Tularaemia outbreaks in Sakarya, Turkey: case-control and environmental studies.

INTRODUCTION: Tularaemia is an important zoonotic disease that leads to outbreaks. This study aimed to compare the epidemiological characteristics of two tularaemia outbreaks that occurred in the Sakarya region of Turkey, analyse the risk factors for the development of outbreaks and identify Francisella (F.) tularensis in the water samples. METHODS: Two tularaemia outbreaks occurred in the Kocadongel village in 2005 and 2006. A field investigation and a case-control study with 47 cases and 47 healthy households were performed during the second outbreak. Clinical samples from the patients and filtrated water samples were analysed for F. tularensis via real-time polymerase chain reaction. RESULTS: From the two outbreaks, a total of 58 patients were diagnosed with oropharyngeal tularaemia based on their clinical and serological results. Both outbreaks occurred between the months of January and April, and the number of patients peaked in February. Logistic regression analysis revealed that the consumption of natural spring water was the only significant risk factor for tularaemia infection (odds ratio 3.5, confidence interval 1.23-10.07). F. tularensis was detected in eight clinical samples and in the filtrated natural spring water. CONCLUSION: This study is the first report of tularaemia from this region. The results show that both tularaemia outbreaks were related to the consumption of untreated natural spring water. To prevent waterborne tularaemia, community water supplies should be treated and checked periodically.

Integrating cervical length measurement into routine antenatal screening and only emergency cerclage when indicated.

PURPOSE: To integrate cervical length measurement into antenatal screening and apply emergency cerclage when indicated to prevent spontaneous deliveries at < 34 weeks of gestation. METHODS: Cervical length measurements of 400 pregnant volunteers were obtained at gestational weeks 12-14, 18-20 and 28-32. Whenever a cervical measurement < 30 mm was observed, vaginal cultures and bacterial vaginosis were investigated, and weekly cervical length measurements were performed thereafter. Emergency cerclage was performed whenever complete cervical effacement and > or = 3 cm cervical dilatation were observed before 32 completed weeks of gestation. We adopted and tested a strategy of only emergency cerclage application when clinically indicated after ultrasound screening and microbial monitoring of short cervices. Patients were given cyclooxygenase-inhibitors, progesterone, and antibiotics in the postoperative period. RESULTS: Spontaneous preterm births at < 34 weeks of gestation occurred in 15 women (3.8%). We performed five emergency cerclages according to the presented screening strategy between 20-28 weeks of gestation all of which reached > 34 weeks. We successfully postponed 62.5% (5/8) of deliveries before 32 completed weeks and 33.3% (5/15) of deliveries before 34 completed weeks. CONCLUSION: Routine cervical length measurement combined with serial transvaginal sonograms and vaginal microbial monitoring of the short cervices will avoid unnecessary prophylactic cerclages while increasing the success of emergency cerclages performed upon solid clinical findings.

Rifampicin resistance phenotyping of Brucella melitensis by rpoB gene analysis in clinical isolates.

R Rifampicin resistance of Brucella melitensis by rpoB gene analysis has not yet been performed in Turkey, where brucellosis is endemic. In this study, we investigated the efficacy of E-test and single nucleotide polymorphism (SNP) analysis of the B. melitensis rpoB gene, for the detection of mutations conferring rifampicin resistance, by sequencing 21 human B. melitensis strains from the Southeast and Marmara regions of Turkey. On CLSI slow-growing bacteria standards, all isolates were sensitive to rifampicin except for 6 which showed intermediate resistance to rifampicin. MIC(50) and MIC(90)values were 1 microg/ml and 1.5 microg/ml respectively (range 0.50 -1.5 microg/ml). The rifampicin-resistant phenotype was investigated at Cd 154 (GTT/TTT), Cd 526 (GAC/TAC, GAC/AAC, GAC/GGC), Cd 536 (CAC/CTC, CAC/TAC), Cd 539 (CGC/AGC), Cd 541 (TCG/TTG) and Cd 574 (CCG/CTG) of the rpoB gene in B. melitensis 16M and B115 strains, and in clinical isolates. No missense mutations were found in any of the B. melitensis isolates, which indicates that all isolates were rifampicin-susceptible. In conclusion, SNP analysis was useful as a molecular tool for rifampin resistance testing. Although resistance to rifampicin was not detected in our strains of B. melitensis; the presence of strains with intermediate resistance to rifampicin indicates that susceptibility testing should be performed periodically.

Peritonitis due to Pseudomonas putida in a patient receiving automated peritoneal dialysis.

A patient, who had recently undergone a laparoscopic ovarian cyst operation, receiving nightly automated peritoneal dialysis treatment, was discovered to have peritonitis due to Pseudomonas putida. She was successfully treated with a 21-day course of intraperitoneal ceftazidime and gentamicin, without needing to remove the dialysis catheter. No recurrence was observed over 3 months of follow-up.