Immune responses in multiple hosts to Nucleocapsid Protein (NP) of Crimean-Congo Hemorrhagic Fever Virus (CCHFV)

In 2019, the World Health Organization declared 3 billion to be at risk of developing Crimean Congo Hemorrhagic Fever (CCHF). The causative agent of this deadly infection is CCHFV. The data related to the biology and immunology of CCHFV are rather scarce. Due to its indispensable roles in the viral life cycle, NP becomes a logical target for detailed viral immunology studies. In this study, humoral immunity to NP was investigated in CCHF survivors, as well as in immunized mice and rabbits. Abundant antibody response against NP was demonstrated both during natural infection in humans and following experimental immunizations in mice and rabbits. Also, cellular immune responses to recombinant NP (rNP) was detected in multispecies. This study represents the most comprehensive investigation on NP as an inducer of both humoral and cellular immunity in multiple hosts and proves that rNP is an excellent candidate warranting further immunological studies specifically on vaccine investigations.

Crimean Congo Hemorrhagic Fever Virus (CCHFV) is the most lethal human pathogen of medical importance after the dengue virus among arboviruses. The increasing geographic spread of Hyalomma ticks, which are responsible for viral transmission widespread, threatens billions of people. WHO currently declares the field of research on CCHFV as the second most urgently needed areas of investigations on emerging pathogens. About 10 to 40% of those infected with the virus lose their life due to the rapidly developing severe clinical manifestations. Pandemic potential and the lack of any approved treatment or vaccine make raise the studies on CCHFV as critical. The studies on CCHFV are challenging due to the necessities of BSL-4 facilities and the immunological characterization of individual structural proteins will lay the groundwork for the steps to be taken to treat and prevent this emerging disease. As is known from other RNA viruses, nucleoprotein (NP) has crucial roles in the viral life cycle, both in viral replication and transcription and in the formation of the virion structure. So far, detailed and comprehensive immunological characterizations on NP in multiple are not undertaken. Our study was set out to embark such detailed investigation. The strong humoral and cellular immune response to NP demonstrated by this study indicates that NP might be an excellent candidate for future scrutinies on vaccines and diagnostic reagents.

Evaluation of the cell culture based and the mouse brain derived inactivated vaccines against Crimean-Congo hemorrhagic fever virus in transiently immune-suppressed (IS) mouse model

Crimean-Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus in the Nairoviridae family within the Bunyavirales order of viruses. Crimean-Congo hemorrhagic fever (CCHF) is the most widespread among tick-borne human viral diseases. It is endemic in many areas of Africa, Asia, the Middle East, in the Balkans, Russia and countries of the former Soviet Union. The confirmed CCHF cases were seen in Spain in 2016 to signify expansion of the virus into new geographical areas. CCHFV causes a viral human disease characterized by sudden onset of fever, headache, abdominal pain, nausea, hypotension, hemorrhage, and hepatic dysfunction with fatality rates up to 30%. Currently, there are no spesific treatments or licensed vaccines available for CCHFV. The absence of a susceptible animal model for CCHFV infection was severely hindered work on the development of vaccines. However, several animal models of CCHFV infection have been recently developed and used to assess vaccine efficacy. In this study, we have used the transiently immune-suppressed (IS) mouse model that MAb-5A3 was used to block IFN-I signaling in immune intact, wild-type mice at the time of CCHFV infection to evaluate the immune response and efficacy of the cell culture based and the mouse brain derived inactivated vaccines against CCHFV. Both vaccine preparations have provided complete protection but the cell culture based vaccine more effectively induced to CCFHV spesific antibodies and T cell responses. This is the first comparison of the cell culture based and the mouse brain derived vaccines for assessing the protective efficacy and the immunogenicity in the IS mouse CCHFV model.

Total Occlusion of the Left Descending and circumflex Coronary Artery without ST Elevation: the De Winter electrocardiographic pattern

de Winter syndrome, or anterior ST segment elevation myocardial infarction (STEMI), constitutes 2% of acute myocardial infarctions. In contrast to classic ST segment elevation as seen with STEMI, it involves ST depression with precordial derivations and sharp waves. de Winter syndrome indicates critical narrowing of the left ascending coronary artery (LAD). Recognizing this presentation is important in terms of both mortality and morbidity. We present the case of a 71-year old patient presenting at the Emergency Department with chest pain, who had findings of de Winter syndrome on their ECG. Coronary angiography confirmed occlusions in the LAD and circumflex (CX) coronary arteries.

P908 The novel predictor for mortality in patients with functional mitral regurgitation: the modified MIDA-Score

EuroSCORE and STS-Score are used to assess surgical risk in patients with valvular heart diseases. The MIDA- Score has been recently published as a representative predictor for short- and long-term prognosis in patients with degenerative mitral regurgitation (DMR). The adequate assessment of long-term prognosis in patients with functional MR is scarce. We aim to adapt this classical score system for patients with FMR.

We retrospectively included 105 patients with FMR who underwent transcatheter mitral regurgitation therapy (TMVR) between January 2014 and August 2016 in our center. Due to the different underlying pathomechanisms of FMR, annular dilatation and impaired left ventricle function, and more elderly patient population we adapted some cut-off values to FMR patients (Age > 65 to Age > 75; LV-EF ≤ 60% to LV-EF ≤ 45%; sPAP≥50mmHg to sPAP≥45mmHg). Moreover, according to Cox proportional hazard analysis of our patient collective we re-calculated the weights of the risk factors: Age 2 points, Symptoms 1 point, atrial fibrillation 2 points, left atrial diameter 1 point, right ventricle systolic pressure 2 points, left ventricle end-systolic diameter 2 points, left ventricle ejection fraction 2 points. We defined three risk groups according to total points from the risk factors; Grade 1 (0-4 points): low risk, Grade 2 (5-9 points): moderate risk, Grade 3 (10-12 points): high risk.

We retrospectively included 105 patients (76.7 ± 8.8 years, 50,6% female) with symptomatic (functional NYHA class > II ) moderate-to-severe FMR (PISA: 0.7 ± 0.4cm, VC width: 0.8 ± 0.3cm, EROA: 0.22cm2, RegVol: 38.1 ± 19.2ml) at surgical high risk (EuroSCORE II: 5.4 ± 3.8%, STS-Score: 4.7 ± 2.8%). We found all-cause mortality 7% at one-year follow-up. 34.1% of our collective were hospitalized.

The classical MIDA Score was not significantly correlated with mortality and rehospitalization in patients with FMR at follow-up (p = 0.5); however, the modified MIDA score was found to be a strong predictor for mortality and rehospitalization in patients with FMR (AUC: 0.89). According to multivariate analysis, the modified MIDA score was found to be superior compared to the other conventional score systems (The modified MIDA-Score HR: 4.1, p = 0.021; EuroSCORE II; HR: 1.2, p = 0.004, STS-Score; HR: 1.7, p = 0.005).

We performed Cox proportional hazard analysis to assess the weighting factor of the predictors. As a result of this, we found age (HR: 2,95, p = 0.03) as the most reliable parameter to predict the combined outcome.

The 12,5% of grade 1, 27% grade 2, 57% grade 3 patients showed combined endpoint. According to regression analysis, the modified score >9 points found to be a strong predictor for high mortality and rehospitalization (OR: 3.35, p = 0.011).

We found the modified MIDA Score sufficient and extensive to assess outcomes in patients with FMR. The modified MIDA Score offers a sufficient promising tool to predict individual prognosis in patients with FMR.

The diagnostic value of the serum irisin level in patients with acute pericarditis and acute myopericarditis

OBJECTIVE

This preliminary study aims to examine a change in the blood levels of irisin in patients with acute pericarditis (AP) and acute myopericarditis (AMP) and examine the diagnostic value of the serum irisin level in AP and AMP.

METHODS

10 patients, who applied to the emergency service and cardiology clinic with chest pain and who were diagnosed with AP and 5 patients, who were diagnosed with AMP as a result of routine examinations, were included in the study. The basal laboratory parameters, echocardiography findings and serum irisin levels of the patients and during check one month later were examined.

RESULTS

While the basal irisin levels were found to be significantly low in the AMP group and high during the check (6.6 ± 1.58, 8.19 ± 1.43, respectively), no statistically significant difference was determined (p = 0.23). It was observed that the basal and control irisin levels did not vary significantly in the AP group (8.03 ± 1.6, 8.19 ± 1.43, respectively) (p = 0.84).

CONCLUSION

In this preliminary study, the basal irisin levels were found to be significantly low in the AMP group, while there was no statistically significant difference between the basal irisin levels and control irisin levels in the AP and AMP groups (Tab. 5, Ref. 17).

Successful intravenous lipid emulsion therapy: Olanzapine intoxication

Olanzapine is an antipsychotic drug used in psychiatric diseases. At high doses it exhibits cardiovascular and neurological sideeffects in particular. Lipid emulsion therapy for the removal of medication from plasma in high-dose lipophilic drug use has recently become very widespread. In the light of current literature, this report discusses the successful treatment of a patient within 4 hrs of olanzapine overdose as an attempted suicide, who presented with agitation and clouded consciousness.

[Measles outbreak in the adult age group: evaluation of 28 cases]

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

Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis

OBJECTIVES

In Sweden, reports indicate surprisingly large regional variation in prescription of biological drugs despite a growing number of clinical studies describing their beneficial effects and guidelines by professional organizations and agencies. Our objectives were to ascertain whether there is also variation between individual rheumatologists in prescribing biologics to patients with rheumatoid arthritis (RA) and to evaluate reasons for treatment choices.

METHOD

Ten hypothetical patient cases were constructed and presented to 26 rheumatologists in five regions in Sweden. The cases were based on actual cases and were thoroughly elaborated by a senior rheumatologist and pre-tested in a pilot study. The respondents were asked whether they would treat the patients with a biological agent (Yes/No) and to explain their decisions.

RESULTS

The response rate was 26/105 (25%). Treatment choices varied considerably between the rheumatologists, some prescribing biologics to 9/10 patients and others to 2/10. In five of the 10 hypothetical cases, approximately half of the respondents would prescribe biologics. No regions with particularly high or low prescription were identified. Both the decisions to prescribe biologics and also not to prescribe biologics were mainly motivated by medical reasons. Some rheumatologists also referred to lifestyle-related factors or the social function of the patient.

CONCLUSIONS

The choice of initiation of biologics varied substantially among rheumatologists presented with hypothetical patient cases, and there were also disparities between rheumatologists practicing at the same clinic. Treatment choices were motivated primarily by medical reasons. This situation raises concerns about a lack of consensus in RA treatment strategies.

In vitro activity of Brucella melitensis isolates to various antimicrobials in Turkey

BACKGROUND

Brucellosis is a systemic infectious disease caused by Brucella bacteria. A successful treatment requires antibiotics that can penetrate into the cell at high concentrations. The aim of this study was to assess the biotype and in vitro activity of 80 Brucella isolates obtained from blood against various antimicrobials for human brucellosis in Turkey.

METHODS

Identification of the types of the species designated Brucella species was made using the polymerase chain reaction (PCR), with type-specific primers. Serotyping was performed using mono-specific A and M antisera. The minimum inhibitory concentrations (MICs) of antibiotics known to have good intracellular penetration (doxycycline, rifampicin, ofloxacin, levofloxacin, moxifloxacin, clarithromycin, and azithromycin) were determined by the agar dilution method.

RESULTS

All of the 80 Brucella isolates were determined to be Brucella melitensis: 75 B. melitensis biotype 3 (93.7%) and 5 B. melitensis biotype 1 (6.3%). Doxycycline was the most effective among the tested antibiotics against Brucella species (MIC(50)-MIC(90), 0.25-0.5 μg/ml), and it was followed by levofloxacin (MIC(50)-MIC(90), 0.5-1 μg/ml), moxifloxacin (MIC(50)-MIC(90), 1-1 μg/ml), ofloxacin (MIC(50)-MIC(90), 1-1 μg/ml), rifampicin (MIC(50)-MIC(90), 2-4 μg/ml), azithromycin (MIC(50)-MIC(90), 4-8 μg/ml), and clarithromycin (MIC(50)-MIC(90), 8-32 μg/ml), respectively.

CONCLUSIONS

The in vitro activity of doxycycline and rifampicin, which are used in the classic treatment of brucellosis, was found to be very good. Quinolones were found to have in vitro activity against Brucella isolates. Among the macrolides, azithromycin had a higher level of activity compared with clarithromycin. A combination of quinolones and azithromycin could be an alternative to doxycycline and rifampicin in the treatment of brucellosis.

Changes in sociodemographic characteristics at baseline in two Swedish cohorts of patients with early rheumatoid arthritis diagnosed 1996-98 and 2006-09

OBJECTIVES

To compare baseline sociodemographic characteristics in two rheumatoid arthritis (RA) cohorts enrolled 10 years apart, and to examine differences with respect to the general population.

METHOD

Clinical and sociodemographic data were collected in 320 early RA patients during 1996-98 (TIRA-1) and 467 patients in 2006-09 (TIRA-2). Multivariate logistic regression tests were performed and intercohort comparisons were related to general population data, obtained from official databases.

RESULTS

TIRA-2 patients were older than TIRA-1 (58 vs. 56 years). Women (both cohorts, 67%) were younger than men in TIRA-1 (55 vs. 59 years) and in TIRA-2 (57 vs. 61 years). Disease activity was similar but TIRA-2 women scored worse pain and worse on the HAQ. Approximately 73% were cohabiting, in both cohorts and in the general population. Education was higher in TIRA-2 than in TIRA-2 but still lower than in the general population. Women had consistently higher education than men. Education was associated with age, younger patients having higher education. In both cohorts, lower education was associated with increased disability pension and increased sick leave. Sick leave was lower in TIRA-2 than in TIRA-1 (37% vs. 50%) but disability pension was higher (16% vs. 10%). In TIRA-1, 9% of women had disability pension compared with 17% in TIRA-2. A similar decrease in sick leave and an increase in disability pension were also seen in the general population. Older age and a higher HAQ score were associated with increased sick leave and being in the TIRA-2 cohort was associated with decreased sick leave.

CONCLUSIONS

TIRA-2 patients were slightly older, better educated, had lower sick leave and higher disability pension than those in TIRA-1. Similar changes were seen simultaneously in the general population. Belonging to the TIRA-2 cohort was associated with decreased sick leave, indicating that societal changes are of importance.

Treatment of Gram-positive left-sided infective endocarditis with daptomycin

The aim of this study was to evaluate the effectiveness of daptomycin in left-sided infective endocarditis (IE) patients. Fourteen patients with left heart endocarditis, monitored with a diagnosis of IE based on modified Duke criteria between July 2010 and May 2011, and receiving daptomycin as monotherapy, were enrolled. The success of daptomycin in these patients was revealed with improvements in microbiological, biochemical, and radiologic findings, as well as physical examination findings. Patient average age was 63.5 ± 14.2 years (36-80 years); 8 (57 %) were men and 6 (43 %) women. The pathogens methicillin-resistant Staphylococcus aureus (71.5 %), Streptococcus mutans (21.5 %), and methicillin-sensitive Staphylococcus aureus (7 %) were isolated from our patients. Daptomycin was used in initial treatment in 5 (36 %) patients; treatment was subsequently modified to daptomycin in 9 (64 %) patients as a consequence of drug serum level insufficiency, agent sensitivity to the drug administered, or drug side effects. Thirteen patients were discharged in a healthy condition, with successful surgical treatment in 5 (36 %). Only 1, an 80-year-old IE patient, was lost from advanced cardiac failure. No significant side effects were seen in any patient receiving daptomycin. The most frequent side effects were minimal rises in serum CPK levels during treatment; these values returned to normal after treatment. Daptomycin can be used successfully in left heart endocarditis with no significant side effects. Studies involving a wider patient series are now needed to support the use of daptomycin in left heart endocarditis.

Pseudo-plaque reduction neutralization test (PPRNT) for the measurement of neutralizing antibodies to Crimean-Congo hemorrhagic fever virus

Background

Crimean-Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus of the genus Nairovirus family Bunyaviridae, which are enveloped viruses containing tripartite, negative polarity, single-stranded RNA. CCHF is characterized by high case mortality, occurring in Asia, Africa, the Middle East and Europe. Currently, there are no specific treatments or licensed vaccines available for CCHFV. Recently, two research groups have found adult mice with defective interferon responses allowed to lethal CCHFV infection. These mouse models could provide invaluable information for further studies. Efforts to develop a vaccine against CCHFV are being made. To determine the efficacy of vaccine candidates it is important to conduct serological studies that can accurately measure levels of protective antibodies. In the present study, a pseudo-plaque reduction neutralization test (PPRNT) based on enzyme-catalyzed color development of infected cells probed with anti-CCHFV antibodies was used to measure neutralization antibody of CCHFV.

Methods

Sixty-nine human serum samples (20 acute and 49 convalescent) were tested. The presence of CCHFV antibodies was determined and confirmed by a commercial ELISA kit. CCHFV RNA was determined by RT-PCR. All the samples were analyzed by PPRNT and fluorescent focus reduction neutralization test (FFRNT) to measure of CCHFV-neutralizing antibodies.

Results

Pseudo-plaque reduction neutralization test showed a high sensitivity (98%), specificity (100%) and agreement (96,6%) in qualitative comparison with those of the FFRNT. There was a high correlation between the titers obtained in PPRNT and FFRNT (R2 = 0.92). The inter- and intra-assay variation of PPRNT revealed good reproducibility and positive cut-off of PPRNT was defined as 1:4 by the geometric mean titers for the individual samples distributed.

Conclusion

The pseudo-plaque reduction neutralization test described in this study is a fast, reproducible and sensitive method for the measurement of CCHF neutralizing antibodies. This novel assay could serve as useful tools for CCHF research in epidemiology, vaccine development and other studies of immunity. It also provides an alternative to PRNT when viruses with no or poor CPE in cell culture.

Naturally Occurring Cutaneous Anthrax: Antibiotic Treatment and Outcome

<i>Objectives:</i> Cutaneous anthrax (CA) is the most common clinical presentation in human anthrax, but the duration of antibiotic therapy in naturally occurring CA is controversial. The aim of this study was to compare the clinical outcomes of patients receiving antibiotic treatment for either 3-5 days (group 1) or 7-10 days (group 2) in uncomplicated CA. <i>Methods:</i> A total of 66 patients were enrolled; 29 (44%) in group 1 and 37 (56%) in group 2. Infections were classified as mild (n = 22, 33%) or severe (n = 44, 67%) CA. <i>Results:</i> There were no significant differences between the groups in symptom resolution time, fever clearance time, healing of lesions, development and healing of eschars, requirement for surgical intervention or the development of complications. Both edema resolution time and duration of hospital stay were longer in group 2. There were no therapeutic failures, relapses or deaths in either group. Steroid therapy was used in 32% of patients with severe CA, but a beneficial effect on resolution of edema was not demonstrated. <i>Conclusions:</i> These results suggest that short-course antibiotic therapy is as effective as standard-duration therapy in uncomplicated CA and that steroid therapy may not be effective.

Hepatocyte growth factor (HGF) in patients with acute brucellosis

In this prospective study, we investigated the serum levels of hepatocyte growth factor (HGF) and C-reactive protein (CRP) before and after the treatment of patients with acute brucellosis. The study comprised 58 patients with acute brucellosis and 30 healthy volunteers. Pre-treatment serum HGF levels of 58 patients with acute brucellosis (1548.6 +/- 220.1) were significantly higher than levels of the control group (401.4 +/- 69.7) (p < 0.001). Serum levels of HGF and CRP significantly decreased at the end of the treatment period (p < 0.001). Post treatment, levels did not differ from those of the control group (p > 0.05). Serum HGF levels of patients with acute brucellosis correlated to CRP and ALT levels (r: 0.922, 0.752; p < 0.001, respectively). Our findings suggest that serum HGF levels may be used as a supplementary marker to evaluate the effectiveness of the treatment in patients with acute brucellosis.

Toxocara seroprevalence in schizophrenic patients in Turkey

PURPOSE

To investigate the seroprevalence of toxocariasis in patients diagnosed as schizophrenia.

PATIENTS AND METHODS

Ninety-eight schizophrenic patients hospitalized at The Elazig Psychiatric Hospital were included in the study. Anti-Toxocara IgG and/or IgM antibodies were determined by using commercial Toxocara canis IgG and/or IgM ELISA kit.

RESULTS

Seropositivity for T. canis was detected in 45 (45.9%) of 98 patients and 2 (2.0%) of 100 control subjects the difference was statistically significant (p<0.001). The seroprevalence was 40.4% (19 cases) and 51.0% (26 cases) for female and male subjects, respectively (p=0.3). When the seropositive and seronegative schizophrenic patients were compared with respect to the age group environment they were living in, occupation period of follow up and number of hospitalizations, there were no differences between the two groups (all, p>0.05).

CONCLUSION

In conclusion, the schizophrenic state seems to present a high risk for Toxocara infection in Turkey.

Crimean-Congo hemorrhagic fever virus: genetic analysis and tick survey in Turkey

Crimean-Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus in the family Bunyaviridae, genus Nairovirus. The virus is transmitted to humans through infected tick bites or from direct contact with viremic animals or humans. In the present study, a total of 1,015 adult ticks were collected from cattle (603 specimens), sheep (17 specimens), and goats (395 specimens) in the Kelkit Valley in Turkey. Four tick species were recognized on the animals in the surveyed region. The most abundant species were Rhipicephalus bursa and Hyalomma marginatum marginatum, at 47.68% (484/1,015) and 46.40% (471/1,015), respectively. Reverse transcriptase PCR was used to recover partial sequences of the CCHFV small (S) genome segment. The presence of CCHFV was determined in 3 of 33 (9.09%) R. bursa pools and in 1 of 31 (3.22%) H. m. marginatum pools. Virus sequences from R. bursa were extremely different from those of the Greek CCHFV strain (U04958) isolated from an R. bursa tick. Phylogenetic analysis indicated that the CCHFV isolates obtained in this study clustered in group 5, whose range encompasses southwestern Russian and Kosovo. This is the first evidence of CCHFV in ticks from Turkey. Even though Hyalomma is the main vector for CCHFV, R. bursa may play a role in CCHFV transmission.

Paradoxically Developed Optochiasmatic Tuberculoma and Tuberculous Lymphadenitis: A Case Report with 18-Month Follow up by MRI

We report the first case ofextracranial tuberculous lymphadenitis which paradoxically developed during treatment of intracranial tuberculoma. Our patient, a 15-year-old girl who initially presented with meningitis and intracranial tuberculomas, developed extracranial tuberculomas during treatment for central nervous system tuberculosis. She was followed clinically with cerebrospinal fluid (CSF) studies and magnetic resonance imaging (MRI) at three monthly intervals. Within 18 months of specific antituberculous treatment, the patient had fully recovered. The course and response to therapy are discussed in light of the current literature.

Detection of Molluscum contagiosum Virus (MCV) Subtype I as a Single Dominant Virus Subtype in Molluscum Lesions from a Turkish Population

BACKGROUND

Molluscum contagiosum has a worldwide occurrence and its primary mode of transmission is via direct human contact including sexual means. The aim of the study was to implement a polymerase chain reaction-based assay for detection and subtyping of Molluscum contagiosum virus (MCV) in skin lesions diagnosed with molluscum contagiosum in a large regional teaching hospital in Turkey.

METHODS

For this purpose, a total of 61 patients were included in the study. Randomly selected single lesion from each patient was used to extract DNA material and a specific PCR reaction amplifying 393-bp- and 575-bp-long regions from MCV genome was used in the detection. Subtyping was carried out by digestion of the amplified 575-bp product with restriction endonuclease enzyme BamHI. Both amplified and restriction enzyme digested products visualized on agarose gel electrophoresis.

RESULTS

All 61 molluscum cases (100%) included in the study contained MCV genetic material as demonstrated by the presence of 393- and 575-bp-long PCR amplified products. Restriction enzyme BamHI digestion of the 575-bp-long amplicon indicated that the infecting subtype in all the cases (100%) was MCV subtype I.

CONCLUSIONS

Results of this study demonstrate that subtype I is the only infecting strain dominant in our region. Because the only consecutive molluscum patients admitted to our hospital were included in the study, our data do not rule out the possibility that other genotypes might be present in the Turkish population. However, it is not unreasonable to conclude that similar trends exist in the rest of the country. Results also show that a molecular-based diagnostic assay would be feasible in cases where diagnosis was deemed necessary.

Combined branched-DNA and conventional HBV PCR assays for detection of serum HBV-DNA in hepatitis B e antigen-positive chronic hepatitis B patients

BACKGROUND/AIMS

Monitoring of HBV replication level is very useful for the management of patients with chronic HBV. However, the use of the correct tools to quantify HBV-DNA levels in serum and monitor the replication of HBV is of paramount importance in terms of diagnosis, and antiviral treatment of patients with chronic HBV infection. The aim of this study was to combine the bDNA assay and HBV PCR to improve detection of viremia the patients with HBeAg-positive chronic hepatitis B infection.

METHODOLOGY

In this study, 67 HBeAg-positive chronic hepatitis B patients were analyzed to determine viremia level using bDNA and HBV PCR assays.

RESULTS

Sixty-four patients with HBeAg-positive chronic hepatitis B showed positivity by conventional HBV PCR, whereas 56 subjects with HBeAg-positive chronic hepatitis B showed HBV-DNA levels by bDNA.

CONCLUSIONS

The results indicated that it is reasonable to use the bDNA assay to determine HBV replicative activity first, and use conventional HBV-PCR for HBeAg-positive chronic hepatitis B patient samples that are negative in bDNA assay.

[Expression of the cathepsin L1 gene of Fasciola hepatica eucaryotic cells]

The parasitic trematode Fasciola hepatica is the causative agent of fasciolosis that is common in ruminants especially sheep and cattle and is occasionally found in humans. Fasciolosis has a worldwide distribution including Turkey and causes major economic losses in agricultural industry. Cathepsin L1 is one of the major molecules in the excretory-secretory products of F. hepatica and is involved in tissue penetration, immune evasion and feeding and therefore may be used in vaccination and serological diagnosis. The aim of this study was to evaluate cloning and expression of the cathepsin L1 gene of F. hepatica eucaryotic cells. For this purpose, total RNA was extracted from adult F. hepatica. Cathepsin L1 DNA amplicons were obtained with the reverse transcription polymerase chain reaction (RT-PCR). The 981 base-coding gene region of cathepsin L1 was amplified using specific primers to the cathepsin L1 gene. Then, the cathepsin L1 gene was cloned into the pCI-neo mammalian expression vector. The presence of the cathepsin L1 gene was confirmed by PCR screening and enzyme digestion assays. So, the resulting recombinant plasmid was named pFhCL1. Afterwards, the pFhCL1 vector was transiently transfected into Vero cells. The presence of the cathepsin L1 proteins was shown by Western immunoblotting.

Lipid peroxidation levels in patients with acute brucellosis

The purpose of this study was to investigate levels of lipid peroxidation, indicated by plasma malondialdehyde (MDA), with consideration of clinical status and treatment outcomes in patients with acute brucellosis. Plasma MDA levels were measured in patients with acute brucellosis and healthy subjects. Significantly higher MDA levels were detected in plasma of patients with acute brucellosis compared to controls (P<0.01). Plasma levels of MDA were significantly decreased after the brucellosis treatment (P<0.01). The results of the present study indicate for the first time that a considerable level of lipid peroxidation is involved in acute brucellosis cases and this may be of importance with respect to the understanding of disease pathogenesis and may serve as a target for treatment regime.

Prevalence and genotypic distribution of hepatitis GB-C/HG and TT viruses in blood donors, mentally retarded children and four groups of patients in eastern Anatolia, Turkey

We investigated the prevalence and genotypic distribution of GB virus-C/hepatitis G virus (GBV-C/HGV) and TT virus (TTV) in blood donors, mentally retarded children and four groups of patients living in Eastern Anatolia, Turkey. The prevalence and genetic analysis of TTV were determined by using the primers of the UTR and ORF1 regions of TTV, respectively. Reverse transcription nested (RT-n)-PCR was used to amplify 5' UTR of GBV-C/HGV. Genotyping of HGV was carried out by PCR-based genotyping assay while RFLP was conducted to determine the genotypes of TTV. TTV DNA was detected in 118 of 410 sera tested, giving an overall prevalence of 28.7%; GBV-C/HGV-RNA was detected in only 17 cases, giving an overall prevalence of 4.1%. No significant differences were observed in the number of positive or negative tests for GBV-C/HGV and TTV according to duration of illness or mean duration of institutionalization in any of the groups studied. Although all samples from the study population belonged to genotypes 1 and 4, the most common TTV genotype is G2. In conclusion, our results indicate a low endemicity of GBV-C/HGV and TTV infection in Eastern Anatolia, Turkey. The presence of G2 strains reveals the limited genetic diversity of the GBV-C/HGV circulating in Turkey. We suggest that TTV infection of genotypes 1 and 4 is prevalent in the same region.

Investigation of Epstein-Barr virus DNA in formalin-fixed and paraffin- embedded breast cancer tissues

OBJECTIVE

To investigate etiological role of Epstein-Barr virus (EBV) DNA in breast cancer.

MATERIALS AND METHODS

The presence of EBV DNA in 57 breast cancer tissues was investigated with a sensitive PCR assay. The breast cancer tissues were from invasive ductular (n=28), lobular (n=20) and other miscellaneous carcinomas (n=9). Tissues from normal breasts and patients with various benign breast diseases (n=55): fibrocystic disease (n=34), fibroadenoma (n=16), hyperplasia, and granulomatous mastitis (n=5), were used as control samples.

RESULTS

EBV DNA was detected in 13 (23%) cancerous tissues (7 ductular, 4 lobular, 2 other carcinoma) and 19 (35%) in the control tissues. The difference between EBV presence in malignant and benign tissues was not statistically significant (p>0.05).

CONCLUSION

The presence of EBV DNA was detected almost equally in both breast cancer and normal tissues, which indicates no etiological role for EBV in breast cancer. We suggest further etiological studies.

A case of brucella spondylodiscitis with extended, multiple-level involvement

Brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse was seen with a combined treatment (doxycycline/rifampin) for 3 months, followed by doxycycline alone for 6 months. Almost all radiologic findings disappeared at the end of a 1-year follow-up without any further treatment.

Serum neopterin levels in patients with chronic hepatitis B

The aim of this study was to determine the neopterin levels and peripheral blood lymphocyte subgroups in HBeAg-positive and -negative chronic hepatitis B patients. A total of 89 patients were included in the study. The mean serum neopterin level of patients with chronic hepatitis B was significantly higher than that of the control group. In HBeAg-positive chronic hepatitis B patients, the mean serum neopterin level was significantly higher than that of anti-HBeAb-positive patients. There was no significant correlation between the serum neopterin levels and alanine aminotransferase and HBV-DNA levels in HBeAg-positive chronic hepatitis B patients. There were no significant differences between the control subjects and patients with HBeAg-positive or anti-HBeAb-positive hepatitis in terms of the percentage of peripheral blood CD4+ or CD8+ or the ratio of CD4+/CD8+ lymphocytes. Our results suggest an association between elevated neopterin concentrations and HBeAg-positivity in patients with chronic hepatitis B. However, there appears to be no association between the neopterin levels and either hepatocyte damage or viral replication status.

Prevalence and genotypes of hepatitis G virus among hemodialysis patients in Eastern Anatolia, Turkey

OBJECTIVES

To study the prevalence and genotype distribution of hepatitis G virus (HGV) in hemodialysis patients in East Anatolia, Turkey.

SUBJECTS AND MATERIALS

Eighty-nine hemodialysis patients and 30 healthy individuals were analyzed by using reverse-transcriptase nested polymerase chain reaction with primers specific for 5' untranslated region. HGV genotyping was performed by PCR and three randomly selected HGV-positive samples were sequenced.

RESULTS

Of the 89 hemodialysis patients, HGV RNA was detected in 9 (10.2%). All of our isolates were assigned to genotype 2.

CONCLUSION

Our results showed that hemodialysis patients carry the risk for HGV infection in East Anatolia, Turkey.

Toxocariasis seroprevalence in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease for which immunogenetic susceptibility factors have been defined. The aim of this study was to investigate seroprevalence of Toxocara canis (T. canis) in patients with RA. Forty-five patients with RA who were all diagnosed according to the ACR criteria and 48 health controls were included in this study. The mean age of patients with RA and of controls was 50+/-14 and 49+/-13, respectively. In both groups T. canis IgG antibodies were investigated with ELISA. Toxocara canis seroprevalence in patients with RA (35.6%) was significantly higher than that in the control group (8.3%) (p=0.001). There was no significant difference between patients with RA and control group in terms of behavioral factors (except in frequency of hand washing), demographic and socio-economic factors, while there was a difference in terms of owning dogs and cats or in the duration of ownership. When the patients with RA were divided into seropositive and seronegative, there were no significant differences between both groups in terms of demographic factors, socio-economic factors, behavioral factors, owning dogs and cats or duration of ownership and active or remission state of the illness, duration of disease and disability level in patients with RA (p > 0.05). In view of the present results, it is suggested that Toxocara infection was acquired before RA had developed and that high seroprevalence may result from exposure to pets and soil. It seems that this subject requires further investigations with larger numbers of samples in order to fully evaluate the causes of high seropositivity.

A case of mumps conjunctivitis: detection of the virus RNA by nested PCR in tear sample

Mumps is a disease caused by a virus that can infect many parts of the body, especially the parotid salivary glands. A case of epidemic parotitis in an adult female affected by bilateral conjunctivitis is presented. Mumps virus was detected in tear samples by reverse transcription nested polymerase chain reaction (RT-n-PCR). The conjunctivitis resolved completely within 11 d.

Hepatocyte growth factor (HGF) in patients with hepatitis B and meningitis

OBJECTIVES

The present study investigates serum hepatocyte growth factor (HGF) levels in patients with acute and chronic hepatitis B and the relation between these levels and intrahepatic inflammatory markers of the liver and fibrosis, as well as the cerebrospinal fluid (CSF) HGF levels in patients with meningitis and the relation between these levels and CSF findings. To our knowledge this is the first study regarding CSF HGF levels in tuberculous meningitis.

PATIENTS AND METHODS

The study consisted of 35 patients with chronic hepatitis B (HbeAg and HBV-DNA positive), 20 with acute hepatitis B, 20 with acute bacterial meningitis and 15 having tuberculous meningitis. HGF levels in the serum and CSF samples were measured by using the ELISA method.

RESULTS

The mean serum HGF levels in acute hepatitis B group were found statistically significantly higher than those in the control group and chronic hepatitis B group (p<0.0001). It was established that serum HGF levels in patients with chronic hepatitis B were significantly correlated with serum alanine aminotransferase (ALT) and HBV-DNA levels (r: 0.816, 0.951; p<0.05, respectively). Similarly, serum HGF levels of patients with chronic hepatitis B were correlated with fibrosis score and hepatic activity index of the liver histopathology (r: 0.750, 0.459; p<0.05, respectively). The mean CSF HGF levels of patients with acute bacterial meningitis and tuberculous meningitis were higher than those in the control group (p<0.05). In addition, it was observed that mean CSF HGF levels in patients suffered from tuberculous meningitis were statistically significantly higher than those in acute bacterial meningitis (p<0.05).

CONCLUSIONS

We suggest that serum HGF level in patients with chronic hepatitis B might reflect viral load, necro-inflammatory activity in the liver and the degree of structural progression. Our findings have demonstrated that tuberculous meningitis cause increased HGF concentrations in CSF. It is, therefore, suggested that examination of HGF levels in CSF may provide additional information in the differential diagnosis.

Incidence of bacteraemia after urodynamic study

The aim of the present study was to determine the incidence of bacteraemia after urodynamic study (UDS) in patients with lower urinary tract symptoms, and to evaluate the role of bacteraemia as a morbidity factor related to UDS. A total of 57 patients (mean age: 52.8 years, range: 8-76 years) were evaluated by UDS. Prophylactic antibiotics were not administered to any of the patients before the procedure. Before UDS, urine cultures were examined for the presence of infection of the urinary tract (UTI). Venous blood was taken before and just after performing UDS. There was no bacterial growth in blood cultures of any patients before the UDS. Of the 57 patients, two had bacteriuria before study. After UDS, bacteraemia was determined in four (7%) out of 55 patients. The two patients with a bacteriuria before the procedure also had positive blood cultures. Infectious complications are the most important morbidity factors related to the UDS. Despite the use of strict aseptic techniques, bacteraemia may occur in patients undergoing UDS. The results of the present study may help when counselling patients who are to undergo UDS.

Role of L-carnitine in the prevention of acute liver damage induced by carbon tetrachloride in rats

BACKGROUND AND AIM

Lipid peroxidation is the most important mechanism in the pathogenesis of acute liver damage with carbon tetrachloride (CCl4). L-carnitine may prevent lipid peroxidation and thus may protect against liver damage. In the present study we investigated the protective effect of L-carnitine in experimental acute liver damage induced by CCl4.

METHODS

Fifty rats were allocated to five equal groups. The first group was the control (group 1), the second group received an intraperitoneal CCl4 injection for 3 days (group 2), and the third group received a 50 mg/kg subcutaneous L-carnitine injection for 4 days, beginning a day before CCl4 injection. The CCl4 injection was continued for 3 days in the concerned group (group 3). Group 4 was given a CCl4 injection for 7 days and group 5 received a 50 mg/kg subcutaneous L-carnitine injection for 8 days, beginning a day before CCl4 injection. This group continued to receive a CCl4 injection for 7 days. Rats in groups 2 and 3 were killed on the fifth day. Rats in groups 1, 4 and 5 were killed on the ninth day. Plasma and liver tissue malondialdehyde (MDA) levels, glutathione peroxidase (GSH-Px) activity and liver enzyme levels were studied. Histopathological investigations were conducted.

RESULTS

Liver tissue MDA levels decreased significantly in group 3 compared to group 2 (P<0.001). Liver tissue MDA levels in group 5 decreased significantly in comparison to those of group 4 (P<0.001). Liver tissue GSH-Px activity in group 5 was significantly lower than that in group 4 (P<0.05). There were no significant differences between groups 3 and 4 regarding GSH-Px activity (P>0.05). Steatosis, inflammation and necrosis in group 3 were significantly reduced when compared to group 2 (P<0.01). Fibrosis development was not identified in groups 2 and 3. Steatosis in group 5 was significantly lower than that in group 4 (P<0.05) and there were no significant differences between groups 4 and 5 with regards to inflammation and necrosis (P>0.05). Mild fibrosis development was identified in groups 4 and 5 but the difference between the groups was not significant.

CONCLUSION

It appears that L-carnitine has a protective effect in the early stage of experimental acute liver damage induced by CCl4. As the toxic effect or damage continues, its effect lessens.

The frequency of Toxocara infection in mental retarded children

Human toxocariasis is commonly seen in places where stray and Toxocara canis-infected dog population is high. There is a strong correlation between frequency of Toxocara infection, life style, and infection risk. Institutionalization of mental retarded patients increases to risk of toxocariasis. In this study, we aimed at investigating the frequency of Toxocara infection among children with mental retardation not requiring institutionalization. The study included 96 cases, who had educatable mental retardation and 85 healthy subjects who comprised the control group. Anti-Toxocara IgG or IgM antibodies were investigated in all serum samples, using ELISA method. The frequency of Toxocara infection was found significantly higher in mental retarded cases than in those in the control group (18.8% and 7.1% respectively) (p < 0.05). There was no significant difference between mental retarded children and the control group in terms of mean age, age groups, gender, owning dogs and cats and duration of their ownership, socio-economic level and behavioural factors, and personal hygiene (p > 0.05). We did not find any significant difference between Toxocara seropositive and seronegative mental retarded children in terms of demographic factors and epidemiological factors that could increase the risk of Toxocara infection (p > 0.05). The present study is the first seroprevalence study carried out with a mental retarded group not requiring institutionalization. Determination of high frequency of Toxocara infection suggests that these subjects constitute a risk factor for Toxocara infection, which may be attributed to their behavioural patterns.

Serum cytokine levels in patients with acute brucellosis and their relation to the traditional inflammatory markers

The number of clinical studies on gamma interferon (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha) and interleukin-4 (IL-4) in human brucellosis is limited. The present study was focused on IFN-gamma, TNF-alpha and IL-4 levels in acute brucellosis cases, in the acute phase and at the end of the treatment. The relation of these cytokines to traditional inflammation markers was also investigated. The study included 27 cases of acute brucellosis and 20 healthy volunteers who had no complaints. It was found that mean IFN-gamma and TNF-alpha levels, CRP (C-reactive protein) levels and ESR (erythrocyte sedimentation rate) values were significantly higher in acute brucellosis cases as compared to post-treatment values and values measured in the control group. In addition, IFN-gamma and TNF-alpha levels measured in the acute phase correlated with the increase in CRP levels and ESR values. Our results confirmed that IFN-gamma and TNF-alpha are involved in the pathophysiology of brucellosis and are closely related to the inflammatory activation of the disease. In view of the present findings, it is suggested that IFN-gamma and TNFalpha may be used for monitoring brucellosis.

Cutaneous Anthrax in Adults: A Review of 25 Cases in the Eastern Anatolian Region of Turkey

BACKGROUND

The clinical features, therapy and outcome of anthrax cases from the Elazig province (the eastern Anatolian region) of Turkey seen in our clinic over an 8-year period were reviewed.

PATIENTS AND METHODS

The records of 25 anthrax cases observed in our clinic during the period January 1994 to April 2002 were examined.

RESULTS

All cases were cutaneous; 18 (72%) patients exhibited malignant pustules and seven (28%) malignant edema. Three of the patients with a malignant pustule developed anthrax sepsis when admitted to our clinic. All cases were treated with penicillin. One patient who had penicillin allergy was treated with ciprofloxacin. In addition, patients with malignant edema were also treated with systemic corticosteroids (methylprednisolone or dexamethasone). Two patients died due to anthrax sepsis; one case with anthrax sepsis recovered. The mortality rate was 8%.

DISCUSSION

Anthrax is still a reality in Turkey. Cutaneous anthrax should be considered in any patient with a painless ulcer with vesicles, edema and a history of exposure to animals or animal products. In our series, penicillin and ciprofloxacin were effective in treatment of anthrax. Our anthrax sepsis case demonstrates that anthrax sepsis is not always fatal if antibiotic treatment is given early after diagnosis.

Levels of plasma malondialdehyde and erythrocyte antioxidant enzyme activities in patients with chronic hepatitis B

BACKGROUND/AIMS

Hepatitis B virus infection, extensively seen throughout the world, can become highly chronic. Pathogenesis of chronic hepatitis is not yet known fully. It is shown that oxidative stress may play a role in pathogenesis and may regulate collagen synthesis and thus may contribute to the process of liver damage. This study is aimed at investigating the existence of oxidative stress in chronic hepatitis B cases and its relation with alanine aminotransferase and aspartate aminotransferase which are the serum indicators of liver damage; along with interaction of erythrocyte antioxidation enzyme activities in the same cases.

METHODOLOGY

Eighty patients with chronic hepatitis B under follow-up, and 40 healthy volunteers were included in this study. In the control and patients groups, together with serological markers for viral etiology, alanine aminotransferase and aspartate aminotransferase levels; plasma malondialdehyde level; erythrocyte superoxide dismutase, glutathione peroxidase and catalase activities were analyzed.

RESULTS

Malondialdehyde levels of chronic hepatitis B cases were statistically high compared to control group (p < 0.05). There was correlation between serum malondialdehyde levels and serum alanine aminotransferase, aspartate aminotransferase levels in the patient group (r = 0.324, p < 0.01, r = 0.273, p < 0.05). Average superoxide dismutase and catalase activities were found to be significantly low compared to control group (p < 0.001); average glutathione peroxidase activity were significantly high when considered statistically (p < 0.001). No correlation between serum alanine aminotransferase and aspartate aminotransferase levels and glutathione peroxidase, catalase and superoxide dismutase activities was found in the patients group (p > 0.05).

CONCLUSIONS

In the study we showed that there is correlation between serum malondialdehyde level and alanine aminotransferase and aspartate aminotransferase levels of chronic hepatitis B patients. According to the results of our study, it might be thought that serum malondialdehyde level might be a marker of hepatocellular damage in chronic hepatitis B cases. We suggest that antioxidant treatment for chronic hepatitis B patients should be examined in future studies.

Seropositivity of Epstein-Barr virus in Eastern Anatolian Region of Turkey

In the present study, we have investigated the seropositivity of Epstein-Barr virus (EBV) and the epidemiological factors affecting this seropositivity. A total of 540 subjects living in central Elazig Province and its surroundings were enrolled in the study. IgG antibodies against capsid antigen of EBV (anti-VCA IgG) were determined by ELISA. Seropositivity was found to be 99.4%. There was a significant relationship between increased anti-VCA IgG levels and age, living in crowded families, exposure in public places and low income (p < 0.05). However, no significant alterations in serum anti-VCA IgG antibody were observed in terms of gender, blood transfusion and educational status (p > 0.05). In conclusion, we have demonstrated the commonly presence of EBV Infections in the public and contamination with the infection at early stages of life in the Elazig region. An overpopulated family environment, low income status and living in shared accommodation facilities play important roles in acquiring EBV infection.