Is the extraction by Whatman FTA filter matrix technology and sequencing of large ribosomal subunit D1-D2 region sufficient for identification of clinical fungi?

Although conventional identification of pathogenic fungi is based on the combination of tests evaluating their morphological and biochemical characteristics, they can fail to identify the less common species or the differentiation of closely related species. In addition these tests are time consuming, labour-intensive and require experienced personnel. We evaluated the feasibility and sufficiency of DNA extraction by Whatman FTA filter matrix technology and DNA sequencing of D1-D2 region of the large ribosomal subunit gene for identification of clinical isolates of 21 yeast and 160 moulds in our clinical mycology laboratory. While the yeast isolates were identified at species level with 100% homology, 102 (63.75%) clinically important mould isolates were identified at species level, 56 (35%) isolates at genus level against fungal sequences existing in DNA databases and two (1.25%) isolates could not be identified. Consequently, Whatman FTA filter matrix technology was a useful method for extraction of fungal DNA; extremely rapid, practical and successful. Sequence analysis strategy of D1-D2 region of the large ribosomal subunit gene was found considerably sufficient in identification to genus level for the most clinical fungi. However, the identification to species level and especially discrimination of closely related species may require additional analysis.

Prevalence of cagA and vacA genotypes of Helicobacter pylori isolated from Turkish patients with active or non-active chronic gastritis.

Several virulence factors of Helicobacter pylori may contribute to gastric mucosal damage. In this study, the prevalence of cagA and vacA genotypes of H. pylori was examined in different patterns of chronic gastritis. Oesophagogastroendoscopy was performed in 147 dyspeptic patients. Antrum biopsies were obtained for isolation of H. pylori and for histopathological assessment. H. pylori vacAs1 and cagA genes were directly genotyped in the gastric biopsy specimens by polymerase chain reaction (PCR). A total of 102 dyspeptic patients, all H. pylori-positive by PCR, were included in the study. Of these, 59 had active chronic gastritis and 37 had non-active chronic gastritis. The prevalence of cagA and vacAs1 was higher among patients with active chronic gastritis than among those with non-active chronic gastritis (45.8% vs 21.6% (p = 0.02) and 78.0% vs 40.5% (p < 0.001), respectively). In conclusion, both cagA and vacAs1 genotypes are associated with the activity of chronic gastritis.

In vitro anti-Helicobacter pylori activity of usnic acid.

Eradication of Helicobacter pylori is an important objective in overcoming gastric diseases. Many regimens are currently available but none of them could achieve 100% success in eradication. Medicinal lichen is used in the treatment of gastric ulcer in local folk medicine in Anatolia (Turkey). The present study was performed to assess the in vitro effects of usnic acid from Usnea dasypoga against clinical isolates and standard H. pylori strains and their minimum inhibitory concentrations (MICs). A total of 38 strains was assayed for anti-H. pylori activity. The agar dilution method was used for the determination of usnic acid and clarithromycin resistance.Six (16.2%) clinical isolates were resistant to usnic acid and five (13.5%) were resistant to clarithromycin. Dual susceptibility to usnic acid and clarithromycin rate was detected as very high (97.3%). Usnic acid has a strong and dose-dependent activity against H. pylori strains. The synergism between usnic acid and clarithromycin may be effective in the treatment of H. pylori infection.

The effects of caspofungin and voriconazole in an experimental fungal infection of the ear due to Aspergillus.

The purpose of the study was to evaluate the effectiveness of caspofungin and voriconazole in the treatment of experimental Aspergillus otitis media in an experimental rabbit model. A total of 30 New Zealand white rabbits were divided into four treatment groups and one control group. The rabbits were immunosuppressed by cyclophosphamide and triamcinolone acetonide. The right ear of each rabbit was infected by an injection of the inoculum of 0.1 ml (8.6 x 103 CFU/0.1 ml) of Aspergillus fumigatus into the middle ear cavity. At 72 h after the inoculation, amphotericin B 1 mg/kg per day (n = 6), itraconazole 10 mg/kg per day (n = 6), voriconazole 10 mg/kg per day (n = 6) and caspofungin 5 mg/kg per day (n = 6) were injected to each treatment group. No antifungal drug was administered to the control group (n = 6). Clinical and histopathological examination scores and microbiological analysis of middle ear mucosa were compared.There was statistically significant difference in the clinical scores, histopathological scores, and mean CFU/g between the treatment and control groups (P < 0.05). There was no statistically significant difference among the treatment groups in the clinical and histopathological scores, whereas there was statistically significant difference in the mean CFU/g (P < 0.05). The mean CFU/g of amphotericin B and caspofungin groups were similar and both were lower than the itraconazole and voriconazole groups. Also, the mean CFU/g of voriconazole group was lower than the itraconazole group (P < 0.05). Caspofungin and voriconazole were demonstrated at least as effective as amphotericin B and itraconazole. We suggest that caspofungin and voriconazole may be considered for the treatment of fungal infection of the ear.

Etiology of foot intertrigo in the District of Afyonkarahisar, Turkey: a bacteriologic and mycologic study.

BACKGROUND: Foot intertrigo, occurring in the interdigital space, is mostly caused initially by dermatophytes and yeasts and less frequently by gram-negative and gram-positive bacteria. With time, a "complex" may develop in the setting of moisture and maceration that contains multiple fungal and bacterial organisms. METHODS: We examined and sampled 84 patients with toe web intertrigo for bacteriologic and mycologic studies. RESULTS: In the culture media, the prominent isolated pathogens as single agents were coagulase-negative staphylococci in 17.9% of patients, which is assessed as contamination from skin flora; Pseudomonas aeruginosa in 16.7%; dermatophytes, Corynebacterium minutissimum, and Staphylococcus aureus each in 11.9%; beta-hemolytic streptococcus in 2.4%; and Proteus mirabilis in 1.2%. However, we recovered double pathogens from patients with foot intertrigo as mixed infection in 19 patients (22.6%). The most common predisposing factors were exposure to spa pools and ablutions. CONCLUSIONS: Several pathogens and factors might play a role in toe web infections. Therefore, clinical and microbiologic studies are suggested to assist in the selection of appropriate treatment and the prevention of important complications of toe web infections.

[Short communication: Determination of methicillin resistance in staphylococci with different methods and detection of multiple antibiotic resistance]. / Kisa bildiri: Stafilokoklarda metisilin direncinin farkli yöntemlerle arastirilmasi ve coklu antibiyotik direncinin saptanmasi.

The aims of this study were to determine the methicillin resistance of a total of 256 staphylococcus strains [213 Staphylococcus aureus and 43 coagulase negative staphylococci (CNS)], isolated from different clinical samples and hospital environmental specimens by different methods and to detect multiple antibiotic resistance in these isolates. Methicillin resistance of staphylococci was investigated by using oxacillin agar screening (OAS), oxacillin disk diffusion (ODD), cefoxitin disk diffusion (CDD), PBP2a latex agglutination (LA) and microdilution tests. The resistance of the strains against penicillin G, amoxycillin/clavulanate, cephalothin, tetracycline, erythromycin, fusidic asid, ofloxacin, vancomycin, co-trimoxazole and gentamicin was investigated by standard disk diffusion method. As a result, 152 (71.3%) S. aureus and 30 (69.7%) CNS isolates were found to be methicillin-resistant with the use of OAS and PBP2a LA tests, respectively. The numbers of the isolates which were detected as methicillin-resistant and methicillin-susceptible were 182 and 74 by OAS; 183 and 73 by ODD; 181 and 75 by SDD; 180 and 76 by PBP2a LA; 183 and 73 by microdilution tests, respectively. There was no statistically significant differences-between the results obtained by all of the methods (p > 0.05), however the sensitivity of PBP2a LA test was lower in the detection of methicillin resistance in S. aureus strains. CDD test which was found to be as sensitive as ODD test, may be preferred in the detection of methicillin resistance in staphylococci. In our study staphylococci which were sensitive to methicillin, were also found generally sensitive to the other antibiotics, whereas staphylococci which were resistant to methicillin were also resistant to the other antibiotics. The difference between methicillin sensitive and resistant staphylococci in terms of the rates of resistance against other antibiotics was found statistically significant with the exception of fusidic acid (p < 0.05). The resistance rates of isolates for fusidic acid were very low and all of the strains were susceptible to vancomycin. In conclusion, for better determination of methicillin resistance, agar screening test which is proposed as a confirmatory test by CLSI, should be used when necessary.

Anti-Toxoplasma gondii antibodies in patients with schizophrenia--preliminary findings in a Turkish sample.

Schizophrenia is a serious neuropsychiatric disease of uncertain etiology. We investigated the seropositivity rate for anti-Toxoplasma IgG and IgM antibodies by enzyme-linked immunosorbent assay (ELISA) in patients with schizophrenia to ascertain a possible relationship between Toxoplasma gondii and schizophrenia. We selected 100 patients with schizophrenia, 50 with depressive disorder, and 50 healthy volunteers to investigate the seropositivity rate of anti-Toxoplasma antibodies by ELISA. The seropositivity rate for anti-Toxoplasma IgG antibodies among schizophrenia patients (66%) was significantly higher than among patients with depressive disorder or healthy volunteers (P < .01). Thus, there might be a causal relationship between toxoplasmosis and the etiology of schizophrenia.

Efficacy of topical caspofungin in experimental fusarium keratitis.

PURPOSE: To evaluate the efficacy of caspofungin in an experimental rabbit model of Fusarium keratitis and to compare it with amphotericin B. METHODS: Eighteen New Zealand white rabbits were randomly divided into 2 treatment groups and 1 control group. One cornea of each rabbit was inoculated with Fusarium solani spores. The first group received topical amphotericin B 0.15%, the second group received topical caspofungin 1%, and the control group received topical balanced salt solution hourly for 2 days and then 4 times daily for 3 additional days. Treatment effects were evaluated by clinical assessment at days 3 and 5 and by fungal culture after 5 days of treatment. RESULTS: In the treatment groups, progression of keratitis was inhibited, and cultures were sterile at the end of the study. In the control group, keratitis progressed, and cultures were positive for F. solani. CONCLUSIONS: Topical caspofungin is effective in Fusarium keratitis, and clinical efficacy studies seem justified.

Effects of intravitreal moxifloxacin and dexamethasone in experimental Staphylococcus aureus endophthalmitis.

PURPOSE: To evaluate the effects of intravitreal moxifloxacin and moxifloxacin and dexamethasone combination in an experimental rabbit model of Staphylococcus aureus endophthalmitis. METHODS: The right eyes of 24 rabbits weighing 2 to 3 kg were used. Ten thousand colony-forming units (CFU) of S. aureus in 0.1 ml saline solution were inoculated into the vitreous cavity. The eyes were randomly assigned to one of the four groups equally. Twenty-four hours after the inoculation of S. aureus, group 1 received 50 microg moxifloxacin, group 2 received 50 microg moxifloxacin plus 400 microg dexamethasone, and group 3 received 1 mg vancomycin intravitreally. No treatment was given to group 4. Clinical examination scores were recorded. Vitreous aspirates were obtained for microbiological analysis just before sacrifice, and the eyes were enucleated for histopathologic examination. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: In all treatment groups, mean number of CFU and histopathologic score were significantly lower compared with control group (p<0.05), and the difference between treatment groups was not statistically significant (p>0.05). The clinical score was not significantly different between groups (p>0.05). CONCLUSIONS: Intravitreal injection of 50 microg moxifloxacin was effective in the treatment of S. aureus endophthalmitis. Bacteriological, histopathologic, and clinical outcomes after treatment using moxifloxacin, moxifloxacin and dexamethasone combination, and vancomycin were comparable. Intravitreal moxifloxacin may be an option in the treatment of S. aureus endophthalmitis.

The effects of caspofungin and voriconazole in experimental Candida endophthalmitis.

PURPOSE: To evaluate the efficacy of newly developed antifungal agents caspofungin and voriconazole in Candida albicans endophthalmitis in rabbit eyes. METHODS: Thirty New Zealand white rabbits were divided into four treatment groups and one control group. One eye of each rabbit was infected by inoculation of 1 x 10(4) CFU/ml of C. albicans. Seventy-two hours after the inoculation, caspofungin 100 microg/0.1 ml in group 1 (n = 6), voriconazole 50 microg/0.1 ml in group 2 (n = 6), amphotericin B 10 microg/0.1 ml in group 3 (n = 6), itraconazole 10 microg/0.1 ml in group 4 (n = 6), and 0.1 ml NaCl 0.9% in control group (n = 6) were injected into the vitreous cavity. Clinical and histopathologic examination scores and microbiological analysis of vitreous aspirates were compared. RESULTS: There was statistically significant difference in the clinical scores, histopathologic scores, and mean CFU/ml between the treatment and control groups (p < 0.05). In caspofungin and voriconazole groups, histopathologic scores and mean CFU were lower than other treatment groups and control group. CONCLUSIONS: Intravitreal injection of caspofungin and voriconazole was effective against C. albicans endophthalmitis in this experimental rabbit model.

Evaluation of bacteremias in a Turkish university hospital: 3-year outcomes.

In this retrospective study, the investigators examined blood cultures from patients that had been diagnosed with bacteremias over a 3-y period. The study was conduced at Kocatepe University Hospital (Middle Anatolia, Turkey). Blood samples that arrived at the university's microbiology laboratory between 2002 and 2005 were evaluated retrospectively. These samples were classified as contamination, false positivity, community-acquired bacteremia (CAB), or hospital-acquired bacteremia (HAB). Patient age and sex, foci of bacteremia, present comorbidities, predisposing factors, pathogens, and mortality rates were evaluated. A total of 1783 blood cultures that had been drawn from 1441 patients during this 3-y period were examined retrospectively. Of 354 positive isolates, 61 (17.2%) were CABs and 293 (82.8%) were HABs. In HABs, the most commonly isolated microorganisms were Staphylococcus aureus (37.5%), coagulase-negative staphylococci (29.7%), and Escherichia coli (10.2%); in CABs, the most commonly isolated microorganisms were S aureus (29.5%), Brucella spp (26.2%), and E coli (24.6%). Crude mortality rates were determined to be 15.2% for HABs and 12.7% for CABs. This study yielded data on the most common foci of bacteremia, microbiologic factors, and the epidemiology associated with HABs and CABs. It is hoped that these data will enhance empirical antibiotic therapeutic approaches, thereby preventing delays in treatment and decreasing mortality rates associated with bacteremias.

[Short communication: determination of hepatitis C virus genotypes by INNO-LIPA and sequence analysis methods]. / Kisa bildiri: hepatit C virus genotiplerinin INNO-LIPA ve sekans analizi yöntemleri ile belirlenmesi.

The detection of genotypes of hepatitis C virus (HCV) which exhibit very high genetic variability, has a great impact for the therapy and follow-up of the chronicity of infections. The aim of this study was to detect the genotypes of HCV strains by using two different methods. Thirty patients (5 hemodialysis patients, 9 chronic hepatitis C patients, 5 blood donors, 1 hospital staff) who were positive for both anti-HCV (Vitros, Ortho-Clinical Diagnostics) and HCV-RNA (Rotorgene, Artus) were included to the study. The serum samples were studied by Inno-LIPA (Inno-LIPA HCV-II, Innogenetics, Belgium) and sequence analysis (9700 Sequence Detection System, and ABI PRISM 310 Genetic Analyzer, Applied Biosystems, USA) methods. For Inno-LIPA, 5'non-coding region (5'NCR) of HCV-RNA was amplified by reverse transcriptase polymerase chain reaction (RT-PCR) and genotyped by line probes. For sequence analysis (SA), NS5B and 5'NCR regions were amplified by RT-PCR, and genotypic variations were assessed by Cycle Sequencing system (Applied Biosystems, USA). As a result, one strain was found as 1a, and 28 strains were found as 1b with both Inno-LIPA and SA methods, however, one strain was genotyped as 1b/3a by Inno-LIPA, but as 1b by SA method. Our data have indicated that the results obtained by Inno-LIPA and sequence analysis methods were in concordance for the detection of HCV genotypes, considering that they have similar sensitivities.

[Investigation of the presence of Clostridium difficile in antibiotic associated diarrhea patients by culture and toxin detection methods]. / Antibiyotige bagli ishal olgularinda Clostridium difficile varliginin kültür ve toksin saptama yöntemleriyle arastirilmasi.

Clostridium difficile-associated disease can be observed especially in hospitalized patients who use broad-spectrum antibiotics. The aim of this study was to investigate the presence of C. difficile as the causative agent of diarrhea in outpatients and inpatients. During January-December 2005, 45 outpatients and 46 inpatients (of them 11 were intensive care unit patients) who had developed diarrhea due to antibiotic use, were included to the study. In addition 7 intensive care unit personnel and 20 food handlers were also included to the study in order to detect their carrier states. The age range of patients was 16-80 years, and of them 45 (49.5%) were male, while the age range of the personnel was 25-55 years, and of them 21 (78%) were male. Stool samples collected from the study groups were cultivated in C. difficile agar media (C. difficile Agar Base, Oxoid) as well as on routine bacteriologic media, and C. difficile growth was confirmed by latex agglutination test with the use of specific antisera. The presence of C. difficile toxin A was investigated by latex method (Oxoid, UK), and toxin A and B was searched by enzyme-linked immunoassay (ELISA; Seramun GmbH, Serazym C. difficile Toxin A+B), in the stool samples. While C. difficile was isolated from 13 (14.3%) of the 91 samples, no positive result was detected in the personnel. There was no statistically significant difference between outpatient and inpatient groups by means of C. difficile culture positivity (15.5% and 17.1%, respectively) (p>0.05). All of the culture positive samples were also found positive by ELISA Toxin A+B method (100%), but only 4 of them (30.7%) yielded positive result by Toxin A latex test. It was detected that 84.6% (11/13) of the patients had used ampicillin/sulbactam, 7.7% (1/13) used cotrimoxazole-SXT, and 7.7% (1/13) used macrolide antibiotics. The use of ampicillin/sulbactam was found statistically significant in development of diarrhea (p<0.05). Our data indicated that ELISA Toxin A+B is a reliable method with 100% specificity and sensitivity in the rapid diagnosis of C. difficile until the culture results were obtained, however, although specificity of Toxin A latex test is 100%, its use alone as a primary rapid diagnostic test was not recommended because of its low (30.7%) sensitivity.

[Investigation of hemodialysis patients in terms of the presence of occult hepatitis B]. / Hemodiyaliz hastalarinin gizli hepatit B varligi yönünden arastirilmasi.

The presence of hepatitis B virus (HBV) DNA in case of negative HBV surface antigen (HBsAg) in serum is known as "occult hepatitis B". There are many reports indicating that occult HBV infections are more frequently encountered in case of hepatocellular carcinoma, hemodialysis practice and co-infections with hepatitis C virus (HCV). The aim of this study was to investigate the presence of HBV-DNA in HBsAg negative hemodialysis. patients and subjects who had never experienced hemodialysis. A total of 226 HBsAg negative sera were included to the study, of which 153 were from hemodialysis patients (97 male, 56 female; mean age: 41.3 +/- 5.8 years), and 73 were from non-hemodialyzed individuals (46 male, 27 female; mean age: 36.5 +/- 6.9 years) who had serological evidence of previous HBV and HCV infections. Of these 73 subjects, 41 were anti-HCV positive, 22 were "anti-HBc IgG positive alone", seven were anti-HBc IgG and anti-HBs positive, and three were anti-HBc IgG and anti-HBe positive, while 40 of 153 (26.1%) hemodialysis patients were anti-HCV positive. HBV and HCV markers were detected by commercial enzyme immunoassays (bioMerieux, France and Murex, UK, respectively), and HBV-DNA testing was performed by a commercial real-time polymerase chain reaction (PCR; 5700 and 7700 Sequence Detection System, Applied Biosystems, UK) assay. Nineteen (12.4%) of HBsAg-negative hemodialysis patients and five (6.8%) of the non-hemodialyzed subjects were found positive for HBV-DNA (viral loads were > or =10(4) copies/ml, and 10(3)-10(4) copies/ml, repectively). The rates of occult HBV infection in the anti-HCV positive hemodialysis patients and anti-HCV positive non-hemodialyzed subjects were detected as 27.5% (11/40) and 2.4% (1/41), respectively. These rates in the other groups were found as follows; 7.1% (8/113) in the anti-HCV negative hemodialysis patients, 9.1% (2/22) in the "anti-HBc positive alone" subjects, and 20% (2/10) in the subjects positive for anti-HBc+anti-HBs or anti-HBe. The results of this study indicated that the prevalence of HBV viremia (12.4%) in hemodialysis patients being more prominent in those of anti-HCV positive patients (27.5%) should not be overlooked. In conclusion, the hemodialysis patients should be screened by sensitive PCR-based methods for occult HBV infections, even if they were negative for HBsAg, in order to prevent or at least to decrease the transmission risk of HBV infection which is still an important health problem in dialysis units.

[Evaluation of the level of knowledge of medical secretaries about clinical specimens]. / Tibbi sekreterlerin klinik örnekler hakkindaki bilgi düzeylerinin belirlenmesi.

The rapid development of medical industry in the last 5 years in Turkey led to an increased demand for medical technicians and secretaries. The aim of this study was to evaluate the level of knowledge of students in Occupational School of Medical Documentation and Secretary about the clinical specimens, and to estimate the need for an additional education on clinical specimens. Four hundred and forty eight students from eight universities were participated to this questionnaire survey. Mean age of the participants were 20.4+/-1.66 years and 342 (76.3%) of them were female students. The mean answer rate of students to the questions about clinical specimens was found 3.4+/-1.9% (min-max: 0-10). Correct answer rates were similar for both first and second year students. There was a negative relationship between the educational year and the rate of correct answer, however the correlation was not significant. Additionally, internship period did not have any effect on the level of knowledge. The results of this survey have indicated that the level of knowledge of medical secretaries about clinical specimens was very low. As the roles and responsibilities of medical secretaries in medical industry increases, in order to increase the cost-effectivity, quality and patient satisfaction, the contents of their education programs must be reorganized, and a lecture about clinical specimens should be integrated.

Custody and prison deaths autopsied in Istanbul between 2010 and 2012.

The occurred death of a convict in prison, police custody cell or in a hospital always attracts public attention and can be considered as a complex phenomenon. The aim of this study is to evaluate the data obtained from autopsies performed to the custody and prison deaths in Istanbul and to discuss the possible solutions by comparing with the literature. It is also aimed to discuss the postponement of the sentence and presidential amnesty facts in Turkey. Deaths of inmates, which occurred in hospitals, prisons, prison medical rooms, police vans and police custody cells between 2010 and 2012 in Istanbul, Turkey were included in the study. Totally 125 cases were found and 98.4% of them were male. Natural deaths accounted for a great majority of deaths (83.2%). The most common natural cause was cardiovascular diseases. Unnatural deaths accounted for 15.2% of the deaths. Death reason cannot be determined for 1.6% of the cases. More than half of the cases (56%) were died at the hospital, 34.4% were died at the prison, 4% of them at the police van, 3.2% were died under police custody and 2.4% were died at the prison medical room. Moreover, twelve of these cases had applied to Third Specialization Board previously for postponement of the sentence or Presidential amnesty. Totally five of these cases found suitable for postponement of the sentence. Prison conditions should be improved, prisoners with chronic diseases should be examined periodically and if appropriate their sentences should be postponed until they heal.

Antifungal susceptibilities of dermatophytic agents isolated from clinical specimens.

The aim of this study was to investigate the susceptibility to four antifungal agents: ketoconazole, terbinafine, itraconazole and fluconazole, of the different species of dermatophyte strains isolated from clinical specimens. A total of 128 specimens were collected from toe nail, foot, inguinal region, trunk, hands and head. The dermatophytes tested included Trichophyton rubrum 108 (84.4%), Trichophyton mentagrophytes 11 (8.6%), Epidermophyton floccosum 5 (3.9%), Microsporum canis 2 (1.5%) and Trichophyton tonsurans 2 (1.5%). The mean minimum inhibitory concentrations (MIC) for the five species of dermatophytes ranged between 0.09-1.12 microg/mL for ketoconazole, 0.04-0.27 microg/mL for terbinafine, 0.08-0.43 microg/mL for itraconazole and 16.18-24.0 microg/mL for fluconazole. In vitro analysis of antifungal activity of these agents would also allow for the comparison between different systemic antifungals, which in turn may clarify the reasons for the lack of clinical response or serve as an effective therapy for patients with chronic infection.

Seroprevalence of human brucellosis in a rural area of Western Anatolia, Turkey.

This study was conducted to determine the seroprevalence of human brucellosis and identify the potential risk factors in a rural area of Western Anatolia, Turkey. A simple random-sampling method was used for identifying 1,052 subjects for the study. Blood samples, collected from all the subjects, were studied following the methods of Rose Bengal slide agglutination and standard tube agglutination tests. One thousand and one samples (95.2%) were seronegative, and 51 (4.8%) were seropositive. There was a statistically significant correlation between seropositivity and age, sex, consuming fresh cheese and cream made from unboiled milk (p values 0.005, 0.019, <0.001, and <0.001 respectively). Seropositivity was not related to educational level (0.270). It is concluded that pasteurization of milk and dairy products and education regarding eating habits must be pursued for eradication of human brucellosis from rural areas. The findings of the study suggest that human brucellosis is still an important public-health problem in the western Anatolia region of Turkey, especially in rural areas.

In vitro investigation of antifungal activities of phenotypic variation Candida albicans strains against fluconazole, itraconazole and voriconazole.

The aim of this study was to investigate the susceptibility of the different phenotypes of Candida albicans strains isolated from clinical specimens to three antifungal agents, fluconazole, itraconazole and voriconazole. Totally 215 specimens were collected from oropharyngeal, gastrointestinal and urogenital tracts of non-neutropenic patients who had received no previous prophylactic treatment. Each of the 215 C. albicans strains recovered was found to express one of the six phenotypes: smooth 73%, fuzzy 10.7%, irregular 2.3%, star 2.8%, ring 6% or stipple 5.1%. The mean MICs for the six phenotypes of C. albicans strains ranged between 0.25 microg/ml and 64 microg/ml for fluconazole, 0.03 microg/ml and 1 microg/ml for itraconazole and 0.03 microg/ml and 0.5 microg/ml for voriconazole. The mean minimum inhibitory concentration (MIC) of fluconazole was consistently higher for C. albicans strains expressing the stipple phenotype. The antifungal susceptibility of the phenotypic switching requires attention, especially in patients who are clinically unresponsive to fluconazole chemotherapy or in cases of serious C. albicans infections of immunocompromised hosts.

Assessment of indoor air fungi in Western-Anatolia, Turkey.

This study was conducted to determine fungal spores in the indoor air of the houses in the city of Afyon, Western-Anatolia, Turkey. We investigated the seasonal properties of mould spores in 10 houses of Afyon over a period of one year. Viable moulds were recovered from all 10 houses. Twenty seven different moulds were isolated and identified from the indoor air of the houses. The most common genus was Cladosporium spp. (31.9%), followed by Aspergillus spp. (18.6%), Penicillium spp. (15.5%), Altemaria spp. (13.0%) and other species (21.0%). The mould concentration was higher in the kitchens than in other parts of the houses such as the living rooms and bedrooms (p < 0.05). The fungal flora of the air in the Afyon city region has a seasonal variation. All fungal species had their highest prevalence in summer and their lowest in winter, but only Aspergillus spp. had a significant seasonal variation (p = 0.012). Viable moulds are common in the houses of Afyon. Reducing these indoor fungi is necessary to improve the health of individuals with fungal-induced diseases like asthma.