Oral yeast colonization in peritoneal dialysis and hemodialysis patients and renal transplant recipients

OBJECTIVE

We aimed to investigate the frequency of oral yeast colonization (OYC) and the risk factors for patients who received continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD) or were renal transplant recipients (RTRs). The patients admitted to the Nephrology Clinic at Ataturk University Medical School from January through April 2013 were included in the study. A questionnaire about risk factors was filled out, and swab cultures were taken from the tongue surface of each participant. OYC was detected in 32.1% of the RTRs, 40% of the HD patients, 20.9% of the CAPD patients, and 18% of the healthy control (HC) group. Of the 42 yeast strains isolated from the renal replacement therapy groups, 26 strains (61.9%) were Candida albicans, nine (21.4%) were Candida glabrata, two (4.7%) were Candida krusei, two (4.7%) were Candida kefyr, one (2.38%) was Candida parapsilosis, and two (4.7%) were Geotrichum candidum. Risk factors for OYC in the RTRs group included antibiotic use and the presence of dental prostheses; however, in patients with chronic renal failure undergoing CAPD, only the presence of dental prostheses was found to be a statistically significant risk factor. Although OYC was mostly detected in patients with chronic kidney disease (undergoing HD, a variety of isolated yeast strains in the RTRs was noted. The rates of OYC and isolated Candida species in CAPD were similar to those of the HC group.

Differences in the gut microbiota of healthy children and those with type 1 diabetes

BACKGROUND

Intestinal barriers, intestinal flora, and mucosal immunity are the main factors responsible for the development of various allergic and autoimmune diseases. The aim of this study was to investigate the relationship between the intestinal flora of children and the presence of type 1 diabetes, and to determine if gut microbiota could partly explain the etiology of the disease.

METHODS

Fecal flora analysis was done using quantitative cultures on selective and non-selective media with different thermal and atmospheric conditions for bacterial and fungal growth. The study group consisted of 35 patients (16 female, 19 male; mean age, 10.73 ± 4.16 years), who had been followed by the University of Istanbul, Cerrahpasa Medical Faculty, Department of Pediatrics, and were newly diagnosed with type 1 diabetes. The control group consisted of 35 healthy subjects (15 female, 20 male; mean age, 9.96 ± 4.09 years), who were randomly selected and had similar demographics.

RESULTS

Bifidobacterium colonization was lower in patients with type 1 diabetes compared to the control group, whereas Candida albicans and Enterobacteriaceae other than Echerichia coli colonization was increased.

CONCLUSION

A decrease in beneficial anaerobic bacteria levels and a concomitant increase in Enterobacteriaceae other than E. coli and C. albicans colonization may lead to a disturbance in the ecological balance of intestinal flora, which could be a triggering factor in type 1 diabetes etiology.

A case of urinary tract infection due to Salmonella enterica serovar Virchow and review of the related literature

Nontyphoid salmonella (NTS) serotypes can cause gastroenteritis, bacteriemia, and focal infections. However, these focal infections, including urinary tract infections (UTI), are occasionally observed; in particular, the presence of several predisposing factors, such as immunodeficiency and structural abnormality in the urinary tract, increase the possibility of the occurrence of infection. We present a case of UTI caused by Salmonella enterica serovar Virchow in an elderly and debilitated patient with benign prostatic hyperplasia (BPH). Administration of appropriate antibiotic treatment resulted in recovery of the patient's clinical course.

Prevalence of toenail onychomycosis in patients with type 2 diabetes mellitus and evaluation of risk factors

BACKGROUND

we sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors.

METHODS

data regarding patients' diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients' toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture.

RESULTS

of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A(1c) and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts.

CONCLUSIONS

long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus.

Co-existence of Hashimoto's thyroiditis with familial Mediterranean fever: is there a pathophysiological association between the two diseases?

Familial Mediterranean fever is an autosomal recessive disease characterized by periodic attacks of fever and polyserositis, while Hashimoto's thyroiditis is the most common cause of hypothyroidism. We suggest that common autoimmune mechanisms may underlie both disorders, describe their clinical co-existence in a patient, and discuss a possible causal link between them.

Evaluation of glucose tolerance status in patients with asthma bronchiale

BACKGROUND

Asthma is characterized by inflammation and airway hyperesponsiveness, which results in episodic airflow obstruction. A relationship between inflammation and insulin resistance (IR) has been previously characterized, and asthma is known to correlate with increasing IR. Thus, we tested whether patients with asthma bronchiale exhibited abnormally low glucose tolerance. The aim of this study was to compare the occurrence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), two precursors of type 2 diabetes mellitus (DM), in patients with asthma bronchiale and paired control patients.

PATIENTS AND METHODS

We examined patients diagnosed with asthma bronchiale. We excluded patients taking any medications other than inhaler broncodilators, patients with a history of other systemic illness, and patients with any diabetic risk factors. Age- and sex-matched healthy volunteers were included as the control group in this study. History, physical examination, and laboratory analyses were performed for both study and control groups.

RESULTS

Mean age of the study group was 40.3 +/- 7.8 (F/M: 32/19), and mean BMI of the study group was 26.7 +/- 2.2. Mean age of the control group was 39.5 +/- 6.7 (F/M: 25/15) and mean BMI of the control group was 26.0 +/- 2.1. Fasting blood glucose (FBG), Pg2hBG, Plasma insulin, Homeostasis Model Assessment-Insulin Resistance (HOMA IR), IFG, IGT, both IFG and IGT and (LDL) C levels were significantly higher in the asthmatic group, while HDL C levels were significantly higher in the control group.

CONCLUSION

Our results suggest that disturbance of the glucose metabolism caused by inflammation-induced insulin resistance may occur in asthmatic patients and that this phenomenon may increase the risk of diabetes mellitus in these individuals.

Evaluation of risk factors and seroprevalence of hepatitis B and C in diabetic patients in Kutahya, Turkey

AIM

To assess the prevalence of hepatitis B and C viruses among Turkish patients with type 1 and type 2 diabetes mellitus and to determine the risk factors affecting the prevalence in these patient groups.

METHODS

This study included 630 diabetic and 314 nondiabetic patients. Serologic testing for anti-hepatitis C virus (anti-HCV) and HbsAg was done using a third-generation commercial enzyme-linked immunosorbent assay, and samples positive for anti-HCV and HbsAg were confirmed by a polymerase chain reaction assay. Diabetic patients were classified by HbsAg and anti-HCV status and were evaluated according to demographic features, diabetic characteristics and nondiabetic general risk factors, harmful habits, and aminotransferase (alanine aminotransferase and aspartate aminotransferase) levels.

RESULTS

HbsAg and anti-HCV seropositivity rates were 5.1% and 3.2% in diabetic patients and were 3.8% and 1.3% in control group, respectively. There was no statistically significant difference between the 2 groups with respect to either marker. Shared risk factors for both hepatitis infections were increased aminotransferase levels and history of hospital admission. In addition, long duration of diabetes mellitus, poor diabetic regulation, and insulin treatment usage were found to relate to HbsAg, whereas a history of blood transfusions and surgical procedures were found to associate with anti-HCV seropositivity.

CONCLUSIONS

We determined that hepatitis B virus and hepatitis C virus infections were slightly but not significantly higher in diabetic patients compared with a normal population. If it is considered that different results might be obtained in various countries or even in various regions of same country, it may be concluded that multicenter and comprehensive studies are needed to elucidate true infection rates and to identify other risk factors affecting the prevalence of these infections.

Evaluation of risk factors and seroprevalence of hepatitis B and C in diabetic patients in Kutahya, Turkey

AIM

To assess the prevalence of hepatitis B and C viruses among Turkish patients with type 1 and type 2 diabetes mellitus and to determine the risk factors affecting the prevalence in these patient groups.

METHODS

This study included 630 diabetic and 314 nondiabetic patients. Serologic testing for anti-hepatitis C virus (anti-HCV) and HbsAg was done using a third-generation commercial enzyme-linked immunosorbent assay, and samples positive for anti-HCV and HbsAg were confirmed by a polymerase chain reaction assay. Diabetic patients were classified by HbsAg and anti-HCV status and were evaluated according to demographic features, diabetic characteristics and nondiabetic general risk factors, harmful habits, and aminotransferase (alanine aminotransferase and aspartate aminotransferase) levels.

RESULTS

HbsAg and anti-HCV seropositivity rates were 5.1% and 3.2% in diabetic patients and were 3.8% and 1.3% in control group, respectively. There was no statistically significant difference between the 2 groups with respect to either marker. Shared risk factors for both hepatitis infections were increased aminotransferase levels and history of hospital admission. In addition, long duration of diabetes mellitus, poor diabetic regulation, and insulin treatment usage were found to relate to HbsAg, whereas a history of blood transfusions and surgical procedures were found to associate with anti-HCV seropositivity.

CONCLUSIONS

We determined that hepatitis B virus and hepatitis C virus infections were slightly but not significantly higher in diabetic patients compared with a normal population. If it is considered that different results might be obtained in various countries or even in various regions of same country, it may be concluded that multicenter and comprehensive studies are needed to elucidate true infection rates and to identify other risk factors affecting the prevalence of these infections.

May primary empty sella turcica be a cause of isolated ACTH deficiency? A case report and the review of related literature

Isolated ACTH deficiency is an uncommon cause of secondary adrenocortical insufficiency and accompaniment with primary empty sella has been reported in several cases. We present a case of isolated ACTH deficiency associated with empty sella. A sixty-two year old woman was admitted to our endocrine clinic with complaints of weakness, fatigue, weight loss, nausea, vomiting, and lack of appetite for about one month. Physical examination indicated orthostatic hypotension and epigastric tenderness. Laboratory investigations revealed hypoglycemia, hyponatremia and anemia, in addition low plasma cortisole and ACTH levels. Serum cortisole responses to short and prolonged ACTH stimulation were tested and partial and accurate responses were obtained, respectively. Plasma ACTH and serum cortisole levels failed to respond after intravenous injection of human corticotropin releasing hormone. Other hypophysial hormone levels were within the normal reference ranges. Although cranial and abdominal computerized tomography images were evaluated as normal, cranial magnetic resonance imaging of the pituitary gland revealed 'primary empty sella turcica'. Replacement therapy with methylprednisolon resulted in the improvement of hypoglycemia, hyponatremia and clinical symptoms. Based on these results, the patient was diagnosed as isolated ACTH deficiency and was scheduled for follow up by our outpatient clinic. Our report is consistent with other reports pointing out that primary empty sella may be responsible for pathogenesis of isolated ACTH deficiency.

Phospholipase and proteinase activities in different Candida species isolated from anatomically distinct sites of healthy adults

The aim of the present study was to determine in vitro phospholipase and protease activities in 122 Candida spp. isolated from several anatomically distinct sites of healthy adults. C. albicans (66.4%) was the most frequently isolated Candida spp. C. glabrata (7.3%), C. tropicalis (6.3%) and C. kefyr (4.9%) were the most frequently isolated non-C. albicans Candida spp. Fifty (40.9%) of the isolates examined were phospholipase positive and 64 (52.4%) were protease positive. Forty-three (53.8%) of the C. albicans isolates tested were phospholipase producers--however, only a few strains of non-C. albicans Candida spp. behaved in the same way. Protease activity was detected in 46 (56.7%) of the C. albicans strains tested and in a few strains of non-C. albicans Candida spp. The levels of phospholipase and protease activities in commensal isolates were found to be lower than the levels of other enzyme activities previously reported in clinical Candida spp. isolates. The phospholipase activity of Candida spp. was found to be higher in oral (59.0%) and fecal (42.8%) isolates. The protease activity of Candida spp. was found to be higher in urogenital (55.1%) and skin (58.8%) isolates. We conclude that further investigations will be needed on the phospholipase and protease activity of Candida spp. in healthy subjects in order to clarify their contribution to fungal virulence.

Is aerobic preputial flora age dependent?

Urinary tract infection (UTI) is one of the most commonly encountered infections in childhood. It has been demonstrated that the preputial sac can act as a reservoir of organisms and is thus responsible for causing ascending UTIs. This study was performed to determine the presence of preputial flora in different age groups. Prepuce and urine samples were taken simultaneously from 92 uncircumcised and healthy male children aged between 0-12 years. The data were analyzed by age, with 47 subjects of 6 years of age or less, and 45 aged 7-12 years. Twenty-seven percent of the older patients had negative preputial cultures versus 8% of those under 6 years of age (chi2 = 5.27, P = 0.02). In addition, enteric bacteria were the most common pathogens isolated from the prepuce in younger children while skin flora bacteria were most common in the older group (chi2 = 9.18, P = 0.002). The urine was sterile in all cases. Preputial cultures change with age in uncircumcised boys. This change may be related to the development of immune status, to histological or anatomical changes in the prepuce, and/or to improved personal hygiene.

Prevalance and risk factors for yeast colonization in adult diabetic patients

The aim of this study is to describe the associations between various host characteristics and yeast colonization; biofilm and phospholipase production in diabetic patients. The study was conducted between January 2003 and June 2003 in Abant Izzet Baysal University, Duzce, Turkey. One hundred and fourty five diabetic patients were included to the study. All oral and faecal specimens were placed on Sabourand dextrose agar with chloramphenicol and gentamicin. All isolates were identified with classic methods and carbohydrate assimilation patterns using API 20 CAUX. C. dubliniensis isolates were identified by CHROM agar Candida and chlamydospore formation according to the referral to the literature. Biofilm and phospholipase production was assessed by using previously described methods. The most common colonized species were C. albicans in oral and faecal cultures. C. dubliniensis was isolated in four oral cultures of the patients. Dental prosthesis, tooth brushing, older age, antibiotic use in the previous two weeks were found to be the significant factors for the oral yeast colonization. Younger age, smoking, shorter duration of diabetes, hospitalization in the last year and antibiotic use in the previous two weeks were found to be the significant factors for the faecal yeast colonization. Biofilm production was found to be positive in nine cases of oral and seven of faecal isolates. Phospholipase production was determined to be positive in 18 cases oral and 14 of faecal isolates. In conclusion, glycaemia control and other diabetic factors are not effective for yeast colonlizing. There was not any significant correlation between biofilm and phospholipase production and host characteristics in yeast colonization. Oral hygiene may be an effetive for decreasing the oral colonization in diabetic patients.