Ayse Nedret Koc

Comparison of in vitro activities of antifungal drugs and ethanolic extract of propolis against Trichophyton rubrum and T. mentagrophytes by using a microdilution assay

The in vitro activities of propolis against 29 strains of dermatophytes were compared with those of terbinafine, itraconazole, ketoconazole, and fluconazole. Minimal inhibitory concentrations (MICs) were determined according to a National Committee for Clinical Laboratory Standards broth microdilution method. Among the systemic antifungals tested, terbinafine was the most potent. Propolis showed important antifungal activity and it merits further investigation as a potentially useful agent for the treatment of dermatophytosis.

Antifungal Activity of the Honeybee Products Against Candida spp. and Trichosporon spp.

Honeybee products (honey, royal jelly, pollen, and propolis) were evaluated for their ability to inhibit the growth of 40 yeast strains of Candida albicans, Candida glabrata, Candida krusei, and Trichosporon spp. The broth microdilution method was used to assess the antifungal activity of honeybee products against yeasts. Fluconazole was selected as the antifungal control agent. Using the broth microdilution method, minimal inhibitory concentration ranges with regard to all isolates were 5-80% (vol/vol), 0.06-1 μg/mL, 0.002-0.25 μg/mL, 0.006-0.1 μg/mL, and 0.02-96 μg/mL for honey, royal jelly, pollen, propolis, and fluconazole, respectively. The antifungal activities of each product decreased in the following order: propolis >pollen > royal jelly > > honey. This study demonstrated that honeybee products, particularly propolis and pollen, can help to control some fluconazole-resistant fungal strains.

Antifungal Activity of Turkish Honey against Candida spp. and Trichosporon spp: an in vitro evaluation

Abstract Honey samples from different floral sources were evaluated for their ability to inhibit the growth of 40 yeast strains (Candida albicans, C. krusei, C. glabrata and Trichosoporon spp.). Broth microdilution method (CLSI, M27-A2) was used to assess the activity of the honeys against yeasts at different concentrations ranging from 1.25-80% (v/v). All of the yeast strains tested were inhibited by honeys in this study. Broth microdilution assay revealed that inhibition of growth depends on the type and concentration of honey as well as the test pathogen. Little or no antifungal activity was seen at honey concentrations <2%. Rhododendron and multifloral honeys have generally more inhibitory effect than eucalyptus and orange honeys (P<0.05). Fluconazole-resistant yeast strains were examined for their susceptibility to honeys. This study demonstrated that, in vitro, these honeys had antifungal activity at the high concentration of 80% (v/v) in these fluconazole-resistant strains. Further studies are now required to demonstrate if this antifungal activity has any clinical application.

Can bacteraemia lead to false positive results in 1,3-beta-D-glucan test? Analysis of 83 bacteraemia episodes in high-risk patients for invasive fungal infections.

BACKGROUND Although bacteraemia has been reported to be related to false positive results in the 1,3-beta-D-glucan (BDG) test, the evidence for this interaction is limited. AIMS To investigate the association between bacteraemia and the BDG test. METHODS Records of the Infection Control Committee were reviewed to identify bacteraemia in patients who were hospitalized in the haematology ward and stem cell transplantation unit. Patients who had undergone the BDG test at least once within 5 days of a positive blood culture were included in the study. BDG levels in the sera were assayed using the Fungitell kit (Associates of Cape Cod, East Falmouth, MA) according to the manufacturers specifications. The cutoff for BDG positivity was 80 pg/mL. RESULTS Eighty-three bacteraemic episodes were identified in 71 patients. BDG positivity was detected in 14 patients with bacteraemia, and only 1 patient with Escherichia coli bacteraemia had high BDG levels (over 80 pg/mL) despite having no evidence of invasive fungal infection (IFI). CONCLUSIONS Our study suggests that the cross-reactivity of the BDG test with a concomitant or recent bacteraemia is a very rare condition. Patients with risk factors for IFI should be evaluated cautiously when a positive BDG test is reported.

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.

BackgroundInvasive pulmonary aspergillosis (IPA) is an infection often occurring in neutropenic patients and has high mortality rates. In recent years, it has been reported that the incidence of IPA has also increased in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study is to investigate the clinical and demographic characteristics and treatment responses of IPA in patients with COPD.MethodsSeventy-one patients with a positive culture of Aspergillus from lower respiratory tract samples were examined retrospectively. Eleven (15.4%) of these patients, affected with grade 3 or 4 COPD, had IPA.ResultsAspergillus hyphae were detected in lung biopsy in three (27.3%) out of 11 patients and defined as proven IPA; a pathological sample was not taken in the other eight (72.7%) patients, and these were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. While five patients required intensive care unit admission, four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography (CT) (respectively 63.6%, 72.7%) was infiltration. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voriconazole after amphotericin B therapy. Six patients (54.5%) died before treatment was completed.ConclusionsIPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation, poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids.

Investigation of the relationship between virulence factors and genotype of Candida spp. isolated from blood cultures.

INTRODUCTION The aim of study was to investigate the virulence factors of phospholipase, proteinase, esterase production and biofilm formation in Candida species isolated from patients with candidemia, and to assess their relationship with Candida genotypes derived after repetitive sequence-based polymerase chain reaction (rep-PCR) fingerprinting. METHODOLOGY Fifty-two strains were identified to species level according to conventional methods and sequencing. The DiversiLab system was used for the genotyping. Enzyme activities and biofilm formation were evaluated using microbiological methods. RESULTS The 52 strains were identified as follows: 29 C. parapsilosis, 19 C. albicans, 2 C. glabrata, and 2 C. tropicalis. Phospholipase and proteinase activities were observed to have statistically significant differences between C. albicans and non-albicans Candida (NAC) strains (p < 0.05), with C. albicans strains showing higher virulence. Rep-PCR revealed eight major genotypes (A-H).The 19 C. albicans and the 33 non-albicans Candida isolates yielded seven (A-G) and four (A, B, C, H) genotypes, respectively. C. albicans strains were not shown to have a predominant genotype and showed higher phospholipase and proteinase activitiy than did NAC, regardless of genotype. Genotype H (52%) was the predominant genotype for the NAC including 27 C. parapsilosis strains, but the majority of strains showed low virulence. CONCLUSIONS NAC species were the most common causative agent for candidemia. Genotyping showed low transmission of C. albicans strains, but transmission of C. parapsilosis was high. In candidemia, several Candida virulence factors may be responsible at the same time. However, different genotypes of Candida strains showed different virulence activity.

What is the role of the (1→3)-β-D-glucan assay in the screening of patients undergoing autologous haematopoietic stem-cell transplantation?

The aim of this study is to determine the clinical contribution of (1→3)‐β‐d‐glucan (BDG) screening in the case of patients undergoing autologous haematopoietic stem‐cell transplantation (HSCT). The records at our stem‐cell transplantation centre were reviewed to identify the patients who underwent autologous HSCT between April 2009 and December 2010. Patients were classified as having proven invasive aspergillosis (IA), probable IA, or possible IA on the basis of the criteria established by the European Organization for Research and Treatment of Cancer and Mycoses Study Group (independent of the BDG results). During the study period, the patients were screened for BDG twice a week from transplant (day 0) until engraftment. Three patients were diagnosed with probable IA and five were diagnosed with possible IA. A total of 354 serum samples from79 patients who met the study inclusion criteria were used for statistical analysis. At the cut‐off value of 80 pg ml−1, the sensitivity was 27.2% [95% confidence interval (CI); 7.3–60.6]; specificity, 94.4% (95% CI; 91.3–96.5); positive predictive value, 6.2%; and negative predictive, 93.7%. The clinical contribution of the BDG assay as a screening test was relatively limited in this cohort of patients undergoing autologous HSCT.

Relationship between depression and proinflammatory cytokine levels in hemodialysis patients.

Aim: To evaluate the presence of the relationship between depression and proinflammatory cytokine levels in hemodialysis (HD) patients. Methods: The study included 40 HD patients and 20 healthy controls. All participants were evaluated for the presence of depression using the structured clinical interview based on criteria defined by Diagnostic and Statistical Manual Mental Disorders (Fourth Edition, Text Revision) Axis I disorders. The severity of depressive symptoms was assessed using the Beck Depression Inventory, the Hamilton Depression Rating Scale, and the Hamilton Anxiety Rating Scale. The depressive patients received antidepressants for 8 weeks. Blood samples were taken at baseline and after 8 weeks of antidepressant treatment for interleukin-1 (IL-1), IL-6, and tumor necrosis factor-α (TNF-α) levels. Results: A total of 9 (22.5%) of the 40 HD patients had depression. IL-1, IL-6, and TNF-α levels were significantly higher in HD patients compared with that in the control group, but were not significantly different between HD patients with and without depression. In the depressive patients, we observed no significant difference in proinflammatory cytokine levels after antidepressant treatment. The psychometric measurements in depressive patients decreased significantly after antidepressant treatment. Conclusion: We observed that depression is a common psychiatric disorder and has no significant effect on proinflammatory cytokine levels in HD patients; no important improvement in cytokine levels was observed after antidepressant therapy.

Case Report. Successfully treated subcutaneous infection with Sporothrix schenckii in Turkey

Summary. Sporotrichosis is rare in Turkey. We report a 48‐year‐old man who had subcutaneous sporotrichosis caused by Sporothrix schenckii that was successfully treated with short‐term itraconazole and potassium iodide. The isolate was susceptible to itraconazole also in vitro. Short‐term itraconazole and potassium iodide should be agents of choice for treatment of subcutaneous sporotrichosis. However, treatment is controversial both in choice of agent used and in duration of therapy.

Terbinafine versus itraconazole and fluconazole in the treatment of Vulvovaginal candidiasis.

Vulvovaginal candidiasis is one of the most frequent infections of the female genital tract with a high incidence. Although numerous antimycotical agents are available for treatment of yeast vaginitis, there are few comparative data on the in vivo and in vitro activity of these drugs. The aim of this open, randomized, and comparative study was to determine in vivo and in vitro effectiveness of the 3 systemic antifungal agents: terbinafine and 2 azoles (itraconazole and fluconazole) in the treatment of patients with Vulvovaginal candidiasis. A total of 44 patients who had signs and symptoms of Vulvovaginal candidiasis were recruited for the study. Patients were randomly assigned to 3 groups: terbinafine 500 mg/d orally was used for 7 days, itraconazole 200 mg/d orally was used for 7 days, and fluconazole 150 mg orally was used as a single dose. Both clinical and mycologic examinations were performed for posttreatment assessment at week 4. This study revealed a clinical cure rate 33.3% for terbinafine, 60% for itraconazole, and 66.6% for fluconazole (P>0.05). Mycologic cure rates were 33.3%, 10%, and 66.6% respectively (P<0.05). Overall cure rates were 33.3%, 10%, and 53.3% (P>0.05). Terbinafine could be an alternative treatment option in Vulvovaginal candidiasis because there were no significant differences in the clinical and overall cure rates among 3 antifungal agents. However, terbinafine could not be suggested as a first-line treatment in Vulvovaginal candidiasis. Systemic use of terbinafine in larger numbers of cases may give more information about the effectiveness of this drug in the treatment of patients with vulvovaginal candidiasis.