Candida vaginitis in non-pregnant patients: a study of antifungal susceptibility testing and virulence factors.

Vulvovaginal candidosis (VVC) is a major problem for the female population worldwide, and considerably little is known about the difference between acute VVC (AVVC) and recurrent VVC (RVVC). We investigated the susceptibility to six antifungal agents and boric acid of Candida spp. isolated from vaginal cultures, as described in the CLSI document M27-A3, from 228 non-pregnant sexually active women (aged 18-49 years), and the virulence factors of these isolates. The isolates were derived from patients with AVVC (n = 64), those with RVVC (n = 125) and those without signs or symptoms (n = 39). In total, C. albicans was the most commonly isolated species (50%), followed by C. glabrata (35.5%) and other Candida spp. (14.5%). We observed slightly different minimum inhibitory concentration (MICs) for various antifungals among the species and study groups that could have potential therapeutic benefits for the treatment. Analysis of the virulence factors revealed that haemolytic activity is not involved in VVC pathogenesis but that germ-tube formation, adhesion to VECs, and proteinase and phospholipase production may be important in the pathogenesis of VVC.

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.

Detection of Candida albicans by culture, serology and PCR in clinical specimens from patients with ulcerative colitis: re-evaluation of an old hypothesis with a new perspective.

The relationship between inflammatory bowel disease and microorganisms was evaluated. The presence of Candida albicans-specific IgM and IgG antibodies in serum samples and the presence of C. albicans in stool and colonal mucosa samples of the patients did not exhibit any significant difference between 21 patients in active stage and 15 patients in remission of ulcerative colitis (UC) (compared with 19 control patients). The invasion of yeast cells to the colonal mucosa was demonstrated by detecting C. albicans DNA using specific PCon1, PCon2, and PspA2 primers in PCR assay. Eighteen of 36 patients (50%) were found to be DNA positive while in 19 controls only 4 (21%) were found to be positive. The presence of DNA in the association of the positive serological reactivity is suggested as an important diagnostic marker of UC.

Distribution of secreted aspartyl proteinases using a polymerase chain reaction assay with SAP specific primers in Candida albicans isolates.

Secreted aspartyl proteinase (Sap) distribution among different C. albicans isolates was determined using SAP-specific primers in polymerase chain reaction (PCR) assay. SAP1, SAP2, and SAP3 were detected in 13 of 40 (32.5%), SAP4 in 38/40 (95%), SAP5 were detected in 30/40 (75%), SAP6 in 23/40 (57.5%) of C. albicans strains isolated from blood cultures. SAP1-SAP3 were detected in 37 of 40 (92.5%), SAP4 were detected in 3/40 (7.5%), SAP5 in 3/40 (7.5%), SAP6 in 5/40 (12.5%) of C. albicans strains isolated from vaginal swab cultures. Sap1, Sap2 and Sap3 isoenzymes were found to be related to the vaginopathic potential of C. albicans; Sap4, Sap5 and Sap6 isoenzymes were found to be correlated with systemic infections.

The role of tumour necrosis factor-alpha (TNF-alpha) and platelet-activating factor (PAF) interaction on murine candidosis.

Tumour necrosis factor-alpha (TNF-alpha) is related to some other factors in addition to being the essential cytokine of the sepsis which results from Candida infections. In our study, we investigated serum TNF-alpha levels, measured by enzyme-linked immunosorbent assay (ELISA), and platelet-activating factor (PAF)-like activity, measured by high-pressure liquid chromatography (HPLC) of the mice infected with Candida species. The PAF antagonist, ginkgolide BN 52021 was used to evaluate the possible interaction between TNF-alpha and PAF. The average TNF-alpha levels were found to be 396, 489, 699 and 803 pg ml(-1) on the 4th, 5th, 6th and 19th days of Candida albicans infection, respectively (P<0.05). There was no statistically significant difference between the serum TNF-alpha levels of the groups infected with other Candida species, such as C. kefyr, C. krusei and C. tropicalis (P>0.05). Serum TNF-alpha levels were found to be more significantly different in mice with C. albicans infection that were injected with PAF antagonists on the 6th day (23 pg ml(-1)). It was therefore thought that PAF antagonists have an inhibitory effect on TNF-alpha production. No significant difference was found between PAF levels in the three groups: healthy control mice, C. albicans-infected mice and C. albicans-infected mice given PAF antagonists (466 milli-absorbance unit (mAU), 475 mAU and 329 mAU, respectively). It was noticed that the positive interaction between PAF and TNF-alpha was not important after the first 4 days of the infection had passed.

Effect of nordihydroguaretic acid and fluconazole on the LTC4/PGE2 ratio in the kidney of mice damaged by Candida albicans.

The kidney is a major target organ in generalized candidiasis. When mice were infected with C.albicans, prostaglandin E2 (PGE2)-like activity was found to be significantly decreased while leukotriene C4 (LTC4)-like activity increased in the kidneys within 10 days. The aim of this study is to investigate the effect of nordihydroguaretic (NDGA) and fluconazole on the LTC4/PGE2 ratio in the mice kidneys infected by proteinase (+) C. albicans. The LTC4/PGE2 ratio was found to be significantly decreased both in NDGA and fluconazole-pretreated groups. These results indicate that pretreatment with the lipoxygenase inhibitor NDGA and the antifungal drug fluconazole, protect the kidney against C. albicans infection. These results also indicate a possible role of arachidonic acid metabolites (increase LTC4 and decrease PGE2) in kidney damage due to C. albicans infection.

Fluorometric determination of acid proteinase activity in vulvovaginal candidosis.

Vulvovaginal candidosis is one of the most frequent disorders in obstetrics and gynaecology. Candida albicans is commonly considered to be the true vaginopathic agent. The secreted acid proteinase might be especially relevant in the pathogenesis of vulvovaginal candidosis. A fluorometric determination of acid proteinase activity of clinical C. albicans isolates was carried out during the present work using fluorescamine. L-Leucyl-L-alanine was included as an internal standard and the results were expressed as nmoles of leucylalanine equivalents h-1 per 2 x 10(4) cells. The 13 isolates were taken from non-diabetic, non-pregnant women aged 22-35 years with vulvovaginal candidosis. Candida albicans ATCC 44858 was used as a control. The proteinase activity in culture supernatants was detectable starting from the mid- to late- exponential phase of growth, peaked between 30 and 46 h, and then declined. The control had an activity of 2.72 nmol h-1 per 2 x 10(4) cells, whereas eight of the samples had a lower activity (1.05 nmol h-1 per 2 x 10(4) cells on average) and five of the samples had a higher activity (6.53 nmol h-1 per 2 x 10(4) cells on average). The fluorometric determination of acid proteinase activity was found to be more reproducible and sensitive than the previously used spectrophotometric determinations.

Sample adequacy in detecting Chlamydia trachomatis.

OBJECTIVE: Chlamydia trachomatis is an important etiological agent in female genital infection and may result in infertility. In recent years rapid diagnostic methods have become widely used as alternatives to cell culture. Our objective was to evaluate the technique of direct fluorescence assay (DFA) in estimating the presence of C. trachomatis. METHODS: Specimens taken from 40 infertile and 20 fertile women were examined by DFA for the presence of C. trachomatis. RESULTS: Six of forty (15%) infertile women were found to be positive whereas no positive specimens were detected in the control group. When the specimens were grouped into those which were adequate or inadequate, 19 and five specimens, respectively, were adequate in the infertile and healthy groups. If only adequate specimens are included in estimating the presence of Chlamydia, the percentage is 31.6%. CONCLUSIONS: In order to use DFA as a more reliable and rapid diagnostic test of C. trachomatis in female genital infection, false-negativity must be eliminated. Specimens must be collected adequately and concentrated in order to achieve optimal diagnostic success.

The role of eicosanoids in the kidney damage induced by Candida albicans.

A major target organ in generalized candidiasis is the kidney. The purpose of this study was to investigate the role of eicosanoids in the kidney infected by proteinase-positive and proteinase-negative Candida albicans. Prostaglandin (PG) E2-like activity was found to be significantly decreased while leukotriene (LT) C4-like activity increased within 10 days in the kidneys of mice infected with C. albicans. These results indicate that arachidonic acid metabolism is shifted to the lipoxygenase pathway and lipid peroxides, produced via this enzyme system may play an important role in the kidney damage induced by C. albicans.

[Antibody levels against coxsackie B viruses in patients with type 1 diabetes mellitus]. / Tip 1 diabetes mellituslu hastalarda Coxsackie B viruslara karsi antikor düzeylerinin arastirilmasi.

In order to detect if the presence of interrelationship between Coxsackie B Viruses (CBV) and etiology of type 1 diabetes mellitus, antibodies to CBV by microneutralization test serotypes 1, 2, 3, 4, 5 and 6 were investigated in 37 sera obtained from patients with type 1 diabetes mellitus and 100 sera from healthy individuals as control group. No significant difference could found that neutralizing antibody levels to CBV serotypes between in sera obtained from patient with type 1 diabetes mellitus and sera obtained from control group. As a result, interrelationship was not detected between CBV infection and having type 1 diabetes mellitus.

[Fungus-induced arthritis caused by Scedosporium apiospermum (Pseudallescheria Boydii)]. / Uber eine Pilz-induzierte Arthritis durch Scedosporium apiospermum (Pseudoallescheria Boydii).

Scedosporium (monosporium) apiospermum is the most common causative agent of maduro mycosis. Recent research reports claim that this fungus can also induce arthritis. We report on the disease in a woman from a rural area who was admitted to our clinic because of arthritis symptoms. We were able to detect Scedosporium apiospermum, i.e., it was probably a fungus-induced arthritis which had developed after an intraarticular steroid injection.

[In vitro susceptibility of dermatophyte strains to imidazole derivatives]. / Dermatofit suslarinin imidazol türevlerine karsi invitro duyarliligi.

Recently, imidazole derivatives are being successfully used for the dermatomycoses. These drugs have the strongest antimycotic activity. 44 dermatophyte strains were isolated from our out-patient with dermatomycosis. Imidazole derivatives such as isoconazole, oxiconazole, bifonazole and tioconazole were studied their efficacy on these fungal agents in vitro. 4 imidazole derivatives were effective on all of the dermatophyte strains in less than or equal to 5 micrograms/ml concentration. Whereas, there were differences in Minimal Inhibition Concentration (MIC) and MIC50 values.

[Selective IgA deficiency in patients with systemic lupus erythematosus and rheumatoid arthritis]. / Sistemik lupus eritematozus ve romatoid artritli hastalarda IgA yetmezliginin arastirilmasi.

In this study, antinuclear antibody (ANA), rheumatoid factor (RF) studied and IgA was determined with single radial immunodiffusion (RID) technic in the sera of 96 patients with systemic lupus erythematosus, 25 with rheumatoid arthritis and 100 normal individuals. In normal control group, the average level of IgA was found to be 212 mg/dl. In one patient (1: 100), IgA deficiency was detected with a level of 2.1 mg/dl, the average level of IgA in 96 patients with SLE was 320 +/- 16.25 mg/dl. In 3 patients of this group IgA deficiency was observed. According to this finding, the prevalence of IgA deficiency in the group of SLE ise 1: 32. This prevalence is higher than that of the normal population. The average level of IgA in 25 patients with RA 302.66 +/- 36.57 mg/dl. In this group we observed IgA deficiency only in one patient which means a prevalence of 1: 25, that is higher than the normal group. Reports indicate that the incidence of IgA deficiency in general populations may vary from 1: 400 up to 1: 3080. But in patients with SLE and RA, this may be encountered more frequently as we observed in our cases.

Cerebral cladosporiosis.

A 49-year-old woman was admitted to Hacettepe Medical Faculty Hospital with the complaints of headache, nausea, vomiting, lethargy, and weakness on her right side. She revealed a history of pulmonary Cryptococcus infection 5 years before and she had been treated with amphotericin B. After clinical and laboratory investigation she was thought to have an intracranial mass, but her deteriorating situation did not allow any surgical intervention; she died within 7 days. On necropsy, hard, gray-white nodular pulmonary lesions, ranging 0.1-4 cm in diameter, basal meningitis, infarcts, and a nodular lesion 1.5 cm in diameter similar to those of the lung were present in the white matter of the right hemisphere of the brain. Microscopic examination revealed granulomatous inflammation caused by Cladosporium, which had brown pigment and septate hyphae.

[Salmonella tester strain TA104 for the detection of mutagenic and carcinogenic chemicals in our environment]. / Cevremizdeki mutajenik ve karsinojenik maddelerin Salmonella typhimurium TA104 susu ile saptanmasi.

We used the Salmonella mutagenicity test for detecting chemical carcinogens as mutagens in the Salmonella typhimurium tester strain TA104 . The mutagenicity of several compounds was assessed by induction of histidine revertants in the TA104 . In each experiment we routinely included positive mutagenesis controls using three different concentrations of known mutagens. The mutagenic chemicals such as sodium azide, hydrogen peroxide and hydroxylamine were found to be mutagenic to TA104 at very low concentration (10(-4) mg/ml). Their mutagenic activity decreased while their concentrations were increased. The effect of acridine orange, 2, 4, 6-trinitrobenzene sulphonic acid, 2- phenylnaphthalene and 20- methylcholanthrene were also found to be mutagenic to TA104 at the concentration of 10(-2) mg/ml. The mutagenicity of other materials such as hair dyes, meat- broth preparations+ and cigarette smoke condensates were also tested, and all of them were found to be mutagenic to TA104 . The highest mutagenic activities were observed at the concentration of 10 mg/ml for two different hair dyes and of 1 mg/ml for cigarette smoke condensates.

[Indoor and outdoor fungal flora of Ankara]. / Ankara'nin çesitli semtlerinde ev içi ve ev disi havasinin fungal florasi.

The variation of atmospheic fungal flora of Ankara were studied. Beside this the fungal floras of indoor and outdoor air were compared. In outdoor air Penicillium was detected most, followed by Cladosporium, Alternaria, Helminthosporium, Aspergillus, Rhizopus and Mucor. In the indoor air the same fungi were detected. However, Penicillium and Aspergillus were found more compared with outdoor findings. Since in many parts of Ankara (Yenisehir, Cebeci, Küçükesat, Bahçelievler, Aydinlikevler), different fungi are found in indoor and outdoor air and many of them are the etiologic agents of allegic diseases, doctors have to make fungal cultures from the indoor and outdoor air of living and working buildings in order to find the source of allergic diseases.

[Fungal flora of Ankara air in the morning and evening (author's transl)]. / Ankara'nin çesitli semtlerinde aksam ve sabah havasinda fungal flora.

The fungal flora in different areas parts of Ankara in morning and evening atmosfere are discussed. It was seen that Penicillium, and Mycelia sterilia were found more in evenings, when Cladosporium and Alternaria were found in higher concentrations in mornings. Aspergillus was found in evening air either in less or at least in same concentrations. The rate of Monilia in evenings and mornings showed variable concentration according to areas.

[The mycological and bacteriological flora of cigarettes and its relation to human throat culture and inhalation air]. / Sigaralarin mikolojik ve bakteriyolojik florasinin hava ve kisilerin bogaz floralari ile iliskisi

In our research we studied the mycological and bacteriological flora of both filtered and non-filtered Turkish cigarettes. We also studied by bacteriologic and mycologic methods, the specimens taken from throath of healthy people of varied ages who smoke and who do not smoke, and the flora of inhalation air from different area.