Adjunctive use of laser biostimulation with nonsurgical periodontal therapy: a split-mouth, randomized, case-control study in diabetic and nondiabetic periodontitis patients.

Background/aim: Laser biostimulation therapy (LBT) is suggested to have positive effects on periodontal healing. This study evaluated LBT with nonsurgical periodontal therapy (NSPT) in diabetes mellitus (DM) and systemic health (SH) conditions. Materials and methods: Thirty periodontitis patients (15 with DM and 15 with SH) were included in the study, which had a split-mouth design, by applying LBT in the mouth of the same systemic condition. Thus, 4 study groups were formed, as 1) NSPT - DM: NSPT alone in DM, 2) NSPT + LBT - DM: NSPT + LBT application in DM, 3) NSPT - SH: NSPT alone in SH, and 4) NSPT + LBT - SH: NSPT + LBT application in SH. NSPT was performed on days 15, 30, 37, 44, 51, 58, and 65. LBT was performed 6 times on days 30, 37, 44, 51, 58, and 65 with an Nd:YAG laser. The plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed as the clinical parameters and recorded at baseline and days 30, 37, and 72. Gingival crevicular fluid levels of interleukin 1 beta (IL-1ß) and IL-10 were evaluated by ELISA as the biochemical parameters at baseline and on days 30, 37, and 72. Results: Clinical parameters had improved in all of the groups on day 72 (p < 0.01). PPD and CAL improved more in the DM group with NSPT and LBT group than in the DM group with NSPT without LBT on day 37 (p < 0.05). IL-1ß decreased and IL-10 increased in all of the groups on day 72 (p < 0.01). This change was more evident in the DM group with NSPT and LBT than in the DM group with NSPT without LBT on day 7 (p < 0.05). Conclusion: These results revealed the short-term impacts of LBT on periodontal healing, which return to ineffectiveness with repeated irradiation. Therefore, it may be speculated that LBT via the protocol herein may have a short-term antiinflammatory contribution to NSPT, only in impaired healing conditions such as DM.

[Investigation of the presence of class 1, 2, 3 integrons and their relationships with antibiotic resistance in clinical Stenotrophomonas maltophilia isolates]. / Klinik Stenotrophomonas maltophilia izolatlarinda sinif 1, 2, 3 integron varliginin ve antibiyotik direnci ile iliskilerinin arastirilmasi

Stenotrophomonas maltophilia is an opportunistic emergent pathogen causing hospital-acquired infections. It is resistant to majority of the broad spectrum antibiotics due to several mechanisms which significantly limit the treatment options. Although the relationship between integrons, mobile genetic elements which play role in transferring resistance genes, and the antibiotic resistance in different gram-negative bacteria have been investigated, the data are limited in Turkey especially for S.maltophilia. The aims of this study were to detect the presence of different classes of integrons and plasmids in clinical isolates of S.maltophilia and to investigate the antibiotic resistance profiles of those isolates. One hundred S.maltophilia strains isolated from various clinical samples (32 sputum, 25 tracheal aspirates, 9 urine and blood, 7 exudates and catheters, 4 sterile body fluids and wounds, 2 CSF, 1 conjunctiva) in our microbiology laboratory during January 2011-September 2012, were included in the study. The isolates were identified by VITEK2 Compact (BioMerieux, France) or Phoenix 100 (BD, USA) automatized systems, and the susceptibilities of the strains to levofloxacin, chloramphenicol, ceftazidime and trimethoprim/sulfamethoxazol (SXT) were evaluated via broth microdilution method according to the CLSI recommendations. Class 1 (intI-1), class 2 (intI-2), class 3 (intI-3) integron gene cassettes and integron 5'-3' conserved gene regions (intI-5'-3'CS) were investigated by polymerase chain reaction (PCR) using specific primers in all of the strains. Nucleotide sequence analysis of PCR products was performed in case of positive result, and the presence and size of plasmids were further investigated. The susceptibility rates of S.maltophilia strains to ceftazidime, chloramphenicol, SXT and levofloxacin were found as 24%, 66%, 93% and 95%, respectively, while MIC(50) and MIC(90) values were 64-128 µg/ml, 8-16 µg/ml, 1/19-2/38 µg/ml and 1-2 µg/ml, respectively. In PCR amplification with intI-1, intI-2 and intI-3 primers, 12%, 2% and 10% of the isolates yielded expectative bands, respectively. DNA sequence analysis of the amplified products revealed five isolates to harbour intI-1 gene, while intI class 2 and class 3 genes were not detected in any of the strains. Furthermore in PCR amplification with intI-5'CS and 3'CS primers, 20% of the strains yielded expected bands. Sequence analysis of these amplicons revealed the presence of quaternary ammonium compound resistance protein genes (qacL) in two, aminoglycoside adenyltransferase gene (aadA) in one and integron-associated recombination site (attI1) genes in five strains. Additionally, the presence of plasmids have been detected in 9 (9%) of the strains, however all of them was integron-negative. The sizes of plasmids were 2340, 1350, 2760, 18600, 20000, 3570-2540, 2510 and 5000-2540 base pairs, respectively. When the antibiotic susceptibility patterns of strains were compared with the presence of intI gene regions, no statistically significant relationship was observed (p> 0.05). In conclusion, the demonstration of integron class 1 genes and plasmids among clinical S.maltophilia strains is regarded as a warning data to indicate the potential for spread of those resistant strains in our hospital.

In vitro antimicrobial activity of Medilox® super-oxidized water.

AIM: Super-oxidized water is one of the broad spectrum disinfectants, which was introduced recently. There are many researches to find reliable chemicals which are effective, inexpensive, easy to obtain and use, and effective for disinfection of microorganisms leading hospital infections. Antimicrobial activity of super-oxidized water is promising. The aim of this study was to investigate the in-vitro antimicrobial activity of different concentrations of Medilox® super-oxidized water that is approved by the Food and Drug Administration (FDA) as high level disinfectant. MATERIAL AND METHODS: In this study, super-oxidized water obtained from Medilox® [Soosan E & C, Korea] device, which had been already installed in our hospital, was used. Antimicrobial activities of different concentrations of super-oxidized water (1/1, 1/2, 1/5, 1/10, 1/20, 1/50, 1/100) at different exposure times (1, 2, 5, 10, 30 min) against six ATCC strains, eight antibiotic resistant bacteria, yeasts and molds were evaluated using qualitative suspension test. Dey-Engley Neutralizing Broth [Sigma-Aldrich, USA] was used as neutralizing agent. RESULTS: Medilox® was found to be effective against all standard strains (Acinetobacter baumannii 19606, Escherichia coli 25922, Enterococcus faecalis 29212, Klebsiella pneumoniae 254988, Pseudomonas aeruginosa 27853, Staphylococcus aureus 29213), all clinical isolates (Acinetobacter baumannii, Escherichia coli, vancomycin-resistant Enterococcus faecium, Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, Bacillus subtilis, Myroides spp.), and all yeastsat 1/1 dilution in ≥1 minute. It was found to be effective on Aspergillus flavus at 1/1 dilution in ≥2 minutes and on certain molds in ≥5 minutes. CONCLUSION: Medilox® super-oxidized water is a broad spectrum, on-site producible disinfectant, which is effective on bacteria and fungi and can be used for the control of nosocomial infection.

The evaluation of serum surfactant protein D (SP-D) levels as a biomarker of lung injury in tuberculosis and different lung diseases.

BACKGROUND: To evaluate the predictive powers of serum surfactant protein D (SP-D) levels as a biomarker of lung damage in tuberculosis and lung diseases. METHODS: This study prospectively included 137 subjects who applied to our hospital. We measured serum SP-D levels from patients with active tuberculosis (TB) (n = 35), chronic obstructive disease (COPD) patients experiencing acute exacerbations (n = 30), patients with pneumonia (n = 45), and control subjects (n = 27). RESULTS: The mean age of all patients was 54.89 +/- 18.81 years (15 to 100 years); males accounted for two-thirds (70.1%) of the cases. Serum SP-D levels were higher in patients with pnemonia, tuberculosis, and COPD than in control patients (p < 0.001, p < 0.001, and p < 0.001, respectively). Serum SP-D levels in patients with pneumonia, tuberculosis, and COPD were higher than in the control group and mean serum SP-D levels were associated with pulmonary injury scores in patients with pneumonia, severity of COPD attack, and the extent of radiological lung involvement in patients with pneumonia and TB. CONCLUSIONS: Serum SP-D may be a useful biomarker of the severity of pneumonia, COPD, and tuberculosis.

[NDM-1 cases and outbreaks in Turkey]. / Ülkemizdeki NDM-1 olgu ve salginlari

We are grateful to Hatipoglu and Turhan [Mikrobiyol Bul 2014; 48(1): 188-9] for their interest in our study published in Mikrobiyol Bul 2013; 47(2): 382-4. As Hatipoglu and Turhan mentioned in their comment, ertapenem is more sensitive than other carbapenem antibiotics for the identification of New Delhi Metallo-beta-lactamase (NDM-1) producers among carbapenem-resistant strains being studied. However, its low specificity [Dortet et al. Biomed Res Int 2014; 2014: 249856] makes it equal with other carbepenems. Since all the isolates in our study were not tested for ertapenem susceptibility, we used the susceptibility data for three carbapenems to increase the sensitivity of our study regarding isolate selection. We agree Hatipoglu and Turhan about the Modified Hodge Test (MHT) and we did not use MHT at all in our study. However we couldn't understand how they came to a conclusion that we used MHT and didn't mention in Material and Methods section. ZnSO4 supplemented MHT which was recommended by the authors [Dortet et al. Biomed Res Int 2014; 2014: 249856] has a sensitivity rate of about 85%. Thus we used molecular methods instead of MHT not to miss any single isolate. Hatipoglu and Turhan mentioned about previously reported four NDM-1 positive isolates without any international relation in Turkey. However, since this mentioned study [Alp et al. J Hosp Infect 2013; 84(2): 178-80] was published after the appeal, acceptance and publication of our study, eventually we didn't have the opportunity to discuss the data of Alp's report. In the same study authors stated that NDM-1 producing isolates were isolated from pediatric patients and had no connection with patients from Indian peninsula. At the same time Poirel et al. [Antimicrob Agents Chemother 2014; 58(5): 2929-33] reported in their study that NDM-1 producing isolates from pediatric patients had clonal relation with Enterobacter cloacae strains and subject to an outbreak. The evaluation of the previous reports about NDM-1 indicated that NDM-1 was initially originated from foreign sources before exhibiting endemicity in a country. Thus the situation in our region was not an exception. In conclusion, medical facilities taking care of foreign patients should pay particular attention to identification of NDM-1 isolates and establishment of appropriate control measures.

Colistin use in pediatric intensive care unit for severe nosocomial infections: experience of an university hospital.

BACKGROUND: The aim of this study was to investigate the efficacy and safety of colistin therapy in pediatric patients with severe nosocomial infections in pediatric intensive care unit. METHODS: The medical records of patients treated with colistin at a 200-bed university children hospital were reviewed. RESULT: Thirty-one patients (male/female = 22/9; median age, 3 years; range, 3 months-17 years) received forty-one courses of colistin. The average dose of colistin was 4.9 ± 0.5 mg/kg/day and average treatment duration was 19.8 ± 10.3 days. Three patients who received concomitant nephrotoxic agent with colistin developed nephrotoxicity. Colistin treatment was well tolerated in other patients, and neurotoxicity was not seen in any patient. Favourable outcome was achieved in 28 (68.3%) episodes. Twelve patients died during the colistin therapy. Six of these patients died because of primary underlying disease. The infection-related mortality rate was found 14.6% in this study. CONCLUSION: In our study, colistin therapy was found to be acceptable treatment option for the severe pediatric nosocomial infections caused by multi-drug resistant bacteria. However, the use of concomitant nephrotoxic drugs with colistin must be avoided and renal function test should be closely monitored.

[Investigation of the presence of New Delhi metallo-beta-lactamase-1 (NDM-1) by PCR in carbapenem-resistant gram-negative isolates]. / Karbapeneme dirençli gram-negatif izolatlarda New Delhi metallo-beta-laktamaz-1 (NDM-1) varliginin PCR ile arastirilmasi

Bacteria producing New Delhi metallo-beta-lactamase-1 (NDM-1) exhibit high level resistance to beta-lactams including carbapenems. This broad-spectrum resistance limits treatment options for infections caused by NDM-1 producers. NDM-1 was first isolated from an Indian patient in Sweden; since then, NDM-1 producing isolates have been identified in many countries including Turkey. In this study, we investigated the presence of NDM-1 by PCR method in various gram-negative isolates recovered from clinical specimens in tertiary care hospitals in Samsun, Turkey. A total of 210 carbapenem-resistant gram-negative isolates (132 Acinetobacter baumannii, 54 Pseudomonas aeruginosa, 5 Pseudomonas putida, 8 Enterobacter cloacae, 3 Enterobacter aerogenes, 3 Klebsiella pneumoniae, 2 Providencia rettgeri, 2 Escherichia coli and 1 Citrobacter freundii) were included in the study. Identification and antibiotic susceptibility testing of the isolates were performed by using Vitek-2 Compact (bioMerieux, France) and BD Phoenix (BD Diagnostic Systems, MD) automated systems. The results of antibiotic susceptibility testing were interpreted according to the CLSI recommendations. In our study, NDM-1 gene was not detected in any of the clinical isolates by PCR. There was only one case study that reported the presence of NDM-1 in clinical isolates from Turkey [Poirel L et al. Antimicrob Agents Chemother 2012;56:2784]. Our data, together with the others, indicated that the existence of NDM-1 in clinical isolates is not common in Turkey. However, since NDM-1 is a plasmid-encoded enzyme, there is always a risk of spread of this resistance through the bacterial strains in our country. Therefore, continuous surveillance and investigation of carbapenem-resistant isolates with resistance patterns suggestive of NDM-1 may enable to identify NDM-1 producing isolates. Meanwhile special care should be given on rational antibiotic use and establishment of appropriate infection control policies to prevent the spread of NDM-1 producers and other potential resistant strains.

Comparison of a real-time polymerase chain reaction-based system and Erlich-Ziehl-Neelsen method with culture in the identification of Mycobacterium tuberculosis.

BASCKGROUND/AIM: Mycobacterium tuberculosis is still a major health problem throughout the world, especially in developing countries. Disease control heavily depends on the establishment of early diagnosis. The aim of this study is to compare the efficacy of culture, GeneXpert MTB/RIF device, and Erlich-Ziehl-Neelsen direct microscopic method. MATERIALS AND METHODS: A total of 927 samples (243 respiratory and 684 nonrespiratory), which were sent to Ondokuz Mayis University Medical Faculty Tuberculosis Laboratory on suspicion of M. tuberculosis, were included in the study. RESULTS: When compared to standard culture, sensitivity, specificity, and positive and negative predictive values of the GeneXpert system for respiratory samples were 100%, 98.7%, 87%, and 100%, respectively; these values for nonrespiratory samples were 71%, 98.6%, 71%, and 98.6%, respectively. CONCLUSION: New, reliable, rapid, and easy-to-use methods that display high specificity and sensitivity are required for an effective struggle against tuberculosis. According to these results, we suggest that GeneXpert MTB/RIF is a rapid and reliable system, and when used in company with conventional tests, it would make significant contributions to the diagnosis of tuberculosis.

Apoptosis-Related Gene Expression in an Adult Cohort with Crimean-Congo Hemorrhagic Fever.

Crimean-Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection characterized by fever, bleeding, leukopenia and thrombocytopenia. It is a major emerging infectious diseases threat, but its pathogenesis remains poorly understood and few data exist for the role of apoptosis in acute infection. We aimed to assess apoptotic gene expression in leukocytes in a cross-sectional cohort study of adults with CCHF. Twenty participants with CCHF and 10 healthy controls were recruited at a tertiary CCHF unit in Turkey; at admission baseline blood tests were collected and total RNA was isolated. The RealTime ready Human Apoptosis Panel was used for real-time PCR, detecting differences in gene expression. Participants had CCHF severity grading scores (SGS) with low risk score (10 out of 20) and intermediate or high risk scores (10 out of 20) for mortality. Five of 20 participants had a fatal outcome. Gene expression analysis showed modulation of pro-apoptotic and anti-apoptotic genes that facilitate apoptosis in the CCHF patient group. Dominant extrinsic pathway activation, mostly related with TNF family members was observed. Severe and fatal cases suggest additional intrinsic pathway activation. The clinical significance of relative gene expression is not clear, and larger longitudinal studies with simultaneous measurement of host and viral factors are recommended.

Ceftaroline activity on certain respiratory tract and wound infection agents at the minimum inhibitory concentration level.

INTRODUCTION: The aim of this study was to investigate the effectiveness of ceftaroline against agents frequently isolated from respiratory tract and wound infections. METHODOLOGY: The study included a total of 250 strains isolated from various clinical specimens, among which were Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysagalactiae, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catharralis. The bacteria were identified using the matrix-assisted laser desorption/ionization time-of-flight method and conventional methods. The bacteria's antibiotic susceptibility was tested using appropriate broth microdilution. Mueller-Hinton broth with 4% lysed horse blood, Haemophilus test medium broth, and Mueller-Hinton broth were used. Ceftaroline fosamil results at the minimum inhibitory concentration (MIC) were evaluated using Clinical and Laboratory Standards Institute (CLSI) criteria. For quality assurance, E. coli ATCC 35218, S. aureus ATCC 29213, S. aureus ATCC 43300, S. pneumoniae ATCC 49619, H. influenzae ATCC 49766, H. influenzae ATCC 10211, and H. influenzae ATCC 49247 standard strains were used. RESULTS: According to CLSI criteria, resistance was not detected in any strains. Due to the absence of CLSI criteria for M. catharralis, the susceptibility state for this bacterium was not evaluated. The various strains' MIC50-MIC90 values were as follows: for S. pyogenes, 0.015-0.06; for S. agalactiae, 0.03-0.125; for S. dysagalactiae, 0.03-0.06; for S. pneumoniae, 0.06-0.125; for H. influenzae, 0.015-0.125; and for M. catharralis, 0.5-1. CONCLUSIONS: The results indicate that ceftaroline is quite effective against bacteria that are frequently isolated from respiratory tract and wound infections.

An investigation into the in-vitro effectiveness of electrolyzed water against various microorganisms.

The aim of this study was to investigate the in-vitro antimicrobial activity of usage and normal concentrations of electrolyzed water in hospital. In our study, the effects of different concentrations of electrolyzed water named Envirolyte® (Industries International Ltd., Estonia) on two gram positive, four gram negative standard strains and clinical isolates of four gram negative, two gram positive, one spore-forming bacillus and Myroides spp strains that lead to hospital infections were researched. The effects of different concentrations and different contact times of Envirolyte® electrolyzed water on cited strains were researched through method of qualitative suspension tests. Petri dishes fo bacteria have been incubated at 37°C 48 hours. Bactericidal disinfectant was interpreted to be effective at the end of the period due to the lack of growth. Solutions to which disinfectant were not added were prepared with an eye to control reproduction and controlcultures were made by using neutralizing agents. 1/1, 1/2, and 1/10 concentrations of Envirolyte® electrolyzed water were found to be effective on the bacteria that lead to hospital infections used during all test times. As a conclusion, based upon the results we acquired, it was observed that Envirolyte® electrolyzed water of 100% concentration would be convenient to be used for disinfection when diluted to a usage concentration of 1/10.

[Evaluating of Plasmodium species isolated from peripheral blood samples in a non-endemic region]. / Endemik Olmayan Bir Bölgede Periferik Kan Örnegi Incelemesinde Saptanan Plasmodium Türlerinin Degerlendirilmesi.

OBJECTIVE: Malaria is a parasitic disease, caused by Plasmodium species, which transmitted to humans through genus Anopheles mosquitoes. This disease widely spreaded in tropical and subtropical areas. The aim of our study is to evaluate malaria cases diagnosed by peripheral blood examination. METHODS: Peripheral blood samples sent to Parasitology Laboratory between 2001 and 2013 years, were examined using thick and thin blood smear techniques. RESULTS: A total of 102 blood samples obtained from suspected patients were examined and eight of them were found to be positive. All cases were male and Plasmodium falciparum and Plasmodium vivax was detected in seven (87.5%) and one (12.5%) of them, respectively. Blood samples were mainly sent from Departments of Infectious Diseases. All P. falciparum cases had a history about work or travel to different African countries. CONCLUSION: We think that patients who has fever and travel history to endemic countries especially in Africa, blood examination for malaria parasites should be taken into account in differential diagnosis.

Evaluation of the efficacy of akacid plus® fogging in eradicating causative microorganism in nosocomial infections.

OBJECTIVE: The novel polymeric guanidine Akacid Plus® is a member of the cationic family of disinfectants. The aim of the present study was to evaluate the activity of Akacid Plus® against bacteria which cause nosocomial infections and remain viable after contaminating the environment and determine the effects of organic materials to the activity. METHODS: Closed room and control room were created for experimental disinfection. Bacterial suspensions of 0.5 McFarland were prepared from methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter baumannii and vancomycine-resistant Enterococcus faecium (VRE) strains. A 0.1 mL of each suspension was applied on the chipboard (25 cm(2)) and tile (25 cm(2)) test surfaces without albumin and with 2% albumin to simulate organic dirt, and the test surfaces were placed in the test and control rooms after drying. Before testing, cotton swab premoistened with serum physiologic was used to obtain samples from various surfaces in the environment and the samples were transferred onto 5% sheep blood agar for incubation at 37°C. Akacid Plus® solution at a concentration of 0.5% was nebulized with an aerosol applicator (Prowi-06, Germany) for 45 minutes. After a 2-hour waiting period, 1 mL neutralizing broth (Dey-Engley Neutralizing Broth, Fluka) was transferred on the test surfaces, and samples were collected with a swab from the test surfaces and various surfaces in the testing room and inoculated on 5% sheep blood agar for incubation at 37oC for 24 hours. At the end of the incubation period, number of colonies were evaluated on the control and test plates. RESULTS: Although coagulase-negative staphylococci, Bacillus spp., and fungi were grown in cultured samples obtained from the environment of experimental laboratory, no growth was observed in the test plates after room disinfection with Akacid Plus®. After room disinfection, MRSA and A. baumannii were not detectable in the cultured media prepared from the test surfaces with or without albumin. The bacterial count for vancomyine-resistant E. faecium was reduced from 10(7) to 5×10(2) on surfaces without albumin and from 10(7) to 2.5×10(3) on surfaces with albumin. All test plates prepared from the surfaces in the control room showed abundant growth of the microorganism. CONCLUSION: The nebulization of Akacid plus® solution at a concentration of 0.5% proved to be an efficient means of disinfection for the removal of pathogenic microorganisms that cause hospital outbreaks and use of isolation measures.

[Evaluation of materials sent due to suspected cystic echinococcosis to the parasitology laboratory of Ondokuz Mayis University Medical School between the Years 2005-2011]. / Kistik Ekinokokkozis Süphesi ile 2005-2011 Yillari Arasinda Ondokuz Mayis Üniversitesi Tip Fakültesi Parazitoloji Laboratuvarina Gönderilen Örneklerin Degerlendirilmesi.

OBJECTIVE: Cystic echinococcosis (CE) is an important health problem common in our country. In this study, anti-Echinococcus granulosus IgG antibodies were investigated in the serum samples of 454 patients who attended the Ondokuz Mayis University, Faculty of Medicine, Department of Parasitology between 2005 and 2011. METHODS: IHA (Fumouze, France) and ELISA (R-Biopharm, Germany) tests were performed at the same time. RESULTS: While serum samples from 328 patients (72%) were negative with both tests, 81 samples (18%) were found to be positive with both tests. Forty (49%) cases were female, 41 (51%) cases were male who were positive by both tests. 25 (31%) positive cases were between 31 and 50 years old. While IHA was negative for 33 patients (7%) ELISA was positive for the same samples. In 2 patients (0.4%), both tests revealed low-positivity. CONCLUSION: Using these two tests together for serologic detection of cystic echinococcosis could be recommended because of the high sensitivity and specificity ratios.

Fulminant pertussis in very young infants: two cases and review of the literature.

Pertussis is one of the leading causes of death that can be prevented by vaccination. More than 600,000 deaths from pertussis occur annually, with a disproportionate number appearing in unvaccinated infants. Pertussis is particularly troublesome because it does not necessarily present itself in its commonly known classical stages. Therefore, in very young and non-immunized children, the disease may have a fulminant process characterized by severe leukocytosis, neurologic involvement and serious cardiopulmonary failure that can be accompanied by pulmonary hypertension, persistent hypoxia and death. This article describes two infants with fulminant pertussis; they were admitted for acute respiratory failure and severe leukocytosis and ultimately died from multi-organ failure.

[Strongyloides stercoralis in a patient with ankylosing spondylitis: case report]. / Ankilozan Spondilitli Bir Hastada Strongyloides stercoralis: Olgu Sunumu.

Strongyloidiasis is a nematode-borne disease caused by several Strongyloides species. This case was presented in order to indicate Strongyloidosis in immunocompromised patients with several clinical findings. A fifty-five year old male patient on corticosteroid medication for a long time because of ankylosing spondylitis was on infliximab medication for 5 years. He presented with swelling of his right foot for ten days, right shoulder stiffness and low back pain. The presence of anaemia was remarkable. S. stercoralis was reported in histological examination of endoscopic duodenal biopsy specimen. Peripheral blood smear showed 68.4% neutrophils, 17% lymphocytes, 7.5% monocytes, and 6.7% (normal range 2%-6.2) eosinophils. The level of IgE was raised: 285IU/mL (normal range 5-120IU/mL). A large number of S. stercoralis larvae were detected upon stool examination with saline and iodine mounts and the formaldehyde ether concentration method. After treatment with two cure albendazole 400 mg/day for 7 days, S. stercoralis larvae were not detected in stool examination. It is interesting that response to treatment was not observed on the first cure and the recovery was seen on the second cure. We suggest that hyperinfections should be taken into consideration in the diagnosis and treatment of immunocompromised patients with several complaints so that life-threatening effects of the nematode may be prevented.

Comparison of Culture, Real-Time DNA Amplification Assay and Ehrlich-Ziehl-Neelsen for Detection of Mycobacterium tuberculosis.

OBJECTIVE: Mycobacterium tuberculosis is still a substantial health problem universally. Although culture is the gold standard method, reliable, rapid and new methods are required for effective struggle with disease. We retrospectively compared the results of Ehrlich-Ziehl-Neelsen (EZN) stain and real-time DNA amplification assay (BD ProbeTec ET system) with culture. STUDY DESIGN: Retrospective study. MATERIAL AND METHODS: A total of 703 samples, 182 pulmonary and 521 extra pulmonary, collected from 630 patients between May 2008 and February 2011 were evaluated. Culture was considered the gold standard. RESULTS: For pulmonary specimens, sensitivity, specificity, positive predictive and negative predictive values of BD ProbeTec ET and EZN were calculated to be 100%, 98.8%, 87.5%, 100% and 71.4%, 98.8%, 83.3%, 97.6%, respectively. For extra pulmonary specimens, sensitivity, specificity, positive predictive and negative predictive values of BD ProbeTec ET and EZN were calculated to be 80%, 98.7%, 76.9%, 98.9% and 24%, 98.3%, 42.8%, 96.2%, respectively. CONCLUSION: According to these results, we suggest that the BD ProbeTec ET system is more reliable than EZN. In addition, the BD ProbeTec ET system produces faster results. Based upon these results, we consider that the BD ProbeTec ET system may be employed in the diagnosis of M. tuberculosis.

Old agent, new experience: colistin use in the paediatric Intensive Care Unit--a multicentre study.

Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem around the world, especially in Intensive Care Units. The aim of this study was to investigate the efficacy and safety of colistin therapy in paediatric patients with severe nosocomial infections caused by MDR Gram-negative bacteria. There were 87 episodes in 79 paediatric Intensive Care Unit patients in five different hospitals; each patient was treated intravenously with colistin and evaluated. Of the 79 patients, 54.4% were male and the median age was 30 months. The most commonly isolated microorganism was Acinetobacter baumannii, the most common isolation site was tracheal aspirate fluid and the most common type of infection was ventilator-associated pneumonia. The mean colistin dose in patients without renal failure was 5.4 ± 0.6 mg/kg/day, the mean therapy duration was 17.2 ± 8.4 days and the favourable outcome rate was 83.9%. Serious side effects were seen in four patient episodes (4.6%) during therapy; two patients suffered renal failure and the others had convulsive seizures. Other patients tolerated the drug well. The infection-related mortality rate was 11.5% and the probability of death within the first 9 days of treatment was 10 times higher than after the first 9 days. In conclusion, this study suggests that colistin is effective in the treatment of severe nosocomial infections caused by MDR Gram-negative bacteria and is generally well tolerated by patients, even after relatively long-term use.