Can chitotriosidase be a surrogate marker for invasive fungal disease?

BACKGROUND

Chitotriosidase (CHT) enzyme has been known to be secreted from the activated macrophages. We infer with these data that CHT activity is an indicator for the defence.

METHODS

In this study, we evaluated CHT levels in both neutropenic and non neutropenic patients. CHT enzyme activity was measured and compared to each other groups.

RESULTS

Chitotriosidase levels were found to be significantly higher in neutropenic patients with candidemia.

CONCLUSION

In the comparison between neutropenic and non neutropenic patients, there was a significant difference for CHT levels. The use of this enzyme as a surrogate marker for candidemias were evaluated in neutropenic and non neutropenic patients.

Interferon therapy of Turkish patients with chronic hepatitis B virus infection

BACKGROUND/AIMS

The efficacy of alpha interferon therapy in Turkish individuals with chronic hepatitis B virus infection was examined.

METHODOLOGY

Sixty-one patients (54 males and 7 females) were studied between 1992 and 1996. Their mean age was 33.4 years (range: 20-57). Each was treated with 4.5 million international units interferon alpha 3 times a week for 24 weeks. Serum alanine aminotransferase (ALT) levels and hepatitis B virus markers (HBsAg, HBeAg, anti-HBe, and HBV DNA) were monitored. A liver biopsy was obtained before and 6 months after the termination of interferon therapy.

RESULTS

Before treatment, the serum ALT level was elevated in all 61 subjects. Six months after the termination of therapy, 23 (38%) had a normal serum ALT level. In all patients, before the start of therapy and 6 months after the termination of therapy, HBsAg was detectable. In 36 (59%), HBeAg was present and anti-HBe was not detectable in serum before the initiation of therapy. In 12 (33%), the serum was negative for HBeAg and positive for anti-HBe 6 months after the termination of therapy. HBV DNA was detectable in all serum samples before the onset of therapy and disappeared in 14 (23%) patients, and continued to be undetectable 6 months after the termination of interferon therapy. Histological improvement defined by an improvement in the Knodell score of 2 points or more was observed in 38 (62%).

CONCLUSIONS

Interferon therapy eliminates serum markers of active hepatitis B virus infection (eAg and HBV DNA) and is associated with histological improvement in 30-60% of Turkish patients with chronic HBV infection. Interferon therapy did not eliminate sAg from the serum and the histologic improvement achieved was often incomplete.

The diagnosis and treatment of Clostridium difficile in antibiotic-associated diarrhea

BACKGROUND/AIMS

This study was initiated to evaluate the role of C. difficile in diarrhea associated with the use of antibiotics, to determine which antibiotics are most often responsible, to characterize the response to several different treatment regimens, and to define the relapse rate as seen in a large teaching hospital in Turkey.

METHODOLOGY

Three different patient groups were studied. The first group consisted of 154 individuals with antibiotic-associated diarrhea. The stools of all 154 cases were cultured on cycloserine-cefoxitin-fructose agar (CCFA). If any bacteria grew out, they were identified specifically as C. difficile using a commercially available latex agglutination kit specific for bacterial antigens of C. difficile (MicroScreen C. difficile Latex Slide Test; Merica Diagnostic Limited, Guilford, England). The presence of toxin-A (CDTA) was determined using a MicroScreen CDTA Enzyme Immunoassay kit.

RESULTS

The stools of 31 of these patients grew out enteric pathogens. Twenty-eight of these 31 were CCFA positive. Three different drug regimens (Ornidazole, Ornidazole + Cholestyramine, and Vancomycin) were used to treat these 28 C. difficile positive cases. The second group consisted of 37 hospitalized patients who had been in hospital for more than 30 days without any gastrointestinal symptoms. This group was used to identify the in-hospital carrier rate for C. difficile. Stools from these 37 cases were cultured on CCFA and were analyzed for the presence of CDTA by EIA. Colonization with C. difficile was detected in 4 cases. The third group consisted of 40 healthy subjects who served as a population-based control group. The stools obtained from these 40 cases were cultured on CCFA and analyzed for CDTA as were the stools for the other 2 groups. None were CDTA positive. One case was positive for the presence of non-toxigenic C. difficile.

CONCLUSIONS

It can be concluded from these data that, in Turkey, C. difficile is responsible for 20% of antibiotic-associated diarrheas. Lincomycin, Azithromycin and Ampicillin were most often associated with the development of antibiotic-associated diarrhea. Ornidazole and Vancomycin were effective agents for C. difficile-associated diarrhea with the latter agent being associated with no relapses.

Use of interferon for the treatment of chronic hepatitis C in the elderly

Hepatitis C virus is a worldwide health care problem. It affects all age groups. Many patients have had the infection for 20-30 years before they present for therapy. With a peak incidence of disease in the 30-40 year age group, it is obvious that a large number of cases must occur in the elderly (age > 65 years). Of these, a fraction progress to cirrhosis and hepatocellular carcinoma. Interferon is the only agent approved for use in patients with chronic hepatitis C. The efficacy of interferon in younger patients is reported to be 50%. Half of these will experience a relapse within 1 year. There are few studies assessing the role of interferon used for elderly patients with chronic hepatitis C. The reported response rate to interferon in elderly patients was 60%, with 30% having a virologic/complete response. These studies demonstrate that the elderly tolerate interferon reasonably well. No significant differences have been reported between elderly and young treatment groups.