Objective: Haemorrhagic cystitis associated with BK virus (BKV) is a common and life-threatening complication in patients with haematopoietic stem cell transplantation (HSCT). In this study, we aimed to investigate the incidence of BKV infection in children with HSCT. Methods: A total of 21 patients aged 7 months to 16 years followed between July 2014 and July 2015 were included in the study. 19 of the patients received allogeneic HSCT and 2 received autologous HSCT. artus ® BK Virus RG PCR Kit (Qiagen GmbH, Hilden, Germany) was used for detection of BKV DNA in urine and blood samples. Results: BKV infection was detected in 10 (47%) of 21 patients. Cystitis due to BKV developed in 4 (19%) of the patients. Haemorrhagic cystitis was observed to appear at a median of 23 days after HSCT. Urinary viral load was found to be >10 8 copies/μl within the previous week before the development of cystitis, and this finding has been accepted as a prognostic indicator. On the other hand, viral load in blood increased to >10 4 copies/ μl after 21-28 days from the onset of cystitis. All patients with cystitis were allogeneic HSCT recipients under myeloablative therapy (high-intensity regimen) for conditioning regimen. Conclusions: Screening of HSCT recipients for BKV infection, especially for viruria, is important for establishing the predictive diagnosis of patients at high risk for haemorrhagic cystitis and for better management of their treatment.

Influenza virus infections are extremely important for human health due to the occurence of seasonal epidemics and pandemics worldwide. Influenza is associated with high morbidity and may result in serious complications such as life threatening viral or bacterial pneumonia. Especially, young children, older adults, patients with chronic diseases such as heart, lung, kidney, and diabetes and immunosuppressed people are at higher risk for complications and death from influenza virus infections. The aim of this study was to determine the incidence of influenza type A and B virus infections and influenza A virus subtypes in hospitalized patients with respiratory tract infections by real-time reverse transcriptase-polymerase chain reaction (RT-PCR, Sacace, Italy), conventional RT-PCR and direct immunofluorescence antibody (DFA, Argene SA, France) tests. Nasopharyngeal swab specimens were collected from a total of 476 patients with respiratory tract symptoms by using flocked swabs (Copan Diagnostics, Italy) between 1 April 2012 and 31 December 2013. Influenza A virus was detected in 20.5% (98/476) and influenza B virus in 3.3% (16/476) of the cases by real-time RT-PCR test. During the study period, 63.3% of 98 influenza virus isolates were found as influenza A(H1N1)pdm09 and 36.7% were influenza A(H3N2) subtypes. Influenza A (H1N1) pdm09 subtype was observed in 12 cases in January 2013 and influenza A(H3N2) subtype was observed in 11 cases in December 2013 as the highest values. When the real-time RT-PCR test was regarded as the reference test, the sensitivities of DFA test for influenza A and B and conventional RT-PCR test with WHO primers (M30F2/08 and M264R3/08) for influenza A were detected as 72.4%, 75%, 96% and the specificities were detected as 99.2%, 99.5% and 100%, respectively. In conclusion, influenza A virus infection was detected rather high with a rate of 20.5% in the study group. The monitoring of influenza virus types and subtypes is required for the evaluation of influenza vaccine strains and circulating influenza viruses and for the identification of subtypes with pandemic potential. Planning for appropriate antiviral therapy using real-time RT-PCR in the early diagnosis of influenza virus infections will significantly contribute to the management of the patient's treatment. Thus, unnecessary drug use will be prevented and controlled with effective treatment of the disease at the time of infection.

Purpose: Haematopoietic stem cell transplant (HSCT) recipients with iatrogenic immunosuppression are high-risk patients for viral infections. The aim of this study was to investigate the incidence of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and adenovirus (ADV) infections in HSCT recipients. Materials and Methods: We prospectively monitored 35 patients aged 0-17 years who had allogeneic (n=30) and autologous (n=5) HSCT by quantitative real-time polymerase chain reaction tests for CMV, EBV, and ADV. The monitoring was performed one week before HSCT and weekly for the first 100 days, once a month up to one year after HSCT. In addition, seropositivity for viruses was analysed by Enzyme-Linked Immuno Sorbent Assay a week before transplantation. Results: Before transplantation, all 35 (100%) patients who underwent HSCT were CMV IgG positive, 30 (85.7% - 95% CI: 74.1%-97.3%) HSCT recipients were found to be EBV IgG positive. CMV infection was found in 24 (80% - 95% CI: 65.7%-94.3%), ADV infection in 11 (36.7% - 95% CI: 19.4%-53.9%) and EBV infection in 8 (26.7% - 95% CI: 10.8%-42.5%) allogeneic HSCT patients. In this group, CMV DNA viral load in 8 (26.7%) patients, of which one (3.3%) coinfected with EBV DNA and one (3.3%) with ADV DNA, was higher than 1000 copies/mL which was required for pre-emptive treatment. Among 5 autologous HSCT recipients, CMV DNA was detected in 2 patients, EBV DNA in 5 and ADV DNA in 2. Pre-emptive treatment was given to 11 (%31.4 - 95% CI: 16%-46.8%; 6 CMV, 2 EBV, 1 ADV, 1 CMV-EBV and 1 CMV-ADV infection) of 35 patients. Thus, the development of viral disease was prevented in 7 (63.6% - 95% CI: 35.2%-92.1%). Of the total 35 patients, only 2 (5.7% - 95% CI: 0.0%-13.4%) died due to viral infection. Conclusion: Early diagnosis of viral infections by prospective monitoring of viral loads in HSCT patients would be effective in preventing morbidity and mortality by ensuring timely initiation of pre-emptive therapy.

Background: Human parvovirus B19 infection during pregnancy may cause fetal loss. The aim of this study was to detect the incidence of B19 infection in cases of nonimmune hydrops fetalis (NIHF), spontaneous abortion, intrauterine fetal death (IUFD) and in healthy pregnant women. Material and Methods: Serum samples of pregnant women with NIHF (9), spontaneous abortion (27), IUFD (5) and healthy pregnant women (47) were tested by nested PCR to detect B19 DNA and by ELISA test for B19 specific IgM and IgG antibodies. In other case series of the study, paraffin-embedded fetal and placental tissue samples from 33 NIHF cases and 19 spontaneous abortion cases and placental tissues from 40 normal pregnant women at term were analyzed for B19 DNA by nested PCR. Results: B19 infection was diagnosed by PCR and ELISA tests using serum samples in 4 (44%) of 9 NIHF cases and 9 (33%) of 27 spontaneous abortion cases and in 1 (20%) of 5 IUFD cases. In addition, B19 IgG prevalence was found to be 51% (24/47) in the control group. In other case series, the presence of B19 DNA in fetal and placental tissue samples was found in 14 (42.4%) of 33 NIHF cases and 6 (31.5%) of 19 spontaneous abortion cases, while in none of 40 placental tissues samples from the control group. Conclusion: Our findings show that the incidence of parvovirus B19 infection in NIHF and spontaneous abortion cases is relatively high. Nested PCR and ELISA tests should be used together for the early diagnosis of B19 infection in pregnant women.

Giriş: Kronik hepatit B virüs (HBV) enfeksiyonun uzun süreli tedavisi sırasında nükleoz(t)id analoglarına karşı ilaç direnci mutasyonlarının gelişmesi tedavi başarısızlığına yol açabilen önemli bir sorundur. Bu çalışmanın amacı kronik hepatit B enfeksiyonu olan hastalarda HBV ilaç direnci gen mutasyonlarının pyrosequencing metodu ile araştırılmasıdır. Gereç ve Yöntem: Kasım 2013 ve Mayıs 2014 tarihleri arasında, kronik hepatit B enfeksiyonu olan 89'u tedavi almayan (naif) ve 48'i tedavi alan toplam 137 hastaya ait serum örnekleri lamivudin (LAM), adefovir, telbivudin (TEL), entekavir (ETV) ve tenofovir (TDF) ile ilişkili ilaç direnç mutasyonlarının tespiti için real-time polimeraz zincir reaksiyonu testi sonrası pyrosequencing metodu (PyroStar HBV Drug Resistance Test, Altona Diagnostics, Germany) ile analiz edilmiştir. Bulgular: Tedavi almayan 89 hastada, TDF'ye duyarlılığı azaltan rtA194T mutasyonu bir (%1,1) olguda bulunmuştur. Tedavi edilen 48 hastada, LAM ve TEL'e ilaç direnci ve ETV'ye karşı da çapraz dirence sebep olan rtM204I mutasyonu bir (%2,1) olguda tespit edilmiştir. Kompansatuvar mutasyon olan rtL180M iki (%4,2) hastada gözlenmiştir. ETV direncini gösteren rtT184S mutasyonu ile birlikte rtM204V'nin varlığı bir (%2,1) hastada tespit edilmiştir. ÖzIntroduction: The development of drug resistance mutations to nucleos(t)ide analogues during long-term therapy for chronic hepatitis B virus (HBV) infection is a major problem that may lead to treatment failure. The aim of this study was to investigate the HBV drug resistance gene mutations in patients with chronic HBV infection by pyrosequencing method. Materials and Methods: Between December 2013 and May 2014, serum samples collected from 137 patients with chronic HBV infection, (89 treatment-naive and 48 treatment-experienced), were analyzed with real-time polymerase chain reaction analysis followed by pyrosequencing (PyroStar HBV Drug Resistance Test, Altona Diagnostics, Germany) for drug resistance mutations associated with lamivudine (LAM), adefovir, telbivudine (TEL), entecavir (ETV), and tenofovir (TDF). Results: Of the 89 treatment-naive patients, one (1.1%) had the rtA194T mutation, associated with reduced susceptibility to TDF. Of the 48 treatment-experienced patients, one (2.1%) had the rtM204I mutation, associated with drug resistance to LAM, TEL, and cross-resistance to ETV. Compensatory mutation rtL180M was observed in two patients (4.2%). The presence of rtM204V combined with rtT184S mutation indicating ETV resistance was detected in one patient (2.1%). Conclusion: The incidence of drug resistance mutations was 8.3% in treatment-experienced and 1.1% in treatment-naive patients. The use of pyrosequencing technology before and during treatment of patients with chronic HBV infection would contribute to the rapid detection of drug resistance mutations. Abstract Mehmet