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Öğe A Case of Rickettsiosis in a non-Endemic Region(Bilimsel Tip Yayinevi, 2025) Salduz, Ekrem; Erdemci, Leyla; Altunisik Toplu, SibelMediterranean spotted fever (MSF) is an acute, febrile rickettsiosis caused by Rickettsia conorii, which is endemic in Africa, Mediterranean countries, and Turkiye, with most reported cases originating from the Marmara region. This case presents a patient from a non-endemic region who was hospitalized with a preliminary diagnosis of Crimean-Congo Hemorrhagic Fever (CCHF) after experiencing a tick bite, followed by fever, rash, and headache, and was subsequently diagnosed with MSF. The patient initially presented to the emergency department with a tick attached to the distal posterolateral area of the left thigh. The tick was removed, and the patient was discharged. Approximately ten days later, they returned with joint pain, headache, weakness, and fever. Initially suspected of CCHF, the examination revealed widespread maculopapular rashes and petechiae, along with a hyperemic lesion at the tick attachment site. Laboratory tests ruled out CCHF, with negative PCR and IgM results. Due to persistent symptoms, R. conorii IgM and IgG tests were ordered, and empirical treatment with doxycycline (2 x 100 mg/day PO) was initiated. A fever response was observed by the second day of Rickettsia treatment, with indirect immunofluorescence antibody tests confirming R. conorii IgM (1/384) and IgG (1/1280) positivity. After completing a full ten-day course of doxycycline, the patient was discharged. This case underscores the importance of considering rickettsiosis in the differential diagnosis of fever and rash following tick exposure, even in non-endemic regions, and aims to raise awareness through its publication in the literature.Öğe Antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae isolated from patients with urinary tract infections in a tertiary care hospital(2021) Dogan, Ahmet; Kose, Adem; Gezer, Yakup; Bayindir, Yasar; Ersoy, Yasemin; Ozden, Mehmet; Memisoglu, Funda; Altunisik Toplu, SibelAim: To determine etiological microorganisms from urine samples in patients diagnosed with UTI and to detect the antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae in a Tertiary Care Hospital. Materials and Methods: A cross-sectional study was conducted using urine culture samples and sensitivity reports collected retrospectively from our laboratory records over a period from Jan 2013 to Dec 2017. Results: A total of 729 urine culture isolates from 660 patients were included. Two-hundred eighty-four (41.8%) of the patients were male and 384 (58.2%) were female. The most common microorganisms were 46.4% E. coli, 18.2% K. pneumoniae and 12.1% Enterococcus spp., respectively. A total of 284 urine culture isolates produced extended spectrum beta-lactamases (ESBL), of which 186 (65.5%) were E. coli and 98 (34.5%) were K. pneumoniae. The most susceptible antimicrobials are meropenem, imipenem, amikacin, and fosfomycin, respectively. We determined that the antimicrobial drugs with the lowest susceptibility rates for both E. coli and K. pneumoniae were amoxicillin-clavulanate (24.5%), trimethoprim-sulfamethoxazole (30.7%) and ceftriaxone (43.2%). Additionally, their susceptibilities have gradually decreased. Ertapenem susceptibility has decreased more in K. pneumoniae isolates than E. coli. Conclusion: Antimicrobial resistance and ESBL-producing for both E. coli and K. pneumoniae have been increasing over the years. Our findings may contribute to choosing the proper antibiotic for the empirical treatment of UTI and preventing treatment failure.Öğe Antimicrobial susceptibility pattern of Escherichia coli andKlebsiella pneumoniae isolated from patients with urinarytract infections in a tertiary care hospital(2021) Doğan, Ahmet; Köse, Adem; Gezer, Yakup; Ersoy, Yasemin; Bayindir, Yasar; Özden, Mehmet; Memisoglu, Funda; Altunisik Toplu, SibelAim: To determine etiological microorganisms from urine samples in patients diagnosed with UTI and to detect the antimicrobial susceptibility pattern of Escherichia coli and Klebsiella pneumoniae in a Tertiary Care Hospital.Materials and Methods: A cross-sectional study was conducted using urine culture samples and sensitivity reports collected retrospectively from our laboratory records over a period from Jan 2013 to Dec 2017.Results: A total of 729 urine culture isolates from 660 patients were included. Two-hundred eighty-four (41.8%) of the patients were male and 384 (58.2%) were female. The most common microorganisms were 46.4% E. coli, 18.2% K. pneumoniae and 12.1% Enterococcus spp., respectively. A total of 284 urine culture isolates produced extended spectrum beta-lactamases (ESBL), of which 186 (65.5%) were E. coli and 98 (34.5%) were K. pneumoniae. The most susceptible antimicrobials are meropenem, imipenem, amikacin, and fosfomycin, respectively. We determined that the antimicrobial drugs with the lowest susceptibility rates for both E. coli and K. pneumoniae were amoxicillin-clavulanate (24.5%), trimethoprim-sulfamethoxazole (30.7%) and ceftriaxone (43.2%). Additionally, their susceptibilities have gradually decreased. Ertapenem susceptibility has decreased more in K. pneumoniae isolates than E. coli.Conclusion: Antimicrobial resistance and ESBL-producing for both E. coli and K. pneumoniae have been increasing over the years. Our findings may contribute to choosing the proper antibiotic for the empirical treatment of UTI and preventing treatment failure.Öğe A Case of Infective Endocarditis Due to Abiotrophia defectiva, and Treatment with Ertapenem(Galenos Publ House, 2021) Duman, Yucel; Altunisik Toplu, Sibel; Tanriverdi, Elif Seren; Bayindir, YasarThe most frequently reported infections due to Abiotrophia defectiva worldwide are bacteraemia and endocarditis. It is estimated that A. defectiva causes approximately 5-6% of microbiologically proven endocarditis and plays a role in the etiology of culture negative endocarditis. In this article we reported a patient with infective endocarditis (IE) due to penicillin resistant A defectiva, which caused vegetation in the mitral valve, embolism in the spleen and successfully treated with ertapenem. A 70-year-old female patient was admitted to the emergency service with fever and abdominal pain. The patient had a pronounced widespread abdominal tenderness in the left quadrant. The body temperature was 38.9 degrees C, C-reactive protein (CRP) level was 12.7 mg/dl and white blood cell count was 13.3x10(3) mm(3). The patient was hospitalized to investigate fever's reason. It was learned in the anamnesis that she used warfarin. Considering the pre-diagnosis of urinary tract infection, empirical treatment with ceftriaxone 2x1 g/day was started. However, due to the increase in International Normalized Ratio value on the second day of ceftriaxone treatment, ertapenem 1x1 g/day was started by considering drug interaction between warfarin and ceftriaxone. Transesophageal echocardiography of the patient revealed a 1.2x1.2 cm vegetation on the posterior leaflet surface of the mitral valve, and ischemia due to embolism in the spleen was detected on abdominal computer tomography. Penicillin resistant A defectiva grew in the blood culture. The patient was diagnosed as having IE on the seventh day of her admission. Ertapenem treatment was completed in six weeks due to the patient's absence of fever, decreased CRP level, and the absence of A. defectiva in the seventh day control blood culture. After treatment, vegetation was not observed in the transthoracic echocardiography of the patient and no signs of ischemia was detected in the spleen. Detection of A. defectiva shaped the follow-up process of our patient by bringing the diagnosis of IE to mind. In treatment of A defectiva-related IE, guidelines suggest long-term combination of aminoglycosides with beta-lactams or vancomycin. However, in our patient, treatment was provided by using ertapenem alone for six weeks. In addition, we believed that early diagnosis and treatment in our patient prevented serious complications.Öğe Commentary on Potential risk factors for Varicella-zoster virus reactivation after COVID-19 vaccination(Wiley, 2022) Turkmen, Dursun; Altunisik, Nihal; Altunisik Toplu, Sibel[Abstract Not Available]Öğe Evaluation of clinical characteristics and outcomes of postoperative infections in living liver donors(Wiley, 2021) Kose, Adem; Altunisik Toplu, Sibel; Akbulut, Sami; Yasar, Seyma; Sarici, Kemal Baris; Duman, Yucel; Kutlu, RamazanAim To analyze developing infections after living donor hepatectomy (LDH) in living liver donors (LLDs). Methods Demographic and clinical characteristics of 1106 LLDs were retrospectively analyzed in terms of whether postoperative infection development. Therefore, LLDs were divided into two groups: with (n = 190) and without (n = 916) antimicrobial agent use. Results The median age was 29.5 (min-max: 18-55). A total of 257 (23.2%) infection attacks (min-max: 1-8) was developed in 190 (17.2%) LLDs. The patients with the infection that were longer intensive care unit (ICU) and hospital stays, higher hospital admissions, emergency transplantation, invasive procedures for ERCP, PTC biloma, and abscess drainage, and the presence of relaparatomies and transcystic catheters. Infection attacks are derived from a 58.3% hepatobiliary system, 13.2% urinary system, 6.6% surgical site, and 5.8% respiratory system. The most common onset symptoms were fever, abdominal pain, nausea, and vomiting. A total of 125 positive results was detected from 77 patients with culture positivity. The most detected microorganisms from the cultures taken are Extended-Spectrum beta-lactamases (ESBL) producing Klebsiella pneumonia (16.8%) and Escherichia coli (16%), Methicillin-Resistant Staphylococcus aureus [(MRSA) (9.6%)], Methicillin-susceptible S aureus [(MSSA) (9.6%)], and Pseudomonas aeruginosa (8.8%), respectively. The average number of ICU hospitalization days was 3 +/- 2 (min 1-max 30, IQR:1) and hospitalization days was 14 +/- 12 (min 3-max 138, IQR: 8). All infection attacks were successfully treated. No patients died because of infection or another surgical complication. Conclusion Infections commonly observed infected biloma, cholangitis, and abscess arising from the biliary system and other nosocomial infections are the feared complications in LLDs. These infections should be managed multidisciplinary without delay and carefully.Öğe Follow-up and treatment of primary HIV infection in Pregnancy(2022) Sağlam Kandemir, Esra; Altunisik Toplu, Sibel; Ersoy, YaseminThe pregnant population infected with "human immunodeficiency virus" (HIV), an important member of the retrovirus family, are encountered with increasing frequency in our clinical experience today. Early and effective suppression of HIV viremia will reduce the risk of mother-to-child transmission of HIV. In the light of the case we aimed to review the antiretroviral treatment (ART) options that can be used in HIV-positive pregnant women and to share an our clinical experience.Öğe The importance of procalcitonin in early diagnosis of sepsis(2017) Yetkin, Funda; Altunisik Toplu, SibelAbstract: Despite the advances and a wide range of studies conducted, sepsis is one of the most frequent causes of death in patients with critical health condition. Early diagnosis, rapid and effective treatment are extremely important. Use of procalcitonin (PCT) for this purpose has become widespread and notable recently. Procalcitonin is an important test as “point-of-care testing (POCT)” just like C-reactive protein (CRP). Procalcitonin is the prohormone of calcitonin. It is released from the parenchymal cells of the liver, kidneys and muscles, and in response to bacterial toxins, it is released from the adipocytes. As a response to bacterial infection, the serum procalcitonin level may increase by 5000-fold within 2-4 hours. C- reactive protein is synthesized in the liver as a result of interleukin-6 (IL-6) trigger due to tissue injury, inflammation and/or infections. The aim of our study was to emphasize the importance of PCT as an indicator in patients suspicious of sepsis in the early period. A total of 66 patients with critical situation were included in the study conducted at the İnönü University Medical Faculty Turgut Özal Medical Center Investigation Hospital between February 2007 and August 2008. These patients were appropriate for the diagnostic criteria of systemic inflammatory response syndrome (SIRS). Appropriate antibiotiotherapy was begun for the patients. The PCT and CRP levels were investigated on the first day after having been included in the study, and on the third and seventh days. The mean C-reactive protein levels were 132.41, 108.39 and 83.47 mg/l on the 1, 3rd and 7th days, respectively. The minimum level of procalcitonin was 0.095 ng/ml on the first day, and the maximum level was 316.054 ng/ml. The minimum/maximum levels were 0.091 and 306.043 ng/ml on the 3rd day, and 0.081 and 12.15136 ng/ml on the 7th days, respectively. No statistically significant difference was observed betweern the serum procalcitonin levels on the 1st and the 3rd days ( p<0.229), whereas a significant difference was observed between its levels between the 1st and the 7th days (p<0.002). Likewise, the difference between the 3rd and the 7th days was statistically significant (p<0.005). C-reactive protein levels revelaed a significant difference between the 1st and the 7th days (p<0.013) and between the 3rd and the 7th days (p<0.010). The Wilcoxon Signed test was used to investigate statistical significance. The diagnostic value of procalcitonin has been widely used in septic patients. Although conflicting results have been obtained in different studies, despite the fact that some studies have not found PCT supportive for the diagnosis of sepsis, we believe that PCT is an appropriate and important indicator in the early diagnosis and follow-up of sepsis as CRPÖğe Kaposi's sarcoma in individuals living with HIV: comparative assessment of AI-based clinical responses using a standardized questionnaire set(Taylor & Francis Ltd, 2026) Altunisik Toplu, Sibel; Altunisik, Nihal; Turkmen, DursunObjectiveTo comparatively evaluate the clinical responses of three digital platforms (ChatGPT 5.2, DeepSeek, Consensus) in terms of responsiveness, accuracy, and clinical applicability, using a standardized set of questions on HIV-related Kaposi's sarcoma. Kaposi's sarcoma is a cutaneous malignancy; therefore, the relationship of this study to toxicology is indirect and methodological, focusing on information synthesis rather than toxicological evaluation.MethodsTen clinical questions titled 'Kaposi's Sarcoma in HIV-Infected Patients - Standard Questionnaire' were administered to each platform in separate sessions, and responses were recorded. Answers were independently evaluated by three field experts (one Infectious Diseases and Clinical Microbiology specialist and two Dermatology specialists) using a four-point accuracy scale. Quantitative analyses focused on response availability and accuracy distribution across platforms. Qualitative characteristics, including citation practices, visual support, and presentation of clinical decision algorithms, were assessed descriptively.FindingsChat GPT and Consensus answered all questions (10/10), whereas DeepSeek failed to generate a response to the KS-IRIS question due to a technical error (9/10). Comparison of accuracy category distributions across platforms revealed no statistically significant difference (Pearson chi-square test, p = 0.663). The median accuracy score was 1 (excellent) for all three platforms, with an interquartile range of 1-2. Qualitative analysis demonstrated that consistent citation of sources was observed only in Consensus, visual support was exclusive to ChatGPT, and structured clinical decision-making algorithms were most prominent in ChatGPT outputs.ConclusionAlthough quantitative accuracy was comparable across platforms when assessed using a standardized Kaposi's sarcoma question set, notable differences were identified in qualitative features, including evidence presentation, visual support, and clinical decision structure. Artificial intelligence and literature-based digital platforms may support clinicians in complex conditions such as HIV related Kaposi's sarcoma. However, their outputs should be interpreted alongside current clinical guidelines and expert judgment.Öğe Reconsidering clindamycin-rifampicin use in hidradenitis suppurativa: balancing anti-inflammatory benefits and resistance risk(Oxford Univ Press, 2025) Altunisik Toplu, Sibel; Altunisik, Nihal[No abstract available]Öğe Retrospective Review of Patients with Staphylococcus aureus Bacteremia(Bilimsel Tip Yayinevi, 2024) Yilmaz, Zeynep Burcin; Duman, Yuecel; Altunisik Toplu, Sibel; Memisoglu, Funda; Kose, Adem; Ozden, Mehmet; Bayindir, YasarIntroduction: Staphylococcus aureus causes community-acquired and healthcare-associated infections with high morbidity and mortality. It is critical to initiate appropriate and effective treatment considering the risk factors for S. aureus bacteremia. There is insufficient data available regarding this patient group in our region. This study aimed to assess the focus of infection, resistance status, and clinical course in patients with S. aureus bacteremia detected in blood culture. Materials and Methods: Patients with healthcare-associated or community-acquired S. aureus bacteremia who were hospitalized in a tertiary hospital during the one year between January 2020 and December 2020, and microbiological data were retrospectively analyzed. The distribution of Staphylococcus aureus bacteremia was evaluated based on the organ involved, the clinics where it was observed, and its resistance status. Results: OStaphylococcus aureus isolate growth was detected in the blood cultures of 66 adult patients within one year. The mean age of the patients was 56.5 +/- 16.8 (18-84) years, and 76% were male. While bacteremia was community-acquired in 12 (18.2%) of the patients, it was healthcare-related in 54 (81.8%) and methicillin resistance rates were 8.3% and 25.9%, respectively. The most common focus of infection was catheter-related bloodstream infection in 21.2% and pneumonia in 21.2% of patients. No focus was detected in 34.8% of the bacteremias. In terms of methicillin-resistant S. aureus (MRSA) distribution, the difference between intensive care and wards was 20% and 80%, respectively. No statistically significant difference was found (p> 0.05). While the 14-day mortality in MRSA bacteremia was 33.6%, the 14-day mortality in methicillin-susceptible S. aureus was 27.5% (p= 0.731). Conclusion: It was found that Staphylococcus aureus bacteremia was predominantly nosocomial, with pneumonia and catheter infections being the most common causes. The conclusion drawn suggests a need for heightened infection control measures, particularly focusing on improving hand hygiene practices. To guide empirical treatment effectively, it is crucial to monitor resistance changes that may have occurred over the years, consider risk factors for MRSA, and elucidate the resistance profiles specific to individual healthcare facilities.Öğe Tuberculosis screening before biologic therapy: considering epidemiology(Oxford Univ Press, 2026) Altunisik Toplu, Sibel; Turkmen, Dursun; Altunisik, NihalWe read with interest the retrospective evaluation by Tan et al., entitled 'Are chest X-rays still necessary for prebiologic tuberculosis screening? A retrospective audit' recently published in Clinical and Experimental Dermatology. The authors report that including interferon-gamma release assay-based screening may be sufficient in a dermatology cohort and that the additional diagnostic contribution of routine chest X-ray remains limited. However, as the study was conducted in a population with a low incidence of tuberculosis, the generalizability of the findings to different epidemiological contexts warrants careful consideration.
