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    A Case of Rib Tuberculosis and Chest Wall Abscess with Multi-Drug Hypersensitivity Reactions
    (ANKARA MICROBIOLOGY SOC, 2015) Akduman Alasehir, Elcin; Sariman, Nesrin; Yaman, Gorkem; Olgac, Muge; Saygi, Attila
    Extrapulmonary tuberculosis is the reactivation of the remaining latent organism which spreads during primary infection by the lymphohematogenous way. It should be considered in the differential diagnosis especially in endemic countries for tuberculosis. Tuberculosis (TB) treatment is based on the principle of the combined use of several drugs. As a result of the combination therapy there can be life threatening side effects which can lead to improper use of medications and may also cause drug resistance. In this report, we present an 85-year-old male patient desensitized due to the development of allergy against multi-drugs with rib tuberculosis and chest wall abscess to whom, culture, drug susceptibility and genotypical tests were applied. In November 2012, the patient applied to a medical center with complaints of swelling and pain under the right rib, underwent rib resection and eventually diagnosed as rib TB by histopathological examination. However, the anti-TB treatment was discontinued due to the hypersensitivity reactions in the skin and in addition to the hepatic and renal dysfunction side effects. The patient had widespread redness, rash and pruritus on the body and the laboratory findings were as follows; ALT: 114 U/L, AST: 152 U/L, ALP: 93 U/L, GGT: 26U/L, blood urea nitrogen (BUN): 26 mg/dL and creatinine: 1.7 mg/dL. After the disapperance of the complaints within 3 days of drug discontinuation, isoniazid treatment was initiated. However, the new treatment was also discontinued when the reactions reoccurred. Afterwards, the patient developed hypersensitivity reactions against the combination of streptomycin and ethambutol. The patient refused any further treatment and was discharged from the hospital. The patient was untreated for the last 5 months and admitted to our clinic with a fistulized swelling and abscess in the right chest wall. Bacteria was not detected in the acid-fast staining of the abscess material, however Mycobacterium tuberculosis was isolated from culture by MGIT (Mycobacteria Growth Incubator Tube; BBL MGIT, BD, USA) system. The spoligotyping revealed that the genotype was Haarlem 1. Major drug susceptibility testing against rifampin, streptomycin, ethambutol, isoniazid, and pyrazinamide yielded sensitivity to those drugs. Minor drug susceptibility testing against paraaminosalicylic acid, ethionamide, kanamycin, capreomycin and ofloxacin was found to be sensitive. A regimen of isoniazid 300 mg/day, ethambutol 1000 mg/day and moxifloxacin 400 mg/day was initiated. Rapid oral desensitization against isoniazid and ethambutol were repeated on two consecutive days. The patient continued antituberculosis therapy for 12 months without adverse reactions. The chest wall fistula was closed. Abscess was drained surgically. Clinical and radiological improvements were achieved. The patient remains clinically disease free and continues his regular follow ups. This case is presented to emphasize about the importance of culture and susceptibility testing in extrapulmonary tuberculosis cases and desensitization in drug hypersensitivity reactions.
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    Evaluation of mycobacterial microscopy and culture results of Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital: A 3-year analysis
    (TURKISH ASSOC TUBERCULOSIS & THORAX, 2016) Akduman Alasehir, Elcin; Balikci, Ahmet; Partal, Mualla; Catmabacak, Gulay; Yaman, Gorkem
    Introduction: Effective diagnosis of tuberculosis is of great importance for transmission control and treatment success. The purpose of this study is to evaluate microscopic examination results of Ehrlich-Ziehl Neelsen (EZN) and Auramine-Rhodamine staining methods and automated BACTEC MGIT 960 (TM) system and Lowenstein-Jensen (L-J) culture results of various clinical samples in the light of recent data from the world and Turkey. Materials and Methods: Specimens that were sent from various clinics to Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital Microbiology Laboratory from January 2012 to December 2015 were evaluated retrospectively. Results: From a total of 62456 samples; 60923 (97.5%) were pulmonary and 1533 (2.5%) were non-pulmonary samples, especially pleura. 2853 (4.6%) Acid-resistant bacilli (ARB) positivity was detected and mycobacterial culture positivity was in total 12.2%. 7076 (93%) and 535 (7%) mycobacteria other than tuberculosis (MOTT) strains were isolated. In 356 specimens the cultures were negative in despite the positive ARB results. Considering mycobacterial culture as the gold standard; the sensitivity, specificity, positive and negative predictive values of ARB microscopy were 32.8%, 99.4%, 87.5% and 91.4%, respectively. The contamination rates in total were within acceptable limits being 2.7% for L-J and 3.8% for MGIT. Conclusion: Analysis of our data indicated that the sensitivity of microscopy is low and it should be evaluated together with the mycobacterial culture to rule out tuberculosis infection. With the use of fluorescent staining and also L-J and MGIT broth together for routine culture since 2013; ARB false negativity rate was observed to fall to 51.7% from 74.1% compared to the years. The follow-up of data such as the sensitivity of microscopy, culture positivity, false-positivity and false-negativity rates and contamination values is of great importance in terms of assessing compliance with laboratory quality standards and contributing to the surveillance studies.
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    The seroprevalence of hepatitis A in Istanbul, Turkey
    (MARMARA UNIV, FAC MEDICINE, 2017) Karadeniz, Asli; Akduman Alasehir, Elcin; Yesilbag, Zuhal; Balikci, Ahmet; Yaman, Gorkem
    Objective: Hepatitis A, a leading cause of enterically transmitted acute viral hepatitis throughout the world, has changed its pattern in developing countries. The objective of this study is to determine the current seroprevalence of hepatitis A virus (HAV) for different age groups in Istanbul, Turkey. Materials and Methods: Serum samples of 3,868 patients, which had been previously taken, were used to determine anti-HAV IgG levels by the microparticle enzyme immunoassay (MPEIA) method (Architect SR i1000 and i2000, Abbott Diagnostics, Germany) between January 2011 and December 2013. Results: The prevalence of total anti-HAV antibodies was 64.8% for all patients. Among the 3,868 serum samples tested, 54% were from male patients and 46 % were from female patients. Seropositivity rates among the age groups were determined and anti-HAV antibody positivity rates were 55% for the 0-16 age group; 47% for the 17-30 age group; 73.5% for the 31-45 age group and the seroprevalence increased significantly from 50% (972/1944) in 0 to 30 years old to 89% in patients older than 46 years. Conclusion: The low seronegativity rates in young adults, show this group to be at high risk of acquiring an HAV infection. The results support the routine vaccination of children and the seronegative young adults against HAV.