Psoas Abscess Due to Aeromonas hydrophila: Case Report

Forty-one years old male patient who was operated on with the diagnosis of acute necrotizing pancreatitis admitted with probable intraabdominal infection. We determined psoas abscess which fistulized to the skin of abdominal wall by radiological examinations. As Aeromonas hydrophila was isolated from the pus, the patient was evaluated for the risk factors. Intraabdominal infection was treated by imipenem during three weeks without any surgical intervention. The patient remained symptomless during three months follow up. The case was presented because of the unusual psoas abscess which was caused by A. hydrophila

Bacteremia Caused by Chryseobacterium indologenes in a Patient with High Grade Non-Hodgkin Lymphoma

We report a case of bacteremia caused by Chryseobacterium indologenes in a patient who was treated due to the non-Hodgkin lymphoma and developed neutropenia and fever. According to the antimicrobial susceptibility test result, ciprofloxacin was added to the treatment. On the 10th day of the treatment a good response was achieved and the patient discharged after complete recovery

Candidemia in Akdeniz University Hospital and Predictors of Mortality

Blood-stream infections due to Candida species are important causes of morbidity and mortality in hospitalized patients. We conducted a prospective study of patients with candidemia at Akdeniz University Hospital, between 01 March 2002 and 01 March 2003 and predictors of mortality were investigated. Thirty-five consecutive patients with candidemia identified by at least one positive blood culture. Risk factors for candidemia that previously described in literature as central venous catheters (86%), multiple broad-spectrum antibiotics (82%), urinary catheters (71%), parenteral nutrition (60%) found in our patients. C. albicans was the most frequently isolated species (60%). Overall mortality was 57%. In univariate analysis, mortality was significantly associated with the presence of central venous catheters (p= 0.009), stay in intensive care unit (p= 0.016) and prolonged use mechanical ventilator (p= 0.036). In multivariate logistic regression; mortality was not statistically significant associated with any risk factors in patient with candidemia. It may be related to small sample size

İshalli hastalarda Entamoeba histolytica'nın saptanmasında kullanılan yöntemlerin değerlendirilmesi

Giriş ve amaç: Entamoeba histolytica’nın neden olduğu amibiyaztüm dünyada paraziter enfeksiyona bağlı üçüncü ölüm nedenidir. Amibiyazın tanısında yaygın olarak kullanılan yöntem dışkı mikroskopisidir.Ancak E. histolytica ile morfolojk olarak benzer olan diğer amip türleriarasında ayrım yapılması direkt mikroskobik inceleme ile imkansızdır.Bu yüzden dışkıda E. histolytica’ya özgü antijen varlığını araştıran ELISA ve PZR gibi yöntemler tanıda kullanılmaya başlanmıştır.Bu çalışmada; ishal şikayeti ile başvuran ve intestinal amibiyaz ön/ayırıcı tanısı için E. histolytica araştırılması istenen hastaların dışkı örneklerinde, direkt ve boyalı mikroskobik inceleme, dışkıda E. histolytica’yaözgü adezin antijeni saptamaya yönelik ELISA testi ve PZR testinin çalışılması ve bu testlerin tanı değerlerinin araştırılması amaçlanmıştır.Gereç ve Yöntem: Akdeniz Üniversitesi Hastanesi’nde 1 Ekim 2015-31 Temmuz 2016 tarihleri arasında çeşitli servis ve polikliniklerden Merkez Laboratuvarı’na gelen kanlı ve/veya mukuslu, şekilsiz toplam 546dışkı örneği çalışmaya alınmıştır. Bu örneklerde, E. histolytica varlığınıaraştırmak için direkt ve boyalı mikroskopi, ELISA (Entamoeba CELISA Path, Cellabs, Avustralya) ve PZR (BD Max Enteric Parasite Panel,Becton Dickinson, ABD) yöntemleri uygulanmıştır.Bulgular: Çalışmaya alınan örneklerin 257 (%47)’si kadın, 289(%53)’u erkek hastalara aittir. Hastaların yaş ortalaması 23,77±24,05olarak bulunmuştur. Hastaların %53’ünü çocuk yaş grubu oluşturmaktadır. Direkt mikroskobik inceleme ile örneklerin 198 (%36.3)’inde şüpheli E. histolytica/dispar/moshkovskii kist ve/veya trofozoiti görülmüş vebu örnekler trikrom boyama yapılarak incelenmiştir. Trikrom boyamayapılan örneklerin 49’unda şüpheli E. histolytica/dispar/moshkovskiikist ve/veya trofozoiti saptanmış ve bu örneklerde ELISA ve PZR testleri çalışılmıştır. ELISA yöntemi ile örneklerin hiçbirinde pozitiflik saptanmamıştır. PZR yöntemi ile örneklerin 44’ü negatif bulunmuştur. Üçörnekte PZR inhibitörü nedeniyle, iki örnekte ise sistem hatasına bağlıolarak geçerli sonuç elde edilememiştir.Sonuç: Mikroskobi, spesifik antijen testi ve moleküler yöntemlerinbirlikte kullanıldığı çalışmamızda hasta popülasyonumuzda E. histolytica saptanmamıştır.E. histolytica’nın saptanmasında mikroskobik inceleme yetersiz kalmaktadır.Mikroskobik inceleme ile şüpheli pozitif olarak değerlendirilen örnekler PZR ve E. histolytica‘ya özgü antijen saptanması gibi daha özgülyöntemlerle doğrulanmalıdır.</p

Respiratory Syncytial Virus Pneumonia During Febrile Neutropenia and Its Treatment

Twenty-four years old male who had chronic myelocytic leukemia (CML) for eight months, was admitted to emergency unit because of fatigue, palpitation, dyspnea and fever. He was hospitalized because of blastic transformation from CML to acute myelocytic leukemia (AML) and also febrile neutropenia. Respiratory distress and hypotension occurred and respiratory syncytial virus (RSV) pneumonia was laboratorally diagnosed. He responded to the oral ribavirin therapy but he died because of a new febrile neutropenic episode and bleeding. This case is the first reported RSV pneumonia in a febrile neutropenic patient and its treatment choices are limited in our country

Recurrent Legionnaires’ Disease in an HIV Positive Renal Transplant Patient

Legionnaires’ disease is a community-acquired or nosocomial pneumonia caused by Legionella species, and the immunocompromised patient is at particular risk. In this study we report a case of Legionnaires’ disease repeating three times in an HIV positive renal transplant patient. The laboratory diagnosis was obtained by detection of Legionella pneumophila using direct fluorescent antibody (DFA) staining. An environmental investigation failed to reveal L. pneumophila in any water specimens taken from the patients private accomodation. We conclude that Legionnaires’ disease should be always considered in the diagnosis among immunocompromised patients who have pneumonia without an etiologic diagnosis or in cases of treatment failure. We also remark that patients who have AIDS should be considered at risk for recurrent Legionella infections

INVESTIGATION OF PLASMID-MEDIATED AmpC BETA-LACTAMASE TYPES IN KLEBSIELLA SPP. AND ESCHERICHIA COLI ISOLATES RESISTANT OR INTERMEDIATE TO CEFOXITIN

Plasmid mediated AmpC beta-lactamases are reported from Enterobacteriaceae with increasing frequency. There have been reports of treatment failures in patients infected with these organisms and given broad-spectrum cephalosporins. The aim of this study was to investigate the presence of plasmid mediated AmpC beta-lactamases in Escherichia coli and Klebsiella spp. A total of 41 strains of cefoxitin resistant or intermediate E.coli (n= 27) and Klebsiella spp. (n= 14) were collected from January 2005 to January 2006 at Akdeniz University Hospital Central Laboratory. Three-dimensional test was used as a phenotypic confirmatory test. Analytical isoelectric focusing electrophoresis was used to measure the pl values of the beta-lactamases. Plasmid mediated AmpC enzyme genes were amplified using multiplex polymerase chain reaction and sequenced by Beckman Coulter CEQ 8000. AmpC beta-lactamases were only detected in two isolates (7.4%) of E.coli. These isolates produced CMY-2 like enzymes and have either CTX-M or TEM enzyme. Transferable AmpC beta-lactamases are associated with multiple antibiotic resistance. Therefore detection of these enzymes in gram-negative bacteria has a clinical importance, since it can often provide valuable information to clinicians leading to more effective and appropriate use of antimicrobials

Evaluation of the Methods Used for the Detection of Entamoeba histolytica in Stool Samples of Patients with Diarrhea

Amoebic dysentery (amebiasis) is a parasitic infection caused by Entamoeba histolytica. The diagnosis of invasive amebiasis has traditionally been based on direct and stained microscopic examination of stool samples. Stool microscopy exhibits low sensitivity and it is difficult to distinguish E.histolytica cysts and trophozoites from cells such as leukocytes, macrophages and non-pathogenic Entamoeba species in the stool by microscopy. Therefore more sensitive and specific diagnostic methods such as enzyme linked immunosorbent assay (ELISA) tests which investigate the presence of E.histolytica-specific antigen in sto- ol, and polymerase chain reaction (PCR) are being widely used. In this study it was aimed to study stool samples of the patients who applied with the clinical signs of amebiasis by using direct and permanent stained microscopy, E.histolytica adhesin antigen ELISA test and real-time PCR-based BD Max Enteric Parasite Panel (BD Max EPP) test and to evaluate the diagnostic values of these tests. A total of 546 faecal samples with blood and/or mucus were analyzed in the study. In these samples, the presence of E.histolytica was investigated by direct and permanent stained microscopy, E.histolytica adhesin antigen ELISA and BD Max EPP PCR. Of the samples 36.3% were suspected to contain E.histolytica/dispar/mosh-kovskii cyst and/or trophozoite by direct microscopic examination. Trichrome staining was performed on these samples and 49 samples were found suspicious for the presence of E.histolytica/dispar/moshkovskii cysts and/or trophozoites. The presence of E.histolytica and other Entamoeba species was not confirmed in 75.2% of the samples. BD Max EPP PCR and E.histolytica adhesin antigen ELISA tests were studied in 49 faecal samples that were suspected by trichrome staining. None of these samples were positive by ELISA. Forty-four samples were negative by PCR and invalid test results were obtained in five samples. In this study, E.histolytica was not detected in the patient population. The results of this study showed that microscopic examination alone is not sufficient for the detection of E.histolytica. It is concluded that it is necessary to use a more sensitive and specific also rapid diagnostic test such as E.histolytica-specific antigen detection test or PCR in the diagnosis of amebiasis to avoid misdiagnosis and unnecessary tre- atment of patients

Evaluation of the BD Phoenix CPO Detect Test for detection of carbapenemase-producing Enterobacterales

Plain language summaryEnterobacterales are a type of bacteria that usually live harmlessly in the gut of humans. However, if the bacteria get access to the bladder or bloodstream, they can cause infection. Carbapenemase-producing Enterobacterales (CPE) are a type of bacteria that can cause carbapenem antibiotic-resistant infections, a group of powerful antibiotics. The rapid spread of CPE will pose an increasing threat to public health and medical treatment practices; therefore, rapid detection of CPE is crucial. This study assessed the performance of the BD Phoenix CPO Detect Test for the detection of carbapenemase-producing Enterobacterales. The BD Phoenix CPO Detect Test offers both the detection of carbapenemase production and antimicrobial susceptibility testing simultaneously and can be clinically useful for determining possible treatment options. Aims: This study aimed to evaluate the performance of the BD Phoenix CPO Detect Test (BD Diagnostic Systems) for the detection and classification of carbapenemase-mediated carbapenem resistance. Methods: A total of 447 Enterobacterales strains were included in the study. All strains were tested with the BD Phoenix CPO Detect Test and the modified carbapenem inactivation method. Results: Carbapenemase production was detected in 157 of 159 carbapenemase producers, including 95.7% of class B and 99.2% of class D isolates using the BD Phoenix CPO Detect Test. BD Phoenix CPO Detect has a sensitivity of 98.7% and a specificity of 95.5% in detecting carbapenemase production. Conclusion: The classification of OXA-48 and class B carbapenemases, the most common carbapenemases circulating in Turkey, was highly accurate