Species level identification and antifungal susceptibility of yeasts isolated from various clinical specimens and evaluation of Integral System Yeasts Plus

It is essential to use easy, standard, cost-effective and accurate methods for identification and susceptibility testing of yeasts in routine practice. This study aimed to establish the species distribution and antifungal susceptibility of yeast isolates and also to evaluate the performance of the colorimetric and commercially available Integral System Yeasts Plus (ISYP). Yeast isolates (n=116) were identified by conventional methods and ISYP. Antifungal susceptibility testing was performed by the microdilution method according to the standards of CLSI M27-A3 and ISYP. Candida albicans (50%) was the most common species isolated, followed by C. parapsilosis (25%) (mostly in blood samples). According to the CLSI M27-S3 criteria, resistance rates for amphotericin B, flucytosine, fluconazole, itraconazole, and voriconazole were 0%, 0%, 4.6%, 4.5% and 1.8%, respectively. Resistance for miconazole (MIC >1 mg/L) was found as 17.9%. Sixty-two (53.4%) of the isolates which were analyzed by ISYP showed disagreement with those identified by the conventional methods and API ID 32C identification kit or a specific identification code could not be assigned by ISYP. The performance of ISYP could be indicated as low for all antifungal drugs tested according to the ROC analysis (AUC: 0.28-0.56). As the current version of ISYP displays a poor performance, it is recommended to use the other commercial systems whose results are approved as reliable and in agreement with those of the reference methods in identification and susceptibility testing of yeasts

The diagnostic efficiency of QuantiFERONTB®-Gold test in the diagnosis of tuberculous pleurisy

Background: Diagnosis of tuberculous pleurisy is difficult and better diagnostic tools are needed. Interferon gamma release assays (IGRAs) are in vitro immunologic diagnostic tests used to identify Mycobacterium TB infections. They cannot differentiate between latent and active infections. As IGRA tests have recently been approved for the differential diagnosis of active TB, the diagnostic accuracy of the latest generation of IGRA were assessed to detect tuberculous pleurisy in this study. Methods: The QuantiFERONTB®-Gold (QFT-G) test was used in pleural fluid from 100 immunocompetent patients (23 patients for the tuberculous group and 77 patients for the non-tuberculous group). Clinical data were recorded. Adenosine deaminase activity (ADA) analysis and TB culture were performed on pleural fluid. Results: The QFT-G in pleural fluid was positive in 10 (43.5%) patients and indeterminate in 13(56.5%) patients in the tuberculous pleurisy group. There was not a single patient with a negative test result in the tuberculous pleurisy group. The ADA levels were detected as 46.2 ± 12.6 in patients with tuberculous pleurisy and18.6 ± 39.8 in patients with non-tuberculous pleurisy. The sensitivity, specificity, positive predictive value and negative predictive value of QFT-G in pleural fluid for tuberculous pleurisy were 43.5%, 54.5%, 30.3% and 100%; and of ADA in pleural fluid (>40IU/ml) for tuberculous pleurisy the results were 82.6%, 96.1%, 90.5% and 92.5% respectively. Conclusion: While the value of the QFT-G test in exclusion of tuberculous pleurisy was found to be higher in this study, its other diagnostic efficiency values were detected to be low. It is recommended that a new cut-off value be established while diagnosing active TB in prospective clinical studies and that it is also essential to do the same for the studies in various regions with high and low prevalence of TB

Etiology and Epidemiology of Community-Acquired Pneumonia in Turkey

OBJECTIVES: Due to its prevalence and mortality, Community Acquired Pneumonia (CAP) poses a significant health issue. Epidemiological data is crucial in deciding empirical treatment. Since sufficient knowledge of CAP epidemiology is not available in Turkey, this study has been planned