Our department specializes in the management of patients presenting with fever and/or other symptoms such as diarrhea, jaundice, rash, burning sensation during urination, sore throat, cough, sputum production, joint pain, etc., both in outpatient clinics and hospital settings. We also provide consultative services to patients admitted to other departments of our hospital.

In addition to routine patient examinations in our outpatient clinic, we offer adult vaccinations, pre-transplant infection screening, hepatitis prevention, and travel-related infection prevention counseling. We are also responsible for the monitoring and treatment of infections in patients admitted to intensive care units and wards. Our goal is to provide effective treatment for adult patients with infections through early diagnosis using contemporary medical knowledge and technology, to provide necessary information and preventive measures such as vaccines to individuals seeking to prevent infections acquired from the community (hepatitis, AIDS, sexually transmitted diseases, etc.), and to minimize the risk of developing infections in hospitalized patients.

The faculty members of our department participate as speakers in national and international scientific meetings and host one-month sessions annually at Ankara meetings organized by national specialty associations.

Our faculty members have publications in national and international scientific journals, as well as chapters in national books. Additionally, our faculty members are involved in the preparation of diagnostic and treatment guidelines.

Clinical Microbiology Laboratory

The clinical microbiology laboratory provides 24-hour service to patients referred from outpatient clinics and those admitted to the hospital. We ensure service delivery adheres to the total quality management approach during the acceptance, processing, and interpretation of patient samples. All antibiogram procedures conducted in our laboratory follow the annually updated CLSI (Clinical Laboratory and Standards Institute) recommendations. Bacterial culture, antibiotic susceptibility tests, acid-fast bacilli staining, and sensitivity tests are regularly evaluated every month by an international external quality control system. Our microbiology laboratory also houses a molecular diagnosis (PCR) laboratory, which accepts samples from external sources.

Services include but are not limited to:

- Diagnosis and monitoring of fever of unknown origin

- Hospital-acquired infections

- Healthcare worker health

- Infections in patients undergoing bone marrow transplantation

- Monitoring and treatment of infections in patients undergoing kidney transplantation

- Monitoring and treatment of meningitis and other central nervous system infections

- Tuberculosis

- Brucellosis (Malta fever)

- Malaria

- Bone and joint infections

Frequently Asked Questions:

- What is Influenza (Flu)?

- Are all flu viruses the same?

- How does the flu spread?

- What are the symptoms of the flu?

- Who should not receive the flu vaccine?

- Is the severity of the flu the same at all ages?

- Is it important to differentiate between the common cold and the flu?

- What are the distinguishing features between the common cold and the flu?

- Preventive measures

Influenza (Flu)

The flu is a highly contagious respiratory illness caused by a virus called the influenza virus. Although the flu is classified among the viruses that cause the common cold, it differs from the common cold in many ways. Therefore, it is beneficial to examine the flu separately.

Are all flu viruses the same?

There are three types of flu viruses: A, B, and C.

- Infections caused by types A and B are the most severe. These viruses, especially type A, undergo continuous antigenic changes, which are the main reason for annual flu outbreaks. Therefore, new vaccines need to be developed each year against the changing viruses.

- Type C is a benign virus and does not undergo antigenic changes, causing mild illness. Therefore, unlike type A viruses, it does not pose a significant public health problem.

How does the flu spread?

The flu is a highly contagious disease that affects 20-50% of the population each winter. Like the viruses that cause the common cold, the flu virus spreads through the upper respiratory tract. Patients with the virus in their nose and throat are a source of infection. When these patients speak, especially when they cough or sneeze, invisible droplets containing the flu virus spread at speeds of 100-150 kilometers per hour and up to approximately 3 meters. Consequently, healthy individuals who encounter such situations inhale the virus through the air they breathe, entering their upper respiratory tract and even their eyes; some of the inhaled flu viruses can also reach the lungs through the breathed air. The virus settles in the upper and lower respiratory tract upon entry and immediately begins to multiply. Another way the flu virus spreads is through contaminated objects with respiratory secretions of flu patients. This route is also significant during epidemics.

What are the symptoms of the flu?

The flu is characterized by more severe symptoms than the common cold, with sudden onset, especially high fever, severe cough, joint and muscle pain.

The main symptoms of a typical flu case are:

- Sudden onset of headache

- Chills

- High fever

- Dry cough

- Burning sensation in the throat

- Weakness

- Muscle and joint pain.

These symptoms worsen rapidly. Especially, the pain and aches in the back and legs lead to extreme weakness and a feeling of extreme fatigue, necessitating bed rest. The fever is often 39-40 degrees and begins to decrease from the third day of illness. However, symptoms of respiratory tract such as nasal congestion and sore throat begin afterward. Complaints of weakness and fatigue can last for days or even weeks. That is why the flu is called "rag disease" among the public. Additionally, it can also cause gastrointestinal disorders in patients and nausea, vomiting, and diarrhea may occur. The disease resembles a gastroenteritis (gastrointestinal disease) in this form.

Who should not receive the flu vaccine?

If any of the following conditions apply to you, you should not receive the flu vaccine:

- If you have an egg allergy, you should not receive the flu vaccine because it is prepared from embryonated eggs. However, if your doctor deems it absolutely necessary for you to receive the flu vaccine in some cases, they can administer the vaccine while taking necessary precautions.

- If you have a history of Guillain-Barre Syndrome, you should not receive the flu vaccine.

- If you have an acute illness or fever at the time of vaccination, you should postpone vaccination until you recover.

Is the severity of the flu the same at all ages?

The disease can present different clinical pictures in adults and children.

- Mild flu cases in adults present with symptoms similar to those of the common cold. However, as seen in classical cases more often, the main symptoms are 39.5-40 °C fever, severe cough, severe headache, muscle and joint pain, sore throat, chills, tremors, and extreme fatigue. Recovery takes longer than with a common cold. Some patients recover in 1-2 weeks. However, weakness and fatigue may last much longer in the elderly.

- In school-age children, flu symptoms are similar to those in adults. Fever tends to be higher in children than in adults.

- Diagnosis is difficult in preschool children and infants due to atypical symptoms of the disease. Symptoms often resemble those caused by other common cold viruses. When fever is detected in infants under one year of age, medical attention should be sought.

Is it important to differentiate between the common cold and the flu?

Adults usually experience a mild illness without fever, called a common cold, and can manage it without much need for medication. The flu, on the other hand, should be taken seriously both because of its clinical symptoms and the complications it can cause. It is largely possible to distinguish between these two disease conditions based on the differences listed below. Therefore, distinguishing between these two disease conditions is of great importance.

Differentiating features of the common cold and flu

Source: National Institute of Allergy and Infectious Diseases

Preventive Measures

Taking precautions early in the winter season reduces the likelihood of contracting a viral infection like the flu. Consume plenty of vitamin C, a potent antiviral agent. In addition to a vitamin combination, consume plenty of foods rich in vitamins. Fresh vegetables and fruits such as kiwi, broccoli, black grapes, and Brussels sprouts are rich sources of vitamins. Those that are red, yellow, and orange also contain beta-carotene, which supports the immune system. Increasing fluid intake makes it harder for infections to settle into lubricated respiratory tract membranes. Avoid air-conditioned places as they dry out the membranes. Crowded and warm places are environments where viruses are ready to spread, so stay away from them. For instance, long flights create suitable breeding grounds for viruses. Excessive stress suppresses the immune system. Try to reduce stress. Rest and relaxation will shorten the duration of a flu attack and reduce the risk of complications.

Does the flu cause complications?

The most significant viral complication that can arise during or after the flu is pneumonia. The flu virus itself can cause viral pneumonia directly, and weakened defense systems as a result of the flu virus can lead to bacterial pneumonia caused by subsequent bacteria. If you are suffering from the flu and notice any of the following symptoms in yourself or a family member:

• Difficulty breathing,

• Increased coughing and phlegm production,

• Yellow-green discoloration of phlegm or blood in phlegm,

• Chest pain (especially when coughing), consult your doctor immediately.

• Sinusitis, otitis media, and bronchitis, which are common cold symptoms, can also develop in the flu due to the same mechanism.

• After flu symptoms subside, a clinical condition called post-flu cough may develop. This cough does not contain phlegm, often lasts for weeks, and can be so bothersome that it disrupts sleep at night. This condition, resembling asthma, can be treated with asthma medications. If such a cough develops, consult your doctor.

• Another significant side effect of the flu is severely weakening the body's defense system. In this condition, known as anergy, there is a significant weakening of cellular immunity, and there is a deterioration in a person's resistance to tuberculosis. If coughing, weakness, loss of appetite, mild evening fever, and sweating persist after the flu, it is advisable to consult a doctor again.

Do antibiotics work against the flu virus?

The cause of the flu is a virus. It is worth mentioning once again that antibiotics are ineffective against viruses. Antibiotics should only be used in viral diseases if a bacterial complication (such as pneumonia, sinusitis, otitis media, etc.) develops and as prescribed by your doctor.

Is there an effective drug against the flu virus?

Currently, there are some antiviral drugs that can be used in the treatment of the flu. These drugs shorten the duration of the illness and improve the quality of life during the illness. However, these drugs should ideally be started as early as possible in the course of the illness. Whether or not to use these drugs is at the discretion of your doctor.

Can we protect ourselves from the flu with a vaccine?

The best way to protect against the flu is to get vaccinated with the flu vaccine. The flu vaccine is an annual vaccine that needs to be repeated every year. The reason for this is that the flu virus changes its antigenic structure, i.e., its identity, every year. Therefore, newly manufactured vaccines should be used every year, and any vaccine left over from previous years should not be used for any reason. After flu vaccination, approximately 80% protection is achieved in healthy individuals. This rate may be lower in the elderly, those with weakened immune systems, or those with chronic diseases. It is worth mentioning that no vaccine provides complete protection.

International Super Strains

Super flu is the name given to the flu caused by a new virus that spreads rapidly because no immunity has been developed against it. It causes a pandemic approximately every 10 years and leads to 10 times more deaths than in any given year. Fortunately, modern vaccination programs usually include this type of flu as well. It is not known exactly how these "super strains" suddenly emerge. The strongest theory is that they are transmitted from the animal kingdom to humans. The initial source of super strains is believed to be birds and pigs. This explains why viruses often originate from regions where humans live closely with animals, such as rural areas of China. The "avian flu" seen in 1997 is an example of this. Super flu viruses are usually different types of Type A. Infection begins when parts of the new virus - hemagglutinins (H) and neuraminidases (N) - attach to a human cell. These subtypes give the flu its name.

Super Influenzas and Pandemics

Diarrhea

Providing a precise definition of diarrhea can be challenging. It is generally characterized by increased stool frequency, increased stool volume, or watery stool consistency. Individuals experiencing diarrhea typically pass more than 250 grams of stool per day, with at least 70% being liquid. The World Health Organization defines diarrhea as passing watery stools three or more times a day. In breastfed infants, more frequent and watery stooling than usual is considered diarrhea. The condition of diarrhea indicates damage to the mucous lining of the intestines. This is usually caused by microbes or a decrease in enzymes that facilitate various reactions. One such enzyme is lactase, which helps digest lactose, a carbohydrate found in milk. If lactase is reduced, lactose cannot be absorbed by the body and combines with water, leading to increased diarrhea. In severe cases of diarrhea, fluid loss can reach up to 13-14 liters per day, equivalent to the volume of blood in the body. A small amount of painful and bloody diarrhea is known as dysentery. Diarrheal diseases result in nutritional disturbances and fluid loss. Globally, nearly 1 billion cases of diarrhea occur in children under the age of 5, with approximately 2.5 million deaths, primarily due to fluid loss, especially in children under two years old.

Symptoms of Diarrhea

Common symptoms of diarrhea include watery stools, urgency for bowel movements, inability to control bowel movements, frequent defecation, thirst, nausea, vomiting, fever, weakness, abdominal pain, and gas. These symptoms vary depending on the severity of diarrhea. Mild dehydration occurs when a small amount of fluid is lost, leading to thirst. Approximately 4% of body weight is lost. Moderate dehydration presents with dry mouth, decreased urine output, and restlessness. Fluid loss is around 7-8% of body weight. Severe dehydration results in intense symptoms, with fluid loss of up to 10% of body weight.

Consequences of Diarrhea

In diarrhea, fecal matter moves through the intestine at a faster rate than usual, hindering proper digestion. Not all bacteria in the human intestine are harmful; some aid in digestion and are considered beneficial. However, during microbial diarrhea, harmful bacteria utilize protein structures in the colon, leading to a decrease in beneficial bacteria and an increase in harmful bacteria. This disruption impairs digestive function and causes discomfort. To prevent this, prebiotics that preserve beneficial bacteria can be used. One such product is "Prebiotic Humana HN" formula, the only prebiotic diarrhea formula available worldwide.

Diarrhea Treatment

Diarrhea treatment varies depending on the underlying cause. If bacteria are responsible, hospitalization and medical intervention are necessary, especially for infants, as it can be dangerous. Prompt antibiotic treatment is required in such cases. Bacterial-induced diarrhea often presents with fever and bloody stools. Additionally, the use of prebiotic diarrhea formula is recommended. Non-microbial diarrhea is generally mild, without fever or blood in the stool, and does not require antibiotic treatment. It may result from dietary changes or environmental factors and can be managed with diarrhea formula alone. To prevent diarrhea, it is essential to wash hands before and after meals. Proper hygiene should be maintained for infants, including washing hands with soap after changing diapers.

Management of Diarrhea in Children or Infants

In children with diarrhea, fluid loss should be compensated by providing water and watery fluids such as buttermilk, soup, and fruit juice. Breastfed infants should be nursed more frequently. If the baby can drink, boiled and cooled water can be given. Feeding should continue as usual for breastfed babies, while formula-fed infants should maintain their regular feeding schedule. Infants over 6 months of age can be given yogurt, puree, meat, fruit juice, and the frequency of meals can be increased. Adequate nutrition is essential for children, and meals can be increased in frequency. Additionally, certain risk factors for diarrhea are known. Bottle feeding and introducing solid foods before 6 months of age increase the risk of diarrheal diseases. Furthermore, attention should be paid to hygiene, with hands washed after using the toilet and avoiding contaminated water. Infants whose feeding is stopped due to diarrhea, those who vomit twice or more, those who defecate 6-7 times with watery stools, and those under 1 year old lose a significant amount of fluid and are at higher risk.

Crimean-Congo Hemorrhagic Fever (CCHF)

What is the causative agent of Crimean-Congo Hemorrhagic Fever (CCHF)?

Viruses belonging to the Nairovirus genus of the Bunyaviridae family are responsible for this disease. These viruses are approximately 100 nanometers in size, contain Ribonucleic acid (RNA), have a helical capsid, and are enveloped.

What is Crimean-Congo Hemorrhagic Fever (CCHF)?

Crimean-Congo hemorrhagic fever is a tick-borne infection caused by Nairoviruses, characterized by fever, skin and other organ bleeding, among other symptoms. It is an important infection in humans, manifesting clinically and subclinically with syndromes such as encephalitis, short-term febrile illnesses, hemorrhagic fevers, and polyarthritis. Despite advances in treatment in recent years, mortality rates from these infections remain high.

How sensitive is the Crimean-Congo hemorrhagic fever virus to chemical and physical factors?

Nairoviruses are fragile and cannot survive outside their host. These viruses are inactivated in 30 minutes at 56 degrees Celsius, can survive in blood at 40 °C for 10 days, are sensitive to 1% hypochlorite and 2% glutaraldehyde, and are rapidly inactivated by ultraviolet rays. They are susceptible to Ribavirin in vitro.

Where was Crimean-Congo hemorrhagic fever first described?

Crimean-Congo hemorrhagic fever was first observed in the summer of 1944 and 1945 among Soviet soldiers primarily assisting with crop harvesting in the Western Crimea steppes. The disease was initially termed Crimean hemorrhagic fever. In 1956, the Congo virus was identified in a febrile patient in Zaire. In 1969, it was determined that the Congo virus and the Crimean hemorrhagic fever viruses were the same virus, leading to the renaming of the disease as Crimean-Congo hemorrhagic fever.

In which countries has Crimean-Congo hemorrhagic fever been reported?

The disease is frequently reported in Africa, Western Asia, the Middle East, and Eastern Europe. Outbreaks of Crimean-Congo hemorrhagic fever caused by the virus have been reported in Bulgaria, Macedonia, Pakistan, Iraq, Afghanistan, Iran, Kosovo, Kazakhstan, Sub-Saharan African countries, former Soviet Union countries, Yugoslavia, Greece, the Arabian Peninsula, Dubai, Kuwait, China, and Mauritania.

Crimean-Congo hemorrhagic fever was observed in some provinces of Turkey during the spring and summer months in 2002, and through the efforts of the Ministry of Health, it was confirmed that the disease was CCHF.

Is there an intermediary agent involved in transmission?

CCHF is a tick-borne infection transmitted from animals to humans by ticks. It has been shown to be present on migrating birds moving between Southeast Europe and South Africa. It is believed that these birds contribute to the

 transmission of the virus between continents. Ticks of the Hyalomma genus inhabit a wide geographical area, including Turkey.