Retrospective Results of Hacettepe University Faculty of Medicine Parasitology Laboratory Between 2014-2019

OBJECTIVE

Parasitic infections emerge as a significant health problem, especially in underdeveloped and developing countries. Epidemiological data play an important role in taking effective measures against parasitic diseases.

METHODS

Clinical samples (stool, blood, bone marrow and tissue samples, etc.) that were sent to Hacettepe University Hospitals Parasitology Laboratory between 2014 and 2019 were analyzed retrospectively.

RESULTS

The positivity rates of the parasites detected in this study are as follows; Blastocystis sp. (71.6%), Dientamoeba fragilis (13.3%), Giardia lamblia (4.7%), Echinococcus spp. (1.9%), Enterobius vermicularis (1.8%) and Taenia spp. (0.3%). In this study, four of the patients were found to be positive for Leishmania spp. and two patients for Plasmodium falciparum and four patients for Plasmodium spp. E. histolytica/E. dispar cysts and/or trophozoites examined by Trichrome staining in our study were not detected within six years.

CONCLUSION

According to this data and in the light of the results obtained from different regions of our country, it will be possible to properly direct the necessary strategies for the diagnosis, treatment of parasitic infections and the implementation of preventive measures.

A Rare Case of Oral Myiasis Caused by Phormia regina (Meigen) (Diptera: Calliphoridae) in an Intubated Patient

Myiasis is the infestation of tissues with living larvae. Oral myiasis is an extremely rare form of the disease, with open mouth, unconsciousness, and poor oral hygiene being the predisposing factors. It is generally observed in the tropics or subtropics, as well as rural places with low socio-economic income. Mechanical removal and ivermectin are frequently used as treatments. Herein, we present a case of oral myiasis in a 69-year-old male intubated patient with myocardial infarction. Multiple larvae were observed in the mouth and mechanically removed. With the microscopic investigation, the larvae were identified as Phormia regina (Meigen) (Diptera: Calliphoridae), which is extremely rare globally. For preventing oral myiasis, good patient care, good sanitary practice for oral health, efficient treatment of dental diseases, and fly population control, usage of masks for the risk groups are recommended.

Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital

Objective

Immunocompromised patients are at a greater risk of developing intestinal parasite infections. In this study, we examined the presence of Enterocytozoon bieneusi, Encaphalitozoon intestinalis and other intestinal protozoa in stool samples of immunosuppressed patients.

Methods

A total of 100 stool samples were obtained from patients receiving chemotherapy because of solid organ tumour with haematological malignancies and those receiving immunosuppressive treatment because of rheumatic diseases, organ transplant patients and patients receiving treatment for HIV-related infections. Stool samples were examined by using the native-lugol method in which the stool concentration, modified Kinyoun acid-fast and trichrome staining methods and parasite presence were analysed. The stool samples were also examined for the presence of Enterocytozoon bieneusi and Encephalitozoon intestinalis using an indirect fluorescent antibody method.

Results

Intestinal parasites were detected in 12% of all patients. The distribution of intestinal parasites in patients were 7% Blastocystis spp., 2% Blastocystis spp. + Dientamoeba fragilis, 1% Blastocystis spp. + Entamoeba coli, 1% Blastocystis spp. + Giardia intestinalis and 1% G. intestinalis. Microsporidia spp. were detected in 4% of all patients by the IFAT method and in 8% of all patients by calcoflour staining method.

Conclusion

In our study, the most prevalent parasite detected in the immunosuppressed patients was Blastocystis spp. The pathogenesis of Blastocystis spp. remains to be controversial, and their role in immunocompromised patients continues to remain unknown. Although these rates detected in our study are similar to the prevalence in the normal population, it is important to study these microorganisms in immunocompromised patients in terms of the associated decreasing morbidity and mortality rates.

Cystoisospora belli infection in a renal transplant recipient: a case report and review of literature

Cystoisospora belli is a coccidian parasite that causes prolonged watery diarrhea especially among immunocompromised patients. Herein, we report a renal transplant patient who complaints of alternating diarrhea and review of literature related to cystoisosporiasis amongst the transplant recipients.

Persistent dermal lesions in a patient with previous history of visceral leishmaniasis

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) that most frequently occurs after an episode of VL caused by Leishmania donovani. In this case report, we present a 21-year-old male patient with persistent skin lesions and recurrent visceral leishmaniasis (VL) due to Leishmania infantum. The patient did not respond to multiple lines of anti-leishmanial treatment (including Liposomal amphotericin B and miltefosine) and later died from cerebral lesions presumed to be secondary to persistent VL.

[The Importance of Awareness for Malaria Regarding Prophylaxis and Early Diagnosis: Two Imported Malaria Cases in Turkey]

In spite of the fact that Plasmodium vivax is the leading causative agent of malaria in our country, imported malaria cases have been reported, recently. In this report, two malaria cases originated from sub-Saharan Africa, and their diagnostic and therapeutic approaches were aimed to be presented. First case, 45-year-old male, who has been working in Republic of Ghana, was admitted to Hacettepe University Hospitals Emergency Service with complaints of fever, sweating and shivering, after returning to Turkey. On admission, his general condition was fine and his physical examination revealed no pathological finding. After his admission, a fever episode occured and his blood tests revealed anemia, trombocytopenia and increased alkaline phosphatase level. Second case, 39-year-old-male admitted to the emergency service with the complaints of fever, shivering and myalgia. His physical examination revealed decreased breath sounds and splenomegaly, his laboratory tests resulted in pansitopenia and elevated liver enzymes. In the thick blood smears of the patients ring formed young trophozoites are detected and in the thin films multiple ring forms demonstrated in one erythrocyte with the absence of mature trophozoites and schizont forms, which were compatible with falciparum malaria. The rapid antigen test (Digamed, Belgium) of the second case found to be positive for both Plasmodium falciparum and P.vivax and this patient followed-up in intensive care unit due to his deterioration of general condition, respiratory distress, hematuria and change of consciousness. Neither cases were commenced on malaria prophylaxis. Both patients have been in countries which chloroquine resistance is commonly seen, they were treated with artemether/lumefantrine as current World Health Organization recommended. Targeting hypnozoites of P.vivax, primaquine was added to the therapy of the second patient. Both patients resulted in cure. In conclusion, while travelling to endemic countries, people should be informed about the importance of malaria prophylaxis and prophylaxis should be commenced immediately and continued appropriately. Additionally, malaria should always be considered in the differential diagnosis of high fever for the patients who admitted to the hospital with a travelling history to these countries.

Refractory Giardiasis in an Immunosuppressed Patient in Turkey

Giardiasis is an infection of the small intestine caused by the protozoan parasite Giardia duodenalis. In immunocompetent patients the infection is usually self-limited and no treatment may be needed. Immunodeficiency, however, is a predisposing factor for the development of severe Giardia infection. In this report, a case of recurrent giardiasis refractory to nitroimidazoles and nitazoxanides presented. A 28-year-old male patient with hypogammaglobulinemia admitted to our hospital because of chronic diarrhoea. Microscopic examination of stool revealed a high number of Giardia trophozoites and cysts. Treatment with higher doses and a longer course of metronidazole, trimethoprim-sulfamethoxazole, ornidazole and albendazole failed. Administration of nitazoxanide, which has been reported to be effective against Giardia duodenalis refractory to nitroimidazoles, was commenced, but his symptoms persisted and stool samples demonstrated Giardia trophozoites and cysts again.

[Plasmodium falciparum malaria: evaluation of three imported cases]

Among Plasmodium species the causative agent of malaria in Turkey is P.vivax, however the incidence of imported falciparum malaria cases is steadily increasing. P.falciparum may cause severe malaria with the involvement of central nervous system, acute renal failure, severe anemia or acute respiratory distress syndrome. Furhermore most of the casualties due to malaria are related with P.falciparum. There is recently, a considerable increase in malaria infections especially in tropical areas. In this report, three cases, who have admitted to our hospital with three different clinical presentations of falciparum malaria, and all shared common history of travelling to Africa were presented. First case was a 27 years old, male patient who returned from Malawi seven days ago where he stayed for two weeks. He admitted to our hospital with the complaints of sensation of cold, shivering and fever. In physical examination his body temperature was 37.9°C, C-reactive protein level was high, and the other systemic results were normal. The second case was a 25 years old, male patient who returned from Gambia two weeks ago. He was suffering from fever, headache, shivering and unable to maintain his balance. The patient's body temperature was 38°C. Laboratory tests revealed hyperbilirubinemia and thrombocytopenia. Parasitological examination of the Giemsa-stained peripheral blood smear of these two patients demonstrated ring forms compatible with P.falciparum. Treatment was commenced with arthemeter plus lumefantrine, resulting with complete cure. Third case was a 46 years old, male patient who had been working in Uganda, and returned to Turkey two weeks ago. He had sudden onset of fever, headache, nausea and vomiting and impaired consciousness. His peripheral blood smear revealed ring-formed trophozoites and banana-shaped gametocytes of P.falciparum. Arthemeter plus lumefantrine therapy was started, however, he developed severe thrombocytopenia and jaundice under treatment. His general condition was detoriated and the patient lost his consciousness. As the patient's clinical signs were compatible with sepsis ceftriaxone plus clindamycin were added to the antiparasitic treatment emprically. Due to the development of acute tubular necrosis, the patient have undergone hemodialysis. On the 9th day of therapy the complaints and laboratory findings of the patient have improved, so he was discharged. However, visual defects due to retinopathy and severe neurocognitive impairment that were thought to be the complications of malaria continued in his follow-ups. As a result, it should be keep in mind that both the African students who have come to our country for education from endemic regions and as well as the returned citizens of our country who have gone to work in endemic areas, are under risk of malaria and it is very important to consider malaria in the distinctive diagnosis of patients with the complaints of fever, headache, nausea, vomiting and muscle pain.

Detection of parasites in children with chronic diarrhea

The aim of this study was to investigate the frequency of intestinal parasites in patients with chronic diarrhea and clarify the importance of these parasitic pathogens in such cases. A total of 60 pediatric patients with chronic diarrhea between June 2012 and October 2014 were enrolled in the study. Out of 60 stool samples, five were positive for Giardia lamblia, two, Dientamoeba fragilis, and one, Blastocystis hominis. One stool sample was positive for Entamoeba hartmanni and B. hominis, another one was positive for G. lamblia and B. hominis, another, G. lamblia and E. hartmanni and one sample was positive for Enterobius vermicularis, D. fragilis and B. hominis together. Parasitic infection, which decreases quality of life and increases susceptibility to other infections, should not be neglected, particularly in patients with chronic diarrhea. Accurate diagnosis decreases morbidity and mortality in patients with parasite infection.

[The results of Hacettepe University Faculty of Medicine Parasitology Laboratory in 2003-2012: evaluation of 10 years]

OBJECTIVE

Parasitic diseases are common throughout the world. Evaluation of regional epidemiological data is needed to determine protective measures and treatment strategies.

METHODS

This study evaluates the parasites detected in Hacettepe University Faculty of Medicine Parasitology Laboratory.

RESULTS

Of the 87,100 clinical samples evaluated in the study, 85,707 (98.4%) were from stool samples. Parasites were shown in 3,681 (4.2%) of the samples from 2,906 patients. The most common parasites were Giardia intestinalis (40%), Blastocystis spp. (22%), Entamoeba coli (12%), Dientamoeba fragilis (9%), Enterobius vermicularis (5%), Echinococcus spp. (4%) and Taenia spp. (3%) respectively. When distribution among years was evaluated, G. intestinalis, the most common parasite, had a tendency to decrease after 2004 whereas cases with Blastocystis spp. showed a clear increase in 2011 and 2012. The downward trend in parasite-positive cases also stopped in the last two years, in parallel to the increase of Blastocystis spp. During the study, Leishmania spp. and Plasmodium spp. were detected in four patients each.

CONCLUSION

This study evaluated the results of a laboratory that scans a large number of patients in our region. Data obtained from different regions will allow to direct strategies to diagnose, treat and implement preventive measures against parasitic diseases in our country.

[Adaptation of a sensitive DNA extraction method for detection of Entamoeba histolytica by real-time polymerase chain reaction]

This study was aimed to adapt a sensitive DNA extraction protocol in stool samples for real-time polymerase chain reaction (PCR) detection of Entamoeba histolytica which causes important morbidity and mortality worldwide. Stool extraction is a problematic step and has direct effects on PCR sensitivity. In order to improve the sensitivity of E.histolytica detection by real-time PCR, "QIAamp DNA stool minikit (Qiagen, Germany)" was modified by adding an overnight incubation step with proteinase K and sodium dodecyl sulfate (SDS) in this study. Three different extraction methods [(1) original method, (2) cetyltrimethyl-ammonium bromide (CTAB) method, (3) modified method] were evaluated for effects on sensitivity in real-time quantitative PCR (Artus RealArt TM E.histolytica RG PCR Kit, Qiagen Diagnostics, Germany). For this purpose, several concentrations of standard E.histolytica DNA were spiked in parasite-free stool samples and three different extraction protocols were performed. Detection sensitivities of "QIAamp DNA stool minikit" was found 5000 copies/ml and of CTAB method was found 500 copies/ml. Detection sensitivity of the extraction was improved to 5 copies/mL by modified "QIAamp DNA stool minikit" protocol. Since detection sensitivities of nucleic acid extraction protocols from stool samples directly affect the sensitivity of PCR amplification, different extraction protocols for different microorganisms should be evaluated.

[Molecular typing of clinical Candida krusei isolates by using restriction endonuclease analysis of genomic DNA and polymerase chain reaction]

Candida krusei is inherently resistant to fluconazole and is an important pathogen responsible for nosocomial candidiasis especially in patients with hematological malignancy. Despite the growing clinical importance of C. krusei infections, little is known of its genetic diversity and molecular epidemiology. Therefore, differentiating between C. krusei isolates is of importance for a better understanding of the epidemiology, mode of transmission and pathogenesis of the organism. We investigated the use of two different methods (restriction endonuclease analysis of genomic DNA (REAG) with Hinfl and polymerase chain reaction by using Arno1 and Arno2 primers) for molecular typing of 56 C. krusei isolates from 56 patients. Ten different types (A-J) were determined by REAG. Depending on the patterns of isolates, the number of the bands varied from 12 to 15 and the size of the fragments varied from 2.0 kb to 6.2 kb. Of the isolates 71.4% were gathered under three major patterns (D, F, H). In the second method, PCR amplified different sizes of fragments varied approximately from 1 kb to 2 kb, which yielded 13 types (a-m) from 56 patients. Four major patterns (d, f, h, k) were observed for 58.9% of the isolates. The genotypes detected by REAG and PCR methods were found to be same in 43 isolates out of 56. As the banding patterns of the isolates were found to be similar in this study, it was thought that an exogenous origin could be the source of infections caused by C. krusei isolates. Both REA of genomic DNA and PCR analysis seem to be useful for the typing of C. krusei, however PCR assay can be preferred as it is a simple and rapid method. As a result, further studies are required for the validation of reproducibility and discriminatory power of these methods.

Characteristics of Blastocystis hominis infection in a Turkish university hospital

In order to determine characteristics of Blastocystis (B.) hominis infection; 770 individuals' stool specimens were examined both by simple and concentration techniques and stained with iodine solution and trichrome in the Parasitology Laboratory of Hacettepe University Faculty of Medicine, Turkey. Among the examined 770 specimens, B. hominis was detected in 94 (12.2%). B. hominis was the most common intestinal parasite among the study group. It was mostly detected with Dientamoeba fragilis. Among the groups the incidence of B. hominis in allergic patients was higher than controls. Among the immunosuppressed patients, B. hominis was detected significantly higher in patients who had solid tumours. Of the 48 individuals who had only B. hominis in their stool the most common symptom was abdominal pain. Concentration technique with trichrome stain was more sensitive than simple smear with lugol solution for the detection of B. hominis. Studies with more patients must be planed to understand the B. hominis infection in solid tumour patients and coexistence of B. hominis and D. fragilis.

Case report: Isospora belli infection in a renal transplant recipent

Isospora belli, an opportunistic protozoon, is one of the most commonly recognized causes of diarrhea in patients with acquired immunodeficiency syndrome (AIDS). Infection is acquired through fecal contaminated food or water, and generally diagnosed by examination of stool and/or duodenum biopsy specimens with acid-fast staining. Here, we present an uncommon case, chronic diarrhea caused by I. belli infection in a patient who is a renal transplant recipient.

Diarrhea in neutropenic patients: a prospective cohort study with emphasis on neutropenic enterocolitis

BACKGROUND

Although diarrhea is a frequent complication in neutropenic patients, its true incidence, risk factors and clinical course have not been investigated prospectively.

PATIENTS AND METHODS

The study was carried out at Hacettepe University Hospital for Adults and involved patients over 16 years of age. Patients with malignant diseases who were neutropenic on admission or who became neutropenic during their stay in the wards between January 2001 and February 2003 were included. They were monitored daily until discharge, exitus, or recovery from neutropenia-whichever occurred earlier-to monitor the presence of diarrhea and other infections.

RESULTS

A total of 317 neutropenic episodes in 215 patients were followed. Diarrhea was observed in 18.6% episodes, and the incidence of NEC was 3.5%. The etiology in 27% episodes of diarrhea could not be identified. The use of anthracyclines and mitoxantrone increased the incidence of diarrhea. Prior use of penicillin derivatives plus beta-lactam inhibitors and N-imidazoline derivatives was associated with decreased incidence of diarrhea.

CONCLUSIONS

Diarrhea is a common complication in neutropenic patients. Not only specific conditions like NEC, but also nonspecific diseases like parasitosis may be the cause of diarrhea in this patient population.

[A plasmodium alciparum malaria case originated from Mozambique: clues for the diagnosis and therapy]

The aim of this report was the presentation of a falciparum malaria case originated from Mozambique and the evaluation of diagnostic and therapeutic approaches. Sixty years old Canadian male patient who has been working in Mozambique for 13 years was admitted to hospital with the complaints of high fever (39.6 degrees C), weakness, nausea and vomiting, when returned to Turkey. The patient was sleepiness and has undulating confusions with the laboratory findings of thrombocytopenia, hypoglycemia, hyperlactatemia, increased BUN/creatinine levels, increased LDH levels and hypocholesterolemia. The diagnosis was based on the detection of multiple ring formed trophozoites in the thick blood film and the presence of multiple ring forms inside the erythrocytes and the absence of trophozoite and shizont forms in the thin blood film. His medical history revealed that he experienced another falciparum malaria infection one year ago, although he has been using mefloquine prophylaxis during his stay in Mozambique. Since chloroquine resistance was thought to be high in this region, the patient was treated with quinine sulphate and doxycycline. Six days after the onset of therapy, the biochemical markers turned to normal and 14 days later the blood films were free of the parasite. The patient was given doxycycline prophylaxis since he would return to Mozambique. In conclusion, the followings should be taken into consideration for the diagnosis and therapy: (i) cyclic type of fever which is characteristic for malaria, might not be detected in falciparum malaria; (ii) some of the clinical symptoms might be blocked by partial immune response in case of recurrent infections; (iii) thrombocytopenia and hypocholesterolemia might indicate the presence of falciparum malaria; and when falciparum malaria is confirmed by parasitological examinations the patient should be treated as if he/she is accepted as resistant to chloroquine.

Cyclospora infection in five immunocompetent patients in a Turkish university hospital

Infection with Cyclospora has been increasingly reported worldwide in both immunocompetent and immunocompromised individuals. Here the cases of five patients infected with Cyclospora cayetanensis, who sought medical care at Hacettepe University in Turkey, are reported. Diarrhoea occurred from five to fifteen times a day in all of these patients, whose ages ranged from 27 to 67 years. All the patients were considered immunocompetent. Identification of C. cayetanensis was made by detection of the oocysts by using a modified acid-fast stain.

Fasciola hepatica infection: clinical and computerized tomographic findings of ten patients

BACKGROUND/AIMS

Fasciola hepatica is the cause of liver infection, fascioliasis. Although rare, it is still a problem even in developed countries. In this study, the clinical and computerized tomographic findings of 10 patients diagnosed with fascioliasis are summarized.

METHODS

The medical records of the patients with fascioliasis were retrospectively examined. Clinical, laboratory findings and computerized tomographic results were recorded.

RESULTS

Abdominal pain, fever, eosinophilia and abnormal liver function tests were the most commonly encountered symptoms and signs. One patient was human immunodeficiency virus -positive with active tuberculosis. Serologic test for fasciola hepatica was positive in all patients. Nodular masses without prominent enhancement, and branching low-attenuated tubular lesions were the most commonly seen tomographic findings and were supportive for the diagnosis. All except the HIV-positive patient received bithionol therapy; six patients responded well, two lost contact with the clinic and one patient who was unresponsive to bithionol therapy received triclabendazole. During follow-up of the six patients who responded, all the clinical and radiological findings regressed.

CONCLUSION

In any patient with peripheral eosinophilia, abdominal pain and elevated liver enzymes, especially when CT reveals tubular and nodular hypodense lesions particularly in subcapsular area, F. hepatica infection should be considered. Either triclabendazole or bithionol can be used effectively for the treatment.

[Comparison of the methenamine silver staining, direct fluorescent antibody and nested-polymerase chain reaction methods in the diagnosis of Pneumocystis carinii pneumonia]

Pneumocystis carinii is one of the most common causative agents of pneumonia in immunocompromised patients, but the problems in the laboratory diagnosis of the disease frequently leads to diagnosis according to the response to medical treatment. In this study, the presence of P. carinii was investigated in immunocompromised patients who were presenting with the clinical symptoms of atypical pneumonia, by Gomori methenamine silver staining (GMS), direct fluorescent antibody (DFA) test and nested-polymerase chain reaction (nPCR) methods. Fifty-three samples of 49 patients were included in the study. Twelve of the samples (22.6%) were found to be positive by nPCR, 6 of them (11.3%) were found to be positive by DFA, while only one of them (1.8%) was positive by GMS staining method. As a result, for the appropriate treatment and prophylaxis of P. carinii infections, PCR which is a rapid and reliable diagnostic test should be used for diagnosis.

[The rate of parasite detection over a 5-year period in the parasitology faculty laboratory at the Hacettepe University]

The aim of this retrospective study was to investigate the rate of parasite positivity, in the samples which were sent to Parasitology Laboratory of Hacettepe University Medical School, between 1997-2001. A total of 58.150 specimens collected from subjects of whom 42% were adult and 58% were children, have been evaluated for the presence of parasites. Most of the samples (98%) were feces, and the remaining were sputum, cellotapes, blood and cyst materials. One or more parasites were detected in 2.117 (3.6%) of the specimens, and Giardia intestinalis (69.5%), Enterobius vermicularis (9.7%) and Taenia saginata (6.8%) were the most frequently encountered parasites.

Cryptosporidiosis in immunocompromised patients in a Turkish university hospital

The prevalence of Cryptosporidiosis in 18 immunosuppressed diarrheic patients was evaluated by examination of fecal samples by direct staining (Modified Kinyoun and Giemsa), direct and indirect immunofluorescence methods. Forty patients (10 nondiarrheic immunosuppressed, 10 nondiarrheic immunocompetent, and 20 diarrheic immunocompetent) were included in the study as the control group. 11 of 18 samples were positive for cryptosporidial oocysts by at least one of the methods. Oocysts were detected in all (n = 7) of the AIDS patients. This high frequency was attributed to a probable nosocomial infection. None of the samples from control subjects were found positive for Cryptosporidium. Our results indicate that Cryptosporidial oocysts should be detected particularly in immunosuppressed patients with diarrhea. Modified Kinyoun staining method is practical and reliable for this purpose. Immunofluorescence staining methods can be applied for confirmation of the results.

Cryptosporidium parvum prevalence in a group of Turkish children

Stool samples from two hundred children with diarrhea and from 50 healthy children were examined, by modified Kinyoun's acid-fast staining (MAF), Giemsa staining and direct (DFA) and indirect immunofluorescence antibody (IFA) methods, in order to determine cryptosporidiosis prevalence under the age of 12 and to detect the most efficient identifying method for use in our country. Cryptosporidium oocysts were detected in seven (3.5%) of the cases. None of the samples from the control subjects was found to be positive for Cryptosporidium. Our results indicate that Cryptosporidial oocysts should be detected in children with diarrhea. Modified Kinyoun staining method is practical and reliable for this purpose. Immunofluorescence staining methods can be applied for conformation of the results, if available.

Visceral and cutaneous leishmaniasis (report of 2 cases)

Leishmaniasis is an endemic, sporadic infection in many parts of the world. Turkey is geographically unique in linking Asia and Europe. Of special interest is leishmaniasis, as various forms of this disease have long been reported in the surrounding regions. Visceral and cutaneous leishmaniasis are endemic in the western and southeastern parts of Turkey, respectively. Here, we report a cutaneous and a visceral leishmaniasis case, to draw attention to the increase in the incidence of leishmaniasis in Turkey. In the patient with cutaneous leishmaniasis, the ulcerative lesion on the cheek had persisted for two months before admittance to the hospital. Direct smears prepared from this lesion were negative for leishmania amastigotes whereas the promastigote forms were maintained in NNN (Novy-MacNeal-Nicolle) medium. The second patient was hospitalized with a prediagnosis of haematological malignancy, but the smears prepared from the bone marrow aspirates revealed leishmania amastigotes and promastigotes were seen on the smears from NNN cultures. These two reports mark the importance of inoculation of the specimens to NNN medium for the recovery of the promastigote forms. Cutaneous and visceral leishmaniasis have become endemic in considerable number of foci in Turkey, possibly due to the cessation of vector control programmes and increase in the agricultural and irrigation areas. These two reports also point out the increased prevalence of leishmaniasis in Turkey after 1980's.

Detection of Listeria monocytogenes in milk by the polymerase chain reaction

A on the polymerase chain reaction (PCR) method based was developed for detection of Listeria monocytogenes in milk samples after enrichment culture. It consists of culturing samples in Listeria enrichment broth, followed by DNA extraction and detection of the organism using PCR. Dilutions of L. monocytogenes in milk were subjected to PCR amplification after enrichment culture. When determining the sensitivity of the method, it was found to be possible to detect 37 CFU (colony forming unit gl/ml) of the bacterium in milk. The method was assessed as a sensitive, specific, times-saving and practical way of detecting L. monocytogenes in milk samples.

Comparison of cytochemical staining, immunofluorescence and PCR for diagnosis of pneumocystis carinii on sputum samples

Detection of P. carinii has increased with the use of polymerase chain reaction (PCR), particularly in sputum samples. In this study, sputum samples obtained from 30 immunosuppressed patients with respiratory symptoms (12 HIV-infected) were tested by standard cytochemical staining (Giemsa and methenamine silver), immunofluorescence (IF) staining and PCR for detection of P. carinii and the results were compared. Pneumocystis carinii was detected in 4, 8 and 13 sputum samples by cytological staining, IF test and PCR, respectively. Specific amplification bands were obtained in all sputum samples that were positive by both other tests. All tests gave negative results in sputum samples obtained from 5 HIV-infected asymptomatic patients and 22 non-immunosuppressed tuberculosis patients. Our observations suggest that PCR results were well correlated with P. carinii pneumonia (PCP), especially in non-HIV-infected patients. However, PCR positivity obtained in HIV-infected patients could be misleading in the diagnosis of PCP without careful clinical evaluation. Positive results obtained by Giemsa staining or IF test confirm diagnosis of PCP authoritatively. As a result, we suggest testing sputum samples by both PCR and IF techniques for detection of P. carinii.

Detection of Listeria in raw and pasteurized milk

One hundred raw milk samples from different regions of Anatolia and 20 pasteurized milk samples from three different manufacturers in Ankara were analyzed for the presence of Listeria spp. L. monocytogenes was found in 1% of the raw milk samples and in 5% (1/20) of the pasteurized milk samples. L. innocua and L. seeligeri were found in 8 and 2% of the raw milk samples, respectively. No other species of Listeria was found. The overall incidence of Listeria spp. was 10% in the raw milk samples and 5% in the pasteurized milk samples.

Isolation, in vitro antimicrobial susceptibility and penicillin tolerance of Arcanobacterium haemolyticum in a Turkish university hospital

Arcanobacterium haemolyticum (Ah) was isolated from 5 (0.3%) out of 1531 throat cultures of patients with presumed pharyngotonsillitis. The age of the patients who had a positive culture for Ah varied between 6 and 22. The isolation rate of beta-haemolytic streptococci (BHS) was 7.4%, 72.6% of which belonged to Group A, followed by groups G, C and B. None of the throat samples yielded simultaneous growth of Ah and BHS. Antimicrobial susceptibility of Ah isolates to phenoxymethylpenicillin, cephalexin, cefotaxime, vancomycin, erythromycin, azithromycin, doxycycline, ciprofloxacin, and trimethoprim-sulfamethoxazole was tested by the agar dilution method. The isolates were found to be susceptible to all antimicrobials tested except trimethoprim-sulfamethoxazole. Penicillin tolerance could be detected in none of the Ah strains, including the reference strain Ah ATCC 9345. We conclude that Ah should be kept in mind as a potential pathogen causing pharyngitis in adolescents and young adults.

[The role of Candida albicans in denture stomatitis]

Denture stomatitis is a clinical inflammatory picture that is seen at oral mucosa of the upper chin of patients who use removable dentures. There are various reasons of denture stomatitis. In order to detect the presence rate of C. albicans on lesions as the most important factor and the factors which effect this situation, 41 patients (31 with denture stomatitis and 10 as controls) were chosen. The smears obtained from the hard palate of the patients were microbiologically investigated. C. albicans was found to be the causative agent in 35.4% of the cultures which have shown growth. The relationship of sex, age and the period of denture usage was investigated in these cases.

[Antisperm and anticardiolipin antibodies in recurrent abortions]

In this study, antisperm (ASA), anticardiolipin (ACL) and some other autoantibodies have been investigated in 63 cases of habitual abortion, spontaneous abortion and intrauterine fetal death. ASA antibodies and ACL antibodies were positive in 28.5% and 33.3% of the patients respectively. 7 cases (11.1%) were positive for both ASA and ACL antibodies. According to our results it can be supposed that, besides other factors antisperm antibodies may play role in early abortions.

[Anticardiolipin antibodies in autoimmune rheumatic diseases]

In this study, ELISA and VDRL tests have been employed in order to detect ACL antibodies in sera samples obtained from 105 patients with SLE, RA, scleroderma, dermatomyositis, primary Sjögren's syndrome, vasculitis and pulmonary thromboemboli; Using by IFAT, AMA-type 5 and other autoantibodies, RIA anti-DNA antibodies were also tested in SLE patients. In sera obtained from the patients with RA; autoantibodies and RF have been investigated. In SLE cases, ACL antibodies were found to be positive in 55.5% of the patients. In RA cases the rate of ACL antibodies were found to be 51.7%. In SLE cases, the presence of IgG-ACL antibody was found to be in association with thrombosis and fetal loss; while IgM-ACL antibody was found to be in association with fetal loss only. Serologic parameters such as VDRL and AMA type 5 were significantly connected with the presence of ACL-IgG and IgM antibodies (p less than 0.05). In cases of RA connection was detected only between IgG-ACL antibody and thrombosis. Concerning the other rheumatic autoimmune diseases; ACL antibodies were detected in cases: 4 patients out of 11 scleroderma, 1 patient out of 7 vasculitis, 2 patients out of 5 primary Sjögren's syndrome, and 3 patients out of 6 pulmonary thromboemboli.

[Reproductive immunology]

In this article, immunology of fetoplacental survival in pregnancy and immunologic mechanisms in infertility, abortions and preeclampsia are discussed. Rh incompatibility, pregnancy in renal transplant patients, autoimmune diseases and cancer in pregnancy are also reviewed.

[The immunologic processes of the etiopathogenesis of Sjögren's syndrome]

In this study 32 Sjögren's syndrome cases--16 primary and 16 secondary--have been followed-up for 3 years in Hacettepe University Medicine Faculty Ophthalmology Department. The serum levels of rheumatoid factor and complement have been determined and autoantibodies have been looked for by the indirect immunofluorescence technique. The immunological processes that play a role in the pathogenesis of Sjögren's syndrome have been discussed with regard to the results of the study.

[Myasthenia gravis and autoimmunity]

A disorder in immune system is thought to be the factor in Myasthenia gravis. Certain antibodies against various tissues have been detected in the sera of this group of patients. Anti-acetyl-cholin receptor antibodies are positive in 90% of the patients with M.G. Basic pathology is thought to be the destruction in post-synaptic membrane, resulted from the reaction in which an autoimmune response directed to acetyl-cholin receptors.