Mikrobiyoloji bulteni最新文献

Onychomycosis is a nail infection most commonly caused by dermatophytes. However in recent years, non-dermatophyte molds have also been increasingly reported as causative agents of onychomycosis. Phoma glomerata is a saprophytic fungus commonly found in nature, which rarely causes infections in humans and to date, only one case has been reported in another country as a causative agent of onychomycosis. In this case report, a case of onychomycosis caused by P.glomerata was presented. A 67-year-old female patient admitted to the dermatology outpatient clinic of our hospital with a oneyear history of discoloration, thickening and fragility of the left big toenail. In the potassium hydroxide microscopic examination of the specimen taken from the nail bed, septate and branched hyphae were observed. Dark brown pigmented, slow-growing mold colonies were observed within 10 days of culture on Sabouraud dextrose agar. Microscopic examination revealed the presence of pycnidial structures. The fungus isolated from the patient was identified as P.glomerata using the VITEK MS Mould Kit with the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (VITEK MS, bioMérieux, France) system and DNA sequencing analysis was performed to confirm the diagnosis. Following genomic DNA extraction, the 28S rRNA gene region was amplified by polymerase chain reaction (PCR) using the NL1 and NL4 primers. After agarose gel electrophoresis of the PCR products, the amplicons were sequenced using the SQK-NBD114.96 kit on the MinION (Oxford Nanopore, United Kingdom) platform. The obtained data were analyzed using the BLAST algorithm in the National Center for Biotechnology Information GenBank database. The sequence was submitted to the NCBI GenBank under the accession number PV975047. The patient was treated with oral terbinafine (250 mg/day) and topical antifungal therapy. Clinical improvement was observed after two months of follow-up. In this study, we present a case of onychomycosis caused by P.glomerata in an elderly diabetic patient living in a rural area. According to our literature review, this is the first case reported from Türkiye and the second worldwide. Current scientific data suggest that Phoma species can cause infections in the skin, subcutaneous tissues or other organs, especially in immunocompromised or debilitated individuals, or following penetrating trauma. Classical phenotypic methods pose significant challenges in identifying this agent and MALDI-TOF MS or molecular methods may be useful for accurate identification.

Neisseria meningitidis is an important pathogen that can cause invasive meningococcal diseases, especially with serogroups A, B, C, W and Y, which can be seen endemic or sporadic. Early diagnosis and treatment of invasive meningococcal disease is life-saving. Delay in diagnosis of meningitis infection, especially in the adolescent age group, which initially presents with atypical symptoms, can further increase the risk of morbidity and mortality. In this case report the clinical evaluation and diagnostic process of a 15-year-old female patient who admitted to the emergency department with abdominal pain, fever, cough and hallucinations and was initially considered to have an abdominal pathology was presented. Based on systematic clinical evaluations in the pediatric emergency department, a preliminary diagnosis of meningitis was established and cerebrospinal fluid (CSF) was obtained via lumbar puncture for diagnostic confirmation. The purulent-appearing CSF sample was analyzed using the Bio-Speedy® Meningitis/Encephalitis quantitative polymerase chain reaction (qPCR) MX-17 Panel (Bioeksen, Türkiye) multiplex PCR kit, which identified N.meningitidis as the causative pathogen. We used an real-time (RT)- PCR-based method to identify the serogroup of N.meningitidis and identified as serogroup C. Based on these findings, empirical treatment with ceftriaxone [2 g intravenous (IV)] was initiated and vancomycin (15 mg/kg IV) was subsequently added following the observation of abundant leukocytes in direct examination of cerebrospinal fluid.Chemoprophylaxis was administered to close contacts. The appearance of ecchymotic rashes and laboratory parameters were closely monitored throughout the clinical course. Prompt molecular diagnosis, coupled with efficacious antimicrobial therapy and intensive supportive care enabled the patient's discharge without neurological sequelae. In this case report, we emphasized the potential for meningitis infections to present with atypical clinical courses, the critical importance of rapid molecular diagnostic methods and the necessity of vaccination as a fundamental contribution to the protection of public health.

Orf is a zoonotic infection caused by the parapoxvirus belonging to the Poxviridae family. It is usually transmitted to humans from sheep and goats. Human-to-human transmission is quite rare. Shepherds, veterinarians, slaughterhouse workers and people living in rural areas who are in close contact with farm animals constitute the main risk group. It most commonly presents as pustular dermatitis on the hands, usually painless but sometimes associated with tenderness and pain in the early clinical stages. Auricular localization is quite rare, with a few cases involving the ear reported in the literature but earlobe involvement has not been previously reported. In this case report, a 14-year-old female patient who admitted with an erythematous, thick-walled pustular lesion on the right earlobe was presented. In the patient's history, there was close contact with sheep and especially newborn lambs. On physical examination, the lesion was observed to extend to the earring hole and had a fistulized appearance. Total surgical excision was performed under local anesthesia. Histopathological examination revealed proliferative inflammatory features as well as vacuolization and inclusion bodies consistent with viral infection. In molecular analysis, paraffin block-prepared samples were examined and the ORF-RPA gene region encoding the major component (RPO132) of the viral polymerase of the orf virus was amplified by polymerase chain reaction and a definite diagnosis was made. After surgical excision, no additional treatment was applied to the patient and she was followed up for six months with no recurrence or residual disease. Orf is generally a self-limiting infection; however, in atypical localizations it may show a rapidly growing course that mimics malignancy. In the differential diagnosis, especially cutaneous anthrax which is endemic in our country and monkeypox infections which have been reported in recent years, are of importance. In conclusion, it should be kept in mind that orf lesions may occur even in unexpected sites such as the periauricular region, particularly in patients living in rural areas with a history of animal contact. Early diagnosis of orf infection will prevent unnecessary aggressive surgical interventions and will also contribute to the proper follow-up of patients and the prevention of complications.

Hepatitis C virus (HCV) is a virus that can cause hepatitis, hepatic steatosis, cirrhosis and hepatocellular carcinoma. The distribution of HCV genotypes and subtypes varies according to geographical regions. The choice and duration of treatment for hepatitis C infection are influenced by genotype. This study aimed to investigate the distribution of HCV genotypes in chronic hepatitis C patients who admitted to a university hospital in Diyarbakır and to evaluate the impact of migration on this distribution. This crosssectional retrospective study included patients who tested positive for HCV RNA between January 2011 and December 2020. One sample per patient was included in the study. Genotype determination was performed by sequencing the HCV genome obtained after amplification in serum samples containing HCV RNA. Of the 815 samples included in the study, genotype 1 was detected in 768 (94.2%), genotype 2 in five (0.6%), genotype 3 in 27 (3.3%), genotype 4 in 14 (1.7%) and genotype 5 in one (0.12%). It was determined that the sample in which genotype 5 was detected, belonged to a Syrian patient. It was determined that the prevalence of genotype 1 decreased over the years, while the prevalence of genotype 4 increased. An increase in genotype 3 was observed in the last two years of the study (2019- 2020). The majority of patients with genotype 3 were male (88.8% male, 11.2% female). The study suggests that the increase in genotype 4 rates over the years and the identification of genotype 5 indicate that migration from Syria has altered the genotype distribution. Furthermore, the increasing prevalence of genotype 3, known to be more common in intravenous drug users, highlights the involvement of various factors influencing genotype distribution. While cure rates have increased with the use of directly effective antiviral drugs, the presence of rare mutations means that regular monitoring of genotype determination and molecular epidemiological data can contribute to the development of treatment modalities.

This study aimed to evaluate the antibiotic resistance profiles, molecular epidemiology, and biofilm formation of Corynebacterium striatum isolated from clinical samples in our hospital. A total of 132 C.striatum isolates were included in the study. Antimicrobial susceptibility testing was performed using the disk diffusion method in accordance with the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Resistance genes were determined using polymerase chain reaction. Biofilm formation was investigated using the microtiter plate method. Clonal relationships in isolates were examined using the Pulsed Field Gel Electrophoresis (PFGE) method. All isolates were found to be susceptible to vancomycin and linezolid. Resistance rates among the isolates were quite high, with resistance to ciprofloxacin, penicillin, clindamycin, rifampin, tetracycline, gentamicin and erythromycin observed in 100.0%, 98.5%, 97.0%, 99.2%, 100.0%, 90.2%, and 74.2% of the isolates, respectively. bla/ampC, ermX, aac(3)-XI, aphA1, gyrA, and tetA genes were detected as 99.2%, 96.2%, 93.2%, 91.7%, 100.0% and 43.8%, respectively. In isolates positive for the aphA1 and aac(3)-XI genes, the gentamicin resistance rate and in isolates positive for the ermX gene, the clindamycin and erythromycin resistance rates were found as significantly higher (p< 0.05). Biofim formation was detected in 28% of the isolates. The similarity ratio of the isolates was determined to be 85%. The four main clusters, A, B, C, and D showed 32 different PFGE patterns. The clustering rate was determined to be 96.0%. In conclusion, the high rates of phenotypic and genotypic antimicrobial resistance among C.striatum strains in our hospital are quite remarkable.

In this report a case of cutaneous Scedosporium apiospermum infection in 75-year-old woman with asthma who was receiving long-term therapy with corticosteroids was presented. She was hospitalized in the department of chest diseases for the follow-up of worsening dyspnea, cor pulmonale and stasis dermatitis. Erythema, localized tenderness and swelling developed on her left foot dorsum during her follow-up in the hospital. A few days later, black-colored papules with an erythematous base were observed on her foot dorsum and anterior surface of the tibia. She was diagnosed with cellulitis. Skin biopsy revealed numerous septated fungal hyphae. Preemptive amphotericin B was added to the antibacterial treatment. Within 48 h of incubation, the Scedosporium colony was isolated based on conventional methods. The fungal ribosomal RNA gene internal transcribed spacer sequence analysis revealed S.apiospermum and deposited into GenBank with accession number OM948685. The minimum inhibition concentration was defined as 1 µg/mL for amphotericin B; 16 µg/mL for fluconazole; 0.25 µg/mL voriconazole, 4 µg/mL for caspofungin, 1 µg/mL for itraconazole and 0.125 µg/mL for posaconazole on 48 h of incubation. The patient was transferred to the intensive care unit due to the deterioration of her general condition with the diagnosis of sepsis. Antimicrobial treatment was modified to caspofungin/ voriconazole combination and imipenem administration. Hepatic failure, bone marrow suppression with severe thrombocytopenia and disseminated intravascular coagulation syndrome developed on the third day of intensive care unit stay. The patient died of severe septic shock and multiorgan failure. We also reviewed the literature presenting similar cutaneous scedosporiosis cases and discussed the results.

Abdominal tuberculosis is a form of extrapulmonary tuberculosis that frequently involves the ileocecal region and often mimics conditions such as colorectal cancer or inflammatory bowel disease due to its nonspecific symptoms. While Mycobacterium tuberculosis remains the most common causative agent, rare zoonotic species like Mycobacterium caprae can also lead to human disease. In this case report, a rare case of cecal tuberculosis caused by M.caprae in a 46-year-old woman with a healthy immune system was presented. The patient presented chronic abdominal pain, diarrhea and weight loss for two years. Radiological imaging revealed ileocecal thickening and colonoscopy showed an ulcerovegetative mass raising suspicion of malignancy. Histopathological examination showed chronic granulomatous inflammation with acid-fast bacilli and molecular testing confirmed the presence of M.caprae. The patient was treated with standard anti-tuberculosis therapy including isoniazid, rifampicin, pyrazinamide and ethambutol. However, due to the development of post-treatment intestinal stenosis, surgical intervention was necessary. Human diseases with M.caprae are exceedingly rare and typically associated with occupational or environmental exposure to infected animals or unpasteurized dairy products. In this case, no such exposure was identified. The case highlights the diagnostic challenges posed by intestinal tuberculosis and underscores the importance of considering mycobacterial infections even in immunocompetent hosts. Early recognition and molecular identification are essential for accurate diagnosis and appropriate treatment. Clinicians should remain alert to potential complications such as fibrotic strictures that may require surgical management. This case represents one of the rare reports in the literature of cecal tuberculosis caused by M.caprae. To the best of our knowledge, reports describing similar cases are exceedingly rare.

Acute gastroenteritis (AGE) is an important public health problem that is very common all over the world. Knowing the causative agents is important for understanding the clinical course of the disease, effective treatment and necessary precautions to be taken. In this study, we aimed to determine the pathogen distribution in AGE cases admitted to our center using multiplex real-time polymerase chain reaction (mRt-PCR) and to demonstrate the clinical and laboratory differences between luminal (type I) and mucosal/invasive (type II) infections. We also aimed to define biomarker thresholds to facilitate decision-making in situations where access to advanced diagnostic tests is limited. Eighty-five patients aged ≥ 18 years were retrospectively analyzed between June and September 2023. Clinical complaints, stool macroscopy and laboratory results recorded at admission including; leukocyte count, neutrophil/ lymphocyte ratio (NLR), hemoglobin, platelet count, C-reactive protein (CRP), renal and hepatic function tests and lactate dehydrogenase (LDH) values were recorded. Stool samples were evaluated by microscopic examination, culture/antigen tests and Bio-Speedy Gastroenteritis mRt-PCR (MX-24L). According to PCR results, the cases were categorized as a pathogen-negative group, a mucosal-type infection group and a luminal-type infection group. Appropriate statistical tests were used, ROC analysis was performed for CRP, NLR and platelet count to predict mucosal type. The median age was 54 years (interquartile range= 38-67) and 56.5% were male. At least one pathogen was detected by PCR in 76% (65/85) of the cases; the most common were Campylobacter spp. (17.3%), enteroinvasive Escherichia coli (12.9%) and norovirus (12.9%). 41.2% of the cases were mucosal type, 35.3% were luminal-type and 23.5% were in the group in which no causative agent was detected. Age was higher in the mucosal type group (p= 0.009). Red color/blood in stool and fever were significantly more common in mucosal type group (both p< 0.001); vomiting was more common in mucosal type group (p= 0.016). CRP and NLR values were significantly higher in mucosal type group (both p≤ 0.001), while platelet count was lower (p= 0.021). ROC analysis revealed CRP as the strongest predictor for mucosal type group. mRt-PCR enables high-rate detection of acute gastroenteritis pathogens, supporting accurate and early treatment and contributing to a reduction in unnecessary antibiotic use. By using this test, the most frequently identified acute gastroenteritis pathogens in our region were detected as Campylobacter, norovirus and EIEC. In settings where these tests are not available, CRP levels ≥ 42.5 mg/L and/or NLR ≥ 3 may serve as indicators in favor of mucosal-type pathogens and thrombocytopenia may further support this clinical profile. The use of simple and easily accessible biomarkers in combination with clinical findings may contribute to more effective field management of AGE cases.