Subtype Distribution of Blastocystis in Türkiye

Blastocystis is an anaerobic protozoan with global importance because of infecting a variety of hosts and having high prevalence in many countries. Blastocystis isolates display remarkable genetic differences, and many subtypes (STs) have currently been defined based on polymorphism in SSU rRNA coding gene. Each 25 subtype may have different characteristics such as pathogenicity, host specificity, and structural variations. Most current research on Blastocystis has focused on these differences and molecular epidemiology. This review aimed to provide a summary of Blastocystis subtype distribution in Türkiye. Regarding human samples, 16 manuscripts were found in the literature, which presented 783 Blastocystis isolates from 9 cities in Türkiye. The most common subtype was ST3 (47.9%), the others were ST1 30 (17.5%), ST2 (14.7%), ST4 (4%), and ST5-ST7 (15.9%). There were few studies on animal hosts and environmental samples. The faecal samples from rats, farm, and pet animals were examined for Blastocystis subtypes and ST1, ST3, ST4-ST7, ST10, and ST12-ST14 were reported. In addition, two studies reported Blastocystis ST1 and ST3 subtypes in environmental water samples. In conclusion, the review of available literature showed that a systematic understanding of the subtype distribution of 35 Blastocystis in Türkiye is still lacking. Most of the studies were performed in a limited number of cities, animal hosts, and environmental samples, therefore, more studies from different provinces are needed in forthcoming research. The majority studies were performed in a limited number of provinces, animal species and very few environmental samples, so in the future; there is a need of novel studies that evaluate more samples from different provinces.

Arthropod vectors of disease agents: their role in public and veterinary health in Turkiye and their control measures

Mosquitoes, sandflies, and ticks are hematophagous arthropods that pose a huge threat to public and veterinary health. They are capable of serving as vectors of disease agents that can and have caused explosive epidemics affecting millions of people and animals. Several factors like climate change, urbanization, and international travel contribute substantially to the persistence and dispersal of these vectors from their established areas to newly invaded areas. Once established in their new home, they can serve as vectors for disease transmission or increase the risk of disease emergence. Turkiye is vulnerable to climate change and has experienced upward trends in annual temperatures and rising sea levels, and greater fluctuations in precipitation rates. It is a potential hotspot for important vector species because the climate in various regions is conducive for several insect and acari species and serves as a conduit for refugees and immigrants fleeing areas troubled with armed conflicts and natural disasters, which have increased substantially in recent years. These people may serve as carriers of the vectors or be infected by disease agents that require arthropod vectors for transmission. Although it cannot be supposed that every arthropod species is a competent vector, this review aims to (1)illustrate the factors that contribute to the persistence and dispersal of arthropod vectors, (2)determine the status of the established arthropod vector species in Turkiye and their capability of serving as vectors of disease agents, and (3)assess the role of newly-introduced arthropod vectors into Turkiye and how they were introduced into the country. We also provide information on important disease incidence (if there's any) and control measures applied by public health officials from different provinces.

Efficacy of malachite green mediated photodynamic therapy on treatment of Cutaneous Leishmaniasis: In vitro study

BACKGROUND

Leishmaniasis is a common zoonotic disease that is transmitted by phlebotomus and causes several clinical conditions, from self healing lesion to deadly internal organ involvement. Photodynamic therapy (PDT) is a treatment method that leads to the generation of cytotoxic species and consequently to cell death and tissue destruction by visible light in the presence of a photosensitizer and oxygen. The aim of this study was to investigate effect of malachite green (MG)-mediated PDT in Leishmania tropica (L. tropica) promastigotes.

MATERIAL AND METHODS

Parasites were incubated with 0.19, 0.39, 1.56, 3.25 and 6.25 μM of MG for one hour and subjected to 46.4 J/cm² light irradiation. Trypan blue assay was used to evaluate the viability of the cells and mitochondirial activity alteration was determined by MTT. Morphological changes were analyzed by Giemsa staining and Scanning electron microscopy (SEM) analyses. Flow cytometry was used to quantify the fluorescence emitted by cell volume, JC-1, Cell Cycle and Annexin V/PI staining reagents.

RESULTS

Malachite green mediated photodynamic therapy at 1.56 and 3.125 μM decreased the viability of the L. tropica promastigotes and induced changes in the mitochondrial membrane potential. L.tropica promastigotes was bloked in G0/G1 phase. The morphology of the parasite was affected at the 1.56 and 3.125 μM MG+PDT, resulting in rounded cells with loss of flagellum and irregular shape.

CONCLUSIONS

This study demonstrated that antileishmanial effects through mitochondrial dysfunction, cell cycle arrest, and apoptosis-like cell death to parasites. This work showed PDT with MG effectedparasites. Therefore, MG-mediated PDT may provide a promising approach for L. tropica promastigotes.

[An In Vitro Study on Sonodynamic Therapy of Leishmania tropica Using Curcumin]

Leishmaniasis is an infectious disease that is transmitted by Phlebotomus, 400 thousand new cases appearing every year, and approximately 350 million people are at risk, and accepted by the World Health Organization as one of the six important tropical diseases. Cutaneous leishmaniasis is a disease that occurs on exposed areas of the body and is characterized by long-term non-healing skin lesions. Although the treatment methods applied today vary according to the clinical picture of the patient, the immune system of the person and the causative agent Leishmania species, there is still no standard treatment scheme that has few side effects and can be used in the treatment of leishmaniasis. Therefore, alternative treatment methods with less side effects are being tried. Sonodynamic therapy (SDT) has also emerged as an active antimicrobial research area in recent years. SDT, a new modality for antibacterial therapy, aims to increase antibacterial effects with the simultaneous combination of low-intensity ultrasound and sonosensitizer. There is no information in the literature about the effect of SDT on parasites. In this study, it was aimed to demontrate the anti-leishmanial effect and possible mechanisms of curcumin mediated SDT on L.tropica promastigotes in vitro. Parasites were incubated with 0.25, 1.0, 4.0 and 15.6 micromolar (μM) of curcumin for one hour and subjected to 1 MHz frequency, 50% duty cycle and 3 W/cm2 intensity ultrasound irradiation. XTT assay was used to evaluate the viability of the cells and morphological changes were analyzed by Giemsa staining. Flow cytometry was used to quantify the fluorescence emitted by intracellular reactive oxygen species (ROS) signal, JC-1, cell cycle, Annexin V/PI staining reagents. With the combination of curcumin (15.6 μM) and ultrasound (3 W/cm2 intensity, seven minutes), L.tropica promastigote viability was found to be significantly decreased compared to the control group. Giemsa staining results showed that 15.6 μM curcumin mediated SDT induced several morphological alterations in L.tropica promastigotes typical for apoptosis. Late apoptosis was observed in 15.6 μM curcumin combined SDT treated parasites according to Annexin/PI staining. Besides, curcumin mediated SDT caused mitochondrial membrane potential (∆ᴪm) loss. Cell cycle analysis data indicated that curcumin based SDT caused an subG1 arrest in the cell cycle of L.tropica promastigotes. The generation of intracellular ROS detected by flow cytometry was increased in L.tropica promastigotes treated with curcumin mediated SDT. This study provided new data elucidating the molecular mechanism underlying the anti-leishmanial effect of curcumin mediated SDT. Curcumin mediated SDT has the potential to inactivate L.tropica promastigotes. However, further testing with amastigote or animal models is needed.

Evaluation of photodynamic therapy against Leishmania tropica promastigotes using different photosensitizers

BACKGROUND

Photodynamic therapy is a two-step procedure, involving the use of photosensitizing agents followed by selective illumination of the target lesion with visible light. Photodynamic therapy has been described recently as a promising strategy for treatment of leishmaniasis. This study aims to evaluate the in vitro phototoxic, morphological, and apoptotic effect of methylene blue, toluidine blue, chloro-aluminum phthalocyanine, and pheophorbide a-mediated photodynamic therapy on the viability of Leishmania tropica promastigotes.

METHODS

Parasites were treated with methylene blue, toluidine blue, chloro-aluminum phthalocyanine, and pheophorbide a or/and methylene blue, toluidine blue, chloro-aluminum phthalocyanine, and pheophorbide a-mediated photodynamic therapy, and cell proliferation, morphological changes, and apoptosis were evaluated by XTT, giemsa staining, DAPI staining, and DNA fragmentation, respectively.

RESULTS

Parasite viability was significantly different in between the groups treated with methylene blue, toluidine blue, and pheophorbide a, with or without irradiation. chloro-aluminum phthalocyanine treatment did not lead to any alterations in cell viability in Leishmania tropica promastigotes with or without irradiation. DAPI staining results indicated that apoptotic bodies and nucleus fragmentation started to be visible in methylene blue, chloro-aluminum phthalocyanine, and pheophorbide a-mediated photodynamic therapy groups. DNA ladder pattern which is used to define apoptosis was observed in irradiated methylene blue, chloro-aluminum phthalocyanine, and pheophorbide a groups.

CONCLUSIONS

The results revealed that apoptosis-induced cell death was observed in Leishmania tropica promastigotes after the application of photosensitizers in combination with light irradiation.

Antiprotozoal activity of different Xenorhabdus and Photorhabdus bacterial secondary metabolites and identification of bioactive compounds using the easyPACId approach

Natural products have been proven to be important starting points for the development of new drugs. Bacteria in the genera Photorhabdus and Xenorhabdus produce antimicrobial compounds as secondary metabolites to compete with other organisms. Our study is the first comprehensive study screening the anti-protozoal activity of supernatants containing secondary metabolites produced by 5 Photorhabdus and 22 Xenorhabdus species against human parasitic protozoa, Acanthamoeba castellanii, Entamoeba histolytica, Trichomonas vaginalis, Leishmania tropica and Trypanosoma cruzi, and the identification of novel bioactive antiprotozoal compounds using the easyPACId approach (easy Promoter Activated Compound Identification) method. Though not in all species, both bacterial genera produce antiprotozoal compounds effective on human pathogenic protozoa. The promoter exchange mutants revealed that antiprotozoal bioactive compounds produced by Xenorhabdus bacteria were fabclavines, xenocoumacins, xenorhabdins and PAX peptides. Among the bacteria assessed, only P. namnaoensis appears to have acquired amoebicidal property which is effective on E. histolytica trophozoites. These discovered antiprotozoal compounds might serve as starting points for the development of alternative and novel pharmaceutical agents against human parasitic protozoa in the future.

Wound Myiasis in Diabetic Foot Ulcer: Calliphoridae and Sar-cophagidae Family

Background:

Myiasis is a parasitic infestation of tissues or body cavities of mammals with dipterous larvae. The patients with diabetic foot ulcers are more vulnerable to acquiring infestation; however, the infestation may be neglected and mistreated in some cases.

Methods:

Data were collected of twelve myiasis cases with diabetic foot ulcers in Nazli-Selim Eren Chronic Wound and Infections Care Unit, Aydin, Turkey between 2017 and 2019. Demographic, clinical characteristics of the patients and clinical examination of the wound were recorded. To morphology-based identification method of the agents, the developmental stages of the maggots were examined.

Results:

The cases aged between 46 and 81 years (10 males, two females). Eight of the larvae collected from wounds had Calliphoridae and four had Sarcophagidae family. The larvae were infested right/left foot sole, thumb, ankle, and mostly left toes. The number of larvae collected from the cases ranged from 2 to 48. Third-stage larvae (L3) were mostly detected. Mixed (L1-L2, L2-L3) larvae were detected in a patient. The infestations were more common in July and August. According to the score of Infectious Diseases Society of America (IDSA), ten (83%) cases had moderate and two (17%) cases were mild diabetic foot infections (DFIs).

Conclusion:

Diabetic foot ulcers should be evaluated in terms of myiasis. This was the first study in our province indicating that myiasis should not be neglected and different species of flies were responsible for myiasis cases.

Investigation of Dientamoeba fragilis Frequency in Faecal Samples of Patients with Enterobius vermicularis Infection by Polymerase Chain Reaction

Objective

Dientamoeba fragilis (D. fragilis) is a flagellated protozoan with an amoeba-like morphology, located in the gastrointestinal tract. The hypothesis was that the parasite was transported by Enterobius vermicularis (E. vermicularis) eggs. This study aimed to determine the association of D. fragilis and E. vermicularis with the genotypes of the identified strain of D. fragilis. Results of trichrome staining were compared with those of polymerase chain reaction (PCR), which is widely used in the diagnosis of D. fragilis.

Methods

A total of 391 samples were obtained. The stool and cellophane slide samples were sent together to the Parasitology Department Laboratory, Faculty of Medicine, Aydın Adnan Menderes University, between 1 October 2017 and 1 October 2018. Stool samples of all patients with E. vermicularis (n=74) and without E. vermicularis (n=74) infection were used. All samples were examined for the presence of D. fragilis by trichrome staining and PCR. The 18S ribosomal RNA region of D. fragilis isolates was sequenced. Demographic characteristics and clinical findings of the patients were evaluated.

Results

D. fragilis was detected in 42 (28.37%) of 148 samples; 28 (66.6%) of them were detected in patients with E. vermicularis infection. The coexistence of two parasites was significant (p<0.05). All isolates sequenced were genotype 1. No significant relationship was found between the presence of parasites and clinical findings, living area and gender (p>0.05).

Conclusion

D. fragilis is frequently associated with E. vermicularis, so the presence of D. fragilis should be also considered in affected patients. The use of high-sensitivity molecular methods such as PCR is important in preventing false results.

Amaç

Dientamoeba fragilis (D. fragilis), amip benzeri morfolojiye sahip, gastrointestinal yerleşimli, kamçılı bir protozoondur. Parazitin Enterobius vermicularis (E. vermicularis) yumurtalarıyla taşındığı hipotezi kabul görmektedir. Çalışmamızda D. fragilis ve E. vermicularis birlikteliğini incelemek, bulunan D. fragilis’lerin genotiplerini belirlemek ve D. fragilis tanısında yaygın olarak kullanılan trikrom boyama ile polimeraz zincir reaksiyon (PZR) yöntemlerini karşılaştırmak amaçlanmıştır.

Yöntemler

Çalışmamızda Aydın Adnan Menderes Üniversitesi Tıp Fakültesi, Parazitoloji Laboratuvarı’na 1 Ekim 2017-1 Ekim 2018 tarihleri arasında dışkı ve selofan lam örneği birlikte gönderilmiş toplam 391 olgu örneği incelenmiştir. Selofanlı lam örneklerinde E. vermicularis saptanan tüm gönüllü olguların (74 olgu) dışkı örneği ile E. vermicularis negatif 74 olgunun dışkı örneği çalışılmıştır. Tüm dışkılar trikrom boyama ve PZR yöntemleri ile D. fragilis varlığı açısından incelenmiştir. Saptanan D. fragilis izolatlarının 18S ribozomal RNA bölgesi sekanslanmıştır. Olguların demografik özellikleri ve kliniği değerlendirilmiştir.

Bulgular

Toplam 148 olgunun 42’sinde (%28,37) D. fragilis saptanmıştır. D. fragilis pozitif olan 42 olgunun %66,6’sını E. vermicularis pozitif olgular oluşturmuş ve iki parazitin birlikteliği anlamlı bulunmuştur (p<0,05). Sekanslanan tüm izolatlar genotip 1 olarak saptanmıştır. Klinik bulgular, yaşanılan bölge ve cinsiyet ile parazit varlığı arasında anlamlı bir ilişki saptanamamıştır (p>0,05).

Sonuç

Araştırmamızda D. fragilis’in sıklıkla E. vermicularis ile birliktelik gösterdiği ve bu olgularda D. fragilis varlığına ayrıca dikkat edilmesi gerektiği vurgulanmıştır. Yanlış sonuçları engellemede, yüksek duyarlılığa sahip PZR gibi yöntemlerin önemi bir kez daha görülmüştür.

First Molecular Characterisation of Blastocystis from Experimental Rats in Turkey and Comparison of the Frequencies Between Obese and Non-obese Groups

Objective

Blastocystis is a zoonotic protozoan that infects a wide range of animals, including humans and rodents. This study aimed to determine the frequency and subtype distribution of Blastocystis in laboratory rats at a laboratory animal facility in Turkey.

Methods

This study included 54 male Sprague-Dawley rats from Aydın Adnan Menderes University Laboratory Animal Center. Among these rats, 30 were fed with high-fat diet (obese group) and the remaining 24 received standard chow (non-obese group). Blastocystis positivity was determined with amplification of small subunit 18S rRNA gene following their nucleic acid extraction from faecal samples. Subtypes were detected by submitting the partial 18S rRNA gene sequences to the database (pubmlst.

Results

Blastocystis infection was detected in 33 (61.1%) of 54 laboratory rats. The frequency of Blastocystis was significantly different between obese and non-obese rats (p<0.05), with 43.3% and 83.3%, respectively. When referred to the database, exact matches were identified with Blastocystis subtype 4 (ST4) for all isolates. In the phylogenetic analysis of the partial 18S rDNA sequence, the sequence was closely clustered with reference ST4 subtypes from other countries, including China, Japan, United Kingdom and Czech Republic.

Conclusion

This study revealed the high rate of Blastocystis colonisation in laboratory rats, posing a risk for human transmission. The comparison of obese and non-obese groups supported the idea that Blastocystis might be an indicator of healthy gut flora. The detection of ST4 in all rats agreed with previous reports of the predominance of this subtype in rodents.

Subtype Distribution of Blastocystis in Pregnant Women and Analysis of Possible Risk Factors

Objective

Since the identification of Blastocystis subtypes (ST) in the last decade, much has been learned about the genetic diversity of Blastocystis isolates in different populations, except pregnant women. The objective of this study is to investigate the genetic diversity of Blastocystis in pregnant women and analyse some demographic factors.

Methods

The faecal samples from 100 pregnant women were collected at an Obstetrics and Gynecology Department in Muğla, Turkey. Thereafter, Blastocystis positivity was detected by direct microscopy and culture. The positive cultures were subjected to DNA isolation, and the Blastocystis barcode region was amplified with polymerase chain reaction. Next, the sequences were queried against GenBank nucleotide and Blastocystis STs (18S) databases.

Results

Blastocystis was detected in 14% (14 out of 100) of the faecal samples by culture and 10% (10 out of 100) of the samples by direct microscopy. Nine of Blastocystis isolates (64.4%) were ST3, three (21.4%) were ST1 and two (14.2%) were ST2. Neither the demographic features nor the gastrointestinal symptoms were statistically related to Blastocystis infection.

Conclusion

The findings in this study agreed with the most of the previous human studies that found ST3 as the most abundant genotype. This study reported the frequency of Blastocystis in pregnant women and highlighted the importance of comprehensive studies with more cases of Blastocystis during pregnancy.

Microsatellite-Based Genotyping, Analysis of Population Structure, Presence of Trichomonas vaginalis Virus (TVV) and Mycoplasma hominis in T. vaginalis Isolates from Southwest of Turkey

Background:

The present study aimed to determine genetic diversity of Trichomonas vaginalis (T. vaginalis) isolates with microsatellite markers in Turkey (Nov 2015 to 2016) and to create a web-based microsatellite typing (MT) approach for the global interpretation of the data. In addition, the endosymbiosis of Mycoplasma hominis (M. hominis) and T. vaginalis virus (TVV) in the isolates was also examined.

Methods:

The allele sizes for each locus were calculated and microsatellite types were determined according to the allele profiles. The population structure was examined with Bayesian clustering method. A website (http://mttype.adu.edu.tr) was created for collection and sharing of microsatellite data. Presence of TVV and M. hominis in T. vaginalis isolates were investigated with electrophoresis and PCR.

Results:

Of 630 vaginal samples T. vaginalis was detected in 30 (4.7%) and those were used for further analysis. The structure produced by a clustering algorithm revealed eight genetic groups. The typing of isolates according to microsatellites revealed 23 different microsatellite types. Three clones were determined among isolates (MT10 16.7%; MT18 10% and MT3 6.7%). The frequency of TVV and M. hominis was 16.6% (n=5) and 20% (n=6), respectively.

Conclusion:

Presence of three clones among 30 T. vaginalis isolates indicated that microsatellite-based genotyping was efficient to determine the clonal distribution of T. vaginalis isolates. Therefore, a promising tool might be developed further and adapted to the studies dealing with molecular epidemiology of T. vaginalis. Microsatellite data from forthcoming studies will be deposited and presented on the website. In addition, we also presented the frequency of two endosymbionts in T. vaginalis isolates for the first time in Turkey.

[Determination of Antimony Resistance Mechanism of Leishmania tropica Causing Cutaneous Leishmaniasis in Turkey]

World Health Organization reported that approximately one billion people are at risk in endemic areas, one million cases of cutaneous leishmaniasis (CL) and approximately 300,000 cases of visceral leishmaniasis (VL) were reported per year in the last five years. The number of deaths due to VL is reported to be approximately 20,000 per year. Approximately 2500 cases/year have been reported as CL, caused by Leishmania tropica and Leishmania infantum, in Turkey. The significant increase observed in many cities mainly in the provinces of Mediterranean and Aegean regions in cases and foci in recent years, suggests that there may be an increase in this infections in the following years as well. In Turkey, the causative agent of CL is L.tropica and meglumine antimoniate is used in the treatment of CL. We aimed to determine antimony resistance genes specific for L.tropica by comparing the gene and protein expressions of antimony-resistant and non-resistant L.tropica strains. L.tropica isolates obtained from 3 CL patients without antimonate resistance from Aegean, Mediterranean and Southeastern regions of Turkey were provided to transform into 3 resistant isolates against meglumine antimony in the laboratory conditions. Gene expression alterations by microarray method; protein profiles by two-dimensional gel electrophoresis (2D-PAGE) and relevant proteins by MALDI-TOF/TOF MS of these isolates were accomplished and compared. L.tropica isolates from 10 CL patients who did not respond to antimony therapy were analyzed for resistance to antimonial compounds and quantitative real-time polymerase chain reaction was performed to detect the expression of genes responsible for resistance development. Moreover, differences in protein expression levels in isolates with and without antimony resistance were determined by comparing protein profiles and identification of proteins with different expression levels was carried out. Enolase, elongation factor-2, heat shock protein 70, tripanthione reductase, protein kinase C and metallo-peptidase proteins have been shown to play roles in L.tropica isolates developing resistance to antimonial compounds and similar expression changes have also been demonstrated in naturally resistant isolates from patients. In conclusion, it was revealed that L.tropica strains in our country may gain resistance to meglumine antimoniate in a short time. It is foreseen that if the patients living in our country or entering the country are treated inadequately and incompletely, there may be new, resistant leishmaniasis foci that may increase the number of resistant strains and cases rapidly.

Molecular characterisation of Trichomonas vaginalis isolates in Southwest Turkey with multilocus sequence typing and genetic structure analysis in relation to different countries

Trichomonas vaginalis, a flagellated protozoan parasite, is among the most common sexually transmitted pathogens in the world. The present study aimed to identify the genetic profiles of T. vaginalis in the southwest of Turkey with multilocus sequence typing (MLST) and to analyse the genetic structure of the parasite in a collection of isolates from different countries. The study included 27 T. vaginalis isolates from symptomatic females in Aydin, Turkey. Seven housekeeping genes of T. vaginalis were partially amplified and sequenced after genomic DNA extraction from in vitro cultures. The allele profiles and sequence types (STs) of the isolates were determined by using the MLST database (https://pubmlst.org/tvaginalis). The genetic structure and differentiation of the parasite were analysed in relation to findings from other countries by assembling the available MLST sequences. When referred to the database, a total of 22 STs, including 18 new STs were found; besides, there were two new allele types. The genetic analysis of MLST data demonstrated the presence of two main genetic structures: Type I and Type II. In addition, the neighbor-joining method also revealed that the isolates were clustered into two groups. The genetic types distributed almost equally in the Netherlands and the USA, however, the predominance of Type I was noted in Turkey and the UK. The genetic differentiation among four countries was significant (p < .05), the gene flow was relatively high between the Netherlands and the USA, in contrast to Turkey. Finally, genetic variations were originated within populations (93.8%) rather than among populations (6.2%). In conclusion, we studied the genetic diversity of T. vaginalis isolates with MLST in the southwest of Turkey and showed the origin of genetic differentiation of the parasite among different countries. The presentation of MLST profiles and genetic variance of T. vaginalis isolates will contribute to the development of new diagnostic and treatment options for the parasite.

The Retrospective Analysis of Demodex spp. Results in Aydın Adnan Menderes University Faculty of Medicine Hospital Parasitology Laboratory

Objective

Demodex spp. is one of the most common ectoparasites in humans. The aim of the present study is to evaluate the positivity of Demodex spp. in our Parasitology Laboratory, retrospectively.

Methods

The study included Demodex spp. suspected cases from different departments between 2008 and 2017. The link between Demodex spp. and demographics and symptoms was investigated. In addition, Demodex spp. was evaluated regarding symptoms and distribution pattern (U, T and diffuse region).

Results

Demodex spp. was detected in 576 (78%) of 738 cases. There was no relationship between sex and parasite positivity, but frequency was lower in cases below 19 years. There was a relationship between presence of parasite and redness, itching, burning and rash. The parasite density was higher in U region (n=335, 58.2%). When clinical findings and parasite number were statistically compared; itching, burning and rash were significantly higher in patients with parasite density ≥5 parasites/cm2, while a similar result was not observed in patients with redness.

Conclusion

Given its prevalence and its relationship with the clinical findings; we believe that Demodex is an important parasitic disease for our province and should be evaluated in cases with various dermatological complaints in the face.

Retrospective Analysis of Cystic Echinococcosis Results in Aydın Adnan Menderes University Training and Research Hospital Parasitology Laboratory Between 2005 and 2017

Objective

Echinococcus granulosus is the causative helminth of cystic echinococcosis (CE). The parasite is known to form fluid-filled cysts that grow slowly in the internal organs, particularly the liver and/or lungs. This disease is still important in terms of public health and economically in Turkey and other countries where animal husbandry is widespread. The aim of our study was to retrospectively evaluate the cases that were admitted to the Adnan Menderes University, Training and Research Hospital Parasitology laboratory on suspicion of CE between January 2005 and January 2017.

Methods

Totally, 3446 sera (from 2019 female and 1427 male) were tested with an in-house ELISA for the presence of E. granulosus specific IgG antibodies at the timeswhen they were sent. Socio-demographic characteristics (age, gender, residence, and dog ownership), positivity titers, and cyst locations of pathologically confirmed CE patients were analyzed retrospectively.

Results

The ages of patients varied between 4-87 years. It was found that 1104 (32%) of the 3446 sera were positive, and of them, 642 (58.1%) were female and 462 (41.9%) were male. Patients who had pathologically confirmed CE diagnosis constituted 247 (22.3%) of the total seropositive sera. Liver was the most commonly affected organ (81.8%), followed by lungs (6.1%).

Conclusion

CE remains an important public health problem in our city; therefore, it is once again emphasized that preventive studies should be planned.

[Transfection of Leishmania tropica with green fluorescent protein (gfp) gene and investigation of the in vitro drug effect]

Cutaneous leishmaniasis (CL) is a parasitic disease transmitted by vector sand flies Phlebotomus and Lutzomyia. This disease is characterized by long time non-healing skin lesions, and caused by Leishmania species. CL is the most common infection in Eastern and Southeastern Anatolia in Turkey and L.tropica is known as the main agent of the disease. Number of cases is increasing in our country in time because of malnutrition, migration, travel, low socioeconomic level and ecological changes. For the treatment, the pentavalent antimonials are often used as intralesionally for many years, and it was reported that resistant cases have increased in recent years. New treatment methods and anti-Leishmanial activity of new agents have been investigated because of side effects, resistance development and toxic reactions of the present drugs. These studies are first carried out in vitro and afterwards with in vivo experimental animal models. Reporter gene technology has been used to investigate a variety of purposes like biological events in microorganisms and the efficacy and resistance of drugs in recent years. The major areas that green fluorescent protein (gfp) used are that they can be incorporated into different genes to determine the amount of expression of these genes in different organisms and can be used as markers in living cells. Especially gfp gene, which encodes the green fluorescent protein, is widely used nowadays. Gene-based assays have several advantages like being easy to follow-up, inexpensive and have improved biosecurity. The aim of the present study was to perform the transfection of L.tropica with "enhanced gfp (egfp)" and in vitro usefulness of gfp-transfectants as a drug screening model in comparison to the conventional methods. Promastigotes of L.tropica were transfected with p6.5/egfp by electroporation and selected for tunicamycin-resistance as previously described. L.tropica promastigotes transfected with gfp and in vitro effect of meglumine animoniate was assessed using different methods such as fluorescence microscopy, fluorometer and XTT (2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxyanilide) assay. The use of gfp-transfected Leishmania strains was found more rapid and more sensitive by fluorescent microscopy and fluorometry than conventional assays for the evaluation of potential anti-leishmanial agents. Consequently, stable gfp-transfected Leishmania species will be used in vitro and in vivo for screening of anti-leishmanial drugs and vaccine development as well as for understanding the biology of the host-parasite interactions at the cellular level. As a result ot this study, gfp transfected model using a Turkish L.tropica isolate was established to be used in further studies.

[Genotyping of Echinococcus granulosus isolates by sequencing of mitochondrial cytochrome C oxidase subunit 1 (cox1) gene in Aydin]

Cyst hydatid (CH) is a zoonotic infection that is characterized by the development of metacestode form of Echinococcus granulosus primarily in liver of humans and ruminants. With a worldwide distribution, the infection is still considered as an important parasitic disease that threatens the public health in Turkey as in the other developing countries. Morphological and biological features of parasite fail to discriminate isolates for typing so molecular methods should be used for this purpose. Recently, a total of eleven genotypes of E.granulosus (G1-10 and lion strain) have been identified and these genotypes are highly correlated with host specificity of the parasite. The aim of this study, was to determine the genotypes of E.granulosus isolates from human samples in Aydın. Cyst fluids from CH operated cases in Adnan Menderes University Faculty of Medicine, Training and Research Hospital were used in the present study. Samples were washed with phosphate buffered saline (PBS) and stored in 70% ethanol at -20ºC. Mitochondrial cytochrome C oxidase subunit 1 (cox1) gene was amplified partially by polymerase chain reaction (PCR). The PCR products were sequenced initially, compared to other database in Genbank and evolutionary distances were estimated with references. The genotypes of E.granulosus isolates were determined according to the closest or exact matches to the references. A total of 20 E.granulosus isolates were genotyped in the present study, most of them (15 isolates, 75%) were identified as Genotype 1 (G1), that is defined as sheep genotype and the remaining isolates were defined as pig/camel genotype G6/7 (five isolates, 25%). A possible explanation to our results may be related to the geographical position of Turkey. The identification of G6/7 in addition to sheep genotype G1 indicated that pigs and camels in this area have role in the transmission and distribution of E.granulosus to humans. There is still limited information about the molecular epidemiology of E.granulosus in Turkey. This study reveals the first data about the genotype distribution of E.granulosus in our city, therefore the findings may help to design control program for the disease with a combination of epidemiological data.

Retrospective Analysis of Toxoplasma gondii Serology Results from Adnan Menderes University Faculty of Medicine Parasitology Laboratory from 2007 to 2017

OBJECTIVE

Toxoplasma gondii is a common apicomplexan parasite of humans and can cause significant morbidity and mortality due to congenital transmission and in patients with immune deficiency. The aim of this study was to evaluate T. gondii serology results of 11 years and to determine compatibility of serologic diagnosis methods.

METHODS

The study was conducted between 2007 and 2017, and anti-T. gondii IgG antibodies were investigated by an in-house Enzyme Linked Immunosorbent Assay (ELISA) and Indirect Fluorescence Antibody (IFA) methods. Moreover, T. gondii-specific IgM antibodies were also studied by ELISA and a commercial kit. In our study, compatibility of ELISA and IFA methods was also investigated statistically.

RESULTS

Serology of T. gondii was studied in 8095 individuals including 1123 (13.9%) males and 6972 (86.1%) females. The overall rate of anti-T. gondii IgG positivity was 31.5% (n=2550) and anti-T. gondii IgM positivity was 1.6% (n=127). There was no significant relationship between sex and seropositivity. A high degree of correlation was found between ELISA and IFA.

CONCLUSION

The current findings reveal that toxoplasmosis is still an important public health disease and that the seropositivity rate is consistent with the region in general. Moreover, using IFA and ELISA methods together in the laboratory seems to be effective.

The current clinical and geographical situation of cutaneous leishmaniasis based on species identification in Turkey

Leishmaniases are a group of vector-borne diseases caused by the members of Leishmania genus, and there are three main clinical forms of the infection as visceral, cutaneous, and mucocutaneous. Cutaneous leishmaniasis is a growing public health problem in Turkey due to increasing detection of autochthonous cases caused by L. major and L. donovani in some regions in addition to Syrian imported cases. For this reason, we aimed to evaluate the current epidemiological situation of CL in the view of causative agents and their geographical distribution throughout Turkey. The samples were collected from 356 CL patients admitted to different centers in 18 provinces between January 2013 and December 2016. Direct microscopy, culture (regular and enriched NNN) and molecular techniques (real-time ITS1 PCR and hsp70 PCR/sequencing) were performed. By molecular techniques, 299, 28, 19 and 10 isolates/clinical samples were identified as L. tropica, L. major, L. infantum and L. donovani, respectively. Most of the patients (65.73%) had one lesion usually on their face/head. Dry-nodular type lesions (n = 291) were mainly associated with L. tropica while L. major was mainly found related to wet-ulcerative ones. Leishmaniasis recidivans was also detected in 2.52% among 356 patients. L. tropica was detected as most widespread species causing CL in Turkey. L. infantum and L. major was also found in one third of the provinces. Enriched NNN culture was worked well for isolating the parasite and 346 isolates were successfully grown and stored in liquid nitrogen. The comparison of all diagnostic techniques showed that the parasitological positivity rate could increase if the combination of direct microscopy and real-time ITS1 PCR is used. Besides well-known anthroponotic L. tropica cases, the increasing detection of CL cases caused by zoonotic species, L. infantum and L. major, is one of the most important findings in the present study. In our opinion to ensure timely and accurate diagnosis, proper treatment and countrywide effective control of CL in Turkey a systematic approach is needed on the base of information about characteristics of lesions and patients and epidemiological features of the disease.

Use of Internal Transcribed Spacer Sequence Polymorphisms as a Method for Trichomonas vaginalis Genotyping

OBJECTIVE

Trichomonas vaginalis is the most common non-viral, sexually transmitted pathogen with a worldwide distribution. The aim of the present study was to design a new genotyping tool for T. vaginalis isolates using internal transcribed spacer (ITS) sequences.

METHODS

First, a total of 20 cryopreserved T. vaginalis isolates were thawed and genomic DNA was isolated from fresh cultures. A polymerase chain reaction (PCR) was performed to amplify the ITS regions and the amplicons were sequenced. These sequences were aligned with others from Genbank and polymorphisms were detected. At last, each ITS sequence was given a different sequence type.

RESULTS

More than 99% homology was observed among sequences. Of 20 isolates, five had identical ITS sequence to reference (L29561) defined as ITST1. Moreover, 13 had A58 deletion (ITST10), one had C203T mutation (ITST2), and one had both A58 deletion and C203T mutation (ITST11). ITS typing of T. vaginalis sequences on Genbank revealed a total of 11 ITS types with the predominance of ITST1 (44.4%) globally.

CONCLUSIONS

ITS typing seems to be an applicable and useful tool for a better understanding of molecular epidemiology as well as for the dissemination of T. vaginalis clones.

Investigation of the Applicability of a Rapid Diagnosis Test in the Diagnosis of Cystic Echinococcosis

OBJECTIVE

Echinococcus granulosus, the etiological agent of cystic echinococcosis (CE) in humans and livestock, is a widely distributed zoonotic pathogen tapeworm. The infection is transmitted to humans by the ingestion of E. granulosus eggs released in the feces of definitive hosts such as dogs. The larval stage of the parasite develops a slowly enlarging cyst in the visceral organs, particularly in the liver and/or lung. The aim of the present study was to evaluate the diagnostic value of an immunochromatographic test (ICT) for CE.

METHODS

A total of 50 sera from surgically and/or pathologically confirmed patients with CE were included in the study as the study group; the control group comprised patients who tested negative for enzyme-linked immunosorbent assay (ELISA). Sera were selected from the collection at Adnan Menderes University, Faculty of Medicine, Parasitology Laboratory, by simple random sampling. The collection included sera obtained between 2010 and 2014; antibody titers of each serum sample were determined using in-house ELISA, before storage at -20°C. The presence of E. granulosus antibody in the sera was determined using a commercially available ICT (VIRAPID® HYDATIDOSIS) kit method.

RESULTS

In the study group (E. granulosus-confirmed cases), two (4%) of the 50 sera were negative and 48 (96%) were positive with ICT. In the control group (ELISA-negative), all were negative with ICT.

CONCLUSION

The rapid diagnostic test has been evaluated as a practical, easy-to-use method for detecting CE, and it can be used as a screening test in routine diagnosis and research.

Determination of Trichomonas vaginalis Genotypes Using PCR-Restriction Fragment Length Polymorphism (RFLP)

OBJECTIVE

Trichomonas vaginalis is an anaerobic protozoon and the most common non-viral sexually transmitted pathogen. The present study was designed to determine the genotypes of T. vaginalis using polymerase chain reaction (PCR)-restriction fragment length polymorphism of actin gene.

METHODS

A total of 20 isolates from symptomatic females isolated and cryopreserved at Adnan Menderes University, Research and Training Hospital Parasitology Laboratory were included. The isolates from liquid nitrogen were thawed and grown in trypticase-yeast extract-maltose medium prior to the study. Following nucleic acid extraction, the actin gene of T. vaginalis was amplified using nested PCR and amplicons were concentrated with phenol-chloroform-isoamyl alcohol precipitation. The final products were digested with HindII, MseI, and RsaI and were visualized using agarose gel electrophoresis.

RESULTS

Most isolates were actin genotype E (n=9, 45%). The remaining isolates were genotype G (n=7, 35%), genotype N (n=1, 5%), and genotype H (n=1, 5%); two were mixed genotypes of E and H (10%).

CONCLUSION

To the best of our knowledge, this study is the first to provide data on T. vaginalis genotypes in Turkey. However, further studies should be conducted to understand the molecular epidemiology of T. vaginalis at the national and global levels.

Evaluation of In vitro and In vivo Drug Efficacy Over Leishmania tropica: A Pilot Study

OBJECTIVE

Two pentavalent antimonials, meglumine antimoniate (Glucantime®, France) and sodium stibogluconate (Pentostam®, England), are used to treat cutaneous leishmaniasis (CL) in Turkey. The present study, serving as a guidebook for young researchers, aims to provide basis for conducting drug resistance tests and active ingredient scanning in in vitro and in vivo models.

METHODS

A CL isolate kept in liquid nitrogen was initially thawed and genotyped by real-time polymerase chain reaction (PCR) using ITS1 prob. In vitro and in vivo tests were conducted to determine drug resistance against meglumine antimoniate and sodium stibogluconate. Hemocytometry and XTT (sodium 3,39-[1-(phenylaminocarbonyl)-3,4-tetrazolium]-bis (4-methoxy-6-nitro) benzenesulfonic acid hydrate) methods were used to investigate in vitro drug resistance. CL mouse models were used to analyze in vivo drug resistance.

RESULTS

The isolate was determined as Leishmania tropica by genotyping by PCR on the internal transcribed spacer 1 (ITS1) gene region. In in vitro drug resistance tests, sodium stibogluconate was observed to be more effective than meglumine antimoniate, but there was no statistically significant difference between the two (p > 0.05). It was observed that the footpad lesions of the animals started to shrink afterward the 5th week of infection following treatment with these agents, and parasitologic recovery was observed at the end of 3 months.

CONCLUSIONS

With an aim to be used as a guidebook for young researchers, active ingredient scanning and drug resistance tests in both in vitro and in vivo models were presented in the current study.

[Investigation of in vitro metronidazole resistance in the clinical isolates of Trichomonas vaginalis]

Trichomonas vaginalis, a flagellated, urogenital anaerobic protozoon is reported as an important cause of vaginitis with a global distribution. Although metronidazole is the primary choice of drug for the treatment of trichomoniasis, the presence of resistant isolates from many different countries highlights the need of novel drugs for the treatment. Many studies from Turkey mostly dealing with the in vitro effects of compounds and natural products against T.vaginalis have been reported, however, only one study has been encountered searching the metronidazole resistance in a single T.vaginalis isolate. The aim of this study was to determine the in vitro metronidazole resistance and minimum lethal concentrations (MLCs) of the isolates from symptomatic cases. T.vaginalis strains isolated from vaginal discharge samples of symptomatic women that were sent to Adnan Menderes University Faculty of Medicine, Research and Training Hospital Parasitology Laboratory, between 2009-2014 period, were included in the study. The strains were isolated by the inoculation of samples into trypticase-yeast-maltose medium supplemented with 10% fetal calf serum. A total of 40 T.vaginalis isolates stored by cryopreservation were revived before the experiments. T.vaginalis trophozoites were incubated with different concentrations of metronidazole (200, 100, 50, 25, 12.5, 6.25, 3.12, 1.56 μg/ml) and the viability of cells were examined in both aerobic and anaerobic conditions under phase contrast microscope. Additionally, non-motile isolates were further inoculated into fresh media and viability was checked. The wells containing motile trophozoites after 48 hours of incubation with 15 µg/ml and/or higher metronidazole concentration in anaerobic condition and 75 µg/ml and/or higher metronidazole concentration in aerobic conditions were determined as resistant isolates. Of the 40 T.vaginalis isolates three (7.5%) were resistant to metronidazole. MLC mean values of metronidazole-sensitive isolates were 27.17 µg/ml in aerobic and 7.75 µg/ml in anaerobic conditions. The rate of metronidazole resistance detected in this study was higher than most of reports from different countries. Despite being limited to the isolates from Aydin province (located at Agean region of Turkey), the present study has a value as it presented the existence of metronidazole-resistant isolates in Turkey for the first time. More research from other parts of Turkey is needed to better understand the metronidazole resistance at a national scale and to investigate novel strategies for the treatment. Moreover, further studies need to be carried out in order to clarify the relationship between clinical treatment response and in vitro metronidazole resistance in trichomoniasis.

Epidemiological analysis of Leishmania tropica strains and giemsa-stained smears from Syrian and Turkish leishmaniasis patients using multilocus microsatellite typing (MLMT)

Turkey is located in an important geographical location, in terms of the epidemiology of vector-borne diseases, linking Asia and Europe. Cutaneous leishmaniasis (CL) is one of the endemic diseases in a Turkey and according to the Ministry Health of Turkey, 45% of CL patients originate from Şanlıurfa province located in southeastern Turkey. Herein, the epidemiological status of CL, caused by L. tropica, in Turkey was examined using multilocus microsatellite typing (MLMT) of strains obtained from Turkish and Syrian patients. A total of 38 cryopreserved strains and 20 Giemsa-stained smears were included in the present study. MLMT was performed using 12 highly specific microsatellite markers. Delta K (ΔK) calculation and Bayesian statistics were used to determine the population structure. Three main populations (POP A, B and C) were identified and further examination revealed the presence of three subpopulations for POP B and C. Combined analysis was performed using the data of previously typed L. tropica strains and Mediterranean and Şanlıurfa populations were identified. This finding suggests that the epidemiological status of L. tropica is more complicated than expected when compared to previous studies. A new population, comprised of Syrian L. tropica samples, was reported for the first time in Turkey, and the data presented here will provide new epidemiological information for further studies.

Turkey is one of the endemic countries for leishmaniasis, cutaneous and visceral. Cutaneous leishmaniasis caused by Leishmania tropica is a serious public health problem with more than two thousands of local cases each year. Moreover, with the civil war in Syria more than three million refugees were accepted to reside in different cities of Turkey. To date, several population genetic studies were performed using Turkish L. tropica isolates but all previously studied isolates were originating from the same geographical area thus population structure could not be revealed in detail for Turkey. The findings of this study suggests two new population structure for Turkey, which are consist of Syrian and Mediterranean isolates. Our findings provide important knowledge on epidemiology of L. tropica in Turkey and highlights the future role of L. tropica to Europe through the current wave of migration of infected people.

Blastocystis in ulcerative colitis patients: Genetic diversity and analysis of laboratory findings

OBJECTIVE

To determine Blastocystis frequency and subtypes (ST) in ulcerative colitis (UC) patients and analyse some laboratory findings between Blastocystis positive and negative cases.

METHODS

Faecal samples from 150 UC patients in Adnan Menderes University, Training and Research Hospital were examined by direct microscopy and cultivated in Jones medium. Blastocystis positive cultures were subjected to DNA isolation and subtypes were identified by sequencing of barcode region. A retrospective analysis was conducted on C reactive protein (CRP), leucocyte counts (WBC), neutrophil counts, and sedimentation rates.

RESULTS

The overall positive rate of Blastocystis was 8% (12 patients) and the most abundant subtype was ST3 (eight isolates, 66.7%), followed by ST1, ST2 and ST7. Laboratory findings between Blastocystis infected and non-infected UC patients were not significantly different. Blastocystis frequency was 3.8% among the patients in active stage, while it was 11.8% among the patients in remission stage.

CONCLUSIONS

The present study confirms previous findings that have indicated the predominance of Blastocystis ST3 in humans and contributes additional evidence that suggests the low colonisation of Blastocystis infection in ulcerative colitis patients during active stage.

Comparative Evaluation of Three Methods (Microscopic Examination, Direct Fluorescent Antibody Assay, and Immunochromatographic Method) for the Diagnosis of Giardia intestinalis From Stool Specimens

OBJECTIVE

The aim of this study was to compare direct microscopic examination, direct fluorescent antibody assay (DFA), and the immunochromatographic method (IK) and identify the best suitable method for the diagnosis of Giardia intestinalis.

METHODS

In this study, 25 stool samples that had been diagnosed as being infected with G. intestinalis using the native-Lugol and/or formol-ethyl acetate concentration method and 25 non-parasite-infected samples (the control group) were examined. After microscopic examination of stools, they were kept at -20°C for examination using DFA and IK. Stool samples were studied using DFA (CeLLabs, Crypto/Giardia-Cel IF) and IK (RIDA QUICK, Cryptosporidium/Giardia Combi Dipstick), as per the manufacturers' instructions.

RESULTS

In our study, using the DFA method, parasites were detected in all 25 stool samples in which G. intestinalis was diagnosed by direct microscopic examination. Using the IK method, a particular band indicative of the parasite was detected in 24 samples. No parasites were detected in all 25 samples in the control group.

CONCLUSION

Thus, when direct microscopic examination is taken as reference, the senstivity and specificity of DFA for the diagnosis of G. intestinalis were found to be 100% each, while those of IK were found to be 96% and 100%, respectively.

[The Retrospective Analysis of Toxoplasma Serology Results from Muğla Sıtkı Koçman University Training and Research Hospital between 2012 and 2013]

OBJECTIVE

The aim of the present study was the evaluation of serology results in Muğla Sıtkı Koçman University Training and Research Hospital Microbiology Laboratory between 2012 and 2013 among cases from different divisions for anti-Toxoplasma antibodies, retrospectively.

METHODS

Anti-Toxoplasma IgG and IgM antibodies were detected by a commercial kit in serum samples. The age and gender of cases, the division where the samples were sent and the changes in the seropositivity between years were evaluated statistically by chi-square test.

RESULTS

Totally 1162 cases varying from 9 months to 85 ages (mean 29.1 ± 10.8) were included in the study, due to the orders from divisions anti-Toxoplasma IgG antibodies were investigated in 747 samples and 154 (20.6%) of them were positive. Anti-Toxoplasma IgM antibodies were investigated in 1112 samples and 27 of them (2.4%) were positive. The seropositivity of anti-Toxoplasma IgG antibodies were increased with age (p = 0.001) and a significant relationship was found with anti-Toxoplasma IgM seropositivity and the division where the samples were sent (p = 0.003).

CONCLUSION

It can be concluded that as in the other parts, toxoplasmosis is an important public health concern in Muğla and it is crucial especially for women in reproductive age, the risk group for toxoplasmosis, should be informed about toxoplasmosis.

Antimony(III) complexes with 2-amino-4,6-dimethoxypyrimidines: Synthesis, characterization and biological evaluation

Novel pyrimidine compound bearing disulfide bridge, 5,5'-disulfanediylbis(2-amino-4,6-dimetoxypyrimidine) (3) was synthesized by reduction of 2-amino-4,6-dimethoxy-5-thiocyanatopyrimidine for the first time, and its structure was confirmed by X-ray crystallographic analysis. Novel binuclear antimony(III) compound of (3), {Sb[5,5'-disulfanediylbis(2-amino-4,6-dimetoxypyrimidine)]Cl3}2 (4) and mononuclear antimony(III) compounds, SbL2Cl3, [L: 2-amino-5-thiol-4,6-dimethoxy pyrimidine (2) and 2-amino-5-(1H-tetrazol-5-ylthio)-4,6-dimethoxypyrimidine (6)] were synthesized and characterized with the help of elemental analysis, molecular conductivity, FT-IR, (1)H-NMR and LC-MS techniques. The geometrical structures optimized by a DFT/B3LYP/LANL2DZ method of the compounds, indicated that monomeric compounds have square pyramidal shape. Both antileishmanial activity against Leishmania tropica promastigote and glutathione reductase inhibitory activity were determined in vitro. The results showed that (3) has the best biological activity.

[Comparison of direct microscopy, culture and polymerase chain reaction methods for the diagnosis of cutaneous leishmaniasis]

Cutaneous leishmaniasis (CL) is an endemic disease especially in Southeastern Anatolia of Turkey and recently shows a trend for spread to other regions of the country including the Aegean region. The diagnosis of CL is based on combined evaluation of epidemiological data with the clinical symptoms and laboratory findings. Direct microscopic examination and culture methods are mainly used in the routine diagnosis of CL, while molecular methods are mainly used for research. The aim of this study was to detect the presence of Leishmania spp. in samples obtained from CL-suspected patients by using direct microscopy, culture and polymerase chain reaction (PCR) methods and to compare the results. A total of 55 patients who were admitted to Parasitology Laboratory of Adnan Menderes University Hospital, Aydin (located at Aegean region in Turkey), between 2012-2014 were included in the study. Smear preparations from the skin lesions of cases were fixed and stained with Giemsa, and the presence of amastigote forms were evaluated by direct microscopy. NNN medium was used for the cultivation of samples. Total genomic DNA of Leishmania from the samples were extracted with a commercial kit (NucleoSpin Tissue(®) Kit, Macherey-Nagel, Germany) and PCR was performed by using 13A and 13B primers to amplify the 116 base pair fragment of Leishmania spp. specific kinetoplast DNA. Amastigotes were observed in 29 (53%) of the 55 samples by direct microscopy, promastigotes were detected among 34 (62%) samples in culture, and parasite-specific amplicons were revealed in 30 (55%) samples by PCR. All assays were positive in 24 patients while in 18 patients all of the tests yielded negative results. Thirty-seven (67%) out of 55 cases were diagnosed as CL when reactivity in at least one of these three methods were considered as positive. Accordingly the positivity rates of the methods were 78.4% (29/37) for direct microscopy, 92% (34/37) for culture and 81.1% (30/37) for PCR in CL-diagnosed patients, indicating culture as the most sensitive method. Regarding the culture method as gold standard, the sensitivity and specificity of direct microscopy were calculated as 76.4% and 86%, respectively, while PCR presented with 85.3% sensitivity and 95% specificity. In conclusion, it was thought that the usage of more than one method for CL diagnosis leads to increase the sensitivity and specificity which enables the diagnosis of a wide range of patients.

Detection of Leishmania major and Leishmania tropica in domestic cats in the Ege Region of Turkey

Leishmaniosis is a group of diseases caused by different species of Leishmania parasites in mammalian species. The aim of the present study was to investigate the presence of Leishmania spp. DNA in cats using real time polymerase chain reaction (RT-PCR) assays targeting internal transcribed spacer (ITS1) and heat-shock protein 70 gene (Hsp70) regions with Leishmania species-specific primers and probes. Blood samples were collected from 147 cats (73 female; 74 male) in the endemic regions for zoonotic visceral leishmaniasis in the western provinces of Turkey and analyzed using two RT-PCR assays. Additionally, Hsp70 RT-PCR products were sequenced. ELISA assays for feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) were also carried out for 145 of the 147 samples. Overall, 13/147 (8.84%) cats were positive for Leishmania by RT-PCR (4 L. major and 9 L. tropica). FIV and FeLV antibody and/or antigen was detected in 4 and 5 cats among Leishmania DNA positives, respectively. To the best of our knowledge, this study is the first to investigate and report the presence of L. major and L. tropica infections in a large group of domestic cats in Turkey. The results obtained indicate that species identification of Leishmania is essential for epidemiological understanding and that clinical signs alone are not indicative for leishmaniosis in cats, as it is in dogs. This study suggests that extensive research should be carried out in cat populations in order to fully understand the role of cats in the epidemiology of the disease.

[Retrospective evaluation of the results of female patients of childbearing age at a microbiology laboratory for screening Toxoplasma gondii in Kocaeli Derince]

OBJECTIVE

The aim of the previous study was to retrospectively analyze the seropositive rate of Toxoplasma among women of childbearing age who were suspected to have toxoplasmosis at the Microbiology Laboratory of Kocaeli Derince Education and Research Hospital.

METHODS

The presence of Toxoplasma antibodies (IgM, IgG) with Axsym commercial ELISA kits between January 2009 and February 2011 and the presence of Toxoplasma antibodies (IgM, IgG) with Architect commercial ELISA kit between February 2011 and June 2012 were investigated in a total of 943 sera from women included in the study.

RESULTS

The seropositive rate of anti-Toxoplasma IgG and IgM in the study was 28.5% (N=741), 0.9% (N=898), respectively. Additionally, 10 samples (1.3%) were considered as border-line for IgG antibodies and 4 samples (0.4%) for IgM antibodies against T. gondii.

CONCLUSION

In general, 70.2% of women in the study were seronegative for anti-Toxoplasma IgG antibodies; it can be concluded that most of them were sensitive to a newly acquired infection, and that their babies were at risk of congenital toxoplasmosis in case of a possible pregnancy. In conclusion, the present study suggested that toxoplasmosis was still an emerging public health problem in study area, and particularly, women of reproductive age should be warned and informed about toxoplasmosis.

[An epidemiological study on canine leishmaniasis (CanL) and sand flies in Northern Cyprus]

OBJECTIVE

In this study, the investigation on the prevalence of canine leishmaniasis (CanL) and sand fly species incriminated as potential vectors of leishmaniasis in the northern part of the Cyprus were aimed.

METHODS

This research was conducted in two periods; 2004 and 2012. Serological (IFAT and rK39) and molecular (PCR) tests were performed on 83 dog blood samples during the 2004 survey. PCR was performed using primers 13A/13B targeting kinetoplastid minicircle constant region. Genomic Nested-PCR was applied using R221/R332 and R323/333 primers for 5 clinically suspected dog samples in 2012. Sand flies were collected from the Lapithos town and Kyreniae province using CDC light traps and midgut dissection was done for the presence of Leishmania parasites during the 2012 survey.

RESULTS

Three (3.61%) out of 83 dogs were found to be positive for CanL in 2004, while 3 out of 5 clinically suspected dogs were positive in 2012. In total 296 female sand flies were dissected and 9 species belonging to Phlebotomus and Sergentomyia genera were determined. No promastigote was found in the dissected females.

CONCLUSION

The results obtained in two different periods showed that the importance and risk of canine disease are increasing in the northern Cyprus and further studies should be performed in northern Cyprus for determining the incidence of canine and human leishmaniasis.

[Investigation of anti-Toxoplasma gondii IgG and IgM antibodies in beta-thalassemia major patients in Aydın province]

OBJECTIVE

Blood transfusion therapy for Thalassaemia patients may cause transmission of some infectious agents to the recipients. As Toxoplasma gondii is a transfusion-transmitted parasite, we aimed to investigate anti-Toxoplasma antibodies.

METHODS

We arranged two groups: patients and controls. There were 36 Thalassaemia cases in the patient group. The control group also included 36 healthy people (of the same ages and gender) who were selected by the one-to-one mapping method. Mean age was 18.1 ± 8.3 (4-35). Toxoplasma gondii IgG and IgM antibodies were analyzed by the Enzyme-Linked Immunosorbant Assay (ELISA).

RESULTS

We determined parasite-specific Toxoplasma gondii IgG antibodies in 7 (19.4%) and borderline levels of IgM antibody in 2 Thalassaemia major cases (5.5%). In the control group, parasite-specific IgG antibody was found in 5 cases (14%). Serum samples of patients with borderline levels were analyzed with an avidity test and were found to have high avidity. There were no significant differences between patient and control groups when considering the presence of anti-Toxoplasma IgG antibodies (p=0.752).

CONCLUSION

Although there is no significant statistical difference, we suggest that blood transfusion donors should be investigated for infectious agents such as Toxoplasma gondii.

[Comparison of polymerase chain reaction with wet mount and culture methods for the diagnosis of trichomoniasis]

OBJECTIVE

Wet mount, culture and staining methods are generally used in the diagnosis of trichomoniasis. Polymerase chain reaction (PCR) methods with different primer pairs have been tested and used for research in recent years.

METHODS

In this study, T. vaginalis was tested for in the vaginal samples of 102 patients referred to obstetrics and gynecology polyclinic of Aydın Obstetrics and Children Hospital for various reasons, with direct microscopy, culture and PCR with primers targeting Tv-E650. In addition, PCR was applied to 20 T. vaginalis strains that were isolated from patients who were previously diagnosed with vaginitis.

RESULTS

Of 102 samples, T. vaginalis was found to be positive in 2.94, 4.90 and 4.90% with wet mount, TYM medium and PCR respectively. The positivity rate reached 5.88% using the 3 methods together. All 20 strains isolated from patients with vaginitis were reported as positive by the PCR method.

CONCLUSION

The wet mount had 60% sensitivity and 100% specificity, while PCR showed 80% sensitivity and 97.95% specificity when compared with the culture method, which is accepted as the "gold standard". The PCR method was performed for the first time as a diagnostic assay for trichomoniasis in this study and it is concluded that it can be used routinely for its diagnosis.

Spatial distribution of phlebotomine sand flies in the Aydin Mountains and surroundings: the main focus of cutaneous leishmaniasis in western Turkey

An entomological survey was conducted to determine the spatial distribution of phlebotomine fauna and understand the effect of environmental factors. The entomological survey was carried out during 2006-2007 in a study area in the rural area of Aydin province, near the Kusadasi town where VL, CL, and canine leishmaniasis (CanL) are endemic. In 2006 and 2007, 132 locations were sampled using sticky traps mainly on embankments. Detailed environmental and meteorological information was also collected for each location. The results of entomological studies indicated that the probable vectors are Phlebotomus tobbi and P. neglectus for VL and CanL, and P. similis for CL in this western leishmaniasis focus. The data revealed a correlation between their presence and spatial variables such as altitude, sampling site location, and humidity. The distribution areas of probable vector species in this study area allowed the identification of risk levels, which may provide useful information to guide the leishmaniasis research in endemic regions.

[The effect of trimethoprim-sulfamethoxazole in Blastocystis hominis infection]

The aim of this study was to investigate clinical findings and the effects of trimethoprim-sulfamethoxazole (TMP-SMX) in cases of blastocystosis. A total of 37 cases whose stool specimens were sent to the parasitology laboratory from the outpatient clinics of our hospital for various reasons were included in the study. Only five or more Blastocystis hominis were found during examination with direct wet mount using the 40x objective. The stool specimens were tested for other agents (Salmonella spp., Shigella spp., Escherichia coli H157:07, rotavirus) and cases with one of these were excluded from the study. The cases with blastocystosis were given TMP-SMX for 7 days. After the treatment, the cases were questioned as to symptoms once again, the stool specimen examinations were repeated with the same methods, and the results were evaluated. In 34 (91.89%) out of the 37 cases where B. hominis was found, various clinical symptoms such as stomach ache, flatulence, diarrhea, itching and fever were observed singly and/or together. After the treatment it was found that 36 (97.3%) out of 37 cases improved. This study supports the premise that TMP-SXT is effective in the treatment of B. hominis.

Serological and entomological survey of zoonotic visceral leishmaniasis in Denizli Province, Aegean Region, Turkey

A cross-sectional seroepidemiological survey of leishmaniasis was carried out among children and adults from four villages and one district of Denizli province located in the Southern Aegean Region of Turkey where 14 human visceral leishmaniasis (HVL) cases including 4 adults were reported between 1993 and 2000. Blood samples were taken from 329 children, 217 adults and 140 dogs and a physical examination was also done. Indirect fluorescent antibody test and enzyme linked immunosorbent assay were performed for all sera. All 329 sera collected from children were found to be negative while 2 (0.09%) out of 217 adult sera were found to be seropositive. One seropositive adult patient was confirmed parasitologically as HVL after bone marrow aspiration and treated with AmBisome while the other was followed only serologically because of the absence of symptoms. The overall canine leishmaniasis seroprevalence was found to be 20.7%. Sand flies were collected using CDC light traps in three out of five study sites and midguts of females were checked for promastigotes after dissection/identification. Eight Phlebotomus species were found in the region. Phlebotomus neglectus and P. papatasi were determined as dominant species with the ratio of 43.52% and 37.35%, respectively. No promastigotes were found in the midgut specimens. In addition, the results showed the presence of vector sand fly species, as well as a high seroprevalence of anti-Leishmania antibodies among dogs from rural and a suburban area of Denizli province with a large proportion of asymptomatic seropositive dogs.

[Investigating the seroprevalance of leishmaniasis in four dog shelters in Antalya and its districts]

Human visceral leishmaniasis (HVL) is endemic along the Aegean and Mediterranean coasts, while it occurs sporadically in other regions of Turkey. A relationship between canine leishmaniasis (CanL) and HVL has been detected and dogs have been found to be the reservoir of Leishmania infantum. In this epidemiologic study, the seroprevalence of CanL was investigated in dog shelters of four districts (Kepez, Kemer, Alanya and Gazipasa) of Antalya, in which visceral leishmaniasis and cutaneous leishmaniasis were observed according to the official records of The Ministry of Health of Turkey. Blood specimens of 176 dogs were examined and seropositive, borderline, seropositive, and negative results were detected in 14 (7.95%), 24 (13.63%), and 138 (78.4%) dogs, respectively. Weight and alopecia, onychogryphosis, and skin ulcers around the nose were observed in only two (14.2 %) dogs of seropositive cases. In conclusion, our data indicate that there is a potential danger for humans because L. infantum carrying dogs were detected in four districts of Antalya in the present study and also the appropriate vector spp. for this parasite has been reported in a previous one. Therefore, it would be advisable to perform new studies in order to determine the seroprevalence of CanL in dogs and the population size of vector spp. of L. infantum in other districts of Antalya.

[Case report: Acanthamoeba keratitis]

Acanthamoeba keratitis (AK) is an opportunistic protozoan infection caused by the pathogenic Acanthamoeba and associated with soft contact lens wear. If untreated, it can cause serious visual disability. A 23 year-old female wearing soft contact lenses applied to the Department of Ophthalmology of the Aydin Adnan Menderes University School of Medicine, with symptoms of redness, pain and blurred vision of both eyes. She was given a diagnosis of AK on clinical and laboratory grounds. The agent isolated was found to be T4 genotype "Acanthamoeba castellani". The patient regained visual ability following treatment. Although contact lens wear is the major risk factor for Acanthamoeba keratitis, the disease is usually seen unilaterally whereas in our case a bilateral involvement was observed. Great care should be practiced during contact lens use and there should be strict adherence to hygienic conditions if infections affecting the eye are to be avoided.