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    Atypical HSV encephalitis with initial negative polymerase chain reaction for HSV DNA [Polii?meraz zii?ncii?r reaksii?yonu ii?le başlangiç HSV-DNA'si negatii?f olan atii?pii?k hsv ensefalii?tii?]
    (Nobelmedicus, 2014) Sümer Ş.; Ural O.
    HSV-DNA in cerebrospinal fluid by polymerase chain reaction is considered as the gold standard in the diagnosis of Herpes Simplex Virus (HSV) encephalitis. Sometimes the test may be negative in the initial stage of the disease. HSV-DNA quantitation by polymerase chain reaction should be repeated in 3-7 days if a patient is thought to have HSV encephalitis, as indicated by electroencephalography / magnetic resonance imaging of brain findings even though the initial HSV-DNA quantitation by polymerase chain reaction is negative. We presented two cases with a tentative diagnosis of HSV encephalitis with atypical course, whose polymerase chain reaction results were negative for HSV-DNA initially.
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    Brucellar epididymoorchitis: A report of five cases [Brucella epididimoorşiti: Beş olgu sunumu]
    (2010) Ural O.; Dikici N.
    Epididymoorchitis caused by Brucella species is a rare infection. In this report five cases of epididymoorchitis due to brucellosis are presented with their laboratory and clinical findings. All patients complained of fever, swollen and painful testicles. The duration of their complaints varied between 10 and 21 days. All of these patients had unilateral epididymoorchitis. Brucellosis was diagnosed serologically in all patients. Brucella melitensis was isolated from the blood culture of one patient. Four patients were treated with rifampicin and doxycycline and one patient was treated with streptomycin and doxycycline. In all cases, complete resolution was achieved with medical treatment and relapse did not occur. Brucellosis should be considered in the differential diagnosis of patients presenting with epididymoorchitis in endemic areas.
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    A case of Sjogren's syndrome accompanied by signs of non-cardiac pulmonary edema and infection [Non-kardiyak akci?er ödemi ve enfeksiyon bulgularinin eşlik etti?i Sjögren sendromu olgusu]
    (2013) Sümer S.; Efe P.B.; Ural O.; Yilmaz S.
    At first presentation connective tissue diseases may mimic infectious diseases. But recurrent non-cadiac pulmonary edema accompanied by serious infectious signs is observed rarely. This patient presented with signs of pneumonia, and developed recurrent non-cadiac pulmonary edema, and had to be intubated despite appropriate treatment and Sjögren's syndrome was diagnosed after examinations and detailed history which were warranted by lack of treatment response. She was treated with hydroxychloroquine. This patient's problem was thought to be due to both findings of systemic involvement of connective tissue disease and increased frequency of infectious diseases in these patients.
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    The importance of soluble urokinase plasminogen activator receptor in patients with acute brucellosis [Solubl ürokinaz plazminojen aktivatör reseptörü’nün akut brusellozlu hastalardaki önemi]
    (Nobelmedicus, 2014) Demir N.A.; Daği H.T.; Fındık D.; Sümer S.; Ural O.; Kölgelier S.
    Objective: Brucellosis is a common zoonotic infectious disease especially in Mediterranean countries. Inflammatory markers are elevated during the course of acute brucellosis. C-reactive protein (CRP) is the most commonly used biochemical marker in clinical practice. Soluble urokinase type plasminogen activator receptor (suPAR) is an interesting biomarker which has drawn attention recently. Purpose of this study is to examine correlation between suPAR and CRP levels as markers of infectious disease in patients diagnosed with acute brucellosis. Material and Method: This study included 125 acute brucellosis patients and 50 healthy controls. Pretreatment blood samples were taken from the patients. suPAR levels were measured using ELISA and CRP levels were measured with nephelometry. Results: There was a positive correlation between suPAR levels and CRP, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (p=0.045, 0.039, 0.040; respectively). When we compared patient and control groups, CRP and suPAR levels were significantly higher than controls (p=0.001, 0.001; respectively). Growth in blood culture was detected in 14 (11.2%) patients. There was not a significant difference between patients who have or did not have growth in blood cultures (p=0.117). In the ROC curve analysis performed for suPAR, area under the curve (AUC) was 93.6% (p=0.001). Sensitivity and specificity were calculated as 84.8% and 86.0%, respectively, when suPAR’s cut-off value was taken as 3.85 ng/mL according to the ROC curve. Conclusion: Results of this study suggest that suPAR, like CRP, is a promising biomarker in acute brucellosis. © 2015, Nobelmedicus. All Rights Reserved.
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    Plasmodium falciparum and Salmonella Typhi co-infection:A case report [Plasmodium falciparum ye Salmonella Typhi Koenfeksiyonu: Bir Olgu Sunumu]
    (2014) Sümer Ş.; Ural G.; Ural O.
    Malaria and salmonella Infections are endemic especially in developing countries, however malaria and salmonella co-infection is a rare entity with high mortality. The basic mechanism in developing salmonella co-infection is the impaired mobilization of granulocytes through heme and heme oxygenase which are released from haemoglobin due to the breakdown of erythrocytes during malaria infection. Thus, a malaria infected person becomes more susceptible to develop infection with Salmonella spp. In this report a case with Plasmodium falciparum and Salmonella Typhi co-infection was presented. A 23-year-old male patient was admitted to hospital with the complaints of diarrhea, nausea, vomiting, abdominal pain, fatigue and fever. Laboratory findings yielded decreased number of platelets and increased ALT, AST and CRP levels. Since he had a history of working in Pakistan, malaria infection was considered in differential diagnosis, and the diagnosis was confirmed by the detection of P.falciparum trophozoites in the thick and thin blood smears. As he came from a region with chloroquine-resistant Plasmodium, quinine (3 x 650 mg) and doxycycline (2 x 100 mg/day) were started for the treatment. No erythrocytes, parasite eggs or fungal elements were seen at the stool microscopy of the patient who had diarrhoea during admission. No pathogenic microorganism growth was detected in his stool culture. The patient's blood cultures were also taken In febrile periods starting from the time of his hospitalization. A bacterial growth was observed in his blood cultures, and the isolate was identified as S. Typhi. Thus, the patient was diagnosed with P.falciparum and Salmonella Typhi coinfection. Ceftriaxone (1 x 2 g/day, 14 days) was added to the therapy according to the results of antibiotic susceptibility test. With the combined therapy (quinine, doxycycline, ceftriaxone) the fever was taken under control, his general condition improved and laboratory findings turned to normal values. However, on the fifth day of his anti-malaria therapy sudden bilateral hearing loss developed due to quinine use. Thus, the treatment was replaced with an artemisinin-based (arthemeter/lumefantrine) combination therapy. No adverse effects were detected due to artemisinin-based therapy, and the patient completely recovered. In conclusion, if a patient is diagnosed with malaria, he/she should be closely monitored in terms of having co-infections and appropriate diagnostic methods including blood cultures taken in febrile episodes should be performed.