A 33-year-old male livestock farmer was admitted to our hospital with high fever, night sweats, and back pain. Laboratory investigations revealed a white blood cell count of 7,500/uL, a C-reactive protein level of 68 mg/L, and an 80 mm/h erythrocyte sedimentation rate. Brucella Rose Bengal and Brucella Wright (1:320 titer) tests were positive. The lumbar magnetic resonance imaging findings were consistent with those of spondylodiscitis ( Figure 1). Treatment with gentamicin, rifampicin, and doxycycline was initiated based on the diagnosis of Brucella spondylodiscitis. Gentamicin was discontinued after 1 week, and the patient was discharged on an outpatient basis.
Background and Objectives: Long-acting cabotegravir and rilpivirine (LA-CAB/RPV) offers an alternative to daily oral antiretroviral therapy (ART) for people living with HIV (PLWH). Although LA-CAB/RPV has been approved in Turkey, the country remains in the pre-rollout period, and national data on patient perspectives are lacking. This is the first nationwide study from Turkey, a setting of increasing HIV incidence, assessing PLWH perspectives on switching to LA-CAB/RPV and the influence of motivational factors on treatment preferences. Materials and Methods: A prospective, multicenter, cross-sectional study was conducted across 11 HIV treatment centers representing all regions of Turkey. Virologically suppressed PLWH meeting current eligibility criteria for LA-CAB/RPV were included. Treatment preferences (switch to LA-CAB/RPV or remain on oral ART) and five anticipated motivational domains, namely perceived efficacy, safety, convenience, privacy, and cost, were systematically assessed through structured, face-to-face interviews. Results: Among 200 eligible participants, 86% (n = 172) preferred switching to LA-CAB/RPV. In all subgroups, LA-CAB/RPV was preferred over oral ART, except for those with no formal literacy. Prior awareness of LA-CAB/RPV was significantly associated with the switching preference (p < 0.001), with healthcare providers being the most common source of information, at 45.5% (n = 172) (p < 0.001). Residential proximity to the healthcare center (p = 0.018) and all motivational factors significantly influenced the preference (p < 0.05). Notably, when participants who initially chose to remain on oral ART were asked whether they would reconsider switching if injections were administered every six months, overall preference for long-acting therapy increased from 86% to 98%. Conclusions: High clinical eligibility and strong acceptability for LA-CAB/RPV were observed among Turkish PLWH. Our findings demonstrate that structured motivational factors significantly influence the treatment preference. Addressing these patient-centered factors and logistical barriers may support the successful integration of long-acting therapies into routine HIV care. Future longer-interval agents may improve patient-centered acceptability.
1 January 2024 in Revista do Instituto de Medicina Tropical de São Paulo
Candida glabrata is a yeast which incidence has increased in recent years and usually causes urogenital and bloodstream infections. Its resistance to fluconazole hinders C. glabrata infections treatment. This case report presents a case of candidemia and scrotal abscess caused by C. glabrata, which was successfully treated with liposomal amphotericin B. The primary treatment options for C. glabrata candidemia are echinocandins and amphotericin B formulations. However, echinocandins and lipid-based amphotericin B formulations do not properly pass through the urinary system. Amphotericin B deoxycholate has a high risk of side effects and is difficult to obtain. The treatment option for candidemia caused by fluconazole-resistant C. glabrata secondary to urinary tract infection is unclear and there are no sufficient studies. For treatment, liposomal amphotericin B may be considered, especially for scrotal and prostatic fluconazole-resistant fungal abscesses. More studies comparing the penetration of antifungals into scrotal and prostatic tissue and the success of antifungal treatment in these tissue infections are needed.
1 January 2025 in Revista do Instituto de Medicina Tropical de São Paulo
Rickettsia species are Gram-negative, pleomorphic coccobacilli that are obligate intracellular pathogens transmitted by arthropod vectors such as ticks. Among them, Rickettsia conorii, the causative agent of Mediterranean spotted fever (MSF), is endemic in many Mediterranean countries, including Turkey. This case series describes three patients from Balıkesir, Turkey, who developed high-grade fever, generalized maculopapular rash involving the palms and feet soles, arthralgia, and necrotic eschars (tache noire) at the tick bite sites. All cases occurred during summer and had documented exposure to Rhipicephalus sanguineus. Laboratory evaluations ruled out other tick-borne diseases, while real-time PCR performed on skin biopsy samples confirmed Rickettsia spp. Subsequent DNA sequencing of the gltA and ompA gene regions enabled species identification. Additionally, serological tests showed a significant rise in IgM and IgG antibody titers reacting with Rickettsia conorii antigen by indirect immunofluorescence assay. All patients were treated with doxycycline and recovered without complications. This case series highlights the importance of considering rickettsial infections in the differential diagnosis of febrile patients with rash and recent tick exposure, especially in endemic regions during warm seasons.