Objective: To evaluate the prevalence of Candida species in cancer patients with candidemia around the world, and to identify related risk factors and their antifungal resistance, with an emphasis on non-albicans Candida species (NACs). Methods: The published papers related to the subject were systematically searched in databases of MEDLINE (including PubMed), Web of Science, Scopus, Science Direct, and Google Scholar between the 1 st January 2000 and 21 st April 2021. Results: Among the 4 546 records, 69 studies met the inclusion criteria. The pooled prevalence of NACs in cancer patients with candidemia was 62% (95% CI 58%-67%; I 2 =94.85%, P=0.00). Based on type of cancer, the pooled prevalence of NACs in hematologic and solid cancer patients were 68% (95% CI 65%-70%) and 52% (95% CI 49%-54%), respectively. Among NACs, Candida (C.) parapsilosis was the most frequently isolated organism followed by C. tropicalis and C. glabrata. In addition, the therapeutic usage of antibiotics was found as the most common risk factor, accounting for 85% (95% CI 81%-89%) and central venous catheter accounting for 69% (95% CI 62%-77%). Conclusions: The incidence of Candida bloodstream infections among cancer patients is a growing concern, especially when the etiologic agents of candidemia tend to shift towards NACs.

Objective: To evaluate long-term effects of COVID-19, and to determine the risk factors in long-COVID in a cohort of the Turkish Thoracic Society (TTS)-TURCOVID multicenter registry. Methods: Thirteen centers participated with 831 patients; 504 patients were enrolled after exclusions. The study was designed in three-steps: (1) Phone questionnaire; (2) retrospective evaluation of the medical records; (3) face-to-face visit. Results: In the first step, 93.5% of the patients were hospitalized; 61.7% had a history of pneumonia at the time of diagnosis. A total of 27.1% reported clinical symptoms at the end of the first year. Dyspnea (17.00%), fatigue (6.30%), and weakness (5.00%) were the most prevalent long-term symptoms. The incidence of long-term symptoms was increased by 2.91 fold (95% CI 1.04-8.13, P=0.041) in the presence of chronic obstructive pulmonary disease and by 1.84 fold (95% CI 1.10-3.10, P=0.021) in the presence of pneumonia at initial diagnosis, 3.92 fold (95% Cl 2.29-6.72, P=0.001) of dyspnea and 1.69 fold (95% Cl 1.02-2.80, P=0.040) fatigue persists in the early-post-treatment period and 2.88 fold (95% Cl 1.52-5.46, P=0.001) in the presence of emergency service admission in the post COVID period. In step 2, retrospective analysis of 231 patients revealed that 1.4% of the chest X-rays had not significantly improved at the end of the first year, while computed tomography (CT) scan detected fibrosis in 3.4%. In step 3, 138 (27.4%) patients admitted to face-to-face visit at the end of first year; at least one symptom persisted in 49.27% patients. The most common symptoms were dyspnea (27.60%), psychiatric symptoms (18.10%), and fatigue (17.40%). Thorax CT revealed fibrosis in 2.4% patients. Conclusions: COVID-19 symptoms can last for extended lengths of time, and severity of the disease as well as the presence of comorbidities might contribute to increased risk. Long-term clinical issues should be regularly evaluated after COVID-19.

Objective: To investigate long-term symptoms after acute COVID-19, the link between symptoms and respiratory function, radiological changes in the post-COVID period, and risk factors for post-COVID syndrome. Methods: In this cross-sectional study, 123 participants who were admitted within the first 3 months were categorized as group 1, and those who applied after 3 months were categorized as group 2. According to thoracic imaging and pulmonary function tests, patients were split into 3 groups as mild, moderate and severe. Results: At least one symptom was present in 91.9% and 61.8% in acute and post-COVID period, respectively. Pulmonary function tests were normal in 60 (70.6%) in the first three months, and 30 (78.9%) in 91-days to 1-year period after acute COVID-19 infection. After 3 months, 22.4% of chest X-rays and 7.9% of computerized tomography revealed progression. Patients who developed acute complications (OR 9.91, 95% Cl 1.93-50.87), had 2 or more symptoms at admission (OR 7.73, 95% CI 2.56-23.33), had 1% to 14% CT involvement (OR 3.05, 95% CI 1.06-8.79), or had 50% or more CT involvement (OR 14.68, 95% CI 1.24-172.55) had a higher risk of developing post-COVID syndrome. Conclusions: COVID-19 symptoms can last for long time. Severity of symptoms, acute complications, and the extent of radiological involvement may all contribute to elevated risk of post-COVID syndrome. As a result, patients with COVID-19 should be checked for long-term clinical difficulties on regular basis.

Objective: To compare the DNA sequences of Leishmania (L.)donovani isolated from individuals in two districts of the Northern Province with other parts of Sri Lanka and neighboring countries. Methods: Samples were collected from military personnel at the Army Hospital, Narahenpita, Sri Lanka from November 2018 to March 2020. A portion of the samples was fixed, stained with Giemsa and observed under the light microscope. The genomic The DNA was extracted from the remaining portion of the samples using DNEasy blood tissue kit (Qiagen, Germany) and amplified using Leishmania genus-specific primers for molecular diagnosis initially. DNA was amplified using L. donovani species-specific primers by PCR and the amplified product was sequenced for comparison of nucleotide sequences. Results: Out of 76 suspected patients, at least one biological sample of 45 (59.2%) was positive for L. amastigotes upon microscopy. Overall, 33 (43.4%) were positive in Leishmania genus-specific PCR, but only 23 (30.3%) were positive in L. donovani specific PCR. The dendrogram indicates that the current sequences clustered together with those from Nepal and Gampaha districts (Western Province), Sri Lanka, while the Indian and Eastern African sequences clustered separately. Conclusions: The genetic diversity was low among the isolates, indicating a single and possibly a local point of origin. However, the similarity of Sri Lankan and Nepal strains indicate a possibility of a shared point of origin, which needs more extensive evidence to confirm.

Rationale: Guillain Barre syndrome (GBS) is an acute neurological illness leading to quadriparesis with respiratory involvement. It can be triggered by infections, vaccinations, surgery, trauma, transplantation and drugs. Anti-rabies cell culture vaccines introduced to overcome the high rate of neurological complications associated with tissue based rabies vaccine, can be very rarely associated with GBS. Patient concerns: A 50-year-old female presented with acute severe upper back pain evolving into pure motor quadriparesis following administration of human diploid cell vaccine for rabies. Diagnosis: Acute motor axonal neuropathy variant of GBS following anti-rabies human diploid cell vaccine. Interventions: Intravenous high dose steroids. Outcomes: Patient recovered completely within 1 month. Lessons: Although anti-rabies cell culture vaccines are highly immunogenic and safe, they are rarely associated with GBS. Clinicians should be aware of this link because prompt diagnosis and treatment can result in complete recovery and avoid complications.

Objective: To compare the efficacy and safety outcomes of different antileishmanial agents used in visceral leishmaniasis clinical trials. Methods: A systematic literature search in PubMed/MEDLINE, EMBASE, Cochrane, and Google Scholar was done using keywords 'randomized controlled trials', 'antileishmanial' and 'visceral leishmaniasis'. The outcomes included were cure rate, overall withdrawals, relapse rate, and treatment-emergent adverse events. Effect estimates through the frequentist network meta-analysis approach were presented as OR with 95% CI. Rankogram plots were used for identifying the 'best intervention' based on p-scores obtained using the surface under the cumulative ranking. The risk of bias was evaluated by using Pedro Scale. Results: Seventeen randomized controlled trials with 5 143 visceral leishmaniasis patients who received different antileishmanial agents (amphotericin B, miltefosine, paromomycin, meglumine antimoniate, sodium stibogluconate, sitamaquine, and pentavalent antimonials) and met the inclusion criteria were included. For efficacy outcomes of the treatments, the rankogram of the network meta-analysis revealed that paromomycin (p-score=0.814 8) has the highest probability of being best in the pool, followed by sodium stibogluconate (OR 0.82, 95% CI 0.24-2.79, p-score=0.758 0), amphotericin B+miltefosine (OR 0.66, 95% CI 0.02-19.04, p-score=0.732 9) as compared to the remaining treatments; however, the most of the treatment-emergent adverse events were reported with sitamaquine. Conclusions: Paromomycin reported the highest cure rates, while the maximum treatment-emergent adverse events were seen with sitamaquine.

Objective: To examine the effects of human bocavirus type 1 (HBoV1) on the course of lower respiratory tract infections in cases of monoinfection and coinfection, and the effects of HBoV1 viral load on the disease in children under six years old hospitalized with a diagnosis of HBoV1-associated lower respiratory tract infections. Methods: Children under six years of age, who were hospitalized with the diagnosis of lower respiratory tract infection due to HBoV1 between 1 January 2021 and 1 January 2022 were included in the study. Laboratory confirmation of the respiratory pathogens was performed using polymerase chain reaction (PCR). Results: Fifty-four (16.4%) children with HBoV1 among 329 children whose PCR was positive with bacterial/viral agent in nasopharyngeal swab samples were included in the study. There were 28 (51.9%) males and 26 (48.1%) females with a median age 23.4 months [interquartile range (IQR): 13.2, 30.0 months] (min-max:1 month-68 months). HBoV1 was detected as a monoinfecton in 26 (48.1%) children, and as a coinfection with other respiratory agents in 28 children (51.9%). In multiple regression analysis, coinfection (P=0.032) was associated with the length of hospitalization (P<0.001; R 2 =0.166). There was a negative correlation (r= 0.281, P=0.040) between cough and cycle threshold. Fever was found to be positively correlated with C-reactive protein (r=0.568, P<0.001) and procalcitonin (r=0.472; P=0.001). Conclusions: Although we found a higher HBoV1 viral load in children with more cough symptoms in our study, it had no effect on the severity of the disease, such as length of hospital stay and need for intensive care. Coinfection was found to affect the length of hospitalization.

Objective: To identify the relationship between interleukin (IL)-15 levels and sarcopenia in human immunodeficiency virus (HIV)- infected patients who have received antiretroviral therapy. Methods: This study was a cross-sectional design with 70 participants conducted from January to March 2021. All the participants were assessed for sarcopenia and the IL-15 levels. Sarcopenia was established based on the the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Plasma IL-15 was determined. This analysis was carried out by means of 2×2 tabulation and the statistical test used is Chi-square. Results: Seventy patients received antiretroviral therapy >6 months and showed a good clinical response. Among them, 36 (51.4%) took zidovudine-based antiretroviral therapy with a median duration of illness of 5 years. The proportion of sarcopenia in patients with HIV infection was 32.9%. The median CD4 cell count was 395.5 cells/L (range: 203-937 cells/L). Logistic regression analysis revealed that age>50 years (aOR 8.3, 95% CI 1.6-44.5), underweight (aOR 7.7, 95% CI 1.5-40.5), IL-15≥150.5 ng/L (aOR 4.9, 95% CI 1.3-19.0) and female (aOR 4.8, 95% CI 1.2-18.3 were significant and independent adverse predictors of sarcopenia in subjects with HIV infection. Conclusions: There is an association between high levels of IL-15 and sarcopenia in HIV-infected patients on antiretroviral therapy for more than 6 months with good clinical response.

Objective: To find a proper method to assess colistin resistance in multidrug resistant Gram negative bacteria (MDR-GNB) on a routine basis in resource limited settings. Methods: Clinical samples were processed. MDR-GNB were identified and were examined for colistin resistance by colistin broth elution method, colistin agar method, and colistin disk elution screening method. Broth microdilution method was used the gold standard. Results: A total of 10 235 clinical samples were processed, in which 857 (8.4%) MDR-GNB were identified. The very significant errors, categorical agreement, major errors, positive predictive values, negative predictive values, specificity and sensitivity of all the phenotypic methods were 5.5%, 0%, 94.4%, 100%, 99.6%, 100% and 94.4%, respectively for the detection of colistin resistance. The colistin elution screening method was cheap and easy to perform with similar results to broth microdilution method. Conclusions: All the evaluation methods for colistin resistance showed similar results. So the laboratories can choose any method for detection of colistin resistance. However, we recommend colistin disk elution screening method because, it is easy and cheap and can be performed in limited resources.

Objective: To report an outbreak of Burkholderia (B.) cepacia related to contaminated surface cleaner in the pediatric ward of a tertiary hospital in Turkey. Methods: This study retrospectively reported the outbreak occurred between January 16, 2018 and January 23, 2018. Twelve immunocompetent patients who developed a bloodstream infection a few days after the hospitalization and who were positive for B. cepacia were included. Environmental samples were collected from various areas in the hospital to find the source of the outbreak. Results: All patients had clinical and biochemical evidence of sepsis. None of the patients had an underlying disease or had a central venous catheter as a risk factor. B. cepacia was isolated from the samples taken from the surface cleaners. The antibiotic susceptibilities of B. cepacia isolates were identical in the surface cleaners with the isolates from the patients' blood cultures. The outbreak was controlled after removing the surface cleaners from use. None of the infected patients died during the outbreak. Conclusions: Nosocomial B. cepacia outbreak may occur in immunocompetent children as well. Rapid identification of the outbreak, defining the source and taking appropriate measures to control the outbreak are the key points in the management.