Evaluation of the GenoType MTBDR assay for detection of rifampicin and isoniazid resistance in Mycobacterium tuberculosis complex isolates.

Detection of drug resistance plays a critical role in tuberculosis treatment. The aim of this study was to evaluate the performance of GenoType Mycobacteria Drug Resistance (MTBDR) assay (Hain Lifescience, Germany) and to compare it with radiometric BACTEC 460 TB system (Becton Dickinson, USA) for the detection of rifampicin (RIF) and isoniazid (INH) resistance in 84 Mycobacterium tuberculosis complex (MTBC) isolates. RIF resistance was identified in 6 of 7 (85.7%) isolates and INH resistance was identified in 8 of 14 (57.1%) isolates by the GenoType MTBDR assay. Compared with BACTEC system, the sensitivity, specificity, positive predictive value and negative predictive values were 85.7%, 98.7%, 85.7% and 98.7% for RIF resistance; and 57.1%, 100%, 100% and 92.1% for INH resistance, respectively. GenoType MTBDR assay is reliable when tested specimen is resistant to the tested drugs. Although test was more successful in the detection of RIF resistance, it exhibited low sensitivity for the detection of INH resistance.

Correlation between broth microdilution and disk diffusion methods for antifungal susceptibility testing of caspofungin, voriconazole, amphotericin B, itraconazole and fluconazole against Candida glabrata.

Candida glabrata is one of the most frequent organisms isolated from superficial and invasive fungal infections, after Candida albicans. This organism also exhibits intrinsically low susceptibility to azole antifungals and treatment often fails. The microdilution method is not very practical for use in routine susceptibility testing in the clinical laboratory, thus necessitating the use of other methods. In this study, we compared the in vitro activity of five antifungal agents in three different groups (echinocandin, polyene and azole) against 50 C. glabrata isolates by broth microdilution and disk diffusion methods recommended by Clinical Laboratory Standards Institute CLSI M27-A3 and CLSI M44-A, respectively. All the isolates were susceptible to amphotericin B (100%) and 98% of the isolates were susceptible to caspofungin by the broth microdilution method. Within the azole group drugs, voriconazole was the most active followed by fluconazole and itraconazole in vitro. The highest rate of resistance was obtained against itraconazole with a high number of isolates defined as susceptible-dose dependent or resistant. Although the disk diffusion method is easy to use in clinical laboratories, it shows very poor agreement with the reference method for fluconazole and itraconazole against C. glabrata (8% and 14%, respectively).

Oropharyngeal candidiasis with dry-powdered fluticasone propionate: 500 microg/day versus 200 microg/day.

We aimed to determine the frequency of oropharyngeal candidiasis and its clinical correlates in the asthmatic patients who use fluticasone propionate (FP) as a dry powdered inhaler. We selected four groups of patients: 62 asthmatic patients who were taking 200 microg/d FP, 122 asthmatics who were taking 500 microg/d FP, 50 asthmatic patients who had not been on inhaled corticosteroid (ICS) treatment and 40 normal non-asthmatic subjects. The frequency of positive swabs for Candida colonization was higher in 500 microg/d FP group than asthmatics without ICS use (chi2 = 6.8, p < 0.05) and normal controls (chi2 = 4.9, p < 0.05), whereas it wasn't different in the 200 microg/day FP group when compared to controls. When we considered patients who used ICS, the most effective variables affecting the occurrence of Candida colonization were washing of the throat by the patients (OR = 9.4, 95 % Confidence Interval [CI] = 3.9-22.7, p < 0.0001) and duration of ICS use more than 12 months (OR = 2.5, 95 % CI = 1.1-2.6, p < 0.05). The present study showed that in the patients who use ICS, the most important determinants on colonization were not washing the throat regularly and duration of ICS use for more than 12 months.

Oropharyngeal candidiasis with dry-powdered fluticasone propionate: 500 mg/day versus 200 mg/day

We aimed to determine the frequency of oropharyngeal candidiasis and its clinical correlates in the asthmatic patients who use fluticasone propionate (FP) as a dry powdered inhaler. We selected four groups of patients: 62 asthmatic patients who were taking 200 ìg/d FP, 122 asthmatics who were taking 500 ìg/d FP, 50 asthmatic patients who had not been on inhaled corticosteroid (ICS) treatment and 40 normal non-asthmatic subjects. The frequency of positive swabs for Candida colonization was higher in 500 ìg/d FP group than asthmatics without ICS use (÷2 = 6.8, p < 0.05) and normal controls (÷2 = 4.9, p < 0.05), whereas it wasn't different in the 200 ìg/day FP group when compared to controls. When we considered patients who used ICS, the most effective variables affecting the occurrence of Candida colonization were washing of the throat by the patients (OR = 9.4, 95 % Confidence Interval [CI] = 3.9-22.7, p < 0.0001) and duration of ICS use more than 12 months (OR = 2.5, 95 % CI = 1.1-2.6, p < 0.05). The present study showed that in the patients who use ICS, the most important determinants on colonization were not washing the throat regularly and duration of ICS use for more than 12 months

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Rapid detection of Mycobacterium tuberculosis from sputum specimens using the FASTPlaqueTB test.

OBJECTIVES: To determine the performance of the FASTPlaqueTB test, based on bacteriophage amplification technology, by comparison with the BACTEC 460 TB culture system, the Löwenstein-Jensen (LJ) medium culture method and Ziehl-Neelsen (ZN) staining. METHODS: Of 400 sputum specimens studied in our laboratory, 19 were excluded due to contaminant growth. The FASTPlaqueTB test was performed according to the manufacturer's instructions. RESULTS: Only 42 of the 381 specimens examined were positive on at least one test: 30 were positive with ZN staining, 34 with LJ medium, 36 with the FASTPlaqueTB test and 39 with BACTEC 460 TB. The combination of BACTEC 460 TB and LJ medium culture was considered the gold standard. The sensitivity and specificity were 70.7% and 99.7% for ZN staining, 87.8% and 100% for the FASTPlaqueTB test, 82.9% and 100% for LJ, and 95.1% and 100% for BACTEC 460 TB. CONCLUSIONS: The FASTPlaqueTB test is useful in the rapid diagnosis of TB.

Pulmonary multinodular mucormycosis in type 1 diabetic patient with diabetic ketoacidosis.

We report a case of pulmonary multinodular mucormycosis in a Type 1 diabetic patient with diabetic ketoacidosis. He had a history of 20-pack-year tobacco use. The initial chest roentgenogram and thorax tomography (after the treatment of diabetic ketoacidosis) revealed multiple nodular lesions with cavitation in the upper lobes of pulmonary parenchyma. Resection of three nodular lesion demonstrated cheesy necrotic mass in the cavitating lesions. The diagnosis of pulmonary multinodular mucormycosis was made depending on the histopathologic examination yielding nonseptated right angle branching-shaped hyphae typical of mucormycosis. The patient was started on liposomal amphotericin B and discharged at the sixth week of therapy with a scheduled therapy of amphotericin B. When he came back after 33 months, he was metabolically unregulated under the insulin therapy. He confessed that he had been smoking heroin besides tobacco for the last 5 years. A new thorax computerized tomography showed that pulmonary nodules were slightly regressed but not resolved.

Preparation of re-usable photocatalytic filter for degradation of Malachite Green dye under UV and vis-irradiation.

Sn(4+) doped and undoped nano-TiO(2) particles easily dispersed in water were synthesized without using organic solvent by hydrothermal process. Nanostructure-TiO(2) based thin films were prepared on flyswatter substrate, made with stainless steel, by dip-coating technique. The structure, surface and optical properties of the particles and thin films were characterized by element analysis and XRD, BET, SEM and UV/vis/NIR techniques. The photocatalytic performance of the films were tested for degradation of Malachite Green dye in solution under UV and vis-lights. The results showed that the coated flyswatter has a very high photocatalytic performance for the photodegradation of Malachite Green irradiated with UV and vis-lights. The results also proved that the hydrothermally synthesized nano-TiO(2) particles are fully anatase crystalline form and are easily dispersed in water, the coated surfaces are hydrophilic, and the doping of transition metal ion efficiently improved the degradation performance of TiO(2)-coated flyswatter. The photocatalytic performances determined at both irradiation conditions were very good and were almost similar to each other for Sn(4+) doped TiO(2)-coated flyswatter and it can be repeatedly used with increasing photocatalytic activity compared to undoped TiO(2)-coated flyswatter.

Photocatalytic performance of Sn-doped TiO2 nanostructured mono and double layer thin films for Malachite Green dye degradation under UV and vis-lights.

Nanostructure Sn(4+)-doped TiO(2) based mono and double layer thin films, contain 50% solid ratio of TiO(2) in coating have been prepared on glass surfaces by spin-coating technique. Their photocatalytic performances were tested for degradation of Malachite Green dye in solution under UV and vis irradiation. Sn(4+)-doped nano-TiO(2) particle a doping ratio of about 5[Sn(4+)/Ti(OBu(n))(4); mol/mol%] has been synthesized by hydrotermal process at 225 degrees C. The structure, surface and optical properties of the thin films and/or the particles have been investigated by XRD, BET and UV/vis/NIR techniques. The results showed that the double layer coated glass surfaces have a very high photocatalytic performance than the other one under UV and vis lights. The results also proved that the hydrothermally synthesized nano-TiO(2) particles are fully anatase crystalline form and are easily dispersed in water. The results also reveal that the coated surfaces have hydrophilic property.

Prevalence of tinea capitis in primary schools in Turkey.

The aim of our study was to determine the prevalence of tinea capitis in Middle Anatolia. Between February 2000 and April 2000, a school survey of 4760 primary school children was carried out and 34 cases of tinea capitis were clinically diagnosed. Sixteen (0.3%) of them were diagnosed both clinically and using culture. Eighteen cases (52.9%) were diagnosed microscopically whereas the remaining 16 cases (47.0%) had a clinical diagnose. We also isolated and identified the following species of fungi causing the infection: Trichophyton verrucosum (five cases), T. rubrum (three), T. mentagrophytes var. mentagrophytes (three), Microsporum canis (three) and T. tonsurans (two). We detected a higher rate of infection than that of the country's average.

Scedosporium apiospermum chorioretinitis.

PURPOSE: A case of a 24-year-old immunocompetent woman who developed unilateral Scedosporium apiospermum chorioretinitis and diffuse cervical lymphadenitis 10 years after facial steroid injection is described. METHODS: The patient was initially treated for the misdiagnosis of tuberculous lymphadenitis. Contemporaneous to the enlargement of her lymph nodes, she experienced gradual loss of vision in her left eye. She subsequently underwent lymph node biopsy. RESULTS: Histopathologic sections stained with Grocott's methenamine silver showed branched septate hyphae and cultures on Sabouraud's agar yielded Scedosporium apiospermum. The patient received oral itraconazole 200 mg twice daily. Lymphadenitis regressed within a year and chorioretinitis scarred within two years. CONCLUSION: Scedosporium apiospermum may cause isolated chorioretinitis in an immunocompetent individual years after local surgery or trauma and result in significant visual morbidity. Treatment may require prolonged use of systemic itraconazole.

Lymphadenitis caused by Scedosporium apiospermum in an immunocompetent patient.

A case of lymphadenitis caused by Scedosporium apiospermum in a 25-year-old immunocompetent woman had been misdiagnosed as tuberculous lymphadenitis. Clinical response to itraconazole therapy was obtained in 6 months; to our knowledge, this is the first report of lymphadenitis caused by S. apiospermum in humans.

Case report. Rhodotorula rubra fungaemia due to use of indwelling venous catheters.

Rhodotorula has been an infrequent cause of infection in humans but there have been some case reports about this systemic yeast infection. In this article, a Rhodotorula rubra fungaemia due to an indwelling catheter in a 23-year-old woman who had been diagnosed with non-Hodgkin's lymphoma grade IV B is described.

Phenotypic variation and antifungal susceptibility patterns of Candida albicans strains isolated from neutropenic patients.

The aim of this study was to investigate the relationship between phenotypes of Candida albicans strains isolated from clinical specimens and the susceptibility of the strains to three antifungal agents, fluconazole, amphotericin B and flucytosine. Oropharyngeal, gastrointestinal and urogenital tract specimens were collected from 122 neutropenic patients who had received no previous prophylactic treatment. Each of 122 C. albicans strains recovered was found to express one of the six phenotypes: smooth, fuzzy, irregular, star, ring and stipple. The mean minimum inhibitory concentrations (MICs) of fluconazole was consistently higher for C. albicans strains expressing the stipple phenotype. The mean MICs for the six phenotypes of C. albicans strains ranged between 1.22 and 7.94 micrograms ml-1 for fluconazole, 0.99 and 2.55 micrograms ml-1 for amphotericin B and 1.23 and 1.83 micrograms ml-1 for flucytosine. The antifungal susceptibility of the stipple phenotype requires attention, especially in patients who are clinically unresponsive to fluconazole chemotherapy or in cases of life-threatening C. albicans infections of immunocompromised hosts. Long-term use of fluconazole may explain the outcome of the resistant stipple phenotype.

[In vitro evaluation of antibiotic diffusion from antibiotic impregnated xenografts]. / Evaluation in vitro de la diffusion des antibiotiques à partir d'une xénogreffe imprégnée d'antibiotiques.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate xenografts as a slow release antibiotic delivery system, as xenografts also have excellent biocompatibility and osteogenesis-stimulating effect. MATERIAL: Xenograft (Unilab Surgibone) blocks of 5 x 5 x 5 mm were used in the study. Antibiotics used for impregnation were gentamicin sulphate, ciprofloxacin and penicillin G. METHODS: In the pilot study, xenograft blocks impregnated with gentamicin sulphate solution and the contact time was between 1/2 to 10 hours. Then the grafts were incubated and the antibiotic concentration was measured in the elution fluid changed every day. The minimum contact time to release the antibiotic 10 days over 0.5 microgram/ml was 8 hours. The 8 hours contact time was used in the main study to evaluate gentamicin sulphate, ciprofloxacin and penicillin G. The method was the same as in the pilot study. RESULTS: All antibiotics showed similar release patterns reaching their peaks on the 5th day and then gradually decreasing below the effective level (0.5 microgram/ml) approximately on day 10. DISCUSSION: Although various materials have been used to deliver antibiotics, they have some certain disadvantages especially reduced biocompatibility. The superiority of xenografts over other materials, is not only biocompatibility but also to facilitate osteogenesis. The only objection may be the relatively short duration of release (10 days) but the length of antibiotherapy is controversial and standard 6 weeks of administration has no documented superiority over other time intervals. CONCLUSION: Our delivery system is superior to others as its function is not only to deliver antibiotics but has its place in orthopedic practice to fill defects and stimulate osteogenesis. Also the preparation of this system is not time and skill consuming.

[Actinomycosis abscess developing in the rectus muscle. (One case history)]. / Rektus kasi içinde gelisen aktinomikoz absesi (bir olgu nedeniyle).

A 36 year old male patient having an abscess in right rectus muscle's cover 2 years after stomach operation; attended to our hospital. The abscess was discharged. Following this, at 6 months intervals new abscess were formed in left lower and right upper rectus cover and discharged. Samples from abscess were routinely observed microbiologically and for tuberculosis; but the etiologic agent could not be identified. Six months later the patient attended to our hospital with abscess in right lower rectus cover again. The sample taken from the patient was examined thinking actinomycosis. After clinical and microbiological observation, the causative agent was identified as Actinomyces israeli.

Some nitroimidazole derivatives as possible antibacterial agents.

In this study, six 1-[2(benzazol-2-yl)thioethyl]-2-methyl-5- nitroimidazole derivatives were synthesized. Antibacterial activities of the compounds obtained were examined and it was found that they are effective against aerobe bacteria.

[The antibacterial activity of the amniotic fluid during the last week of pregnancy]. / Gebeligin son haftasinda alinan amniyon sivilarinin antibakteriyel etkinliginin arastirilmasi.

Amnion fluid samples were obtained from 100 pregnant women in the last week of pregnancy just before in labor. In detecting of antibacterial effectiveness, S. aureus ATCC 29213, E. coli ATCC 25922 and S. agalactiae ATCC 13813 strains were used. Antibacterial effectiveness of amnion fluid to these bacteria are found respectively as; 74%, 63% and 73.9%.

[Comparison of latex agglutination and bacitracin-SXT methods used for the identification of 142 beta-hemolytic streptococci]. / 142 beta hemolitik streptokokun tanimlanmasinda kullanilan lateks aglutinasyon ile basititrasin-SXT sonuçlarinin karsilastirilmasi.

We compared the latex agglutination and bacitracin-SXT methods to identify Group A Streptococci (GAS) from throat cultures. In our study all 118 GAS strains identified by latex agglutination method were found susceptible to bacitracin, 115 were found resistant and 3 were susceptible to SXT. All beta hemolytic streptococci rather than GAS were found resistant to bacitracin. As a result bacitracin method is found valuable in rutin studies in GAS identification.

[Grouping of beta-hemolytic streptococci isolated from clinical specimens and their sensitivity to penicillin G]. / Cesitli klinik örneklerden izole edilen beta hemolitik streptokoklarin gruplandirilmasi ve penisilin G'ye duyarliliklarinin arastirilmasi.

260 beta hemolytic streptococci were isolated from clinical specimens sent to Microbiology Laboratory, Faculty of Medicine, Anadolu University between September 1988 - September 1989. They were grouped according to their sensitivity to bacitracin and trimethoprim/sulfamethoxazole (SXT) and also serologically. Of 260 isolates, 83.8% were group A, 1.2% group B, 6.5% group C, 3.5% group D and 5% were group G. All of 121 group A isolates confirmed serologically were susceptible to bacitracin. Excluded 9 strains, all of them were resistant to SXT. Other groups were mostly resistant to bacitracin. While group C and G generally were susceptible to SXT, B and D were resistant. Streptococci were documented according to distribution of clinical specimens. From throat 191 group A, 16 group C, 1 group D and 11 group G; from nose 7 group A; from pus 19 group A, 4 group D and 1 group G; from vagina 1 group A, 3 group B, 2 group D and 1 group G; from urine 2 group D; from blood 1 group C were isolated. All isolates were tested for penicillin G sensitivity by Kirby-Bauer disc diffusion method. While one of three group B strains and four of eight group D strains were resistant to penicillin G, all the other isolates were susceptible to penicillin G.