Vulvovajinal kandidoz, tum dunyada, ozellikle dogurganlik cagindaki kadinlari etkileyen bir probl... more Vulvovajinal kandidoz, tum dunyada, ozellikle dogurganlik cagindaki kadinlari etkileyen bir problemdir. Gunumuzde mevcut olan ilac terapileri, yuksek guvenilirlik ve etkinlige sahip olsalar da, meydana gelen komplike enfeksiyonlar ve ilac direnc problemi, arastirmacilari; yeni oral ve lokal terapotik alternatiflere yonlendirmektedir. Bu calismada, bir borik asit turevi ve proteosom inhibitoru olan ZL3B'nin Candida turleri uzerine in vitro etki mekanizmasini arastirmayi amacladik.Calismamizda; Haziran 2010 - Aralik 2010 tarihleri arasinda, Ankara Universitesi Tip Fakultesi Kadin Hastaliklari ve Dogum Kliniginde VVK on tanisi almis ve Cebeci Hastanesi Merkez Mikrobiyoloji laboratuvarinda kulturu yapilmis vajinal suruntu orneklerinden, standart yontemlerle izole edilen, rast gele secilmis 23 hasta ornegi ve 2 standart koken (C. albicans ATCC 90028, C. crusei ATCC 6258) olmak uzere toplam 25 Candida izolati kullanilmistir. Calismaya alinan, 23 kokenin 11'i (%45.4) C. albicans, 8...
Bu çalışma streptokoksik farenjitli çocuklarda benzatirı penisilin C, penisilin V ve azitromisin ... more Bu çalışma streptokoksik farenjitli çocuklarda benzatirı penisilin C, penisilin V ve azitromisin tedavilerinin etkinliği ve emniyetini karşılaştırmak amacıyla yapılmıştır. Boğaz kültüründe beta hemolitik streptokok üreyen, yaşları 7-77 arasındaki 197 çocuk çalışmaya alınmıştır. Hastalardan 85'i benzatin penisilin C (BPG), 57'si penisilin V (PV) ve 55'i azitromisin ile tedavi edilmiştir. Hastalar tedaviyi izleyen 10. ve 20. günlerde klinik ve bakteriolojik olarak değerlendirilmiştir. Tüm tedavi gruplarında yeterli klinik yanıt saptanmıştır. Bakteriolojik eradikasyon oranı ilk kontrolde BPG grubunda % 95.6, PV ve azitromisin grubunda % 97.8 olarak saptanmıştır. İkinci kontrolde ise rekürrens oranı BPG grubunda % 3.1, PV ve azitromisin grubunda %2.3'dür. Hiç bir hastada ciddi yan etki görülmemiştir.
Introduction. The aim of this prospective singlecenter study was to determine the changings in in... more Introduction. The aim of this prospective singlecenter study was to determine the changings in incidence of invasive pneumococcal disease (IPD), serotype distribution and the antimicrobial resistance patterns of S. pneumoniae in children with IPD after the period (1 to 7 years) of vaccination with PCV7 (2008) and PCV13 (2011). Population and methods. The study was conducted on 39 Turkish children with IPD between ages 1 month and 18 years in Ankara, Turkey. Streptococcus pneumoniae was identified using standard laboratory procedures from blood, cerebrospinal fluid (CSF), pleural fluid, and other sterile body fluids and tissues. S. pneumoniae isolates were tested for resistance to penicilin and ceftriaxone using the E-test methodology. Serotypes of the isolates were determined by Quellung reaction. Results. The overall annual incidence rate of IPD decreased significantly from 7.71 (95% CI, 1.99-13.4) to 1.58 (95% CI, 0.6-3.77; RRR=-79.5; p= 0.006) per 100 000 population among ≤5 years of age without underlying disease. During the overall study period, the PCV7-serotypes and PCV13-serotypes represented 27.8% and 63.8% of isolates, respectively. PCV13-serotypes made up 81.8% of cases of IPD in the pre-PCV13 era and decreased to 56% in the 4 years after PCV13. The penicillin and ceftriaxone (for meningitis) resistance rates were 48.5% and 9.1%, respectively. Conclusions. This is the first study about the changing pattern of the incidence of IPD in Turkish children after the implementation of the PCV7 and PCV13 in Turkish national vaccine schedule and a prominent decrease in incidence of IPD has seen after the implementation of PCV13.
Kerion celsi is generally known as an inflammatory form of tinea capitis which is the result of d... more Kerion celsi is generally known as an inflammatory form of tinea capitis which is the result of delayed type hypersensitivity reaction of the body to fungal agents. It causes a painful, inflamed, crusty mass on the scalp and is often associated with purulent drainage and regional lymphadenopathy. Kerion celsi is often reported in children between three to seven years of age and it has a male predominance. This diagnosis should be kept in mind in patients with scalp scaling and alopecia, especially if they have pustular, crusted and nodular lesions and easily breaking hairs on the scalp. If untreated, alopecic scar tissue inevitably develops on the scalp. Differential diagnosis with bacterial pyoderma or abscess is important and may avoid unnecessary and inappropriate surgical drainage. Although causative species show variations between regions, zoophilic dermatophytes such as Microsporum canis, Trichophyton verrucosum and Trichophyton interdigitale complex are usually isolated from cultures. Herein, we report a ten year-old boy who was referred to our clinic because of pyodermic skin lesion and abscess formation which did not respond to antibacterial treatment. He was diagnosed as kerion celsi related to Trichosporon asteroides and successfully treated with systemic fluconazole within eight weeks. To our knowledge this is the first case of kerion celsi in the literature caused by T. asteroides.
Featured in New York Times "Searching the Web for Flu Outbreaks" November 28, 2008 Usin... more Featured in New York Times "Searching the Web for Flu Outbreaks" November 28, 2008 Using Internet Searches for Influenza Surveillance Philip M. Polgreen, Yiling Chen, David M. Pennock, and Forrest D. Nelson One study, published by the journal Clinical Infectious ...
... Betül Ulukol Bulut* Ayla Günlemez* Derya Aysev* Şükrü Cin ... Bu araştırmaya Şubat 1995... more ... Betül Ulukol Bulut* Ayla Günlemez* Derya Aysev* Şükrü Cin ... Bu araştırmaya Şubat 1995-Ocak 1996 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi Çocuk Hastalıkları Polikliniğine üst solunum yolu enfeksiyo-nuna ilişkin yakınmalar ve semptomlar ile başvuran ...
This study was performed to determine the effectiveness of the Breese scoring system for the diag... more This study was performed to determine the effectiveness of the Breese scoring system for the diagnosis of streptococcal pharyngitis with respect to different age groups. Two hundred and two children aged three years and younger (Group 1), and 514 children over three years old (Group 2) with complaints of acute pharyngitis were evaluated by Breese scoring and throat-swab cultures. In Group 1, no significant difference was detected in Breese scoring between subjects who had positive and negative culture for group A beta-hemolytic streptococci (GABHS). However, in Group 2 the mean value of the Breese scores was found to be higher in subjects who had positive GABHS. The diagnostic value of Breese scoring was examined for each group. Its sensitivity, and positive and negative predictive values were higher in Group 2 than in Group 1. In conclusion, Breese scoring was determined to be helpful in the diagnosis of streptococcal pharyngitis in children over three years of age.
The aim of this study is to document the clinical characteristics and outcomes of Acinetobacter b... more The aim of this study is to document the clinical characteristics and outcomes of Acinetobacter baumannii infections in pediatric patients in a pediatric intensive care unit (PICU) in Turkey. The ages ranged from 1 month to 16 years with a mean age of 55.5 months, and the male-to-female ratio was 1:1.5. Ventilator-associated pneumonia (10 patients) was the leading diagnosis, followed by catheter-related blood stream infection (4 patients), and bacteremia and ventilator-associated pneumonia associated with meningitis (1 patient) due to A. baumannii. Mechanical ventilation (93.3%), central venous catheter (73.3%), urinary catheter (93.3%), and broad spectrum antibiotic usage (80%) were the frequently seen risk factors. Neuromuscular (40%) and malignant (26.7%) disorders were the most common underlying diseases. Nosocomial A. baumannii is commonly multidrug-resistant, prolongs the length of stay in the PICU and increases the mortality rates in pediatric critical care.
The aims of the study were to examine the distribution of Candida spp. isolated from sterile body... more The aims of the study were to examine the distribution of Candida spp. isolated from sterile body sites, the antifungal susceptibility of the isolates to amphotericin B, fluconazole, voriconazole, and caspofungin, and factors affecting mortality with invasive Candida infections in children. Thirty-five children with invasive candidiasis between January 2004 and January 2008 were evaluated retrospectively. The antifungal susceptibility of isolated Candida species was studied by Etest. Of the invasive Candida infections, 65.7% were due to C. albicans. The second most common isolated species was C. parapsilosis (11.4%). The rates of resistance to fluconazole, amphotericin B and voriconazole were 8.5%, 2.8% and 5.7%, respectively. Caspofungin was the most effective antifungal agent. 22.8% of the patients died in the first 30 days. In univariate analyses, increased mortality was associated with stay in the intensive care unit, the presence of central venous catheter (CVC), failure to rem...
The multidrug-resistant bacterial infections cause high mortality in immunocompromised patients b... more The multidrug-resistant bacterial infections cause high mortality in immunocompromised patients because of the limited antibacterial choices. Tigecycline, first member of the glycylcyclines, has in vitro activity against a wide variety of organisms, including multidrug-resistant pathogens; however, it has not yet been approved for use in children. Herein, we report a nine-year-old girl with acute myeloid leukemia who was treated successfully with tigecycline due to multidrug-resistant Escherichia coli bacteremia.
The purpose of this study was to investigate the effects of pneumococcal conjugate vaccine (PCV7)... more The purpose of this study was to investigate the effects of pneumococcal conjugate vaccine (PCV7) on nasopharyngeal (NP) carriage rates of Streptococcus pneumoniae in healthy Turkish children. The study was conducted on 1101 healthy Turkish children between 1 month and 18 years of age. The median and mean ages of the children were 25 months (1 month-18 years) and 45.7±49.6 months, respectively. S. pneumoniae was isolated in 241/1101 (21.9%) children included in the study. According to multivariate analysis, being <5 years of age, presence of a child attending a daycare center, recovery from respiratory infection within the last month, low income level of the family, and presence of more children in the family were found to be the risk factors for the NP pneumococcal carriage. The carriage rate of NP pneumococci in healthy children was not influenced by PCV7 in Turkey.
Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of ... more Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of the fact that penicillin is preferred in the treatment of infections caused by S. pneumoniae, there has been a world-wide increase in the frequency of penicillin-resistant S. pneumoniae. One hundred and fifty sick children with a clinical diagnosis of pneumonia, meningitis, acute otitis media, acute sinusitis and septicemia or bacteremia, and 150 healthy children without any infection were examined. Streptococcus pneumoniae, which were isolated from the nasopharynx, were analyzed with respect to penicillin susceptibility using the agar dilution method. The S. pneumoniae carriage rate was observed to be 43.3% in the group of sick children and 30.0% in the control group (P &lt; 0.05). The penicillin resistance of S. pneumoniae isolated from the nasopharynx was determined to be 35.4% from a total of 110 isolates, with an intermediate resistance of 32.7% and a high resistance of 2.7%. The penicillin resistance of S. pneumoniae carried in the nasopharynx was determined to be 41.5% in the group of sick children and 26.6% in the control group (P &gt; 0.05). Resistance rates of other antibiotics were determined as follows: cefotaxime 2.7%, erythromycin 19%, clarithromycin 5.4%, tetracycline 21.8%, trimethoprim-sulfamethoxazole 4.5% and rifampin 0%. Penicillin resistance of S. pneumoniae has recently become a problem in Turkey. Because of this, we require new strategies to limit the spread of drug-resistant S. pneumoniae.
Vulvovajinal kandidoz, tum dunyada, ozellikle dogurganlik cagindaki kadinlari etkileyen bir probl... more Vulvovajinal kandidoz, tum dunyada, ozellikle dogurganlik cagindaki kadinlari etkileyen bir problemdir. Gunumuzde mevcut olan ilac terapileri, yuksek guvenilirlik ve etkinlige sahip olsalar da, meydana gelen komplike enfeksiyonlar ve ilac direnc problemi, arastirmacilari; yeni oral ve lokal terapotik alternatiflere yonlendirmektedir. Bu calismada, bir borik asit turevi ve proteosom inhibitoru olan ZL3B'nin Candida turleri uzerine in vitro etki mekanizmasini arastirmayi amacladik.Calismamizda; Haziran 2010 - Aralik 2010 tarihleri arasinda, Ankara Universitesi Tip Fakultesi Kadin Hastaliklari ve Dogum Kliniginde VVK on tanisi almis ve Cebeci Hastanesi Merkez Mikrobiyoloji laboratuvarinda kulturu yapilmis vajinal suruntu orneklerinden, standart yontemlerle izole edilen, rast gele secilmis 23 hasta ornegi ve 2 standart koken (C. albicans ATCC 90028, C. crusei ATCC 6258) olmak uzere toplam 25 Candida izolati kullanilmistir. Calismaya alinan, 23 kokenin 11'i (%45.4) C. albicans, 8...
Bu çalışma streptokoksik farenjitli çocuklarda benzatirı penisilin C, penisilin V ve azitromisin ... more Bu çalışma streptokoksik farenjitli çocuklarda benzatirı penisilin C, penisilin V ve azitromisin tedavilerinin etkinliği ve emniyetini karşılaştırmak amacıyla yapılmıştır. Boğaz kültüründe beta hemolitik streptokok üreyen, yaşları 7-77 arasındaki 197 çocuk çalışmaya alınmıştır. Hastalardan 85'i benzatin penisilin C (BPG), 57'si penisilin V (PV) ve 55'i azitromisin ile tedavi edilmiştir. Hastalar tedaviyi izleyen 10. ve 20. günlerde klinik ve bakteriolojik olarak değerlendirilmiştir. Tüm tedavi gruplarında yeterli klinik yanıt saptanmıştır. Bakteriolojik eradikasyon oranı ilk kontrolde BPG grubunda % 95.6, PV ve azitromisin grubunda % 97.8 olarak saptanmıştır. İkinci kontrolde ise rekürrens oranı BPG grubunda % 3.1, PV ve azitromisin grubunda %2.3'dür. Hiç bir hastada ciddi yan etki görülmemiştir.
Introduction. The aim of this prospective singlecenter study was to determine the changings in in... more Introduction. The aim of this prospective singlecenter study was to determine the changings in incidence of invasive pneumococcal disease (IPD), serotype distribution and the antimicrobial resistance patterns of S. pneumoniae in children with IPD after the period (1 to 7 years) of vaccination with PCV7 (2008) and PCV13 (2011). Population and methods. The study was conducted on 39 Turkish children with IPD between ages 1 month and 18 years in Ankara, Turkey. Streptococcus pneumoniae was identified using standard laboratory procedures from blood, cerebrospinal fluid (CSF), pleural fluid, and other sterile body fluids and tissues. S. pneumoniae isolates were tested for resistance to penicilin and ceftriaxone using the E-test methodology. Serotypes of the isolates were determined by Quellung reaction. Results. The overall annual incidence rate of IPD decreased significantly from 7.71 (95% CI, 1.99-13.4) to 1.58 (95% CI, 0.6-3.77; RRR=-79.5; p= 0.006) per 100 000 population among ≤5 years of age without underlying disease. During the overall study period, the PCV7-serotypes and PCV13-serotypes represented 27.8% and 63.8% of isolates, respectively. PCV13-serotypes made up 81.8% of cases of IPD in the pre-PCV13 era and decreased to 56% in the 4 years after PCV13. The penicillin and ceftriaxone (for meningitis) resistance rates were 48.5% and 9.1%, respectively. Conclusions. This is the first study about the changing pattern of the incidence of IPD in Turkish children after the implementation of the PCV7 and PCV13 in Turkish national vaccine schedule and a prominent decrease in incidence of IPD has seen after the implementation of PCV13.
Kerion celsi is generally known as an inflammatory form of tinea capitis which is the result of d... more Kerion celsi is generally known as an inflammatory form of tinea capitis which is the result of delayed type hypersensitivity reaction of the body to fungal agents. It causes a painful, inflamed, crusty mass on the scalp and is often associated with purulent drainage and regional lymphadenopathy. Kerion celsi is often reported in children between three to seven years of age and it has a male predominance. This diagnosis should be kept in mind in patients with scalp scaling and alopecia, especially if they have pustular, crusted and nodular lesions and easily breaking hairs on the scalp. If untreated, alopecic scar tissue inevitably develops on the scalp. Differential diagnosis with bacterial pyoderma or abscess is important and may avoid unnecessary and inappropriate surgical drainage. Although causative species show variations between regions, zoophilic dermatophytes such as Microsporum canis, Trichophyton verrucosum and Trichophyton interdigitale complex are usually isolated from cultures. Herein, we report a ten year-old boy who was referred to our clinic because of pyodermic skin lesion and abscess formation which did not respond to antibacterial treatment. He was diagnosed as kerion celsi related to Trichosporon asteroides and successfully treated with systemic fluconazole within eight weeks. To our knowledge this is the first case of kerion celsi in the literature caused by T. asteroides.
Featured in New York Times "Searching the Web for Flu Outbreaks" November 28, 2008 Usin... more Featured in New York Times "Searching the Web for Flu Outbreaks" November 28, 2008 Using Internet Searches for Influenza Surveillance Philip M. Polgreen, Yiling Chen, David M. Pennock, and Forrest D. Nelson One study, published by the journal Clinical Infectious ...
... Betül Ulukol Bulut* Ayla Günlemez* Derya Aysev* Şükrü Cin ... Bu araştırmaya Şubat 1995... more ... Betül Ulukol Bulut* Ayla Günlemez* Derya Aysev* Şükrü Cin ... Bu araştırmaya Şubat 1995-Ocak 1996 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi Çocuk Hastalıkları Polikliniğine üst solunum yolu enfeksiyo-nuna ilişkin yakınmalar ve semptomlar ile başvuran ...
This study was performed to determine the effectiveness of the Breese scoring system for the diag... more This study was performed to determine the effectiveness of the Breese scoring system for the diagnosis of streptococcal pharyngitis with respect to different age groups. Two hundred and two children aged three years and younger (Group 1), and 514 children over three years old (Group 2) with complaints of acute pharyngitis were evaluated by Breese scoring and throat-swab cultures. In Group 1, no significant difference was detected in Breese scoring between subjects who had positive and negative culture for group A beta-hemolytic streptococci (GABHS). However, in Group 2 the mean value of the Breese scores was found to be higher in subjects who had positive GABHS. The diagnostic value of Breese scoring was examined for each group. Its sensitivity, and positive and negative predictive values were higher in Group 2 than in Group 1. In conclusion, Breese scoring was determined to be helpful in the diagnosis of streptococcal pharyngitis in children over three years of age.
The aim of this study is to document the clinical characteristics and outcomes of Acinetobacter b... more The aim of this study is to document the clinical characteristics and outcomes of Acinetobacter baumannii infections in pediatric patients in a pediatric intensive care unit (PICU) in Turkey. The ages ranged from 1 month to 16 years with a mean age of 55.5 months, and the male-to-female ratio was 1:1.5. Ventilator-associated pneumonia (10 patients) was the leading diagnosis, followed by catheter-related blood stream infection (4 patients), and bacteremia and ventilator-associated pneumonia associated with meningitis (1 patient) due to A. baumannii. Mechanical ventilation (93.3%), central venous catheter (73.3%), urinary catheter (93.3%), and broad spectrum antibiotic usage (80%) were the frequently seen risk factors. Neuromuscular (40%) and malignant (26.7%) disorders were the most common underlying diseases. Nosocomial A. baumannii is commonly multidrug-resistant, prolongs the length of stay in the PICU and increases the mortality rates in pediatric critical care.
The aims of the study were to examine the distribution of Candida spp. isolated from sterile body... more The aims of the study were to examine the distribution of Candida spp. isolated from sterile body sites, the antifungal susceptibility of the isolates to amphotericin B, fluconazole, voriconazole, and caspofungin, and factors affecting mortality with invasive Candida infections in children. Thirty-five children with invasive candidiasis between January 2004 and January 2008 were evaluated retrospectively. The antifungal susceptibility of isolated Candida species was studied by Etest. Of the invasive Candida infections, 65.7% were due to C. albicans. The second most common isolated species was C. parapsilosis (11.4%). The rates of resistance to fluconazole, amphotericin B and voriconazole were 8.5%, 2.8% and 5.7%, respectively. Caspofungin was the most effective antifungal agent. 22.8% of the patients died in the first 30 days. In univariate analyses, increased mortality was associated with stay in the intensive care unit, the presence of central venous catheter (CVC), failure to rem...
The multidrug-resistant bacterial infections cause high mortality in immunocompromised patients b... more The multidrug-resistant bacterial infections cause high mortality in immunocompromised patients because of the limited antibacterial choices. Tigecycline, first member of the glycylcyclines, has in vitro activity against a wide variety of organisms, including multidrug-resistant pathogens; however, it has not yet been approved for use in children. Herein, we report a nine-year-old girl with acute myeloid leukemia who was treated successfully with tigecycline due to multidrug-resistant Escherichia coli bacteremia.
The purpose of this study was to investigate the effects of pneumococcal conjugate vaccine (PCV7)... more The purpose of this study was to investigate the effects of pneumococcal conjugate vaccine (PCV7) on nasopharyngeal (NP) carriage rates of Streptococcus pneumoniae in healthy Turkish children. The study was conducted on 1101 healthy Turkish children between 1 month and 18 years of age. The median and mean ages of the children were 25 months (1 month-18 years) and 45.7±49.6 months, respectively. S. pneumoniae was isolated in 241/1101 (21.9%) children included in the study. According to multivariate analysis, being <5 years of age, presence of a child attending a daycare center, recovery from respiratory infection within the last month, low income level of the family, and presence of more children in the family were found to be the risk factors for the NP pneumococcal carriage. The carriage rate of NP pneumococci in healthy children was not influenced by PCV7 in Turkey.
Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of ... more Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of the fact that penicillin is preferred in the treatment of infections caused by S. pneumoniae, there has been a world-wide increase in the frequency of penicillin-resistant S. pneumoniae. One hundred and fifty sick children with a clinical diagnosis of pneumonia, meningitis, acute otitis media, acute sinusitis and septicemia or bacteremia, and 150 healthy children without any infection were examined. Streptococcus pneumoniae, which were isolated from the nasopharynx, were analyzed with respect to penicillin susceptibility using the agar dilution method. The S. pneumoniae carriage rate was observed to be 43.3% in the group of sick children and 30.0% in the control group (P &lt; 0.05). The penicillin resistance of S. pneumoniae isolated from the nasopharynx was determined to be 35.4% from a total of 110 isolates, with an intermediate resistance of 32.7% and a high resistance of 2.7%. The penicillin resistance of S. pneumoniae carried in the nasopharynx was determined to be 41.5% in the group of sick children and 26.6% in the control group (P &gt; 0.05). Resistance rates of other antibiotics were determined as follows: cefotaxime 2.7%, erythromycin 19%, clarithromycin 5.4%, tetracycline 21.8%, trimethoprim-sulfamethoxazole 4.5% and rifampin 0%. Penicillin resistance of S. pneumoniae has recently become a problem in Turkey. Because of this, we require new strategies to limit the spread of drug-resistant S. pneumoniae.
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