ANNALS OF SAUDI MEDICINE

BACKGROUND: Although high antituberculosis (anti-TB) drug resistance rates have been reported in Turkey, the clinical characteristics and implications for the outcome of anti-TB treatment have not been fully investigated. We determined the prevalence of anti-TB drug resistance and examined demographic data, clinical characteristics and treatment outcome in relation to patterns of resistance. METHODS: From the TB case registry of a university hospital and the two largest dispensaries in Manisa city, we identified all pulmonary TB cases with a culture-proven definitive diagnosis and antimicrobial susceptibility results for a 7-year period. We collected and analyzed demographic and clinical data and information on treatment outcome for those cases in relationship to anti-TB drug resistance. RESULTS: Of 355 M. tuberculosis strains, 71.5% were susceptible to streptomycin, isoniazid, rifampicin and ethambutol. Any drug resistance and multi-drug resistance (MDR) rates were 21.1% and 7.3% and were higher in males (53% and 9%, respectively) than in females (22% and 1%, respectively). Drug resistance was significantly higher in old cases (acquired drug resistance) vs new cases (primary drug resistance), and was associated with treatment failure (P<0.001). The prevalence of MDR was significantly higher in the old cases (22.4%) than in the new cases (4.4%) (P<0.001). Symptoms, radiographic findings, associated diseases, and sputum smear positivity were unrelated to the development of resistance. The prevalence of any drug resistance and MDR was significantly higher in those with treatment failure than in patients with treatment success. CONCLUSION: High resistance rates, particularly for acquired MDR, indicate a need for improvement in the TB control programme in our region

BALKAN MEDICAL JOURNAL

Objective: The aim of this study was to investigate the molecular diversity and clonal relationship of drug resistant Mycobacterium tuberculosis strains isolated in Western Turkey. Materials and Methods: A total of 87 strains isolated between 2006 and 2009, eight of which were rifampicin monoresistant and 79 were multidrug resistant, were analyzed with IS6110 RFLP and spoligotyping methods. Results: The results of spoligotyping showed that 7% of the strains were orphans, and 8% were undefined for family in the SpolDB4 database. Major families of the strains were LAM (38%), T (35%), Haarlem (7%), Beijing (2%), S (2%) and U (1%) families. The clustering rate by spoligotyping was calculated as 75%. The most predominant SIT cluster was SIT41 (29%). According to the results of IS6110 RFLP, 71 different patterns of IS6110 were observed. Low copy number was found in 26% of the strains. When the results of two methods were combined, the final clustering rate was calculated as 26%. Conclusions: The genotypical distribution of drug resistant tuberculosis isolates in our region indicates genetic diversity and the clustering rate was found low in our region. However, more comprehensive and long-term molecular epidemiological studies are needed to control the drug resistant strains

MIKROBIYOLOJI BULTENI

Tuberculosis has spread by human movements throughout history. There have been reports indicating tuberculosis transmission on all travel vehicles, including aircrafts, ground vehicles and vessels until today. However, due to the ever increasing of air transportation and air travelling among countries with low and high tuberculosis incidence, transmission risk especially in aircrafts has become an important issue worldwide. But in many of the studies conducted in this regard, transmission of tuberculosis in aircrafts was found very low. The case of active tuberculosis has not yet been reported. This is due to the fact that in modern aircrafts, there are ventilation systems that provide hepa filtered laminar air flow and change the air 15-20 times per hour. The guidelines for the prevention of tuberculosis infection in aircrafts published by the World Health Organization Tuberculosis and Air Travel, 2008 and European Centre for Disease Prevention and Control RAGIDA-TB, 2014 confirm each other. According to these guidelines, air travelling of patients with active pulmonary tuberculosis should be prohibited until smears of two consecutive sputum samples become negative for drug susceptible cases, and cultures of two consecutive of sputum samples become negative for multidrug or extensively drug resistant cases. When it is reported that a tuberculosis patient has travelled by the aircraft, it is recommended that the exposed passengers should be investigated for tuberculosis infection if the flight duration equal to or exceeding eight hours including ground delays and the time elapsed between flight and diagnosis of the case is no longer than three months. Contact screening is only recommended for passengers sitting in the same row, two rows ahead and two rows behind the index case. Tuberculin skin test or interferon gamma release assay can be used for investigation. It is very difficult to determine the risk of tuberculosis transmission in ground vehicles like buses, subways and trains. The reason is that it is often not possible to access the information of the passengers travelling in these vehicles. Because the ventilation systems in ground vehicles are not as reliable as in aircrafts and the crowded environment in the ground vehicles, the risk of tuberculosis transmission is theoretically higher. In modelling studies, the transmission risk in the buses was found to be higher than the trains. In the case of regular travelling with an index case such as school bus riders, the risk increases significantly. The increased human population travelling all over the world nowadays has also raised concerns about travel-related tuberculosis risk. However, because of the limited evidence, it may be more efficient to spend time and resources for the other actions in order to prevent tuberculosis. In this review article, the transmission risk of tuberculosis in vehicles has been discussed

MIKROBIYOLOJI BULTENI

Since rapid diagnosis is critical in control of tuberculosis, nucleic acid amplification techniques have been widely used. The purpose of the present study was to assess the performance of Amplified Mycobacterium tuberculosis Direct Test (Amplified MTD Test, Gen-Probe) for the diagnosis of pulmonary and extrapulmonary tuberculosis in our laboratory. A total of 267 specimens (170 pulmonary and 97 extrapulmonary) were tested in the Clinical Mycobacteriology Laboratory of Manisa (a province located in Aegean part of Turkey) University Hospital from September 2001 to March 2005. When Amplified MTD (AMTD) test results were compared to the culture results taken as the gold standard, the sensitivity, specificity, positive and negative predictive values (PPV, NPV) for pulmonary specimens were found to be 84%, 96%, 73%, and 98%, respectively. When AMTD test positive, culture negative discrepant results were evaluated against the clinical history of the patients, these rates were detected as; 88%, 100%, 100%, and 98%, respectively. For 97 extrapulmonary specimens, sensitivity, specificity, PPV and NPV of AMTD test were 60%, 100%, 100%, and 98%, respectively. In conclusion, the results of the AMTD assay were reliable for the rapid diagnosis of pulmonary tuberculosis; if the results were evaluated together with the clinical status of patients, the performance of the test would be increased. However, even though the culture positive extrapulmonary specimens were sparse in our study (5%), the sensitivity of the AMTD test in extrapulmonary specimens was found less than that in pulmonary specimens. Therefore it is thought that AMTD test results should be evaluated carefully for the diagnosis of extrapulmonary tuberculosis

POLISH JOURNAL OF MICROBIOLOGY

In this study, we tested the advantages of TaqMan real time PCR technique and compare it to conventional methods using serum samples from patients with different clinical forms of brucellosis. A total of 50 patients were included in the study. Blood culture using BACTEC 9240 system, Standard Wright's tube agglutination, and real time PCR methods were used. Control blood samples from 30 people with no history of brucellosis or exposure to Brucella spp. were examined too. Serological assay was positive for 49 patients (98%). Forty-four (88%) of the 50 patients had a positive PCR result, whereas Brucella spp were isolated from blood cultures of 18 patients (36%). STA test was all positive for focal brucellosis. Real time PCR test was positive in 9 patients with focal disease (90%), whereas blood culture was positive only in 4 patients (40%). The sensitivity, specificity, positive and negative predictive values of the real time PCR method were calculated as 88%, 100%, 100%, and 83%, respectively. Our results suggest that the high sensitivity and specificity of real time PCR method make it a useful tool for diagnosis of brucellosis with different clinical manifestations

DERMATOLOGIC THERAPY

Tuberculin skin test (TST), which is used in the diagnosis of latent tuberculosis infection, may cause Koebner's phenomenon and false-positive results in psoriasis patients. The purpose of this study is to compare TST with QuantiFERON-TB Gold Plus (QFT-plus) test in psoriasis patients and to determine the effects of psoriasis on TST results. Ninety-two psoriasis patients and 30 control subjects were included in the study. QFT-plus test, TST, and prick test to distinguish the increase of induration because of the skin trauma were performed on both groups. The demographics, risk factors for latent tuberculosis infection, BCG vaccination history, Koebner's history, psoriasis severity, and treatment history of the patients were recorded. The effects of these variables on test results were investigated by comparing those with control group. The criteria of National Tuberculosis Diagnosis and Treatment Guidelines were used in the evaluation of test results, and threshold value of positivity for TST was taken as 10 mm in BCG-vaccinated patients who are planned to start biological treatment. Prick test results were negative in the control group. There was no significant relation between the results of prick test and TST induration diameters in the patient group. Although TST positivity was significantly higher in patients (62%) compared with control group (33%), QFT-plus test results were not statistically different between two groups. Agreement between two tests was determined to be low in patient group with 48% (K = 0.1), and it was determined to be moderate with 77% in control group (K = 0.4). QFT-plus test was found to be negative in 46 of 57 TST-positive patients (80.7%) in patient group. It was determined in both groups that vaccination did not have any effect on test results. When threshold value was lowered to 5 mm in patient group without considering BCG reaction, the number of TST-positive patients increased from 57 to 65. Mean TST induration diameter was 10 mm and 14 mm in cases with mild and moderate to severe clinical manifestation, respectively (P = .04). However, no effect of disease period and treatment was determined on both test results. TST positivity was higher in psoriasis patients compared with control group. It was considered due to the increased reaction of the skin to mycobacterial antigens rather than the Koebner's response. Although TST results were not affected by BCG, it was concluded that a 10-mm threshold value of positivity was a suitable approach in order to reduce the number of patients receiving unnecessary preventive treatment in patients who are considered to initiate biologic agents. Furthermore, it was also concluded that QFT-plus test may be preferred in psoriasis patients since it is applied in vitro and its specificity is higher and not affected by disease severity

Prevalence of Chlamydia trachomatis/Neisseria gonorrhoeae and Human Papilloma Virus among Women-at Risk in the Aegian Region of Turkey, and their knowledge about HIV/AIDS

Background: The aim of this study was to determine the prevalence of selected sexually transmitted diseases (STDs) and the level of knowledge and attitudes regarding HIV/AIDS among Turkish brothel based sex-workers (SWs). Subjects and Methods: A pre-designed questionnaire was administered to 199 SWs to obtain their sexual behaviours and their level of knowledge of HIV/AIDS. The specimens collected for C trachomatis/N gonorrhoeae and human papillomavirus (HPV) were tested using Gen-Probe PACE 2 and HPV-screening assays, respectively. Result: Aproximatelly sixty-seven per cent of the SWs knew that condoms afforded protection against HIV/AIDS and 62% reported continued use of condoms. Although most of the SWs had heard about HIV/AIDS, thorough knowledge of transmission and prevention was lacking. The overall estimated rates for C trachomatis/N gonorrhoeae and HPV were 18.6% and 9.7%, respectively. CONCLUSION: There is a need for further studies to generate more data on the prevalence of STDs and the knowledge of STDs in this population. "Prevalencia de Chlamydia trachomatis/Neisseria gonorrhoeae y el Virus del Papiloma Humano entre las Mujeres en Riesgo, y sus Conocimientos Sobre la VIH/SIDA, en la Región egea de Turquía" RESUMEN Antecedentes: El objetivo de este estudio es determinar la pevalencia de las enfermedades de trasmisión sexual (ETS) seleccionadas, y el nivel de conocimientos y actitudes en relación con el VIH/SIDA entre las trabajadoras sexuales (TS) en burdeles turcos. Sujetos y Métodos: Se aplicó un cuestionario prediseñado a 199 trabajadoras sexuales a fin de revelar sus comportamientos sexuales y su nivel de conocimientos acerca del VIH/SIDA. Las muestras de C trachomatis/N gonorrhoeae y virus del papiloma humano (VPH) recogidas, fueron analizadas mediante la sonda genética conocida como Gen-Probe PACE 2 y ensayos de pesquisaje de VPH, respectivamente. Resultado: Aproximadamente sesenta y siete por ciento de las TS sabían que los condones daban protección contra el VIH/SIDA, y el 62% reportó uso continuado de condones. Aunque la mayor parte de las TS habían oído acerca del VIH/SIDA, les faltaban conocimientos cabales sobre la trasmisión y prevención de ETS. Las tasas generales estimadas de C trachomatis/N gonorrhoeae y VPH fueron 18.6% y 9.7%, respectivamente. Conclusión: Es necesario realizar estudios ulteriores a fin de generar más datos acerca de la prevalencia de las ETS y los conocimientos acerca de ellas en esta población