Travel-associated Legionnaires’ Disease Affected Two Individuals from the Same Family

In this report the first two cases of travel-associated Legionnaires’ disease in Turkey were discussed. It is known that 24 and 30 years old, previously healthy sisters had stayed in a hotel in central Anatolia, just ten days before admission to the hospital with fever, cough and weakness symptoms. Their serum samples were examined by indirect fluorescent antibody assay for the presence of Legionella antibodies. In both cases Legionella pneumophila antibodies were found to be positive in high titers, as 1/256 and 1/1024 respectively

Rotavirus and Enteric Adenovirus Investigation in Children with Diarrhea

Rotavirus and enteric adenovirus (type 40/41) were investigated by latex agglutination method in stool specimens of 0-5 years old patients with diarrhea between December 1995 and February 1997. Other enteric pathogens were also investigated. We determined etiological agents in 29% of the specimens. Rotavirus was found to be as 8.5%, adenovirus was 3.4% where other pathogens; Salmonella typhimurium was 8.5%, Shigella flexneri was 1.7%, Campylobacter jejuni was 3.4% and Aeromonas caviae was 1.7% of the total agents. We also observed Giardia intestinalis cysts in one of the direct microscopic examinations of the stool specimens. Among all pathogens rotavirus ratio was 29.4% and adenovirus was 11.8%. These results indicated the significance of rotaviruses and adenoviruses for infant diarrhea as important pathogens to be investigated

Legionella spp. in Plumbing Systems of Hotels: A Study in Aegean and Mediterranean Coasts

In this study, the presence of Legionella spp. in hotels’ plumbing systems between July 1995 and February 1997 has been investigated in resort places of Turkey. 592 water samples from 21 hotels were analyzed all through the study. A total of 324 water specimens was collected for initial sampling. Legionella spp. strains were detected in 61% of hotels (13/21) and 17.5% of water samples (57/324). These hotels were reevaluated whether bacteria were eliminated by decontamination procedures or not. Legionella colonization was found to be still positive in five of the plumbing systems. During the study, a total of 95 isolates of Legionella spp. was isolated from 92 water samples. The most frequent isolated species was Legionella pneumophila. This is the earliest data for the prevalence of Legionnaires’ disease agent in environmental samples from the hotels in the Aegean and Mediterranean coasts of Turkey. The persistent colonization of bacterium indicates that the certain hotels might be endemic focuses for Legionnaires’ disease in our country too

Distribution of Bacterial Enteric Pathogens Isolated from Diarrheic Children

In this study, we planned to investigate the distribution of Salmonella, Shigella, Campylobacter jejuni and the other pathogens like Vibrio cholerae O1 and O139, Aeromonas spp, enterohemorrhagic Escherichia coli (EHEC) O157:H7 and Yersinia enterocolitica in the stool samples of children in whom gastrointestinal infections are most commonly seen. For this purpose, 1200 stool samples from diarrheic and 100 stool samples from healthy children were investigated between June 1995 and October 1997. After microscopic examination, the samples were inoculated in the enrichment broths, then streaked onto selective media. The suspected colonies were then identified by the conventional biochemical methods and/or by API 20E (BioMerieux, France). Then the diagnosis of Salmonella, Shigella, V. cholerae O1 and O139, EHEC 0157:H7 were confirmed by slide agglutination tests with Difco antisera. Enteric pathogens were determined in 13.7% of the samples. The distribution of enteric pathogens were as follows: C. jejuni (72 isolates, 6%), Shigella (54 isolates, 4.5%), Salmonella (30 isolates, 2.5%), EHEC 0157:H7 (5 isolates) and Aeromonas caviae/hydrophila (4 isolates). There were no V. cholerae O1 and O139 and Y. enterocolitica isolates in our population. In one sample A. hydrophila and C. jejuni were isolated at the same time. No enteric pathogen was determined in the healthy control group. We conclude that like most laboratories in the world, Salmonella, Shigella and Campylobacter species should be investigated in routine stool cultures unless there is an additional order for the other enteric pathogens

Diagnostic Approches in Legionnaires’ Disease: A Clinical, Microbiological and Epidemiological Review on Cases Between 1995-2002

In this report, results of 183 cases, dispatched to our laboratory by suspicion of Legionnaires’ disease between February 1995 and July 2002, were interpreted for matching to the standard case definitions and outcomes. As diagnostic techniques, culture, direct fluorescence antibody assay, urinary antigen test, and serology were used according to the samples. Demographical, clinical and epidemiological characteristics were analyzed from the records of “Laboratory Request Log”. It is observed that the most of the cases (60.4%) were classified as community-acquired pneumonia. The 80.3% of these individuals came from the populations by having medium- and low socio-economic standards, that are controversial for the epidemiology of Legionnaires’ disease, were comprehended. The most preferred samples were urine (145) and the less preferred samples were from lower respiratory tract (52) for sending to the laboratory. Totally 6 (3.3%) cases were confirmed as Legionnaires’ disease based on positive urinary antigen test results. Four of these cases were reported as travel-associated Legionnaires’ disease based on their travel histories. Additionally 9 (4.1%) cases were classified as probable Legionnaires’ disease by serological findings. Since the clinical and radiological presentations of Legionnaires’ disease are not discriminative, definitive diagnosis requires application of specialized microbiology techniques. However, it seems that as the samples are sending to the laboratory to take into account some of the clinical and epidemiological characteristics is essential for using the time and sources effectively

The evaluation of antibiotic resistance in urinary tract ınfection agent enterobacteriaceae spp. for two years

Amaç: Üriner sistem infeksiyonu (ÜSİ) etkeni Enterobacteriaceae türlerinin iki yıllık antibiyotik direnç oranlarının saptanması amaçlanmıştır. Gereç ve Yöntem: Laboratuvarımıza, 2001-2003 tarihleri arasında ayaktan başvuran hastaların 533’ünde üriner sistem infeksiyonu etkeni izole edilmiş olup, 469’unda Enterobacteriaceae türleri tanımlanmıştır. Enterobacteriaceae izolatlarında antibiyotik duyarlılık testleri CLSI kriterlerine göre Kirby-Bauer disk difüzyon yöntemi ile çalışılmış, A ve U grubu antibiyotiklerden ampisilin, sefazolin, sefalotin, gentamisin, karbenisilin, norfloksasin/ofloksasin, lorakarbef ve nitrofurantoinin sonuçları irdelenmiştir. Bulgular: Hastaların %71.9’u kadın, %28.1’i erkekdir. Hastaların yaş grupları 0-2; 3-15; 16-45; >45 şeklinde sı- nıflandırılmış olup, ÜSİ görülme sıklığının dağılımı sırasıyla %25.3; %28.0; %26.5; %20.3 olarak bulunmuştur. Yaş grupları içerisinde yine kadınların oranlarının daha yüksek bulunduğu, ancak 0-2 yaş grubunda erkelerin oranının (%64,4) daha yüksek olduğu gözlenmiştir. En sık izole edilen tür E.coli (%78)’dir. Diğer türler sırasıyla K.pneumonia, P.mirabilis, K.oxytoca olup sıklıkları sırasıyla %8,7; %5,1 ve %3,1 şeklindedir. P.vulgaris, C.freundii, E.cloaca, M.morgagni ise toplam %3,8 sıklık göstermiştir. Tüm Enterobacteriaceae suşları için direnç oranları ampisilin, karbenisilin ve sefalotine karşı sırasıyla %69,0; %63,8 ve %55,3 olduğu, diğer antibiyotiklere karşı direncin ise %40’nin altında kaldığı gözlenmiştir. Sonuç: Bu çalışmanın bulgularına göre, ÜSİ ampirik tedavisinde sefazolin, gentamisin, norfloksasin/ofloksasin, lorakarbef ve nitrofurantoinin kullanılabilir durumda olduğu gözlenmiştir. Ancak yerel çalışmaların ülkenin bütü-nünü yansıtmakta yetersiz kalacağı düşünülerek, ulusal antibiyotik direnç surveyans sisteminin kurulmasının gerekli olduğu düşünülmektedir. Ayrıca, genel olarak infeksiyon hastalıklarının tedavisinde olduğu gibi ÜSİ vakalarında da antibiyotik duyarlılık testlerinin önemi bir kez daha vurgulanmaktadır

The seropositivity and risk factors for rickettsial infections in selected areas from Black Sea Region of Turkey

Objectives: The aim of this study was to evaluate the seropositivity of rickettsial infections (rickettsioses) and to as-sess risky behaviors for rickettsioses in North Anatolia, which have dense tick population. Materials and methods: Blood samples of 409 voluntary participants were collected in a cross-sectional seropreva-lence research in Samsun-Tekkeköy and 171 from Samsun Regional Laboratory, KTÜ Medical Faculty/Clinic of Infec-tion Diseases and Tokat State Hospital to determine regional characteristics and risk factors of rickettsial infections. The total sample size was 580 persons. A standard questionnaire was performed by a face to face interview with par-ticipants. The 0-4 age group children were not included. The presence of anti-Rickettsia IgG antibodies was tested in blood samples with Indirect Immunoflourescein Antibody (IFA) method.Results: Spotted fever group anti-Rickettsia IgG antibody seropositivity was detected in 68 (11.7%) blood samples. Contrarily, typhus group anti-Rickettsia IgG antibody seropositivity was not found in any participant. With bivariate analyses following variables were found to be significantly correlated with rickettsia seropositivity: education status (p=0.015), age (p=0.001), working in farm (p=0.008), working in garden (p=0.022), agricultural activities (p=0.001), being interested in relaxation activity (p=0.009), animal breeding (p=0.007), milking (p=0.001) and exposure to wild animals (p=0.004). With logistic regression analysis; age [Risk Odds Ratio ‘ROR’=1.03 (95% GA=1.02-1.05)] and ex-posure to wild animals [ROR=1.97 (95% GA=1.12-3.46)] were found to be associated with increased seropositivity.Conclusions: Our results supported the existence of rickettsial diseases in Turkey. Further seroepidemiological in-vestigations are needed to detect incidence/prevalences of rickettsioses and related risky behaviors in our country