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    Diagnosis of tularemia in a university hospital in Türkiye - 11-year evaluation
    (2023) Gezer, Yakup; Toplu, Sibel; Celık, Dondu; Ersoy, Yasemin; Bayindir, Yasar; Özden, Mehmet; Memişoğlu, Funda
    Aim: Francisella tularensis is a Gram-negative coccobacillus and is the causative agent of tularemia, which is endemic in our country. The most common clinical form in Turkey is the oropharyngeal form. Sensitive lymphadenopathy is the most important finding, and fever, fatigue, and muscle and joint pain may occur in all clinical forms. Rodents such as rabbits, mice, and squirrels are the main reservoirs for humans, and the transmission is through contact with infected animal secretions and organs, contaminated water, and food. This study aimed to examine the socio-demographic, epidemiological, and clinical features of cases diagnosed with tularemia. Materials and Methods: Among the 583 patients whose serum samples were sent with a preliminary diagnosis of tularemia between 2011 and 2021, tularemia microagglutination test result (MAT) ?1/160 titer, 18 years and older cases were included in the study. Results: A total of 24 tularemia cases were detected, with a mean age of 43.3±17 years, 10 (41.7%) were male, and 14 (58.3%) were female. The most common symptoms and findings among the cases were lymphadenopathy (LAP) (95.8%), fatigue (66.7%), sore throat, and high fever (58.3%), and the most common epidemiological history was living in a rural area (91.7%) and dealing with animal husbandry (66.7%), and 18 (75%) cases were referred to as oropharyngeal tularemia. More than half of the cases were detected between October and March. Conclusion: Tularemia is one of the endemic diseases in our country, and the epidemio- logical history should be taken carefully and kept in mind in the differential diagnosis of lymphadenopathy. Since it is the first tularemia study conducted in Malatya, it shows the epidemiological characteristics of the region.
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    Evaluation of CD4/CD8 ratio in treatment follow-up of patients with HIV diagnois in an infection clinic
    (2022) Gezer, Yakup; Toplu, Sibel; Yüksel, Mustafa; Köse, Adem; Memişoğlu, Funda; Ozden, Mehmet; Bayindir, Yasar
    Abstract Aim: Antiretroviral therapy (ART) regimens used in the treatment of HIV are assumed to suppress the virus in plasma indefinitely and restore CD4 lymphocyte count. There is increasing evidence that a reversed CD4/CD8 ratio is associated with immune dysfunction, even in patients who have achieved virological suppression with ART and have elevated CD4 lymphocytes. The CD4/CD8 ratio has emerged as a guiding marker as an indicator of immunoactivation in HIV-infected patients. It was aimed to evaluate the CD4/CD8 ratio of HIV-diagnosed patients at baseline and at follow-up after ART regimen. Materials and Methods: A total of 150 patients were included in the study by retrospectively scanning the CD4/CD8 ratio at the initial and 24th week of follow-up in patients who were diagnosed with HIV and started treatment in the Infectious Diseases and Clinical Microbiology Clinic of the Hospital of the Medical Faculty between 2011-2021. ART treatment regimens were divided into three groups as nucleoside reverse transcriptase inhibitor (NRTI)+protease inhibitor (PI), NRTI+non-nucleoside reverse transcriptase inhibitor (NNRTI) or NRTI+ integrase strand transfer inhibitor (INSTI). Results: A total of 150 patients were included in the study. While the initial CD4/CD8 ratio of the patients was 0.36, it increased to 0.61 at the 24th week of treatment. Among the 144 patients whose baseline values were CD4/CD8<1, the rate of the ones who achieved CD4/CD8?1 value at week 24 after ART regimens was found as 13.2% (19/144). It was observed that the CD4/CD8 ratio in the group receiving INSTI was higher (15.1%) than those of the other groups. The undetectable HIV RNA level after treatment was significantly mostly observed in the group, receiving the integrase-based regimen, with 77.1%. With effective ART, CD4/CD8 normalization is higher in individuals with high CD4 T cell counts before treatment. There was a significant increase in the CD4/CD8 ratio in all three ART regimen groups. However, most of the patients who achieved a CD4/CD8 ratio ?1 were in the INSTI-based ART group. Conclusion: The CD4/CD8 ratio may contribute to clinical evaluation in long-term follow-up as a marker of immunological response in individuals treated with a diagnosis of HIV.
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    Evaluation of the patient with lymphadenopathy: Is it always easy to reach the correct diagnosis?
    (2021) Köse, Adem; Doğan, Ahmet; Bayindir, Yasar; Ersoy, Yasemin; Özden, Mehmet; Memişoğlu, Funda; Toplu, Sibel
    Lymphadenopathy (LAP) is a common clinical problem in adult patients and should be thoroughly evaluated in a tertiary hospital to investigate its reasons. In this study,we aimed to present the demographic characteristics, etiology, diagnosis and follow-up results of the patients who applied with LAP symptoms and findings. This studywas designed to include adult patients with neck, armpit, or groin swelling accompanied by symptoms, such as fever, night sweats, weight loss, cough and sputum betweenJanuary 2010 and August 2017, retrospectively. Patients’ data were collected from electronic files. Patients were diagnosed using radiological, histopathological,bacteriological, serological and other microbiological methods. Two hundred-thirty patients were included in this study. The mean age was 43.12±17.06 SD in males and45.74±16.64 in females. On admission, the most common symptoms were night sweats (31%), fever (23%), weight loss (17%) and cough and/or sputum (13%) in orderof frequency. However, 16% of the patients were asymptomatic. In this study, 157 (68.26%) patients were diagnosed. Tuberculosis (n=76; 33%), malignancies (n=28,12.1%) and tularemia (N=14; 6.1%) were the most common diseases causing LAP that was most commonly located in the bilateral cervical chain. Lymphadenopathyshould be evaluated comprehensively concerning diagnosing or ruling out many diseases that must be treated necessarily. Knowledge and awareness of the diseases as acause of LAP may contribute to the early and correct diagnosis. Therefore, undiagnosed patients should be followed, and the institutions should develop policies for thispurpose, such as telemedicine applications.