Can chitotriosidase be a surrogate marker for invasive fungal disease?

BACKGROUND: Chitotriosidase (CHT) enzyme has been known to be secreted from the activated macrophages. We infer with these data that CHT activity is an indicator for the defence. METHODS: In this study, we evaluated CHT levels in both neutropenic and non neutropenic patients. CHT enzyme activity was measured and compared to each other groups. RESULTS: Chitotriosidase levels were found to be significantly higher in neutropenic patients with candidemia. CONCLUSION: In the comparison between neutropenic and non neutropenic patients, there was a significant difference for CHT levels. The use of this enzyme as a surrogate marker for candidemias were evaluated in neutropenic and non neutropenic patients.

Immune status of individuals with differing clinical courses of HBV infection.

The immune reactivity of individuals with 3 types of clinical hepatitis B virus infection and a normal control group were compared. The groups studied were individuals with acute hepatitis, chronic hepatitis, chronic carriers and normal controls. Although the groups differed in terms of the number of circulating lymphocytes, T cells, B cells, calculated helper (CD4+)/suppressor (CD8+) ratios as well as skin test reactivity to a panel of widely recognized antigens, no consistent pattern was recognized for any group and responses observed did not support current hypotheses with the goal to explain the different clinical patterns of HBV infection.

The diagnosis and treatment of Clostridium difficile in antibiotic-associated diarrhea.

BACKGROUND/AIMS: This study was initiated to evaluate the role of C. difficile in diarrhea associated with the use of antibiotics, to determine which antibiotics are most often responsible, to characterize the response to several different treatment regimens, and to define the relapse rate as seen in a large teaching hospital in Turkey. METHODOLOGY: Three different patient groups were studied. The first group consisted of 154 individuals with antibiotic-associated diarrhea. The stools of all 154 cases were cultured on cycloserine-cefoxitin-fructose agar (CCFA). If any bacteria grew out, they were identified specifically as C. difficile using a commercially available latex agglutination kit specific for bacterial antigens of C. difficile (MicroScreen C. difficile Latex Slide Test; Merica Diagnostic Limited, Guilford, England). The presence of toxin-A (CDTA) was determined using a MicroScreen CDTA Enzyme Immunoassay kit. RESULTS: The stools of 31 of these patients grew out enteric pathogens. Twenty-eight of these 31 were CCFA positive. Three different drug regimens (Ornidazole, Ornidazole + Cholestyramine, and Vancomycin) were used to treat these 28 C. difficile positive cases. The second group consisted of 37 hospitalized patients who had been in hospital for more than 30 days without any gastrointestinal symptoms. This group was used to identify the in-hospital carrier rate for C. difficile. Stools from these 37 cases were cultured on CCFA and were analyzed for the presence of CDTA by EIA. Colonization with C. difficile was detected in 4 cases. The third group consisted of 40 healthy subjects who served as a population-based control group. The stools obtained from these 40 cases were cultured on CCFA and analyzed for CDTA as were the stools for the other 2 groups. None were CDTA positive. One case was positive for the presence of non-toxigenic C. difficile. CONCLUSIONS: It can be concluded from these data that, in Turkey, C. difficile is responsible for 20% of antibiotic-associated diarrheas. Lincomycin, Azithromycin and Ampicillin were most often associated with the development of antibiotic-associated diarrhea. Ornidazole and Vancomycin were effective agents for C. difficile-associated diarrhea with the latter agent being associated with no relapses.

Interferon therapy of Turkish patients with chronic hepatitis B virus infection.

BACKGROUND/AIMS: The efficacy of alpha interferon therapy in Turkish individuals with chronic hepatitis B virus infection was examined. METHODOLOGY: Sixty-one patients (54 males and 7 females) were studied between 1992 and 1996. Their mean age was 33.4 years (range: 20-57). Each was treated with 4.5 million international units interferon alpha 3 times a week for 24 weeks. Serum alanine aminotransferase (ALT) levels and hepatitis B virus markers (HBsAg, HBeAg, anti-HBe, and HBV DNA) were monitored. A liver biopsy was obtained before and 6 months after the termination of interferon therapy. RESULTS: Before treatment, the serum ALT level was elevated in all 61 subjects. Six months after the termination of therapy, 23 (38%) had a normal serum ALT level. In all patients, before the start of therapy and 6 months after the termination of therapy, HBsAg was detectable. In 36 (59%), HBeAg was present and anti-HBe was not detectable in serum before the initiation of therapy. In 12 (33%), the serum was negative for HBeAg and positive for anti-HBe 6 months after the termination of therapy. HBV DNA was detectable in all serum samples before the onset of therapy and disappeared in 14 (23%) patients, and continued to be undetectable 6 months after the termination of interferon therapy. Histological improvement defined by an improvement in the Knodell score of 2 points or more was observed in 38 (62%). CONCLUSIONS: Interferon therapy eliminates serum markers of active hepatitis B virus infection (eAg and HBV DNA) and is associated with histological improvement in 30-60% of Turkish patients with chronic HBV infection. Interferon therapy did not eliminate sAg from the serum and the histologic improvement achieved was often incomplete.

A comparative trial of two surface subunit recombinant hepatitis B vaccines vs a surface and PreS subunit vaccine for immunization of healthy adults.

Hepatitis B virus (HBV) infection is the leading cause of chronic hepatitis and cirrhosis in Turkey. The prevalence of hepatitis B surface antigen (HBsAg) positivity in Turkey is 5 to 10%. HBV is almost completely preventable with the use of hepatitis B vaccines. The most commonly used vaccine is that which contains the predominant viral surface (S) polypeptide. It elicits protective antibodies in greater than 90% of healthy subjects. A vaccine containing the PreS1 and PreS2 antigenic domains has recently been reported as being more efficient in achieving successful immunization in individuals who have not previously responded to the isolated S-antigen vaccine. In this study, the efficacy of a S and PreS-containing vaccine was compared with that of two different standard isolated S-antigen-containing vaccines in terms of the immunization protection produced against HBV in normal healthy adults who had not previously been immunized. Seventy-six young adults (aged 17-22) were randomly assigned to receive 1 ml (20 micrograms) of either one of two standard S-subunit recombinant hepatitis B vaccines (Engerix B. or Hepavax) or the combined S and PreS subunit vaccine (Gen Hevac B) intramuscularly in the deltoid muscle at 0, 1 and 2 months. Hepatitis B surface antigen antibody titres were measured at 1, 2 and 12 months. A titre > or = 10 IU ml-1 was considered to be protective. All subjects receiving the two standard isolated S-antigen-containing vaccines responded to the vaccination with reasonable antibody titres. One-half to two-thirds of those vaccinated developed high antibody titres (> 100 IU ml-1). In contrast, 9% of those receiving the combined PreS1 and PreS2 plus S antigens failed to respond, as demonstrated by antibody titres below the level considered to be protective. The mean titres at 12 months were 107 +/- 12 IU ml-1 (Engerix B), 102 +/- 12 IU ml-1 (Gen Hevac B) and 117 +/- 12 IU ml-1 (Hepavax Gene). Hence, no important difference in term of response to vaccination was found between the two different types of vaccines. As recombinant S-subunit vaccines are less expensive than those that combine S and PreS antigens, it is suggested that, when immunizing normal healthy adults, a standard isolated S-antigen-containing vaccine should be used.

Use of interferon for the treatment of chronic hepatitis C in the elderly.

Hepatitis C virus is a worldwide health care problem. It affects all age groups. Many patients have had the infection for 20-30 years before they present for therapy. With a peak incidence of disease in the 30-40 year age group, it is obvious that a large number of cases must occur in the elderly (age > 65 years). Of these, a fraction progress to cirrhosis and hepatocellular carcinoma. Interferon is the only agent approved for use in patients with chronic hepatitis C. The efficacy of interferon in younger patients is reported to be 50%. Half of these will experience a relapse within 1 year. There are few studies assessing the role of interferon used for elderly patients with chronic hepatitis C. The reported response rate to interferon in elderly patients was 60%, with 30% having a virologic/complete response. These studies demonstrate that the elderly tolerate interferon reasonably well. No significant differences have been reported between elderly and young treatment groups.

[Nose and throat carriage in "food handlers"]. / "Gida elleyicileri"nde burun ve bogaz portörlügü.

From December 1991 to February 1992, 450 personnel have been investigated for pathogen microorganisms in their nose and throat. The study was performed in the Infectious Diseases Section of Gülhane Military Medical Academy. Pathogen microorganisms have been isolated from 54 nose culture (12%) and 6 throat culture (1.33%). In one person pathogen microorganisms have been isolated from his nose and throat. The difference between the two groups (The nose and throat cultures) was significant at p = 0.001 by Fisher's exact test (t = 6.414). In the nose cultures the pathogen microorganisms were Staphylococcus aureus (85.2%), Proteus vulgaris (5.6%), Proteus mirabilis (3.7%), Klebsiella pneumoniae (1.8%), Citrobacter freundii (1.8%), Group C beta-hemolytic streptococcus (1.8%) and Pseudomonas aeruginosa (1.8%). Only one (1.85%) had two different pathogen microorganisms (Staphylococcus aureus and Proteus vulgaris) in his nasal culture. In the throat cultures the pathogen microorganisms were Staphylococcus aureus (66.7%) and group A beta-hemolytic Streptococcus (50%). Only one (16.6%) had two different pathogen microorganisms (S.aureus and group A beta-hemolytic Streptococcus) in his throat culture. The same pathogen microorganisms (S.aureus) has been isolated in an only one person's nasal and throat cultures (0.22%). We treated 60 personnel who were nasal and throat carriers according to the results of antibiograms. After treatment, two still had previous pathogen microorganism (Staphylococcus aureus). These two carriers were eradicated by repeating the treatment.