Inci Tuncer

Serratia marcescens sepsis outbreak in a neonatal intensive care unit.

Background:  Contaminated parenteral nutrition (PN) is an important source of infection in neonates. Many organisms have been reported to cause contamination resulting in outbreaks in intensive care units. The aim of the present study was to investigate an outbreak caused by Serratia marcescens in a neonatal intensive care unit (NICU).

Streptococcus zooepidemicus meningitis and bacteraemia.

Group C streptococci are common causative agents of epidemic infections in animals and a rare cause of meningitis in humans. The case is reported of a 75-y-old man with meningitis caused by a group C streptococcus (Streptococcus zooepidemicus). He had frequent contact with horses, which were a possible source of infection. In spite of treatment with a third generation cephalosporin, the outcome was fatal.

Two outbreaks of ESBL‐producing Klebsiella pneumoniae in a neonatal intensive care unit

In the present study, two epidemic episodes of extended spectrum beta‐lactamase (ESBL)‐producing Klebsiella pneumoniae in the neonatal intensive care unit (NICU) were evaluated.

First case report of neurobrucellosis associated with hydrocephalus

Brucellosis is a common zoonosis in many parts of the world, including Mediterranean and Middle Eastern countries. The disease is primarily related to occupations at risk, such as veterinarians, farmers, laboratory technicians, abattoir workers, and others working with animals and their products. Neurologic complications of brucellosis are quite rare, ranging from 1.7 to 10% of those infected. To date, no cases of neurobrucellosis with hydrocephalus have been reported. A 38-year-old right-handed farmer complained of headaches, nausea, vomiting, gait disturbance, and sweating for 2 days. He also complained of bilateral hearing loss of 4 months duration. On neurologic examination, dysmmetry, dysdiadochokinesis, ataxia on the left, and bilateral sensorineural hearing loss existed. On cranial MRI, a communicating hydrocephalus was noted. Because the patient consumed fresh sheep cheese and was a farmer, brucellosis was considered in the differential diagnosis. Brucella agglutination was positive with a 1/320 titer in the blood and a 1/80 titer in the cerebrospinal fluid. Ceftriaxone, doxycycline, and rifampicin were administered and by the fourth week of treatment, the ataxia was markedly improved, and the patient was able to walk without support. His cranial MRI demonstrated a total regression of the hydrocephalus. As a result, we suggest that neurobrucellosis should be considered in patients with hydrocephalus, especially if they live in an endemic area for brucellosis, even in the absence of other systemic signs.

Late-onset Streptococcus pasteurianus sepsis in a preterm baby in a neonatal intensive care unit.

Apnea, cyanosis, lethargy and prolongation in capillary filling time developed on the postnatal 37(th) day in a preterm baby who was born at the 30(th) gestational week with a birth weight of 1 300 g. Acute phase reactants and immature/total neutrophil count ratio were found to be high. The patient who was diagnosed with sepsis was successfully treated with meropenem which was started empirically. In his blood culture Streptococcus pasteurianus grew. S. pasteurianus is in the subgroup of streptococcus bovis which is one of the D group streptococci and its previous name is S. bovis type II/2. In the literature, there are very few cases of neonatal infection related with this bacterium. As far as we know, this is first case of neonatal sepsis caused by S. pasteurianus in Turkey. In addition, we tried to determine the clinical properties of neonatal infections arising from S. pasteurianus by reviewing the literature.

Streptococcus pyogenes İzolatlarının Virülans Faktörlerinin Araştırılması ve “Multiple Locus Variable Number Tandem Repeat Fingerprinting (MLVF)” Yöntemi ile Tiplendirilmesi

Streptococcus pyogenes is an important bacterial pathogen that colonizes the throat and skin of human beings and causes a wide variety of diseases ranging from mild infections like pharyngitis, tonsillitis and impetigo to severe invasive infections such streptococcal toxic shock syndrome, septicemia, and necrotizing fasciitis, and produces a wide variety of virulence factors. The aim of this study was to investigate the antibiotic resistance, virulence genes; [pyrogenic exotoxin genes (speA, C, G, H, I, J, K, L, M, smeZ and ssa), deoxyribonuclease genes (sdaB, spd3, sdc ve sdaD), protease genes (speB, spyCEP ve scpA) and inhibitor genes (mac and sic)] of S.pyogenes strains isolated from throat cultures of patients with symptomatic tonsillo-pharyngitis and typing by multiple locus variable number tandem repeat fingerprinting (MLVF) method. One hundred and fifty S.pyogenes isolates were identified by conventional methods and streptococcus group A latex kit (Biomerieux, France). Antibiotic susceptibility tests were performed by Kirby-Bauer disk diffusion method as recommended by Clinical and Laboratory Standards Institute. DNA isolation was performed by using a commercial DNA isolation kit (Qiagen, Germany) in accordance with manufacturers recommendations. The virulence genes were determined by multiplex PCR. MLVF method was performed with multiplex PCR using specific primers for repeated sequences within bacterial genome. All of the S.pyogenes isolates were susceptible to penicillin G, cefotaxime, ceftriaxone, chloramphenicol, clindamycin, erythromycin, levofloxacin, vancomycin and linezolid. Among streptococcal pyrogenic exotoxin genes the most frequent gene was smeZ (90.0%) followed by speG (88.0%), speC (58.7%), ssa (42.7%), speA (33.3%), speJ (24.0%), speK (18.7%), speH (14.0%), speI (13.3%), speL and speM (9.3%). Of the DNase genes, sdaB was detected in all strains (100%), spd3, sdc, sdaD genes were determined as 64.7%, 36.0%, 24.7% respectively. Protease genes (speB, spyCEP, scpA) and mac gene from the inhibitor genes were positive in all strains, and sic gene was positive in only 3 (2.0%) of the isolates. Thirty-two different patterns that contained two or more isolates were determined by MLVF analysis. Ninety one isolates were included in any of the 32 different patterns, while 59 isolates were defined as sporadic isolates. In conclusion, S.pyogenes isolates collected from throat cultures of patients with symptomatic tonsillo-pharyngitis in Konya/Turkey were susceptible to all antibiotics studied and have carried a very high rate of virulence factors. However the isolates were mostly clonally unrelated and sporadic. This study is the first report in Turkey, in which S.pyogenes isolates were typed by the MLVF method and a large number of virulence factors were investigated.

Enterococcus avium Peritonitis in a Child on Continuous Ambulatory Peritoneal Dialysis

1. Brady HR, Abraham G, Oreopoulos DG, Cardella CJ. Bowel erosion due to a dormant peritoneal catheter in immunosuppressed renal transplant recipients. Perit Dial Int 1998; 8:163–5. 2. Watson LC, Thompson JC. Erosion of colon by a long dwelling peritoneal dialysis catheter. jaMa 1980; 243:2156–7. 3. Askenazi D, Katz A, Tenney F, Benfield M, Barnhart D. An unusual case of peritoneal dialysis malfunction. Kidney Int 2007; 72:524. 4. Finkle SN. Peritoneal dialysis catheter erosion into bowel: amyloidosis may be a risk factor. Perit Dial Int 2005; 25:296–7. 5. Rotellar C, Sivarajan S, Mazzoni MJ, Aminrazavi M, Mosher WF, Rakowski TA, et al. Bowel perforation in CAPD patients. Perit Dial Int 1992; 12:396–8. 6. Grzegorzewska AE. Perforation of the transverse colon caused by a permanent peritoneal dialysis catheter. Perit Dial Int 2004; 24:298. 7. Shrestha BM, Wilkie M, Raftery AT. Delayed colonic perforation caused by an unused CAPD catheter in a patient presenting with diarrhea. Perit Dial Int 2003; 23:610–11. doi:10.3747/pdi.2013.00078