[Nocardia spp. isolated from immunocompromised patients in Trakya University Medical Faculty Hospital and their antibiotic susceptibilities]. / Trakya Uuniversitesi Tip Fakültesi Hastanesinde bagisklik sistemi baskilanmis hastalardan izole edilen Nocardia türleri ve antibiyotiklere duyarliliklari.

The aims of this study were the isolation and identification of Nocardia spp. from clinical samples of immunocompromised patients and patients with underlying diseases, and determination of antibiotic susceptibilities of the isolates. A total of 234 patients (172 male, 62 female; mean age: 58.6 +/- 15.9 years) of whom 126 (53.8%) with malignancy and 108 (46.2%) with other underlying diseases (pulmonary diseases, rheumatologic disorders, diabetes mellitus, chronic renal disfunction, cerebrovascular disorders and malnutrition) were included to the study. Biochemical characteristics, growth properties and antibiotic susceptibility patterns were used for the identification of the isolates. The distribution of specimens were as follows; sputum (124), tracheal aspirate (54), pleural fluid (27), bronchoalveolar lavage (23), abscess material (7) and lung biopsy (1) material. Nocardia spp were isolated from four out of 234 patients (1.7%), and two of them were identified as N. farcinica, one as N. asteroides and one as N. otitidiscaviarum. All of the four patients have had predisposing factors (hepatocellular carcinoma/diabetes mellitus; antiphospholipid syndrome/steroid use; nephrotic syndrome/ steroid use; chronic obstructive lung disease/lung cancer?), with a mean age of 52.5 years, and of them two were male. Nocardiosis has been presented as pulmonary infection in two of the cases, and brain and soft tissue abscesses in one of each patient. Kirby-Bauer disk diffusion, E-test and broth microdilution methods were used in order to detect the antibiotic susceptibilities of the strains. All isolates were found susceptible to imipenem and amikacin and resistant to erythromycin and ampicillin. One N. asteroides isolate was found susceptible to trimetoprim-sulphamethoxazole (TMP-SMX), whereas two N. farcinica and one N. otitidiscaviarum strains were resistant. The antibiotics to which N. farcinica isolates were susceptible were ceftriaxone and cefotaxime. As a result, since there is an increase in the number of immunocompromised patients recently, Nocardia spp. should be considered in such patients, and TMP-SMX should be used with care for empirical therapy.

Prospective evaluation of rickettsioses in the Trakya (European) region of Turkey and atypic presentations of Rickettsia conorii.

In 2004 between the months of May-November, 11 patients with spotted fever group (SFG) rickettsioses were admitted to the Trakya University Hospital in Edirne, Turkey. SFG rickettsioses were diagnosed clinically. Before treatment, punch biopsy from skin lesions, especially from the eschar, was performed. Serum specimens were tested by IFA using a panel of nine rickettsial antigens, including SFG rickettsiae and R. typhi. Western blotting and standard PCR were also performed. The average age of the 11 patients (4 male and 7 female) was 51 years. All the patients had high fever; 10 (91%) had maculopapular rash; 8 (73%) had rash in the palms or on the soles. Five patients had a unique eschar; two had double eschars (64%). Two patients presented with multiple organ failure and one of them died. All the patients had significant antibody titers against SFG rickettsiae. PCR experiments of skin biopsies were positive in six (60%) of 10 skin biopsy samples and DNA sequencing of the positive PCR products gave 100% homology with Rickettsia conorii Malish 7 for opmA and gltA. Trakya Region in an endemic area for rickettsioses. In this series, three patients presented with life-threatening diseases and one of them died. This patient was the first fatal case (2.8%). Atypic and serous life-threatening presentations of rickettsioses must be kept in mind for the differential diagnosis of febrile disease in Turkey.

Nocardial brain abscess: review of clinical management.

Nocardiosis has become a significant opportunistic infection over the last two decades as the number of immunocompromised individuals has grown worldwide. We present two patients with nocardial brain abscess. The first patient was a 39-year-old woman with systemic lupus erythematosus. A left temporoparietal abscess was detected and aspirated through a burr-hole. Nocardia farcinica infection was diagnosed. The patient had an accompanying pulmonary infection and was thus treated with imipenem and amikacine for 3 weeks. She received oral minocycline for 1 year. The second patient was a 43-year-old man who was being treated with corticosteroids for glomerulonephritis. He was diagnosed with a ring-enhancing multiloculated abscess in the left cerebellar hemisphere, with an additional two small supratentorial lesions and triventricular hydrocephalus. Gross total excision of the cerebellar abscess was performed via a left suboccipital craniectomy. Culture revealed Nocardia asteroides, and the patient was successfully treated with intravenous ceftriaxone, then oral trimethoprime-sulfamethoxazole for 1 year. The clinical course, radiological findings, and management of nocardial brain abscess are discussed in light of the relevant literature, and current clinical management is reviewed through examination of the cases presented here.

The antimicrobial susceptibility of Stenotrophomonas maltophilia isolates using three different methods and their genetic relatedness.

BACKGROUND: Stenotrophomonas maltophilia is inherently resistant to many antimicrobials. So far, antimicrobial susceptibility tests for S. maltophilia have not been fully standardized. The purpose of the study was to compare the susceptibility of S. maltophilia isolates against seven different antimicrobials using three different methods and to investigate their genetic relatedness. RESULTS: Although trimethoprim/sulfamethoxazole (SXT) and ciprofloxacin have the lowest MIC values, SXT (98.1%) and ticarcillin/clavulanate (TLc) (73.1%) were found to be the most effective antimicrobials by agar dilution method, which was in accordance with the breakpoints established by NCCLS. Disc diffusion and E-test was in agreement with agar dilution method for SXT. When the isolation dates, clinics, antibiotyping, and AP-PCR data were investigated, two small outbreaks consisting of five and three cases were determined. CONCLUSION: By using the NCCLS criteria, disc diffusion and E-test were unreliable alternative methods for S. maltophilia, except for SXT. However, the significance of these data should be confirmed by further experimental and clinical studies.