Comparison of the serial surveillance with quantitative and non-quantitative tracheal aspirate in predicting ventilator-associated pneumonia etiology in patients receiving antibiotic therapy.

BACKGROUND: The aim of this study was to investigate the value of serial quantitative (QC) and non-quantitative (NQC) endotracheal aspirate (ETA) surveillance cultures in predicting the causative pathogen of ventilator associated pneumonia (VAP) in patients receiving antibiotic therapy and the factors associated with their predictive value. This was a prospective observational cohort study carried out in the Intensive Care Unit of a tertiary hospital. METHODS: The study enrolled 109 patients receiving mechanical ventilation for at least four days. Tracheal surveillance cultures were obtained routinely thrice weekly. Each sample was processed non-quantitatively and quantitatively (103 and 105 cfu/mL). The sensitivity, specificity and predictive values (true positives plus true negatives) of these cultures for the development of VAP were evaluated, and the causative pathogens were assessed. RESULTS: Sixty-eight VAP episodes were detected during this period. The NQCs and QCs detected the responsible pathogens of VAP in 63% and 28% of the VAP patients, respectively. Surveillance with NQC and QC were negative in 78% and 85% of the patients without VAP, respectively. Compared with the QC-ETAs (47%), NQC-ETAs (65%) were more predictive in all of the 109 patients. The NQC-ETA and QC-ETA predicted the causative pathogens at 3.3+/-2.7 days and 2.5+/-1.7 days prior to the development of VAP episodes, respectively. Both NQC and QC surveillance cultures were less predictive in older patients, and QCs were less predictive in A. baumannii infections. CONCLUSION: These results suggest that surveillance with NQ-ETA is better than the Q-ETA in predicting the development and causative pathogen of VAP in patients who have already been receiving antibiotic therapy.

Expression of ALS1, HWP1 and SAP4 genes in Candida albicans strains isolated from women with vaginitis.

Total mRNA of Candida strains( isolated form whole vaginal swabs) was investigated and the in vivo expression of C. albicans secreted aspartyl proteinase (SAP4), aglutinin-like sequence (ALS1) and hyphal wall protein (HWP1) genes was determined. A spectrum of gene expression profiles of strain isolated from vulvovaginal candidiasis(VVC) cases consisting of 10 pregnant, 4 postmenopausal, and 15 reproductive age (12 primary and 3 recurrent) 9 women with different estrogen level. Expression of SAP4, ALS1 and HWP1 genes was evaluated by reverse-transcriptase polymerase chain reaction using specific primer sets. The expression of ALS1, HWP1, and SAP4 was detected as 69, 62, and 38 %, respectively, in all cases. In pregnant, postmenopausal, and reproductive age women with VVC, the expression of ALS1 was observed as 70, 75, 67%, and HWP 60, 25, 73% respectively . Expression of SAP4 was found in pregnant, postmenopausal, and reproductive age women as 40, 50, and 33% respectively. Expression of teh adhesion genes in VVC does not correlate with estrogen level of patients.

Age and duration of disease as factors affecting clinical findings and sacroiliitis in brucellosis.

OBJECTIVE: Brucellosis may be seen in any age group, but it still involves young and middle aged adults more frequently. Our aim was to investigate the relationship between age and the duration of disease on clinical findings of brucellosis in adults in this study. PATIENTS AND METHOD: One hundred and sixty-three patients with brucellosis, treated in our hospital, between 1997 and 2003, were evaluated retrospectively. RESULTS: Fever was found in 60.7% of the patients, and it was significantly higher when the duration of disease was less than one month (p = 0.03). Fever was significantly lower in the > or = 65 age group (p = 0.01). Sacroiliitis was detected in 44.1% of patients. Sacroiliitis was significantly higher in the 15-35 age group (p = 0.03). There were no differences between age groups and other clinical and laboratory findings. CONCLUSIONS: Sacroiliac involvement was noted particularly in young adults who manifested lumbar pain and fever, but this might not be a major symptom of brucellosis in the elderly, or in patients showing symptoms for more than a month.

The influence of BCG immunisation on tuberculin reactivity and booster effect in adults in a country with a high prevalence of tuberculosis.

The relationship of age and previous BCG vaccination with tuberculin skin test (TST) reactivity was investigated to assess the interpretation of TST results in the adult population of Turkey, where there is a high prevalence of tuberculosis and a routine BCG vaccination programme. The influences of age and BCG vaccine status on booster reaction were also evaluated. TST was applied (5 tuberculin units of purified protein derivative intradermally) to two healthy adult groups, namely 98 medical students and 187 elderly people in a retirement home. The TST was considered positive if an induration > or = 10 mm in diameter was produced. Subjects (41 elderly people and 39 students) with a reaction < 10 mm in diameter were retested 1 week later. There was no significant difference between the students (59.1%) and elderly subjects (58.8%) with respect to positive TST response. No influence of BCG scars on TST reactivity was observed in either group. The booster effect was seen more commonly in the elderly, but the presence of a BCG scar did not influence the booster effect in either group. It was concluded that a positive TST response and booster reaction in adults in high-prevalence countries may be caused by latent tuberculosis rather than previous vaccination.

An outbreak of Aseptic Meningitis due to echovirus type 30 in two cities of Turkey.

An outbreak of aseptic meningitis due to echovirus 30 occurred in Ankara and Antalya in Turkey, during June to September 1999, with 176 cases fitting the clinical case definition. Cases were ascertained from attendees of the three hospitals in Ankara and one in Antalya. Medical files were reviewed and evaluated retrospectively. Clinical presentation and laboratory findings were typical of viral meningitis. Cerebrospinal fluid and/or stool samples of 86 patients were cultured for enteroviruses. Echovirus type 30 was isolated in 38 patients (44%). This is the first report and epidemiologic data about an aseptic meningitis outbreak due to echovirus type 30 from Turkey.

Pulmonary nocardiosis in a non-Hodgkin's lymphoma patient.

Nocardiosis is an opportunistic infection especially in immunocompromised patients. Lungs are the most common infection sites and therapy poses some difficulties. We describe a case of pulmonary infection with Nocardia asteroides in a non-Hodgkin's lymphoma patient. Although the mortality from pulmonary nocardiosis is high in immunocompromised patients, our patient was successfully treated with trimethoprim-sulfamethoxazole (TMP/SMZ) and amikacin. Maintenance therapy with TMP/SMZ was continued for 1 year. This case supports the importance of the long-term maintenance treatment after the initial combination therapy.