Rapid detection of bacterial atypical pneumonia agents by multiplex PCR.

Approximately one third of community acquired pneumonia cases are caused by atypical pneumonia agents, Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydophila pneumoniae (formerly Chlamydia pneumoniae). The laboratory diagnosis of these organisms is difficult and time-consuming by conventional microbiological techniques. Polymerase chain reaction (PCR) is one of the important tools which can circumvent this problem. A multiplex PCR assay was developed to achieve the diagnosis of these three organisms in a single tube. Primers used in PCR were selected in a way that they amplified different length DNA fragments from different agents but they all worked at the same amplification conditions. Therefore the organisms could be diagnosed according to the length of amplified products by agarose gel electrophoresis without using any hybridization probes. After development of the multiplex PCR method, totally 309 clinical samples which were sent to our laboratory for single-agent PCR, were also evaluated by this technique. The results showed that the multiplex PCR assay is a sensitive, useful, cheap, and rapid diagnostic tool for the management of pneumonia patients.

The relationship between cholesterol levels and depression in the elderly.

OBJECTIVE: This study was undertaken to evaluate the possible association between low levels of serum cholesterol and depression in the elderly. BACKGROUND: The alteration of cholesterol content of synoptosomal membrane in response to low serum cholesterol levels has been shown to decrease the serotonin receptors in depressed patients. Previous studies suggest that low levels of serum cholesterol may be associated with the increased risk of depression in the elderly. SUBJECTS AND METHODS: This was a cross-sectional study where 189 subjects over 65 years old of both sexes were enrolled. Serum total cholesterol, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), and triglycerides were measured. Cognitive functions were evaluated with mini mental state examination survey (MMSES) and depression was assessed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). RESULTS: Of the 189 subjects, 42 were affected by depression. Low serum cholesterol level (cut-off < or =160 mg/dl) as well as the levels of HDL-C, LDL-C and triglycerides were not associated with depression in older men or women. CONCLUSIONS: In the present cross sectional study, there was no association between depression and low serum cholesterol levels after adjusted for confounding factors. Further studies are needed to clarify this suggestion with larger number of patients.

Fatal peritonitis due to Trichoderma sp. in a patient undergoing continuous ambulatory peritoneal dialysis.

We describe a rare case of peritonitis caused by an unusual fungus, Trichoderma sp., in a patient on continuous ambulatory peritoneal dialysis. Management of the patient consisted of Tenckhoff catheter removal and antifungal chemotherapy, but the patient died.

Polymicrobial ventriculitis and evaluation of an outbreak in a surgical intensive care unit due to inadequate sterilization.

At the end of 1999, a case of polymicrobial ventriculitis in the Department of Neurosurgery followed by an outbreak of Serratia marcescens mediastinitis in the intensive care unit of cardiovascular surgery occurred. These nosocomial surgical infections were considered to be the result of contamination of surgical sites with inadequately sterilized instruments or theatre linen. An epidemiological survey was focused on the central sterilization unit of the hospital. The microbiological results of this survey proved that the cause of the outbreak was the use of inadequately decontaminated theatre linen. This study indicates that strict infection control measures including the control of sterilization procedures and a well-organized infection control team are necessary to prevent nosocomial surgical infections.

Spermatozoa selection by the swim-up procedure and two-layer percoll gradient centrifugation.

The efficiency of the swim-up procedure and two-layer Percoll gradient centrifugation in procession of spermatozoa was assessed in ejaculates from 47 infertile men. A significantly higher total number of spermatozoa was harvested from Percoll gradients than from the swim-up procedure, the loss rates in concentration being -13.6 +/- 6.4% and -70.8 +/- 5.8%, respectively (p < 0.0001). Recovery in per cent motility was significantly higher after the Percoll gradient than after the swim-up procedure (34.8 +/- 10.2% versus -10.4 +/- 17.2%, p < 0.05). No significant difference was noted between the mean motility grades of the final solutions obtained by the two methods (2.7 +/- 0.2 and 2.0 +/- 0.4, respectively, p > 0.05). When evaluation was conducted within three initial fresh sample concentration categories such as severe oligospermia (lower than 5 x 10(6)/ml), moderate oligospermia (5 to 10 x 10(6)/ml) and mild oligospermia (higher than 10 x 10(6)/ml), the Percoll technique recovered significantly higher number of spermatozoa than the swim-up procedure through all concentration categories (p < 0.05 for each range). Despite being statistically insignificant, Percoll gradients produced final spermatozoa pools with higher per cent motility and motility quality within all concentration ranges. The results suggest that the Percoll gradient centrifugation should be the preferred selection method regardless of the initial fresh sample concentration.

Epidemiology of meningococcal infections in children in mid-southern part of Turkey.

59 patients were treated for meningococcal infections in Cukurova University Faculty of Medicine, Division of Pediatric Infectious Diseases. 50.8% of patients were male, 33.9% were under two years of age and 61% were under five. 78% of patients were admitted to hospital in winter and spring time. Meningococcal meningitis (MM) was present in 39% of patients on admission, however, meningococcemia in 27.1% and meningococcemia and meningococcic meningitis (Meningococcemia + MM) in 33.9%. Fatality rate was 18.6% and no association was found between mortality and clinical type of disease (p > 0.05), but mortality ratio decreased with an increasing age (p < 0.01). No deaths occurred among the 12 patients who received i.v. penicillin treatment shortly before admitting to hospital, on the other hand 11 of 47 patients (23.4%) without such a previous treatment died.

PIP: The clinical and laboratory findings of 59 patients treated for meningococcal disease between January 1, 1989, and December 31, 1993, in Adana, Turkey's Cukurova University, Faculty of Medicine, Division of Pediatric Infectious Diseases were analyzed retrospectively. The diagnosis was based on clinical findings, positive blood or cerebrospinal fluid (CSF) cultures, and the presence of gram negative diplococci in the CSF and in the smears from petechiae. Of 59 patients, 29 (49.2%) were female and 30 (50.8%) were male, with ages ranging from 1 month to 14 years. 20 (33.9%) patients were in the 0-2 and 36 (61%) were in the 0-5 age group. Most of the patients (45.7%) were admitted to the hospital in the winter, followed by spring (32.2%), summer (15.3%), and fall (6.8%). In January and February there seemed to be a peak in admission rates (18.6% and 16.9%, respectively). The distribution of patients with respect to seasons showed a statistically significant difference (p .0001). The overall case fatality was 18.6% (11/59). Meningococcal meningitis (MM) was diagnosed in 23 (39%) patients, meningococcemia in 16 (27.1%), and MM + meningococcemia in 20 (33.9%). 10 of 20 children 0-2 years of age presented with meningococcemia alone. On the other hand, 11 (47.8%) of the 23 patients over 5 years showed MM alone. Clinical presentation revealed a significant association with certain age groups (p .05). Fatality ratios in children under 2 years old and in children 2-14 years old were 35% and 10.2%, respectively, and there was a significant trend for decreasing case fatality rate with increasing age (p .01). All patients aged 0-3 months died. The fatality rate was the lowest among patients over 5 years of age (8.7%, 2/23). The mortality rate did not change with clinical presentation (p .05). Two patients (8.7%) with MM died, while this rate was 20% (4/20) in patients with MM + meningococcemia. 5 of 16 (31.3%) patients died in the group with meningococcemia only. Signs of upper respiratory tract infection were present in 11 (18.6%) patients during their initial physical examination, but no statistically significant relationship was found in respect to mortality (p .05).