[A New Case of Fournier's Gangrene Caused by Actinotignum schaalii]. / Actinotignum schaalii'nin Etken Oldugu Yeni Bir Fournier Gangreni Olgusu.

Actinotignum schaalii (formerly known as Actinobaculum schaalii) is an anaerobic or facultative anaerobic gram-positive bacillus that can be found commensally in the urogenital region. It can be overlooked because it grows slowly and is difficult to identify with classical microbiology laboratory techniques. Colonies become visible after 48-72 hours of incubation on blood agar in anaerobic or CO2-rich media. While it typically causes urinary tract infection in older individuals, cases of bacteremia, vertebral osteomyelitis, endocarditis and cellulitis have been reported. Fournier's gangrene caused by A.schaalii has been reported very rarely so far. Fournier's gangrene has been defined as necrotizing fasciitis of the external genitalia, perineal and perianal region. Diabetes, immunosuppression, peripheral vascular disease, urethral anomalies, chronic alcoholism and smoking are important predisposing factors. In addition, approximately 25% of the cases have no known or identifiable etiology. The bacteria causing the infection may originate from skin, urogenital or intestinal microbiota. In this case report, a new case of Fournier's gangrene caused by A.schaalii was presented. A 65-year-old male patient admitted to the emergency department with the complaints of pain, swelling, redness in the left testis and also nausea, vomiting and chills that started three days ago. Physical examination revealed increased diameter of the scrotum, intense hyperemia of the skin and foci of necrosis. It was learned that the patient had no known chronic disease other than benign prostatic hyperplasia. The patient reported smoking of 25 packs of cigarettes per year. Routine laboratory tests revealed leukocyte= 32.41 x 109/L, neutrophil= 89.9%, procalcitonin= 1.62 ug/L, CRP= 265.07 mg/L and the patient was operated with the diagnosis of Fournier's gangrene. Gram staining of the abscess specimen obtained during the operation showed gram-positive bacilli both inside and outside the leukocytes. After 24 hours, grampositive bacilli were detected in the Gram staining of thin, transparent/gray colonies grown on 5% sheep blood and chocolate agar. The isolate was identified as A.schaalii by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) VITEK® MS (bioMérieux, France) microbial identification system. VITEK®2 ID ANC (bioMérieux, France) bacterial identification card was also used for comparison but the bacteria could be identified. As a result of the sequence analysis performed for confirmation, it was shown to be 100% homologous with Actinobaculum schaalii (GenBank accession no: FJ711193.1). For susceptibility tests, 5% sheep blood Schaedler agar was used and incubated in anaerobic environment. According to the minimal inhibitory concentration (MIC) results evaluated after 48 hours, penicillin was found to be 0.032 mg/L, clindamycin 0.125 mg/L, ciprofloxacin 0.19 mg/L, ceftazidime 4 mg/L, and amoxicillin 0.19 mg/L. The primary cause that initiated the infection in the case could not be identified, but it was thought that the presence of prostatic hyperplasia and smoking history may have contributed to the occurence or the progress of the disease. It is noteworthy that the ciprofloxacin MIC result was quite low compared to other studies. In addition, this study revealed the value of MALDI-TOF MS based methods in identification. In conclusion, it is thought that a significant proportion of A.schaalii infections may be overlooked due to the difficulty in growth and identification. Increasing the diagnostic power of clinical microbiology laboratories for poorly identified bacteria and renewing the databases of commercial identification systems are important for the early and accurate diagnosis and treatment of serious infections that may occur with such agents.

The effects of measures taken during the COVID-19 pandemic on the seasonal dynamics of respiratory viruses in children.

BACKGROUND: We aimed to evaluate the effects of public health measures taken during the COVID-19 pandemic on respiratory viruses. METHODS: The study was conducted between February 1, 2021 and December 1, 2022. Patients aged 1 month to 18 years hospitalized for infectious diseases were tested for SARS-CoV-2 and respiratory viruses by multiplex PCR. RESULTS: Of the total 1173 patients, 56.2% were male and 43.8% were female, and 47.5% of the patients were under 24 months of age. The viruses detected were SARS-CoV-2 31.9%, human rhinovirus/enterovirus 19.4%, respiratory syncytial virus (RSV) 9.3%, parainfluenza virus 7%, adenovirus 6%, seasonal coronavirus 5.2%, bocavirus 3.8%, influenza 3.1%, and metapneumovirus 2.8%. Among the patients, 386 were hospitalized with lower respiratory tract infections, 238 with upper respiratory tract infections, 202 to evaluate fever etiology, 111 with acute gastroenteritis and 236 with other diagnoses. Of these patients, 113 were admitted to the intensive care unit. Intensive care unit admission rates were statistically significantly higher for bocavirus and RSV, in those hospitalized between July 1, 2021 and July 1, 2022 (first period when schools were held full-time face-toface at all grades) and in children aged 1-24 months. CONCLUSIONS: Public health measures taken during the COVID-19 pandemic have affected the seasonal distribution of respiratory viruses and the severity of illness in children.

Fatal panresistant Lomentospora prolificans fungemia in a patient with aplastic anemia: First report from Türkiye.

Lomentospora prolificans is an opportunistic pathogen that can cause invasive lomentosporiosis in immunocompromised patients. Patients with hematological malignancies and those who have undergone stem cell or solid organ transplantations are in the highest risk group. In addition to the limitations and delays in diagnostic possibilities, L. prolificans has a high mortality due to its resistance to all available antifungal drugs. In a patient diagnosed with aplastic anemia, we described the first case of L. prolificans in Türkiye. L. prolificans was identified in the blood culture, and despite the initiation of antifungal treatments, the fungemia resulted in mortality on the 7th day of intensive care hospitalization. This case highlights the importance of early recognition and prompt initiation of appropriate antifungal therapy to improve the outcome of patients with rare mold infections.

[The Importance of Mycological Diagnosis: A Scedosporium apiospermum Complex Mycetoma Case Neglected For 20 Years]. / Mikolojik Taninin Önemi: 20 Yil Ihmal Edilen Bir Scedosporium apiospermum Kompleks Miçetoma Olgusu.

Scedosporium apiospermum complex members are opportunistic fungi that can be found in environments such as soil and polluted water. In this report, we aimed to present a case of mycetoma caused by Scedosporium apiospermum complex that developed in a 40-year-old female patient with immunocompetent system and diagnosed by fungal culture. In the anamnesis of the patient who admitted in 2015 with the complaint of more than one fistulized discharge wound, pain and swelling in the dorsal of the right hand and wrist; it was learned that her complaints started about 20 years ago with a slight swelling on the back of the wrist, and when it worsened, the abscess was drained and antibiotic treatment was initiated in a private surgical center. However, it was learned that she did not benefit from the treatments, and over time, fistulized, yellow-discharged wounds appeared on the back of her hand and wrist, and she had undergone various surgical interventions and used antibiotics. Routine laboratory tests of the patient, who did not have an underlying chronic disease, were normal. Magnetic resonance imaging (MRI) and X-ray findings were compatible with osteomyelitis and 'dot in circle' sign seen on MRI was characteristic for mycetoma. Pathological examination was interpreted as active chronic inflammatory reaction in the soft tissue and chronic osteomyelitis. Mycobacteria, bacteriological and fungal cultures of the two biopsy samples taken during surgical debridement and one month later were performed. Bacteriological and mycobacterial cultures were negative, while Scedosporium genus grew in the fungal cultures of the both samples. Isolates were identified as Scedosporium apiospermum/Pseudallescheria boydii with MALDI Biotyper (Bruker Daltonics, Bremen, Germany) system and Scedosporium boydi by sequence analysis of the ITS region. The antifungal susceptibility tests were performed according to CLSI M38-A2 criteria, and were evaluated at the 72nd hour. The minimum inhibitory concentration (MIC) values of fluconazole, caspofungin, amphotericin B, itraconazole, vorikonazole, posaconazole and isavuconazole were > 64 µg/ml, 16 µg/ml, 4 µg/ml, 16 µg/ml, 0.25 µg/ml, 2 µg/ml and 0.25 µg/ml, respectively. Voriconazole and terbinafine treatment was initiated. In the control performed in the 9th month of the treatment, it was observed that the complaints of discharge, pain and swelling were resolved, pain and swelling complaints were recovered, fistula tracts were closed and joint movements were painless. In the control MRI performed at 15th and 18th months, it was observed that there was no soft tissue involvement and the findings were compatible with osteoarthritis after infective osteomyelitis. This case whose longterm complaints improved with mycological diagnosis and appropriate treatment; reveals the importance of keeping mycological diagnosis in mind in chronic bone and soft tissue infections. Identifying the fungus to the genus and species level and arranging the treatment according to the antifungal susceptibility test results are very important in patient management.

Magnusiomyces capitatus Peritonitis in a Child With Acute Lymphocytic Leukemia as a Breakthrough Infection During Caspofungin Therapy.

Magnusiomyces capitatus is an emerging opportunistic fungal pathogen particularly in immunocompromised patients. We report a case of a M. capitatus peritonitis in child with acute lymphocytic leukemia as a breakthrough infection during caspofungin therapy. The possibility of breakthrough infections caused by M. capitatus must be taken into consideration, particularly in immunosupressed patients being treated for systemic fungal infections by caspofungin. Although there are no defined breakpoints for susceptibility testing of M.capitatus, minimal inhibitory concentration results can be helpful for therapy. Antifungal treatment with amphotericin B lipid complex plus flucytosine can be effective against infections caused by M. capitatus.