In modern medicine, for early diagnosis of infections, tests that have high specificity and sensitivity should be preferred. For this reason, especially for patients with hematological malignancies and transplantation, that have high mortality and morbidity ratios, some molecular biological techniques are coming into use today for differential diagnosis and follow up of invasive fungal infections. In the coming years it will become easier to early diagnose and also to plan optimal treatments, by using these techniques for diagnosis of fungal infections. In this study, we made fungal DNA isolation from blood samples, which were taken from patients, in immunodeficiency state, with hematological malignancies and transplantation. For polymerase chain reaction (PCR), we used universal fungal primers. By using real-time PCR samples from 20 patients, which were found positive by PCR, the amount of DNA was measured. In real-time PCR, we used Aspergillus colonies as our standard, and for this purpose, SDA petri dishes were incubated for 72 hours at 30°C and; 101-106 cfu/mL serial dilutions were made by using hemocytometry. We performed DNA isolation and PCR from these dilutions. Fungal species specific products giving one band of 500 bp, were fixed in 2% agarose gel. We measured the DNA amounts by real-time PCR by using Sybr Green I. Standard dilution series and extraction samples were studied at the same time by real-time PCR. Measurement of the DNA quantities in the separate samples, one at the time of first day and the other after 15 days were interpreted by the LightCycler system. Results of real-time PCR in these two different samples were compared; it was noted that fungal DNA was increased in 5, decreased in 6 and equivalent in 9 patients. These findings showed that real-time PCR is a new, specific and a sensitive method among the other quantitative PCR systems. This method was also quicker than the other quantitative PCR systems. Currently, the investigators prefer this method because, it gives early idea about patient condition, for early diagnosis of infections and treatment patients who are under risk of some kind of infection, and for follow up treatment results. Additionally for diagnosis of fungal infections serial samples in PCR, together with other conventional diagnostic methods, should used.

Değişken klinik prezentasyon ve spesifik laboratuvar bulgularının olmaması nedeniyle kobalamin eksikliğinin tanısı zor olabilir. Kobalamin eksikliğinde hipersegmentasyon ve makrositoz önemli bulgular olmasına rağmen sensitivite ve spesifiteleri düşüktür. Ayrıca ticari kitlerle serum kobalamin düzeylerinin ölçümünün güvenilir olmaması tanıyı daha da zorlaştırabilir. Homosistein ve metilmalonik asit gibi metabolitlerin ölçümünün oldukça pahalı olması yaygın kullanımını engellemektedir. Bu çalışmadaki amaç, genel pratikte sık rastlanan bu klinik tabloda daha kolay ve daha ucuz bir tanı ve tedavi stratejisi uygulamaktır. Retrospektif olarak kobalamin eksikliği tanısı konmuş 50 hasta değerlendirildi. Sekiz (%16) hastada hastaneye başvurduğu esnada kobalamin seviyeleri normaldi. Bu hastaların hepsinde kobalamin tedavisinin yedinci gününde retikülosit krizi gözlendi ve tedavinin üçüncü ayının sonunda bütün hematolojik parametreleri normale döndü. Klinik ve laboratuvar bulguları ile megaloblastik anemi düşünülen hastalarda serum kobalamin seviyeleri normal olsa bile, kobalamin ile deneme tedavisi hem ekonomiktir hem de tanının gecikmesini önler.

Fifty-five febrile neutropenic episodes were monitored by C-reactive protein (CRP) in 26 patients with acute leukemia. In nonfebrile period of patients, serum CRP level was 0.89 mg/dL (range 0.1-8.8 mg/dL) while it was found to be raised to 9.57 mg/dL (range 0.5-24.1 mg/dL) in the febrile group (p= 0.0001). Serum CRP level at the onset of fever was 9.25 mg/dL (range 0.1-16.2 mg/dL) in patients in whom fever was treated succesfully with antipseudomonal beta-lactam antibiotic and aminoglycoside therapy declined to normal levels (p= 0.01); 17.0 mg/dL (range 5.2-33.5 mg/dL) in patients still persisting fever with this combined therapy and so obtained vancomycin (p= 0.001); 16.6 mg/dL (range 0-38.7 mg/dL) in patients required amphotericin B in addition (p= 0.001). In the initial febrile episode; fever resolved at day 3.3 ± 1.21 in patients with serum CRP value below 5 mg/dL; at day 4.42 ± 1.88 in patients with serum CRP value between 10-15 mg/dL; at day 5.14 ± 1.68 in patients with serum CRP value above 15 mg/dL. There was no statistical difference at the time of fever resolution among the first three groups. There was a remarkable difference between groups with CRP values below 5 mg/dL and above 15 mg/dL (p= 0.04). We conclude that determination of serum CRP level before and after infection in febrile neutropenic patients is useful for the follow-up and estimation of febrile neutropenic episode in acute leukemic patients.

Human T-cell lymphotropic virus type I (HTLV-I) is the first human retrovirus to be associated with malignant disease-namely, adult T-cell leukemia/lymphoma. HTLV-I has also been associated with several diseases. HTLV-I has a worldwide distribution with major endemic foci in the Caribbean and Southern Japan. HTLV-II is a closely related retrovirus that shares considerable genomic homology with HTLV-I but has not been proven to be a pathogen. Major routes of transmission are blood transfusion, breast milk and sexual activity. In this study, we examined the seroprevalance of HTLV-I/II among healthy blood donors attended to Ege University Hospital in Izmir. 913 healthy blood donors were examined for the presence of anti-HTLV-I/II antibody in their sera. Serum specimens were tested with an enzyme immunoassay (EIA) (Organon Teknika, Vironostika HTLV-I/II Microelisa System, Holland). All of the 913 healthy blood donors were seronegative with EIA. These findings indicate that screening of blood donors for HTLV I/II is not necessary at present time.

We evaluated the prevalence of hepatitis G virus (HGV) infection in patients who had received multiple blood components and in blood donors and the possible coinfection with hepatitis C virus (HCV). Eighty patients who had received multiple blood components and 70 eligible blood donors, as controls were included in this study. HGV RNA was determined by reverse polymerase chain reaction in serum. HGV-RNA was detected in three (3.7%) of patients and in one (1.4%) of controls. Statistical analysis showed no difference between the groups (p> 0.05). HGV and HCV coinfection was not observed in both patient and control groups. Although the most important risk factor for HGV infection was found to be blood transfusions in various studies, this study showed that there is not significant relationship between blood components transfusion and HGV infection.

A six-year-old boy was admitted with acute agranulocytosis four weeks after the onset of infectious mononucleosis. His bone marrow aspiration revealed maturation arrest of myeloid series. He was hospitalized for agranulocytosis and he was put on intravenous immunoglobulin (IVIG) (400 mg/kg/day) on the third day of hospitalization for two days. His white blood cell count increased to 4200/mm3 (1176 PMNL absolutely) on the fifth day. This may suggest that IVIG therapy may be effective for early recovery from agranulocytosis which is a very rare complication of infectious mononucleosis.

Hemophagocytic syndrome is a rare disorder characterized by a group of clinical, laboratory and histopathological findings such as fever, hepatosplenomegaly, cytopenia, hypertriglyceridemia, and hemophagocytosis in the bone marrow, spleen, and lymph nodes. Hemophagocytic syndrome may occur as a primary or secondary disease. Primary type of hemophagocytic syndrome is also known as familial erythrophagocytic lymphohistiocytosis and secondary type is mostly associated with an viral infection and known as infection-associated hemophagocytic syndrome (IAHS). Rapid diagnosis is very important in these patients since suggested treatment strategies for the two types have been different and mortality rate is very high. In this report we present the clinical and laboratory findings and the outcome of two children with IAHS to emphasize the importance of early diagnosis and the effectiveness of intravenous immunoglobulin therapy in these patients.

Hemophagocytic syndrome (HPS) is mostly associated with malignant and infectious diseases. The causes and prognosis of this clinical syndrome depend on the underlying disease. And also treatment of this disease must be arranged according to the underlying causes. While non-Hodgkin’s lymphomas (NHL) associated with HPS has been frequently observed, anaplastic T-cell NHL associated with HPS has been rarely reported. In this article we report a case of Ki-1+ anaplastic T-cell lymphoma associated with HPS in a 16-year-old woman who presented with fever and lymphadenopathy.

Although parasitic infestations and allergic disorders are the most common causes of eosinophilia it may also occompany malignant diseases. Many studies suggested that eosinophilia is related to tumor dissemination or necrosis. We are presenting a case; 10 months after gastric carcinoma operation who had severe eosinophilia with bone marrow and skin infiltration that gave response to steroid therapy. After three months, tongue squamous cell carsinoma as a second malignancy occurred in our patient that the eosinophilia could be the preclinical sign of the second cancer.