HPV genotype distribution among women with normal and abnormal cervical cytology in Turkey / Distribución del genotipo del VPH en mujeres con citología cervical normal y anormal en Turquía

OBJECTIVES: The aim of this study was to determine the human papillomavirus (HPV) genotype distribution and to investigate the relationship between HPV genotypes and cervical cytology in women with HPV infection. MATERIAL AND METHODS: In this study, 493 women who were admitted to the obstetrics clinic between 2007 and 2015 years and had HPV positivity were examined retrospectively. RESULTS: The median age of women included in the study was 37.3 +/-10.6. The positivity of single and multiple HPV genotypes was 64.1% and 35.9%, respectively. HPV16 was the most common genotype in women with normal and abnormal cytology. The incidence of atypical squamous cells of undetermined significance (chi-square:8.32 p = 0.04) and high-grade squamous intraepithelial lesion (chi-square:13.75 p < 0.001) with HPV16 was significantly higher than in other HPV genotypes. In additional, abnormal cytology results in the group 1 (included HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and group 4 (included HPV40, 42, 54, 55, 61, 62, 81, 83, 84) were significantly higher than other groups (chi-square:23.15 p < 0.001). CONCLUSIONS: Group 1 genotype ratios were found to be quite high among women with abnormal cytology and women with normal cytology. For this reason, close follow-up is very important in addition to cytological findings along with genotyping, especially from an early age. We were found that multiple HPV infection was not related to the grades of cytological abnormalities. Although abnormal cytology results in group 4 were significantly higher than the other groups, it was not possible to comment on the relationship between these genotypes and cervical cancer since more than one HPV genotype was found in most of these women

OBJETIVOS: El objetivo de este estudio fue determinar la distribución del genotipo del virus del papiloma humano (VPH) e investigar la relación entre los genotipos del VPH y la citología cervical en mujeres con infección por VPH. MATERIAL Y MÉTODOS: En este estudio, 493 mujeres que ingresaron en la clínica de obstetricia entre los años 2007 y 2015, y que presentaron VPH positivo fueron examinadas retrospectivamente. RESULTADOS: La edad media de las mujeres incluidas en el estudio fue de 37,3 +/- 10,6. La positividad de los genotipos de VPH individuales y múltiples fue de 64,1% y 35,9%, respectivamente. VPH16 fue el genotipo más común en mujeres con citología normal y anormal. La incidencia de células escamosas atípicas de importancia indeterminada (chi-cuadrado: 8,32 p: 0,04) y lesión intraepitelial escamosa de alto grado (chi-cuadrado: 13,75 p <0,001) con VPH16 fue significativamente mayor que en otros genotipos de VPH. Además, los resultados citológicos anormales en el grupo 1 (incluido VPH 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) y el grupo 4 (incluido el VPH 40, 42, 54, 55, 61, 62, 81, 83, 84) fueron significativamente más altos que en otros grupos (chi-cuadrado: 23,15 p <0,001). CONCLUSIONES: Se encontró que las proporciones de genotipos del grupo 1 fueron bastante altas entre las mujeres con citología anormal y las mujeres con citología normal. Por esta razón, el seguimiento cercano es muy importante además de los hallazgos citológicos junto con el genotipado, especialmente desde una edad temprana. Se encontró que la infección múltiple por VPH no estaba relacionada con los grados de anomalías citológicas. Aunque los resultados anormales de la citología en el grupo 4 fueron significativamente superiores a los otros grupos, no fue posible valorar la relación estos genotipos y el cáncer cervical ya que se encontró más de un genotipo de VPH en la mayoría de estas mujeres

Is Toxoplasma gondii infection protective against multiple sclerosis risk?

BACKGROUND: Parasitic infections may play a protective role in neurodegenative diseases. OBJECTiVE: To determine the association between Toxoplasma gondii (T. gondii) infection and Multiple Sclerosis (MS). METHODS: One hundred fifteen patients with MS were included in the study. Sixty age and gender-matched healthy subjects were recruited as controls. Subjects were assessed for clinical and demographic parameters. The presence of specific IgG antibodies against T. gondii microorganism was searched by using an enzyme immunoassay test in the sera of the subjects. RESULTS: T. gondii seropositivity was found to be lower in MS patients than in healthy controls (33.9% vs. 55%, p=0.007). Mean age and disease duration of the patients were 41.15±11.20 (18-74) and 1.90±1.44 (0-6) years, respectively. MS patients with a high IgG titer had lower expanded disability status scale (EDSS) scores (p=0.001) and lower annualized relapse rates (ARR) (p=0.005). There was no significant association between T. gondii seropositivity and disease duration (p=0.598). Female MS patients tended to have higher T. gondii seropositivity than males although the difference did not reach statistical significance (p=0.192). We found a negative correlation between T. gondii seropositivity and both EDSS scores (r=-0.322, p<0.001) and ARR (r=-0.263, p=0.004). CONCLUSiON: We found a negative association between T. gondii infection and the presence of MS. Furthermore, parasite infected MS patients had experienced fewer relapses with lower disability scores supporting the hypothesis of immunomodulatory effects of parasitic infections in autoimmune diseases. Further studies are required to establish the protective role of parasitic infections in MS.

Evaluation of laboratory diagnosis for cutaneous tuberculosis.

BACKGROUND AND AIM: Cutaneous tuberculosis (CTB) is still difficult to diagnose due to its varied clinical presentation and limitations of diagnostic methods. The aim of this study was to evaluate the results of diagnostic laboratory tests available for CTB. MATERIALS AND METHODS: Twenty-six skin biopsy specimens belonging to clinically suspected cases of CTB were studied retrospectively. The specimens were divided into two portions, one part processed for histopathological evaluation and the other was used for microscopy and inoculation for the isolation of mycobacteria. Polymerase chain reaction (PCR) technique was applied to 14 of 26 specimens to detect Mycobacterium tuberculosis complex (MTBC) DNA. RESULTS: Of the 26 biopsy specimens, 11 were confirmed as CTB by identification of MTBC in culture and/or histopathologic affirmation. Of these, four were lupus vulgaris, four were TB verrucosa cutis, one was scrofuloderma, one was primary inoculation TB, and one was periorifical CTB. Culture for mycobacteria was positive for five (45.45%) specimens, while histopathologic affirmation was obtained in ten (90.90%) specimens. Acid-fast Bacilli were not demonstrated in any of the specimens on microscopic examination. The PCR was found to be applied to six of the 11 specimens diagnosed as CTB and was positive in two specimens (33.3%), which were positive for growth in culture and histopathological correlation. CONCLUSION: The recovery rate of MTBC from biopsy specimens was found to be satisfactory for CTB with histopathological correlation, but the combination of culture with a rapid method, PCR, may improve the diagnostic rate.

Primary inoculation tuberculosis: a report of a rare entity.

Primary inoculation tuberculosis is an exogenous infection resulting from direct inoculation of bacteria into individuals with no acquired immunity to the organism. We report a 63-year-old male patient who was diagnosed with primary inoculation tuberculosis on the basis of clinical appearance and histopathological examination. The findings from this case emphasize the importance of clinical and histopathological findings in this rarely seen form of skin tuberculosis if the organism cannot be shown to grow in culture.

Primary inoculation tuberculosis: a report of a rare entity

Primary inoculation tuberculosis is an exogenous infection resulting from direct inoculation of bacteria into individuals with no acquired immunity to the organism. We report a 63-year-old male patient who was diagnosed with primary inoculation tuberculosis on the basis of clinical appearance and histopathological examination. The findings from this case emphasize the importance of clinical and histopathological findings in this rarely seen form of skin tuberculosis if the organism cannot be shown to grow in culture.

Frequency of dense fine speckled pattern in immunofluorescence screening test.

OBJECTIVE: The presence of antinuclear antibodies (ANA), directed against intracellular antigens, is a distinctive feature of systemic autoimmune rheumatic diseases (SARDs). The standard test for antinuclear antibody screening is the indirect immunofluorescence (IIF). Anti-dense fine speckled 70 (anti-DFS70) antibodies were initially identified as an ANA IIF pattern from a patient with interstitial cystitis, but they were later associated with various other conditions. The objective of the study was to determine the frequency of anti-DFS70 antibodies in a cohort of patients undergoing routine ANA testing. MATERIAL AND METHODS: From January 2011 to January 2012, a total of 5800 serum samples were screened for ANA by IIF (Euroimmune AG, Lübeck, Germany). DFS pattern was searched. RESULTS: ANA were present in 1302 (22.4%) of all patients. There were 16 (1.2%) anti-DFS70 antibody-positive patients. The number of females and males who have anti-DFS70 antibody was eleven and five, respectively. All of the samples presented a titer of ≥1/320. There was one patient with SARD from the rheumatology department. Another 15 patients were from gastroenterology, endocrinology, and general internal medicine. CONCLUSION: Although a distinctive clinical association has not been reported, anti-DFS70 have been proposed as a significant biomarker for the exclusion of SARD. The present study is a preliminary study. There is a need for a reliable assay to ensure reactivity to DFS70 and screening large populations.

Evaluation of antinuclear antibodies by indirect immunofluorescence and line immunoassay methods': four years' data from Turkey.

The presence of antinuclear antibodies (ANAs), directed against intracellular antigens, is a hallmark of systemic autoimmune rheumatic diseases. The indirect immunofluorescence (IIF) assay is among the most commonly used routine methods for ANA detection as the screening test. The objective of the study was to evaluate ANA patterns in a 4-year period retrospectively. All 19 996 serum samples that were sent to the Laboratory of Medical Microbiology of the tertiary Hospital by any hospital department between 1 January 2009 and 1 January 2013 with a request to test for ANA, anti-ENA or both were included in the study. Of these samples, 4375 (21.9%) were ANA-IIF-positive and 15621 (78.1%) were ANA-IIF-negative. The presented ANA-positive samples consisted of 2392 (54.67%) homogenous, 818 (18.70%) speckled, 396 (9.05%) centromere, 242 (5.53%) nucleolar, 213 (4.87%) nuclear dots, 178 (4.07%) cytoplasmic (except for actin and golgi), 24 (0.55%) actin, 9 (0.21%) golgi, 53 (1.21%) nuclear membrane and 50 (1.14%) mixed pattern. Totally 7800 samples were examined by LIA. Of these samples, 3440 were positive and 4307 were negative with IIF and LIA. In addition, 22 samples were detected as IIF-positive but LIA-negative, whereas the rest 31 samples were IIF-negative but LIA-positive. ANA patterns in 22 IIF-positive samples were homogenous (9), speckled (5), golgi (4), cytoplasmic (3) and nucleolar (1). SSA/Ro-52, SSB/La and Scl-70 positivity were detected in 31 IIF-negative/LIA-positive samples by LIA. The present study comes forward with its overall scope, which covers 4-year data obtained in tertiary hospital located in the western part of Turkey.

Evaluation of hepatitis delta virus (HDV) infection in blood donors in western Turkey.

BACKGROUND: Hepatitis B virus (HBV) and hepatitis delta virus (HDV) infections are potentially dangerous complications of transfusion therapy. OBJECTIVE: The aim of this study was to determine the prevalence of HDV markers examined by serological and molecular methods in hepatitis B surface antigen (HBsAg)-reactive sera among blood donors. MATERIALS AND METHODS: Samples from 88 HBsAg-reactive blood donors were investigated for total anti-delta antibody (anti-HDV) and HDV-RNA between April 2010 and February 2011. HBsAg screening tests were performed by "microparticle enzyme immunoassay" (MEIA) method using the AxSYM system (Abbott Laboratories, USA), and total anti-delta antibody tests were performed by MEIA method using the Alisei system (Radim, Italy). HDV-RNA was quantified using the polymerase chain reaction (PCR) method. Viral nucleic acid isolation system (Anatolia Geneworks) was used with Bosphore HDV quantification kit. RESULTS: HBsAg reactivity was determined as 1% (124/12.423) among blood donors as a whole. Eighty-eight of these 124 samples were investigated further for HDV. Three (3.4%) of the 88 HBsAg-reactive serum samples were total anti-delta antibody-reactive. Of the 3 anti-HDV-reactive sera, 2 were reactive for HDV-RNA. Therefore, HDV-RNA reactivity was determined as 2.3% (2/88) in HBsAg-reactive donors as a whole. The 2 HDV-RNA-reactive donors were brothers. CONCLUSIONS: Investigation of HDV is important because HBV infection is endemic in Turkey. Intrafamilial transmission is important in HDV transmission.

[Comparison of Cefoxitin Disk Diffusion Test, Automated System and Chromogenic Medium for Detection of Methicillin Resistance in Staphylococcus aureus Isolates]. / Staphylococcus aureus Suslarindaki Metisilin Direncinin Belirlenmesinde Sefoksitin Disk Difüzyon Testi, Otomatize Sistem ve Kromojenik Besiyerinin Karsilastirilmasi

The mecA gene is responsible for the development of methicillin resistance in staphylococci however accurate detection of methicillin resistance is not feasible evermore because of heterogenous expression of mecA gene. Although mecA gene determination by polymerase chain reaction (PCR) is considered as the gold standard method, molecular tests are not easily applied in all routine laboratories. Thus, for the rapid and accurate diagnosis of MRSA strains, easy and practical phenotypic tests are still required. This study was aimed to compare the performance of mecA gene analysis by gel bases multiplex PCR with dual primer (Seeplex, Seegene Inc, Korea), cefoxitin disc diffusion method (30 µg, Oxoid, UK), automated system (Phoenix 100, Becton Dickinson, USA) and chromogenic medium CHROMagar MRSA (CHROMagar Microbiology, Salubris, Turkey) for the detection of methicillin resistance in staphylococci. It was found that 60 of the 98 Staphylococcus aureus strains carried the mecA gene. Methicillin resistance was observed by cefoxitin disc diffusion test in 59 isolates, by automated system in 61 isolates, and by CHROMagar MRSA in 65 isolates. When mecA gene analysis was considered as the reference method, the sensitivity, specificity, positive and negative predictive values of the tests that were used for the detection of methicillin resistance were found as 98.3%, 100%, 100% and 97.4% for cefoxitin disc diffusion (CDD) method; 100%, 97.4%, 98.4% and 100% for automated system; 96.7%, 81.6%, 89.2% and 93.9% for chromogenic medium CHROMagar MRSA, respectively. The highest sensitivity and negative predictive values were obtained by the automated system, and the highest specificity and positive predictive values were obtained by the CDD test. Although the sensitivity of chromogenic medium was found to be similar with the CDD test at the end of 48 hours, the specificity of chromogenic medium was lower than the other tests at the end of each incubation period. Likewise, positive and negative predictive values of the chromogenic medium were determined low compared to other tests. In laboratories that cannot perform molecular analysis, the determination of methicillin resistance should be done by the CDD test which is known to be a better inducer of the mecA gene expression of staphylococci. Determination of minimum inhibitory concentration (MIC) with automated systems can be the second choice especially in laboratories with intensive work loads. As a result chromogenic media can be particularly used for screening in laboratories that have a heavy workload and insufficient personnel number. However, due to its low specificity and the possibility of false positive results, it was recommended that positive strains should be confirmed by other methods such as disc diffusion or microdilution.

[Linezolid-resistant Enterococcus faecium: the first G2576T mutation in Turkey]. / Linezolide Dirençli Enterococcus faecium: Türkiye'deki Ilk G2576T Mutasyonu.

Linezolid which is the first member of oxazolidinone class of synthetic antimicrobial agents, was licensed for the treatment of gram-positive coccal infections in Turkey in 2006. In recent years, multidrug-resistant pathogens, especially vancomycin-resistant enterococci (VRE), have emerged rapidly worldwide and linezolid exhibited good clinical efficacy against VRE. However, linezolid-resistant bacteria have been reported from Turkey. In April 2011, a 66-year-old paraplegic woman was admitted to our hospital because of an infected decubitis ulcer and empirical antibiotic therapy was started. Since the patient's condition worsened during treatment, she was moved to the intensive care unit. Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium were recovered from tracheal aspirates and blood, respectively. Following three weeks of linezolid therapy blood culture yielded linezolid and vancomycin resistant E.faecium. Linezolid resistance in the VRE strain was confirmed by polymerase chain reaction and sequence analysis, subsequently. Linezolid-resistant two isolates were identified as E.faecium by 16S rRNA sequencing and both isolates had G2576U mutation in 23S rRNA gene. Linezolid resistance which was identified in a vancomycin-resistant E.faecium isolate is a new problem for Turkey. Last year another mutation related to linezolid resistance was reported from Istanbul, Turkey. The isolate had G2576T mutated 23S rRNA genes. Resistance should be considered and closely followed-up during linezolid treatment.

Infection and autoimmune disease.

Most infectious agents, such as viruses, bacteria and parasites, can trigger autoimmunity via different mechanisms. The development of an autoimmune disorder after infection tends to occur in genetically susceptible individuals. Some parameters, such as genetic predisposition, feature of the infectious agent and sometimes protective effect of the infections, have a significant role in this process. These parameters and various pathogens that could lead to enhancement or exacerbation of autoimmune disease were examined in this review. Recent studies were reviewed from a microbiological perspective.

[In vitro activity of daptomycin against methicillin-resistant Staphylococcus aureus strains isolated from blood cultures]. / Daptomisinin Kan Kültürlerinden Izole Edilen Metisiline Dirençli Staphylococcus aureus Suslarina In Vitro Etkinligi.

The aim of this study was to detect the in vitro activity of daptomycin against methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from blood cultures at Ataturk Training and Research Hospital, Izmir, Turkey between 2006-2010. A total of 64 MRSA clinical isolates were included in the study, and daptomycin susceptibility were investigated by E-test (AB bioMerieux, Sweden). The identification of the MRSA isolates was based on conventional microbiological methods and an additional automated identification system (Phoenix 100, BD Diagnostic Systems, USA). Etest strips were applied to the surface of Mueller-Hinton agar plates and incubated at 35°C in ambient air for 18 to 24 hours. Strains with a MIC value of ≤ 1 µg/ml were accepted as susceptible to daptomycin. In our study all of the 64 MRSA isolates were found susceptible to daptomycin (MIC ≤ 1 µg/ml). The MIC50, MIC90 and MIC ranges were detected as 0.125, 0.5 and 0.125-0.5 µg/ml, respectively. Only a single isolate yielded MIC value of 1 µg/ml. As a result daptomycin was found to be very active against MRSA strains in vitro. Our findings suggested that daptomycin might be a suitable alternative agent for treating bacteremia caused by MRSA. However, further large-scaled studies and clinical trials are necessary to support these in vitro data.

Comparison of various surgical methods in the treatment of implant-related infection.

The treatment of implant-related infections is troublesome. This study was conducted to compare the effectiveness of three different surgical modalities in the treatment of implant-related infection. A total of 32 Wistar albino rats were randomised into four groups after the establishment of implant-related infection: no treatment, surgical débridement, antibiotic-loaded bone cement and antibiotic-loaded autogenous bone. Microbiological colony counts were made at the sixth week in order to evaluate the effectiveness of of the treatments. The antibiotic-loaded bone cement group revealed superior results compared with the other groups in terms of reduction of microbiological colonies. Three animals in the bone cement group revealed extensive infection. Although antibiotic-loaded bone cement showed superiority over other treatment modalities, it should be employed after an unsuccessful trial of débridement because of the risk of extensive infection.

Evaluation of Epstein-Barr virus antibodies, anti-VCA avidity by immunofluorescence and immunoblot assays for assessment of Epstein-Barr virus immunologic state.

Three hundred twenty two serum samples were evaluated by indirect immunofluorescence assay (IFA) and immunoblotting for the assessment of the immunologic status of Epstein-Barr virus (EBV). Serological profiles of 322 serum samples were classified by the IgM and IgG antibodies by the immunofluorescence assay as seronegative, acute infection, reactivation and past infection. Higher rates of seropositivity were determined in serum samples belonging to old age groups. Routine tests used for EBV diagnosis were efficient.

[Investigation of the relationship between serum nitric oxide levels, HBV-DNA and ALT levels in chronic hepatitis B patients]. / Kronik hepatit B hastalarinda serum nitrik oksit düzeyi ile HBV-DNA ve ALT düzeyleri arasindaki iliskinin arastirilmasi.

It has been reported that increased nitric oxide (NO) production by the hepatocytes during chronic inflammatory processes, plays an important role in the pathogenesis of chronic hepatitis B. The aim of this study was to investigate the relationship between serum levels of NOx (nitrite + nitrate) with the viral load and alanine aminotransferase (ALT) levels in chronic hepatitis B (CHB) patients. A total of 93 CHB patients (67 male, 26 female; mean age: 47.3 +/- 10.9 years) and 53 healthy control subjects (17 male, 36 female; mean age: 58.6 +/- 2.1 years) followed-up during 2006-2007 period were included to the study. Hepatitis B virus (HBV) serologic markers, viral load and ALT levels were studied by chemiluminescence method (Ortho-Clinical Diagnostics, USA), by real-time polimerase chain reaction (PCR) (ABI PRISM 7700, Applied Biosystem, CA), and by Aeroset System (Abbott Laboratories, USA), respectively. NOx levels were determined by a method which was based on the reduction of nitrate to nitrite by cadmium. Mean levels of ALT and HBV-DNA of the patients were found as 98.7 +/- 138.4 IU/I and 1.6 x 10(9) +/- 4.0 x 10(9) copies/ml, respectively. In the evaluation of mean levels of NOx in patient and control groups, the difference was found statistically significant (30.6 +/- 21.7 micromol/l and 23.7 +/- 5.2 micromol/l, respectively; p< 0.05). In view of the relationship between the parameters, a positive correlation was detected between viral load and ALT levels (r= 0.768; p< 0.001), besides the significant correlations between NOx and viral load, and NOx and ALT (r= 0.346, p= 0.001 and r= 0.314, p= 0.002, respectively). As a result, although the NOx levels in chronic hepatitis patients were found higher than those in the control group, and significant correlations were detected between NO, viral load and ALT, the exact role of NO in the disease pathogenesis and outcome needs to be studied further at cellular level.

Evaluation of the results of Mycobacterium tuberculosis direct test (MTD) and Mycobacterial culture in urine samples

Tuberculosis remains a public health problem in Turkey. Rapid detection of Mycobacterium tuberculosis plays a key role in control of infection. In this article, the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD) was evaluated for detection of M. tuberculosis in urine samples. The performance of the MTD was very good and appropriate for routine laboratory diagnosis.

A tuberculose continua sendo um problema de saúde pública na Turquia. A detecção rápida de Mycobacterium tuberculosis tem um papel importante no controle da infecção. Nesse artigo, avaliou-se o Gen-Probe Amplified Mycobacterium Tuberculosis Test (MTD) para detecção de M. tuberculosis em amostras de urina. O desempenho do MTD foi muito bom e adequado para diagnóstico laboratorial de rotina.

Antimicrobial resistance in Campylobacter spp isolated from broiler flocks / Avaliação de resultados do Teste Direto para Mycobacterium tuberculosis (MTD) e da cultura para micobacterias em amostras de urina

Tuberculosis remains a public health problem in Turkey. Rapid detection of Mycobacterium tuberculosis plays a key role in control of infection. In this article, the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD) was evaluated for detection of M. tuberculosis in urine samples. The performance of the MTD was very good and appropriate for routine laboratory diagnosis.

A tuberculose continua sendo um problema de saúde pública na Turquia. A detecção rápida de Mycobacterium tuberculosis tem um papel importante no controle da infecção. Nesse artigo, avaliou-se o Gen-Probe Amplified Mycobacterium Tuberculosis Test (MTD) para detecção de M. tuberculosis em amostras de urina. O desempenho do MTD foi muito bom e adequado para diagnóstico laboratorial de rotina.

Lupus vulgaris in a pediatric patient: a clinicohistopathological diagnosis.

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 10-year-old boy who was diagnosed as lupus vulgaris clinically and histopathologically. He had well demarcated, irregularly bordered, pink, infiltrated plaques on his left cheek showing apple-jelly appearance on diascopy. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux reactivity was in normal limits, and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed marked improvement on anti-tuberculosis treatment. We want to emphasize that histopathological examination has diagnostic value in lupus vulgaris in correlation with clinical appearance, when direct analysis or culture is negative.

A case of Acremonium strictum peritonitis.

During the past two decades opportunistic fungal infections have emerged as important causes of morbidity and mortality in patients with severe underlying illnesses. A few cases of Acremonium spp. infections have been described in immunocompromised patients, but they have on occasion been reported as the cause invasive disease in immunocompetent individuals. Peritonitis is a common clinical problem that occurs in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). Yeasts, or rarely molds, may also cause peritonitis in patients on CAPD and we present here a case caused by Acremonium strictum.