Although brucellosis is very common in the world and Türkiye, there are no evidence-based guidelines to guide the diagnosis and treatment of the disease. This guide has been prepared by the Turkish Society of Clinical Microbiology and Infectious Diseases to provide evidence-based recommendations to physicians from different specialties interested in the diagnosis and treatment of brucellosis. The recommendations of the Clinical Practice Guide Development Guide of the Infectious Diseases Society of America (IDSA) were taken as the basis for preparing this guide. The guideline preparation group determined 20 questions considered to be important in the diagnosis and treatment of brucellosis, and the publications that could answer these questions prepared in PICO (Population/Patient [P], Intervention [I], Comparison [C], Outcome [O]) format, were searched in ULAKBİM Tr Dizin, PubMed, Cochrane databases without date restrictions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to rank the evidence and determine the strength of the recommendations for each PICO question and for each individual outcome. Meta-analyses of comparative clinical studies were performed to answer the PICO questions. Individual participant data (IPD) meta-analyses with data obtained from case reports and case series were conducted in the absence of comparative clinical studies. It is planned to update the recommendations at regular intervals in line with the results of new studies.

Endocarditis is the most common cause of death from brucellosis. The information used to guide the management of cases with Brucella endocarditis has relied on case reports/series. Risk factors related to death and other adverse outcomes in patients with Brucella endocarditis were identified by an individual-patient data analysis of all reported Brucella endocarditis cases in the literature. The keywords “Bruce” and “endocard” were used to search articles published until July 2022 on PubMed and ULAKBIM databases. Case reports/series containing patients with endocarditis caused by Brucella spp., aged ≥17 years, and with data on antimicrobial or surgical treatment were included in the study. Epidemiological, clinical, laboratory, and treatment characteristics and outcomes of 273 cases from 86 eligible articles were recorded. It was found that male gender, a Wright serum tube agglutination (STA) titer of ≥1/1280 on admission, development of heart failure due to endocarditis were independent risk factors that increase mortality, while the usage of aminoglycoside and cardiac surgical intervention for endocarditis were factors reducing mortality. Including streptomycin or gentamicin in the treatment regimen may benefit patients with Brucella endocarditis. Valve surgery could be life-saving in patients with Brucella endocarditis. An STA titer of ≥1/1280, which probably reflects long-term and advanced disease, may be used as a marker for increased mortality. However, additional and more reliable studies are needed to define the most appropriate management approach in diagnosing and treating cases with Brucella endocarditis due to the low quality of the current evidence.

Objective: We aimed to find the incidence and risk factors of hematologic adverse effects of piperacillin-tazobactam (TZP). Materials and Methods: Adult patients who used TZP for more than 10 days were included in the study. Results: The incidence of leukopenia, neutropenia, and eosinophilia in 110 TZP therapy episodes was found to be 16.3%, 10%, and 10 0 !0, respectively. Lower Charlson Comorbidity Index score, lower initial leukocyte count, combination of TZP with another antibiotic, and total duration of TZP therapy were found to be independent risk factors for leukopenia, while initial higher eosinophil count (IHEC) and usage of TZP for >20 days were independent risk factors for neutropenia and IHEC and total duration of TZP therapy were independent risk factors for eosinophilia. Conclusion: Longer duration of therapy, combination with other antibiotics, younger age with fewer comorbidities, and IHEC could result in hematologic adverse effects in patients treated with TZP. Patients with IHEC may be more prone to allergic reactions, so immunological mechanisms may facilitate the development of hematological adverse effects of TZP.

Objective: Tularemia is a zoonotic disease that causes epidemics in Turkey. An increase in tularemia cases was noticed in the province of Muş compared to previous years. With this study, we aimed to increase the awareness of tularemia in the region by sharing the characteristics of the cases. Methods: The epidemiological, demographic, and clinical characteristics of tularemia cases seen in the province of Muş between 2017-2019 were retrospectively analyzed. Only confirmed cases were included. Results: Fifty cases were seen between 2017-2019. 52% were male; the average age was 23 (3-66), and 44% were 18 years or younger. The average admission time to the hospital was 23 days (3-79). Lymphadenopathy (LAP) (100%), sore throat (78%), weakness (66%), and loss of appetite (60%) were among the most common symptoms and signs at the onset of the disease. Oropharyngeal form (90%) was seen in most of the cases. 96% of the patients lived in rural areas, and 84% of them were using mains water as drinking water. Mains water chlorination rate was 30%. Most cases were seen in autumn and winter (76%). Similar clinical presentations were observed in 46% of the people in the neighborhood. No mortality was seen in the patients. Conclusion: Data of two tularemia epidemics and six sporadic cases in the region within three years were presented. It should not be forgotten that tularemia is also seen in the pediatric age group in our region. Tularemia should be considered in patients of all age groups who present with complaints of LAP, sore throat, weakness, anorexia, and fever, especially during autumn and winter. Contact with contaminated water should be questioned in patients with atypically located LAP, and detailed epidemiological history should be taken. Taking sanitation measures and making prompt investigations are significant in preventing possible epidemics in areas with an increase in tularemia cases.

COVID-19 vaccines are highly protective against severe disease; however, vaccine breakthrough infections resulting in hospitalization may still occur in a small percentage of vaccinated individuals. We investigated whether the clinical and microbiological features and outcomes were different between hospitalized COVID-19 patients who were either fully vaccinated with Coronovac or not. All hospitalized COVID-19 patients who had at least one dose of Coronavac were included in the study. The oldest unvaccinated patients with comorbidities, who were hospitalized during the same period, were chosen as controls. All epidemiologic, clinical and laboratory data of the patients were recorded and compared between the fully vaccinated and unvaccinated individuals. There were 69 and 217 patients who had been either fully vaccinated with Coronavac or not, respectively. All breakthrough infections occurred in the first 3 months of vaccination. Fully vaccinated patients were older and had more comorbidities than unvaccinated patients. There were minor differences between the groups in symptoms, physical and laboratory findings, anti-spike IgG positivity rate and level, the severity of COVID-19, complications, and clinical improvement rate. The mortality rate of fully vaccinated patients was higher than the mortality rate in unvaccinated patients in univariate analysis, which was attributed to the fact that vaccinated patients were older and had more comorbidities. The severity and clinical outcomes of hospitalized patients with breakthrough COVID-19 after Coronavac vaccination were similar to those of unvaccinated patients. Our findings suggest that the immune response elicited by Coronovac could be insufficient to prevent COVID-19-related severe disease and death within 3 months of vaccination among elderly people with comorbidities.

Toxoplasmosis is a common disease all over the world and is caused by Toxoplasma gondii. Although toxoplasmosis is usually mild, it can be clinically more serious in immunocompromised and pregnant women. Toxoplasmosis may cause miscarriage, premature birth and stillbirth in pregnancy. In this study, we aimed to report the regional prevalence of T. gondii seropositivity and acute toxoplasmosis cases. In the study, Toxoplasma IgM, IgG and Toxoplasma IgG avidity test results of pregnant women who applied to our hospital between 01/11/2018 and 14/05/2020 were reviewed for toxoplasmosis retrospectively. The duplicate samples were excluded and the results of the remaining 6567 pregnant women’s test results were evaluated. Toxoplasma IgM and IgG tests were performed together in 6435 pregnant women. Toxoplasma IgG positivity was detected in 1902 (28.9%) of them. Toxoplasma IgG avidity test was performed in 53 of 146 pregnant women, whose Toxoplasma IgM values were positive or within the limits of range. Three of these pregnant women had low Toxoplasma IgG avidity and were considered to be risky for intrauterine infection and treatment was initiated. As a result; we retrospectively evaluated the Toxoplasma IgM, Toxoplasma IgG and Toxoplasma IgG avidity test results requested from pregnant women who applied to our hospital in our study,. Similar to other studies conducted in our country, we observed that Toxoplasma IgG positivity increased significantly with age (p<0.001). Because the animal husbandry is widespread in our province, it is thought that the risk of encountering the agent increases with age, which may explain this situation. Toksoplazmoz tüm dünyada yaygın olarak görülen ve etkeni Toxoplasma gondii olan bir hastalıktır. Genellikle hafif olmakla birlikte, immün yetmezliği olanlarda ve gebelerde klinik olarak daha ciddi seyredebilmektedir. Gebelikte geçirilen toksoplazmoz sonucu düşük, erken ve ölü doğum görülebilmektedir. Bu çalışmada T. gondii seropozitifliğinin ve akut toksoplazmoz olgularının bölgesel prevalansının incelenmesi amaçlanmıştır. Çalışmada 01/11/2018 ile 14/05/2020 tarihleri arasında hastanemize başvuran gebelerin Toksoplazma IgM, IgG ve Toksoplazma IgG avidite test sonuçları retrospektif olarak incelenmiştir. Mükerrer örnekler çıkarıldığında geriye kalan 6567 gebeye ait test sonuçları değerlendirmeye alınmıştır. Gebelerin 6435’inde Toksoplazma IgM ve IgG testleri birlikteliği gözlenmiştir. Bunların 1902’sinde (%28.9) Toksoplazma IgG pozitifliği saptanmıştır. Toksoplazma IgM değeri pozitif veya sınır değer aralığındaki 146 gebenin 53’ünde Toksoplazma IgG avidite testi istemi yapılmıştır. Bu gebelerden üçünde Toksoplazma IgG aviditesi düşük bulunmuş ve intrauterin enfeksiyon açısından riskli olarak kabul edilerek tedavi başlanmıştır. Sonuç olarak; çalışmada hastanemize başvuran gebelerden istenen Toksoplazma IgM, Toksoplazma IgG ve Toksoplazma IgG avidite test sonuçları retrospektif olarak değerlendirilmiştir. Ülkemizde yapılan diğer çalışmalarla benzer şekilde Toksoplazma IgG pozitifliğinin yaşla birlikte anlamlı olarak arttığı gözlenmiştir (p<0.001). İlimizde hayvancılığın yaygın olması nedeniyle etkenle karşılaşma riskinin yaş ilerledikçe artmasının bu durumu açıklayabileceği düşünülmüştür.