Serotype distribution of Streptococcus pneumoniae and pneumococcal vaccine coverage in adults in Turkey between 2015 and 2018.

OBJECTIVE: To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines. PATIENTS AND METHODS: This passive surveillance study was conducted with the Streptococcus pneumoniae strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test. RESULTS: In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged <65 and ≥65 years, respectively. About 21.1% and 4.3% of the patients with and without IPD had cefotaxime resistance. Non-susceptibility to erythromycin and moxifloxacin was 38.2% and 1.2%, respectively. CONCLUSIONS: The results revealed that novel PCV vaccines may provide improved coverage as compared with the currently available vaccine, PCV13. The significant antibiotic resistance rates imply the need to extend the serotype coverage of the vaccines. Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution and incidence changes of IPD cases in the population and to inform policy makers to make necessary improvements in the national immunization programmes.Key messagesThis multicentre study demonstrated the most recent serotype distribution and antibiotic resistance in adult population in Turkey.Shifting from PCV13 to novel conjugated vaccines will significantly increase the coverage.Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution changes and the incidence of cases with invasive pneumococcal disease in the population.

Retrospective Analysis of the Distribution of Intestinal Parasites in Patients Admitted to Dicle University Faculty of Medicine Between the Years 2011-2020

Objective: The purpose of this study was to determine and evaluate retrospectively the distribution of intestinal parasites detected in patients who applied to Dicle University Medical Faculty Parasitology Laboratory between 2011-2020. Methods: Stool samples sent to the parasitology laboratory for parasite examination were examined by the native-Lugol method and the samples sent with cellophane tape were examined microscopically for parasite examination. In addition, modified acidfast and trichrome staining methods were used to identify protozoan. Results: Parasites were detected in 5.99% of 60.501 stool samples sent to the parasitology laboratory. Blastocystis spp. (57.62%) was detected with the highest rate among positive samples, followed by 31.93% Giardia intestinalis, 3.75% Entamoeba histolytica/dispar, 2.37% Hymenolepis nana, 1.57% Fasciola spp., 0.91% Taenia saginata, 0.72% Enterobius vermicularis, 0.52% Cryptosporidium spp., 0.42% Cyclospora cayetanensis, 0.19 Ascaris lumbricoides were detected. Conclusion: Although the incidence of intestinal parasite infections in our study decreased over a ten-year period, it continues to maintain its importance. Therefore, to reduce the prevalence of intestinal parasites; It is important to safeguarding clean water resources, solve infrastructure problems, and inform the public about sanitation rules.

Serotype distribution of Streptococcus pneumonia in children with invasive disease in Turkey: 2015-2018.

Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes in this distribution in time to guide effective vaccine strategies. Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population. Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%). Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination.

Three cases of Chronic Suppurative Otitis Media (CSOM) caused by Kerstersia gyiorum and a review of the literature.

New identification techniques such as gene sequencing and mass spectrometry have increased the incidence of novel agents such as Kerstersia gyiorum. As a new member of the Alcaligenaceae family, K. gyiorum was isolated from wounds, respiratory tract, urine specimens and most frequently from chronic suppurative otitis media (CSOM). We isolated three K. gyiorum strains from three CSOM cases over a one-year period. The strains were analyzed by mass spectrometry and identified by Bruker Biotyper 3.1 (Bruker Daltonics, USA). The cases were young patients without chronic diseases and immunodeficiencies. Two strains were resistant to ciprofloxacin.

[Results of a multicenter study investigating plasmid mediated colistin resistance genes (mcr-1 and mcr-2) in clinical Enterobacteriaceae isolates from Turkey]. / Ülkemizde klinik Enterobacteriaceae izolatlarinda plazmit aracili kolistin direnç genlerini (mcr-1 ve mcr-2) arastiran çok merkezli çalismaya ait sonuçlar.

Colistin is a polymyxin antibiotic which is considered as one of the last line agents against infections due to multidrug resistant or carbapenem resistant gram-negative pathogens. Colistin resistance is associated with chromosomal alterations which can usually cause mutations in genes coding specific two component regulator systems. The first plasmid-mediated colistin resistance gene, mcr-1 was described in Escherichia coli and Klebsiella pneumoniae isolates in December 2015 and followed by another plasmid-mediated colistin resistance gene mcr-2 in 2016. The rapid and interspecies dissemination of plasmid-mediated resistance mechanisms through horizontal gene transfer, have made these genes considerably threatening. After the first reports, although mcr-1/mcr-2 producing Enterobacteriaceae isolates have been reported from many countries, there have been no reports from Turkey. Thus, the aim of this study was to investigate the presence of mcr-1/mcr-2 in clinical Enterobacteriaceae isolates from different parts of our country. A total of 329 Enterobacteriaceae isolates from 22 laboratories were collected which were isolated between March, 2015 and February, 2016. mcr-1/mcr-2 were investigated by polymerase chain reaction during February-March, 2016. Two hundred and seventeen of Klebsiella pneumoniae (66%), 75 of Salmonella spp. (22.8%), 31 of Esherichia coli (9.4%), 3 of Enterobacter cloacae (0.9%), 2 of Klebsiella oxytoca (0.6%) and 1 of Enterobacter aerogenes (0.3%) isolates were included to the study. Agarose gel electrophoresis results of PCR studies have shown expected band sizes for positive control isolates as 309 bp for mcr-1 and 567 bp for mcr-2. However, the presence of mcr-1/mcr-2 genes was not detected among the tested study isolates of Enterobacteriaceae. Although mcr-1/mcr-2 were not detected in our study isolates, it is highly important to understand the mechanism of resistance dissemination and determine the resistant isolates by considering that colistin is a last-line antibiotic against infections of multidrug or carbapenem resistant gram-negative bacteria. Thus, it is suggested that these mechanisms should be followed-up in both clinical and non-clinical (e.g. isolates from food animals, raw meats and environment) isolates of special populations.

Serotype distribution of Streptococcus pneumoniae in children with invasive diseases in Turkey: 2008-2014.

Successful vaccination policies for protection from invasive pneumococcal diseases (IPD) dependent on determination of the exact serotype distribution in each country. We aimed to identify serotypes of pneumococcal strains causing IPD in children in Turkey and emphasize the change in the serotypes before and after vaccination with 7-valent pneumococcal conjugate vaccine (PCV-7) was included and PCV-13 was newly changed in Turkish National Immunization Program. Streptococcus pneumoniae strains were isolated at 22 different hospitals of Turkey, which provide healthcare services to approximately 65% of the Turkish population. Of the 335 diagnosed cases with S. pneumoniae over the whole period of 2008-2014, the most common vaccine serotypes were 19F (15.8%), 6B (5.9%), 14 (5.9%), and 3 (5.9%). During the first 5 y of age, which is the target population for vaccination, the potential serotype coverage ranged from 57.5 % to 36.8%, from 65.0% to 44.7%, and from 77.4% to 60.5% for PCV-7, PCV-10, and PCV-13 in 2008-2014, respectively. The ratio of non-vaccine serotypes was 27.2% in 2008-2010 whereas was 37.6% in 2011-2014 (p=0.045). S. penumoniae serotypes was less non-susceptible to penicillin as compared to our previous results (33.7 vs 16.5 %, p=0.001). The reduction of those serotype coverage in years may be attributed to increasing vaccinated children in Turkey and the increasing non-vaccine serotype may be explained by serotype replacement. Our ongoing IPD surveillance is a significant source of information for the decision-making processes on pneumococcal vaccination.

[Evaluation of the diagnostic value of the ELISA tests developed by using EgHF, Em2 and EmII/3-10 antigens in the serological diagnosis of alveolar echinococcosis]. / Alveoler ekinokokkozun serolojik tanisinda EgHF, Em2 ve EmII/3-10 antijenleri ile hazirlanan ELISA yöntemlerinin tanisal etkinliginin degerlendirilmesi.

Alveolar echinococcosis (AE), caused by larva stage of Echinococcus multilocularis, is one of the lethal parasitic diseases of man and a major public health problem in many countries in the northern hemisphere. When the living conditions and habits in Turkey were considered in terms of relation with the life cycle of the parasite, it was suggested that AE has been much more common than reported mainly from the Eastern Anatolia region of Turkey. Since in vitro serologic diagnosis tests with high specificity for AE have not been used in our country, most of the cases with liver lesions were misdiagnosed by radiological investigations as malignancies. The aim of this study was to evaluate the diagnostic value of the in-house ELISA methods developed by using three different antigens (EgHF, Em2, EmII/3-10) in the serological diagnosis of AE. The study samples included a total of 100 sera provided by Bern University Parasitology Institute where samples were obtained from patients with helminthiasis and all were confirmed by clinical, parasitological and/or histopathological means. Ten samples from each of the cases infected by E.multilocularis, E.granulosus, Taenia solium, Wuchereria bancrofti, Strongyloides stercolaris, Ascaris lumbricoides, Toxocara canis, Trichinella spiralis, Fasciola hepatica and Schistosoma haematobium were studied. In the study, EgHF (E.granulosus hydatid fluid) antigens were prepared in our laboratory from the liver cyst fluids of sheeps with cystic echinococcosis, however Em2 (E.multilocularis metacestode-purified laminated layer) and EmII/3-10 (E.multilocularis recombinant protoscolex tegument) antigens were provided by Bern University Parasitology Institute. Flat bottom ELISA plates were covered with EgHF, Em2 and EmII/3-10 antigens in the concentrations of 2.5 µg, 1 µg and 0.18 µg per well, respectively, and all sera were tested by EgHF-ELISA, Em2-ELISA and EmII/3-10-ELISA methods. For each tests, the samples which were reactive above the cut-off value (mean OD of negative controls+2 SD) were accepted as positive. The sensitivity of the ELISA tests performed with EgHF, Em2 and Em2II/3-10 antigens were estimated as 100%, 90% and 90%, respectively, whereas the specificity were 63%, 91% and 91%, respectively. When Em2-ELISA and EmII/3-10-ELISA tests were evaluated together, the specificity increased to 96%. Our data indicated that the highest sensitivity (100% with EgHF-ELISA) and specificity (96% with Em2-ELISA + EmII/3-10-ELISA) for the serodiagnosis of AE can be achieved by the combined use of the ELISA tests with three different antigens. It was concluded that the early and accurate diagnosis of AE in our country which is endemic for that disease, could be supported by the use of highly specific serological tests such as Em2-ELISA ve EmII/3-10-ELISA contributing radiological data.

Phthiriasis palpebrarum in an infant.

The authors describe a case of phthiriasis palpebrarum embedded in the right upper eyelid of a 9-month-old male infant. The patient was successfully treated with mechanical removal of all lice and nits from the eyelashes. In children, phthiriasis palpebrarum should be considered in the differential diagnosis of blepharoconjunctivitis that is resistant to treatment.

One-year follow-up of the effect of fixed orthodontic treatment on colonization by oral Candida.

The aim of this study was to assess quantitative and qualitative alterations in the carrier rate of Candida spp. in south-eastern Turkey among adolescents, and to investigate the effect of fixed orthodontic appliances on the Candida count in a 1-year follow-up study. In the first phase of the study, the oral Candida carriage rate of 72 patients was evaluated. Samples were collected from the dorsal surface of the tongue, the mid-palate and saliva. In the second phase of the study, 42 patients who were determined to be carriers of oral Candida were treated with fixed orthodontic appliances, and from these patients a second set of samples were collected from the saliva and the orthodontic brace surfaces of eight teeth adjacent to the enamel surfaces. The saliva samples were collected before and during orthodontic treatment at 1st, 6th and 12th month, and samples from the braces were collected during the 1st, 6th and 12th month of treatment. Forty-two of the 72 patients (58.5%) were oral Candida carriers. The distribution of Candida spp. in these patients was as follows: (i) Candida albicans was identified in 31 patients (73.8%), (ii) C. tropicalis, C. krusei and C. kefyr were found in three patients each (7.14%) and (iii) C. parapsilosis occurred in two patients (4.76%). During orthodontic treatment, the micro-organism count increased both in the saliva and on tooth surfaces. The results indicate that the prevalence of oral Candida spp. is high in young adults in south-eastern Turkey and that the Candida counts increase when braces are involved.

[Short communication: evaluation of the correlation between hepatitis D virus (HDV) RNA positivity and HDV antibodies]. / Kisa bildiri: hepatit D virus (HDV) RNA pozitifligi ile HDV antikorlari arasindaki iliskinin degerlendirilmesi.

The objective of this study was to evaluate the correlation between serum hepatitis D -delta- virus (HDV) RNA detection and anti-HDV IgG and IgM antibodies, in the serodiagnosis of delta hepatitis. A total of 153 HBsAg positive sera were screened for the presence of anti-HBc IgM, anti-HDV IgG and anti-HDV IgM by commercial enzyme immunoassays and HDV-RNA by real time polymerase chain reaction (PCR). Of 153 sera, 86 (56.2%) were found positive for HDV antibodies. Although isolated anti-HDV IgG was present in 35 and isolated anti-HDV IgM was present in 11 patients, IgG and IgM were present concurrently in 40 additional patients. HDV-RNA was detected in 21.5% (33/153) of the patients. Four of the 33 HDV-RNA positive patients were positive only for anti-HDV IgG, 8 were positive only for anti-HDV IgM, and 19 were positive for both anti-HDV IgG and IgM antibodies. Twenty seven of 51 (53%) anti-HDV IgM positive patients were also found positive for HDV-RNA, while 27 of 33 (82%) HDV-RNA positive patients exhibited anti-HDV IgM positivity. Increased serum ALT levels were detected approximately in 85% (28/33) of viremic patients. As all of the HDV-RNA positive patients were found negative for anti-HBc IgM, superinfection with delta virus were considered. In conclusion, PCR is a sensitive and useful method for the detection of viremic patients as well as for the monitorization of antiviral therapy, anti-HDV IgM positivity together with increased ALT levels appear to be good markers for the prediction of hepatitis delta viremia, especially in the countries with limited economical sources as Turkey.

[Comparison of microscopy and EIA in the diagnosis of Giardia intestinalis in stool specimens.]. / Giardiasisin tanisinda Enzym Immun Assay (EIA) ve direkt inceleme yöntemlerinin karsilastirilmasi

In this study; we compared the direct microscopic method and EIA test in the investigation of the stools of patients with gastrointestinal symptoms who presented at clinics. A total of 188 stool specimens collected from clinics were investigated by direct microscopy using native-Lugol preparations. Giardia cysts and/or trophozoites were observed in 141 specimens. There were no Giardia cysts and/or trophozoites or any other intestinal parasites detected in the other 47 stool specimens. The RIDASCREENR EIA kit procedure was applied in all specimens. Out of 141 specimens positive with direct microscopy, 136 specimens were positive with the EIA test and 5 specimens, negative. Parasites were not found in 47 stool specimens with direct microscopy. Of these, 38 specimens were negative with the EIA test and 9 specimens, positive. When the patient and control groups were compared, a significant difference was observed between the two methods (p < 0.05). The sensitivity and specificity of the EIA method that was used to determine the antigenic properties of G. intestinalis in stools were 96.4% and 80.8%, respectively.

The seroprevalence of varicella zoster antibodies in Behçet's and other skin diseases.

The purpose of this study was to investigate the association of the varicella zoster virus (VZV) IgG, and IgM antibodies with Behçet's and other skin diseases (group 1: recurrent aphthos stomatitis, fungal infections, psoriasis; group 2: vitiligo, lichen planus). Twenty eight patients with Behçet's disease (BD), and 117 patients with dermatological disorders other than BD were evaluated for specific VZV IgG and IgM antibodies by using a third generation enzyme-linked immunosorbent assay (ELISA). The Mantel Heizshel chi2 method was used to adjust the confounding of age and sex of the patients. The serological positivity for VZV IgG and IgM antibodies in BD was not statistically different from other skin diseases. When we considered the age of the patients, chi2 = 2.64, CI (0.27-1.65), odds ratio (1, 1.25, 2.21) (p = 0.10) and when we considered the sex of the patients, chi2 = 0.31, CI (0.81-1.28), odds ratio (1, 1.45, 1.41), (p = 0.57).