Ahmet Carhan

Characterization of a sandfly fever Sicilian virus isolated during a sandfly fever epidemic in Turkey

BACKGROUND Phleboviruses cause sandfly fever but isolates are rare. OBJECTIVES To analyse samples from concurrent outbreaks of suspected sandfly fever in the Mediterranean provinces of Adana, Izmir and the central province of Ankara, Turkey. STUDY DESIGN Samples from acute cases were analysed by immunofluorescence assay (IFA). Virus isolation was attempted and pyrosequencing performed. RESULTS In IFA 38% of 106 samples tested scored IgM positive for sandfly fever Sicillian virus (SFSV), 12% for SFSV/sandfly fever Cyprus Virus (SFCV) and only 4% for SFCV. A sandfly fever Sicilian type virus designated sandfly fever Turkey virus (SFTV) was isolated. The S-segment sequence of SFTV had a homology of 98% to that of SFCV. The M-segment sequence showed a 91.1% homology to the only SFSV sequence available. The L-segment sequence showed a homology of 58% and 60.3% to Toscana virus and Rift Valley Fever virus sequences, a partial 201nt sequence showed 95.5% homology to the SFSV Sabin strain. CONCLUSION A new phlebovirus related to sandfly fever Sicilian virus, SFTV was isolated and characterized from acute patient material. The sandfly fever Sicilian virus activity seems to be changing in Turkey. Entomological studies are needed.

Detection of Crimean-Congo hemorrhagic fever virus genome in saliva and urine.

BACKGROUND The Crimean-Congo hemorrhagic fever (CCHF) virus is transmitted by tick bites and by contact with the blood or tissues of infected patients and livestock. This study was designed to investigate the genome of CCHF virus in saliva and urine samples of patients with CCHF. METHODS Eight patients with laboratory-confirmed CCHF were included in the study. The diagnosis was made by detection of viral RNA in blood by real-time reverse transcriptase-polymerase chain reaction (real-time RT-PCR). Samples of saliva from six patients and samples of urine from three patients were collected at the same time as the blood samples and analyzed for viral RNA. RESULTS The genome of CCHF virus was detected in the saliva from five of the six patients and in the urine from two of the three patients. The levels of viral load in the saliva and urine samples were similar to those in the blood samples in all but one patient, in whom higher levels were detected in blood compared to saliva or urine. CONCLUSIONS This study shows that during human infection with CCHF virus, viral genomes are present in the saliva and urine. Further studies to isolate infectious viruses from these fluids and to study whether they represent an infectious risk are underway.

The neutralizing capacity of Androctonus crassicauda antivenom against Mesobuthus eupeus scorpion venom.

Scorpion envenomations are considerable health problem in tropical and subtropical regions. There are approximately 1,500 species of scorpions worldwide. The number of dangerous species in the Buthidae family is significantly higher than in other families of scorpions. Mesobuthus eupeus is a member of Mesobuthus genus, Buthidae family. In this study, the potency and para-specific activities of Androctonus crassicauda antivenom were investigated against M. eupeus scorpion venom. The median lethal dose of M. eupeus and A. crassicauda scorpion venoms were found to be 0.18 mg/kg, 15.45 microg/kg by i.c.v injection route. The antivenom showed neutralization effect against the venoms of M. eupeus. One milliliter of A. crassicauda antivenom neutralizes 464LD(50) of M. eupeus and 940LD(50)A. crassicauda venom on mice. Western blotting demonstrated immunologic reaction with the venoms. The monovalent antivenom has immunoactivity and neutralizing capacity to the scorpion venoms. This study indicates that the antivenom produced by Refik Saydam Hygiene Center could be used for the treatment of M. eupeus stings in Turkey.

Crucial parameter of the outcome in Crimean Congo hemorrhagic fever: Viral load.

BACKGROUND Crimean Congo hemorrhagic fever (CCHF) is a fatal disease with a mortality rate of 5-30%. CCHF can be asymptomatic or it may progress with bleeding and cause mortality. OBJECTIVES To evaluate relation of viral load with mortality, clinical and laboratory findings in CCHF. STUDY DESIGN A total of 126 CCHF patients were included. Serum samples obtained from all patients on admission for measurement of viral load. RESULTS In our study, mortality rate was 11.1%. The most important prognostic factor was viral load. Mean viral load was 8.3×10(7)copy/ml and 4.6×10(9)copy/ml in survived and dead patients, respectively (p<0.005). Probability of survival is found to be significantly reduced where AST >1130U/l, ALT >490U/l, CPK >505U/l, LDH >980U/l, platelet count <23×10(3)/l, creatinine >1.4mg/dl, INR >1.3, d-dimer >7100ng/dl, and viral load >1.03×10(8)copy/ml. Patients with 10(8)copy/ml or higher viral load had diarrhea, headache, unconsciousness, bleeding, and seizure significantly more frequently (p<0.05). WBC, hemoglobin, platelet counts were significantly lower whereas AST, ALT, CPK, LDH, creatinine levels, PT and aPTT time, d-dimer levels, and INR were found to be significantly higher in these group. CONCLUSIONS There are several severity criteria for prognosis of CCHF. In addition to these parameters, we introduce creatinine as a predictive factor for prognosis. Our study, which has the largest number of patients among studies that evaluate viral load on CCHF shows that viral load is the most effective parameter on mortality.

Determination of Circulating Tumor Cells by Flow Cytometry in the Bladder Cancer Patients

Background The current study aimed to detect of circulating tumor cells (CTCs) in 7.5 mL blood sample in bladder cancer patients treated with transurethral resection (TUR) or radical cystectomy (RC) and compare the pre-operative and post-operative CTC counts. Materials and Methods CTCs were detected in peripheral blood of 10 bladder cancer patients with flow cytometry using biomarkers EpCAM, CK 14, 15, 16, 19 and CK 7, 8 for positive selection and CD45 for negative selection. The blood samples obtained before and after operation were studied in 5 out of 10 patients. Results The CTC counts decreased significantly in patients (Z=2.032; p=0.042) after the operation. The pre-operative CTC counts for the patient group were found to be significantly higher than the control group. No CTCs were detected in the control group. Conclusion The results are promising in terms of CTC detection in bladder cancer (Bca) by flow cytometry. Preand post-operative CTC counts as predictive and prognostic biomarker dramatically change in this study.