Publications by authors named "Seray Özensoy Toz"

38 Publications

Clinical practice guidelines for the diagnosis and treatment of cutaneous leishmaniasis in Turkey.

Int J Dermatol 2018 Aug 16;57(8):973-982. Epub 2018 Apr 16.

Department of Dermatology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.

Background: Cutaneous leishmaniasis (CL) is a vector-born parasitic disease characterized by various skin lesions that cause disfiguration if healed spontaneously. Although CL has been endemic for many years in the southern regions of Turkey, an increasing incidence in nonendemic regions is being observed due to returning travelers and, more recently, due to Syrian refugees. Thus far, a limited number of national guidelines have been proposed, but no common Turkish consensus has emerged.

Objectives: The aim of this study was to develop diagnostic and therapeutic guidelines for the management of CL in Turkey.

Methods: This guideline is a consensus text prepared by 18 experienced CL specialists who have been working for many years in areas where the disease is endemic. The Delphi method was used to determine expert group consensus. Initially, a comprehensive list of items about CL was identified, and consensus was built from feedback provided by expert participants from the preceding rounds.

Results: Evidence-based and expert-based recommendations through diagnostic and therapeutic algorithms according to local availability and conditions are outlined.

Conclusion: Because CL can mimic many other skin diseases, early diagnosis and early treatment are very important to prevent complications and spread of the disease. The fastest and easiest diagnostic method is the leishmanial smear. The most common treatment is the use of local or systemic pentavalent antimony compounds.
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http://dx.doi.org/10.1111/ijd.14002DOI Listing
August 2018

Incidence of Parasitic Diarrhea in Patients with Common Variable Immune Deficiency.

Turkiye Parazitol Derg 2016 Jun;40(2):67-71

Ege Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, İzmir, Türkiye.

Objective: Parasites might cause atypical and severe infections in immunocompromised hosts. The prevalence of diarrhea among common variable immune deficiency (CVID) syndrome patients varies between 20% and 94%, which indicates that diarrhea and gastrointestinal system (GIS) complaints could be the second leading cause of morbidity in CVID patients after respiratory tract infections. This study aimed to assess the prevalence of intestinal parasites in CVID patients with GIS complaints and diarrhea.

Methods: In this study, all cases followed up in the Immunology and Allergy Clinic of Ege University School of Medicine from July 2008 to August 2015 with the diagnosis of CVID were reviewed retrospectively. The stool samples of patients with diarrhea were identified using direct microscopy of native (0.09% NaCl) and Lugol's iodine preparations followed by formol-ethyl acetate concentration to apply modified Kinyoun, trichrome, acid-fast trichrome, and modified trichrome stains for the presence of intestinal parasites.

Results: Overall, 26 of 37 CVID patients had diarrhea; white and red blood cells (WBCs and RBCs, respectively) were identified in 11 and 10 of these 26 samples, respectively. Intestinal parasites were found to be present in 7 of the 11 patients with WBCs and 3 of the 10 patients with RBCs. With the addition of patients who neither had WBCs nor RBCs in their stool, a parasitic agent was detected in 13 (50%) of the 26 patients with diarrhea. There was no significant difference between the diarrheic patients with or without intestinal parasites with respect to cramps, fever, nausea and vomiting, tenesmus, bloody feces, and presence of mucus in the stool. Only one patient had malabsorption, which was not associated with intestinal parasites. The most common parasites detected in this study were Cryptosporidium spp. (n=9; 69.2%), Giardia spp. (n=7; 53.8%), and Blastocystis spp. (n=3; 23.1%). We also identified that parasitic diarrhea in CVID patients tended to last longer (M (mean): 16.2 days) than other causes of infectious diarrhea; this is in accordance with previous studies.

Conclusion: Cryptosporidium spp. was found be the major cause of parasitic intestinal infection in this patient population. It was concluded that parasitic infections may cause chronic diarrhea, which are major causes of morbidity in CVID patients. Therefore, special attention is necessary for the identification of intestinal parasites in CVID patients with diarrhea.
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http://dx.doi.org/10.5152/tpd.2016.4687DOI Listing
June 2016

Leishmaniasis in Turkey: Determination of Leishmania Species by Matrix-Assisted Laser Desorption Ionization Time-Of-Flight Mass Spectrometry (MALDI-TOF MS).

Iran J Parasitol 2014 Apr-Jun;9(2):239-48

Department of Medical Parasitology, School of Medicine, Celal Bayar University, Manisa, Turkey.

Background: Cutaneous leishmaniasis (CL) is endemic in Southeastern Anatolia, mainly in Sanliurfa and Hatay provinces, and the causative agents are mostly Leishmania tropica and less frequently L. infantum. Here, we report the first MALDI-TOF analyses of Leishmania promastigotes obtained from the cultures of two CL cases from Osmaniye and Hatay provinces who were initially diagnosed by microscopy, culture and identified as L. infantum with Real-Time PCR (RT-PCR).

Methods: Samples obtained from the skin lesions of patients were initially stained with Giemsa and cultivated in NNN medium. Examination of the smears and cultures revealed Leishmania amastigotes and promastigotes, respectively. The promastigotes (MHOM/TR/2012/CBU15 and MHOM/TR/2012/MK05) obtained from the cultures of both patients were used for RT-PCR targeting the ITS-1 region in the SSU of rRNA. The reference strains of four Leishmania species (L. infantum, L. donovani, L. tropica and L. major) were initially assessed with MALDI-TOF and their data were added to MALDI-TOF Biotyper Library.

Results: Both RT-PCR and MALDI-TOF analyses indicated that the causative agent in both patient samples was L. infantum.

Conclusion: Despite disadvantages such as requirement of culture fluid with nothing but promastigotes and high cost, MALDI-TOF analysis may be a fast, sensitive and specific diagnostic tool in especially large-scale research studies, where the cost declines, relatively.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386045PMC
April 2015

Prevalence of head lice in two socio-economically different schools in the center of Izmir City, Turkey.

Turkiye Parazitol Derg 2014 ;38(1):32-6

Department of Biology, Ege University Faculty of Medicine, İzmir, Turkey.

Objective: The well-known and common infestation caused by Pediculus humanus capitis is an important public health and a social issue in many communities in the world. The aim of this study was to compare the head louse infestation rate in two schools having pupils from different socio-economic levels in the city center of Izmir.

Methods: The pupils aged between 6 and 11 years, were screened for the presence of eggs and nymph/adult lice using a fine-tooth head louse comb.

Results: A total of 88 and 126 pupils from the schools with low and medium socio-economic level were screened and 24 (27.2%) and 5 (3.96%) of them were found to be positive for head lice, respectively. Overall, the infestation rate among girls was 3.14 times higher than in boys.

Conclusion: Head louse infestation is a significant public health problem among primary schools. Increasing the knowledge about pediculosis and self-hygiene would be helpful in successfully reducing head louse infestation in the school setting. School authorities must encourage the parents to look for head lice routinely and a "school nurse" system is needed for effective head louse control in the schools.
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http://dx.doi.org/10.5152/tpd.2014.3447DOI Listing
November 2014

[Co-occurence of visceral leishmaniasis and lymphoma].

Turkiye Parazitol Derg 2013 ;37(4):282-4

Ege Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, İzmir, Türkiye.

Clinicians have usually considered malignancies during follow up of patients who have infectious diseases as a pre-diagnosis. However, malignancy and an infectious disease are seen together more rarely, with the exception of immunosuppressed patients. This presentation is a case report followed up for fever of unknown origin. The patient was admitted to the hospital with the symptoms of fever, weight loss, abdominal pain and weakness. Anemia and hypergamaglobulinemia by biochemical analyses and splenomegaly by total body computed tomography were detected. Amastigotes were seen in bone marrow aspiration smears and promastigotes were isolated in NNN medium. At the end of the Liposomal Amphotericin B treatment, control bone marrow aspiration was applied. Leishmania amastigotes were not seen, while patient was diagnosed as diffuse B cell lymphoma pathologically.
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http://dx.doi.org/10.5152/tpd.2013.3211DOI Listing
August 2014

Genetic diversity and structure in Leishmania infantum populations from southeastern Europe revealed by microsatellite analysis.

Parasit Vectors 2013 Dec 5;6:342. Epub 2013 Dec 5.

Laboratory of Molecular Parasitology, Hellenic Pasteur Institute, 127 Vasilissis Sofias Avenus, 11521, Athens, Greece.

Background: The dynamic re-emergence of visceral leishmaniasis (VL) in south Europe and the northward shift to Leishmania-free European countries are well-documented. However, the epidemiology of VL due to Leishmania infantum in southeastern (SE) Europe and the Balkans is inadequately examined. Herein, we aim to re-evaluate and compare the population structure of L. infantum in SE and southwestern (SW) Europe.

Methods: Leishmania strains collected from humans and canines in Turkey, Cyprus, Bulgaria, Greece, Albania and Croatia, were characterized by the K26-PCR assay and multilocus enzyme electrophoresis (MLEE). Genetic diversity was assessed by multilocus microsatellite typing (MLMT) and MLM Types were analyzed by model- and distance- based algorithms to infer the population structure of 128 L. infantum strains.

Results: L. infantum MON-1 was found predominant in SE Europe, whilst 16.8% of strains were MON-98. Distinct genetic populations revealed clear differentiation between SE and SW European strains. Interestingly, Cypriot canine isolates were genetically isolated and formed a monophyletic group, suggesting the constitution of a clonal MON-1 population circulating among dogs. In contrast, two highly heterogeneous populations enclosed all MON-1 and MON-98 strains from the other SE European countries. Structure sub-clustering, phylogenetic and Splitstree analysis also revealed two distinct Croatian subpopulations. A mosaic of evolutionary effects resulted in consecutive sub-structuring, which indicated substantial differentiation and gene flow among strains of both zymodemes.

Conclusions: This is the first population genetic study of L. infantum in SE Europe and the Balkans. Our findings demonstrate the differentiation between SE and SW European strains; revealing the partition of Croatian strains between these populations and the genetic isolation of Cypriot strains. This mirrors the geographic position of Croatia located in central Europe and the natural isolation of the island of Cyprus. We have analysed the largest number of MON-98 strains so far. Our results indicate extensive gene flow, recombination and no differentiation between MON-1 and MON-98 zymodemes. No correlation either to host specificity or place and year of strain isolation was identified. Our findings may be associated with intensive host migration and common eco-epidemiological characteristics in these countries and give valuable insight into the dynamics of VL.
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http://dx.doi.org/10.1186/1756-3305-6-342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029556PMC
December 2013

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

Turkiye Parazitol Derg 2013 ;37(2):107-12

Ege Üniversitesi Tıp Fakültesi, Parazitoloji Anabilim Dalı, İzmir, Turkey.

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.
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http://dx.doi.org/10.5152/tpd.2013.25DOI Listing
March 2014

A real-time ITS1-PCR based method in the diagnosis and species identification of Leishmania parasite from human and dog clinical samples in Turkey.

PLoS Negl Trop Dis 2013 9;7(5):e2205. Epub 2013 May 9.

Ege University, Medical School Department of Parasitology, Bornova, Izmir, Turkey.

Human visceral leishmaniasis (VL) caused by L. infantum and cutaneous leishmaniasis (CL) caused by L. tropica and L. infantum have been reported in Turkey. L. infantum is also responsible for canine leishmaniasis (CanL) and it is widely common in the country. The main aim of the present study was to design a real-time PCR method based on the internal transcribed spacer 1 (ITS1) region in the diagnosis of all clinical forms of leishmaniasis in Mediterranean, and to identify the species directly from clinical samples. Totally, 315 clinical specimens, human/canine visceral (blood, bone marrow, lymph node) and cutaneous (lesion aspiration) samples, and 51 Turkish Leishmania isolates typed by isoenzymatic method were included in the study. For optimization, DNA samples of the 34 strains were amplified by conventional ITS1-PCR and then sequenced for designing the primers and probes, allowing the species identification. Following the validation with the isolates, the test was applied on clinical samples and melting temperatures were used for genotyping. A group of PCR products were further sequenced for confirmation and assigning the inter- and intraspecies heterogeneity. The diagnosis of leishmaniasis is successfully achieved by the new real-time PCR method, and the test identified 80.43% of human and canine VL samples as L.infantum and 6.52% as L.tropica; 52.46% of CL samples as L. infantum and 26.90% as L. tropica. In 13.04% of visceral and 20.62% of cutaneous samples, two peaks were observed. However, the higher peak was found to be concordant with the sequencing results in 96.96%, in terms of species identification. The real-time ITS1 PCR assay clearly identified the leishmanial species in 81.58% of all clinical samples. Genotypic variations of Leishmania parasites in Turkey within species and intraspecies were observed, and L. tropica is also found as causative agent of human and canine VL in Turkey.
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http://dx.doi.org/10.1371/journal.pntd.0002205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649959PMC
November 2013

[Detection of entomopathogen nematode [EPN - sand flies (Phlebotomus tobbi)] caught in the wild in Aydın, Kuşadası town and its assessment as a biological control agent].

Turkiye Parazitol Derg 2013 ;37(1):36-9

Ege Üniversitesi Fen Bilimleri Enstitüsü, Biyoloji Anabilim Dalı, İzmir, Türkiye.

Objective: In this study, the midgut of the sand flies investigated with direct method for the presence of parasites and other organisms.

Methods: Wild sand flies collected in Kuşadası Town-Aydın, were dissected and midgut contents were examined by light microscopy. After midgut dissection, the head and genitalia of sand fly specimens were clarified and mounted for species identification.

Result: During the study, a total of 1027 sand flies were dissected. Eight and two species belonging to Phlebotomus and Sergentomyia genera were determined, respectively. Phlebotomus tobbi was found to be most abundant species (61.34%). A third stage of infective Entomopathogen Nematode belonging to Steinernematidae family was observed in the hemocoel of one specimen of P. tobbi during the dissection process.

Conclusion: This is the first finding related to entomopathogen nematodes found in sand flies in Turkey. In the study, the sand fly fauna was determined in Kuşadası Town. For the control of sand flies, entomopathogenic nematodes which are not harmful for non-target organisms, can be used instead of chemical insecticides that can cause unknown damage in the environment.
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http://dx.doi.org/10.5152/tpd.2013.09DOI Listing
November 2013

Multilocus microsatellite typing (MLMT) of strains from Turkey and Cyprus reveals a novel monophyletic L. donovani sensu lato group.

PLoS Negl Trop Dis 2012 14;6(2):e1507. Epub 2012 Feb 14.

Laboratory of Molecular Parasitology, Hellenic Pasteur Institute, Athens, Greece.

Background: New foci of human CL caused by strains of the Leishmania donovani (L. donovani) complex have been recently described in Cyprus and the Çukurova region in Turkey (L. infantum) situated 150 km north of Cyprus. Cypriot strains were typed by Multilocus Enzyme Electrophoresis (MLEE) using the Montpellier (MON) system as L. donovani zymodeme MON-37. However, multilocus microsatellite typing (MLMT) has shown that this zymodeme is paraphyletic; composed of distantly related genetic subgroups of different geographical origin. Consequently the origin of the Cypriot strains remained enigmatic.

Methodology/principal Findings: The Cypriot strains were compared with a set of Turkish isolates obtained from a CL patient and sand fly vectors in south-east Turkey (Çukurova region; CUK strains) and from a VL patient in the south-west (Kuşadasi; EP59 strain). These Turkish strains were initially analyzed using the K26-PCR assay that discriminates MON-1 strains by their amplicon size. In line with previous DNA-based data, the strains were inferred to the L. donovani complex and characterized as non MON-1. For these strains MLEE typing revealed two novel zymodemes; L. donovani MON-309 (CUK strains) and MON-308 (EP59). A population genetic analysis of the Turkish isolates was performed using 14 hyper-variable microsatellite loci. The genotypic profiles of 68 previously analyzed L. donovani complex strains from major endemic regions were included for comparison. Population structures were inferred by combination of bayesian model-based and distance-based approaches. MLMT placed the Turkish and Cypriot strains in a subclade of a newly discovered, genetically distinct L. infantum monophyletic group, suggesting that the Cypriot strains may originate from Turkey.

Conclusion: The discovery of a genetically distinct L. infantum monophyletic group in the south-eastern Mediterranean stresses the importance of species genetic characterization towards better understanding, monitoring and controlling the spread of leishmaniasis in this region.
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http://dx.doi.org/10.1371/journal.pntd.0001507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279343PMC
June 2012

Serological monitoring of paediatric visceral leishmaniasis By IFA and ELISA methods.

Turkiye Parazitol Derg 2011 ;35(3):125-8

Department of Medical Microbiology, Faculty of Medicine, Trakya University, Edirne, Turkey.

Objective: Visceral leishmaniasis (VL) is endemic in all Mediterranean countries including Turkey, and children are at greater risk than adults in endemic areas. In VL patients, serological assays are considered to be sensitive for the diagnosis and/or follow up. The aim of this study was to assess the usefulness of serology for following up of childhood VL in Turkey.

Methods: Sera obtained from twenty parasitologically confirmed children with VL were tested using IFAT and ELISA. The patients were monitored clinically and serologically (range: 20-500 days) during and after treatment. All VL patients were treated with meglumine antimonate.

Results: Anti-Leishmania antibodies in successfully treated VL patients showed a steep decline but, in three patients who had relapsed, an increase was detected. Significantly lower values were observed after treatment with both serological techniques. Mean ELISA optical density values before and after treatment were: 0.78 ± 0.36 (0.26-1.76) and 0.38 ± 0.24 (0.09-0.83) respectively, (p < 0.001) and mean IFAT values (log10 transformed titers) before and after treatment were: 3.02 ± 0.90 (1.81-4.51) and 2.16 ± 0.75 (1.20-3.90) respectively, (p < 0.001).

Conclusion: ELISA and IFAT are valuable not only for diagnosis but also for monitoring of drug therapy in childhood visceral leishmaniasis as rapid and non-invasive techniques.
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http://dx.doi.org/10.5152/tpd.2011.31DOI Listing
November 2012

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

Turkiye Parazitol Derg 2011 ;35(1):1-5

Adnan Menderes Üniversitesi Tıp Fakültesi, Parazitoloji Anabilim Dalı, Aydın, Turkey.

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.
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http://dx.doi.org/10.5152/tpd.2011.01DOI Listing
July 2012

Degree and frequency of inhibition in a routine real-time PCR detecting Pneumocystis jirovecii for the diagnosis of Pneumocystis pneumonia in Turkey.

J Med Microbiol 2011 Jul 1;60(Pt 7):937-944. Epub 2011 Apr 1.

Department of Parasitology, Ege University Medical School, Bornova/Izmir 35100, Turkey.

Routine laboratory diagnosis of Pneumocystis jirovecii is currently achieved by PCR in almost all laboratories with sufficient equipment due to its high sensitivity and specificity compared to staining methods. A current issue that limits the reliability and sensitivity of PCR is the degree of inhibition caused by inhibitory substances in respiratory samples. The present study aimed to analyse the degree and frequency of inhibition in real-time PCR detecting P. jirovecii in respiratory specimens submitted to a Pneumocystis pneumonia (PcP) diagnosis laboratory in Ege University Medical School, Turkey. Between July 2009 and December 2010, 76 respiratory specimens [63 bronchoalveolar lavage (BAL) fluid, 10 sputum samples, two tracheal aspiration fluid and one thoracentesis fluid] obtained from 69 PcP-suspected patients were investigated for the presence of P. jirovecii using real-time PCR targeting the cdc2 gene. Of these samples, 42 of the specimens were stained and examined by microscopy according to the request of the clinicians. PCR was positive in 15 specimens in the initial run. Of the remaining 61 samples, 41 of them were negative with positive internal inhibition controls (i.e. true-negative group). The frequency of inhibition in the initial run was 26.31 % (20/76) as determined by spiked negative controls. All of the inhibited samples were resolved after 1 : 2, 1 : 5, 1 : 10 and 1 : 20 dilutions. P. jirovecii was detected by PCR in two inhibited specimens after retesting with diluted samples which were also positive by microscopy. The incidence of P. jirovecii in respiratory specimens was 22.36 % (17/76) as determined by real-time PCR and 7.14 % (3/42) by microscopy. Overall, the incidence of P. jirovecii in respiratory samples was 23.68 % (18/76) as detected by both methods. In conclusion, inclusion of spiked positive controls in each sample and retesting with diluted samples to resolve inhibition increased the reliability of the real-time PCR assay in terms of determining false-negative results and influencing the treatment of the patient. Furthermore, results of the present study determined for the first time the frequency and degree of inhibition in a real-time PCR detecting P. jirovecii in respiratory specimens during routine diagnosis of PcP.
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http://dx.doi.org/10.1099/jmm.0.030775-0DOI Listing
July 2011

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

J Vector Ecol 2011 Mar;36 Suppl 1:S99-S105

Ege University Medical School Department of Parasitology, Bornova, Izmir, 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.
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http://dx.doi.org/10.1111/j.1948-7134.2011.00118.xDOI Listing
March 2011

Quantiferon-Leishmania as an epidemiological tool for evaluating the exposure to Leishmania infection.

Am J Trop Med Hyg 2010 Oct;83(4):822-4

Department of Parasitology, Ege University Medical School, Izmir, Turkey.

The aim of the present preliminary study was to investigate the potential of measurement of IFN-γ secretion by T cells into blood plasma using QuantiFERON assay with leishmanial antigens to determine the presence of Leishmania infection. Blood samples from cured visceral (N = 18), and cutaneous (N = 20) leishmaniasis cases, and 20 healthy controls were tested. The IFN-γ responses to Leishmania major H2B and Leishmania infantum H2B antigens were detected from the majority of treated old visceral leishmaniasis cases, but not from controls. Future studies using larger groups will be required to establish the true potential of the assay for epidemiological screening of leishmaniasis.
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http://dx.doi.org/10.4269/ajtmh.2010.09-0605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946749PMC
October 2010

[The investigation of Entamoeba gingivalis and Trichomonas tenax in a group of patients with periodontal disease].

Turkiye Parazitol Derg 2010 ;34(2):91-4

Ege Universitesi Diş Hekimliği Fakültesi Oğrencisi, Izmir, Turkey.

The oral cavity is suitable for invasion of many microorganisms. Entamoeba gingivalis (E.gingivalis) and Trichomonas tenax (T.tenax) settle in the oral cavity of patients with poor oral hygiene and gingival disease. In the present study, two slide specimens were prepared from the cole region of the teeth of 46 persons for investigation of the parasites. One of the slide specimens was dried in the air while the other one put into fixative and they were stained with trichrome and Giemsa stains. The two staining methods were used for 36 samples and only Giemsa, for 10 samples. E. gingivalis was positive in 7 (19.44%) out of 36 samples stained by the trichrome stain while T. tenax was positive in one (2.17%) out of 46 samples stained by Giemsa stain. Parasitic infections were found to be positive in seven (21.2%) specimen from 33 patients with periodontal disease and in one (7.69%) specimen from 13 healthy controls. Dental policlinics are generally far from parasitology laboratories and microscopical wet mount examination can not be performed. Therefore dentists can send the specimens and have the parasites diagnosed with Giemsa and trichrome staining methods as an alternative to wet mount examination.
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April 2012

[Case report: two imported Plasmodium falciparum cases].

Turkiye Parazitol Derg 2009 ;33(4):280-2

Tepecik Eğitim ve Araştirma Hastanesi, Klinik Mikrobiyoloji ve Enfeksiyon Hastaliklari, Izmir, Turkey.

A 23 year-old Pakistani man presented at the emergency clinic of Tepecik Research and Training Hospital with the symptoms such as fever (39.3 degrees C), blurred consciousness, subicteric sclera and splenomegalia. In the laboratory examination, a slightly increase of the liver enzymes and anemia were detected. The gametocytes and trophozoites of Plasmodium falciparum were seen in a bone marrow aspiration and treatment was started with quinine and doxycycline but since resistance was detected to these medicines, mefloquine was chosen as alternative therapy. He was cured and discharged. The second case was also a Pakistani 20-year old man and he was a friend of first case. He presented at our hospital with the symptoms such as fever (39.4 degrees C), closed consciousness, icteric sclera and systolic soufflé in all cardiac foci. During the laboratory examination, severe anemia and trombocytopenia, and an increase in the liver enzymes were found. P. falciparum gametocytes and young trophozoites were seen in a blood smear stained with Giemsa. For treatment, mefloquine was used but unfortunately the patient died due to an adult respiratory distress syndrome (ARDS) complication. In this study, two cases with different clinical manifestations were presented to emphasize the importance of timing in starting the correct treatment.
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October 2010

In vitro activity of Arbutus unedo leaf extracts against Trichomonas vaginalis trophozoites.

Turkiye Parazitol Derg 2009 ;33(4):263-5

Adnan Menderes University Medical School, Department of Parasitology, Aydin, Turkey.

Trichomonas vaginalis (T. vaginalis) is a flagellated protozoan commonly causing sexually transmitted disease. T. vaginalis infections are treated with a 5-nitroimidazole derivate. However, drug resistance has been known to occur for a long time and new alternatives are under investigation. Arbutus unedo is a wild plant mainly growing in maquis and rocky places of the seaboard in Southern Europe. In our study, ethanolic, water, hexane and ethyl acetate extracts of Arbutus unedo leaves were tested in vitro against T. vaginalis trophozoites and the ethyl acetate extract of Arbutus unedo leaves was found to be effective (Growth inhibition rate (GI): 100%, at the concentration of 500 microg/ml). It may be a promising anti-trichomonacidal agent in the future and further experiments are needed.
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October 2010

Detection and identification of old world Leishmania by high resolution melt analysis.

PLoS Negl Trop Dis 2010 Jan 12;4(1):e581. Epub 2010 Jan 12.

School of Veterinary Medicine, Hebrew University, Rehovot, Israel.

Background: Three major forms of human disease, cutaneous leishmaniasis, visceral leishmaniasis and mucocutaneous leishmaniasis, are caused by several leishmanial species whose geographic distribution frequently overlaps. These Leishmania species have diverse reservoir hosts, sand fly vectors and transmission patterns. In the Old World, the main parasite species responsible for leishmaniasis are Leishmania infantum, L. donovani, L. tropica, L. aethiopica and L. major. Accurate, rapid and sensitive diagnostic and identification procedures are crucial for the detection of infection and characterization of the causative leishmanial species, in order to provide accurate treatment, precise prognosis and appropriate public health control measures.

Methods/principal Findings: High resolution melt analysis of a real time PCR product from the Internal Transcribed Spacer-1 rRNA region was used to identify and quantify Old World Leishmania in 300 samples from human patients, reservoir hosts and sand flies. Different characteristic high resolution melt analysis patterns were exhibited by L. major, L. tropica, L. aethiopica, and L. infantum. Genotyping by high resolution melt analysis was verified by DNA sequencing or restriction fragment length polymorphism. This new assay was able to detect as little as 2-4 ITS1 gene copies in a 5 microl DNA sample, i.e., less than a single parasite per reaction.

Conclusions/significance: This new technique is useful for rapid diagnosis of leishmaniasis and simultaneous identification and quantification of the infecting Leishmania species. It can be used for diagnostic purposes directly from clinical samples, as well as epidemiological studies, reservoir host investigations and vector surveys.
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http://dx.doi.org/10.1371/journal.pntd.0000581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797090PMC
January 2010

Leishmaniasis in Turkey: molecular characterization of Leishmania from human and canine clinical samples.

Trop Med Int Health 2009 Nov 7;14(11):1401-6. Epub 2009 Sep 7.

Department of Parasitology, Ege University Medical School, Bornova, Izmir, Turkey.

Human leishmaniasis, both visceral and cutaneous, and canine leishmaniasis have been reported in Turkey for centuries. However, the advent of new diagnostic tools during the last 30 years has led to the recognition that leishmaniasis is an important public health problem throughout the country. In most disease foci both canine and human leishmaniases exist together and identification of parasite species causing these diseases is a pre-requisite for understanding disease epidemiology. A total of 109 samples obtained from human and canine leishmaniasis cases were examined using internal transcribed spacer 1 PCR followed by restriction fragment length polymorphism analysis. Our results indicate that two species, Leishmania tropica and Leishmania infantum, are primarily responsible for cutaneous and visceral leishmaniasis, respectively, in Turkey. However, a new focus of human cutaneous leishmaniasis caused by L. infantum in Hatay region is described. This finding further stresses the importance of Leishmania species molecular characterization in prescribing appropriate therapy and understanding the disease's transmission in different endemic foci.
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http://dx.doi.org/10.1111/j.1365-3156.2009.02384.xDOI Listing
November 2009

In vitro activity of Arbutus unedo against Leishmania tropica promastigotes.

Turkiye Parazitol Derg 2009 ;33(2):114-5

Ege University Faculty of Pharmacy, Department of Pharmacognosy, Izmir, Turkey.

Pentavalent antimonials are the first choice for the treatment of anthroponotic cutaneous leishmaniasis (ACL) in health centers in Turkey, however in rural areas, traditional plants may be preferred for the treatment of lesions. In recent years a number of papers are published related to the natural products especially plant derivates. Our aim is to investigate the antileishmanial effect of Arbutus unedo which is a wild plant mainly grown in maquis and rocky places of the seabord in South Europe. In the present study, the ethanolic, water and n-hexane extracts from the leaves of Arbutus unedo were originally tested in vitro against Leishmania tropica promastigotes. The ethanol extract of Arbutus unedo leaves at the concentrations of 100, 250, 500 microg/ml were found to be more effective than the other extracts (p:0.000). Our study showed that the ethanolic extract of Arbutus unedo leaves can be a promising antileishmanial agent and further experiments are needed.
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April 2010

[The serological and entomological survey of zoonotic visceral leishmaniasis in Ayvacik Region of Canakkale Province, Turkey].

Turkiye Parazitol Derg 2009 ;33(2):109-13

Canakkale Onsekiz Mart Universitesi Fen Edebiyat Fakültesi Biyoloji Bölümü, Canakkale, Turkey.

The field studies were carried out in Ilyasfaki village belonging to Ayvacik town, Kalabakli village and center of Kepez town belonging to Canakkale province to determine the epidemiological situation of visceral leishmaniasis between June and August 2007. A total of 27 blood samples were taken from the dogs which are known as reservoir of Leishmania infantum causing visceral leishmaniasis in human and dogs. The dogs were also examined physically for clinical symptoms of the disease. A total of 789 sand fly specimens were collected using CDC miniature light traps and examined. Six Phlebotomus and one Sergentomyia species were identified as: Phlebotomus negletus, P. tobbi, P. simici, P. papatisi, P. perfiliewi, P. halepensis and S. theodori. Among these species P. neglectus, was found to be a dominant species in Ilyasfaki village by the rate of 94.4%, while P. tobbi was also found to be a dominant species in city center (including Kepez) and Kalabaki village by the rate of 50% and 48.1%, respectively. No seropositive dogs were found by IFA test. Seropositivity below cut-off level was only observed in two dogs from Kepez, in dilutions of 1/16 and 1/64. The risk level for human and canine visceral is found to be high and it requires more field studies on canine leishmaniasis in and around the area.
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April 2010

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

New Microbiol 2009 Jan;32(1):93-100

Ege University Medical School Department of Parasitology Bornova, Izmir, 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.
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January 2009

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

Turkiye Parazitol Derg 2009 ;33(1):4-7

Celal Bayar Universitesi Tip Fakültesi, Parazitoloji Bilim Dali, Manisa, Turkey.

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.
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February 2010

[Seroprevalence of visceral leishmaniasis in stray dogs in Kocaeli].

Turkiye Parazitol Derg 2008 ;32(3):183-6

Kocaeli Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Kocaeli, Turkey.

Dogs are the most important reservoir of visceral leishmaniasis (VL). A male child who lives in Köseköy in Kocaeli was diagnosed with VL. Since this child had never been outside Kocaeli, serum samples of 65 stray dogs were analyzed for canine VL using the indirect fluorescence antibody test (IFAT) and ELISA. Two dogs (3.07%) tested positive with both ELISA and IFAT. Leishmania amastigotes were observed in the lymph aspiration material from one of them. Growth was observed in NNN medium inoculated with lymph aspiration material from the other dog. This was the first study investigating canine VL prevalence in our city and plans were made for control of the disease.
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June 2009

Drug regimens for visceral leishmaniasis in Mediterranean countries.

Trop Med Int Health 2008 Oct 24;13(10):1272-6. Epub 2008 Aug 24.

Istituto Superiore di Sanità, Rome, Italy.

Until the early 1990s, pentavalent antimony was the only documented first-line drug employed for the treatment of zoonotic visceral leishmaniasis (VL) in the Mediterranean, with reported cure rates exceeding 95% in immunocompetent patients. The emergence of antimony resistance in other endemic settings and the increase in drug options have stimulated re-evaluation of the current therapeutic approaches and outcomes in Mediterranean countries. A scientific consortium ('LeishMed' network) collected updated information from collaborating clinical health centres of 11 endemic countries of Southern Europe, Northern Africa and the Middle East. In contrast with the previous situation, VL is now treated differently in the region, basically through three approaches: (1) In Northern Africa and in part of the Middle East, pentavalent antimony is still the mainstay for therapy, with no alternative drug options for treating relapses; (2) In some European countries and Israel, both pentavalent antimony and lipid-associated amphotericin B (AmB) formulations are used as first-line drugs, although in different patients' categories; (3) In other countries of Europe, mainly liposomal AmB is employed. Importantly, cure rates exhibited by different drugs, including antimonials in areas where they are still in routine use, are similarly high (>/=95%) in immunocompetent patients. Our findings show that antimony resistance is not an emerging problem in the Mediterranean. A country's wealth affects the treatment choice, which represents a balance between drug efficacy, toxicity and cost, and costs associated with patient's care.
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http://dx.doi.org/10.1111/j.1365-3156.2008.02144.xDOI Listing
October 2008

[Investigation of anti-Leishmania seroprevalence by different serologic assays in children inhabiting in the northwestern part of Turkey].

Mikrobiyol Bul 2008 Jan;42(1):103-11

Osmangazi Universitesi Tip Fakültesi, Mikrobiyoloji Anabilim Dali, Eskişehir.

Human visceral leishmaniasis (VL) caused by Leishmania infantum in Mediterranean region is still an important public health problem in those countries including Turkey. The asymptomatic presentation of the infection in most of the cases leads to difficulties in the diagnosis and prevention of the spread of infection. The aim of this study was to investigate the seroprevalence of anti-Leishmania antibodies in children inhabiting in the northwestern part of Turkey. A total of 572 healthy children (260 girls, 312 boys) aged between 1-17 years old (mean age: 8.1 years) inhabiting in Eskisehir, Bilecik, Kutahya and Afyon provinces and their counties were included to the study with the informed consent obtained from their families. All serum samples were screened by a commercial ELISA (Leishmania Ab Panel, Cypress Diagnostics, Belgium), two in-house ELISA (with whole antigens and rK39 antigen) tests and an in-house indirect fluorescent antibody test (IFAT). The sera yielding a positive result by commercial ELISA, have been re-evaluated with rK39 dipstick test. Of 572 children, 5.2% (n = 30) were found positive with commercial ELISA, 3.8% (n = 22) with IFAT, 4.7% (n = 27) with in-house whole ELISA, and 3.6% (n = 21) with in-house rK39 ELISA. Of 30 commercial ELISA positive sera, 19 (63.3%) gave positive result also by dipstick test. This difference was attributed to the use of multiple antigens belonging to different Leishmania species in commercial ELISA test. The number of children who were seropositive with all of the tests were 15 (2.6%) and with at least three of the tests were 24 (4.2%). Most (76.7%) of the 30 seropositive children with commercial ELISA were found to be inhabiting in Iscehisar town of Afyon province (n = 16) and Sogut town of Bilecik province (n = 7) where canine VL was also endemic. Our results also indicated that 93.3% (28/30) of seropositive children were living in the rural parts of the study region. Thirty seropositive children were followed-up for one year, but none of them have exhibited clinical findings of VL. As a result, the rate of anti-Leishmania seropositivity (5.2% with at least one test, and 4.2% with at least three tests) in healthy children in the study area should not be ignored, and prevention strategies should be undertaken since our previous study have also showed that the rate of VL in dogs was high and the vector Phlebotomus species were determined in these areas of Turkey.
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January 2008

Seroepidemiological survey for Toxocara canis infection in the northwestern part of Turkey.

Turkiye Parazitol Derg 2007 ;31(4):288-91

Osmangazi Universitesi Tip Fakültesi, Cocuk Sağliği ve Hastaliklari Anabilim Dali, Izmir, Turkey.

In this study, an ELISA with Toxocara canis antigen was used for the determination of sero-epidemiological survey of Toxocara canis infection in urban and rural areas of northwestern part of Turkey. Toxocara seroprevalance was detected among randomly selected 430 children in the rural areas and 141 children in the urban areas. Total seroprevalence rate of Toxocara antibodies was found as 12.95% in both groups. While significant levels of anti-Toxocara antibodies were detected in 73 out of 430 (16.97%) children from rural area while only one children (0.71%) had positive level of anti-Toxocara antibodies from urban area (p<0.001). In rural areas, anti-Toxocara antibodies were significantly higher in children who have a dog in their house than the children who have no dogs (53 vs. 20 children; p<0.01). Seropositivity rate of Toxocara antibodies were similar between age groups and genders (p>0.05). Based on these results, however total seroprevalence rate is lower than other countries, we have proposed that public health programs especially for children, may be effective for protecting from Toxocara infection.
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February 2009

In vitro and in vivo activities of Haplophyllum myrtifolium against Leishmania tropica.

New Microbiol 2007 Oct;30(4):439-45

Vocational School of Health Services, Celal Bayar University, Manisa, Turkey.

This study aimed to evaluate the in vitro and in vivo leishmanicidal activity of an endemic Turkish plant and compare its efficacy with a reference drug. In addition to the in vitro activities of the ethanol, acidified and alkaloid extracts and furoquinoline alkaloids skimmianine and gamma-fagarine, in vivo antileishmanial activitiy of the acidified extract of Haplophyllum myrtifolium Boiss. (Rutaceae) were investigated against Leishmania tropica (L. tropica), a causative agent of cutaneous leishmaniasis. All the extracts and pure compounds showed in vitro inhibitory activity against the promastigotes of. L. tropica. The in vitro 50% inhibitory concentrations of y-fagarine, acidified extract, ethanol extract, skimmianine and alkaloid extract against promastigotes were determined as 8.7, 9.4, 10.9, 25.7 and 25.8 microg/ml respectively. In vivo results of Haplophyllum myrtifolium acidified extract showed that this plant has a limited effect on decreasing the lesion size of experimental mice infected with Leishmania tropica. To the best of our knowledge, this is the first time both the in vitro and in vivo antileishmanial activity of Haplophyllum mrytifolium have been reported in the same research.
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October 2007

Differentiation of Entamoeba histolytica and Entamoeba dispar by PCR: a preliminary study in Izmir, Turkey.

New Microbiol 2007 Jan;30(1):45-8

Ege University School of Medicine, Department of Parasitology, Izmir, Turkey.

The causative agent of amoebiasis is currently attributed to two distinct species (E. histolytica and E. dispar). The aim of this study was to differentiate these species by PCR in stool samples. Isolated genomic DNA was amplified by PCR and band products of 101 bp (E. dispar) were obtained. All seven stool samples were found to be E. dispar, not E. histolytica. Our results demonstrated the significance of E. histolytica/dispar differentiation in the diagnosis of amoebiasis. This study is preliminary to our current research project entitled "Investigation of the prevalence of amoebiasis and Entamoeba species in Izmir and its hinterland".
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January 2007
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