Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients / Abordagens diagnósticas e terapêuticas em infecções cervicais profundas: uma análise de 74 pacientes consecutivos

Abstract Introductıon: Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options. Objectives: Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media. Methods: A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years. Results: According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008). Conclusions: Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.

Resumo Introdução: As infecções cervicais profundas constituem um grupo de doenças com graves complicações e mortalidade, que podem ocorrer como resultado de doenças comuns na comunidade e que têm opções de tratamento médico e cirúrgico. Objetivo: Detectar bactérias anaeróbias e comparar a eficácia do tratamento médico-cirúrgico em diferentes faixas etárias. Método: Foram sistematicamente registrados idade dos pacientes, sexo, queixas, achados do exame físico, queixas na hospitalização, histórico de uso de antibióticos, doenças adicionais, exames radiológicos e análise dos exames, tipo de tratamento, agentes antibióticos selecionados no tratamento, resultados de cultura bacteriana, duração da hospitalização, complicações e taxas de mortalidade. No estudo, culturas bacterianas anaeróbias, difíceis de obter rotineiramente, mesmo considerando-se condições especiais de transporte e meios, foram obtidas. Foram avaliados prospectivamente 74 pacientes internados no Departamento de Otorrinolaringologia da Universidade de Mersin, entre 01.07.2016 e 07.07.2017, devido a infecção cervical profunda. O estudo incluiu 37 pacientes do sexo feminino e 37 do masculino. A idade dos pacientes variou de 1 a 69 anos e a média foi de 31. Resultados: De acordo com a análise dos dados obtidos, houve uma relação estatisticamente significante entre os pacientes com doenças adicionais e as modalidades de tratamento dos pacientes (p = 0,017). A taxa de tratamento cirúrgico foi maior nesse grupo de pacientes. Em pacientes com histórico de uso de antibióticos, verificou-se que aqueles do grupo pediátrico permaneceram mais tempo hospitalizados em comparação aos adultos (p = 0,036). Nos pacientes adultos submetidos à cirurgia, verificou-se que o eixo longo absortivo era mais longo em mm do que nos pacientes que receberam tratamento médico isolado (p = 0,008). Conclusão: As infecções cervicais profundas constituem um grupo de doenças que são preocupantes na saúde pública, com sua mortalidade e morbidade. Garantir a segurança das vias aéreas dos pacientes deve ser a primeira intervenção. Os abscessos localizados lateralmente à cápsula tonsilar podem não apresentar drenagem sem a tonsilectomia.

[Legionella Species Isolated in the Water Systems of Ships and Their Molecular Characterization]. / Gemilerin Su Sistemlerinden Izole Edilen Legionella Türleri ve Moleküler Karakterizasyonu.

Legionella species are generally found in nature and in water resources, and they are gram negative bacilli that can cause pneumonia by being transmitted from water systems to humans via aerosol or aspiration. Legionnaires' disease caused by this agent continues to be a public health problem in cruise ships. In this study, it was aimed to determine the prevalence of the colonization of Legionella species by culture method and to determine the molecular characterization of the isolated Legionella in water samples taken from the water systems of the ships docking in Mersin International Port. A total of 158 cold water samples were taken from 18 ferry and/or cargo ships docking in Mersin International Port between December 2014 and June 2015. Fifty-four of the samples were obtained from tanks, 68 from taps and 36 from shower heads. All samples were centrifuged and inoculated from the pellet onto "Buffered Coal Yeast Extract" (BCYE) (Oxoid, CM0655, UK) agar medium supplemented with iron pyrophosphate, L-cysteine and α-ketoglutarate (Oxoid, SR0110, UK). The culture plates were incubated for 10-15 days in microaerophilic environment in a desiccator at 37°C. The suspicious colonies grown in cultures were serogrouped by latex agglutination test (Oxoid, DR0800M, UK) and fluorescent antibody method (m-Tech Monoclonal Technologies, Inc., USA). For the molecular analysis of Legionella species grown in culture, DNA isolation was made from Legionella colonies and then polymerase chain reaction amplification was performed using specific primer sequences targeting the rpoB gene region of the Legionella genome. Direct DNA sequencing of rpoB gene products was performed in the "ABI PRISM 3130XL Genetic Analyzer" (Applied Biosystems, USA). The DNA sequences were typed by BLAST analysis and the determined types, and NCBI (National Center for Biotechnology Information) reference Legionella sequences were phylogenetically compared with the Neighbor-Joining comparison method by using the Mega 7 program. Legionella spp. was isolated in 18 (11.4%) of 158 samples. Of these, four (7.4%, 4/54) were detected from the tank, 11 (16.2%, 11/68) from the tap and three (8.33%, 3/36) from the shower head. After the latex agglutination test performed from the growing bacterial colonies, five (27.8%) were serogrouped as Legionella spp., four (22.2%) as Legionella pneumophila sg 5, two (11.1%, each) as L.pneumophila sg 1,L.pneumophila sg 8 and Legionella bozemanii and one (5.6%) as L.pneumophila sg 3. Two (11.1%) of the isolates grown in culture could not be serogrouped. Molecular characterization of 12 Legionella isolates could be performed. One of them was serologically serogrouped as L.bozemanii, and it was found to be 99% similar to Legionella rubrilucens when compared with NCBI Legionella sequence data in the BLAST program. One isolate that could not be differentiated by serogrouping was identified as Legionella erytra in the BLAST program after DNA sequence analysis. The remaining 10 isolates (55.6%, n= 18) were confirmed as L.pneumophilia after the comparison with reference NCBI sequences. In this study, it was determined that 11.4% of the water samples collected from the water systems of the ships docking in Mersin International Port were contaminated with Legionella species. The detected Legionella species have an important potential source of infection for the captain, ship workers and passengers travelling on the ships. In this respect, this study reveals the necessity of establishing studies to improve the risk management of Legionella in the water systems of ships.

Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients.

INTRODUCTiON: Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options. OBJECTIVES: Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media. METHODS: A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years. RESULTS: According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008). CONCLUSIONS: Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.

[Investigation of rotavirus, adenovirus and astrovirus frequencies in children with acute gastroenteritis and evaluation of epidemiological features]. / Akut gastroenteritli çocuklarda rotavirus, adenovirus ve astrovirus sikliginin arastirilmasi ve epidemiyolojik özelliklerinin degerlendirilmesi.

Viral agents are the most common causes of childhood gastroenteritis over the world. Rotaviruses, the main causative agents of viral gastroenteritis in infant and young children, are followed by other viruses, namely adenoviruses, astroviruses, noroviruses and caliciviruses. The aims of this study were to determine the frequencies of rotavirus, adenovirus and astrovirus infections in children with acute gastroenteritis in our region, and to evaluate these frequencies according to age, gender and seasonal features. A total of 363 stool specimens obtained from 182 female and 181 male children (age range: 0-6 years) who were admitted to hospital with diarrhea, during January-December 2008 in Mersin (a province located at Mediterranean coast of Turkey), were included to the study. The presence of rotavirus, adenovirus and astrovirus antigens in the samples were investigated by ELISA method (R-Biopharm RIDASCREEN, Germany). Viral antigen positivity was detected in 44.4% (161/363) of the samples, and the positivity rates of rotavirus, adenovirus and astrovirus were 32.2% (117/363), 10.5% (38/363) and 1.7% (6/363), respectively. Rotavirus was the most frequently detected agent in children with viral gastroenteritis (117/161; 72.6%), while adenovirus was found in 23.6% (38/161) and astrovirus in 3.7% (6/161) of the cases. Two of the patients (0.6%) yielded triple viral antigen positivity in their stool samples, and 35 (9.6%) of the patients yielded two at a time. Rotavirus + adenovirus (26/363; 7.2%) associations were the most frequently detected coinfections. The difference between the rates of viral antigen positivities in males and females was statistically insignificant (p > 0.05). Rotavirus antigen positivity was detected as 23.7% in 0-12 months group (n = 97), 44.9% in 13-24 months group (n = 69), 40.3% in 25-36 months group (n = 62), 35.4% in 37-48 months group (n= 48), 30.3% in 49-60 months group (n = 33), and 20.4% in 61-72 months group (n = 54). These rates were 7.2%, 18.8%, 8.1%, 16.7%, 6.1% and 5.6%, respectively for adenovirus positivity. Of astrovirus antigen positive children, two were 0-12 months, three were 13-24 months and one was 25-36 months old. No astrovirus positivity was detected in 135 children older than 3 years. The difference between the rates of rotavirus positivities in age groups was found statistically significant (p = 0.0016); however there was no significant differences between the rates of adenovirus and astrovirus positivities (p > 0.05) according to age groups. Rotavirus infections were mainly detected in winter season, namely december (n = 17; 50%), january (n= 22; 46.8%), february (n = 21; 41.2%) and march (n = 12; 31.6%), reduced during the summer, and started to rise in november (n = 14; 38.9%). Comparatively adenovirus and astrovirus positive cases were also seen especially in fall and winter months, while no cases were detected between may to august. In conclusion, since nearly half of the childhood gastroenteritis cases (44.4%) were due to viral agents in our region, testing for the viral antigens may guide the clinical approach to the patients with acute diarrhea especially in 1-3 years old children and in winter season.

[Investigation of aflatoxin M1 levels in raw and market milks in Mersin Province, Turkey]. / Mersin ilinde cig ve market sütlerinde aflatoksin M1 düzeyinin arastirilmasi.

Aflatoxin M1 (AFM1) which is produced by some Aspergillus species, mainly Aspergillus flavus, is the hydroxylated metabolite of aflatoxin B1 (AFB1) and can be found in milk and dairy products of livestock fed with contaminated feed. AFM1 is a potential threat to human health owing to its toxic and carcino- genic effects. This study was aimed to investigate the level of AFM1 in raw and ultra-high-temperature pasteurized (UHT) milk samples. A total of 137 milk specimens (39 from goats, 53 from cows, and 45 from UHT marketmilks) were included to the study, and AFM1 levels were analyzed by high performance liquid chromatography (HPLC; Aflaprep M immunoaffinity column; R-Biopharm Rhone Ltd., Glasgow) method. AFM1 positivity was detected in 14 (35.8%) goat milk samples, in 46 (86.7%) cow milk samples and 33 (73.3%) UHT milk samples, with the levels ranging from 0.0021 microg/l to 0.8666 microg/I in raw milk, and from 0.001 microg/I to 0.059 microg/I in UHT milk samples. In 10.2% (4/39) of goat milk, 73.5% (39/53) of cow milk, and 2.2% (1/45) of UHT milk samples, the toxin levels were found to be above the officially reasonable limit value (> 0.05 microg/l) recommended by Turkish Food Codex Regulation. Since AFM1 levels were found to be significantly high in the raw milk samples collected in Mersin province (located on Mediterranean part of Turkey), it was concluded that people dealing with feed, milk and dairy products should be informed about the importance of aflatoxins and the preventive measures to get protected from AFB1 and AFM1.

Does Helicobacter pylori play a role in the development of chronic adenotonsillitis?

OBJECTIVE: Evaluation of the possible relationship between chronic adenotonsillitis and Helicobacter pylori (HP). PATIENTS AND METHODS: The study was performed prospectively on 91 pediatric patients who underwent tonsillectomy, adenoidectomy or adenotonsillectomy due to chronic tonsillitis and/or adenoiditis. The adenotonsillectomy specimens were examined for HP colonization by rapid urease test (RUT) and immunohistochemical evaluation. Before surgery, anti-HP IgG and IgA antibody titers were detected by enzyme linked immunosorbent assay (ELISA) test in venous blood samples of the patients. RESULTS: The RUT was positive in only two of the adenoidectomy specimens (2.2%) and in none of the tonsillectomy specimens. A positive result was not detected in any tonsillectomy specimens using immunohistochemical examination. Serum IgG antibody was positive in 21 (23%) patients, IgA antibody was detected in 7 (7.69%) patients and both tests were positive only in 3 (3.29%) patients. CONCLUSION: The results of this study suggested that HP would not colonize in tonsil tissue of patients with chronic tonsillitis.

Relationship between airway colonization, inflammation and exacerbation frequency in COPD.

RATIONALE: To evaluate bacterial colonization and the airway inflammatory response, and its relationship to the frequency of exacerbation in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: Quantitative bacteriologic cultures, neutrophil elastase, myeloperoxidase (MPO), tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-8 were measured in bronchoalveoler lavage (BAL) in 39 patients with stable COPD [19 with frequent exacerbation (> or = 3/year), and 20 with infrequent] and in 18 healthy controls (10 smokers and 8 non-smokers). RESULTS: BAL revealed the microorganisms with potential pathogenicity above the established threshold (> or = 10(3)cfu/ml) in 68.4% of patients with frequent exacerbation, 55% of infrequent exacerbation, 40% of smokers and 12.5% of non-smokers controls (P=0.05). BAL MPO, IL-8 and TNF-alpha levels were found to be significantly higher in COPD as compared to controls (P=0.001). However, only IL-8 level was significantly higher in COPD patients with frequent exacerbation as compared to infrequent (P=0.001). Airway bacterial load correlated with levels of airway inflammation markers in COPD (P<0.05). CONCLUSION: The bacterial load and airway inflammation contributes to each other in stable COPD. However, there is a link only between interleukine (IL)-8 and frequent exacerbations. Clearly, the relationship between bacterial colonization, airway inflammation and frequent exacerbations is of major importance in understanding of the COPD pathogenesis.

The diagnostic role of serum inflammatory and soluble proteins on dementia subtypes: correlation with cognitive and functional decline.

In the past years, the possible involvement of inflammation in the pathogenesis of dementia has been the subject of several investigations. However there are restricted data about the profile of the inflammatory and soluble proteins in well evaluated Alzheimer's disease (AD), vascular dementia (VD), mild cognitive impairment (MCI) and healthy controls. There are also no reliable data regarding the relationship between the overlapping protein levels and cognitive or functional decline. We measured levels of IL-1beta, IL-2, IL-6, IL-18, TNF-alpha, beta-Amlyloid 1-40 and alpha1-antichymotrypsin levels in plasma in groups of total 82 subjects with AD, MCI, VD and controls using enzyme-linked immunosorbent assay (ELISA) method. Our study samples showed high levels of proinflammatory cytokine levels (especially IL-18) in all patient groups but only high levels of alpha1-antichymotrypsine in VD patients compared to controls. There is no significant correlation between the laboratory and clinical variables except for a link between IL-1beta and NPI scores of AD. In conclusion, this study yielded evidence of some shared mechanisms underlying AD and VD and thus motivates further studies of inflammatory markers in various types of dementia and MCI.

Detection of Entamoeba histolytica/Entamoeba dispar in stool specimens by using enzyme-linked immunosorbent assay

Entamoeba histolytica actually comprises two genetically distinct but morphologically indistinguishable species. E. histolytica can cause invasive intestinal and extra intestinal disease, while E. dispar cannot. Identification and differentiation of E. dispar and E. histolytica in stool sample by microscopy is imprecise. Several weeks of culture and isoenzyme analysis are required to differentiate E. histolytica from E. dispar. In this study, we have used an enzyme-linked immunosorbent assay (ELISA) for detection of E. histolytica/E.dispar and compared it with microscopy. Eighty-eight samples were evaluated, trichrome staining was positive in 20.4 percent (18) and ELISA was positive in 29.5 percent (26). Both tests were positive in 14 (15.9 percent) samples, 4 (4.5 percent) only with direct microscopy, and 12 (13.6 percent) only with ELISA. Both tests were negative in 58 (65.9 percent) samples. Microscopy has low sensitivity and high specificity, low negative predictive value and high positive predictive value in comparison with ELISA. E. histolytica/E. dispar antigen detection ELISA tests are inexpensive compared to the specific tests, yield objective results and do not require experienced microscopists and can therefore be recommended for screening of stools worldwide and the results can be taken for treatment that are fitting with its clinic.