Haluk Güriz

The value of the levels of acute phase reactants for the prediction of familial Mediterranean fever associated amyloidosis: a case control study

In order to determine the role of levels of acute phase proteins (APPs) for the development of amyloidosis in familial Mediterranean fever (FMF) patients, the levels of serum amyloid A (SAA), C reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate were measured in paired sera of 36 FMF patients during and in between acute attacks, 39 of their healthy parents (obligate heterozgotes), and 15 patients with FMF associated amyloidosis. To compare the levels of APPs, 39 patients with chronic infections or inflammatory diseases who may develop secondary amyloidosis, 20 patients with acute infections who are known to have elevated acute phase response but will never develop amyloidosis and 19 healthy controls were included. The median levels of all APPs are increased in the patients with FMF during attacks and a significant decrease was observed after the attack was over. The level of SAA was above reference range in all FMF patients during the attack free period and the level of at least one other APP was also above normal in 64% of the patients. Both CRP and SAA levels were found to be higher in obligate heterozygotes compared to controls. The levels of SAA in patients with FMF during the attack-free period, obligate heterozygotes and patients with FMF-amyloidosis were found to be similar. The levels in each group were found to be higher than SAA levels found in healthy controls yet lower than the levels measured in the patients with acute infections and patients with chronic inflammation or chronic infections. In conclusion, our results show that SAA level reflects subclinical inflammation with high sensitivity but its value for the prediction of amyloid formation process seems to be low.

Genotype distribution of Candida albicans isolates by 25S intron analysis with regard to invasiveness

The aim of this study was to genotype Candida albicans strains isolated from patients with invasive and non‐invasive deep‐seated infections. For this purpose, 301 C. albicans isolates (81 invasive and 220 non‐invasive) were genotyped by using specific PCR primers designed to span the transposable group I intron of the 25S rDNA gene. Fifty‐three of the 81 invasive isolates were genotype A (65.4%), eight were genotype B (9.9%) and 20 were genotype C (24.7%), while 98 of the 220 non‐invasive isolates were genotype A (44.6%), 46 were genotype B (20.9%) and 76 were genotype C (34.5%). Genotype A was more prevalent among invasive isolates and genotypes B and C were more prevalent among non‐invasive isolates (P = 0.0046). Genotypes D and E which represent C. dubliniensis were not found. These results indicate that there may be a relationship between C. albicans genotypes and invasiveness; genotype A being more invasive than others. The presence or absence of the transposable group I intron in the 25S rDNA gene may be important in determining the invasiveness of C. albicans.

Nasopharyngeal colonization with penicillin-resistant Streptococcus pneumoniae in Turkish children.

Abstract Background: Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of the fact that penicillin is preferred in the treatment of infections caused by S. pneumoniae, there has been a world‐wide increase in the frequency of penicillin‐resistant S. pneumoniae.

Caspofungin treatment in two infants with persistent fungaemia due to Candida lipolytica

Candida lipolytica has infrequently been identified as a cause of infection and is associated mostly with vascular catheter-related fungaemia. Patients reported in the literature have been successfully treated with catheter removal or amphotericin B treatment. We report 2 infants with C. lipolytica fungaemia unresponsive to catheter removal and amphotericin B therapy and treated successfully with the addition of caspofungin to amphotericin B.

Urinary tract infections owing to ESBL‐producing bacteria: microorganisms change – clinical pattern does not

Aim:  Urinary tract infections (UTIs) caused by extended‐spectrum beta lactamase (ESBL)‐producing bacteria have become a growing problem worldwide. The aim of this study was to investigate the clinical and radiological findings in patients with community‐acquired UTIs owing to ESBL‐producing bacteria.

Drug Resistance of Shigella Strains Isolated in Ankara, Turkey, 1993-1996

289 Shigella strains were isolated from children at the paediatrics department of Ankara University. 75% of the isolates were S. sonnei and 24.8% were S. flexneri. Each strain was tested for resistance to 9 antimicrobial agents. 79% of the isolates were resistant to streptomycin (S), 56% to tetracycline (T), 55.7% to trimethoprim-sulfamethoxazole (SXT), 27.7% to ampicillin (Am) and 19.7% to chloramphenicol (C). None of the isolates was resistant to ciprofloxacin, nalidixic acid, cephalothin, ampicillin-sulbactam and ceftriaxone. 56% of the isolates were resistant to 3 or more antimicrobial agents. The most frequent pattern of resistance of S. sonnei and S. flexneri strains was SXT, T, S (39.6%) and Am, SXT, T, S, C (48.6%), respectively (p < 0.0001). These results demonstrate that trimethoprim-sulfamethoxazole should not be used in the treatment of shigellosis.

The use of colistin in critically ill children in a pediatric intensive care unit.

Background: Colistin is active against most multidrug-resistant, aerobic Gram-negative bacteria. Because of the reported nephrotoxicity during the first years of use of colistin, there were concerns of its use in pediatrics where there was limited experience The aim of this study is to document the clinical characteristics and outcomes of use of colistin in pediatric patients at a pediatric intensive care unit in Turkey. Methods: We reviewed the medical and laboratory records of 29 critically ill children who were treated with colistin for 38 courses between January 2011 and December 2011 at the Department of Pediatric Intensive Care Unit in Ankara University Medical School, Turkey. Results: The median age was 17 months (range 3–217 months). Male-to-female ratio was 1:1.37. Ventilator-associated pneumonia (21 courses) was the leading diagnosis followed by catheter-related blood stream infection (6 courses), bacteremia (4 courses), ventriculoperitoneal shunt infection, peritonitis and pneumonia (1 course). The most commonly isolated microorganisms were Acinetobacter baumanni, Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia marcescens, Stenotrophomonas maltophilia, and Enterobacter cloacae. Two colistin formulations were used. Colimycin (Kocak Farma) was used in 21 colistin treatment episodes. The median dosage of colistin in this group was 5.0 mg/kg/d (2.3–5.6 mg/kg/d). Colomycin (Forest Laboratories) was used in 17 colistin treatment episodes. The median dosage of colistin in the second group was 75,000 International Unit/kg/d (50,000–80,000 International Unit/kg/d). Thirty colistin treatment episodes (79%) had a good or partial clinical response and 8 (21%) had a poor clinical response. Of the 8 colistin treatment episodes with poor clinical response, 3 were in the Colimycin group and 5 were in the Colomycin group. Ten patients died. There was no evidence of neurotoxicity in this study. Nephrotoxicity was observed in 1 patient but was not attributed to colistin because the patient had multiorgan failure at the same time. Conclusions: This study in a small cohort of patients suggests that the use of colistin in severe nosocomial infections caused by multidrug-resistant Gram-negative bacteria is well-tolerated and efficacious.

Bacteraemia and candidaemia: a considerable and underestimated complication of severe rotavirus gastroenteritis.

Despite the high incidence of rotavirus gastroenteritis, secondary bacteraemia later in the course of the disease has rarely been reported. To date, the exact incidence of this complication has not been determined. A prospective study was conducted between January 2007 and December 2008 to determine the incidence of bacteraemia by organisms of the normal intestinal flora during severe rotavirus gastroenteritis. Rotavirus gastroenteritis was diagnosed by antigen detection in stool. A previously described 20-point numerical score system was used to determine the severity of disease. There were 289 cases (30%) of rotavirus gastroenteritis during the study period, 106 (36.7%) of which were accepted to be severe rotavirus gastroenteritis and hospitalized. On admission stool and blood cultures tested negative. In cases of persistent or recurrent fever, additional blood cultures were obtained. Among cases with severe rotavirus gastroenteritis, 4 (3.8%) had positive blood cultures (Klebsiella pneumoniae in 1 patient, Escherichia coli in 1 patient, Pseudomonas aeruginosa and Candida albicans in 1 patient, and Candida albicans in 1 patient). All patients were successfully treated with fluid replacement and antimicrobial therapy. Bacteraemia and candidaemia appear to be a considerable and underestimated complication of severe rotavirus gastroenteritis.

Investigation of Candida dubliniensis in Candida spp.-positive hemocultures.

Candida dubliniensis is one of the Candida species which was first recognized in 1995. The yeast was misidentified because of its phenotypic similarities with Candida albicans. In this study, blood samples of patients from various departments at Ankara University Medical Faculty between January 1996 and September 2000 were investigated for distribution of Candida spp. and presence of C. dubliniensis. Ninety‐eight culture positive fungi were included in the study. Phenotypic tests for identification of C. dubliniensis and tests for differentiation of the yeast from C. albicans , such as colony morphology on Staib agar, growth at 42 °C and 45 °C, β‐glucosidase activity and carbohydrate assimilation, were carried out. Sixty‐four of the isolates produced germ tubes and chlamydospores, and none of them had the phenotypic characteristics of C. dubliniensis. Further large‐scale studies of specific patient groups are necessary to reveal the etiologic importance of this yeast.

Successful treatment of Trichosporon mucoides infection with lipid complex amphotericin B and 5-fluorocytosine

Infections in immunocompromised children can stem from bacteria, fungi, viruses, or protozoa, but most importantly, from the hosts endogenous bacterial flora. Disseminated infection caused by Trichosporon species is one of the emerging mycoses in neutropenic patients, particularly when they are treated for haematological malignancy with cytotoxic and immunosuppressive chemotherapy. We report a 15‐year‐old boy with acute lymphoblastic leukaemia, whose Trichosporon mucoides infection was successfully treated with lipid complex amphotericin B plus 5‐fluorocytosine.