Search

This study was carried out in order to investigate the frequency of Clostridium difficile toxin in the stool samples of hospitalized 74 neutropenic (mean age: 41.78 +/- 14.3 years; 40 male) and 75 non-neutropenic patients (mean age: 44.09 +/- 15.6 years; 30 male) who developed antibiotic-associated diarrhea between January 2003-September 2004 in a university hospital and also to analyze the related risk factors. C. difficile toxin A and toxin A/B were searched by immunochromatographic method (Toxin Detection Kit, Oxoid, UK), and commercial ELISA (Clostridium difficile Antigen, Generic Assays GmbH, Germany) kit, respectively. Stool samples were also analysed in terms of the presence of other bacterial and parasitic agents which may cause diarrhea. Statistical evaluation were performed by Kaplan-Meier survival analysis and by Cox regression analysis. Both neutropenic and non-neutropenic groups were compared according to their incidence densities based on times in days of overall hospitalization, total antibiotic use and hospitalization until diagnosis. The antibiotics used in neutropenic patients were piperacillin-tazobactam (41.9%), imipenem (25.7%), cefepime (17.5%), ciprofloxacin (2.7%) and others (12.2%) and in non-neutropenic patients were ampicillin-sulbactam (29.3%), ciprofloxacin (18.7%), ceftriaxone (14.6%) and others (30.7%). C. difficile toxin A positivity rates in neutropenic and non-neutropenic groups were found as 13.5% (10/74) and 14.7% (11/75), respectively, with a total rate of 14.1% (21/149). The positivity rate of toxin A/B was 24.3% (n= 18) for neutropenic, and 21.3% (n= 16) for non-neutropenic patients, with a total rate of 22.8% (n= 34). There was no statistically significant difference between the groups by means of toxin A or toxin A/B positivity rates (p > 0.05). Thirteen (38.2%) of 34 toxin A/B positive patients yielded negative results with toxin A detection test. Our results revealed that infection in the neutropenic patients developed much earlier than that in the non-neutropenic group by comparing durations of hospitalization and antibotic use which were shorter for toxin positive individuals (p < 0.01 and p < 0.001, respectively). In the control group, implementation of sulbactam-ampicillin or amoxicillin-clavulanate was determined as a risk factor. In addition to duration of hospitalization, use of antibiotics was evaluated as a risk factor for C. difficile associated colitis, especially in the neutropenic group. According to these results, it is possible to point out that antibiotic-associated colitis develops relatively earlier in neutropenic patients and is more frequently C. difficile toxin positive. In this context, appropriate control measures should therefore be kept in mind.

During the last week of December 1989, an outbreak of respiratory system infection involved 32 hospital personnel and 2 patients was detected in Gazi University Medical Faculty Hospital. White blood cells count of the patients were either normal or there were a slight leucopenia. Throat cultures of the most patients were normal. Serum ASO, CRP, bilirubin, AST and ALT were usually within normal limits. According to symptoms, signs and laboratory data we considered a viral disease, especially influenza. All patients recovered without any sequelae. Of 34 in-patients, 8 paired sera, 2 acute phase sera, and 10 convalescent phase sera were tested for the presence of Hemagglutination Inhibition (HI) antibody to three influenza virus strains recommended by WHO in the 1989-1990 season: Influenza A/Taiwan/1/86 (H1 N1), Influenza A/Shanghai/11/87 (H3 N2), Influenza B/Victoria/2/87. All of the sera were negative for Influenza B/Victoria/2/87. There were no significant rises in HT antibody titer for Influenza A/Taiwan/1/86 (H1 N1). The sera for 4 of 8 patients examined both acute and convalescent phase sera had fourfold or greater rise in HI antibody for Influenza A/Shanghai/11/87 (H3 N2). Four patients examined only convalescent sera had 1/40 or greater rises in HI antibody for this influenza subtype. It was considered that this influenza outbreak was probably caused by Influenza A/Shanghai/11/87 (H3 N2).

In order to certify the significance of the bedside culture in acute bacterial meningitis (ABM), the results of CSF cultures performed at the bedside and in the laboratory were compared in 66 children with ABM. The etiologic agents were isolated in 83% of bedside cultures and in 62% of laboratory cultures. N. meningitidis was isolated from bedside cultures in 30 patients, 14 of these have failed to grow in laboratory cultures. There was no difference between the two methods for the isolation of bacteria other than N. meningitidis. Consequently, it can be said that the bedside culture is the most reliable culture method in ABM especially due to N. meningitidis.

In August 1988, following a luncheon, an explosive epidemic of pharyngitis due to group A streptococci (M type 11, T type 3/13/B3264 and opacity factor positive) occurred among the staff of an institution in Ankara. Epidemiological investigation indicated that the outbreak was food-borne. A salad prepared by bean with boiled egg was incriminated as the vehicle of transmission. Group A streptococci were isolated from the throats of 37 (63.8 percent) of 58 persons with pharyngitis. High levels of antistreptolysin O titers were observed in serum samples from 39 (81.2 percent) of 48 persons with pharyngitis. Secondary transmission had accounted for only 3.8% of cases.

The fungal flora of the air was investigated in 13 villages of Samsun, Carşamba, Kizilot Health Center in December and February. In most of the villages, Penicillium and Alternaria were isolated most frequently. Scopulariopsis and Fusarium were also found at high quantity in the air.

In this paper, a food poisoning outbreak of 42 people who ate the sucuk (Turkish sausage flavored with garlic) which was made of the same meat has been described. Salmonella typhimurium was isolated from the stool of 20 patients and from the sucuk. Efficacy rate of Ofloxacin was 75 percent in these 20 patients treated Ofloxacin.

During an outbreak of food poisoning caused by Salmonella typhimurium, the duration of excretion of salmonella was studied for patients who received no antibiotic therapy and for those treated with Ofloxacin. In untreated group 85.7% of patients at 8 days and 28.5% of patients at 18 days were excreting S. typhimurium. However, in Ofloxacin-treated group only 25.0% of patients at 8 days and 5.0% of patients at 18 days were excreting S. typhimurium. The differences were statistically significant. We showed that Ofloxacin shortens the duration of excretion of S. typhimurium in feces. This phenomen may important in halting the spread of infection.