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    Evaluation of Prolonged Rt-Pcr Positivity and Viral Load in COVID-19 Patients
    (2023) Urkmez, Fatma Yekta; Erol, Ozlem; Polat, Esra; Kaygusuz, Sedat
    Aim: Real-time reverse transcription polymerase chain reaction (RT-PCR) test is used in the diagnosis of COVID-19. It was aimed to evaluate the factors affecting the viral conversion time, to examine the relationship between viral load, and to determine other factors that may be associated with viral load. Material and Methods: Patients were hospitalized between 15.03.2020-01.08.2020, and viral conversion detected were evaluated retrospectively. Patients were divided into two according to viral conversion time (0-14 days vs >14 days). Results: 349 patients were included in the study (284 vs 65 patients). The age and gender characteristics were similar. Prolonged PCR positivity group had more death (p=0.036) and lower cycle-threshold (CT) value (p=0.017). In the examination of CT values of 246 patients, 228 patients with viral conversion and 18 patients without viral conversion due to death, the CT value was found to be lower, therefore the viral load was higher in patients over 60 years of age (p=0.006), in the presence of cardiovascular system disease (p<0.001) and in patients who died (p<0.001). Conclusion: Prolonged PCR positivity may indicate excess viral load and adverse outcomes. An evaluation including the patient's age, CT value, comorbid conditions, and viral conversion time can give an idea about the prognosis.
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    Predictive Significance of Laboratory Tests in Bacteremic Brucellosis
    (Iranian Scientific Society Medical Entomology, 2024) Celik, Mehmet; Cicek, Yeliz; Atalay, Ebru; Altindag, Deniz; Akgul, Fethiye; Urkmez, Fatma Yekta; Gurbuez, Esra
    Background: Brucellosis is one of the most common zoonotic infections. Although culture is the gold standard diagnostic method, bacterial growth in blood cultures may not always occur due to various factors. We aimed to investigate demographic, clinical, and laboratory findings that may have predictive significance for bacteremia in brucellosis. Methods: Patients older than 18 years of age followed up with a diagnosis of brucellosis between 2012 and 2022 were included in this retrospective multicenter study. They were divided into two main subgroups according to their Brucella species reproductive status as bacteremic and non-bacteremic. Results: A total of 743 patients, 370 (49.80%) bacteremic and 373 (50.20%) non-bacteremic brucellosis patients, were enrolled. The mean age of the bacteremic group (36.74 years) was lower than the non-bacteremic group (43.18 yr). High fever, chills/cold, sweating, nausea, vomiting, and weight loss were more common in the bacteremic group. In the bacteremic group, white blood cell count, platelet count, hemoglobin level, mean platelet volume, eosinophil, and neutrophil counts were lower, and lymphocyte, erythrocyte sedimentation rate, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and ferritin levels were higher. According to the receiver operating characteristic (ROC) analysis, when the cut-off value of ferritin was considered 67, it was the parameter with the strongest predictive significance in Brucella bacteremia. Conclusion: High ferritin level, low eosinophil count, and increased erythrocyte sedimentation rate were determined as the most critical laboratory findings in predicting bacteremia in brucellosis.
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    Predictive value of c-reactive protein to albumin ratio and systemic immune-inflammation index for the long-term mortality in COVID-19
    (2023) Polat, Esra; Şabanoğlu, Cengiz; Caner, Muhdedir; Urkmez, Fatma Yekta; İnanç, Fulden Akyüz; Öztürk, Ünal; Kandemir, Hüseyin
    Aim: Several studies have investigated the association between biomarkers and short-term prognosis in the coronavirus infectious disease 2019 (COVID-19). However, data on the long-term prognosis are limited. To determine the predictive value of systemic immune-inflammation index (SII) and C-reactive protein (CRP) to albumin ratio (CAR) for in-hospital and 1-year outcomes during COVID-19. Material and Method: The primary outcomes were in-hospital and 1-year mortality. The secondary outcomes were the intensive care unit (ICU) need at admission and transfer to the ICU later on. Results: The study included 449 (53.6%) males and 389 (46.4%) females with a mean age of 53.8±18.5 years. Previously known heart failure (HF), COVID-19-related HF, acute renal failure (ARF), diabetes mellitus, hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD)/asthma, high CO-RADS scores (>4), low ejection fraction (EF), higher CAR and SII were associated with an increased in-hospital and 1-year mortality (p<0.05). After multivariate analysis; CAR, SII, ARF, and diabetes mellitus were independent predictors of in-hospital and 1-year mortality,whereas CAD was only an independent predictor of 1-year mortality. After ROC analysis, CAR cut-off levels of 2.54 and 2.23 predicted in-hospital and 1-year mortality, respectively (p<0.001). The SII cut-off levels of 1274 and 1191 predicted in-hospital and 1-year mortality, respectively (p<0.001). Conclusion: CAR and SII can be used as valuable prognostic indexes to predict both the short-term and long-term mortality in COVID-19.
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    Salmonella Bacteremia Accompanying COVID-19: The First Salmonella Co-Infection in the World Unrelated to Pakistan
    (Ankara Microbiology Soc, 2022) Urkmez, Fatma Yekta; Atalay, Tugba
    Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection emerged in China at the end of 2019 and caused coronavirus disease 2019 (COVID-19). The lymphopenia seen in COVID-19 increases the incidence of susceptibility to other microorganisms and may cause co-infections. As the signs and symptoms of the diseases overlap with other infectious diseases and due to the intensity in health services, the diagnosis of co-infections becomes difficult and the treatment may be delayed. Therefore, infections accompanying COVID-19 cause an increase in morbidity and mortality.The isolation and quarantine measures taken during the COVID-19 process have reduced the number of infections transmitted from person to person. However, there was no significant decrease in diseases transmitted by food, such as salmonellosis. During the pandemic, salmonellosis continued to be a problem, especially in endemic areas such as Pakistan, and an increase in Salmonella infections associated with backyard poultry has been reported in countries such as the United States. A co-infection of COVID-19 and enteric fever associated with travel to Pakistan was reported for the first time in the literature in February 2021. In this case report, the first co-infection of COVID-19 and Salmonella in our country was presented. A 56-year-old male patient with no known systemic disease was admitted to the hospital with fever, shortness of breath, weakness and myalgia lasting for three days. SARS-CoV-2 polymerase chain reaction test was positive. The patient has been hospitalized and favipiravir, moxifloxacin, and methylprednisolone were started. Blood cultures were taken from the patient whose clinical picture worsened and fever continued despite of the medical treatment. Salmonella enterica spp. enterica was isolated and ceftriaxone treatment was started. The patient's anamnesis was deepened, but no diarrhea, abdominal pain, suspicious food consumption, travel history were determined. From the second day of the ceftriaxone treatment, the patient's fever decreased and no growth was detected in the control blood cultures. Ceftriaxone treatment was completed in 14 days and the patient was discharged on the 28th day. Approximately 87-95% of Salmonella strains isolated in our country are S.enterica spp. enterica, and S.enterica spp. enterica was also isolated in our case. Salmonella infections most commonly present as gastroenteritis, but the risk of bacteremia increases in case of immunosuppression. Although there was no additional disease in our case, it was considered that the infection in the form of bacteremia occurred due to an immunosuppression caused by COVID-19. In this context; drawing blood cultures of patients hospitalized with the diagnosis of COVID-19 is very important in terms of detecting co-infections and superinfections, and administering appropriate antibiotic therapy at appropriate treatment times. Presentation of first case of Salmonella bacteremia and simultaneous COVID-19 infection in our country was the strong side of our report. In addition, our case is also important as being the first SARS-CoV-2 and Salmonella co-infection unrelated to Pakistan in the literature. The limitation of our case was that S.enterica spp. enterica detected in the blood culture could not be subtyped and the stool culture could not be examined. However, this does not constitute a diagnostic requirement. In addition, the patient's pre-COVID-19 Salmonella carrier status was also unknown. As a result, patients become vulnerable to other infections due to the lymphopenia seen in COVID-19. Therefore, Salmonella bacteremia can be seen with SARS-CoV-2 infection without a comorbid condition. Drawing blood cultures in hospitalized patients with the diagnosis of COVID-19 is very important in terms of detecting concomitant infections in a short time. In patients whose clinical condition does not improve and fever continues despite of treatment, blood cultures should be taken, especially in the case of an advanced immunosuppresive treatment plan, and it should always be kept in mind that secondary infections and co-infections may occur.