Gül, Özlem; Binay, Umut Devrim; Barkay, Orçun; Karakeçili, Faruk

The coronavirus disease-2019 (COVID-19) pandemic, which affects millions of people around the world, has been affecting our country since March 2020. The fact that the symptoms such as fever, myalgia, headache, joint pain which are common in COVID-19 patients are quite similar to the symptoms of diseases such as Crimean-Congo hemorrhagic fever (CCHF) and Brucellosis. This may cause a diagnostic confusion in regions where these diseases are seen as endemic. In this report, a patient hospitalized with a pre-diagnosis of COVID-19 and diagnosed with acute Brucellosis, CCHF and COVID-19 during followup was presented. A 31-year-old female patient living in a rural area admitted to the emergency service with complaints of fever, weakness, headache, and body/joint pain. Physical examination revealed a temperature of 38.3°C, a pulse rate of 102/minute, and a peripheral capillary oxygen saturation of 97% in room air. The system examination was normal. In the laboratory findings, an increase in liver enzymes and acute phase reactants was observed and the platelet count was at the lower limit of the normal range. In terms of COVID-19, no involvement compatible with COVID-19 was detected in the thorax computed tomography (CT) of the patient whose nasopharyngeal and oropharyngeal mixed swab samples were taken.The patient was transferred to our infectious diseases service with a pre-diagnosis of COVID-19 and CCHF. Serum samples were sent to the Public Health Agency Microbiology Reference Laboratory Department (PHA-MRLD) for CCHF diagnostic tests and supportive treatment was started. Brucella Rose Bengal and Coombs’ immuncapture (1/1280 titer) tests were found as positive in the patient, who was examined for brucellosis because of living in a rural area and having a history of consuming fresh dairy products. In the tests performed at PHA-MRLD, CCHF-specific IgM positivity and the presence of viral RNA were detected. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction (RT-PCR) test was negative. For Brucellosis, doxycycline and rifampicin were added to the treatment of the patient whom was given supportive therapy for CCHF. In the followup, the patient’s fever was persisting and loss of taste and smell complaint developed. In this context, COVID-19 test was repeated and resulted as positive. Upon this, hydroxychloroquine sulfate treatment was started due to the recommendation of the current Ministry of Health Scientific Committee Guide. No new infiltration was detected in the chest radiography of the patient. The patient’s fever subsided during follow-up and laboratory findings improved. The treatment of brucellosis was completed to eight weeks at the outpatient clinic. No problems were detected in the follow-up. This report was prepared because of a case with simultaneous brucellosis, CCHF and COVID-19 infections which could not be encountered in the literature review. As a result; in regions such as our country where both brucellosis and CCHF are seen as endemic, it is very important to keep these diseases in mind in the differential diagnosis of COVID-19 infection.

Erdal, Berna; Yalinay, Meltem; Elmas, Çiğdem; Yazici, Gülce Naz

Pseudomonas aeruginosa is a non-fermentative, oxidase-positive, motile gram-negative bacillus widespread in nature. The virulence factors of P.aeruginosa including the ability to grow under minimal growth conditions, the widespread presence in nature, and the ability to form biofilms make P.aeruginosa a highly important bacterium along with its resistance mechanisms against many antibiotics. The ability to form biofilms increases the symptom severity in diseases caused by P.aeruginosa and causes difficulties in the treatment. The aim of this study was to investigate the effects of sub-minimal inhibitory concentrations (sub-MIC) of piperacillin/tazobactam (TZP) and ciprofloxacin (CIP) which are used for the treatment of P.aeruginosa infections on biofilm formation and to investigate the relationship between the severity of biofilm formation and Quorum Sensing (QS) genes. The study included 24 P.aeruginosa isolates from the culture collection of Medical Microbiology Laboratory of Gazi University Faculty of Medicine. MIC values of TZP and CIP antibiotics were determined by the microdilution method. The biofilm layers in the antibiotic-free medium and in the sub-MIC (MIC/2, MIC/4 ve MIC/8) concentrations of antibiotics were visualized by using a scanning electron microscope (SEM). The QS genes (lasI, lasR, rhlI, and rhlR) of the 24 isolates with known biofilm characteristics were identified via the amplification of chromosomal DNA by using PCR method. In the study, it was foundthat both antibiotics reduced biofilm formation in a dose-dependent manner in sub-MIC concentrations compared to the antibiotic-free condition and that MIC/2 was the concentration, which reduced the biofilm formation most. These results were further confirmed by viewing the SEM images. The QS genes lasI, lasR, and rhlI were detected in a total of 19 isolates with moderately strong and strong biofilm formation, the rhlR gene was detected in six of the strong biofilm-forming isolates, in four of the moderately strong biofilm-forming isolates, and in three of the weak biofilm-forming isolates, respectively. The investigation of the effects of sub-MIC concentrations of antimicrobials, used for the treatment of P.aeruginosa infections, on the biofilm formation of P.aeruginosa and the investigation and better understanding of the QS systems associated with biofilm production will allow for finding out new treatment approaches and offer different options in combating infections with high morbidity and mortality.

Binay, Umut Devrim; Fincanci, Muzaffer; Fersan, Esra; Karakeçili, Faruk

Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus (HIV)-infected patients. Diagnosis and treatment of latent tuberculosis infection (LTBI) is the most important step in preventing the development of active TB. In our country where TB is moderately endemic, HIV-infected patients should be investigated for LTBI. Tuberculin skin test (TST) and interferon-gamma release assays (IGRA) are used in the diagnosis of LTBI but there isn't a standard practice. The aim of this study is to compare the TST and T-SPOT.TB test efficiency in the diagnosis of LTBI in HIV-infected patients. Patients who had no previous active TB infection, who were not treated for LTBI and who had no active tuberculosis infection at the time of admission were included in the study. A total of 100 HIV-infected patients who were admitted to the Infectious Diseases and Clinical Microbiology outpatient clinic between June 2015 and March 2016 were evaluated cross-sectionally. CD4+ T lymphocyte counts in the last one month were detected. All patients underwent chest radiography at the time of admission. Patients who are not considered as active TB infection with clinical and laboratory findings and who had no TST within the last one month were included in the study. TST was performed after the blood samples were taken for T-SPOT.TB test. In our study, 87% of the patients were male and the mean age was 40.2. The mean CD4+ T lymphocyte count was 605 cells/mm3 (26-1313). 16% of the patients had a history of encountring a person with tuberculosis and 81% had BCG vaccination scar. TST positivity and T-SPOT.TB positivity were 22.9% and 22%, respectively. The concordance between the two tests was found to be moderate (Kappa= 0.491). It was determined that BCG vaccination and the presence of a contact with a patient with TB did not affect TST and T-SPOT.TB test positivity (p> 0.05). There was a positive correlation between CD4+ T lymphocyte count and TST measurement values (r= 0.3, p= 0.003). Accordingly, as the number of CD4+ T lymphocytes increased, TST positivity increased (p= 0.007). T-SPOT.TB test was not affected by CD4+ T lymphocyte count (p= 0.289). Our study showed that TST was affected by CD4+ T lymphocyte count and patients' compliance with this test was also low. On the contrary T-SPOT.TB test was not affected by CD4+ T lymphocyte count. There was no statistically significant difference between T-SPOT.TB test positivity and CD4+ T lymphocyte count (p= 0.289). The concordance between the two tests was found to be moderate. It is thought that the main reason for the discordance between the tests is due to false negative or false positive results of TST. In conclusion, T-SPOT.TB was found more reliable in the diagnosis of LTBI in HIV-infected individuals. In the light of these findings, especially in HIV-infected patients with low CD4+ T lymphocyte counts, T-SPOT.TB test can be considered for LTBI diagnosis.

Özçiçek, Fatih; Karakeçili, Faruk; Akin, Hicran; Kalkan, Ahmet; Çıkman, Aytekin

Nowadays, the age group affected from measles has widened and the disease has become more common among adolescents and young adults. The number of measles case reports have increased in our country, particularly from 2010-2011, and measles outbreaks occurred in various regions in 2012 and 2013. The aim of this study was to analyze the demographical and epidemiological characteristics, clinical and laboratory fi ndings, and complications of adult patients with measles who were affected during the outbreak. A total of 28 patients (25 male, 3 female; age range: 19-39 years, median age: 24) who were hospitalized and followed-up in our clinic between January 2013 and June 2013, were evaluated. In the serum sample of the index case, measles-specifi c IgM antibodies were detected by ELISA, and measles virus RNA by real-time polymerase chain reaction (RT-PCR), then genotyping was performed to detect the epidemiological relationship. In all of the other cases, measles IgM and IgG antibodies were screened by ELISA. The most common symptoms on admission included high fever (n= 28, 100%), malaise (n= 25, 89%), sore throat (n= 25, 89%), headache (n= 20, 71%) and cough (n= 18, 64%). At physical examination, rash (n= 28, 100%), lymphadenopathy (n= 11, 39%) and conjunctivitis (n= 10, 36%) were in the foreground, and Koplik spots were detected in fi ve (18%) cases. The most common laboratory fi ndings were; increased level of C-reactive protein (n= 15, 54%), leukopenia (n= 12, 43%) and increased serum levels of aminotransferases (n= 12, 43%), and thrombocytopenia was detected in fi ve (18%) patients. One or more complications (secondary bacterial pneumonia in 5, diarrhea in 4, hepatitis in 3 and otitis in 2 cases) developed in the eight (29%) patients. Measles RT-PCR and IgM tests yielded positive results for the index case, and the isolate was identifi ed as D8 strain by genotyping. Measles lgM antibodies were also positive in all of the other cases. The hospitalization period was estimated as 3-7 days (median: 5 days), while all the patients were discharged with recovery. It appeared that, our index case had come from a troop in Amasya province three days ago and he had a history of contact with suspected measles patients. In addition, the D8 strain determined in the index case was found to be related with the strain that caused the outbreak in Amasya province. Of the cases, 20 (71.4%) were military personnel, and eight (28.6%) were civilian who had histories of contact with military personnel. Regardless of immunity status in the outbreak period, all of the healthcare staff in our hospital, especially in risky departments, was recommended to be vaccinated. Personnel vaccination was provided at a high rate, however nosocomial transmission occurred in two unvaccinated cases. In conclusion, measles is an important health problem, especially in the adult age group, because of the complications and labour loss. For outbreak management; the awareness of health personnel should be increased following the identifi cation of index case, proper isolation measures should be taken for the hospitalized patients, and routine reporting should be carried out timely and accurately

Karakeçili, Faruk; Özçiçek, Adalet; Akin, Hicran; Gülhan, Barış; Çıkman, Aytekin

Tüm dünyada, özellikle de gelişmekte olan ülkelerde yaygın olarak görülen bruselloz, halen önemini koruyan zoonotik bir hastalıktır. Bir diğer zoonotik hastalık olan Kırım-Kongo kanamalı ateşi (KKKA) ise, insanlara enfekte kene ısırığının yanı sıra, enfekte hayvanların kan ve dokuları ile temas sonucunda bulaşabilir. Her iki hastalık da, genellikle kırsal alanda yaşayanlarda ve hayvancılıkla uğraşanlarda görülmektedir. Brusellozda özgül olmayan ve birçok hastalıkla kolayca karışabilen klinik belirtilerin ortaya çıkması, bu enfeksiyonların tanısında hatalara veya gecikmelere yol açabilmektedir. Bu raporda, her iki hastalığın da birlikte görülebileceğinin vurgulanması amacıyla, bruselloz ve KKKA koenfeksiyonu tespit edilen bir olgu sunulmaktadır. Kırsal bölgede hayvancılıkla uğraşan 70 yaşında bir kadın hasta, yüksek ateş, halsizlik, yaygın vücut/eklem ağrıları ve baş ağrısı şikayetleriyle kliniğimize başvurmuştur. Son iki gündür şikayetlerinin arttığı, bulantı/kusma, karın ağrısı ve kanlı ishalinin olduğu öğrenilmiştir. Kene tutunma öyküsü olmayan olgunun fi zik muayenesinde 38.8°C ateş, bağırsak seslerinde artış ve splenomegali saptanmış; yapılan tetkiklerinde lökopeni, trombositopeni ve karaciğer enzimlerinde yükselme olduğu izlenmiştir. KKKA ön tanısıyla yatırılan hastanın serum örneği değerlendirilmek üzere, Türkiye Halk Sağlığı Kurumu (THSK) Mikrobiyoloji Referans Laboratuvarı Daire Başkanlığı'na (MRLDB) gönderilmiştir. Hastanın serviste yatışı sırasında öyküsü daha detaylı sorgulanınca, halsizlik, iştahsızlık, terleme, eklem ağrıları ve aralıklı ateş şikayetlerinin bir aydır devam ettiği ve çeşitli antibiyotik tedavileri aldığı öğrenilmiştir. Bunun üzerine bruselloz açısından yapılan tetkiklerde; Brucella Rose Bengal, tüp aglütinasyonu (1/160 titre) ve Coombs'lu immün yakalama (1/320 titre) testleri pozitif bulunmuştur. Aynı zamanda, THSK-MRLDB'de yapılan testlerde; immünofl oresan yöntemi ile KKKA virusuna özgül IgM pozitifl iği ve gerçek zamanlı polimeraz zincir reaksiyonu ile viral RNA varlığı tespit edilmiştir. Hastanın yatışında alınan iki kan kültüründe üreme olmamış, bu durumun, son bir ay içinde kullandığı antibiyotiklerden kaynaklanmış olduğu düşünülmüştür. Olguya bruselloz için doksisiklin ve rifampisin tedavisi başlanmış, KKKA için destek tedavisi uygulanarak yakın takibe alınmıştır. Yatışının ikinci gününde trombosit değerinde hızlı düşüş (37000/mm3) olması üzerine hastaya 5 ünite random trombosit ve 2 ünite taze donmuş plazma verilmiştir. Daha sonraki takiplerinde ateşi düşen ve kan tablosu düzelen olgunun bruselloz tedavisi ayaktan sekiz haftaya tamamlanmış; tedavi sonrası takiplerinde herhangi bir sorun tespit edilmemiştir. Yapılan literatür taramasında, ulaşılabildiği kadarıyla, bruselloz ve KKKA koenfeksiyonu daha önce bildirilmemiştir. Sonuç olarak, ülkemizin hem bruselloz hem de KKKA açısından endemik bir bölge olduğu göz önüne alındığında, her iki enfeksiyonun da ayırıcı tanısında bu durumun dikkate alınması önem taşımaktadır. Ayrıca bizim olgumuzda olduğu gibi koenfeksiyon olabileceği de akılda tutulmalıdır

Karakeçili, Faruk; Çikman, Aytekin; Akin, Hicran; Gülhan, Banş; Özçiçek, Adalet

Brucellosis, a zoonotic disease which is especially seen in developing countries is still an important public health problem worldwide. Crimean-Congo hemorrhagic fever (CCHF) is another zoonotic disease that transmits to humans by infected tick bites as well as exposure to blood or tissue from infected animals. Both of the diseases are common among persons who live in rural areas and deal with animal husbandry. Since brucellosis usually presents with non-specific clinical symptoms and may easily be confused with many other diseases, the diagnosis of those infections could be delayed or misdiagnosed. In this report, a case of coinfection of brucellosis and CCHF has been presented to emphasize the possibility of association of these infections. A 70-year-old female patient with a history of dealing with animal husbandry in a rural area admitted to our hospital with the complaints of fever, malaise, generalized body and joint pains, and headache. Her complaints had progressed within the past two days. She also reported nausea, vomiting, abdominal pain and bloody diarrhea. She denied any history of tick bites. Her physical examination was significant for the presence of 38.8°C fever, increased bowel sounds and splenomegaly. Laboratory analysis revealed leukopenia, thrombocytopenia and high levels of liver enzymes. The patient was admitted to our service with the prediagnosis of CCHF. Serum sample was sent to the Department of Microbiology Reference Laboratory at Public Health Agency of Turkey for CCHF testing. During patient's hospitalization in service, more detailed history was confronted and it was learned that she had fatigue, loss of appetite, sweating, joint pain, and intermittent fever complaints were continuing within a month and received various antibiotic treatments. The tests for brucellosis were conducted and positive results for Brucella Rose Bengal test, tube agglutination (1/160 titers) and immune capture test with Coombs (1/320 titers) were determined. The tests performed in the reference laboratory revealed CCHF virus-specific IgM positivity by immunofluorescence assay and viral RNA positivity by real-time polymerase chain reaction. Two blood cultures remained sterile during hospitalization, this situation was considered to be the cause of antibiotic usage in the last month. Doxycycline and rifampicin therapy were initiated for brucellosis, and close monitoring with supportive therapy for CCHF. On the second day of admission, the patient was transfused with 5 units random platelets and 2 units fresh frozen plasma due to dramatic decline of platelet count (37.000/mm3). Early clinical response to brucellosis therapy was confirmed with resolution of fever and improved blood counts and the treatment was completed in eight weeks on an outpatient basis. No other problems were encountered during follow-ups after completion of treatment. According to accessible literature search, coinfection of brucellosis and CCHF has not been reported previously. In conclusion, as our country is endemic for both brucellosis and CCHF, it is important to consider both infections in the differential diagnosis. Physicians should keep in mind that, likewise in our case, coinfection of brucellosis and CCHF can be detected.

Karakečili, Faruk; Akin, Hicran; Čikman, Aytekin; Özčiček, Fatih; Kalkan, Ahmet

Nowadays, the age group affected from measles has widened and the disease has become more common among adolescents and young adults. The number of measles case reports have increased in our country, particularly from 2010-2011, and measles outbreaks occurred in various regions in 2012 and 2013. The aim of this study was to analyze the demographical and epidemiological characteristics, clinical and laboratory findings, and complications of adult patients with measles who were affected during the outbreak. A total of 28 patients (25 male, 3 female; age range: 19-39 years, median age: 24) who were hospitalized and followed-up in our clinic between January 2013 and June 2013, were evaluated. In the serum sample of the index case, measles-specific IgM antibodies were detected by ELISA, and measles virus RNA by real-time polymerase chain reaction (RT-PCR), then genotyping was performed to detect the epidemiological relationship. In all of the other cases, measles IgM and IgG antibodies were screened by ELISA. The most common symptoms on admission included high fever (n= 28, 100%), malaise (n= 25, 89%), sore throat (n= 25, 89%), headache (n= 20, 71%) and cough (n= 18, 64%). At physical examination, rash (n= 28,100%), lymphadenopathy (n= 11, 39%) and conjunctivitis (n= 10, 36%) were in the foreground, and Koplik spots were detected in five (18%) cases. The most common laboratory findings were; increased level of C-reactive protein (n= 15, 54%), leukopenia (n= 12, 43%) and increased serum levels of aminotransferases (n= 12, 43%), and thrombocytopenia was detected in five (18%) patients. One or more complications (secondary bacterial pneumonia in 5, diarrhea in 4, hepatitis in 3 and otitis in 2 cases) developed in the eight (29%) patients. Measles RT-PCR and IgM tests yielded positive results for the index case, and the isolate was identified as D8 strain by genotyping. Measles IgM antibodies were also positive in all of the other cases. The hospitalization period was estimated as 3-7 days (median: 5 days), while all the patients were discharged with recovery. It appeared that, our index case had come from a troop in Amasya province three days ago and he had a history of contact with suspected measles patients. In addition, the D8 strain determined in the index case was found to be related with the strain that caused the outbreak in Amasya province. Of the cases, 20 (71.4%) were military personnel, and eight (28.6%) were civilian who had histories of contact with military personnel. Regardless of immunity status in the outbreak period, all of the healthcare staff in our hospital, especially in risky departments, was recommended to be vaccinated. Personnel vaccination was provided at a high rate, however nosocomial transmission occurred in two unvaccinated cases. In conclusion, measles is an important health problem, especially in the adult age group, because of the complications and labour loss. For outbreak management; the awareness of health personnel should be increased following the identification of index case, proper isolation measures should be taken for the hospitalized patients, and routine reporting should be carried out timely and accurately.

Parlak, Mehmet; Bayram, Yasemin; Çikman, Aytekin; Ceylan, Nesrin; Berktas, Mustafa

Lyme borreliosis, which is more prevalent in the northern hemisphere, is the most common tickborne contagious disease among people living in the North America and Europe. The causative agent of Lyme borreliosis, Borrelia burgdorfed, is transmitted by the bites of ticks of the genus lxodes. In Turkey, the seroprevalence of Lyme disease is increased in regions where ticks and tick-bite cases are prevalent. The present study aimed to determine the seroprevalence of Lyme borreliosis in people at risk, living in the rural areas of Van province, which is located in the eastern region of Turkey. No previous study on this topic has been performed in our province. The study included a total of 446 subjects (mean age: 39.6 15.5 years), of them 139 were male and 307 were female, living in the rural areas of Van province between January 2012 and July 2012. The serum samples collected from participants after informed consent were screened for the presence of B.burgdorferi IgG antibodies by ELISA method. Western blot (WB) method was used for the confirmation of positive or borderline positive samples, and also for the investigation of IgM antibodies. During the study, the individuals from whom samples were taken, were questioned whether they have ever been exposed to tick or insect bite. B.burgdorferi IgG positivity was detected in 17 (3.8%) of the cases, whereas it was within the limit values in 14 cases. A total of 31 samples which yielded positive and borderline positive results were retested by WB and 4 (12.9%) were detected as positive while 10 (32.3%) of the samples were indeterminate. B.burgdorfed IgM antibody positivity was not detected in any of the samples. Considering the WB as reference method, the rate of B.burgdorferi IgG seropositivity was estimated as 0.9% (4/446). Three of these four cases were defined as tick or insect bites. The seroprevalence rate of B.burgdorferi detected in the present study was low as compared to the results of the other studies reported from Turkey. The reason of this result might be from the geographical characteristics and the differences of tick fauna in our region. As a result, it was concluded that our province is not endemic for Lyme borreliosis, however for the reduction of tick exposure, emphasis must be placed on preventive health services for the individuals at risk.

Özekinci, Tuncer; Kalaycı, Yıldız; Bilmen Bayındır, Fulya; Solmaz, Sinem; Gültepe, Bilge; Gülhan, Barış; Çıkman, Aytekin; Aydın, Merve; Parlak, Mehmet

ÖZ Bu çalışmanın amacı, ülkemizin farklı coğrafi bölgelerindeki hastanelerde izole edilen metisiline dirençli Staphylococcus aureus (MRSA) suşlarında vankomisin, teikoplanin, daptomisin, kinupristin/dalfopristin, linezolid, tigesiklin, kloramfenikol, rifampisin, ofl oksasin ve tetrasiklin için minimum inhibitör konsantrasyonu (MİK) değerlerinin saptanması ile azalmış vankomisin duyarlılığının araştırılmasıdır. Çalışmaya, Ağustos 2013-Ağustos 2014 tarihleri arasında; İstanbul (n= 15), Ankara (n= 15), İzmir (n= 15), Adana (n= 15), Diyarbakır (n= 15), Erzincan (n= 15) ve Van (n= 10) olmak üzere Türkiyedeki yedi merkezde yatan hastalardan (%50si yoğun bakımda yatan) izole edilen toplam 100 MRSA suşu dahil edilmiştir. Suşların 43ü kan, 21i alt solunum yolu örneği, 17si yara, sekizi kateter, altısı idrar, dördü burun sürüntüsü, biri ise beyin omurilik sıvısından izole edilmiştir. İzolatların metisilin direnci, sefoksitin (30 μg) diski kullanılarak standart disk difüzyon yöntemiyle, diğer antibiyotiklerin MİK değerleri ise E-test yöntemi ile CLSI (Clinical and Laboratory Standards Institute) önerileri doğrultusunda belirlenmiştir. MİK sonuçlarının değerlendirmesinde; kinupristin/dalfopristin (K/D) için CLSIın metisiline duyarlı S.aureus için önerdiği kriterler; tigesiklin için ise FDA (Food and Drug Administration)nın MRSA için önerdiği kriterler dikkate alınmıştır. Vankomisine orta düzeyde duyarlı S.aureus (VISA) ve heterojen VISA (hVISA) suşlarının belirlenmesinde öncelikle agar tarama yöntemi (ATY) kullanılmıştır. ATYnde 6 μg/ml vankomisin içeren beyin kalp infüzyon agar kullanılmış; bu yöntemle şüpheli VISA/hVISA olarak belirlenen izolatlara standart E-test ve makro E-test yöntemleri uygulanmıştır. Tüm MRSA suşları E-test yöntemiyle vankomisin, teikoplanin, daptomisin, K/D ve linezolide duyarlı bulunmuş; tigesiklin, kloramfenikol, rifampisin, ofl oksasin ve tetrasikline duyarlılık oranları ise sırasıyla; %89, %97, %40, %39 ve %32 olarak belirlenmiştir. MİK50/MİK90 değerleri sırasıyla; vankomisin için 1.5/2 μg/ml, teikoplanin için 2/4 μg/ml, daptomisin için 0.19/0.38 μg/ml, K/D için 0.19/0.38 μg/ml, linezolid için 0.75/1 μg/ml, tigesiklin için 0.19/0.75 μg/ml, kloramfenikol için 3/6 μg/ml, rifampisin için 32/32 μg/ml, ofl oksasin için 32/32 μg/ml ve tetrasiklin için 32/64 μg/ml olarak saptanmıştır. Azalmış vankomisin duyarlılığı araştırıldığında, ATY ile MRSA suşlarının %2 (2/100)si VISA, %5 (5/100)i ise hVISA olarak tanımlanmıştır. ATY ile VISA/hVISA olarak saptanan bu yedi suştan birisi hem standart E-test hem de makro E-test yöntemiyle şüpheli hVISA olarak değerlendirilmiştir. Sonuç olarak çalışmamızda, MRSA suşlarında vankomisin, teikoplanin, daptomisin, K/D ve linezolide dirençli suş saptanmamış, tigesiklin direnci (%11) ise beklenenden yüksek bulunmuştur. Dünyada artan glikopeptid direnci ve ülkemizde bu grup ilaçların yoğun kullanımı nedeniyle, MRSA suşlarında vankomisin direnç oranlarının periyodik olarak araştırılması gerektiği düşünülmüştür.

Berktaş, Mustafa; Çıkman, Aytekin; Parlak, Mehmet; Bayram, Yasemin; Ceylan, Nesrin

Daha sık olarak Kuzey yarım kürede görülen bir hastalık olan Lyme boreliyozu, Kuzey Amerika ve Avrupa'da yaşayan kişilerde kene kaynaklı en yaygın bulaşıcı hastalıktır. Hastalığın etkeni, Borrelia burgdorferi olup Ixodes cisindeki kenelerle bulaşmaktadır. Ülkemizde kenelerin yaşadığı ve kene ısırma olgularının bulunduğu bölgelerde Lyme seroprevalansında artış göze çarpmaktadır. Bu çalışmada, Türkiye'nin doğusunda yer alan Van ilinde kırsal bölgede yaşayan risk grubundaki kişilerde Lyme boreliyozu seroprevalansının belirlenmesi amaçlanmıştır. Bölgemizde bu konuda daha önce yapılmış seroprevalans çalışması bulunmamaktadır. Çalışmaya, Ocak 2012-Temmuz 2012 tarihleri arasında Van merkez ve ilçe kırsalında yaşayan 139'u erkek ve 307'si kadın olmak üzere toplam 446 kişi (yaş ortalaması: 39.6 ± 15.5 yıl) dâhil edilmiştir. Bilgilendirilmiş onam ile çalışmaya katılan kişilerden alınan serum örneklerinde B.burgdorferi IgG antikorları ELISA yöntemi ile taranmıştır. Test sonucunda IgG pozitif veya sınırda pozitif olarak saptanan örnekler, Western blot (WB) yöntemi ile doğrulamaya alınmış ve ayrıca bu yöntem ile IgM varlığı da araştırılmıştır. Çalışma sırasında örnek veren kişilere kene veya böcek ısırığına maruz kalıp kalmadıkları sorulmuştur. ELISA yöntemi ile B.burgdorferi IgG antikorları, olguların 17'sinde pozitif (%3.8) olarak saptanmış, 14 olguda ise sınırda pozitifl ik belirlenmiştir. Pozitif ve sınırda pozitif sonuç veren 31 serum örneği WB yöntemi ile çalışıldığında, 4 (%12.9) örnekten pozitif; 10 (%32.3) örnekten ise belirsiz (indeterminate) sonuç alınmıştır. Hiçbir örnekte B.burgdorferi IgM pozitifl iğine rastlanmamıştır. WB yöntemi referans kabul edildiğinde, çalışılan grupta B.burgdorferi IgG pozitifl ik oranı %0.9 (4/446) olarak belirlenmiştir. Pozitif bulunan 4 olgunun 3'ü, kene veya böcek ısırığı tarif etmiştir. Çalışmamızda saptanan B.burgdorferi seroprevalans oranı, ülkemizde bildirilen diğer çalışmalarla kıyaslandığında düşük olarak bulunmuş, bu durumun bölgenin coğrafi yapısı ve kene faunasının farklı olmasından kaynaklandığı düşünülmüştür. Sonuç olarak, bölgemizin Lyme boreliyozu açısından endemik olmadığı kanaatine varılmış; ancak kene maruziyetini azaltmak için risk grubundaki kişiler için koruyucu sağlık hizmetlerine önem verilmesi gerektiği düşünülmüştür