Gulden Yilmaz

Rotavirus and adenovirus frequency among patients with acute gastroenteritis and their relationship to clinical parameters: a retrospective study in Turkey

BackgroundDiarrhea is the third leading cause of death related to infectious diseases all over the world. The diseases related to viral gastroenteritis are gradually increasing, particularly in the developed countries. The purpose of our study was to determine the frequency and to investigate the clinical manifestations of acute rotavirus and adenovirus gatroenteritis and to assess the diagnostic value of the related clinical findings.MethodsIn 2007-2008 patients with diarrhea and/or vomiting attended to Yeditepe University Hospital and related clinics, Istanbul, were studied. The rotavirus and/or adenovirus antigen in stool of these patients were investigated. Data regarding clinical findings were collected from the electronic records, retrospectively. Age, gender, symptoms, fever, antibiotic use, vomiting, number of vomiting and diarrhaeae, dehydration, abdominal pain, the other pathological physical examination findings were analyzed by the physicians in the study group. To investigate the rotavirus and adenovirus antigen CerTest Rota-Adeno Blister Test (CerTest, Biotec, Spain), a qualitative immunochromotographic assay was used. Statistical analysis wasperformed with SPSS v. 11,5 statistical software. X2 test was used for bivariate and logistic regression analysis was used for multivariate analysis.ResultsRotavirus positivity was 18,7% (n = 126). Concomitantly, in 596 cases adenovirus antigen test were also performed. Adenovirus positivity was 8,9% (n = 53) and rota-adenovirus co-infection was 4,4% (n = 26). Most of rotavirus positive cases were seen in December, January, February and March (p < 0.001). In clinical parameters, there was a significant difference between rotavirus positive cases and negative cases regarding to vomiting, dehydration and vomiting and diarrhea coexistence (respectively p = 0.010, p < 0.00, p = 0.007).ConclusionRotavirus can be seen in all age groups, but more frequently in childhood. Although there is no clinical gold standard to distinguish the rotavirus cases from the other gastroenteritis agents, the findings of dehydration and vomiting-diarrhea coexistence, considering months of referral may lead clinician to perform rapid antigen tests and affect approach to the treatment. Prospective studies with representative samples are needed to determine the rotavirus and adenovirus incidence and to develop safe and reliable protective policies in our country.

The sensitivity and the specifity of rapid antigen test in streptococcal upper respiratory tract infections.

BACKGROUND It is aimed to detect the sensitivity and specificity of rapid antigen detection of group A beta hemolytic streptococci from throat specimen compared with throat culture. The other goal of the study is to help in giving clinical decisions in upper respiratory tract infections according to the age group, by detection of sensitivity and positive predictive values of the rapid tests and throat cultures. MATERIALS AND METHODS Rapid antigen detection and throat culture results for group A beta hemolytic streptococci from outpatients attending to our university hospital between the first of November 2005 and 31st of December 2008 were evaluated retrospectively. Throat samples were obtained by swabs from the throat and transported in the Stuart medium and Quickvue Strep A [Quidel, San Diego, USA] cassette test was applied and for culture, specimen was inoculated on 5% blood sheep agar and identified according to bacitracin and trimethoprim-sulphametaxazole susceptibility from beta hemolytic colonies. RESULTS During the dates between the first of November 2005 and 31st of December 2008, from 453 patients both rapid antigen detection and throat culture were evaluated. Rapid antigen detection sensitivity and specificity were found to be 64.6% and 96.79%, respectively. The positive predictive value was 80.95% whereas negative predictive value was 92.82%. Kappa index was 0.91. When the results were evaluated according to the age groups, the sensitivity and the positive predictive value of rapid antigen detection in children were 70%, 90.3% and in adults 59.4%, 70.4%. DISCUSSION When bacterial infection is concerned to prevent unnecessary antibiotic use, rapid streptococcal antigen test (RSAT) is a reliable method to begin immediate treatment. To get the maximum sensitivity of RSAT, the specimen collection technique used and education of the health care workers is important. While giving clinical decision, it must be taken into consideration that the sensitivity and the positive predictive value of the RSAT is quite lower in adult age group than in pediatric age group.

Varicella gastritis in an immunocompetent child

The varicella zoster virus (VZV) is a very rare cause of gastritis. Gastritis caused by VZV can be presented as abdominal pain, vomiting. Most of the cases reported with varicella gastritis in the literature are immunocompromised patients with various kinds of malignancy, and most of these patients are adults. Here we report an adolescent girl with acute abdominal pain. The girl was immunocompetent. Her endoscopically taken biopsy material revealed varicella, and her gastritis was healed with acyclovir therapy. This is a very rare condition and not frequently reported in the literature. The authors want to drive attention to the fact that varicella gastritis can be seen in immunocompetent children, the presentation can be nausea, vomiting and/or (severe) abdominal pain. Serological studies may be less helpful than tissue studies, so interventional procedures should be done.

A Retrospective Analysis of Acute Gastroenteritis Agents in Children Admitted to a University Hospital Pediatric Emergency Unit

Background: Acute gastroenteritis is responsible observed in all age groups, especially infants and children. The etiology and clinical course of acute gastroenteritis may vary with age and etiological agents. In developing countries, the morbidity and mortality associated with infectious diarrhea is higher in children younger than five-years-of-age. Objectives: The aim of this study was to determine the prevalence and seasonal distribution of the major agents of acute gastroenteritis in children who were admitted to a Turkish university hospital pediatric emergency unit during 2009. Patients and Methods: Seasonal distribution within a one year period and quantitative distribution were analyzed with demographic data and laboratory findings. A total of 644 subjects were enrolled in the study, with a mean age of 4.14 years. Pathogens were detected in 183 (28.4%) stool samples in children less than 16 years, admitted with acute gastroenteritis. Results: Pathogens were detected in 184 (28.4%) stool samples. The age distributions of the cases were 0 - 24 months (n = 59), 2 - 5 years (n = 100), and > 5 years (n = 25). The detection rate of rotavirus, norovirus and adenovirus were; 12.7% (75/588), 9.8% (51/520) and 4.9% (28/575), respectively. Bacterial agents were detected in 36 cases. The main agent was norovirus in the 0 - 24 months group (n = 25, 42.4%), and rotavirus for ages 2 - 5 years (n = 43, 43%) and > 5 years. On the monthly distribution, cases of rotavirus were found to be more frequent in the first four months of the year. Discussion: Viruses were the major pathogens in all age groups. Norovirus was the leading pathogen in the first two years. For the age groups 2 - 5 years and 6 - 16 years, rotavirus was the major pathogen.

Isolation rates and antibiotic susceptibilities of different Enterobacteriaceae species as urinary tract infection agents in Turkey: a systematic review

BACKGROUND/AIM In Turkey, few systematic reviews have analyzed the results of studies on the isolation rates of urinary tract infection agents and their antibiotic susceptibilities. This review was done to fill this gap and enable the correct application of guideline-based medical therapy by determining the isolation rates and antibiotic susceptibilities of different Enterobacteriaceae species in Turkey. MATERIALS AND METHODS Relevant studies found from various databases with the help of previously specified search strategies were examined and eliminated according to eligibility criteria. The remaining 22 studies were included in this systematic review. RESULTS Escherichia coli was the most frequently isolated species among all agents in both in- and outpatient settings. Only the antibiotic susceptibility data of E. coli could be analyzed because among the 22 studies only E. coli had adequate antibiotic susceptibility data to be analyzed. The calculated resistance rates of the most frequently preferred antibiotics (trimethoprim/sulfamethoxazole, ciprofloxacin, and ceftriaxone) were 46%, 32%, and 19% for outpatients and 54%, 48%, and 28% for inpatients, respectively. CONCLUSION The resistance profiles of commonly used antimicrobial agents are much higher than the thresholds set by international guidelines. Hence, treatment algorithms for urinary tract infections should be designed according to Turkeys antimicrobial resistance patterns.

Esophageal squamous papilloma in a child.

7-year-old boy experienced nausea, abdominal pain, and vomiting for 3 years. He was hospitalized several times due to respiratory tract infections. His weight and height were in the 25-50th percentile. The results of physical and laboratory evaluations were normal. Upper gastrointestinal system endoscopy (UGE) indicated the presence of a 1×2 cm polypoid mass with a rough surface adjacent to the lower esophageal sphincter, and a linear ulcer (>5 mm) on the upper tip of the lesion (Figure 1). He had gastric hyperemia and normal bulbus and duodenum. A pathological evaluation indicated the presence of a papillomatous proliferation in the squamous epithelium (Figure 2), severe esophagitis, and gastritis without Helicobacter pylori infection. Multiplex polymerase chain reaction could not detect any HPV DNA. Esomeprazole therapy was initiated, and the family was informed about the recommended diet. The boy underwent monthly evaluations and his gastrointestinal symptoms had resolved on the second visit. Repeat endoscopy, which was performed after 4 months, indicated normal histological findings, with no esophageal mass.

ISO 15189 accreditation experience at the Microbiology Laboratory of a Turkish University Hospital

We aimed to share the experience of the ISO/IEC 15189:2007 accreditation process in a University Hospital’s Medical Microbiology Laboratory before and after the assessment, and tried to seek answers to some questions in applying the standard. Our ISO 15189 accreditation process began in 2008 after having acquired JCI accreditation in 2007. The aim was to be the first accreditated university hospital laboratory in our country. The applied tests in bacteriology, mycology, parasitology, virology, immunology and molecular serology were accreditated. We completed the validation and verification procedures mostly applied to quantitative analyses. Regarding the external quality controls and the internal controls, the corrective actions provided us great control and self correction. We increased the rate of success in the quality controls. We encouraged our laboratory personnel to fill out a laboratory discrepancy form to control our process and to arrange training. During the course of 2009, 60 of the 85 forms were completed in the microbiology laboratory among the central laboratories. Statistical analyses were performed throughout a year and this information helped us in making improvements. The number of training hours in one year was found as 78 h and 30 min during the routine laboratory process. We should provide support in bringing quality to laboratories in our country. As a matter of fact, having our own external quality controls is believed to bring cost effectiveness in acquiring an accreditation process.