Serdar Susever

Prevalence, susceptibility profile and proteinase production of yeasts causing vulvovaginitis in Turkish women.

In this study the prevalence of vulvovaginal candidiasis (VVC), antifungal susceptibility and proteinase production of isolated Candida species were investigated. Vaginal swabs were collected from symptomatic women with vulvovaginitis attending the Obstetrics and Gynecology Clinic of Kocaeli University, Turkey. The relation between risk factors, such as pregnancy, diabetes mellitus, antibiotic and corticosteroid use, history of sexually transmitted diseases and contraceptive methods, was recorded. Candida spp. were identified by conventional methods, then evaluated for proteinase secretion in a medium containing casein. Antifungal susceptibility was determined according to the NCCLS microdilution method. The prevalence of women with vulvovaginitis was 35.7% (170/6080) and 16% (28/170) of them were diagnosed as VVC. Candida albicans was the dominant species: 21 (75%), followed by 4 C. glabrata (14%), 2 C. tropicalis (7%), and one C. krusei (3.5%). All isolates were susceptible to fluconazole, itraconazole and amphotericin B, except one C. krusei, one C. glabrata and one C. albicans that were resistant to fluconazole. Proteinase production was determined in 19 (90.5%) C. albicans and in all C. tropicalis isolates. Proteinase activity was not associated with antifungal resistance. No association was found between risk factors and VVC.

In vitro susceptibility of yeasts isolated from patients in intensive care units to fluconazole and amphotericin B during a 3-year period

Fungal infections have increased dramatically in recent years and candidemia is a major risk factor for morbidity and mortality in intensive care units (ICUs). Candidemia has been considered to be a nosocomial infection that is strongly associated with neutropenia, recent surgery or presence of intravascular lines, and previous colonization is an independent risk factor. We evaluated the in vitro efficacy of fluconazole and amphotericin B against yeasts isolated from various clinical specimens of colonized or infected patients treated in the ICUs of the Institute of Cardiology, Istanbul University. A total of 1397 ICU patients were treated at the Institute of Cardiology between January 2000 and December 2002. A total of 117 yeasts isolated from 97 patients were included in this study. These ICU patients were hospitalized for a mean of 29 days. All yeasts were identified by conventional methods and using the API (20C AUX, ID 32C) system (Bio Meriéux, France). Susceptibility to fluconazole and amphotericin B was evaluated using the E‐test (AB Biodisk, Solna, Sweden). The most commonly isolated yeast was Candida albicans (72.6%), followed by Candida tropicalis (16.2%), Candida kefyr, Candida krusei, Candida parapsilosis, Trichosporon mucoides and Geotrichum spp. Fluconazole and amphotericin B MIC90 values were 0.75 μg/ml; 0.19 μg/ml and 1 μg/ml; 0.38 μg/ml for C. albicans and C. tropicalis, respectively. All Geotrichum spp. were found to be susceptible‐dose dependent (SDD) (MIC=16–32 μg/ml) to fluconazole. Two C. albicans, two C. tropicalis, one C. krusei and one Geotrichum spp. had a MIC value of ≥0.38 μg/ml for amphotericin B. The rate of colonization was 3.36% (47/1397). Only 10 (0.71%) patients out of a total of 1397 developed candidemia during the period of the investigation. Of these, 7 (70%) were caused by non‐albicans Candida spp.

An outbreak of Fusarium solani endophthalmitis after cataract surgery in an eye training and research hospital in Istanbul

To report an outbreak of Fusarium solani endophthalmitis after uneventful cataract surgeries performed on the same day in the same operating room. Nine patients underwent phacoemulsification at 4th Clinic of Beyoglu Eye Training and Research Hospital in Istanbul. Cefuroxime axetyl was injected intracamerally from the same vial to all patients at the end of surgery. All patients developed acute postoperative endophthalmitis. Presentation, cultural studies, treatment, clinical responses and risk factors were evaluated. Cultural and DNA sequence findings revealed F. solani. Antifungal therapy was begun and pars plana vitrectomy, intraocular lens and capsule extraction were performed. Corneal involvement was correlated with old age and systemic disease. Fusarium solani should be considered in acute postoperative endophthalmitis. This infection can be controlled with early and aggressive combined antifungal and surgical treatment. The patients with corneal involvement had poor prognosis. It is important to use solutions prepared separately for each patient.

Biological Hazards in Tannery Workers

A total of 431 workers from 14 leather factories located in the Tuzla Organized Industry Region, Istanbul were involved in the study. Subjects were interviewed and examined individually with regard to asthma symptoms. Physical examinations were undertaken and respiratory function measured by spirometer. Moreover, the atmosphere of the working areas in the factories was assessed microbiologically. The fungal genera most often detected were Penicillium spp., followed by Aspergillus spp., Alternaria spp., Scopulariopsis spp., and Cladosporium spp. multiplying at differing rates. The number of those physically examined with indications of peripheral respiratory obstruction was 176 (40.8%) while those with suspected asthma following questioning was 153 (35.5%). The obstruction demonstrated by the use of respiratory function tests was associated with the mold isolated from the environment and was included in the logistic model that was developed as a risk factor for increasing obstruction. Workers employed in tanneries encounter many health problems. These may be reduced by: improving the factory environment, environmental control of allergens, elimination of allergen reservoirs, control of humidity and reducing exposure to excessive heat or cold. In addition there should be air filtration and vacuum cleaning to control dust mites and control of other workplace risks not necessarily associated with tanning. Importantly, workers should have medical examinations before employment and periodic examinations during training and employment to reduce the risk of occupational diseases to a minimum.

Assessment of Nasal Swab Samples, Environmental Microbiological Analyses and Respiratory Function Tests of Bakery Workers Working Under Modern Conditions: A Brief Report

Studies have shown that bakery workers may develop asthma and rhinitis as a result of their occupation and approximately 30% of bakery workers and wheat farmers will become sensitised. This ratio can change depending on the exposure time and a history of atopy. The present study has looked at the relationship between nasal and environmental flora and pulmonary function in such workers to see if it can explain the occurrence of asthma and rhinitis. Workers from three of the largest bakery companies in Istanbul were recruited, a total of 372 people; 223 bakery workers and 149 administrative employees of the same companies as a control group. Face to face interviews were conducted to determine asthma status and all were given physical examinations with nasal flora samples collected by sterile swabs. Aerial samples were taken from administrative and product departments for microscopic examination. Compared to administrative staff, bakery workers had insignificantly more asthma symptoms (p> 0.05).C. albicanswas isolated from four (1.9%) nasal samples from bakery workers and one (0.7%) from the control group (p> 0.05). A statistically significant level of wheeze (X2= 4.65, p= 0.03, OR= 2.32 95% CI (1.06–5.07)), suggesting bronchial obstruction, was detected in 28 (13.1%) bakery workers and in nine people (6.1%) from the control group. Looking at smoking and non-smoking groups, a significant decrease was observed for PEF (%) in the smokers and FEV1/FVC (%) in the non-smokers. These results suggest that pulmonary function of bakery workers is slightly impaired even with modern engineering controls.

YEASTS ISOLATED FROM PATIENTS IN THE CORONARY AND SURGICAL INTENSIVE CARE UNITS AND THEIR SUSCEPTIBILITIES TO FLUCONAZOLE AND AMPHOTERICIN B

also observed in epithelial infection with the less virulent species C. tropicalis and C. glabrata. Heat-killed C. albicans failed to induce epithelial immune response. By the use of the proteinase inhibitor pepstatin A we could demonstrate that expression of the chemokines IL-8 and GM-CSF is modulated by the proteolytic activity of C. albicans. At the protein level, expression of IL-8 protein was strongly enhanced during the course of C. albicans infection while lower levels were seen with C. tropicalis and C. glabrata. The different expression patterns of cytokines were associated with differences in virulence of the Candida strains. Our data therefore show a correlation between the virulence potential of pathogenic fungi, possible mediated by specific virulence factors (such as proteinases), and the secretion of epithelial cytokines and chemokines, which may initiate in vivo a protective Th-1 immunoresponse and contribute to the recruitment of activated leucocytes and lymphocytes to the site of mucosal infection.