The evaluation of the reverse algorithm for syphilis screening in blood donors

Background: In Turkey, prior to transfusion and apheresis, it is mandatory to screen blood for HBsAg, anti-HCV, anti-HIV 1/2, and syphilis. In recent years, efforts have been made to create effective diagnostic algorithms for screening, and as a screening strategy, many countries have switched from traditional algorithms to reverse algorithms. This study was carried out to evaluate the results we obtained after changing to chemiluminescence immunoassay (CLIA) based reverse algorithm, which is more sensitive and specific than the traditional algorithm and VDRL test we currently use for syphilis screening

New Models for Identification of Enterococci in Clinical Microbiology Laboratories

Identification of enterococci in clinical microbiology laboratories has gained importance since antibiotic susceptibility tests of this group of bacteria need special approach. This study is performed to build a new identification model by using the least number of conventional tube tests for adequate identification of this group of microrganisms by genus and species levels. Sixty enterococci isolated in the Clinical Microbiology Laboratory of Ankara Hospital were identified by using growth in 6.5% NaCl and bile-esculin mediums, and detection of pyrolidonyl arylamidase (PYR) tests in addition to mannitol, sorbitol, lactose, arabinose fermentation tests and arginin dihydrolase test. For the prediction of true evaluation rates of the panels used, API 20 Strep (Bio Merieux) was selected as a reference test. Forty-one strains were E. faecalis, 16 E. faecium, 1 E. durans and 2 E. avium. Growth in 6.5% NaCl and bile-esculin or PYR tests excellenty identified enterococci in the genus level. For species identification the first panel (which included mannitol, sorbitol and lactose fermentation tests) and the second panel (arabinose, mannitol and sorbitol fermentations) had error rates of 16.7% and 15% respectively. When arginin dihydrolase was added to the second panel the true identification rate was 100%. In Hospital Clinical Microbiology Laboratories, detection of growth in NaCl and bile-esculin mediums and arabinose, mannitol, sorbitol fermentations besides arginin dihydrolase tests can adequately and succesfully identify enterococci by species level

A Fungal Keratitis Case Caused by Fusarium solani

Fungal keratitis, an eye infection with poor prognosis, is difficult to treat and it can cause vision loss. Fusarium species are soil saphrophyte, facultatively anaerobic fungi and they can cause infection and toxicosis in humans and animals. It’s generally the second most common cause of mold infections in humans, after Aspergillus but it can be different according to center. Filamentous fungi, widely distributed in nature can cause serious oppurtunistic infections, especially in patients who have certain risk factors. Trauma with vegetative or organic materials, broad spectrum antibiotic or steroid usage, previous eye surgery, contact lens usage, ocular surface disease, immundeficiency status and diabetes disease are some of the risk factors causing fungal keratitis development. Topical antifungal agents are often used in the treatment of keratitis. In recent years, successful treatments with topical and oral voriconazole are reported. We aimed to report a case of keratitis caused by Fusarium solani in a 34-year-old immunocompetent male patient who had refractive surgery

In Vitro Susceptibility of Clinical Candida lusitaniae Isolates Against Amphotericin B: A Multicenter Study

Amaç: Amfoterisin B (AmB) invazif mantar enfeksiyonlarının tedavisinde kullanılan poliyen grubu bir antifungaldir. Klinikte Candida lusitaniae ile oluşan mantar enfeksiyonlarının AmB tedavisine yanıt vermediği, in vitro duyarlılık testlerinde kökenlerin dirençli bulunduğu bildirilmiştir. AmB ile karşılaşma sonrasında minimum inhibitör konsantrasyon (MİK) değerlerinin yükseldiği ile ilgili çalışmalar bulunduğu gibi, tersine kökenlerin bütünüyle AmB'ye duyarlı olduğunu bildiren çalışmalar da bulunmaktadır. Bu çalışmanın amacı, C. lusitaniae kökenlerinin AmB duyarlılığının gösterilmesidir.Gereç ve Yöntem: Bu çalışma kapsamında dört ayrı merkezden tür düzeyinde tanımlanmış 60 C. lusitaniae kökeni toplanmıştır. Toplanan kökenlerin tür düzeyinde tanımlanmaları üç merkezde klasik mikolojik yöntemler ile yapılmıştır. Acıbadem Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı'nda tür tanımı MALDI-TOF cihazı ile gerçekleştirilmiştir. Gazi Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı'nda kökenlere in vitro duyarlılık testi uygulanmıştır. Clinical and Laboratory Standards Institute (CLSI) mikrodilüsyon yöntemi ve E-test yöntemi ile MİK değerleri elde edilmiştir. Bulgular: Mikrodilüsyon yönteminden elde edilen MİK değerlerine göre MİK aralığı 0.125-2 ?g/ml, MİK50 değeri 0.5 ?g/ml, MİK90değeri 1 ?g/ml olarak hesaplanmıştır. E-test sonucunda elde edilen MİK değerlerine göre MİK aralığı 0.012-2 ?g/ml, MİK50 değeri 0.25 ?g/ml, MİK90 değeri 0.75 ?g/ml olarak hesaplanmıştır. Mikrodilüsyon yöntemi sonuçlarına göre 60 kökenden 8 tanesinden (%13), E-test sonuçlarına göre 6 tanesinden (% 10) >= 1 ?g/ml MİK değerleri elde edilmiştir. Mikrodilüsyon ile iki, E-test ile bir köken için MİK değeri 2 ?g/ml olarak bulunmuştur. Sonuç: Bu in vitro çalışma, AmB'ye intrensek dirençli olduğu ileri sürülen C. lusitaniae kökenlerinin in vitro duyarlı olduğunu, bu nedenle C. lusitaniae enfeksiyonlarında AmB kullanımı seçeneğinin yeniden gözden geçirilmesi gerektiğini ortaya çıkarmıştır. Sonuçlarımız in vivo modeller ile desteklendiğinde daha kesin yargılara varılabilecektirAim: Amphotericin B (AmB) is a wide spectrum antifungal drug which is used for the treatment of invasive fungal infections. Among the fungal pathogens, Candida lusitaniae has been reported to be resistant to AmB in-vitro. Therefore, AmB is not recommended for the treatment of C. lusitaniae infections. There are conflicting data on this subject in the literature. Some of the studies showed that minimal inhibitory concentration (MIC) values increased following exposure to AmB, while the others indicated that all C. lusitaniae were fully susceptible to AmB. The aim of the present study was to evaluate the AmB susceptibility of the C. lusitaniae strains.Materials and Methods: The study included 60 C. lusitaniae strains obtained from four different teaching hospitals in Turkey. The strains were identified at species level by using conventional methods in three of the centers and by MALDI-TOF method in one center. In vitro susceptibility testing was performed by E-test and Clinical and Laboratory Standards Institute (CLSI) reference microdilution method. Results: AmB MIC range was found as 0.125-2 ?g/ml, MIC50 value was 0.5 ?g/ml, and MIC90 value was 1 ?g/ml by microdilution method. MIC range, MIC50, and MIC90 values were 0.012-2 ?g/ml, 0.25 ?g/ml, and 0.75 ?g/ml by E-test method, respectively. The number of isolates with MIC >=1 ?g/ml were 8 (13%), and 6 (10%), for microdilution and E-test methods, respectively. MIC value was 2 ?g/ml for two strains by microdilution method, and one strain by E-test method. Conclusion: Our results showed that C. lusitaniae strains which were considered as intrinsically resistant, were susceptible to AmB. Although, more definite conclusions achieved by in vivo studies are required, this study indicated that AmB could be a good choice for the treatment of infections caused by C. lusitania

Correlation of Treponemal Chemiluminescent Microparticle Immunoassay Screening Test Signal Strength Values With Reactivity of Confirmatory Testing

Background Automated chemiluminescent microparticle immunoassays (CMIAs) are the most common first step at high-volume laboratories for syphilis screening. If the initial screening test is reactive, 1 more treponemal test is required, resulting in increased cost. In this multicenter study, we aimed to determine the correlation between the CMIA signal-to-cutoff ratio (S/Co) and the confirmatory tests to reduce unnecessary confirmatory testing. Methods Eight hospitals from 5 provinces participated in this study. All laboratories used Architect Syphilis TP CMIA (Abbott Diagnostics, Abbott Park, IL) for initial screening. Treponema pallidum hemagglutination (TPHA), rapid plasma reagin (RPR), and fluorescent treponemal antibody absorption (FTA-ABS) were used as confirmatory tests according to the reverse or European Centre for Disease Prevention and Control algorithms. A receiver operating characteristic analysis was used to determine the optimal S/Co ratio to predict the confirmation results. Results We evaluated 129,346 serum samples screened by CMIA between January 2018 and December 2020. A total of 2468 samples were reactive; 2247 (91%) of them were confirmed to be positive and 221 (9%) were negative. Of the 2468 reactive specimens, 1747 (70.8%) had an S/Co ratio >= 10.4. When the S/Co ratios were >= 7.2 and >= 10.4, the specificity values were determined to be 95% and 100%, respectively. In a subgroup of 75 CMIA-positive patients, FTA-ABS was performed and 62 were positive. Among these FTA-ABS-positive patients, 24 had an S/Co ratio = 10.4, obviating the need for secondary treponemal testing in about 71% of the screening-reactive samples. This would substantially reduce the confirmatory testing volume and laboratory expenses. However, in high-risk group patients with CMIA positive results, S/Co ratio <10.4, and negative TPHA and RPR, FTA-ABS may be used for confirmation