The value of neopterin and procalcitonin in patients with sepsis.

OBJECTIVE: Neopterin (NT) is a compound of low molecule-based pteridine. It is secreted by macrophages as a response to the stimulation of cytokines such as interferon-gamma, interferon-1beta, tumor necrosis factor alpha or bacteria compounds such as lipopolysaccharides. Procalcitonin (PCT) levels may increase in the course of bacterial, parasitic, and fungal infections. Therefore, it can be used for the differential diagnosis of the infection, especially in cases of serious inflammation. In this study, the role of NT, and PCT in sepsis as a prognostic factor, and the relationship between the two parameters are examined. METHODS: From November 1, 2005 through December 31, 2005, fifty patients with sepsis admitted to the Department of the Infectious Diseases and Clinical Microbiology and/or Department of Anaesthesiology and Reanimation were enrolled in the study. Patients were divided in two subgroups according to their survival: group I (n=23) nonsurviving patients and group II (n=27) surviving patients. RESULTS: Serum NT levels have been found to be increased in group I (median: 15 ng/mL, range: 2-69) when compared to group II (median: 5 ng/mL, range: 2-130). The difference was statistically significant (P=0.03). Other laboratory parameters and PCT levels (group I median: 0.13; group II median: 0.08; P<0.05) were not different between the two groups. CONCLUSIONS: NT was found to be a prognostic factor in patients with sepsis.

[Community-acquired Pseudomonas stutzeri meningitis in an immunocompetent patient]. / Immün kompetan bir hastada toplum kökenli Pseudomonas stutzeri menenjiti.

Pseudomonas stutzeri which is an aerobic, non-fermentative gram-negative bacillus frequently found in soil, water and hospital environment, rarely leads to serious community-acquired infections. In this report a case of community-acquired meningitis due to P. stutzeri was presented. A 73-years-old male patient was admitted to the emergency department with the complaints of nausea, vomiting, headache, dizziness, difficulties in walking and speaking and loss of consciousness. There was no history of an underlying disease or immunosuppression. Physical examination revealed nuchal rigidity, however, Kernig and Brudzinski signs were negative. The cerebrospinal fluid (CSF) analysis revealed 0.4 mg/dl glucose (simultaneous blood glucose 145 mg/dl), and 618 mg/dl protein and 640 leucocyte/mm3 (90% PMNL). No bacteria were detected in Gram stained and Ehrlich-Ziehl-Neelsen stained CSF smears. Upon the diagnosis of acute bacterial meningitis, treatment with ceftriaxone and ampicillin was initiated, however, the patient died after 16 hours of hospitalization. CSF culture yielded the growth of gram-negative oxidase-positive bacteria and the isolate was identified as P. stutzeri by Vitek-2 Compact system (bioMerieux, France). The isolate was found to be sensitive to piperacillin/tazobactam, amikacin, gentamycin, ceftazidime, cefepime, ciprofloxacin, imipenem and meropenem. Since the patient was lost due to acute respiratory and cardiac failure, it was not possible to change the therapy to agent specific therapy. In conclusion, it should always be kept in mind that uncommon agents could lead to community-acquired meningitis in elderly patients and empirical treatment protocols might fail in such cases resulting in high morbidity and mortality.

Detection of hepatitis B virus in used razor blades by PCR.

BACKGROUND AND AIMS: Hepatitis B virus (HBV) infection ranks among the most devastating health problems in the world.The most probable transmission routes of HBV are blood contact, sexual, and horizontal transfer. Other sources of HBV transmission are razor sharing, beauty treatments, tattooing, piercing, and manicures and other chiropody treatments.Many infections have been reported in South-East Asia, where barbers commonly share and reuse razors. Detection of HBV DNA in contaminated devices such as razor blades is important in the demonstration of transmission routes and indirect estimation of HBV prevalence in specific subpopulations such as barbershop clientele. Therefore, we aimed to detect the presence of HBV contamination on razor blades by nucleic acid testing. METHODS: Used razor blades (n = 151) were purchased from different barber's shops. Used razor blades purchased from chronic HBV patients (n = 8) were included as a positive control. The amplification and detection of HBV DNA was carried out by a semi-nested PCR method in a thermal cycler. RESULTS: The presence of HBV DNA was found in 10 (6.6%) used razor-blade samples by the detection of a specific positive band with agarose gel electrophoresis. CONCLUSIONS: In conclusion, used razor blades may be contaminated with HBV, and the practice of sharing used razor blades may pose a risk of transmission. Nucleic acid detection methods involving PCR can be used to detect HBV contamination of razor blades. HBV control and prevention programs should educate barbers about the importance of contagious diseases, proper sterilization techniques, and avoiding reuse and sharing of contaminated equipment and supplies such as razor blades. As an infection control measure, prohibition of razor reuse can reduce the spread of HBV infection in rural areas, where the practice is often common at barbershops.

The effect of aspirin on adherence of slime-producing, coagulase-negative staphylococci to vascular grafts.

In this study, we examined the adherence of slime-producing standard Staphylococcus epidermidis strain ATCC 12228 to Dacron and polytetrafluoroethylene (PTFE) grafts in in vitro medium either containing salicylate or not. Dacron and PTFE graft pieces of standard size were placed in trypticase soy broth either containing 5 mM acetylsalicylic acid solution or not. These soy broths also contained 1 x 10(7) colony-forming units/mL S. epidermidis ATCC 12228. The incubation period lasted for 18 hr at 37 degrees C. The bacteria on the graft were freed by vortexing. The obtained bacteria suspension was diluted serially. Afterward, the suspension was plated on 5% sheep blood agar and counted after overnight incubation. In this study, we demonstrate that aspirin of an ideal concentration (5 mM) decreased the adherence of slime-producing S. epidermidis strain to Dacron and PTFE grafts. The mean number of colonies was significantly lower for both Dacron and PTFE groups in salicylated medium. We believe that aspirin provided in the postoperative period can, by maintaining the ideal serum level, decrease graft infections emerging due to coagulase-negative staphylococcus.