Barcin Ozturk

The seroprevalence of Crimean-Congo haemorrhagic fever among inhabitants living in the endemic regions of Western Anatolia

Abstract Background: In Turkey, Crimean-Congo haemorrhagic fever (CCHF) is seen particularly in the north-eastern part of Anatolia. Aydin was thought to be a non-endemic area, however the first case was reported from Aydin in 2006 and a total of 39 cases were reported between 2006 and 2010. Methods: Four hundred and twenty-nine volunteers from 3 endemic regions of Aydin were enrolled in this study. We determined the IgG seropositivity against the virus by enzyme-linked immunosorbent assay (ELISA) method. Results: IgG seropositivity in the study group was found to be 19.6% (n = 84). Chi-squared automatic interaction detector (CHAID) analysis was performed and a significant relationship between IgG seropositivity and tick-bite was found. The IgG seropositivity rate was 13% in cases without a history of tick-bite, while it was 41.1% in those with a tick-bite history (p < 0.001). In cases without a history of tick-bite (n = 339), the most important factor related to seropositivity was cattle-dealing. The seropositivity rate was higher in women than in men in the group dealing with cattle without a history of tick-bite (p = 0.013). In cases with a tick-bite history, the most important factor related to IgG seropositivity was age; the rate was 81% in cases younger than 34 y old, while it was 29% in cases older than 34 y. Conclusions: This study indicates that people suffering from the disease did not ask for any professional healthcare or that the healthcare providers could not diagnose these cases.

Tetanus seroepidemiology and factors influencing immunity status among farmers of advanced age

OBJECTIVES Tetanus, which is a vaccine preventable disease, remains a significant health concern. The mortality is especially high in elderly and farming is a significant risk factor for the disease. This study evaluates the serological immunity of tetanus and the related factors, in a farmer population. METHODS This cross-sectional study was carried out in a village located in the western part of Turkey. Volunteer farmers over the age of 50 were included in the study. The study group was determined by the systematic sampling method. IgG class tetanus antibody was measured in sera of each participant. A structured questionnaire evaluating the demographic characteristics was completed by the investigators. RESULTS A total of 293 participants (55.3% female, 44.7% male) were recruited from March 2010 to June 2010. A serum protective tetanus antitoxin level (> 0.1 IU/ml) was detected in 99 out of 293 (33.9%) of participants. According to univariate analysis; advancing age, female gender, lower education, low monthly income, presence of chronic disease, absent or incomplete vaccination history or being unvaccinated in the last ten years were risk factors for insufficient tetanus immunity. After multiple logistic regression analysis, up-to-date vaccination, gender and age were the only factors that remained independently associated with immune status (p < 0.001). CONCLUSION Farmers of advancing age are a population at risk for tetanus due to their work environment and their absent or incomplete immunization to the disease. Low rates of immunity detected highlight the importance to explore strategies in order to improve immunization status in this risky population.

A Rare Presentation of Endocarditis in Adult-onset Still's Disease in Diagnosis of Fever of Unknown Origin

To the Editor: Adult-onset Still’s disease (AOSD) was first described by Bywaters in 1971, with descriptions of 14 patients1. Differentiation between microbial infections and rheumatic diseases such as AOSD remains difficult in many cases. Heart involvement in AOSD is uncommon and valvular involvement is extremely rare. We describe a case of AOSD in a 39-year-old woman who presented with fever, endocarditis, and hyperferritinemia. Our patient was admitted to the emergency service with fever and chest pain. One week before she had had a sore throat, so she was given amoxicillin-clavulanate 2 × 1000 mg/day for 1 week. On examination, tachycardia and apical 2/6 systolic murmur were detected. Cardiac enzymes were normal. Laboratory tests (Table 1) showed acute-phase inflammation and leukocytosis. Cardiomegaly was seen on chest radiography. Echocardiography (ECO) showed mitral stenosis, 1.7 cm pericardial effusion, second-degree mitral insufficiency, and second- and third-degree aortic insufficiency. She had a fever of 38.7°C, and blood cultures were obtained. In transesophageal ECO, 0.6 × 0.5-cm diameter vegetation on aortic valve was seen. The diagnosis was … Address correspondence to Dr. B.M. Ertugrul, Department of Infectious Diseases and Clinical Microbiology, University of Adnan Menderes, School of Medicine, 09100 Aydin, Turkey. E-mail: bertugrul{at}adu.edu.tr

Effects of vancomycin, daptomycin, and tigecycline on coagulase-negative staphylococcus biofilm and bacterial viability within biofilm: an in vitro biofilm model

Bacteria may hide in a hydrated polysaccharide matrix known as a biofilm. The structure of the bacterial biofilm renders phagocytosis difficult and increases antibiotic resistance. We hypothesized that repeated doses of antibiotics have an effect on bacteria within the biofilm and that it could inhibit or eradicate biofilm formation. Two clinical biofilm-positive coagulase-negative staphylococcus isolates were evaluated. The effects of antibiotics on preformed and nascent biofilm and on bacterial eradication within the biofilm were determined using different doses of vancomycin, daptomycin, and tigecycline for different durations in an in vitro biofilm model. Vancomycin neither penetrated the biofilm nor had any microbicidal effect on bacteria within the biofilm. Daptomycin had a microbicidal effect on bacteria within the biofilm but had no effect on biofilm inhibition and eradication (independent from dose and treatment time). Tigecycline inhibited and eradicated biofilm formation and had a microbicidal effect on bacteria within the biofilm. In conclusion, (i) biofilm formation appeared to be a major barrier to vancomycin activity, (ii) daptomycin had an antimicrobial effect on the bacteria within the biofilm but not on the biofilm burden, and (iii) tigecycline had effects both on bacteria within the biofilm and on biofilm burden. Thus, both tigecycline and daptomycin might be promising candidates for the treatment of biofilm infections.

Adult‐Onset Still's Disease in an 83‐Year‐Old

One study showed a mean age at diagnosis of 44. Patients with achalasia experience dysphagia, chest pain, and regurgitation as the main symptoms. Dysphagia occurs early with liquids and solids and is worsened by emotional stress and hurried eating. Undigested food and saliva that accumulate in the dilated esophagus can be aspirated into the respiratory tract, leading to pulmonary infections. Endoscopically guided botulinum toxin injection can reduce the lower esophageal sphincter pressure, relieving dysphagia and risk of aspiration. Clinical response to botulinum toxin injection has been used to support the diagnosis of achalasia. Primary presenting symptoms of this patient were chronic intermittent cough and dyspnea over 15 months. He was treated with bronchodilators and antibiotics with temporary improvement in symptoms. Diagnosis of achalasia followed by botulinum toxin injection offered definitive treatment for the underlying cause of aspiration, preventing further pneumonia. Incidence of aspiration pneumonia increases with age because risks of oropharyngeal aspiration are more prevalent in older adults. Careful assessment of the risk factors and efforts to minimize recurrence are the cornerstone of treatment of aspiration pneumonia. Identification of the reversible risk factor in this nonagenarian resulted in successful treatment and prevention of aspiration pneumonia.

Renal Cyst Infection Caused by Brucella abortus

A 49-year-old man with a medical history of polycystic kidney disease was presented to the emergency department with fever and left flank pain. Abdominal examination revealed an enlarged and painful left kidney. The C-reactive protein level was significantly high and the magnetic resonance imaging revealed areas of abnormal intensity and fluid–fluid levels in renal cysts. Brucella abortus was yielded from both blood and cyst fluid culture. Standard therapy (rifampicin plus doxycycline) of brucellosis was started, but the clinical and laboratory signs subsided after the addition of ciprofloxacin. There was no need for aspiration of infected cyst fluid. Hereby, according to the medical database search, we report that the first renal cyst infection caused by B. abortus was successfully treated with triple antibiotic therapy.