Sibel Ergüven

Pneumocystis carinii pneumonia in a rheumatoid arthritis patient treated with adalimumab

Patients with rheumatoid arthritis (RA) have an increased risk of infection as a result of alterations in immune regulation, debility, and comorbid illnesses. TNF-α is of central importance in the pathophysiological responses to infection and inflammation, and plays a crucial role in host defence. Pneumocystis carinii is an opportunistic pathogen that commonly affects individuals with inadequate T-cell mediated immune response. Patients with acquired immune deficiency, as well as those receiving immunosuppressive drugs for various conditions have an increased risk of P. carinii pneumonia (PCP). We report the development of PCP in a woman with RA shortly after the initiation of anti-TNF-α treatment with adalimumab.

Compartment-Specific Remodeling of Splenic Micro-Architecture during Experimental Visceral Leishmaniasis

Progressive splenomegaly is a hallmark of visceral leishmaniasis in humans, canids, and rodents. In experimental murine visceral leishmaniasis, splenomegaly is accompanied by pronounced changes in microarchitecture, including expansion of the red pulp vascular system, neovascularization of the white pulp, and remodeling of the stromal cell populations that define the B-cell and T-cell compartments. Here, we show that Ly6C/G+ (Gr-1+) cells, including neutrophils and inflammatory monocytes, accumulate in the splenic red pulp during infection. Cell depletion using monoclonal antibody against either Ly6C/G+ (Gr-1; RB6) or Ly6G+ (1A8) cells increased parasite burden. In contrast, depletion of Ly6C/G+ cells, but not Ly6G+ cells, halted the progressive remodeling of Meca-32+ and CD31+ red pulp vasculature. Strikingly, neither treatment affected white pulp neovascularization or the remodeling of the fibroblastic reticular cell and follicular dendritic cell networks. These findings demonstrate a previously unrecognized compartment-dependent selectivity to the process of splenic vascular remodeling during experimental murine visceral leishmaniasis, attributable to Ly6C+ inflammatory monocytes.

Comparison of cytochemical staining, immunofluorescence and PCR for diagnosis of pneumocystis carinii on sputum samples

Detection of P. carinii has increased with the use of polymerase chain reaction (PCR), particularly in sputum samples. In this study, sputum samples obtained from 30 immunosuppressed patients with respiratory symptoms (12 HIV-infected) were tested by standard cytochemical staining (Giemsa and methenamine silver), immunofluorescence (IF) staining and PCR for detection of P. carinii and the results were compared. Pneumocystis carinii was detected in 4, 8 and 13 sputum samples by cytological staining, IF test and PCR, respectively. Specific amplification bands were obtained in all sputum samples that were positive by both other tests. All tests gave negative results in sputum samples obtained from 5 HIV-infected asymptomatic patients and 22 non-immunosuppressed tuberculosis patients. Our observations suggest that PCR results were well correlated with P. carinii pneumonia (PCP), especially in non-HIV-infected patients. However, PCR positivity obtained in HIV-infected patients could be misleading in the diagnosis of PCP without careful clinical evaluation. Positive results obtained by Giemsa staining or IF test confirm diagnosis of PCP authoritatively. As a result, we suggest testing sputum samples by both PCR and IF techniques for detection of P. carinii.

Isolation, in vitro antimicrobial susceptibility and penicillin tolerance of Arcanobacterium haemolyticum in a Turkish University Hospital

Arcanobacterium haemolyticum (Ah) was isolated from 5 (0.3%) out of 1531 throat cultures of patients with presumed pharyngotonsillitis. The age of the patients who had a positive culture for Ah varied between 6 and 22. The isolation rate of beta-haemolytic streptococci (BHS) was 7.4%, 72.6% of which belonged to Group A, followed by groups G, C and B. None of the throat samples yielded simultaneous growth of Ah and BHS. Antimicrobial susceptibility of Ah isolates to phenoxymethylpenicillin, cephalexin, cefotaxime, vancomycin, erythromycin, azithromycin, doxycycline, ciprofloxacin, and trimethoprim-sulfamethoxazole was tested by the agar dilution method. The isolates were found to be susceptible to all antimicrobials tested except trimethoprim-sulfamethoxazole. Penicillin tolerance could be detected in none of the Ah strains, including the reference strain Ah ATCC 9345. We conclude that Ah should be kept in mind as a potential pathogen causing pharyngitis in adolescents and young adults.

Detection of parasites in children with chronic diarrhea

The aim of this study was to investigate the frequency of intestinal parasites in patients with chronic diarrhea and clarify the importance of these parasitic pathogens in such cases. A total of 60 pediatric patients with chronic diarrhea between June 2012 and October 2014 were enrolled in the study. Out of 60 stool samples, five were positive for Giardia lamblia, two, Dientamoeba fragilis, and one, Blastocystis hominis. One stool sample was positive for Entamoeba hartmanni and B. hominis, another one was positive for G. lamblia and B. hominis, another, G. lamblia and E. hartmanni and one sample was positive for Enterobius vermicularis, D. fragilis and B. hominis together. Parasitic infection, which decreases quality of life and increases susceptibility to other infections, should not be neglected, particularly in patients with chronic diarrhea. Accurate diagnosis decreases morbidity and mortality in patients with parasite infection.

[The results of Hacettepe University Faculty of Medicine Parasitology Laboratory in 2003-2012: evaluation of 10 years].

OBJECTIVE Parasitic diseases are common throughout the world. Evaluation of regional epidemiological data is needed to determine protective measures and treatment strategies. METHODS This study evaluates the parasites detected in Hacettepe University Faculty of Medicine Parasitology Laboratory. RESULTS Of the 87,100 clinical samples evaluated in the study, 85,707 (98.4%) were from stool samples. Parasites were shown in 3,681 (4.2%) of the samples from 2,906 patients. The most common parasites were Giardia intestinalis (40%), Blastocystis spp. (22%), Entamoeba coli (12%), Dientamoeba fragilis (9%), Enterobius vermicularis (5%), Echinococcus spp. (4%) and Taenia spp. (3%) respectively. When distribution among years was evaluated, G. intestinalis, the most common parasite, had a tendency to decrease after 2004 whereas cases with Blastocystis spp. showed a clear increase in 2011 and 2012. The downward trend in parasite-positive cases also stopped in the last two years, in parallel to the increase of Blastocystis spp. During the study, Leishmania spp. and Plasmodium spp. were detected in four patients each. CONCLUSION This study evaluated the results of a laboratory that scans a large number of patients in our region. Data obtained from different regions will allow to direct strategies to diagnose, treat and implement preventive measures against parasitic diseases in our country.

Detection of Listeria monocytogenes in Milk by the Polymerase Chain Reaction

A on the polymerase chain reaction (PCR) method based was developed for detection of Listeria monocytogenes in milk samples after enrichment culture. It consists of culturing samples in Listeria enrichment broth, followed by DNA extraction and detection of the organism using PCR. Dilutions of L. monocytogenes in milk were subjected to PCR amplification after enrichment culture. When determining the sensitivity of the method, it was found to be possible to detect 37 CFU (colony forming unit gl/ml) of the bacterium in milk. The method was assessed as a sensitive, specific, times-saving and practical way of detecting L. monocytogenes in milk samples.