High frequency of pertussis in older children and adolescents with prolonged cough in Turkey.

This study aimed to determine the frequency of B. pertussis infection among Turkish children with prolonged cough. Nasopharyngeal specimens were collected from 7-18 year old children, presenting with prolonged cough of two to four weeks' duration. Specimens were examined for B. pertussis by PCR. Of 101 children with prolonged cough, 20 (19.8%) had a positive PCR testing for B. pertussis. Children who were vaccinated ≥5 years previously had a 6.13-fold higher risk of PCR-confirmed pertussis than those who were vaccinated < 5 years before. The classic symptoms of pertussis (paroxysmal cough, whooping and post-tussive vomiting) were seen in 30%, 15% and 25% of the patients with positive PCR, respectively; 55% of them had only a prolonged cough without any classic symptoms. Pertussis is common among Turkish children with prolonged cough, even after implementation of a fifth dose of pertussis vaccination and despite high vaccination coverage.

Possible transmission risks and genotype distribution of hepatitis C virus infection in Western Turkey.

BACKGROUND/AIMS: The aim of this study was to investigate the risk factors which may be involved in the transmission of hepatitis C virus and to determine the recent distribution of various genotypes in Western Turkey. MATERIALS AND METHODS: The risk determination study consisted of 215 patients whose serum samples were sent to the Medical Microbiology Laboratory at Ege University Hospital between 2005 and 2010 and were anti-hepatitis C virus positive. For the determination of recent genotype distribution, genotyping results of all 535 patients sent to the same laboratory from 2007 to 2011 were analyzed. Information on possible risk factors for the transmission of hepatitis C virus was obtained by a telephone questionnaire. Hepatitis C virus typing was performed by restriction fragment length polymorphism analysis. RESULTS: The most frequently reported risk factors were history of dental procedures in 171 (79,5%) patients and surgical operations in 137 (63,7%) patients. Genotype 1 was observed in 499 of the 535 patients (93,3%) with chronic hepatitis C virus infection. Of these, 69 patients showed infection with subtype 1a (12.9.%) and 430 - with subtype 1b (80.4%). Genotype 3 was determined in 20 patients (3,7%), genotype 2 - in 8 patients (1,5), and genotype 4 - in 8 patients (1,5%). CONCLUSIONS: Even though there is an increase in non-1 genotypes, Turkish patients with chronic hepatitis C still represent a rather homogenous group with genotypic diversity encountered rarely. The risk factors detected in the patients admitted to our hospital are mainly medical procedures which can be prevented by the use of simple infection control practices and implementation of an education program.

[Detection of Bordetella pertussis infection by culture, real-time polymerase chain reaction and serologic tests among children with prolonged cough]. / Uzamis Öksürügü Olan Çocuklarda Kültür, Gerçek Zamanli Polimeraz Zincir Reaksiyonu ve Seroloji ile Bordetella pertussis Enfeksiyonunun Arastirilmasi

Pertussis is a respiratory infection caused by Bordetella pertussis. It attacks all age groups. It has significantly higher mortality and morbidity among newborns and children. Adolescents and adults with symptomatic but unrecognized pertussis are often the source of the infection for pediatric cases. Therefore, it is suggested to perform laboratory diagnostic tests for B.pertussis infection in children and adolescents with prolonged cough of more than two weeks. In this study, it was aimed to identify B.pertussis infection by culture, real-time polymerase chain reaction (Rt-PCR) and serological methods among children with prolonged cough. Nasopharyngeal swab samples were obtained from 51 children (19 female, 32 male; age between 2 months-14 years; median age: 7.0), who attended the outpatient clinic of Ege University Medical Faculty Department of Pediatrics, Izmir, Turkey with prolonged cough (≥ 14 days) during December 2009-August 2010. While pertussis vaccination had been completed in 48 (94%) of the cases, three cases had not been vaccinated. Previous antibiotic treatment was reported for 38 (75%) of the cases. Cultivation was done by using 7% horse blood and charcoal containing Bordetella Agar (Becton Dickinson, Germany) and Rt-PCR targeting IS481 sequence (Roche Applied Science, Germany) was used to detect B.pertussis. In addition, in house ELISA was performed to detect titers of anti-pertussis toxin (anti-PT) IgG and anti-filamentous hemagglutinin (anti-FHA) IgG antibodies in paired sera collected in 2-4 week intervals. Fourfold titer increase of antibodies or anti-PT IgG levels of at least 100 EU/ml in one serum were evaluated as serological confirmation of B.pertussis infection. In our study, B.pertussis was isolated from one nasopharyngeal swab samples culture among the 51 patients, and IS481 Rt-PCR yielded positive results for B.pertussis in 6 (11.8%) samples. Nine (17.6%) patients were diagnosed as B.pertussis infection by serological tests. Totally 12 patients were evaluated as positive using at least one method. Among them only one had positive results with three of the tests used and two were positive with IS481 Rt-PCR assay and serologic tests. Three patients were found positive with only IS481 Rt-PCR and six were identified only with serologic diagnosis. In this study, 23.5% (12/51) of children with persistant cough were evaluated as having B.pertussis infection. The age range of these cases (5 female, 7 male) was 2 months-11 years and one case had not been vaccinated at all while four cases had not completed the vaccination schedule. It was concluded that since B.pertussis can be detected as the etiologic agent of persistant cough in a significant number of children by culture, PCR and serologic tests, diagnostic tests must be applied to evaluate B.pertussis infection. However, standardized serological methods and PCR protocols are needed for accurate and reliable diagnosis.