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COVID-19, which emerged in Wuhan in December 2019 and spread all over the world, is an infectious disease. Vaccine studies have been started rapidly by many centers. One of them is the inactive CoronaVac vaccine of Sinovac Company. Turkey has given approval for the emergency use of CoronaVac. In this study, it was aimed to investigate the antibody responses to the vaccine in health workers who work in high-risk departments for COVID-19 in our university and are vaccinated with CoronaVac. Health workers participating in the study were divided into the vaccine group and control group. Forty-one people from the vaccine group and 12 people from the control group volunteered to our study. The vaccine and control group samples taken 14 days after the first dose of vaccine were studied with anti SARSCoV-2 IgG (Euroimmun, Germany). The antibody levels of four people in the vaccine group could not be examined after the second dose of vaccine due to reasons such as resignation and annual permit. Antibody levels were not measured in the control group after the second dose of vaccine. The antibody level after the first dose was found to be 9.8% and 0% in the vaccine group and control group, respectively. After the second dose of the vaccine, this rate was found to be 94.6% in the vaccine group. Based on the current findings, it is thought that a single dose of the vaccine cannot produce an antibody response at the desired rate in the study group, and it is essential to comply with personal protection rules until social immunity reaches the desired levels.

COVID-19, which emerged in Wuhan in December 2019 and spread all over the world, is an infectious disease. Vaccine studies have been started rapidly by many centers. One of them is the inactive CoronaVac vaccine of Sinovac Company. Turkey has given approval for the emergency use of CoronaVac. In this study, it was aimed to investigate the antibody responses to the vaccine in health workers who work in high-risk departments for COVID-19 in our university and are vaccinated with CoronaVac. Health workers participating in the study were divided into the vaccine group and control group. Forty-one people from the vaccine group and 12 people from the control group volunteered to our study. The vaccine and control group samples taken 14 days after the first dose of vaccine were studied with anti SARSCoV-2 IgG (Euroimmun, Germany). The antibody levels of four people in the vaccine group could not be examined after the second dose of vaccine due to reasons such as resignation and annual permit. Antibody levels were not measured in the control group after the second dose of vaccine. The antibody level after the first dose was found to be 9.8% and 0% in the vaccine group and control group, respectively. After the second dose of the vaccine, this rate was found to be 94.6% in the vaccine group. Based on the current findings, it is thought that a single dose of the vaccine cannot produce an antibody response at the desired rate in the study group, and it is essential to comply with personal protection rules until social immunity reaches the desired levels.

Objectives Aspergillus fumigatus causes several diseases in humans and azole resistance in A. fumigatus strains is an important issue. The aim of this multicentre epidemiological study was to investigate the prevalence of azole resistance in clinical and environmental A. fumigatus isolates in Turkey. Methods Twenty-one centres participated in this study from 1 May 2018 to 1 October 2019. One participant from each centre was asked to collect environmental and clinical A. fumigatus isolates. Azole resistance was screened for using EUCAST agar screening methodology (EUCAST E.DEF 10.1) and was confirmed by the EUCAST E.DEF 9.3 reference microdilution method. Isolates with a phenotypic resistance pattern were sequenced for the cyp51A gene and microsatellite genotyping was used to determine the genetic relationships between the resistant strains. Results In total, resistance was found in 1.3% of the strains that were isolated from environmental samples and 3.3% of the strains that were isolated from clinical samples. Mutations in the cyp51A gene were detected in 9 (47.4%) of the 19 azole-resistant isolates, all of which were found to be TR34/L98H mutations. Microsatellite genotyping clearly differentiated the strains with the TR34/L98H mutation in the cyp51A gene from the strains with no mutation in this gene. Conclusions The rate of observed azole resistance of A. fumigatus isolates was low in this study, but the fact that more than half of the examined strains had the wild-type cyp51A gene supports the idea that other mechanisms of resistance are gradually increasing., Bursa Uludag University Scientific Research Projects Commission [QUAP[T]-2015-5]; Ener Private Health Service Company, This work was partly supported by Bursa Uludag University Scientific Research Projects Commission (QUAP[T]-2015-5) and Ener Private Health Service Company.

Lysinibacillus massiliensis is an aerobic, endospore-forming, gram-negative staining bacterium with peritrichous flagella belonging to the Bacillaceae family. A few cases of L. massiliensis isolated from the cerebrospinal fluid and tissue have been reported. In this study, we aimed to describe a case of L. massiliensis isolated from the synovial fluid. The synovial fluid from a 74-year-old female patient was inoculated into blood culture bottle. Gram-negative rods were observed in a gram-stained smear from a positive blood culture bottle. The bacterium was identified as Lysinibacillus sphaericus/Lysinibacillus fusiformis, with a probability of 89% using an automated bacterial identification system (VITEK2; Biomerieux, France). Subsequently, 16S rRNA gene sequencing was performed, and the sequence was analyzed using the Basic Local Alignment Search Tool. The sequence had 99.9% (1426/1427) identity with the strain L. massiliensis (GenBank ID: NR_043092.1). To our knowledge, this is the first reported case of L. massiliensis isolated from the synovial fluid. When an endospore-forming gram-negative staining bacterium can not be identified by phenotypic characterization, L. massiliensis should be considered, and different microbiological methods should be used for identification.

Background: According to Egyptian records, tularemia emerged in the Canaan region, where it was first identified and spread to Anatolia over the Euphrates. It was used as an active biological weapon for the first time in the Hittite-Arzawa War in 1320-1318 BC. This study aimed to investigate the seroprevalence of tularemia in the Inner Aegean Region, which is thought to be the regions where this war was fought 3300 years ago. Methods: Tularemia seropositivity in humans was investigated in 27 villages/neighborhoods in 3 districts in each of Manisa, Kutahya, and Usak provinces. Before the study, the participants were informed about the disease via posters, and their blood samples were taken following filling out the questionnaire. Sera were separated from the blood on the same day and stored in a suitable environment until the tests were performed. Microagglutination tests were performed using in-house tularemia antigen and V plate for serological experiments. Rose-Bengal test was also performed on seropositive sera. Results: Of the total 410 people, 226 (55·12%) were male. The mean age of the volunteers was 43·72. Among the age groups of those who volunteered to participate in the study, the most participation was 61 years and over. The most participation was from Kutahya province. According to the results of the tularemia microagglutination test, seropositivity was detected in 6 cases. It was determined that all of the seropositive volunteers were in Kutahya. When the tularemia antibody titers were examined, seropositivity was determined at 1/20-1/160 titers. No positivity was detected in the Rose-Bengal test for cross-reaction. Interpretation: Kutahya has been identified as a risky region in terms of tularemia in the Inner Aegean Region. In order to use the resources in the country economically, first of all, the risk areas in terms of tularemia should be determined by serological studies in all regions. In order to increase awareness about the disease, physicians and filiation teams should be trained in risky areas. Surveillance studies should be conducted to identify and monitor possible sources in areas identified as risky. Funding Information: Trakya University Scientific Research Projects Commission Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study was carried out with the approval of the Trakya University Scientific Research Ethics Committee dated 13/04/2020 and numbered TUTF-BAEK 2019/381 and the support of the Trakya University Scientific Research Projects Commission (TUBAP) project numbered 2020/121.

Candida tropicalis is the fourth leading cause of candidemia in Turkey. Although C. tropicalis isolates from 1997 to 2017 were characterized as fully susceptible to antifungals, the increasing global prevalence of azole-non-susceptible (ANS) C. tropicalis and the association between high fluconazole tolerance (HFT) and fluconazole therapeutic failure (FTF) prompted us to re-evaluate azole susceptibility of C. tropicalis in Turkey. in this study, 161 C. tropicalis blood isolates from seven clinical centers were identified by ITS rDNA sequencing, genotyped by multilocus microsatellite typing, and tested for susceptibility to five azoles, two echinocandins, and amphotericin B (AMB); antifungal resistance mechanisms were assessed by sequencing of ERG11 and FKS1 genes. the results indicated that C. tropicalis isolates, which belonged to 125 genotypes grouped into 11 clusters, were fully susceptible to echinocandins and AMB; however, 18.6% of them had the ANS phenotype but only two carried the ANS-conferring mutation (Y132F). HFT was recorded in 52 isolates, 10 of which were also ANS. Large proportions of patients infected with ANS and HFT isolates (89 and 40.7%, respectively) showed FTF. Patients infected with azole-susceptible or ANS isolates did not differ in mortality, which, however, was significantly lower for those infected with HFT isolates (P = 0.007). There were significant differences in mortality (P = 0.02), ANS (P = 0.012), and HFT (P = 0.007) among genotype clusters. the alarming increase in the prevalence of C. tropicalis blood isolates with ANS and HFT in Turkey and the notable FTF rate should be a matter of public health concern., Major National R&D Projects of the National Health Department [2018ZX10101003]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [31770161]; Shanghai Science and Technology CommitteeShanghai Science & Technology Committee [17DZ2272900, 14495800500]; Shanghai Municipal Commission of Health and Family Planning [2017ZZ01024-001]; Shanghai Sailing Program [19YF1448000]; Chinese Academy of Engineering [2019-XY-33], This work was supported by the Major National R&D Projects of the National Health Department (2018ZX10101003), National Natural Science Foundation of China (31770161), Shanghai Science and Technology Committee (17DZ2272900 and 14495800500), Shanghai Municipal Commission of Health and Family Planning (2017ZZ01024-001), Shanghai Sailing Program (19YF1448000), and the Chinese Academy of Engineering (2019-XY-33).

BACKGROUND Obstructive jaundice is a serious, life-threatening condition that can lead to death as a result of sepsis and multiorgan failure due to bacterial translocation. Treatment should be started as soon as possible after diagnosis. MATERIAL AND METHODS Forty 24-week-old male Sprague Dawley rats, with an average weight of 250 g to 300 g, were included in this study. The rats were randomly placed into five groups, each group consisted of eight rats. The sham group underwent only common bile duct (CBD) dissection and no ligation was performed. CBD ligation was applied to the other groups. After the operation, one CBD group was fed with rat chow only, the others were fed with rat chow supplemented with honey, or immunonutrients, or honey plus immunonutrients. After 10 to 12 days, all rats were sacrificed; blood and tissue samples were collected for biochemical, microbiological, and histopathological evaluation. RESULTS In the groups that were fed with honey and immunonutrients, alanine aminotransferase (ALT) levels were decreased significantly compared to the other groups. Statistically significant differences were detected in terms of bacterial translocation (BT) rates among liver and spleen samples, and laboratory values of serum, except for MLNs of the BDL+HI group, when compared to other groups. We found mean mucosal thickness of ileum samples have been improved notably in the BDL+HI group compared to the other groups, especially compared to the C/BDL group. CONCLUSIONS Immunonutrition applied with honey had immunostimulant effects, decreased BT due to an additive effect, and had positive effects on intestinal mucosa.

Streptococcus uberis is a gram-positive bacterium that is mostly responsible for mastitis in cattle. The bacterium rarely has been associated with human infections. Conventional phenotyphic methods can be inadequate for the identification of S.uberis; and in microbiology laboratories S.uberis is confused with the other streptococci and enterococci isolates. Recently, molecular methods are recommended for the accurate identification of S.uberis isolates. The aim of this report is to present a lower respiratory tract infection case caused by S.uberis and the microbiological methods for identification of this bacterium. A 66-year-old male patient with squamous cell lung cancer who received radiotherapy was admitted in our hospital for the control. According to the chest X-Ray, patient was hospitalized with the prediagnosis of ''cavitary tumor, pulmonary abscess''. In the first day of the hospitalization, blood and sputum cultures were drawn. Blood culture was negative, however, Candida albicans was isolated in the sputum culture and it was estimated to be due to oral lesions. After two weeks from the hospitalization, sputum sample was taken from the patient since he had abnormal respiratory sounds and cough complaint. In the Gram stained smear of the sputum there were abundant leucocytes and gram-positive cocci, and S.uberis was isolated in both 5% sheep blood and chocolate agar media. Bacterial identification and antibiotic susceptibility tests were performed by VITEK 2 (Biomerieux, France) and also, the bacterium was identified by matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) based VITEK MS system as S.uberis. The isolate was determined susceptible to ampicillin, erythromycin, clindamycin, levofloxacin, linezolid, penicillin, cefotaxime, ceftriaxone, tetracycline and vancomycin. 16S, 23S ribosomal RNA and 16S-23S intergenic spacer gene regions were amplified with specific primers and partial DNA sequence analysis of 16S rRNA polymerase chain reaction (PCR) products were performed by 3500xL Genetic Analyzer (Applied Biosystems, USA). According to the partial 16S rRNA gene sequencing results, bacterium was confirmed as S.uberis. This report makes a significant contribution to the number of case reports of human infections caused by S.uberis as the identification was performed by current microbiological methods in our case. In conclusion, S.uberis should be evaluated as an opportunistic pathogen among the immunosuppressed patients and in addition to phenotypic bacteriological methods, the other recent microbiological methods should also be utilized for the identification.

Streptococcus uberis is a gram-positive bacterium that is mostly responsible for mastitis in cattle. The bacterium rarely has been associated with human infections. Conventional phenotyphic methods can be inadequate for the identification of S.uberis; and in microbiology laboratories S.uberis is confused with the other streptococci and enterococci isolates. Recently, molecular methods are recommended for the accurate identification of S.uberis isolates. The aim of this report is to present a lower respiratory tract infection case caused by S.uberis and the microbiological methods for identification of this bacterium. A 66-year-old male patient with squamous cell lung cancer who received radiotherapy was admitted in our hospital for the control. According to the chest X-Ray, patient was hospitalized with the prediagnosis of ''cavitary tumor, pulmonary abscess''. In the first day of the hospitalization, blood and sputum cultures were drawn. Blood culture was negative, however, Candida albicans was isolated in the sputum culture and it was estimated to be due to oral lesions. After two weeks from the hospitalization, sputum sample was taken from the patient since he had abnormal respiratory sounds and cough complaint. In the Gram stained smear of the sputum there were abundant leucocytes and gram-positive cocci, and S.uberis was isolated in both 5% sheep blood and chocolate agar media. Bacterial identification and antibiotic susceptibility tests were performed by VITEK 2 (Biomerieux, France) and also, the bacterium was identified by matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) based VITEK MS system as S.uberis. The isolate was determined susceptible to ampicillin, erythromycin, clindamycin, levofloxacin, linezolid, penicillin, cefotaxime, ceftriaxone, tetracycline and vancomycin. 16S, 23S ribosomal RNA and 16S-23S intergenic spacer gene regions were amplified with specific primers and partial DNA sequence analysis of 16S rRNA polymerase chain reaction (PCR) products were performed by 3500xL Genetic Analyzer (Applied Biosystems, USA). According to the partial 16S rRNA gene sequencing results, bacterium was confirmed as S.uberis. This report makes a significant contribution to the number of case reports of human infections caused by S.uberis as the identification was performed by current microbiological methods in our case. In conclusion, S.uberis should be evaluated as an opportunistic pathogen among the immunosuppressed patients and in addition to phenotypic bacteriological methods, the other recent microbiological methods should also be utilized for the identification.

Sporothrix schenckii causes clinical cutaneous forms consisting of lymphangitic, localised, disseminated or extracutaneous forms of sporotrichosis. Cutaneous form caused by the agent entering the body through the skin after trauma is the most frequently seen sporotrichosis form and it progresses in the form of either nodular lymphangitic lesions or localised (fix) lesions (da Rosa AC et al., J Am Acad Dermatol 2005; 52: 451–9; Schamroth JM, Grieve TP, Kellen P. Int J Dermatol 1988; 27: 28–30). Causative agent entering the body through skin causes erythematous, ulcerative or verrucous nodules and lesions generally progress to nodular lymphangitic cutaneous sporotrichosis (Kwon-Chung KJ, Bennett JE. Medical Mycology, Lea & Febiger, Philadelphia–London, 1992: 707–29). Lymphangitic sporotrichosis (nodular lymphangitic cutaneous sporotrichosis) accounts for 70–80% of the total number of the cases (Vismer HF, Hull PR. Mycopathologia 1997; 137: 137–43). The case presented in this paper is that of patient with a sporotrichosis in nodular lymphangitic cutaneous form which developed after the prick of a thorn in hand.

The aim of this study was to evaluate the efficiency of methylene blue (MB) in preventing renal scar formation after the induction of pyelonephritis (PNP) in a rat model with delayed antimicrobial therapy. An inoculum of the K-12 strain of Escherichia coli was injected into both kidneys. Control groups received isotonic saline instead of bacterial solution. Four equal groups were then formed: the PNP group was untreated and the PNP ciprofloxacin (CIP) treated group was treated only with CIP intraperitoneally (i.p.) starting on the third day following bacterial inoculation. In the PNP (MB)-treated group, MB was given i.p., and in the PNP MB + CIP-treated group, MB + CIP were administered i.p.. In the sixth week following bacterial inoculation, all rats were sacrificed, and both kidneys of the rats in all groups were examined biochemically and histopathologically for renal scarring. Renal scar was significant in the groups treated with MB alone or MB + CIP combination compared with untreated or antibiotic only groups. Delayed treatment with antibiotics had no effect on scarring. These results suggest that the addition of MB to the delayed antibiotic therapy might be beneficial in preventing PNP-induced oxidative renal tissue damage.

Background: Bacterial Translocation is believed to be an important factor on mortality and morbidity in Obstructive Jaundiced. Aims: We investigated the probable or estimated positive effects of tauroursodeoxycholic acid, which has antibacterial and regulatory effects on intestinal flora, together with glutamine on BT in an experimental obstructive jaundiced rat model. Study Design: Animal experimentation. Methods: Forty adult, male, Sprague Dawley rats were used in this study. Animals were randomised and divided into five groups of eight each: sham (Sh); control (common bile duct ligation, CBDL); and supplementation groups administered tauroursodeoxycholic acid (CBDL+T), glutamine (CBDL+G), or tauroursodeoxycholic acid plus glutamine (CBDL+TG). Blood and liver, spleen, MLN, and ileal samples were taken via laparotomy under sterile conditions for investigation of bacterial translocation and intestinal mucosal integrity and hepatic function tests on the tenth postoperative day. Results: There were statistically significant differences in BT rates in all samples except the spleen of the CBDL+TG group compared with the CBDL group (p=0.041, p=0.026, and p=0.041, respectively). Conclusion: It is essential to protect hepatic functions besides maintaining intestinal mucosal integrity in the active struggle against BT occurring in obstructive jaundice. The positive effect on intestinal mucosal integrity can be increased if glutamine is used with tauroursodeoxycholic acid, which also has hepatoprotective and immunomodulatory features. Turkish Başlık:Tıkanma Sarılığında Meydana Gelen Bakteriyel Translokasyon Üzerine Tauroursodeoksikolik Asit ve Glutaminin Birlikte Gösterdikleri Etki Anahtar Kelimeler:Bakteriyel translokasyon, glutamin, tauroursodeoksikolik asit Amaç: Bağırsak florasını düzenleyici ve antibakteriyel etkisi bulunan tauroursodeoksikolik asit (TUDCA) ile birlikte glutaminin deneysel olarak oluşturulan tıkanma sarılığı modelinde meydana gelen bakteriyel translokasyon üzerine olası yada tahmin edilen pozitif etkilerini araştırmayı amaçladık. Çalışma Tasarımı: Hayvan deneyi Yöntemler: Bu çalışmada 40 erişkin erkek Sprague Dawley sıçan kullanıldı. Hayvanlar randomize edildikten sonra her biri 8 rattan oluşan 5 gruba ayrıldı. Sırasıyla; Sham (sh) grubu, Kontrol (koledok ligasyonu) grubu, ayrı ayrı taurodeoksikolik asit (TUDCA) ve glutamin verilen gruplar ile TUDCA ve Glutaminin birlikte verildiği grup. Postoperatif 10. gün laparotomi sonrası karaciğer fonksiyon testlerini, ince barsak mukozal bütünlüğünü ve bakteriyel translokasyonu araştırmak için steril şartlarda karaciğer, dalak, lenf nodu, ileal doku ve kan örnekleri alındı. Bulgular: Kontrol grubu ile taurodeoksikolik asit ve glutaminin birlikte verildiği deney grubu karşılaştırıldığında dalak dışındaki kan ve doku örneklerinde istatistiksel olarak anlamlı farklılık saptandı (p=0.041, p=0.026 ve p=0.041). Sonuç: Tıkanma sarılığında ortaya çıkan bakteriyel translokasyona karşı aktif mücadelede intestinal mukozal bütünlüğü devam ettirmenin yanında karaciğer fonksiyonlarının korunması da gerekmektedir. Glutamin, hepatoprotektif ve immünmodülatör özellikleri olan TUDCA ile birlikte kullanıldığında intestinal mukozal bütünlük üzerindeki olumlu etkisi artabilir.

Objectives: It was aimed to investigate anaplasmosis seropositivity in people exposured to tick bite. Materials and Methods: A total of 116 individuals (89 males, 27 females; mean age 43; range 6 to 88 years) with tick bite history in rural areas of Thrace Region were included in this study. Possible risk factors were evaluated by a questionnaire. Sera obtained from volunteers were preserved in –70˚C deep freezer until the study is done. Antibodies against Anaplasma phagocytophilum were investigated by indirect fluorescent antibody (IFA) test in the sera. Results: Antibodies against A. phagocytophilum were positive for 29 individuals (25%). Contact with horse/donkey is defined as a risk factor for anaplasmosis seropositivity. Conclusion: Antibodies against A. phagocytophilum were found at high rates in people exposured to tick bite in rural areas of Thrace Region. Amaç: Kene ısırığı öyküsü olan kişilerde anaplazmoz seropozitifliğinin araştırılması amaçlandı. Gereçler ve Yöntemler: Trakya Bölgesi kırsal alanlarında kene ısırığı öyküsü olan 116 kişi (89 erkek, 27 kadın; ort. yaş 43; dağılım 6-88) çalışmaya alındı. Bir anket formu ile risk faktörü olabilecek durumlar sorgulandı. Gönüllülerden alınan serumlar çalışma yapılıncaya kadar –70˚C'lik derin dondurucuda saklandı. Serumlarda indirekt floresan antikor (IFA) yöntemi ile Anaplasma phagocytophilum antikorları araştırıldı. Bulgular: A. phagocytophilum antikorları 29 kişide (%25) pozitif bulundu. Anaplazmoz seropozitifliği için at/eşek teması bir risk faktörü olarak belirlendi. Sonuç: Trakya Bölgesi'nin kırsal alanlarında yaşayan, kene ile ısırılmış insanlarda A. phagocytophilum'a karşı gelişen antikorlar yüksek oranlarda saptanmıştır.

Key Words: Tularemia, tuberculosis, granulomatous lymphadenitis, Thrace

Infections with Beauveria bassiana are extremely rare in humans. A 51-year-old man was admitted to hospital with the diagnosis of lung adenocarcinoma. Thoracic wall resection with lobectomy was applied and empyema has developed after prolonged air leakage. B. bassiana was isolated in pleural fluid. The patient improved without antifungal therapy after thoracotomy with securing of air leakage.

To investigate the features of a new tularemia outbreak that occurred in the Thrace region. Materials and methods: The research team visited the village after the identification of the index case. Serum and throat samples were taken from 41 villagers who were examined, and environmental samples were taken in order to identify the source of the outbreak. Culture, serology, and molecular methods were used to search for Francisella tularensis in these samples. Results: A total of 8 children were diagnosed with tularemia. The adults and all of the other children were seronegative for tularemia. All of the patients had a history of swimming in a pool filled with water from a local stream, and contact with stream water was calculated to increase the risk of developing the disease 9.3-fold. Polymerase chain reaction analysis was positive in a lymph node aspirate of the index case and in the home tap water of 3 patients as well as in the spring water and stream water in the village. Francisella tularensis could not be isolated from any culture of samples. Interestingly, the waterborne tularemia outbreak affected only children. Conclusion: Although tularemia has been not reported from Tekirdağ Province for 74 years, the disease reemerged in the region due to the removal of hygienic measures. These clues may signify that the agent had maintained its presence in the region for many years.

Francisella tularensis is a small gram-negative aerobic bacillus which was named after Edward Francis and the location (Tulare County, California) where the organism was discovered. F. tularensis includes four [corrected] subspecies known as tularensis (type A biovar), holarctica (type B biovar) and mediasiatica and novicida [corrected] Tularemia (rabbit fever) is a rare and primarily rural disease which may be transmitted by ingestion, inhalation, or by direct skin contact with rabbits, other rodents and by blood-sucking arthropods. Infection occurs in different forms, such as typhoidal, pneumonic, oculoglandular, oropharyngeal, ulceroglandular, and glandular. The incubation period is about 3-5 days, but may vary between 1 to 21 days, and symptoms vary based on the mode of infection. Infections by F. tularensis subsp. tularensis are generally presented as ulceroglandular form and cause more severe diseases leading 5-60% mortality in untreated patients. F. tularensis subsp. holarctica which is a less virulent organism, mainly cause oropharyngeal form of infection especially in Europe countries as well as in Turkey. Since F. tularensis is extremely virulent organism and is difficult to culture on standard media, laboratory diagnosis is mainly based on the serological assays such as microagglutination or ELISA tests. Streptomycin or gentamycin (for 10-14 days) are the first choise antibiotics for the treatment. Tularemia becomes a reemerging zoonosis in Turkey. The first published tularemia epidemic in Turkey had been reported in 1936 from Thrace region (Luleburgaz town), and the second was in 1945 again in the same location. In recent years, tularemia outbreaks were reported from various regions of Turkey. The reliable data were obtained after 2005 because of the inclusion of this infection into Group C of notification system of communicable diseases by Turkish Ministry of Health. A total of 431 confirmed cases were reported from various provinces according to data of the year 2005. In this review, general characteristics of F. tularensis and its infections have been discussed emphasizing the data related with tularemia in Turkey.

Tularaemia was diagnosed by TaqMan RT-PCR and microagglutination tests in 5 patients, all from a new settlement constructed after the earthquake of 1999. During the follow-up, 129 more cases were found in this settlement (data from the local Health Care Authority). In this study, clinical features of 5 cases are presented briefly, and the Turkish literature on past outbreaks of tularaemia is reviewed.

Objective. In this study, the patients who developed asymptomatic candiduria in the intensive care unit were followed prospectively for the persistence of candiduria after the replacement of indwelling urethral catheter and the correlation between persistence and virulence factors (proteinase enzyme activity and epithelial adhesion) was assessed. Design. Prospective study. Setting. Intensive care unit and mycology laboratory at a university hospital. Patients. Thirty-four patients with asymptomatic candiduria were included in the study. Results. Candiduria persisted in 19 of 34 patients(56%; group 1) and cleared in 15 of 34 patients(44%; group 2) after urinary catheters were changed. When the virulence factors (epithelial adhesion and proteinase activity) and distribution of Candida spp. were compared between two groups, no statistically significant correlation was found. Conclusion. The host immune response might be more important than virulence factors of Candida spp. for persistence of candiduria.

Stenotrophomonas maltophilia is inherently resistant to many antimicrobials. So far, antimicrobial susceptibility tests for S. maltophilia have not been fully standardized. The purpose of the study was to compare the susceptibility of S. maltophilia isolates against seven different antimicrobials using three different methods and to investigate their genetic relatedness. Although trimethoprim/sulfamethoxazole (SXT) and ciprofloxacin have the lowest MIC values, SXT (98.1%) and ticarcillin/clavulanate (TLc) (73.1%) were found to be the most effective antimicrobials by agar dilution method, which was in accordance with the breakpoints established by NCCLS. Disc diffusion and E-test was in agreement with agar dilution method for SXT. When the isolation dates, clinics, antibiotyping, and AP-PCR data were investigated, two small outbreaks consisting of five and three cases were determined. By using the NCCLS criteria, disc diffusion and E-test were unreliable alternative methods for S. maltophilia, except for SXT. However, the significance of these data should be confirmed by further experimental and clinical studies.

Both tuberculosis cervical lymphadenitis (TCL) and oropharyngeal tularaemia (OT) have similar signs, symptoms and pathological findings. We aimed to investigate the frequency of tularaemia antibodies in patients diagnosed with TCL. Using data from the Tuberculosis Control Dispensaries between the years of 2008 and 2011 in Turkey, all patients diagnosed with TCL were informed about and included in the study. Control group subjects were selected from healthy blood donors who lived in the same region. After informed consent was obtained, the sera obtained from volunteer TCL patients and the control group were tested with a microagglutination technique for Francisella tularensis. Antibodies to Brucella were also investigated with a tube agglutination test for cross-reactivity in sera that were seropositive for tularaemia. Sera were obtained from a total of 1170 individuals in the TCL group and 596 in the control group from 67 of 81 provinces In Turkey. Francisella tularensis-positive antibodies were found in 79 (6.75%) cases in the TCL group and two (0.33%) cases in the control group with a titre of ≥ 1:80 (p < 0.01). When the presence of antibody of any titre was considered, the ratio became 8.2% (96/1170) in the TCL group and 0.67% (4/596) in the control group (p < 0.001). For the first time, with this study, tularaemia serology was found to be positive in a significant portion (6.75%) of diagnosed cases of TCL. In tularaemia endemic regions, it was concluded that tularaemia serology should be investigated in patients suspected of having TCL.

Aims: To report a rare case of oropharyngeal anthrax. Materials and Methods: A case report of oropharyngeal anthrax is presented together with the related world literature. Results: A 70-year-old female patient with respiratory distress and extensive swelling of neck, soft palate and uvula is presented. There was ecchymosis on the neck circumferentially. Bacillus anthracis grew in the blood culture. The patient died of toxemia and sepsis. Conclusions: Oropharyngeal anthrax is the least common form of anthrax. This acute illness should be added to the differential diagnosis of inflammatory lesion of the oropharynx with extensive neck swelling. Successful diagnosis of anthrax depends on a high level of suspicion.

The first case of haemorrhagic meningitis due to Bacillus anthracis in the European part of Turkey is reported here. B. anthracis, sensitive to penicillin, was isolated from the cerebrospinal fluid and blood cultures. Although appropriate therapy was administered, the patient died two days after hospitalization.

Tularemia is a disease that has been reported in Turkey since 1936. Although mice are considered to have a role in the transmission of Francisella tularensis to man, this has not been exactly confirmed yet. The aim of this study was to investigate the presence of F. tularensis in mice by using culture, serology and molecular methods. For this purpose, four villages (Edirne-Demirkoy, Kirklareli-Kaynarca, Tekirdag-Muzruplu, Tekirdag-Sinanli) were selected in Thrace Region of Turkey where tularemia cases had been reported previously. A total of 126 live-catch mouse traps were established in warehouses, barns, areas near wells, water tanks and creeks in the villages in December 2012. Traps were kept overnight and the next day the animals collected were identified at species-level. The live-captured mice were anesthetized and their heart blood samples were obtained. Subsequently, liver and spleen tissues were removed from every mouse under aseptic conditions in the class-2 safety cabinet. These tissues were cultivated in Francis medium containing 5% sheep blood, 0.1% cystein, 1% glucose and incubated for seven days in both normal atmosphere and 5% carbondioxide incubator at 37°C. Tularemia microagglutination test was performed by using the sera which were obtained from live-captured mice. Finally, DNAs were isolated from both liver and spleen tissues of mice, and real-time polymerase chain reaction (Tularemia RT-PCR; Public Health Agency of Turkey, Ankara) were performed. In our study, a total of 19 mice were captured and of these 11 were alive. Ten mice were identified as Apodemus flavicollis, seven were Mus macedonicus and two were Mus musculus. There were no Francisella tularensis isolation in the cultures of mice liver and spleen tissues. Serological tests yielded negative results for 10 mice whose serum samples could be obtained. In RT-PCR, positivity were detected in spleen tissues of two mice which were captured from Kaynarca where first tularemia cases in Turkey in 1936 were reported but has no report from then on. One of them was a live female Mus macedonicus, and the other was a dead male Apodemus flavicollis. In quantitative evaluation, number of microorganism per organ were calculated as 4 x 103 cfu/spleen in Mus macedonicus and 4 x 104 cfu/spleen in Apodemus flavicollis. This is the first study in Turkey indicating that the mice in natural environment harbored F.tularensis. In conclusion, the results of this study indicated that the agent of tularemia has been retained since 1936 in Kaynarca region and this persistence might present a potential risk for tularemia epidemics.

Gurcan, Saban/0000-0002-5052-481X WOS: 000220224200003 PubMed: 15004863 The aim of this study was to investigate the source and the size of a tularemia outbreak in a village located in a non-endemic area. Five patients from the same village were admitted to hospital with the same complaints all within one week of September 2001. Tularemia was suspected and a diagnosis was made after physical and anamnesis examinations. The village was visited the same week that the patients were admitted to the hospital, in the January and April 2002. The villagers were examined and screened serologically by microagglutination method and the water sources were investigated bacteriologically. A total of 14 people were found to be infected from the outbreak and the oropharyngeal form was the only clinical presentation. Antibody titers ranged between 1 : 80 and 1 : 640. The patients responded well to the aminoglycoside plus tetracycline therapy. Examination of the pipewater and three springs revealed that all the water sources were contaminated by coliforrns, however, Francisella tularensis could not be isolated in glucose-cystine. medium. Antibody levels stayed stable or decreased seven months after. Tularemia had not been reported in this area before, so the first patients were misdiagnosed. In conclusion tularemia should be considered in differential diagnosis of patients with fever, sore throat and cervical lymphadenopaties.