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Öğe Anti-tuberculosis drug resistance in southeast of turkey(Acta Medica Mediterranea, 2013) Dal T.; Özcan N.; Tekin R.; Tekin A.; Çelen M.K.; Özekinci T.Objective: Tuberculosis is a globally prevalent life-threatening infectious disease. In this study we aimed to evaluate antibiotic suscebtibility rates of Mycobacterium tuberculosis complex strains. Materials and methods: A total of 150 culture-positive samples were included in. Among culture positive samples 86 were Mycobacterium tuberculosis complex and 64 were non-tuberculous mycobacterium. Of Mycobacterium tuberculosis complex isolated samples 45 were Ziehl-Neelsen positive. Of 64 non-tuberculous mycobacterium isolated samples 15 were Ziehl-Neelsen positive. Mean age of the patients with tuberculosis was 37.74±20.53 and non-tuberculous mycobacterium isolated patients was 46.80±23.32. Antibiotic susceptibility testing was performed for the four first-line anti-tuberculosis drugs by BACTEC MGIT-960 instrument (Becton Dickinson). Of M. tuberculosis strains 41 % was resistant to at least one or more of the drugs (isoniasid 27.9%, ethambutol 8.13%, streptomycin 12.79 %, rifampicine 9.3 %). Of the strains 5.8 % was resistant to two, 3.4 % to three and 3.4 % to four drugs. Conclusion: Mycobacterium tuberculosis complex and drug resistance of this microorganism continued to be a problem for our country and non-tuberculous mycobacterium species may become a problem in the future. We thought that a strong and costeffective tuberculosis control programme contributes to reduce the incidence of drug resistance in the community.Öğe Assessment of cases with intracranial hydatid cyst: A 23-year experience(Ege University Press, 2014) Turan Y.; Yilmaz T.; Göçmez C.; Kamaşak K.; Kemaloğlu S.; Tekin R.; Hattapoğlu S.Objective: Brain is involved in 1-2% of hydatid cyst infections. A cranial location is rare. In this study, we aimed to assess clinical findings, radiological investigations, and treatment modalities of cases with intracranial hydatid cyst. Materials and Method: The present study included 26 patients operated for cerebral hydatid cyst disease between January 1990 and October 2012. Results: Seventeen patients were male and 9 were female. The mean age of the study population was 20.3 years (range 7-50 years). Headache and nausea were the most common clinical symptoms. The lesions were demonstrated by computed tomography (CT) and magnetic resonance imaging (MRI) as large, smooth, thin walled, spherical-shaped, cystic homogenous lesions with the same density as cerebro spinal fluid, which showed no edema or contrast uptake. Two patients were complicated or infected cysts with perifocal edema and contrast uptake. In 20 patients, the cysts were removed completely with Dowlings technique, by rectifying cysts without rupturing. Eleven patients with ruptured cysts during operation, recurrent or systemic hydatid cyst were treated medically. Conclusion: Medical therapy appears effective in hydatid cyst disease. Cerebral hydatid cysts should be excised totally without rupturing them. Preoperative imaging techniques are central to surgical planning. Intracranial hydatid cyst should be remembered when CT or MRI shows a cystic lesion, especially in countries where hydatid cyst is endemic.Öğe Assessment of methicillin and clindamycin resistance patterns in staphylococcus aureus isolated from a tertiary hospital in Turkey(2013) Tekin A.; Dal T.; Deveci O.; Tekin R.; Atmaca S.; Dayan S.In order to detect the methicillin susceptibility and determine the prevalence of constitutive and inducible clindamycin resistance in Staphylococcus aureus strains, a total of 254 S. aureus isolates, including 139 (54.7%) methicillin-sensitive and 115 (45.3%) methicillin-resistant, were tested for clindamycin and erythromycin by Kirby-Bauer's disk diffusion method. The disk diffusion induction test or D-test was performed on erythromycin-resistant and clindamycin-sensitive strains using the disk diffusion method. The erythromycin-resistant and clindamycin-sensitive strains with a D-shaped zone around the clindamycin disk were considered positive for inducible clindamycin resistance. If a strain was found to be both erythromycin-resistant and clindamycin-resistant, it was considered to have constitutive clindamycin resistance. Overall, ten (3.9%) strains, including two methicillin-resistant S. aureus and eight methicillin-sensitive S. aureus, were found to be erythromycin-resistant and clindamycin-sensitive according to the disk diffusion method and all of these strains showed inducible clindamycin resistance by the D-test method. Constitutive clindamycin resistance was detected in 100 of all MRSA strains. In conclusion, the presence of inducible clindamycin-resistant strains may lead to clindamycin treatment failure in patients with S. aureus infection. The D-test method should be used for antimicrobial susceptibility testing of clindamycin.Öğe Assessment of the laboratory transmission of brucellosis in an endemic region(Acta Medica Mediterranea, 2014) Deveci O.; Tekin R.; Aslan E.; Hosoglu S.; Bozkurt F.; Dayan S.; Demirpence O.Objectives: Laboratory-acquired brucellosis (LB) has been one of the most commonly reported laboratory-associated bacterial infections in both endemic and non-endemic countries. Brucellosis is endemic in Turkey. The aim of this study is to describe the risk factors of LB among laboratory healthcare workers. Material and method: A regional survey study was conducted by face-to-face interview in 7 hospitals from Diyarbakir, Mardin and Batman province, in southeaster Anatolia in Turkey. A structured survey questionnaire was administered to the Laboratory healthcare workers, employed in infectious diseases clinics and microbiology departments, who were at risk of Brucella infection. Result: Of the 136 laboratory workers, 13 (9.5%) had a history of laboratory-acquired brucellosis. Logistic regression analysis identified factors independently associated with an increased risk of LB including lack of biosafety cabinet (P<0.005) and a lack of compliance in the use of the same (P<0.005). Using a biosafety cabinet (P<0.005), existence of biosafety cabinet (P<0.005), full adherence to glove use (P<0.005) and male gender(P<0.005) were found to be protective factors. Conclusion: Increased adherence to personal protective equipment and use of biosafety cabinets should be priority targets to prevent LB.Öğe Brucellosis as a primary cause of tenosynovitis of the extensor muscle of the arm(EDIMES Edizioni Medico Scientifiche, 2015) Tekin R.; Cevik F.C.; Tekin R.C.; Cevik R.Osteoarticular involvement is the most frequently observed complication of brucellosis. Brucellosis tenosynovitis of the extensor tendon sheath is an extremely rare manifestation of musculoskeletal brucellosis. A 36-year-old male patient presented with described pain in his right wrist that had started six days earlier. There was also a diffuse swelling in the 1st finger of his right hand. The patient described fever, night sweats, widespread muscle pain and fatigue that had been going on for the last six days. Standard tube agglutination for Brucella was positive at a titre of 1/320. At diagnosis, the patient showed radiographic abnormalities. Doxycycline 200 mg/d and rifampicin 600 mg/d were given for six weeks. Complete resolution was achieved with medical treatment. © 2015, EDIMES Edizioni Medico Scientifiche. All rights Reserved.Öğe Carbapenem resistance in Acinetobacter baumannii: Where is it heading?(2013) Deveci O.; Dal T.; Tekin R.; Bozkurt F.; Tekin A.; Dayan S.In the context of the substantial increase in antibiotic resistance rates of Acinetobacter baumannii, we aimed to evaluate the susceptibility rate changes of A. baumannii strains for carbapenems. A. baumannii strains isolated from patients diagnosed with healthcare-associated infections between 2007-2010 were included. A total of 127 A. baumannii strains [53 (42%) from the intensive care unit and 74 (58%) from the non-intensive care unit] were isolated. Conventional methods and an automated microbiology system were used for identification. Susceptibility testing was studied by Kirby-Bauer disk diffusion method. In 2007, five of 26 strains, in 2008, 18 of 31, in 2009, 10 of 35, in 2010, and 20 of 35 were obtained from intensive care unit patients. The susceptibility rate for imipenem was 50% in 2007 but 20% in 2010, while for meropenem it was 55% in 2007 but 12% in 2010. Prevention and control of antibiotic resistance among Acinetobacter species needs antibiotic usage restrictions and infection control precautions.Öğe The distribution according to the species of Gram-negative bacteria isolated from hospitalized patients's urine specimens and their antimicrobial susceptibility(2012) Dal T.; Tekin A.; Tekin R.; Deveci O.; Can S.; Özekinci T.; Dayan S.Objective: In this retrospective study, we aimed to determine the distribution according to the species of Gram-negative bacteria in isolates obtained from urine cultures of hospitalized patients with urinary tract infections and to detect their antimicrobial susceptibility pattern for contribute to empirical treatment approach to urinary tract infections in our hospital. Methods: Between the dates of January 2006 and September 2011, a total of 3,548 Gram-negative isolates obtained from urine cultures of hospitalized patients with urinary tract infection were identified by conventional methods and the BD PhoenixTM 100 (Becton Dickinson, MD, USA) fully automated microbiology system. Antimicrobial susceptibility testing of isolates was performed by Kirby- Bauer's disk diffusion method according to the Clinical and Laboratory Standarts Institute (CLSI) criteria. In addition, extended-spectrum beta-lactamase (ESBL) production of predominant urinary pathogenic bacteria was detected by the double-disk synergy method. Results: In this study, a significantly higher incidence of urinary tract infection was observed in females compared with males; 2,245 (63.3%) and 1,303 (36.7%), respectively. Escherichia coli was the predominant pathogenic bacterium and accounted for 2,341 (65.8%) of 3,548 hospitalized patients with urinary tract infections. In addition, Klebsiella pneumoniae accounted for 679 (19.1%), Acinetobacter spp. for 177 (5%), Enterobacter spp. for 176 (5%), Pseudomonas aeruginosa for 142 (4%), and other Gram-negative bacteria for 38 (1.1%). Antimicrobial susceptibility rates of Gram-negative bacteria isolated from urine cultures for ceftazidime, trimethoprim-sulfamethoxazole, ciprofloxacin, piperacillin-tazobactam, cefoperazonesulbactam, amikacin, imipenem, meropenem were detected as 34.5%, 38%, 42%, 50%, 70%, 87%, 90%, and 92%, respectively. In addition, the rates of ESBLproducing Escherichia coli and Klebsiella pneumoniae were detected as 38% and 36%, respectively. Conclusion: The present study and the other studies show that in the near future it is possible our therapeutic options may become more limited than ever due to the development of high-level resistance against broad-spectrum antibiotics such as cephalosporins, carbapenems and fluoroquinolones. Due to the highlevel resistance to ceftazidime, ciprofloxacin and trimethoprim-sulfamethoxazole, we recommend that these antibiotics should not be used for the empirical treatment of urinary tract infections.Öğe Efficiency of treatment of long period pegile-interferon in delta hepatitis(2010) Tekin R.; Ayaz C.; Çelen M.K.Despite all, it's treatment is still uneffective and has few alternatives. There is no more alternative utility treatment way except interferons in hepatitis delta infection. Twenty one naive patients with chronic hepatitis delta were included to this study. The patients were arranged in two groups. First group contains 11 patients who received PEG-IFN-?-2a for 1 year, and second group contains 10 patients who received PEG-IFN-?-2a for 2 years. We ascertained the effects of the treatment on liver function tests, virologic parameters and changes in liver histopathology. HDV-RNA became negative in 2 patients in first group (18%), and 3 patients in second group (30%). This negativeness continued up to 24th week after treatment had ended both of two groups. Post-treatment serological response, biochemical response, and histological response was no significant differences in statistically (p>0.05). In conclusion, PEG-IFN-?-2a treatment for two years has more superiority than one year treatment. Limitted number of patients in our study suggests other studies and treatment options for large series in the future.Öğe [Fascioliasis and brucellosis in same patient].(2014) Deveci O.; Aslan E.; Tekin A.; Toka Özer T.; Tekin R.; Bozkurt F.; Çetinçakmak M.G.Brucellosis is a zoonotic infectious disease that can affect many organs and systems and leads to very different clinical circumstances. Brucellosis is rare in association with various infectious agents. Fascioliasis is a zoonotic disease caused by Fasciola hepatica, popularly referred to as a large leaf-shaped liver fluke. This case is a 39-year-old male patient, and his complaints began a week ago, which were chills, fever, abdominal pain, nausea, vomiting, weakness, sweating, and widespread pain. The patient was considered brucellosis in the preliminary diagnosis. Rose Bengal test and Wright test (1/640) were detected as positive. Due to patients having elevated liver enzymes, abdominal ultrasound was taken. A liver lesion was seen with abdominal ultrasound. So, abdominal computed tomography (CT) was taken. The CT result report came in the form that at the left lobe of the liver segment 2, largely necrosis that showed no contrast enhancement, approximately 61x63 mm in size (compatible with fascioliasis) is viewed. The patient's IHA test results, required for fascioliasis, were detected as 1/320 positive. Especially for zoonotic diseases in areas with high endemicity, it should be considered that more than one infectious agent can be present together in high-risk patients.Öğe Idiopathic thrombocytopenic purpura associated with splenic tuberculosis: Case report(2013) Dal M.S.; Dal T.; Tekin R.; Bodakçi E.; Düzköprü Y.; Ayyildiz M.O.Tuberculosis is still one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. There are limited numbers of cases in which immune thrombocytopenia is associated with splenic tuberculosis. We report a case of immune thrombocytopenic purpura due to splenic tuberculosis. Our case was a 58-year-old female with headache, gum bleeding, redness in legs, and ecchymoses on the arms for 10 days. On admission to hospital, laboratory tests were as follows: platelet count 6.000/mm3 (150 000-450 000), haemoglobin: 12 g/dl, WBC: 8000/mm3, erythrocyte sedimentation rate: 58 mm/h and C-reactive protein was in normal ranges. After standard laboratory tests, the pa tient was diagnosed with idiopathic thrombocytopenic purpura. The patient presented abdominal lymphadenopathies and spleen in normal size in radiological examinations. Diagnostic laparotomy and splenectomy and lymph node excision was performed and splenic tuberculosis was detected in pathologic and microbiologic examination. The patient was successfully treated with apheresis platelets suspension, intravenous immunoglobulin and antituberculous therapy. In conclusion, splenic tuberculosis should be suspected in patients who have fever, abdominal lymphadenopathies and immune thrombocytopenic purpura. Histopathological examination is still an ideal method to confirm the diagnosis, suitably aided by microbiological examination.Öğe In vitro antimicrobial susceptibility pattern among stenotrophomonas maltophilia strains isolated from clinical specimens(Duzce University Medical School, 2014) Tekin A.; Dal T.; Tekin R.; Deveci Ö.; Demirkaya S.; Mete M.; Dayan S.Aim: In this study, the determination of in vitro antimicrobial susceptibility rates among Stenotrophomonas maltophilia strains isolated from clinical specimens was aimed. Method: A total of 60 S. maltophilia strains isolated from various clinical specimens sent to Dicle University Hospital clinical microbiology laboratory between January 2006 and September 2011 were included retrospectively in this study. Urine samples were inoculated onto 5% sheep blood agar and Eosin-Methylene Blue (EMB) agar media, quantitatively; other clinical samples were inoculated, qualitatively. Identification of S. maltophilia isolates was performed by conventional methods and fully automated microbiology system. Antimicrobial susceptibility tests were performed by Kirby-Bauer’s disk diffusion method and by broth dilution. Results: A total of 60 S. maltophilia strains isolated from clinical specimens as 24 urine, 15 blood, 11 sputum, four synovial fluids, three cerebrospinal fluids, two wound swabs and one middle ear materials. The resistance rates against antibiotics were detected as 85% (n=51) for piperacillin-tazobactam, 75% (n=45) for levofloxacin, 73% (n=44) for ciprofloxacin, 57% (n=34) for trimethoprim-sulfamethoxazole, 5% (n=3) for meropenem and imipenem, and 0% (n=0) for amikacin. Conclusion: In this study, it was detected that piperacillin-tazobactam can be used as an alternative option other than trimethoprim-sulfamethoxazole, for the treatment of infections due to S. maltophilia at least in our region. © 2012 Düzce Medical Journal.Öğe In vitro efficiency of ertapenem among escherichia coli strains isolated from clinical specimens(2013) Tekin A.; Deveci Ö.; Dal T.; Tekin R.; Bacalan F.; Akpolat N.In this study, in vitro efficiency of ertapenem and extanded-spectrum beta-lactamase (ESBL) producing among Escherichia coli strains isolated from clinical specimens were investigated. 334 E. coli strains isolated from clinical specimens that sent to Dicle University Hospital clinical microbiology laboratory between December 2010 and August 2011 were included in this study. Identification of isolates was performed by conventional methods and a fully automated microbiology system. Antimicrobial susceptibility testing of strains was performed by Kirby- Bauer's disc diffusion method and E-test method. Double-disk synergy method was used for the detection of ESBL-producing. 334 E. coli strains were isolated from clinical specimens as 233 (69.8%) urine, 55 (16.4%) blood, 32 (9.6%) wound swabs and 14 (4.2%) others. In 177 (53%) from 334 E. coli strains were determined the ESBL activity. Ertapenem sensitivity rate among strains was determined as 93.4%. Although there was no resistance to ertapenem in ESBL-non-producing strains, ertapenem resistance rate was found as 12.4% in ESBL-producing strains. The high resistance rate for ertapenem in ESBL-producing strains according to the ESBL-non-producing strains was found to be statistically significant (p<0.001). In the light of present study, we think as the better option of ertapenem which has got a high sensitivity rate in the treatment with antimicrobial agents of infections caused by ESBL-producing E. coli strains at least in our hospital.Öğe Nasopharyngeal carcinoma in the etiology of fever of unknown origin(2010) Ulu? M.; Çelen M.K.; Geyik M.F.; Tekin R.; Ayaz C.Fever of unknown origin is defined as a temperature higher than 38.3°C lasting three weeks or longer and not beind diagnosed even after one week of study in-hospital settings. Infections and malignancies had been the most common causes of fever of unknown origin overall. Nasopharyngeal carcinoma, constituting less than 0.03% of all malignant tumors and only 2% of all head and neck cancer. Ebstein Barr virus infection consumption of smoked and salted fish and vitamin-C deficient diet have been blamed in its etiology. In this study,we present two cases who were admitted to our clinic with fever of unknown origin initially and later diagnosed with nasopharyngeal carcinoma atypically progressing.Öğe Non-invasive parameters in the assessment of liver fibrosis(Scientific Publishers of India, 2017) Dayan S.; Dal T.; Tekin R.; Deveci O.; Ipek D.; Ozcan N.; Bozkurt F.Liver biopsy and histopathological evaluation are the main methods to assess liver pathology. However, liver biopsy is not widely used due to implementation challenge. We aimed to investigate non-invasive parameters for evaluation of liver fibrosis in chronic Hepatitis B patients. A total of 65 patients who admitted to outpatient clinic and diagnosed as chronic hepatitis were included in this study. Liver puncture biopsy was performed for all patients and was evaluated according to the Modified Ishak Fibrosis Score. The patients without fibrosis or with mild and moderate fibrosis were evaluated as Group I (Stage O, I, II), the patients with advanced fibrosis were evaluated as Group II (stage III, IV, V, VI). Among 65 patients, 42 were male and 23 were female; 48 of the patients were in group I while 17 patients belonged to group II. Gamma-Glutamyl Transferase (GGT), Alkaline Phosphatase (ALP), Aspartat Transaminaz (AST) and Alanin Aminotransferaz (ALT) levels were significantly higher in Group II patients. In the assessment of liver fibrosis, liver biopsy remains the gold standard diagnostic method but AST, ALT, GGT, ALP parameters have contribution to this evaluation. Non-invasive testing may be useful in cases which biopsy cannot be performed or repeat biopsy required. © 2017, Scientific Publishers of India. All rights reserved.
