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.

Introduction: Mpox virus is an orthopoxvirus that causes the zoonotic infectious disease known as mpox. The disease can also spread from humans to humans. It can be transmitted through contact with bodily fluids, lesions on the skin, or internal mucosal surfaces. Method: The number of mpox cases increased during the COVID-19 pandemic. Early diagnosis and prompt management of mpox are critical in people living with HIV (PLHIV). In this study, a cross-sectional survey was conducted among PLHIV followed at the outpatient clinic between 20 April–20 August 2023. A questionnaire was used to assess the knowledge and anxiety levels of patients as well as their opinions about vaccination against mpox. The severity of symptoms in the past two weeks was assessed using the Generalised Anxiety Disorder 7-item scale. A total of 203 PLHIV were interviewed for this survey study. Result: The mean age was 39.37±11.93. The majority of them were male (86.7%), and 41.4% were men who have sex with men (MSM). Only 21 of the surveyed participants (10.4%) had a “good knowledge” score about mpox. The mean knowledge score on human Mpox was 2.05 (min:0-max:8), and 107 (52.7%) had a score of 0. Conclusion: The future study should focus on continuous education, promoting awareness through programs and establishing measures to successfully overcome identified variables that contribute to mpox pandemic understanding and attitudes. Applying the lessons learned from the COVID-19 pandemic will help the management of mpox virus.

Introduction: Stenotrophomonas maltophilia is the only opportunistic human pathogen in the genus Stenotrophomonas. These bacteria can be isolated from healthcare settings, possibly resulting in bacterial colonization of medical devices, which cause nosocomial infections. S. maltophilia bacteremia results in high mortality and morbidity. This study aimed to determine the outcomes of S. maltophilia bacteremia and its associated mortality risk factors. Methodology: This was a retrospective study conducted at the University of Medical Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital (Istanbul, Turkey) from December 2015 to December 2022. Medical records, demographic information, clinical conditions, laboratory data, antimicrobial susceptibility, and clinical outcomes were retrospectively analyzed for the period between December 2015 and December 2022. Results: Data from 87 patients (median age 61 years) with bacteremia were included in this study. The most common underlying conditions were diabetes mellitus (DM; 32.2%), hypertension (29.9%), and malignancies (19.5%). The most common sources of bacteremia were central venous catheters (CVCs; 44%), primary blood infection (32%), respiratory tract infection (20.7%), and wound site/abscess infection (2.3%). Seventy-eight percent of the patients were admitted to the intensive care unit (ICU) when bacteremia was detected. The 28-day mortality rate was 55%. The mortality rate was significantly higher in the ICU (p < 0.001). Elevated values of procalcitonin and C-reactive protein, and the presence of CVC were significant risk factors for mortality in those with S. maltophilia bacteremia. Conclusions: S. maltophilia bacteremia should be carefully monitored in patients with CVCs. Timely removal of CVCs can result in decreased mortality.

Background: Long life expectancy in people living with human immunodeficiency virus (PLWH) caused an increase in comorbidities and co-medications. We aimed to analyse co-medications and drug-drug interactions (DD1s) in antiretroviral therapy (ART)-naive PLWH in the era of integrase inhibitors. Methods: A retrospective observational study was conducted between January 2016-August 2019. Patients' characteristics and chronic co-medications were recorded. The University of Liverpool HIV drug interaction database was used for DDIs. Results: Among 745 patients, the chronic co-medication rate was 30.9%. Older age (p<0.001, OR:6.66, 95% CI: 3.86-11.49) and female gender (p=002, OR:2.25, 95%:1.14-4.44) were independently associated with co-medication. Cardiovascular system (CVS) and central nervous system (CNS) drugs were the most common co-medications. Older age patients (p<0.001, OR:12.04, 95% CI:4.63-36.71), having heterosexual (HS) contact (p=0.003, OR:3.8, 95% CI:1.57-9.22) were independently associated with CVS drugs use, while being men who have sex with men (MSM) (p=0.03, OR:2.59, 95% CI:1.11-6.03) were associated with CNS drugs use. DDIs were seen in 37.4% of patients with co-medications. Antidiabetics (23.3%), CNS (22.1%) and CVS drugs (19.8%) most commonly had DDIs. Contraindication was most conunonly seen between inhaled corticosteroids and elvitegravir/cobicistat. A number of non-ART drugs, elvitegravir/cobicistat, antidiabetics, vitamins were independently associated with the presence of DDIs. Conclusion: Results suggested the need for attention about co-medication in PLWH regardless of whether they are young or older. CNS drugs should be questioned more detailed in MSM, as well as CVS drugs in older HS patients. Elvitegravir/cobicistat is significantly associated with DDIs and switching to an unboosted INSTI should be considered in patients with multiple comorbidities.

Bakirkoytip, Medical Journal of Bak?rk?y