A rare agent of continuous ambulatory peritoneal dialysis peritonitis: Rhizobium Radiobacter.

Peritonitis is a common clinical problem in patients treated by continuous ambulatory peritoneal dialysis (CAPD). The most common microbiological factors causing peritonitis are Gram-positive (especially Staphylococcus spp.). Peritonitis with Rhizobium radiobacter (Agrobacterium radiobacter) is a rare infection in CAPD patients. Peritonitis due to R. radiobacter has been reported in our patient's dialysate culture who underwent CAPD for three years. We report the case of a 26-year-old female PD patient who had CAPD peritonitis due to R. radiobacter and successfully treated with intraperitoneal vancomycin and oral ciprofloxacin without relapses or removing the PD catheter.

A Comparative Study of the Effects of Intravitreal Anidulafungin, Voriconazole, and Amphotericin B in an Experimental Candida Endophthalmitis Model.

PURPOSE: To compare the safety and efficacy of intravitreal anidulafungin injection with voriconazole and amphotericin B (Amp B) in an experimental Candida endophthalmitis (CE) model. METHODS: Intravitreal 1 × 105 CFU/0.1 ml Candida albicans was injected into the right eyes of 24 New Zealand rabbits, which were divided into 4 groups. Voriconazole 50 µg/0.1 ml, Amp B 10 µg/0.1 ml, and Anidulafungin 50 µg/0.1 ml were injected by intravitreal injection 72 h after inoculation. The control group was injected with 0.1 ml 0.9% NaCl. Clinical scoring was performed by assessing the cornea, conjunctiva, iris, and vitreous on days 3 and 7 of therapy. At the end of the study, the right eyes of all rabbits were enucleated and histopathological evaluation was performed. Therapy groups were compared according to the clinical, histopathological, and microbiological analysis scores. RESULTS: Total clinical scores were significantly different between treatment groups and the control group (p < 0.05). On day 7 of the therapy, clinical scores of the anidulafungin group were found to be significantly lower when compared with the other therapy groups, while a significant improvement was observed in the eyes of rabbits in the anidulafungin group (p < 0.05). Also, microbiological scores of the anidulafungin group were lower than those of the control group (p < 0.05). Histopathological scores of the anidulafungin treatment group were significantly better than the voriconazole and control groups. Inflammation was evidently suppressed and marked retinal toxicity was not observed with anidulafungin. CONCLUSIONS: This is the first study comparing the efficacy of anidulafungin with other antifungal agents. In this CE model, an intravitreal single dose of anidulafungin was shown to be noninferior to voriconazole and Amp B. As an alternative to Amp B or voriconazole, intravitreal anidulafungin is suggested as an effective antifungal agent for the treatment of CE.

[Comparison of conventional methods and real-time multiplex polymerase chain reaction for identification and typing of Brucella isolates of human origin]. / Insan Kaynakli Brucella izolatlarinin tanimlama ve tiplendirmesinde konvansiyonel yöntemler ile gerçek zamanli multipleks polimeraz zincir reaksiyonunun karsilastirilmasi.

Brucellosis which is a worldwide zoonotic disease, still constitutes a major public health problem in rural areas of Turkey. The aim of the present study was to evaluate the species and biovar distribution of 187 presumptive Brucella strains isolated from patients inhabiting at the provinces in Eastern, South Eastern and Mediterranean regions over a 7-years period (from 2001 to 2007) and to compare multiplex real-time-polymerase chain reaction (M-RT-PCR) and conventional biotyping for the differentiation of three Brucella species. The isolates were identified at genus level by conventional microbiological methods and classified using the classical Brucella species biotyping scheme based on CO2 requirement for growth, urease activity, H2S production, sensitivity to basic fuchsin and thionin (20 and 40 µg/ml), lysis by Tbilisi and Berkeley phages, and agglutination with monospecific antisera for A and M antigens. All Brucella isolates were identified as Brucella melitensis biovar 3. M-RT-PCR assay targeted bcsp31 gene and the specific integration of IS711 elements within the genome of the respective Brucella species. For the identification of Brucella spp. The primers and probes which targeted the bcsp31 gene were used. The Brucella abortus primers and probe set targeted the specific insertion of an IS711 element downstream of the alkB gene, whereas the B.melitensis primers and probe set targeted the insertion of an IS711 element downstream of BMEI1162. M-RT-PCR results were found to be 100% compatible with the reference conventional typing methods. Due to its high sensitivity, the M-RT-PCR assay could be a valuable tool for the rapid detection and differentiation of Brucella species in clinical samples which usually have very low bacterial load. These findings indicated that B.melitensis biovar 3 was by far the most frequent species for human brucellosis in these specific regions of Turkey and multiplex-RT-PCR seemed to be promising in the detection and differentiation of Brucella species.

Multiple-locus variable-number tandem-repeat analysis genotyping of human Brucella isolates from Turkey.

A multiple-locus variable-number tandem-repeat analysis (MLVA) was applied to investigate the epidemiological relationship and genetic diversity among 162 human Brucella isolates collected from all geographic regions of Turkey in an 8-year period (2001 to 2008). The isolates were genotyped by using an MLVA assay developed in Orsay, France (MLVA-16(Orsay)) including eight minisatellite (panel 1) and eight microsatellite (panel 2, subdivided into 2A and 2B) markers. Panels 1 and 2A distinguish 14 genotypes; two of these represented 85% of the strains. Panel 2B displayed a very high discriminatory power. Three loci from panel 2B had diversity index values higher than 0.74. MLVA-16(Orsay) yielded 105 genotypes; 73 were represented by a unique isolate, and 32 included two to eight isolates. The isolates from different patients within the same outbreak or from the same patient before first-line therapy and after relapse showed identical genotypes. A number of MLVA genotypes appeared to be partially restricted to some geographic areas and displayed no annual variation, possibly reflecting persistence of genotypes in certain areas for a time span of at least a decade. This study, representing the first molecular typing results of human Brucella isolates from Turkey, indicated that Turkish human Brucella melitensis isolates were most closely related to the neighboring countries' isolates included in the East Mediterranean group.

[Tularemia seroprevalence in the risky population living in both rural and urban areas of Erzurum]. / Erzurum Merkez ve Kirsalinda Yasayan Riskli Gruplarda Tularemi Seroprevalansi

Tularemia which is a zoonotic infection, caused by Francisella tularensis, has become a re-emerging disease in Turkey. Infection is often transmitted to human by handling animal tissues and products, but it is also possible to acquire the disease from contaminated water or food. Recently several cases and epidemics of tularemia have been reported in the northwest areas of Turkey, particularly in Marmara and West Black Sea regions. Erzurum is a city in Eastern Anatolia Region, Turkey and animal husbandry is the main agricultural activity in that area. However, neither tularemia cases were reported from this province nor seroprevalence studies were performed. In this study we aimed to determine F.tularensis antibody seropositivity in the risky population living at both rural and urban area of Erzurum. Blood samples from 240 volunteer subjects (134 male with mean age: 36.2, age range: 17-75 years and 106 female with mean age: 39.1, age range: 16-77 years) whose occupations were farming and animal husbandry, were included in the study. Serum samples were screened for the presence of F.tularensis antibodies by slide agglutination method (BD, USA) and Serazym ELISA kit (anti-F.tularensis IgG/IgA/IgM, Seramun, Germany). The positive samples with those tests were also retested by microagglutination test (MAT) in National Tularemia Reference Laboratory of Refik Saydam Hygiene Center, using antigen prepared in the same laboratory from the local strain. The serum samples were also searched for the presence of Brucella and Salmonella antibodies in terms of cross-reactivity. Seropositivity was detected in 71 (29.6%) out of 240 subjects by slide agglutination test (SAT), whereas only 5 (2.1%) gave positive result for total antibody by ELISA. Twenty-five of the 71 SAT positive samples yielded F.tularensis antibodies by MAT, of which 21 were between 1/20-1/40 and four were between 1/80-1/160 titers. However, all of the MAT positive samples (n= 25) were found reactive in Brucella and/or Salmonella antibody tests. One of the four MAT positive samples with 1/40 titer and all of the four MAT positive samples with ≥ 1/80 titer yielded positive results in ELISA. Since MAT gave very high cross reactive results, the five subjects (2.1%) found positive with ELISA were evaluated as seropositive for tularemia. Of those subjects (four were female, one was male; age range: 27-38 years), four were the inhabitants of the same village, and one from another neighboring village. All of the seropositive subjects were dealing with raising livestock and two were also farming. No history of contact with rat and wild animals or tick bite were detected, however it was noted that non-chlorinated fountain water has been used in both of these villages. In conclusion, our data emphasized that, populations inhabiting especially in rural area and dealing with farming and stock raising in our region are at risk for tularemia.

The effects of diabetes and/or polymicrobial sepsis on the status of antioxidant enzymes and pro-inflammatory cytokines on heart, liver, and lung of ovariectomized rats.

BACKGROUND: The rat sepsis model in the present study was used to understand the role of sustained hyperglycemia and ovariectomy, either separately or together, on the response of pro-inflammatory mediators and oxidative response. MATERIALS AND METHODS: Polymicrobial sepsis was induced using cecal ligation and two-hole puncture. Diabetes was induced in the female Wistar albino rats using intraperitoneal administration of aqueous alloxan monohydrate at a single dose of 150 mg/kg body weight. The rats were divided into five groups: sham control: group 1, ovariectomy: group 2, ovariectomy + sepsis: group 3, ovariectomy + diabetes: group 4, and ovariectomy + diabetes + sepsis: group 5. RESULTS: In lung, heart, and liver tissues, the levels of myeloperoxidase (MPO) and lipid peroxidation (LPO) were higher for the groups 3, 4, and 5 than in control group. In heart and liver tissues, superoxide dismutase (SOD) and catalase (CAT) activities were higher for the groups 3, 4, and 5 than control group. In lung tissue SOD activities were higher for the groups 3, 4, and 5 than in control group. Diabetes + ovariectomy caused a significant increase in serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) in comparison to the sham group. The strongest production of TNF-α and IL-6 in serum was observed in the group 5. CONCLUSIONS: Hyperglycemia and ovariectomy (postmenopausal period) severely increased serum cytokines and oxidant levels with the stages of our sepsis model. The lung tissue was most affected by diabetes and ovariectomy under sepsis conditions. Ovariectomy leading to estrogen deficiency results in general changes in metabolism, which are seen in the liver, lungs, and heart with diabetes under sepsis conditions.

The effects of polymicrobial sepsis with diabetes mellitus on kidney tissues in ovariectomized rats.

OBJECTIVES: Sepsis model was used to understand the role of sustained hyperglycemia and ovariectomy, either separately or concomitantly, on the response of the activity of the nuclear factor kappa B (NF-kappaB) and the oxidative response in kidney. SUBJECTS: Polymicrobial sepsis was induced by cecal ligation and puncture (CLP). Diabetes was induced in female rats using administration of alloxan. The rats were divided into five groups: sham control (group 1), ovariectomy (group 2), ovariectomy + sepsis (group 3), ovariectomy + diabetes (group 4), and ovariectomy + diabetic + sepsis (group 5). RESULTS: In kidney tissues, the levels of lipid peroxidation (LPO) and glutathione (GSH) and the activity of catalase (CAT) were higher for groups 3, 4, 5 than the control groups. Superoxide dismutase (SOD) activity was lower for groups 3, 4, 5 than the control groups. We determined that CLP produced injury evident in the kidneys of rats when compared to the control group, whereas the severity of the injury was higher in the diabetes + ovariectomy + CLP group when compared to the CLP group. In immunohistochemical staining, we determined that CLP operation increased NF-kappaB activation. In the ovariectomized, septic, and diabetic group, NF-kappaB activation was significantly higher than other groups. CONCLUSIONS: Hyperglycemia and ovariectomy severely increased NF-kappaB activation and oxidant levels with the stages of our sepsis model. Ovariectomy resulted in general changes in metabolism, which are seen in the kidney with diabetes under sepsis conditions.

Alpha-lipoic acid as a potential target for the treatment of lung injury caused by cecal ligation and puncture-induced sepsis model in rats.

One of the common lethal complications of septic shock, a major cause of morbidity and mortality in patients with severe trauma and so on, is acute lung injury. alpha-Lipoic acid (ALA), with antioxidant properties, is a popular agent. Thus, we investigated the potential protective effects of ALA (200 mg/kg) on sepsis-induced acute lung injury. Rats were exposed to cecal ligation and puncture (CLP) to induce sepsis. Rat groups were designed as (a) sham operated, (b) sham operated + ALA treated, (c) CLP applied, (d) CLP + ALA treated. Sixteen hours after CLP induction, serum samples and lung tissues were obtained for biochemical and histopathological examination. alpha-Lipoic acid decreased the serum levels of inflammatory cytokines such as TNF-alpha and IL-6, which increased after CLP. Increased activity of nuclear factor kappaB in septic lung tissues was decreased by ALA. alpha-Lipoic acid improved the decreased antioxidant activity and alleviated the increased oxidant activity, which occurred after CLP application. We can suggest that ALA showed beneficial effects by decreasing nuclear factor kappaB activation in lung tissues, resulting in decreased serum levels of TNF-alpha and IL-6, and also increasing the antioxidant capacity of the lungs.

Antibodies directed to cyclic citrullinated peptides in familial Mediterranean fever.

The aim of this study was to find the prevalence of anti-cyclic citrullinated peptide (anti-CCP) in patients with familial Mediterranean fever (FMF) and to examine the relationship between anti-CCP and joint findings. We measured the serum levels of the anti-CCP antibodies in patients with FMF (n = 55) and healthy controls (n = 43). Serum levels of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen, ferritin, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) were also measured in all the samples. Fibrinogen, ferritin, erythrocyte sedimentation rate (ESR), and RF levels were normal in the patient and the control groups (P > 0.05). There was a significant difference in anti-CCP between the patient and the control groups (P = 0.008). There was a positive correlation between arthritis and anti-CCP (P = 0.001). In patients without arthritis, there was no significant relationship between abdominal pain or fever and anti-CCP (P > 0.05). Anti-CCP levels increased in FMF patients with arthritis independent from acute phase reactants such as CRP, ESR, and fibrinogen. We conclude that in patients who are under investigation for arthritis, the ones with positive anti-CCP and negative RF, may be examined for FMF. In addition, we also conclude that it is very likely that FMF patients with anti-CCP antibodies will have signs of arthritis. On the other hand, it is possible that long-term follow-up of the FMF patients with anti-CCP antibodies may reveal the eventual development of inflammatory joint disease.

Relationships between intestinal parasitosis and handedness.

The aim of the study was to investigate if there is a possible relation between intestinal parasitosis and handedness in patients with suspected intestinal parasitosis. Hand preference was assessed on the Edinburgh Handedness Inventory. Stool samples were examined microscopically for the presence of parasite. In the present study right-handers had many more helminth infections and left-handers had many more protozoon infections. Lower rate of helminth infections in the present study, and higher asthma incidences in the left-handed population in literature, may be associated with different immune machinery in left-handed people than in right-handed ones.

Atypical Colony Morphology of Staphylococcus lugdunensis Isolated from a Wound Specimen.

The incidence of infections due to coagulase-negative staphylococci (CoNS) has been steadily increasing in recent years. In this report, we describe an isolate of the CoNS Staphylococcus lugdunensis from a wound specimen with a colony morphology distinct from that of a classical S. lugdunensis colony. Specifically, wrinkled, medium-sized, beta hemolytic, opaque, rough white colonies were detected on blood agar. Catalase-positive, coagulase-negative, gram-positive cocci-yielding such colonies should be suspected of being S. lugdunensis.

Aural Myiasis by Wohlfahrtia magnifica: Case Report.

A 5-year-old child living in Erzurum, Turkey, complaining of otalgia, otorrhea and pruritus in the right ear for three days, was examined. Otoscopic examination at the Department of Otorhinolaryngology revealed live maggots in the external auditory canal. Ten maggots were recovered and were identified as third stage larvae of Wohlfahrtia magnifica (Diptera: Sarcophagidae). Local and systemic antibiotic therapies were applied. No pathological findings were present at the follow-up examination after 15 days of therapy.

Effects of cirrhosis on bone mineral density and bone metabolism.

OBJECTIVE: The present study was undertaken to examine the correlation between the severity of liver disease and the presence and severity of bone disease in patients with hepatic cirrhosis. MATERIALS AND METHODS: Between January 2005 and February 2006, 40 patients with cirrhosis and 22 healthy controls were enrolled in a cross-sectional study. All subjects underwent standard laboratory testing and bone densitometric studies of the lumbar spine and femoral neck using dual X-ray absorptiometry (DEXA). RESULTS: Cirrhotic patients had lower serum follicle-stimulating hormone (FSH) levels than controls. Male patients had lower serum free testosterone (fT) levels than male controls. 25-hydroxyvitamin D (25-OHD3) levels were significantly higher in the controls as compared to patients with cirrhosis. In the cirrhotic group, 25-OHD3 concentrations did not differ significantly between patients with Child B and C class cirrhosis. As compared to the control group, cirrhotic patients had significantly elevated levels of urinary deoxypyridinoline (DPD). The cirrhotic patients also had a significantly lower mean spinal (SD) bone mineral density (BMD) than the control group. BMD of the lumbar spine (LS) was noted to be significantly lower in the Child C group than in the Child B group. In the cirrhotic patients, there was a positive correlation between the BMD T score of the femoral neck (FN) and albumin levels whereas there was a negative correlation between BMD T scores of the FN and age, bilirubin and prothrombin time (PT). CONCLUSION: Osteopenia and osteoporosis are highly prevalent in individuals with liver cirrhosis. Cirrhotic patients should undergo routine bone densitometric assessment and, if necessary, be treated for osteoporosis.

Evaluation of quinolone resistance in gram negative bacilli isolated from community- and hospital-acquired infections.

OBJECTIVE: Gram negative bacilli are among the most important microbial agents involved in both hospital- and community-acquired infections. The quinolones are preferred antibacterial agents for the treatment of both community- and hospital-acquired urinary tract infections caused by gram negative bacilli because of their strong antibacterial effects, and because they can be administered both orally and parenterally. In this study, it was aimed to determine the sensitivity of gram negative bacteria isolated from both hospital- and community-acquired infections, to quinolones. MATERIALS AND METHODS: Bacterial strains used in this study were isolated from pathologic samples of patients who were treated in different clinics or who were admitted to the polyclinics of Atatürk University Research Hospitals. Susceptibility to ciprofloxacin, levofloxacin, ofloxacin and norfloxacin was assessed for all strains included in the study via the Kirby-Bauer disk diffusion method according to CLSI criteria. RESULTS: Of the 205 strains tested, 116 (56.5%) were from community-acquired infections, and 89 (43.5%) were from hospital-acquired infections. Resistance rates of community-origin strains against ciprofloxacin, ofloxacin and levofloxacin were 25%, whereas they were 26.7% against norfloxacin. Ciprofloxacin was the most effective quinolone (65.2%) against hospital-origin strains. E. coli was the most commonly isolated etiological agent from both community- and hospital-acquired infections. CONCLUSION: In this study, resistance to quinolones was observed for gram negative bacilli isolated from both hospital- and community-acquired infections, with the exception of community-acquired Salmonella and Shigella. Thus, these drugs should not be used empirically in the treatment of infections caused by gram negative bacilli, and susceptibility test results should be considered when planning therapy.

Submandibular tuberculous lymphadenitis after endodontic treatment of the mandibular first premolar tooth: report of a case.

Cervical tuberculous lymphadenitis (scrofula) is an infectious granulomatous disease that requires a precise diagnosis. The differential diagnosis involves mainly the pathologic conditions involving the regional lymph nodes and the submandibulary salivary glands. Although tuberculous lesions generally develop secondary to pulmonary disease, clinical manifestations are occasionally seen with no evidence of involvement of the lungs. In this report, a case of tuberculous submandibular lymphadenitis developing after endodontic treatment of the mandibular first premolar tooth is described.