[Evaluation of the toxoplasmosis seroprevalence in pregnant women and creating a diagnostic algorithm]. / Gebelerde toksoplazmoz seroprevalansinin degerlendirilmesi ve bir tani algoritmasinin olusturulmasi

Toxoplasma gondii, an obligatory intracellular protozoon is widely distributed around the world and can infect all mammals and birds. While acquired toxoplasmosis is usually asymptomatic in healthy subjects, acute infection during pregnancy may lead to abortion, stillbirth, fetal neurological and ocular damages. For the prevention of congenital toxoplasmosis it is recommended that a screening programme and a diagnostic algorithm in pregnant women should be implemented while considering the cost effectiveness. Thus, it is necessary to determine the seroprevalence of toxoplasmosis in pregnant women and the actual risk of T.gondii transmission during pregnancy in a certain area. The aims of this study were to detect the T.gondii seropositivity in the pregnant women admitted to our hospital and to create a diagnostic algorithm in order to solve the problems arising from interpretation of the serological test results. A total of 6140 women aged 15-49 years who were admitted to our hospital between April 1st, 2010 to July 31st, 2013, were evaluated retrospectively. In the serum samples, T.gondii IgM, IgG and IgG avidity tests were performed by VIDAS automated analyzer using TOXO IgM, TOXO IgG II and TOXO IgG avidity kits (bioMerieux, France). It was noted that, both T.gondii IgM and IgG tests were requested from 4758 (77.5%) of the pregnant women, while only IgM test from 1382 (22.5%) cases. Sole IgM positivity was found as 0.2% (11/6140), IgG as 26.4% (1278/4758) and both IgM + IgG as 0.9% (44/4758). T.gondii IgG avidity tests were requested from 12 of 44 women who were found both IgM and IgG positive and eight of them revealed high avidity and four low avidity. Avidity test was ordered for the 91 (7.1%) of 1278 sole IgG positive cases and four of them were found to have low avidity. IgG avidity test was ordered for 554 (16.2%) of IgM and/or IgG negative subjects, however, the test was not performed according to rejection criteria of the laboratory. It was noticed that no re-testing was requested for none of the seronegative cases (3428/4758; 72%) during their follow-up. In our study, total Toxoplasma seropositivity rate among pregnant women was detected as 28% (1330/4758), showing statistically significant increase (p< 0.05) with age. There was no significant difference (p> 0.05) in the seropositivity rate between the years (2010-2013). Following the evaluation of the test orders, the problems related to test orders and interpretation of the test results were determined and a diagnostic algorithm to be used in our hospital, was established to minimize such problems in toxoplasma serology. It was concluded that a diagnostic algorithm related to toxoplasmosis serology should be implemented for the appropriate evaluation of the risk of acute toxoplasmosis during pregnancy. Such an approach is necessary to support the clinical diagnosis and to minimize the anxiety in pregnant women about congenital toxoplasmosis.

[Role of Dientamoeba fragilis and Blastocystis spp. in Irritable Bowel Syndrome]. / Irrite Bagirsak Sendromunda Dientamoeba fragilis ve Blastocystis spp.'nin Rolü

OBJECTIVE: We investigated the prevalence of Dientamoeba fragilis and Blastocystis spp. in IBS patients and evaluated whether there was a possible link between IBS and these parasitic infections. METHODS: Stool specimens collected from 55 IBS patients, 80 patients with gastroenteritis as control group 1 (CG-1) and 50 healthy volunteers as control group 2 (CG-2) were included the study. Samples were examined by direct microscopy, trichrome staining and culture methods. RESULTS: While there was no significant difference in the prevalence of Blastocystis spp. between IBS patients and CG-1 (p > 0.05), a significant difference was found between IBS and CG-2 (p < 0.05). Patients with IBS were found to have five or more Blastocystis spp. per field than control groups. After eradication, all symptoms were cured in four patients, there were only constipation problems left in eleven patients and there were no changes in clinical findings in three patients. D. fragilis was not found in any of the samples. CONCLUSION: The reason we did not find any D. fragilis may be due to the low infection rate in the region. However, significantly having five or more Blastocystis spp. per field (X40) in IBS patients and regression of IBS symptoms after treatment in most of the patients suggested a possible link between IBS and Blastocystis spp.

[Phenotypic and genotypic traits of vancomycin-resistant enterococci in a public hospital: the first vanB-positive Enterococcus faecium isolates]. / Bir Devlet Hastanesinde Vankomisine Dirençli Enterokok Suslarinin Fenotipik ve Genotipik Olarak Degerlendirilmesi: Ilk vanB-Pozitif Enterococcus faecium Izolatlari

Thirty eight vancomycin resistant enterococci (VRE) were isolated in one year surveillance study for hospital infection control programme in a state hospital in Ankara, Turkey. All isolates were identified as Enterococcus faecium by VITEK2 system (bioMerieux, France). Vancomycin and teicoplanin resistant 30 strains were defined as vanA phenotype while vancomycin-resistant teicoplanin-susceptible eight strains were defined as vanB phenotype. vanA genes were found in 30 strains while vanB genes were found in five strains by using PCR method. Those five strains were the first vanB positive E.faecium strains in our country. VRE strains revealed six different band patterns by PFGE, while six isolates could not be classified. All isolates with vanB type resistance were found in the same cluster. Source of vanB positive strains was considered as the hemodialysis unit. When the previous national reports related to vancomycin-resistant enterococci were considered, this was the first report of vanB positive E.faecium isolates in our country. This emphasized that both the diversity of VRE and the isolation rate was increasing. In order to eliminate the spread of VRE, effective surveillance studies should be performed and protective measures should be established promptly.