Gemella morbillorum endocarditis in a patient with a bicuspid aortic valve.

Gemella morbillorum is one of the rare causative microorganisms of endocarditis. We herein report a case of infective endocarditis in a patient with bicuspid aortic valve caused by G. morbillorum. Infective endocarditis diagnosis was established based on the Modified Duke's criteria. The patient was successfully treated with medical-surgical management.

The gut microbiome in epilepsy.

The close relationship between epilepsy and autoimmune diseases and the fact that the cause of epilepsy is idiopathic in 60% of cases suggest that intestinal microbiota may play a role in the etiology of epilepsy. In this study, we analyzed and compared the intestinal microbiota composition of patients with idiopathic focal epilepsy (n = 30) and healthy volunteer group (n = 10) by 16s ribosomal DNA sequencing. Proteobacteria phylum was found to be higher in patients with epilepsy (25.4%) than in healthy volunteers group (1.5%). The genera of Campylobacter, Delftia, Haemophilus, Lautropia, Neisseria among Proteobacteria phylum were found to be statistically significantly higher in patients with epilepsy than in healthy volunteers (p < 0.05). Fusobacteria phylum was detected in 10.6% of the patients with epilepsy but not in the healthy volunteer group. The genus of the Fusobacteria phylum was found as Leptotrichia and Fusobacterium. In our study, taxonomic drift and significant differences in the intestinal microbiota of patients with epilepsy according to healthy volunteer group showed that autoimmune mechanisms and inflammation may have a role in the etiology of epilepsy. Our data should be supported by other studies as to the role of the intestinal microbiome in the prevention and treatment of epilepsy.

An unusual presentation of brucellosis: hepatic microabscesses.

Hepatic abscess due to Brucella species is an extremely rare complication especially in acute illness. Here, we report a case of hepatic microabscesses probably caused by Brucella in a 33-year-old woman with acute infection who was successfully treated with a combination of doxycycline and rifampicin for 3 months.

Relationship among MIF, MCP-1, viral loads, and HBs Ag levels in chronic hepatitis B patients.

BACKGROUND/AIM: To determine whether macrophage migration inhibitory factor (MIF) and monocyte chemoattractant protein-1 (MCP-1) levels in patients with hepatitis B (HB) are different than in normal individuals and whether the HB surface antigen (HBs Ag) level and viral load are correlated with each other and with the two aforementioned parameters. MATERIALS AND METHODS: Sera were obtained from 52 chronic active HB (CAHB) patients and 33 healthy controls, and their MIF and MCP-1 levels were measured. Statistical analyses were performed. A value of P < 0.05 was considered statistically significant. RESULTS: The MIF and MCP-1 values of the control group were increased compared to those of the CAHB group. The MIF and MCP-1 levels were negatively correlated with HBs Ag levels and viral loads. The MIF and MCP-1 levels were positively correlated. The HBs Ag levels and the log10 of the viral loads were positively correlated. CONCLUSION: We conclude that the negative correlation of MIF and MCP-1 with viral load and HBs Ag levels may be due to T-cell deficiency, antinuclear antibody seropositivity, and/or inhibition of chemokine ligand 2 receptors by viral antigens. More studies with a greater number of subjects are needed to evaluate the potential role of MIF and MCP in CAHB.

[Can curcumin prevent the formation of Pseudomonas aeruginosa biofi lm on the surface of tympanostomy tubes?]. / Kurkumin, timpanostomi tüpleri yüzeyinde Pseudomonas aeruginosa biyofi lminin olusmasina engel olabilir mi?

Formation of bacterial biofilm on the surface of tympanostomy tubes are held responsible in the pathogenesis of post-tympanostomy tube otorrhea. To prevent the formation of biofilm, various methods were employed and varying degrees of success have been achieved. In some recent studies curcumin, which is the fenolic form of Curcuma longa (turmeric), has been pointed out to have inhibitory effects on virulence factors of Pseudomonas aeruginosa. The aim of this study was to investigate whether the administration of curcumin is able to prevent the formation of P.aeruginosa biofilm on the surface of silicone tympanostomy tubes in vitro conditions. For this purpose, qualitative and quantitative analysis of P.aeruginosa biofilm created on the surface of the tympanostomy tubes were performed following a period of 48 hours incubation in microplate wells that contained decreasing concentrations of curcumin. For qualitative analysis, specimens were evaluated with an environmental scanning electron microscope for the existence of biofilm. For the quantitative analysis, bacteria attached to the tube surface was detached using a combination of vortexing and sonication. Following serial dilutions, the obtained solution was then inoculated on the sheep blood agar plates using calibrated loop, incubated for 24 hours and the colony forming unit (CFU) per mL were recorded. Environmental scanning electron microscope analysis revealed that 100 µg/mL of curcumin could prevent formation of the biofilm. Lower concentrations of curcumin could not prevent the biofilm formation. Qualitative analysis also revealed that when the concentrations of curcumin in the wells were decreased, the number of CFU/mL was increased significantly. Mean number of CFU in 100 µg/mL and 12.5 µg/mL groups were 35±7.07 and 650±494, respectively. Curcumin could prevent formation of P.aeruginosa biofilm on the surface of tympanostomy tubes in vitro with concentrations lower than the MIC value. The results of the present study show that local administration of curcumin may prevent suppurative otitis media following tympanostomy tube insertion, keep the patency of the tube and decrease the rate of treatment failure. In vivo studies are needed to support the in vitro anti-biofilm action of curcumin on tympanostomy tubes.

[Blood culture positivity: is it pathogen or contaminant?]. / Kan Kültürü Pozitifligi: Etken ya da Kontaminasyon mu?

Blood culture is the gold standard for diagnosis of bloodstream infections. Many studies have shown that rapid isolation and identification of the microorganisms in blood culture and initiation of early antimicrobial therapy are critically important to reduce the mortality rate. It was found that the rate of contamination in blood cultures is increasing with automated systems developed to facilitate the growth of microorganism and tracking positivity. It is more difficult to interpret a positive blood culture result especially in the case of having only one sample bottle. In this study the effect of growth time observed in the automated blood culture systems was evaluated in terms of interpretation of blood culture results as being pathogens or contaminants. A total of 1201 blood cultures tested in BACTEC 9120 (Becton Dickinson, USA) system in Maltepe University Hospital Medical Microbiology Laboratory, Istanbul, Turkey during one-year period were included in the study and growth times were recorded for positive bottles. The decision about the growth as being a pathogen or contamination was made by considering the clinical condition of the patient, the number of positive blood cultures and the results of inflammation markers (white blood cell counts, procalsitonin and CRP levels). Of the blood cultures 290 (24%) yielded positive results and 73% (212/290) of them were evaluated as pathogens, while 27% (78/290) were identified as contaminants. The mean detection time for clinically significant isolates was 17.87 hours and for contaminants was 40.56 hours. The difference between the growth time of pathogens and contaminants was found statistically significant (p< 0.0001). With regard to all positive results, it was detected that 66% of the bacteria grew within the first 24 hours. While 29.6% of the pathogens grew within 12 hours, none of the contaminants grew during that time. The evaluation of growth time among staphylococci in terms of methicillin resistance revealed that methicillin- resistant staphylococci grew later (26 hours) than the susceptible ones (11 hours) both in the pathogen group and the contaminant group (p< 0.01). The data of our study emphasized that, the growth time detected in blood culture systems had a critical role in estimating whether the isolated microorganism is a pathogen or a contaminant, especially in case of lack of more than one blood samples. It was concluded that, the bacterial growth detected within the first 24 hours most probably indicated the microorganism as pathogen, while blood culture positivity detected after 48 hours strongly pointed out that it was contaminant. However, it should be considered that methicillin-resistant staphylococci needed much longer time than 24 hour for growth, both as pathogens or contaminants.

Primary lymphoepithelioma-like carcinoma of the lung: report of a rare case and review of the literature.

Primary lymphoepithelioma-like carcinoma of the lung is a rare type of non-small cell lung carcinoma. In this study, we aimed to present a 62-year-old smoker male with a primary lymphoepithelioma-like carcinoma of the hilar region of the left lung. The patient underwent left pneumonectomy and no adjuvant therapy was given. There were no other abnormalities on whole body PET/CT scan including the nasopharyngeal region. The patient showed seropositivity for EBV IgG but immunohistochemistry and PCR amplification studied on paraffin-embedded tissue sections of the tumor failed to show any sign of EBV infection within the tumor cells. He is alive and disease-free four months after the operation. Although primary lymphoepithelioma-like carcinoma of the lung is usually reported in young females with no history of tobacco use and the tumor cells are infected with EBV, it may rarely be seen in elderly males with a history of tobacco use and the tumor cells not infected with EBV.