Zehra Çağla Karakoç

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.

In recent years, evolving patterns in candidemia epidemiology, including increasing proportions of non-albicans Candida (NAC) species and the emergence of Candida auris, have been reported. We aimed to characterize contemporary candidemia epidemiology in Turkey and to assess the association between guideline adherence and 30-day mortality. In this nationwide retrospective multicenter cohort study, adult patients with blood culture-confirmed candidemia diagnosed between January 2022 and December 2023 in 20 hospitals were included. Species identification was standardized and confirmed using MALDI-TOF MS. A total of 398 candidemia episodes were analyzed. Although Candida albicans remained the single most common species (34.7%), NAC species predominated overall (65.3%), mainly driven by Candida parapsilosis (26.6%), while C. auris accounted for 6.5% of cases and was detected across multiple centers. Crude mortality was 68.3% and 30-day mortality was 56.3%. Failure to remove central venous catheters (CVC) was independently associated with higher 30-day mortality. Kaplan-Meier analysis demonstrated significant differences in 30-day survival across EQUAL Candida score categories in the overall candidemia cohort (log-rank p = 0.02) and among patients with CVC-related candidemia cohort (log-rank p = 0.008). Collectively, our findings provide a contemporary nationwide overview of candidemia in Turkey, highlighting the predominance of NAC species, the multicenter detection of C. auris, and the clinical importance of early source control.

Purpose: Mucormycosis is a rapidly progressive angioinvasive fungal infection with limited large-scale outcome data. We aimed to describe the epidemiology, clinical spectrum, treatment strategies, and predictors of outcomes in adult patients with proven mucormycosis in Türkiye. Methods: We conducted a nationwide, retrospective study of 280 adults diagnosed with proven mucormycosis between 2004 and 2024 across 27 tertiary centers. Case definitions were applied according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clinical characteristics, antifungal management, surgical interventions, and outcomes were systematically analyzed. Results: The median age of the cohort was 60 years, and diabetes mellitus, frequently complicated by ketoacidosis, was the most common underlying condition. Rhino-orbital-cerebral disease represented the predominant clinical form, whereas pulmonary, gastrointestinal, and disseminated presentations were less frequent but carried less favorable prognoses. Liposomal amphotericin B was the main first-line therapy, often combined with surgery, although antifungal treatment was initiated at a median of five days after symptom onset. Ninety-day mortality was 42.1% by Kaplan–Meier estimation (crude 49.3%) and reached 49.3% (crude 55.0%) at 365 days. Crude mortality was lowest in patients who did not undergo surgery; however, this association was not significant in the time-dependent Cox regression analysis, suggesting confounding by baseline severity. Poor outcomes were associated with corticosteroid exposure, prolonged neutropenia, and neurological manifestations, while a history of sinusitis appeared to be associated with improved survival. Conclusion: In this multicenter study, survival was mainly determined by host-related factors rather than the choice of antifungal agent. Corticosteroid exposure, prolonged neutropenia, and neurological involvement independently predicted poor outcomes, whereas a prior history of sinusitis was linked to improved survival, likely reflecting earlier diagnosis and intervention. These findings reinforce the need for heightened clinical awareness, rapid recognition, and prompt multidisciplinary management to improve outcomes in patients with mucormycosis.

Tuberculous tenosynovitis is a rare form of extrapulmonary tuberculosis characterized by an indolent course and nonspecific clinical findings, frequently leading to delayed diagnosis. Paradoxical inflammatory reactions during or after anti-tuberculosis therapy may further complicate clinical management and mimic disease relapse. This is a case study regarding a 54-year-old female veterinarian presented with a four-year history of progressive swelling and induration of the right index finger extending to the palm, accompanied by gradually worsening limitation of finger flexion and hand grasp. Magnetic resonance imaging demonstrated extensive flexor tenosynovitis with synovial proliferation. Tenosynovectomy revealed multiple rice bodies surrounding the flexor tendon. Histopathology showed well-formed granulomas without central necrosis, accompanied by focal stromal coagulative necrosis, while microbiological tests were negative. Tuberculous tenosynovitis was diagnosed based on clinical, radiological, and histopathological findings, and anti-tuberculosis therapy was initiated. The patient showed gradual clinical improvement over the nine-month course of treatment. However, one month after therapy completion, recurrent finger swelling with axillary and new epitrochlear lymphadenopathy developed. In the absence of evidence of relapse, a post-treatment paradoxical inflammatory reaction was suspected. Corticosteroid therapy resulted in rapid clinical improvement. This case highlights the diagnostic challenges of tuberculous tenosynovitis, particularly in patients with delayed presentation and negative microbiological findings, and underscores that paradoxical inflammatory reactions may occur even after completion of anti-tuberculosis therapy, potentially mimicking disease relapse.

Healthcare-associated infections (HAIs) are common yet largely preventable through adherence to evidence-based guidelines. In 2005, Türkiye implemented a national infection control program, which led to significant reductions in HAI rates, including a 50% decrease in central line-associated bloodstream infections (CLABSIs) between 2008 and 2017. This result was in parallel with data from

This multicentre retrospective study investigated the epidemiology, clinical characteristics, and fluconazole resistance rates of Candida species in osteoarticular infections across Turkey as well as the factors influencing complete recovery. Data were gathered from 73 adult patients diagnosed with proven or probable Candida-associated osteoarticular infections between 2015 and 2025 from 20 healthcare centres. The most common clinical presentation was spondylodiscitis, followed by the involvement of phalangeal bones in the hands and feet. Non-albicans Candida species accounted for 37/73 cases (50.7%), with Candida parapsilosis being the most frequent. Fluconazole resistance was low among Candida albicans isolates (3%) but higher among non-albicans yeasts (27%). Bacterial co-infection, predominantly Gram-positive bacteria, was detected in 52.1% of cases. Diabetes was present in 50/73 patients (68.5%), particularly insulin-dependent diabetes, and was a prominent comorbidity that may have also contributed as a predisposing factor. Radiological detection of osteomyelitis was achieved in 69.9% of patients. Fluconazole was the most commonly used antifungal agent (74%) with a median treatment duration of 90 days. Multivariate analysis revealed that surgical debridement was significantly associated with a higher odds of clinical recovery (adjusted odds ratio [aOR], 5.764; 95% confidence interval [CI], 1.360–24.434; p = 0.017), whereas diabetes mellitus was significantly associated with a lower odds of total recovery (aOR, 0.205; 95% CI, 0.053–0.792; p = 0.022). In conclusion, this multicentre study provides epidemiological data and fluconazole resistance rates of Candida species causing osteoarticular infections in Turkey, highlights the occurrence of C. auris in this cohort, identifies surgical intervention and diabetes mellitus as factors significantly associated with recovery.

Purpose: Türkiye experienced its largest West Nile virus (WNV) infection outbreak in 2024. We described the clinical and laboratory features of human cases with WNV infection collected from eleven tertiary hospitals in Türkiye in 2024. Methods: The clinical characteristics of the patients were gathered using a structured form in the retrospective study. According to the ECDC case definition of WNV infections, the patients were classified as ‘confirmed’ or ‘probable’ cases. The odds ratio (OR) and 95% confidence interval (CI) for possible mortality predictors in WNV infections were calculated using multivariate logistic regression analysis. p < 0.05 was considered statistically significant. Results: The mean age of the 51 patients was 63.3 ± 13.6 years, and 37 (72.5%) were male. Twenty-six cases (51%) were confirmed, and 49% were probable WNV infection. Forty-eight patients (94.1%) had WNV neuroinvasive disease: 24 (47%) were diagnosed with meningoencephalitis, 20 (39.2%) with encephalitis, one (2%) with meningitis, and seven (13.7%) with acute flaccid paralysis. Twenty patients (39.2%) had movement disorders (tremor, myoclonus, bradykinesia, or rigidity). The case fatality rate was 17.6%. In multivariate analysis, older age (OR: 1.09, CI: 1.03–1.19, p = 0.042) and secondary bacterial infection during hospitalization (OR: 10, CI: 1.55–64.95, p = 0.015) were associated with fatality. Conclusion: We highlighted the increasing number of cases and diagnostic challenges by describing the highest number of the patients with WNV infections in Türkiye. Raising awareness among healthcare professionals, facilitating access to diagnostic tests, and developing rapid, reliable, and easily applicable tests would enable early diagnosis and help improve outcomes.

The Medical Bulletin of Sisli Etfal Hospital

Vajinitler jinekoloji polikliniklerinde en sık karşılaşılan tanılardan biri olup, çoğunlukla enfeksiyöz kaynaklıdır. Çalışmamızda; jinekoloji polikliniklerine vajinal akıntı şikayeti ile başvuran hastalardan alınan vajinal sürüntü örneklerinin, mikrobiyolojik değerlendirme sonuçlarının ve etiyolojide rol alan mikroorganizmaların değerlendirilmesi amaçlanmıştır.Ocak-Haziran 2019 tarihleri arasında hastanemiz jinekoloji polikliniklerinde vajinit ön tanısı konulan 290 hastadan alınan 305 vajinal sürüntü örneği çalışmaya dahil edildi. Örneklerin mikroskobik inceleme ve kültür sonuçları klinik mikrobiyoloji laboratuvar kayıtlarından retrospektif olarak değerlendirildi. Vaginal sürüntü kültürleri; %5 koyun kanlı agar, Çikolata agar, MacConcey agar, Sabouraud Dextroz agar besiyerlerine ekilerek, gram boyamaları ve direkt mikroskobik incelemeleri yapıldı. Plaklar 48-72 saat süre ile 37°C’de inkübe edildi. Üreyen mikroorganizmaların identifikasyonu ve antibiyogramı için VITEK 2 Compact® (bioMeriéux, Marcy l’Etoile, Fransa) otomatize sistemi kullanıldı. Hastaların ortalama yaşı 35.1±10.3 (18-84) olup, mikroorganizma üremesi saptanan örnek sayısı 131 (%42.9)’di ve bunların 84(%64.1)’ünde Candida albicans’ın etken olduğu belirlendi. Hastalar premenopozal ve postmenopozal (<45 yaş ve ≥45 yaş) olarak gruplandırıldı. Premenopozal grupta vajinal sürüntü örneği kültüründe üreme oranı (118/131), C. albicans üreme oranı (81/131) bakteriyel vajinoz ile ilişkili bulgular (25/262) daha fazla oranda belirlendi. Mikroskopik incelemede Trichomonas vaginalis saptanan hastaların tamamı premenopozal gruptaydı. Buna mukabil postmenopozal grupta ise, bakteriyel üreme oranı (10/13) daha fazlaydı. İzole edilen gram-pozitif bakterilerde ampisilin, penisilin ve gentamisin direnci saptanmadı. Gram-negatif bakterilerde ise karbapenemler ve gentamisine karşı direnç saptanmazken, diğer antibiyotiklere olan duyarlılık %47.2-97.2 arasında değişti. Çalışmamızda tüm hasta popülasyonu değerlendirildiğinde izole edilen en sık etken C. albicans’tır. Ancak postmenopozal grupta bakteriyel etkenlerin ön plana geçtiği, premenopozal grupta ise; literatürle uyumlu olarak Candida’ların daha sık vajinit etkeni olduğu belirlenmiştir.