Demir Serter

Brucellosis: a retrospective evaluation.

One hundred and sixty-six presumed brucellosis patients were included in the study. These patients were classified as primary (91), relapse (18) and suspected (57) cases according to their clinical presentations, and serologic and microbiologic test results. Primary and relapse cases were evaluated retrospectively according to age, sex, residence, routes of transmission, clinical and laboratory findings, treatment regimens, duration of treatment, and relapse rates. Of the 109 primary and relapse patients, 57 were male and 52 female. The ages of the patients ranged between 16–75 (mean age 40.2). The percentages of the urban and rural residence of the patients were 41.3% and 58.7%, respectively. The most common mode of transmission was consumption of unpasteurized milk and milk products (67.9%). Malaise, fever and sweating were the most frequently observed symptoms (96.3%, 95.4%, 91.7%, respectively). The most common signs were fever (97.2%), splenomegaly (59.6%), and hepatomegaly (37.6%). The liver was the most frequently involved organ (21.1%). Almost all (99.1%) patients were serologically positive. However, the positivity rate of culture was low (15.6%). The most frequently preferred antimicrobial regimen was rifampin and doxycycline combination. The relapse rate was 8.3%. Brucellosis is still prevalent in Turkey as in many other countries in the Mediterranean basin. The clinical presentation of the disease may show regional variations. Patients with a history of occupational or nutritional contact with the bacterium and with a compatible clinical picture should be examined using appropriate diagnostic techniques before any attempt to prescribe an antimicrobial.

Comamonas testosteroni meningitis in a patient with recurrent cholesteatoma

Comamonas testosteroni, a lesser‐known member of the genus, has shown little apparent capacity for causing infections in humans. We here present a case of purulent meningitis due to C. testosteroni, which occurred in a patient who had recurrent cholesteatoma. Ceftriaxone treatment was not effective in this patient even though in vitro the bacteria were susceptible to the drug. The patient responded well to meropenem therapy.

In vitro activities of various antimicrobials against Brucella melitensis strains in the Aegean region in Turkey.

Objective: To study in vitro activities of three quinolones (ciprofloxacin, levofloxacin, moxifloxacin), four macrolides (erythromycin, dirithromycin, azithromycin, clarithromycin) and doxycycline against 44 clinical isolates of Brucella melitensis. Materials and Methods: Forty-four B. melitensis strains were isolated from blood cultures of adult patients with acute brucellosis who were hospitalized in the clinical ward of the Department of Clinical Microbiology and Infectious Diseases. The minimum inhibitory concentrations (MICs) of the tested antimicrobials were measured by the agar dilution method. MIC90 and MIC50 values were defined as the lowest concentration of the antibiotic at which 90 and 50% of the isolates were inhibited, respectively. Results: Doxycycline (MIC50: 0.25 µg/ml, MIC90: 0.50 µg/ml) had the lowest MIC in vitro against the B. melitensis strains. Among the quinolones, ciprofloxacin and levofloxacin had similar activities (MIC50: 0.5 µg/ml, MIC90: 2 µg/ml), whereas MIC of moxifloxacin (MIC50: 1 µg/ml, MIC90: 8 µg/ml) was higher than both antibiotics in this group. Clarithromycin and azithromycin were the most active macrolides (MIC50: 8 µg/ml and MIC90: 32 µg/ml), followed by erythromycin (MIC50: 16 µg/ml, MIC90: 32 µg/ml) and dirithromycin (MIC50: 64 µg/ml and MIC90: 64 µg/ml). Conclusion: The results indicate that the conventional agent doxycycline is more active than quinolones and macrolides against the B. melitensis in vitro.

Prevalence of Chlamydia pneumoniae specific antibodies in different clinical situations and healthy subjects in Izmir, Turkey

Serological markers for Chlamydia pneumoniae were investigated by using the microimmunofluorescence (MIF) test in various age and patient groups in a specific area in Turkey. IgG seropositivity to C. pneumoniae was 64.3% and 18.7% in healthy adults and children, respectively. The highest positivity rate (77%) was in the 15–19 age group. Among the groups investigated, serological findings revealed a possible etiological association between C. pneumoniae and the clinical condition in the groups with acute myocardial infarction, atypical pneumoniae and chronic obstructive pulmonary disease.

Detection of respiratory syncytial virus in children in the 1993-94 winter season in Izmir, Turkey, by two diagnostic methods

Respiratory syncytial virus (RSV) infection was searched for in 65 children between 2 months and 2 years of age hospitalized with the presumptive diagnosis of acute bronchiolitis, and in 35 children aged 6 months to 8 years with upper respiratory tract symptoms, by direct fluorescent antibody (DFA) test and cell culture. RSV infection was detected in 29.2% of the first and in 11.4% of the second group. The overall positivity rate was 23%. The sensitivity and the specificity of the commercially available DFA test in comparison with cell culture were 81.8% and 92.5%, respectively.

Chlamydial infection in infants

Conjunctival and nasopharyngeal samples were collected from 51 infants aged 1 month-1 year, who have been hospitalized for lower respiratory tract disease which had begun on the 4-12th week of life and has shown recurrences since then. Acute period blood samples were available from 42 of these children. Chlamydia trachomatis antigen was searched for in the conjunctival and nasopharyngeal specimens by a direct fluorescence test (MikroTrak, Syva Co.), and serum anti-chlamydial IgM antibodies were detected by enzyme immunoassay (Sero ELISA Chlamydia, Savyon Diagnostics). Chlamydia trachomatis was detected from at least one site in 20 children, and 15 children were positive for anti-chlamydial IgM antibodies. Serum samples were available in 16 of 20 children who were positive for C. trachomatis antigens, and 12 had IgM antibodies. Three infants who were antigen negative, also had anti-chlamydial antibodies. Whether antigen positive or not, all patients with antichlamydial antibodies were considered to have pneumoniae due to C. trachomatis, and those who had only antigens without any antibodies, to be superficially infected and carry the organism symptomatically or asymptomatically.

Evaluation of a direct fluorescent antibody test for detection of Chlamydia trachomatis in endocervical specimens

A total of 160 endocervical specimens collected from 72 symptomatic and 82 asymptomatic women attending a gynecology outpatient clinic were investigated for genital Chlamydia trachomatis infection by the use of tissue culture and DFA test. The infection rate was 42% for symptomatic and 23% for asymptomatic patient groups. The sensitivity rates of the DFA test in the symptomatic and asymptomatic groups were 84% and 75%), while the specificity rates were 89% and 95%, respectively. The DFA test had an overall sensitivity of 80% and specificity of 93%. There was 90% agreement between the two techniques. Therefore, DFA is recommended as an alternative to tissue culture where laboratory facilities are limited and genital chlamydial infections are highly prevalent.

A Case of Tuberculous Meningitis Presenting with Atypical Cerebrospinal Fluid Findings

Mycobacterium tuberculosis is still an important cause of meningitis in developing countries. Since clinicians cannot delay treatment in order to receive a definite diagnosis, thera