Differential identification of atypical pneumonia pathogens in aorta and internal mammary artery related to ankle brachial index and walking distance.

BACKGROUND: We studied the existence of agents in aorta biopsies, such as Chlamydia pneumoniae, cytomegalovirus, and Mycoplasma pneumoniae, that are thought to have a role in atherosclerosis etiopathogenesis role, and their association with peripheral artery disease. MATERIALS AND METHODS: We examined aorta wall and internal mammarian artery (IMA) biopsies taken from two different places in 63 patients in whom coronary artery bypass was performed. In these biopsies, we evaluated the deoxyribonuclease (DNA) of these microorganisms using polymerase chain reaction. From the same patients, we recorded the ankle brachial index, road walking distance information, lipid profile, C-reactive proteins, blood parameters such as fibrinogen, and the patient's operation data. RESULTS: In the nine aorta biopsies taken from 63 patients, we isolated C pneumoniae DNA. In IMA biopsies taken from the same patients, we detected no microorganism DNA (P < 0.001). In the same aorta biopsies, we found no cytomegalovirus or M pneumoniae DNA. We examined 12 patients using an index value of 0.9 in the ankle brachial index evaluation; eight had C pneumoniae in the aorta biopsies (P < 0.001). CONCLUSIONS: We found a significant relationship between C pneumoniae DNA and the existence of peripheral artery disease. In the development of atherosclerosis with C pneumoniae, there may be a determinant pathogen in both the aorta and the peripheral arteries. The nonexistence of C pneumoniae DNA in the IMA biopsies may indicate infectious agents because of the predominant endothelial functions in this artery, and thus its resistance to atherosclerosis.

[Investigation of the Presence of Disinfectant Resistance Genes qacA/B in Nosocomial Methicillin-Resistant Staphylococcus aureus Isolates and Evaluation of Their In Vitro Disinfectant Susceptibilities]. / Hastane Enfeksiyonu Etkeni Olan Metisiline Dirençli Staphylococcus aureus Suslarinda qacA/B Dezenfektan Direnç Genlerinin Varligi ve Dezenfektanlara In Vitro Duyarliliklarinin Arastirilmasi

Development of resistance to disinfectant substances in nosocomial microorganisms is an important problem encountered during disinfectant practices. Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant cause of hospital-acquired infections. Besides being resistant to several antimicrobial agents, MRSA strains can also become resistant to some disinfectant substances. Resistance to disinfectant substances may develop due to the misuse of disinfectants. This may either be due to the frequent use of disinfectant substances or use in lower concentrations than recommended. MRSA strains may harbour the qacA/B disinfectant resistance genes that may cause resistance to quarternary ammonium compounds and some cationic disinfectants. These resistance genes are found in plasmids and are responsible for decreased susceptibility or resistance. In this study, a total of 69 nosocomial MRSA strains isolated from clinical specimens in our hospital were tested for disinfectant activity and the presence of qacA/B disinfectant resistance genes in these isolates was investigated by polymerase chain reaction. We determined whether the presence of these genes caused phenotypic resistance to chlorhexidine and benzalkonium chloride by the use of bactericidal and bacteriostatic tests. For this purpose, the minimum inhibitory concentration (MIC) values of these disinfectants against MRSA isolates were detected by microdilution method with the proposals of CLSI, and bactericidal effects of these disinfectants were also detected by using quantitative suspension test according to EN13727:2003 European Standard. It has been found that 11.6% (8/69) of the isolates harbored qacA/B resistance genes. MIC values for chlorhexidine and benzalkonium chloride were found in the range of 2-8 µg/ml. Although it was observed that MIC values were higher in five of the qacA/B gene positive isolates, statistically significant difference was not found between gene positive and gene negative groups. Both 1% chlorhexidine and 1% benzalkonium chloride were found bactericidal against the isolates including the ones carrying the qacA/B resistance genes. It was concluded that the presence of the qacA/B disinfectant resistance genes did not lead to resistance to the disinfectant substances at the concentrations used in clinical practices. Furthermore, tested disinfectants still exhibited bactericidal activity even with high MIC values.

Predictors of hospital-onset Clostridioides difficile infection in children with antibiotic-associated diarrhea.

BACKGROUND: This study aimed to determine the predictors of hospital-onset Clostridioides difficile infection (CDI) in pediatric patients with antibiotic-associated diarrhea (AAD) and to develop a predictive scoring system to identify at-risk patients. METHODS: This retrospective case-control study included patients aged ≥2-18 years with AAD who underwent C. difficile polymerase chain reaction testing >3 days after hospital admission. Patients with hospital-onset CDI were selected as cases and matched with the control patients without CDI. Univariate and multivariate logistic regressions were used to determine predictors of CDI and to construct a prediction score for the outcomes of interest. RESULTS: Sixty-five patients with hospital-onset CDI and 130 controls were enrolled. Independent predictors for CDI identified and combined into the prediction score included abdominal pain (adjusted odds ratio [95% confidence interval]: 7.940 [3.254-19.374]), hospitalization for ≥14 days before the onset of diarrhea (3.441 [1.034-11.454]), antibiotic use for ≥10 days before the onset of diarrhea (6.775 [1.882-24.388]), receipt of meropenem (4.001 [1.098-14.577]) and clindamycin (14.842 [4.496-49.000]). The area under the receiver operating characteristic curve for this score was 0.883. CONCLUSIONS: The presented scoring system can be easily applied by clinicians at the bedside to decide which patients with AAD are likely to have CDI.

[Determination of hepatitis B virus genotypes by DNA sequence analysis in patients from Ankara, Turkey]. / Ankara bölgesindeki hepatit B virusu genotiplerinin DNA dizi analizi yöntemi ile belirlenmesi.

Hepatitis B virus (HBV) genotypes vary depending on the geographical region. The HBV genotype determined in Turkey has been genotype D which is found as the homogenously disseminated single genotype. The aim of this study was to determine HBV genotypes in a group of HBV infected patients who were admitted to a university hospital in Ankara, Turkey. Serum samples from HBsAg positive and anti-HBs negative 84 (52 male, 32 female) patients with HBV infection were included into the study. Anti-HBc was positive in 95.2%, HBeAg was positive in 47.6% and anti-HBe was positive in 11.9% of the patients. Mean HBV-DNA levels of the patients were 5.7 x 10(7) +/- 4.6 x 10(7) IU/ml; mean ALT levels were 131 +/- 171 IU/ml and mean AST levels were 98 +/- 170 IU/ml. HBV-DNA was extracted from serum by the phenol-chloroform method and PCR was performed to amplify the S gene region of HBV-DNA. Cycle sequencing of PCR products was performed by a commercial "Cy5/Cy5.5 Dye Primer Cycle Sequencing Kit" (Visible Genetics, Canada) based on dideoxy chain termination method. The sequences were read and analyzed in an automated fluorescence-based DNA-sequencing system (Long-Read Tower System, Visible Genetics, Canada). The nucleotide sequences of the patient samples were compared with the previously reported sequences in gene bank for each genotype. According to the comparative analysis of S-sequences of all patient samples with the published sequences of the genotypes in gene bank, all of the 84 hepatitis B strains (100%) were shown to be related to D genotypic group, subtype ayw. A phylogenetic analysis was performed and phylogenetic trees were constructed using programs in the PHYLIP phylogeny inference package. The patient samples clustered within the genotypic group D. According to these results, the main HBV genotype in our patients was genotype D in accordance with the previous molecular epidemiologic information on HBV in this geographic area. HBV genotype determination may help to establish more rational clinical approach in the evaluation of HBV infected patients.

Nasopharyngeal pneumococcal carriage in healthy Turkish children after 13-valent conjugated pneumococcal vaccine implementation in the national immunization program.

BACKGROUND: In Turkey, pneumococcal conjugated vaccine (PCV) was introduced to the national immunization program as PCV7 in 2008, and was replaced with PCV13 in 2011. The aims of this study were to investigate the effects of PCV13 on nasopharyngeal pneumococcal carriage (NPC) by determining the serotype distribution, and to identify risk factors for carriage, in healthy Turkish children. METHODS: This prospective study was conducted on 500 healthy children aged 0-13 years between April and November 2014. Nasopharyngeal swab samples were taken, and molecular method for capsular serotyping was performed by multiplex PCR. RESULTS: Of 500 children, 43.4% were unvaccinated with a PCV (7- or 13-valent), 56.6% were vaccinated and The NPC rate was found to be 9.8%. Of 49 positive Streptococcus pneumoniae isolates, 26 (53%) were PCV13 vaccine strains (VSs), and 17 (34.7%) were non-VS. Six isolates (12.2%) were not typeable by the method applied. The most common serotypes detected were serotype 3 (18.3%), serotype 19F (14.2%), serotype 6A/B (8.1%), serotype 11A (8.1%), and serotype 15B (8.1%). The total coverage rate of the PCV13 serotypes was 60.4%. CONCLUSION: A significant decrease in carriage rate was detected within three years after the introduction of PCV13 in Turkey. However, the nasopharyngeal carriage of PCV13 strains was found to be interestingly high.

Hepatitis B virus and hepatitis C virus seroprevalence in the elderly living in nursing homes.

BACKGROUND: : Communal living situations such as nursing homes create a risk for the spread of hepatitis B virus and hepatitis C virus (HCV). The aim of this study was to determine the seroprevalence of hepatitis B virus and HCV in the elderly living in 2 nursing homes in Ankara, Turkey. METHODS: : A total of 227 persons (mean age, 76.11 +/- 8.55 years) participated in this cross-sectional study. All individuals were investigated seroprevalence for hepatitis B surface antigen (HBsAg), anti-HBs immunoglobulin G (IgG), anti-hepatitis B core IgG, and anti-HCV IgG. RESULTS: : Positive seroprevalence was 11.9% for HBsAg, 48.0% for anti-HBs IgG, 25.1% for anti-hepatitis B core IgG, and 2.5% for anti-HCV IgG. Hepatitis B surface antigen positivity was 12.4% in males and 11.5% in females (P > 0.05); and the seroprevalence was 10.4% for those living in nursing homes for 1 year or less and 13.0% for those living in nursing homes for more than 1 year (P > 0.05). CONCLUSIONS: : The fact that nearly half of those living in nursing homes had not encountered hepatitis B infection or had not received hepatitis B vaccination indicates the need for administering hepatitis B vaccines in this group.

Seroprevalences of herpes simplex virus type 2 and Chlamydia trachomatis in Turkey.

OBJECTIVE: Aim was to detect the seroprevalences of Herpes simplex virus type 2 (HSV-2) and Chlamydia trachomatis in a subpopulation of Turkey. MATERIALS AND METHODS: The study was performed in the "Golbasi" rural area of Ankara, the capital city of Turkey. Ten milliliter of peripheral blood was drawn from 1,115 women over 15 years old. Once the sera were separated, ELISA was used to detect seropositivity. Data were transferred to Epi Info Version 6.0 statistical program and the analysis was performed. RESULTS: Among all participants, 53.5% were found to be seropositive for HSV-2 and 52.2% were found to be seropositive for C. trachomatis. CONCLUSION: This study detected a much higher HSV-2 and C. trachomatis seroprevalence for the Turkish population than expected and previously reported. A percentage around 50% for both agents creates an important conflict with the common misbelief of the Turkish population that sexually transmitted diseases are not common in this population. This study points out the importance of preventive measures and the need for greater surveillance for sexually transmitted infections among the Turkish population.

Topical N-acetylcysteine reduces interleukin-1-alpha in tear fluid after laser subepithelial keratectomy.

PURPOSE: To evaluate the effect of topical N-acetylcysteine (NAC) on interleukin 1-alpha (IL-1alpha) levels in tear fluid after myopic laser subepithelial keratectomy (LASEK) and its possible role in modulating corneal wound healing. METHODS: Twenty-six eyes of 13 patients who underwent myopic LASEK were divided into 2 groups. Group 1 (n=10 eyes) was used as a control group. All patients received topical lomefloxacin and dexamethasone postoperatively. Additionally, patients in Group 2 received topical NAC for 1 month postoperatively. Tear fluid samples were collected with microcapillary tubes preoperatively, on the first and on the fifth postoperative day, and the release of IL-1alpha in tear fluid was calculated. Haze grading and confocal microscopic examination were performed at 1 and 3 months postoperatively. RESULTS: The mean IL-1-alpha release values were 0.285-/+0.159 pg/min in Group 1 and 0.235-/+0.142 pg/min in Group 2 preoperatively. In Group 1, the values were 0.243-/+0.155 pg/min on day 1 and 0.164-/+0.125 pg/min on day 5. In Group 2, the mean IL-1alpha release values were 0.220-/+0.200 pg/min on day 1 and 0.080-/+0.079 pg/min on day 5. The difference between the groups was significant only for day 5 (p<0.05). Mean corneal haze score and grey scale value in confocal microscopy were significantly higher (p<0.05) in Group 1 at 1 month. However, at 3 months there was no difference between groups (p>0.05). CONCLUSIONS: NAC seems to have an additive effect to steroids in suppressing IL-1alpha levels in tear fluid and may be clinically advantageous in modulating corneal wound healing during the early postoperative period after LASEK.

Identification of Helicobacter species by 16S rDNA PCR and sequence analysis in human liver samples from patients with various etiologies of benign liver diseases.

BACKGROUND/AIMS: Several reports indicated an increased prevalence of the Helicobacter species in hepatocellular cancer tissue and in liver samples infected with hepatitis viruses. The frequency of Helicobacter spp. in benign liver diseases was, however, not thoroughly investigated. METHODS: Seventy-five consecutive patients with suspected liver disease were enrolled. The indications were hepatitis B virus (n=30), C virus (n=8), B and C dual infection (n=1), nonalcoholic steatohepatitis (n=27), autoimmune hepatitis (n=3), primary biliary cirrhosis (n=1) and idiopathic elevation of liver enzymes (n=5). PCR detection of 16S recombinant RNA gene of Helicobacter spp. was performed on liver samples. PCR products of positive samples were further identified by DNA sequencing. The patients also had upper gastrointestinal endoscopy and gastric biopsy for the detection of H. pylori using histopathology and PCR. RESULTS: Helicobacter spp. DNA was detected in two out of 75 liver biopsy samples (2.6%), which were typed as H. pylori by DNA sequencing. One of these patients had chronic hepatitis C infection (man, 51 years old) and the other had nonalcoholic steatohepatitis (woman, 44 years old). Fifty-two out of 75 of the patients (69.3%) had H. pylori infection in their stomachs. CONCLUSION: We have found that H. pylori infection is much less prevalent in benign liver diseases. The presence of H. pylori in nonalcoholic steatohepatitis (NASH) patients is a novel finding and this finding should be confirmed in a larger series.

Could the simplified (14)C urea breath test be a new standard in noninvasive diagnosis of Helicobacter pylori infection?

OBJECTIVE: The carbon-14 ((14)C) urea breath test (UBT) is a reliable and noninvasive technique for the diagnosis of Helicobacter pylori (HP) infection. The diagnostic performance of a new practical and low dose (14)C UBT system (Heliprobe, Stockholm, Sweden) was compared with those of other diagnostic tests, namely, rapid urease test (RUT), histopathology, and DNA detection using polymerase chain reaction (PCR). METHODS: Eighty-nine patients (mean age = 45 +/- 13, 30 men) with dyspeptic complaints who underwent an endoscopic procedure were studied. Biopsy specimens acquired during the procedure were subjected to RUT, histopathological examination using hematoxylin and eosin (HP-HE) and PCR. All patients underwent UBT using the Heliprobe system on a different day. The gold standard for HP positivity was defined as any two of the three tests being positive, excluding UBT, and the sensitivity and specificity of any single test alone were determined using this gold standard. Whenever only one test was positive, it was considered to be a false-positive one. RESULTS: With the gold standard used in this study, 59 (66%) patients were diagnosed HP positive. The Heliprobe method detected HP infection with 96.6% sensitivity and 100% specificity and had the best diagnostic performance when compared with all the other methods. The sensitivity and specificity of the other methods for the detection of HP positivity were 89.8% and 100% for RUT, 93.2% and 63.3% for PCR, and 93.2% and 76.6% for HP-HE, respectively. Areas under the receiver-operating characteristic were 0.977 for UBT, 0.947 for RUT, 0.84 for HP-HE, and 0.775 for PCR. CONCLUSIONS: Using a combination of invasive diagnostic tests as the gold standard, Heliprobe UBT was found to be highly sensitive and specific for the diagnosis of HP infection in patients with dyspeptic complaints.

Detection of Helicobacter pylori DNA in aortic and left internal mammary artery biopsies.

We investigated the relationship between acute coronary ischemia and the presence of Helicobacter pylori DNA in aortic regions that were absent macroscopic atheromatous plaques. The study group (Group 1) consisted of 42 patients who underwent coronary artery bypass grafting. Biopsy samples were obtained from 2 different locations: from regions of the aorta that were free (macroscopically) of atheromatous plaque (Group 1A), and from the internal mammary artery (Group 1B). The control group (Group 2) of 10 patients who had no atherosclerotic vascular disease provided aortic tissue samples for comparison. The real-time polymerase chain reaction method was used to detect H. pylori DNA in all biopsy samples. Eleven of 42 aortic tissue samples (26%) in Group 1A were positive for H. pylori DNA. Neither biopsies from the left internal mammary arteries of those patients nor biopsies from the aortas of the control group (Group 2) were positive for H. pylori DNA. There was a statistically significant difference between 1A and 1B in terms of H. pylori positivity (P=0.001). In Group 1 as a whole, acute coronary ischemia was more prevalent in the H. pylori-positive patients than in the H. pylori-negative patients (P=0.001). To our knowledge, this is the 1st study to investigate the detection of H. pylori DNA in aortic biopsy samples that are macroscopically free of atheromatous plaque. Such detection in patients who have atherosclerotic coronary artery disease could be an important indication of the role of microorganisms in the pathogenesis of atherosclerosis.

Rubella seroprevalence among women of childbearing age residing in a rural region: is there a need for rubella vaccination in Turkey?

It is essential to evaluate the susceptibility of women in the reproductive age group to rubella virus in order to set strategies for the prevention of congenital rubella syndrome (CRS). Turkey began implementing measles-mumps-rubella vaccination as part of the national vaccination schedule for children (12 months, 6 years) and adolescents (14 years) in July, 2006, and there is an ongoing discussion of the need for a policy of vaccinating women of child-bearing age against rubella. The aim of this study was to determine the rubella seroprevalence among women in the reproductive age group in a rural district in Ankara and to provide data about rubella susceptibility for policymakers. Four hundred ninety of the women in the 15- to 49-year-old age group in the region who were targeted were reached (68.2%), and 467 (65.0%) of them who had a convenient serology were included in the study. Rubella IgG antibodies were quantified by the enzyme-linked immunosorbent assay method. Seropositivity was 95.5% for the total group and 96.2% among pregnant women. The seropositivity of this rural group of women was found to be high, but in order to rule out the need for a rubella vaccination program for women of child-bearing age, large-scale studies in different settings and studies that describe the CRS burden in Turkey are required.

Effects of atypical pneumonia agents on progression of atherosclerosis and acute coronary syndrome.

BACKGROUND: The aim of this study was to investigate the presence of various atypical pneumonia agents (Chlamydia pneumoniae, cytomegalovirus, Mycoplasma pneumoniae), which are considered to have a role in the ethiopathogenesis of atherosclerosis, in aortic biopsies without macroscopically visible plaque and in internal thoracic artery biopsies. MATERIAL AND METHODS: Thirty-three patients (group 1), who had undergone coronary bypass operation and 10 non-atherosclerotic patients (group 2), were included in the study. Seventy-six tissue biopsies were taken. Biopsies from the patients in group 1 a were obtained from the atheroma plaque-free aortic tissue and 33 biopsies (group Ib) were obtained from their internal thoracic arteries. Following DNA extraction, nested PCR was used to detect Chlamydia pneumoniae DNA, and real time PCR was used to detect cytomegalovirus and Mycoplasma pneumoniae DNA. Blood parameters (lipid profile, CRP, fibrinogen) of the patients and operation characteristics were recorded. RESULTS: Chlamydia pneumoniae DNA was detected in 5 of 33 biopsy samples from coronary bypass patients, whereas none of the control patients (group 1b and group 2) were positive for this agent (P = 0.001). Neither CMV nor Mycoplasma pneumoniae was detected in IMA and aortic biopsies of both bypass and control patients. Elevated total cholesterol levels (P = 0.02) and positive CRP (P = 0.001) was found in C. pneumoniae positive patients. Prevalence of acute coronary syndrome was significantly higher in C. pneumoniae detected patients compared (P = 0.00 1). CONCLUSIONS: Detection of C. pneumoniae DNA in the atheroma free aortic biopsies might indicate that this micro-organism intervened in the progression of atheroma plaque. There was a strong relationship between the detection of this micro-organism in the aortic wall and acute coronary syndrome. The absence of DNA of the corresponding micro-organisms in the IMA wall may show its resistance to infective agents and in turn to atherosclerosis, which is a result of the prevailing endothelial functions of this artery.

[Comparison of agar screening plates and double disk synergy method in detection of extended-spectrum beta-lactamase production]. / Genislemis spektrumlu beta-laktamaz uretiminin saptanmasinda agar tarama plaklari ve çift disk sinerji yönteminin karsilastirilmasi.

In this study, extended-spectrum beta-lactamase (ESBL) production of 83 enteric isolates has been investigated by using a new agar screening method described by Storenburg et al. and double disk synergy (DDS) method. Agar screening method has also been evaluated in terms of presumptive bacterial identification. ESBL production was shown in 15 (18.1%) and 17 (20.5%) of 83 isolates by using DDS method with a distance of 25 and 22-20 mm between antibiotic disks, respectively. Agar screening plates demonstrated 16 (19.3%) ESBL positive isolates and was more sensitive compared to DDS method with 25 mm distance between disks. However, agar screening method gave a successful presumptive bacterial identification in only 10 of 16 ESBL positive isolates. In conclusion, the potential of the new agar screening test in direct identification of ESBL production in clinical samples should be evaluated.

A possible role of Helicobacter pylori in chronic rhinosinusitis: a preliminary report.

OBJECTIVE: The objective was to investigate the presence of Helicobacter pylori with polymerase chain reaction in the sinonasal mucosa of patients with or without chronic rhinosinusitis (CRS). STUDY DESIGN: A prospective clinical trial. METHODS: Mucosal tissue samples were collected from ethmoid cells of 12 patients with CRS and the removed mucosal part of the middle concha of 13 patients with concha bullosa who were treated surgically in our institution. DNA extracted from these samples was used for the amplification of 16S ribosomal RNA gene of H pylori by nested polymerase chain reaction. RESULTS: Helicobacter pylori DNA was detected in 4 of 12 patients with CRS, but it was not detected in patients with concha bullosa. Three of four patients with positive results for H pylori had gastroesophageal reflux-related complaints. CONCLUSIONS: It is possible to detect H pylori in the sinus mucosa of some patients with CRS. However, whether H pylori is a causative agent for CRS or a result of CRS is not known.

Detection of Helicobacter pylori and its CagA gene in tonsil and adenoid tissues by PCR.

OBJECTIVE: To determine the presence of Helicobacter pylori and, if detected, the prevalence of the CagA gene in adenotonsillectomy specimens by polymerase chain reaction (PCR). DESIGN: A prospective clinical trial. SETTING: Tertiary referral center. PATIENTS AND METHODS: The study population comprised 23 patients who had undergone adenoidectomy, tonsillectomy, or adenotonsillectomy under local or general anesthesia. Helicobacter pylori DNA was extracted from 3-mm-diameter tissue samples obtained from each tonsil and adenoid tissue specimens. The amplifications were performed for the 16S ribosomal RNA (rRNA) and CagA genes of H pylori in the samples of which H pylori DNA was detected. RESULTS: In examining all the samples, 7 (30%) of 23 patients were shown to be positive for H pylori DNA, 5 (71%) of whom also possessed the CagA gene. CONCLUSIONS: Tonsil and adenoid tissues may be an ecological niche of the mouth without regard to transient or permanent colonization. Oral-oral transmission may be a possible mode of spread of H pylori.

[The value of polymerase chain reaction methods targeting two different gene regions for the diagnosis of brucellosis]. / Brusellozisin tanisinda iki farkli gen bölgesini hedefleyen polimeraz zincir reaksiyonu yöntemlerinin degeri.

The conventional laboratory diagnosis of brucellosis, a worldwide zoonotic infection, depends on the isolation of organisms in cultures and serological methods. Recently, polymerase chain reaction (PCR) which is a widely used method for the identification of especially fastidious or slowly growing organisms, has been introduced for use in the diagnosis of brucellosis. The aim of this study was to evaluate the molecular diagnostic value of PCR method targeting two different gene regions in Brucella. For this purpose, the blood samples of 29 acute brucellosis patients (of them 13 were blood culture positive) whose serum agglutination titers were > or = 1/160, and 10 cases whose serum agglutination titers were 1/80 with negative blood culture, have been searched by PCR, targeting two different gene regions of Brucella DNA, and the sensitivities of the methods were compared. As a result, 51.7% of the patients were found to be positive by amplification of IS6501 gene (an insertion sequence of Brucella spp) and 48.3% of the patients were positive by amplification of 223-basepair region of the gene encoding 31-kDa Brucella abortus protein, by semi-nested PCR. In conclusion, the diagnostic application of PCR in brucellosis may be a good alternative compared to conventional methods by providing results in a short period of time, however its disadvantages such as low detection limit of bacterial DNA in blood samples, increased risk of carry-over contamination and higher cost must be further evaluated.

[Detection of cytomegalovirus DNA in immunosuppressed patients using qualitative and quantitative molecular methods]. / Immünsüpresif hastalarda sitomegalovirus DNA'sinin kalitatif ve kantitatif moleküler yöntemlerle arastirilmasi.

In this study, blood samples collected from 101 immunosuppressive patients were investigated for the presence of cytomegalovirus (CMV) DNA, with qualitative nested-polymerase chain reaction (PCR), and leukocytes obtained from these samples with quantitative hybrid capture assay (HCA). CMV-DNA was found positive in 32 (31.7%) and negative in 45 (44.5%) patients with both of the methods, and the agreement between the methods were estimated as 76.2%. The number of samples, which were PCR positive and HCA negative, were 24 (23.7%), while there were no samples which were PCR negative and HCA positive. All of the 56 CMV-DNA positive patients detected by PCR, were found positive for CMV-IgG, and 7 of them were also CMV-IgM positive. As a result, it was concluded that PCR is a practical and reliable method especially for the routine procedures for the investigation of CMV-DNA, however in cases which necessitate the detection of viral load, hybridization may be the preferable method.

Brain abscess caused by Nocardia cyriacigeorgica in two patients with multiple myeloma: novel agents, new spectrum of infections.

OBJECTIVE AND IMPORTANCE: Introduction of high-dose chemotherapy and the novel agents including bortezomib, Lenalidomide, and Thalidomide has provided a significant progress in the treatment of multiple myeloma (MM) with an increase in median overall survival up to 6-8 years. However, the advances in myeloma treatment comes at a price with new spectrum of treatment-related infectious complications which should be taken into consideration while treating these patients. CLINICAL PRESENTATION: We report here two patients with Ig G λ MM presenting with intracerebral mass lesions in the abscence of constitutional symptoms that would suggest an infectious etiology. Both patients had severe hypogammaglobulinemia and lymphopenia, which was attributed to treatment regimens including bortezomib. Intervention The surgical intervention-revealed abscess in both cases caused by Nocardia cyriacigeorgica, a relatively new pathogen which rarely causes infections in humans and also an unexpected pathogen in myeloma patients. CONCLUSION: Although every aspect of immune system is known to be affected in MM, humoral immune deficiency is the hallmark of the inherent immune defect in this disease. Introduction of the novel agents, bortezomib in particular seems to have changed the characteristics of the immune dysfunction and the spectrum of the opportunistic infections by causing qualitative and quantitative changes in cellular immunity. The new spectrum of infectious agents might not be limited to hepatitis B and herpes zoster. Monitoring lymphopenia and administration of prophylactic antimicrobial agents accordingly could be considered in patients treated with bortezomib.