Browsing by Author "Özkütük, N"
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Item Seroprevalence of West Nile virus, Crimean-Congo hemorrhagic fever virus, Francisella tularensis and Borrelia burgdorferi in rural population of Manisa, western TurkeyGazi, H; Özkütük, N; Ecemis, T; Atasoylu, G; Köroglu, G; Kurutepe, S; Horasan, GDBackground & objectives: Zoonotic diseases are well recognised threat to public health globally. The information of regional prevalence and associated risk factors allow the national programmes to determine and frame better strategies for their control, as they also provide the actual status of zoonosis in the region. The aim of this study was to determine the seroprevalence of West Nile virus (WNV), Crimean-Congo hemorrhagic fever virus (CCHFV), Francisella tularensis and Borrelia burgdorferi among the rural residents of Manisa region, Turkey and to identify the associated risk factors. Methods: Cross sectional study was conducted in rural parts of Manisa, Aegean region of western Turkey in 2012. Blood samples from 324 randomly selected subjects were screened for the presence of IgG antibodies to WNV, CCHFV, F. tularensis and B. burgdorferi with commercially available kits. The demographic structure of the rural residents and risk factors related to lifestyle such as outdoor agriculture activities, animal husbandry, hunting and history of tick bite were questioned and their relationships with positive results were analyzed statistically. Results: It was observed that 49 subjects (15%) had IgG antibodies to at least one of the zoonotic agents studied. The seroprevalence of F. tularensis was highest with a percentage of 7.1% (n = 23). Distribution of the positive results for WNV, CCHFV and B. burgdorferi were 4.3% (n = 14), 3.7% (n = 12) and 0.9% (n = 3), respectively. Older age and uncompleted secondary education were the statistically significant risk factors for seropositivity to at least one zoonotic agent investigated. Logistic regression analyses confirmed that older age (over 50) increased the risk of WNV and CCHFV seropositivity. Interpretation & conclusion: Seropositivity rates were not found to be higher than the expected rates. Further, studies are needed to evaluate the threat of vector borne zoonoses and associated risk factors in the study area.Item The reliability of tuberculin skin test in the diagnosis of latent tuberculosis infection in psoriasis patients: A case-control studySürücüoglu, S; Ermertcan, AT; Çetinarslan, T; Özkütük, NTuberculin 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.Item Antimicrobial Resistance Patterns of Mycobacterium abscessus Complex Clinical IsolatesSürücüoglu, S; Özkütük, N; Gazi, H; Çavusoglu, CObjective:This study aimed to identify subspecies of Mycobacterium abscessus complex (MABC) isolates from clinical samples by a molecular technique and to determine mutations responsible for macrolide and aminoglycoside resistance. We also aimed to investigate the correlation of phenotypic and molecular test results by examining the resistance to antimicrobial agents according to CLSI standard using the liquid microdilution test. Methods: 27 MABC isolates from clinical samples were examined. Molecular subspecies identification and mutations responsible for aminoglycoside (rrs mutation) and macrolide resistance (rrl mutation) were determined using the GenoType NTM-DR test. The resistance phenotypes of the strains to various antimicrobial agents were investigated by the Sensititre (TM) RAPMYCOI AST microdilution test. Results: Of the 27 isolates tested, 21 were M. abscessus subsp. abscessus, three were M. abscessus subsp. bolletii, and three were M. abscessus subsp. massiliense; rrs and rrl mutations were not observed in any strains. Except for one isolate, all M. abscessus subsp. abscessus strains showed the erm(41) T28 genotype, which indicates inducible macrolide resistance. The correlation between the GenoType NTM-DR and phenotypic susceptibility test results was 81% (k=0.5, p=0.02) for inducible macrolide resistance and 89% for acquired macrolide resistance. The most effective antimicrobial agents were amikacin, cefoxitin, imipenem, linezolid, and tigecycline. Conclusion: Although the GenoType NTM-DR test is reliable in identifying and detecting molecular macrolide and aminoglycoside resistance, there were discrepancies in the results. We recommend confirming the results with the phenotypic susceptibility method after growth on culture. Although the M. abscessus complex is resistant to many antimicrobial agents, it has shown high sensitivity to amikacin, cefoxitin, imipenem, linezolid, and tigecycline. High levels of inducible macrolide resistance in isolates indicate the importance of subtyping and sensitivity testing of iso-lates in patients where culture conversion has not been achieved.Item Pyrazinamide monoresistance in clinical isolatesKalir, N; Özkütük, AA; Esen, N; Özkütük, NAim: To determine pyrazinamide (PZA) monoresistance in clinical isolates of Mycobacterium tuberculosis complex (MTBC) isolated in hospitals in and around Izmir. Materials and methods: The study was performed between 2004 and 2009 with 150 streptomycin, isoniazid, rifampicin, and ethambutol susceptible MTBC clinical strains isolated in the university hospitals of Izmir and Manisa. The PZA susceptibility of the isolates was determined by the BACTEC 460 TB test. Results: The results indicated that resistance to PZA was present in 5 (3.3%) of the 150 MTBC isolates susceptible to all primary drugs except PZA. Conclusion: It is not essential to perform PZA susceptibility tests routinely along with other primary drugs due to the low PZA monoresistance level in our region.Item Molecular Diversity of Drug Resistant Mycobacterium Tuberculosis Strains in Western TurkeySürücüoglu, S; Günal, S; Özkütük, N; Biçmen, C; Özsöz, A; Gazi, H; Durmaz, RObjective: 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.Item Second-line drug susceptibilities of multidirug-resistant Mycobacterium tuberculosis isolates in Aegean region - TurkeyÖzkütük, N; Sürücüoglu, S; Gazi, H; Coskun, M; Özkütük, A; Özbakkaloglu, BAim: The emergence of multidrug-resistant tuberculosis (MDR-TB) is increasing, and the standard short-course regimen used for the treatment of TB is likely to be ineffective against MDR-TB, leading to the need for second-line drugs. In such situations, drug susceptibility testing is necessary to select an appropriate treatment regimen. Unfortunately, there are few studies showing the pattern of the second-line drug resistance in Turkey. We aimed to analyze the resistance to second-line anti-tuberculosis drugs of MDR strains of Mycobacterium tuberculosis isolated from the Aegean region of Turkey. Materials and Methods: In this study, drug susceptibility testing of 40 MDR-TB strains isolated from the Aegean region of Turkey was performed using the BACTEC 460 TB radiometric system. Capreomycin, ethionamide, kanamycin, amikacin, clofazimine and ofloxacin were tested in 1.25 mu g/ml, 1.25 mu g/ml, 5.0 mu g/ml, 1.0 mu g/ml, 0.5 mu g/ml, and 2.0 mu g/ml concentrations, respectively. Results: The results showed that 37.5% of the strains were resistant to ethionamide, 25% to capreomycin, 5% to kanamycin, amikacin and ofloxacin, and 2.5% to clofazimine. One (2.5%) of the 40 MDR-TB cases was defined as extensively drug-resistant tuberculosis (XDR-TB). Conclusions: The results of the study indicate that the high rates of resistance to ethionamide and capreomycin may be a problem in the treatment of patients with MDR-TB; XDR-TB is not yet a serious problem in our region.Item Comparison of Proportion Method in Lowenstein-Jensen Medium with the BACTEC 460 TB System for Antimycobacterial Susceptibility Testing of Mycobacterium tuberculosis IsolatesYurtsever, SG; Biçmen, C; Gündüz, AT; Özkütük, N; Salman, S; Demirci, MThis study was conducted to compare BACTEC 460 TB system and the proportion method in commercially available and ready to use antibiotic added Loweinstein-Jensen (LJ) medium for susceptibility testing of first line drugs in Mycobacterium tuberculosis complex isolates. A total 238 M.tuberculosis strains isolated from clinical samples in our laboratory between 2006-2010 period were included in the study. Susceptibility testing for streptomycin, isoniazid, rifampicin and ethambutol in commercially provided LJ medium (Salubris Inc., Istanbul) was performed by the proportion method as recommended by the manufacturer, and the results were compared with the results of BACTEC 460 TB (Becton Dickinson, USA) system. Resistance rates of M.tuberculosis strains against streptomycin, isoniasid, rifampicin and ethambutol obtained by BACTEC 460 TB system were 19.7%, 42%, 40.8% and 18%, respectively. Those rates were 22.7%, 38.7%, 37% and 15.5%, respectively, by antibiotic added LJ proportion method. There was no statistically significant difference between the two methods in terms of resistance rates (p > 0.05). The rates of consistency between proportion method in LJ medium and BACTEC 460 TB system for streptomycin, isoniasid, rifampicin and ethambutol susceptibility were found as 85.3%, 92.4%, 95.4% and 92.4%, respectively. When comparing the reporting time (interval between beginning of the process to reporting of the results) of the methods, minimal, maximal and average reporting spans for BACTEC 460 TB system were 5, 12 and 8.08 +/- 2.65 days, and 15, 42 and 23.89 +/- 6.02 days for the proportion method in LJ medium, respectively, being statistically significant (p = 0.001). It was determined that the sensitivity test results of major antimycobacterial drugs in commercial LJ medium were compatible with the BACTEC 460 TB system. Nonetheless, the rate of incompatible results was higher for STR than the other drugs. Although there has been some disadvantages such as longer reporting time, need for experience in manual processing and visual evaluation, standardized LJ media approved for quality can be used for susceptibility testing of M.tuberculosis in the laboratories which do not have eligible conditions for the establishment of automated systems.Item Use of standardized patients in patient education practices of senior nursing students: A mixed-methods studyOrgun, F; Özkütük, N; Akkoç, CP; Çomglu, GBackground: There is a need for innovative teaching practices in nursing education due to many factors, such as global changes, the rapid development of technology, the increasing number of students, and the recent pandemic. Objectives: This research was conducted using standardized patients to evaluate the attitudes and skills of senior nursing students toward patient education practices following the implementation of a patient education training program. Design: Mixed-methods design. Settings: The study was conducted at a nursing faculty. Participants: The sample of the study consisted of 47 senior nursing students. Intervention: The students participating in the study were given a four-hour patient education training that included the preparation of patient education, preparation of materials, and effective presentation. Methods: A descriptive information form prepared by the researchers, the Patient Education Implementation Scale (PEIS), the Turkish version of the Patient Education Materials Assessment Tool for Printable Materials (PEMATTR-P), and the presentation skill evaluation form (PSEF) were used to collect quantitative data. Semistructured interview forms were utilized to collect qualitative data. SPSS for Windows v. 25.0 and MAXQDA20 were used for the data analyses. Results with a p value of <0.05 were considered statistically significant. Results: The post-test mean PEIS scores of the students increased in the total scale and in all subdimensions. A significant difference was found in the understandability and actionability of patient education materials evaluated with PEMATTR-P (p < 0.05). The mean PSEF score of the students was 85.14 +/- 9.25 points. Within the scope of the research, two main themes, namely emotions and efficacy, were determined. Conclusions: This study confirms that structured patient education training, including the use of standardized patients, is important for supporting and developing nursing senior students' attitudes and skills toward patient education.Item Comparison of interferon-gamma whole blood assay with tuberculin skin test for the diagnosis of tuberculosis infection in tuberculosis contactsÖztürk, N; Sürücüoglu, S; Özkütük, N; Gazi, H; Akçali, S; Köroglu, G; Çiçek, CTuberculin skin test which is used for the detection of latent tuberculosis (TB), has many disadvantages such as false positivities due to cross reactions between environmental mycobacteria and BCG strain, false negativities due to immunosuppression and malpractice, and also difficulties in application and evaluation. Recently a new diagnostic test which measures the production of interferon (IFN)gamma in whole blood upon stimulation with specific ESAT-6 and CFP-10 antigens of Mycobacterium tuberculosis has been introduced. Since most of the mycobacteria other than tuberculosis and BCG strain do not contain these antigens, the detection of IFN-gamma levels indicates the specific T-cell response against M.tuberculosis. The aim of the study was to compare the tuberculin skin test and whole blood IFN-gamma assay (QuantiFERON (R)-TB Gold, Cellestis Ltd, Carnegie, Victoria, Australia) for the identification of latent TB infection in the contacts with active TB patients. The tests results were evaluated by using Kappa (K) analysis, and K coefficients of < 0.4, 0.4-0.75 and > 0.75 were accepted as poor, moderate and excellent agreements, respectively. A total of 233 subjects from three risk groups were included to the study. Group 1 included the household members (n=133) who had contact with smear positive index cases, Group 2 included the subjects from community (n=46) who had contact with smear positive index cases, and Group 3 included health care workers (n=74) who had contact with TB patients or their specimens. The positivity rates of tuberculin skin test and IFN-gamma assay in the cases were found as 37% and 42%, respectively. There were no significant differences among the three patient groups with regard to the results of the tuberculin skin test (p > 0.05). However, the positive result of the IFN-gamma assay in Group 1 was found statistically higher than the other groups (51.3%, p=0.013). A poor agreement between the two tests was detected in the results taken from 233 subjects (65.7%, K=0.28), while agreement was moderate in unvaccinated group (72.7%, K=0.44). Evaluation of agreement rates of the tests according to the risk groups yielded 64.6% (K=0.3) for Group 1, 71.7% (K=0.32) for Group 2, and 63.5% (K=0.21) for Group 3, which all coefficients showed poor agreement. Although IFN-gamma blood assay has many advantages such as objective and quantitative results, no interference with vaccination due to the use of specific antigens and being practical, the high cost and the need for well-equipped laboratory are its disadvantages. As a result it was concluded that, IFN-gamma blood assay has limited value for the detection of latent TB infection in our country, since the prevalence of TB infection and BCG vaccination rates are high in Turkey.Item Chronic subcutaneous nodules, plaques and ulcers of the handErmertcan, AT; Özkütük, N; Temiz, P; Çavusoglu, C; Sürücüoglu, SItem In vitro Activity of Rifabutin and Clofazimine to Macrolide- Resistant Mycobacterium abscessus Complex Clinical IsolatesSürücüoglu, S; Özkütük, N; Gazi, H; Çavusoglu, CMycobacterium abscessus complex (MABSC) is one of the most resistant bacteria against antimicrobial agents. The number of agents that can be used by oral route, such as macrolides, is limited in antimicro- bial therapy. In recent years, rifabutin and clofazimine have gained importance as they can be admin- istered by oral route and have shown synergistic effects with macrolides and aminoglycosides. The aim of this study was to determine the in vitro activity of rifabutin and clofazimine against clinical isolates of MABSC resistant to macrolides. A total of 48 MABSC isolates obtained from respiratory tract and other clinical samples in the Tuberculosis Laboratories of the Faculty of Medicine of Manisa Celal Bayar and Ege Universities were included in the study. Subspecies differentiation and aminoglycoside and macrolide resistance of the isolates were determined by GenoType NTM-DR test. Rifabutin and clofazimine sus- ceptibilities were determined by standard broth microdilution method. Of the MABSC isolates 42 were identified as M.abscessus subsp. abscessus, three as M.abscessus subsp. bolletii and three as M.abscessus subsp. massiliense. None of the isolates exhibited rrs and rrl mutations indicating acquired macrolide resistance and aminoglycoside resistance. However, the erm(41) T28 genotype which is associated with inducible macrolide resistance was detected in 41 (85%) of the strains. All M.abscessus subsp. massiliense isolates were found to be genotypically susceptible to macrolides. The minimum inhibitory concentration (MIC) range values for rifabutin were 0.0625 to 32 mu g/mL, while for clofazimine, the range was 0.0625 to 1 mu g/mL. Rifabutin MIC values were significantly higher (mean 5.98 mu g/mL vs 0.5 mu g/mL, p= 0.026) in the isolates with macrolide resistance. There was no correlation between macrolide resistance and clofazimine MIC values (mean 0.25 mu g/mL vs. 0.214 mu g/mL, p= 0.758). The MIC50 and MIC90 values for rifabutin were 1 and 8 mu g/mL, respectively, while for clofazimine they were 0.25 and 0.5 mu g/mL. Macrolide resistance was found to be higher in isolates with rifabutin MIC values above the MIC50 value (p= 0.045). In conclusion, the determination of higher rifabutin MIC values in isolates resistant to macrolides suggested that susceptibility testing should be performed before adding rifabutin to the treatment regimen. The low MIC values of clofazimine in all strains indicated that it may be used as a first choice in the combination therapy. However, further studies using a larger number of clinical isolates and applying genotypic and phenotypic susceptibility tests are needed to determine threshold MIC values to assist clinicians in treatment decisions.Item Pott's disease with scrofuloderma and psoas abscess misdiagnosed and treated as hidradenitis suppurativaErmertcan, AT; Öztürk, F; Gençoglan, G; Inanir, I; Özkütük, N; Temiz, PA 29-year-old man with painless ulcers on the lumbar and inguinal regions associated with purulent discharge of 1.5 years' duration presented to our outpatient clinic. Dermatological examination revealed palpable nodules, discharging sinuses and scars on the left lumbar, gluteal and inguinal regions. According to the clinical, histopathological, scintigraphy, and magnetic resonance imaging findings as well as mycobacteriological examinations, the patient was diagnosed with Pott's disease with scrofuloderma and psoas abscess. Herein, we present an interesting case of Pott's disease with scrofuloderma and psoas abscess mistreated as hidradenitis suppurativa for a long time.Item Roles of Phospholipase, Esterase and Slime Activities of Candida albicans Strains in Infection-Colonisation DifferentiationPekintürk, N; Degerli, K; Özkütük, N; Ecemis, T; Kurutepe, S; Özbakkaloglu, BObjective: This study investigated slime factor, phospholipase and esterase activities of C. albicans strains isolated as the infectious agent from healthy individuals, their effectiveness as virulence factors and interactions between each other. For this purpose, virulence factors of 50 C. albicans strains isolated from specimens as infectious agent (infection group) and 50 C. albicans isolates obtained from oral smears of the control group (control group) were analyzed and roles of virulence factors in differentiation of colonisation and infection were investigated. Material and Methods: C. albicans ATCC 10039 and 50 C. albicans strains isolated from clinical specimes of patients who were treated in various clinics of our hospital were used as reference strains. The strains isolated from sterile body sites and from clinical specimens containing pseuduhyphe on direct examination were considered as infectious agent and were identified as C. albicans by germ tube test and chlamidospore formation. Yolc sac agar medium was used to detect phospholipase activity, Tween 80 agar medium was used to detect esterase activity and Kongo red brain-heart infusion agar medium was used to detect slime activity. Results: There was no significant difference in terms of slime, phospholipase and esterase activities of C. albicans strains isolated from patients compared to controls (p=0.357, p=0.842, p=0.841). Consistency analysis between virulence factors revealed no significant difference in the patient group. In the other hand, in the control group, esterase/phospholipase coexistence consistency was significant (K value=+0.35, p=0.001). Conclusion: In conclusion, we suggest that many virulence factors of C. albicans have important roles in the development of C. albicans-related infections.Item Evaluation of the Xpert MTB/RIF Assay for the Diagnosis of Pulmonary and Extrapulmonary Tuberculosis in an Intermediate-Prevalence SettingÖzkütük, N; Sürücüoglu, SEarly and accurate detection of tuberculosis (TB) is a global priority for TB control. In order to obtain results in a short period of time, nucleic acid amplification tests are increasingly used worldwide for the rapid diagnosis of tuberculosis. The Xpert MTB/RIF (R) (Cepheid, USA) is a commercially available, real-time PCR-based assay, which can detect both TB and resistance to rifampicin directly in clinical samples. The aim of this study was to evaluate the performance of Xpert MTB/RIF assay for M.tuberculosis detection in pulmonary and extrapulmonary clinical samples in routine laboratory practice in Turkey, an intermediate-prevalence setting. A total of 2639 clinical specimens, 1611 of which were pulmonary and 1028 were extrapulmonary, were included in the study. The results of Xpert MTB/RIF assay were evaluated by comparing the results with those obtained by culture [BACTEC MGIT 960 (Becton Dickinson, USA) and Lowenstein Jensen medium]. Overall sensitivity, specificity, positive and negative predictive values of Xpert MTB/RIF assay were determined as 73.9%, 98.6%, 79.6% and 98.1%, respectively. These values were calculated as 80.8%, 98.8%, 84.9% and 98.4% for pulmonary specimens, and 58.2%, 98.4%, 66.7% and 97.7% for extrapulmonary specimens. The sensitivity and specificity were 100% and 58.1%, respectively, for acid-fast bacilli (AFB) smear-positive specimens, 39.7% and 99.1%, respectively for smear-negative specimens. The sensitivity and specificity were 100% and 76.2% for smear-positive pulmonary specimens; 100% and 20% for smear-positive extrapulmonary specimens; 47.8% and 99.1% for smear-negative pulmonary specimens; and 28.2% and 99.2% for smear-negative extrapulmonary specimens, respectively. The sensitivity and specificity of microscopic examination were found to be 56.7% and 98.7% for all specimens; 63.2% and 98.6% for pulmonary specimens; and 41.8% and 99% for extrapulmonary specimens, respectively. Rifampicin resistance was detected by Xpert MTB/RIF assay in only two specimens, however, rifampicin resistance was failed to be detected by BACTEC MGIT 960 TB method in one of these samples. Xpert MTB/RIF assay appeared to be a reliable method for the diagnosis of TB for AFB smear-positive samples, but less sensitive for smear-negative samples, particularly for extrapulmonary samples which include low numbers of bacilli. However, we concluded that the MTB/RIF is a useful assay for rapid diagnosis of tuberculosis, considering that the results can be given in the same day of sample collection and the assay is superior in sensitivity than microscopic examination.Item PYRAZINAMIDE MONORESISTANT MYCOBACTERIUM TUBERCULOSIS IN MANISA REGION, TURKEYÖzkütük, N; Ecemis, T; Sürücüoglu, SPyrazinamide (PZA) is a primary antituberculous drug. BACTEC 460TB is the recommended reference method for the detection of PZA resistance in Mycobacterium tuberculosis. This method is more expensive than the conventional susceptibility methods and therefore, it is recommended that each laboratory should establish their own protocol for the inclusion of PZA in the panel of primary drugs tested. One of the most important factors that help this decision is the prevalence of PZA resistance, particularly PZA monoresistance in the related community. The aim of the present study was to determine the extent of PZA monoresistance in M.tuberculosis complex (MTBC) isolates in our region. In this study, PZA susceptibility testing of 109 MTBC strains (susceptible to isoniazid, rifampicin, ethambutol and streptomycin) isolated from Manisa province in the Aegean region of Turkey was performed by using the BACTEC 460TB radiometric system (Becton Dickinson, MD). Two (1.8%) of the 109 isolates which were susceptible to all primary drugs revealed monoresistance against PZA. One of the PZA-monoresistant isolates has been identified as M.bovis and the other as M.tuberculosis by molecular method (Genotype MTBC, Hain Lifescience, Germany). The results of our study indicated that since the rate of PZA monoresistance was low, susceptibility testing of a panel of primary drugs without PZA may be an economical alternative in our region.Item Two novel serum-free media for the culture of Trichomonas vaginalisLimoncu, ME; Kilimcioglu, AA; Kurt, Ö; Östan, I; Özkütük, N; Özbilgin, ADefinitive diagnosis of Trichomonas vaginalis, one of the common causes of sexually transmitted diseases in Turkey, relies on the microscopic examination of both fresh preparations and culture material of genital secretions and urine. The aim of this study was to compare the diagnostic efficacies of two culture media, serum-free TB1 and TB2, including iron and vitamin B12, respectively, with the well-known medium, TYM. Growth rate reached peak levels 48 h in TYM and 72 h in both TB1 and TB2 after inoculation. The highest amount of viable trophozoites has been obtained from TB1, almost equal to TYM but significantly higher than TB2. Fresh preparations obtained from the vaginal secretions of 119 patients have been examined and vaginal samples have been inoculated in TB1, TB2, and TYM. Viable T. vaginalis trophozoites have been detected in ten (8.4%) of fresh preparations and 11 (9.9%) of each medium. It is concluded that serum-free TB1 medium could be used effectively in both the isolation and maintenance of T. vaginalis culture in vitro.Item Comparison of Lowenstein Jensen Medium and Bactec 460TB Culture System for Diagnosis of TuberculosisBaskesen, T; Sürücüoglu, S; Özkütük, N; Ecemis, TObjective: In this study, it was intestigated that whether the use of Lowenstein Jensen (LJ) medium with BACTEC460 TB liquid culture system contributed to bacteria isolation rates for diagnosis of tuberculosis. Material and Methods: A total of 4237 specimens were evaluated in the study for the results of microscopic examination and culture. Of 4237 specimens, 2719 were obtained from respiratory tract and remaining 1518 were obtained out of the respiratory tract. Results: According to the results of culture. Mycobacterium tuberculosis complex were isolated in 271 (6.4%) specimens on BACTEC 460TB system and in 238 (5.6%) specimens on Lowenstein Jensen medium. Contamination rates at BACTEC 460TB system and Lowenstein Jensen medium were 3.6% and 10.2%, respectively. The mean times of recovery were determined as 9.6 days for BACTEC system and 21 days for Lowenstein Jensen medium. When contaminated specimens were excluded, Mycobacterium tuberculosis was grown on at least one culture technique in 258 out of 3718 (6.9%) specimens. Sensitivity of BACTEC 460 TB culture system was found as 96%, while sensitivity of Lowenstein Jensen medium was found as 92%. The correlation between two culture techniques was found as 99%. Contribution of BACTEC 460 TB system and LJ medium alone to culture positivity were found as 8.3% and 3.9% respectively. No statistically significant difference was found when microscopic evaluation and culture systems were compared. Conclusion: It was concluded that the liquid culture systems are needed for rapid detection of tuberculosis, however liquid and solid culture systems should be used together in order to reach maximum isolation rates.Item Assessment of performance of amplified Mycobacterium tuberculosis direct test in pulmonary and extrapulmonary specimensSürücüoglu, S; Özkütük, N; Gazi, H; Çelik, PSince 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.Item Seroprevalance of Chlamydophila pneumoniae in Patients With Alzheimer's Disease and Vascular DementiaEcemis, T; Mavioglu, H; Özkütük, N; Akçali, S; Karaçam, M; Sanlidag, TIn recent years, it was been argued that Chlamydophila pneumoniae, which is an intracellular pathogen capable of causing chronic infection, might be effective in some forms of dementia, an argument confirmed or rejected by some studies. The objective of this study was to determine if there was an association between C. pneumoniae infection and Alzheimer's disease and vascular dementia. We tested 54 patients with Alzheimer and 29 patients with vascular dementia and 50 controls for C. pneumoniae IgG and IgA antibodies and analyzed the results statistically. C. pneumoniae IgG antibodies were found in 25 patients (49.2%) with Alzheimer's disease, 15 patients (51.8%) with vascular dementia and 22 controls (44%) whereas 6 patients (11.1%), 2 patients (6.9%) and 3 controls (6%), respectively, tested positive for IgA. It was found no serological evidence for a significant association between C. pneumoniae and Alzheimer's disease as well as vascular dementia.Item Investigation of Extensive Drug Resistance in Multidrug Resistance Tuberculosis IsolatesBektöre, B; Haznedaroglu, T; Baylan, O; Özyurt, M; Özkütük, N; Satana, D; Çavusoglu, C; Seber, EIncreasing number of drug resistant tuberculosis (TB) cases, observed in recent years, is an important public health problem. Extensively drug resistant TB (XDR-TB) is the development of resistance against any fluoroquinolones and at least one of the injectable second line anti-TB drugs in addition to resistance against isoniazide and rifampicin which are the first line anti-TB drugs [definition of multidrug resistant TB (MDR-TB)]. Anti-TB therapy failed with first-line anti-TB drugs due to MDR-TB cases is being planned according to second-line anti-TB drug susceptibility test results if available and if not, standart treatment protocols are used. Although it is recommended that individual anti-TB therapy should be designed according to the isolate's susceptibility test results, standart therapeutic protocols are always needed since second-line anti-TB drug susceptibility testing generally could not be performed in developing countries like Turkey. For this reason, nationwide and regional surveillance studies to determine the resistance patterns are always needed to make decisions about the standard therapy algorithms. In this study, it was aimed to investigate the presence of extensive drug resistance among 81 MDR-TB isolates obtained from various health care facilities from Istanbul, Izmir and Manisa and to determine the XDR-TB incidence in Marmara and Aegean regions. Furthermore, we aimed to provide epidemiological data to clinicians to support their choice of second-line anti-TB drugs for MDR-TB infections. Susceptibility testing of isolates for the first and the second-line anti-TB drugs were performed by using modified Middlebrook 7H9 broth in fluorometric BACTEC MGIT 960 system (Becton Dickinson, USA). Eighty-one MDR-TB isolates included in this study were isolated from 43 (53.1%) patients residing in Istanbul, 26 (32.1%) in Izmir and 12 (14.8%) in Manisa provinces. We could not find any isolate consistent with XDR-TB definition in this study. Second-line drug resistance rates of MDR-TB isolates to amikacin and kanamycin were 1.2%, ofloxacin and levofloxacin were 2.5%, capreomycin was 14.8%, ethionamide was 37% whereas linezolid resistance was not detected. Statistically significant correlation was detected between resistance rates of these antibiotic pairs; levofloxacin-ofloxacin (p< 0.01), amikacin-kanamycin (p= 0.01) and streptomycin-ethionamide (p= 0.04). In our study, extensive drug resistance was not encountered in any MDR-TB isolates while high resistance rates was observed against ethionamide and capreomycin. It can be concluded that parenteral aminoglycosides amikasin and kanamycin, fluoroquinolones and linezolid seemed to be reliable anti-TB agents in MDR-TB treatment, however, further larger scale studies are needed.