The characteristics of indoor and outdoor fungi and their relation with allergic respiratory diseases in the southern region of Turkey

Indoor and outdoor fungal exposure has been shown to be associated with the development of allergic respiratory diseases. The aim of the study was to investigate the types and concentrations of airborne fungi inside and outside homes and evaluate the association between fungal levels and allergic diseases in the southern region of Turkey. A total of 61 children admitted with respiratory complaints to the pediatric allergy clinic between September 2007 and November 2008 were included in this study. The air samples were obtained using the Air IDEAL volumetric air sampler longitudinally for 1 year. A comprehensive questionnaire was used for medical history and housing conditions. Skin prick test was performed to determine fungal sensitivity and spirometric indices were employed. The predominant indoor fungal species were Cladosporium (69.3 %), Penicillium (18.9 %), Aspergillus (6.5 %), and Alternaria (3.1 %). A strong correlation between indoor and outdoor fungal levels was detected for the Cladosporium species (p < 0.001, r = 0.72) throughout the year. Living in a detached home (p = 0.036) and the presence of cockroaches (p = 0.005) were associated with total indoor fungal levels. The presence of cockroaches (aOR 3.5; 95 % CI 0.95-13.10, p = 0.059) was also associated with fungal sensitization at the edge of significance. The statistical cutoff values of indoor and outdoor Cladosporium levels to predict symptomatic asthma were found to be >176 CFU/m(3) (p = 0.003, AUC 0.696; sensitivity 65.5 %; specificity 68.7 %) and >327 CFU/m(3) (p = 0.038; AUC 0.713; sensitivity 66.6 %; specificity 76.9 %), respectively. Children with respiratory symptoms are exposed to a considerable level of fungi inside and outside their homes. The prevention of fungal exposure may provide valuable intervention for respiratory diseases.

Evaluation of Antifungal Efficacy of 0.1% and 0.25% Riboflavin with UVA: A Comparative In Vitro Study

PURPOSE

Antifungal efficacy of photochemical cross-linking (PACK-CXL) with 0.1% and 0.25% riboflavin was evaluated with a comparative in vitro study.

METHODS

Candida albicans and Aspergillus fumigatus ATCC reference strains, Candida parapsilosis, Aspergillus fumigatus, Fusarium solani, Scedosporium apiospermum, and Alternaria alternata strains isolated from keratitis cases were chosen as targeted microorganisms. Unique "black plate method" was developed in polystyrene microplates. Riboflavin suspensions in 0.1% and 0.25% were separately added into inoculated wells. Non-inoculated wells were filled by black colored dye in order to protect treated wells from reflection of UV treatment. After ultraviolet A (UVA) treatment, each well was evaluated by microbiological culture in order to count viable fungal colonies. Fungal killing rate was calculated by comparing fungal counts (CFU/mL) before and after UVA application of riboflavin-added wells.

RESULTS

Four different fungal inoculum concentrations of targeted microorganisms, including 10⁴, 10³, 10², and 10¹ CFU/mL, were assayed. PACK-CXL with 0.25% riboflavin was found to be highly effective on fungal cells even in 10⁴ CFU/mL of concentration.

CONCLUSIONS

PACK-CXL appears as a promising treatment option for difficult-to-treat cases of fungal keratitis and 0.25% riboflavin concentration increases fungicidal effect of the procedure dramatically.

[Investigation of the clonal relationship between nosocomial Acinetobacter baumannii isolates by Rep-PCR]

Acinetobacter spp. are opportunistic bacterial pathogens primarily associated with hospital-acquired infections and the spread of multidrug resistant Acinetobacter strains is a growing problem in terms of infection control. The aim of this study was to determine the clonal relationship between strains of nosocomial Acinetobacter baumannii by using rep-PCR method. A total of 75 Acinetobacter strains isolated from various clinical samples of the hospitalized patients between October 2011-May 2012 were included in the study. Antibiotic susceptibilities of Acinetobacter isolates were investigated by Kirby-Bauer disk diffusion method according to CLSI guidelines. According to disk diffusion test, the resistance rates for piperacillin, piperacillin-tazobactam, cefepime, ceftazidime, imipenem, meropenem, gentamicin, amikacin, tetracycline, levofloxacin, ciprofloxacin and trimetoprim-sulfamethoxazole were 96%, 96%, 97.3%, 89.3%, 96%, 94.6%, 66.7%, 85.3%, 68%, 82.7%, 97.3% and 89.3% respectively. In this study, 73 (97%) strains were found resistant to three or more than three antibiotics (multidrug resistant). Rep-PCR analysis have shown the presence of eight clones, including two major clones [A (7subtypes), B (3 subtypes)] and six unique clones (C-H). Clone A was found to be the dominant type. Fifty-four (72%) of the 75 Acinetobacter strains belonged to clone A, 13 (17.3%) to clone B, two strains to clone C, D, and one of each to the other clones (E, F, G, H). Clone A was isolated from 71% (20/28), 70% (7/10) and 100% (6/6) of the samples sent from reanimation intensive care unit, surgery ward and internal diseases intensive care units, respectively. The time interval between the first and last strain was eight months. The results of this study indicated an increase in the resistance rates of Acinetobacter strains in our hospital and this increase was attributed to the clonal dissemination of the strains. Strains of the clone A were found to be dominant at the intensive care and other clinics of our hospital. It is contemplated that Acinetobacter strains were scattered as a result of cross transmission and patient transfer among clinics. The rep-PCR method which was used in this study was evaluated as a rapid, easily applicable and successful procedure for epidemiological studies. Clonal distribution of resistant strains in the hospital environment emphasizes the significance of infection control measures.

Does Helicobacter pylori have a role in the development of chronic otitis media with effusion? A preliminary study

OBJECTIVE

To investigate the possible relationship between chronic otitis media with effusion (COME) and Helicobacter pylori (HP).

PATIENTS AND METHODS

Twenty-five patients (7 girls and 18 boys; age range 2-10 years, mean age 7.8 years) with COME with or without adenotonsillary disease were included in this study. Myringotomy was performed on all patients. Nine patients also underwent adenoidectomy, and 10 patients underwent adenotonsillectomy. The adenoidectomy specimens and middle ear effusions were examined for HP colonization by the Campylobacter-like organism (CLO) test. Adenoidectomy specimens were also evaluated for HP using immunohistochemical (IHC) evaluation. Before surgery, anti-HP immunoglobulin G (IgG) and A (IgA) antibody titres were detected by enzyme-linked immunosorbent assay in the venous blood samples of the patients.

RESULTS

The CLO test results were not positive in any of the adenoidectomy specimens and middle ear effusions. IHC examination also revealed that none of the adenoid tissue specimens had a positive HP result. The anti-HP IgG antibody was detected to be positive in eight patients (32%), and IgA antibody was detected in three patients (12%). In three patients (12%), both IgA and IgG antibodies were positive.

CONCLUSION

We were unable to detect the presence of HP in the middle ear effusions and adenoid specimens of children with COME. Owing to the small size of the group in our study, we propose that further studies be carried out with larger study and control groups in an effort to explain the presence of HP in middle ear effusions.

Consistence of miniexon polymerase chain reaction–restriction fragment length polymorphism and single-copy gene sequence analyses in discriminating Leishmania genotypes

Recently, a new polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP)-based assay had been developed using the miniexon sequences for genotyping Leishmania isolates. We had used this method for rapid diagnosis and genotyping of visceral and cutaneous leishmaniasis with the combination of microcapillary cultivation. In this study, we have evaluated this approach by examining genomic DNAs from 47 independent isolates, which were grouped into 19 genotypes of Leishmania subgenus complexes by sequence polymorphism of single-copy genes. Results obtained provide miniexon RFLP configurations specific to Leishmania enriettii, Leishmania tarentolae, and Leishmania gerbilli for the first time. Altogether, 92% of the results from miniexon PCR-RFLP are in agreement with those based on the sequence database of single-copy genes from the same isolates. The miniexon PCR-RFLP method is simple, sensitive, and specific method useful for routine diagnosis of different Leishmania.

An outbreak of Pichia ohmeri infection in the paediatric intensive care unit: case reports and review of the literature

Since the first report in 1998, 10 cases of Pichia ohmeri infection have been reported in the literature. Here we present two new cases of P. ohmeri infection in the paediatric age group. The first case was an 8-month-old male infant, who was admitted with fever, convulsions and altered consciousness. Conservative therapy was started with a presumptive diagnosis of encephalitis. The patient failed to respond to the given treatments and died on the 21st day of hospitalisation. The second case was a 10-year-old male with B-cell acute lymphoblastic leukaemia. He was hospitalised with neutropenic fever. He was discharged after 3 weeks of therapy. In both cases P. ohmeri was identified in blood samples. Growing evidence indicates that P. ohmeri should be added to the lengthening list of opportunistic fungal pathogens that can cause infection in all ages, including infants, and particularly in those who are immunocompromised.

An outbreak of Dipodascus capitatus infection in the ICU: three case reports and review of the literature

A mini epidemic of Dipodascus capitatus (teleomorph of Geotrichum capitatum) involving three cases is reported. The index case was pulmonary infection and a fulminant course of fungal infection, which resulted in the patient's death with acute myelocytic leukemia. In the other cases, the patients were simultaneously hospitalized, the first in the intensive care unit. In all cases, D. capitatus was identified in different samples (sputum, deep tracheal aspiration, blood, and urine) from each of the patients. Growing evidence indicates that D. capitatus should be added to the lengthening list of opportunistic fungal pathogens that can cause infection in people of all ages and particularly in those who are immunocompromised. Further, the danger of cross-contamination and potential "outbreak" should be kept in mind during hospital management.