Alterations of serum cytokine levels and their relation with inflammatory markers in candidemia.

The roles of CRP, PCT, serum amyloid A (SAA), and cytokines in the diagnosis of fungal infections have not yet been clearly demonstrated. This study aims to measure the serum levels of interleukin (IL)-23, IL-17, IL-1ß, tumor necrosis factor (TNF)-α, IL-10, transforming growth factor (TGF)-ß, C-reactive protein (CRP), procalcitonin (PCT), and serum amyloid A (SAA) in cases of candidemia and to compare them with those observed in cases of bacteremia. For this purpose, the serum cytokine levels from 50 patients with candidemia were compared with those of 14 patients with polymicrobial sepsis, 30 patients with bacteremia, and 27 healthy control subjects. The cytokine levels were studied using sandwich ELISAs according to the manufacturer protocol. The serum levels of TGF-ß, IL-23, and IL-17 were found to be significantly higher in the candidemia group in comparison with the samples from those with bacteremia and healthy controls. The PCT and SAA levels were higher in samples from the group with bacteremia those from individuals with candidemia and the healthy control group. Assuming an IL-17 level threshold of >38.79 pg/ml, the sensitivity and specificity were 38% and 96.6%, respectively but considering an IL-23 threshold of >59.97 pg/ml, the sensitivity and specificity values were found to be 72% and 60%, respectively. The sensitivity and the specificity of the TGF-ß levels were found to be 85.71% and 53.33%, respectively, when the TGF-ß threshold is >560 pg/ml. PCT and SAA demonstrated a superior performance for the differentiation of candidemia and bacteremia. Our study demonstrates that IL-17, IL-23, TGF-ß, PCT, and SAA levels could be a diagnostic marker for candidemia.

Colonisation in adult patients with nosocomial candidemia.

The aim of this prospective study was to investigate the association between Candida spp. isolated from blood culture and the colonisation of different anatomical sites of patients with candidemia, and to evaluate the colonisation dynamics and Pittet's index. Cultures were collected from the different anatomical sites of all the patients within 24 h of diagnosis of candidemia. Molecular similarities between identical species colonised with Candida species were evaluated via karyotyping. The colonisation index, as developed by Pittet et al. was calculated using screening culture results from patients. Among the 40 patients screened for colonisation, 35 (87.5%) had colonisation of at least one anatomical site. Twenty-six (74.3%) of the 35 patients with colonisation in any of the three anatomical sites (respiratory, rectum and urinary sites) were shown to be colonised with the same species that caused candidemia. When the anatomical sites were compared with each other, no significant difference was observed at the species level in terms of colonisation index. The colonisation index (≥ 0.5) positivity rate was 74% in patients with candidemia. The investigation of Candida colonisation of at least three anatomical (respiratory, rectum and urinary) sites could help in the selection of empirical antifungal therapy when nosocomial candidemia is suspected.

[Polyclonal activation due to Epstein-Barr virus superinfection in a case with chronic hepatitis B]. / Kronik B hepatitli bir olguda Epstein-Barr virus süperenfeksiyonuna bagli poliklonal aktivasyon.

Primary infection with Epstein-Barr virus (EBV) often occurs subclinically during childhood, resulting in a latent infection of B lymphocytes. In this report, a chronic hepatitis B case who presented with a serologic profile mimicking acute hepatitis B virus (HBV) infection and exhibiting transient autoantibody positivities because of the polyclonal activation of B cells due to EBV reactivation has been presented. The test results of 56 years old male patient who suffered from fatigue and pain on the right upper quadrant, revealed high levels of liver enzymes (AST: 187 U/L, ALT: 569 U/L), positivity of HBsAg, anti-HBc IgG and anti-HBe, and negativity of anti-HBc IgM, HBeAg and anti-HBs. Since HBV-DNA level was found 405,974 copies/mL by quantitative real time polymerase chain reaction (PCR), the patient was taken into follow-up. At the 6th month AST and ALT levels further elevated (352 U/L and 609 U/L, respectively), and anti-HBc IgM and anti-HBs became positive in addition to the previous positive markers of HBV. With the suspicion of superinfection, further laboratory investigations yielded negative results in CMV-IgM and Paul Bunnel test, while positive results in EBV anti-VCA IgM and IgG, anti-EBNA IgM and IgG, anti-p22 IgM and IgG and anti-EA IgM. In the follow-up period high levels of autoantibody positivities [rheumatoid factor (42.200 U/ml), anti-nuclear antibody (1/100) and anti-Ro-52] together with increased levels of total IgG, IgM and IgA were detected. In the following months, the levels of transaminases, total immunoglobulins and HBV-DNA have distinctively decreased, and in the 20th month the previous HBV profile regained (HBsAg, anti-HBc IgG and anti-HBe positive, anti-HBc IgM and anti-HBs negative, HBV-DNA: 6984 copies/ml) and the other pathological test results returned to normal. As a result, ALT increases seen during the course of chronic hepatitis B should not always be considered as HBV manifestations and the unusual serologic patterns should be evaluated as a consequence of superinfection with various viral agents.