Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Colonization of Legionella Species in Turkish Baths in Hotels in Alanya, Turkey(2015) Erdogan, Haluk; Arslan, Hande; 0000-0002-5708-7915; 0000-0002-9033-4236; 25850992; ABG-7034-2021; O-2247-2015This study evaluated the prevalence of Legionella species in water samples collected from Turkish baths in hotels in Alanya, Turkey, from August 2003 to September 2013. Water samples were collected in 100-mL sterile containers and then concentrated by filtration. Heat treatment was used to eliminate other microorganisms from the samples, which were then spread on Legionella-selective-buffered charcoal yeast extract alpha (BCYE-alpha) agar and on BCYE-alpha agar supplemented with glycine, vancomycin, polymyxin, and cycloheximide. Cysteine-dependent colonies were identified by latex agglutination. In total, 135 samples from 52 hotels with Turkish baths were evaluated. Legionella species were identified in 11/52 (21.2 %) hotels and 18/135 (13.3%) samples. The most frequently isolated species was Legionella pneumophila, with most isolates belonging to serogroups 6 (55.6 %) and 1 (22.2 %). The colony count was <100 colony-forming units (CFU) mL(-1) in nine samples, from 100 to 1000 CFU mL(-1) in six samples, and >1000 CFU mL(-1) in three samples. These findings suggest that the hot water systems of Turkish baths in hotels must be viewed as a possible source of travel-associated Legionnaires' disease, and preventative measures should be put in place.Item Acute Respiratory Distress Syndrome Associated with Legionnaires' Disease: Two Case Reports(2018) Erdogan, Haluk; Arslan, Hande; 0000-0002-9033-4236; 0000-0002-5708-7915; O-2247-2015; ABG-7034-2021Introduction: Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of illness, bilateral chest radiographic infiltrates consistent with pulmonary edema, and poor systemic oxygenation. ARDS has severe morbidity and mortality. The most common risk factor for the development of community-acquired ARDS is severe sepsis with a pulmonary source of infection. The first step in the therapy of ARDS is identification and treatment of the underlying disease. Here, we report two cases of ARDS associated with Legionnaires disease. Case 1: A 54-year-old male tourist with diabetes mellitus apply to our institution with diarrhea and high fever. At the time of admission, the patient had a temperature of 39.5 degrees C, a blood pressure of 140/70 mmHg, a heart rate of 102 beats/min and a respiratory rate of 24 breaths/min. His oxygen saturation was 93% while breathing room air. Chest examination revealed rales and the chest x-ray showed right-lower zone infiltrates. Legionella urinary antigen was positive on admission day. Treatment with levofloxacin (1000 mg/day) was started in the first 4 hours of admission after taking cultures. The patient had progressive dyspnea and cyanosis was developed. Analysis of arterial blood gas revealed a pH of 7.29, CO2 pressure of 30 mmHg, O-2 pressure of 37 mmHg and oxygen saturation of 62%. Roentgenogram of the chest worsened and showed bilateral infiltration, indicating ARDS. Thirty-two hours after admission, the patient was admitted to intensive care unit for ventilator support. The patient's clinical status continued to deteriorate. He was hypotensive and required dopamine infusions for blood pressure support. Legionella pneumophila serogroup 1 was isolated on sputum culture. Five days after hospitalization, chlarithromycin (1000 mg/day) and ciprofloxacin (1200 mg/day) were substituted for the initial antibiotics. The patient had nosocomial pneumonia caused by methicilline resistant Staphylococcus aureus during subsequent days. Vancomycine 2 gr/days was added to treatment. Clinical status improved and the body temperature fell below 37.5 degrees C on the eleventh day. On the patient's relatives' request, he was flown back to his country by air ambulance. One year later, the patient came back again as a tourist and had fully recovered from the illness. Case 2: A 82-year-old female with diabetes mellitus applied to our institution with high fever, dyspnea and mental change. She had been treated for pulmonary edema without any response to this therapy in a private hospital. She had been hospitalized in another hospital due to gastrointestinal bleeding approximately two weeks prior to her application. Chest examination revealed diffuse rales and the chest x-ray showed bilateral infiltrates. Analysis of arterial blood gas revealed pH of 7.31, CO2 pressure of 41.7 mm Hg, O-2 pressure of 21.9 mmHg and oxygen saturation of 33.6%. The patient was admitted to intensive care unit for ventilator support. Legionella urinary antigen was positive on admission day. Treatment with ciprofloxacin (1200 mg/day) and chlarithromycin (1000 mg/day) was started on admission after taking cultures. Legionella pneumophila serogroup 1 was isolated on endotracheal aspirate culture. The patient died on the 7th day. Conclusions: The clinicians should be aware of Legionnaires disease in etiology of ARDS. Early diagnosis and treatment are important factors in determining prognosis.Item Antimicrobial Resistance of Salmonella Isolates in A Holiday Center on the South of Turkey(2016) Erdogan, Haluk; Erdogan, Askin; Arslan, Hande; 0000-0002-9033-4236; 0000-0002-5708-7915; O-2247-2015; AAD-5420-2020; ABG-7034-2021Objective: Salmonella is an important pathogen that causes food-borne infection in children and adults worldwide. The aim of this study is to evaluate the antimicrobial activity of antimicrobial agents against Salmonella isolates in Alanya, an important holiday center in Turkey. Material and Method: The study was carried out at Baskent University Alanya Research and Teaching Hospital between January 2004 and September 2013. Salmonella spp. were isolated from stool samples and stored at -80 degrees C for antimicrobial susceptibility. Antimicrobial susceptibility was determined according to the Clinical and Laboratory Standards Institute (CLSI) criteria. The antimicrobial agents tested against Salmonella spp. included ampicillin, trimethoprim-sulfamethoxazole, tetracycline, chloramphenicol, nalidixic acid, ciprofloxacine and ceftriaxone. Quality control was ensured by testing Escherichia coli ATCC 25922. Results: A total of 63 consecutive Salmonella spp. were assessed for their antimicrobial susceptibility patterns, 21 of which were obtained from travellers. Serogroup D1 was the most common serotype (65.1%), followed by B (22.2%), A (7.9%), C1 (1.6%) and C2-C3 (3.2%). The resistances against ampicillin, tetracycline, trimethoprim-sulfamethoxazole and chloramphenicol were found to be 15.9%, 15.9%, 14.3%, and 11.1%, respectively. None of the strains was resistant to ciprofloxacin and ceftriaxone, while 14.3% were nalidixic acid-resistant. Antimicrobial resistance rates of Salmonella isolates obtained from travellers and local residents were not significantly different (p>0.05). Conclusion: This study suggests that ciprofloxacin and ceftriaxone can be used as empirical therapies in patients who are suspected to have salmonellosis with predisposing factors to severe infection and a history of travel to Alanya, Turkey. However, the nalidixic acid resistance of Salmonella isolates may be a cause for concern.