Nur Yapar

Epidemiology and risk factors for invasive candidiasis

The number of immunosuppressive patients has increased significantly in recent years. These patients are at risk for opportunistic infections, especially fungal infections. Candidiasis is one of the most frequent fungal infections determined in these immunosuppressive patients and its epidemiology has changed over the last two decades. Recently, new antifungal agents and new therapy strategies such as antifungal prophylaxis, secondary prophylaxis, and preemptive therapy have come into use. These changes resulted in the alteration of Candida species causing invasive infections. The incidence of Candida albicans was decreased in many countries, especially among patients with immunosuppressive disorders, while the incidence of species other than C. albicans was increased. In this review, incidence, risk factors, and species distribution of invasive candidiasis are discussed.

Evaluation of species distribution and risk factors of candidemia: A multicenter case-control study

This study was planned to determine the risk factors of candidemia, and the most common Candida species causing bloodstream infections. A case-control study which included adult patients was conducted over a 1-year period at tertiary-care educational hospitals in Turkey. A total of 83 candidemia episodes were identified during the study period. Candida albicans was the most common species recovered (45.8%) followed by Candida tropicalis (24.1%) Candida parapsilosis (14.5%) and Candida glabrata which was isolated from only four (4.8%) patients. Presence of a urethral catheter (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.09-5.19; P = 0.02), previous use of antibiotics (OR 2.61; 95% CI 1.05-6.46; P = 0.03), RBC transfusions (OR 2.14; 95% CI 1.16-3.94; P = 0.01) and parenteral nutrition (OR 4.44; 95% CI 2.43-8.11; P < 0.01) were found as independent risk factors for candidemia. TPN (Total Parenteral Nutrition) was an independent risk factor for both C. albicans and non-Candida albicans Candida species (P < 0.001). Most of the risk factors were invasive procedures and former medications. We conclude that a great number of candidemia cases are preventable by means of reduction of unnecessary invasive procedures and the use of antimicrobials.

Nosocomial bloodstream infections associated with Candida species in a Turkish University Hospital

In recent years, a progressive increase in the frequency of nosocomial candidaemia has been observed, especially among the critically ill or immunocompromised patients. The aim of this study was to evaluate the trend in incidence of candidaemia together with potential risk factors in an 850‐bed Turkish Tertiary Care Hospital in a 4‐year period. A total of 104 candidaemia episodes were identified in 104 patients. The overall incidence was 0.56 per 1000 hospital admissions and the increase in incidence of candidaemia from 2000 to 2003 was found to be statistically significant (P = 0.010). Candida albicans was the most common species (57.7%) and non‐albicans species accounted for 42.3% of all episodes. The most common non‐albicans Candida sp. isolated was C. tropicalis (20.2%) followed by C. parapsilosis (12.5%). The most frequent risk factors possibly associated with the candidaemia were previous antibiotic treatment (76.9%), presence of central venous catheter (71.2%) and total parenteral nutrition (55.8%). Our results show the fact that the incidence of candidaemia caused by non‐albicans species is frequent and increasing significantly, although the most common isolated Candida species were C. albicans and further investigations are necessary to evaluate the mechanisms of increasing incidence of candidaemia caused by non‐albicans species.

A Large‐Scale Outbreak of Trichinellosis Caused by Trichinella britovi in Turkey

An outbreak of trichinellosis occurred in Izmir, Turkey, between January and March 2004. The outbreak was caused by the consumption of raw meat balls made of beef deceptively mixed with pork infected with Trichinella britovi. A total of 1098 people who had consumed this food either in 14 restaurants or from the street vendors located in three different neighbourhoods, consulted six different healthcare centres with a wide range of clinical signs and symptoms. Of them, 418 (38.1%) patients fulfilled the criteria for the diagnosis of acute trichinellosis. The most commonly observed signs and symptoms were myalgia (89.2%), arthralgia (69.9%) and eyelid (67%) and facial oedema (65.8%). High levels of creatinine kinase (69.3%) and lactate dehydrogenase (93.8%) with leucocytosis (>10 000/mm3, 58.9%) and eosinophilia (>1000/mm3, 60.5%) were the most prominent laboratory findings. All, but 13 of these patients were treated with mebendazole or albendazole. Based on the physicians’ assessments of disease severity, 78 (19%) patients were additionally given prednisolone in whom a significantly more rapid recovery of clinical signs and symptoms (e.g. fever, myalgia, facial and eyelid oedema) was observed, with a rapid improvement in leucocytosis, eosinophilia and muscle enzymes, compared with those, who had not received corticosteroids (P < 0.05). Beef illegally mixed with pork of unknown origin, by a wholesale butcher who had sold this product to restaurants and street vendors at a lower price than the prevailing market price of beef, was the cause of this large‐scale outbreak in a country with a predominantly Muslim population.

Risk of infection in health care workers following occupational exposure to a noninfectious or unknown source

BACKGROUND The major concern after occupational exposures is the possible transmission of blood-borne pathogens, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study was undertaken to evaluate the risk of infection after exposure to blood or body fluids of an unknown or an HBV-, HCV-, and HIV-negative source and to determine the epidemiologic characteristics of these incidents in health care workers. METHODS The survey was conducted over a 6-year period at a university hospital in Turkey, using a questionnaire to elicit demographic and epidemiologic information. Serologic tests for HBV, HCV, and HIV were performed and repeated after 3 months. RESULTS Of the 449 incidents, complete follow-up was achieved in 320 (71.3%), and no seroconversion was observed for HBV, HCV and HIV. Most of the incidents occurred in medical (34.7%) and surgical (25.4%) work areas. The most frequent type of exposure was percutaneous injury (94%), most commonly caused by handling of garbage bags (58.4%), needle recapping (16.5%), and invasive interventions (13.4%). CONCLUSION Infection risk seems to be extremely low for HCV and HIV, because of low endemicity, and for HBV in groups immunized against HBV.

Acute phase reactants predict the risk of amputation in diabetic foot infection.

BACKGROUND prediction of amputation would aid clinicians in the management of diabetic foot infections. We aimed to assess the predictive value of baseline and post-treatment levels of acute phase reactants in the outcome of patients with diabetic foot infections. METHODS we collected data prospectively during minimum follow-up of 6 months in patients with infected diabetic foot ulcers hospitalized in Dokuz Eylul University Hospital between January 1, 2003, and January 1, 2008. After excluding patients who did not attend the hospital for follow-up visits regularly (n = 36), we analyzed data from 165 foot ulcer episodes. RESULTS limb ischemia and osteomyelitis were much more frequent in patients who underwent amputation. Wagner grade, which assesses ulcer depth and the presence of osteomyelitis or gangrene, was higher in patients who needed amputation. Ulcer size was slightly larger in the amputation group. Baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, white blood cell counts, and platelet counts were significantly elevated in patients who underwent amputation. Albumin levels were significantly suppressed in the amputation group. Univariate analysis showed that a 1-SD increase in baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, and white blood cell counts and a 1-SD decrease in post-treatment albumin levels were significantly associated with increased risk of amputation. Post-treatment C-reactive protein level was strongly associated with amputation risk. CONCLUSIONS circulating levels of acute phase reactants were associated with amputation risk in diabetic foot infections.

Antibiotic-associated diarrhea in a turkish outpatient population : Investigation of 288 cases

Abstract Oral antibiotics are often prescribed, especially for respiratory tract infections in the community. The widespread use of broad-spectrum antibiotics causes an increased incidence of antibiotic-associated diarrhea (AAD). Although AAD has been studied in hospitalized patients, there is little available information concerning the characteristics of AAD in outpatient populations. The aim of this study was to investigate the clinical and laboratory findings of adult patients with communityacquired AAD. Between June 1998 and December 2003, the clinical reports of 288 patients were retrospectively reviewed. We observed that the duration between the start of antibiotic treatment and onset of symptoms was 7 days in most of the patients (86%), and the mean time was 9±1.0 days. The diarrhea was self-limited in all cases and mean duration of symptoms was 3 (± 1.0) days (1-7 days). The most common symptoms were abdominal discomfort and tenesmus (61.1%), while elevated WBC counts and fever were detected rarely. We were able to perform microbiologic investigations in only 88 patients because of the financial problems. Of the 88 stool specimens tested, none of them were positive for pathogenic bacterial growth or toxin A production.

rpoB Gene Mutations in Rifampin-Resistant Mycobacterium tuberculosis Strains Isolated in the Aegean Region of Turkey

Abstract Although DNA sequencing method has not been used routinely for detecting resistance of Mycobacterium tuberculosis to antituberculosis drugs, it is suggested for the investigation of gene mutations causing resistance. Using DNA sequencing (Automated Applied Biosystems), we attempted to determine mutations in the 81- bp cor region (rifampin resistance determining region) of the rpoB gene in 48 Mycobacterium tuberculosis strains found to be rifampin resistant by classical phenotypic methods. Of the 48 strains, 46 (95.8%) were found to have rpo gene mutations with 13 different types while in two (4.2%) of the 48 strains, no mutations were detected. None of the strains had mutations at more than one codon. Point mutations at the 531st (52.1 %) and 526th (18.9 %) codons were frequent. The most frequent point mutation was Ser531Leu, and it was found in 21 (43,8 %) of 48 strains. This is the first study from Turkey, reporting Ser522Leu point mutation in one isolate and deletion of 515th codon (ATG - Met) in two isolates.

[Acute appendicitis and coinfection with enterobiasis and taeniasis: a case report].

Parasites are rarely associated with inflammation of the appendix. Generally, parasites cause acute abdominal pain via blocking the gut lumen. In this article, we presented a case of appendicitis where Enterobius vermicularis was detected in the surgical specimen and Taenia was detected in the stool. A 31 year old male patient was admitted to the emergency room with severe abdominal pain, which has begun two days ago. On physical examination, tenderness was positive on palpation of the right lower abdominal quadrant and the patient was operated on with the diagnosis of acute appendicitis. Histopathological examination of the patients appendectomy material revealed numerous parts of parasites resembling Enterobius vermicularis and slight mucosal erosion. On parasitological examination of the patients stool, Taenia eggs and adult forms were determined. Antiparasitic therapy was started with niclosamide for taeniasis and albendazole for enterobiasis. Parasitic infections can mimic acute appendicitis clinically. Radiological and laboratory findings do not help to distinguish the diagnosis of acute appendicitis. In the histopathological examination of the appendix, the findings of acute inflammation of the appendix wall may not be defined. For patients with normal histopathological examination, screening for parasites should be done, and anti-parasitic treatment should be started after appendectomy.

Investigation of the cases presenting to Dokuz Eylül University Hospital with tick bites

OBJECTIVE Determination of the properties of ticks, which are the vectors of many infectious diseases and the patients with tick bites are important for the prevention of these diseases. For tist reason, the purpose of this study is to determine the important properties of the cases presenting with tick bites to Dokuz Eylul University Hospital and of the removed ticks from the cases. METHODS Two hundred seventy three of 294 patients, who presented with tick bites to Dokuz Eylül University Hospital, Izmir, were included in the study. Demographic parameters, symptoms related to tick borne diseases of the patients and the species and other characteristics of ticks removed from humans, also the tick population in the related habitat were investigated. RESULTS Removed ticks were classified into five genera. The overwhelmingly dominant genera were Hyalomma and it comprised 52.4% of the collection. The majority of these ticks were nymphs. The majority (11.4%) of removed adult ticks were Rhipicephalus sanguineus (R. sanguineus). In most cases (60.7%) the ticks were removed from the patients by medical staff. CONCLUSION There was no significant difference in removing ticks without damage between the health personnel and the patient or relatives (p=0.133).