Ilknur Tosun

Breakthrough Trichosporon asahii Fungemia in Neutropenic Patient with Acute Leukemia while Receiving Caspofungin

A 47-year-old man with newly diagnosed acute myeloblastic leukemia and non-insulin-dependent diabetes mellitus developed Trichosporon asahii fungemia while receiving caspofungin as empirical antifungal therapy. The diagnosis was based on repeated isolation of T. asahii in culture of blood for three times. Despite treatment with amphotericin B and voriconazole, the patient died. The in vitro antifungal susceptibilities of the T. asahii isolates were only available after the patient died. In vitro antifungal susceptibility tests showed high caspofungin and amphotericin B minimal inhibitory concentrations (MICs) value for this Trichosporon strain (MICs, 16 μg/ml, and > 32 μg/ml, respectively). Fluconazole, itraconazole, and voriconazole exhibited low MICs in vitro (MICs, 4 μg/ml, 0.5 μg/ml, and ≤ 0.015 μg/ml, respectively). Our experience strongly suggest that identification and antifungal susceptibility testing for T. asahii in neutropenic patients who may develop signs of infection in the presence of caspofungin as well as broadspectrum antibiotics treatment should not be overlooked.

Distribution, virulence attributes and antifungal susceptibility patterns of Candida parapsilosis complex strains isolated from clinical samples

It was recently proposed that Candida parapsilosis represents a complex composed of three closely related species, i.e., C. parapsilosis sensu stricto, C. orthopsilosis, and C. metapsilosis. The aim of this study was to describe the distribution of C. parapsilosis complex isolates among clinical samples. We also evaluated antifungal susceptibility profiles, in vitro presence of lipase and secreted aspartyl proteinase, as well as their ability to grow in total parenteral nutrition (TPN) solution, and biofilm production. A total of 413 non-C. albicans Candida isolates were obtained from various clinical samples between 2010 and 2011 in a Turkish Tertiary Care Hospital. Of them, 42 were identified as members of the C. parapsilosis complex. Among these, 38 (90.5%) were C. parapsilosis sensu stricto, 3 (7.1%) C. metapsilosis, and 1 (2.4%) C. orthopsilosis. All isolates recovered from blood were found to be C. parapsilosis sensu stricto and C. metapsilosis. In phenotypic tests, all 42 isolates grew in TPN solution and, although 26.2% of C. parapsilosis sensu stricto-isolates were capable of forming biofilms in vitro, neither C. orthopsilosis nor C. metapsilosis isolates were able to do so. Acid proteinase activity was detected in 31% of isolates and lipase activity in 33%. All isolates were sensitive to voriconazole, caspofungin, and anidulafungin, with only a single C. parapsilosis sensu stricto isolate showing dose-dependent susceptible to fluconazole. While the number of C. metapsilosis and C. orthopsilosis isolates remained low, there were no significant differences in antifungal MIC as compared to C. parapsilosis sensu stricto.

Bloodstream yeast infections in a university hospital in Northeast Turkey: a 4-year survey

This study presents data on species distribution and antifungal susceptibility profiles of Candida bloodstream isolates obtained from a Turkish Tertiary Care Hospital during a 4-year period. All hospitalized patients who had ≥ 1 blood culture positive for yeast during their hospital stay from January 2005 through 2009 were included in this study. All isolates were identified to species level using CHROMagar and ID 32 C. Fluconazole and voriconazole antifungal susceptibility testing was performed using the disk diffusion method according to CLSI M44-A. In vitro activity of amphotericin B was determined by the Etest. Of all 166 yeast isolates, C. albicans was the dominant species (34.3%), followed by Candida parapsilosis (28.9%) and C. tropicalis (8.4%). All of the 48 C. parapsilosis strains were identified as C. parapsilosis sensu stricto. Resistance to fluconazole was more common among C. krusei isolates. Voriconazole resistance was absent. One C. lusitaniae strain showed a high amphotericin MIC (4 μg/ml). Our survey indicated an increase of some non-C. albicans Candida species in our hospital while antifungal resistance was uncommon.

Induction of secretory aspartyl proteinase of Candida albicans by HIV-1 but not HSV-2 or some other microorganisms associated with vaginal environment

The most common type of candidiasis involves mucosal sites such as the oral cavity, the gastrointestinal tract and the vagina. Among many of virulence factors, the production of secretory aspartyl proteinase (Sap) by Candida albicans (C. albicans) has gained much attention, and factors leading to Sap induction are thus under intense study. The aim of this study was to examine whether some microorganisms such as Lactobacillus, Gardnerella vaginalis (G. vaginalis), human immunodeficiency virus type-1 (HIV-1) and human herpes simplex virus type-2 (HSV-2) had any Sap inducing effect on C. albicans. Here we showed that among the microorganisms tested in vitro only HIV-1 induced Sap production from C. albicans.

Significance of cagA status and vacA subtypes of Helicobacter pylori in determining gastric histopathology: Virulence markers of H. pylori and histopathology

Background:  It has been suggested that Helicobacter pylori strains containing the cytotoxin‐associated gene A (cagA), and s1m1 genotype of vacuolating cytotoxin gene A (vacA) may have been associated with peptic ulcer disease. The aim of the present study was to analyze such an association of cagA presence and vacA subtypes of H. pylori with histopathological findings in patients with gastritis.

Frequency of bacterial vaginosis among women attending for intrauterine device insertion at an inner-city family planning clinic.

The aim of this study was to investigate the rate of bacterial vaginosis in women attending an inner-city family planning clinic for intrauterine device (IUD) insertion. In a population of 86 women, eight (9.3%) and 20 (23.2%) were found to have bacterial vaginosis according to the criteria of Amsel and Nugent, respectively. Sensitivity, specificity, positive and negative predictive values were calculated in relation to bacterial vaginosis for Amsels criteria. The detection of clue cells demonstrated excellent sensitivity (85%). Positive amine test and vaginal discharge demonstrated poor sensitivity (50% and 55%, respectively). Our results suggest that Gram staining of vaginal specimens may be of use to identify the presence of bacterial vaginosis prior to IUD insertion.

Could Pyelonephritic Scarring Be Prevented by Anti-Inflammatory Treatment? An Experimental Model of Acute Pyelonephritis

Objectives. This study aimed to demonstrate if the addition of anti-inflammatory treatment to antibiotic therapy shows any superiority to the treatment with antibiotic only. Methods. Forty-nine Wistar rats were divided into 7 groups. Pyelonephritis was performed by E. coli injection to upper pole of kidneys except control group. Group 2 was not treated. Ceftriaxone, ketoprofen, “ceftriaxone + ketoprofen,” methylprednisolone, and “ceftriaxone + methylprednisolone” were given in the groups. The technetium-99m-dimercaptosuccinic acid scintigraphies were performed in 3rd day to detect pyelonephritis and 10th week to detect renal scarring. All kidneys were also histopathologically evaluated. Results. When 3rd day and 10th week scintigraphies were compared, initial 2.00 ± 0.30 point pyelonephritis score resulted in 0.71 ± 0.36 renal scar score in “ceftriaxone + ketoprofen” group (P = 0.039). Initial 2.00 ± 0.43 point pyelonephritis score resulted in 0.86 ± 0.26 renal scar score in “ceftriaxone + methylprednisolone” group (P = 0.041). Renal scar score was declined in “ceftriaxone + ketoprofen” group and “ceftriaxone + methylprednisolone” group compared with no-treatment group on 10th week of the study (P = 0.026, P = 0.044). On histopathological evaluation, it was seen that renal scar prevalence and expansion declined significantly in “ceftriaxone + ketoprofen and ceftriaxone + methylprednisolone” (P = 0.011, P = 0.023). Conclusion. It was evidenced that ceftriaxone treatment in combination with ketoprofen or methylprednisolone declined scar formation in scintigraphic and histopathologic examinations of the kidneys.

The effect of ethinyl estradiol and drospirenone-containing oral contraceptives upon mucoprotein content of cervical mucus.

OBJECTIVE To report the effect of oral contraceptives (OC) on cervical mucoprotein content by evaluating quantitatively mucoprotein 1 (MUC1), mucoprotein 2 (MUC2), mucoprotein 5AC (MUC5AC) and mucoprotein 5B (MUC5B) levels. STUDY DESIGN This prospective controlled study included 20 women of reproductive age who had requested OC. Cervical mucus samples were obtained from the women before use of the OC and after 2 months of OC use. The mucus samples were then evaluated quantitatively for MUC1, MUC2, MUC5AC and MUC5B by ELISA by using specific antibodies. RESULTS MUC5AC mucoprotein predominated quantitatively both before and after OC use. After OC use, compared to before OC use, variable increases in the levels of all studied mucoproteins were recorded, but the increases in MUC1, MUC2 and MUC5B were statistically significant. The difference in the level of MUC2 was remarkable (+54.36 ± 31.88 ng/mL). CONCLUSION OC use may change the mucoprotein content (especially for MUC2) of cervical mucus and thus, may cause a highly viscous pattern of cervical mucus which may enhance the contraceptive efficacy of OC pills.

Horizontol dissemination of TEM- and SHV-typr beta-lactamase genes-carrying resistance plasmids amongst clonical isolates of Enterobacteriaceae.

The extended-spectrum β-lactamase (ESBL)-producing bacteria have been isolated at increasing frequency worldwide. Expression of ESBL is often associated with multidrug resistance and dissemination by resistance plasmids. During a two-month period in 2000, 133 clinical isolates of enterobacterial strains were randomly collected from outpatients and inpatients at a university hospital in Turkey. The ESBL producing strains were determined by double-disk synergy (DDS) testing. Twenty ESBL producing strains (15%) including Escherichia coli (n = 9), Klebsiella pneumoniae (n = 7), Klebsiella oxytoca (n = 2) and Enterobacter aerogenes (n = 2) were detected and further analyzed for their resistance transfer features, plasmid profile and nature of the resistance genes. Plasmid transfer assays were performed using broth mating techniques. TEM- and SHV- genes were analyzed by polymerase chain reaction (PCR) and hybridization using specific probes. EcoRI restriction enzyme analyses of R plasmids were used in the detection of epidemic plasmids. Fourteen plasmid profiles (A, B1, B2, C1, and C2 to L) were obtained with EcoRI restriction enzyme analysis. Most of these plasmids were detected to carry both TEM- and SHV-derived genes by PCR, and confirmed by localizing each gene by hybridization assay. Epidemiological evidence indicated that there was an apparent horizontal dissemination of conjugative R plasmids among multidrug-resistant enterobacterial genera and species in this hospital.

Cytomegalovirus excretion in pregnant women in the eastern Black Sea region of Turkey.

Aim The study was carried out to determine the viral excretion rate of cytomegalovirus (CMV) in pregnant women in the eastern Black Sea region of Turkey, and to observe how it compared with that in western countries. Method Cervical excretion of cytomegalovirus by pregnant women was studied employing a highly sensitive CMV detection assay supported with fluorescent labeled monoclonal antibody directed against an immediate early antigen, known as DEAFF (detection of early antigen by fluorescent foci assay) test. Results CMV excretion rates during the third trimester of pregnancy were similar to the detection rates reported from most developed countries. Our results also showed that the rate of cervical CMV excretion was higher among pregnant women who had a history of more than one spontaneous abortion.