Clinical characteristics of Turkish women with Candida krusei vaginitis and antifungal susceptibility of the C. krusei isolates

PubMedID: 24396265Objective. Candida krusei causes approximately 1% of vulvovaginal candidiasis (VVC) cases and is naturally resistant to fluconazole. Antifungal testing may be required if C. krusei vaginitis fails to respond to non-fluconazole therapy, particularly in patients with recurrent infections. Design. We investigated the clinical characteristics and antifungal susceptibility profile of vaginal C. krusei isolates. Between 2009 and 2012, we identified 560 unrelated Candida spp.-positive vaginal cultures, of which 28 (5.0%) were C. krusei. These isolates were analyzed according to host factors and the clinical forms of VVC, and their in vitro susceptibility to 10 antifungal agents was tested using a reference microdilution method. Results. We observed that perineal laceration and increased age (>50 years) were significant predictors of C. krusei in vaginal samples (P<0.05). All isolates were susceptible to amphotericin B, caspofungin, ketoconazole, and miconazole. Additionally, susceptible dose-dependent and resistant rates were found for fluconazole as 42.9% and 57.1%, respectively. Remarkably, only 42.9% and 67.9% of the isolates were susceptible to itraconazole and voriconazole, respectively. Conclusions. Understanding local susceptibility patterns, especially those of non-C. albicans Candida species, can significantly aid in the selection of an effective antifungal agent. The in vivo response of C. krusei vaginitis to various antifungal therapeutics remains unknown and requires further research. © 2013 Ahmet Bariş Güzel et al

Ovarian pregnancy after intrauterine insemination: A case report [Intrauterin inseminasyon sonrasi ovaryan gebelik: Olgu sunumu]

Ectopic pregnancy is defined as implantation of a fertilized ovum in an area other than endometrial lining of uterus. The most common localization for ectopic pregnancy is the ampuller portion of the tuba uterina, but it can be to exist anywhere in the intraabdominal space. Ovarian pregnancy is a rare form of ectopic pregnancy and represents 1-3% of all the ectopic pregnancies. The incidence is 1 per 7000 to 1 per 60,000 deliveries Pregnancy was determined at the right ovary after intrauterine insemination(IUI). Laparoscopy performed and ectopic ovarian pregnancy was removed by protecting the ovary

Scalp Dermatophyte Carriage in Pregnant, Pre-, and Postmenopausal Women: A Comparative Study Using the Hairbrush and Cytobrush Methods of Sample Collection

PubMedID: 21063784Tinea capitis is a dermatophyte infection of the scalp that is most often seen in prepubescent children. In this investigation, we examined the prevalence of tinea capitis and symptom-free colonization of the scalp with dermatophytes in 786 pre- and postmenopausal women aged 12-84 years. Scalp samples were collected from all participants by cytobrush or hairbrush, and cultures were then grown from these samples on Sabouraud glucose agar. No participant was diagnosed with tinea capitis; however, one 43-year-old patient (0.1%) was positive for a "scalp carriage" related to anthropophilic Trichophyton rubrum, as detected using a hairbrush. The internal transcribed spacer (ITS) regions of the isolate were sequenced, and the assembled DNA sequences were examined using the basic BLAST (nucleotide-nucleotide) software of the National Center for Biotechnology Information Web database. This patient was followed up without any antimycotic treatment, and after 4 weeks, mycological clearance was documented. In addition, the contacts and environment at home were screened, where all fungal cultures were sterile. To the best of our knowledge, this study is the first report of a "scalp carriage" related to a cosmopolitan fungus, T. rubrum. © 2010 Springer Science+Business Media B.V.TF2010BAP14Acknowledgments This study was supported by the Research Fund of Cukurova University (Project No: TF2010BAP14). We gratefully acknowledge Prof Dr G. Sybren de Hoog’s (Centraal-bureau voor Schimmelcultures, Utrecht, The Netherlands) kind cooperation and confirmation of the isolate examined in this study

Yeast vaginitis during pregnancy: Susceptibility testing of 13 antifungal drugs and boric acid and the detection of four virulence factors

PubMedID: 22369624A higher prevalence of vulvovaginal candidiasis (VVC) is seen in pregnant women compared with those who are not pregnant. Recurrence is also more common in pregnant women, and therapeutic responses are reduced. In this investigation, 207 vaginal yeast isolates recovered from pregnant women were tested for susceptibility to 13 antifungal drugs and boric acid and through these studies four virulence factors were also determined. The isolates were recovered from vaginal samples of patients with acute VVC [AVVC, (n = 73)], symptomatic recurrent VVC [RVVC, (n = 89)], asymptomatic RVVC (n = 27), and those without signs and symptoms (n = 18). Candida albicans was the most common species found (59.9%), followed by C. glabrata (19.8%), other Candida spp., (19.8%), and Saccharomyces cerevisiae (0.5%). Antifungal susceptibility testing was performed as described in CLSI document M27-A3. Additionally, we examined phospholipase and proteinase production, adhesion to vaginal epithelial cells and hemolytic activity. Notably, the MIC values of Candida spp. isolates derived from patients with VVC were no different from those of the controls (P > 0.05). In addition, Candida isolates derived from patients with AVVC or RVVC produced significantly higher amounts of phospholipase and proteinase compared with the controls (P <0.05). Antifungal testing and the determination of virulence factors may lead to the effective and prompt treatment of VVC, particularly in pregnant women. © 2012 ISHAM.Funding was received from both Ç ukurova University, Adana, Turkey (Project No: TF2010BAP1) and Gazi University, Ankara, Turkey. Additionally, we appreciate and give our sincere thanks to two anonymous reviewers for their critical comments on earlier drafts of this paper

Necrotizing fasciitis in a diabetic patient due to vulvar abscess: A case report

Nekrotizan fasiit, cilt ve ciltaltı fasyası boyunca hızla ilerleyen bir yumuşak doku infeksiyonudur. Kas fasyasının bütünlüğünün çoğu kez bozulmamış olması infeksiyonun derinlemesine yayılmasını önler. Hastalık çoğu kez diabet, ileri yaş, periferik damar hastalığı, beslenme bozukluğu gibi bağışıklık sisteminin zayıfladığı durumlarda görülür. Mortalitesi oldukça yüksek olan bu durumun tedavisi agresif debritman ve geniş spektrumlu antibiyoterapidir. Bu makalede diabetik bir hastada gelişmiş vulva infeksiyonunun, tedavisindeki gecikmeye bağlı olarak, gösterdiği hızlı ilerlemeye dikkat çekmek istiyoruz.Necrotizing fasciitis is an infection which disseminates along the skin and the fascia of the subcutaneous tissue. The integrity of the muscular fascia is always not broken and deep invasion of the infection is rarely seen. Necrotizing fasciitis is usually seen in patients with disease causing immunodeficiency like diabetes, advanced age, peripheral vascular disease and malnutrition. The only treatment option of this highly mortal condition is the debridement of all infected tissues and the use of broad-spectrum antibiotics. In this article, we want to indicate the rapid progression of the vulvar infection in woman with diabetes due to delay of the treatment

Primitive uterine neuroectodermal tumours: Two case reports [Uterusun primitif nöroektodermal tümörleri: İki olgu sunumu]

Primitive neuroectodermal tumor (PNET) arise from Kulchitsky cells and are rarely seen in the female genital tract. Differential diagnosis of PNET can be made based on immunohistochemical profiles and genetic analyses. Genital tract pNETs are very aggressive pathologies with different clinical and molecular manifestations and there are no standard guidelines for treatment. We aimed to present two cases of uterine PNETs with different symptomatology and clinical findings. © 2015, Turkish Society of Obstetrics and Gynecology. All rights reserved

Candida vaginitis in non-pregnant patients: A study of antifungal susceptibility testing and virulence factors

PubMedID: 23654320Vulvovaginal candidosis (VVC) is a major problem for the female population worldwide, and considerably little is known about the difference between acute VVC (AVVC) and recurrent VVC (RVVC). We investigated the susceptibility to six antifungal agents and boric acid of Candida spp. isolated from vaginal cultures, as described in the CLSI document M27-A3, from 228 non-pregnant sexually active women (aged 18-49 years), and the virulence factors of these isolates. The isolates were derived from patients with AVVC (n = 64), those with RVVC (n = 125) and those without signs or symptoms (n = 39). In total, C. albicans was the most commonly isolated species (50%), followed by C. glabrata (35.5%) and other Candida spp. (14.5%). We observed slightly different minimum inhibitory concentration (MICs) for various antifungals among the species and study groups that could have potential therapeutic benefits for the treatment. Analysis of the virulence factors revealed that haemolytic activity is not involved in VVC pathogenesis but that germ-tube formation, adhesion to VECs, and proteinase and phospholipase production may be important in the pathogenesis of VVC. © 2013 Informa UK, Ltd

Asymptomatic groin dermatophyte carriage detected during routine gynaecologic examinations

PubMedID: 23006021We investigated the epidemiological characteristics of both symptomatic and asymptomatic dermatophytic groin infections in 1970 women (age: 36.2±12.5) during routine gynaecologic examinations. Bilateral groin samples were collected with sterile cotton swabs premoistened with sterile physiological saline. The samples were then separately inoculated onto Sabouraud glucose agar. Fungi were identified by sequencing the rDNA internal transcribed spacer region. Dermatophytes were recovered from five patients (four Trichophyton rubrum and one Arthroderma vanbreuseghemii, 0.25%) with a diagnosis of asymptomatic carriers (four) and tinea inguinalis (one). In one case, groin carriage converted into tinea inguinalis after 3weeks. Analysis of risk factors indicated that patients of at least 49years were more likely to be positive for dermatophyte isolation (P=0.002). In conclusion, groin dermatophyte carriage is more common than tinea inguinalis and can potentially convert into a symptomatic infection. © 2012 Blackwell Verlag GmbH

Extraperitoneal metastasis of the fallopian tube cancer: A review of the literature [Fallop tüpü kanserinde periton dişi metastazlar: Literatür derlemesi]

Fallopian tube cancer is a rare event and its extraperitoneal metastasis is even rarely seen. The most part ofthe knowledge about the fallopian tube cancer is derived from the epithelial ovarian carcinoma which has a very close similarity on clinical behavior. Disease usually disseminates to the peritoneal surfaces of the abdominal organs by exfoliation of the tumor cells in the peritoneal cavity. It is believed that the lymphogenic or hematogenous ways are the causes of extraperitoneal metastasis. We reported a review of the cases of fallopian tube cancer with extraperitoneal spreading. The majority of the patients were treated with combination of surgery and chemotherapy. On the other hand, the early reports state that the patients were treated with radiotherapy and intraperitoneal chemotherapy. Lymph node is the most common site for extraperitoneal dissemination. Lungs and central nervous system are usually involved synchronously. Central nervous system involvement is usually diagnosed while evaluating a neurological symptom. In this situation it is possible to emphasize that the central nervous system involvement is more common with asymptomatic patients. Bone, liver, spleen, skin, pleura, pericardium and breast are the other sites of extraperitoneal metastasis. The time interval for extraperitoneal recurrence was 37.5 ± 21.2 (7-74) months. The survival after the diagnosis of extraperitoneal metastasis 21.8 ± 21.0 (0, 5-72) is months. In some patients while extraperitoneal dissemination is detected, the peritoneal spread was absent. Although it is believed that when an extraperitoneal metastasis happened the prognosis is extremely poor, some patients may have a longer survival. Copyright © 2010 by Türkiye Klinikleri

Conservative treatment of the ectopic pregnancy in the cesarean scar site: Case report [Sezaryen skar yerinde gelişen diş gebeligin konservatif tedavisi]

Cesarean scar pregnancy is a rare form of the ectopic pregnancy and its consequences may be fatal. Its treatment is based on the hysterectomy or conservative choices. Conservative modalities may be listed as surgical (low uterine segment excision with laparotomy or laparoscopy, hysteroscopy, curettage), medical [systemic or local use of methotrexate, local potassium chloride (KCI) injection] and minimally invasive interventions (selective uterine artery embolization). A cesarean scar pregnancy was tried to treat with low dose methotrexate regiment in a woman who had two cesareans previously. While this regiment was unsuccessful it was switched to the high dose methotrexate and uterine artery embolization. The bleeding during the destruction of the gestational sac was controlled with curettage and cervical balloon tamponade. Preservation of the uterus and the life of the woman are related to the early diagnosis and treatment. A combination of the many ways may be necessary in the treatment ofthe cesarean scar pregnancy. The collaboration of the ß-hCG levels as well as the progesteron levels and the presence of the cardiac activity may be more useful in the prediction of treatment success of the low dose methotrexate regiment. Copyright © 2010 by Türkiye Klinikleri