Nevzat Unal

Ventriculoperitoneal shunt infection with Listeria innocua

Listeria species may cause life‐threatening events including meningitis and invasive infection in newborns, pregnant women, older and immunodeficient people. The most common Listeria species that causes infection is L. monocytogenes. It is known that Listeria innocua has no pathogenicity. A 9‐month‐old baby had ventriculoperitoneal shunt and was treated with adrenocorticotropic hormone because of infantile spasms. He was brought to hospital with fever and vomiting. Upon physical examination, the patient seemed uncomfortable and had a temperature of 38.6°C. Laboratory results were as follows: hemoglobin, 6.7 g/dL; leukocyte count, 5420/mm3; platelet count, 169 000/mm3; and C‐reactive protein, 100 mg/L (normal <5 mg/L). On analysis of cerebrospinal fluid (CSF), leukocyte count was 480/mm3, protein was 46 mg/dL and CSF glucose was 35 mg/dL. L. innocua was isolated in CSF culture. We describe this unusual case of ventriculoperitoneal shunt infection with L. innocua.

[Strongyloides stercoralis in a patient with ankylosing spondylitis: case report].

Strongyloidiasis is a nematode-borne disease caused by several Strongyloides species. This case was presented in order to indicate Strongyloidosis in immunocompromised patients with several clinical findings. A fifty-five year old male patient on corticosteroid medication for a long time because of ankylosing spondylitis was on infliximab medication for 5 years. He presented with swelling of his right foot for ten days, right shoulder stiffness and low back pain. The presence of anaemia was remarkable. S. stercoralis was reported in histological examination of endoscopic duodenal biopsy specimen. Peripheral blood smear showed 68.4% neutrophils, 17% lymphocytes, 7.5% monocytes, and 6.7% (normal range 2%-6.2) eosinophils. The level of IgE was raised: 285IU/mL (normal range 5-120IU/mL). A large number of S. stercoralis larvae were detected upon stool examination with saline and iodine mounts and the formaldehyde ether concentration method. After treatment with two cure albendazole 400 mg/day for 7 days, S. stercoralis larvae were not detected in stool examination. It is interesting that response to treatment was not observed on the first cure and the recovery was seen on the second cure. We suggest that hyperinfections should be taken into consideration in the diagnosis and treatment of immunocompromised patients with several complaints so that life-threatening effects of the nematode may be prevented.

[Evaluation of materials sent due to suspected cystic echinococcosis to the parasitology laboratory of Ondokuz Mayıs University Medical School between the Years 2005-2011].

OBJECTIVE Cystic echinococcosis (CE) is an important health problem common in our country. In this study, anti-Echinococcus granulosus IgG antibodies were investigated in the serum samples of 454 patients who attended the Ondokuz Mayıs University, Faculty of Medicine, Department of Parasitology between 2005 and 2011. METHODS IHA (Fumouze, France) and ELISA (R-Biopharm, Germany) tests were performed at the same time. RESULTS While serum samples from 328 patients (72%) were negative with both tests, 81 samples (18%) were found to be positive with both tests. Forty (49%) cases were female, 41 (51%) cases were male who were positive by both tests. 25 (31%) positive cases were between 31 and 50 years old. While IHA was negative for 33 patients (7%) ELISA was positive for the same samples. In 2 patients (0.4%), both tests revealed low-positivity. CONCLUSION Using these two tests together for serologic detection of cystic echinococcosis could be recommended because of the high sensitivity and specificity ratios.

Acinetobacter species isolated from various clinical specimens between 2006-2011 years and their susceptibilities against antibiotics

Objective: The aim of this study was to investigate the distribution and antibiotic susceptibility of Acinetobacter species isolated in our hospital in the last six years. Method: Acinetobacter species isolated from various clinical samples sent to Ondokuz Mayıs University, Medical Faculty Hospital Central Laboratory, Bacteriology Sub Discipline Laboratory between January 2006 and June 2011 were included. Conventional methods and Vitek 2 Compact (bioMérieux-SE, France) automated systems were used for the identification and antibiotic susceptibility of the isolates. Results: During the study period, a total of 3.212 Acinetobacter species were isolated. Species distribution of Acinetobacter isolates and their ratios were found as follows: Acinetobacter baumannii Acinetobacter calcoaceticus complex (n=3006; 93.6%), Acinetobacter lwoffii (n=83; 2.6%), Acinetobacter junii (n=27; 0.8%), Acinetobacter haemolyticus (n=19; 0.6%) and Acinetobacter spp. (n=77; 2.4%). Acinetobacter isolates were isolated at the most from tracheal aspirate samples (n=747; 23.2%) and samples sent from intensive care units (n=705; 21.9%). Ceftazidime resistance increased from 70.2% to 82.7%; cefepime from 26.4% to 79.7%; imipenem from 27.2% to 77.2%; meropenem from 4.5% to 77% and ciprofloxacin from 40.4% to 78.9% in the last six years. In the first six months of 2011, the resistance ratios to tigecycline and colistin were determined as 5.9% and 0.2% respectively. No significant changes were observed in ampicillin-sulbactam resistance ratios. ÖZET Amaç: Son altı yılda, hastanemizde izole edilen Acinetobacter türlerinin dağılımı ve antibiyotik duyarlılıklarının incelenmesi amaçlanmıştır. Yöntem: Çalışmaya; Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi Merkez Laboratuvarı Bakteriyoloji Subdisiplin Laboratuvarına, Ocak 2006 Haziran 2011 tarihleri arasında çeşitli kliniklerden gönderilen örneklerden izole edilen Acinetobacter türleri dahil edilmiştir. İzolatların tanımlanmasında ve antibiyotik duyarlılıklarının belirlenmesinde konvansiyonel yöntemler ve Vitek 2 Compact (bioMérieux-SA, Fransa) otomatize sistemi kullanılmıştır. Bulgular: Çalışma döneminde toplam 3.212 Acinetobacter türü izole edilmiştir. Acinetobacter izolatlarının tür dağılımı ve oranları; Acinetobacter baumannii Acinetobacter calcoaceticus complex 3006 (%93,6), Acinetobacter lwoffii 83 (%2,6), Acinetobacter junii 27 (%0,8), Acinetobacter haemolyticus 19 (%0,6) ve Acinetobacter spp. 77 (%2,4) olarak bulunmuştur. En fazla Acinetobacter izolatı 747 (%23,2) trakeal aspirat örneğinden ve en çok yoğun bakım ünitesinden gönderilen 705 (%21,9) örnekten izole edilmiştir. Son altı yılda seftazidim direnci %70,2’den %82,7’e, sefepim %26,4’dan %79,7’e, imipenem %27,2’den %77,2’ye, meropenem %4,5’ten %77’ye, siprofloksasin %40,4’dan %78,9’a yükselmiştir. 2011 yılı ilk altı aylık dönemde tigesikline %5,9, kolistine %0,2 oranlarında direnç saptanmıştır. Ampisilin-sulbaktam direnç oranlarında belirgin değişim gözlenmemiştir. 1 Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, SAMSUN 2 Adana Numune Eğitim ve Araştırma Hastanesi, Mikrobiyoloji Laboratuvarı, ADANA 3 Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, SAMSUN 4 Yeditepe Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, İSTANBUL 5 İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, İSTANBUL Geliş Tarihi / Received : Kabul Tarihi / Accepted : İletişim / Corresponding Author : Nevzat ÜNAL Adana Numune Eğitim ve Araştırma Hastanesi, Mikrobiyoloji Laboratuvarı, ADANA Tel : +90 532 442 61 42 E-posta / E-mail : drnevzatunal@hotmail.com 14.02.2015 28.10.2015 DOI ID : 10.5505/TurkHijyen.2016.68915 Türk Hijyen ve Deneysel Biyoloji Dergisi Eroğlu C, Ünal N, Karadağ A, Yılmaz H, Acuner İÇ, Günaydın M. Çeşitli klinik örneklerden 2006-2011 yılları arasında izole edilen Acinetobacter türleri ve antibiyotik duyarlılıkları. Turk Hij Den Biyol Derg, 2016; 73(1): 25-32. Makale Dili “Türkçe”/Article Language “Turkish”

[Evaluating of Plasmodium species isolated from peripheral blood samples in a non-endemic region].

OBJECTIVE Malaria is a parasitic disease, caused by Plasmodium species, which transmitted to humans through genus Anopheles mosquitoes. This disease widely spreaded in tropical and subtropical areas. The aim of our study is to evaluate malaria cases diagnosed by peripheral blood examination. METHODS Peripheral blood samples sent to Parasitology Laboratory between 2001 and 2013 years, were examined using thick and thin blood smear techniques. RESULTS A total of 102 blood samples obtained from suspected patients were examined and eight of them were found to be positive. All cases were male and Plasmodium falciparum and Plasmodium vivax was detected in seven (87.5%) and one (12.5%) of them, respectively. Blood samples were mainly sent from Departments of Infectious Diseases. All P. falciparum cases had a history about work or travel to different African countries. CONCLUSION We think that patients who has fever and travel history to endemic countries especially in Africa, blood examination for malaria parasites should be taken into account in differential diagnosis.

[Isosporiasis in an elderly patient with chronic diseases: case report].

Isospora belli is a coccidian protozoon that can cause serious diarrhea especially in immunocompromised patients. The laboratory diagnosis depends primarily on the identification of oocysts in stool specimens by direct microscopic examination with iodine or special stains. This case is presented in order to draw attention to isosporiasis among the diarrheas that can be seen in elderly patients with several chronic diseases. A 81 year-old debilitated male, who had a history of hypertension, Alzheimers disease, previous cerebrovascular accident and right hemiplegia, was admitted to our hospital complaining of malaise, anorexia, chills, abdominal pain, dysuria, cough, sputum and diarrhea of ten days duration. I. belli oocysts were detected by microscopic examination of the sample with iodine after concentration by formalin-ethyl acetate sedimentation. Then, modified acid-fast and trichrome stains were performed and I. belli oocysts were detected with both methods. Similar to this case, infections caused by I. belli can occur in elderly immunocompromised patients with several chronic diseases and inadequate nutrition and care. Consequently, in individuals with persistent diarrhea, examinations and tests should be carried out by taking their immune status into consideration and stool examinations should be done at frequent intervals using the concentrations methods and special stains.