In vitro effect of ankaferd blood stopper®, a plant extract against Mycobacterium tuberculosis isolates

Dirençli Mycobacterium tuberculosis enfeksiyonlarının tedavisi, toksik yan etkileri olan antitüberküloz ilaçların kombinasyonunu gerektirdiğinden, güvenli ve etkili yeni ilaçlara gereksinim vardır. Alpinia officinarum, Glycyrrhiza glabra, Thymus vulgaris, Urtica dioica ve Vitis vinifera bitki ekstrelerinin bir karışımı olan Ankaferd Blood Stopper® (ABS), homeostatik ve antibakteriyel etkilere sahiptir. Ülkemizde ABS’nin standart solüsyonları, travmatik veya cerrahi sonrası kanama kontrolü amacıyla topikal olarak kullanılmaktadır. Bu çalışmada, M.tuberculosis izolatlarına karşı ABS’nin in vitro antitüberküloz etkinliğinin araştırılması amaçlanmıştır. Çalışmaya, 57 klinik izolat [17’si çok ilaca dirençli (ÇİD), biri izoniazid (INH) ve streptomisin (STR)’e dirençli, 11’i sadece INH’e dirençli, ikisi sadece STR’e dirençli, ikisi sadece etambutol (ETM)’e dirençli, 24’ü bütün ilaçlara duyarlı] ve üç standart suş [H37Rv (bütün ilaçlara duyarlı), ATCC 35822 (INH’e dirençli), ATCC 35820 (STR’e dirençli)] dahil edilmiştir. ABS MİK değerleri agar dilüsyon yöntemi kullanılarak tespit edilmiştir. Çalışmamızda, bütün ilaçlara duyarlı M.tuberculosis H37Rv suşu için ABS MİK değeri 10.94 ?g/ml olarak belirlenirken, INH dirençli ATCC 35822 ve STR dirençli ATCC 35820 suşları için 21.88 ?g/ml olarak saptanmıştır. Klinik izolatlar dikkate alındığında; duyarlı 24 suşun 17’sinde ABS MİK değeri 10.94 ?g/ml, altısında 21.88 ?g/ml ve birinde < 1.37 ?g/ml; ÇİD 17 suşun ise birinde 5.47 ?g/ml, beşinde 10.94 ?g/ml ve 11’inde 21.88 ?g/ml olarak bulunmuştur. Sadece INH direnci olan 11 izolatın MİK değerleri < 1.37-21.88 ?g/ml arasında değişiklik göstermiştir. Yalnızca STR’ye dirençli iki izolatın MİK değerleri 21.88 ?g/ml; yalnızca ETM’e dirençli iki izolatın MİK değerleri de 21.88 ?g/ml ve 10.94 ?g/ml olarak saptanmıştır. Hem INH hem de STR direnci olan bir izolatın MİK değeri ise 21.88 ?g/ml olarak izlenmiştir. Test edilen bakterilerin MİK50 ve MİK90 değerleri sırasıyla 10.94 ?g/ml ve 21.88 ?g/ml olarak tespit edilmiştir. Sonuç olarak çalışmamızda, ABS’nin topikal olarak kullanılan solüsyonunun yaklaşık 16 kat dilüe edilmiş konsantrasyonu, tüberküloz basillerine karşı in vitro olarak etkili bulunmuş ve bu sonuç ABS’nin kütanöz tüberkülozda, özellikle ÇİD M.tuberculosis’in neden olduğu osteomiyelit ve lenfadenit gibi tüberküloz odaklarının cerrahi debridmanında antitüberküloz ilaçlarla birlikte destekleyici amaçla başarıyla kullanılabileceğini düşündürmüştür.Treatment of drug-resistant Mycobacterium tuberculosis infections requires combination of anti-tuberculosis drugs which have several toxic side effects. Thus there is a need for safer and effective new drugs. Ankaferd Blood Stopper&reg; (ABS), which is a mixture of plant extracts prepared from Alpinia officinarum, Glycyrrhiza glabra, Thymus vulgaris, Urtica dioica and Vitis vinifera, has homeostatic and antibacterial effects. Standard solutions of ABS are already being used topically for post-traumatic and post-operative bleeding control in our country. This study was aimed to evaluate the in vitro activity of ABS against M.tuberculosis isolates. A total of 57 clinical isolates [17 multidrug resistant (MDR), 11 resistant to only isoniazid (INH), one resistant to INH and streptomycin (STR), two resistant only to STR, two resistant only to ETM, and 24 susceptible to all drugs] and three standard strains [H37Rv (susceptible to all drugs), ATCC 35822 (INH-resistant), ATCC 35820 (STR-resistant)] were included in the study. Agar dilution method was used to detect the MIC values of ABS. In the study, ABS MIC value was determined as 10.94 &amp;#956;g/ml for M.tuberculosis H37Rv strain which was susceptible to all antituberculosis drugs, whereas it was determined as 21.88 &amp;#956;g/ml for INH-resistant ATCC 35822 and STRresistant ATCC 35820 strains. The MIC values for 24 susceptible clinical isolates were as follows; 10.94 &amp;#956;g/ml (n= 17), 21.88 &amp;#956;g/ml (n= 6) and &lt; 1.37 &amp;#956;g/ml (n= 1). When evaluating 17 MDR clinical isolates, MIC values were determined as 5.47 &amp;#956;g/ml (n= 1), 10.94 &amp;#956;g/ml (n= 5) and 21.88 &amp;#956;g/ml (n= 11). MIC values were ranging between &lt; 1.37-21.88 &amp;#956;g/ml among 11 INH-resistant isolates. These isolates were susceptible to other first line anti-tuberculosis drugs. MIC value of one isolate resistant to both of INH and STR was determined as 21.88 &amp;#956;g/ml. MIC value of the two sole STR-resistant isolates was 21.88 &amp;#956;g/ml. MIC values of the two sole ETM-resistant isolates were determined as 21.88 &amp;#956;g/ml and 10.94 &amp;#956;g/ml. MIC50 and MIC90 values for the tested bacteria were 10.94 &amp;#956;g/ml and 21.88 &amp;#956;g/ml, respectively. It was concluded that 16 fold diluted concentration of the topically used ABS solution was found to be active against tuberculosis bacilli in vitro. Thus ABS might be used as a supportive agent together with anti-tuberculous drugs during debridement of multiple drug-resistant M.tuberculosis caused osteomyelitis and lymphadenitis lesions

Laboratory Acquired Brucellosis in Turkey

Background Laboratory healthcare workers (HCWs) are at risk of laboratory-acquired brucellosis (LAB). Aim To describe the risk factors of LAB among HCWs. Methods A multicentre survey study was conducted by face-to-face interview in 38 hospitals from 17 provinces of Turkey. A structured survey was administered to the HCWs, working in infectious diseases clinics and microbiology departments, who were at risk of brucella infection. Findings The survey response rate was 100%. Of the 667 laboratory workers, 38 (5.8%) had a history of LAB. In multivariate analysis, factors independently associated with an increased risk of LAB included working with the brucella bacteria (odds ratio: 5.12; 95% confidence interval: 2.28&ndash;11.52; P&nbsp;&lt;&nbsp;0.001) and male gender (2.14; 1.02&ndash;4.45; P&nbsp;=&nbsp;0.042). Using a biosafety cabinet level 2 (0.13; 0.03&ndash;0.60; P&nbsp;=&nbsp;0.009), full adherence to glove use (0.27; 0.11&ndash;0.65; P&nbsp;=&nbsp;0.004) and longer duration of professional life (0.86; 0.80&ndash;0.92; P&nbsp;&lt;&nbsp;0.001) were found to be protective. Conclusions Working with the brucella bacteria, being male, a lack of compliance with personal protective equipment and biosafety cabinets were the independent risk factors for the development of LAB in our series. Increased adherence to personal protective equipment and use of biosafety cabinets should be priority targets to prevent LAB.</p