Seroprevalence of Toxoplasma gondii in Different Patient Groups in Our Hospital

OBJECTIVE

Toxoplasma gondii (T. gondii) is an obligate intracellular parasite. It is regarded as an important cause of morbidity and mortality in congenital contamination and immunosuppressive patients. This study aimed to determine the seropositivity of T. gondii in various ages and patient groups, as well as to reveal the current immune status, especially in risk groups.

METHODS

Results of T. gondii serology conducted between 2015 and 2019 in the medical microbiology laboratory in a university hospital were retrospectively analyzed. In the study, anti-T. gondii IgM, anti-T. gondii IgG antibodies, and anti-T. gondii IgG avidity test results were investigated by the enzyme-linked fluorescent assay method. Additionally, seropositivity rates among immunosuppressed patients and pregnant women, which are risk groups for toxoplasmosis, were revealed. In the identification of the immunosuppressed patients, groups with significant immunosuppression were retrospectively determined by examining their files.

RESULTS

The serology of T. gondii was investigated in serum samples of a total of 20.875 individuals, among which 6.220 (29.8%) are males and 14.655 (70.2%) are females. Anti-T. gondii IgM and IgG positivity rates were significantly higher in women than in men. When all years are evaluated, IgM positivity in 16.448 patients and IgG positivity in 4.427 patients were investigated. In the 5-year period, T. gondii IgM seropositivity and T. gondii IgG seropositivity was among all the patients was 2.4% and 24.1%, respectively. While the rate of T. gondii IgG seropositivity in women of childbearing age was 36.1%, it was 42.4% in pregnant women and 14.6% in immunosuppressed patients.

CONCLUSION

T. gondii serology follow-up of pregnant women and immunosuppressed patients in terms of reactivity of latent infection should be advised and toxoplasmosis should be considered in suspicious clinical cases.

Comparative Evaluation of the Efficacy of Indirect Hemagglutination Test and Radiological Methods in the Pre-diagnosis of Cystic Echinococcosis

Objective

Cystic echinococcosis (CE) is a common public health concern in Turkey. In this study, we investigated the agreement between the results of radiological imaging methods and serological tests through a 5-year retrospective evaluation in patients admitted to a university hospital with a suspicion of CE so as to determine the frequency of CE in the study region.

Methods

The indirect hemagglutination test (IHA) results of 1.046 patients obtained from various clinics with the suspicion of CE between January 2014 and December 2018 were retrospectively analysed. Of these, patients with at least one radiological imaging report in the system (938 patients) were included in the study. Radiological imaging findings and IHA test results were compared and examined.

Results

Seropositivity was detected by IHA test in 143 (15.2%) of 938 patients included in the study. The CE findings were recorded in at least one radiological imaging report in 130 (90.9%) of 143 patients with positive IHA test. At least one of the radiological imaging reports suggested presence of CE in 362 (38.5%) of all the patients.

Conclusion

Thus, serological test and radiological imaging methods should be used in combination for the diagnosis of CE.

General Features and Laboratory Diagnosis of Toxoplasma gondii Infection

Toxoplasmosis is a common infection worldwide caused by Toxoplasma gondii, an intracellular parasite. The prevalence of Toxoplasmosis ranges from 17.5% to 69.5% in Turkey. Toxoplasmosis is mostly asymptomatic. It may cause fetal mortality in case of vertical passage. The most common clinical findings in congenital toxoplasmosis are chorioretinitis, hydrocephalus and cerebral calcification. Another group of susceptible patients for Toxoplasma gondii are immunesuppressive patients. Reactivation of a latent infection in the case of immunodeficiency can lead to fatal toxoplasmic encephalitis. Serological diagnostic methods based on the detection of specific antibodies for Toxoplasma gondii are the most commonly used diagnostic methods. However, it may be difficult to interpret the results in pregnant women, neonates, and the patients receiving treatment. It is stated that using more than one method together to improve the reliability of the diagnosis is a more accurate approach. In the prenatal diagnosis of congenital toxoplasmosis, in patients with immunodeficiency, in ocular toxoplasmosis, the polymerase chain reaction is seen as having a higher sensitivity. The aim of this review is to present the general features, diagnostic methods and current approaches in toxoplasma infection, an important public health problem.

[Urogenital Myiasis Caused by Psychoda spp. in Female Patient with No Risk Factor for Myiasis]

Myiasis is defined as follows; some flies lay their eggs and larvae on live organs and tissues or on cavities of nose, eye, ear and etc of humans or animals and the larvae develop there and cause pathological disorders. One of the rare types of myiasis is the urogenital myiasis. This condition has been associated with covering urogenital area with clothes in almost all populations and therefore, less chance for flies to reach this site and lay their eggs. Low socio-cultural level and poor hygiene conditions are stated as the most important risk factors of myiasis. On the other hand, toilets within the human living spaces are ideal environments for fly larvae that are fed on bacteria as they contain moisture and a microbial environment. It is stated that especially in case of the presence of an underlying infection, flies are more prone to lay their eggs or larvae on this area due to the bad smell. In this case report, a patient with a moderate sociocultural level with no underlying chronic disease, no open wound in the genital area and no urinary tract infection was presented. A 53-year-old female patient living with her family in an apartment flat in the city center of Konya admitted to the outpatient clinic of infectious diseases with the complaint of moving worms in her urine. The patient stated that she had seen maggots while urinating for two weeks and that she passed her urine into a container to be sure that the maggots were coming from her urine, upon seeing the maggots there she has admitted to the hospital. The Larvae were defined as the fourth stage larvae of Psychoda spp. No open lesions or wounds were seen in genitourinary area of the patient who had no complaints other than mild urinary burning. Complete blood count test results of the patient were normal and there was no growth in her urine culture. It was stated that other family members whom she lived with did not have similar complaints. The patient was diagnosed as genitourinary myiasis caused byPsychoda spp. and informed about the relationship between hygiene and the disease. And urinary antiseptics were initiated as the treatment for the patient. After the treatment, no larvae were seen in the urine of the patient. In conclusion, many regions are suitable for Psychoda type of adult flies to live in our country due to the climate conditions. It is considered that infestation may develop in patients with less risk factors in terms of urogenital myiasis, that larvae may increase in number of patients who are not treated or followed up and that the infestation may become chronic and results in more serious clinical conditions. The necessary treatment and follow-up must be performed in such cases and the patients should be educated about the relationship between infestation and hygiene.

Investigation of Respiratory Tract Pathogen Human Parechoviruses in Konya, Turkey

Objective This study aims to better understand the epidemiological characteristics of parechoviruses and to determine the genotype distribution in Konya, Turkey.

Methods In this study, nasal and throat swab samples taken from 1,110 children who were diagnosed with respiratory tract infection (bronchitis, pneumonia, asthmatic bronchitis, and other respiratory diseases) and applied to various pediatric polyclinics of Meram Medical Faculty Hospital, Necmettin Erbakan University between September 2017 and March 2019 were evaluated. Human parechovirus (HPeV) RNA was investigated by multiplex polymerase chain reaction (PCR) in respiratory tract samples. Specific genotypes of the positive samples were identified by real-time PCR amplification of the VP1 region followed by sequence analysis.

Results Of the total of 1,110 samples, 4 were positive for HPeV. Of these, HPeV1 was the most predominant genotype (n = 3), followed by HPeV4 (n = 1). HPeV infections were detected throughout the year in Konya, Turkey.

Conclusion Although the number of positive samples for HPeV is low, these findings provide information about the genetic diversity and epidemiological of HPeV genotypes circulating in pediatric patients in Turkey. This is the first study to detect prevalence and genotyping of HPeV in respiratory tract infections in Turkey. HPeVs should be considered as causative agents especially in infants with sepsis, meningitis, or encephalitis, and routine testing panels for HPeV detection should be available in hospital laboratories. Further studies using molecular epidemiological methods will be beneficial for identifying genotypes of all HPeVs involved in the etiology and for better monitoring of these infections.

[A dog related Demodex spp. infestation in a student: a rare Demodex case]

Demodicosis is an ectoparasitic cutaneous infestation of pilosebaceous unit caused by Demodex mites. Demodex spp. are considered to be pathogenic when they increase in number and infect dermis.They can be the cause of diseases such as pityriasis folliculorum, papulopustular rosacea, granulomatous rosacea, inflammatory papule, acne vulgaris, perioral dermatitis, blepharitis and folliculitis. These mites can be found in most mammals including human. Canine and feline demodicosis is a well-known example of severe dermatitis caused by the proliferation of Demodex mites. Dogs are one of the most popular pets worldwide with well-being feeling to their owners. However, they may cause a health risk to humans due to their zoonotic diseases potential. Demodicosis is a severe and prevalent dermatologic disease in dogs. In this case report, a Demodex case thought to be related with a dog infestation was presented. A twenty-year-old girl student who feeds a Miniature Pinscher crossbred dog in her house for a while noticed common itchy papulopustular lesions, incrustation and some alopecic loci in her dog and admitted to Selçuk University Faculty of Veterinary Medicine, Department of Parasitology. Itchy papules and pustules were also observed in dog's owner face and arm about three or four weeks later. Skin scrapings and hair samples were taken from the patient and the dog and examined with light microscope. Adult and egg forms of Demodex spp. were detected in both patient and dog specimens in microscopic examination. Ivermectin treatment was recommended as 0.2 mg/kg for the dog. The owner of the dog was sent to a dermatology clinic and topical permethrin was recommended for the treatment. At the end of the first month the dog was controlled again, a whole clinical and microscopic improvement was observed and all of the lesions were disappeared for both the dog and its owner. This demodicosis case, thought to originate from a dog, is a rare condition because of Demodex mites are known to be highly host specific and not a zoonotic parasite. Although host specific cross infections between humans and animals have been rarely reported, D. canis was determined to be more transmissible across species than the other Demodex mites as indicated in the literature. As a result, it is necessary and important to keep in mind about Demodex spp. infestation in patients with skin complaints and pet feeding.

A rare cause of bacteremia in a pediatric patient with Down syndrome: Sphingomonas paucimobilis

Sphingomonas paucimobilis, is a yellow-pigmented, aerobic, non fermentative, gram negative motile bacillus. S. paucimobilis which is widely found in nature and hospital environments rarely cause serious or life threatening infections. In this report, a case of hospital acquired bloodstream infection due to S. paucimobilis in a patient with Down syndrome who was on treatment for presumed pneumonia is presented. A one year-old child patient who was a known case of Down syndrome and had previously experienced cardiac surgery was hospitalized and treated for pneumonia. On the 12th day of hospitalization, blood cultures were taken because of a high body temperature. One of the blood cultures was positive for gram-negative rods. After 48 hour of incubation, the sub-cultures on blood agar medium yielded pure growth of a yellow, non-fermentative, gram-negative, rod-shaped bacterium. The microorganism was positive for oxidase, and esculin hydrolysis, while negative for urea and nitrate reduction, citrate utilisation and motility. The isolate had been identified as S. paucimobilis by using Vitek 2 system. The antibiotic susceptibility test was also performed with the same system and the strain was found to be susceptible to piperacillin-tazobactam and other antibiotics. Treatment with intravenous piperacilin-tazobactam (150 mg/kg/day) was initiated. He responded well to the treatment and was discharged after 10 days. This case is reported to emphasize that S. paucimobilis should be kept in mind as a nosocomial infectious agent in patients with Down syndrome and immunosuppressive patients and the infections should be treated according to the sensitivity test results.