Role of Neutrophils as Therapeutic Targets in Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) is a major health problem. It is one of the most common types of stroke and results in mortality in approximately half of patients. More than half of the fatalities occur in the first 2 days. In addition to the mass effect after ICH hemorrhage, complex pathophysiological mechanisms such as intracranial vessel vasospasm, microthrombosis, and inflammatory immune reaction also increase brain damage. Both resident (including microglia and astrocytes) and circulating immune cells (including neutrophils, macrophages, and lymphocytes) involved in the inflammatory process. The inflammatory response is especially harmful in the acute phase due to harmful substances secreted by infiltrating immune cells. The inflammatory response also has beneficial effects, especially in the later stages. Their role in pathophysiology makes immune cells important therapeutic targets. General immunosuppressive approaches and depleting cell groups such as neutrophils or keeping them away from the lesion site may not be sufficient to prevent poor outcomes after ICH. This is most likely because they suppress anti-inflammatory activities and pro-inflammatory effects. Instead, directing immune cells to the beneficial subpopulation seems like a more rational solution. The pro-inflammatory N1 subpopulation of neutrophils damages the tissue surrounding ICH. In contrast, the N2 subpopulation is associated with anti-inflammatory reactions and tissue repair. Studies show that when neutrophils are polarized toward the N2 subpopulation, clinical outcomes improve and the volume of the infarct decreases. However, more research is still needed. This study aims to evaluate the role of neutrophils as immunotherapeutic targets in ICH in light of current knowledge.

Ly6Chi inflammatory monocytes promote susceptibility to Leishmania donovani infection.

Ly6Chi inflammatory monocytes (iMO) are critical for host defense against toxoplasmosis and malaria but their role in leishmaniasis is unclear. In this study, we report a detrimental role of Ly6Chi iMOs in visceral leishmaniasis (VL) caused by Leishmania donovani. We demonstrate that Ly6Chi iMOs are continuously recruited into the spleen and liver during L. donovani infection and they are preferential targets for the parasite. Using microarray-based gene expression profiling, we show that Ly6Chi iMOs isolated from the infected liver and spleen have distinct phenotypic and activation profiles. Furthermore, we demonstrate that blocking the recruitment of Ly6Chi iMOs into the liver and spleen during L. donovani infection using a CCR2 antagonist reduces the frequency of the pathogenic IFN-γ/IL10 dual producer CD4+ T cells in the spleen and leads to a significant reduction in parasite loads in the liver and spleen. Using STAT1-/- mice we show that STAT1 is critical for mediating the recruitment of Ly6Chi iMOs into organs during L. donovani infection, and adaptive transfer of wild type Ly6Chi iMOs into STAT1-/- recipients renders them susceptible to disease. Our findings reveal an unexpected pathogenic role for Ly6Chi iMOs in promoting parasite survival in VL and open the possibility of targeting this population for host-directed therapy during VL.

Pediatric Cutaneous Leishmaniasis in an Endemic Region in Turkey: A Retrospective Analysis of 8786 Cases during 1998-2014.

BACKGROUND: Cutaneous leishmaniasis (CL) is a major public health concern in Turkey and Sanliurfa represents the most endemic city in Turkey. Although children are most commonly affected by CL, detailed studies of pediatric CL in Turkey are lacking. METHODOLOGY/PRINCIPAL FINDINGS: In this report we retrospectively evaluated clinical and epidemiological data of 8786 pediatric CL cases, and how children respond to antimonial therapy. CL was observed most frequently in children between 6-10 years old. Interestingly this group showed shorter duration of disease and smaller lesions compared to 0-5 year and 11-15 year old groups. Females were more affected in all groups. Lesion localization and types varied among groups, with 0-5 year old presenting head/neck and mucosal lesions, and more often suffered from recidivans type, this could be associated to the longest duration of the disease in this group. Eleven-15 year old group showed fewer lesions in the head/neck but more generalized lesions. Evaluation of treatment response revealed that intra-lesional treatment was preferred over intramuscular treatment. However, 0-5 year old received intramuscular treatment more often than the other groups. Furthermore, the majority of 0-5 year old group which received intra-lesional treatment did not received subsequent intra-lesional cycles, as did children in the range of 6-15 years old. CONCLUSIONS/SIGNIFICANCE: We report an increase in pediatric CL patients within the last four years. Analysis of pediatric CL patients by age revealed significant differences in CL progression. The data suggest that children between 0-5 years old responded better than other groups to intralesional treatment, since they received more often a single cycle of IL treatment, although follow up observation is required since they were more prone to develop recidivans. Eleven-15 year old patients comprise the largest percentage of patients receiving two or three cycles of intralesional treatment, suggesting that this group did not respond efficiently to intralesional treatment and highlighting the need for more effective therapeutic strategies against CL.

Rapid Identification of Klebsiella pneumoniae by Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry and Detection of Meropenem Resistance by Flow Cytometric Assay.

BACKGROUND: The aim of this study was to develop a rapid detection method of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains both MALDI-TOF MS and flow cytometry (FCM). METHODS: A total of 174 K. pneumoniae strains were included in this study. Molecular characterization of carbapenemase gene was performed by PCR. Bacterial identification was performed by MALDI-TOF-MS. Meropenem susceptibility was tested at the concentrations of breakpoints described by the Clinical and Laboratory Standards Institute (CLSI) guide by FCM. RESULTS: Sixty-two CRKP were positive for at least one carbapenemase gene. A total of 174 K. pneumoniae isolates obtained from clinically relevant material were correctly identified by Bruker MALDI-TOF MS with log (score) >2.0. These results were 100% concordant with the Phoenix™ Automated Microbiology System (BD, MD) and conventional identification results. Based on the analysis of the receiver operating characteristic (ROC) curves, the best validity and sensitivity data were obtained with a cut-off value of 18.88% by FCM. The concordance, sensitivity, and specificity for FCM by the selected cut-off values were 99.4%, 98.9%, and 100%, respectively. CONCLUSIONS: We conclude that reliable results on bacterial identification and meropenem susceptibility test can be obtained within 2 hr combined by MALDI-TOF-MS and FCM.

Meglumine antimoniate is more effective than sodium stibogluconate in the treatment of cutaneous leishmaniasis.

Sodium stibogluconate (SSG, Pentostam) and meglumine antimoniate (MA, Glucantime) are two antimonials that are widely used to treat cutaneous leishmaniasis (CL), but the relative efficacies of these treatments are not clear. The aim of this study is to compare the efficacy of intralesional SSG with intralesional MA therapy in the treatment of CL. One month after completion of the therapy, 1431 of 1728 patients (82%) who received intralesional MA showed complete clinical cure compared to 1157 of 1728 patients (67%) in the SSG group. Patients who did not respond to the first round of therapy were re-administered the same treatment but with twice weekly injections. Following completion of the second course of therapy, 237 of 297 patients (80%) in the MA group and 407 of 561 patients (72%) in the SSG group healed their lesions by 1-month post-treatment. At both times, the differences in cure rates between MA and SSG groups were statistically significant (p < 0.05). Cure rates in the MA group were always significantly higher than SSG groups irrespective of other parameters including age, gender, lesion site and type of lesion. Intralesional MA is more effective than intralesional SSG in the treatment of CL.

[Rapid detection of extended-spectrum beta-lactamases by flow cytometry method]. / Genislemis spektrumlu beta-laktamazlarin akim sitometrisi yöntemiyle hizli tespiti.

Extended-spectrum beta-lactamases (ESBL), produced by Enterobacteriaceae members are enzymes that especially cause a resistance to cephalosporin group antibiotics commonly used in clinics. Early and rapid detection of ESBL production is crucial for antimicrobial treatment and infection control; however the methods used for this purpose are time consuming (24 to 48 hours). The aim of this study was to determine a flow cytometry based-test which provides to detect ESBL producing bacteria in a short time. A total of 38 ESBL-producing (29 Escherichia coli, 9 Klebsiella pneumoniae) and 10 non-producing (5 E.coli, 5 K.pneumoniae) Enterobacteriaceae strains isolated between 2012 and 2013 were included in this study. The identification and antibiotic susceptibility tests of the isolates were performed by using Phoenix(TM) 100 automated system (Becton Dickinson, USA). The presence of bla(TEM), bla(SHV), bla(CTX-M1), bla(CTX-M2) and bla(CTX-M9) genes were investigated in ESBL positive isolates via polymerase chain reaction method. At least one of the ESBL genes were detected in 36 out of 38 isolates and no genes were detected in two E.coli isolates. In flow cytometric method, the percentages of death cells exposed to cephalosporin [(ceftazidime (CAZ) or cefotaxime (CTX)] and clavulanic acid (CLA) combination, were compared with death cells exposed only to cephalosporin (CAZ or CTX). CLA index values (CAZ-CLA and CTX-CLA indices) were obtained for CTX and CAZ. Index values which was higher than 1.5 just for one cephalosporin were accepted as GSBL positive. The mean index values for CTX-CLA in ESBL positive strains according to their genotypic characteristics were between 1.14 and 7.22, while those values for CAZ-CLA were between 0.85 and 5.6. When the two groups of 38 ESBL positive and 10 ESBL negative strains were evaluated, statistically significant difference was detected for both CAZ-CLA and CTX-CLA indices (p< 0.005). CTX-CLA indices (p= 0.001) shown a better determination of ESBL when CAZ-CLA and CTX-CLA indices were compared statistically. In conclusion, flow cytometry is a rapid and reliable method for the detection of ESBL in clinical microbiology laboratories when compared with the other methods.

A Comparison of Demographic and Clinical Characteristics of Syrian and Turkish Patients with Cutaneous Leishmaniasis.

Cutaneous leishmaniasis (CL) is a significant public health problem with increasing incidence, especially in extreme circumstances. In this study, we compared the sociodemographic and clinical characteristics of 685 Syrian CL patients afflicted by the Syrian conflict and 685 Turkish CL patients in 2012. Patient age, gender, duration of disease, lesion size, type, and localization were evaluated. The duration of CL disease in Syrian CL patients (4.5 ± 4.3 weeks) was shorter than that of Turkish CL patients (11.9 ± 9.7 weeks). The number of lesions was greater in Syrian patients (2.46 ± 2.43) than in Turkish patients (1.93 ± 1.47). Lesion sizes were comparable between both groups (Syrian, 11.2 ± 8.7 mm; Turkish, 10.7 ± 7.7 mm). In Syrian CL patients, nodular type lesions were the most common (325 patients, 49.1%), whereas, in Turkish CL patients, ulcer type lesions were the most common (352 patients, 51.5%). Our results indicate variations in the clinicoepidemiological features of CL between Turkish and Syrian patients within Sanliurfa province. This highlights the impact of social unrest and environmental conditions on the epidemiology of CL within this region. Approaches to prevention, control, and treatment of CL in these areas should take into consideration the emerging changes in clinicoepidemiological parameters of the disease.

[Phenotypic and genotypic identification of Candida strains isolated as nosocomial pathogens]. / Hastane enfeksiyonu etkeni olarak izole edilen Candida suslarinin genotipik ve fenotipik olarak tanimlanmasi.

Over the last decade, there have been important changes in the epidemiology of Candida infections and antifungal agents used to treat these infections. In recent years, Candida species have emerged as important causes of invasive infections among patients in intensive care units. One of the main goals of this study was to evaluate the molecular epidemiology of infectious Candida species isolated in our hospital and accordingly supply data for hospital infection (HI) control. The other aim of this study was to evaluate effectiveness and practical applicability of traditional and molecular methods used to identify Candida isolates to the species level. A total of 77 Candida strains that were isolated from various clinical specimens of 60 hospitalized patients (29 male, 24 female; 7 were children) were included in the study. Fifty-seven (74%) of those isolates were defined as HI agents according to Centers for Disease Control and Prevention (CDC) criteria. The most common Candida species identified as agents of HI were C.albicans (22; 38.6%), followed by C.tropicalis (14; 24.6%), C.parapsilosis (13; 22.8%), C.glabrata (7; 12.3%) and Candida spp. (1; 1.75%). It was determined that bloodstream (26; 45.6%) and urinary tract infections (24; 42.1%) were the most frequently encountered nosocomial infections caused by Candida species. In addition it was detected that the most frequent causative agent of bloodstream infections was C.parapsilosis (10; 38.5%) and of urinary tract infections was C.albicans (12; 50%). The evaluation of advantages and disadvantages of traditional phenotypic methods [germ tube formation, chlamydospore formation in corn meal agar, growth at 45°C, colony characteristics on CHROMagar Candida medium, carbohydrate assimilation properties detected by API ID 32C (BioMerieux, France) system] and some molecular techniques [polymerase chain reaction (PCR) by using ITS-1, ITS-3 and ITS 4 primers, PCR-Restriction fragment length polymorphism (RFLP), PCRRFLP in which ITS1-ITS4 products cut by Msp I ve Bln I restriction enzymes] for the identification of Candida species revealed that CHROMagar Candida medium combined with API ID 32C kit yielded the same results (100% compatible) as molecular techniques for the species identification of Candida isolates. Since these phenotypic methods were simple and cost effective when compared to molecular techniques, they should be considered in the identification of Candida species.

[Investigation of E6/E7 mRNAs of high risk human papilloma virus types by a commercial automatized NASBA assay in cervical swabs]. / Servikal sürüntü örneklerinde yüksek riskli insan papilloma virus tiplerine ait E6/E7 mRNA'larinin ticari otomatize bir NASBA sistemiyle arastirilmasi.

High-risk human papillomaviruses (HPV) are associated with the development of cervical cancer and its precursor lesions. In addition to cytological screening, nucleic acid testing is the mainstay of diagnosis and follow-up. The molecular tests used for the detection of HPV-DNA in cervical specimens, usually rely on consensus polymerase chain reaction assays that target L1 region of the viral genome. Diagnostic assays that monitor mRNAs from HPV oncogenic proteins, E6 and E7, have also been recently developed. This study was aimed to detect E6/E7 mRNAs from high-risk HPV types 16, 18, 31, 33 and 45 qualitatively by a commercial Nucleic Acid Sequence Based Amplification (NASBA) assay (NucliSENS EasyQ HPV; bioMérieux, France) from cervical specimens. Cervical smear samples were collected from 57 women who had suspected lesions in gynecologic examination and transported by a commercial liquid-based cytology system (ThinPrep Pap Smear Method, Cytyc, USA). Nucleic acid purification was performed by an automated commercial station (NucliSENS easyMAG, bioMérieux, France) as directed by the manufacturer. Presence of viral E6/E7 mRNAs were detected in 38.6% (22/57) of the samples. HPV type 33 mRNA was observed as the most common (11/22, 50%), followed by type 16 (9/22, 41%), 31 (5/22, 22.7%), 45 (4/22, 18.2%) and 18 (1/22, 4.5%). Single and multiple infections with 2 HPV types were identified in 63.6% (14/22) and of 36.4% (8/22) of the positive samples, respectively. The most common co-infection pattern was observed as HPV type 16 and 33 that comprised 13.6% (3/22) of the positive samples. This study was conducted as a preliminary evaluation of commercial NASBA E6/E7 mRNA testing in routine molecular microbiology applications. More studies are required to fully assess the performance of the system for diagnostic laboratories in Turkey.

[An overview of Strongyloides stercoralis and its infections]. / Strongyloides stercoralis ve enfeksiyonlarina genel bakis.

Strongyloidiasis which is an infection caused by Strongyloides stercoralis, has a cosmopolitan distribution in tropical and subtropical regions; whereas, it is sporadic in Turkey. It is estimated that 30-100 million people are infected with this agent worldwide. The infection is usually asymptomatic, however, eosinophilia may be the only sign. S. stercoralis have the ability to persist and replicate within the host for decades and it may lead to infections with high mortality especially in immunocompromised host. Humans are generally infected transcutaneously with filariform larvae. Infections with S. stercoralis usually lead to cutaneous, gastrointestinal, or pulmonary symptoms. Definitive diagnosis of strongyloidiasis is made on the basis of detection of larvae in the stool, sputum or duodenal fluid. Hovewer, strongyloidiasis is difficult to diagnose since the parasite load is low and the larval output is irregular in majority of the patients. This situation necessitates the collection of consecutive samples and the use of concentration techniques. The burden of Strongyloides may be overlooked in especially non-endemic regions. Strongyloidiasis should be considered before the application of immunosuppressive therapy in patients with unexplained eosinophilia, serpiginous skin lesions, or pulmonary or gastrointestinal symptoms. The goal of treatment is to eliminate the parasites and ivermectin is the drug of choice. Besides, albendazole or thiabendazole may used as alternative agents in the treatment. Improved human waste disposal services are considered to be the main requirement to reduce the high prevalence of this disease. In this review, it was aimed to withdraw attention to strongyloidiasis and to overview its prevalence, clinical manifestations, diagnosis, management and prevention strategies.

[In vitro activity of fosfomycin trometamol in the treatment of Escherichia coli related uncomplicated urinary tract infections]. / Escherichia coli nedenli komplike olmamis üriner sistem enfeksiyonlarinda fosfomisin trometamolün in vitro etkinligi.

Although in certain countries in Europe fosfomycin trometamol (FT) has been used for many years, in Turkey FT has become available in recent years. FT has a broad-spectrum activity against most of gram-positive and gram-negative bacteria. In this study, we aimed to evaluate the effect of FT, a new alternative antimicrobial agent in the treatment of patients with Escherichia coli related uncomplicated lower urinary tract infection (UTI). For this purpose, between May 2007-July 2008, FT susceptibility of 771 nonduplicate E. coli strains, isolated from urine samples of patients with uncomplicated lower UTI (bacteria > or = 10(5) cfu/mL), was determined by disk diffusion method according to Clinical and Laboratory Standarts Institute (CLSI) criteria. Simultaneously, extended-spectrum beta-lactamase (ESBL) detection was performed by double disk synergy test in all isolates. Among all E. coli isolates, FT resistance rate was 0.4% (3/771) and ESBL positivity was 19.5% (150/771). The rates of ESBL producing strains isolated from inpatients and outpatients were 34.1% (70/205) and 14.1% (80/566), respectively, and the difference was found statistically significant (p = 0.0001). Although resistance to FT was not detected in non-ESBL producing E. coli isolates (n = 621), FT resistance rate was 2% (3/150) in ESBL producers. As far as the current literature was concerned this was the largest scale study investigating the activity of FT in Turkey. Resistance to antimicrobials that had been used frequently as therapeutic options for the treatment of E. coli related UTIs, has been increasing. In the present study high susceptibility rates to FT was determined for urinary E. coli isolates. In conclusion, these data suggest that FT may be a good alternative for the treatment of uncomplicated UTIs as a first line antimicrobial agent.

[Antimicrobial resistance profiles of community-acquired uropathogenic Escherichia coli isolates during 2004-2006 in a training hospital in Istanbul]. / Istanbul'da bir arastirma hastanesinde 2004-2006 yillari arasinda izole edilen toplumdan kazanilmis üropatojen Escherichia coli izolatlarinin antibiyotik direnç profilleri.

In order to reveal the antimicrobial resistance profiles against first-line antimicrobial agents in community-acquired acute uncomplicated urinary tract infections (UTIs), resistance patterns were determined for 1664 Escherichia coli strains collected between 2004 and 2006 in GATA Haydarpasa Training Hospital, Istanbul, Turkey. Of the isolates 38.2% were found to be susceptible to all of the tested antimicrobial agents, while the resistance rate to single antibiotic was 13.5%. Highest prevalence of antimicrobial resistance was observed for ampicillin (AMP) (49%), followed by amoxycillin-clavulanic acid (AMC) (34%), sulphamethoxazole/trimethoprim (SXT) (34%) and ciprofloxacin (CIP) (18%). The rate of multidrug resistant isolates was 33.5% and 48.4% of them were co-resistant. Resistance against two antimicrobials was identified in 244, against three antimicrobials in 205, against four antimicrobials in 160, against five antimicrobials in 63 and against six antimicrobials in 23 strains. Most frequent phenotypes indicating resistance against two, three and four antimicrobial agents were AMP/AMC (5.7%), AMP/AMC/SXT (5.4%) and AMP/AMC/cephazolin/SXT (2.6%), respectively. Extended spectrum beta-lactamase (ESBL) activity was detected in 40 (2.4%) of the isolates. Most prominent increases in resistance prevalence during the study period were observed for AMP (from 52% to 63%), AMC (from 33% to 45%) and CIP (from 15% to 22%). These results show that resistance to AMP, AMC and SXT are frequent in community-acquired E. coli strains and empirical initial treatment with these agents will most probably be inappropriate in our region.

Procalcitonin as a diagnostic aid in diabetic foot infections.

The diagnosis of diabetic foot infection (DFI) is usually a challenge to the clinician. Procalcitonin (PCT), a 116-amino acid propeptide of calcitonin, is a new marker of bacterial infections and sepsis. We evaluated the serum value of PCT as a marker of bacterial infection in diabetic patients with foot ulcers. Forty-nine diabetic patients with foot ulcers were consecutively enrolled into the study. DFI was diagnosed clinically by the presence of purulent secretions or at least two of the symptoms of inflammation including redness, warmth, swelling, and pain. According to these criteria, DFI was determined in 27 patients (DFI group) and not detected in 22 patients (NDFI group). The blood samples were taken for biochemical analysis on admission. PCT, white blood cell count (WBC) and erythrocyte sedimentation rate (ESR), but not C-reactive protein (CRP), was found significantly higher in DFI group compared with NDFI group. The best cut-off value, sensitivity and specificity were 0.08 ng/ml, 77% and 100% for PCT, 32.1 mg/dl, 29% and 100% for CRP, 8.6 10(9)/L, 70% and 72% for WBC and 40.5 mm/h, 77% and 77% for ESR, respectively. The area under the receiver operating characteristic curve for infection identification was greatest for PCT (0.859; p < 0.001), followed by WBC (0.785; p = 0.001), ESR (0.752; p = 0.003), and finally CRP (0.625; p = 0.137). These results suggest that PCT may be a useful diagnostic marker for DFI. Additional research is needed to better define the role of PCT in DFI.

[Evaluation of intestinal parasites in a period of four years in the coprology laboratory of a training hospital]. / Bir egitim hastanesi koproloji laboratuvarinda geçen dört yillik dönemde saptanan bagirsak parazitlerinin degerlendirilmesi.

Parasitological examination of stool samples of 9867 individuals, submitted from both inpatient and outpatient departments to the Microbiology Department of an 800-bed Training Hospital between 1.1.2003 and 31.12.2006, revealed that 582 individuals (5.9%) were infected with intestinal parasites. Different diagnostic methods were employed in two different periods, and Blastocystis hominis, Giardia intestinalis and Entamoeba histolytica/dispar were found to be the most common parasites, respectively. Patients were predominantly male (67% (n=336) male vs. 33% (n=165) female) and aged between 15-25 years (36%). In addition, 14% (81/582) patients had multiple parasitoses. Despite being labor-intensive, parasitological examination of stool samples with necessary staining methods by experienced staff will surely help determine both the diagnosis and exact prevalence of intestinal parasitic infections in Turkey.

Risk factors for the infections caused by temporary double-lumen hemodialysis catheters.

BACKGROUND: Temporary hemodialysis catheters are important devices used in dialysis practice but may be the source of infection in hemodialysis patients. METHODS: We investigated the infectious complications in 70 hemodialysis patients using 113 hemodialysis catheters. RESULTS: The frequency of catheter-related bacteremia was 23.9%, of which Staphylococci were the most frequently growing organism (96.3%). Exit-site infection was observed in one patient. No cases were lost due to the infectious complications. The risk for the development of catheter-related bacteremia was increased after the 24th day of catheterization and after the second venous puncture. CONCLUSIONS: There was a positive correlation between hypoalbuminemia and bacteremia. Internal jugular venous catheterization and hypoalbuminemia were determined as risk factors for the development of catheter-related bacteremia. The risk factors for catheter-related bacteremia in patients with hemodialysis catheter should be determined and modified in order to decrease infectious complications.

Investigation of aminoglycoside modifying enzyme genes in methicillin-resistant staphylococci.

Methicillin-resistant staphylococci may also be resistant to some other antibiotics as well as beta-lactams. In this study, co-existence of resistance to methicillin and aminoglycosides was genetically investigated in staphylococci. A total of 50 staphylococci from in-patients, 17 Staphylococcus aureus and 33 coagulase negative staphylococci (CNS) that contained mecA (gene encoding PBP 2a, an altered penicillin-binding protein) determined by polymerase chain reaction (PCR) were included in the study. Aminoglycoside modifying enzyme (AME) genes were investigated using multiplex-PCR. Aminocyclitol-6'-acetyltransferase-aminocyclitol-2''-phosphotransferase [aac(6')/aph(2'')] gene (encoding bifunctional acetyltransferases/phosphotransferases) was determined in 66% of the isolates, aminocyclitol-4'-adenylytransferase (ant(4')-Ia) gene (encoding phosphotransferases) in 24%, and aminocyclitol-3'-phosphotransferase (aph(3')-IIIa) gene (encoding nucleotidyltransferases) in 8%. Two isolates contained all these three genes. Thirty-six (72%) isolates had at least one of these genes. Three CNS and one S. aureus isolates sensitive to oxacillin had the mecA gene. In conclusion, a high rate of aminoglycoside resistance was determined in methicillin-resistant staphylococci. The aac(6')/aph(2'') was the most frequently detected.

Is the incidence of malaria decreasing in endemic area of Turkey?

Much international business and tourism travels occur, as well as the deployment of soldiers to other places. The aim of this study was both to determine incidence of malaria in the military hospital, Diyarbakir, southeast region of Turkey, and to point out the incidence of this disease. During the study period (1997-2004), 609 cases were found in a military hospital, which is in an endemic area for vivax malaria. This article review trends in current malaria status as well as possible factors for the decreasing prevalence throughout the study period.