A rare agent of continuous ambulatory peritoneal dialysis peritonitis: Rhizobium Radiobacter.

Peritonitis is a common clinical problem in patients treated by continuous ambulatory peritoneal dialysis (CAPD). The most common microbiological factors causing peritonitis are Gram-positive (especially Staphylococcus spp.). Peritonitis with Rhizobium radiobacter (Agrobacterium radiobacter) is a rare infection in CAPD patients. Peritonitis due to R. radiobacter has been reported in our patient's dialysate culture who underwent CAPD for three years. We report the case of a 26-year-old female PD patient who had CAPD peritonitis due to R. radiobacter and successfully treated with intraperitoneal vancomycin and oral ciprofloxacin without relapses or removing the PD catheter.

Revitalization of necrotic mature permanent incisors with apical periodontitis: a case report.

Despite considerable focus on the regenerative endodontic treatment of immature teeth with necrotic infected pulps and apical periodontitis, little data exist with regard to its possible implementation in necrotic permanent teeth with complete apical and radicular development. The present report describes the procedures and outcome of a regenerative endodontic treatment approach in 2 previously-traumatized incisors with closed apex with apical periodontitis. A 2-visit treatment procedure was employed. At initial visit, the root canals were copiously irrigated, followed by placement of a triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin into the root canals. After 4 weeks, the antibiotic paste was removed, and apical bleeding was initiated with size 10 hand files beyond the apices. The root canals were coronally sealed with mineral trioxide aggregate, and the access cavities were restored with bonded resin composite. At post-operative 60 months, both teeth were remained asymptomatic, with the recall radiographs showing complete resolution of apical radiolucency and reestablishment of periradicular tissues. In both teeth, the dimensions of root space remained unchanged as verified by image analysis. The revitalization protocol utilizing root canal disinfection and induced apical bleeding in necrotic, closed-apex incisors may offer a clinically acceptable alternative to conventional root canal treatment.

The efficacy of platelet-rich plasma gel in MRSA-related surgical wound infection treatment: an experimental study in an animal model.

INTRODUCTION: The wound healing properties of platelet-rich plasma (PRP) gel have been documented in many studies. PRP gel has also become a promising agent for treating surgical site infections. In this study, we investigated the antibacterial activity and wound healing effectiveness of PRP in an animal model of Methicillin-resistant Staphylococcus aureus subsp. aureus (MRSA N315)-contaminated superficial soft tissue wounds. MATERIALS AND METHODS: Subcutaneous wounds in Wistar Albino male rats were created by making two cm midline incisions followed by inoculation of microorganisms. Study groups comprised of Sham (no treatment), PRP alone, MRSA alone, MRSA + PRP, MRSA + Vancomycin, and MRSA + Vancomycin + PRP groups. We inoculated 0.1 mL (3 × 108 CFU/mL) of MRSA in contaminated groups. After 8 days, all rats were killed, wounds were excised and subjected to histopathologic examination, and MRSA counts were determined. RESULTS: MRSA counts in MRSA, MRSA + PRP, MRSA + Vancomycin and MRSA + Vancomycin + PRP groups were 5.1 × 106 (SD ± 0.4) CFU/mL, 4.3 × 106 (SD ± 0.7) CFU/mL, 2.3 × 106 (SD ± 0.3) CFU/mL, 1.1 × 106 (SD ± 0.4) CFU/mL, respectively. The inflammation scores of MRSA + PRP, MRSA + Vancomycin, and MRSA + Vancomycin + PRP groups were significantly lower than the MRSA group. MRSA + Vancomycin + PRP group inflammation score was significantly lower than the MRSA + PRP group. DISCUSSION: All treatment groups were effective in wound healing and decreasing the MRSA counts. MRSA + PRP combined created identical inflammation scores to the PRP group. More in vivo studies are required to corroborate these findings.

A Comparative Study of the Effects of Intravitreal Anidulafungin, Voriconazole, and Amphotericin B in an Experimental Candida Endophthalmitis Model.

PURPOSE: To compare the safety and efficacy of intravitreal anidulafungin injection with voriconazole and amphotericin B (Amp B) in an experimental Candida endophthalmitis (CE) model. METHODS: Intravitreal 1 × 105 CFU/0.1 ml Candida albicans was injected into the right eyes of 24 New Zealand rabbits, which were divided into 4 groups. Voriconazole 50 µg/0.1 ml, Amp B 10 µg/0.1 ml, and Anidulafungin 50 µg/0.1 ml were injected by intravitreal injection 72 h after inoculation. The control group was injected with 0.1 ml 0.9% NaCl. Clinical scoring was performed by assessing the cornea, conjunctiva, iris, and vitreous on days 3 and 7 of therapy. At the end of the study, the right eyes of all rabbits were enucleated and histopathological evaluation was performed. Therapy groups were compared according to the clinical, histopathological, and microbiological analysis scores. RESULTS: Total clinical scores were significantly different between treatment groups and the control group (p < 0.05). On day 7 of the therapy, clinical scores of the anidulafungin group were found to be significantly lower when compared with the other therapy groups, while a significant improvement was observed in the eyes of rabbits in the anidulafungin group (p < 0.05). Also, microbiological scores of the anidulafungin group were lower than those of the control group (p < 0.05). Histopathological scores of the anidulafungin treatment group were significantly better than the voriconazole and control groups. Inflammation was evidently suppressed and marked retinal toxicity was not observed with anidulafungin. CONCLUSIONS: This is the first study comparing the efficacy of anidulafungin with other antifungal agents. In this CE model, an intravitreal single dose of anidulafungin was shown to be noninferior to voriconazole and Amp B. As an alternative to Amp B or voriconazole, intravitreal anidulafungin is suggested as an effective antifungal agent for the treatment of CE.

USE OF NEUTROPHILS TO LYMPHOCYTES RATIO AS AN INFLAMMATION MARKER IN PATIENTS WITH CHRONIC TONSILLITIS.

The aim of this study was to assess the neutrophil to lymphocyte ratio (NLR) as an inflammation marker in patients with chronic tonsillitis and to compare the NLR values to other inflammation markers, such as antistreptolysin-O (ASO), C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR). Thirty patients aged between 4 and 15 y.o. who had undergone surgery for chronic tonsillitis were included in this retrospective study. Blood samples including haemogram, ASO, CRP and ESR were taken from the patients the day before and one month after the surgery and were analysed retrospectively. Preoperative ASO values were 170±75.5 U, CRP values were 7.6±5 mg/L, ESR values were 15.7±10 mm/H and NLR values were 0.9±0.2. Postoperative ASO values were 140.9±58.5 U, CRP values were 6.8±3.4 mg/L, ESR values were 12.5±5.4 mm/H and NLR values were 1.2±0.4. Statistically significant decreases were observed in the white blood cell count (WBC), lymphocytes, ASO and ESR results, with increase in NLR values after the surgery (p<0.05). The neutrophil and CRP values after the surgery have shown statistically insignificant decrease (p>0.05). The NLR values were compared with the ASO, CRP and ESR values, which were used as inflammation markers. Negative correlation was found between decrease in ASO and ESR and increase in the NLR values after the surgery.

THE USEFULNESS OF MONITORING THE NEUTROPHIL TO LYMPHOCYTE RATIO IN PATIENTS WITH PERIPHERAL VERTIGO.

The purpose of this study was to evaluate the usefulness of the neutrophil to lymphocyte ratio (NLR) in a differential diagnosis and follow-up of patients with peripheral vertigo. Twenty patients with benign positional paroxysmal vertigo (BPPV) and 20 patients diagnosed with vestibular neuritis (VN) were included in the study. Serum samples were analysed at the initial presentation and on the seventh day of admission retrospectively. The WBC (white blood cell) count was 10500±2100 /mm3, the neutrophil count was 4700±1100/mm3, the lymphocyte count was 5000±1200/mm3 and the NLR was 0.9±0.2 in the VN group. In patients with BPPV, the WBC count was 9200±1300/mm3, the neutrophil count was 5200±1200/mm3, the lymphocyte count was 3100±1200/mm3 and the NLR was 1.9±0.9. The NLR was lower in patients with VN than in patients diagnosed with BPPV. The WBC and lymphocyte count was significantly higher in the patients with VN than in the patients diagnosed with BPPV. Within the first week of admission, the WBC and lymphocyte counts in patients with VN decreased, and the NLR was more elevated than at the admission. It is highly recommended that NLR is used in the diagnosis and follow-up of the most commonly observed aetiological factors of peripheral vertigo, BPPV and VN.

ASSESSMENT OF WARFARIN TREATMENT EFFICACY BY MEANS; OF USING COAGULATION TEST RESULTS WITHIN THE THERAPEUTIC RANGE.

Time in Therapeutic Range (TTR) is a value used to assess the efficacy of Warfarin treatment. The aim of our study is to determine the effective INR levels and the rate of TTR in patients on Warfarin regimen due to Atrial Fibrillation (AF) or Mechanical Prosthetic Valve (MPV). A total of 94 patients (58 female, and 36 male, mean age: 64.9±11years) on Warfarin treatment due to AF or MPV with at least 10 INR levels measurements in the last 6 months were included in this retrospective study. The patients were divided into 2 groups. Group 1 consisted of the patients with Valvular AF (n=47); Group 2 included the patients with Non-Valvular AF (n=47); TTR and INR levels were compared. The average of INR values were found as 2,4 (min: 1,3, max: 4,3) in all patients; 2,3 (min: 1,3, max: 4,2) in Group 1; 2,6 (min: 1,3, max: 4,3) in Group 2. The average of TTR values was found 40.3% (min: 10%, max: 80%) in all patients; 43.8% (min: 10%, max: 80%) in Group 1; 36,8% (min: 10%, max: 80%) in Group 2. INR and TTR values are needed to assess the effectiveness of the Warfarin treatment. The patients in treatment with Warfarin should be well trained and frequently monitored. On the other hand, the underlying factors of the TTR values being determined as lower in the Turkish patient population might be due to the lower socio-economic and socio-cultural status, inadequate education levels, and the insufficient information on use of the medication provided by the doctors to the patients.

Effect of several intracanal medicaments on the push-out bond strength of ProRoot MTA and Biodentine.

AIM: To evaluate the effect of prior application of several intracanal medicaments on the push-out bond strength of ProRoot MTA and Biodentine. METHODOLOGY: Sixty freshly extracted maxillary anterior teeth were sectioned below the cementoenamel junction, and the root canals instrumented using rotary files. Thereafter, a parallel post drill was used to obtain a standardized root canal dimension. The roots were randomly assigned into one of the following groups with respect to the intracanal medicament applied: group 1: calcium hydroxide (CH) powder (Merck, Darmstadt, Germany) mixed with distilled water; group 2: a mixture of metronidazole, ciprofloxacin and minocycline (triple antibiotic paste); group 3: a combination of amoxicillin and clavulanic acid (Augmentin; Champs Pharmacy, San Antonio, TX, USA); group 4: an antibiotic-corticoid compound paste (Ledermix; Riemser, Greifswald, Germany); and group 5: no medicament (control). Following removal of medicaments with instrumentation and irrigation, the roots were cut into 1-mm-thick parallel transverse sections in a coronal-to-apical direction (5 slices/tooth). Thereafter, the specimens were divided into two subgroups according to the calcium silicate cement applied (n = 30/group): (i) ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK, USA) and (ii) Biodentine (Septodont, Saint-Maur-des-Fosses, France). A push-out test was performed, and the data were analysed statistically using two-way anova and Tukey's post hoc test. RESULTS: Regardless of the type of intracanal medicament used, Biodentine had significantly higher bond strength than MTA (P < 0.05). The highest push-out bond strength results were obtained in CH-treated dentine. Compared with other medicaments, this value was only significantly higher than that of Ledermix (P < 0.05). In both the MTA and Biodentine groups, pairwise comparisons between other medicaments showed similar debonding values (P > 0.05). CONCLUSIONS: Biodentine had a higher bond strength to root canal dentine than ProRoot MTA. Prior CH in distilled water intracanal placement increased the dislodgment resistance of both calcium silicate cements.

High sensitivity detection of salivary 8-hydroxy deoxyguanosine levels in patients with chronic periodontitis.

BACKGROUND: Inflammation is associated with hydroxyl radical damage to DNA as a result of oxidative stress. 8-Hydroxy deoxyguanosine (8-OHdG) is a marker of this process and its levels in saliva could be linked to the severity of periodontal inflammation. The aim of this study was to test the sensitivity of liquid chromatography with tandem mass spectrometry (LC-MS/MS) in comparison to enzyme-linked immune sorbent assay (ELISA) for the detection of 8-OHdG in saliva in patients with chronic periodontitis before and after periodontal treatment. METHODS: Saliva samples were collected from 23 patients (eight females and 15 males; 46.1 ± 5.1 years of age) with generalized chronic periodontitis and 25 (15 females and 10 males; 44.9 ± 6.8 years of age) periodontally healthy individuals. Patients received initial periodontal treatment consisting of scaling and root planing and were evaluated at baseline and after 6 wk of completion of non-surgical therapy. Salivary 8-OHdG levels were measured using ELISA and LC-MS/MS before and after the treatment. Clinically, plaque index, gingival index, clinical attachment level, bleeding on probing, gingival recession and probing pocket depth were measured at baseline and after 6 wk. RESULTS: Salivary levels of 8-OHdG decreased significantly after the non-surgical periodontal treatment (p < 0.001). Statistically significant positive correlations were observed between plaque index, gingival index, probing pocket depth, clinical attachment level, bleeding on probing values and LC-MS/MS and ELISA levels of 8-OHdG (p < 0.001). CONCLUSION: LC-MS/MS is a reliable and sensitive method for evaluating salivary 8-OHdG levels to monitor the treatment response of periodontitis.

Peritonitis incidence was correlated with duration of peritoneal dialysis rather than leptin or neutrophil to lymphocyte (n/l) ratio in peritoneal dialysis patients.

OBJECTIVE: End stage renal disease (ESRD) has a high worldwide prevalence and incidence. Peritonitis is one of the leading causes of hospitalization in peritoneal dialysis patients. Although inflammatory markers show increased inflammatory responses, cellular immune response was decreased in ESRD patients. Leptin is an adipocyte-derived hormone that has activity in energy, nutrition and immune system. Neutrophil to lymphocyte ratio (N/L) was emerged as a predictive and prognostic criterion in many instances. In this study, we aimed to investigate the relationships between increased inflammation in peritoneal dialysis patients and leptin, N/L ratio. MATERIALS AND METHODS: Forty-one ESRD patients, who were been at least 12 months of peritoneal dialysis therapy, were included in the study. Patients' demographic properties were recorded. Serum leptin level, WBC count, C-reactive protein, erythrocyte sedimentation rate and biochemical markers were measured. Patients with active viral or bacterial infection, malignancy, inflammatory disease, immunosuppressive medication users were all excluded from the study. Age and sex-matched healthy control group was included in the study only for their leptin levels. RESULTS: The measured mean serum leptin level of the patient group was statistically significantly higher than control group (1624.88±1608.16 and 416±439.85). The calculated mean peritonitis incidence was 0.041±0.047 peritonitis/per year. The number of peritonitis attack was significantly correlated with duration of peritoneal dialysis, body mass index (BMI), age and presence of cardiovascular disease. Serum leptin level was significantly correlated with sex, age, primary cause of ESRD, BMI, blood glucose level and duration of peritoneal dialysis (PD). CONCLUSION: We detected that ESRD patients have higher serum leptin levels compare to healthy adults. Increased leptin was correlated with sex, age, BMI, primary cause of ESRD and serum glucose level. Number of peritonitis attack and peritonitis incidence was significantly correlated with the duration of PD, BMI and sex. We weren't able to show the predictive N/L value in PD patients in case of peritonitis.

A comparison of residual smear layer and erosion following different endodontic irrigation protocols tested under clinical and laboratory conditions.

OBJECTIVE: To compare the smear layer removal efficacy and erosive effects of different irrigation protocols under clinical and laboratory conditions. MATERIALS AND METHODS: Mandibular third molars (n = 32) of 30-45 year-old patients were instrumented with rotary files and were randomly assigned to one of the following groups for final irrigation: (1) 5.25% NaOCl; (2) 17% EDTA; and (3) BioPure MTAD. Thereafter, the teeth were immediately extracted and processed for micromorphological investigation. In vitro specimen pairs were prepared by repeating the clinical experiments on freshly-extracted mandibular third molars. To compare open and closed systems, laboratory experiments were repeated on 32 additional teeth with enlarged apical foramen. The cleanliness of the root canals and the extent of erosion were assessed by environmental scanning electron microscopy. RESULTS: Specimens prepared under clinical and laboratory conditions had similar cleanliness and erosion scores (p > 0.05). Under both conditions, the tested solutions were more effective in removing the smear layer in the coronal and middle regions than in the apical one. Comparison of closed and open systems showed similar levels of cleanliness and erosion in all regions (p > 0.05), with the exception of 17% EDTA showing significantly higher levels of cleanliness and erosion in the apical third of open-end specimens. CONCLUSIONS: Based on clinical correlates of in vitro root canal cleanliness and erosion, laboratory testing of root canal irrigants on extracted teeth with closed apices can serve as a reliable method to simulate the clinical condition. EDTA was the most effective final irrigation solution in removing the smear layer at the expense of yielding the greatest erosive effect.

Effect of ethylenediaminetetraacetic acid on root fracture with respect to concentration at different time exposures.

INTRODUCTION: The objective of this study was to evaluate the effect of ethylenediaminetetraacetic acid (EDTA) on root fracture with respect to various concentrations at different time exposures. METHODS: A total of 48 mandibular incisors were selected. Eight nonprepared roots were selected as a negative control. The remaining 40 specimens were instrumented with rotary files and randomly assigned to one of the following groups for final irrigation: (1) 10 mL distilled water for 10 minutes (positive control); (2) 10 mL of 17% EDTA for 1 minute + 10 mL of 1% NaOCl for 1 minute; (3) 10 mL of 5% EDTA for 1 minute + 10 mL of 1% NaOCl for 1 minute; (4) 10 mL of 17% EDTA for 10 minutes + 10 mL of 1% NaOCl for 1 minute; (5) 10 mL of 5% EDTA for 10 minutes + 10 mL of 1% NaOCl for 1 minute. Thereafter, the root canals were filled by using AH26 root canal sealer with a single-cone technique. The specimens were loaded vertically at 1 mm/min crosshead speed until vertical root fracture occurred. Results were evaluated statistically with 1-way analysis of variance and Student's t test. RESULTS: Statistically significant differences were detected among the groups (P < .05). The highest mean fracture resistance was obtained from the group treated with 5% EDTA for 10 minutes. This is about 2 times more than the weakest mean fracture resistance, which was obtained from the 17% EDTA-10 minute group. CONCLUSIONS: The fracture resistances of endodontically treated roots were found to be differently affected by the various concentrations of EDTA at different time exposures.

Effects of diabetes on cytokines and oxidative organ injury in a rat model of sepsis.

We aimed to investigate how Diabetes Mellitus (DM) affects myeloperoxidase activity, antioxidant status, and lipid peroxidation using biochemical approaches in heart, liver, and lung and serum cytokine analyses, such as interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) in rat with sepsis induced by a cecal ligation and puncture-induced (CLP) sepsis. The rats were divided into four groups: control group, diabetic group, sepsis group, and diabetic+sepsis group. DM was induced in the male Wistar albino rats by administration of alloxan. Polymicrobial sepsis was induced by cecal ligation and two-hole puncture. After alloxan administration, all groups of rats were allowed to recover for 1 month. CLP model was applied after 1 month recovery to group 3 and 4. IL-6 and TNF-α, were measured. Effects of antioxidant defenses on the DM and/or sepsis process, the antioxidant levels superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) were evaluated in heart, lung and liver tissues. The oxidant levels, such as lipid peroxidation (LPO) and myeloperoxidase (MPO) levels were also evaluated in tissues. We demonstrated DM to augment the level of oxidant and proinflammatory cytokines in lung, liver, and heart and also to exacerbate oxidative injury as assessed by increased LPO and MPO, and decreased GSH and SOD levels in a sepsis model. DM increased levels of proinflammatory cytokines while DM also resulted in significantly increased levels of proinflammatory cytokines following CLP. DM-increased plasma proinflammatory cytokines levels correlated positively with tissue oxidant levels, such as MPO and LPO levels in a rat abdominal sepsis model, based on CLP, which resulted in the exacerbation of oxidative organs injury.

Dentin moisture conditions affect the adhesion of root canal sealers.

INTRODUCTION: The purpose of this study was to evaluate the effects of intraradicular moisture conditions on the push-out bond strength of root canal sealers. METHODS: Eighty root canals were prepared using rotary instruments and, thereafter, were assigned to 4 groups with respect to the moisture condition tested: (1) ethanol (dry): excess distilled water was removed with paper points followed by dehydration with 95% ethanol, (2) paper points: the canals were blot dried with paper points with the last one appearing dry, (3) moist: the canals were dried with low vacuum by using a Luer adapter for 5 seconds followed by 1 paper point for 1 second, and (4) wet: the canals remained totally flooded. The roots were further divided into 4 subgroups according to the sealer used: (1) AH Plus (Dentsply-Tulsa Dental, Tulsa, OK), (2) iRoot SP (Innovative BioCeramix Inc, Vancouver, Canada), (3) MTA Fillapex (Angelus Indústria de Produtos Odontológicos S/A, Londrina, Brasil), and (4) Epiphany (Pentron Clinical Technologies, Wallingford, CT). Five 1-mm-thick slices were obtained from each root sample (n = 25 slices/group). Bond strengths of the test materials to root canal dentin were measured using a push-out test setup at a cross-head speed of 1 mm/min. The data were analyzed statistically by two-way analysis of variance and Tukey tests at P = .05. RESULTS: Irrespective of the moisture conditions, iRoot SP displayed the highest bond strength to root dentin. Statistical ranking of bond strength values was as follows: iRoot SP > AH Plus > Epiphany ≥ MTA Fillapex. The sealers displayed their highest and lowest bond strengths under moist (3) and wet (4) conditions, respectively. CONCLUSIONS: The degree of residual moisture significantly affects the adhesion of root canal sealers to radicular dentin. For the tested sealers, it may be advantageous to leave canals slightly moist before filling.

[Comparison of conventional methods and real-time multiplex polymerase chain reaction for identification and typing of Brucella isolates of human origin]. / Insan Kaynakli Brucella izolatlarinin tanimlama ve tiplendirmesinde konvansiyonel yöntemler ile gerçek zamanli multipleks polimeraz zincir reaksiyonunun karsilastirilmasi.

Brucellosis which is a worldwide zoonotic disease, still constitutes a major public health problem in rural areas of Turkey. The aim of the present study was to evaluate the species and biovar distribution of 187 presumptive Brucella strains isolated from patients inhabiting at the provinces in Eastern, South Eastern and Mediterranean regions over a 7-years period (from 2001 to 2007) and to compare multiplex real-time-polymerase chain reaction (M-RT-PCR) and conventional biotyping for the differentiation of three Brucella species. The isolates were identified at genus level by conventional microbiological methods and classified using the classical Brucella species biotyping scheme based on CO2 requirement for growth, urease activity, H2S production, sensitivity to basic fuchsin and thionin (20 and 40 µg/ml), lysis by Tbilisi and Berkeley phages, and agglutination with monospecific antisera for A and M antigens. All Brucella isolates were identified as Brucella melitensis biovar 3. M-RT-PCR assay targeted bcsp31 gene and the specific integration of IS711 elements within the genome of the respective Brucella species. For the identification of Brucella spp. The primers and probes which targeted the bcsp31 gene were used. The Brucella abortus primers and probe set targeted the specific insertion of an IS711 element downstream of the alkB gene, whereas the B.melitensis primers and probe set targeted the insertion of an IS711 element downstream of BMEI1162. M-RT-PCR results were found to be 100% compatible with the reference conventional typing methods. Due to its high sensitivity, the M-RT-PCR assay could be a valuable tool for the rapid detection and differentiation of Brucella species in clinical samples which usually have very low bacterial load. These findings indicated that B.melitensis biovar 3 was by far the most frequent species for human brucellosis in these specific regions of Turkey and multiplex-RT-PCR seemed to be promising in the detection and differentiation of Brucella species.

Multiple-locus variable-number tandem-repeat analysis genotyping of human Brucella isolates from Turkey.

A multiple-locus variable-number tandem-repeat analysis (MLVA) was applied to investigate the epidemiological relationship and genetic diversity among 162 human Brucella isolates collected from all geographic regions of Turkey in an 8-year period (2001 to 2008). The isolates were genotyped by using an MLVA assay developed in Orsay, France (MLVA-16(Orsay)) including eight minisatellite (panel 1) and eight microsatellite (panel 2, subdivided into 2A and 2B) markers. Panels 1 and 2A distinguish 14 genotypes; two of these represented 85% of the strains. Panel 2B displayed a very high discriminatory power. Three loci from panel 2B had diversity index values higher than 0.74. MLVA-16(Orsay) yielded 105 genotypes; 73 were represented by a unique isolate, and 32 included two to eight isolates. The isolates from different patients within the same outbreak or from the same patient before first-line therapy and after relapse showed identical genotypes. A number of MLVA genotypes appeared to be partially restricted to some geographic areas and displayed no annual variation, possibly reflecting persistence of genotypes in certain areas for a time span of at least a decade. This study, representing the first molecular typing results of human Brucella isolates from Turkey, indicated that Turkish human Brucella melitensis isolates were most closely related to the neighboring countries' isolates included in the East Mediterranean group.

[Tularemia seroprevalence in the risky population living in both rural and urban areas of Erzurum]. / Erzurum Merkez ve Kirsalinda Yasayan Riskli Gruplarda Tularemi Seroprevalansi

Tularemia which is a zoonotic infection, caused by Francisella tularensis, has become a re-emerging disease in Turkey. Infection is often transmitted to human by handling animal tissues and products, but it is also possible to acquire the disease from contaminated water or food. Recently several cases and epidemics of tularemia have been reported in the northwest areas of Turkey, particularly in Marmara and West Black Sea regions. Erzurum is a city in Eastern Anatolia Region, Turkey and animal husbandry is the main agricultural activity in that area. However, neither tularemia cases were reported from this province nor seroprevalence studies were performed. In this study we aimed to determine F.tularensis antibody seropositivity in the risky population living at both rural and urban area of Erzurum. Blood samples from 240 volunteer subjects (134 male with mean age: 36.2, age range: 17-75 years and 106 female with mean age: 39.1, age range: 16-77 years) whose occupations were farming and animal husbandry, were included in the study. Serum samples were screened for the presence of F.tularensis antibodies by slide agglutination method (BD, USA) and Serazym ELISA kit (anti-F.tularensis IgG/IgA/IgM, Seramun, Germany). The positive samples with those tests were also retested by microagglutination test (MAT) in National Tularemia Reference Laboratory of Refik Saydam Hygiene Center, using antigen prepared in the same laboratory from the local strain. The serum samples were also searched for the presence of Brucella and Salmonella antibodies in terms of cross-reactivity. Seropositivity was detected in 71 (29.6%) out of 240 subjects by slide agglutination test (SAT), whereas only 5 (2.1%) gave positive result for total antibody by ELISA. Twenty-five of the 71 SAT positive samples yielded F.tularensis antibodies by MAT, of which 21 were between 1/20-1/40 and four were between 1/80-1/160 titers. However, all of the MAT positive samples (n= 25) were found reactive in Brucella and/or Salmonella antibody tests. One of the four MAT positive samples with 1/40 titer and all of the four MAT positive samples with ≥ 1/80 titer yielded positive results in ELISA. Since MAT gave very high cross reactive results, the five subjects (2.1%) found positive with ELISA were evaluated as seropositive for tularemia. Of those subjects (four were female, one was male; age range: 27-38 years), four were the inhabitants of the same village, and one from another neighboring village. All of the seropositive subjects were dealing with raising livestock and two were also farming. No history of contact with rat and wild animals or tick bite were detected, however it was noted that non-chlorinated fountain water has been used in both of these villages. In conclusion, our data emphasized that, populations inhabiting especially in rural area and dealing with farming and stock raising in our region are at risk for tularemia.