The clinical characteristics of fascioliasis in pediatric patients.

Fascioliasis is a trematode flatworm infection caused by Fasciola hepatica and F. gigantica. Fasciola hepatica is mesoendemic in Turkey. Six cases of pediatric fascioliasis are presented here. All patients had histories of consumption of various raw vegetables. Four of our patients were at the hepatic phase, and two were at the biliary phase. Except for one patient, all patients had eosinophilia. In three patients, total IgE levels were markedly increased. In these patients, there was an eosinophilic leukomoid reaction accompanied by a high total IgE level. Except for one of our patients, all patients had positive indirect hemagglutination tests. This patient was diagnosed as having fascioliasis with a compatible clinical picture. Except one, all of our patients were completely treated with a single-treatment regimen of triclabendazole; one patient needed re-administration. Only in patient 1, liver enzymes increased after triclabendazole administration because he had taken the medication for longer than prescribed by mistake. The elevation of liver enzymes was not observed in the other patients who received the correct dose. All patients recovered completely with triclabendazole treatment. The patients' dietary habits, eosinophilia, and markedly elevated IgE levels may be significant predictors for physicians to suspect fascioliasis.

Pediatric Visceral Leishmaniasis Caused by Leishmania infantum in Northern Cyprus.

Visceral leishmaniasis (VL) is a vector-borne disease widespread in the Mediterranean basin, including Cyprus. During the last decades no cases were notified from northern Cyprus, but herein three cases of VL (female: 2, male: 1, median age: 24.6 months) diagnosed during their hospital admission between January 2011 and December 2012 are reported. Diagnosis was based on clinical findings; 1 ≥ 1/64 titer positivity of immunofluorescence antibodies, Leishmania amastigotes in Giemsa-stained slides of bone marrow, as well as molecular identification confirmed that in all three the infecting pathogen was Leishmania infantum Fever, splenomegaly, and hepatomegaly were the typical clinical findings. First-line treatment with liposomal amphotericin B (AmBisome®; intravenous, 3 mg/kg) on days 1-5, followed by the same on days 10 and 21 yielded a successful outcome with no relapse in all cases. These confirmed VL cases found within 2 years demonstrate the presence of VL on the island.

Colon perforation and Budd-Chiari syndrome in Behçet's disease.

BACKGROUND: Behçet's disease is a chronic inflammatory disease involving multiple systems, with vasculitis being the most important pathological feature. Multiple colon perforations are thought to be secondary to vasculitis and they occur in patients with ulcers. These may be encountered within the entire colon but most commonly in the ileocecal region. Intestinal perforation and Budd-Chiari syndrome are infrequent in Behçet's disease, and are associated with high mortality and morbidity. Budd-Chiari syndrome results from occlusion of either hepatic veins or adjacent inferior vena cava, or both. CASE REPORT: We report a patient with Behçet's disease having multiple perforations in the transverse colon, descending colon, and sigmoid colon. The patient also had Budd-Chiari syndrome due to inferior vena cava thrombosis extending into the right and middle hepatic vein. Our observations are presented with a review of the literature. CONCLUSIONS: In Behçet's disease, treatment of colon perforation necessitates urgent surgery, whereas management of Budd-Chiari syndrome is directed towards the underlying cause. Behçet's disease, as a chronic multisystemic disease with various forms of vasculitis, is resistant to medical and surgical treatment. Prognosis is worse in Behçet's disease with colon perforation than that in Budd-Chiari syndrome alone.

[Evaluation of Cystic Echinococcosis Suspected Patients Applied to National Parasitology Reference Laboratory of Public Health Institution of Turkey Between 2009-2013]. / Gaziantep Üniversitesi Tip Fakültesi Leishmaniasis Tani ve Tedavi Merkezine Basvuran Kutanöz Leishmaniasis Olgularinin Degerlendirilmesi.

OBJECTIVE: Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is an important public health problem common in our country. In this study, anti-E. granulosus antibodies were aimed to investigate in the serum samples of CE suspected patients who applied to the National Parasitology Reference Laboratory of Public Health Institution of Turkey. METHODS: In the study, serum samples of 2921 patients which were sent to our laboratories from different hospitals between 1 January 2009 and 31 December 2013 were evaluated with at least one of the following tests: Enzyme-Linked Immunosorbent Assay (ELISA), Indirect Hemaglutination Assay (IHA) and Western Blot (WB) techniques. RESULTS: Four hundred thirty nine (15.03%) of inspected 2921 samples were determined seropositive with at least one of the methods. When the results analyzed by gender, 13% of males and 16.40% of females were found positive. Examined the distribution of the results by years, with a maximum of 25% positivity was observed in 2009. Compatibility was determined at the rate of 91.4% among ELISA and IHA results; also 89.7% among WB and the other tests results. CONCLUSION: Despite the gradual decreases the CE in Ankara and its surroundings, it is still continues to be a major public health problem. Essential prevention and control measures should be taken to reduce the prevalence of the disease. Also in the diagnosis of the disease, more reliable results can obtained with applying two tests (ELISA/IHA) together and confirm the positivity with WB.

A case of ectopic intraabdominal fascioliasis presented with acute abdomen.

Human fascioliasis with Fasciola species occurs worldwide and is most common among rural people who tend sheep and eat uncooked water vegetables, particularly watercress. The natural history of the acute phase begins with ingestion of metacercariae encysted on various kinds of aquatic vegetation such as watercress. Fascioliasis primarily involves the liver, bile ducts, gallbladder, and occasionally ectopic sites. We describe herein a case of ectopic fascioliasis. This uncommon form of disease was peritonitis; both visceral and parietal peritoneal layers were affected with the formation of multiple nodules and ascites.

Encephalitozoonosis in New Zealand rabbits and potential transmission risk.

Encephalitozoon cuniculi is a small protozoan parasite in the phylum Microspora. It has been shown to naturally infect several host species, including humans. Encephalitozoonosis is routinely diagnosed in vivo by serological examination or post mortem by histopathology. In a conventional rabbit colony, two animals suddenly showed clinical signs (torticollis and asthenia of limbs). Serum samples of these rabbits were seropositive for E. cuniculi after definitive diagnosis (Toxoplasma gondii and Listeria monocytogenes). The animals in the same breeding facility were also clinical examined, and the present study evaluated the prevalence of specific anti-E. cuniculi antibodies using serological testing, both in animals and in people working with animals, after two clinical cases. The rabbits showed no clinical symptoms of the disease. Blood samples were taken for E. cuniculi infection from 50 clinically healthy rabbits. Anti-E. cuniculi antibodies were found in two asymptomatic and two clinically affected animals belonging to the same rabbit colony. Finally, the present study found that the 7.7% (4/52) prevalence of CIA, test positive in rabbits. E. cuniculi spores were detected in the urine of one clinically affected rabbit, and one seropositive animal caretaker after staining with the modified trichrome stain. In conclusion, the presence of seropositive, but apparently healthy rabbits indicates the need for screening examinations to detect the anti-E. cuniculi antibody in rabbits, especially considering the potential zoonotic risk. Therefore, persons should avoid contact with the urine of infected or healthy animals, and always use good personal hygiene when handling animals.

[Seroprevalance of listeriosis and leishmaniasis in shelter dogs of the Erzurum province]. / Erzurum Ili Barinak Köpeklerinde Listeriosis ve Leishmaniasisin Seroprevalansinin Arastirilmasi.

Dogs are known to play an important role in the spread of the zoonotic diseases, listeriosis and leishmaniasis. In this study, the seroprevalances of these infections were investigated in shelter dogs in Erzurum. The Osebold agglutination test for listeriosis and IFAT for leishmaniasis were performed in analysis of the specimens. Out of 72 dogs, 19 (26.3%) were found to be seropositive for Listeria monocytogenes. Leishmaniasis seropositivity was not detected in any of the specimens. A total of 13 (29.5%) of female dogs and 6 (21.4%) of male dogs were L. monocytogenes positive. Seropositivity rates were 41.6% in dogs less than 1 year old, 24% in those 1-3 years old, and 16.6% in those over 3 years old. Regarding percentages, the seropositivity rate of L. monocytogenes was found to be higher in female dogs and those younger. However, these changes were not found to be statistically significant (p > 0.05). Detection of L. monocytogenes in dogs of Erzurum province was considered to be crucial for veterinary medicine and public health and preventive measures should be taken as soon as possible.

[Investigation of the prevalence of visceral leishmaniasis by the microculture method and IFAT in dogs in Kirikkale.]. / Kirikkale'deki Köpeklerde Mikrokültür Yöntemi ve IFAT ile Visseral Leishmaniosisin Prevalansinin Arastirilmasi.

This study was carried out in order to compare the seroprevalence of visceral leishmaniasis in dogs from different areas of Kirikkale between 2006-2008 using the microculture method (MCM) which is a new method, and the indirect fluorescent antigen test (IFAT). All of the blood collected from total of 50 dogs was found to be negative by MCM. Only one male Beagle strain dog (3 years old) was found to be seropositive at 1/128 titers (2%) for anti-Leishmania infantum IgG antibodies by IFAT.

[Seroprevalance of toxoplasmosis, leishmaiosis and listeriosis in shelter dogs of Diyarbakir, Turkey]. / Diyarbakir Bölgesindeki Sahipsiz Köpeklerde Toxoplasmosis, Leishmaniasis ve Listeriozisin Seroprevalansi.

The aim of this study was to determine the prevalence of toxoplasmosis, listeriosis and leishmaniasis in dogs in Diyarbakir region, Turkey. A total of 100 sera were collected from healthy dogs and tested for toxoplasmosis, leishmaniasis and listeriosis by the Sabin-Feldman Dye Test (SFDT), Indirekt Florescence Antikor Test (IFAT) and, Osebold Agglutination Test (OAT), respectively. Among these 100 dogs, 94 (94%) were seropositive for toxoplasmosis and and 17 (17%), for listeriosis. All of them were found to be seronegative for leishmaniasis. No statistically significant differences were observed between male and female dogs in the seroprevalence of toxoplasmosis and listeriosis. As a result, the presence of anti-Toxoplasma gondii and Listeria monocytogenesis specific antibodies in dogs in the region of Diyarbakir was determined.

[Cystic echinococcosis in Turkey from 2001-2005]. / Türkiye'de 2001-2005 Yillari Arasinda Kistik Ekinokokkozis.

Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. In the present study, CE cases were determined during 2001-2005 by investigating different hospital and health directorship documents and Health Ministry documents, retrospectively. Our results show that there were 2534 (13.13%) cases in the Marmara region; 2114 (16.94%), in the Aegean region; 2578 (16.09%), Mediterranean region; 5404 (38.57%), in the Middle Anatolian region; 428 (5.70%), in the Black Sea region; 844 (6.80%), in the eastern Anatolian region; and 887 (2.75%), in the southeastern Anatolian region making a total of 14,789 CE cases. Finally, it has been determined that the patients were hospitalized for a total of 149,464 days.

Investigation of anti-Toxoplasma gondii antibodies in cats of the Ankara region of Turkey Using the Sabin-Feldman dye test and an indirect fluorescent antibody test.

Blood samples from 99 cats from the Ankara province of Turkey were examined for the presence of anti-Toxoplasma gondii antibody with the use of both the Sabin-Feldman dye test (DT) and an indirect fluorescent antibody test (IFAT). Forty of the 99 sera (40.3%) were positive for antibodies against T. gondii with the DT, whereas the IFAT assay detected antibodies in 34 (34.3%). The study also evaluated 3 factors for their potential association with the presence of T. gondii antibody: age (<1 yr, 1-2 yr, and >2 yr), gender (female vs. male), and outdoor access (stray, owned with outdoor access, or indoor only). The DT detected antibodies in 3 cats under 1 yr of age, 22 cats between 1 and 2 yr, and 15 cats older than 2 yr, whereas the IFAT found 1, 18, and 15 cats positive for antibodies, respectively, in each of these categories. Of 61 female cats, 27 (44.2%) were positive by the DT; and of 38 male cats, 13 (34%) were positive by the DT. For the IFAT, 24 female cats (39.3%) and 10 male cats (26.3%) were positive. The percent seropositivity in indoor cats was 30.8% by the DT and 23.1% by the IFAT. In stray cats, the percent seropositivity was 52.8% by the DT and 41.7% by the IFAT. Antibody presence was significantly associated with age, but not with outdoor access.

[Investigation of Leishmania infantum seropositivity in HIV/AIDS patients]. / HIV/AIDS hastalarinda Leishmania infantum seropozitifliginin arastirilmasi.

In recent years an increase in the rate of detection of HIV and Leishmania co-infections has been reported from many countries especially countries in Southern Europe. Visceral leishmaniasis (VL) is sporadically detected in some parts of Turkey. Although the natural transmission is via sandfly bites, VL may be transmitted by needle sharing of intravenous drug addicts or by blood transfusion in HIV/AIDS patients. The aim of this study was to investigate the presence of specific antibodies against Leishmania infantum, which is the causative agent of VL, in the sera of HIV/AIDS patients. A total of 79 HIV/AIDS patients (61 male, 18 female; mean age: 30 +/- 2 years) with confirmed diagnosis by HIV Reference Laboratory of Refik Saydam Hygiene Center between the years of 2004-2006, were included in the study. L. infantum antibodies were searched by fast agglutination screening test (FAST), direct agglutination test (DAT), indirect immunofluorescent antibody test (IFAT) and rK39 dipstick assay. Only one serum sample (1.2%) was found to be seropositive by all of the serological tests (> 1/100 by FAST, 1/3200 by DAT, 1/256 by IFAT, and specific bands for L. infantum by rK39 dipstick test), while the remaining samples were negative with all of the methods. The seropositive serum was from a 49 years-old heterosexual male, living on the Mediterranean cost and has had acquired the HIV infection by sexual contact. He has no history of intravenous drug use but he had experienced blood transfusion. Since the seropositive serum sample was collected 2-3 weeks after the transfusion, the transmission of L. infantum was thought to be during blood transfusion, however it could also be acquired via a previous sandfly bite. In conclusion although the rate of L. infantum seropositivity was low in HIV/AIDS patients in our study, the possibility of HIV/Leishmania co-infections should be considered.

[Entomophobia and delusional parasitosis]. / Entomofobi ve Deluzyonel Parazitoz.

Entomophobia is an abnormal and persistent fear of insects. Sufferers experience anxiety even though they realize that most insects pose no threat. A similar phenomenon, known as arachnophobia is fear of spiders. Delusional parasitosis (DP) is a hypochondrial psychosis, usually monosymptomatic, where the patient is convinced of being infested with animal parasites while no objective evidence exists to support this belief. The complaints are usually about skin infestation, but involvement of the gastrointestinal tract has also been described. Numerous samples are brought for examination from their skin, clothes and environment. Practically all patients refuse psychiatric help. In primary DP, the delusion arises spontaneously as a monodelusional disorder, while in secondary DP, the delusional disorder arises secondary to another major medical, neurological or psychiatric disorder. Shared delusion -folie a deux- is a known phenomenon in delusional parasitosis. One or more members of the same family often suffer from the same psychosis, the characteristic delusional state being identical. The secondary victims are often family members, who are dominated by their spouses, show filial devotion or are trying to keep the family in harmony. Patients whose delusion of parasitosis is not severe can be helped without psychopharmacological intervention. They can be relieved of their symptoms by giving them sympathetic counseling, and gaining their confidence. Symptomatic medication may be prescribed for the relief of pruritus, pain and other symptoms. It is more important to treat patients with empathy, providing a place where they can express their distress without being stigmatized. Second-generation antipsychotics such as amisulpride, risperidone or olanzapine in age-appropriate doses are being used today for the treatment of DP.

[Investigation of Cryptosporidium oocysts in elementary school students in Mersin]. / Mersin ilinde ilkokul ögrencilerinde Cryptosporidium spp. ookistlerinin arastirilmasi.

Cryptosporidium parvum, a protozoon, is an obligate intracellular parasite which can cause fatal diarrheal disease in immunocompromised individuals. Cryptosporidium parvum and Cryptosporidium hominis are usually known to be transmitted from fecally contaminated drinking and tap waters. Because oocysts can be detected in asymptomatic healthy individuals and no safe and effective therapy for cryptosporidial enteritis is available, the importance of cryptosporidiosis is increased. In this study, stool specimens (n=72) were collected from children, 8-12 years in age, in four elementary school in Mersin. These specimens were stained with modified Kinyoun's acid-fast (cold) and auramine O stains and examined for the oocysts of Cryptosporidium spp. Cryptosporidium oocysts were found in the specimens of 4 (5.5%) asymptomatic children.

Serological and entomological survey in a zoonotic visceral leishmaniasis focus of North Central Anatolia, Turkey: Corum province.

In the present study, we aimed to carry out an epidemiological and entomological survey on a visceral leishmaniasis (VL) focus located on the northern central part of Anatolia, Turkey. Five villages of Corum province, where five confirmed cases of human visceral leishmaniasis (HVL) (one patient/village) were reported between June 1998 and August 2001 were included in the study. A total of 625 children and 131 dogs were sampled and the physical examination was carried out by authorized physicians and veterinarians. An indirect fluorescent antibody test (IFAT) was performed by standard procedures for human and dog sera, while the direct agglutination test (DAT) was only performed for dog sera. Sand fly collection was performed in three villages by CDC miniature light traps. Hepatosplenomegaly and hepatomegaly were detected in two and eight children, respectively. The seropositivity rate among children was found to be 0.16% (1/625) in the region. The seroprevalence of canine infection in these five villages ranged between 0.0% and 28.26%. In two villages, named Ahlatcik and Asagifindikli, no seropositive dogs were found. A total of 1218 sand flies were collected throughout the study. Six species of Phlebotomus were identified: P. transcaucasicus, P. neglectus, P. halepensis, P. tobbi, P. papatasi, and P. jacusieli. P. transcaucasicus was found to be the predominant species in Cevizli (47.44%; 343/723) and Ucoluk (79.95%; 351/439) villages, while P. tobbi was abundant in Kucukerikli (42.85%; 24/56).