Three cases of Chronic Suppurative Otitis Media (CSOM) caused by Kerstersia gyiorum and a review of the literature

New identification techniques such as gene sequencing and mass spectrometry have increased the incidence of novel agents such as Kerstersia gyiorum. As a new member of the Alcaligenaceae family, K. gyiorum was isolated from wounds, respiratory tract, urine specimens and most frequently from chronic suppurative otitis media (CSOM). We isolated three K. gyiorum strains from three CSOM cases over a one-year period. The strains were analyzed by mass spectrometry and identified by Bruker Biotyper 3.1 (Bruker Daltonics, USA). The cases were young patients without chronic diseases and immunodeficiencies. Two strains were resistant to ciprofloxacin.

Diagnosis and Species Discrimination of Positive Malaria Samples by Real-Time Polymerase Chain Reaction

OBJECTIVE

Malaria is an important tropical disease that is detected in 198 million people and causes 367-755 thousand deaths annually. Recently, the real-time Polymerase Chain Reaction (PCR) technique has enabled quick determination of Plasmodium spp. and species identification in the same assay with a low contamination risk. In the present study, we aimed to use real-time PCR targeting the 18S rRNA gene to diagnose Plasmodium spp. and perform species identification.

METHODS

DNA samples of 15 patients with malaria (14 caused by P. vivax, 1 caused by P. falciparum) confirmed by microscopy as well as positive control plasmids were used. As the negative control, DNA samples of 15 individuals without malaria were used.

RESULTS

According to the results of real-time PCR, samples of 15 patients with malaria were found to be positive for Plasmodium spp. Melting curve analysis showed that 14 of them were P. vivax and the remaining was P. falciparum. In addition, mixed infection with P. falciparum and P. vivax was successfully detected by real-time PCR when DNA of P. falciparum- and P. vivax-positive samples was experimentally mixed.

CONCLUSION

The present study showed that real-time PCR can be useful in the diagnosis and species identification of Plasmodium spp. as well as the detection of mixed infections in addition to microscopy in Turkey.

Preliminary analysis of Plasmodium vivax genotypes isolated in southeastern Turkey

Plasmodium vivax is the most common cause of malaria worldwide as well as southeastern Turkey. After the implementation of a successful national elimination program that the local malaria cases were not reported in 2011, malaria returned to county of Savur located in southeastern Turkey in summer of 2012. The present study aimed to determine the prevalent P. vivax genotypes isolated from southeastern Turkey. Genetic polymorphism in P. vivax CSP gene was analyzed by PCR-RFLP to assess the ratio of VK210 and VK247 types. Blood samples were obtained from 15 patients who lived in southeastern between 2005-2006. According to the results, VK210 type was detected in 10 samples (66.6%), VK247 type was observed in three samples (20%). Remaining two samples showed mixed infection (13.3%). The results of the present study first time showed the ratio of P. vivax genotypes in southeastern Turkey before the elimination in 2011. The results of the present study will be enable researchers to compare the new isolates with the previously detected ones and design new treatment and/elimination strategies.

HBsAg, anti-HCV, anti-HIV 1/2 and syphilis seroprevalence in healthy volunteer blood donors in southeastern Anatolia

Introduction: This study investigated the seroprevalence of hepatitis B virus surface antigen (HBsAg), antibody against hepatitis C virus (anti-HCV), antibody against human immunodeficiency virus type 1/2 (anti-HIV 1/2), and antibody against Treponema pallidum (anti-Treponemal or syphilis antibody) in healthy volunteer blood donors, and assessed their distribution according to the years and genders. Methodology: HBsAg, anti-HCV, anti-HIV ½, and syphilis screening results of a total of 266,035 healthy volunteer blood donors who had been admitted for blood donation to the Regional Blood Center of Dicle University Hospital between January 2000 and December 2010 were evaluated, retrospectively. HBsAg, anti-HCV, and anti-HIV 1/2 screening were performed using a fully automated device with the microparticle enzyme immunoassay method (MEIA). Syphilis screening was performed by Rapid Plasma Reagin (RPR) carbon test between January 2000 and December 2009, and by using a fully automated device with the MEIA method between January 2010 and December 2010. Results: Of 266,035 healthy volunteer blood donors, 259,384 (97.5%) were male and 6,651 (2.5%) were female. Statistically, there was not any significant difference between male and female genders for HBsAg, anti-HCV and syphilis seropositivities (P = 0.729, P = 0.748, and P = 0.861, respectively). HBsAg was found to be positive in 8,422 (3.17%), anti-HCV in 1,703 (0.64%), anti-HIV 1/2 in one (0.0004%) of 266,035 healthy volunteer blood donors, and syphilis antibody with RPR in 166 (0.07%) of 246,341 healthy volunteer blood donors. Conclusion: Blood donor forms should be carefully tailored to improve the identification of possible risks of transfusion-transmitted infections.

Action plan to regain unnecessary deferred blood donors due to malaria risk in Turkey

Malaria was expected to be a major problem during blood donation in Turkey due to existence of malaria cases in southeastern region of Turkey. The present study aimed for the first time, to investigate malaria in "donors deferred for malaria risk" and to determine the regional rates of malaria deferral in Turkey. Blood samples were collected from several Blood Banks of southeastern provinces where local malaria cases still exist and from Blood Bank of Ege University Medical School (EUMS) located in western Turkey where malaria is eradicated decades ago. Plasmodium spp. and specific antibodies were investigated by stained smears, antigen detection, PCR and ELISA. Among the donors deferred for malaria risk, Plasmodium spp. were not detected by microscopy, PCR or antigen detection. Seroprevalances were 2% and 3.92% in western and southeastern regions, respectively. Rate of donor deferral for malaria risk was 0.9% in EUMS and deferrals were exclusively because of travel to southeastern Turkey. In southeastern provinces, deferrals were mainly due to malaria like fever history. The present study first time assessed regional rates of donor deferral due to malaria risk in Turkey. Previously, malaria was expected to be a major problem during blood donation in Turkey due to existence of malaria cases in southeastern region of Turkey. The results of the study showed that 97% of the deferrals were unnecessary. In conclusion, to reduce unnecessary donor deferrals in Turkey, in addition to comprehensive questioning for malaria history, the usage of a malaria antibody screening method should be initiated prior to deferral decision.

Evaluation of carotid intima media thickness in impaired fasting glucose and impaired glucose tolerance

AIM

Increased carotid intima media thickness (CIMT) is recognized as the early indicator of atherosclerosis. We aimed to evaluate the effect of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) on the CIMT.

METHODS

We evaluated 51 dysglycemic patients (IFG [N.=22]; IGT [N.=29]) and 25 controls who have similar age and gender. Patients who were known to have coronary heart disease, cerebrovascular disease, hypertension, hyperlipidemia, diabetes mellitus and hypo-hyperthyrodism were excluded. We measured fasting blood glucose (FBG), postprandial blood glucose (PPG), insulin, insulin resistance, lipid profile, hsCRP, microalbuminuria, and glycosylated hemoglobin A1c (HbA1c). We measured the CIMT by Doppler ultrasonography.

RESULTS

Both IFG and IGT patients have increased CIMT according to controls (P<0.001). Mean CIMT of IFG, IGT and control were 0.704, 0.738 and 0.555 respectively. There were no differences in point of fasting insulin and HOMA-IR between IFG and IGT. There were positive correlation of CIMT and FBG, PPG, HbA1c, fasting insulin and HOMA-IR in both groups. In linear regression analysis, PPG and HbA1c is the major factor affecting CIMT (t=0.017 and 0.036).

CONCLUSION

IFG and IGT have increased CIMT according to controls, and PPG and HbA1c are the major affecting factors to CIMT.

Investigation of malaria in blood donors and comparison of the optimal rapid malaria test to the classical method

Malaria is still a problem in the southeastern region of Turkey despite all the effort to eradicate the disease. The spread of malaria is by the transfer of agents by mosquitoes, transfusions of blood and blood products, organ transplantations from infected individuals and the use of contaminated injectors. The numerical load of parasites in infected donors may be very low, therefore no clinical symptoms may be observed and Plasmodium species may live in the body of donors for years. As the agents may live long in the body of donors, the blood from donors must be examined thoroughly for agents. The aim of this study was to determine whether malaria which is endemic in our region is transmitted by transfusion products. The blood from 1850 donors, who presented at the Dicle University Faculty of Medicine Blood Bank (Diyarbakir) in 2006, was examined by the optimal rapid malaria test and by Giemsa stained preparations. No pathogens were detected by any of these methods. In conclusion, the screening tests for malaria may be useful but not sufficiently sensi-tive for blood banks. In endemic regions; a more specific questionnaire and physical examination can be used to exclude blood donors who are at the risk of malaria.

The distribution of the intestinal parasitic diseases in the Southeast Anatolian (GAP=SEAP) region of Turkey

OBJECTIVES

The physical alterations put in place by the Southeastern Anatolia Project will undoubtedly provide a remarkable economical growth and a social development in the area. In addition, the influence that formation of dam ponds, enlargement of irrigation areas, change of product and the way of cultivation, urbanization and industrialization will have an impact on the environment. To minimize the adverse effects of this process on human beings, a Community Health Project was completed by the teams participated by Ege, Dicle, Gaziantep and Harran Universities under the Directorate of Turkish Parasitology Association and by Southeastern Anatolia Project Regional Development Administration between 2001 and 2003.

RESULTS

To identify individuals with parasite, feces samples were taken from a total of 4,470 individuals. Parasites were found in feces of 41.8% of men, 44.3% of women and 32.2% of children, 0-59 months old, who were included in the research and gave feces samples for parasites tests. These prevalence values indicate how widespread parasitic diseases are in the region. The high prevalence of parasitic diseases in this area is one of the causes of malnutrition in 40% of children. Parasites were detected in 44.2% of feces samples taken from rural areas and in 39.5% taken from urban areas. When the distribution of parasites detected in feces samples was studied, the most common parasites were Giardia intestinalis (18.1%), Entamoeba coli (11.8%), Ascaris lumbricoides (4.8%), Trichuris trichiura (4.5%) and Hymenolepis nana (3.9%). Distribution of parasites according to cities varied widely. The most frequently seen parasites were T. trichiura in Gaziantep; G. intestinalis in Batman, Mardin, Diyarbakir, Sirnak and Sanliurfa; and E. coli in Siirt, Kilis and Adiyaman.

CONCLUSIONS

This study is the first investigation of intestinal parasite prevalence in a large region, specifically, in this GAP region and in Turkey, in general. There is no direct relationship between irrigating the cultivation areas and diffusion of parasitic diseases because the existence of intestinal parasites mentioned above is not related to the range of irrigation of cultivation areas, but is related to factors already discussed.

[Evaluation of malaria cases in Diyarbakir between 1999 and 2004]

In this study; we investigated the prevalence and distribution of malaria in the city of Diyarbakir, retrospectively. The investigation was carried out according to age, gender and areas of settlement between 1999 and 2004. The records were obtained from the Health Directorship of the Ministry of Health in Diyarbakir. A total of 22,062 malaria cases (11,643 male, 10,419 female) had been reported during a period of five years. Compared to previous years, the prevalence of malaria had significantly decreased. However; since the geographic conditions in Diyarbakir are suitable for the reproduction of Anopheles spp. and malaria is still endemic in Diyarbakir, the fight against malaria should be continued.

Antibacterial Activity of 2% Chlorhexidine Gluconate and 5.25% Sodium Hypochlorite in Infected Root Canal: In Vivo Study

In this study, the antibacterial activity of the different antibacterial solutions using as root canal irrigant was compared in the teeth with pulpal necrosis and with periapical pathosis. Thirty root canals of incisors and premolars of 20 patients were used. Before and after the root canal preparation, two canal samples were obtained by a harvesting method using a sterile paper point in the first appointment. During the biomechanical preparation, both irrigant solutions were used for each tooth which were randomly divided into two groups. Last samples were also obtained before the root filling procedure. Samples obtained from the root canals were subjected to microbiologic processing, including anaerobic incubation on trypticase soy agar for 5 to 7 days. After counting of CFU on the plates, we concluded that both chlorhexidine gluconate and sodium hypochlorite were significantly effective to reduce the microorganisms in the teeth with necrotic pulp, periapical pathologies, or both, and could be used successfully as an irrigant solution.

Listeria monocytogenes in Products of Animal Origin in Turkey

A study was carried out on 430 samples of different foodstuffs (soft cheese, raw chicken, minced beef, sausage, fish) and 400 carcase samples (sheep, young and adult cattle) for screening of Listeria monocytogenes. It was found that only one of the samples contained L. monocytogenes at > 10(3) cfu/ml in the initial examination, but another 42 samples contained L. monocytogenes following an enrichment process. L. monocytogenes was isolated most frequently from raw chicken samples (18%), but was not isolated from sausage samples. Forty-three isolates were defined as serotypes by using Bacto-Listeria-O-antisera Type 1 (Difco 2300-50-2) and Type 4 (Difco 2301-50-1) except that Type poly was not used. For these reasons, all isolates were classified as type 1 or type 4 and the other was termed untypeable. Twenty-one samples were type 1, 17 were untypeable, and 5 were both serotype 4 and untypeable.

The effects of magnesium, calcium and EDTA on slime production by Staphylococcus epidermidis strains

Effect of magnesium, calcium and EDTA on slime production by 15 slime-positive and 13 slime-negative Staphylococcus epidermidis strains isolated from various clinical specimens was determined. The slime production on tryptic soy broth was significantly enhanced after addition of 128 mumol/L Mg2+. Similarly, the addition of Ca2+ caused a significant increase in slime production of all tested strains when concentration of Ca2+ exceeded 64 mumol/L. In contrast, in the presence of EDTA the slime production by all strains was significantly reduced. Hence Ca2+ and Mg2+ increase slime production of S. epidermidis. This finding is important in the context of the pathogenesis of biomedical implant infections caused by S. epidermidis.

[Typhoid fever epidemic in Ahmetli village, Diyarbakir-Ergani]

Salmonella typhi leads to typhoid fever outbreaks due to the contamination of drinking water. In this study, a typhoid fever outbreak due to drinking water contamination in Ahmetli village, Ergani-Diyarbakir, in the period of December 25, 2001-January 4, 2002 was evaluated. A total of 181 suspicious cases were admitted to different health care centers during the outbreak and 71 (39.2%) of them were hospitalized. Gruber-Widal test could be performed for only 8 hospitalized patients, and were found positive in 6 of them. S. typhi was isolated from 3 of the 26 blood cultures and two of the 73 stool cultures of the patients. All village inhabitants were visited and suspicious cases were screened for salmonellosis. It was shown that the village-drinking water was contaminated with sewage. No S. typhi was isolated from the drinking water since it was previously disinfected. Maintenance of drinking water supply system, individual chloride usage and education were recommended, as safety cushions.

Effects of nimodipine and ofloxacin on staphylococcal brain abscesses in rats

The therapeutic effects of nimodipine (CAS 66085-59-4) and ofloxacin (CAS 82419-36-1) were investigated against experimental brain abscess formation in rats. Nimodipine, a 1,4-dihydropyridine derivative, is chemically related to nifedipine but the smooth muscle relaxant effect preferentially acts on cerebral arteries. Ofloxacin is a member of 4-Quinolone broad spectrum antibiotics. Ninety-six male Sprague-Dawley rats were inoculated intracortically with Staphylococcus aureus and then different groups were treated with either saline, ofloxacin or the combination of ofloxacin and nimodipine. The rate of brain abscess formation and mortality were considerably decreased by nimodipine and ofloxacin therapy. Combination therapy was found histologically to be considerably more effective than ofloxacin alone against brain abscess formation in rats.

Comparison of slime production under aerobic and anaerobic conditions

A total of sixteen clinical isolates of coagulates-negative staphylococci were investigated for slime production by the test tube and Congo red agar method. In order to determine the role of oxygen in slime production, Staphylococcus epidermidis culture plate assay was performed under aerobic and anaerobic conditions. Findings revealed that the slime production was less under the anaerobic conditions.