Candidemia ranks among the top causes of nosocomial bloodstream infections, significantly increasing hospital stays and costs. Rapid and effective empirical antifungal therapy is crucial. The Candida parapsilosis species complex, the second most common cause of candidemia, has shown rising fluconazole resistance globally and in our country. Additionally, echinocandins exhibit higher minimum inhibitory concentrations (MICs) for C. parapsilosis, complicating empirical treatment decisions. This retrospective study analyzed 173 C. parapsilosis candidemia cases over 22 years in a tertiary care hospital. We compared 88 fluconazole non-susceptible (minimum inhibitory concentration [MIC] = 4 µg/mL: susceptible dose dependent; MIC ≥ 8 µg/ml resistant) and 85 fluconazole susceptible cases, examining demographics, clinical characteristics, risk factors, and 28-day mortality. Independent risk factors for fluconazole non-susceptibilty included age ≥ 66 years (p = 0.016), central venous catheter use (p < 0.001), total parenteral nutrition (p = 0.003), and colostomy (p = 0.049). Fluconazole non-susceptible cases had lower microbiological cure rates and higher mortality. Mortality in this group was independently associated with microbiological cure failure (p < 0.001). This study highlights the importance of identifying risk factors to estimate the likelihood of resistant pathogens, initiating targeted antifungal therapy, and providing individualized management. Monitoring local resistance patterns is essential to guide empirical therapy. Further multicenter research is needed to validate findings and optimize treatment for fluconazole resistant candidemia. Clinical trial number: Not applicable.

Stenotrophomonas maltophilia (SM) is one of the common gram-negative pathogens that cause nosocomial infections. The aim of the present study is to evaluate the treatment and outcome of SM bacteraemia. We retrospectively evaluated antimicrobial treatment in adult patients with nosocomial SM bacteraemia, with the 14th and 30th-day mortality as the outcome. In total, 140 adult patients with SM bacteraemia who were diagnosed between January 1, 2002, and December 31, 2016 were enrolled in the present study. Seventy-one (50.7%) patients were in the intensive care unit (ICU). The 14th and the 30th-day mortality rates were 32.9% (n=46) and 45.7% (n=64), respectively. Female sex (OR, 7.47; 95% CI 1.61-34.47, p<0.01), steroid use within the last month (OR, 10.2; 95% CI 1.27-82.27, p=0.029), Pittsburgh bacteraemia score (PBS) ≥4 (OR, 39.9; 95% CI 4.96-321.32, p<0.001) and solid organ malignancy (OR, 9.6; 95% CI 1.73-53.72, p<0.01) were independent risk factors for 14th day mortality. Removal of the catheter was an independent protective factor for both 14th (OR, 0.05; 95% CI 0.22-0.010, p<0.001) and 30th day (OR, 0.039;95% CI 0.164-0.009, p<0.001) mortality. We did not detect any difference between treatment regimens including trimethoprim-sulfamethoxazole (TMP/SMX) or levofloxacin in terms of mortality. We found that TMP/SMX and levofloxacin combination did not significantly improve patient prognosis. Due to the high mortality rates associated with nosocomial SM bacteraemia, adequate antibiotic therapy should be initiated immediately in the suspicion of infection, and prompt removal of any indwelling central venous catheter is important.

Toxoplasmosis infestation during pregnancy is typically asymptomatic however, the risk of vertical transmission increases with advancing gestational age. Due to the absence of overt clinical symptoms in most pregnant women, diagnosis relies on serological testing. Seroprevalence rates vary widely depending on geographical location and cultural practices. In the fetus, toxoplasmosis can result in a spectrum of outcomes, ranging from asymptomatic infection to severe neurological impairment. This study aimed to determine the seroprevalence of Toxoplasma gondii during pregnancy and to evaluate fetal transmission in seropositive pregnant women. For those diagnosed with acute toxoplasmosis, neonatal examination, serological tests, and transfontanel ultrasonography were conducted. This retrospective cohort study evaluated Anti-Toxoplasma IgM, IgG, and IgG avidity results of patients who presented to a tertiary medical center between 2015 and 2020. All maternal serological results, ultrasonographic evaluations, and neonatal data (e.g., serology, transfontanel ultrasonography) from births in the institution were obtained from hospital records. During the study period, 69 out of 2137 women (3.2%) had positive or borderline Toxoplasma IgM results. Seventeen patients were considered to have preconceptional infection, other 46 were suspected as acute toxoplasmosis during pregnancy. Three patients were lost to follow-up, and 5 pregnancies were terminated. Overall, 46 patients (2.1%) were started on spiramycin treatment by a mean gestational age of 14 weeks. Amniocentesis was performed in 14 cases, all of which had negative PCR results. Among neonates with available data, no findings suggestive of congenital toxoplasmosis were detected. The maternal seroprevalence of Toxoplasma gondii observed at our center aligns with findings from similar studies. 2 percent of 2137 women were suspected as acute toxoplasmosis and none of the 38 babies had neonatal intracranial abnormalities. However, the low acceptance rate (30%) for fetal diagnostic testing and the lack of complete neonatal serologic data may contribute to the observed low rate of congenital toxoplasmosis.

Because of their similar modes of transmission, the simultaneous infection of viral hepatitis and human immunodeficiency virus are increasingly seen as a big problem related to human health. To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1 patients in Turkey. Retrospective cross-sectional study. The present study was conducted between 2010 and 2017. HBsAg, anti-hepatitis C virus, and anti-human immunodeficiency virus were tested with ELISA. All anti-human immunodeficiency virus positive results by ELISA were verified for anti-human immunodeficiency virus positivity by a Western blot test, and Anti-human immunodeficiency virus positive patients with HBsAg and/or anti-hepatitis C virus positivity were included in the study. Subtyping and genotypic resistance analyses were performed by population sequencing of the viral protease and reverse transcriptase regions of the human immunodeficiency virus-1 pol gene. We detected 3896 human immunodeficiency virus-1 positive patients whose sera were sent from numerous hospitals across the country to our polymerase chain reaction unit for detection of drug resistance mutations and whose molecular laboratory tests were completed. Viral hepatitis co-infections were detected in 4.3% (n=170) of patients. Hepatitis B virus and hepatitis C virus co-infection were observed in 3.2% and 0.5% of all human immunodeficiency virus-1 infected patients, respectively. The major human immunodeficiency virus-1 subtype detected was group M, subtype B (62.9%). However, 13.5% of drug resistance mutation motifs were found in human immunodeficiency virus-1 genomes of patients included in the study. Due to similar transmission routes, HIV1 patients are at risk of hepatitis B and C virus co-infection. However, antiretroviral drug resistance mutation model is similar to patients with hepatitis negative.

Önemli transfüzyon komplikasyonlardan biri olan transfüzyonla ilişkili immün düzenlenme (TRIM), allojeneik kan transfüzyonunun (AKT) alıcının immün sisteminde yol açtığı değişiklikler olarak tanımlanabilir. En çok suçlanan etken, kan bileşeni içindeki mononükleer (MNH) hücrelerdir. Bu nedenle çalışmamızda eritrosit süspansiyonları (ES) içindeki T hücreler (CD3+CD4+ ve CD3+CD8+) hedeflenmiş, depolama koşullarının etkisiyle canlılık, proliferasyon ve aktivasyon düzeylerindeki değişimler incelenmiştir. Bu amaçla, üç adet kan bağışçısından alınan tam kanlardan ES’ler elde edilmiştir. Her kan bileşeninden tam kan örneği (5. saat) ve ES örnekleri (0, 7, 14, 21, 42. gün) elde edilmiştir. Ayrıca bağışçıdan bağış öncesi EDTA’lı tüplere alınan iki adet örnek de çalışmaya katılmıştır. Analizler bu örneklerden ayrıştırılan MNH kullanılarak yapılmıştır. Canlılık analizleri doğrudan MNH’ler, proliferasyon ve aktivasyon analizleri MNH kültürleri aracılığıyla akan hücre ölçerde gerçekleştirilmiştir. Canlılık düzeylerinin depolama süresi ortalarında azalmaya başladığı, 42. gün ES örneklerinde hemen tamamen yok olduğu belirlenmiştir. T hücrelerin proliferasyon becerisi daha erken azalmış ve 21. gün ES örneklerinde kaybolmuştur. Aktivasyon belirteci düzeyleri MNH kültürünün sıfırıncı saatlerine göre 16 ve 72 saatlerde artış göstermiştir. Ayrıca bağışçıların yaşlarına göre de sonuçlarda belirgin farklılıklar gözlemlenmiştir. Sonuç olarak ES depolama süresi ve koşullarının etkisiyle ürün içindeki T lenfositlerin canlılığı ve proliferasyon becerileri azalmaktadır. Bu sonuçlar allojeneik T lenfositlerin TRIM gelişimiyle ilişkilerinin düşük olabileceğini; T lenfosit aktivasyon kapasitelerinin ES’den uzaklaştıklarında artmış göstermesi eritrositlerin baskılayıcı özellik gösterebildiğini; TRIM gelişiminde bağışçı ve hasta yaşı gibi demografik parametrelerin de rol oynayabileceğini düşündürmektedir.

Background/Objectives: Our study was designed to explore the potential role of allogeneic CD8⁺ T lymphocytes present in red blood cell concentrates (RBCs) in the development of transfusion-related immunomodulation (TRIM) and the effect of storage time on these cells. Methods: From six units of whole blood, donated by volunteers, RBCs were obtained and each one was divided into three equal parts to provide the samples for storage days 0, 21, and 42. On related days, mononuclear cells (MNCs) were isolated from these RBC samples. MNCs were cultured, and phytohemagglutinin was added to half of the culture wells to stimulate the cells and achieve T cell division. Supernatants and MNCs were obtained from stimulated (STI) and unstimulated (US) wells. Supernatants were used for cytokine analyses, while MNCs were used to investigate the T cells and transcription factors. Results: The frequency of CD8⁺ T lymphocytes (Tc), their subgroups (Tc1, Tc2, and Tc17), specific transcription factors, and effector cytokines decreased during the storage time, but cell viability increased. CD3⁺CD8⁺TNF-α+ cells were significantly higher in the STI group on day 0 compared to the US group. Other cells did not respond to the mitogen (phytohemagglutinin) stimulation. Conclusions: During storage, the number of Tc cells and their ability to respond to mitogens decreased over time. The unresponsiveness was not recovered in ex vivo cell culture. Our findings suggest that transfused Tc cells are unlikely to be primary mediators of TRIM.