Alaaddin Pahsa

Saccharomyces boulardii and infection due to Giardia lamblia

Therapy with metronidazole is the recommended option in giardiasis. However, some clinical trial reports suggest the appearance of drug resistance to explain therapeutic failure. Several investigations have been carried out on the effect of probiotic microorganisms for preventing or treating gastrointestinal diseases, but little is known about their efficacy against protozoal infections. The principal objective of our study was to evaluate the efficacy of Saccharomyces boulardii against Giardia lamblia infections. A double-blind, placebo-controlled study was carried out on adult patients with giardiasis. Group 1 (30 patients) included metronidazole 750 mg 3 times daily along with S. boulardii capsules (250 mg b.i.d. orally) for 10 d while group 2 (35 patients) was treated with metronidazole 750 mg 3 times daily and with empty capsules as placebo for 10 d. Patients were re-examined at 2 and 4 weeks after treatment, and stool examinations were performed. At week 2, G. lamblia cysts were detected in 6 cases (17.1%) of group 2 and none in group 1. At the end of the fourth week, presence of the cysts continued in the same 6 cases in group 2 (control group). These findings indicated that S. boulardii may be effective in treating giardiasis when combined with metronidazole therapy.

Cutaneous Anthrax in Turkey: A Review of 32 Cases

Anthrax, caused by the Gram-positive, rod-shaped, spore-forming bacterium Bacillus anthracis, is rarely seen in industrialized nations but is common in developing countries. Cutaneous anthrax accounts for 95% of cases and usually develops on exposed sites. This study reviews the clinical and laboratory findings of 32 patients diagnosed with cutaneous anthrax over a 4-y period in the eastern part of Turkey. All patients had a history of direct contact with infected animals. The patients, aged 6-72 y, comprised 17 (53%) males and 15 (47%) females. The most frequent localization site of skin lesions was the hands and fingers (31 patients), whereas the suborbital part of the face was invaded in 1 patient. The diagnosis was made as a result of typical clinical lesions, direct microscopy or bacterial isolation. All but 2 patients were successfully treated with penicillin; these other 2 patients were treated initially with sulbactam-ampicillin. All patients, including the patient with suborbital anthrax, were cured.

Identification of yeasts in public hospital primary care patients with or without clinical vaginitis.

Objective:  Vaginal yeast infections are one of the most common female genital tract infections. Candida albicans is the most common infectious cause. Candida species other than C. albicans are being diagnosed with increasing frequency. The aim of the present study was to determine species of yeasts obtained from the vaginal fluid among public hospital primary care patients with or without clinical vaginitis and to evaluate the correlation of vaginal yeast colonisation with epidemiological and clinical features of applicants.

Effect of climate on the bacteriology of chronic suppurative otitis media.

Objectives: We evaluated the correlation between the microbial content of chronic suppurative otitis media (CSOM) and regional climatic parameters. Methods: We assessed the interrelations between monthly mean records of temperature, maximum temperature, atmospheric pressure, and humidity and the aerobic microbial flora in CSOM. Results: Forty-three bacteria of Enterobacteriaceae, 67 staphylococcal spp, 51 Pseudomonas aeruginosa, 9 Streptococcus pneumoniae, 1 α-hemolytic Streptococcus, 1 Enterococcus sp, and 2 Edwardsiella tarda strains were recovered from 173 patients with CSOM. There was a good relationship between enteric bacteria and monthly mean temperature (r = 0.501) and significant colonization rates due to increasing monthly mean temperature (p = .040) and monthly mean maximum temperature values (p = .048). Conclusions: When the weather warmed, the frequency of isolation of enteric bacteria increased significantly. Temperature changes may affect the enteric bacterial colonization of CSOM.

Minimal Change Disease in a Patient Receiving IFN-α Therapy for Chronic Hepatitis C Virus Infection

Chronic hepatitis C virus (HCV) infection is associated with several extrahepatic syndromes. The principal types of renal disorders associated with chronic HCV infection are cryoglobulinemia or noncryoglobulinemic membranoproliferative glomerulonephritis (MPGN). Interferon-alpha (IFN-alpha) may precipitate or exacerbate the occurrence of MPGN. Our patient was a 32-year-old man who tested positive for HCV in July 1997. The patient was treated with IFN-alpha in another medical center for 6 months because his liver biopsy showed chronic active hepatitis. In December 1998, he applied to our clinic for a follow-up examination. The level of aspartate aminotransferase (AST) was 44 U/L, and that of alanine aminotransferase (ALT) was 69 U/L. HCV RNA was positive in serum, and chronic HCV infection was detected by liver biopsy. IFN-alpha therapy (5 million U/day) was administered for 6 months longer. In May 1999, the patient came to our polyclinic with edema of the feet and legs. We detected proteinuria, serum cholesterol of 269 mg/dl, AST of 50 U/L, ALT of 41 U/L, serum total protein of 3.4 g/dl, serum albumin of 1.2 g/dl, positive cryoglobulin, and urine protein of 9.84 g/day. Cryoglobulinemic MPGN was suspected and kidney biopsy was performed, resulting in a diagnosis of minimal change disease (MCD).

Assessment of the antibody response in 110 healthy individuals who have been subject to Vi capsular polysaccharide vaccine

Typhoid fever is a disease predominant in underdeveloped and developing countries. Typhoid fever is more prevalent, in fact endemic, in countries where fecal contamination of water and food sources are very common. The majority of the reported cases are in the adult age group. There are three different vaccines which can be used to prevent typhoid fever. In this study, we have used the parenteral Vi vaccine which was developed using the polysaccharide Vi antigen that covers the bacterial surface, thus, concealing the O antigen protecting the bacteria against Anti-O antibodies and regarded as virulence factor. A total of 110 individuals whose sera were negative for seroconversion prior to vaccination were included in this study in which we have assessed Anti-Vi antibodies by tube agglutination. Serum and stool samples of 110 individuals were assessed 1 month after the vaccination. A total of 105 (95.5%) of the vaccinated people were considered to have positive (1/40 and higher) response and this result was regarded as prophylactic seroconversion. None of the people in the study group had Salmonella typhi, S. paratyphi A,B,C isolated from their stool cultures.

Prevalence of hepatitis B virus infection in young Turkish men.

Hepatitis B virus (HBV) infection is an important public health problem in developing countries and is one of the leading causes of chronic hepatitis, cirrhosis and hepatocellular carcinoma. The World Health Organization has estimated that two billion HBV-infected people world wide. It is already known that the prevalence of HBV infection differs greatly throughout the world, and even within communities. All young Turkish men at the age of 20 are obliged to perform military service. At the beginning of this service, they congregate randomly from all over the country at military training centres. Hence, the population in training centres directly represents the young male population of the whole country. The Turkish Kizilay Agency checks viral markers in all the soldiers on admission to military service to facilitate voluntary blood donations. The present study was designed to evaluate the prevalence of HBV infection in this population. All soldiers, 87 (592 through 1996–2003) were enrolled in this study after joining the Fifth Infantry Training Brigade. Donors were evaluated in two groups (group I [1996–1999], n1⁄4 40,953 and group II [2000–2003], n1⁄4 46,639) to compare the eight-year course of HBV infection. The Turkish Kizilay Agency screened the obtained sera by enzyme-linked immuno-sorbent assay kits. An overall prevalence rate of 4.7% was detected for HBV. The prevalence of HBV infection was higher in group I (n1⁄4 1991, 4.86%) than in group II (n1⁄4 2138, 4.58%) (P1⁄4 0.053). Based on the prevalence of hepatitis B carrier state in the general population, countries are classified as having high (8% or more), intermediate (2–7%) or low (less than 2%) HBV endemicity. In previous studies, it was shown that the prevalence of HBV infection varied between the different regions in Turkey and decreased from east to west from 10% to 4%, with an average rate of 6% in the general population. That is, Turkey is in the median endemicity region. The Turkish Ministry of Health has designed various HBV vaccination projects since 1996. Today, the valid policy is to vaccinate newborns, preschool children, health-care workers, partners or the family members of HBV-infected patients, commercial sex workers and nursing home residents, and the populations of the hyper-endemic region were accepted as risk groups. Our study comprises a population which directly reflects the young male population of the whole country. Consequently, these data emphasize that Turkey will have HBV prevalence rates scattered in the range of median endemicity cut-offs in the near future. The clues on the beneficial sides of vaccination programmes are obvious. However, Turkey must enforce stricter prevention strategies than those in common practice today to lower HBV prevalence rates and to put the country into the lower endemicity category.

Profiles of biochemical parameters in central nervous system fluid during the therapeutic courses of adult Mycobacterium tuberculosis meningitis

Clinical features, cerebrospinal fluid (CSF) examination, and neuroimaging findings can yield a presumptive diagnosis of tuberculosis meningitis (TM). However, confirmed diagnosis depends on the culture of Mycobacterium tuberculosis from the CSF [1]. Generally, the decision to begin with tuberculostatic treatment cannot await the proof of the causative agent and the prognosis of the disease may be devastating even if treatment is started promptly [2]. Sometimes the clinicians are confused from the diagnostic burden whether to start therapy for TM or not. In some TM cases without microbiological confirmation, the clinical and laboratory parameters resolve very quickly after the initiation of antibiotics. There remains another controversy in this situation, i.e. whether the clinician will stop therapy or continue for 12 months. There is little knowledge on the changes of CSF biochemical parameters during antituberculosis therapy in TM patients. What happens to the biochemical profile in CSF in due course? To the authors’ knowledge there are no data in the literature on this issue. Our study, which was performed between 1 January 2000 and 31 December 2004, focuses on these CNF changes in biochemical profiles for TM patients receiving therapy. There is a chain of military hospitals over the country in Turkey. If a soldier is diagnosed as TM in 1 of the military hospitals, the patient is given antibiotics and sent home for 2 /3 months of rest following the hospitalization necessary for patient stabilization. The patient returns to hospital either in an emergency situation or following the end of the official rest period. Thus, all TM patients return to military hospitals every 2 to 3 months, but the patient does not necessarily apply to the hospital where the disease is diagnosed. Generally the patient applies to the military hospital nearest to where he lives, i.e. another institution may follow a TM case diagnosed in our hospital in the follow-up periods or we may follow a previously diagnosed case in another military hospital during the therapeutic course. In every periodical visit the patient was punctured once again either to delineate the status of infection or to present an official clue to provide the patient with an additional rest time. After the end of 12-month therapy, the surveillance of the patient is stopped. Therefore we have sparse data on TM patients which we may have encountered at any period during anti-tuberculosis therapy. All the cases were young males ranging from 20 to 28 y of age without immunosuppression. Dexamethasone was given to all patients in standard dosages

Giardiasis in Sivas, Turkey

Giardiasis is an endemic parasitic disease in Turkey. Giardia spp. is one of the major agents in water-born non-bacterial diaorrhea, and may cause outbreaks. In our study, stool samples obtained from 2247 cases (1216 adults and 1031 children) were investigated in macroscopic and microscopic methods in Kizilay Medicine Center of Sivas between January and December 2002, and the results were assessed. The study was performed in Sivas City, which is located in central Turkey and has a population of 300,000. Either the presence of cysts or trophozoids in the stool samples were the main diagnosis. In 107 samples of 2247 cases (4.76%), the diagnosis of giardiasis was established. The parasite was seen in 103 of 2063 stools (4.9%) in accordance with macroscopic diaorrhea, and in four of 184 patients (2.1%) without diaorrhea. There was no significant difference between the two groups (P1⁄4 0.085). Our results imply that giardiasis is an important healthcare burden in our region. The stool search must be performed attentively in every patient, even in cases without diaorrhea, particularly in the endemic regions.