Suheyla Surucuoglu

Drug-resistant pulmonary tuberculosis in western Turkey: prevalence, clinical characteristics and treatment outcome.

BACKGROUND Although high antituberculosis (anti-TB) drug resistance rates have been reported in Turkey, the clinical characteristics and implications for the outcome of anti-TB treatment have not been fully investigated. We determined the prevalence of anti-TB drug resistance and examined demographic data, clinical characteristics and treatment outcome in relation to patterns of resistance. METHODS From the TB case registry of a university hospital and the two largest dispensaries in Manisa city, we identified all pulmonary TB cases with a culture-proven definitive diagnosis and antimicrobial susceptibility results for a 7-year period. We collected and analyzed demographic and clinical data and information on treatment outcome for those cases in relationship to anti-TB drug resistance. RESULTS Of 355 M. tuberculosis strains, 71.5% were susceptible to streptomycin, isoniazid, rifampicin and ethambutol. Any drug resistance and multi-drug resistance (MDR ) rates were 21.1% and 7.3% and were higher in males (53% and 9%, respectively) than in females (22% and 1%, respectively). Drug resistance was significantly higher in old cases (acquired drug resistance) vs new cases (primary drug resistance), and was associated with treatment failure (P<0.001). The prevalence of MDR was significantly higher in the old cases (22.4%) than in the new cases (4.4%) (P<0.001). Symptoms, radiographic findings, associated diseases, and sputum smear positivity were unrelated to the development of resistance. The prevalence of any drug resistance and MDR was significantly higher in those with treatment failure than in patients with treatment success. CONCLUSION High resistance rates, particularly for acquired MDR, indicate a need for improvement in the TB control programme in our region.

Use of DNA hybridization test for diagnosing bacterial vaginosis in women with symptoms suggestive of infection.

The purpose of this study was to evaluate a DNA hybridization test (Affirm VPIII) as an alternative to Gram stain for the rapid diagnosis of bacterial vaginosis in women with clinical signs of vaginal infection. Vaginal specimens were collected from 321 symptomatic women, and analyzed for bacterial vaginosis by both Gram stain using Nugent criteria and DNA hybridization test. Sensitivity, specificity, positive predictive value, and negative predictive value of the DNA hybridization test were determined using the Gram staining as the standard for diagnosis of bacterial vaginosis. Of the 321 patients, 115 (35.8%) were Gram positive for bacterial vaginosis and 126 (39.2%) were negative. 80 patients (25.0%) demonstrated intermediate Gram staining that was also considered negative. The Affirm system detected G. vaginalis in 107 (93.0%) of 115 vaginal specimens positive for bacterial vaginosis diagnosed by Gram stain. Compared to the Gram stain, DNA hybridization test had a sensitivity of 87.7% and a specificity of 96.0%. Positive and negative predictive values of the DNA hybridization test were 93.0% and 92.7%, respectively. In conclusion, Affirm VPIII hybridization test correlated well with Gram stain and may be used as a rapid diagnostic tool to exclude bacterial vaginosis in women with genital complaints.

A case of mycetoma successfully treated with itraconazole and co‐trimoxazole

A 29‐year‐old woman with swelling, multiple nodules and discharging sinuses of her right foot is presented. A single nodule on the sole was excised 15 years ago and since then she has had recurrent attacks of swelling and discharging sinuses that improved partially with antibiotics. Magnetic resonance images (MRI) revealed an ill‐defined mass predominantly with low signal intensity on T2W images. Within the granulomata, multiple unenhancing foci, with low T1W and T2W signal most likely representing the fungal balls or grains were detected. Histopathological examination revealed large clusters of microorganisms resembling fungal hyphae and bacteria, which were surrounded by mixed inflammatory infiltrate cells and stained positively by PAS and Gomoris methenamine silver stain. As minimal regression was seen on MRI with 4 months’ itraconazole (200 mg day−1) treatment, co‐trimoxazole (160 TMP/800 SMX b.i.d.) was added to treatment. Complete remission was established by MRI examination after 10 months with this combination therapy.

E-Test: An Alternative Method for Susceptibility Testing of Mycobacterium tuberculosis

Objective: The purpose of this study was to compare the agar proportion method with the E-test method for susceptibility testing of Mycobacterium tuberculosis.Materials and Methods: A total of 100 isolates were tested for isoniazid, rifampin, streptomycin and ethambutol susceptibility using an indirect-proportion method as well as the E-test method. Results:Categorical agreement between the methods was 100% for isoniazid, rifampin, streptomycin, and ethambutol. Conclusion: The E-test method appears to be an alternative method to agar proportion for testing the susceptibility of M. tuberculosis isolates to the first-line antituberculous agents.

In vitro activity of ciprofloxacin, ofloxacin and levofloxacin against Mycobacterium tuberculosis

BACKGROUND The increasing incidence of drug-resistant Mycobacterium tuberculosis necessitates therapeutic alternatives. The fluoroquinolones fulfill most of the criteria for an ideal class of antimycobacterial drugs. The aim of the present study was to determine to in vitro activities of ciprofloxacin, ofloxacin, and levofloxacin against M. tuberculosis strains. METHODS Susceptibility to four antituberculous drugs used in first-line treatment of tuberculosis was tested in 100 strains isolated from clinical samples. Nineteen strains (19%) were resistant to at least one of the four antituberculous drugs and 13 were multidrug resistant. The in vitro antimycobacterial activity of ciprofloxacin, ofloxacin, and levofloxacin was then determined against 100 M. tuberculosis strains using standard agar proportion dilution method. RESULTS Ciprofloxacin, ofloxacin, and levofloxacin were active against all tested strains of M. tuberculosis in vitro. CONCLUSIONS Ciprofloxacin, ofloxacin, and levofloxacin have relatively potent in vitro activity against M. tuberculosis. Further in vivo studies are needed to determine the role of these compounds in the treatment of tuberculosis, but use should be limited to special circumstances rather than first-line treatment.

Multicenter evaluation of crystal violet decolorization assay (CVDA) for rapid detection of isoniazid and rifampicin resistance in Mycobacterium tuberculosis

The aim of this multicenter study was to evaluate the performance of the crystal violet decolorization assay (CVDA) for detection of multidrug resistant tuberculosis (MDR-TB). This study was performed in 11 centers in two phases. A total of 156 isolates were tested for INH and RIF resistance. In the phase I, 106 clinical isolates were tested in the Center 1–7. In the phase 2, 156 clinical isolates were tested in the center 1–6, center 8–11. Eighty six of 156 tested isolates were the same in phase I. Agreements were 96.2–96.8% for INH and 98.1–98.7% for RIF in the phase I-II, respectively. Mean time to obtain the results in the phase I was 14.3 ± 5.4 days. In the phase II, mean time to obtain the results was 11.6 ± 3.5 days. Test results were obtained within 14days for 62.3% (66/106) of isolates in the phase I and 81.4% (127/156) of isolates in the phase II. In conclusion, CVDA is rapid, reliable, inexpensive, and easy to perform for rapid detection of MDR-TB isolates. In addition, it could be adapted for drug susceptibility testing with all drugs both in developed and developing countries.

Chronic subcutaneous nodules, plaques and ulcers of the hand.

© 2017 Indian Journal of Dermatology, Venereology, and Leprology | Published by Wolters Kluwer Medknow A 54-year-old man presented with multiple draining sinuses on the right hand for 2 years. Dermatological examination revealed erythematous nodules and pustules leading to draining abscesses localized on the dorsal aspect of the right hand [Figure 1]. The infection had not responded to several courses of antibiotics. There was no history of trauma or foreign body. A punch biopsy was performed for histopathological, bacteriological, mycobacterial, parasitological and mycological examinations. Routine bacterial, fungal and parasitological cultures were negative. Histopathological examination revealed granulomas along with an infiltrate of lymphocytes. Areas of caseous necrosis surrounded by histiocytes and multinucleated giant cells were observed [Figure 2].

Molecular Diversity of Drug Resistant Mycobacterium Tuberculosis Strains in Western Turkey

OBJECTIVE The aim of this study was to investigate the molecular diversity and clonal relationship of drug resistant Mycobacterium tuberculosis strains isolated in Western Turkey. MATERIALS AND METHODS A total of 87 strains isolated between 2006 and 2009, eight of which were rifampicin monoresistant and 79 were multidrug resistant, were analyzed with IS6110 RFLP and spoligotyping methods. RESULTS The results of spoligotyping showed that 7% of the strains were orphans, and 8% were undefined for family in the SpolDB4 database. Major families of the strains were LAM (38%), T (35%), Haarlem (7%), Beijing (2%), S (2%) and U (1%) families. The clustering rate by spoligotyping was calculated as 75%. The most predominant SIT cluster was SIT41 (29%). According to the results of IS6110 RFLP, 71 different patterns of IS6110 were observed. Low copy number was found in 26% of the strains. When the results of two methods were combined, the final clustering rate was calculated as 26%. CONCLUSIONS The genotypical distribution of drug resistant tuberculosis isolates in our region indicates genetic diversity and the clustering rate was found low in our region. However, more comprehensive and long-term molecular epidemiological studies are needed to control the drug resistant strains.