Diarrhea in neutropenic patients: a prospective cohort study with emphasis on neutropenic enterocolitis.

BACKGROUND: Although diarrhea is a frequent complication in neutropenic patients, its true incidence, risk factors and clinical course have not been investigated prospectively. PATIENTS AND METHODS: The study was carried out at Hacettepe University Hospital for Adults and involved patients over 16 years of age. Patients with malignant diseases who were neutropenic on admission or who became neutropenic during their stay in the wards between January 2001 and February 2003 were included. They were monitored daily until discharge, exitus, or recovery from neutropenia-whichever occurred earlier-to monitor the presence of diarrhea and other infections. RESULTS: A total of 317 neutropenic episodes in 215 patients were followed. Diarrhea was observed in 18.6% episodes, and the incidence of NEC was 3.5%. The etiology in 27% episodes of diarrhea could not be identified. The use of anthracyclines and mitoxantrone increased the incidence of diarrhea. Prior use of penicillin derivatives plus beta-lactam inhibitors and N-imidazoline derivatives was associated with decreased incidence of diarrhea. CONCLUSIONS: Diarrhea is a common complication in neutropenic patients. Not only specific conditions like NEC, but also nonspecific diseases like parasitosis may be the cause of diarrhea in this patient population.

Infection with Fasciola hepatica.

Fascioliasis, caused by the liver fluke Fasciola hepatica, is an infection that occurs worldwide, although humans are accidental hosts. F. hepatica infection comprises two stages, hepatic and biliary, with different signs and symptoms. Stool examination and ELISA can be used for the initial diagnosis. Radiographic techniques, such as computerised tomography and ultrasonography, as well as magnetic resonance imaging, are used widely for confirmation and follow-up of the disease. Invasive techniques, such as percutaneous cholangiography, endoscopic retrograde cholangiography and liver biopsy, may aid in the diagnosis but are not essential. Triclabendazole is recommended as the first-line agent for the treatment of F. hepatica infection, with bithionol as an alternative.

Antineutrophil cytoplasmic antibodies in juvenile chronic arthritis.

We present the results of antineutrophil cytoplasmic antibody (ANCA) staining in patients with juvenile chronic arthritis (JCA). Thirty-one patients with an age range of 1-16 years were included in the study: 13, 15 and three patients, respectively, were classified having oligoarticular, polyarticular and systemic-onset disease. Indirect immunofluorescence analysis revealed ANCA staining in 45% of the patients. All, except one, revealed atypical pANCA staining. ELISA studies for anti-myeloperoxidase were positive in only one patient with typical pANCA staining. PR-3 ANCA tested negative in all patients. There were no significant correlations between ANCA staining and the clinical parameters of the patients. We conclude that, although the specificity of ANCA in JCA remains to be elucidated, it may be effective in the pathogenesis of the disease.

Cryptosporidiosis in immunocompromised patients in a Turkish university hospital.

The prevalence of Cryptosporidiosis in 18 immunosuppressed diarrheic patients was evaluated by examination of fecal samples by direct staining (Modified Kinyoun and Giemsa), direct and indirect immunofluorescence methods. Forty patients (10 nondiarrheic immunosuppressed, 10 nondiarrheic immunocompetent, and 20 diarrheic immunocompetent) were included in the study as the control group. 11 of 18 samples were positive for cryptosporidial oocysts by at least one of the methods. Oocysts were detected in all (n = 7) of the AIDS patients. This high frequency was attributed to a probable nosocomial infection. None of the samples from control subjects were found positive for Cryptosporidium. Our results indicate that Cryptosporidial oocysts should be detected particularly in immunosuppressed patients with diarrhea. Modified Kinyoun staining method is practical and reliable for this purpose. Immunofluorescence staining methods can be applied for confirmation of the results.

Visceral and cutaneous leishmaniasis (report of 2 cases).

Leishmaniasis is an endemic, sporadic infection in many parts of the world. Turkey is geographically unique in linking Asia and Europe. Of special interest is leishmaniasis, as various forms of this disease have long been reported in the surrounding regions. Visceral and cutaneous leishmaniasis are endemic in the western and southeastern parts of Turkey, respectively. Here, we report a cutaneous and a visceral leishmaniasis case, to draw attention to the increase in the incidence of leishmaniasis in Turkey. In the patient with cutaneous leishmaniasis, the ulcerative lesion on the cheek had persisted for two months before admittance to the hospital. Direct smears prepared from this lesion were negative for leishmania amastigotes whereas the promastigote forms were maintained in NNN (Novy-MacNeal-Nicolle) medium. The second patient was hospitalized with a prediagnosis of haematological malignancy, but the smears prepared from the bone marrow aspirates revealed leishmania amastigotes and promastigotes were seen on the smears from NNN cultures. These two reports mark the importance of inoculation of the specimens to NNN medium for the recovery of the promastigote forms. Cutaneous and visceral leishmaniasis have become endemic in considerable number of foci in Turkey, possibly due to the cessation of vector control programmes and increase in the agricultural and irrigation areas. These two reports also point out the increased prevalence of leishmaniasis in Turkey after 1980's.

Detection of Listeria monocytogenes in milk by the polymerase chain reaction.

A on the polymerase chain reaction (PCR) method based was developed for detection of Listeria monocytogenes in milk samples after enrichment culture. It consists of culturing samples in Listeria enrichment broth, followed by DNA extraction and detection of the organism using PCR. Dilutions of L. monocytogenes in milk were subjected to PCR amplification after enrichment culture. When determining the sensitivity of the method, it was found to be possible to detect 37 CFU (colony forming unit gl/ml) of the bacterium in milk. The method was assessed as a sensitive, specific, times-saving and practical way of detecting L. monocytogenes in milk samples.

Cryptosporidium parvum prevalence in a group of Turkish children.

Stool samples from two hundred children with diarrhea and from 50 healthy children were examined, by modified Kinyoun's acid-fast staining (MAF), Giemsa staining and direct (DFA) and indirect immunofluorescence antibody (IFA) methods, in order to determine cryptosporidiosis prevalence under the age of 12 and to detect the most efficient identifying method for use in our country. Cryptosporidium oocysts were detected in seven (3.5%) of the cases. None of the samples from the control subjects was found to be positive for Cryptosporidium. Our results indicate that Cryptosporidial oocysts should be detected in children with diarrhea. Modified Kinyoun staining method is practical and reliable for this purpose. Immunofluorescence staining methods can be applied for conformation of the results, if available.

Detection of Listeria in raw and pasteurized milk.

One hundred raw milk samples from different regions of Anatolia and 20 pasteurized milk samples from three different manufacturers in Ankara were analyzed for the presence of Listeria spp. L. monocytogenes was found in 1% of the raw milk samples and in 5% (1/20) of the pasteurized milk samples. L. innocua and L. seeligeri were found in 8 and 2% of the raw milk samples, respectively. No other species of Listeria was found. The overall incidence of Listeria spp. was 10% in the raw milk samples and 5% in the pasteurized milk samples.

Comparison of cytochemical staining, immunofluorescence and PCR for diagnosis of pneumocystis carinii on sputum samples.

Detection of P. carinii has increased with the use of polymerase chain reaction (PCR), particularly in sputum samples. In this study, sputum samples obtained from 30 immunosuppressed patients with respiratory symptoms (12 HIV-infected) were tested by standard cytochemical staining (Giemsa and methenamine silver), immunofluorescence (IF) staining and PCR for detection of P. carinii and the results were compared. Pneumocystis carinii was detected in 4, 8 and 13 sputum samples by cytological staining, IF test and PCR, respectively. Specific amplification bands were obtained in all sputum samples that were positive by both other tests. All tests gave negative results in sputum samples obtained from 5 HIV-infected asymptomatic patients and 22 non-immunosuppressed tuberculosis patients. Our observations suggest that PCR results were well correlated with P. carinii pneumonia (PCP), especially in non-HIV-infected patients. However, PCR positivity obtained in HIV-infected patients could be misleading in the diagnosis of PCP without careful clinical evaluation. Positive results obtained by Giemsa staining or IF test confirm diagnosis of PCP authoritatively. As a result, we suggest testing sputum samples by both PCR and IF techniques for detection of P. carinii.

Isolation, in vitro antimicrobial susceptibility and penicillin tolerance of Arcanobacterium haemolyticum in a Turkish university hospital.

Arcanobacterium haemolyticum (Ah) was isolated from 5 (0.3%) out of 1531 throat cultures of patients with presumed pharyngotonsillitis. The age of the patients who had a positive culture for Ah varied between 6 and 22. The isolation rate of beta-haemolytic streptococci (BHS) was 7.4%, 72.6% of which belonged to Group A, followed by groups G, C and B. None of the throat samples yielded simultaneous growth of Ah and BHS. Antimicrobial susceptibility of Ah isolates to phenoxymethylpenicillin, cephalexin, cefotaxime, vancomycin, erythromycin, azithromycin, doxycycline, ciprofloxacin, and trimethoprim-sulfamethoxazole was tested by the agar dilution method. The isolates were found to be susceptible to all antimicrobials tested except trimethoprim-sulfamethoxazole. Penicillin tolerance could be detected in none of the Ah strains, including the reference strain Ah ATCC 9345. We conclude that Ah should be kept in mind as a potential pathogen causing pharyngitis in adolescents and young adults.

[The role of Candida albicans in denture stomatitis]. / Protez stomatitlerinde Candida albicans'in rolü.

Denture stomatitis is a clinical inflammatory picture that is seen at oral mucosa of the upper chin of patients who use removable dentures. There are various reasons of denture stomatitis. In order to detect the presence rate of C. albicans on lesions as the most important factor and the factors which effect this situation, 41 patients (31 with denture stomatitis and 10 as controls) were chosen. The smears obtained from the hard palate of the patients were microbiologically investigated. C. albicans was found to be the causative agent in 35.4% of the cultures which have shown growth. The relationship of sex, age and the period of denture usage was investigated in these cases.

[Antisperm and anticardiolipin antibodies in recurrent abortions]. / Tekrarlayan abortuslarda antisperm ve antikardiyolipin antikorlari.

In this study, antisperm (ASA), anticardiolipin (ACL) and some other autoantibodies have been investigated in 63 cases of habitual abortion, spontaneous abortion and intrauterine fetal death. ASA antibodies and ACL antibodies were positive in 28.5% and 33.3% of the patients respectively. 7 cases (11.1%) were positive for both ASA and ACL antibodies. According to our results it can be supposed that, besides other factors antisperm antibodies may play role in early abortions.

[Anticardiolipin antibodies in autoimmune rheumatic diseases]. / Romatizmal otoimmün hastaliklarda antikardiyolipin antikorlarinin arastirilmasi.

In this study, ELISA and VDRL tests have been employed in order to detect ACL antibodies in sera samples obtained from 105 patients with SLE, RA, scleroderma, dermatomyositis, primary Sjögren's syndrome, vasculitis and pulmonary thromboemboli; Using by IFAT, AMA-type 5 and other autoantibodies, RIA anti-DNA antibodies were also tested in SLE patients. In sera obtained from the patients with RA; autoantibodies and RF have been investigated. In SLE cases, ACL antibodies were found to be positive in 55.5% of the patients. In RA cases the rate of ACL antibodies were found to be 51.7%. In SLE cases, the presence of IgG-ACL antibody was found to be in association with thrombosis and fetal loss; while IgM-ACL antibody was found to be in association with fetal loss only. Serologic parameters such as VDRL and AMA type 5 were significantly connected with the presence of ACL-IgG and IgM antibodies (p less than 0.05). In cases of RA connection was detected only between IgG-ACL antibody and thrombosis. Concerning the other rheumatic autoimmune diseases; ACL antibodies were detected in cases: 4 patients out of 11 scleroderma, 1 patient out of 7 vasculitis, 2 patients out of 5 primary Sjögren's syndrome, and 3 patients out of 6 pulmonary thromboemboli.

[Reproductive immunology]. / Reprodüktif immünoloji.

In this article, immunology of fetoplacental survival in pregnancy and immunologic mechanisms in infertility, abortions and preeclampsia are discussed. Rh incompatibility, pregnancy in renal transplant patients, autoimmune diseases and cancer in pregnancy are also reviewed.

[The immunologic processes of the etiopathogenesis of Sjögren's syndrome]. / Sjögren sendromunun etyopatogenezinin immünolojik olarak incelenmesi.

In this study 32 Sjögren's syndrome cases--16 primary and 16 secondary--have been followed-up for 3 years in Hacettepe University Medicine Faculty Ophthalmology Department. The serum levels of rheumatoid factor and complement have been determined and autoantibodies have been looked for by the indirect immunofluorescence technique. The immunological processes that play a role in the pathogenesis of Sjögren's syndrome have been discussed with regard to the results of the study.

[Myasthenia gravis and autoimmunity]. / Myastenia gravis ve otoimmunite.

A disorder in immune system is thought to be the factor in Myasthenia gravis. Certain antibodies against various tissues have been detected in the sera of this group of patients. Anti-acetyl-cholin receptor antibodies are positive in 90% of the patients with M.G. Basic pathology is thought to be the destruction in post-synaptic membrane, resulted from the reaction in which an autoimmune response directed to acetyl-cholin receptors.