Ali Agacfidan

In vitro activity of azithromycin (CP-62,993) against Chlamydia trachomatis and Chlamydia pneumoniae.

The in vitro susceptibilities of 49 strains of Chlamydia trachomatis and 3 strains of Chlamydia pneumoniae to azithromycin and tetracycline or doxycycline were determined. The MIC of azithromycin ranged from < or = 0.06 to 1.0 micrograms/ml, the MIC of tetracycline ranged from 0.03 to 0.12 micrograms/ml, and the MIC of doxycycline ranged from 0.015 to 0.06 micrograms/ml against C. trachomatis. The MIC ranges for C. pneumoniae were 0.12 to 0.25 micrograms/ml for azithromycin and 0.06 to 0.12 micrograms/ml for tetracycline. All minimal chlamydicidal concentrations were either equal to the MIC or one or two dilutions higher. No strains resistant to these antibiotics were detected. In vitro activity shows that azithromycin is highly active against C. trachomatis and C. pneumoniae.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Turkey among men with urethritis.

Background Chlamydia trachomatis and Neisseria gonorrhoeae are known to cause urethritis. However, only a small number of studies in Eastern European countries have investigated the causes of urethritis. Goals To determine the prevalence of C trachomatis and N gonorrhoeae among men with symptomatic urethritis in Istanbul, Turkey, and to determine whether contact with a commercial sex worker increased the likelihood of chlamydial infections. Study Design Men with a diagnosis of urethritis at the Istanbul Faculty of Medicine were screened for C trachomatis and N gonorrhoeae by Abbott’s ligase chain reaction (LCR) using either urethral swabs or first-void urine. N gonorrhoeae cultures were done on a subset of these patients. Results The study enrolled 813 men. All of the men denied condom use during their previous sexual exposures. The overall prevalence of C trachomatis, as determined by LCR, was 15.7%. Only 192 patients were screened for both organisms. N gonorrhoeae prevalence was 9.4%. There was no difference in the chlamydia prevalence between men who had contact with commercial sex workers (CSWs) and men who had no such contact (15.3% versus 17.2%). However, clients of foreign CSWs were more likely to have chlamydia than clients of registered Turkish CSWs. Conclusions C trachomatis and N gonorrhoeae are commonly found in Turkish men with urethritis. The findings did not show more chlamydial infection among men who had contact with CSWs than among men who had no such contact. The failure to use condoms among these men must be addressed.

Screening of sex workers in Turkey for Chlamydia trachomatis.

Background: Increasing migration of sex workers across East European borders into Turkey has resulted in increased arrests of unregistered sex workers. There is concern regarding the prevalence of sexually transmitted diseases(STD) such as C. trachomatis in this unregulated group. Objective: To measure the prevalence of C. trachomatis infection and selected related demographic and behavioral factors among registered and unregistered sex workers in Istanbul, Turkey. Methods: In a cross‐sectional study, the prevalence of C. trachomatis infection was studied by direct fluorescent antibody testing in 248 sex workers: 158 presented for routine medical screening and 90 who were arrested for lack of registration. All subjects were interviewed regarding demographic factors, sexual activity, and antibiotic and drug use. Results: The overall C. trachomatis prevalence was 12.9% (12.0% registered and 14.4% unregistered). There was a strong association between never using condoms and chlamydia positivity (odds ratio 8.9 [95% confidence interval 3.7 to 21.6]). Conclusions: The high rate of C. trachomatis among all tested sex workers and the lack of regular condom use, particularly among unregistered sex workers, indicate that there is an urgent need for safe sex education and continued STD screening of unregistered sex workers.

HIV prevalence and route of transmission in Turkish immigrants living in North-Rhine Westphalia, Germany

The high number of Turkish immigrants in the German state North-Rhine Westphalia (NRW) compelled us to look for HIV-infected patients with Turkish nationality. In the AREVIR database, we found 127 (107 men, 20 women) Turkish HIV patients living in NRW. In order to investigate transmission clusters and their correlation to gender, nationality and self-reported transmission mode, a phylogenetic analysis including pol gene sequences was performed. Subtype distribution and the number of HIV drug resistance mutations in the Turkish patient group were found to be similar to the proportion in the non-Turkish patients. Great differences were observed in self-reported mode of transmission in the heterosexual Turkish male subgroup. Neighbour-joining tree of pol gene sequences gave indication that 59% of these reported heterosexual transmissions cluster with those of men having sex with men in the database. This is the first study analysing HIV type distribution, drug resistance mutations and transmission mode in a Turkish immigrant population.

Hyper-IgE syndrome with widespread premalign oral papillomas treated with interferon α2b

We report a case of a 7-year-old girl with hyperimmunoglobulin-E syndrome presenting with widespread oral papillomas which were tested for human papilloma virus DNA and had shown to be at high/intermediate risk group for malignancy. She had elevated levels of IgE, recurrent sinopulmonary infections, atopic-like dermatitis, peripheral eosinophilia and defective neutrophil chemotaxis. Interferon alfa 2b therapy and chemoprophylaxis with sulfamethoxazole-trimethoprim was given. Although the papillomas partially improved with the treatment, sinopulmonary infections continue to occur.

Syphilis prevalence among unregistered prostitutes in Istanbul, Turkey.

Between August and November 1991 in Turkey police arrested 203 prostitutes who had not registered as prostitutes in Istanbul. Physicians at the Dermatology and Venereal Diseases Hospital took a medical history and blood samples from these unregistered prostitutes. 96 prostitutes were Rumanian women 88 were Turkish women and 19 were Turkish male transsexuals. No unregistered prostitute had signs or symptoms of primary secondary or tertiary syphilis. 14.3% (29) did have early or late latent syphilis however. 19.7% (40) had history of treatment for syphilis and did not currently have syphilis. No significant differences existed in syphilis prevalence between Rumanian and Turkish prostitutes. Syphilis diagnosis was significantly more common in male transsexuals than in women (31.6% vs. 12.5%; p = .036). Further male transsexuals were more likely to have been treated for syphilis in the past than were women (58 vs. 15.8%; p = .0001). Moreover the men were more apt to have positive Treponema palladium hemagglutination assay (TPHA) and enzyme immunoassay (EIA)-IgG results than the women (89.5 vs. 28.3%; p < .0001). Positive TPHA and EIA-IgG results were significantly more common in Rumanian women than in Turkish women (38.5 vs. 17%; p = .002). Prevalence of IgM antibodies was basically the same in all 3 groups. Prevalence of syphilis in unregistered prostitutes was much greater than in about 5000 normal obstetric patients in Istanbul (1 case of latent syphilis). These findings indicated that unregistered prostitutes are at high risk for syphilis due to their illegal status. This places their clientele at high risk of syphilis and other sexually transmitted diseases.

Role of Autoantibodies to N-Methyl-d-Aspartate (NMDA) Receptor in Relapsing Herpes Simplex Encephalitis A Retrospective, One-Center Experience

Post–herpes simplex virus encephalitis relapses have been recently associated with autoimmunity driven by autoantibodies against N-methyl-d-aspartate (NMDA) receptors. Because it offers different treatment options, determination of this condition is important. Between 2011 and 2014, 7 children with proven diagnosis of herpes simplex virus encephalitis were identified in a university hospital of Istanbul. Two patients had neurologic relapse characterized mainly by movement disorders 2 to 3 weeks after initial encephalitis. The first patient received a second 14 days of acyclovir treatment together with antiepileptic drugs and left with severe neurologic sequelae. The second patient was found to be NMDA receptors antibody positive in the cerebrospinal fluid. She was treated with intravenous immunoglobulin and prednisolone. She showed substantial improvement, gradually regaining lost neurologic abilities. Post–herpes simplex virus encephalitis relapses may frequently be immune-mediated rather than a viral reactivation, particularly in children displaying movement disorders like choreoathetosis. Immunotherapy may provide benefit for this potentially devastating condition, like the case described in this report.

Bacterial pathogens in male patients with urethritis in Istanbul [letter]

A study conducted at the Medical Facility of Istanbul (Turkey) investigated the presence of bacterial pathogens in 486 male patients with urethritis. Patients had one or more complaints of urethral discharge dysuria or urethral pruritus and more than four polymorphonuclear leukocytes per oil-immersion field of Grams stain of urethral swabs. The explored bacteria were detected and confirmed by a second test in 316 of these patients. The bacteria isolated were Neisseria gonorrhoeae (n = 41 8.4%) Chlamydia trachomatis (n = 112 23%) Ureaplasma urealyticum (n = 175 36%) Haemophilus influenzae (n = 8 1.8%) Haemophilus parainfluenzae (n = 11 2.2%) and Gardnerella vaginalis (n = 2 0.4%). Of 42 N. gonorrhoeae strains 8 (19%) were resistant to penicillin G and 7 of these strains were penicillinase-producing N. gonorrhoeae; 1 isolate was resistant to tetracycline. The resistance rates of the 67 U. urealyticum isolates were 23.8% for ciprofloxacin 5.9% for tetracycline and 2.9% for minocycline. The high rate of penicillin G resistance in N. gonorrhoea and ciprofloxacin resistance to U. urealyticum underscores the need for conventional therapies to be reviewed and new schemes developed through systematic multicenter studies in communities where empiric therapy for sexually transmitted diseases is widely used.

The treatment of non-gonococcal urethritis with single dose oral azithromycin.

In an uncontrolled study, the efficacy of azithromycin in the treatment of non-gonococcal urethritis was assessed in 41 male patients aged between 20 and 40 years with a mean age of 27 ± 5 years. Clinical and microbiological diagnosis confirmed that 28 men were found positive for Chlamydia trachomatis, 10 for Ureaplasma urealyticum and three for both C. trachomatis and U. urealyticum. All patients received 1 g azithromcyin orally (four 250 mg capsules). The length of time between the treatment and following visits were 7 – 10 days and 14 – 21 days for second and third visits, respectively. Complete eradication was achieved in 27 out of 41 patients. Of the remaining 14, six were found positive for C. trachomatis and were excluded as they did not return for the follow-up visit, one patient did not achieve complete eradication, one patient infected with both C. trachomatis and U. urealyticum failed to achieve complete eradication, and six patients infected with U. urealyticum failed to be completely cured. No adverse effects were reported in any patient. Single dose administration of 1 g azithromycin appears to be an effective and well-tolerated treatment for chlamydial urethritis and an advantage in terms of patient compliance.

HIV in Turkey, a country bridging the Islamic world and Europe

The last conference of the International AIDS ociety in Kuala Lumpur in 2013 drew attention o the underestimated number of people with IV/AIDS in Muslim countries. Turkey is located at he intersection of two continents, with the ancient ity of Istanbul located in Europe and the larger part f the country, Anatolia, located in Asia. Turkey borers countries with high reported rates of sexually ransmitted diseases. Three cases of HIV/AIDS were eported in Turkey in 1985, and the number of cases as increased ever since. According to Turkish Minstry of Health (MoH) data from 2012, there are 5137 IV-positive cases and 1051 AIDS cases registered n Turkey [1]. During the last few decades, the priary focus of diagnostic, therapeutic and scientific ork in Turkey was on Hepatitis B, C and D, and o lesser extent on HIV. Today, HIV/AIDS is considred to be an emerging disease in Turkey (Fig. 1). he reported prevalence data published by the MoH eveal that the HIV/AIDS rates in Turkey are relaively low compared to the hardest-hit countries. ere, most cases of HIV/AIDS can be observed in he 20—59 age group. Of people with HIV/AIDS, 2% are male and 28% are female. The transmision of HIV/AIDS in Turkey differs from Western urope in that the main 2 routes of transmission re through heterosexual contact (48.9%) followed y homosexual contact (8.9%) whereas in Europe, IV/AIDS is more frequently transmitted by risk ehavior among homosexuals [1]. It should be noted hat sex work is considered to be the major driver f the epidemic of sexually transmitted diseases nd HIV in Turkey [2]. The HIV/AIDS Control Proramme in Turkey monitors HIV infection through 1 countrywide Provincial Health Directorates that re geographically distributed to represent all parts f the country. HIV/AIDS cases are reported to local ealth directorates and then to the MoH through patient coding system after blood samples are onfirmed by Western Blot in one of nine Confiration Centres countrywide. The Department of T i k N