Aysegul Yagci

Asymtomatic carriage of Neisseria meningitidis and Neisseria lactamica in relation to Streptococcus pneumoniae and Haemophilus influenzae colonization in healthy children: Apropos of 1400 children sampled

Meningococcal disease is one of the most important causes of morbidity and mortality among children in many parts of the world. Main reservoir of carriage and site of meningococcal dissemination appears to be the upper respiratory tract. Colonization of Neisseria meningitidis and lactamica and factors affecting this carriage were determined in a group of healthy children aged 0–10 years. Meningococcus and N. lactamica carriage were detected in 17 (1.23%) and 245 (17.7%) of 1382 subjects, respectively. Number (%) of serogroups for meningococci was 1 (6), 5 (29), 0 (0), 1 (6), 1 (6), and 9 (53) for A, B, C, D, W135, and Y, respectively. Having more than three household members, elementary school attendance, pharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae were associated with carriage of meningococci, whereas age less than 24-month was associated with carriage of N. lactamica. There was a reverse carriage rate between N. meningitidis and N. lactamica by age which may suggest a possible protective role of N. lactamica against meningococcal colonization among pre-school children.

Molecular Typing of Myroides odoratimimus (Flavobacterium odoratum) Urinary Tract Infections in a Turkish Hospital

The taxonomy of the genus Flavobacterium has undergone substantial changes in recent years since it was defined by Holmes et al. [1] as a group of gram-negative, yellow-pigmented, oxidase-positive rods that are strictly aerobic and nonmotile. Today, several Flavobacterium species have been reclassified into different genera [2]. Flavobacterium odoratum was reclassified into the new genus Myroides [3] and further differentiated into two species, Myroides odoratus and Myroides odoratimimus, on the basis of DNA homology, carbon source assimilation profiles and cellular fatty acid composition.

Use of T Cell-Based Diagnosis of Tuberculosis Infection to Optimize Interpretation of Tuberculin Skin Testing for Child Tuberculosis Contacts

BACKGROUND Treatment of recent tuberculosis infection in children aged <2 years is essential, because of high risk of progression to disease, but diagnosis is hindered by the inaccuracy of the tuberculin skin test (TST). More-accurate T cell-based tests of infection could enhance diagnosis by optimizing interpretation of the TST results. METHODS A total of 979 child tuberculosis contacts in Istanbul underwent the TST and enzyme-linked immunospot assay. Using enzyme-linked immunospot test results as a reference standard, we assessed the effect of age and bacille Calmette-Guérin (BCG) vaccination on the sensitivity and specificity of the TST, and we computed the optimal TST cutoff points, using receiver operating characteristic curves. RESULTS With a TST cutoff point of >or=10 mm, the sensitivity of the TST was 66% for children aged <2 years, which was lower than that for older children (P= .006). Specificity was 75% for BCG-vaccinated children, compared with 92% for unvaccinated children (P= .001). Optimal cutoff points improved TST specificity for children with 1 BCG scar, with little loss of sensitivity. Despite the use of optimal cutoff points, TST sensitivity remained <70% for children aged <2 years, specificity remained <87% for BCG-vaccinated children aged >or=2 years, and overall accuracy was low for children with >1 BCG scar. CONCLUSIONS Negative results of the TST cannot exclude tuberculosis infection for child tuberculosis contacts aged <2 years, which supports the use of preventive therapy regardless of the TST results for this age group. In children aged >or=2 years, the accuracy of the TST can be improved by adjustment of cutoff points for BCG-vaccinated children but remains poor for children with >1 BCG scar. This methodology can define optimal TST cutoff points for diagnosis of tuberculosis infection tailored to target populations.

Extended‐spectrum β‐lactamase‐producing Klebsiella pneumoniae in paediatric wards: A nested case‐control study

Aim:  A high rate (48.6%) of extended spectrum beta‐lactamase production among Klebsiella pneumoniae (ESBL‐KP) clinical isolates in the paediatric wards of our hospital prompted the introduction of enhanced infection control measures, and after the implementation of these measures, we instituted a prospective surveillance programme, with a nested case‐control study to determine the risk factors for rectal colonisation by ESBL‐KP.

Epidemiology of Candidemia in a Turkish tertiary care hospital

In order to determine the local epidemiology of candidemia, Candida strains isolated between 1994 and 2000 were identified to species level; antifungal resistance patterns and DNA fingerprints were analyzed. Identification of Candida strains (n: 140) was performed with germ tube test and carbohydrate assimilation reactions. Minimal inhibitory concentrations were determined using a commercial test for 5‐flucytosine and the broth macrodilution method according to NCCLS for fluconazole and amphotericin B. Molecular relatedness was determined by restriction endonuclease analysis of genomic DNA followed by probe hybridization. C. albicans (37.2%), C. parapsilosis (32.2%), and C. tropicalis (12.2%) comprised 114 (81.4%) of 140 isolates. Susceptibility tests did not reveal resistance to amphotericin B in any of the Candida isolates. Fluconazole resistance was detected in one isolate of C. krusei, and 5‐flucytosine resistance in two C. tropicalis isolates and one C. albicans isolate. Significantly higher frequency of clusters with identical strains in C. parapsilosis and C. tropicalis was detected compared to C. albicans. Pediatric wards are particularly important in the nosocomial transmission of non‐albicans candida species.

Pharyngeal colonization with Haemophilus influenzae type b among healthy Turkish infants and children

Background : An absence of Haemophilus influenzae type b (Hib) disease surveillance and epidemiological data on the pharyngeal carriage of Turkish children causes delay in the introduction of conjugated Hib vaccination into proposed national vaccination programs.

Panton-Valentine leukocidin and biofilm production of Staphylococcus aureus isolated from respiratory tract.

INTRODUCTION Staphylococcus aureus is one of the first bacteria colonizing in cystic fibrosis (CF) respiratory tract and different virulence factors are responsible for disease progression. It is not clear if CF S. aureus strains are more virulent than strains isolated from non-CF patients. METHODOLOGY Biofilm production was detected by a modified tissue culture plate method, presence of genes encoding for Panton-Valentine leukocidin (PVL) was investigated by a signal amplified sandwich hybridization assay and antimicrobial susceptibility patterns were detected by disk diffusion method. RESULTS Staphylococcus aureus clinical isolates (n = 88) recovered from respiratory tract specimens in which 31 of them were from cystic fibrosis (CF) patients were analysed. Biofilm production was detected in 96.8% of CF isolates in which 32.3% exhibited strong positive phenotype and in 47.4% of non-CF isolates in which strong positive phenotype was not observed (p <0.05). All CF isolates were methicillin susceptible, whereas 53.4% of non-CF isolates (n = 31) were methicillin resistant. No resistance was observed for vancomycin, chloramphenicol and trimethoprim/sulfamethoxazole in any of the isolates. PVL genes were detected only in two isolates (2.3%), one from each group, CF and non-CF, which both were methicillin susceptible. CONCLUSION Biofilm rather than PVL production appears to be an important virulence factor in CF patients.

Detection of anti-tetanus antibodies in Turkish population

Step 3 A thin rubber or a plastic tube is passed into the nose and brought out through the oral cavity. The two ends are pulled and fixed at the angle of the mouth (Figure 3), thus pulling or stiffening or tightening the soft palate. The patient is then allowed to sleep. The controlled snore recording is repeated. A decrease or disappearance of snoring indicates that soft palate surgery alone will be beneficial for snoring. RR has used this method on five patients during the last 3 years to identify the level of obstruction before planning the surgery. The disadvantages of this method are the amount of time involved and possible discomfort

Surveillance of Haemophilus influenzae among respiratory tract samples of Turkish children

We conducted three prospective studies of Haemophilus influenzae in different groups of children. Pharyngeal swab samples were taken (i). from 1382 healthy infants and children between 0 and 10 years of age (group 1), attending well child clinics (n=438), day care centres (n=440) and elementary schools (n=504), and (ii). from 322 children aged 2-10 years (group 2), clinically diagnosed as having upper respiratory tract infection. Pharyngeal swab samples and sinus aspirates were obtained from 49 children between 2 and 9 years of age (group 3), clinically diagnosed as having sinusitis. H. influenzae was isolated in similar rates from 315 (22.7%) of children in group 1, 72 (22.3%) of children in group 2 and 12 (24.4%) of children in group 3. Serotype b comprised 7, 5.2 and 2% of all H. influenzae isolates for group 1, 2 and 3, respectively. Production of beta-lactamase was detected in 1.0% of H. influenzae type b isolates in group 1, 1.2 and 6.1% of all isolates in group 2 and 3, respectively. There were no beta-lactamase negative ampicillin-resistant strains.

Value of washed sputum samples in children with lower respiratory tract infections

Lower respiratory tract infections (LRTI) represent one of the serious infections in children with significant morbidity and mortality, especially in developing countries. Accurate identification of respiratory pathogens is the basis of management, and initial appropriate treatment is related to lower mortality rate. Microbiologic diagnosis of LRTI in children is difficult because samples of sputum are difficult to obtain and invasive collection techniques such as bronchoscopy or biopsy are rarely performed. Among respiratory tract samples sputum is a non-invasive clinical specimen, but normal resident bacteria of the oropharynx may contaminate samples and a large number of different species may overgrow, preventing determination of true epidemiologic agent. Previously some authors have suggested that in order to reduce bacterial contamination, sputum can be washed, and, to increase the yield of cultivation, a certain amount of the sample can be inoculated quantitatively. The aim of the present study was therefore to determine the incidence of bacterial pathogens in children with clinically suspected LRTI and to evaluate the value of direct examination and quantitative culture method of sputum samples. Antimicrobial therapy for LRTI is frequently empirical and selection of appropriate drug requires awareness of the patterns and clinical significance of antibiotic resistance. We analyzed the susceptibility patterns of the present bacterial isolates in order to generate antimicrobial susceptibility data to guide physicians in choice of treatment.