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Background Vaccinations have been widely used worldwide since their invention to prevent various diseases, but they can also have some adverse effects ranging from mild local reactions to serious side effects. These adverse effects are generally self-limited and resolve within a short time without any treatment. While a sterile abscess following vaccination is a rare condition in adults, many cases have been reported regarding children in the literature. Here, we report a case of recurrent sterile abscesses, which occurred after a Td vaccination, treated with corticosteroids. Case presentation A 22-year old woman was admitted to our department with a complaint of swelling at the site of the vaccination. On physical examination, this mass was about 6 × 6 cm in size and fluctuating, but there were no pain complaints and no redness present. She had received her Td vaccination 3 weeks ago and the swelling had started at the site of the injection 4 days following this immunization. Oral amoxicillin/clavulanic acid and local antibiotic cream were administered for 10 days. The laboratory values were unremarkable. Despite the administration of antibiotics, the swelling did not regress, and on the contrary, continued to increase in size. On ultrasound, two interconnected abscesses were observed in the subcutaneous area, and did not involve the muscle tissue. Later, the abscesses were completely drained, and the samples were cultured. The current antibiotics were continued. The gram staining of the samples revealed abundant leukocytes but no microorganisms. The solid and liquid cultures of the materials remained negative. Despite the administration of multiple drainages and antibiotics, the mass recurred. Finally, the patient was considered to have a sterile abscess due to Td immunization. The antimicrobials were stopped. Local and oral corticosteroids were initiated. The swelling regressed significantly, and the treatments continued for 7 days. The patient has been doing well and has had no recurrence for over a year. Conclusions Corticosteroids appeared to improve the patient and therefore we suggest that the efficacy and route of administration of steroids in this situation should be explored further.

Syphilis is a sexuality transmitted disease caused by Treponema pallidum . Liver involvement is very rarely seen and occurs in the second phase of the disease. Syphilitic hepatitis generally is mild clinical condition and is characterized by high serum alkaline phosphatase level, often with normal or only slightly abnormal transaminases. The skin eruptions are classically diffuse, symmetric maculopapular rashes involving trunk and extremities. Involvement of palms and soles is a strong clue to the diagnosis of secondary syphilis. Therefore, syphilitic hepatitis should be included in the early differential diagnosis in patient with abnormal liver enzyme, especially increased alkaline phosphatase, and rashes involving palms and soles.

Candidemia is a nosocomial infection mostly found in critically ill patients. Our objectives were to evaluate the change in distribution and resistance profile of Candida spp. isolated from candidemic patients in our intensive care unit over two 5-year periods spanning 15 years and to evaluate the risk factors. Records from the microbiology laboratory were obtained, from January 2004 to December 2008 and from January 2013 to December 2017, retrospectively. Antifungal susceptibility was performed by E-test and evaluated according to EUCAST breakpoints. A total of 210 candidemia cases occurred; 238 Candida spp. were isolated in 197 patients (58.8% male; mean age, 59.2 ± 19.6 years). The most predominant risk factor was central venous catheter use. Species distribution rates were 32%, 28%, 17%, and 11% for C. albicans (n = 76), C. parapsilosis (n = 67), C. glabrata (n = 40), and C. tropicalis (n = 27), respectively. Resistance rate to anidulafungin was high in C. parapsilosis over both periods and increased to 73% in the second period. Fluconazole showed a remarkable decrease for susceptibility in C. parapsilosis (94 to 49%). The prevalence of MDR C. parapsilosis (6%/33%) and C. glabrata (0%/44%) increased in the second period. We observed a predominance of non-albicans Candida spp., with C. parapsilosis being the most frequent and C. glabrata infections presenting with the highest mortality. High level of echinocandin resistance in C. parapsilosis and increasing prevalences of MDR C. parapsilosis and C. glabrata seem emerging challenges in our institution.

Tuberculosis (TB) is one of the most common opportunistic infections in people living with HIV (PLHIV). Mycobacterium tuberculosis may cause more TB in all stages of HIV infection than in the general population, with the incidence of TB and the spread of pulmonary TB to other organs increasing as the CD4 count decreases. In this HIV cohort study, we aimed to evaluate the clinical features, diagnosis, and prognosis of TB among PLHIV in Türkiye. We conducted a retrospective cohort study to analyze clinical outcomes and identify determinants of mortality among people living with HIV (PLHIV) co-infected with tuberculosis. We included 264 patients diagnosed and treated for TB across six centers in Türkiye. We extracted clinical, demographic, laboratory, microbiological, and radiological data from patient medical records. To identify independent predictors of mortality, we performed multivariable logistic regression and reported the results as odds ratios (ORs) with 95% confidence intervals (CIs). Of the 9,687 PLHIV who were followed for 10 years, 2.7% (264 individuals) developed TB. The median age of these individuals was 40 years, and 89% were male. The prevalence of pulmonary TB only, extrapulmonary TB only, and the coexistence of pulmonary and extrapulmonary TB were 42.4%, 48.8%, and 8.7%, respectively. Opportunistic infections and cancers were found in 23% (62 out of 264) of patients with HIV/TB co-infection. Among patients with HIV/TB co-infection, 42% showed lymphadenopathy, with 70% of these cases being generalized. In patients who underwent chest CT scans (n=200), radiological patterns revealed post primary TB in 46%, primary TB in 36%, and miliary TB in 18%. The positivity rates of Ehrlich-Ziehl-Neelsen staining (EZN), polymerase chain reaction (PCR), and TB cultures in clinical samples were found to be 47.5%, 72.5%, and 53%, respectively. Most of our patients (95%) were given the standard TB treatment regimen (HRZE), with a paradoxical reaction observed in 11.6% of cases and hepatotoxicity occurring in 18% of cases. Age, CD4 count (<200 cells/mm3-late presenters), and thrombocytopenia were identified as independent risk factors for mortality in the 58 patients (22%) who died after diagnosis. Even today, more than one fifth of patients with HIV-TB co-infection in our cohort died. Mortality was higher among individuals who presented late with tuberculosis disease, especially those with advanced immunosuppression (CD4 <200 cells/μL). These findings underscore the urgent need for early HIV diagnosis and systematic TB screening to reduce co-infection-related mortality and improve clinical outcomes.

Abdurrahman Kaya,1 Sibel Yıldız Kaya2 1Department of Infectious Disease, Istanbul Training and Research Hospital, Istanbul, Turkey; 2Department of Infectious Disease, Sungurlu State Hospital, Istanbul, TurkeyCorrespondence: Abdurrahman KayaDepartment of Infectious Disease, Istanbul Training and Research Hospital, Istanbul, TurkeyTel +90 506 6113328Email dr.abdkaya@hotmail.com View the original paper by Dr Lensen and colleagues

In this case, we report a patient who developed acute trigeminal neuritis after using a Pfizer-BioNtech vaccination against SARS-CoV-2. The patient was completely recovered with steroid treatment.In this case, we report a patient who developed acute trigeminal neuritis after using a Pfizer-BioNtech vaccination against SARS-CoV-2. The patient was completely recovered with steroid treatment.

Prolonged fever presents a challenge for the patient and the physician. Fever with a temperature higher than 38.3°C on several occasions that lasts for at least 3 weeks and lacks a clear diagnosis after 1 week of study in the hospital is called a fever of unknown origin (FUO). More than 200 diseases can cause FUO, and the information gathered from history taking, physical examination, laboratory and imaging studies should be evaluated with care. History taking and physical examination may provide some localizing signs and symptoms pointing toward a diagnosis. Infection, cancers, noninfectious inflammatory diseases and some miscellaneous diseases are the main etiologies, and some patients remain undiagnosed despite investigations. Tuberculosis, lymphoma and adult-onset Still's disease are the main diseases. Fluorodeoxyglucose PET is a promising imaging modality in FUO. Establishing a uniform algorithm for FUO management is difficult. Every patient should be carefully evaluated individually considering the previous FUO management experience.

Increased glycemic variability (GV) is associated with increased oxidative stress, vascular complications, and mortality in metabolic syndrome (MS) and diabetes mellitus patients. To investigate the relationship between GV and inflammatory parameters in obese children with insulin resistance (IR) and to elucidate their effects on the development of MS. Fifty obese adolescents with IR were included in the study. All patients underwent anthropometric measurements, body fat analysis, and continuous glucose monitoring system (CGMS) for 24 hours. Serum lipids, adiponectin, and interleukin-6 (IL-6) levels were measured. GV coefficient (GVC) was calculated using the standard deviation and the average glucose value obtained by CGMS. IR was diagnosed according to the results of oral glucose tolerance test (OGTT). MS was diagnosed according to the modified World Health Organization and the International Diabetes Federation criteria. Twenty-seven of the patients had MS and the remaining had only IR. Body fat mass, HbA1c, IL-6 levels, and peak insulin levels in the OGTT were significantly higher in the group with MS, but there was no difference in adiponectin levels. GVC was not different between the groups, but GVC significantly positively correlated with homeostasis model of assessment for IR, as well as with fasting, peak, and total insulin levels when all the patients were analyzed, while no significant relation was detected with adiponectin and IL-6 levels. This study suggests that GV is not different among obese adolescents with IR and MS. There seems to be a significant association between GV and IR parameters. However, other diagnostic criteria of MS (hypertension and/or dyslipidemia) or elevated IL-6 levels does not cause further increase in GV.

Objective: Chronic hepatitis C (CHC) virus infection is one of the leading causes of chronic liver disease in all over the world. The prevalence of CHC is almost 0.5-1% in Turkey. Until recently, pegylated-interferon (PEG IFN) alpha in combination with ribavirin was the main treatment of CHC. The aim of the study was to evaluate the real life data of CHC patients. Materials and Methods: We retrospectively evaluated the demographical data and treatment responses of patients with CHC who were followed and treated in our clinic between January 2008 and December 2015. Results: A total of 117 patients (67 female and 50 male) with a mean age of 48 (15-65) were included in the study. 105 patients were genotype 1, 3 were genotype 2 and 9 were with genotype 3. The patients were treated with PEG IFN alpha-2a (81/117) or alpha-2b (36/117) combined with ribavirin. We observed sustained virologic response (SVR) in 68% of all genotype 1 patients. While relapse was observed in only 1 patient among those with genotype 2 and 3, SVR was achieved in 11. The rate of SVR was only 42% among patients older than 60 years of age, whereas SVR was achieved in all young patients (range: 15-30). The overall SVR rate was 70%. Conclusion: As CHC can result in long-term complications (cirrhosis, terminal liver failure and hepatocellular carcinoma), patients without therapy remain at risk of developing progressive liver disease. Since advanced fibrosis is a predictor for poor prognosis and insufficient therapy outcome, early treatment is required to efficiently cope with this health problem, Although the rates of SVR with direct acting antivirals are very high, starting treatment in early stage could reduce the complications of CHC and transmission of the disease.

Osteoporosis is a common health problem, especially in the elderly and in women after menopause. Although there are some treatment methods, they impose serious side effects. Recently, the use of an electromagnetic field (EMF) has been a promising candidate for better treatment of osteoporosis. In the present study, we investigated the preventive effects of low-frequency (50 Hz), low-intensity (1 mT), and long-term (6 weeks) EMF on bone loss in ovariectomized rats. We used 18 female albino Wistar rats (8 unexposed and 10 exposed) to assess the effect of EMF. We examined the mineralization and the morphology of the tibia in control and EMF-exposed rats. The cortical thickness of the tibia was increased in EMF-exposed rats ( P < 0.002). The levels of Na and K in the tibia were significantly increased in rats exposed to EMF ( P < 0.001; P < 0.002, respectively). We also observed an increased blood alkaline phosphatase (ALP) level after EMF exposure ( P < 0.05). No significant differences in the levels of Ca, Mg, Li, or creatine were found between the exposed and unexposed groups. Our data support the notion that an EMF may prove to be an effective treatment method for osteoporosis and other abnormalities related to bone loss.