The effect of melatonin on antifungal susceptibility in planktonic and biofilm forms of Candida strains isolated from clinical samples.

In recent years, the significant increase in the isolation of antifungal resistant Candida species in presence of biofilm, have made it necessary to develop alternative agents for the treatment of these infections. In this study, the effect of antifungal susceptibility of melatonin were investigated in planktonic and biofilm forms of Candida strains isolated from the clinical samples sent to our laboratory. Biofilm formation was determined by modified microplate method. In order to determine antifungal susceptibility in biofilm-forming strains, MIC was determined by broth microdilution method in planktonic form, and MBEC values by Calgary biofilm method in biofilm form. Susceptibility tests were repeated in the presence of melatonin. Antifungal susceptibility tests repeated with antifungals combined with melatonin showed a decrease in both MIC and MBEC values; melatonin was found to be more effective especially in planktonic forms. While the most effective combination was achieved with fluconazole in the planktonic form, no statistically significant difference was found between the combinations in biofilm form. As a result, melatonin was thought to be a new alternative in the treatment of Candida infections.

Investigation of plasmid mediated AmpC beta-lactamases in Escherichia coli and Klebsiella pneumoniae isolates by phenotypic and genotypic.

OBJECTIVE: To investigate the susceptibility and specificity of the phenotypic methods to determine plasmidmediated AmpC. METHODS: The cross-sectional study was conducted at Duzce University Faculty of Medicine, Microbiology Laboratory from January 2015 to June 2016, and comprised Escherichia coli and Klebsiella pneumonia isolates intermediate susceptible or resistant to cefoxitine. Combined disk diffusion test, double disc synergy test, agar gradient test and polymerase chain reaction were used to detect plasmid-mediated AmpC. RESULTS: Of the 2024 E. coli samples, 44(2.17%), and of the 792 K. pneumoniae samples, 16(2%) were included. Combined disk diffusion test had susceptibility of 68% and specificity of 50%; double disc synergy test 24% and 82%; and agar gradient test 40% and 68%. Of the isolates positively detected by polymerase chain reaction method, more than one gene region positivity was detected in 15(25%) isolates. CONCLUSION: All three phenotypic methods were found to be insufficient to detect plasmid-mediated AmpC positivity.

Seroprevalence of hantavirus and Borrelia burgdorferi in Düzce (Turkey) forest villages and the relationship with sociodemographic features

Background/aim: Hantavirus and Borrelia burgdorferi are two zoonotic agents that pose a great risk especially for people living in forest areas. This study aimed to investigate the seroprevalence of hantavirus and B. burgdorferi in forest villages of Düzce and its relationship with sociodemographic features. Materials and methods: The presence of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against hantavirus and B. burgdorferi in serum samples was investigated via enzyme-linked immunosorbent assay (ELISA). Hantavirus IgG and B. burgdorferi IgM and IgG positivity was then validated by western blot (WB) method. Results: During the analyses, 193 serum samples were tested. Eleven (6%) cases of hantavirus IgM was found positive by ELISA. Six (3%) cases of hantavirus IgG, 3 (2%) cases of B. burgdorferi IgM, and 12 (6%) cases of B. burgdorferi IgG were found positive by WB. Borrelia burgdorferi IgG positivity was found to be higher in the 46­70 age group and it was seen that the positivity was the highest among those who lived in mud-brick houses. Conclusion: This study was the first to determine the frequency of hantavirus in the study region and it includes current data for B. burgdorferi. Consequently, it is recommended that similar studies be carried out on rodents in all the regions at risk.

[Investigation of Mycobacterium bovis subsp. bovis among the strains of Mycobacterium tuberculosis complex isolated in Düzce Province, Turkey]. / Düzce ilinde izole edilen Mycobacterium tuberculosis kompleks suslarinda Mycobacterium bovis subsp. bovis varliginin arastirilmasi.

Throughout the history of mankind, tuberculosis (TB) has caused serious illness and still continues to do so. Archaeobiological studies indicated that TB in humans dates back to 4000-8000 BC, and cases were shown to be due to Mycobacterium bovis subsp.bovis rather than Mycobacterium tuberculosis. Moreover, this situation was thought to begin with domestication of animals, consumption of their milk, and living together in the same environment with them. Over time, with the consumption of boiled milk and with the establishment of separate animal shelters, M.bovis subsp. bovis infection began to be seen rarely. Today, M.bovis infection is mostly transmitted from animals to humans and very rarely from humans to other humans. The most significant means of transmission of the infection are to the gastrointestinal tract via consumption of raw milk and to the respiratory system via droplet infection from the animals with disease. In this study, it was planned to investigate the cause of occurrence of TB in cattles in Düzce in the past few years along with the presence of bovine type TB in cases of human tuberculosis. We aimed to carry out subtype determination of the M.tuberculosis complex (MTBC) strains isolated in our mycobacteriology laboratory between the years 2004-2014, and evaluate the clinical and sociodemographic data of patients in whom M.bovis subsp. bovis was detected. The strains that were selected for the study have been isolated from radiometric BACTEC™ 12B broth and/or Löwenstein-Jensen (LJ) media between 2004-2009, and BACTEC™ MGIT™ (Mycobacteria Growth Indicator Tube) and/or LJ media between 2009-2014 periods. The GenoType MTBC Kit (Hain-Lifescience GmbH, Germany) was used in the study for determination of the subspecies. Extraction and amplification of DNA and hybridizations were performed according to test procedure in order to investigate the presence of subtypes of the MTBC species in skimmed milk from collections stored at -20°C. In the study, MTBC strains isolated from 220 patients (217 adults, 3 children; 145 male, 75 female) were evaluated and 217 (98.6%) of them were identified as M.tuberculosis/M.canettii and three (1.4%) as M.bovis subsp. bovis. When the distribution of the isolates were evaluated according to the years, it was noted that three (2.8%) cases out of 106 patients within the last three years, were found to be infected with M.bovis subsp. bovis, while none were detected in the 114 cases from the previous years. This data emphasized a parallel course with the reported cases of cattle tuberculosis in recent years. The risk factors, clinical and sociodemographic features, treatment process, outcomes, and mycobacteriological findings of those three patients were reviewed. Accordingly, the first case was a 63-year-old female with diabetes mellitus and chronic renal failure, who was dealing with animal husbandry. She was diagnosed as miliary TB on July 2012 and completed her treatment schedule. The second case, who was also dealing with animal husbandry was a 85-year-old male with prostate carcinoma. This case was diagnosed as pulmonary TB on December 2013, however he has quited the treatment and died two months later. The third case, a 27-year-old female was admitted to the hospital with a cervical mass that developed when she was working as a seasonal laborer. She was diagnosed to have lymph node TB in September 2014 and completed her treatment schedule. The strains isolated from the first and third cases were found to be susceptible to streptomycin (STR), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB), while the strain isolated from the second case was susceptible to STR, INH and RIF, but resistant to EMB. All of the three isolates were resistant to pyrazinamide. As a result, it was concluded that large-scaled and attentive monitoring of TB infections in animals, as well as searching for M.bovis subsp. bovis in TB cases, especially in high-risk groups would be essential for an accurate diagnosis.

[A rare case of Hymenolepis diminuta infection in a small child]. / Nadir bir olgu olarak küçük bir çocukta Hymenolepis diminuta enfeksiyonu.

Unlike Hymenolepis nana that transmits directly from person to person, the transmission of Hymenolepis diminuta to human is via accidentally ingesting of arthropods carrying cysticercoid larvae as intermediate host. In places with poor hygienic conditions, this cestod may cause seldom infections especially in children. Studies carried out on various populations have reported the prevalence rate of H.diminuta between 0.001% and 5.5%. Although the reported cases are mostly children, the disease can be seen in every age group. In this report, a pediatric case of H.diminuta infection is presented. A twenty one-month-old male patient with the symptoms of vomiting 3-4 times a day along with mud-like diarrhea continuing for a week was admitted to the pediatric outpatient clinic. According to the history, it was learned that the house where he lived was above a barn and there was a history of insect swallowing. Laboratory findings revealed iron-deficiency anemia. The macroscopic appearance of the stool was in a pale clay-like form, and by direct microscopic examination with lugol solution, 70-75 µm in diameter, thick-shelled and six central hookleted eggs that are characteristic for H.diminuta were identified. A six-day course of oral niclosamide was administered to the patient beginning with 500 mg on the first day and 250 mg on the following five days, together with the treatment for the iron deficiency anemia. After fifteen days, the oral niclosamide treatment was repeated. No H.diminuta eggs were detected in the parasitological examination performed one month after completion of the second round of treatment. This case has been presented to call attention to the importance of patient anamnesis and microscopic examination in the diagnosis of H.diminuta infection which is a rarely seen parasitosis.

Leptospirosis: a six-case report from west black sea, Turkey.

Leptospirosis is a ubiquitous acute bacterial zoonosis. This report describes six cases presenting to our hospital with symptoms such as fever and muscle pain and diagnosed as leptospirosis. All cases presented with fever, muscle pain, and lethargy and were engaged in activities such as farming, hunting, and fishing. Thrombocytopenia and impaired liver function tests were found in all patients, increased creatine-kinase in five, and increased creatinine in four. Leptospirosis was diagnosed using polymerase chain reaction (PCR). The course of the disease resulted in cure in three cases, chronic kidney disease sequelae in one, and death in two. In conclusion, the possibility of leptospirosis should be considered in patients presenting with non-specific symptoms such as fever and muscle pain and developing thrombocytopenia, and liver and kidney function disorder. Risk factors should also be investigated when taking histories. Early diagnosis and antibiotic therapy being started as quickly as possible are important in terms of the course of the disease.

Effects of topical azithromycin, moxifloxacin, and povidone iodine on conjunctival bacterial flora in patients undergoing intravitreal injection.

PURPOSE: To compare effects of 5% topical povidone iodine with prophylactic topical azithromycin and moxifloxacin on bacterial flora in patients undergoing intravitreal injection. METHODS: A total of 132 patients were randomly assigned to receive treatment with azithromycin or moxifloxacin, or no treatment (control group). In total, 528 specimens were obtained at the time of admission, 4 days before intravitreal injection, 4 days after intravitreal injection, and 8 days after intravitreal injection. Samples were immediately sent to the microbiology laboratory for incubation. RESULTS: The microorganism observed most frequently was coagulasenegative Staphylococcus (23.8%). When the results of samples obtained on Day 4 before injection were assessed, growth of coagulase-negative Staphylococcus was significantly lower in the moxifloxacin group, compared with controls (p=0.049). Acinetobacter baumannii continued to grow after administration of azithromycin (p=0.033). When the results of four days after intravitreal injection were evaluated, growth of coagulase-ne gative Staphylococcus was higher in controls, compared with patients who received azithromycin or moxifloxacin (p=0.004). Eradication rate was significantly higher in the moxifloxacin group than in the control group (p=0.001). Samples obtained on Day 8 after intravitreal injection showed similar levels of bacterial growth in all groups (p=0.217). CONCLUSION: Moxifloxacin was more effective than 5% povidone iodine in controlling the growth of conjunctival bacterial flora. Use of moxifloxacin in combination with 5% povidone iodine resulted in a synergistic effect.