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Objective:Obesity might be a risk factor for patients with Coronavirus disease-19 (COVID-19). We aimed to investigate the association of the obesity with intensive care need and mortality caused by severe acute respiratory syndrome-CoV-2 (SARS-CoV-2) infection in this retrospective cohort.Methods:Between March 11th and May 1st, 135 patients, who were treated in our clinic, were enrolled in the study. Body mass index (BMIs) of the patients were grouped according as WHO criteria (30 kg/m2: obese).Results:Of our patients, 34.1% (n=46) were obese. Mean BMI of the mortality group was 31.2 kg/m2 and was not different from that of the survivors (p=0.09), However, mean BMI of the patients, in whom intensive care was needed, was 31.2 kg/m2 and higher than that of those intensive care was not needed (p=0.04). In subgroup analyses, obesity (BMI >30 kg/m2) was more common among mortality group versus survivors in males older than 60 years old (p=0.03).Conclusion:Obesity with associated disorders are negative prognostic factors for COVID-19 and should be tackled as the end of the pandemic is obscure.

Streptococcus dysgalactiae (SD) is a common pathogen among elderly population. However, to our knowledge, there is no periprosthetic joint infection case reported that is infected with Streptococcus dysgalactiae subspecies equisimilis (SDSE) in the English literature. In this article, we report a 77 -year -old male patient who had undergone total knee arthroplasty three years ago and had the diagnosis of cellulitis at his leg followed by swelling, pain and hyperemia localized at his knee. Three knee aspirations were performed and the SDSE was identified. There was no direct contact of patient to animals.

KARA, Murat/0000-0002-4144-2409; aydin, merve/0000-0002-1522-6083 WOS: 000473414800014 PubMed: 30745200 Background: mecA is a predefined gene causing methicillin resistance in Staphylococcus aureus (S. aureus) isolates; however, it has been shown that some methicillin-resistant S. aureus (MRSA) strains do not carry this gene. Recently, in isolates found to be MRSA-positive but mecA-negative, a new resistance gene called mecC, which is a homolog of mecA, has been reported. This study aimed to investigate the mecC and mecA genes in MRSA strains isolated from different geographic regions in Turkey. Methods: the sample of the study consisted of 494 MRSA strains isolated from seven geographical regions in Turkey between 2013 and 2016. the strains were obtained from 17 centers, comprising 13 university hospitals, three education and research hospitals, and one state hospital. Methicillin resistance in S. aureus strains was determined using the agar disk diffusion method with a cefoxitin disk and the agar dilution method with oxacillin. the mecC and mecA genes in MRSA strains was investigated by Polymerase Chain Reaction (PCR). Results: of the MRSA strains investigated, 47.9% were isolated from intensive care units. Concerning sample type, 36.7% were detected in the respiratory tract (tracheal aspirate, sputum, etc.), 24.8% in blood, 18.7% in skin and soft tissues, 9.3% in nasal swabs, 5.4% in urine, 4.1% in ears, and 1% in sterile body fluid. Using PCR, mecC was not identified in any of the S. aureus strains isolated from different clinical microbiology laboratories. mecA gene positivity was found in 315 of the MRSA strains (63.8%). Staphylococcal Cassette Chromosome mec ( SCCmec) type was identified in 232 strains (46.9%), of which 136 (58.7%) were type II, 75 (32.4%) were type IV, 12 (5.1%) were type Mb, six (2.5%) were type I, and three (1.3%) were type III. Conclusion: This is the first multi-centered study to investigate MRSA strains isolated from different regions in Turkey. the mecC gene was not detected in any of the MRSA strains. We believe that this study will constitute an important basis for monitoring possible future changes. (C) 2019 the Authors. Published by Elsevier Limited on behalf of King Saud Bin Abdulaziz University for Health Sciences. Scientific Research and Project Unit of Erzincan Binali Yildirim University [SAG-A-240215-0121] This study was financially supported by the Scientific Research and Project Unit of Erzincan Binali Yildirim University (Project No: SAG-A-240215-0121). This research was presented as a poster in the 4th National Clinical Microbiology Congress in Antalya, Turkey, 2017.

BACKGROUND: We investigated the factors affecting antibiotic resistance in the intensive care unit (ICU)-related hospital-acquired infections caused by Klebsiella pneumoniae (KP-HAI) and the effects of antibiotics used for high-level antibiotic resistance on patient survival. MATERIAL AND METHODS: This retrospective study was performed at the adult ICU of Bezmialem Vakif University Hospital. Patients who were followed up between 01 January 2012 and 31 May 2017 were evaluated. Each KP strain was categorized according to resistance patterns and analyzed. The efficiency of antibiotic therapy for highly-resistant KP-HAI was determined by patients’ lifespans. RESULTS: We evaluated 208 patients. With the prior use of carbapenem, antibiotics against resistant Gram-positives, and tigecycline, it was observed that the resistance rate of the infectious agents had a significant increase. As the resistance category increases, a significant decrease was seen in the survival time. We observed that if the treatment combination included trimethoprim-sulfamethoxazole, the survival time became significantly longer, and tigecycline-carbapenem-colistin and tigecycline-carbapenem combination patients showed significantly shorter survival times. CONCLUSIONS: When the resistance increases, delays will occur in starting suitable and effective antibiotic treatment, with increased sepsis frequency and higher mortality rates. Trimethoprim-sulfamethoxazole can be an efficient alternative to extend survival time in trimethoprim-sulfamethoxazole-susceptible KP infections that have extensive drug resistance.

Hand, foot, and mouth disease (HFMD) is caused by various serotypes of Enterovirus genus. Coxsackievirus A16 (CV-A16) and enterovirus A71 (EV-A71) were known to be the only responsible agents for these epidemics; however, this opinion was challenged after the detection that coxsackievirus A6 (CV-A6) was the responsible species for the outbreak in Finland in 2008. HFMD is frequently seen in Turkey, and no detailed study on its clinical and microbiological epidemiology has previously been reported. The present study addresses this question. Twenty-seven patient samples collected between 2015 and 2017 were included in the study. Typing was conducted by RT-PCR and the sequencing applied directly to patient's samples and as well as to the viral cultures with pan-enterovirus and serotype-specific primers. The presence of Enterovirus in 12 of 27 HFMD samples was shown with RT-PCR. The causative agent for three of these 12 samples was CV-A16, one of the most frequent two serotypes around the world, and the remaining nine samples was CV-A6. The findings of the study are relevant since it pertains to the molecular epidemiology of HFMD in Turkey, a gateway country where different serotypes might be circulating and transmitted. The findings also support the notion that CV-A6 cases are rising in number, which has caused more severe clinical features and widespread rashes in recent outbreaks. Hand, foot, and mouth disease (HFMD) is caused by various serotypes of Enterovirus genus. Coxsackievirus A16 (CV-A16) and enterovirus A71 (EV-A71) were known to be the only responsible agents for these epidemics; however, this opinion was challenged after the detection that coxsackievirus A6 (CV-A6) was the responsible species for the outbreak in Finland in 2008. HFMD is frequently seen in Turkey, and no detailed study on its clinical and microbiological epidemiology has previously been reported. The present study addresses this question. Twenty-seven patient samples collected between 2015 and 2017 were included in the study. Typing was conducted by RT-PCR and the sequencing applied directly to patient’s samples and as well as to the viral cultures with pan-enterovirus and serotype-specific primers. The presence of Enterovirus in 12 of 27 HFMD samples was shown with RT-PCR. The causative agent for three of these 12 samples was CV-A16, one of the most frequent two serotypes around the world, and the remaining nine samples was CV-A6. The findings of the study are relevant since it pertains to the molecular epidemiology of HFMD in Turkey, a gateway country where different serotypes might be circulating and transmitted. The findings also support the notion that CV-A6 cases are rising in number, which has caused more severe clinical features and widespread rashes in recent outbreaks.

Introduction: Mucosal healing (MH) has been a treatment target with the introduction of biological agents in Crohn's disease (CD). Histone H4 increases in chronic inflammation. Aim: Our goal was to investigate the role of serum histone H4 in predicting MH. Material and methods: The study included 44 patients who applied to the endoscopy unit for ileocolonoscopic evaluation with the diagnosis of ileocecal CD and 26 healthy controls. After ileocolonoscopic evaluation, we divided the patients into 2 groups: those with and those without MH, according to the presence of endoscopic ulcer or erosion findings. Blood samples were taken from these patients to analyse serum histone H4 before the endoscopic procedure. We first compared serum histone H4 levels between CD patients and the healthy control group and then between those with and those without MH among the CD patients. Finally, we compared CRP, ESR, and serum histone H4 levels in patients with CD according to the presence of MH and symptoms. Results: Serum histone H4 levels were significantly higher in ileocolonic CD patients compared to the healthy control group (p = 0.002). Also, serum histone H4 levels were significantly higher in CD patients with no MH (p = 0.028) or symptomatic patients (p = 0.033). We did not find a significant difference in C-reactive protein and erythrocyte sedimentation rate levels between CD patients in the presence of MH (p = 0.281 and p = 0.203, respectively) or symptoms (0.779 and 0.652, respectively). Conclusions: Serum histone H4 might be a useful biomarker for MH prediction in ileocolonoscopic CD patients. Validation is needed for large numbers of patients.

Introduction: Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae is an important health problem all over the world. In this study, it was aimed to determine the ESBL genes in Escherichia coli and Klebsiella pneumoniae strains isolated for approximately four-year period. Materials and Methods: A total 100 ESBL-producing E. coli and 100 ESBL-producing K. pneumoniae strains which were isolated between January 2008 and October 2012 were included into this study. The strains were identified using classical bacteriologic methods and BD Phoenix (Becton Dickinson, US) automatized bacterial identification device. CTX-M, TEM, SHV, VEB, GES, PER and OXA beta-lactamase genes were analyzed with the PCR method. Results: The beta-lactamase genes detected in ESBL-positive K. pneumoniae strains were as follows: 99% for CTX-M, 91% for SHV, 71% for TEM, 10% for OXA-10 group, and 5% for OXA-2 group. In E. coli strains, the prevalence of CTX-M was 92%; TEM was 70%, SHV was 21%, and OXA-2 group was 3%. CTX-M alone was found to be positive in 25 of the 98 (25.5%) in E. coli strains; TEM alone was found to be positive in 2 of 98 (2%) and SHV alone was found in 2 of 98 (2%). CTX-M alone was found positive in 3 of 100 (3%) K. pneumoniae strains. No other resistance genes alone were found in the strains. No GES, VEB and PER-producing strains were determined in this study. Conclusion: In the study, high prevalence of CTX-M beta-lactamase was found in ESBL-producing strains. It was thought that the high potential of mobility with CTX-M genes was the most possible reason for this result. Determination of ESBL genes will be useful to understand resistance epidemiology, develop effective therapeutic strategies, and plan the appropriate preventive measurements.

Objectives For perforated appendicitis in children, microbiological cultures should always be sought if an adequate sample is available. Knowledge of local epidemiology is important for optimal selection of antimicrobial therapy. The aim of this study was to evaluate the aetiology and susceptibility of pathogens in paediatric patients with perforated appendicitis. Methods Microbiological results of tissue samples obtained at surgery from children with acute appendicitis over 24 months were evaluated retrospectively. Results Among 209 children operated for acute appendicitis, 62 (29.7%) were perforated appendicitis. Intraperitoneal culture results were available for 42 patients, of which 41 (97.6%) had positive microbiological growth (57 pathogens). The male:female ratio was 1.8 and the mean age at presentation was 11 years (range 4–18 years). The most common pathogen was Escherichia coli (66.7%), among which 57.9% produced an extended-spectrum β-lactamase (ESBL). All patients received initial treatment with intravenous antibiotics (ampicillin, gentamicin and metronidazole). The antibiotic regimen was modified in 22 patients (52.4%). Seven patients (16.7%) developed a post-operative complication. No significant difference was observed for development of complications between patients with ESBL-positive and -negative E. coli growth (P = 0.698). Conclusion The high rate of ESBL-positive E. coli may indicate bowel colonisation with resistant bacteria even in the community setting. Prospective studies will show whether treatment options should be directed according to identified pathogens.

Background/aims Despite various scoring systems and imaging methods, it is hard to predict the severity and the course of acute pancreatitis (AP), thereby necessitating better and more reliable markers. Since inflammation plays a key role in the pathogenesis of AP, we sought to determine whether histone, which is a novel inflammatory marker, may play a role in the prediction of severity and prognosis. Materials and methods A total of 88 consecutive adult patients (>18 years) with a first AP episode were prospectively enrolled in the study. Severe AP was defined as having a revised Atlanta score >3 in the first 48 h after admission. Circulating histone 3 and 4 levels were measured using the enzyme-linked immunosorbent assay method. Results Eighty-eight consecutive adult patients with a first episode of AP were divided into two groups according to severity, in which 56 (63.6%) were assigned to the mild AP group and 32 (36.4%) to the severe AP group. White blood cell, hemoglobin, creatinine, and aspartate aminotransferase levels were significantly higher in the severe AP group. However, there was no difference in serum histone levels between the groups, and there was no correlation between revised Atlanta score and serum histone levels either. Conclusion Serum histone levels did not significantly differ between the severe and mild AP groups. Therefore, these markers may not provide additional benefit for determining the severity of AP.

Actinomyces are gram positive bacilli which generally colonize in mouth, colon and vagina. The members of genus Actinomyces are facultative anaerobic or microaerophilic organisms and have a branching flamentous structure. They cause classical actinomycosis. Among the Actinomyces species; A. israelii, A. viscosus, A. naeslundii, A. odontolyticus, A. bovis and A. neuii are the mostly isolated organisms from clinical cases. A rarely encountered member of this group, Actinomyces neuii does not show branching and is catalase and CAMP positive and is a coryneform shaped bacillus. Although Actinomyces is mostly found as contaminating organism, in some cases it is reported as a pathogen. Actinomyces neuii has been reported in chorioamnionitis, neonatal sepsis, vertebral osteomyelitis, cervical lymphadenitis, breast abscess, fatal bacteremia and postoperative endophthalmitis. In our case, A. neuii was isolated from a perineal abcess and it was not previously reported. In our case, Actinomyces neuii was identified by commercial identification systems. For this purpose; VITEK MS and VITEK (R) 2 Compact (both by bioMerieux, France) were used in the clinical microbiology laboratory and then this identification was confirmed as the Actinomyces neuii subsp. neuii by the 16S rRNA sequencing. Also, the positivity of CAMP was demonstrated in the laboratory. As in the cases of other actinomycosis, the treatment of the abcess caused by the Actinomyces neuii is through the surgical debridement. The antimicrobial susceptibility testing is not performed since the organism is reported to be susceptibile to common antibiotics. Beta lactam antibiotics are acknowledged as the proper selection for antibiotic treatment.

Leptospirosis is a systemic infection with varying degree of clinical manifestations from mild to fatal disease. Clinical suspicion is very important to identify leptospirosis. A field worker patient was admitted to our clinic with emerging acute hepatitis and renal failure accompanying conjunctivitis, autoimmune hemolytic anemia, thrombocytopenia, pneumonia and epididymorchitis. During the follow-up the patient was transmitted to intensive care unit, and hemodialysis with plasma exchange was performed. Usually mild disease is treated in outpatient clinics because severe organ failure is experienced rarely. Alternative treatments such as plasma exchange and corticosteroids may also provide benefits especially in patients who were unresponsive to classical therapies., Leptospirozis, hafif ile ölümcül hastalığa kadar değişen derecede klinik bulgulara sahip sistemik bir enfeksiyondur. Teşhis konusundaki en önemli vizyonun klinik şüpheniz olduğu düşünülmektedir. Kliniğimize, konjontivit, otoimmün hemolitik anemi, trombositopeni, pnömoni ve epididimo-orşitin eşlik ettiği akut hepatit ve böbrek yetmezliği tablosuyla başvuran ; takibinde yoğun bakım ünitesine alınıp plazma değişimi ve hemodiyaliz ile takip edilen tarlada çalışan bir işçiyi sunduk. Leptospiroziste genellikle hafif hastalık ayaktan tedavi edilirken, ciddi organ yetmezliği nadiren görülür. Plazma değişimi ve kortikosteroidler gibi alternatif tedaviler, özellikle klasik tedavilere yanıtsız kabul edilen hastalarda fayda sağlayabilir.

Background / Aims:Clostridium difficile is a Gram-positive, strict anaerobe, spore-forming bacterium. It can cause self-limiting mild diarrhea, severe diarrhea, pseudomembranous colitis, and fatal fulminant colitis. We aimed to investigate the changes in epidemiology and incidence of C. difficile infection in our hospital database. Patients and Methods: Episodes of C. difficile toxin were identified in hospital database, and data such as age, sex, community versus hospital acquisition, intensive care follow-up, current or previous treatments with antibiotics within the past 3 months, medication with proton pump inhibitors, or immunosuppressive therapies were collected. Results: Toxin-positive 78 individuals constituted the patient group. In univariate analyses, independent risk factors for toxin positivity were community versus hospital acquisition [odds ratio (OR), 5.49; 95% confidence interval (CI), 2.52–11.95; P = 0.0001], presence of inflammatory bowel diseases (IBDs) (OR, 21.5; 95% CI, 8.65–53.44; P = 0.0001), proton pump inhibitors' use (OR, 4.53; 95% CI, 1.97–10.43; P = 0.0001), immunosuppressive drug use (OR, 4.1; 95% CI, 2.01–8.3; P = 0.0001), and use of quinolone group of antibiotics (OR, 5.95; 95% CI, 1.92–18.46; P = 0.001). Antibiotic use was a protective risk factor (OR, 0.09; 95% CI, 0.01–0.78; P = 0.01) and presence of IBDs was an independent risk factor (OR, 6.8; 95% CI, 1.5–30.08; P = 0.01) in community-acquired group (OR, 0.09; 95% CI, 0.01–0.78; P = 0.01). Conclusion: In recent studies, C. difficile infections were demonstrated to be more frequent in younger individuals who did not have a history of hospitalization but had an underlying disease such as IBD. In our study, we showed the change in the epidemiological data with prominence of underlying diseases such as IBDs.

Objective: To determine the role of serum histone H3.3 and H4 in patients with chronic hepatitis B to explore any relationship between the two.Methods: The prospective controlled clinical pilot study was conducted in the Gastroenterology Clinic of Bezmialem Vakif University, Istanbul, Turkey, from January to October 2017, and comprised biopsy-proven patients with chronic hepatitis B and healthy controls. Demographics, hepatitis B virus deoxyribonucleic acid quantity, hepatitis B e-antigen, aspartate aminotransferase, alanine transaminase, international normalized ratio, total/direct bilirubin, albumin and thrombocyte counts as well as histological activity index and fibrosis scores were noted. Data was analysed using SPSS 22.Results: Of the 140 subjects, 70(50%) each were cases and controls. The overall mean age of the sample was 43.38±15.07 years (range: 18-70 years). There was positive correlation of histone H3.3 with hepatitis B virus deoxyribonucleic acid, aspartate aminotransferase, alanine transaminase and international normalized ratio levels. Histone H4 levels only correlated with hepatitis B virus deoxyribonucleic acid and international normalized ratio. Hepatitis B e-antigen positivity was present in 14(20%) of the cases.Conclusion: Histone H3.3 levels appeared to be associated with pathophysiological changes in chronic hepatitis B patients, suggesting that future treatments should target H3.3.Keywords: Histone H3.3, Histone H4, Extracellular histone, Chronic Hepatitis B, HBV.(JPMA 70: 1596; 2020)DOI:https://doi.org/10.5455/JPMA.19365 Bezmiâlem Vakıf Üniversitesi

Objectives: This study assessed trends and patterns in antimicrobial resistant intensive care unit (ICU)-acquired infections caused by Gram-negative bacteria (GNB) in Istanbul, Turkey. Methods: Bacterial culture and antibiotic susceptibility data were collected for all GNB causing nosocomial infections in five adult ICUs of a large university hospital during 2012-2015. Multi-resistance patterns were categorised as multidrug (MDR), extensively-drug (XDR) and pandrug (PDR)-resistance. Patterns and trends were assessed using seasonal decomposition and regression analyses. Results: Of 991 pathogenic GNB recorded, most frequent were Acinetobacter baumannii (35%), Klebsiella species (27%), Pseudomonas aeruginosa (18%), Escherichia coli (7%) and Enterobacter species (4%). The overall infection rate decreased by 41% from 18.4 to 10.9 cases per 1000 patient-days in 2012 compared to 2015 (p

The aim of our study was to evaluate the association of the patients having the diagnosis of non-cystic fibrosis bronchiectasis with bronchoscopy secretion scoring, aerobic/anaerobic growth in bronchoalveolar lavage, Bhalla scoring, bronchoscopic imaging classification of bronchi. Patients followed up with the diagnosis of non-cystic fibrosis bronchiectasis between 2010 and 2016 were included in the study. The bronchoscopic imaging classification of bronchi (1), bronchoscopy secretion (BS) scoring (2), culture growth in bronchoalveolar lavage (BAL) and pulmonary function testing were recorded. The thorax CT findings of the patients were classified according to Bhalla scoring. Of 103 patients with non-CF BE, 54(52%) were girl and mean age of 11.7 years. As the BS grade increased, FEV1 and FVC had a declining tendency and this finding was statistically significant (p:0.048 – p: 0.04) (Figure 1). As the bronchoscopy secretion score increased, Bhalla score degree and rate of microorganism growth in BAL were determined to increase as well (p: 0,007, p:0,03). The mean values of FEV1 and FVC were lower in the patients with severe Bhalla score and this association was determined to be statistically significant (p: In this respect, study made a new contribution to the literature in the non-CF bronchiectasis pediatric patient group.

The aims of this study were to determine the minimum inhibitory concentration (MIC) values of vancomycin, teicoplanin, daptomycin, quinupristin/dalfopristin, linezolid, tigecycline, chloramphenicol, rifampicin, ofloxacin and tetracycline and to investigate the reduced vancomycin susceptibility among methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in hospitals located in different geographical regions of Turkey. A total of 100 MRSA strains isolated from patients (of which 50% were from intensive care units) hospitalized in seven centers in Turkey [Istanbul (n= 15), Ankara (n= 15), Izmir (n= 15), Adana (n= 15), Diyarbakir (n=15), Erzincan (n= 15), Van (n= 10)], between August 2013 - August 2014, were included in the study. Fourty-three strains were isolated from blood, whereas 21 were from lower respiratory tract, 17 from wounds, eight from catheters, six from urine, four from nasal swab and one from cerebrospinal fluid samples. Methicillin resistance of the isolates was determined by using cefoxitin (30 µg) disk with standard disk diffusion method, while the MIC values of other antibiotics were determined with E-test in accordance with the recommendations of Clinical and Laboratory Standards Institute (CLSI). MIC results obtained for quinupristin-dalfopristin (Q/D) were evaluated according to the CLSI criteria used for methicillin-susceptible S.aureus and for tigecycline according to the criteria recommended by the Food and Drug Administration for MRSA. Primarily, agar screening method (ASM) was used for determination of vancomycin-intermediate S.aureus (VISA) and heterogeneous VISA (hVISA) strains. Brain heart infusion agar containing 6 µg/ml vancomycin was used in ASM, and the strains with suspicion of VISA/hVISA were screened by standard E-test and macro E-test methods. All MRSA strains were susceptible to vancomycin, teicoplanin, daptomycin, Q/D and linezolid by E-test method; and their rates of susceptibility for tigecycline, chloramphenicol, rifampicin, ofloxacin and tetracycline were detected as 89%, 97%, 40%, 39% and 32%, respectively. MIC50/MIC90 values were 1.5/2 µg/ml for vancomycin, 2/4 µg/ml for teicoplanin, 0.19/0.38 µg/ml for daptomycin, 0.19/0.38 µg/ml for Q/D, 0.75/1 µg/ml for linezolid, 0.19/0.75 µg/ml for tigecycline, 3/6 µg/ml for chloramphenicol, 32/32 µg/ml for rifampicin, 32/32 µg/ml for ofloxacin and 32/64 µg/ml for tetracycline, respectively. For the evaluation of reduced vancomycin susceptibility, 2% (2/100) of MRSA strains were defined as VISA and 5% (5/100) as hVISA with ASM. One of those seven isolates identified as VISA/hVISA with ASM was evaluated as suspected hVISA by using both standard E-test and macro E-test methods. In conclusion, no MRSA resistant strain to vancomycin, teicoplanin, daptomycin, Q/D and linezolid was determined in our study. However tigecycline resistance (11%) was found higher than expected. As the glycopeptide resistance is increasing in the world and because of the intense use of these drugs in Turkey, the rates of vancomycin resistance among MRSA strains should be investigated periodically.

The Fonsecaea species, which are the leading causes of chromoblastomycosis, are not considered neurotropic fungal agents. Fonsecaea pedrosoi is the primary species in the genus and is usually isolated from chromoblastomycosis cases. However, the recently distinguished species F. monophora has been reported in a few cerebral phaeohyphomycosis cases. Here, a case of cerebral phaeohyphomycosis caused by Fonsecaea monophora is presented in a 71-year-old female subject with chronic diabetes mellitus and hypertension. The identification of F. monophora was made through mycological and molecular analysis, and an isolate was differentiated from the closely related F. pedrosoi by sequence data on key bases on the ribosomal internal transcribed spacer region. The case was successfully treated with surgical and medical approaches, and the patient has remained healthy and stable after a ten-month follow up. Given the increasing incidence of this type of infection of the central nervous system (CNS), this case provides further support for the consideration that F. monophora might represent a neurotropic agent.

OBJECTIVE: Meningitis is an infectious disease with high risk of complications that must be diagnosed and treated immediately. In most of the cases, meningitis treated empirically without knowing the etiology. This empirical choice of antimicrobial treatment is made according to the common pathogens present in that particular geographic region and antibiotic susceptibility of these pathogens and age of the patient. In this study, the aim was to determine bacterial and viral meningitis agents that might be present in the CSF of patients who are followed with early diagnosis of meningitis.METHODS: In our study, 100 CSF samples, which belongs to different patients, sent from multiple clinics with early diagnosis of meningitis were analyzed. Among the bacterial meningitis agents, the presence of Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae were investigated by NHS Meningitis Real-TM Sacace, Italy and Speed-Oligo Bacterial Meningitis Test Vircell, Spain ; the presence of the HSV, as one of the agents of the aseptic meningitis, was investigated by HSV I/II Typing Real-TM Sacace, Italy and Attomol HSV 1 - 2 differentiation-DNA-LINA Vircell, Spain .RESULTS: With NHS Meningitis Real-TM method, 10 S. pneumonia, two N. meningitidis and one H. influenzae identified from CSF samples. By using the Speed-Oligo Bacterial Meningitis method, S. pneumoniae was identified in four of the samples and only in one sample N. meningitidis was identified. No H. influenzae was identified in any of the samples with this method. With HSV I/II Typing Real-TM, HSV positivity was identified in 5 of the CSF samples and 3 of them were identified as type 2 and other 2 were identified as type 1. With the use of Attomol HSV 1 - 2 method, HSV positivity was identified in 3 samples. All the HSVs determined with the use of this method were identified as type 1.CONCLUSION: For appropriate and adequate treatment of patients with meningitis, first of all the agent must be determined. With methods like PCR, it is possible to identify the agents early in the infection. Despite the wrong positive and negative results arising from the reasons like inhibitors present in the environment, contaminant materials, mistakes arising from DNA isolation steps and being unable to standardize these methods, molecular methods are thought to maintain their importance., AMAÇ: Menenjit, tanısının hızla konarak erken tedavi yapılması gereken komplikasyonları yüksek bir enfeksiyon hastalığıdır. Menenjitlerin çoğunda etiyoloji bilinmeden ampirik tedaviye başlanması gerekmektedir. Bu ampirik antimikrobiyal tedavi seçimi, coğrafi bölgedeki yaygın olan patojenlere, hastanın yaşına ve o bölgedeki patojenlerin antibiyotik duyarlılıklarına göre yapılmaktadır. Çalışmada, menenjit ön tanısı ile takip edilen hastaların beyin omurilik sıvısı BOS örneklerinde moleküler testler kullanılarak bakteriyel ve viral etkenlerin belirlenmesi amaçlanmıştır. YÖNTEMLER: Çalışmamızda, menenjit ön tanısı ile çeşitli kliniklerden gönderilen farklı hastalara ait 100 BOS örneği incelenmiştir. Bakteriyel menenjit etkenlerinden Streptococcus pneumoniae, Neisseria meningitidis ve Haemophilus influenzae; NHS Meningitis Real-TM Sacace, Italy ve Speed-Oligo Bacterial Meningitis Test Vircell, Spain yöntemleri ile, aseptik menejit etkenlerinden HSV ise; HSV I/II Typing Real-TM Sacace, Italy ve Attomol HSV 1,2 differentiation-DNA-LINA Vircell, Spain yöntemleri ile araştırılmıştır. BULGULAR: NHS Meningitis Real-TM yöntemi ile BOS örneklerinde 10 S. pneumoniae, 2 N. meningitidis ve bir H. influenzae tespit edilmiştir. Speed-Oligo Bacterial Meningitis yöntemi kullanılarak; 4 örnekte S. pneumoniae ve 1 örnekte ise N. meningitidis saptanmıştır. Bu yöntem ile H. influenzae’ya rastlanmamıştır. HSV I/II Typing Real-TM ile 5 BOS örneğinde HSV pozitifliği belirlenmiştir. Tespit edilen HSV’ün 3’ü HSV tip 2 bulunmuş, 2’si ise HSV tip 1 olarak saptanmıştır. Attomol HSV 1-2 yöntemi kullanılarak da HSV pozitifliği 3 örnekte belirlenmiştir. Bu yöntem ile belirlenen tüm HSV’ler, HSV tip 1 olarak saptanmıştır. SONUÇ: Menenjit hastalarında uygun ve yeterli antimikrobiyal tedavi için öncelikle etkenin belirlenmesi gerekmektedir. PCR gibi moleküler yöntemlerle etkenlerin erken saptanması mümkün olmaktadır. Ortamda bulunan inhibitörler, kontaminant maddeler ve DNA izolasyonundan kaynaklanan hatalar ile yöntemin standardize olmaması gibi nedenlerden kaynaklanan yanlış pozitif ve yanlış negatif sonuçlara rağmen moleküler yöntemlerin önemini koruduğu düşünülmektedir.

OBJECTIVE: Currently incidence of hepatitis A is shifting to an advanced age and the virüs seem to cause a significant clinical disease at advanced ages. There is a considerable segment of population susceptible to HAV. The aim of the study was to investigate the seroprevalance of hepatitis A for adults age groups.METHODS: In this study, the seropositivity of hepatitis A infection of patients who had attended to Bezmialem Vakif University Hospital were retrospectively evaluated between 30 October 2011 and 31 December 2013. Anti-HAV IgG was tested by chemiluminescence method Cobas 6000, Roche, Almanya . RESULTS: A total of 787 adult patients, 390 49.5% male and 397 50.5% female, were included in the study. Anti HAV IgG positivity was detected in 630 80.0% patients. Of the anti-HAV IgG positive patients, 318 50.5% were male, and 312 49.5% were female. Anti-HAV IgG seropositivity increased with age. However, 57.2% of the patients in 17-27 years age group were still anti-HAV IgG negative. CONCLUSION: HAV infections in adult patients is more severe than in children. In our study high seronegativity against to HAV infection in young adults were noticed. Therefore, we recommend that subjects who are susceptible against to HAV infections in the 17-27 age group might be included in the routine immunization schedule., AMAÇ: Günümüzde Hepatit A virüs HAV ile karşılaşma çocukluktan ileri yaşlara doğru kaymakta ve erişkilerde ciddi klinik tablolara yol açmaktadır. Bu çalışmadaki amacımız da İstanbul’da farklı erişkin yaş grupları arasında Hepatit A HAV seroprevalansını araştırmaktır. YÖNTEMLER: Bu çalışmada 30 Ekim 2011 ve 31 Aralık 2013 tarihleri arasında Bezmialem Vakıf Üniversitesi Tıp Fakültesi hastanesi’ne başvuran hastaların anti-HAV IgG seropozitifliği retrospektif olarak değerlendirildi. Anti-HAV IgG testi kemiluminesans immunassay yöntemi Cobas 6000, Roche, Almanya ile çalışıldı.BULGULAR: Çalışmaya erişkin yaş gruplarında 390’ı %49.5 erkek ve 397’si %50.4 kadın olmak üzere toplam 787 hasta alındı. Hastalardan alınan kan örneklerinin 630’unda %80 Anti-HAV IgG pozitif bulundu. Anti HAV IgG seropozitif kişilerin 318’i %50.5 erkek, 312’si %49.5 kadındı. Çalışmada 17-27 erişkin yaş grupları arasında %57.2 oranında seronegatiflik saptandı. SONUÇ: HAV enfeksiyonları erişkin yaşlarda çocuklardakinden daha ciddi seyirli olmaktadır. Biz bu çalışmada 17-27 yaş grubundaki genç erişkinlerde HAV enfeksiyonlarına karşı yüksek oranda duyarlılık saptadık. Bu nedenle genç erişkin yaş grubundaki bireylerin de rutin aşılama şeması içerisinde yer almasını öneriyoruz.

OBJECTIVE: The aim of this study was to investigate seroprevalence of antibodies against Rubella virus and Toxoplasma gondii, which may cause congenital infections in childbearing age women in a period of two years.METHODS: This study included pregnant and childbearing age women who had admitted to our hospital in the period between 01.01.2012 and 01.01.2014. Toxoplasma and Rubella antibodies tests in sera of patients were tested with an enzyme immunoassay EIA method using VIDAS BioMerieux, France kits. Test results were evaluated retrospectively.RESULTS: Rubella IgM antibodies n = 15 were detected as positive in 0.5% of samples and the IgG antibody seropositivity rate n = 451 was found to be 95.8%. The Toxoplasma IgM antibody positivity rate was 1.2% n= 38 and the IgG seropositivity was 35.5% n = 158 .CONCLUSION: Routine screening for toxoplasma seropositivity may be needed due to high seronegativity in among women of childbearing age in our region. Additionally, education of all susceptible women about protection and control of toxoplasma infection might be useful in decreasing the risk of congenital infections. However, routine screening for Rubella is considered unnecessary due to the high seropositivity rate., AMAÇ: Bu çalışmanın amacı, iki yıllık dönemde doğurgan yaştaki kadınlarda konjenital enfeksiyonlara yol açabilme potansiyeline sahip Toksoplazma gondii ve Rubella virüsüne karşı oluşan antikorların seroprevalansını araştırmaktı.YÖNTEMLER: Bu çalışmaya 01.01.2012 - 01.01.2014 tarihleri arasında hastanemize başvuran doğurgan yaştaki kadınlar dahil edildi. Hasta serumlarındaki Toksoplazma ve Rubella antikorları VIDAS BioMerieux, France kitleri kullanarak enzim immunoassay EIA yöntemiyle ölçüldü. Test sonuçları retrospektif olarak değerlendirildi.BULGULAR: Rubella IgM antikorlarında n=15 %0.5 oranında pozitiflik saptanırken, IgG antikorlarında n=451 %95.8 oranında bulunmuştur. Toksoplazma IgM antikorlarında n=38 %1.2 oranında pozitiflik saptanırken, IgG antikorlarında n=158 bu oran %35.5 olarak belirlenmiştir. SONUÇ: Bölgemizde doğurgan çağdaki kadınlarda saptanan yüksek toksoplazma seronegatifliğinden dolayı toksoplazma için rutin taramaya ihtiyaç bulunmaktadır. Ancak tüm duyarlı kadınların toksoplazma enfeksiyonlarından korunma ve kontrolü açısından eğitimi konjenital enfeksiyon riskini azaltabilir. Saptadığımız rubella seropozitiflik oranlarının yüksek olması nedeniyle rubella için rutin taramanın mutlak ihtiyaç olmadığını düşünmekteyiz

Coxiella burnetii (C. burnetii) bacterium, the causative agent of Q fever has regained importance due to the increasing cases of infections and outbreaks. A cross-sectional descriptive study was conducted to investigate the seroprevalence of C. burnetii in human populations of Erzincan province located in the eastern Turkey, identify the risk factors, and to explore the relationship between geographical features.A total of 368 people residing in the rural (306) and urban (62) areas of the province were included in the study. Serum samples were analyzed for the presence of C. burnetii phase II IgG antibody using ELISA (Virion/ Serion, Wurzburg, Germany). Spatial analyses were performed to evaluate correlations between seroprevalence and geographical features.The overall seroprevalence of C. burnetii was found to be 8.7% (32/368). In rural residents it was 8.5% (26/306), while in urban population it was 9.7% (6/62). Cattle breeding and contact with animal afterbirth waste were found to be major risk factors, and were significantly correlated with seropositive cases (p0.05). The seropositive cases were only observed in the areas between 1067 and 1923 masl. Of the total seropositive cases, 65.6% were within 1000 m and 87.5% within 4000 m of rivers and their main tributaries. Around 59.4% cases were observed in areas with a slope of 0 to 5°.The results of the study showed that C. burnetii seroprevalence was higher than expected, and significantly differs according to geographical features of a region. Significant risk factors include raising cattle and exposure to infected animals or their birth products/secretions. It is also more frequent in areas with higher number of rivers and streams, higher altitude and lower slope.

Purpose: Bone and soft tissue infections are among the least desired complications after orthopaedic surgery. This study analysed the in vivo effects of the local application of nano-silver particles (AgNPs) [1nm = 1 billionth of a meter] in soft tissue infections.Materials-Method: An experimental osteomyelitis model was formed by inoculating both tibias of 24 rats with methicillin-resistant Staphylococcus aureus. The rats were followed without treatment for 21 days. Blood samples and tibial x-rays at day 21 confirmed the development of infection. Then, the rats were divided randomly into two groups. One group (12 rats) underwent surgical debridement and received 21 days of teicoplanin therapy. The second group had the same treatment, with the addition of local nano-silver. All of the rats were sacrificed at day 42. Blood and wound swab samples were taken and the culture results were analysed.Results: No differences were observed between the groups in healing values at pathological examination, or in changes in the number of colonies at days 21 and 42. No differences in white blood cell count (WBC) were observed between the groups before and after the treatment.Conclusion: Although in vitro studies suggest the effectiveness of AgNPs on pathogens, we found that the application of nano-silver did not make any difference when used in addition to the classical osteomyelitis treatment with antibiotics and local surgical debridement. We believe that additional in vivo studies using repeated nano-silver application could be beneficial.

Introduction: Hepatitis D virus (HDV) infection is a serious health problem leading to cirrhosis and hepatocellular carcinoma (HCC). Despite evidence that zoonotic infections are associated with end-stage liver disease, brucellosis in patients with delta hepatitis related to liver disease has not been well characterized. So, we examined this relationship using recent hospital-based data. Material and methods : We analyzed data from 96 delta hepatitis patients (mean age: 52.5 ±12.8 years; 50 male; 52 cirrhotics) and 117 (mean age: 50.4 ±7 years; 60 male) control subjects who were selected from patients with splenomegaly. The Brucella Wright test in connection with blood culture was used to detect active Brucella infection. Demographic features, laboratory data, results of ultrasonographic examination of the abdomen and Wright agglutination titers were compared between groups. Results : There were 9 (9%) patients with active brucellosis in delta hepatitis patients. Compared to the control group, there was a statistically significant difference between groups in terms of having active brucellosis (9 vs. 2 patients; p < 0.001). Higher MELD scores were also associated with active Brucella infection (p < 0.005). Conclusions : Patients with chronic hepatitis D related cirrhosis (CHD-C) were at risk of developing brucellosis requiring hospitalization. Higher Wright titers among patients with more advanced liver disease may reflect a unique phenomenon that requires further investigation to determine underlying causative factors.

AIM Knowledge about the role of the innate immune system in the pathogenesis of allergic diseases has been expanding in recent years. Defensins are antimicrobial peptides that are components of the innate immune system. Defensins have strong efficacy against bacterial, viral, and fungal infections. Moreover, they have regulatory functions in many physiologic processes such as antitumoral immunity, chemotaxis, inflammation, and wound healing. In this study, we aimed to investigate β-defensin 2 levels in the nasal fluids of children with allergic rhinitis. MATERIAL AND METHODS Study and control groups consisted of 28 patients with newly diagnosed allergic rhinitis who were not taking any medication, and 23 healthy children. Skin prick tests were performed on patients with allergic rhinitis and disease severity was assessed using the total symptom score. Nasal fluid samples were obtained using a modified polyurethane sponge absorption method from patients and control subjects. Nasal fluid β-defensin 2 levels were determined using an enzyme-linked immunosorbent assay (ELISA). RESULTS The median value of nasal fluid β-defensin 2 levels were 173.8 pg/mL (interquartile range; 54.8-205.9 pg/mL) in allergic rhinitis group and 241.6 pg/mL (163.5-315.2 pg/mL) in the control group. There was a statistically significant difference between the two groups (p=0.01). Moreover, nasal fluid β-defensin 2 levels showed a significant negative correlation with total symptom scores (rho= -0.78, p

Aim of the study : Positron emission tomography–computed tomography (PET CT) scan is commonly used in current medical oncology practice as an imaging method. In this study we present data from cancer patients who were followed at our clinic and suspected of having tuberculosis during PET CT scanning. After the biopsy, they were diagnosed with concomitant tuberculosis. Material and methods : In this study, 14 patients who applied to our clinic and followed up due to cancer, and had PET CT scanning for the preliminary staging or further evaluation, were included. The patients were diagnosed with metastatic or recurrent disease, and their biopsy results revealed tuberculosis. Results : The mean age was 57.8 years with SD (standard deviation) 13.1 years and gender distribution of 78.6% (n = 11) females and 21.4% (n = 3) males. None of the patients had tuberculosis in their personal history (0%). Among the patients, 5 (35.7%) were diagnosed with tuberculosis during the preliminary staging, whereas 9 (64.3%) were diagnosed during the follow-up after the treatment. The median time to tuberculosis diagnosis was 11 months (min–max: 3–24 months) after the treatment. The most commonly involved lymph nodes during PET CT scanning were mediastinal in 8 (64.3%), axillary in 3 (21.4%) and para-aortic in 3 (21.4%) patients. The mean SUV max (maximum standardised uptake value) of lymph node involved by PET CT scanning was defined as 8.5 (SD 2.6). Conclusions : Despite all improvements in modern medicine, tuberculosis is still a serious public health problem. It should always be considered in differential diagnosis while evaluating PET CT scanning results of cancer patients, because it may cause false positive results.

Ya z›fl ma Ad re si/Ad dress for Cor res pon den ce: Dr. Meryem Iraz, Bezmialem Vakif Universitesi Tip Fakultesi, Mikrobiyoloji Anabilim Dali, Istanbul, Turkiye Tel.: +90 212 453 17 13 E-posta: meriraz@mynet.com Ge lis ta ri hi/Re cei ved: 13.06.2013 Ka bul ta ri hi/Ac cep ted: 22.08.2013 © Viral Hepatit Dergisi, Ga le nos Ya y› ne vi ta ra f›n dan ba s›l m›fl t›r. / Viral Hepatitis Journal, pub lis hed by Ga le nos Pub lis hing. ABS TRACT Objective: The infections caused by hepatitis B and hepatitis C virus are still remain one of most important health problems for our country. The purpose of this study was to determine the frequency of HBsAg, anti-HBs and anti-HCV positivity in the patients who were admitted to the Research Hospital of the Medical Faculty of Bezmialem Vakif University between November 2011 and May 2013. Materials and Methods: The blood samples were tested for HBsAg, Anti-HBs and anti-HCV by chemiluminescent microparticle immunoassey (CMIA) ( Advia Centaur, Siemens, Almanya) Results: In our laboratuary serologically 53.593 patients are tested for HBsAg, 22.300 patients are tested for Anti-HBs and 39.877 patients are tested for Anti-HCV. In our study 5.5%, 42.2% and 1.3% of the patients are found to be seropositive for HBsAg, Anti-HBs and Anti-HCV respectively. Conclusion: The results detected for hepatitis B and hepatitis C virus seropositivity in our region are comparable to those found in other regions of Turkey. (Viral Hepatitis Journal 2013; 19(3): 106-9)

Amac: Enfeksiyoz gastroenteritler, cocukluklarda morbidite ve mortalitenin en onemli nedenlerinden biridir. Rotavirus ve enterik adenovirusler, enfeksiyoz gastroenteritlerin en onemli etkenleridir. Rotavirus ve enterik adenovirus gastroenteritlerinin bolgemizdeki epidemiyolojisi iyi bilinmemektedir. Bu calisma ile hastanemize basvuran cocuk hastalarda rotavirus ve enterik adenovirus gastroenterit sikligini belirlemeyi amacladik.Gerec ve Yontem: Ocak 2010-Haziran 2011 tarihleri arasinda hastanemize ishal sikayeti ile basvuran 955 hastanin disski orneklerine ait kayitlar retrospektif olarak incelendi. Diski orneklerinde rotavirus ve enterik adenovirus antijenlerinin varligi lateks aglutinasyon test ile arastirildi.Bulgular: Diski orneklerinin 205'inde (%21) viral antijenler belirlenirken bu orneklerin; 124'sinde (%13) rotavirus, 81'unda (%8.5) adenovirus ve 43'unde (%4.5) rotavirus ve adenovirus birlikte pozitif olarak tespit edildi. Viral antijen pozitif vakalar en sik 2 yas grubu ile sonbahar ve kis aylarinda goruldu.Sonuc: Bolgemizde de cocukluk cagi akut gastroenteritlerinde en onemli etken rotavirustur. Ozellikle sonbahar ve kis aylarinda taze diski orneklerinde rotavirus antijeni rutin olarak arastirilmalidir.

Purpose: Klebsiella pneumoniae is the most common endogen agent for nosocomial infections. In this study, mortality markers were investigated in patients with nosocomial K. pneumoniae blood stream infection (NKp BSI). Methods: The characteristics of patients >16 years who had NKp BSI diagnosis by daily active surveillance between January 2012 and January 2016 were retrospectively evaluated. Patients who died until 28th day of the clinical follow up and those who survived until this time were statistically compared in terms of various risk factors. Results: One hundred ninety patients were included into the study. Mortality rate was 47.9%, carbapenem resistance was 43.2%. Statistical analysis have shown that in presence of post-NKp BSI sepsis, septic shock, following in intensive care unit (ICU), meropenem resistance, kidney failure, NKp BSI secondary to pneumonia, use of invasive instruments such as central venous catheter (CVC), urinary catheter (UC) and mechanical ventilator (MV), colostomy, transfusion and hemodialysis mortality was significantly higher. In patients admitted into the hospital for neurological disorders, pancreaticobiliary tract (PBT) diseases and patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and patients in whom NKp BSI secondary to PBT infection mortality rate was lower. Conclusions: Sepsis, septic shock, clinical conditions requiring ICU treatment and meropenem resistance increase mortality rates in NKp BSI significantly. Mortality was higher also in patients with NKp BSI secondary to pneumonia, in kidney failure and when invasive instruments were used. On the other hand, in patients who were admitted to the hospital for neurological disorders and PBT diseases mortality rate was lower.

Background About half of the world population is infected with Helicobacter pylori ( H . pylori ), a bacterium associated with gastric cancer and considered to be a risk factor for pancreatic ductal adenocarcinoma. Whether the bacterium is associated with intraductal papillary mucinous neoplasm, believed to be a precursor of pancreatic ductal adenocarcinoma, is unknown. The aim of this study was to investigate the presence of H. pylori DNA in tissue sections of intraductal papillary mucinous neoplasm. Methods The presence of H. pylori DNA was tested in a retrospective controlled study of formalin-fixed, paraffin-embedded pancreatic tissues from 24 patients who underwent surgery for intraductal papillary mucinous neoplasm. Histologically normal tissues surrounding neoplasms were used as control. H. pylori DNA was evaluated after deparaffinization, DNA extraction, and purification, and results were evaluated statistically. Results Samples were collected from 13 males and 11 females with mean age 59 years (range 44–77), and consisted of 19 cases of main-duct and three cases of branched-duct intraductal papillary mucinous neoplasm. Two patients were diagnosed with pancreatic cancer and main-duct intraductal papillary mucinous neoplasm. H. pylori DNA was not detected either in intraductal papillary mucinous neoplasm tissue, or in surrounding normal tissue. Conclusions Although H. pylori has been implicated in pancreatic ductal adenocarcinoma, it may not play a key role in the development of intraductal papillary mucinous neoplasm.

Cathelicidin, an anti-microbial peptide, is a component of the innate immune system. Cathelicidin has anti-microbial, anti-inflammatory and immunoregulatory functions. Knowledge about the role of the innate immune system in the pathogenesis of allergic diseases has expanded in recent years. We measured levels of the LL-37 peptide in the nasal fluids of children with allergic rhinitis (AR) and investigated the possible role of this peptide in the pathogenesis of AR.The study population included 46 children who were newly diagnosed with AR and not taking any medication. Thirty-three healthy control subjects were also enrolled. Nasal secretions were collected from the study and control groups using a polyurethane sponge nasal secretion collector, and nasal fluid LL-37 levels were determined using the ELISA method.The levels of LL-37 in the nasal fluid of the AR patients were lower than those of the control group (median of 2.3ng/ml [minimum-maximum, 2.1-3.2] vs. 2.6ng/ml [2.1-5.4], respectively; p0.001), and they were significantly reduced in patients with moderate/severe AR compared with those of patients with mild AR (2.2ng/ml [2.1-2.4] vs. 2.5ng/ml [2.1-3.1], respectively; p0.001).Our results show that children with AR have reduced nasal fluid LL-37 levels compared with healthy controls. Additionally, children with moderate/severe AR have decreased nasal fluid LL-37 levels compared with children with mild AR. These findings highlight the role of cathelicidin in the pathogenesis of AR.

Background: The most frequently isolated fungi in patients using TPN belongs to the Candida genus. Various infections including venous catheter infections, fungemia, endocarditis and ophthalmitis may be encountered. Objective: Upon growth of Candida in the blood cultures from the pediatric (neonatal) unit of our hospital, a surveillance was performed in this unit and involving the health care workers. Clonal relationships of the isolates were investigated with molecular tests. Methods: Blood samples obtained from the patients in pediatric neonatal unit were studied with automatized blood culture [BacT/Alert (Bio Merioux, France)]. Yeast isolates from environmental surveillance cultures (TPN solutions, hands of healthcare personnel, etagere, etc) and patients were identified as C. albicans with conventional methods and ID 32 C and ATB (TM) Fungus 3 (Biomerieux, France) kits. Clonal similarity was determined by using AP-PCR as initial method and we have also typified all strains by the method of REP-PCR (diversilab system, bioMerieux). Finally; Pulsed Field Gel Electrophoresis (PFGE) was used for confirmation. Results: C. albicans was isolated in blood cultures of seven patients. Similar antifungal susceptibility patterns were observed in all isolates. AP-PCR and REP-PCR showed that the C. albicans isolates grown in the TPN solution and from the patients- blood cultures were clonally same strains. PFGE analysis further confirmed this clonality. Conclusion: According to results of the molecular methods, we thought that a C. albicans outbreak had occurred in the neonatal pediatric unit, due to contamination of TPN solution.

Introduction: Both hepatitis B virus (HBV) and hepatitis D virus (HDV) infection play an increasingly important role in liver diseases. The main objective of this study was to investigate the socio-epidemiological, laboratory and radiological aspects of both HBV and HDV infection near the Iranian border of Turkey. Material and methods: The study included 3352 patients with HBV and HDV infection. Socioepidemiological, laboratory and radiological aspects of the study subjects were retrospectively examined. Comorbid metabolic diseases were not assessed due to the retrospective design of the study. Results: Most of the study subjects were HBe antigen negative. No significant difference in terms of HBV-DNA levels or HBe antigen seropositivity was detected between the city centre and rural areas (p > 0.005). The mean HBV-DNA level in the anti-HDV-positive group was significantly lower than in the anti-HDV-negative group (p < 0.001). The rate of HDV-RNA positivity in women was higher than in their male counterparts (p = 0.017). Anti-HDV-IgG was detected in 18.4% of tested subjects who came from an urban area. In contrast, 12.5% of subjects of the rural group had a positive result for anti-HDV-IgG. Among 134 ultrasonographically evaluated delta hepatitis patients, 37.3% had liver cirrhosis. On the other hand, in 1244 patients with hepatitis B monoinfection, there were 90 patients with liver cirrhosis. Radiologically, the rate of hepatic steatosis in delta hepatitis patients was lower than in those with HBV monoinfection. Conclusions: Hepatitis D virus infection was particularly prevalent among the urban population as well as in female subjects. More broadly, the current observations are the first to suggest an inverse correlation between delta hepatitis and ultrasonography-proven hepatic steatosis.

Altindis, Mustafa/0000-0003-0411-9669; Karabay, Oguz/0000-0003-0502-432X; KARABAY, OGUZ/0000-0003-1514-1685; Ozdemir, Mehmet/0000-0002-9316-771X; aksaray, sebahat/0000-0002-0552-1337 WOS: 000373926600018 PubMed: 27099693 Background: the prognostic value of blood culture testing in the diagnosis of bacteremia is limited by contamination. Objectives: in this multicenter study, the aim was to evaluate the contamination rates of blood cultures as well as the parameters that affect the culture results. Materials and Methods: Sample collection practices and culture data obtained from 16 university/research hospitals were retrospectively evaluated. A total of 214,340 blood samples from 43,254 patients admitted to the centers in 2013 were included in this study. the blood culture results were evaluated based on the three phases of laboratory testing: the pre-analytic, the analytic, and the post-analytic phase. Results: Blood samples were obtained from the patients through either the peripheral venous route (64%) or an intravascular catheter (36%). Povidone-iodine (60%) or alcohol (40%) was applied to disinfect the skin. of the 16 centers, 62.5% have no dedicated phlebotomy team, 68.7% employed a blood culture system, 86.7% conducted additional studies with pediatric bottles, and 43.7% with anaerobic bottles. One center maintained a blood culture quality control study. the average growth rate in the bottles of blood cultures during the defined period (1259 -26,400/year) was 32.3%. of the growing microorganisms, 67% were causative agents, while 33% were contaminants. the contamination rates of the centers ranged from 1% to 17%. the average growth time for the causative bacteria was 21.4 hours, while it was 36.3 hours for the contaminant bacteria. the most commonly isolated pathogens were Escherichia coli (22.45%) and coagulase-negative staphylococci (CoNS) (20.11%). Further, the most frequently identified contaminant bacteria were CoNS (44.04%). Conclusions: the high contamination rates were remarkable in this study. We suggest that the hospitals' staff should be better trained in blood sample collection and processing. Sterile glove usage, alcohol usage for disinfection, the presence of a phlebotomy team, and quality control studies may all contribute to decreasing the contamination rates. Health policy makers should therefore provide the necessary financial support to obtain the required materials and equipment.

Introduction and aim: Antimikrobial peptides (AMP) are one of the most important component of innate immune system and have important role in many respiratory disease. No data is available in the literature about the levels of AMP in pediatric patients with non-CF bronchiectasis (BE). The aim of this study was to determine cathelicidin and defensin levels of bronchoalveolar lavage fluid (BAL) in non-CF BE pediatric patients and to compare with control group. Method: The patients between 0-16 years-old was admitted between 2012-2013 september and age and gender matched healthy controls were enrolled in the multi-center study. BAL samples of the patients were obtained with flexible bronchoscopy. As control, BAL was taken during operation of participants who had no lung disease and any other chronic disease. Cathelicidin (LL37) ve β2 defensin levels in BAL were determined with ELISA method. Findings: Sixty-seven non-CF BE patients, 57% of them were male, enrolled in the study. Median age was9.9±2.9 years. Thirty-eight children included to the study as control group and age and gender distribution were not statistically different between the two groups (p>0,05). Cathelicidin and beta 2 defensins were significantly higher in BE group compared with healthy controls (p Conclusion: This is the first study about AMP levels of pediatric non-CF BE patients. Cathelicidin and beta 2 defensin levels were significantly higher in pediatric BE patients. AMP may have important roles in immune systems of pediatric BE patients.

The aims of this study were to determine the minimum inhibitory concentration (MIC) values of vancomycin, teicoplanin, daptomycin, quinupristin/dalfopristin, linezolid, tigecycline, chloramphenicol, rifampicin, ofloxacin and tetracycline and to investigate the reduced vancomycin susceptibility among methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in hospitals located in different geographical regions of Turkey. A total of 100 MRSA strains isolated from patients (of which 50% were from intensive care units) hospitalized in seven centers in Turkey [Istanbul (n= 15), Ankara (n= 15), Izmir (n= 15), Adana (n= 15), Diyarbakir (n=15), Erzincan (n= 15), Van (n= 10)], between August 2013 - August 2014, were included in the study. Fourty-three strains were isolated from blood, whereas 21 were from lower respiratory tract, 17 from wounds, eight from catheters, six from urine, four from nasal swab and one from cerebrospinal fluid samples. Methicillin resistance of the isolates was determined by using cefoxitin (30 µg) disk with standard disk diffusion method, while the MIC values of other antibiotics were determined with E-test in accordance with the recommendations of Clinical and Laboratory Standards Institute (CLSI). MIC results obtained for quinupristin-dalfopristin (Q/D) were evaluated according to the CLSI criteria used for methicillin-susceptible S.aureus and for tigecycline according to the criteria recommended by the Food and Drug Administration for MRSA. Primarily, agar screening method (ASM) was used for determination of vancomycin-intermediate S.aureus (VISA) and heterogeneous VISA (hVISA) strains. Brain heart infusion agar containing 6 µg/ml vancomycin was used in ASM, and the strains with suspicion of VISA/hVISA were screened by standard E-test and macro E-test methods. All MRSA strains were susceptible to vancomycin, teicoplanin, daptomycin, Q/D and linezolid by E-test method; and their rates of susceptibility for tigecycline, chloramphenicol, rifampicin, ofloxacin and tetracycline were detected as 89%, 97%, 40%, 39% and 32%, respectively. MIC50/MIC90 values were 1.5/2 µg/ml for vancomycin, 2/4 µg/ml for teicoplanin, 0.19/0.38 µg/ml for daptomycin, 0.19/0.38 µg/ml for Q/D, 0.75/1 µg/ml for linezolid, 0.19/0.75 µg/ml for tigecycline, 3/6 µg/ml for chloramphenicol, 32/32 µg/ml for rifampicin, 32/32 µg/ml for ofloxacin and 32/64 µg/ml for tetracycline, respectively. For the evaluation of reduced vancomycin susceptibility, 2% (2/100) of MRSA strains were defined as VISA and 5% (5/100) as hVISA with ASM. One of those seven isolates identified as VISA/hVISA with ASM was evaluated as suspected hVISA by using both standard E-test and macro E-test methods. In conclusion, no MRSA resistant strain to vancomycin, teicoplanin, daptomycin, Q/D and linezolid was determined in our study. However tigecycline resistance (11%) was found higher than expected. As the glycopeptide resistance is increasing in the world and because of the intense use of these drugs in Turkey, the rates of vancomycin resistance among MRSA strains should be investigated periodically.

Anthrax is primarily seen in the developing countries, but it can be a worldwide medical concern due to bioterrorism threats. Palpebral anthrax is a rare form of cutaneous anthrax. Untreated cutaneous anthrax can be lethal. Patients with palpebral anthrax can develop complications including cicatrisation and ectropion. Thus, anthrax should be considered in differential diagnosis for patients presenting with preseptal cellulitis in high-risk regions. Herein, we report three anthrax cases (with different age) involving eyelids that were cured without any complications due to early diagnosis and treatment.

Background/aims Tuberculous peritonitis (TP) is a rare form of tuberculosis and is caused by peritoneal involvement with Mycobacterium tuberculosis. A distinctive correlation exists between socioeconomic state and disease prevalence. We aimed to evaluate the clinical, laboratory, and radiological findings of patients with TP. Materials and methods We conducted a retrospective study in patients with peritoneal tuberculosis from January 2004 to October 2008 at Yuzuncu Yil University Medical School Education and Research Hospital. During this time, the data of 21 patients (17 females) with TP were reviewed. Results Fever, abdominal pain, and anorexia were the most common symptoms. An analysis of ascites showed lymphocyte predominance and low albumin gradient in all patients. Patients with TP had a median ascites adenosine deaminase (ADA) level of 139 U/L (range, 25 to 303U/L). Peritoneal involvement (wet peritonitis) was seen in all the cases. Following 6-month administration of combined anti-TBC treatment, mean serum CA-125 levels were within the normal range among patients who had previously higher serum CA-125 level. Mortality rate in the total cases was 4.6%. Conclusion Peritoneal tuberculosis should be considered in the differential diagnosis of exudative ascites in eastern Turkey. A high level of suspicion is required, especially in high-risk populations living in rural areas. ADA seems to be a sufficient, safe, and inexpensive method to perform the diagnosis of peritoneal tuberculosis. Serum CA-125 levels may play a key role to support the diagnosis as well as disease management of TP.

Turkey remains an intermediate area for prevalence of hepatitis B virus (HBV) surface antigenemia. The sheep-raising areas of Turkey also pose a high risk for cystic hydatid disease (CHD). Both HBV infection and CHD are major public health issues particularly in eastern parts of Turkey; however, there is no data regarding HBV infection in patients who have had CHD. The aims of this study were to evaluate the association between HBV infection and CHD and suggest ways to reduce HBV infection which is still widespread in Turkey. A retrospective study was conducted with 94 adult patients with active CHD referred to the hepatology department, Yuzuncuyil University School of Medicine from December 2010 to December 2012. All subjects came from rural areas of the region and underwent ultrasonography of abdomen which detected CHD of the liver. All the patients were serologically positive for Echinococcus granulosus. The control group consisted of 500 patients (300 men and 200 women) referred to the internal medicine clinics for other reasons. The patients with CHD and in the control group were tested for the existence of HBs antigen according to the standard procedures. The seroprevalence of HBs antigen was significantly higher in patients with active CHD than those in the control group (12.7% vs 5.2%; P=0.0017). Our data indicate that there is significant association between HBV infection and CHD. All patients with CHD should be screened for HBV infection.

Acinetobacter baumannii is the most important agent of nosocomial infections within the Acinetobacter genus. This gram-negative coccobacillus is intrinsically resistant to many antibiotics used in antimicrobial therapy, and capable of developing resistance including carbapenems. The objective of this study was to develop a multiplex real time polymerase chain reaction (qPCR) kit for OXA subgroups in A.baumannii, and to investigate the distribution of OXA subgroups in A.baumannii strains isolated from geographically different regions of Turkey. A total of 834 A.baumannii clinical isolates collected from different state and university medical centers in 13 provinces (Afyonkarahisar, Ankara, Bolu, Elazig, Erzurum, Isparta, Istanbul, Kahramanmaras, Konya, Sakarya, Van) between 2008-2011, were included in the study. The isolates were identified by conventional methods and automated systems [Vitek2 (bioMerieux, ABD) and Phoenix (BD Diagnostic, MD)]. The susceptibility profiles of the isolates were studied with automated systems and standard disc diffusion method. All samples were subjected to qPCR to detect blaOXA-51-like, blaOXA-23-like and blaOXA-58-like genes. A conventional PCR method was also used to detect blaOXA-24-like gene. The resistance rates observed during the study period were as follows: 96.8% for amoxicillin-clavulanate, 86.8% for ciprofloxacin, 74.7% for gentamicin, 71.7% for amikacin, 73.5% for cefaperozone-sulbactam, 72.1% for imipenem and 73% for meropenem. Six hundred and two (72.2 %) isolates were resistant to both imipenem and meropenem. Colistin was found to be the most effective antibiotic against A.baumannii isolates with 100% susceptibility rate. All isolates were positive for blaOXA-51-like, however blaOXA-24-like gene could not be demonstrated in any isolate. Total positivity rates of blaOXA-23-like and blaOXA-58-like genes were found as 53.7% and 12.5%, respectively, while these rates were 74.4% and 17.3% in carbapenem-resistant isolates, respectively. Twenty-five isolates were positive for both blaOXA-23-like and blaOXA-58-like genes. All of the carbapenem-resistant isolates have OXA type genes with the exception of blaOXA-24-like gene. The positivity rates for blaOXA-23-like and blaOXA-58-like genes varied for each center. In addition, there was a decrease in the frequency of blaOXA-58-like gene, however both blaOXA-23-like gene and carbapenem resistance rates increased during the study period. In conclusion, high rates of resistance to carbapenems were also remarkable but A.baumannii strains keep on sensitivity to colistin. Both blaOXA-23-like and blaOXA-58-like genes were shown to be widespread in carbapenem-resistant A.baumannii clinical isolates. However, blaOXA-23-like gene positive strains were increased throughout the study. Currently, multiplex qPCR is the best way for rapid diagnosis of resistant bacteria for prevention of hospital-acquired infections. The multiplex qPCR kit developed in this study could be useful for rapid diagnosis and identify the frequencies of blaOXA-23-like, blaOXA-51-like and blaOXA-58-like genes in carbapenem-resistant A.baumannii clinical isolates.

Objectives To measure the rate of Demodex folliculorum mite infestation in patients with type 2 diabetes mellitus and to investigate if it was related to blood glucose control. Methods Patients with type 2 diabetes were classified according to their glycosylated haemoglobin (HbA1c) level into two groups: a well controlled blood glucose group (HbA1c ≤ 7%) and a poorly controlled blood glucose group (HbA1c > 7%). A standardized skin surface biopsy method was used to determine if the patients had D. folliculorum infestation (>5 mites/cm2 of skin). Results A total of 69 patients (38 female) were enrolled in the study. Seventeen (24.6%) patients had D. folliculorum infestation. There were no significant differences in age, sex or body mass index between patients with and without D. folliculorum infestations. A significantly higher proportion of patients with poor blood glucose control had D. folliculorum infestation compared with patients with well controlled blood glucose. Conclusions These current findings suggest that poor blood glucose regulation increases the susceptibility to D. folliculorum mite infestation in patients with type 2 diabetes.