Browsing by Author "Degerli, K"
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Item Non-albicans Candida species in blood stream infectionsCetin, CB; Senol, S; Degerli, K; Tunger, OItem Evaluation of nosocomial Candida infectionsSenol, S; Dindar, K; Cetin, CB; Demirci, M; Degerli, K; Ozten, D; Tunger, OItem Influence of oral intake of Saccharomyces boulardii on Escherichia coli in enteric floraAkil, I; Yilmaz, O; Kurutepe, S; Degerli, K; Kavukcu, SEnteric flora constitutes 95% of the cells in the human body. It has been shown that the bacterial content of this flora is affected by diet and changes in nutrition. Considering that urinary tract infections (UTI) are mostly due to ascending infections from the gut flora, the importance of the elements of this flora and their characteristics becomes more evident. The aim of this study was to evaluate the influence of oral Saccharomyces boulardii (S. boulardii) intake on the number of Escherichia coli (E. coli) colonies in the colon. This study was carried out with 14 boys and 10 girls (total of 24 children) aged between 36 and 192 months (mean: 104.3 +/- 45.1 months). A commercial capsule or powder containing 5 billion colony-forming units (cfu) of S. boulardii was administered once a day for 5 days. The number of E. coli and yeast colonies was measured in the stool samples of the study group before and after the use of this drug. Before treatment, the mean number of E. coli colonies in g/ml stool was 384,625 +/- 445,744. This number decreased significantly to 6,283 +/- 20,283 after treatment (p=0.00). S. boulardii was not detected in stool before treatment and the number of colonies increased to 11,047 +/- 26,754 in g/ml stool. S. boulardii may be effective in reducing the number of E. coli colonies in stool. The influence of this finding on clinical practice such as prevention of UTI needs to be clarified by further studies.Item Prevalence and evaluation of a choromogenic medium for isolation of Escherichia coli O157 from children with acute gastroenteritisDegerli, K; Kurutepe, S; Gazi, H; Demirel, M; Gülkan, E; Sürücüoglu, SObjective: Comparative performance status of CHROMagar O157 (CHROM) sorbitol-MacConkey (SMAC) media for the detection of Escherichia coli (E. coli) O157 in stool specimens isolated from 339 children under 5 years of age who presented with acute gastroenteritis between September 2008 and September 2010 was determined. Methods: Stool specimens were inoculated onto Sorbitol-MacConkey agar (SMAC), CHROMagar O157, Selenit F, Salmonella-Shigella (SS) and MacConkey agars. All plates were incubated aerobically for 24 to 48 h at 35 degrees C. Colorless colonies on the SMAC plate and mauve colonies on the CHROM plate were selected for further identification by conventional biochemical tests as well as by semi-automated system. Colonies confirmed to be E. coli were screened for O157 antigen by Dry spot E. coli O157 latex particle agglutination test. Results: In 339 stool samples examined, Salmonella spp was isolated in 14 (4.1%), and Shigella spp. in 11 (3.2%), while Escherichia coli O157 was detected in only 1 (0.3%) sample. Suspect E. coli O157 stains grew on 8 CHROMagar (2.1%; 8/339) and 14 SMAC (14/339; 3.8%) plates. Rate of false positivity for colony picks from SMAC (n= 13; 65%) media was almost 2-fold higher than that for CHROM (n= 7; 35%). Conclusion: Routine use of chromogenic media for the investigation of E. coli O157' nin in the selected cases with bloody diarrhea is deemed appropriate.Item Agents of Otomycosis in Manisa Region, Turkey, 1995-2011Degerli, K; Ecemis, T; Günhan, K; Baskesen, T; Kal, EOtomycosis, which is otitis externa caused by fungi, is common throughout the world especially in tropical and subtropical countries. However, the epidemiologic data about the etiologic agents of otomycosis in Turkey is limited. The aim of this retrospective study was to evaluate the agents of otomycosis in patients living at Manisa region (located at western Anatolia of Turkey). A total of 2279 cases [1465 male, 813 female; age range 1-87 (mean: 41.7) years] who were clinically prediagnosed as otomycosis at Celal Bayar University Hospital, between February 1995 and July 2011, were included in the study. External ear swab samples from patients with suspicion of otomycosis have been evaluated by routine mycological methods. Identification of mold-like fungi was based on colony morphology and microscopic examination of fungal structure, whereas germ tube test, growth characteristics on cornmeal-Tween 80 agar and API 20C AUX (bio-Merieux, France) system were used for the identification of yeast-like fungi. Of the samples, 28% (638/2279) were found positive by direct microscopy and 24% (544/2279) by culture methods. Among culture-positive cases the isolation rates of mold-like and yeast-like fungi were 66% (359/544) and 34% (185/544), respectively. The number of distribution of the molds were as follows; Aspergillus niger (180), Aspergillus fumigatus (95), Aspergillus terreus (32), Aspergillus flavus (23), Aspergillus spp. (14), Penicillium spp. (13), Trichophyton spp. (T.rubrum 1, T.mentagrophytes 1); while this distribution was as follows for the yeasts; Candida tropicalis (97), Candida albicans (39), Candida parapsilosis (21), Candida glabrata (19), Candida kefyr (4), C.guilliermondii (2), Candida krusei (1), Geotrichum candidum (1) and Trichosporon capitatum (1). It was notable that 96% (344/359) of mold-like fungi were Aspergillus spp., and 99% (183/185) of yeast-like fungi were Candida spp. The results of this study indicated that the most frequent agents of otomycosis were non-dermatophyte species such as Aspergillus, followed by Candida. Dermatophytes were isolated in a small number of otomycosis cases. These data will provide support to the establishment of antifungal therapy guidelines for otomycosis.Item Comparison of the efficacy of combination and monotherapy with caspofungin and liposomal amphotericin B against invasive candidiasisTunger, O; Bayram, B; Degerli, K; Dinc, G; Cetin, BCObjective: To investigate if combination therapy with liposomal amphotericin B (LAmB), and caspofungin (CAS) is superior to monotherapies in an experimental model with azole-resistant Candida albicans Methods: This study was carried out between October 2006 and August 2007 in Celal Bayar University, Manisa, Turkey. A total of 144 mice were included in the study, and divided into 4 groups as: control (n=36), CAS treatment group (n=36), LAmB treatment group (n=36), and combination therapy group (n=36). Treatment efficacy was assessed by determining survival, as well as the decrease in tissue fungal densities. Results: The fungal densities in tissues were significantly reduced, and the survival rates were prolonged with either CAS only, or LAmB only, or with combination therapy compared to those of controls (p<0.05). There was no significant difference between monotherapy groups. Decrease in tissue fungal densities were significant in CAS and LAmB (1mg/kg) combination group, compared to CAS (1mg/kg) and LAmB (1mg/kg) groups (p=0.004 for CAS, p=0.009 for LAmB). Survival rates were similar in both treatment groups. Conclusion: The combination treatment was superior with 1mg/kg of doses of LAmB and CAS in terms of reducing the tissue fungal burden. Although with combination therapy the survival rates prolonged in all subgroups, no significant difference between the combination and monotherapies could be shown. Additional studies with a large number of cases are warranted to investigate the superiority of combination therapy.Item Underestimated role of alcohol at skin disinfection: lipid dissolving property when used in association with conventional antiseptic agentsYentur, A; Topçu, I; Isik, R; Degerli, K; Surucuoglu, SAim: After conventional aqueous disinfectant solutions, it was shown that microorganisms were still protected in hair follicles We hypothesized that those aqueous disinfectant solutions when used in combination with alcohol may be more effective on the inhibition of recolonization of skin and therefore catheter tip colonization Materials and methods: Skin surface samples were taken from epidural catheter insertion sites prior to catheterization, and before and after disinfection with different combinations of povidone-iodine, chlorhexidine, and alcohol Before catheter removal, cultures were taken once more and tips of the catheters were cultured Results: Catheter tip colonization and skin culture results of 10% povidone-iodine + 70% alcohol group were significantly lower than those of other groups after disinfection. Conclusion: Sequential use of alcohol and povidone-iodine is the most effective combination for limiting re-colonization of skin flora Contamination of catheters appears to take place at removal or via the spread of these re-colonized bacteria along the catheter tract.Item Epidemiological profile of onychomycosis in the elderly living in the nursing homesGunduz, T; Gunduz, K; Degerli, K; Limoncu, MEIntroduction: Few data is available about the prevalence and the causative microorganisms of onychomycosis in the elderly. The aim of this study was to determine the prevalence and types of onychomycosis in the elderly people living in the nursing homes and to determine the responsible fungal agents. Methods: Elderly people living in nursing homes were examined for onychomycosis. Nails with color and structure changes were suspected of onychomycosis. Scraping materials were evaluated by direct KOH examination and fungal cultures were performed. Results: Totally, 214 elderly persons (59 female, 155 male) from nursing homes were studied. Onychomycosis was suspected clinically in 102 cases and scraping materials were obtained from 122 nails. Clinical types of onyhomycosis were distal subungual in 87, proximal subungual in 21 and white superficial in 14 cases. Fungal spores were seen in 81 (37.8%) samples (3 hand nails, 78 toenails) with direct KOH examination and fungal culture was positive in 54 (25.2%) (3 hand nails, 51 toenails) of them. Trichophyton rubrum was the most frequently isolated fungus (75.9%) followed by Candida glabrata (12.9%). Conclusions: In the elderly, onychomycosis is more common than the general population. However causative fungi are similar; dermatophytes are the most common causative organisms followed by yeasts. (C) 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.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 Efficacy of azithromycin in a murine toxoplasmosis model, employing a Toxoplasma gondii strain from TurkeyDegerli, K; Kilimcioglu, AA; Kurt, Ö; Tamay, AT; Özbilgin, AA murine toxoplasmosis model with Balb/C mice was used to investigate the therapeutic and prophylactic efficacy of azithromycin in a native strain of Toxoplasma gondii. Initially, seven groups-four studies and three controls-were established and 10(3) tachyzoites of this native strain of T. gondii were injected intraperitoneally to the mice in groups 1, 2, 3, 4 and 7. Azithromycin was given to groups 1-4 at different times of infection orally between 100 and 300 mg/kg/day for 10 days. Azithromycin was found to be effective at 200 mg/kg/day and above in the prophylaxis, at 250 mg/kg/day and above in the treatment of toxoplasmosis. These results suggest that azithromycin is effective in the prophylaxis and early infection of a highly virulent strain of T. gondii, and it doubled the survival time in the late infection. Azithromycin could be an alternative treatment regimen for human toxoplasmosis, if supported by further clinical investigations. (C) 2003 Elsevier B.V. All rights reserved.Item Giardiasis treatment in Turkish children with a single dose of ornidazoleÖzbilgin, A; Ertan, P; Yereli, K; Tamay, AT; Kurt, Ö; Degerli, K; Balcioglu, IC; Ok, ÜZ; Onag, AThis study was designed to compare the treatment efficacy of single dose of ornidazole with 5 d treatments of ornidazole and metronidazole in children with giardiasis. 175 children, between 2 and 15 y old, whose stool samples were found to be positive for Giardia lamblia cysts and/or trophozoites by either saline-Lugol, formalin-ethyl acetate or trichrome staining, were enrolled in the study. Of these children, 105 were treated with a single dose of ornidazole: 35 with 30 mg/kg, 35 with 25 mg/kg and 35 with 20 mg/kg; 35 were treated with 25 mg/kg per day of ornidazole for 5 d in 2 doses and 35 children were treated with 20 mg/kg per day metronidazole for 7 d in 3 doses. All cases were examined on the 7th, 10th and 14th days after treatment by the same methods; clinical symptoms were also evaluated. Giardia lamblia was eradicated in 34 of 35 (97%), 34 of 35 (97%) and 33 of 35 (94%) patients treated with 30, 25 and 20 mg/kg single doses of ornidazole, respectively. Eradication was achieved in all 35 patients treated with 25 mg/kg per day ornidazole for 5 d and in 31 of 35 (89%) patients treated with metronidazole. There was no statistically significant difference among doses of ornidazole ( p > 0.05); however, all ornidazole treatment regimens were significantly more effective than metronidazole treatment ( p < 0.05). No important side-effects were detected in any patients and clinical symptoms disappeared in all. Single-dose ornidazole treatment could be considered as a proper and effective alternative method for the treatment of giardiasis in children.Item The necessity of culture for the diagnosis of tinea pedisEcemis, T; Degerli, K; Aktas, E; Teker, A; Ozbakkaloglu, BBackground. This study examined the consistency between the clinical diagnosis of tinea pedis and the results of direct fungal examination, prepared with 10% potassium hydroxide, and culture. Methods: 2427 patients clinically diagnosed with tinea pedis who presented to the mycology laboratory were reviewed retrospectively for the outcomes of direct fungal examination and culture. Results: Direct examination was positive in 54.3% and culture was positive in 36.6% of the cases. The sensitivity and specificity of direct microscopy were 95.7% and 69.6%, respectively Conclusions: The clinical diagnosis of tinea pedis can be misleading, since it features lesions that can also be present in some other skin diseases and direct microscopy may be insufficient to confirm the diagnosis. Therefore, we suggest using culture for a definitive diagnosis.Item Use of DNA hybridization test for diagnosing bacterial vaginosis in women with symptoms suggestive of infectionGazi, H; Degerli, K; Kurt, O; Teker, A; Uyar, Y; Caglar, H; Kurutepe, S; Surucuoglu, SThe purpose of this study was to evaluate a DNA hybridization test (Affirm VPIII) as an alternative to Gram stain for the rapid diagnosis of bacterial vaginosis in women with clinical signs of vaginal infection. Vaginal specimens were collected from 321 symptomatic women, and analyzed for bacterial vaginosis by both Gram stain using Nugent criteria and DNA hybridization test. Sensitivity, specificity, positive predictive value, and negative predictive value of the DNA hybridization test were determined using the Gram staining as the standard for diagnosis of bacterial vaginosis. Of the 321 patients, 115 (35.8%) were Gram positive for bacterial vaginosis and 126 (39.2%) were negative. 80 patients (25.0%) demonstrated intermediate Gram staining that was also considered negative. The Affirm system detected G. vaginalis in 107 (93.0%) of 115 vaginal specimens positive for bacterial vaginosis diagnosed by Gram stain. Compared to the Gram stain, DNA hybridization test had a sensitivity of 87.7% and a specificity of 96.0%. Positive and negative predictive values of the DNA hybridization test were 93.0% and 92.7%, respectively. In conclusion, Affirm VPIII hybridization test correlated well with Gram stain and may be used as a rapid diagnostic tool to exclude bacterial vaginosis in women with genital complaints.Item Oropharyngeal carriage and penicillin resistance of Neisseria meningitidis in primary school children in Manisa, TurkeyGazi, H; Surucuoglu, S; Ozbakkaloglu, B; Akcali, S; Ozkutuk, N; Degerli, K; Kurutepe, SIntroduction: To determine the oropharyngeal carriage rates and serogroups of Neisseria meningitidis in primary schoolchildren in Manisa, Turkey as well as the prevalence and penicillin resistance of N. meningitidis. Materials and Methods: Throat swabs obtained from 1128 children were cultured and recovered organisms were tested by disk diffusion method and the E-test for antimicrobial susceptibilities. Results: The carriage rate of N. meningitidis in our region was 6.2% (71 strains) and the serogroups identified were serogroups A (28.1%), B (22.5%), C (35.2%), D (2.8%) and W-135 (11.2%). Penicillin resistance was found in 16 strains (22.5%), while beta-lactamase activity was found in none. Conclusions: The carriage rate of N. meningitidis and serogroups are similar to the rates reported in other countries. Continued surveillance of meningococci for antimicrobial resistance will allow early detection of changes in susceptibility patterns that might affect recommendations for chemoprophylaxis as well as for treatment.Item Is skin disinfection with 10% povidone iodine sufficient to prevent epidural needle and catheter contamination?Yentur, EA; Luleci, N; Topcu, I; Degerli, K; Surucuoglu, SBackground and Objectives: Epidural space infection is a potential complication of epidural catheter placement. in this study, we investigated the incidence of epidural needle and catheter contamination after skin surface disinfection with 10% povidone-iodine (PI). Methods: Sixty seven patients having surgery under epidural anesthesia were enrolled in this prospective study. After preparation with 10% PI, skin swab cultures were taken from the site of catheter insertion. Epidural needles were cultured immediately after epidural catheters were placed. Catheters were removed at 48 hours and 2 to 3 cm of the distal tips were cultured as well. Results: Fifty-six skin swabs, 52 epidural needles, and 48 catheters were cultured. Although only 3.5% (2) colonization was observed on skin surface cultures, 34.6% (18) of the epidural needles and 45.8% (22) of the catheters were colonized. No systemic or local infection was observed. Conclusion: Our results suggest that despite skin surface disinfection with PI, there is still significant risk for contamination of needles and catheters during epidural catheterization.Item Candida Infection During Successful Treatment of Mucor Infection Through Antifungal and Minimal Invasive Surgery in a Child with Acute Lymphoblastic LeukemiaYildirim, AT; Gülen, H; Günhan, K; Nese, N; Özkol, M; Degerli, KInvasive mucormycosis is a fungal infection that is rare but has a high mortality rate. It is often seen in immune supressed patients with diabetic ketoacidosis, hematologic malignancy, or those that have undergone stem cell transplantation. Febrile neutropenia, swelling of the right cheek, and a necrotic area in the palate developed during the induction chemotherapy of a three year-old male patient with acute lymphoblastic leukemia. Minor debridements and antifungal treatment was applied, and in the sixth month of the treatment, softening of the right maxillary bone was detected in the same area. From the biopsy sample, Candida tropicalis grew in the culture, and was treated with combined antifungal medicines. This case is presented to emphasize the feasibility of mucor infection treatment via minor debridements and antifungal medicines without any need for major surgery, and also to emphasize that breaktrough fungal infections should not be ignored, in spite of the antifungal medicines that are highly effective and have broad-spectrum.