Evaluation of T. gondii, rubella, and cytomegalovirus seroprevalences among female Syrian refugees in Sanliurfa, Turkiye.

INTRODUCTION: Since the Syrian Civil War began in 2011, the official number of refugees under temporary protection in Turkiye is reported to be 3,522,036 in 2023. Most of the Syrians living outside the refugee camps have worse conditions in terms of access to healthcare centers and social opportunities, compared to those living in camps. The Sanliurfa province hosts the third highest number of Syrians (370,291) in Turkiye. There are no data about the seroprevalence of Toxoplasma gondii (T. gondii), rubella (rub), or cytomegalovirus (CMV) among Syrian refugees in Sanliurfa. We aimed to investigate the seroprevalence of T. gondii, rub, and CMV infections among female Syrian refugees of reproductive age (15-49 years) living in Sanliurfa province. METHODOLOGY: A cross-sectional study was conducted in different districts of Sanliurfa. A total of 460 households were selected using the probability sampling method. One married female Syrian refugee aged between 15 and 49 years, was chosen in each household, leading to a sample size of 410 female Syrian refugees. The seropositivity of T. gondii, CMV, and rub IgM and IgG in blood samples were analyzed using enzyme immunoassays (Abbott Architect, Illinois, USA). RESULTS: The seropositivity rates of T. gondii, CMV, and rubella IgM and IgG were 4.4% and 59.8%; 3.9%; and 99%; and 1.9%, and 99.5%, respectively. CONCLUSIONS: A screening program should be implemented for T. gondii, CMV, and rub infections for Syrian refugees. Seronegative women should be vaccinated against rub and educated about the transmission and preventive routes of toxoplasmosis and CMV infection.

Development of a novel immunoFET technology-based POC assay for detection of Leishmania donovani and Leishmania major.

Leishmaniasis is considered as one of the 20 neglected tropical diseases. Current methods of leishmanial diagnosis depend on conventional laboratory-based techniques, which are time-consuming, costly and require special equipment and trained personnel. In this context, we aimed to provide an immuno field effect transistors (ImmunoFET) biosensor that matches the conventional standards for point-of-care (POC) monitoring and detection of Leishmania (L.) donovani/Leishmania major. Crude antigens prepared by repeated freeze thawing of L. donovani/L. major stationary phase promastigotes were used for ELISA and ImmunoFETs. Lesishmania-specific antigens were serially diluted in 1× PBS from a concentration of 106 -102 parasites/mL. A specific polyclonal antibody-based sandwich ELISA was established for the detection of Leishmania antigens. An immunoFET technology-based POC novel assay was constructed for the detection of Leishmania antigens. Interactions between antigen-antibody at the gate surface generate an electrical signal that can be measured by semiconductor field-effect principles. Sensitivity was considered and measured as the change in current divided by the initial current. The final L. donovani/L. major crude antigen protein concentrations were measured as 1.50 mg/mL. Sandwich ELISA against the Leishmania 40S ribosomal protein detected Leishmania antigens could detect as few as 100 L. donovani/L. major parasites. An immunoFET biosensor was constructed based on the optimization of aluminium gallium nitride/gallium nitride (AlGaN/GaN) surface oxidation methods. The device surface was composed by an AlGaN/GaN wafer with a 23 nm AlGaN barrier layer, a 2 µm GaN layer on the silicon carbide (SiC) substrate for Leishmania binding, and coated with a specific antibody against the Leishmania 40S ribosomal protein, which was successfully detected at concentrations from 106 to 102 parasites/mL in 1× PBS. At the concentration of 104 parasites, the immunoFETs device sensitivities were 13% and 0.052% in the sub-threshold regime and the saturation regime, respectively. Leishmania parasites were successfully detected by the ImmunoFET biosensor at a diluted concentration as low as 150 ng/mL. In this study, the developed ImmunoFET biosensor performed well. ImmunoFET biosensors can be used as an alternative diagnostic method to ELISA. Increasing the sensitivity and optimization of immuno-FET biosensors might allow earlier and faster detection of leishmaniasis.

[Typing of Leishmania Species Causing Cutaneous Leishmaniasis by Sybr Green Based ITS-1 Real Time Polymerase Chain Reaction Method]. / Kutanöz Laysmanyazise Neden Olan Olan Leishmania Türlerinin Sybr Green Bazli ITS-1 Gerçek Zamanli Polimeraz Zincir Reaksiyonu Yöntemiyle Tiplendirilmesi.

Cutaneous leishmaniasis (CL) is an important public health problem, most frequently seen in Sanliurfa in Turkey. It is important to determine the species in regions where infection occurs with different Leishmania species, as in our province. In this study, it was aimed to genotype 136 samples with suspected Leishmania from Sanliurfa using the Sybr Green-based ITS-1 real time polymerase chain reaction (Rt-PCR) method and then to compare them with ITS-1 PCR RFLP and direct microscopy methods. Wound fluid samples from patient lesions suspected of leishmaniasis were mounted on a slide, fixed, and stained with Giemsa dye. The preparations were examined under the microscope and evaluated for the presence of amastigote. After the extraction of DNA from Giemsa stained preparations by using the QIAmp DNA Mini Kit (Qiagen, Germany), the samples were studied with the Sybr Green based ITS-1 Rt-PCR method using LITSR and L5.8S primers. As a result of the PCR study, melting curve analysis was determined and the melting curves were compared with the reference strains. Then, PCR was performed in 136 samples for ITS1 region amplification using primers LITSR and L5.8S. PCR products were digested with Hae III restriction enzyme and RFLP process was performed. The products were run on metaphor agarose gel than the gels were stained with ethidium bromide for 15 min and visualized in a UV transilluminator In our study, the results of Sybr Green-based ITS-1 Rt-PCR, ITS-1 PCR-RFLP and direct microscopy methods were compared. The highest positivity rate was determined as 97% (136/132) in ITS-1 Rt-PCR method. With ITS-1 PCR-RFLP method 95.5% (136/130) positivity and with direct microscopy 94.1% (136/128) positivity were obtained, respectively. Of 132 samples, which were studied with the Sybr Green-based ITS-1 Rt-PCR method and found as positive, 121 were genotyped as L.tropica and 11 were genotyped as L.major by melting curve analysis. It was determined that, of 130 samples studied with ITS-1 PCR RFLP method 119 (91.5%) were detected as L.tropica and 11 (8.5%) were detected as L.major. The ITS-1 Rt-PCR method we used in our study was the method that detected the most positivity rate. With this method, Leishmania specimens were typed as L.tropica and L.major. It is thought that this method may be useful for the detection of the presence of Leishmania parasite and in the rapid identification of Leishmania species, as it does not require extra processes such as cutting and staining after PCR and results in a short time, but new studies are needed to observe its effectiveness in detecting other species other than L.tropica and L.major.

[In Vitro Efficacy of the Venome of Black Scorpion (Androctonus crassicauda) on Leishmania tropica Promastigotes]. / Kara Akrep (Androctonus crassicauda) Venomunun Leishmania tropica Promastigotlari Üzerindeki In Vitro Etkinligi.

Scorpion venom is a substance that shows strong neurotoxic effects with its complex protein content and thus plays an important role for the scorpion in catching and digesting the hunt. Human body stung by a scorpion can show life-threatening systemic effects in a short time, ranging from erythema, pain, edema and local fever to abdominal pain, nausea and vomiting, diplopia and even coma. Scorpion venome is known to possess antimicrobial activity, and some of its compounds have potent antibacterial and antifungal activities. Leishmaniasis is a common vector-borne parasitic infection caused by Leishmania sp. protozoa and can lead skin, mucosa and fatal internal organs involvement in patients . There is a need for new drugs in the treatment of leishmaniasis, because it has been documented lately that there is a growing resistance against antimonial compounds which have been used in its treatment for decades. Leishmania species are known to be susceptible to antimicrobial peptides that act as ion-channel inhibitors, which are known to be present in scorpion venome. In this study, it was aimed to investigate the anti-leishmanial activity of scorpion venome extract obtained from Androctonus crassicauda species in our country. In this context, Leishmania tropica promastigotes which were thawed from liquid nitrogen in our laboratory and first grown in NNN and then RPMI-1640 media, were exposed to different dilutions of the extract containing A.crassicauda venom and meglumine antimonate used in the standard treatment of leishmaniasis and the efficacies on the promastigotes were compared and measured in vitro. This was followed by XTT cell viability test, which assessed whether anti-leishmanial dose of the extract was lethal for human cells or not. Trials showed that the half maximal inhibitory concentration (IC50) values of the venome extract and meglumine antimoniate were 18.12 µg/ml (17.33-18.94) and 8.411 µg/ml (7.922- 8.927), respectively. This preliminary study showed that scorpion venome can be lethal on L.tropica promastigotes in vitro, on relatively higher doses compared to meglumine antimonate. Next step will be to determine the anti-leishmanial proteins in the extract and thus to identify new drug candidates with more specific studies.

Atypical and unusual morphological variants of cutaneous leishmaniasis.

OBJECTIVE: Cutaneous leishmaniasis (CL) is a skin disease characterised by prolonged nodulo-ulcerative lesions of the skin that heals with atrophic scar. Clinical features of CL vary depending on the type of parasite and host immune resistance. The aim of this study was to investigate the clinical features of atypical and unusual morphological variants of CL patients diagnosed in our clinic. MATERIALS AND METHODS: In this prospective study, 27 CL patients with atypical clinical features among 486 patients admitted to our clinic between July 2018 and September 2019 and diagnosed as CL by slit-skin smear examination or histopathological examination were included. RESULTS: Of 27 patients, 15 (55.5%) were male and 12 (44.5%) were female. The mean age of the patients was 25.8 ± 7.62 years. Seven (25.9%) patients had lupoid lesions, five (18.6%) patients had eczematoid lesions, four (14.8%) patients had lip lesions, three (11.1%) patients had erysipelas-like lesions, two (7.4%) patients had eyelid lesions, two (7.4%) patients had sporotrichoid lesions, two (7.4%) patients had verrucous lesions, one (3.7%) patient had psoriasiform lesion and one (3.7%) patient had paronychial lesion. CONCLUSION: In conclusion, rare clinical forms of CL are presented in this study. It should be kept in mind that CL may have very different clinical features and should be considered in the differential diagnosis of eczema, psoriasis, erysipelas, sporotrichosis, paronychia and verrucous lesions.

Cutaneous Leishmaniasis due to Three Leishmania Species Among Syrian Refugees in Sanliurfa, Southeastern Turkey.

Sanliurfa, a city in southeastern Turkey, is host to 477,166 Syrian refugees. The incidence of cutaneous leishmaniasis (CL) may be on the rise in areas affected by a refugee crisis, like Sanliurfa; thus, consequently, local uncommon species of Leishmania may be encountered in these regions. This might potentially make diagnosis and treatment more challenging over time. In this study, it was aimed to identify the causative agents of CL in clinical samples. A total of 154 patients (60 Syrian and 94 Turkish) who were diagnosed with CL via microscopical examination and PCR were enrolled this study. All of the samples were analyzed using internal transcribed spacer 1 genes, restriction fragment length polymorphism, DNA-sequencing, and phylogenetic analyses. In this study, Leishmania tropica was determined to be the predominant species in 140 of the patients (90.9%), followed by Leishmania major in 12 patients (7.8%), and Leishmania infantum in 2 patients (1.3%). Of the 94 Turkish patients, 94.7% were infected with L. tropica and 5.3% were infected with L. major, while none were infected with L. infantum. However, of the 60 Syrian patients, 85% were infected with L. tropica, 11.7% were infected with L. major, and 3.3% were infected with L. infantum. There was a significant association between the Leishmania species and the nations (Turkish-Syrian) (P < 0.001). The sequences were numbered from MH347941 to MH347953 and submitted to GenBank. This study confirmed that L. tropica, L. major, and L. infantum coexisted in Sanliurfa. This was the first time that the species L. infantum was reported among recent immigrants from Syria in Sanliurfa. Therefore, it is necessary to discriminate the Leishmania species for diagnosis, treatment, and controlled studies in hyper-endemic regions.

[Determination of imported malaria cases in Hatay by the use of molecular methods]. / Hatay'da yurt disi kaynakli sitma olgularinin moleküler yöntem kullanarak degerlendirilmesi.

Malaria, being among the most important diseases throughout history, is still an important public health problem among parasitic diseases due to increasing population movements with various reasons such as migration, war and travel. According to WHO data each year 300-350 million people get exposed to malaria, each year 1.5-2.7 million people die from malaria and also 40% of the world's population is still at risk for this disease. According to World Health Organisation (WHO) data, imported cases were not reported since 2013 in our country. However among imported cases Plasmodium falciparum malaria can be observed. The aim of this study wasto draw attention to the imported malaria cases increasing gradually and to the importance of the chemoprophylaxis in terms of malaria before travelling. In the study, male patients who have admitted to Hatay Province Malaria Center or Mustafa Kemal University Infectious Disease Department, ages between 25-60 years, were analyzed. All of the patients have worked abroad before. Patients were mostly from Sudan but there were also patients from endemic regions such as Africa, Nigeria, Pakistan, Mali island. The cases were evaluated according to age, gender and whether they had travel stories in Turkey or abroad. Blood samples taken from the patients were firstly prepared by thin and thick smear preparations and examined microscopically by staining with Giemsa stain method. Samples that were found positive by microscopic examination were impregnated on drying papers and genotyped using nested-PCR. Out of the 30 samples from patients who had traveled to endemic countries before, determined as positive by microscopical examination and genotyped by nested-PCR, 16 of them were identified as P.falciparum, six of them as P.vivax and eight of them as P.falciparum/P.vivax. The study suggested that malaria prophylaxis has to be applied before travelling to endemic countries, in return imported malaria has to be considered one of the first diseases in mind and people who will travel should be informed about this disease before travel.

Correction to: Molecular identification of Leishmania spp. isolates causes cutaneous leishmaniasis (CL) in Sanliurfa Province, Turkey, where CL is highly endemic.

In published article (Molecular Identification of Leishmania spp. Isolates Causes Cutaneous Leishmaniasis (CL) in Sanliurfa Province, Turkey, Where CL is Highly Endemic) Table 1 titled "The pH values of yogurts collected from villages in Turkey" doesn't belong to this article.

A community-based survey on Syrian refugee women's health and its predictors in Sanliurfa, Turkey.

Reproductive characteristics, mental health symptoms, micronutrient deficiencies, and symptoms of sexually transmitted infections (STIs) were determined among married Syrian refugee women aged 15-49 years who were living outside of camps in 2015, using probability sampling. Of the 458 participants, 51.3 percent married before the age of 18 years. Early-age marriages and number of desired children increased after the war. In multivariable analyses, education (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.2-1.3) and length of stay in Sanliurfa (aOR = 1.2; 95% CI = 1.1-1.2) were independently associated with early marriage. Approximately 16 percent of women were pregnant, and 26.7 percent of them had not received prenatal care; 47.7 percent had had a pregnancy loss; 50.8 percent reported symptoms of STIs. Of those who were sexually active, 37.8 percent were not using contraception. The prevalence of iron, B12, and folic acid deficiencies was 50 percent, 45.6 percent, and 10.5 percent, respectively. Early marriage (aOR = 2.2; 95% CI = 1.4-3.5) and number of desired children (aOR = 5.03; 95% CI = 3.2-7.9) were associated with not using contraception. Most (89.7 percent) women reported at least two mental health symptoms; lack of social support (aOR = 2.6; 95% CI = 1.3-5.3), language barrier (aOR = 2.3; 95% CI = 1.01-5.2), and B12 deficiency (aOR = 1.8; 95% CI = 1.01-3.4) were associated with such symptoms. The findings demonstrate the need for reproductive health and psychosocial services.

The knowledge and high seroprevalence of hepatitis A in a high-risk group (agricultural reproductive-aged women) in the southeastern region of Turkey

Background/aim: The aim of this study was to determine the seroprevalence of antihepatitis A virus (HAV), risk factors, and the knowledge of female farm workers living in the Southeastern Anatolia Region (SAR) of Turkey. Materials and methods: This representative cross-sectional survey was conducted between January and April of 2013 in the SAR. A total of 705 reproductive-aged women were randomly selected by clustering method using Epi Info software. The sera were analyzed for anti-HAV antibodies using ELISA. Sociodemographic information and the knowledge of female farm workers regarding hepatitis A were collected using a questionnaire. Results: Of the female farm workers, 99.1% were seropositive for anti-HAV. The anti-HAV seroprevalence was significantly higher in the adults than in the adolescents (P < 0.05). Of the participants, 64.5% had 7 or more family members, 58.4% had 5 or more pregnancies, 68.1% were illiterate, 65.2% were family farmers, 90.6% were poor, 71.9% used unsafe water, 58.9% had toilets outside, and 68% had no knowledge about hepatitis A. Conclusion: Turkey is considered to have high endemicity and female farm workers are considered a high-risk group for hepatitis A. This high HAV exposure might be reduced with vaccination, as well as improvements in sanitation, living conditions, health care utilization, safer drinking water, and health education.

Investigation of brucellosis in a female agricultural population in Turkey.

Much epidemiological information concerning brucellosis generally depends on the evaluation of hospital-based retrospective data. The aim of this study was to determine the prevalence and risk factors of brucellosis in female farmworkers in the south-eastern region of Turkey (GAP) in order to obtain a more representative analysis. Our representative community-based cross-sectional study was conducted during four months of 2013, in all nine GAP provinces. An optimum sample size was determined and blood samples were analysed from 707 reproductive-age female farmworkers using the Rose Bengal (RBT) and standard (SAT) agglutination tests. Sociodemographic information was collected during face-to-face interviews with consenting subjects. Crude odds ratios and 95% confidence intervals were calculated, and chi-square analyses and logistic regression were performed. Employment as a seasonal farmworker and having had five or more pregnancies were the only risk factors found to be significant. This study implies much greater priority needs be given to the control, early diagnosis and treatment in this population.

[Evaluation of epidemiological data of malaria between 2001-2011 in Sanliurfa, Turkey]. / Sanliurfa'da 2001-2011 yillarina ait sitma epidemiyolojik verilerinin degerlendirilmesi.

Although Plasmodium vivax is the only cause of malaria cases detected in Turkey, an increase number of imported P.falciparum cases have begun to be observed recently. Sanliurfa is a province located at Southeastern region of Turkey where malaria is endemic and also one of the two largest malaria epidemics of Turkey was experienced with 84.345 cases in 1994. As this region has borders with countries like Iraq, Iran and Syria, cross border migration caused an increase in imported cases. In addition, climate change, alteration in temperature and humidity due to the Southeastern Anatolian Irrigation Project have led an increase in suitable breeding grounds for mosquitoes. Since new indigenous malaria cases, except imported ones are not detected in Sanliurfa nowadays, there is not enough data on the malaria epidemiology in this region including recent years. The aim of this study was to evaluate the epidemiological data in connection with malaria cases observed in Sanliurfa which is a critical region for this infection for a 11-year-period, between the years of 2001 to 2011, retrospectively. Data obtained from the Malaria Control Unit of the Communicable Diseases Division of Sanliurfa Provincial Health Directorate were analized in terms of frequency of the cases, distribution of the cases in years and months, demographical characteristics, the source and species distribution of the parasite and the locations of the disease. A total of 1.149.196 blood smear samples have been examined during 11-year-period as part of surveillance programme and 4394 (0.4%) of them were positive for Plasmodium spp. The agent was P.vivax in 99.9% (4391/4394) of the cases, while in three cases (0.07%) who were diagnosed after 2010, it was P.falciparum. Of the patients 2351 (53.5%) were male and 2043 (46.5%) were female (p> 0.05), whose age ranging from 3 months to 80 years (mean age: 19.21 ± 16.12 years). The frequencies of the cases according to the age groups 0-11 months, 1-4 years, 5-9 years, 10-14 years and 15 years were as follows; 2.5%, 15.1%, 18%, 13.9% and 50.5%, respectively. The detection of Plasmodium spp. in the samples examined in 2002 (1244/110.533; 1.1%) was the highest, and in 2011 (1/50.981; 0.002%) was the lowest. The distribution rates of 4394 cases according to the years between 2001 to 2011, were found as 25.4%, 28.3%, 17.8%, 10.9%, 8.9%, 5.6%, 1.4%, 1.4%, 0.2%, 0.009% and 0.02%, respectively. Of all cases, 80.6% were autochthonous and 19.4% were imported. Most of the cases were detected in Siverek county with a rate of 71.4%, followed by Ceylanpinar (13.5%) and Viransehir (6.6%) counties. Although malaria cases were detected throughout the year in Sanliurfa in respect to the climate, the highest numbers were recorded in September (832/4394; 18.9%) and November (1054/4394; 24%). This study emphasized that malaria cases due to local transmission declined to zero in Sanliurfa like the recent situation in Turkey. However, P.falciparum malaria cases are being reported due to the travels to endemic countries or migrations from those countries. Effective malaria control attempts, within the scope of Malaria Elimination Programme implemented in Turkey, should be continued with the same stability without any abruption in Sanliurfa province where the disease had been endemic in the past.

Detection of Plasmodium using filter paper and nested PCR for patients with malaria in Sanliurfa, in Turkey.

BACKGROUND: The objective of this study to detect Plasmodium and a subspecies of Plasmodium using filter paper in malaria endemic province, Sanliurfa, in Turkey, compare the results of nested PCR (nPCR) with microscopy for the diagnosis of malaria and present the epidemiological data of malaria. METHODS: This study was carried out in malaria-endemic Sanliurfa between 2008 and 2011. Finger prick blood samples, thick and thin Giemsa-stained blood smears, were collected from 153 malaria-suspected farmworkers. The Giemsa-stained blood smears were examined microscopically. The obtained DNA products, extracted from blood-spotted filter papers or from the thick blood smears, were analysed by nPCR to amplify the 18S ssrRNA Plasmodium gene with genus and specific primers. The results of the microscopy were compared to the nPCR results. RESULTS: Of the specimens, 7.2 % were determined as Plasmodium-positive by microscopy, whereas 9.8 % were determined as Plasmodium-positive by nPCR. Of the positive Plasmodium specimens, 93.33 % were identified as P. vivax. Four out of the 15 specimens that were microscopically diagnosed as negative were Plasmodium-positive with nPCR. When compared to the microscopy, the sensitivity, specificity, and positive predictive values of the nPCR were determined as 100, 97.2 and 73.3 %, respectively. nPCR was determined to be more sensitive and specific than microscopy. CONCLUSIONS: This study revealed that the accurate diagnosis of malaria by nPCR was compulsory in malaria-endemic Sanliurfa and nPCR should be applied routinely in laboratory studies.

[Investigation of the prevalence of Trichomonas vaginalis among female Syrian refugees with the complaints of vaginitis aged between 15-49 years]. / Vajinit yakinmalari olan 15-49 yas arasindaki Suriyeli mülteci kadinlarda Trichomonas vaginalis sikliginin arastirilmasi.

Since the Syrian civil war began in 2011, most of the Syrian refugees have immigrated to Turkey due to its open gate policy and the width of the border. By the end of 2015, it was estimated that there were 2.5 million Syrian refugees in Turkey. Many of the Syrian refugees live in Sanliurfa due to its location on the border with Syria. Trichomonas vaginalis, apart from viral agents is the most common parasite among sexually transmitted infection agents. The aim of this study was to determine the prevalence of T.vaginalis among female married Syrian refugees living outside of the camps in Sanliurfa city center, aged between 15-49 years with complaints of vaginitis. This multi-purpose survey was carried out between February and March of 2015, in collaboration with the United Nations Population Fund and Harran University. This study was approved under the heading of "General Health Status of Female Syrian Refugees" by the Ethics Committee of Harran University Faculty of Medicine. A total of 460 Syrian refugees house were selected using the probability cluster sampling method, with a 95% confidence level and a 5% confidence interval with a design effect. Two women refused to participate in the study, and the response rate was 99.6%. Two Syrian nurses, one laboratory technician, and one interpreter who knew Kurdish and Arabic were hired for the field survey. A structured questionnaire written in Turkish was translated to Arabic and used to collect the sociodemographic data during face to face interviews. According to the questionnaire data, the women with the complaints of vaginal discharge, unusual vaginal bleeding and/or dyspareunia were invited to the Gynecology Department of Harran University Research and Training Hospital for a medical examination. During gynecological examination, swab samples obtained from posterior fornix were evaluated by direct microscopy and Giemsa staining methods for the presence of T.vaginalis trophozoites. Of 458 women who have participated the questionnaire survey, 232 (50.6%) have declared that they had vaginitis complaints. Accordingly, 157 symptomatic and non-pregnant women were invited to the hospital, however only 89 (56.7%) accepted the invitation. T.vaginalis infection was detected in 19 (21.3%) by direct microscopy, and in 32 (36%) by Giemsa staining of the samples taken during the examination of those 89 women (mean age: 31.6 ± 8.7 years). In the gynecological examination, 56.2% (50/89) of the women were clinically diagnosed as vaginitis. A statistically significant association was detected between T.vaginalis positivity and the cases with or without the clinical vaginitis diagnosis (p< 0.001). Our data indicated that the prevalence of T.vaginalis (36%) detected in the female Syrian refugees is higher than the prevalence (3-13%) of our general population, but it is close to the prevalence (40%) in groups with risky behaviors (sex workers). In conclusion, health screening studies and health educations about safe sex life for Syrian refugees would be useful in the prevention of sexually transmitted diseases.

[Investigation of cutaneous leishmaniasis by active screening in primary schools in Sanliurfa, Turkey]. / Sanliurfa'da ilkögretim okullarinda aktif tarama yöntemiyle kütanöz leysmanyaz arastirmasi.

Cutaneous leishmaniasis (CL) is endemic in Sanliurfa, a province located at southestern part of Turkey. The aims of this study were to determine CL cases among children aged 7-15 years attending primary schools and evaluate the demographical and clinical characteristics by active screening method. In our study, a total of 163.464 children attending to 123 primary schools have been evaluated in terms of CL prevalence between 2010 to 2012 period. Accordingly, 67.585, 72.279 and 23.600 students studying in 74, 37 and 12 primary schools were actively screened, respectively. Children suspected with CL were invited to the Center for Diagnosis and Treatment of Oriental Sore, Sanliurfa Division of Turkish Public Health Institute. Two slides were prepared from bloodless, serous fluid of the skin lesions and stained with Giemsa for the microscopic examination to identify Leishmania amastigotes. The lesions were also evaluated according to their clinical manifestations, size, duration and number. In the study, 455 (%0.3) of the children were diagnosed as CL. The incidence of CL cases was 0.41%, 0.14%, and 0.31% in 2010, 2011 and 2012, respectively. Of the CL cases, 250 (54.9%) were female and 205 (45.1%) were male with a mean age of 10.54 ± 2.42 years. Most of the cases (64.2%) were in 7-11 years old group, while 35.8% were in 12-15 years old group. The average number of the CL lesions was 1.78±0.7, ranging from one to fifteen. Single lesions were detected in 281 cases (61.8%), whereas double, triple and multiple lesions (≥ 4) were detected in 87 (19.1%), 51 (11.2%) and 36 (7.9%) of the CL cases, respectively. The lesions were mostly involved on face (n= 280, 61.5%) and especially cheeks (133/280, 47.5%), followed by upper (n= 127, 27.9%) and lower (n=39, 8.6%) extremities. The average duration of lesions was 13.40 ± 0.47 months (range: 4-104 weeks) and the average size of lesions was 10.32 ± 0.4 mm (range: 3-10 mm). Among all, mostly nodular (n= 211, 46.4%) and ulcerative (n=204, 44.8%) lesions were recorded. Of the cases 330 (72.5%) were diagnosed as acute CL (duration of lesions were ≤ 24 months), while 125 (27.5%) were chronic CL (duration of lesions were > 24 months). Leishmaniasis recidivans were identified in a total of five (1.1%) cases, of them one was acute and four was chronic CL cases. Twenty-five relatives of the children with CL were diagnosed as new CL cases in the 2011-2012 period. Most of the patients (n= 437, 96%) were successfully treated with topical pentavalent antimonials, however 18 (4%) who were unresponsive to local therapy were treated systemically. Our findings showed that local transmission is ongoing in terms of CL. It should be kept in mind that, primary school aged children might be responsible for the ongoing local transmission in endemic regions and the local transmission may be decreased with the early diagnosis and treatment of CL cases.

Prevalence and associated risk factors of intestinal parasites among children of farm workers in the southeastern Anatolian region of Turkey.

OBJECTIVE: To determine the species, prevalence, and associated risk factors of intestinal parasites in farm workers' children in a representative sample in the southeastern Anatolian region of Turkey. MATERIALS AND METHOD: A total of 333 farm workers' children, under the age of six years, were selected using the probability sampling method. Mean age of the children was 3.63 ± 0.5; 55.5% were female. Data were collected using a structured questionnaire and laboratory analysis of faecal samples. RESULTS: The overall prevalence was 44.6% and the infected children had single, double, and triple parasitic infections at 72.3%, 23.0%, and 4.7%, respectively. The most common parasite was G. intestinalis (47.97%), followed by E. vermicularis (37.84%), T. saginata (27.03%), H. nana (12.16%), and A. lumbricoides (7.43%), respectively. Age, gender, illiteracy of the households, poverty, absence of toilets, bathrooms, and kitchens at the place of residence, lack of safe potable water, geophagia (soil eating habit), and being a child of a seasonal farmworker were the most significant factors associated with intestinal parasitic infection (P<0.05). G. intestinalis and E. vermicularis were found as the most common parasites that cause salivation, abdominal pain, and tiredness (P<0.05). CONCLUSION: The study revealed that health education programmes for farm workers and farmers should be improved to increase awareness about living and working conditions, in order to control intestinal parasites. However, early diagnosis and treatment services for intestinal parasites should be provided by primary health care staff in the national child screening programme in agricultural populations.

Prevalence and associated risk factors of Toxoplasma gondii in female farmworkers of southeastern Turkey.

INTRODUCTION: There are a limited number of studies of the agricultural population about the prevalence of Toxoplasma gondii (T. gondii) infection throughout the world. The aim of this study was to determine the prevalence and risk factors of toxoplasmosis in female farmworkers in the southeastern region of Turkey. METHODOLOGY: The optimum sample size was determined using the Epi Info Program, and blood samples were collected from 684 women of reproductive age. Serum samples were analyzed by qualitative and quantitative methods for anti-T. gondii IgG and IgM antibodies with a commercially available enzyme immunoassay. Questionnaires through which socio-demographic information was collected were applied during face-to-face interviews of subjects who gave their consent to participate in the study. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and Chi-square analyses and logistic regression were performed. RESULTS: Of the 684 women, the prevalence of toxoplasmosis was determined to be 58.3% and 1% for IgG and IgM, respectively. Employment as a seasonal farmworker, increasing age, and having had three or more pregnancies were found to be the crucial associated risk factors that affect the prevalence of T. gondii infection (p < 0.05). In contrast to these, the provincial development level was found to be a confounding factor. There was no association between toxoplasmosis and household size, education attainment, and poverty in the bivariate analyses. CONCLUSIONS: The findings show that control and serological screening programs should be implemented nationwide in Turkey for the reliable and fast detection of congenital Toxoplasma infections.

Risk Factors and Relationship Between Intestinal Parasites and the Growth Retardation and Psychomotor Development Delays of Children in Sanliurfa, Turkey.

OBJECTIVE: The objective of this study was to determine the risk factors for and relationship among parasitic infections, growth retardation, and psychomotor developmental delays in children aged 6 years and below. METHODS: This case-control study was performed in Sanliurfa in southeastern Turkey between October and December 2007. Data were collected using a structured questionnaire, anthropometry, Ankara Development Screening Inventory, and laboratory analysis of stool specimens. RESULTS: The most common parasite was Giardia intestinalis (42.53%) followed by Enterobius vermicularis (27.58%), Ascaris lumbricoides (18.39%), Hymenolepis nana (5.75%), Trichuris trichiura (3.45%), Escherichia coli (1.15%), and Blastocystis spp. (1.15%). Fifty-eight percent of all children were infected with intestinal parasites; 55.2% had only one parasite, whereas 44.8% had multiple parasites. The children infected with G. intestinalis and other intestinal parasites had significantly higher levels of growth retardation and psychomotor development delay than non-infected children. Children with parasitic infections had growth delay up to 2.9 times, general development delay up to 1.9 times, language-cognitive development delay up to 2.2 times, and fine motor development delay up to 2.9 times higher than children without any parasitic infections. However, no significant relationship among intestinal parasites, gross motor development, social-self skills, and development delay was identified. The education level of parents, poor economic situation, number of households, not washing hands, playing with soil, family history of parasitic infection were the significant risk factors for intestinal parasites. CONCLUSION: Our study indicates that the presence of either malnutrition or intestinal parasites may put a child in a high-risk group for developmental delays and growth retardation. Therefore, public health interventions can embrace nationwide deworming in children.

[The effects of intestinal parasites on anemia of children]. / Çocuklarda Baðýrsak Parazitlerinin Anemiye Etkisi.

OBJECTIVE: In this case-control epidemiological study, we aimed to investigate the effects of intestinal parasites on the anemia of children and show the association between intestinal parasites and anemia. METHODS: A total of 50 healthy and 50 malnourished children aged 0-72 months who went to physicians of Tilfindir Primary Health Care Center were enrolled in this study. The stool specimens were examined by using native-lugol, concentration, cellophane tape, and acid fast and trichrome staining methods. The complete blood count was measured by an automatic blood device. RESULTS: A total of 58% of the children were infected with intestinal parasites; 55.2% of these were infected with only one parasite, and 44.8% of them were infected with polyparasites. Also, 50.0% of the children with parasitic infection and 19.0% of children without parasitic infection were anemic. There was a positive association between intestinal parasites and anemia statistically (p<0.05). The mean hemoglobin level of the children with parasitic infection was 11.15±1.30, and the mean hemoglobin level of the children without parasitic infection was 12.13±1.47. There was a significant difference between mean hemoglobin levels of the two groups statistically (p<0.001). CONCLUSION: Consequently, this study emphasized that intestinal parasites can affect the anemia of children adversely, and there was a positive association between intestinal parasites and anemia of children.

[Is the agent of cutaneous leishmaniasis in Sanliurfa changing? First cases of Leishmania major]. / Sanliurfa'da Sark Çibani Etkeni Degisiyor Mu? Ilk Leishmania Major Vakalari.

Today, almost 2 million new leishmaniasis cases are noted annually; 1.5 million of these are cutaneous (CL), and others are visceral leishmaniasis (VL). In Sanliurfa, CL cases caused by Leishmania tropica but not by other agents such as L. infantum and L. major. L. tropica is a unique parasite species in Sanliurfa and is the causative agent of anthroponotic CL (transmitted from human to vector to human). Our aim was to report 3 new CL cases due to L. major ( 2 autochthonous and 1 imported) identified in Sanliurfa. Lesion aspiration samples taken from patients were inoculated into NNN culture. Following successful isolation in NNN, promastigotes were obtained by mass culture using RPMI + 20% FCS medium. Parasites species were identified as L. major using ITS-1 PCR-RFLP analysis. This is the first report of autochthonous CL cases caused by L. major in Sanliurfa, and it is estimated that the number of such cases will increase in this region. Public health measures should be taken for L. major infections, while researchers should plan field studies to identify the vectors and reservoirs of L. major.