Huseyin Agah Terzi

Intra-Abdominal Abscess and Primary Peritonitis Caused by Streptococcus anginosus

Introduction The Streptococcus anginosus group of bacteria are low-virulence bacteria existing as commensals in the oral flora and gastrointestinal tracts of humans. S. anginosus may spread to the blood in individuals with poor oral hygiene in cases of oral infections, such as gingivitis and tooth abscesses, that develop following the loss of mucosal unity. This may lead to infections in the whole body, primarily as brain and liver abscesses. Case Presentation A 32-year-old male patient presented with complaints of nausea, vomiting, and diffuse abdominal pain. Diffuse abdominal tenderness and rebound tenderness were detected particularly in the epigastrium and right upper quadrant. Laboratory assessment revealed a leukocyte count of 20,500/mm3. Free fluid around the liver and heterogeneous areas of abscess formation in the right lateral gallbladder were revealed on abdominal computed tomography. Diffuse adhesions between the bowel and seropurulent free liquid in the abdomen were detected on surgical exploration, and a sample was taken for cultures. The patient was discharged without complications on the sixth postoperative day and his antibiotic course was completed with 4 weeks of oral treatment. We reviewed the literature for similar cases of disseminated pyogenic infections caused by the S. anginosus group. Conclusions It should be kept in mind that the oral flora bacterium S. anginosus may cause transient bacteremia and deep-seated organ abscesses in immunodeficient patients with poor oral hygiene. Such patients with intra-abdominal abscesses should be treated with antibiotics and surgery.

Hepatitis a virus epidemiology in turkey as universal childhood vaccination begins: seroprevalence and endemicity by region

This paper presents the results of a comprehensive examination of current distribution of Hepatitis A virus (HAV) seroprevalence and endemicity in Turkey and the possible links between HAV endemicity and socioeconomic development. We performed a systematic search in online resources published between January 2000 and August 2015. The 22 provinces were able to be assigned a hepatitis A endemicity level based on this systematic review. The incidence rates for symptomatic hepatitis A infection are higher in the eastern part of Turkey than in the western and central region. These differences in socioeconomic indicators by region suggest the likelihood of lower seroprevalence rates in the western parts of the country and higher rates in the eastern region. Turkeys current policy of recommending hepatitis A immunization for all children without contraindications is an appropriate one and is likely to remain the best option for at least the next decade or two.

Investigation of OprD Porin Protein Levels in Carbapenem-Resistant Pseudomonas aeruginosa Isolates.

Background: The Pseudomonas aeruginosa porin OprD is a substrate-specific porin that facilitates the diffusion of basic amino acids, small peptides, and carbapenems into the cell. OprD-mediated resistance occurs as a result of decreased transcriptional expression of oprD and/or loss of function mutations that disrupt protein activity. Objectives: In this study, we examined the level of oprD expression in P. aeruginosa clinical isolates to determine the contribution of OprD porins in carbapenem resistance. Materials and Methods: Included strains were divided into two groups, comprised of multidrug-resistant (MDR) and isolated carbapenem-resistant (ICR) strains. The transcription product level of oprD was identified using real-time polymerase chain reaction (qPCR). Results: Of the 18 clinical isolates, a decrease in the oprD level was found to be significant in 13 isolates. Nine of eighteen isolates with a significant decrease were determined in the first group and comprised MDR isolates that showed a statistically significant difference compared with the ICR group (P = 0.001). In the ICR group, oprD levels were found to be significantly low in 4 isolates. Six different patterns were determined by comparing band profiles in AP-PCR. Conclusions: Although the data support the idea that the basic mechanism of imipenem resistance could be via the loss of oprD, they do not fully explain the role of oprD and indicate that other mechanisms may play an important role. Additionally, the significant decrease in the oprD levels in MDR strains suggests that oprD also plays a role in the emergence of both carbapenem and non-carbapenem resistance.

Investigation of mutations in adeR and adeS gene regions in gentamicine resistant Acinetobacter baumannii isolates

ABSTRACT This study evaluated the relationship between aminoglycoside resistance and the active efflux pump and investigated the role of the active efflux pump in resistance mechanisms. In addition, the mutations related to aminoglycoside resistance were investigated in Acinetobacter baumannii isolates obtained from different clinical specimens. The study included 32 A. baumannii isolates. They were identified and their susceptibilities were determined using conventional techniques and an automated system. Total genomic RNA, DNA and cDNA were obtained using commercial extraction kits. Primers for adeR and adeS were designed using sequences in GenBank. All isolates were subjected to polymerase chain reaction (PCR) to determine the presence of adeR and adeS. The PCR products were electrophoresed for the optimization study. Subsequently, real-time PCR was performed to determine the expression levels of the adeR and adeS genes. Sequence analysis of the two adeRS operons in our isolates showed five mutations differing from those of other isolates. Isolate A21 had three mutations: (Tyr31Phe), (Val136Ala) and (Leu142Ile); isolate A24 had two mutations: (Asn115His) and (Leu142Ile). In our study, the examined gene regions that play a role in the resistance mechanisms of A. baumannii were considered important. The results indicated that adeR and adeS expression clearly affect aminoglycoside resistance. However, gene expression alone does not seem sufficient to explain that. These results could help to design improved active efflux pump inhibitors.