Comparison of Biomechanical Effects of Different Configurations of Kirschner Wires on the Epiphyseal Plate and Stability in a Salter-Harris Type 2 Distal Femoral Fracture Model.

BACKGROUND: We sought to investigate the different configurations of Kirschner wires used in distal femur Salter-Harris (SH) type 2 epiphyseal fracture for stabilization after reduction under axial, rotational, and bending forces and to define the biomechanical effects on the epiphyseal plate and the fracture line and decide which was more advantageous. METHODS: The SH type 2 fracture was modeled using design software for four different configurations: cross, cross-parallel, parallel medial, and parallel lateral with two Kirschner wires, and computer-aided numerical analyses of the different configurations after reduction were performed using the finite element method. For each configuration, the mesh process, loading condition (axial, bending, and rotational), boundary conditions, and material models were applied in finite element software, and growth cartilage and von Mises stress values occurring around the Kirschner wire groove were calculated. RESULTS: In growth cartilage, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration. In Kirschner wires, the stresses were highest in the cross configuration and lowest in the cross-parallel and parallel lateral configurations. In the groove between the growth cartilage and the Kirschner wire interface, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration. CONCLUSIONS: The results showed that the cross configuration is advantageous in fixation. In addition, in the SH type 2 epiphyseal fracture, we believe that the fixation shape should not be applied in the lateral configuration.

HPV types and E6/E7 mRNA expression in cervical samples from Turkish women with abnormal cytology in Ankara, Turkey.

BACKGROUND/AIM: Human papillomaviruses have been established as a risk factor for invasive carcinoma of the uterine cervix. HPV E6/E7 oncogene expression has recently emerged as a promising biomarker to determine the risk for progression to high-grade cervical lesions. The aim of this study was to evaluate HPV mRNA and DNA detection in samples with abnormal cytology. MATERIALS AND METHODS: Cervical specimens were obtained at the Department of Obstetrics and Gynecology via cervical brushes during January-October 2011. Liquid-based cytology slides were evaluated according to the 2001 Bethesda System. Cytology specimens from a total of 81 women with abnormal cytology were included. Real-time PCR and NASBA assays were performed to detect HPV DNA and E6/E7 mRNA, respectively. RESULTS: HPV DNA was identified in 73 samples (90.1%). HPV E6/E7 mRNA expression was observed in 45 samples (55.6%). A statistically significant difference was observed among cytological diagnosis groups. In 25 patients, a biopsy was performed during the follow-up. HPV DNA was detected in all of these patients. HPV E6/E7 expression was present only in CIN I-III diagnosed patients. CONCLUSION: The E6/E7 mRNA test is a robust indicator of cytological atypia and correlates better with progressive lesions than DNA assays.

[Investigation of the hepatitis E virus seroprevalence in cases admitted to Hacettepe University Medical Faculty Hospital]. / Hacettepe Üniversitesi Tip Fakültesi Hastanesine basvuran olgularda hepatit E virusu seroprevalansinin arastirilmasi.

Hepatitis E virus (HEV), classified in Hepeviridae family, Hepevirus genus, is a non-enveloped virus with icosahedral capsid containing single-stranded positive sense RNA genome. HEV infections may be asymptomatic especially in children, however it may present as fulminant hepatitis in pregnant women, as well as chronic hepatitis in immunocompromised patients. There are four well-known genotypes of HEV that infect humans and many mammalian species. Genotype 1 and 2 are frequently responsible for water-borne infections transmitted by fecal-oral way in developing countries, while genotype 3 and 4 cause zoonotic infections in developed countries. Turkey is considered as an endemic country with a total seroprevalence rate of 6.3% for normal population, showing significant variation (0-73%) according to the regions and study groups. The aims of this study were to investigate the HEV seropositivity in cases admitted to Hacettepe University Medical Faculty Hospital (HUMFH), to evaluate the results according to the demographic features of patients, and to determine the current HEV seroprevalence in our region, contributing seroepidemiological data in Turkey. A total of 1043 serum samples (514 female, 529 male; age range: 1-90 years, mean age: 38.03) obtained from 327 blood donors (32 female, 295 male; age range: 19-59 years, mean age: 31.1) who were admitted to HUMFH Blood Center, and 716 sera (482 female, 234 male; age range: 1-90 years, mean age: 41.7) that were sent to HUMFH Central Laboratory from various outpatient/inpatient clinics, between November 2012 to November 2013, were included in the study. The presence of HEV-IgG antibodies in serum samples was detected by a commercial ELISA method (Euroimmun, Germany), and the presence of HEV-IgM antibodies was also investigated in the sera with IgG-positive results. The overall HEV-IgG seropositivity rate was determined as 4.4% (46/1043), and the seropositivity rates for blood donors and in/outpatients were as 0.92% (3/327) and 6.0% (43/716), respectively. HEV-IgM antibody was not detected in any of the cases. The HEV-IgG seropositivity was 3.2% among male, and 5.6% among female, yielding no statistically significant difference between the gender (p= 0.056). HEV-IgG antibodies were detected in none (0/118) of the pediatric age group (0-18 years), while the seropositivity rates were 1.9% (14/731) and 16.5% (32/194) in 19-55 and ≥ 56 years-old groups, respectively. The difference between the age groups was statistically significant (p< 0.001), indicating the age-related pattern of HEV exposure. In conclusion, the total HEV seroprevalence rate found as 4.4% in our study, is comparable to the average results reported from Turkey. Our data is also in agreement with the result of a previous report (3.8%) that performed from Ankara province in 2002 with similar study groups, emphasizing that there was no significant changes for HEV exposure have occured over more than the last decade in Ankara, Cental Anatolia, Turkey.

Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus in children with diabetes mellitus: Trends between 2005 and 2013.

The aim of this prospective study was to establish the methicillin-resistant Staphylococcus aureus (MRSA) colonization rates in pediatric outpatients with type 1 diabetes mellitus, while also evaluating changes in colonization rates over time. There was no significant difference between 2005 and 2013 patients in terms of demographic and clinical findings. MRSA colonization rates were 0.7% (in 101 patients) and 0.9% (in 134 patients) (P = .84). Although increased MRSA colonization has become a significant problem worldwide, it does not seem to be a major issue in our diabetic outpatient population.

Detection and genotyping of cervical HPV with simultaneous cervical cytology in Turkish women: a hospital-based study.

PURPOSE: To investigate the prevalence of cervical human papilloma virus (HPV) with genotyping and simultaneous cervical cytology among Turkish women in a university hospital. A review of literature was done as well to summarize the results of similar Turkish studies based on hospital data. METHODS: Women who were subjected to cervical HPV-DNA testing with simultaneous cervical Pap test were included. Seeplex HPV 18-plex Genotyping Test was used for HPV detection and typing. Liquid-based cytology was used for Pap test and Bethesda system was used for results. RESULTS: Study group included 890 patients with a mean age of 39.5 years. The prevalence of any HPV was 25.7% while high-risk HPV was positive in 23.0%. There were no significant differences in HPV prevalence between younger and older women. Among HPV-positive women, 89.5% had at least one type of high-risk HPV. Most common HPV was type 16 followed by type 31 and 51. Abnormal cervical cytology rate was 11.6%. Rate of HPV positivity was significantly higher in women with abnormal cervical cytology compared to women with normal cytology (54.4 vs. 22.0%). CONCLUSIONS: Cervical HPV infection is a serious and gradually growing problem for Turkish women according to hospital-based data. This may be associated with low age at marriage and more sensitive HPV detection methods.

[Investigation of dengue virus and yellow fever virus seropositivities in blood donors from Central/Northern Anatolia, Turkey]. / Orta/Kuzey Anadolu Bölgesi kan donörlerinde Dengue virusu ve sari humma virusu seropozitifliginin arastirilmasi

Dengue virus (DENV) and yellow fever virus (YFV) are two of the globally prevalent vector-borne flaviviruses. Data on these viruses from Turkey is limited to a single study originating from the western, Aegean region of Turkey, where evidence for DENV exposure had been confirmed in residents and presence of hemagglutination inhibiting antibodies against YFV had been revealed. The aim of this study was to investigate the rates of seropositivity of DENV and YFV in blood donors from Central/Northern Anatolia, Turkey, for the demonstration of possible human exposure. Serum samples were collected by the Turkish Red Crescent Middle Anatolia Regional Blood Center from donation sites at Ankara, Konya, Eskisehir and Zonguldak provinces and included in the study after informed consent. Ankara is the capital and second most-populated city in Turkey. All samples were previously evaluated for West Nile and tick-borne encephalitis virus antibodies and found to be negative. A total of 2435 and 1502 sera have been evaluated for IgG antibodies against DENV and YFV, respectively. Commercial enzymelinked immunosorbent assays (ELISAs) and indirect immunofluorescence tests (IIFTs) were applied (Euroimmun, Germany) for DENV/YFV IgG surveillance. DENV IgG reactive sera were further evaluated for IgM by ELISA and a commercial mosaic IIFT to determine DENV subtypes. IgM positive samples were also analyzed by a commercial NS1 antigen detection assay (Bio-Rad Laboratories, France). YFV IgG reactive samples were evaluated by IIFT for IgM and via mosaic IIFT and antibody specificity were confirmed by plaque reduction neutralization test (PRNT). Anti-DENV IgGs were demonstrated in repeated assays in 0.9% (21/2435) of the sera. In two samples with borderline IgG results, presence of DENV IgM was detected, one of which was also borderline positive for DENV NS1 antigen. In 14.3% (3/21) of the IgG reactive sera, mosaic IIFT was evaluated as positive and displayed prominent reactivity for DENV-2 in all samples. From five donors with DENV reactivity, new samples were obtained after at least six months which revealed the continuing presence of DENV IgG activity in four. One sample which was initially positive for IgM, borderline for NS1 antigen and borderline for IgG was observed to be positive for IgG and negative for IgM in redonation. IIFT results in three redonation samples also indicated reactivity for DENV-1 and DENV-2 subtypes. Anti-YFV IgGs were detected in 0.6% (9/1502) of the sera. YFV IgM could not be demonstrated in any of the IgG reactive samples and PRNT was evaluated as negative. In conclusion, evidence for DENV exposure, presumably to DENV-2, was identified in residents from Central Anatolian provinces of Ankara and Konya for the first time, however, seroreactivity detected against YFV could not be confirmed by PRNT. These findings indicated that DENV or an antigenically-similar flavivirus was probably present in the study region and sporadic human exposure might have occurred.

[Adaptation of a sensitive DNA extraction method for detection of Entamoeba histolytica by real-time polymerase chain reaction]. / Diski örneklerinde gerçek zamanli polimeraz zincir reaksiyonu ile Entamoeba histolytica saptanmasinda duyarli bir DNA saflastirma protokolü uyarlanmasi

This study was aimed to adapt a sensitive DNA extraction protocol in stool samples for real-time polymerase chain reaction (PCR) detection of Entamoeba histolytica which causes important morbidity and mortality worldwide. Stool extraction is a problematic step and has direct effects on PCR sensitivity. In order to improve the sensitivity of E.histolytica detection by real-time PCR, "QIAamp DNA stool minikit (Qiagen, Germany)" was modified by adding an overnight incubation step with proteinase K and sodium dodecyl sulfate (SDS) in this study. Three different extraction methods [(1) original method, (2) cetyltrimethyl-ammonium bromide (CTAB) method, (3) modified method] were evaluated for effects on sensitivity in real-time quantitative PCR (Artus RealArt TM E.histolytica RG PCR Kit, Qiagen Diagnostics, Germany). For this purpose, several concentrations of standard E.histolytica DNA were spiked in parasite-free stool samples and three different extraction protocols were performed. Detection sensitivities of "QIAamp DNA stool minikit" was found 5000 copies/ml and of CTAB method was found 500 copies/ml. Detection sensitivity of the extraction was improved to 5 copies/mL by modified "QIAamp DNA stool minikit" protocol. Since detection sensitivities of nucleic acid extraction protocols from stool samples directly affect the sensitivity of PCR amplification, different extraction protocols for different microorganisms should be evaluated.

[Investigation of West Nile virus in central nervous system infections of unknown etiology in Ankara, Turkey]. / Ankara bölgesinde nedeni bilinmeyen merkezi sinir sistemi enfeksiyonlarinda Bati Nil virusunun arastirilmasi.

Arthropod-borne viral infections have recently gained considerable attention and importance as re-emerging infections in a global scale. West Nile Virus (WNV), a member of Flaviviridae, is an enveloped positive strand RNA virus that is usually transmitted to humans by the bite of Culicine mosquitoes. Although the majority of the human infections are asymptomatic, WNV may also cause febrile and neuro-invasive diseases. Seroprevalence data from Turkey indicate that WNV activity is present in Central Anatolia. In this study performed at Hacettepe University Hospital, paired serum and cerebrospinal fluid (CSF) samples from 87 adult patients with the preliminary diagnosis of aseptic meningitis/encephalitis of unknown etiology were evaluated retrospectively to identify WNV-related syndromes. Bacterial, fungal and mycobacterial cultures yielded negative results and Mycobacterium tuberculosis and Herpes simplex virus nucleic acid tests were also negative for the selected patients. Commercial enzyme-linked immunosorbent assay (ELISA)s and indirect immunofluorescence test (IIFT)s were employed for WNV IgM and IgG antibody detection (Anti-WNV Virus IgG/IgM ELISA, Anti-WNV Virus IgG/IgM IIFT; Euroimmun, Germany). Additional ELISA/IIFT assays were further performed for WNV antibody reactive samples to identify cross-reactions and/or infections with other flaviviruses and phleboviruses. All WNV antibody positive samples were also evaluated by a WNV real-time reverse-transcription polymerase chain reaction (RT-PCR) assay. WNV IgM and IgG antibodies were detected in %9.2 (8/87) and 3.4% (3/87) of the serum samples, respectively. All IgG reactive samples were negative for IgM. All sera with WNV antibody reactivity (n = 11) and the corresponding CSF samples were negative for viral RNA via RT-PCR. In 5 of the 8 WNV IgM positive subjects, sandfly fever virus IgM antibodies were detected, which was also accompanied by Dengue virus IgM positivity in one sample. In another case, intrathecal antibody synthesis against measles virus was demonstrated. Two cases (2/87; 2.3%) with WNV IgM positivity as the only serologic marker were identified as probable WNV infections and clinical features were discussed. In conclusion, in order to fully understand the impact of WNV and/or other flavivirus infections in Turkey, epidemiology and ecological features of these agents need to established.

Pleural fluid PCR method for detection of Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae in pediatric parapneumonic effusions.

BACKGROUND: Parapneumonic effusions cause significant morbidity and mortality despite current developments in diagnostic and therapeutic approaches. Causative microorganisms may remain unidentified in a significant number of patients by cultures and Gram smears. Polymerase chain reaction (PCR) is a molecular technique for the detection of causative bacteria; however, its efficiency in pleural fluids is less known. OBJECTIVES: The present study was performed to compare the efficiency of PCR in the detection of the three most common organisms (Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae) with conventional methods. METHODS: Twenty-eight consecutive patients with parapneumonic pleural effusions were studied. On admission, pleural fluid samples were obtained for Gram staining, routine culture and PCR analysis for S. aureus, S. pneumoniae and H. influenzae. RESULTS: PCR analysis allowed detection of 11 microorganisms in 10 patients (35.7%), whereas pleural fluid cultures detected the etiological agent in only 2 (7.1%). S. pneumoniae was the most frequent agent. CONCLUSIONS: Pleural fluid cultures may have low diagnostic yields, partly due to prior antibiotic use. Pleural fluid PCR analysis may improve the etiologic diagnosis in parapneumonic pleural effusions, with technical advances leading to higher yields than obtained in this study.

Investigation of HSV-1, HSV-2, CMV, HHV-6 and HHV-8 DNA by real-time PCR in surgical resection materials of epilepsy patients with mesial temporal lobe sclerosis.

OBJECTIVE: The objective of this study is to investigate the presence of viral DNAs of HSV-1, HSV-2, HHV-6, HHV-8, and CMV in hippocampus of the patients with mesial temporal lobe epilepsy (MTLE) syndrome. METHODS: Pathological specimens were obtained from 33 patients with MTLE undergone temporal lobectomy with amygdalo-hippocampectomy due to intractable seizures. Autopsy materials from the hippocampus of 7 patients without neurological disease were used as controls. The data was also correlated with the clinical history of patients including febrile convulsions, age, and history of CNS infections. Real-time polymerase chain reaction method was performed for detection of DNAs of these viruses. RESULTS: HHV-6, HSV-1 and HHV-8 were detected in the hippocampus of 3, 2 and 1 patients with MTLE respectively. None of the hippocampus of patients with MTLE was positive for DNA of HSV-2 and/or CMV. Three patients with positive HHV-6 DNAs had febrile convulsions and family history for epilepsy. None of our control specimens showed PCR positivity to any of the 5 tested viruses. CONCLUSIONS: Our study is the first to report the presence of HHV-8 viral genome in the brain tissue of patient with MTLE. Viral DNAs were detected in a total of 18% of the patients in this study; we can conclude that activity of the latent virus in patients with hippocampal sclerosis should be more extensively studied to establish its role in active infection.

[Investigation of Legionella pneumophila seropositivity in the professional long distance drivers as a risky occupation]. / Riskli bir meslek olarak profesyonel uzun yol süruocolerinde legionella pneumophila seropozitifldginin arastirilmasi.

Contaminated water sources, reservoirs and systems such as evaporative condensers of air-conditioners are known to be the main transmission routes of Legionella spp. which are ubiquitous aquatic bacteria. By virtue of this point the aim of this study was to investigate the rate of Legionella pneumophila seropositivity in a profession considered as risky due to the direct and prolonged exposure to air-conditioning and air-circulating systems. For this purpose, in the period of February-August 2004 a total of 79 male subjects (63 were bus drivers and 16 were driver assistants) who were continously travelling to two different route (South part as hot climate and Middle/North parts as cold climate of Turkey) from Denizli province coach station (a province located in internal Aegian where accepted as crossroads), were included to the study. The mean age and mean working duration of bus drivers were 43.0 +/- 1.1 years and 20.0 +/- 1.1 years, respectively, while these values were 22.5 +/- 0.9 years and 4.0 +/- 0.6 years, respectively, for the drivers' assistants. The serum samples collected from the subjects were screened by a commercial indirect immunofluorescence method (Euroimmun, Germany) using L. pneumophila serogrup 1-14 antigens for the presence of specific antibodies. Additionally, air-conditioners' moisture exhaust samples of the busses in which seropositive subjects travelling with have been examined by culture and 5S rRNA gene targeted polymerase chain reaction (PCR) methods, for the presence of Legionella spp. The overall L. pneumophila seropositivity rate was detected as 15.2% (12/79). This rate was 19% (12/63) for bus drivers while all of the drivers' assistants were found seronegative. The seropositivity rate was found statistically higher in the personnel who were travelling to the hot climates (10/36, 27.8%) than those who travel to cold climates (2/43, 4.6%), (p < 0.05). The culture and PCR yielded negative results for Legionella spp. in the exhaust samples collected from the air-conditioners of the busses in which seropositive drivers travel. Our data indicated that long distance bus drivers were chronically exposed to this pathogen and this may be considered as an occupational risk factor for legionellosis especially for drivers who travel to the west and south parts of our country (mean temperature in August 2004: 30-35 degrees C), since the bus air-conditioning and air-circulating systems are active during the travel. Further studies on air spreading of Legionella in intercity buses can reveal how the exposure occurs for bus drivers.

Granulomatous hepatitis after intravesical BCG treatment for bladder cancer.

Intravesical bacillus Calmette-Guerin (BCG) is used in patients with urinary bladder carcinoma. Although it is generally well tolerated, granulomatous hepatitis is a rare but serious complication. We report a 42-year-old man and a 56-year-old man who developed granulomatous hepatitis following intravesical BCG. One of them was treated successfully with antitubercular therapy; the other died because of BCG sepsis and multi-organ failure.

Use of polymerase chain reaction for detection of adenovirus in children with or without wheezing.

Eighty percent of asthma attacks in children are accompanied by an upper respiratory tract viral infection. Adenovirus is one of the major viral causes of childhood bronchiolitis. As the polymerase chain reaction (PCR) is the most sensitive technique for documenting viral respiratory infections, the PCR method was performed on the throat swab samples of asthmatic children with and without wheezing to investigate the presence of the adenovirus genome in the upper respiratory tract. The frequencies of adenovirus in asymptomatic and symptomatic asthmatic patients, healthy controls and wheezy children were as follows: 33.3%, 71.4%, 37% and 62.96%, respectively. The adenovirus was detected in a significantly higher percentage in the upper airways of patients with asthma exacerbation and in children with wheezing than in patients without asthma exacerbation and in the healthy controls (p < 0.05). The frequency of adenovirus was not different between asthmatic patients receiving or not receiving inhaled corticosteroid. Adenovirus has the potential to precipitate asthma exacerbations in asthmatic patients; its frequency was not affected by the treatment of inhaled corticosteroid.

[Comparison of Cobas Amplicor system and microscopic examination with bactec radiometric method for the detection of Mycobacterium tuberculosis in clinical samples]. / Klinik orneklerden Mycobacterium tuberculosis saptanmasinda Cobas Amplicor sistemi ve mikroskopik inceleme yöntemlerinin bactec radyometrik yontemi ile karsilastirilmasi.

Tuberculosis is still a major health problem all around the world. Since the patients with tuberculosis spread the infection by means of aerosols containing tuberculosis bacilli, it is critically important to detect these patients and start the treatment as soon as possible. Therefore there is a need for highly sensitive and specific reliable diagnostic methods. In this study, Ehrlich-Ziehl-Neelsen (EZN) staining method and Cobas Amplicor system were evaluated for the diagnosis of tuberculosis in comparison with the standard reference Bactec radiometric method. A total of 2098 clinical samples collected between July 2002 and February 2004 in Clinical Microbiology Laboratory of Hacettepe University Adult Hospital, were studied by Bactec radiometric system for diagnosis of tuberculosis and M. tuberculosis was detected in 107 (5.1%) samples. The specificity, sensitivity, positive and negative predictive values of EZN staining method were found to be 98.5%, 42.9%, 62.1% and 96.9%, respectively. The specificity, sensitivity, positive and negative predictive values of Cobas Amplicor system were detected as 99.3%, 67.3%, 83.5% and 98.4%, respectively. These results were in concordance with the results of previous studies. In conclusion, microscopic examination and nucleic acid amplification methods should always be used together with culture methods for the laboratory diagnosis of tuberculosis.

[The presence of Chlamydophila pneumoniae, Helicobacter pylori and cytomegalovirus in human atherosclerosis detected by molecular and serological methods]. / Aterosklerozda Chlamydophila pneumoniae, Helicobacter pylori ve cytomegalovirus varliginin moleküler ve serolojik yöntemlerle arastirilmasi.

Persistant infections due to Chlamydophila pneumoniae, Helicobacter pylori, and Cytomegalovirus are suggested to contribute to the development of atherosclerosis. In this study, the presence of these agents was investigated by polymerase chain reaction (PCR) and serological tests in atherosclerotic plaques and non-atherosclerotic vessel samples. Thirty-three specimens from the atherosclerotic plaques (lesion group), 45 specimens from the healthy left internal mammarian arteries and ascending aortas of the atherosclerotic patients (non-lesion group), and 15 specimens from the aortas of non-atherosclerotic patients as determined by angiography (control group), were included to the study. Serum samples were also collected from all study subjects for the serological investigation. PCR and ELISA were used in order to determine the nucleic acid positivity and IgG titers, respectively. C. pneumoniae and H. pylori DNA were found in 6 (18.1%) and 14 (42.4%) of the lesion group, 2 (4.4%) and 9 (20%) of the non-lesion group, respectively. CMV DNA was not found in either groups. All of the PCR results of control group were negative. C. pneumoniae IgG was found positive in one case of the lesion group (3%) and three cases of the non-lesion group (6.7%). H. pylori IgG were positive in all the subjects except for three patients who were in the non-lesion group. The presence of C. pneumoniae and H. pylori DNA in a considerable number of lesion and non-lesion groups' specimens, but absence in control group specimens supports the hypothesis that these agents have an association with atherosclerosis.

[Determination of serologic markers against bacterial atypical pneumonia agents in pneumonia patients]. / Pnömonili hastalarda bakteriyel atipik pnömoni etkenlerinin serolojik olarak degerlendirilmesi.

Approximately one third of all community acquired pneumonia cases are caused by Legionella pneumophila, Mycoplasma pneumoniae and Chlamydophila pneumoniae (previously, Chlamydia pneumoniae) which are known as bacterial atypical pneumonia agents. Serological tests are used commonly for laboratory diagnosis of these agents. The aim of this study was to evaluate the causative role of bacterial atypical pneumonia agents in clinically diagnosed pneumonia patients. Acute and convalescent serum samples were collected from a total of 65 clinically diagnosed adult pneumonia patients in order to evaluate IgM and IgG positivities against L. pneumophila, M. pneumoniae and C. pneumoniae. IgM and IgG were evaluated by enzyme immunoassay (ELISA) for L. pneumophila and M. pneumoniae, and by indirect fluorescent antibody (IFA) method for C. pneumoniae. In acute serum samples, 4 (6.2%) M. pneumoniae IgM positivity in addition to 3 (4.6%) L. pneumophila IgG, 3 (4.6%) M. pneumoniae IgG and 62 (95.4%) C. pneumoniae IgG positivity were detected. In convelescent serum samples, 3 (4.6%) L. pneumophila, 1 (1.5%) M. pneumoniae, 3 (4.6%) C. pneumoniae IgM positivity and 4 (6.2%) L. pneumophila with 1 (1.5%) M. pneumoniae IgG positivity were detected in addition to acute sample positivities. According to these serological data, totally 16 (24.6%) of the patients were infected by bacterial atypical pneumonia agents. These results show that bacterial atypical pneumonia agents are important etiological factors for community acquired pneumonia.

Viral studies in the cerebrospinal fluid in subacute sclerosing panencephalitis.

OBJECTIVES: The pathogenesis of subacute sclerosing panencephalitis (SSPE), and particularly, the cause of measles virus (MV) reactivation following a latent period after primary measles infection is unknown. The hypothesis of other viruses contributing to the pathogenesis of SSPE by affecting the in vivo state of MV was investigated. METHODS: We examined the cerebrospinal fluid of SSPE patients (n=43) for DNA or RNA and antibodies against HSV type 1 and 2, EBV, CMV, VZV, Hepatitis B, Hepatitis C, JC virus, human herpesvirus (HHV)-6, HHV-7, HHV-8, HTLV-1, and HTLV-2. We compared the findings with those of patients with other neurological disorders (n=39). RESULTS: CMV DNA and HSV type 1 IgG were found more frequently in SSPE patients. Other positive results were at similar incidence in SSPE and control groups. The clinical features of SSPE cases with and without positive viral tests did not differ from each other. CONCLUSION: These data do not support a specific role for these agents in SSPE, but imply that the passage of some viruses to the CNS and local antibody synthesis may be facilitated by inflammation. The persistence or reactivation of MV in SSPE may be related to other factors pertaining to the host or environment.

The use of heteroduplex analysis of polymerase chain reaction products to support the possible transmission of Legionella pneumophila from a malfunctioning automobile air conditioner.

Air conditioner condensates have not been previously associated with cases of Legionnaires' disease. We report the possible transmission of Legionella pneumophila serogroup 1 from a malfunctioning automobile air conditioning system's leaking water onto the floorboard of a car driven for a long distance by the patient. Heteroduplex analysis of polymerase chain reaction products was used to help establish an epidemiologic link between the water specimen and the patient.