Pediatric Invasive Aspergillosis: a Retrospective Review of 59 Cases.

Invasive aspergillosis (IA) is a major cause of morbidity and mortality. This study aimed to present our 10-year IA experience at a single center. Fifty-nine pediatric patients with IA were included in this study. The male-to-female ratio was 42/17. The median age was 8.75 years. Hematologic malignancy was present in the majority of the patients (40/59, 68%). The mean neutropenia duration was 18.5 days. Cytosine arabinoside was the most common immunosuppressive therapy directed at T cells during IA diagnosis. IA cases were categorized as proven (27%), probable (51%), or possible (22%) according to the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. The lungs (78%) were the most common site of IA, and nodules were the most frequent radiological findings (75.5%). In 38 patients (64.4%) receiving antifungal prophylaxis, prophylactic agents included fluconazole (30.5%), liposomal amphotericin B (23.7%), posaconazole (8.5%), and voriconazole (1.7%). Initial treatment was most commonly administered as monotherapy (69.5%). The median antifungal treatment duration was 67 days. Eleven deaths (18.6%) were due to aspergillosis. With the increased use of corticosteroids, biological agents, and intensive immunosuppressive chemotherapy, IA will most likely continue to occur frequently in pediatric patients.

[Interferon Gamma Release Assay Request Indications: From Laboratory to Clinical Perspective]. / Interferon Gama Salinim Test Istemi Endikasyonlari: Laboratuvardan Klinige Bakis Açisi.

Tuberculosis is a re-emerging infectious disease that causes high morbidity and mortality worldwide and remains a major health threat in many parts of the world. With the increase in the incidence of HIV-positive/AIDS patients and immunocompromised individuals, accurate and timely diagnosis of latent TB (LTB) and active TB (ATB) has gained great importance. The aim of this study was to investigate the rationale lying behind interferon gamma release assay (IGRA) requests for patients applying to various clinics of a tertiary care hospital. In the study, 2905 IGRA tests requested in two years period were analyzed retrospectively. The IGRA test positivity rates were recorded and analyzed by linking with the requesting departments and indications. IGRA test positivity was determined in 503 cases (17.31%). IGRA test positivity rates were above 20% in samples sent from general surgery, pulmonology, nephrology, and transplantation departments, respectively. At all, 54.17% of the cases from whom IGRA requests were made constituted the first group of "pre-treatment investigation", and the positivity rate in this group was 12.96%. The positivity rate was highest [163 (28.69%)] in the patient group from whom the test was requested with the suspicion of TB. As a conclusion, until today, there is no study in which IGRA test requests are evaluated in terms of clinics. In this respect, this study is thought to be important. It is also desired to highlight that it is important for each country to develop its specific guidelines, country specific indications for IGRA test requests. Multi-centered studies are also essential for a global suggestion.

Correlation of Treponemal Chemiluminescent Microparticle Immunoassay Screening Test Signal Strength Values With Reactivity of Confirmatory Testing.

BACKGROUND: Automated chemiluminescent microparticle immunoassays (CMIAs) are the most common first step at high-volume laboratories for syphilis screening. If the initial screening test is reactive, 1 more treponemal test is required, resulting in increased cost. In this multicenter study, we aimed to determine the correlation between the CMIA signal-to-cutoff ratio (S/Co) and the confirmatory tests to reduce unnecessary confirmatory testing. METHODS: Eight hospitals from 5 provinces participated in this study. All laboratories used Architect Syphilis TP CMIA (Abbott Diagnostics, Abbott Park, IL) for initial screening. Treponema pallidum hemagglutination (TPHA), rapid plasma reagin (RPR), and fluorescent treponemal antibody absorption (FTA-ABS) were used as confirmatory tests according to the reverse or European Centre for Disease Prevention and Control algorithms. A receiver operating characteristic analysis was used to determine the optimal S/Co ratio to predict the confirmation results. RESULTS: We evaluated 129,346 serum samples screened by CMIA between January 2018 and December 2020. A total of 2468 samples were reactive; 2247 (91%) of them were confirmed to be positive and 221 (9%) were negative. Of the 2468 reactive specimens, 1747 (70.8%) had an S/Co ratio ≥10.4. When the S/Co ratios were ≥7.2 and ≥10.4, the specificity values were determined to be 95% and 100%, respectively. In a subgroup of 75 CMIA-positive patients, FTA-ABS was performed and 62 were positive. Among these FTA-ABS-positive patients, 24 had an S/Co ratio <10.4, and negative TPHA and RPR. CONCLUSIONS: We propose a potentially cost-effective reverse screening algorithm with a treponemal CMIA S/Co ratio ≥10.4, obviating the need for secondary treponemal testing in about 71% of the screening-reactive samples. This would substantially reduce the confirmatory testing volume and laboratory expenses. However, in high-risk group patients with CMIA positive results, S/Co ratio <10.4, and negative TPHA and RPR, FTA-ABS may be used for confirmation.

Relation of Acute Decompensated Heart Failure to Silent Cerebral Infarcts in Patients With Reduced Left Ventricular Ejection Fraction.

Heart failure (HF) is a prothrombotic state with increased rate of thromboembolic events. Magnetic resonance imaging studies demonstrated increased rate of silent cerebral infarcts (SCI) in this patient group and SCIs were shown lead to dementia, cognitive decline, and depression. We aimed to show acute decompensated phase is associated with increased rate of recent SCI in reduced ejection fraction HF patients. HF patients with sinus rhythm hospitalized for acute decompensation were studied. Neuron specific enolase (NSE), a sensitive neuronal ischemia marker, was used to detect recent SCI. Decompensated and compensated phase blood samples for NSE were collected on the day of admission and on the third day of compensation, respectively. One hundred and forty seven patients with mean age of 72 were studied. There were significantly more patients with positive NSE levels at decompensated state (29% vs 4%, p <0.001). Multivariate predictors for recent SCI were smoking, new onset atrial fibrillation, spontaneous echo contrast of left ventricle, and aneurysmatic apex. Statin use was found to be protective against NSE elevation. In conclusion, our data reveal that decompensated HF is significantly associated with increased levels of NSE suggestive for silent neuronal injury.

Comparison of Frequency of Silent Cerebral Infarction After Coronary Angiography and Stenting With Transradial Versus Transfemoral Approaches.

Silent cerebral infarction (SCI) can be seen after coronary procedures. We investigated whether vascular access sites have an impact on the risk of SCI. A total of 255 consecutive patients who underwent diagnostic or interventional coronary procedures through transfemoral (n = 126 patients) or transradial (n = 129 patients) approach were evaluated. Neuron-specific enolase (NSE) levels were studied before and 12 hours after the procedure. Elevation of greater than 12 ng/ml was considered as SCI. Patients were mainly men (60%) with a mean age of 62 years. SCI was observed in 74 of 255 patients (29%). It was significantly more prevalent among transradial group. Elevation of NSE was observed in 36% of transradial group (n = 47) and 21% of the transfemoral group (n = 27) (p = 0.008). Patients with SCI were more likely to have male sexuality, hyperlipidemia, history of smoking, and previous myocardial infarction. Multivariate analysis demonstrated that patients who underwent coronary procedures through transradial approach were 2.1 times more likely to have an SCI than patients with transfemoral approach (95% confidence interval [CI] 1.205 to 3.666; p = 0.008). Other independent predictors of NSE elevation were previous myocardial infarction (odds ratio 8.6; 95% CI 4.209 to 17.572; p <0.001) and smoking history (odds ratio 7.251; 95% CI 3.855 to 13.639; p <0.001). The present study suggests that transradial coronary procedures carry higher risk of SCI when compared with transfemoral route.

[Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae strains isolated between 2004-2007 in Ankara University Hospital, Turkey]. / Ankara Universitesi tip fakültesinde 2004-2007 yillari arasinda izole edilen karbapeneme dirençli Klebsiella pneumoniae suslarinin moleküler epidemiyolojisi.

The prevalence of carbapenem-resistant gram-negative bacteria in the hospital setting is in an increasing trend worldwide. Since most of the carbapenem-resistant Enterobacteriaceae are resistant to all antimicrobial agents except polymyxins and tigecycline, the emergence of carbapenem resistance in Klebsiella pneumoniae strains requires careful monitoring. This study was conducted to analyse the epidemiological relatedness between the carbapenem-resistant isolates of K. pneumoniae collected from different wards (intensive-care, surgery, hematology, neurology, internal medicine, emergency services) of Ankara University Hospital. A total of 26 carbapenem-resistant K. pneumoniae isolates (13 blood, 6 urine, 2 bronchoalveolar lavage, 1 abscess, 1 tissue, 1 catheter tip, 1 drainage fluid, 1 tracheal lavage fluid) were identified and antibiotic susceptibility tests were performed with API 20E System or VITEK 2 Compact (Bio-Merieux, France) at the Central Laboratories of Ankara University Hospital between February 2004 and April 2007. MICs of imipenem and meropenem were also confirmed using E-test (AB Biodisk, Sweden). The clonal relationship between the isolates was studied by pulsed-field gel electrophoresis (PFGE). After digestion of total genomic DNA with restriction endonuclease Xbal, the 26 isolates generated 7 PFGE profiles. PFGE pattern B consisting of different antibiotic susceptibility profile was seen only in 2006. Carbapenem-sensitive strains isolated at the same time from the same wards which carbapenem-resistant isolates were recovered, generated different PFGE patterns. The predominant carbapenem-resistant isolates in our hospital were found clonally related. Interhospital transmission of carbapenem-resistant K. pneumoniae strains which have a particular epidemic potential, is likely to occur during patient transfer between wards. It is likely that intensive efforts, similar to those used to control vancomycin resistant enterococci, are needed to identify and control the spread of resistant Klebsiella species. Therefore, active surveillance and strict infection control measures for this multidrug-resistant microorganism should be implemented at local and national basis.

A cluster of Klebsiella pneumoniae bacteremia in a radiation oncology ward.

BACKGROUND: We report an outbreak of genetically related strains of Klebsiella pneumoniae bloodstream infection. METHODS: The practices that were possibly related to the outbreak were investigated through direct observation and interviews with staff by infection control team. Cultures of potential environmental sources of bacteria were obtained. RESULTS: Six patients receiving intravenous medications in saline solution developed fever and shaking chills 1.5 to 4 hours after the infusion was initiated. Cultures of the blood from 4 patients yielded K. pneumoniae. Molecular characterization of K. pneumoniae done by pulsed-field gel electrophoresis revealed the same strain. CONCLUSION: Although a definite source for the outbreak could not be identified, probably environmental contamination, lack of adherence to hand hygiene practices, contamination, and cross contamination led to this outbreak.