Prediction of the Species Distribution of Cryptococcus neoformans Throughout Turkey

WOS: 000465377600011PubMed ID: 31130127Cryptococcus neoformans is a human pathogenic yeast that causes life-threatening infections especially in immunosuppressed patients. The environmental isolation of C.neoformans from Turkey was reported as early as 2004, although this was mostly from Eucalyptus camaldulensis colonization. Successful isolations were also reported from pomegranate (Punica granatum), oriental plane (Platanus orientalis), pine tree (Pinaceae), chestnut (Castanea sativa) and salt cedar (Tamarix hispida). The investigation of the relationship between the bioclimatic factors affecting the environmental isolation sites and the colonization of pathogens is a frequently used method. With this method, detailed risk maps can be generated in which environmental colonization can be estimated. The aim of this study was to use the high-resolution bioclimatic and previously-isolated yeasts' coordinates to create a valid model for the occurrence of C.neoformans in Turkey and provide insight into ecological processes. A machine learning approach using presence-only data software, maximum entropy (MaxEnt), was used to for the prediction of C.neoformans distribution. Climatic data and environmental bioclimatic variables from WorldClim were downloaded as 30 seconds spatial resolutions. The correlation between different Turkey bioclimatic layers were analyzed with ENMTools and similar layers were discarded. Forty-one different coordinates representing C.neoformans isolation points were used to generate a predictive map. The area under the curve and the omission rate were used to validate the model. Meanwhile, Jackknife tests were applied to enumerate the contribution of different environmental variables, and then to predict the final model. Maps were created using QGIS mapping software. In this study, we have shown that the coastal region of Anatolia, which is geographically located in the Northeastern Mediterranean Basin, as well as the entire Aegean region, carry an extremely high risk for the colonization of C.neoformans. Other areas which have not previously been reported for the isolation of C.neoformans were predicted to be potential colonization hotspots, including the western part of Ataturk Dam, the Amik Plain and the Bakircay and Gediz valleys. The maximum temperature of the warmest month, the mean temperature of the warmest quarter and the precipitation of the coldest quarter were the most important factors influencing the model's predictions. It was determined that the humidity in the environment affected the colonization especially in November. In conclusion, we produced a C.neoformans colonization risk map of Turkey for the first time. Obtaining more regional data will facilitate the identification of the regions having similar risk. This approach is useful for the clinical prediagnosis of cryptococcosis cases, which may be more common in places with environmental niches

Isolation of Cryptococcus neoformans from a chestnut tree (Castanea sativa), Denizli, Turkey

WOS: 000434852700767

Frequency of azole resistance in clinical and environmental strains of Aspergillus fumigatus in Turkey: a multicentre study

Objectives Aspergillus fumigatus causes several diseases in humans and azole resistance in A. fumigatus strains is an important issue. The aim of this multicentre epidemiological study was to investigate the prevalence of azole resistance in clinical and environmental A. fumigatus isolates in Turkey. Methods Twenty-one centres participated in this study from 1 May 2018 to 1 October 2019. One participant from each centre was asked to collect environmental and clinical A. fumigatus isolates. Azole resistance was screened for using EUCAST agar screening methodology (EUCAST E.DEF 10.1) and was confirmed by the EUCAST E.DEF 9.3 reference microdilution method. Isolates with a phenotypic resistance pattern were sequenced for the cyp51A gene and microsatellite genotyping was used to determine the genetic relationships between the resistant strains. Results In total, resistance was found in 1.3% of the strains that were isolated from environmental samples and 3.3% of the strains that were isolated from clinical samples. Mutations in the cyp51A gene were detected in 9 (47.4%) of the 19 azole-resistant isolates, all of which were found to be TR34/L98H mutations. Microsatellite genotyping clearly differentiated the strains with the TR34/L98H mutation in the cyp51A gene from the strains with no mutation in this gene. Conclusions The rate of observed azole resistance of A. fumigatus isolates was low in this study, but the fact that more than half of the examined strains had the wild-type cyp51A gene supports the idea that other mechanisms of resistance are gradually increasing.This work was partly supported by Bursa Uludag University Scientific Research Projects Commission (QUAP[T]-2015-5) and Ener Private Health Service Company.Bursa Uludag University Scientific Research Projects Commission [QUAP[T]-2015-5]; Ener Private Health Service Compan

3D printed poly(epsilon-caprolactone) scaffolds modified with hydroxyapatite and poly(propylene fumarate) and their effects on the healing of rabbit femur defects

A large variety of approaches have been used to treat large and irregular shaped bone defects with less than optimal success due to material or design issues. In recent years patient specific constructs prepared by additive manufacturing provided a solution to the need for shaping implants to fit irregular defects in the surgery theater. In this study, cylindrical disks of poly(e-caprolactone) (PCL) were printed by fused deposition modeling and modified with nanohydroxyapatite (HAp) and poly(propylene fumarate) (PPF) to create a mechanically strong implant with well-defined pore size and porosity, controllable surface hydrophilicity (with PPF) and osteoconductivity (with HAp). Cytotoxicity, irritation and inflammation tests demonstrated that the scaffolds were biocompatible. PCL/HAp and PCL/HAp/PPF scaffolds were implanted in the femurs of rabbits with and without seeding with rabbit Bone Marrow Stem Cells (BMSC) and examined after 4 and 8 weeks with micro-CT, mechanically and histologically. BMSC seeded PCL/HAp/PPF scaffolds showed improved tissue regeneration as determined by bone mineral density and micro-CT. Compressive and tension stiffness values (394 and 463 N mm(-1)) were significantly higher than those of the healthy rabbit femur (316 and 392 N mm(-1), respectively) after 8 weeks of implantation. These 3D implants have great potential for patient-specific bone defect treatments

Succinivibrionaceae is dominant family in fecal microbiota of Behcet's Syndrome patients with uveitis

Behcet's Syndrome (BS) is a multisystem vasculitis with various clinical manifestations. Pathogenesis is unclear, but studies have shown genetic factors, innate immunity and autoinflammation to have an important role in the disease course. Diversity in the microbial community of gut microbiota may significantly contribute to the activation of the innate immune system. The clinical features of BS present themselves in clusters and each cluster may be a consequence of different disease mechanisms. For this reason we aimed to investigate the gut microbiota of BS patients with uveitis. In addition to healthy controls, we have aimed to compare the gut microbiota of BS with that of Familial Mediterranean Fever (FMF) and Crohn's Disease (CD) as both diseases have innate and autoinflammatory features in their pathogenesis. Seven patients with BS, 12 patients with FMF, 9 patients with CD and 16 healthy controls (HC) were included in the study. Total genomic DNAs were isolated from fecal samples of the patients. Partial 16S rRNA gene was sequenced using the PGM Ion Torrent (Thermo Fisher Scientific, Waltham, MA, USA) for microbiota analysis. Statistical analysis showed that significant differences were detected on the microbial community of four groups. Succinivibrionaceae is dominant and the signature family, whereas Bacteroides was absent in BS patients

Children with breakthrough varicella infection requiring hospitalization in Turkey (VARICOMP Study 2008-2013)

Introduction: Varicella in previously immunized individuals, known as "breakthrough varicella". While the majority of breakthrough cases are mild, some may be severe, requiring hospitalization in previously healthy children or children with an underlying condition

Antifungal Prophylaxis in Solid Organ Transplant Recipients

WOS: 000219732100007Solid organ transplantation (SOT) is a treatment method that improves quality of life and survival of patients with end-stage organ failure. Immunosuppressive treatments given to these patients may predispose to the development of invasive fungal infections (IFI). The incidence of IFI in SOT recipients, which is between 5% and 42%, depends on the organ to be transplanted. Although Candida spp., followed by Aspergillus spp. are the most common microorganisms, among fungal pathogens, this situation varies according to transplant type. The mortality rate associated with these IFI can be high. Therefore, antifungal prophylaxis may be necessary for SOT recipients. Many transplantation centers employ antifungal strategies according to their own experience because of the lack of randomized controlled studies. If the antifungal prophylaxis is given to all patients, antimicrobial resistance and drug-drug interactions may occur. Therefore, it is important to identify patients at a high risk of developing IFI. In this paper, epidemiology, risk factors, literature data and antifungal prophylaxis associated with IFI in liver, kidney, small intestine, pancreas, heart, and lung transplant recipients are reviewed

Pediatricians' attitudes in management of acute otitis media and ear pain in Turkey

WOS: 000428492100004PubMed ID: 29501295Objectives: Acute otitis media (AOM) is predominantly a disease of childhood and one of the common reasons for prescribing antibiotics. Ear pain is the main symptom of AOM, with the result that parents frequently seek immediate medical assistance for their children. Antibiotic therapy for AOM does not provide symptomatic relief in the first 24 hours, and analgesics are commonly recommended for relieving the pain associated with AOM. The aims of the present study were to assess pediatricians' attitudes toward AOM and ear pain management in Turkey. Methods: This multicenter descriptive questionnaire study was conducted in 20 centers from different geographic locations in Turkey, with 977 pediatricians, between June 2015 and December 2016. The questionnaire comprised 20 questions focusing on the pediatricians' sociodemographic variables, experiences, and treatment related to AOM and ear pain. Results: Of the pediatricians, 58.2% were residents, 36.5% were specialists, and 4.3% were lecturers. Most participants were working in a university hospital (54.8%) or education and research hospital (32.2%). In general daily practice, the AOM diagnosis rates were between 6% and 20% in outpatient clinics, and 52.3% of the participants stated the patients complained about ear pain in pediatric clinics. The watchful waiting (WW) rate, as opposed to immediate antibiotic treatment, was 39.8% for all the pediatricians. The pediatric residents used the WW strategy less than the specialists and lecturers did (p = 0.004). The rates of the WW strategy were higher in outpatient clinics where AOM was commonly diagnosed (p < 0.001). The most common antibiotic prescribed for AOM was amoxicillin clavulanate (76.7%). The mean recommended treatment period for AOM was 9.3 +/- 2.2 days. The choices for systemic ear pain treatment were acetaminophen (26.8%), ibuprofen (29.4%), and alternating between ibuprofen and acetaminophen (43.9%). Moreover, 34.6% of the participants recommended topical agents for otalgia. Topical agents were more commonly recommended by the pediatric residents than specialists or lecturers (p < 0.001). Finally, 58.3% of pediatricians had experiences of the parents' usage of a variety of herbal and folk remedies, such as breast milk or olive oil, for their children's ear pain. Conclusion: Amoxicillin clavulanate was the most frequently prescribed antibiotic for AOM. WW was approved by the pediatricians, and having more AOM patients was a significant factor in the physicians' choice of WW; nevertheless, the WW rate was poor. Implementation of educational intervention strategies will help pediatricians in improving their compliance with evidence-based guidelines for AOM treatment. Otalgia is taken seriously by parents and pediatricians, and otalgia treatment seems to be well accepted in Turkey for providing symptomatic relief and enhancing the patients' quality of life