Department Of Clinical Microbiology Research Articles

The relationship between brucellosis and vitamin D

This study was aimed to determine the relationship between vitamin D and soluble vitamin D receptor (VDR) levels and brucellosis, a common infection in Turkey, in which the cellular immune system is important in the course of the disease. Patients who had been followed up in the Department of Infectious Diseases and Clinical Microbiology of Cukurova University Medical Faculty, having been diagnosed with brucellosis and who had no brucellosis treatment before, were enrolled in the study along with healthy controls. The participants' vitamin D and soluble VDR values were recorded. Laboratory parameters of patients and controls, clinical findings, and disease course of brucellosis patients were also noted. The mean age of the 86 brucellosis patients, of whom 38 (44.2%) were males and 48 (55.8%) were females, was 40.9 ± 18.4 years. Complicated course of brucellosis rate was found to be 29.1%. Vitamin D and VDR levels were lower in brucellosis patients at the time of diagnosis compared to control group. For males, vitamin D and VDR levels were higher in the control group than in the patient group. In males, VDR levels were higher than in females. A significant difference was not found between clinical forms of the disease and vitamin D and VDR levels. Vitamin D and VDR levels were shown to be significantly lower in brucellosis patients before treatment compared to the control group. These results suggest that vitamin D could be involved in the pathogenesis of the disease.

The Effect of Mastery Learning Model with Reflective Thinking Activities on Medical Students’ Academic Achievement: An Experimental Study

This study aimed to determine the effect of mastery learning model supported with reflective thinking activities on the fifth grade medical students' academic achievement. Mixed methods approach was applied in two samples (n = 64 and n = 6). Quantitative part of the study was based on a pre-test-post-test control group design with an experiment group (32 students) and a control group (32 students) selected among the fifth grade students starting their internship training in Infectious Diseases and Clinical Microbiology Department. Afterwards the qualitative data were collected through semi-structured interviews with six students, selected from the experimental group and the faculty member conducting the study. Findings from the quantitative part indicated that there was a significant difference between post- tests scores of the experiment and control groups favoring the experiment group [ t (62)= -2,815; p =.007]. Quantitative results revealed positive attitudes toward the applied model in terms of increasing achievement.

The Effect of Epidural Labour Analgesia on Neonatal Outcomes: A Prospective Randomised Study

Department of Anesthesia and Intensive Care, School of Medicine and Health Science, University for Development Studies, P.O.Box 1883, Tamale N/R, Ghana. Department of Anesthesia, Tamale Teaching Hospital, P.O.Box 16, Tamale N/R, Ghana. Department of Nursing, School of Allied Health Sciences, University for Development Studies, P.O.Box 1350, Tamale N/R, Ghana. Department of Obstetrics and Gynecology, School of Medicine and Health Science, University for Development Studies, P.O.Box 1883, Tamale N/R, Ghana. Department of Clinical Microbiology, School of Medicine and Health Science, University for Development Studies, P.O.Box 1883, Tamale N/R, Ghana. Diagnostic Laboratory Services, Tamale Teaching Hospital, P.O.Box 16, Tamale N/R, Ghana.

Specific Antinuclear Antibody Level Changes after B Cell Depletion Therapy in Systemic Sclerosis Are Associated with Improvement of Skin Thickening

To the Editor: B cell depletion therapy using rituximab (RTX) has emerged as a promising therapy in systemic sclerosis (SSc). Our group reported a clinical benefit on skin thickening when RTX (2 × 1000 mg) in combination with methylprednisolone (100 mg) was administered at months 0 and 61. The rationale behind the use of B cell depletion in SSc treatment is based on the growing evidence that B cells play a role in the pathogenesis of the disease2,3. In addition, SSc-associated antinuclear antibody (ANA) are present in the majority of patients, but are generally accepted to be rather static markers, primarily important in diagnosis rather than in followup4. Moreover, conflicting results have been published5 on the change in disease-specific ANA titers in relation to clinical response in other connective diseases (e.g., systemic lupus erythematosus and rheumatoid arthritis) after RTX. To our knowledge, no studies in SSc are available documenting the longterm effect of RTX on these autoantibody levels. In this letter we report the 2-year serologic followup data (months 0, 3, 6, 12, 15, 18, and 24) on the same 8 patients with SSc with diffuse skin involvement (dcSSc) who were included in our initial RTX studies1,6. The idea was to evaluate the relationship between SSc-ANA level changes and clinical response. To document this latter relationship, we performed … Address correspondence to C. Bonroy, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital 2P8, De Pintelaan 185, B-9000, Ghent, Belgium. E-mail: carolien.bonroy{at}uzgent.be

Importance Of The Rısk Factors For Vancomycın Resıstant Enterococcus Infectıon/Colonızatıon Development In Tertıary Intensıve Care Unıts

Deniz Erdem1, Dilek Kanyilmaz2, Belgin Akan1, Kevser Dilek Andic1, Meltem Arzu Yetkin3, Hurrem Bodur3 1Ankara Numune Education and Research Hospital, Department of Intensive Care Unit I, Ankara, Turkey; 2Ankara Numune Education and Research Hospital, Department of Infection Control, Ankara, Turkey; 3Ankara Numune Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey

Acinetobacter Infection and Resistance Profile of Intensive Care Units In a City of Northwestern Anatolia

1 Department of Anesthesiology and Reanimation, Abant Izzet Baysal University, Turkey 2 Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University, Turkey 3 Union of Public Hospitals, Abant Izzet Baysal State Hospital, Clinic of Infectious Diseases, Turkey 4 Department of Emergency Medicine, Abant Izzet Baysal University, Turkey 5 Infection Control Unit, Abant Izzet Baysal University Training and Research Hospital, Turkey

Human Cutaneous Anthrax, the East Anatolian Region of Turkey 2008-2014.

Anthrax is a zoonotic infectious disease caused by Bacillus anthracis. While anthrax is rare in developed countries, it is endemic in Turkey. The names of the different forms of the disease refer to the manner of entry of the spores into the body-cutaneous, gastrointestinal, inhalation, and injection. The purpose of this study was to evaluate the clinical characteristics, epidemiological history, treatment, and outcomes of patients with anthrax. Eighty-two cases of anthrax hospitalized at Atatürk University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology in 2008-2014 were examined retrospectively. Gender, age, occupation, year, history, clinical characteristics, character of lesions, length of hospitalization, and outcomes were recorded. Thirty (36.6%) patients were female and 52 (63.4%) patients were male; ages were 18-69 and mean age was 43.77 ± 13.05. The mean incubation period was 4.79 ± 3.76 days. Cases were largely identified in August (41.5%) and September (25.6%). Sixty-nine (84.1%) of the 82 patients had been given antibiotics before presentation. Lesions were most common on the fingers and arms. The most common occupational groups were housewives (36.6%) and people working in animal husbandry (31.7%). All patients had histories of contact with diseased animals and animal products. Penicillin-group antibiotics (78%) were most commonly used in treatment. One patient (1.2%) died from anthrax meningitis. The mean length of hospitalization was 8.30 ± 5.36 days. Anthrax is an endemic disease of economic and social significance for the region. Effective public health control measures, risk group education, vaccination of animals, and decontamination procedures will reduce the number of cases.

Rapid, comprehensive, and affordable mycobacterial diagnosis with whole-genome sequencing: a prospective study

SummaryBackgroundSlow and cumbersome laboratory diagnostics for Mycobacterium tuberculosis complex (MTBC) risk delayed treatment and poor patient outcomes. Whole-genome sequencing (WGS) could potentially provide a rapid and comprehensive diagnostic solution. In this prospective study, we compare real-time WGS with routine MTBC diagnostic workflows.MethodsWe compared sequencing mycobacteria from all newly positive liquid cultures with routine laboratory diagnostic workflows across eight laboratories in Europe and North America for diagnostic accuracy, processing times, and cost between Sept 6, 2013, and April 14, 2014. We sequenced specimens once using local Illumina MiSeq platforms and processed data centrally using a semi-automated bioinformatics pipeline. We identified species or complex using gene presence or absence, predicted drug susceptibilities from resistance-conferring mutations identified from reference-mapped MTBC genomes, and calculated genetic distance to previously sequenced UK MTBC isolates to detect outbreaks. WGS data processing and analysis was done by staff masked to routine reference laboratory and clinical results. We also did a microcosting analysis to assess the financial viability of WGS-based diagnostics.FindingsCompared with routine results, WGS predicted species with 93% (95% CI 90–96; 322 of 345 specimens; 356 mycobacteria specimens submitted) accuracy and drug susceptibility also with 93% (91–95; 628 of 672 specimens; 168 MTBC specimens identified) accuracy, with one sequencing attempt. WGS linked 15 (16% [95% CI 10–26]) of 91 UK patients to an outbreak. WGS diagnosed a case of multidrug-resistant tuberculosis before routine diagnosis was completed and discovered a new multidrug-resistant tuberculosis cluster. Full WGS diagnostics could be generated in a median of 9 days (IQR 6–10), a median of 21 days (IQR 14–32) faster than final reference laboratory reports were produced (median of 31 days [IQR 21–44]), at a cost of £481 per culture-positive specimen, whereas routine diagnosis costs £518, equating to a WGS-based diagnosis cost that is 7% cheaper annually than are present diagnostic workflows.InterpretationWe have shown that WGS has a scalable, rapid turnaround, and is a financially feasible method for full MTBC diagnostics. Continued improvements to mycobacterial processing, bioinformatics, and analysis will improve the accuracy, speed, and scope of WGS-based diagnosis.FundingNational Institute for Health Research, Department of Health, Wellcome Trust, British Colombia Centre for Disease Control Foundation for Population and Public Health, Department of Clinical Microbiology, Trinity College Dublin.

Distribution of genital human papillomavirus genotypes in benign clinical manifestations among men from Northern Spain.

BackgroundIn the literature, data on the prevalence of human papillomavirus (HPV) infection in men vary significantly and the exact distribution of specific genotypes is still unclear. As infections usually occur without symptoms, men might only attend their hospital clinic when they have a specific concern, being in most cases genital warts (condylomas), which are often caused by low-risk HPV genotypes. The aim of this study was to assess HPV genotype distribution and prevalence among men attending hospital for HPV-associated conditions and to evaluate infection-associated factors.MethodsSamples from men with clinical manifestations of HPV-related infections seen during 2007–2012 at the Clinical Microbiology and Infectious Control Department at Basurto University Hospital were genotyped using Linear Array HPV Genotyping Test kit (Roche Molecular Diagnostics, Germany). Data on probable risk factors were collected and investigated for possible association.ResultsOf 184 anogenital samples, 138 (75 %) were tested as positive for HPV; 57 (41.3 %) single HPV infections and 81 (58.7 %) multiple infections. Only 45.6 % of HPV-positive samples presented low-risk genotypes 6 or 11, whereas 71/138 (51.4 %) had at least one oncogenic (high-risk) genotype. Oncogenic genotypes and multiple HPV infections were both associated with a higher number of lifetime sexual partners and their incidence appeared to increase with patient age.ConclusionsAlthough it is accepted that HPV 6 and 11 genotypes are main causes of condylomas, our findings show a high incidence of multiple infections and high-risk genotypes in men with benign HPV manifestations. The fact that the condyloma is a skin lesion facilitates the entry of virus into cells and thus cancer progression; therefore, monitoring for HPV is important, especially in those patients with high-risk genotypes (regardless of whether they cause condyloma).

A long-term survey of brucellosis: Is there any marker to predict the complicated cases?

Background: This study aimed to find markers to predict complicated cases in brucellosis. Patients with and without complications were compared in terms of epidemiological, clinical and laboratory properties. Methods: A total of 700 patients hospitalised at the Department of Infectious Diseases and Clinical Microbiology were evaluated retrospectively. Results: Of a total of 700 patients, 383 (54.7%) were male and mean age was 41.5 ± 17.0 years. Of the patients, 517 (73.8%) were classified as acute cases. Complications occurred significantly less frequently in acute infections (p < 0.001). Increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) occurred more frequently in patients with complicated cases (p = 0.005 and 0.021, respectively), whereas malaise, myalgia and blood culture positivity occurred significantly less frequently in those cases (p <0.001, <0.001 and 0.014, respectively). Fever at examination, loss of malaise and myalgia and blood culture negativity were statistically significant predictive factors for complicated patients in multivariate analysis (p < 0.001, for each). As compared to patients without orchitis, leukocytosis occurred more often in cases with orchitis (p < 0.001); leukopenia occurred more often in neurobrucellosis than in cases without neurobrucellosis (p = 0.008). Of patients who attended control regularly, 422 (98%) were treated successfully. All of the nine patients who did not recover fully were cases with osteoarticular involvement. Conclusions: Fever was the most significant predictive marker of complications. Other classical symptoms of brucellosis like myalgia and malaise were absent in most of the complicated cases. Blood culture was of limited value in the diagnosis of complicated cases most of the time.

Serum β-Defensin-2 Levels and Their Relationship with the Clinical Course and Prognosis in Patients with Crimean-Congo Hemorrhagic Fever

Objective: The aim of this study was to investigate the role of the clinical course and prognosis of serum levels of β-defensin-2 (BD-2) in patients with Crimean-Congo hemorrhagic fever (CCHF). Subjects and Methods: Patients who were hospitalized in the Department of Infectious Diseases and Clinical Microbiology of the Faculty of Medicine, Ataturk University, were considered for inclusion in this study. The patients had positive real-time reverse transcription polymerase chain reaction and/or enzyme-linked immunosorbent assay results of the CCHF virus. There were 60 patients with CCHF in the study group and 25 healthy participants in the control group. Serum BD-2 levels were measured using ELISA. Data were analyzed using the Student t test or Mann-Whitney U test. Results: Of the 60 patients, 6 (10%) died and 54 (90%) were discharged following their recovery. The mean BD-2 level of the patient group was significantly higher (4,180.30 ± 3,944.19 pg/ml) than that of the control group (964.45 ± 266.07 pg/ml; p = 0.001). Serum BD-2 levels of the patients with fatal (1,529.81 ± 1,028.14) and nonfatal disease (4,474.80 ± 4,041.58) differed, but this difference showed only borderline significance (p = 0.055). The mean BD-2 level of the severe group was 5,507.45 ± 4,327.06 pg/ml, while it was 3,611.52 ± 3,676.73 pg/ml in the mild/moderate group, and both were significantly higher than that of the control group (p = 0.001). Conclusion: In this study, the expression of serum BD-2 was raised in patients with CCHF, and this increase may beneficially affect survival. Studies with larger sample sizes are needed to confirm the association of serum BD-2 with CCHF prognosis.

Diabetic foot infections: effective microorganisms and factors affecting the frequency of osteomyelitis and amputation

Objectives. Diabetic foot infections are common reason for hospitalization and are associated with high morbidity and mortality. We aimed to evaluate the clinic features and predisposed causes of osteomyelitis and amputation of patients with diabetic foot infections. Methods. Patients with diabetic foot infections who admitted and hospitalized at Infection Diseases and Clinical Microbiology department between January 2012 and July 2014 were included. Osteomyelitis was evaluated using magnetic resonance imaging (MRI) or bone scintigraphy. Microbiological examinations (Gram staining and culture) of the debridement materials and pus aspiration materials of the lesions were performed. Results. Of the seventy-three diabetic foot infected patients, 37 (50.7%) were female, and 36 (49.3%) were male. The mean age of patients was 57±9.8 years. The mean duration of diabetes and HbA1c level were 13.3±5.3 years and 8.17±1.83%; respectively. Soft tissue infection without osteomyelitis was present in only 34 out of 73 (46.5%) patients. A total of 89 pathogens were identified in 52 patients whereas any microorganism was not identified in 28.7%. Polymicrobial infections were detected in 30 (41%) patients. The most common isolated microorganism was Pseudomonas aeruginosa (36.9%), followed by Staphylococcus aureus (31.5%) and Enterococcus spp. (13.6%). Of the 37 (50.7%) patients had a history of diabetic foot infection previously, osteomyelitis progression was higher (89.2%) and statistically significant in these patients. Twelve (16.4%) patients underwent amputation. Conclusions. Advanced age and presence of osteomyelitis were found as risk factors for amputation. In the presence of osteomyelitis, treatment of diabetic foot infections is difficult and amputation rate is higher. For this reason, diabetic foot infections should be promptly treated before the development of osteomyelitis, and multidisciplinary approach is needed.

Clinical and molecular characteristics of bloodstream infection caused by K. pneumonia

Objective To investigate the clinical features and molecular characteristics of bacteremia caused by K. pneumoniae and study on the differences between classical and hypervirulent K. pneumonia(hvKP). Methods The clinical features of 70 cases of K. pneumoniae bacteremia collected from Beijing Chaoyang Hospital from 2008 to 2012 were retrospectively analyzed. The patients were identified according to the records from the Clinical Microbiology Department. Patients' data were obtained from medical records. The molecular characteristics of the K. pneumoniae strains were also studied using PCR, multilocus sequence typing and pulsed field gel electrophoresis(PFGE) methods. Data were analyzed using the statistical package SPSS for windows version 17.0. For categorical data, different groups were compared using the Chi-square test to analyze the quantitative variables. P≤0.05 was considered to be statistically significant. All susceptibility data were analyzed using Whonet, version 5.6. Results The hvKP was identified from 31.4% of the patients with K. pneumoniae bacteremia, which displayed 4 serotypes (K1, K2, K20, and K57). About 40.9% (9/22) hypervirulent strains were isolated from patients without underlying diseases, while 95.8% (46/48) of the classic K. pneumoniae infections were found in patients with the presence of one or more underlying diseases. More hvKP positive patients (95.5%, 21/22) had community-acquired infections compared with classical K. pneumonia (cKP) infected patients (35.4%, 17/48). There was a significant difference between these two groups (χ2=21.912, P<0.001). Two ESBLs-producing hvKP strains were found. The 22 hvKP isolates had 14 different PFGE patterns, among which 6 isolates (patients with primary liver abscess) shared similar PFGE patterns. Conclusions The emerging hvKP was prevalent in patients with severe community-acquired infections in healthy individuals. Two ESBLs-producing hvKP strains were identified. Drug resistance had a rising trend, which called for more attention in clinical settings. (Chin J Lab Med, 2015, 38: 627-631) Key words: Liver abscess; Community-acquired infections; Klebsiella pneumoniae; Virulence

Cerebrospinal fluid biomarkers in facial nerve palsy caused by Varicella Zoster virus

No: 1680 Presentation at ESCV 2015: Poster 1 Cerebrospinal fluid biomarkers in facial nerve palsy caused by Varicella Zoster virus J. Lindstrom1,∗, A. Grahn1, H. Zetterberg2, M. Studahl1 1 Department of Infectious Diseases, Sahlgrenska University Hospital, Ostra, Goteborg, Sweden 2 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sweden Background: Reactivation of Varicella Zoster virus (VZV) can cause facial nerve palsy with neurological sequels despite treatment with aciclovir and/or corticosteroids. Associated symptoms such as vertigo and loss of hearing are frequent. Facial nerve palsy caused by VZV manifest as Ramsay Hunt syndrome when blisters are present, or as zoster sine herpete without blisters. Neurofilament light protein (NFL), glial fibrillary acidic protein (GFAp) and S-100 are cerebrospinal fluid (CSF) biomarkers that have been used to estimate severity of neuronal damage and prognosis in various CNS diseases. One previous study has been performed on VZV in the central nervous system (CNS), but patients with facial palsy have not been specifically studied. Methods: 28 patientswith VZV facial palsy, diagnosed by detection of VZV DNA in CSF by PCR, were retrospectively identified. GFAp, NFL and S-100 were measured in stored CSF samples and compared with a control group (n=52). Medical records were studied for relevant patient data such as severity of symptoms, treatment and laboratory parameters. Results: CSF concentrations of NFL and GFAp were significantly elevated compared to controls (p<0.01 and p<0.05) and S-100 concentrations were reduced. Additionally, NFL kinetics indicated slightly increasing concentrations in CSF samples drawn more than seven days after onset of neurological symptoms. Viral load (VZV DNA copies/ml) correlated with both NFL (Spearman r=0.51; p<0.01) and GFAp (Spearman r=0.54; p<0.01). No correlations were found between biomarkers and severity of symptoms, clinical outcome at follow-up, or treatment with aciclovir prior to CSF sampling in this small study. Conclusion: In this first study on biomarkers in facial palsy caused by VZV, we identified a pattern of elevated NFL, elevated GFAp and decreased S-100 compared to controls. Increased NFL levels reflect axonal damage, and elevated levels of GFAp, in combination with decreased concentrations of S-100 , indicate astrogliosis rather than damage to the astroglial cell membrane. Biomarkers of neuron and glial cell damage can be used to understand pathogenesis, and in future studies assessment of these biomarkers in relation to treatment and clinical outcome should be explored. http://dx.doi.org/10.1016/j.jcv.2015.07.137 Abstract No: 1682 Presentation at ESCV 2015: Poster 1 False negative influenza A virus subtype H3N2 in Prodesse GenProbe ProFlu+ PCR assay in season 2014–2015 N. Kirkby1,∗, T.N. Thomsen1, R. Trebbien2, K. Vorborg2, J. Ronn2, T.K. Fischer2, C.B. Christiansen1 1 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark 2 National Influenza Center, Virological Surveillance and Research Department of Microbiological

Fatigue and tiredness are common sequelae after TBE at long-term follow-up: A self-reported case-control study in Western Gotaland, Sweden

Fatigue and tiredness are common sequelae after TBE at long-term follow-up: A self-reported case-control study in Western Gotaland, Sweden

THE ANTI-TB DRUG SENSITIVITY OF Mycobacterium tuberculosis FROM CEREBROSPINAL FLUID AND BONE TISSUE BIOPSY SPECIMENS OF PATIENTS SUSPECTED TUBERCULOUS MENINGITIS AND SPINAL TB IN Dr SOETOMO HOSPITAL INDONESIA

Tuberculous meningitis (TBM) is an infection of meningens which potentially life threatening with significant morbidity and mortality. Spinal TB has the same problem with TBM, infection in bone and joint, the delayed diagnosis worsens the prognosis. The rapid and accurate diagnosis plus promt adequate treatment is essential for the good outcome. The aim of this research is to study the first line drug sensitivity of Mycobacterium tuberculosis isolated from specimens of cerebrospinal fluid from suspected tuberculous meningitis patients and bone tissue biopsy from suspected spinal TB patients. The method of this research is TB Laboratory examination in Department of Clinical Microbiology – Dr. Soetomo General Hospital, Indonesia, using the gold standard liquid culture method MGIT 960 System (Becton Dickinson) and solid culture method with Lowenstein-Jensen medium. The specimens CSF from 50 TBM patients at January 2013 until May 2014. Positive isolate detection of Mycobacterium tuberculosis complex were 11 isolates (22%), which sensitivity 100% (11/11 isolates) to Rifampin (R), Pyrazinamide (Z), Ethambutol (E), and Streptomycin (S); one isolate resistant to Isoniazid, sensitivity to Isoniazid 90,90% (10/11); and received 21 specimens of bone tissue biopsy which positive 5 isolates (23%), all isolates sensitive 100% (5/5 isolates) to Rifampin and Pyrazinamide, and 1 isolates resistant to Isoniazid, Ethambutol, and Streptomycin, in which sensitivity 80% (4/5 isolates) to Isoniazid, Ethambutol, and Streptomycin. The conclusion of this research is positivity detection 22% of CSF specimens, and 23% of bone tissue biopsy were low. All isolates sensitive 100% to Rifampin and Pyrazinamide, and 80-90% sensitive to Isoniazid.

Role of seasonality and rainfall in Vibrio cholerae infections: A time series model for 11 years surveillance data

BackgroundCholera is a life threatening disease, which alone contributes to the mortality of 2.2 million people globally, per year. The aim of this article was to study the trend, seasonality and the association of Vibrio cholerae(V. cholerae) cases with environmental factors such as Rainfall, Temperature and Humidity over 11 years. MethodsData on V. cholerae were extracted from laboratory records of Department of Clinical Microbiology, Christian Medical College, Vellore (India) between 2000 and 2010. Time series models such as Auto regressive model, Seasonal auto regressive integrated moving average model, Segmented regression model and Harmonic regression model with sine and cosine functions were done to analyze the data. ResultsThere were 132 months of observations and 1039 cholera cases reported during this time. The total number of Vibrio cholerae O1 and O139 reported was 940 and 99 cases, respectively. The number of cases reported gradually declined after 2004. The overall mean (sd) of monthly cholera counts was 7.9 (8.2). Results suggested that there was a near significant reduction of 50% from 2000–2004 to 2005–2010 with mean (sd) were 11.2(8.0) and 5.1(7.4) respectively. The average peak time during the first time period was August, while July was during the second time period. During 2000–2004, there was a positive significant association between Rainfall and V. cholerae cases (r=0.51, p<0.001) and this was not observed in the second time period. ConclusionThe trend of V.cholerae was decreasing from 2000 to 2010 and there was a significant association between Rainfall and cholera cases between 2000 and 2004.

Investigation by the Method of INNO-LiPA of Primary Resistance to Lamivudine in Patients with Chronic Hepatitis B Who Have Not Used Antiviral Therapy.

Two billion people around the world are exposed to the hepatitis B virus (HBV) and about 350 million are infected with chronic HBV. The infection can be acquired early (neonatal) and becomes chronic in 90%; this rate reduces to 30% between ages one and five years. There is a 25% risk of chronicity in adults. Nowadays, immunomodulatory and antiviral pegylated-interferons or oral antiviral agents are used in the treatment of chronic hepatitis B. Lamivudine is an effective oral antiviral agent which inhibits the replication of HVB by blocking reverse transcriptase enzyme. The study aims to detect the resistance of HBV to lamivudine in the community and evaluate the effectiveness and suitability of early treatment with lamivudine. One hundred patients who presented to our Faculty of Medicine Hospital Infectious Diseases and Clinical Microbiology Department and had not received any antiviral treatment were recruited. The INNO-LiPA method was applied to investigate primary lamivudine resistance in patients. Seventy-eight patients were HBeAg-negative and 22 patients were HBeAg-positive. A statistically significant correlation was found between HBeAg positivity, alanine aminotransferase (ALT) elevation and HBV DNA (p < 0.05). The rtM204V and L180M mutation motif was found in one patient with HBeAg positivity. Hepatitis B virus in our region is not a lamivudine-resistant strain and early treatment with lamivudine is an effective and convenient method.

The Mechanisms Involved in IL-2 Production By Regulatory Mast Cells in Chronic Allergic Dermatitis

S A T U R D A Y 208 The Mechanisms Involved in IL-2 Production By Regulatory Mast Cells in Chronic Allergic Dermatitis Alon Hershko, MD, PhD, Itay Moshkovits, Ariel Munitz, PhD, Yoseph A. Mekori, MD, FAAAAI, Pazit Salamon, PhD; Meir Medical Center, Kfar Saba, Israel, Department of Clinical Microbiology and Immunology, The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel, Tel Aviv University, Israel, Meir Hospital, Kfar-Saba, Israel. RATIONALE: We have previously reported that MCs dampen inflammation in oxazolone-induced chronic allergic dermatitis in mice. This suppression occurs by a previously unrecognized regulatory mechanism in which MC’s secrete IL-2 which, in turn, supports regulatory T cell activity at the site of inflammation. However, since IL-2 is not a typical product of MC’s, we sought to define conditions that support its production in the setting of allergic dermatitis. METHODS: Isolated bone marrow-derived MCs (BMMCs) were incubated with various stimulators and IL-2 release was assessed by ELISA. Phosphorylation of signaling molecules was studied by Western blot analysis. Allergic dermatitis was induced in mice by 10 repeated exposures of the ear skin to 0.5% oxazolone in acetone over 4 weeks. Immunohistochemistry was done on paraffin embedded skin specimens. RESULTS: IL-33 is an exclusive inducer of BMMC IL-2 production. Presensitization of cells with IgE further enhanced secretion of IL-2. IL-33 induced phosphorylation of the MAPKs family members ERK, p38 and JNK, and the inhibitors for these MAPKs dampened IL-2 release. The levels of IL-33 in ear homogenates from oxazolone-treated mice was greater than those of na€ive ears. Staining of ears disclosed in vivo co-localization of IL-33 and MC in ears with dermatitis. CONCLUSIONS: MC-derived IL-2 was previously shown to stimulate Tregs in allergic dermatitis, and here we show that its production is stimulated by IL-33. In dermatitis, the levels of IL-33 increase and it colocalizes with MC. We suggest that IL-33 is a pivotal player in the induction of regulatory MC’s.

Infections after Transrectal Prostate Biopsy: Report of Fourteen Cases

After prostate biopsy, serious and life-threatening infections of resistant strains can develop and therefore fluoroquinolones for prophylaxis is widely used. This study aimed to examine infections in patients undergoing transrectal prostate biopsy with quinolone prophylaxis and to review the articles reported in this respect. Patients and Methods: In this study, 14 cases who followed for the development of infection after transrectal ultrasonography guided prostate biopsy between the years 2005-2010 at the Department of Infectious Diseases and Clinical Microbiology of Haydarpasa Numune Training and Research Hospital were retrospectively evaluated. Results: Ten patients (%71.4) developed sepsis, 3 patients (21.4%) urinary tract infection (UTI), and 1 patient (7.1%) acute bacterial prostatitis. In seven out of 14 patients (50%) bacteria growth was in blood culture, in 12 patients (85.7%) was in urine and in 5 patients (35.7%) was in both. E. coli was identified as the causative agent in all of the cases being the rate of extended spectrum of 􀀁-lactamases (ESBL) in E. coli strains was 42.8%, quinolone resistance 92.8 %. Conclusion: This study suggested that fluoroquinolone resistant E. coli should be considered as an important causative agent in infections after transrectal prostate biopsy.