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Yücebağ E, Arslan N, Tok Y, Nohut OK, Salman Yılmaz S, Kuşkucu MA, Midilli K. [P323L Mutation in a Case with Prolonged SARS-CoV-2 PCR Positivity]. MIKROBIYOL BUL 2023; 57:490-497. [PMID: 37462312 DOI: 10.5578/mb.20239941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Coronavirus disease-2019 (COVID-19) emerged in the last months of 2019 and caused a pandemic effecting the whole world. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19 has changed by various mutations since the day it was first identified, causing the pandemic to continue. Age, male gender, obesity, and comorbidity, which are general risk factors for COVID-19, can also cause prolonged PCR positivity. In this report, a case of 37-year-old male who is working in the hospital's COVID-19 molecular diagnostics laboratory was presented. He was vaccinated with three doses of inactivated vaccine, CoronaVac (Sinovac Biotech, Beijing-China), within the context of the vaccination program carried out in Türkiye. His first SARS-CoV-2 positivity was detected on 12.01.2021, four months after the last vaccination, and he continued to be detected positive for SARS-CoV-2 throughout a period of 39 days by quantitative reverse transcription polymerase chain reaction (qRT-PCR) tests performed with 2-3-day intervals. The patient has a 20-pack/year smoking history and his body mass index (BMI) was 29.8 kg/m2 at the time of his COVID-19. The case, which was clinically defined as mild COVID-19 with symptoms including back and headache, cough, fever (38.5°C), and loss of taste-smell, and without any additional complications or respiratory distress during the disease process. In the radiological examination, the lung was found within normal ranges. Prophylactic enoxaparin sodium anti-xa IU/0.6 ml was administered to the patient due to his cardiovascular risk, and no additional treatment was given. Whole genome sequencing was performed from nasopharyngeal swab samples of the patient at the beginning and 16th day of the infection to investigate the the specific genomic features and mutation pattern of the virus in the host over time, due to the prolonged SARS-CoV-2 PCR positivity. Library preparation for the whole next-generation sequencing (NGS) was performed by the SARS-CoV-2 Panel, Paragon CleanPlex kit (Paragon Genomics, USA), and indexing of the library was done by Clean-Plex Dual-Indexed PCR Primers for Illumina Set B kit (Paragon Genomics, USA). NGS analysis was performed on the Illumina Miniseq (Illumina, USA) platform. As a result of the bioinformatics evaluation, both samples were determined as SARS-CoV-2 Delta variant (Nextclade; 21J-Delta variant, Pango lineage; AY.43). Remarkably, the SARSCoV-2 sequences in the two samples taken 15 days apart; several identical mutations; such as D614G in the S gene, P323L in the ORF 1b gene region, and P1228L in the Nsp3 gene region, were detected. Besides that, when compared to the first sample, three additional mutations (P383L, P539S, L838I) were observed in the sequence of the second sample, which led to three amino acid changes, the clinical significance of which has not yet been determined in the literature. It is thought that; these mutations that change amino acid expression, as well as the other three mutations detected, may contribute to the improvement of the fitness of the virus and may be one of the factors responsible for the prolonged SARS-CoV-2 PCR positivity. Additional data to be obtained by further epidemiological sequencing studies will shed light on this issue.
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Affiliation(s)
- Ebru Yücebağ
- İstanbul Arel University Faculty of Medicine, Department of Medical Microbiology, İstanbul, Türkiye
| | - Neşe Arslan
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, İstanbul, Türkiye
| | - Yeşim Tok
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, İstanbul, Türkiye
| | - Okan Kadir Nohut
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Fikret Biyal Central Research Laboratory, İstanbul, Türkiye
| | - Seda Salman Yılmaz
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Forensic Medicine and Forensic Sciences, İstanbul University, Türkiye
| | - Mert Ahmet Kuşkucu
- Koç University Faculty of Medicine, Department of Medical Microbiology, İstanbul, Türkiye
| | - Kenan Midilli
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, İstanbul, Türkiye
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Sarınoğlu RC, Çolak D, Küpesiz OA, Kuşkucu MA, Yalçın K, Sağlık İ, Mutlu D, Midilli K, Peker BO, Özhak B, Özkul A, Foldes K. [Investigation of Ganciclovir Resistance in Cytomegalovirus Isolates by Phenotypic and Genotypic Methods]. MIKROBIYOL BUL 2023; 57:401-418. [PMID: 37462304 DOI: 10.5578/mb.20239933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Ganciclovir-resistant cytomegalovirus (CMV) strains are reported following long-term antiviral agent use, especially for immune-suppressive patients. In this study, it was aimed to investigate the mutations in the UL97 gene of CMV, which causes ganciclovir (GCV) resistance by genotypic and phenotypic methods in patients who developed CMV infection following hematopoietic cell (HCT) or solid organ transplantation (SOT). Thirty patients who had HCT or SOT in Mediterranean University Hospital and developed CMV infection during routine follow-up with a viral load of CMV over 1000 copies/mL were included in the study. CMV DNA was analyzed by an automated system (Cobas Ampliprep/COBAS TaqMan CMV Test, Roche Diagnostics, Germany) quantitatively. DNA sequence analysis of the regions including codons 420-664 in the UL97 gene region was done by the Sanger sequencing method to detect mutations causing antiviral resistance and compared with defined mutations. In order to investigate antiviral resistance by phenotypic methods, heparinized blood samples of the patients were collected, 'buffy coat (leukocyte layer)' was inoculated into MRC-5 cells by centrifugation method and CMV growth in these cells was controlled with monoclonal antibodies when growth was detected, virus titer was determined and plaque reduction test was applied as recommended. It was determined that 22 of the 30 patients were HCT recipients and eight were SOT (five kidney, three liver) recipients. When the CMV serology pattern of the patients was evaluated before transplantation, 29 (96.7%) patients were found to be seropositive and one (3.3%) patient was found to be seronegative. Totally, nine CMV UL97 mutations were detected in seven (23.3%) pediatric patients who had HCT, including six seropositive and one seronegative case. In addition, one mutation (D605E) not known to cause GCV resistance was detected in a seronegative recipient and three previously unidentified mutations were detected (1474T, F499S, V559A) in a seronegative recipient. Five of the mutations defined were UL97 mutations with a defined clinical resistance against GCV in each of the five recipients (C603W, C592G, H520Q, M460V, A594T). In the plaque reduction test using 3 µM, 12 µM, 48 µM and 96 µM concentrations of GCV in CMV strains, the IC50 value was determined to be ≥ 8 µM for the five CMV strains, and the phenotypic presence of GCV resistance was shown. Clinical resistance associated with CMV UL97 mutation was detected in five (22.7%) of 22 patients who had HCT. GCV resistance was also demonstrated in these patients by phenotypic methods. No UL97 mutation was detected in the patients who had SOT.
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Affiliation(s)
- Rabia Can Sarınoğlu
- Bahceşehir University Faculty of Medicine, Department of Medical Microbiology, İstanbul, Türkiye
| | - Dilek Çolak
- Mediterranean University Faculty of Medicine, Department of Medical Microbiology, Antalya, Türkiye
| | - Osman Alphan Küpesiz
- Mediterranean University Faculty of Medicine, Department of Pediatric Hematology-Oncology, Antalya, Türkiye
| | - Mert Ahmet Kuşkucu
- Koç University Faculty of Medicine, Department of Medical Microbiology, İstanbul, Türkiye
| | - Koray Yalçın
- Bahçeşehir University Faculty of Medicine, Medical Park Göztepe Hospital Pediatric Hematology-Oncology and Bone Marrow Transplantation Unit, İstanbul, Türkiye
| | - İmran Sağlık
- Uludağ University Faculty of Medicine, Department of Medical Microbiology, Bursa, Türkiye
| | - Derya Mutlu
- Mediterranean University Faculty of Medicine, Department of Medical Microbiology, Antalya, Türkiye
| | - Kenan Midilli
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, İstanbul, Türkiye
| | - Bilal Olcay Peker
- İzmir Atatürk Training and Research Hospital, Department of Medical Microbiology, İzmir, Türkiye
| | - Betil Özhak
- Mediterranean University Faculty of Medicine, Department of Medical Microbiology, Antalya, Türkiye
| | - Aykut Özkul
- Ankara University Faculty of Veterinary Medicine, Department of Virology, Ankara, Türkiye
| | - Kataline Foldes
- Ankara University Faculty of Veterinary Medicine, Department of Virology, Ankara, Türkiye
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Ozyurt OK, Cetinkaya O, Ozhak B, Ongut G, Turhan O, Yazisiz H, Donmez L, Kuskucu MA, Midilli K, Ogunc D. Evaluation of the BD Phoenix CPO Detect Test for the detection of carbapenemase-producing Enterobacterales. Future Microbiol 2023; 18:399-405. [PMID: 37256285 DOI: 10.2217/fmb-2022-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/24/2023] [Indexed: 06/01/2023] Open
Abstract
Aims: This study aimed to evaluate the performance of the BD Phoenix CPO Detect Test (BD Diagnostic Systems) for the detection and classification of carbapenemase-mediated carbapenem resistance. Methods: A total of 447 Enterobacterales strains were included in the study. All strains were tested with the BD Phoenix CPO Detect Test and the modified carbapenem inactivation method. Results: Carbapenemase production was detected in 157 of 159 carbapenemase producers, including 95.7% of class B and 99.2% of class D isolates using the BD Phoenix CPO Detect Test. BD Phoenix CPO Detect has a sensitivity of 98.7% and a specificity of 95.5% in detecting carbapenemase production. Conclusion: The classification of OXA-48 and class B carbapenemases, the most common carbapenemases circulating in Turkey, was highly accurate.
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Affiliation(s)
- Ozlem K Ozyurt
- Department of Medical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ozgul Cetinkaya
- Department of Medical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Betil Ozhak
- Department of Medical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gozde Ongut
- Department of Medical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ozge Turhan
- Department of Infectious Diseases & Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Hatice Yazisiz
- Department of Medical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Levent Donmez
- Department of Public Health, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mert A Kuskucu
- Department of Medical Microbiology, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Kenan Midilli
- Department of Medical Microbiology, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Dilara Ogunc
- Department of Medical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Dönmez Türkmen A, Ünlü G, Musayeva G, Akkuş E, Özen AG, Önal P, Kuşkucu M, Midilli K, Kılınç AA, Çokuğraş H, Çokuğraş FÇ, Beşer ÖF. Can the Prognosis of COVID-19 Disease Be Determined by Fecal Markers and Cytokines? J Interferon Cytokine Res 2022; 42:542-549. [PMID: 36179036 DOI: 10.1089/jir.2022.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected the entire world, and has a variety of clinical presentations. The aim of this study is to determine the relationships of fecal cytokines and markers with the symptoms and prognosis of children with COVID-19 infection, and to identify noninvasive markers during follow-up. In a cohort of 40 COVID-19-positive children and 40 healthy controls, fecal cytokines and markers were examined in stool samples. A binary logistic model was used to assess the potential of cytokines as risk factors for hospitalization. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. A P-value <0.05 was accepted as statistically significant. Levels of fecal lysozyme, myeloperoxidase, hemoglobin, and interleukin-5 (IL-5) (P < 0.05) were significantly higher among the patients than controls. In a logistic regression analysis, fecal IL-2 (OR = 3.83; 95% CI: 1.44-15.92), IL-4 (OR = 2.96; 95% CI: 1.09-12.93), IL-5 (OR = 4.56; 95% CI: 1.18-27.88), IL-10 (OR = 2.71 95% CI: 1.19-7.94), interferon-gamma (IFN-γ) (OR = 4.03; 95% CI: 1.44-15.73), IFN-α (OR = 3.02; 95% CI: 1.08-11.65), calcium-binding protein B S100 (S100 B) (OR = 4.78; 95% CI: 1.31-27.82), neutrophil elastase (NE) 2 (OR = 4.07; 95% CI: 1.17-19.69), and matrix metalloproteinase 1 (MMP-1) (OR = 3.67; 95% CI: 1.1-18.82) levels were significantly higher in hospitalized patients with COVID-19 infection than outpatients. We demonstrated that various fecal cytokines and markers were increased in patients who had COVID-19. Fecal IL-2, IL-4, IL-5, IL-10, IFN-γ, IFN-α, S100 B, NE, and MMP-1 levels were significantly elevated in hospitalized patients. We suggest that the fecal and serum levels of cytokines could be used to predict the prognosis of COVID-19 disease, although more studies are needed to confirm this.
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Affiliation(s)
- Ahsen Dönmez Türkmen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gülçin Ünlü
- Department of Pediatric Health and Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulustan Musayeva
- Department of Pediatric Health and Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Erkan Akkuş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aybüke Gurup Özen
- Department of Pediatric Health and Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pınar Önal
- Department of Pediatric Infectious Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mert Kuşkucu
- Department of Microbiology, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Midilli
- Department of Microbiology, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Ayzıt Kılınç
- Department of Pediatric Pulmonology, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Haluk Çokuğraş
- Department of Pediatric Infectious Diseases, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fügen Çullu Çokuğraş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ömer Faruk Beşer
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medicine of Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Tuyji-Tok Y, Yücebağ E, Keleş AB, Kılınçarslan AC, Nohut OK, Salman-Yılmaz S, Kuşkucu MA, Midilli K. Novel SARS-CoV-2 Omicron variants in İstanbul; Rapid Preponderance of BA.2 and BA.5. Infect Dis Clin Microbiol 2022; 4:192-198. [PMID: 38633395 PMCID: PMC10985815 DOI: 10.36519/idcm.2022.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/20/2022] [Indexed: 04/19/2024]
Abstract
Objective In Turkey, the fourth wave of SARS-CoV-2 started in December 2021 and peaked in mid-January 2022. Afterward, peaks were seen in the number of COVID-19 cases because of Omicron BA.2 and BA.5 variants. Our study aimed to observe the prevalence and viral load-related transmissibility rates of the Omicron BA.2 and BA.5 variant infections in our region between January 21 and July 01, 2022, using an easy and cost-effective PCR screening method. Methods The frequency of BA.2 and BA.5 were determined by the two-stage allele-specific and drop-out RT-PCR method targeting NSP6 105-107del, spike 69-70del, and spike L452R mutation-specific primers. Transmissibility of the Omicron variants was assessed using cycle threshold (Ct) values (a proxy for SARS-CoV-2 viral load and infectivity). Also, using the next generation sequencing (NGS) method, existing mutations were analyzed by generating full-length sequences of the representative, randomly selected samples from the Omicron variants determined by PCR screening test. Results We defined the first case of BA.2 on January 19, 2022, in İstanbul University-Cerrahpaşa School of Medicine COVID-19 Molecular Diagnosis Laboratory. Following this, it was observed that BA.1 lost its dominance due to the increased transmissibility of BA.2. On May 5, we defined the first case of BA.5, and as of July this Omicron variant rapidly became preponderant, with a frequency of more than 85%. Compared with BA.1, BA.2 and BA.5 were associated with 2.82 (95% CI: 2.33-4.12) and 2.49 (95% CI: 2.16-3.55) fewer cycles, respectively, meaning higher transmissibility. As confirmed by the NGS results, it was concluded that screening with NSP6 105-107del, spike 69-70del and spike L452R mutation targeted PCR method, which is used uniquely in our hospital in Turkey, can be an easy and cost-effective method in the follow-up of Omicron variants. Conclusion The higher viral load detection in infections with BA.2 and BA.5 reflects a prolonged disease period, and increased transmissibility, so rapid expansion of these Omicron variants in Turkey is inevitable. Even though the prevalence of the Omicron variants in the population can be monitored in near real-time by the PCR screening method, more sequencing studies are needed for the early identification of new mutations that will emerge.
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Affiliation(s)
- Yeşim Tuyji-Tok
- Department of Medical Microbiology, İstanbul
University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ebru Yücebağ
- Department of Medical Microbiology, İstanbul
University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ayşe Betül Keleş
- Department of Medical Microbiology, İstanbul
University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ayşe Ceylan Kılınçarslan
- Department of Medical Microbiology, İstanbul
University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Okan Kadir Nohut
- Fikret Biyal Central Research Laboratory, İstanbul
University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Seda Salman-Yılmaz
- Department of Forensic Medicine and Forensic Sciences, İstanbul
University-Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Mert Ahmet Kuşkucu
- Department of Medical Microbiology, İstanbul
University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Kenan Midilli
- Department of Medical Microbiology, İstanbul
University-Cerrahpaşa School of Medicine, İstanbul, Turkey
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Dinç HÖ, Demirci M, Özdemir YE, Sirekbasan S, Aktaş AN, Karaali R, Tok YT, Özbey D, Akçin R, Gareayaghi N, Kuşkucu MA, Midilli K, Aygün G, Sarıbaş S, Kocazeybek B. Anti-SARS-CoV-2 IgG and Neutralizing Antibody Levels in Patients with Past COVID-19 Infection: A Longitudinal Study. Balkan Med J 2022; 39:172-177. [PMID: 35378574 PMCID: PMC9136548 DOI: 10.4274/balkanmedj.galenos.2022.2021-8-131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/08/2022] [Indexed: 12/01/2022] Open
Abstract
Background Monitoring the longevity of immunoglobulin G (IgG) responses following severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections is vital to understanding the role of antibodies in preventing infection. Aims To determine the quantitative IgG responses specific to the Spike-S1 (S1) receptor-binding domain (S1/RBD) region of the virus in serum samples taken between 4 weeks and 7 months after polymerase chain reaction (PCR) positivity in patients who are diagnosed with coronavirus disease-2019 (COVID-19). Study Design A longitudinal study. Methods This study included 113 patients with a clinical and molecular diagnosis of COVID-19. The first and second serum samples were taken 1 and 7 months, respectively, after the PCR positivity. S1/RBD-specific IgG antibody response was assayed using anti-SARS-CoV- 2 QuantiVac ELISA (IgG) kit (Euroimmun, Lübeck, Germany). The neutralizing antibodies were investigated in 57 patients whose IgG test results were above the cut-off value. Results In 57 patients with SARS-CoV-2 IgG, the anti-SARS-CoV-2 IgG quantitative antibody levels significantly decreased after 7 months (Z = −2.197, p = 0.028). A correlation was detected between the anti-SARS-CoV-2 IgG and nAb percent inhibition (IH%) levels detected in 1 month (rs = 0.496, p < 0.001), but without significant correlation in serum samples taken on 7 months. The nAb IH% levels of the first and second were compared for COVID-19 severity and revealed no statistical difference (p = 0.256). In the second serum sample, the nAb IH%s of patients with moderate COVID-19 showed a statistically significant difference from patients with mild COVID-19 (p = 0.018), but without significant differences between severe and moderate or mild COVID-19. Conclusion SARS-CoV-2 quantitative IgG antibody titers are significantly reduced at long-term follow-up (> 6 months). Due to the limited information on seroconversion, comprehensive studies should be conducted for long-term follow-up of the immune response against SARS-CoV-2.
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Affiliation(s)
- Harika Öykü Dinç
- Department of Pharmaceutical Microbiology, Pharmacy Faculty, Bezmialem Vakıf University, İstanbul, Turkey
| | - Mehmet Demirci
- Department of Medical Microbiology Faculty, of Medicine, Kırklareli University, Kırklareli, Turkey
| | - Yusuf Emre Özdemir
- Specialist of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey Bakırköy Sadi Konuk Training Research Hospital, İstanbul, Turkey
| | - Serhat Sirekbasan
- Department of Medical Laboratory, Techniques Çankırı Karatekin University, Eldivan Vocational School of Health Services, Çankırı, Turkey
| | - Ayse Nur Aktaş
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Rıdvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Yeşim Tuyji Tok
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Doğukan Özbey
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Rüveyda Akçin
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Nesrin Gareayaghi
- Blood Center İstanbul Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mert Ahmet Kuşkucu
- Blood Center İstanbul Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Kenan Midilli
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Gökhan Aygün
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Suat Sarıbaş
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Bekir Kocazeybek
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
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Yavuz SŞ, Tunçer G, Altuntaş-Aydın Ö, Aydın M, Pehlivanoğlu F, Tok Y, Mese S, Gündüz A, Güçlü CG, Özdoğan İ, Hemiş-Aydın B, Soğuksu P, Benli A, Başaran S, Midilli K, Eraksoy H. Comparison of the Clinical and Laboratory Findings and Outcomes of Hospitalized COVID-19 Patients Who Were Either Fully Vaccinated with Coronavac or Not: An Analytical, Cross Sectional Study. Vaccines (Basel) 2022; 10:vaccines10050733. [PMID: 35632489 PMCID: PMC9148084 DOI: 10.3390/vaccines10050733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 01/27/2023] Open
Abstract
COVID-19 vaccines are highly protective against severe disease; however, vaccine breakthrough infections resulting in hospitalization may still occur in a small percentage of vaccinated individuals. We investigated whether the clinical and microbiological features and outcomes were different between hospitalized COVID-19 patients who were either fully vaccinated with Coronovac or not. All hospitalized COVID-19 patients who had at least one dose of Coronavac were included in the study. The oldest unvaccinated patients with comorbidities, who were hospitalized during the same period, were chosen as controls. All epidemiologic, clinical and laboratory data of the patients were recorded and compared between the fully vaccinated and unvaccinated individuals. There were 69 and 217 patients who had been either fully vaccinated with Coronavac or not, respectively. All breakthrough infections occurred in the first 3 months of vaccination. Fully vaccinated patients were older and had more comorbidities than unvaccinated patients. There were minor differences between the groups in symptoms, physical and laboratory findings, anti-spike IgG positivity rate and level, the severity of COVID-19, complications, and clinical improvement rate. The mortality rate of fully vaccinated patients was higher than the mortality rate in unvaccinated patients in univariate analysis, which was attributed to the fact that vaccinated patients were older and had more comorbidities. The severity and clinical outcomes of hospitalized patients with breakthrough COVID-19 after Coronavac vaccination were similar to those of unvaccinated patients. Our findings suggest that the immune response elicited by Coronovac could be insufficient to prevent COVID-19-related severe disease and death within 3 months of vaccination among elderly people with comorbidities.
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Affiliation(s)
- Serap Şimşek Yavuz
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
- Correspondence:
| | - Gülşah Tunçer
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, İstanbul 34093, Turkey; (G.T.); (F.P.); (C.G.G.)
| | - Özlem Altuntaş-Aydın
- Department of Infectious Diseases and Clinical Microbiology, Çam and Sakura City Hospital, İstanbul 34093, Turkey; (Ö.A.-A.); (A.G.)
| | - Mehtap Aydın
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul 34093, Turkey; (M.A.); (İ.Ö.)
| | - Filiz Pehlivanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, İstanbul 34093, Turkey; (G.T.); (F.P.); (C.G.G.)
| | - Yeşim Tok
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, Division of Virology, Istanbul Cerrahpaşa University, İstanbul 34093, Turkey; (Y.T.); (K.M.)
| | - Sevim Mese
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Division of Virology and Fundamental Immunology, Istanbul University, İstanbul 34093, Turkey; (S.M.); (P.S.)
| | - Alper Gündüz
- Department of Infectious Diseases and Clinical Microbiology, Çam and Sakura City Hospital, İstanbul 34093, Turkey; (Ö.A.-A.); (A.G.)
| | - Ceyda Geyiktepe Güçlü
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, İstanbul 34093, Turkey; (G.T.); (F.P.); (C.G.G.)
| | - İklima Özdoğan
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul 34093, Turkey; (M.A.); (İ.Ö.)
| | - Börçe Hemiş-Aydın
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
| | - Pınar Soğuksu
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Division of Virology and Fundamental Immunology, Istanbul University, İstanbul 34093, Turkey; (S.M.); (P.S.)
| | - Aysun Benli
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
| | - Seniha Başaran
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
| | - Kenan Midilli
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, Division of Virology, Istanbul Cerrahpaşa University, İstanbul 34093, Turkey; (Y.T.); (K.M.)
| | - Haluk Eraksoy
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
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8
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Ergen P, Koçoğlu ME, Nural M, Kuşkucu MA, Aydin Ö, İnal FY, Öztürk H, Üçişik AC, Çaşkurlu H, Güneysu B, Yildirim B, Midilli K, Çağ Y, Arslan F, Vahaboglu H. Carbapenem-resistant Klebsiella pneumoniae outbreak in a COVID-19 intensive care unit; a case-control study. J Chemother 2022; 34:517-523. [PMID: 35470780 DOI: 10.1080/1120009x.2022.2064698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We analysed a carbapenem-resistant Klebsiella pneumoniae (CRKP) outbreak in the coronavirus disease (COVID) ICU. We retrospectively collected data from ICU records. We identified 25 cases between 12 November 2020 and 19 December 2020, and compared them to 42 controls present in the ICU during the same period. The presence of a femoral haemodialysis catheter was strongly associated with invasive CRKP infections (cases, 9 [36%]; controls, 0 [0%]; odds ratio [OR] 95% confidence intervals [CIs], 21 (5; 89)). We found a significant association between old age and CRKP infection with adverse outcomes. Sequence analysis revealed three distinct carbapenemase genes: blaNDM-1, blaOXA-48 and blaKPC-2. We launched rectal swab sampling upon admission to the ICU, cohorted colonized patients and cases and conducted an intensive training programme for newly employed staff. This study revealed that the emergence and dissemination of CRKP in COVID ICUs were associated with increased adverse outcomes. The presence of a femoral haemodialysis catheter was a significant risk factor for CRKP infections.
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Affiliation(s)
- Pınar Ergen
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - M Esra Koçoğlu
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Müge Nural
- Anestesi ve Rehabilitasyon Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Mert Ahmet Kuşkucu
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Cerrahpaşa Tıp Fakültes, İstanbul Üniversitesi, İstanbul, Turkiye
| | - Özlem Aydin
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Ferda Y İnal
- Anestesi ve Rehabilitasyon Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Hande Öztürk
- Anestesi ve Rehabilitasyon Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Ayşe C Üçişik
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Hülya Çaşkurlu
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Büşra Güneysu
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Büşra Yildirim
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Kenan Midilli
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Cerrahpaşa Tıp Fakültes, İstanbul Üniversitesi, İstanbul, Turkiye
| | - Yasemin Çağ
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Ferhat Arslan
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Haluk Vahaboglu
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
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9
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Kuloğlu ZE, El R, Guney‐Esken G, Tok Y, Talay ZG, Barlas T, Kuskucu MA, Albayrak Ö, Doğan Ö, Yavuz SŞ, Midilli K, Ergönül Ö, Can F. Effect of BTN162b2 and CoronaVac boosters on humoral and cellular immunity of individuals previously fully vaccinated with CoronaVac against SARS-CoV-2: A longitudinal study. Allergy 2022; 77:2459-2467. [PMID: 35437772 PMCID: PMC9111385 DOI: 10.1111/all.15316] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 01/10/2023]
Abstract
Background It is essential to know about immune response levels after booster doses of the two different types of vaccines, mRNA, and the inactivated, currently used against COVID‐19. For this purpose, we aimed to determine the effects of BNT162b2 (BNT) and CoronaVac (CV) boosters on the humoral and cellular immunity of individuals who had two doses of CV vaccination. Methods The study was conducted in three centers (Koc University Hospital, Istanbul University Cerrahpasa Hospital, and Istanbul University, Istanbul Medical School Hospital) in Istanbul, Turkey. Individuals who had been previously immunized with two doses of CV and no history of COVID‐19 were included. The baseline blood samples were collected 3–5 months after the second dose of CV. Follow‐up blood samples were taken 1 and 3 months after administration of third doses of CV, or one dose of BNT boosters. Neutralizing antibody titers were measured by plaque reduction assay. The CD4+ T cell, CD8+ T cell, effector CD4+CD38+CD69+ T cell, and effector CD8+CD38+CD69+ T cell ratios were determined by flow cytometry. The intracellular IFN‐γ and IL‐2 responses were measured by ELISpot assay. Results We found a 3.38‐fold increase in neutralizing antibody geometric mean titers (NA GMT, 78.69) 1 month after BNT booster and maintained at the third month (NA GMT, 80). Nevertheless, in the CV booster group, significantly lower NA GMT than BNT after 1 month and 3 months were observed (21.44 and 28.44, respectively) (p < .001). In the ELISpot assay, IL‐2 levels after BNT were higher than baseline and CV booster (p < .001) while IFN‐γ levels were significantly higher than baseline (p < .001). The CD8+CD38+CD69+ and CD4+CD38+CD69+ T cells were stimulated predominantly in the third month of the BNT boosters. Conclusion The neutralizing antibody levels after 3 months of the BNT booster were higher than the antibody levels after CV in fully vaccinated individuals. On the contrary, ratio of the effector T cells increased along with greater IFN‐γ activation after BNT booster. By considering the waning immunity, we suggest a new booster dose with BNT for the countries that already had two doses of primary CV regimens.
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Affiliation(s)
- Zeynep Ece Kuloğlu
- Koc University School of Medicine Graduate School of Health Sciences Istanbul Turkey
- Koc University IsBank Research Center for Infectious Diseases (KUISCID) Istanbul Turkey
| | - Rojbin El
- Koc University School of Medicine Graduate School of Health Sciences Istanbul Turkey
- Koc University IsBank Research Center for Infectious Diseases (KUISCID) Istanbul Turkey
| | - Gulen Guney‐Esken
- Koc University IsBank Research Center for Infectious Diseases (KUISCID) Istanbul Turkey
| | - Yeşim Tok
- Department of Medical Microbiology Cerrahpasa School of Medicine Istanbul Turkey
| | - Zeynep Gülçe Talay
- Koc University School of Medicine Graduate School of Health Sciences Istanbul Turkey
- Koc University IsBank Research Center for Infectious Diseases (KUISCID) Istanbul Turkey
| | - Tayfun Barlas
- Koc University IsBank Research Center for Infectious Diseases (KUISCID) Istanbul Turkey
| | - Mert Ahmet Kuskucu
- Koc University IsBank Research Center for Infectious Diseases (KUISCID) Istanbul Turkey
- Department of Medical Microbiology Cerrahpasa School of Medicine Istanbul Turkey
| | - Özgür Albayrak
- Koc University Hospital Research Center for Translational Medicine Istanbul Turkey
| | - Özlem Doğan
- Koc University IsBank Research Center for Infectious Diseases (KUISCID) Istanbul Turkey
- Department of Medical Microbiology Koc University School of Medicine Istanbul Turkey
| | - Serap Şimşek Yavuz
- Department of Infectious Diseases and Clinical Microbiology Istanbul University Capa School of Medicine Istanbul Turkey
| | - Kenan Midilli
- Department of Medical Microbiology Cerrahpasa School of Medicine Istanbul Turkey
| | - Önder Ergönül
- Koc University IsBank Research Center for Infectious Diseases (KUISCID) Istanbul Turkey
- Department of Infectious Diseases and Clinical Microbiology Koc University School of Medicine Istanbul Turkey
| | - Füsun Can
- Koc University IsBank Research Center for Infectious Diseases (KUISCID) Istanbul Turkey
- Department of Medical Microbiology Koc University School of Medicine Istanbul Turkey
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10
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Dinc HO, Saltoglu N, Can G, Balkan II, Budak B, Ozbey D, Caglar B, Karaali R, Mete B, Tuyji Tok Y, Ersoy Y, Ahmet Kuskucu M, Midilli K, Ergin S, Kocazeybek BS. Inactive SARS-CoV-2 vaccine generates high antibody responses in healthcare workers with and without prior infection. Vaccine 2022; 40:52-58. [PMID: 34839992 PMCID: PMC8606260 DOI: 10.1016/j.vaccine.2021.11.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/09/2021] [Accepted: 11/17/2021] [Indexed: 12/30/2022]
Abstract
Background and Objectives Healthcare workers (HCWs) were among the first groups to be vaccinated in Turkey. The data to be obtained by the vaccination of HCWs would guide wide spread vaccination programs. Materials and Methods The study included 330 HCWs working at Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospital and vaccinated with inactive CoronaVac (Sinovac Life Sciences, China) SARS-CoV-2 vaccine in two doses (28 days apart). Anti-Spike /RBD IgG levels were measured 14 days after the first dose and 28 days after the second dose. Chemiluminescent microparticle immunoassay (CMIA) (ARCHITECT IgG II Quant test, Abbott, USA), which is 100% compatible with plaque reduction neutralization test (PRNT), was used. Results Of the participants, 211 (63.9%) were female, 119 (36.1%) were male, and mean age was 39.6 ± 7.7 years. In those without prior COVID-19 history; (n = 255) antibody positivity was detected as 48.2% (95% CI: 42.1–54.3) 14 days after the first dose of vaccine, and 99.2% (95% CI: 98.1–100) at day 28 after the second dose. Antibody titers were significantly lower in patients with hypertension (p = 0.011). In those with prior history of COVID-19 (n = 75); both the antibody positivity rates after the first vaccine (48.2% vs 100%, p = 0.000) and the anti-spike/RBD antibody levels after the second vaccine (with a ≥ 1050 AU/mL titer equivalent to PRNT 1/80 dilution) was significant than infection-naive group (25.9% vs. 54.7%, p = 0.000). Antibody positivity after two doses of vaccination for all study group was 99.4% (95% CI: 98.6–100). Conclusions Two doses CoronaVac produce effective humoral immunity in HCWs. Antibody response is significantly higher in those with prior history of COVID-19 than infection-naive group. Given no significant benefit of the second dose, a single shot of vaccination may be sufficient for those with prior history of COVID-19. Monitoring humoral and cellular immune responses, considering new variants, is required to validate this approach.
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Affiliation(s)
- Harika Oyku Dinc
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Bezmialem Vakıf University Istanbul, Turkey; Department of Medical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Nese Saltoglu
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey.
| | - Gunay Can
- Department of Public Health, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Beyhan Budak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Dogukan Ozbey
- Department of Medical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Bilge Caglar
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Rıdvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Yesim Tuyji Tok
- Department of Medical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Yagmur Ersoy
- Department of Medical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Mert Ahmet Kuskucu
- Department of Medical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Kenan Midilli
- Department of Medical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Sevgi Ergin
- Department of Medical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Bekir Sami Kocazeybek
- Department of Medical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
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11
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Karaali R, Dinc H, Ozdemir Y, Dalar Z, Kurt A, Aktas A, Sirekbasan S, Tok Y, Kuskucu M, Balkan I, Mete B, Aygun G, Midilli K, Saribas S, Saltoglu N, Cakan H, Kocazeybek B. Association of SARS-CoV-2 IgG Antibody Levels with Clinical/Laboratory Characteristics in COVID-19 Patients: Data from a Turkish Study. Clin Lab 2022; 68. [DOI: 10.7754/clin.lab.2021.211230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Tok YT, Kuşkucu MA, Erdem H, Sarıbal D, Salman Yılmaz S, Nohut OK, Karaali R, Balkan İİ, Mete B, Tabak ÖF, Aygün G, Midilli K. Detection of SARS-CoV-2 RNA in Upper Respiratory Swap Samples by Pooling Method. Balkan Med J 2021; 39:48-54. [PMID: 34928231 PMCID: PMC8941244 DOI: 10.5152/balkanmedj.2021.21135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Widespread and effective use of molecular diagnostic tests is indispensable for protecting public health and containing the severe respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. More than 1 year into the pandemic, as resources have reached a point of depletion, grouping samples in pools of certain sizes appears to be a reasonable method to reduce both the costs and the processing time without necessitating additional training, equipment, or materials. Aims: To assess whether the pooling strategy that was used in past outbreaks and is used in blood tests prior to transfusion for screening large populations can also be used in SARS CoV-2 tests. Study Design: Diagnostic accuracy study. Methods: This prospective study was conducted with 2815 samples, sent to the coronavirus disease 2019 (COVID-19) Laboratory of our hospital between February 12 and 21, 2021, to be tested for the presence of SARS-CoV-2. The samples were examined individually and in pools of five 100 μl taken from each sequential sample, using 3 different SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) kits, the Allplex™ 2019-nCoV Assay kit (Seegene, Republic of Korea), the GeneMAP™ 2019-nCoV detection V.3 kit (GenMark, Türkiye), and the Bio-Speedy™ SARS-CoV-2 Double Gene™ RT-qPCR kit (Bioeksen, Türkiye) on the BioRAD CFX96™ Touch (Bio-Rad Laboratories Inc., Hercules, CA, USA) platform available in our laboratory. Results: Following the extraction of serial dilutions prepared from the SARS-CoV-2 RNA positive (cycle of threshold: 20) sample, the standard curves of RT-PCR were analyzed. By evaluating the efficiency (E) values, all 3 kits showed high sensitivity and similar results; while the highest level was detected with the Allplex™ 2019-nCoV Assay kit in the nucleocapsid (N) gene (E: 124%), the lowest was detected with the Double Gene™ RT-qPCR kit in the N and ORF 1ab genes (E: 90%). Of the samples included in the study, only 1 positive sample with low viral load was found to be negative when studied by pooling. The total number of kits to be used in pooled tests and then to individually retest the 5 samples in positive pools was calculated as 827 and the savings rate as 69.91% (1968/2815). Conclusion: The pooling strategy is an effective approach to extend the impact of limited testing resources and reagents available in certain periods of the COVID-19 pandemic. Testing by pooling samples requires improvement of RNA extraction methods and careful monitoring of RT-PCR test sensitivity to avoid missing low-positive entities. Therefore, based on the prevalence of COVID-19 in their regions, laboratories should conduct their own validation of pooling studies for RNA extraction and amplification methods they use.
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Affiliation(s)
- Yesim Tuyji Tok
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Mert Ahmet Kuşkucu
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Hazal Erdem
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Devrim Sarıbal
- Department of Biophysics, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Seda Salman Yılmaz
- Department of Forensic Medicine and Forensic Sciences, İstanbul University-Cerrahpasa, İstanbul, Turkey
| | - Okan Kadir Nohut
- Department of Medical Biochemistry, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Rıdvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - İlker İnanç Balkan
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Bilgül Mete
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ömer Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Gökhan Aygün
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Kenan Midilli
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
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13
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Yılmaz SS, Kuşkucu MA, Sarıbal D, Tok Y, Özdemir Y, Alkan S, Arsu HY, Yalçın M, Nohut O, Balkan İİ, Aygün G, Midilli K. Real-life experience: sensitivity and specificity of nasal and saliva samples for COVID-19 diagnosis. Ir J Med Sci 2021; 191:2201-2206. [PMID: 34731445 PMCID: PMC8563820 DOI: 10.1007/s11845-021-02839-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/22/2021] [Indexed: 11/11/2022]
Abstract
Background COVID-19 (coronavirus disease 2019) outbreak has spread rapidly around the world, continues to show its effect, and it is not clear how long it will continue. For the diagnosis of COVID-19, it is important to ensure the comfort of the patients and to protect the healthcare workers (HCWs) by reducing the use of protective equipment. Aims To evaluate or assess whether the samples taken by the patient for COVID-19 testing during this pandemic period can be used in real-life experience. Methods Three different samples (nasopharyngeal taken by the healthcare worker, nasopharyngeal, and saliva taken by the patient) from 132 patients were evaluated for the diagnosis of COVID-19. The sensitivity and specificity of the samples in the diagnosis of COVID-19 were compared with real-life experience. Results Paired analyzes were performed by comparing each sample taken by the healthcare worker with the sample taken by the patient. The sensitivity of the three samples (nasopharyngeal taken by the healthcare worker, nasopharyngeal, and saliva taken by the patient) in the diagnosis of the COVID-19 was (100%, 98.7%, and 96.1%, respectively) accepted to be accurate. Conclusions The sample taken by the paramedic was compatible compared to the real-life experience for the samples taken by the patient in the COVID-19 pandemic period. During the pandemic that is unknown when it will end, this study demonstrated that taking the sample of the patient alone for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test is a beneficial approach to the protection of the healthcare worker, reducing the need for protective equipment, increasing the patient’s comfort and rapid sampling.
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Affiliation(s)
- Seda Salman Yılmaz
- Cerrahpasa Faculty of Medicine, Department of COVID-19 Diagnosis Laboratory, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Mert Ahmet Kuşkucu
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Devrim Sarıbal
- Cerrahpasa Faculty of Medicine, Department of Biophysics, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yeşim Tok
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yusuf Özdemir
- Specialist of Infectious Diseases and Clinical Microbiology, Ministry of Health Sadi Konuk Education Research Hospital, Bakırköy, Istanbul, Turkey
| | - Sena Alkan
- Cerrahpasa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Hatice Yaşar Arsu
- Cerrahpasa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Metin Yalçın
- Cerrahpasa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Okan Nohut
- Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - İlker İnanç Balkan
- Cerrahpasa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gökhan Aygün
- Cerrahpasa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Kenan Midilli
- Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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14
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Tuyji Tok Y, Kuşkucu MA, Sarıbal D, Salman Yılmaz S, Nohut OK, Aygün G, Midilli K. [Periodic Evaluation of Anti-SARS-CoV-2 Antibody Levels and Determination of Surrogate Virus Neutralization in Healthcare Workers with COVID-19]. MIKROBIYOL BUL 2021; 55:507-518. [PMID: 34666652 DOI: 10.5578/mb.20219704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Materials and Methods Result Conclusions
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Affiliation(s)
- Yeşim Tuyji Tok
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Mert Ahmet Kuşkucu
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Devrim Sarıbal
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Biophysics, Istanbul, Turkey
| | - Seda Salman Yılmaz
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Forensic Medicine and Forensic Sciences, Istanbul, Turkey
| | - Okan Kadir Nohut
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
| | - Gökhan Aygün
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Kenan Midilli
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
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Dinç HÖ, Özdemir YE, Alkan S, Güngördü Dalar Z, Gareayaghi N, Sirekbasan S, Tuyji Tok Y, Kuşkucu MA, Karaali R, Özbey D, Aygün G, Midilli K, Kocazeybek B. [Evaluation of the Diagnostic Performance of Different Principles of SARS-CoV-2 Commercial Antibody Tests in COVID-19 Patients]. MIKROBIYOL BUL 2021; 55:207-222. [PMID: 33882652 DOI: 10.5578/mb.20219907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Following the emergence of severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) and using only PCR for diagnosis, antibody tests have been rapidly developed by various commercial companies. There are differences between the sensitivity and specificity of these tests due to the usage of different viral target proteins and antibody subclasses. In order to evaluate the diagnostic use of these tests, we aimed to examine the diagnostic performance, especially sensitivity and specificity, of SARS-CoV-2 IgM, IgA and IgG tests of various companies (Abbott, Roche, Euroimmun, Dia.Pro, Anshlabs, Vircell, UnScience and RedCell), which have different principles (ECLIA/CLIA, EIA, LFA). Current (n= 180) and past (n= 180) COVID-19 patients with clinical and molecular diagnosis of COVID-19 admitted to Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine Hospital, Pandemic Polyclinic with suspected COVID-19 infection, were included in our study. The patients admitted within the first 3 weeks after the onset of symptoms were included in the current patient group, and those admitted at the third and after the third week were included in the past patient group. Serum samples (n= 180) obtained from Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Blood Center between April and June 2018 before the COVID-19 pandemic were included in the study as a control group. All the tests included in our study were studied with the recommendations of the manufacturer companies. Between the IgG detection tests with different principles in patients with past COVID-19, the sensitivity and specificity values of the most effective tests were; 86.7%/99.4% (Abbott), 86.1%/98.9% (Dia.Pro), 91.3%/95% (RedCell). Between the IgM detection tests with different principles in current COVID-19 patients, the sensitivity and specificity values were; 67.8%/99.4% (Abbott), 68.9%/98.6% (Vircell), 50%/97.5% (RedCell). Abbott IgM with a kappa coefficient of 0.67 and Vircell IgM + IgA test with a kappa coefficient of 0.65 showed the best fit in patients with current COVID-19 infection. In patients with past COVID-19, Abbott IgG with 0.86 kappa coefficient and Dia.Pro IgG test with 0.85 kappa coefficient showed the best match. Due to the low sensitivity of IgM detection antibody tests, they should not be preferred instead of real-time reverse transcriptase polymerase chain reaction in routine diagnosis. IgG detection tests may be preferred to detect the antibody response and the titers in people who have had COVID-19 for population seroprevalence and especially therapeutic immune plasma production. However, it is thought that the combined use of both ECLIA/CLIA-based and EIA/ELISA-based tests together may be more effective in routine use for SARS-CoV-2 IgG tests.
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Affiliation(s)
- Harika Öykü Dinç
- Bezmialem Vakıf University Faculty of Pharmacy, Department of Pharmaceutical Microbiology, İstanbul, Turkey
| | - Yusuf Emre Özdemir
- Bakırköy Dr. Sadi Konuk Research and Training Hospital, Clinic of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Sena Alkan
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Zeynep Güngördü Dalar
- Istanbul Altinbas University Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Nesrin Gareayaghi
- Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Blood Center, Istanbul, Turkey
| | - Serhat Sirekbasan
- Çankırı Karatekin University Eldivan Vocational School of Health Services, Department of Medical Laboratory Techniques, Çankırı, Turkey
| | - Yeşim Tuyji Tok
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Mert Ahmet Kuşkucu
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Rıdvan Karaali
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Doğukan Özbey
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Gökhan Aygün
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Kenan Midilli
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Bekir Kocazeybek
- Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
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Coşkun A, Gökahmetoğlu S, Özmen P, Çevik Ş, Karakükçü M, Kaynar L, Midilli K, Kuşkucu MA. [Investigation of Ganciclovir Resistance in Cytomegalovirus Strains Obtained from Immunocompromised Patients]. MIKROBIYOL BUL 2020; 54:619-628. [PMID: 33107291 DOI: 10.5578/mb.70062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
CMV is a virus that is asymptomatic in healthy individuals but can cause serious mortality and morbidity in transplant patients and patients with acquired immunodeficiency syndrome (AIDS). Ganciclovir (GCV) is a nucleoside analog that significantly reduces morbidity and mortality in CMV-related infections and is used as the first choice in treatment. It is the first drug shown to be effective in the treatment of CMV disease in humans, and is also homologous to acyclovir. Long-term antiviral therapy is required to prevent or treat CMV disease, but this can cause antiviral resistance which was reported to be 8-14% in CMV. In CMV strains, GCV resistance is most common in the UL97 kinase gene region. The aim of this study was to investigate GCV resistance in CMV strains obtained from the patients with immune deficiency. A total of 49 patients, including 20 children, 29 adults, who were followed in the department of hematology were included in the study. Fifty-three samples from 49 patients with CMV DNA viral load ≥ 103 copies/ml were examined for GCV resistance. In the study, DNA sequences were determined by Sanger sequence analysis method 3500 Abi Prism Genetic Analyser (Applied Biosystems, Thermo Fisher Scientific, USA) in the 674 bp part of the UL97 gene region. The next generation sequencing (NGS) method was applied to the samples that could not be evaluated with this method. GCV resistance was not detected in 35 (66%) of 53 samples with the Sanger method. C592G, C607S and M460I GCV resistance mutation was detected in three patients. Since the sequences were mixed, resistance analysis could not be evaluated with Sanger in 15 patient samples and the resistance was not detected in these samples studied with NGS. Antiviral resistance mutation was detected in three of 49 patients (6.1%). In 20 patients included in the study, three variant sequences (A442G, C592F, A427V) reported in the literature and determined to be sensitive to drugs by phenotypic tests and 78 variant sequences that were not reported in the literature were detected. As a result, the detection of antiviral resistance is important in the follow-up of the patients and guides the clinician in planning of the treatment. It was concluded that the samples that could not be evaluated with the Sanger method should be studied with NGS and further studies are needed to determine the role of the variant sequences detected for the first time in drug resistance.
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Affiliation(s)
- Ayşenur Coşkun
- Erciyes University Faculty of Medicine, Department of Medical Microbiology, Kayseri, Turkey
| | - Selma Gökahmetoğlu
- Erciyes University Faculty of Medicine, Department of Medical Microbiology, Kayseri, Turkey
| | - Pelin Özmen
- Cappadocia University Faculty of Dentistry, Department of Basic Sciences, Nevşehir, Turkey
| | - Şerife Çevik
- Erciyes University Faculty of Medicine, Department of Medical Microbiology, Kayseri, Turkey
| | - Musa Karakükçü
- Erciyes University Faculty of Medicine, Department Child Health and Diseases, Kayseri, Turkey
| | - Leylagül Kaynar
- Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
| | - Kenan Midilli
- Istanbul University Cerrahpasa Medical Faculty, Department of Medical Microbiology, İstanbul, Turkey
| | - Mert Ahmet Kuşkucu
- Istanbul University Cerrahpasa Medical Faculty, Department of Medical Microbiology, İstanbul, Turkey
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Yildiz S, Gonullu N, Yildiz BP, Hattatoglu DG, Kuskucu M, Midilli K, Aygun G, Mayda PY, Musellim B. The role of typical and atypical pathogens in acute exacerbations of chronic obstructive pulmonary disease. Clin Respir J 2020; 15:209-215. [PMID: 33030784 DOI: 10.1111/crj.13286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The exact role of Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila in the development of chronic obstructive pulmonary disease exacerbations remains to be elucidated. This study was conducted to identify nonspecific and atypical pathogens associated with acute exacerbations of COPD. MATERIALS AND METHODS Between February 2013 and February 2015, 107 patients were analyzed. Sixty-nine comprised the inpatient and 38 comprised the outpatient treatment group. RESULTS When nonspecific culture results were taken into consideration only a causative organism could be detected in 46.7% of the patients. The detection rate increased to 85.1% with the additional use of polymerase chain reaction (PCR), direct fluorescent antibody (DFA) test, and culture methods. More than one causative agent was responsible for COPD exacerbation in 53.3% of patients: two agents in 37.3%, three agents in 15%, and four agents in 0.9%. H. influenzae was detected in 63 (58.9%) patients, S. pneumoniae in 57 (53.2%), P. aeruginosa in 15 (14.0%), and L. pneumophila in 11 (10%). L. pneumophila was the more commonly isolated agent in the inpatient group (P = 0.002). Patients receiving continuous oxygen therapy and noninvasive mechanical ventilation were more likely to have an exacerbation associated with P. aeruginosa (P = 0.008 and P = 0.009, respectively). CONCLUSION The additional use of DFA for Legionella and multiplex PCR in combination with nonspecific microbiological culturing methods greatly improves the ability to identify infectious agents in acute exacerbations of COPD. There should be a high index of suspicion for P.aeruginosa as a causative organism, particularly in subjects receiving continuous oxygen therapy and/or using NIV and L. pneumophila should certainly be taken into consideration in severe COPD exacerbations.
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Affiliation(s)
- Sevilay Yildiz
- Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nevriye Gonullu
- Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Birsen Pinar Yildiz
- Department of Pulmonology, Yedikule Thoracic Disease and Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Didem Gorgun Hattatoglu
- Department of Pulmonology, Yedikule Thoracic Disease and Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mert Kuskucu
- Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Midilli
- Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gokhan Aygun
- Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Benan Musellim
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Aygun D, Kuskucu MA, Sahin S, Adrovic A, Barut K, Yıldız M, Sharifova S, Midilli K, Cokugras H, Camcıoglu Y, Kasapcopur O. Epstein-Barr virus, cytomegalovirus and BK polyomavirus burden in juvenile systemic lupus erythematosus: correlation with clinical and laboratory indices of disease activity. Lupus 2020; 29:1263-1269. [PMID: 32646294 DOI: 10.1177/0961203320940029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Clinical and laboratory investigations have revealed that Epstein-Barr virus (EBV) is involved in altered immunological response of systemic lupus erythematosus (SLE). Higher seroprevalence rates of anti-EBV antibodies and increased viral load are demonstrated in adult SLE patients. The prevalence of BK polyomavirus (BKV) reactivation is also suggested to be higher in SLE. Herein, we aimed to evaluate the immune response of children with SLE to EBV antigens in addition to EBV and BKV DNA. We also tried to evaluate whether these serological results differ from another connective tissue disease - juvenile systemic sclerosis (jSS) - and healthy individuals. METHODS Serum levels of EBV early antigen diffuse (EA-D) IgG, EBV nuclear antigen-1 IgG, EBV viral capsid antigen (VCA), cytomegalovirus (CMV) IgG, EBV DNA, CMV DNA and urinary BKV DNA were evaluated in healthy controls and in patients with a diagnosis of juvenile SLE (jSLE) and jSS. RESULTS A total of 70 jSLE patients, 14 jSS patients and 44 sex-matched healthy individuals were involved in the study. EBV VCA was positive in 84.2% of jSLE patients, 85.7% of jSS patients and 36.3% of healthy controls. EBV EA-D IgG positivity was significantly higher in jSLE patients compared to jSS patients and healthy controls (20% vs. 7.1% and 0%, p = 0.005). EBV VCA positivity was associated with malar rash and immunological disorder, but there was no statistical significance in other antibody positivity in terms of clinical and haemogram findings and autoantibody positivity. CMV DNA positivity was present in only 2.8% of jSLE patients. None of the jSS patients or the healthy controls had CMV DNA positivity. EBV DNA and BKV DNA were also negative in all three groups. CONCLUSION The results of our study assume a relationship between SLE and EBV, but we could not demonstrate an association between CMV and BKV. The negative DNA results in contrast to serological positivity can be interpreted as an altered and impaired immune system and increased viral susceptibility. These results suggest that EBV contributes to disease continuity, even if it does not directly cause development.
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Affiliation(s)
- Deniz Aygun
- Department of Pediatric Infectious Disease, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Mert Ahmet Kuskucu
- Department of Microbiology and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Mehmet Yıldız
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Sabina Sharifova
- Department of Pediatric Infectious Disease, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Kenan Midilli
- Department of Microbiology and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Haluk Cokugras
- Department of Pediatric Infectious Disease, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Yıldız Camcıoglu
- Department of Pediatric Infectious Disease, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
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Sünter AV, Hamit B, Yiğit Ö, Server EA, Kara EÖ, Karataş A, Kuşkucu MA, Doğantürk YE, Midilli K. The Prevalence of Tonsillar Human Papilloma Virus Infection in İstanbul, Turkey: A Human Cadaver Study. Turk Arch Otorhinolaryngol 2019; 57:117-121. [PMID: 31620692 DOI: 10.5152/tao.2019.4312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/02/2019] [Indexed: 01/28/2023] Open
Abstract
Objective To investigate the prevalence of tonsillar human papillomavirus infection in İstanbul, the most populous city of Turkey. Methods Tonsil specimens were obtained from 206 cadavers aged 18 to 89 years. Tonsillectomy was performed during routine autopsy for each subject in the 24 hours after death. After dissolution, tissues were processed with the polymerase chain reaction (PCR) method to identify HPV DNA. The data obtained from the DNA sequencer were processed in the database of GenBank®. Results One hundred sixty-six (80.6%) male and 40 (19.4%) female cadavers were included in the study. One case demonstrated HPV-16, one had HPV-82, one had HPV-55 and one had HPV-13. All four cases were male. Prevalence of tonsillar HPV was 1.94% and of HPV 16 was 0.48%. Conclusion The prevalence of tonsillar HPV infection was found 1.94% and of HPV 16 0.48% in our study.
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Affiliation(s)
- Ahmet Volkan Sünter
- Department of Otorhinolaryngology/Head and Neck Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Bahtiyar Hamit
- Department of Otorhinolaryngology/Head and Neck Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Özgür Yiğit
- Department of Otorhinolaryngology/Head and Neck Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Ela Araz Server
- Department of Otorhinolaryngology/Head and Neck Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | | | - Aysel Karataş
- Department of Medical Microbiology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Mert Ahmet Kuşkucu
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Yağmur Eylül Doğantürk
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Kenan Midilli
- Department of Medical Microbiology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
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Yuksel P, Saribas S, Kuskucu M, Mutcali SI, Kosan E, Habip Z, Demirci M, Kara ES, Birinci I, Caliskan R, Dinc HO, Midilli K, Ziver T, Kocazeybek B. Problems encountered in conventional HIV 1/2 Algorithms: lack of necessity for immunoblot assays to confirm repeated ELISA reactive results. Afr Health Sci 2018; 18:407-416. [PMID: 30602968 PMCID: PMC6306965 DOI: 10.4314/ahs.v18i2.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of conventional (serologically based) HIV 1/2 diagnostic algorithms has become controversial in recent years. OBJECTIVES Sera from patients who underwent verification tests were evaluated because repeated ELISA-reactive results demonstrated a HIV1+HIV2 positive band pattern. METHODS The line immunoassay (LIA) test was used for repeated HIV enzyme immunoassays (EIA)-reactive sera in patients at three centers. The Bio-Rad Geenius™ HIV 1/2 and the HIV-1 RNA tests were used. HIV-1 and RNA HIV-2 were investigated using PCR. RESULTS LIA was used to evaluate 3,224 out of 10,591 samples with repeated ELISA reactivity (30%). We found that 32 (1%) of the sera, along with HIV1 bands and HIV2 gp36 bands, were positive. Only 28 of the 32 verified serum samples with gp36 bands were repeated, and no gp36 band positivity was detected using the Bio-Rad Geenius™ HIV-1/2 confirmatory assay in these serum samples. The HIV-2 proviral DNAs were also negative. Therefore, we excluded the possibility of HIV1+2 co-infection. All samples from the 32 patients were positive for HIV-1 RNA. CONCLUSION Our findings highlight the need to exclude confirmatory tests like the LIA test from the current diagnostic HIV algorithm and replace it with rapid HIV-1 and HIV-2 confirmatory immunochromotographic tests.
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Affiliation(s)
- Pelin Yuksel
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Medical Microbiology, Istanbul/Turkey
| | - Suat Saribas
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Medical Microbiology, Istanbul/Turkey
| | - Mert Kuskucu
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Medical Microbiology, Istanbul/Turkey
| | | | - Erdogan Kosan
- The Turkish Red Crescent Marmara Region Blood Center Laboratory, Istanbul/ Turkey
| | - Zafer Habip
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Medical Microbiology, Istanbul/Turkey
| | - Mehmet Demirci
- Beykent University Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Eda Salihoglu Kara
- Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ilhan Birinci
- The Turkish Red Crescent Marmara Region Blood Center Laboratory, Istanbul/ Turkey
| | - Reyhan Caliskan
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Medical Microbiology, Istanbul/Turkey
| | - Harika Oyku Dinc
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Medical Microbiology, Istanbul/Turkey
| | - Kenan Midilli
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Medical Microbiology, Istanbul/Turkey
| | - Tevhide Ziver
- East Mediterranean University, Health Sciences Faculty, Gazimagusa, North Cyprus
| | - Bekir Kocazeybek
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Medical Microbiology, Istanbul/Turkey
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Alagoz S, Kuskucu M, Gulcicek S, Yalin SF, Oruc M, Midilli K, Yılmaz E, Altiparmak MR, Seyahi N. The Frequency and Associated Factors for BK Virus Infection in a Center Performing Mainly Living Kidney Transplantations. Prog Transplant 2017; 27:152-159. [PMID: 28617169 DOI: 10.1177/1526924817699969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE BK virus (BKV) nephropathy has increasingly become an important cause of morbidity in renal transplant recipients. We evaluated the frequency and associated factors for BKV infection in a center performing mainly living donor transplantations over a long time period. METHODS One hundred consecutive renal transplant patients were included. Quarterly visits were planned to examine urine for decoy cells and to measure the BKV DNA in the blood and urine. Renal biopsy was performed in case of deteriorated allograft function. Serological examinations for BKV immunoglobulin G (IgG) were performed in donors. RESULTS Throughout the entire follow-up period, the rates of viruria, viremia, and the positivity of decoy cells were 12%, 6%, and 13%, respectively. The negative and positive predictive values of decoy cells were 93.1% and 69.2%, respectively, for viruria, and 99.2% and 45.5%, respectively, for viremia. Biopsy-proven BKV nephropathy was observed in 1 patient. The BKV IgG was positive in all living donors. Viruria and viremia were associated with deceased donor transplantation, acute rejection, and pulse steroid therapy. In addition, viremia was associated with antithymocyte globulin therapy and a short duration of the posttransplant period. CONCLUSIONS The frequency of BKV infection was lower in our transplant unit compared to previous reports. Reduced doses of immunosuppression seem to be the main factor that may explain the reduced frequency. However, an active screening strategy is still of importance for this patient group.
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Affiliation(s)
- Selma Alagoz
- 1 Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mert Kuskucu
- 2 Department of Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sibel Gulcicek
- 1 Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Serkan Feyyaz Yalin
- 1 Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Meric Oruc
- 1 Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Kenan Midilli
- 2 Department of Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Erkan Yılmaz
- 3 Tissue Typing Laboratory, Department of Organ Transplantation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- 1 Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nurhan Seyahi
- 1 Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Karakullukçu A, Kuşkucu MA, Ergin S, Aygün G, Midilli K, Küçükbasmaci Ö. Determination of clinical significance of coagulase-negative staphylococci in blood cultures. Diagn Microbiol Infect Dis 2017; 87:291-294. [DOI: 10.1016/j.diagmicrobio.2016.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/29/2016] [Accepted: 12/09/2016] [Indexed: 01/01/2023]
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Kepenekli Kadayifci E, Karaaslan A, Midilli K, Soysal A, Bakır M. First HIV-2 infection in a child in Turkey. J Infect Dev Ctries 2016; 10:1042-1044. [PMID: 27694740 DOI: 10.3855/jidc.7854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 05/27/2016] [Accepted: 06/03/2016] [Indexed: 10/31/2022] Open
Abstract
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Eren Dağlar D, Öngüt G, Çolak D, Özkul A, Mutlu D, Zeytinoğlu A, Midilli K, Gökahmetoğlu S, Günseren F, Öğünç D, Gültekin M. [Determination of cytomegalovirus glycoprotein B genotypes in different geographical regions and different patient groups in Turkey]. MIKROBIYOL BUL 2016; 50:53-62. [PMID: 27058329 DOI: 10.5578/mb.10880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cytomegalovirus (CMV), a common virus found all around the world, usually causes asymptomatic infections in immunocompetent hosts, however it may lead to serious complications in immunodeficient patients and in the fetus. CMV is divided into four genotypes according to the polymorphisms in UL55 gene that encodes for envelope glycoprotein B. Nucleotide polymorphisms of CMV gB gene can affect the cell tropism of the virus and host immune response and believed to have important changes in the pathogenesis of CMV. The aim of this study was to determine the gB genotypes of CMV isolates from different patient groups selected from different regions of Turkey. A total of 136 clinical specimens from patients (66 female, 70 male; age range: 0-65 years, mean age: 24.03 ± 17.17) who were diagnosed to have CMV infection by polymerase chain reaction (PCR) and/or antigenemia tests, between 2001-2014, in the medical school hospitals of Akdeniz, Ege, Istanbul Cerrahpasa and Erciyes Universities (located at Mediterranean, Aegean, northwest and central Anatolia regions, respectively), were included in the study. The patient group consisted of 80 renal transplant (RT) recipients, 35 stem cell transplant (SCT) recipients, 13 newborns, seven heart transplant (HT) recipients and one pregnant woman. CMV gB genotypes were determined by PCR-RFLP (restriction fragment length polymorphism) method, and DNA sequencing and phylogenetic analysis were performed for the randomly selected 15 isolates with different genotypes. Among 136 (135 plasma, 1 amnion fluid) samples, the most frequent genotype was gB1 (n= 44, 32.4%), followed by gB2 (n= 39, 28.6%), gB3 (n= 36, 26.5%) and gB4 (n= 8, 5.9%); however nine (6.6%) samples could not be genotyped. When analysis were interpreted according to the patient groups, it was determined that the genotypes in RT recipients were gB1 32.3%, gB2 28.7%, gB3 26.5% and gB4 5.9%; in SCT recipients gB1 34.3%, gB2 28.6%, gB3 22.9% and gB4 5.7%; in HT recipients gB3 57.1%, gB1 14.3% and gB2 14.3%; in newborns gB1 38.4%, gB3 30.8%, gB2 15.4% and gB4 7.7%, and gB2 genotype in the pregnant woman. As our study was a descriptive study to determine the genotypes of CMV gB, the relationship between the genotypes and the variants such as viral load, symptomatic disease and prognosis were not analyzed. As a result, the isolation of different gB genotypes in various case groups from four distinctive provinces, underlines the diversity of CMV gB genotypes in Turkey.
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Affiliation(s)
| | | | - Dilek Çolak
- Akdeniz University Faculty of Medicine, Department of Medical Microbiology, Antalya, Turkey.
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Yuksel P, Caliskan R, Kuskucu M, Islak Mutcali S, Kosan E, Kırkoyun Uysal H, Habip Z, Abdelkerem A, Mete B, Saribas S, Bonabi E, Birinci I, Dinc O, Midilli K, Kocazeybek B. Current problems in serologically based diagnostic algorithm of HIV 1/2: The re-evaluation of immunodot blot assays in HIV 1/2 verification in Turkey. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bakir M, Engin A, Kuskucu MA, Bakir S, Gündag O, Midilli K. Relationship of plasma cell-free DNA level with mortality and prognosis in patients with Crimean-Congo hemorrhagic fever. J Med Virol 2016; 88:1152-8. [PMID: 26680021 DOI: 10.1002/jmv.24446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/09/2022]
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is a viral infection. Circulating plasma cell-free DNA (pcf-DNA) is a novel marker indicating cellular damage. So far, the role of pcf-DNA did not investigate in CCHF patients. In the current study, pcf-DNA levels were investigated in CCHF patients with different clinical severity grades to explore the relationship between circulating pcf-DNA level, virus load, and disease severity. Seventy-two patients were categorized as mild, intermediate, and severe based on severity grading scores. The pcf-DNA level was obtained from all participants on admission and from the survivors on the day of the discharge. The controls consisted of 31 healthy. Although the pcf-DNA level at admission was higher in patients than in the controls, the difference was not statistically significant (P = 0.291). However, at admission and in the convalescent period, the difference between pcf-DNA levels in mild, intermediate, and severe patient groups was significant. The pcf-DNA level in severe patients was higher than in the others. Furthermore, compared to survivors, non-survivors had higher pcf-DNA levels at admission (P = 0.001). A direct relationship was found between the pcf-DNA level and the viral load on the day of discharge in surviving patients. ROC curve analysis identified a pcf-DNA level of 0.42 as the optimal cut-off for prediction of mortality. The positive predictive value, negative predictive value, specificity, and sensitivity for predicting mortality was 100%, 72%, 100%, and 79%, respectively. In summary, our findings revealed that pcf-DNA levels may be used as a biomarker in predicting CHHF prognosis.
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Affiliation(s)
- Mehmet Bakir
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Aynur Engin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Mert Ahmet Kuskucu
- Department of Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sevtap Bakir
- Department of Biochemistry, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Omür Gündag
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Kenan Midilli
- Department of Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Altindis M, Dal T, Akyar I, Karatuna O, Gokahmetoglu S, Ulger ST, Kulah C, Uzun B, Şener AG, Ozdemir M, Aydogan S, Kuskucu MA, Midilli K, Otlu B, Celen MK, Buruk K, Guducuoglu H. Six-year distribution pattern of hepatitis C virus in Turkey: a multicentre study. BIOTECHNOL BIOTEC EQ 2015. [DOI: 10.1080/13102818.2015.1093430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Akın Belli A, Derviş E, Özbaş Gök S, Midilli K, Gargılı A. [Evaluation of 10 cases of Lyme disease presenting with erythema migrans in Istanbul, Turkey]. MIKROBIYOL BUL 2015; 49:525-531. [PMID: 26649410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Lyme disease (LD) is a tick-borne, multisystemic infection caused by Borrelia burgdorferi. Although variable rates of seropositivity for B.burgdorferi have been reported between 2% to 44% in Turkey, its actual prevalence is not well-understood. The aim of this retrospective study was to evaluate the characteristics of 10 cases of LD presenting as erythema migrans (EM) between 2009 and 2013 from Istanbul which is one of the metropolitan cities of Turkey. Of the patients, five were male and five were female, ages between 9-51 years (mean age: 34.5 years). Five of the patients were admitted in June, three in October, one in November and two in December and all have the history of tick bite in last 1-2 weeks. There were no clinical symptoms for systemic infection among the patients with normal level routine laboratory test (whole blood count and biochemical tests) results. Five of the cases had EM lesions in the trunk, three in the upper extremities, and two in the lower extremities. Four patients presented with annular, three with solitary macular, and three with target-like EM lesions. In all cases, the biopsy specimens were positive for B.burgdorferi sensu lato DNA with polymerase chain reaction and all were also positive in terms of B.burgdorferi IgM antibodies with ELISA. Nine patients were treated with oral doxycycline, 100 mg twice daily and one child patient was treated with oral amoxicillin 500 mg twice daily for 21 days. EM lesions disappeared within 2-4 weeks in all patients. There was no clinical evidence for systemic involvement in any of the patients like neurologic, cardiac, and joint involvement at the follow-ups on the third, sixth and 12(th) months. To our best knowledge, 10 patients in this study are the largest EM series reported from Turkey. The increase in the number of LD cases may be associated with increased tick bite and increased awareness due to the emergence of concurrent Crimean-Congo hemorrhagic fever epidemic in Turkey. As a result, when enlarged erythematous lesions on the skin were observed, LH must also be considered in differential diagnosis, history of tick bite should be questioned and etiological diagnostic test should be performed.
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Affiliation(s)
- Aslı Akın Belli
- Mugla Sitki Kocman University Training and Research Hospital, Dermatology Clinic, Mugla, Turkey.
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Midilli K, Kuskucu MA, Mete B, Aydin OA, Ýmamova N, Tabak F. Emergence of E138 mutations among treatment naïve HIV-infected patients in Istanbul. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.07.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Alagoz S, Seyahi N, Kuskucu M, Midilli K, Yalin S, Gulcicek S, Trabulus S, Altiparmak MR. SP825BK VIRUS NEPHROPATHY IN A CENTER PERFORMING MAINLY LIVING KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv202.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Celikbas AK, Dokuzoğuz B, Baykam N, Gok SE, Eroğlu MN, Midilli K, Zeller H, Ergonul O. Crimean-Congo hemorrhagic fever among health care workers, Turkey. Emerg Infect Dis 2015; 20:477-9. [PMID: 24564994 PMCID: PMC3944849 DOI: 10.3201/eid2003.131353] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated 9 cases of Crimean-Congo hemorrhagic fever (1 fatal, 2 asymptomatic) among health care workers in Turkey. Needlestick injuries were reported for 4 workers. Eight received ribavirin. In addition to standard precautions, airborne infection isolation precautions are essential during aerosol-generating procedures. For postexposure prophylaxis and therapy, ribavirin should be given.
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Sirekbasan L, Gönüllü N, Sirekbasan S, Kuşkucu M, Midilli K. Phenotypes and genotypes of macrolide-resistant streptococcus pneumoniae. Balkan Med J 2015; 32:84-8. [PMID: 25759777 PMCID: PMC4342144 DOI: 10.5152/balkanmedj.2015.15169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/23/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Macrolide resistance in Streptococcus pneumoniae (S. pneumoniae) is a worldwide problem. AIMS The aim of this work was to analyze the phenotypes, genotypes, and clonal relatedness among macrolide-resistant S. pneumoniae strains isolated from various clinical specimens in our hospital. STUDY DESIGN Cross-sectional study. METHODS 80 non-duplicate S. pneumoniae strains were analyzed by polymerase chain reaction for both the erm (B) and mef (A) genes. RESULTS Macrolide resistance was observed in 22.5% (18 strains) of strains. Two (11.2%) isolates possessed mef (A), eight possessed erm (B) (44.4%) and eight strains (44.4%) were positive for both erm (B) and mef (A) genes. Although BOX-PCR of 18 macrolide-resistant strains revealed 11 band patterns, they clustered as seven clones with a genetic distance >10% to each other. Eight isolates possessed both erm (B) and mef (A) genes and belonged to a single clone (44.44% of all macrolide-resistant strains). CONCLUSION Increased positivity rates for both resistance genes have also been reported from other hospitals in Turkey, but this is the first study from Turkey showing the clonal dissemination of both resistance genes.
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Affiliation(s)
- Leyla Sirekbasan
- Department of Microbiology and Clinical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Nevriye Gönüllü
- Department of Microbiology and Clinical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Serhat Sirekbasan
- Department of Microbiology and Clinical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Mert Kuşkucu
- Department of Microbiology and Clinical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Kenan Midilli
- Department of Microbiology and Clinical Microbiology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
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Şimşek-Yavuz S, Şensoy A, Kaşıkçıoğlu H, Çeken S, Deniz D, Yavuz A, Koçak F, Midilli K, Eren M, Yekeler İ. Infective endocarditis in Turkey: aetiology, clinical features, and analysis of risk factors for mortality in 325 cases. Int J Infect Dis 2014; 30:106-14. [PMID: 25461657 DOI: 10.1016/j.ijid.2014.11.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/03/2014] [Accepted: 11/07/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE In order to define the current characteristics of infective endocarditis (IE) in Turkey, we evaluated IE cases over a 14-year period in a tertiary referral hospital. METHODS All adult patients who were hospitalized in our hospital with a diagnosis of IE between 2000 and 2013 were included in the study. Modified Duke criteria were used for diagnosis. The Chi-square test, Student's t-test, Mann-Whitney U-test, Cox and logistic regression analysis were used for the statistical analysis. RESULTS There were 325 IE cases during the study period. The mean age of the patients was 47 years. Causative microorganisms were identified in 253 patients (77.8%) and included staphylococci (36%), streptococci (19%), enterococci (7%), and Brucella spp (5%). A streptococcal aetiology was associated with younger age (<40 years) (p=0.001), underlying chronic rheumatic heart disease (CRHD) (odds ratio (OR) 3.89) or a congenital heart defect (OR 4.04), community acquisition (OR 17.93), and native valve (OR 3.68). A staphylococcal aetiology was associated with healthcare acquisition (OR 2.26) or pacemaker lead-associated endocarditis (OR 6.63) and an admission creatinine level of >1.2mg/dl (OR 2.15). Older age (>50 year) (OR 3.93), patients with perivalvular abscess (OR 9.18), being on dialysis (OR 6.22), and late prosthetic valve endocarditis (OR 3.15) were independent risk factors for enterococcal IE. Independent risk factors for mortality in IE cases were the following: being on dialysis (hazard ratio (HR) 4.13), presence of coronary artery heart disease (HR 2.09), central nervous system emboli (HR 2.33), and congestive heart failure (HR 2.15). Higher haemoglobin (HR 0.87) and platelet (HR 0.996) levels and surgical interventions for IE (HR 0. 33) were found to be protective factors against mortality. CONCLUSIONS In Turkey, IE occurs in relatively young patients and Brucella spp should always be taken into consideration as a cause of this infection. We should first consider streptococci as the causative agents of IE in young patients, those with CRHD or congenital heart valve disease, and cases of community-acquired IE. Staphylococci should be considered first in the case of pacemaker lead IE, when there are high levels of creatinine, and in cases of healthcare-associated IE. Enterococci could be the most probable causative agent of IE particularly in patients aged >50 years, those on dialysis, those with late prosthetic valve IE, and those with a perivalvular abscess. The early diagnosis and treatment of IE before complications develop is crucial because the mortality rate is high among cases with serious complications. The prevention of bacteraemia with the measures available among chronic haemodialysis patients should be a priority because of the higher mortality rate of subsequent IE among this group of patients.
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Affiliation(s)
- Serap Şimşek-Yavuz
- Istanbul University, Istanbul Medical Faculty, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey.
| | - Ayfer Şensoy
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey
| | - Hulya Kaşıkçıoğlu
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Cardiology Department, Istanbul, Turkey
| | - Sabahat Çeken
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey
| | - Denef Deniz
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey
| | - Atilla Yavuz
- Kartal Lutfi Kırdar Research and Education Hospital, Cardiology Department, Istanbul, Turkey
| | - Funda Koçak
- Basaksehir State Hospital, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey
| | - Kenan Midilli
- Istanbul University, Cerrahpasa Medical Faculty, Microbiology Department, Istanbul, Turkey
| | - Mehmet Eren
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Cardiology Department, Istanbul, Turkey
| | - İbrahim Yekeler
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
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Ziver T, Balci A, Ergin S, Gode S, Kuskucum M, Torlak Z, Yuksel P, Tokman HB, Ipek G, Tireli E, Midilli K, Yekeler I, Kiraz N, Kocazeybek B. The role of Porphyromonas gingivalis in the development of atherosclerosis and its relationship with fim A genotype. Clin Lab 2014; 60:1225-32. [PMID: 25134394 DOI: 10.7754/clin.lab.2013.130825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Porphyromonas gingivalis, a major periodontal pathogen, is gaining increasing attention for its possible association with atherosclerosis. Its fimbriae are classified into six genotypes (Types I-V, Ib) based on the diversity of the fim A genes encoding the fimbrial subunits. In this study, fim A genotype's distribution of P. gingivalis was analyzed in atherosclerotic plaque specimens. METHODS A total of 50 atherosclerotic plaque specimens and 50 non-atherosclerotic, post stenotic aneurysm specimens were collected from patients undergoing cardiovascular surgery. Bacterial DNA was also extracted from each specimen, as real-time PCR was carried out with P. gingivalis-specific primer sets. The positive specimens of P. gingivalis were further analyzed to discriminate the fim A genotype using real-time and nested PCR methods. RESULTS P. gingivalis was detected only in one atherosclerotic plaque; however, the genotype was nontypable in this specimen. CONCLUSIONS We state that it is not easy to show a significant relationship between P. gingivalis, its fim A genotype, and atherosclerosis. We suggest that new extended studies based especially upon the quantitave determination of P. gingivalis and its genotype distribution on atherosclerotic specimens are needed to show an evident relationship between atherosclerosis and P. gingivalis.
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Ergönül Ö, Alan S, Ak Ö, Sargın F, Kantürk A, Gündüz A, Engin D, Öncül O, Balkan II, Ceylan B, Benzonana N, Yazıcı S, Şimşek F, Uzun N, Inan A, Gulhan E, Ciblak M, Midilli K, Ozyurt M, Badur S, Gencer S, Nazlıcan O, Özer S, Özgüneş N, Yıldırmak T, Aslan T, Göktaş P, Saltoğlu N, Fincancı M, Dokucu AI, Eraksoy H. Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults. BMC Infect Dis 2014; 14:317. [PMID: 24916566 PMCID: PMC4080987 DOI: 10.1186/1471-2334-14-317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/03/2014] [Indexed: 11/22/2022] Open
Abstract
Background The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. Methods This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. Results In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality. Conclusions Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.
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Affiliation(s)
- Önder Ergönül
- Department of Infectious Diseases and Clinical Microbiology, Koç University, School of Medicine, Istanbul, Turkey.
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Cekin Y, Yazisiz H, Kuskucu MA, Ongut G, Baysan BO, Kilinckaya H, Ogunc D, Midilli K, Ozen NS, Colak D. Evaluation of the BD Phoenix system for detection of methicilin resistance in Staphylococcus aureus isolates in comparison to BD GeneOhm MRSA assay. Clin Lab 2014; 60:863-7. [PMID: 24839833 DOI: 10.7754/clin.lab.2013.130726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In order to identify methicillin-resistant Staphylococcus aureus isolates quickly, automated and semiautomated systems, commercial media, and identification kits are widely used. The Phoenix system (BD, Sparks, MD, USA) has been available since 2004 in our laboratory. This study evaluated the reliability of the Phoenix system for the detection of methicillin resistance in Staphylococcus aureus isolates in comparison to BD GeneOhm MRSA assay (Becton Dickinson Diagnostics GeneOhm, CA, USA). METHODS A total of 206 clinically significant Staphylococcus aureus isolates, submitted to the clinical microbiology laboratory between March 2011 and May 2013, were included in the study. Phoenix panels were studied for identification and susceptibility testing according to manufacturers' instructions. The detection of MRSA was performed using the BD GeneOhm MRSA assay (Becton Dickinson Diagnostics GeneOhm, CA, USA). The assay is a qualitative real-time PCR method. RESULTS The Phoenix system results and mecA gene pozitivity were concordant for 134 methicillin-resistant and 71 methicillin-susceptible strains. One discordant isolate, identified as mecA negative by the PCR method, was methicillin-resistant Staphylococcus aureus positive by the Phoenix system (oxacilline MIC = 2 microg/mL; cefoxitin MIC = 8 microg/mL). In this study, Phoenix automated system's sensitivity, specificity, negative predictive value, and positive predictive value are found as 100%, 100%, 100%, and 100%, respectively. CONCLUSIONS As a result of our study, use of the Phoenix automated identification method for the detection of methicillin-resistant Staphylococcus aureus isolates is a practical and reliable approach for daily clinical laboratory procedures.
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Ziver T, Yuksel P, Balci A, Ergin S, Gode S, Kuskucu M, Torlak Z, Tokman HB, Ipek G, Tireli E, Midilli K, Yekeler I, Kiraz N, Kocazeybek B. The role of Porphyromonas gingivalis in the development of atherosclerosis and its relationship with fim A genotype. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Sahin F, Yıldız P, Kuskucu A, Kuskucu MA, Karaca N, Midilli K. The effect of CD14 and TLR4 gene polymorphisms on asthma phenotypes in adult Turkish asthma patients: a genetic study. BMC Pulm Med 2014; 14:20. [PMID: 24524443 PMCID: PMC3928321 DOI: 10.1186/1471-2466-14-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 02/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endotoxins stimulate T helper 1 cell maturation and send a negative signal to T helper 2 polarisation. This causes a decrease IgE levels and prevents atopy (Hygiene hypothesis). It is shown that this response is under genetic control by polymorphisms in CD14 and TLR4 genes in some researchs. We aimed to investigate the effects of genetic variants of CD14 (-) and TLR4 (Asp299Gly, Thr399Ile) genes on asthma phenotypes in adults with asthma. METHODS Asthma patients (n = 131) and healthy control cases (n = 75) were included in the study. Relations between CD14 C-159 T, TLR4 299 and TLR4 399 genotypes and duration of asthma history of allergic rhinitis-dermatitis, total IgE, eosinophil, skin prick test, forced expiratory volume 1 (FEV1) and severity of disease were evaluated. Real time PCR (RT-PCR) was used for genotyping. RESULTS For CD14-159, presence of the C allele (CC + CT) was more frequent among those with low median log (logarithm) IgE levels, but no statistically significant difference in all asthma group (p = 0.09). C allele was significantly correlated with low total IgE levels and T allele with high total IgE levels in atopics (p = 0.04). CC + CT genotype was more frequent in moderate and severe asthma group in atopics (p = 0.049). TLR4 299 and TLR4 399 genotypes and asthma phenotypes were not found to be significantly correlated (p > 0.05). CONCLUSIONS Total IgE levels were found to be low among patients with the CC + CT genotype, and high among patients with the TT genotype contrary to the results of many other studies, which is therefore an important finding. Another important finding was that the C allele is a risk factor for moderate and severe asthma.
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Affiliation(s)
- Füsun Sahin
- Department of Chest Diseases, Yedikule Chest Diseases and Surgery Training and Research Hospital, Zeytinburnu/İstanbul, 34760, Turkey.
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Aygun G, Midilli K, Cilingir H, Yilmaz M, Kutukcu A, Eker E. A fatal case of urosepsis due to Corynebacterium riegelii. Braz J Microbiol 2013; 44:475-6. [PMID: 24294241 PMCID: PMC3833147 DOI: 10.1590/s1517-83822013000200022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 09/10/2012] [Indexed: 11/22/2022] Open
Abstract
Corynebacterium species other than Corynebacterium diphtheriae rarely cause infections in human but rather reside in flora, however they have been reported to cause opportunistic infections in both immunocompromised and immunecompetent patients. Here we report for the first time a case of an elderly female patient presenting with a fatal urosepsis caused by a recently defined pathogen, Corynebacterium riegelii, identified on second day after patient hospitalization leading to a progressive worsening and death of the patient on 6th day.
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Affiliation(s)
- Gokhan Aygun
- Istanbul University, Cerrahpasa Medical Faculty, Microbiology and Clinical Microbiology Department, Istanbul, Turkey
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Görgün D, Seçik F, Midilli K, Akkaya V, Yıldız P. Diagnostic and prognostic significance of survivin levels in malignant pleural effusion. Respir Med 2013; 107:1260-5. [DOI: 10.1016/j.rmed.2013.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 02/26/2013] [Accepted: 04/09/2013] [Indexed: 12/16/2022]
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Midilli K, Erkılıç A, Kuşkucu M, Analay H, Erkılıç S, Benzonana N, Yıldırım MS, Mülayim K, Acar H, Ergonul O. Nosocomial outbreak of disseminated orf infection in a burn unit, Gaziantep, Turkey, October to December 2012. Euro Surveill 2013; 18:20425. [DOI: 10.2807/ese.18.11.20425-en] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the first outbreak of nosocomial orf infection in a hospital burn unit in Gaziantep, Turkey. The outbreak lasted from October to December 2012 and involved a total of thirteen cases. It demonstrates the risk of introduction of orf virus to a burn unit, and the potential for extensive transmission among patients with compromised skin integrity. The importance of hygiene measures and infection control are highlighted and possible transmission routes of the virus discussed.
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Affiliation(s)
- K Midilli
- Istanbul University, Cerrahpaşa Medical School, Istanbul
| | - A Erkılıç
- Dr.Ersin Arslan Hospital, Gaziantep, Turkey
| | - M Kuşkucu
- Istanbul University, Cerrahpaşa Medical School, Istanbul
| | - H Analay
- Dr.Ersin Arslan Hospital, Gaziantep, Turkey
| | - S Erkılıç
- Gaziantep University, School of Medicine, Gaziantep, Turkey
| | - N Benzonana
- Dr.Lütfü Kırdar Research and Tranining Hospital, Istanbul, Turkey
| | | | - K Mülayim
- Dr.Ersin Arslan Hospital, Gaziantep, Turkey
| | - H Acar
- Dr.Lütfü Kırdar Research and Tranining Hospital, Istanbul, Turkey
| | - O Ergonul
- Koç University, School of Medicine, Istanbul, Turkey
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Ugras M, Vitrinel A, Yilmaz G, Midilli K, Ozkan F. Varicella gastritis in an immunocompetent child. J Clin Virol 2012; 56:153-5. [PMID: 23276431 DOI: 10.1016/j.jcv.2012.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/03/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
Abstract
The varicella zoster virus (VZV) is a very rare cause of gastritis. Gastritis caused by VZV can be presented as abdominal pain, vomiting. Most of the cases reported with varicella gastritis in the literature are immunocompromised patients with various kinds of malignancy, and most of these patients are adults. Here we report an adolescent girl with acute abdominal pain. The girl was immunocompetent. Her endoscopically taken biopsy material revealed varicella, and her gastritis was healed with acyclovir therapy. This is a very rare condition and not frequently reported in the literature. The authors want to drive attention to the fact that varicella gastritis can be seen in immunocompetent children, the presentation can be nausea, vomiting and/or (severe) abdominal pain. Serological studies may be less helpful than tissue studies, so interventional procedures should be done.
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Affiliation(s)
- Meltem Ugras
- Yeditepe University Hospital, Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul, Turkey.
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Gargili A, Palomar AM, Midilli K, Portillo A, Kar S, Oteo JA. Rickettsia species in ticks removed from humans in Istanbul, Turkey. Vector Borne Zoonotic Dis 2012; 12:938-41. [PMID: 22925016 DOI: 10.1089/vbz.2012.0996] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A total of 167 ticks collected from humans in Istanbul (Turkey) in 2006 were screened for Rickettsia species, and nested PCRs targeting gltA and ompA rickettsial fragment genes were carried out. Rickettsia monacensis (51), R. aeschlimannii (8), R. conorii subsp. conorii (3), R. helvetica (2), R. raoultii (1), R. africae (1), R. felis (1), and other Rickettsia spp. (2), were detected. To our knowledge, these Rickettsia species (except R. conorii) had never been reported in ticks removed from humans in Turkey. The presence of R. africae also had not been previously described, either in Hyalomma ticks or in any European tick species. In addition, R. aeschlimannii and R. felis had not been found associated with Rhipicephalus bursa specimens. The presence of human pathogenic Rickettsia in ticks removed from humans provides information about the risk of tick-borne rickettsioses in Turkey.
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Affiliation(s)
- Aysen Gargili
- Infectious Diseases Epidemiology Research Centre, Marmara University, Istanbul, Turkey
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Akçakaya N, Kiliç Ö, Camcioğlu Y, Çokuğraş H, Midilli K. Pediatric impact of the H1N1 pandemic in Istanbul. J Trop Pediatr 2012; 58:160-1. [PMID: 21680556 DOI: 10.1093/tropej/fmr055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Akçakaya N, Kılıç Ö, Camcıoğlu Y, Çokuğraş H, Midilli K. Pediatric non-influenza respiratory viruses during pandemic influenza. Influenza Other Respir Viruses 2011; 5:373-4. [PMID: 21668679 PMCID: PMC5780651 DOI: 10.1111/j.1750-2659.2011.00247.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gargili A, Midilli K, Ergonul O, Ergin S, Alp HG, Vatansever Z, Iyisan S, Cerit C, Yilmaz G, Altas K, Estrada-Peña A. Crimean-Congo Hemorrhagic Fever in European Part of Turkey: Genetic Analysis of the Virus Strains from Ticks and a Seroepidemiological Study in Humans. Vector Borne Zoonotic Dis 2011; 11:747-52. [DOI: 10.1089/vbz.2010.0030] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Aysen Gargili
- Infectious Diseases Epidemiology Research Center, Marmara University, Istanbul, Turkey
| | - Kenan Midilli
- Department of Microbiology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Onder Ergonul
- Department of Infectious Diseases, Marmara University School of Medicine, Istanbul, Turkey
| | - Sevgi Ergin
- Department of Microbiology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Hatice G. Alp
- Parasitology Laboratory, Pendik Veterinary Control and Research Institute, Istanbul, Turkey
| | - Zati Vatansever
- Parasitology Department, Kafkas University Faculty of Veterinary Medicine, Kars, Turkey
| | - Selma Iyisan
- Serology Laboratory, Pendik Veterinary Control and Research Institute, Istanbul, Turkey
| | - Cigdem Cerit
- Infectious Diseases Unit, Ministry of Health, Kırklareli Branch, Kırklareli, Turkey
| | - Gulden Yilmaz
- Department of Microbiology, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Kemal Altas
- Department of Microbiology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Agustin Estrada-Peña
- Parasitology Department, Zaragoza University Veterinary Faculty, Zaragoza, Spain
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Ozdemir N, Celkan T, Midilli K, Aygün G, Sinekbasan S, Kılıç O, Apak H, Camcıoğlu Y, Yıldız I. Novel influenza a (H1N1) infection in a Pediatric Hematology Oncology Clinic during the 2009-2010 pandemia. Pediatr Hematol Oncol 2011; 28:288-93. [PMID: 21413832 DOI: 10.3109/08880018.2010.550986] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pandemic influenza A infection (2009 H1N1) was associated with a worldwide outbreak of febrile respiratory infection. Although usually it results in a mild illness, certain patient groups are at increased risk for complications. The authors reviewed their experience in a pediatric hematology-oncology unit to determine the outcome of this disease in children with hematological conditions and solid tumors. During the second outbreak (1 November 2009 to 14 January 2010), a total of 187 children from pediatric clinic were tested for H1N1 influenza A by multiplex polymerase chain reaction (PCR), 63 of them were positive. Patients' signs and symptoms were recorded prospectively. Ten (35.7%) (5 children with solid tumors, 4 with leukemia, 1 with hereditary spherocytosis) of 28 tested children with hematological conditions were diagnosed with 2009 H1N1 influenza infection. Fever (100%) and cough (90%) were the most common symptoms. Five were neutropenic (neutrophil count <1000/mm(3)), 4 had severe neutropenia (neutrophil count <500/mm(3)). Systemic antibiotics were given in 5 patients with the diagnosis of febrile neutropenia. Four were inpatients, others were hospitalized after the diagnosis. One patient required mechanical ventilation; however, he had concomitant invasive fungal infection. Eight patients were treated by oseltamivir, all tolerated the drug well. A total of 4 cases from 9 cancer patients had a delay in their planned chemotherapy for 7 to 15 days. Pandemic H1N1 influenza caused mild symptoms in children with cancer and/or hematological conditions but resulted in delay in anticancer therapy and increase in hospitalization and antibiotic usage.
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Affiliation(s)
- Nihal Ozdemir
- Department of Pediatric Hematology-Oncology, Cerrahpaşa Medical Faculty, Istanbul, Turkey.
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Akçakaya AA, Sargin F, Erbil HH, Yazici S, Yaylali SA, Mesçi C, Ergin S, Midilli K. A cluster of acute-onset postoperative endophthalmitis over a 1-month period: investigation of an outbreak caused by uncommon species. Br J Ophthalmol 2010; 95:481-4. [PMID: 20733020 DOI: 10.1136/bjo.2009.177709] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To report the clinical course, treatment response and prognosis of eight cases which developed acute-onset postoperative endophthalmitis over a 1-month period. METHODS 8 patients who were operated on over a period of 1 month and developed acute postoperative endophthalmitis were evaluated. Five of the patients had cataract surgery, one had cataract surgery combined with silicone extraction, and two patients had pars plana vitrectomy (PPV). Clinical patterns were observed, intraocular cultures were obtained, and the source of the organisms causing the epidemic was investigated. All patients had intravitreal antibiotic injections, three had PPV, and in two patients anterior chamber irrigation was performed. RESULTS Vitreous cultures showed Cellulosimicrobium cellulans in three cases and Stenotrophomonas maltophilia in one case. Four of the cases were culture negative. Stenotrophomonas maltophilia were also isolated from unused bottles of irrigating solutions. The final visual acuity of the patients ranged between HM and 7/10. All three patients with Cellulosimicrobium cellulans had a final visual acuity of ≥ 5/10. The available irrigating solutions were changed, and the endophthalmitis did not recur. CONCLUSIONS The authors are unaware of any previous reports of postoperative endophthalmitis associated with Cellulosimicrobium cellulans. Prompt management with microbiological support, intravitreal antibiotics and PPV when needed were the key to good visual outcomes in this endophthalmitis outbreak.
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Midilli K, Yılmaz G, Türkoğlu S, Iskanova B, Ergin S, Yarımcam F, Ozdamar M, Gürol Y, Taştan Y, Altaş K. [Detection of human bocavirus DNA by polymerase chain reaction in children and adults with acute respiratory tract infections]. MIKROBIYOL BUL 2010; 44:405-413. [PMID: 21063990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Human bocavirus (HBoV) which was described in 2005 by molecular techniques, is a member of Parvoviridae. The role of HBoV is being questioned in acute respiratory diseases (ARD) in many recent studies. The aim of this study was to determine the presence of HBoV DNA in the respiratory specimens of patients with ARD. A total of 155 throat swab and/or washing specimens from 76 children and 79 adults with ARD were examined. HBoV DNA was investigated by single step in-house polymerase chain reaction (PCR) using NS1 primers (5-'TATGGCCAAGGCAATCGTCCAAG-3', 5'-GCC GCGTGAACATGAGAAA-CAG-3') which amplify the 290 base pair region of NS1 gene located between nucleotides 1545-1835 of prototype HBoV st1 strain. HBoV DNA was detected in 5 (6.5%) of 76 children and 2 (2.5%) of 79 adults. Three sequenced samples showed 100% homology with the reference sequences. This study in which HBoV DNA was detected in children and adults with ARD, is the first HBoV prevalence study in Turkey. Larger scale prospective clinical and molecular studies are required to explain the association between HBoV and respiratory disease.
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Affiliation(s)
- Kenan Midilli
- İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, İstanbul, Türkiye.
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Arslan F, Tabak F, Avşar E, Midilli K, Mert A, Ozaras R, Soysal T, Ozturk R, Ferhanoglu B. Ganciclovir-resistant cytomegalovirus encephalitis in a hematopoietic stem cell transplant recipient. J Neurovirol 2010; 16:174-8. [DOI: 10.3109/13550281003682539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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