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    Characterization of pncA mutations of pyrazinamide-resistant Mycobacterium tuberculosis in Turkey
    (Edizioni Int Srl, 2009) Yuksel, Pelin; Tansel, Ozlem
    Mutations in the pyrazinamidase (PZase) gene (pncA) are considered the major mechanism of pyrazinamide (PZA) resistance in Mycobacterium tuberculosis. The aim of this study was designed to determine pncA mutations among ten PZA resistant and two PZA susceptible M. tuberculosis strains from Turkey and also to compare the PZase activity of them with the genotype. All isolates were identified by BACTEC NAP (P-nitro-alpha-acetylamino-beta-hydroxy-propiophenone)test and PCR-RFLP (Polymerase Chain Reaction-Restriction Fragment Length Polymorphism) method. Drug sensitivity tests were performed by BACTEC system. PncA mutations were detected by DNA sequence analysis. No mutation was detected in two PZA susceptible and three out of tell PZA resistant strains. While, two of the PZA resistant strains had mutations in the same region (Gly24Asp), two of the PZA resistant strains had mutations in different regions (Thr160Lys), (His51Pro). Three of the PZA resistant strains had frameshift as a 167 bp deletion at nucleotide position 102. As a result, we detected two new mutations and a frameshift which may be responsible for PZA resistance in this study different from the other studies which previously 51st codon mutation was reported.
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    Community-Based Seroepidemiology of Diphtheria and Tetanus in Edirne, Turkey
    (Natl Inst Infectious Diseases, 2009) Tansel, Ozlem; Ekuklu, Galip; Eker, Alper; Kunduracilar, Hakan; Yulugkural, Zerrin; Yuksel, Pelin
    The aim of this study was to evaluate the seroprevalence and correlates of diphtheria and tetanus in Edirne, Turkey. Tetanus and diphtheria antitoxin levels were determined by enzyme-linked immunosorbent assay. Among 99 participants, a diphtheria antitoxin level of >= 0.1 IU/mL was found in 97 (98%), while 2 (2%) had antitoxin levels of 0.011-0.099 IU/mL. The geometric mean titers (GMTs) in men were statistically higher. Among 295 participants, a tetanus antitoxin level of >= 0.1 IU/mL was found in 291 (98.6%), while 4 (1.4%) had antitoxin levels of 0.011-0.099 IU/mL. Participants who had completed secondary school or higher education showed higher GMT values. Additionally, participants vaccinated within the previous 5 years had higher GMT values and the percentage of participants who had completed secondary school or higher education was higher among them. GMTs decrease with increasing age and increase as the poverty index increases. The average socioeconomic status index of the participants was high for both diphtheria and tetanus seroepidemiology. In this community-based study, antitoxin levels of diphtheria and tetanus were high. However, revaccination of adults with tetanus-diphtheria toxoids at every opportunity (military service, pregnancy, post-injury prophylaxis, etc.) together with a single booster every 10 years should be considered as an immunization policy.
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    Evaluation of Twelve Patients with Tuberculous Meningitis
    (Ortadogu Ad Pres & Publ Co, 2008) Eker, Alper; Tansel, Oezlem; Yuksel, Pelin; Celik, Ayguel Dogan
    Objective: To assess the presentation, diagnosis and treatment of patients with tuberculous meningitis (TM). Material and Methods: Clinical and laboratory findings of 12 patients with TM, followed-up between 2000 and 2004, were evaluated retrospectively. Results: Seven male and five female patients were enrolled in this study. The mean age of the patients was 34.5 years. Culture of cerebrospinal fluid (CSF) in 10 cases revealed Mycobacterium tuberculosis. None of the CSF samples was positive for acid-fast bacteria (AFB) by Ehrlich-Ziehl-Neelsen (EZN) staining. M. tuberculosis was also isolated from the sputum sample of one patient. Isoniasid (INH) resistance was detected in two isolates. The most frequent finding on cranial computerized tomography (CT) and magnetic resonance imaging (MRI) was tuberculoma. Hydrocephalus was observed in 4 cases. Five patients had pulmonary lesions on chest radiographs. One patient had cavitation on the right upper zone, one patient had bilateral apical hyperdensity, and three patients had miliary involvement. Liver toxicity due to anti-tuberculosis drugs developed in 2 patients. Paradoxical enlargement of tuberculomas was detected during therapy in one case. Cranial MRI appeared to be more sensitive than CT in detecting intracranial lesions of four patients. Three patients died and neurological sequels developed in three patients. Conclusion: Early diagnosis and treatment is of major importance in TM, which is the most serious form of extrapulmonary tuberculosis. However, some problems such as drug toxicity and resistance, and occurrence of paradoxical response during follow up cause problems in treatment course.
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    Seroepidemiology of Toxoplasmosis and the Theoretical Incidence of Congenital Toxoplasmosis in Women of Reproductive Age in Edirne, Turkey. A Community Based Study
    (Ortadogu Ad Pres & Publ Co, 2009) Tansel, Ozlem; Ekuklu, Galip; Kunduracilar, Hakan; Eker, Alper; Yulugkural, Zerrin; Yuksel, Pelin
    Objective: The aims of this community-based study were to determine the seroprevalence of toxoplasmosis in women of reproductive age, to identify the risk factors, and to estimate theoretical incidence of congenital toxoplasmosis in Edirne city center. Material and Methods: Sera from 96 women representing the female population in the city center were tested for toxoplasma IgG antibody using the ELISA technique, For each participant, a questionnaire was completed to provide information on socio-demographic data, obstetrical history, and life style parameters. The relation between toxoplasma positivity and probable risk factors was investigated with chi-square and independent samples t test during statistical analysis. Results: The ages of the study population ranged from 15 to 49 years with a mean age of 31.2 years. 33 (34.4%) of 96 women were positive for toxoplasma IgG antibody. The mean age of women with seropositive samples was 34.2 +/- 10.4 years. The mean age of seronegative women was 29.7 +/- 9.2 years. Although the mean age was higher in seropositive women when compared with seronegative, the rates of seropositivity were not significantly different between age groups (p = 0.246). Toxoplasma seropositivity was 85.7% for women with high income and 100% for women with low income. This difference was statistically significant (p = 0.025). The other risk factors were not significantly different between seropositive and seronegative cases. The mean theoretical incidence of congenital toxoplasmosis was 0.7% in our study and it decreased from 1.3% to 0.2% as the person aged. Conclusion: Approximately two out of every three reproductive age women in Edirne city center is at risk of toxoplasmosis. The risk of congenital toxoplasmosis is higher for babies of women aged 15-24 years. These results underline the necessity of promoting preventive measures for toxoplasmosis in reproductive age women.