A mucormycosis case treated with a combination of caspofungin and amphotericin B.

Mucormycosis is a rare, invasive and fatal disease that occurs mainly in diabetes mellitus patients with uncontrolled blood glucose levels or in immunocompromised patients. The mortality rate of this disease is as high as 25 to 80%, despite aggressive surgical treatment and antifungal therapy. This high mortality requires alternative treatment approaches. The accepted treatment modality of invasive mucormycosis are amphotericin B lipid formulations. Although echinocandins generally show no activity against Mucorales, it was shown that Rhizopus oryzae expressed the target enzyme for echinocandins, 1,3-beta-glucan synthase. Additionally, there are some experimental studies in a diabetic mouse model and case reports regarding the effects of caspofungin. In this report, we present a rhinocerebral mucormycosis case treated with liposomal amphotericin B and caspofungin. There was regression of the patient's clinical and radiological condition with the addition of caspofungin, but she died due to discontinuation of her treatment and reasons other than mucormycosis.

Antimicrobial activity of the extracts and physalin D from Physalis alkekengi and evaluation of antioxidant potential of physalin D.

Physalis alkekengi L. (Solanaceae) is a popular plant in traditional European and Chinese folk medicine, and it has been reported to have many ethnopharmacological properties including antifungal, anti-cough, anti-inflammatory, analgesic, and febricide activities. Some active components from Physalis species have been investigated. However, no antimicrobial activity studies on extracts and physalins of P. alkekengi have been carried out. In this study, we attempted to identify the possible antimicrobial activities of the methanol extract from aerial parts of P. alkekengi and the dichloromethane extract from calyces of the plant. The extracts were tested against five Gram-positive and five Gram-negative bacteria and five Candida species by using disk diffusion and broth microdilution methods. The extracts were fractionated to isolate physalins using chromatographic techniques, and physalin D was isolated from the extracts. The structure of the compound was elucidated on the basis of (1)H-NMR spectroscopic study, and confirmed by comparison with a reference sample and literature data. Results indicated that all the extracts and physalin D were characterized by antibacterial action, especially against Gram-positive bacteria, with MIC values between 32 and 128 microg/mL. The methanol extract had moderate activity against fungi at MICs ranging from 128 to 512 microg/mL, but the dichloromethane extract and physalin D had low activity against fungi at MICs ranging from 256 to 512 microg/mL. Additionally, the antioxidant activity of physalin D was evaluated by qualitative DPPH (1,1-diphenyl-2-picrylhydrazyl) radical and TBA (thiobarbituric acid) assays. Physalin D showed low antioxidant activity with an IC(50) value of >or= 10 +/- 2.1.

Nosocomial diarrhea and Clostridium Difficile associated diarrhea in a Turkish University Hospital.

BACKGROUND: Clostridium difficile (C. difficile) is a well-established cause of nosocomial diarrhea. The aim of our study was to define the incidence of nosocomial diarrhea in our hospital and to determine the role of C. difficile. Additionally, the risk factors for nosocomial diarrhea and Clostridium difficile associated diarrhea (CDAD) were investigated. METHODS: We included all patients, 18 years of age or more, who were admitted to the Uludag Teaching Hospital between October 1, 2004 and February 1, 2005, and developed diarrhea at least three days after hospital admission. A case-control study was performed. RESULTS: The total incidence of nosocomial diarrhea was 0.6 per 1,000 hospitalization-days and 5 per 1,000 patients' admissions. Previous use of chemotherapy was found to be an important predisposing factor for nosocomial diarrhea. The incidence of CDAD was 0.26 per 1,000 hospitalization-days and 2.1 per 1,000 admissions, comparable with incidence rates in Europe. CDAD was diagnosed in 43% of patients with nosocomial diarrhea. No severe cases of CDAD were diagnosed. A correlation was found between CDAD and antibiotic use before admission and during admission in univariate analysis. PCR ribotyping revealed four strains of PCR ribotype 002 and 1 strain of ribotype 012 out of 5C. difficile strains available for extensive identification. CONCLUSION: The incidence rates of nosocomial diarrhea and CDAD are not different than the usual incidence rates in Europe. C. difficile was the causative agent in 43% of patients with nosocomial diarrhea.

Risk factors in community-acquired/onset urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae.

We investigated the risk factors for community acquired/onset urinary tract infections due to extended spectrum beta-lactamase (ESBL)-positive Escherichia coli or Klebsiella pneumoniae in 62 patients who were followed-up from August 1, 2003 to September 1, 2006. Sixty patients with community-acquired urinary tract infections caused by ESBL-negative E. coli or K. pneumoniae who were followed-up during the same dates were included as a control group. Age (> or =65 or <65 years old), sex, bladder cancer, benign prostate hypertrophy (BPH), prostate cancer, urolithiasis, urethral catheter, previous urological operation, diabetes mellitus, use of antibiotics during the last 3 months and hospitalization during the last 3 months were investigated as risk factors. The presence of previous urological operation and quinolone or cephalosporin use for any infection during the last 3 months were found to be independent risk factors. Knowing the risk factors for community acquired/onset urinary tract infections caused by ESBL-positive E. coli or K. pneumoniae is of great importance in planning empirical antibiotic therapy.

Evaluation of serum C-reactive protein, procalcitonin, tumor necrosis factor alpha, and interleukin-10 levels as diagnostic and prognostic parameters in patients with community-acquired sepsis, severe sepsis, and septic shock.

The diagnostic value of procalcitonin, C-reactive protein, tumor necrosis factor-alpha, and interleukin-10 levels in differentiating sepsis from severe sepsis and the prognostic value of these levels in predicting outcome were evaluated and compared in patients with community-acquired sepsis, severe sepsis, and septic shock in the first 72 h of admission to the hospital. Thirty-nine patients were included in the study. The severe sepsis and septic shock cases were combined in a single "severe sepsis" group, and all comparisons were made between the sepsis (n=21 patients) and the severe sepsis (n=18 patients) groups. Procalcitonin levels in the severe sepsis group were found to be significantly higher at all times of measurements within the first 72 h and were significantly higher at the 72nd hour in patients who died. Procalcitonin levels that remain elevated at the 72nd hour indicated a poor prognosis. C-reactive protein levels were not significantly different between the groups, nor were they indicative of prognosis. No significant differences in the levels of tumor necrosis factor-alpha were found between the sepsis and severe sepsis groups; however, levels were higher at the early stages (at admission and the 24th hour) in patients who died. Interleukin-10 levels were also higher in the severe sepsis group and significantly higher at all times of measurement in patients who died. When the diagnostic and prognostic values at admission were evaluated, procalcitonin and interleukin-10 levels were useful in discriminating between sepsis and severe sepsis, whereas tumor necrosis factor-alpha and interleukin-10 levels were useful in predicting which cases were likely to have a fatal outcome.

Effect of electrolytes on the surface behavior of rhamnolipids R1 and R2.

The surface behavior of solutions of the rhamnolipids, R1 and R2, were investigated in the absence and presence of an electrolyte (NaCl) through surface tension measurements and optical microscopy at pH 6.8. The NaCl concentrations studied are 0.05, 0.5 and 1M. Electrolytes directly affect the carboxylate groups of the rhamnolipids. The solution/air interface has a net negative charge due to the dissociated carboxylate ions at pH 6.8 with strong repulsive electrostatic forces between the rhamnolipid molecules. This negative charge is shielded by the Na(+) ions in the electrical double layer in the presence of NaCl, causing the formation of a close-packed monolayer, and a decrease in CMC, and surface tension values. The maximum compaction is observed at 0.5M NaCl concentrations for R1 and R2 monolayers, with the R1 monolayer more compact than R2. The larger spaces left below the hydrophobic tails of R1 with respect to that of R2, due to the missing second rhamnosyl groups are thought to be responsible for the higher compaction. The rigidity of both R1 and R2 monolayers increases with the electrolyte concentration. The rigidity of the R1 monolayer is greater than that of R2 at all NaCl concentrations due to the lower hydrophilic character of R1. The variation of CMC values as a function of NaCl concentration obtained from the surface tension measurements and critical packing parameter (CPP) calculations show that spherical micelles, bilayer and rod like micelles are formed in the rhamnolipid solutions as a function of the NaCl concentration. The results of optical microscopy supported these aggregation states indicating lamellar nematic liquid crystal, cubic lamellar and hexagonal liquid crystal phases in R1 and R2 solutions depending on the NaCl concentration.

Tularemia in Bursa, Turkey: 205 cases in ten years.

Tularemia is a zoonotic disease caused by the coccobacillus F. tularensis. Small epidemics and sporadic cases were seen around Bursa since November 1988. In this study, a total of 205 cases of tularemia were observed. All the cases were diagnosed on clinical, bacteriological and serological grounds. The epidemics were thought to be waterborne. The majority of the patients were young and female. In most of the cases the disease presented itself in oropharyngeal form (83%). Analysing sera from the patients with microagglutination method demonstrated that titers were > or = 1:160 in approximately 85% of the cases, including the ones in subclinical form. Five of ten patients from who the bacteria was isolated were seronegative. Streptomycin was given to the most of the patients by combining with tetracycline, doxycycline or chloramphenicol. The early administration of these antibiotics (before the third week of disease) was found to be much more effective to resolve the infection. As a result, the main mode of transmission of F. tularensis is waterborne in our region. In our region, tularemia should be considered in differential diagnosis for the cases with fever, tonsillopharyngitis and cervical lymphadenopathy to make an early diagnosis and to design relevant treatment.

Influences of alternate therapy protocol and continuous infectious disease consultation on antibiotic susceptibility in ICU.

In this study, the effects of alternate use of imipenem and cefoperazone/sulbactam(CFP/Sul) on antibiotic resistance in the intensive care unit (ICU) were investigated. Between 1 April 1993 and 1 April 1994, the infectious diseases consultant saw patients when required and there was no alternative therapy for antibiotics. For the following 2 years, the same consultant followed up each patient from admission to discharge by daily visits to the ICU and an alternative therapy protocol was initiated. The most common microorganisms were found to be Acinetobacter baumannii and Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae, respectively, in the two periods. This study demonstrated that sensitivity rates of imipenem, ciprofloxacin and aminoglycosides were improved as a result of this protocol.

Detection of Brucella melitensis by BACTEC NR 730 and BACTEC 9120 systems.

In many parts of the world, brucellosis has significantly decreased, but it is still a problem in some regions of Turkey. In our laboratory we have isolated 58 Brucella spp. through BACTEC NR 730 and 30 Brucella spp. through BACTEC 9120 systems. 31 of the 58 isolates were detected by BACTEC NR 730 system in 72 hours. The majority of the growth values were between 45-65. BACTEC 9120 system detected all the isolates in 84 hours.

Cerebrospinal fluid interleukin-1 beta/interleukin-1 receptor antagonist balance and tumor necrosis factor-alpha concentrations in tuberculous, viral and acute bacterial meningitis.

The levels of interleukin-1 beta, IL-1 receptor antagonist and tumor necrosis factor-alpha (TNF-alpha) were analyzed in 19 cases of tuberculous, 14 cases of viral, and 22 cases of acute bacterial meningitis, and in 18 control subjects. 20 patients (91%) with acute bacterial and 8 (42%) with tuberculous meningitis had detectable amounts of TNF-alpha in the initial cerebrospinal fluid (CSF) sample (mean 1044 +/- 131 pg/ml, range 95-1950, and mean 61 +/- 23 pg/ml, range 25-300, respectively), whereas TNF-alpha was not detectable in any of the patients with viral meningitis, or in any of the control subjects. IL-1 beta levels were 767 +/- 110 pg/ml (185-2000) in acute bacterial, 345 +/- 63 pg/ml (50-670) in tuberculous, 257 +/- 70 pg/ml (20-700) in viral meningitis, and 37 +/- 4 pg/ml (10-68) in control subjects. Il-1 receptor antagonist concentrations were significantly elevated in all meningitis groups, without significant differences between the groups. Il-1 receptor antagonist levels were 2487 +/- 62 pg/ml (2250-2950) in acute bacterial, 2216 +/- 82 pg/ml (1350-2550) in tuberculous and 1985 +/- 92 pg/ml (650-2500) in viral meningitis, and 154 +/- 26 pg/ml (20-245) in control CSF samples. A positive correlation was found between TNF and IL-1 beta levels (p < 0.01), and TNF levels and conscious state (p < 0.05). The ratio of concentrations of IL-1 receptor antagonist to IL-1 beta was 3.2 in acute bacterial meningitis, 6.9 in tuberculous meningitis and 8.3 in viral meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the ELISA method for the diagnosis of Helicobacter pylori]. / Helicobacter pylori tanisinda ELISA yönteminin degerlendirilmesi.

Antibodies to H.pylori were investigated in the serum of 50 patients with dyspepsia and 25 healthy controls with ELISA method. The antibody positivity was found in all of the 40 cases (100%) for whom H.pylori was demonstrated in at least two tests of rapid urease, Gram stain, culture and silver staining and in eight of the ten cases (80%) whom H.pylori tests were all negative. Twenty-two of the 25 healthy controls (88%) had also antibodies to H.pylori. The sensitivity of the test was found high (100%), but the specificity was found too low (20%).

Immunological evaluation of erythema nodosum in tularaemia.

During two tularaemia outbreaks in the Bursa region of Turkey in 1991, a total of 98 patients were diagnosed and evaluated. Thirteen of these patients had erythema nodosum, which is accepted as a secondary skin manifestation. The patients with erythema nodosum, 21 patients without any skin lesions, and 20 healthy controls were studied. Comparable elevations of levels of IgG, IgA, and IgM were detected in the two tularaemia groups. There was no difference in complement C3c and C4 levels between the groups. All of the patients with erythema nodosum had elevated circulating immune complex (CIC) levels, when compared with the patients without skin lesions and the control group. The acute phase response (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) of the erythema nodosum group was significantly higher than the patients with normal skin, and healthy controls (P < 0.001). Serum transferrin levels were significantly decreased in both of the tularaemia groups (P < 0.001). Serum soluble interleukin-2 receptor levels (SIL-2R) were significantly elevated in both tularaemia groups (P < 0.001), and the elevation was more marked in the erythema nodosum group (P < 0.05). Histopathological evaluation of biopsies from two patients with erythema nodosum showed dermal oedema, a perivascular lymphocytic infiltrate, and panniculitis. No immunoglobulin or complement deposits were detected on immunofluorescence. Erythema nodosum in the course of tularaemia is associated with many immunological changes, although it is not clear whether these findings are related to the increased tissue response, or whether they play a role in the pathogenesis of the erythema nodosum.

[Salmonella typhimurium in food-producing animals in Bursa]. / Bursa yöresinde besi hayvanlarinda Salmonella typhimurium arastirmasi.

Role of food-producing animals in Salmonella typhimurium infections was investigated in this study. Salmonella typhimurium antibodies with the ratios of 63.3% among the slaughter house staff and 78.1% in the animals slaughtered were established. Multiresistant Salmonella typhimurium bacteria was isolated in the faecal cultures of 3 among 301 animals.

[A serological study of Yersinia enterocolitica]. / Yersinia enterocolitica ile serolojik bir çalisma.

In this study, the incidence of Yersinia enterocolitica was investigated at neighbourhood of Bursa and 13.26 percentage seropositivity was determined.

[Salmonella typhimurium infections in the area of Bursa]. / Salmonella typhimurium enfeksiyonlarinin Bursa yöresindeki durumu.

Salmonella typhimurium infections encountered at the neighbourhood of Bursa since January 1987 were evaluated in regard to the antibiotic resistance and treatment. High proportion of resistance was determined to the antibacterial agents such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, tetracycline and more sensitivity to ofloxacin, amikacin, ceftriaxone and cefotaxime was established in 383 Salmonella typhimurium strains isolated within two years of period. No antibiotic therapy was required to adult uncomplicated patients. A combination therapy with cefotaxime and amikacin was found to be satisfactory in the newborn cases with septicemia.

[Bacteriological comparison of colostrum and mature human milk]. / Kolostrum ve matür insan sütünün bakteriyolojik yönden karsilastirilmasi.

15 colostrum and 15 mature milk were examined in bacteriology laboratory in Ankara Numune Hospital. The number of colonies cultured at "0" hour, 6-24 after at room temperature 24 after refrigeration were evaluated. It was noticed that the cultures obtained at 0 and 6 hours and after refrigeration did not reveal much bacteria. But cultures obtained from Colostrum and mature milk after 24 hours at room temperature revealed colonies. The colonisation in mature milk was significantly higher than the colostrum.

[Distribution of Cryptococcus neoformans in pigeon feces]. / Cryptococcus neoformans'in güvercin diskilarindaki dagilimi.

C neoformans has been investigated in fecal droppings obtained from pigeon coops that placed in several suburbs of Bursa City. In sixteen of the 115 samples (13.9%), C neoformans strains has been isolated and studied their morphological and biochemical properties. But no isolation has been obtained from 8 soil samples and 14 samples of chicken dung.

[The distribution of clostridia in soil samples from Bursa]. / Bursa'da toprak örneklerinde Klostridium'larin dagilimi.

In the soil samples taken from different places of Bursa, distribution of the Clostridia were searched by anaerobic jar and immunofluorescence reaction (FAT). In our study, 122 bacteria belonging to 11 Clostridium species were isolated in 35 soil samples. These strains were identified by studying morphological and biochemical properties, lecithinase C and lipase activities, toxin neutralization characteristics. In addition, FAT were used for 4 Clostridium species.