was statistically significant for each of these microorganisms (p= 0.00 - 0.03). However, such a correlation was not observed for Acinetobacter infections. Since MRSA infections developed in only two patients, no istatistical analysis has been done for this microorganism. In conclusion, our data suggest that MDR microorganisms that cause nosocomial infections, initially colonize the gastrointestinal tract, and early detection of colonized patients in ICUs may help an effective infection control by preventing the spread. of these resistant microorganisms.
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    The seroprevalence of hepatitis A in Istanbul, Turkey
    (MARMARA UNIV, FAC MEDICINE, 2017) Karadeniz, Asli; Akduman Alasehir, Elcin; Yesilbag, Zuhal; Balikci, Ahmet; Yaman, Gorkem
    Objective: Hepatitis A, a leading cause of enterically transmitted acute viral hepatitis throughout the world, has changed its pattern in developing countries. The objective of this study is to determine the current seroprevalence of hepatitis A virus (HAV) for different age groups in Istanbul, Turkey. Materials and Methods: Serum samples of 3,868 patients, which had been previously taken, were used to determine anti-HAV IgG levels by the microparticle enzyme immunoassay (MPEIA) method (Architect SR i1000 and i2000, Abbott Diagnostics, Germany) between January 2011 and December 2013. Results: The prevalence of total anti-HAV antibodies was 64.8% for all patients. Among the 3,868 serum samples tested, 54% were from male patients and 46 % were from female patients. Seropositivity rates among the age groups were determined and anti-HAV antibody positivity rates were 55% for the 0-16 age group; 47% for the 17-30 age group; 73.5% for the 31-45 age group and the seroprevalence increased significantly from 50% (972/1944) in 0 to 30 years old to 89% in patients older than 46 years. Conclusion: The low seronegativity rates in young adults, show this group to be at high risk of acquiring an HAV infection. The results support the routine vaccination of children and the seronegative young adults against HAV.