Yasemin Zer

Synergy Tests by E Test and Checkerboard Methods of Antimicrobial Combinations against Brucella melitensis

ABSTRACT Two different synergy testing methods, the checkerboard and the E test methods, were used to compare the in vitro efficacies of various antimicrobial combinations against 16 Brucella melitensis strains isolated from blood cultures. The rate of agreement of the E test and checkerboard methods was found to be 55%. The most concordant results were found for the streptomycin-doxycycline combination in 12 (75%) tests, in which four strains showed synergistic activity by E test and antagonistic activity by the checkerboard method and in which one strain showed antagonistic activity by both methods. Even though each of these methods uses different conditions and endpoints, the results of both methods frequently agreed.

A prospective epidemiologic survey on the prevalence of onychomycosis and dermatophytosis in male boarding school residents.

Dermatophyte infections and onychomycosis are not usually serious in term of mortality; however, they may have significant clinical consequences such as secondary bacterial infections, chronicity, therapeutic difficulties and esthetic disfigurement in addition to serving as a reservoir of infection. Our aim was to determine the prevalence of onychomycosis and dermatophytosis in a selected high risk group, consisting of male boarding school residents. A total of 410 males inhabiting two houses were evaluated by two dermatologists. In cases of clinical suspicion, appropriate samples were taken for direct microscopy and culture. The results showed that the prevalences of tinea pedis (athlete’s foot) and pure pedal onychomycosis were 51.5% (n:211) and 4.4% (n:18), respectively. Thirty cases of those with tinea pedis were complicated by toenail onychomycosis. Tinea cruris was present only in five cases with tinea pedis. Interestingly 71.1% of those with tinea pedis and 45.8% of those with onychomycosis, associated with or without tinea pedis were unaware of their diseases. The most common fungal isolate was Trichophyton rubrum (76.6%) followed by Epidermophyton floccosum (11.6%), T. interdigitale (10.55%). Approximately one third of the cultures from nail specimens yielded pure growths of nondermatophyte moulds or Candida albicans. In conclusion, we found unexpectedly high prevalences of occult athlete’s foot and toenail onychomycosis among the male residents of student houses. Our results indicate that health-care workers of such common boarding-houses should be more aware of clinical and subclinical dermatophyte infections and onychomycosis, and have more active approaches to educational measures and management strategies to prevent further infections. To our knowledge, this is the first epidemiologic study on the prevalences of dermatophytosis and onychomycosis in boarding-houses from Turkey.

In vitro synergistic activity of colistin with tigecycline or β-lactam antibiotic/β-lactamase inhibitor combinations against carbapenem-resistant Acinetobacter baumannii

Objective Nosocomial infection caused by carbapenem-resistant Acinetobacter baumannii is a worldwide problem and treatment options remain controversial. This study investigated the in vitro effect of various antibiotic combinations against carbapenem-resistant A. baumannii strains. Methods Antibiotic susceptibility of A. baumannii strains was analysed. In vitro synergistic efficacy of colistin combined with tigecycline, cefoperazone/sulbactam or piperacillin/tazobactam was tested against carbapenem-resistant A. baumannii strains. Synergy studies were performed using an eplisometer test-strip method. Results Of the 50 carbapenem-resistant A. baumannii strains tested, 96% were susceptible to colistin and 64% were susceptible to tigecycline. Colistin–tigecycline, colistin–cefoperazone/sulbactam and colistin–piperacillin/tazobactam combinations were found to have synergistic effects against six (12%), two (4%), and one (2%), respectively, of the strains tested. Conclusions Colistin combined with tigecycline, cefoperazone/sulbactam or piperacillin/tazobactam revealed synergistic effects in some carbapenem-resistant A. baumannii strains. These results, together with the shortage of treatment options and the risk of developing resistance to colistin, suggest that clinicians should use colistin combined with other antibiotics or β-lactamase inhibitors when treating carbapenem-resistant A. baumannii infection.

Successful treatment of antifungal- and cryotherapy-resistant subcutaneous hyalohyphomycosis in an immunocompetent case with topical 5% imiquimod cream.

Hyalohyphomycosis is an unusual opportunistic mycotic infection where the tissue morphology of the causative organism is mycelial. Etiological agents, which are not responsible for the otherwise-named infections like aspergillosis, are the species of non-dematiaceous hyaline hyphomycetes including Penicillium, Paecilomyces, Acremonium (formerly known Cephalosporium), Beauveria, Fusarium, and Scopulariopsis. Several cases of Acremonium infection have been described in immunocompromised patients; however it can cause invasive disease in an immunocompetent person very rarely. Optimum therapy of Acremonium infection is unclear because of the limited number of reported cases and conflicting results of therapies. Imiquimod, an imidazoquinoline with potent antiviral, antitumor and immunoregulatory properties, is currently approved for the topical treatment of external anogenital warts and actinic keratosis. Imiquimod has also been found to be effective for other virus-associated dermatologic lesions, including common and flat warts, molluscum contagiosum, and herpes simplex virus type-2 as well as for some cases of cutaneous leishmaniasis. We report herein, for the first time, a case of unusually recalcitrant hyalohyphomycosis of the face due to Acremonium strictum successfully treated with topical 5% imiquimod in an immunocompetent patient, who had failed to respond to various antifungals, including itraconazole, and cryotherapy.

Antimicrobial efficiency of photodynamic therapy with different irradiation durations

Objective: This study aimed to evaluate the antimicrobial efficiency of PDT and the effect of different irradiation durations on the antimicrobial efficiency of PDT. Materials and Methods: Sixty freshly extracted human teeth with a single root were decoronated and distributed into five groups. The control group received no treatment. Group 1 was treated with a 5% sodium hypochlorite (NaOCl) solution. Groups 2, 3, and 4 were treated with methylene-blue photosensitizer and 660-nm diode laser irradiation for 1, 2, and 4 min, respectively. The root canals were instrumented and irrigated with NaOCl, ethylenediamine-tetraacetic acid, and a saline solution, followed by autoclaving. All the roots were inoculated with an Enterococcus faecalis suspension and brain heart infusion broth and stored for 21 days to allow biofilm formation. Microbiological data on microorganism load were collected before and after the disinfection procedures and analyzed with the Wilcoxon ranged test, the Kruskal-Wallis test, and the Dunn′s test. Results: The microorganism load in the control group increased. The lowest reduction in the microorganism load was observed in the 1-min irradiation group (Group 2 = 99.8%), which was very close to the results of the other experimental groups (99.9%). There were no significant differences among the groups. Conclusions: PDT is as effective as conventional 5% NaOCl irrigation with regard to antimicrobial efficiency against Enterococcus faecalis.

First report of pulmonary Nocardia otitidiscaviarum infection in an immunocompetent patient from Turkey

Nocardiosis is a rare disease, and worldwide, respiratory and disseminated infections are most often due to Nocardia asteroides which is recognised increasingly as an opportunistic infection in patients with underlying chronic debilitating disease or immunodeficiency. However, infection with N. otitidiscaviarum and pulmonary nocardiosis in an immune‐competent host remains very rare. We report a 65‐year‐old immune‐competent male with pulmonary N. otitidiscaviarum infection in whom complete cure was provided with a 6 months of antibiotic combination including trimethoprim‐sulfomethaxazol. This is the first report of pulmonary N. otitidiscaviarum infection in an immune‐competent patient from Turkey.

Cutaneous Hyalohyphomycosis and Onychomycosis Caused by Onychocola canadensis: Report of the First Case from Turkey

We present the first Turkish case of skin and nail infection due to Onychocola canadensis in an otherwise healthy farmer who frequently worked barefoot on soil. Cutaneous involvement consisted of scaly and hyperkeratotic lesions resembling tinea pedis, erythematous plaques, and dermal papulonodules of various sizes simulating Majocchis granuloma. Repeated cultures from nail plates, skin scrapings and needle aspiration materials from papules or nodules all yielded the same mold on Sabouroud dextrose media with and without cycloheximide, trichophyton agar, and potato dextrose agar at 26°C. The causal isolate was identified as Onychocola canadensis Sigler gen. et sp. nov., a slow‐growing arthroconidial hyphomycete, on the basis of its colonial and microscopic morphology. While skin lesions were responsive to daily itraconazole in a dose of 200 mg for three months, the onychomycosis was resistant to therapy. To our knowledge, this is the first presentation of O. canadensis as the cause of cutaneous hyalohyphomycosis to date.

Comparison of Lipoprotein(a) Levels between Elderly and Middle-Aged Men with Coronary Artery Disease

Abstract:  Lipoprotein(a) [Lp(a)] is known to be a risk factor for atherosclerotic disease in middle‐aged men, but the role of Lp(a) in women and in the elderly is less clear. In most studies, excess Lp(a) is not associated with increased risk for persons >65 years of age. This study examined the strength of association of a number of risk factors to coronary artery disease (CAD) in groups of men <65 years (n= 108) and >65 of age (n= 66) with angiographically documented significant narrowing of coronary arteries. Serum Lp(a) concentrations were determined; elevated Lp(a) is positively associated with CAD for men <65 years (adjusted OR: 2.45, P <0.05) but not for men >65 of age (adjusted OR: 0.56, P= NS). For middle‐aged men, elevated Lp(a) appears to be an independent risk factor for premature CAD, and the importance of Lp(a) as a risk factor appears to decrease with age. These data suggest that the utility of Lp(a) lipoprotein levels in predicting the risk of CAD in older men is limited. Factors, such as age; sex; levels of total cholesterol, low‐density lipoprotein (LDL) cholesterol, and triglycerides; carotid‐wall thickness; smoking status; the presence or absence of diabetes and systolic and diastolic hypertension; body mass index (BMI); and other traditional risk factors, must be evaluated together to determine the risk of CAD for the entire population.

Serotype distribution of Streptococcus pneumoniae in children with invasive diseases in Turkey: 2008–2014

Successful vaccination policies for protection from invasive pneumococcal diseases (IPD) dependent on determination of the exact serotype distribution in each country. We aimed to identify serotypes of pneumococcal strains causing IPD in children in Turkey and emphasize the change in the serotypes before and after vaccination with 7-valent pneumococcal conjugate vaccine (PCV-7) was included and PCV-13 was newly changed in Turkish National Immunization Program. Streptococcus pneumoniae strains were isolated at 22 different hospitals of Turkey, which provide healthcare services to approximately 65% of the Turkish population. Of the 335 diagnosed cases with S. pneumoniae over the whole period of 2008–2014, the most common vaccine serotypes were 19F (15.8%), 6B (5.9%), 14 (5.9%), and 3 (5.9%). During the first 5 y of age, which is the target population for vaccination, the potential serotype coverage ranged from 57.5 % to 36.8%, from 65.0% to 44.7%, and from 77.4% to 60.5% for PCV-7, PCV-10, and PCV-13 in 2008–2014, respectively. The ratio of non-vaccine serotypes was 27.2% in 2008–2010 whereas was 37.6% in 2011–2014 (p=0.045). S. penumoniae serotypes was less non-susceptible to penicillin as compared to our previous results (33.7 vs 16.5 %, p=0.001). The reduction of those serotype coverage in years may be attributed to increasing vaccinated children in Turkey and the increasing non-vaccine serotype may be explained by serotype replacement. Our ongoing IPD surveillance is a significant source of information for the decision-making processes on pneumococcal vaccination.

Comparison of intravitreal vancomycin and daptomycin application in experimental methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis in rabbits.

Abstract Purpose: To compare bactericidal activities of daptomycin and vancomycin in an experimental rabbit model of methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis. Methods: The right eyes of 19 New Zealand rabbits weighing 2 to 2.5 kg were used. Each eye was inoculated with 1000 colony-forming units (cfu) of MRSA into the vitreous cavity. 24 h after the inoculation, the rabbits were randomly distributed into three groups: control group (n = 5) was given 0.1 ml of balanced saline solution, daptomycin group 2 (n = 7) was given 0.2 mg/0.1 ml daptomycin and vancomycin group 3 (n = 7) was given 1 mg/0.1 ml vancomycin intravitreally. Clinical examination scores were recorded and vitreous aspirates were obtained for microbiological analysis on days 2 and 3 after MRSA inoculation. Rabbits were sacrificed, and the eyes were enucleated for histopathological examination. Results: There was no difference between the daptomycin group, vancomycin group and control in terms of the clinical grading of endophthalmitis 24 h after the inoculation. In all treatment groups, mean number of cfu and histopathological scores were significantly lower compared to the control group. There was no difference between the daptomycin and vancomycin group in terms of the histopathological and clinical examination scores. Culture negativity achieved on day 3 was 71.4% and 57.1% in the daptomycin treatment group and the vancomycin treatment group, respectively. Conclusions: Although both daptomycin and vancomycin are effective in treatment of experimental MRSA endophthalmitis, daptomycin has superior bactericidal activity 72 h after inoculation.