[Serotypes and antimicrobial susceptibilities of invasive group A streptococci identified in eastern Black Sea region of Turkey]. / Türkiye'nin dogu karadeniz bölgesinden tanimlanmis invazif A grubu streptokoklarin serotipleri ve antimikrobiyal duyarliliklari.

Frequency of invasive group A streptococcus (GAS) infections is increasing worldwide in recent 20 years. Serotypes responsible for these clinical manifestations and their antibiotic susceptibilities should be known in order to establish preventive measures and initiate appropriate treatment. This study was aimed to determine the serotypes, antibiotic susceptibilities and inducible clindamycin resistance among invasive GAS isolated between 2006-2009 period. A total of 22 GAS strains isolated from clinical samples [sterile body fluids (peritoneal, pleural, pericardial, joint and cerebrospinal fluids), blood, tissue biopsy] of the patients (14 male, 8 female; age range: 3-82 years, median age: 59) who admitted to Karadeniz Technical University Faculty of Medicine, Farabi Hospital located in Trabzon province (Eastern Black Sea Region of Turkey), between March 2006 and March 2009 were included in the study. GAS serotypes were determined by the investigation of serum opacity factors (SOF), T proteins and M proteins. SOF production was investigated by microplate method using human serum and SOF types were determined by SOF-inhibition test using specific antisera. T protein types were detected by agglutination method using polyvalent anti-T sera, and M serotypes were detected by capillary precipitation method using M antisera. Antimicrobial susceptibility tests were performed by disk-diffusion method according to CLSI recommendations. SOF were positive in 9 (41%) samples. Use of T antiserum yielded T (n= 8) and U (n= 7) types and M antiserum M1 (n= 4) and M2 (n= 3) types. The overall antibiotic susceptibility rate of the isolates was 68% (15/22) and overall resistance rate was 32% (7/22). All of the GAS strains were found susceptible to benzylpenicillin, ceftriaxone, vancomycin, levofloxacine and linezolid, however 9 (41%) were intermediate susceptible to tetracycline and 1 (4.5%) was intermediate susceptible to erythromycin. Four (18%) strains were found resistant to tetracycline, while three strains (13.5%) were found resistant to chloramphenicol. Inducible clindamycin resistance was found positive only in one strain. The serotypes determined in this study indicated that 33% of our invasive serotypes were covered by the hexavalent vaccine and 62% by the 26-valent vaccine. Multi-center surveillance studies are required to determine the serotype distribution of invasive GAS in Turkey and to provide valuable information for the development of appropriate vaccines in our country.

[A frequently overlooked bacteria in clinical microbiology laboratories: Arcanobacterium haemolyticum]. / Klinik mikrobiyoloji laboratuvarinda siklikla atlanan bir etken: arcanobacterium haemolyticum.

Arcanobacterium haemolyticum, previously known as Corynebacterium haemolyticum, is a facultative anaerobic, gram-positive bacillus with negative catalase and positive CAMP inhibition test results. It may be the causative agent of about 0.5-3% of acute bacterial pharyngitis especially in children and young adults. Since growth of A.haemolyticum is usually inhibited by flora members and since it slowly develops hemolysis in sheep blood agar and its colony morphology resembles beta-hemolytic streptococci, it is frequently overlooked in the evaluation of throat cultures. The aims of this study were to investigate the isolation frequency of A.haemolyticum from the throat cultures of pediatric patients by using both sheep and human blood agar media, and to evaluate the performances of those media for the identification of A.haemolyticum. A total of 355 patients (median age: 7 years) who were admitted to pediatric outpatient clinics with the symptoms of tonsillopharyngitis between March-July 2010 period, were included in the study. Swab samples obtained from tonsils and posterior oropharynx were inoculated into a divided plate which contained 5% sheep blood agar in one half and 5% human blood agar in the other half. After incubation in 5% CO2 at 37°C, the beta-hemolytic colonies with a microscopic morphology of gram-positive bacilli were further evaluated on 24, 48 and 72th hours. Identification of A.haemolyticum was based on negative catalase test, positive reverse CAMP test and biochemical characteristics obtained by API-Coryne (bioMérieux, France) identification system. In our study, beta-hemolytic colonies were detected in the throat cultures of 56 (16%) patients, of which 14% (49/355) were identified as beta-hemolytic streptococci (46 group A, 2 group G, 1 group C), and 2% (7/355) were identified as A.haemolyticum. All of the A.haemolyticum isolates were characterized by the production of beta-hemolysis in human blood agar at 24 hours, while the beta-hemolysis generation time in sheep blood agar was 48 hours for four isolates and 72 hours for three isolates. A.haemolyticum was identified in 2% of children with tonsillopharyngitis during the five months study period in spring/summer. All of the strains were isolated at human blood agar in 24 hours. Thus, in order to isolate A.haemolyticum in routine throat cultures, sheep blood agar plates together with human blood agar plates should be used in clinical microbiology laboratories.

Coagulation status and biochemical and inflammatory markers in multiple sclerosis.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system and is the most common cause of neurologic disability in young adults. In this study, the coagulation status and biochemical and non-specific inflammatory markers in patients with MS were investigated. Plasma prothrombin time, activated partial thrombin time, fibrinogen, D-dimer, serum high sensitive C-reactive protein, homocysteine, blood urea nitrogen, creatinine, calcium, total protein, albumin, total cholesterol, vitamin B12, folate levels and erythrocyte sedimentation rate were measured in 42 patients with MS and 31 healthy subjects as a control group. There was a positive correlation between homocysteine and D-dimer levels (r=0.84, p<0.01). However, there was no significant correlation between homocysteine, vitamin B12 (r=0.18) and folate (r=0.23) levels. Serum total protein, albumin and calcium levels of MS patients were lower than the control group. There are some alterations in the coagulation and biochemical status in MS patients. These findings may contribute to better understanding of the etiopathogenesis and clinical characteristics of this disease.

[A case of urinary tract infection caused by Flavimonas oryzihabitans]. / Flavimonas oryzihabitans'in etken oldugu bir jriner sistem enfeksiyonu olgusu.

Flavimonas oryzihabitans is an uncommon bacterial species isolated from clinical specimens. In this report, a 53 years old female patient who had been followed up with the diagnosis of rectum cancer and renal failure for five and two years, respectively, was presented. F. oryzihabitans was isolated from the urine culture of the patient, and the clinical response to ofloxacin therapy was excellent even the urinary catheter has not been removed. Although this pathogen is mostly community aquired, it was found resistant to most of the antimicrobial agents tested. Since it was susceptible to fluoroquinolones and carbapenems, these antibiotics could be the drug of choice for the treatment of infections caused by F. oryzihabitans. The aim of this presentation was to withdraw attention to this bacterium which is thought to be the first urine isolate in our country.

Interleukin-6, C-reactive protein and biochemical parameters during prolonged intermittent fasting.

BACKGROUND: It is well known that nutritional habits, sleeping patterns and meal frequency have profound effects on maintaining human health. Ramadan is a religious month for Islam, during which Muslims do not eat and drink during the daylight hours. The duration of restricted food and beverage intake is approximately 12 h/day for 1 month, which makes Ramadan a model of prolonged intermittent fasting. METHODS: In order to evaluate the effects of long-lasting modifications of food intake on inflammatory markers and biochemical parameters 40 healthy volunteers of normal weight [20 females aged between 20 and 38 years, 20 males aged between 23 and 39 years, body mass index (BMI) <25 kg/m(2)] who fasted during Ramadan and another 28 healthy age- and BMI-matched volunteers (14 males, 14 females) who did not fast participated in the study. Venous blood samples were taken 1 week before Ramadan, during the last week of Ramadan and 3 weeks after Ramadan. Serum interleukin-6 (IL-6), C-reactive protein (CRP), homocysteine, vitamin B(12), folate, total cholesterol (TC), triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels were measured. RESULTS: No significant changes were observed in serum total cholesterol, triglycerides and LDL levels. TC/HDL ratio (HDL risk factor) was decreased during and after Ramadan in both genders in the fasting group while there were no changes in the nonfasting group. IL-6 (p < 0.001), CRP (p < 0.001) and homocysteine (p < 0.01) levels were significantly low during Ramadan in the fasting subjects of both genders when compared to basal values (1 week before Ramadan). CONCLUSION: Our results demonstrate that prolonged intermittent fasting in a model like Ramadan has some positive effects on the inflammatory status of the body and on the risk factors for cardiovascular diseases such as homocysteine, CRP and TC/HDL ratio.

Brain-stem listeriosis: a comparison of SPECT and MRI findings.

Listeria monocytogenes, although uncommon as a cause of illness in the general population, can result in serious illness when it affects pregnant women, neonates, the elderly, and immunocompromised individuals. Typically, it is a food-borne organism. This report describes a case of brain-stem listeriosis in a previously healthy 51-year-old woman. The diagnosis was based on clinical findings, the results of cerebrospinal fluid (CSF) analysis, CSF culture, and magnetic resonance imaging (MRI) findings. MRI demonstrated upper brain stem and cerebellar peduncle involvement. In addition, Tc-99m exametazime (HMPAO)-labeled single photon emission computed tomography (SPECT) of the brain revealed bilateral cerebellar hypoperfusion. Antibiotic therapy resulted in partial clinical recovery after 3 weeks. At the end of 6 months, brain-stem findings had nearly resolved. However, although minimal residual findings were observed on MRI at 6 months, bilateral diffuse cerebellar hypoperfusion remained on Tc-99m HMPAO brain SPECT.