Acute brucella melitensis M16 infection model in mice treated with tumor necrosis factor-alpha inhibitors

Introduction: There is limited data in the literature about brucellosis related to an intracellular pathogen and anti-tumor necrosis factor alpha (anti-TNFα) medication. The aim of this study was to evaluate acute Brucella infections in mice receiving anti-TNFα drug treatment. Methodology: Anti-TNFα drugs were injected in mice on the first and fifth days of the study, after which the mice were infected with B. melitensis M16 strain. Mice were sacrificed on the fourteenth day after infection. Bacterial loads in the liver and spleen were defined, and histopathological changes were evaluated. Results: Neither the liver nor the spleen showed an increased bacterial load in all anti-TNFα drug groups when compared to a non-treated, infected group. The most significant histopathological findings were neutrophil infiltrations in the red pulp of the spleen and apoptotic cells with hepatocellular pleomorphism in the liver. There was no significant difference among the groups in terms of previously reported histopathological findings, such as extramedullary hematopoiesis and granuloma formation. Conclusions: There were no differences in hepatic and splenic bacterial load and granuloma formation, which indicate worsening of the acute Brucella infection in mice; in other words, anti-TNFα treatment did not exacerbate the acute Brucella spp. infection in mice. © 2015 Kutlu et al

Evaluation of Pre-analytical Process with Quality Indicators and Six Sigma Methodology in the Parasitology Laboratory of a Tertiary Healthcare Center [Üçüncü Basamak Sağlık Merkezinin Parazitoloji Laboratuvarında Analiz Öncesi Sürecin Kalite Belirteçleri ve Altı Sigma Yöntemi ile Değerlendirilmesi]

###EgeUn###Laboratories have important role in decisions related to the patient. Laboratory performance needs to be evaluated to ensure accurate and sustainable laboratory results. Total test process consists of pre-analytical, analytical and post-analytical sub-processes. Most of the laboratory errors occur in pre-analytical process, which is mostly outside the laboratory, and this important situation has to be monitored by laboratory specialists. Although the standard statistical methods in which the frequency is evaluated can reveal which error is more than the others, they cannot determine which error is needed due to the absence of accepted target values. The decision to intervene in errors can only be made according to the targets by evaluating with methods such as six-sigma and quality indicators. Six-sigma method; is a quality management tool that provides information about process performance. Low sigma level indicates variability or errors in the relevant process. Quality indicators have been developed to measure quality and efficiency of laboratory processes. Use of quality indicators is effective in reducing errors, increasing patient safety and helping to meet ISO-15189 requirements. In this study, it was aimed to evaluate pre-analytical process performance in Parasitology Direct Diagnosis Laboratory of Ege University Faculty of Medicine according to the quality targets of International Federation of Clinical Chemistry and Laboratory Medicine Working Group on Laboratory Errors and Patient Safety (IFCC WG-LEPS) and the six-sigma method. The data of rejected samples in our laboratory during the period 2014-2017 were obtained retrospectively from laboratory information system. Errors were classified using laboratory errors classification system. Quality indicators were calculated for each error category and assessed according to IFCC WG-LEPS quality targets. Pre-analytical sigma level was calculated for each year. Our pre-analytical process sigma goal was 4.6. Sigma levels were calculated according to the reasons of rejection and Pareto analysis was performed. All of the rejected samples were pre-analytical process errors. Unacceptable quality indicators according to the IFCC WG-LEPS targets were found as "insufficient sample" in 2015; "insufficient sample" and "inappropriate sample tube" in 2016 and 2017. Our pre-analytical process sigma levels according to the rejection reasons were found to be 4.39, 4.31, 4.11, 4.17, respectively in 2014- 2017. "Improper test request" in 2014, and "insufficient sample" in 2015-2017 had sigma levels below 4.6. In addition "improper test request" in 2014, and "insufficient sample" in 2015, 2016 and 2017 were noticeable in Pareto analysis. In this study, pre-analysis process was evaluated with six sigma method and quality indicators and the areas open for improvement were determined quantitatively. We found "insufficient sample", "improper test request" and "inappropriate sample tube" indicators as inappropriate according to our target values with both quality indicators and six-sigma methods. For this reason, we have planned video conference training focused on error sources for all employees. We consider that risk and number of errors will be reduced and efficiency of whole test process can be increased by evaluating pre-analytical process with accepted methods and monitoring the results. Process evaluation studies with six-sigma and quality indicators are limited in microbiology and parasitology laboratories. We think that laboratory quality is indispensable and this study will be an example for the laboratory specialists who want to evaluate pre-analytical process of their laboratories

MIKROBIYOLOJI BULTENI

Leishmaniasis is a vector-borne zoonotic disease that shows different clinical features like cutaneous, mucocutaneous, visceral and viscerotropic forms. The protocols used in the treatment of leishmaniasis are toxic and have many limitations during administration. One of the limitations of treatment is the resistance against the protocols in practice. There is also a need to define new treatment options especially for resistant patients. Ex-vivo models using primary cell cultures may be a good source for evaluating new drug options in patients with antimony resistance, in addition to in-vitro and in-vivo studies. In this study, it was aimed to define a new ex-vivo culture model to evaluate treatment options in patients with cutaneous leishmaniasis who did not respond to treatment. In our experimental model of ex-vivo infection, Leishmania tropica promastigotes isolated from a case previously diagnosed with cutaneous leishmaniasis were used. The primary astroglial cell culture used for the ex-vivo model was prepared from 2-3 days old neonatal Sprague Dawley rat brains under sterile conditions by the modification McCarthy's method. The astroglia cells, which reached sufficient density, were infected with antimony resistant L.tropica promastigotes. After 24 hours of incubation, the supernatant on the cells were collected, the cell culture plate was dried at room temperature, then fixed with methyl alcohol and stained with Giemsa to search for L.tropica amastigotes. Amastigotes were intensely observed in glia cells in primary cell cultures infected with L.tropica promastigotes. No promastigotes were seen on Giemsa stained preparations of the precipitates prepared from the bottom sediment after the centrifugation of the liquid medium removed from the infected plates. In this study, promastigotes from a cutaneous leishmaniasis patient unable to respond to pentavalent antimony therapy were shown to infect rat glia cells and converted to amastigote form. This amastigote glial cell model, as far as we know, is the first model in the literature produced by L.tropica. The occurrence of L.tropica amastigote forms in glia cells may be indicative of the ability of Leishmania species to infect the central nervous system. The central nervous system may be an area for the Leishmania amastigotes to escape from the immune system in cases of leishmaniasis without a treatment response. Our study is important because it is the first study to show the infection of glia cells with L.tropica amastigotes

Infecting glial cells with antimony resistant Leishmania tropica: A new ex-vivo model [Glia Hücrelerinin Antimona Dirençli Leishmania tropica ile Enfekte Edilmesi: Yeni Bir ex-vivo Modeli]

PubMed ID: 29642829Leishmaniasis is a vector-borne zoonotic disease that shows different clinical features like cutaneous, mucocutaneous, visceral and viscerotropic forms. The protocols used in the treatment of leishmaniasis are toxic and have many limitations during administration. One of the limitations of treatment is the resistance against the protocols in practice. There is also a need to define new treatment options especially for resistant patients. Ex-vivo models using primary cell cultures may be a good source for evaluating new drug options in patients with antimony resistance, in addition to in-vitro and in-vivo studies. In this study, it was aimed to define a new ex-vivo culture model to evaluate treatment options in patients with cutaneous leishmaniasis who did not respond to treatment. In our experimental model of ex-vivo infection, Leishmania tropica promastigotes isolated from a case previously diagnosed with cutaneous leishmaniasis were used. The primary astroglial cell culture used for the ex-vivo model was prepared from 2-3 days old neonatal Sprague Dawley rat brains under sterile conditions by the modification McCarthy's method. The astroglia cells, which reached sufficient density, were infected with antimony resistant Ltropica promastigotes. After 24 hours of incubation, the supernatant on the cells were collected, the cell culture plate was dried at room temperature, then fixed with methyl alcohol and stained with Giemsa to search for Ltropica amastigotes. Amastigotes were intensely observed in glia cells in primary cell cultures infected with Ltropica promastigotes. No promastigotes were seen on Giemsa stained preparations of the precipitates prepared from the bottom sediment after the centrifugation of the liquid medium removed from the infected plates. In this study, promastigotes from a cutaneous leishmaniasis patient unable to respond to pentavalent antimony therapy were shown to infect rat glia cells and converted to amastigote form. This amastigote glial cell model, as far as we know, is the first model in the literature produced by Ltropica. The occurrence of Ltropica amastigote forms in glia cells may be indicative of the ability of Leishmania species to infect the central nervous system. The central nervous system may be an area for the Leishmania amastigotes to escape from the immune system in cases of leishmaniasis without a treatment response. Our study is important because it is the first study to show the infection of glia cells with L.tropica amastigotes. © 2018 Ankara Microbiology Society. All rights reserved

[Evaluation of Malassezia species by Fourier transform infrared (FT-IR) spectroscopy].

Malassezia species which are lipophilic exobasidiomycetes fungi, have been accepted as members of normal cutaneous flora as well as causative agent of certain skin diseases. In routine microbiology laboratory, species identification based on phenotypic characters may not yield identical results with taxonomic studies. Lipophilic and lipid-dependent Malassezia yeasts require lipid-enriched complex media. For this reason, Fourier transform infrared (FT-IR) spectroscopy analysis focused on lipid window may be useful for identification of Malassezia species. In this study, 10 different standard Malassezia species (M.dermatis CBS 9145, M.furfur CBS 7019, M.japonica CBS 9432, M.globosa CBS 7966, M.nana CBS 9561, M.obtusa CBS 7876, M.pachydermatis CBS 1879, M.slooffiae CBS 7956, M.sympodialis CBS 7222 and M.yamatoensis CBS 9725) which are human pathogens, have been analyzed by FT-IR spectroscopy following standard cultivation onto modified Dixon agar medium. Results showed that two main groups (M1; M.globosa, M.obtusa, M.sympodialis, M.dermatis, M.pachydermatis vs, M2; M.furfur, M.japonica, M.nana, M.slooffiae, M.yamatoensis) were discriminated by whole spectra analysis. M.obtusa in M1 by 1686-1606 cm-1 wavenumber ranges and M.japonicum in M2 by 2993-2812 cm-1 wavenumber ranges were identified with low level discrimination power. Discriminatory areas for species differentiation of M1 members as M.sympodialis, M.globosa and M.pachydermatis and M2 members as M.furfur and M.yamatoensis could not be identified. Several spectral windows analysis results revealed that FT-IR spectroscopy was not sufficient for species identification of culture grown Malassezia species

Spectroscopy

Malassezia species which are lipophilic exobasidiomycetes fungi, have been accepted as members of normal cutaneous flora as well as causative agent of certain skin diseases. In routine microbiology laboratory, species identification based on phenotypic characters may not yield identical results with taxonomic studies. Lipophilic and lipid-dependent Malassezia yeasts require lipid-enriched complex media. For this reason, Fourier transform infrared (FT-IR) spectroscopy analysis focused on lipid window may be useful for identification of Malassezia species. In this study, 10 different standard Malassezia species (M.dermatis CBS 9145, M.furfur CBS 7019, M.japonica CBS 9432, M.globosa CBS 7966, M.nana CBS 9561, M.obtusa CBS 7876, M.pachydermatis CBS 1879, M.slooffiae CBS 7956, M.sympodialis CBS 7222 and M.yamatoensis CBS 9725) which are human pathogens, have been analyzed by FT-IR spectroscopy following standard cultivation onto modified Dixon agar medium. Results showed that two main groups (M1; M.globosa, Robtusa, M.sympodialis, M.dermatis, M.pachydermatis vs, M2; M.furfur, M.japonica, M.nana, M.slooffiae, M.yamatoensis) were discriminated by whole spectra analysis. M.obtusa in M1 by 1686-1606 cm(-1) wavenumber ranges and M.japonicum in M2 by 2993-2812 cm(-1) wavenumber ranges were identified with low level discrimination power. Discriminatory areas for species differentiation of M1 members as M.sympodialis, M.globosa and M.pachydermatis and M2 members as M.furfur and M.yamatoensis could not be identified. Several spectral windows analysis results revealed that FT-IR spectroscopy was not sufficient for species identification of culture grown Malassezia species