Recep Tekin

Objective: Hydatid disease is a parasitic infection caused by Echinococcus granulosus and Echinococcus multilocularis. Due to the rarity of musculoskeletal involvement and occasional confusion with tumors, delays in diagnosis and treatment may occur. This study aimed to evaluate the outcomes of patients with musculoskeletal soft-tissue hydatid cysts treated with surgical drainage followed by povidone-iodine application as an alternative to wide excision. Materials and Methods: In this retrospective study, the clinical characteristics and follow-up outcomes of patients treated between 2016 and 2024 were reviewed. The patients included in the study were considered to be high-risk for surgical morbidity and were unsuitable for wide excision. The patients included in the study received both preoperative and postoperative albendazole therapy. Results: The study included seven patients who met the inclusion criteria. The mean age was 45.7 years (range, 31–56 years), including four males and three females. The mean follow-up period was 4.2 years (range, 1–6 years). Lesions were located within the right iliacus muscle, the left hemipelvis, the proximal right thigh, and the hand and wrist region. Four patients had lesions involving the hand and wrist region. Throughout the follow-up period, no recurrence, wound infection, or clinically significant functional impairment was observed. Conclusion: In patients with musculoskeletal hydatid disease, when en bloc cyst excision is not feasible, controlled cyst opening with mechanical evacuation followed by povidone-iodine sterilization, in conjunction with albendazole therapy, may represent an effective and viable alternative treatment option.

Background: Cryptococcal infections remain life-threatening fungal infections affecting both people living with HIV (PLWH) and non-HIV populations. Data from real-world cohorts in middle-income settings, particularly those including both groups, remain limited. This study aimed to evaluate the clinical characteristics and identify predictors of one-year mortality in patients with cryptococcal infections. Methods: In this retrospective multicenter cohort study, adult patients diagnosed with cryptococcal infection between 2013 and 2025 were included and followed for one year after diagnosis or until death. Demographic, clinical, laboratory, and treatment data were collected. Survival was analyzed using Kaplan–Meier methods and compared with the log-rank test. Cox proportional hazards regression was used to identify factors independently associated with mortality. Subgroup analyses were performed according to HIV status. Results: A total of 92 patients with an average age of 46 ± 16 years were included; 56.5% were PLWH, and 87% were immunocompromised. Central nervous system involvement was the most common presentation (64.1%). Overall one-year mortality was 46.7%. In the multivariable Cox regression analysis, altered consciousness (HR 3.110, 95% CI 1.624–5.956, p < 0.001) and disseminated infection (HR 2.155, 95% CI 1.156–4.016, p = 0.016) were independently associated with increased mortality, whereas higher serum albumin levels were independently associated with improved survival (HR 0.532, 95% CI 0.328–0.861, p = 0.010). Age remained independently associated with mortality (HR 1.025 per year, 95% CI 1.006–1.045, p = 0.010). Kaplan–Meier analysis showed significantly lower one-year survival among patients with altered consciousness and disseminated infection. Although CNS involvement was more frequent among PLWH (78.8% vs. 45%, p < 0.001), mortality rates were comparable between PLWH and non-HIV patients. Conclusions: Cryptococcal infections are associated with high mortality regardless of HIV status. Altered consciousness and disseminated infection were independently associated with one-year mortality, whereas higher albumin levels were associated with improved survival. Simple clinical parameters may contribute to early clinical risk assessment, particularly in resource-limited settings.

Background: Diabetic foot infection (DFI) is a serious complication of diabetes mellitus associated with chronic inflammation, impaired wound healing, endothelial dysfunction, and oxidative stress. Sirtuin (SIRT) signaling and the apelinergic system have been implicated in these processes. This study aimed to evaluate serum SIRT1, SIRT3, apelin, and elabela (ELA) levels in patients with DFI and to examine their cross-sectional associations with clinical indicators, inflammatory markers, osteomyelitis, and glycemic control. Methods: This cross-sectional study included 47 patients with DFI and 42 healthy controls. Serum biomarker levels were measured using enzyme-linked immunosorbent assay (ELISA). Clinical and laboratory data, including the infection component of the PEDIS classification, were recorded. Group comparisons, Spearman correlation analyses, receiver operating characteristic (ROC) curve analysis, and logistic regression were performed. Results: Patients with DFI exhibited higher inflammatory and glycemic markers and lower hemoglobin and lipid levels compared with controls (p < 0.05). Serum SIRT1, SIRT3, apelin, and ELA levels were significantly lower in the DFI group and showed inverse correlations with HbA1c, PEDIS stage, disease duration, osteomyelitis, and inflammatory markers. Among these biomarkers, SIRT1 showed the highest discriminative ability within this cohort (AUC = 0.820). In an exploratory multivariable model, age and SIRT1 were independently associated with the presence of DFI. Conclusions: Serum SIRT1, SIRT3, apelin, and ELA levels were lower in patients with DFI and were associated with clinical and biochemical indicators of disease burden. Among these biomarkers, SIRT1 demonstrated the strongest discriminative ability within this cohort. These findings suggest that sirtuin signaling and the apelinergic system may be relevant in the biological context of DFI; however, they should be interpreted cautiously. The observed differences may reflect not only DFI but also underlying diabetes, glycemic burden, age, and systemic inflammation. Further prospective studies including appropriate diabetic comparator groups are required to clarify the clinical relevance and potential utility of these biomarkers.

Background: Diabetic foot ulceration represents one of the most severe diabetic complications, with 50–60% progressing to diabetic foot infection (DFI). All diabetic wounds and diseases originate from peripheral vasculopathy and neuropathy, which are caused by oxidative stress and inflammatory processes. We investigated the utility of neutrophil-to-lymphocyte ratio (NLR) and CRP-to-albumin ratio (CAR) as cost-effective inflammatory biomarkers in DFI. Methods: The study included 58 DFI patients and 45 healthy controls. Disease severity was assessed using PEDIS staging. Routine laboratory parameters, NLR, derived NLR (d-NLR), and CAR were measured and compared. Results: In DFI patients, statistically significant increases (p < 0.001) were observed in NLR (3.12 vs. 1.99, p < 0.001), d-NLR (2.13 vs. 1.49, p = 0.003), CAR (0.91 vs. 0.03, p < 0.001), CRP (30.5 vs. 1.3 mg/L, p < 0.001) and PCT (0.1 vs. 0.02 μg/L, p < 0.001) values compared to the control group. Strong correlations existed between NLR, CAR and disease severity markers (CRP, PCT, HbA1c, osteomyelitis, PEDIS stage). ROC analysis revealed excellent discriminatory power for CAR (AUC = 0.915), PCT (AUC = 0.952), and CRP (AUC = 0.902), while NLR showed moderate performance (AUC = 0.702). Conclusions: NLR/CAR demonstrate excellent discrimination vs. healthy controls (AUC 0.915/0.702). The proposed workflow (NLR screening → CAR severity → PCT confirmation) requires prospective validation against with guidelines.

Candida auris is an emerging fungal pathogen that has become a critical global health concern due to its high antifungal resistance and potential to cause nosocomial outbreaks. Since its initial identification in Japan in 2009, C. auris has spread rapidly, posing significant treatment challenges across various healthcare settings worldwide. The biofilm formation ability of C. auris enhances its resilience against disinfectants and antifungal agents, complicating infection control in healthcare environments. This consensus report, developed with the collaboration of several Turkish medical specialty societies, including the Turkish Society of Infectious Diseases and Clinical Microbiology Specialty (EKMUD), the Turkish Society of Anesthesiology and Reanimation (TARD), the Turkish Intensive Care Society (TYBD), the Infectious Diseases – International Research Initiative (ID-IRI), the Clinical Microbiology Specialist Society (KLIMUD), the Turkish Microbiology Society (TMC), and the Public Health Institution of Türkiye (PHIT) under the Ministry of Health, provides a comprehensive overview of C. auris and its’ management. The report focuses on the epidemiology, antifungal resistance mechanisms, recommendations for diagnostic and therapeutic challenges, infection control and prevention measures and surveillance of C. auris. This consensus report aims to establish standardized diagnostic protocols, improve national surveillance systems, and promote effective infection control measures to mitigate C. auris related health risks in Türkiye. It also offers comprehensive national recommendations and addresses the need for inter-institutional collaboration, improve public health, and strengthen the healthcare response to this pathogens.

Background/Objectives: Cutaneous leishmaniasis (CL) is a skin disease caused by Leishmania parasites. Presepsin, irisin, and apelin are biomarkers that are involved in the inflammatory response. The aim of this study was to investigate the association between serum levels of specific biomarkers, such as presepsin, apelin, and irisin, and the clinical features, location, number, and size of lesions in patients with CL. Methods: This study is a single-centre, prospective cohort study involving a total of 30 patients with skin lesions compatible with CL and 30 healthy matched controls. Age, sex, type of skin lesion, location of skin lesion, number of skin lesions, and diameter of skin lesions were recorded. The levels of presepsin, irisin, and apelin measured in the blood samples of the patient group were analysed in comparison to those in the healthy control group. Results: The findings revealed that presepsin levels were significantly elevated in the patient group compared to the controls (p = 0.000). However, no statistically significant differences were observed between the groups for irisin and apelin levels (p-values 0.096 and 0.836, respectively). A negative correlation was identified between presepsin levels and the number of skin lesions, the diameter of the largest lesion, and the total diameter of the lesions (p = 0.000). Conclusions: It appears that measuring presepsin levels in patients with CL may be beneficial. Presepsin has the potential to serve as a prognostic marker in CL, offering significant benefits in guiding clinicians in assessing disease progression and response to treatment.

Background: Delayed diagnosis and inadequate treatment of infectious and inflammatory diseases, such as Brucella, lead to high rates of mortality and morbidity. The aim of our study was to investigate the association between serum levels of apelin, presepsin, and irisin with inflammation, laboratory parameters, and blood culture in patients with brucella. Patients and methods: This prospective case-control study involves 30 patients with brucellosis and 30 healthy, matched control subjects. Thirty patients who were diagnosed with brucellosis were aged ≥ 18 years. Blood samples were taken from the patients on the first day they were diagnosed with brucellosis. The values of irisin, presepsin, and apelin were studied. In addition, blood samples were also taken from 30 healthy individuals for the control group. Irisin, presepsin, and apelin values that were measured in the patients on the first day were compared with those values measured in the control group. Results: The sex and age statuses of the subjects are matched among the groups. The levels of irisin were significantly higher in patients with brucellosis compared to the control group (p<0.045). There was no significant difference between the two groups in terms of apelin and presepsin levels (p values 0.087 and 0.162, respectively). There was a positive correlation between irisin levels and elevated ALT levels, as well as positive blood cultures. Conclusions: It appears that the measurement of irisin levels may be beneficial in patients with brucellosis. Irisin can be used as a diagnostic marker for brucella infection and may greatly clinicians to predict the severity disease and treatment response.

A 28-year-old man presented to the emergency department with a 5-week history of severe headache, dizziness, and weakness in the right arm. Neurological examination revealed 3/5 strength in the right arm. Brain magnetic resonance imaging (MRI) of the brain showed a large hypointense lesion with thick peripheral contrast enhancement in the left periventricular area. The solid components appeared hyperintense after contrast enhancement, and microabscesses were observed in the basal ganglia, subcortical white matter, and left anterior thalamic area. On T2-weighted images, the large hypointense lesion caused a minimal mass effect, which was accompanied by significant peripheral edema ( Figure 1). Diffusion-weighted imaging revealed several diffusely localized lesions with restricted diffusion in both hemispheres and the cerebellum ( Figure 2). Multivoxel MR spectroscopy revealed significant elevation in lipid and lactate levels, indicating an abscess. A brain biopsy was performed and pathological examination confirmed the diagnosis of Aspergillus infection ( Figure 3, arrowheads). The patient was treated with intravenous liposomal amphotericin B but died despite a 57-day course of antifungal therapy. Intracranial Aspergillus infection is a rare condition that is difficult to diagnose because of the lack of specific imaging features¹ 1. Brun S, Fekkar A, Busse A, Seilhean D, Lecsö M, Adler D, et al. Aspergillus flavus brain abscesses associated with hepatic amebiasis in a non-neutropenic man in Senegal. Am J Trop Med Hyg. 2009;81(4):583-6. 2. Lange N, Wantia N, Jörger AK, Wagner A, Liesche F, Meyer B, et al. J. Fungal brain infection-no longer a death sentence. Neurosurg Rev. 2021;44(4):2239-44. ^-3 3. Dal T, Tekin A, Tekin R, Deveci O, Fırat U, Mete M, et al. Soft Tissue Abscess Caused by Aspergillus Fumigatus in an Immunosuppressive Patient. Eur J Gen Med. 2013;10(2):118-22. .

A 23-year-old male patient reported experiencing pain in his right thigh for 2 days along with swelling in the same area for the past 5 months. Upon physical examination, his thigh was found to be mildly painful. Magnetic resonance imaging (MRI) revealed T1-weighted hypointense and T2-weighted fat-suppressed series hyperintense lesions in the semimembranosus muscle ( Figure 1a,b). The MRI further indicated a rupture of a muscular hydatid cyst, as evidenced by the “water lily sign” produced by the detachment of the germinal membrane of the endocyst ( Figure 1c,d arrow). The MRI also confirmed the intramuscular location of the lesion in the semimembranosus muscle, which exhibited significant edematous signal changes in the surrounding muscle structures and between the fascia planes. Based on the clinical, laboratory, and radiological findings, the patient was diagnosed with a ruptured muscular hydatid cyst. A wide resection of the right thigh was performed, ensuring adequate margins of healthy tissue were maintained around the associated soft-tissue cystic components ( Figure 2). The diagnosis of hydatid disease was confirmed through a histopathological examination ( Figure 3). The patient was prescribed 400 mg of oral albendazole daily. The spontaneous rupture of muscular hydatid cysts is an extremely rare condition. The rupture of hydatid cysts into the muscle poses a considerable challenge for surgeons. Pericystectomy is the primary treatment for the muscular rupture of hydatid cysts, with medical treatment typically administered postoperatively¹ 1. Tekin R, Avci A, Tekin RC, Gem M, Cevik R. Hydatid cysts in muscles: Clinical manifestations, diagnosis, and management of this atypical presentation. Rev Soc Bras Med Trop. 2015;48(5):594-8. ^,2 2. Tekin R, Onat S, Tekin RC. Ruptured Pulmonary Hydatid Cyst Complicated by COVID-19. Am J Trop Med Hyg. 2022;107(1):6-7. . It is important to consider hydatid disease in the differential diagnosis of cystic swelling in a musculoskeletal region³ 3. Tekin R, Özkul E, Ulus SA. Hydatid Cyst of the Tibia. Rev Soc Bras Med Trop . 2022;55:e00822022. .

"Ruptured Pulmonary Hydatid Cyst Complicated by COVID-19" published on 31 May 2022 by The American Society of Tropical Medicine and Hygiene.