Investigation of Parasites in Food Handlers in Turkey.

Increasing world population parallelly also brings an increase in food production and consumption. As food consumption increases, so do foodborne infections. In cases where adequate food safety and hygiene is not provided in places such as restaurants, dormitories, prisons, hospitals where mass feeding is made outside the home, many parasitic agents can be transmitted to people through food. People working in the food processing and distribution sector and who are in the position of porters play an important role in the spread of parasites, as they can transmit parasitic agents to food through fingernails and hands. Parasites such as Enterobius vermicularis, Entamoeba histolytica, and Giardia intestinalis can be transmitted to food and then to patients through nails and hands. This study was planned to investigate the presence of parasites in hospital food production and distribution workers, such as cooks and waiters, using various methods. Stool and serum samples were taken from 100 food production and distribution workers. Stool samples were examined by native-Lugol, concentration, trichrome, acid-fast staining, and cellophane tape methods. E. histolytica antigen in stool and Toxoplasma and Taenia antibodies in serum were searched by enzyme-linked immunosorbent assay. Parasites were detected in 59% people, and 41 were evaluated as negative. This positivity was 71.9% (23/32) in the 45-61 age range. Blastocystis sp. (27%), Toxoplasma (25%), E. histolytica (10%), Taenia spp. (7%), E. vermicularis (7%), Entamoeba coli (7%), G. intestinalis (5%), Chilomastix mesnili (1%), and I. butschlii (1%) were detected in food handlers. High Toxoplasma antibody positivity (25%) suggests the possibility of transmission to kitchen workers through ways, such as infected raw meat. However, the detection of E. histolytica, Taenia spp., E. vermicularis, G. intestinalis parasites in workers at significant levels poses a significant risk for society consuming these foods. As a result, it is important to investigate the presence of parasites in the employee dealing with food production and distribution to protect patients from parasitic infections especially in hospitals where the people are immunocompromised and more susceptible, and where mass meals are eaten.

The Importance of Antioxidant Enzymes and Oxidative Stress in Human Fascioliasis

Objective: The aim of this study was to determine the levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), and malondialdehyde (MDA) in the patients infected with Fasciola hepatica and establish whether these parameters differ among the patients with fascioliasis. Methods: The patient group consisted of 140 individuals with F. hepatica seropositive; the control group consisted of 140 healthy individuals who tested negative for this parasite and had no other diseases. The patient group consisted of individuals with no chronic diseases other than fascioliasis; in both the patient and the control groups, the subjects had no unhealthy habits such as smoking and alcohol consumption, etc. The blood samples taken to diagnose fascioliasis were evaluated by the ELISA method. The samples were studied according to the kit procedures for SOD, CAT, GPx and MDA markers. Results: In this study, 43.6% of 140 individuals in the patient group infected with F. hepatica had CAT (p=0.001), 35% had GPx (p=0.001), 12.9% had SOD (p=0.002), 90.7% had MDA (p=0.001). There was found a statistically significant difference between the patient and the control group in terms of the positivity of these four parameters. Conclusion: As a result, a statistically significant relationship was found between the increase in the SOD, GPx, CAT, and MDA levels and fascioliasis. The high rate of MDA revealed that oxidative stress occurred in patients with fascioliasis, resulting in an increased activity of SOD, GPx, and CAT. Amaç: Bu çalismanin amaci, Fasciola hepatica ile enfekte hastalarda süperoksit dismutaz (SOD), glutatyon peroksidaz (GPx), katalaz (CAT) ve malondialdehit (MDA) düzeylerini belirlemek ve fascioliasisli hastalarda bu parametrelerde farklilik meydana gelip gelmedigini ortaya koymaktir. Yöntemler: Hasta grubu, F. hepatica pozitif olan 140 hastadan; kontrol grubu ise bu parazit yönünden negatif bulunan ve baska herhangi bir hastaligi bulunmayan 140 saglikli kisiden olusturuldu. Hasta grubuna fascioliasis disinda herhangi bir kronik hastaligi olmayan ve hem hasta hem de kontrol grubuna sigara, alkol kullanimi olmayan kisiler dahil edildi. Hastalarda fascioliasis pozitifligini belirlemek için alinan kan örnekleri ELISA yöntemi ile çalisildi. Serum SOD, CAT, GPx ve MDA düzeyleri ELISA yöntemi ile degerlendirildi. Bulgular: Bu çalismada F. hepatica ile enfekte hasta grubundaki 140 kisinin %43,6'sinda CAT (p=0,001), %35'inde GPx (p=0,001), %12,9'unda SOD (p=0,002) ve %90,7 MDA pozitifligi saptandi. Bu dört parametrenin pozitifligi açisindan hasta ve kontrol grubu arasinda istatistiksel olarak anlamli fark bulundu (p=0,001). Sonuç: Sonuç olarak SOD, GPx, CAT ve MDA düzeyindeki artis ile fascioliasis arasinda istatistik olarak anlamli bir iliski saptanmistir. Çalismamizda MDA'nin yüksek oranda saptanmis olmasi fascioliasisli hastalarda oksidatif stres olustugunu ve SOD, GPx ve CAT aktivitelerinde artis oldugunu ortaya koymustur.

Detection of Blastocystis sp. in ulcerative colitis, Crohn's and chronic diarrheal patients by microscopy, culture and real-time polymerase chain reaction.

Blastocystis sp. is a zoonotic parasite that is common in humans and animals and settles in the large intestine. The parasite can cause various gastrointestinal system complaints such as indigestion, diarrhea, abdominal pain, bloating, nausea and vomiting. The aim of this study is to determine the distribution of Blastocystis in patients diagnosed with ulcerative colitis, Crohn's and diarrhea from the gastroenterology outpatient clinic and to compare the diagnostic value of the most preferred methods. A total of 100 patients, 47 men and 53 women, were included in the study. Of the cases, 61 had diarrhea, 35 had ulcerative colitis (UC) and four had Crohn's disease. Stool samples of the patients were analyzed by as direct microscopic examination (DM), culture and real-time polymerase chain reaction (qPCR). A total of 42% positivity was detected, 29% positivity in DM and trichrome staining, 28% in culture and 41% in qPCR. 40.4% (20/47) of men and 37.7% (22/53) of women were found to be infected. Blastocystis sp. was found in 75% of Crohn's, 42.6% of diarrheal and 37.1% of UC patients. Diarrhea cases are more common with UC and there is a close relationship between Crohn's and Blastocystis positivity. While DM and trichrome staining showed a sensitivity of 69%, PCR test was found to be the most sensitive diagnostic method with approximately 98%. Diarrhea and UC are often seen together. A close relationship was detected between Crohn's disease and Blastocystis. High prevalence of Blastocystis in cases with clinical symptoms reveals the importance of the parasite. There is a need for studies on the pathogenicity of Blastocystis sp. in various gastrointestinal cases, and it is thought that molecular techniques should be used since PCR is seen to be a much more sensitive.

IL-4, IL-10, TNF-α and IFN-γ Cytokine Levels in Patients with Cystic Echinococcosis and Fascioliasis.

Background: Cytokines are protein substances involved in immune response and inflammation regulation, cell growth, tissue repair and natural and adaptive immunity events such as hematopoiesis. Changes in Th1 and Th2 immune responses provide information on the clinical presentation, pathology and diagnosis of diseases. Methods: This study was conducted on 142 patients, aged 18-95 yr and applied to Parasitology Laboratory of Van Yuzuncu Yil Hospital between Aug 2018 and May 2019. Fifty-one of the patients were serologically diagnosed with CE, 53 with a diagnosis of fascioliasis, and 38 as the control group. Serum samples were taken from patients and levels of IL-4, IL-10, TNF α and IFN γ parameters were investigated by ELISA method. Results were evaluated by spectrophotometer and observed which immunologic parameters increased in which infections. Cytokine results were also evaluated according to patient age groups and genders. Chi-square and/or Fisher's exact test were used to evaluate the results. IL-4 response was detected in 50.9%; IL-10 in 44.2%; TNF-α in 43.3% and IFN-γ in 43.3% of CE seropositive patients. Results: IL-4, IL-10, TNF-α and IFN-responses detected in 50.9%, 44.2%, 43.3% and 43.3% of CE patients, and in 43%, 39.2%, 34.4% and 40.6% of fascioliasis patients, respectively. The presence of Th1 and Th2 responses were detected in both infections. There was a significant relationship between fascioliasis and IL-4 response and between CE and IL-4, IL-10 and TNF-α responses (P≤.05). Conclusion: These cytokine levels may provide information about the immune response to infections, and may be useful for early detection of disease and recurrence and monitoring of treatment.

Prevalência de la criptosporidiosis en seres humanos y terneros, y detección molecular del Cryptosporidium parvum / Prevalence of cryptosporidiosis in humans and calves and molecular detection of Cryptosporidium parvum

RESUMEN Objetivo. El objetivo de este estudio fue investigar la prevalencia de especies de Cryptosporidium en humanos y terneros en la provincia de Van, Turquía. Materiales y métodos. Se incluyeron en el estudio un total de 150 pacientes, incluidos 50 pacientes en hemodiálisis, 40 pacientes inmunosuprimidos con diarrea, 30 pacientes con diarrea solamente y 30 pacientes inmunocompetentes. Se recolectaron muestras de heces rectales de un total de 50 terneros alojados en establos y granjas en 10 aldeas centrales de Van, Turquía. Resultados. Se detectó Cryptosporidium parvum en el 17.3% de las 150 muestras de heces tomadas de seres humanos. C. parvum se observó en el 20% de los 50 pacientes en hemodiálisis, el 32.5% de los 40 pacientes inmunosuprimidos con diarrea y el 10% de los 30 pacientes con diarrea solamente, mientras que no hubo Cryptosporidium spp. detectado en los pacientes inmunocompetentes. C. parvum se observó en sólo el 6% de los 30 terneros diarreicos. Conclusiones. Claramente se entendio que la Criptosporidiosis fue detectada en una alta tasa en las muestras de los pacientes inmunosuprimidos sin y con sintomas de diarrea, y que además la especie activa que causó la enfermedad fue el agente etiologico Criptosporidium parvum. Por lo tanto, estos dos grupos de pacientes deben ser evaluados en lo que a términos de Criptosporidiosis se refiere.

ABSTRACT Objective. To investigate of the prevalence of Cryptosporidium species in humans and calves in the province of Van, Turkey. Materials and methods. Included in this research were 150 patients, comprising 50 hemodialysis patients, 40 immunosuppressed patients with diarrhea, 30 patients with diarrhea only, and 30 immunocompetent patients. Collected were stool rectal samples from 50 calves that were housed in stables and farms in 10 central villages of Van, Turkey. Results. Cryptosporidium parvum was detected in 17.3% of the 150 human stool samples. C. parvum was observed in 20% of the 50 samples from the hemodialysis patients, 32.5% of the 40 samples from the immunosuppressed patients with diarrhea, and 10% of the 30 samples from patients with diarrhea only, whereas no Cryptosporidium spp. was detected in the samples from the immunocompetent patients. C. parvum was observed in only 6% of the samples from the diarrheic 30 calves. Conclusions. It was clearly understood that cryptosporidiosis was detected at a high rate in the samples from the immunosuppressed patients and those who were immunosuppressed with diarrhea, and that the active and effective species that causes cryptosporidiosis in the Van region is C. parvum. Hence, these patient groups should be evaluated in terms of cryptosporidiosis.

Evaluation of Formalin-fixed Paraffin-embedded Tissue Samples Diagnosed by Histopathology as Echinococcus in Çorum

Objective: This study aimed to detect the presence of Echinococcus spp. in formalin-fixed paraffin-embedded (FFPG) samples of hydatid cyst cases and to discuss the DNA isolation problems in FFPG samples. Methods: FFPG samples of 47 cases diagnosed with hydatid cyst were included in this study. Demographic characteristics of the cases were investigated. Microtome sections were taken from the samples and deparaffinization, DNA extraction, polymerase chain reaction (PCR), and gel agarose electrophoresis procedures were performed. Results: Of the cases, 55.3% were female, whereas 45.7% were male. Average age was 45.47 and 68.1% of the cases were located in the liver, 17.0% in the lung, 12.8% in the abdomen, and 2.1% in the brain. DNA was obtained in only 11 (23.4%) of the FFPG cyst samples and no proliferation was detected in the PCR products of any of the sample. Conclusion: The scolex/germinal membrane' absence in the FFPG sections, intense inflammatory cell reaction, presence of fibrosis and stromal/parenchymal tissue, DNA damage due to formaldehyde action, long-term archiving, and insufficient amount of DNA obtained were considered as factors preventing DNA replication in PCR.

A systematic review of Trichomonas vaginalis in Turkey from 2002 to 2020.

Trichomonas vaginalis is a flagellate human parasite responsible for the most common non-viral sexually transmitted infection (STI) in the world. We aim to estimate the prevalence and basic characteristics of T. vaginalis infection in the Turkish population from 2002 to 2020. Six international and two national electronic databases were searched using keywords of "Trichomonas vaginalis" and "Turkey" both in English and Turkish languages. Searching motors for the present study included the following: Google Scholar, PubMed, Scopus, Mendeley, Science Direct, Proquest, Web of Science, YOKtez, and TRDizin. This review includes cross-sectional studies estimating the prevalence of T. vaginalis infection in the Turkish general population. If it meets the criteria for inclusion, the full-text article was obtained and reviewed. The basic characteristics of each paper were extracted and listed. Overall, 65 articles were found about T. vaginalis infection in the general Turkish population in this period. Overall, the mean prevalence of infection was found to be 5.94%, 2.87% in men, and 6.17% in women. The maximum prevalence rates were 42.4% in bar girls, 28.3% in patients with gynecological complaints, 28% in patients applied to gynecology clinics, and 15.37% in patients with vaginal discharge. Among the regions, the highest rate of infection was in the Black Sea (8.76%) and Eastern Anatolia (8.12%). In most of the studies, DM and culture methods were applied together, and the specificity of the culture method was found to be higher. Although the superiority of culture over DM is obvious, both methods can give false negativity. T. vaginalis is still an important health problem among the Turkish population. The prevalence varies depending on the socioeconomic structure of the region, the lifestyle of the person, the method used in the study, the size of the population, and the clinical condition of patients.

Seroprevalence of fascioliasis in the eastern region of Turkey: an eight-year investigation.

BACKGROUND/AIMS: Fascioliasis is a zoonotic disease and one of the most neglected infectious diseases in humans. Its prevalence has been increasing significantly during the last decades. This study aimed to investigate the prevalence of fascioliasis using direct microscopy and indirect hemagglutination (IHA) technique in a region in Eastern Anatolia of Turkey. MATERIAL AND METHODS: This study was conducted on the serum samples obtained from 817 patients (372 male and 445 female) between 2011 and 2018, who were suspected to have fascioliasis. IHA was used to investigate anti-Fasciola hepatica antibodies in the serum samples. Stool specimens were obtained from the seropositive patients and were examined with the native-Lugol method to identify the parasites. RESULTS: It was determined that 5.5% (45/817) of all the patients were F. hepatica seropositive and 6.4% (52/817) were borderline positive. Positivity was 5.7% (21/372) among males and 5.4% (24/445) among females, and the difference in the infection rates between these groups was not significant (p=0.913). The highest number of patients who applied to the clinic was in the "45 and over" age group (317 patients); 270 patients were in the 25-44 age group. A maximum positivity of 10.3% was observed in the 7-14 age group. CONCLUSION: Previously, fascioliasis was considered a rare infection in humans; however, it has emerged as an important public health problem in the world. Considering fascioliasis in patients with clinical symptoms, not only with direct observation but also using serological methods, would be effective in early diagnosis and treatment of the disease.

Investigation of Cryptosporidium spp. Antigen By ELISA in Stool Specimens Sent to Our Laboratory between 2010 and 2018.

OBJECTIVE: Cryptosporidium is an enteric protozoan parasite that affects human and many animal species in worldwide. Staining methods or stool antigen detecting methods are using for detection of Cryptosporidium in faeces. It is known that the ELISA method has high sensitivity and specificity in practice. The aim of this study is to demonstrate the frequency of this parasite by ELISA in samples sent to our laboratory between 2010 January and 2018 September. METHODS: The study was conducted on a total of 723 patients, 431 men and 292 women, who were referred to the Parasitology Laboratory from various outpatient clinics due to digestive system complaints. The presence of Cryptosporidium spp. antigen was investigated by ELISA method. RESULTS: Cryptosporidium spp. was not found in any patient with Nativ-lugol method, whereas Cryptosporidium spp. antigen positivity was detected in 2.8% of 723 patients. In the study, 2.5% of the males and 3.1% of the females were found positive in terms of having the parasite, and there was no significant difference in gender between the parasite frequencies. The highest rate of parasite positivity (4.5%) was found in the 0-6 age group. CONCLUSION: The high rate of cryptosporidiosis detected in our study is thought to be related to factors such as widespread animal husbandry in our region, poor hygiene rules and low socio-economic level. As a result of considering the findings of our study, evaluation of patients with intestinal complaints in terms of Cryptosporidium will be useful for accurate diagnosis, regardless of whether they have diarrhea and/or they are immunocompromised.

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.

Molecular characterization of human lung and liver cystic echinococcosis isolates in Van Province, Turkey.

Cystic echinococcosis (CE) is a zoonotic infection and could lead to significant public health problems. The genetic diversity of CE includes five species: E. granulosus sensu stricto (s.s.) (G1-G3), Echinococcus equinus (G4), Echinococcus ortleppi (G5), Echinococcus canadensis genotypic cluster (G6, G7, G8 and G10, with the doubtful G9) and the Echinococcus felidis (lion strain). The species are important in epidemiology, pathology, control, prevention measures and vaccine/drug designs. The aim of the present study was to determine the E. granulosus genotypes in humans in the Van province in east of Turkey. In total, 102 echinococcal cysts were collected from operated patients. Genomic analyses were conducted with PCR-RFLP of the rDNA internal transcribed spacer 1 (ITS1) fragment and partial PCR sequencing of the cytochrome c oxidase subunit 1 (cox1) mitochondrial DNA gene region. In total, DNAs of 96 isolates could be extracted, unfortunately six extractions failed. The PCR-RFLP analysis findings were identical in all isolates. Two bands were observed at approximately 300 bp and 600 bp. All profiles corresponded to the G1-G3 strain. Also, 446 bp amplified gene regions were observed for cox1. Out of 20 samples, alignment of 16 sequences exhibited a total identification (100%) of granulosus sensu stricto (G1/G3). Of 16 samples, 8 were obtained in the lung and 12 were obtained in the liver; 8 belonged to male and 12 belonged to female patients. Other four samples exhibited one nucleotide substitution at different positions. Four samples had one nucleotide substitution at different positions. We detected single nucleotide variations in TRH1, TRH67, TRH85 and TRH89 isolates at the positions C240T; G330T; G211A and T157C, respectively. In conclusion, the present study was the first comprehensive molecular investigation on genetic characterization of human CE isolates in Van region. The findings demonstrated that E. granulosus s.s. was the dominant species, which indicated that the sheep-dog cycle was the source in human infections. And, probably, it would be possible to describe these mutations as "Turkey" or "lung" variants. In addition to contributing molecular epidemiological data, the present results should be considered when designing and implementing E. granulosus control programs.

An Oral Myiasis Case Caused by Diptera (Calliphoridae) Larvae in Turkey

The objective of the present study is to present a patient with oral myiasis caused by Calliphoridae larvae. The patient was a 63-year-old male who was transferred from Van Closed Prison to Yüzüncü Yil University, Faculty of Medicine Research and Application Hospital. Five alive larvae localized in different points of gingival region were observed during routine oral cleaning. These larvae belonged to Calliphoridae family. As a result, medical staff should be informed about this infestation and this parasite should be kept in mind especially in risky group of patients and necessary controls should be conducted.

A Rare Case of Secondary Hydatid Cyst: Uterus and Colon Locations in the Same Patient

The aim of the present study was to present a case with secondary hydatid cysts in both uterus and colon. The patient was a 71-year-old female living in Hakkari, Turkey. She was admitted to the Van Yuzuncu Yil University Faculty of Medicine Medical Center with complaints of chronic abdominal and pelvic pain, and swelling in the abdomen. First, the sagittal T2 weighted magnetic rezonance imaging (MR) showed a type-3 cyst hydatid with daughter vesicles located at the posterior of uterus. Later, MR revealed a type-2 cystic lesion with detached membrane adhered to the anterior wall of colon and it was reported to be associated with abdomen. When the previous liver surgery history of the patient was kept in mind, the new finding was suggestive of a secondary cystic hydatid . In conclusion, it is possible to diagnose secondary cystic echinococcosis in patients with a history of primary cyst surgery in liver or any other organ by combining the symptoms and imaging findings.

A Comprehensive Retrospective Study: Intestinal Parasites in Human in Van Province

Objective: The aim of present study was to retrospectively determine the prevalence of intestinal parasites in patients, who were referred to Parasitology Laboratory in Van Yüzüncü Yil University, Faculty of Medicine during an 11-year period. Methods: Stool samples of 69633 individuals admitted to the outpatient clinics in the hospital were initially evaluated with native-Lugol, and then by flotation, sedimentation, trichrome staining, modified acid-fast staining and ELISA methods. Results: Twenty-four parasite species were identified in parasite-positive patients. At least one or more parasite species were found in 34.1% of all patients. The most commonly observed parasite was Blastocystis hominis (26.5%). Among pathogen parasites, Giardia intestinalis (G. intestinalis) was detected in 9.3%, Ascaris lumbricoides (A. lumbricoides) was detected in 2.5%, Entamoeba histolytica/Entamoeba dispar in 0.8%, Cystoisospora belli in 0.004%, Fasciola hepatica in 0.04%, Dicrocoelium dendriticum in 0.001%, Strongyloides stercoralis in 0.001% and hookworm in 0.001% of the patients. Conclusion: It was determined that, pathogen parasites such as G. intestinalis and A. lumbricoides were still observed at high rates in Van province, especially in children, and the problem of parasitosis is still continuing, although the prevalence of parasites has declined when compared to the previous years.

Distribution of Intestinal Parasites in Patients Hospitalized in Child Intensive Care Unit.

OBJECTIVE: The purpose of the present study was to investigate the distribution of intestinal parasites in patients hospitalized in a child intensive care unit. METHODS: The study was conducted on 150 patients between the ages of 2 months and 17 years between April 2016 and December 2016. Stool samples were tested by Native-Lugol, sedimentation (formol-ether solution), and acid fast method. Moreover, a questionnaire was used to obtain information about the socio-economic status of the patient, education level of the families, living conditions, and whether or not they have chronic illnesses. RESULTS: 40% of all patients were infected with one or more parasites 41.7% of girls and 38.2% of boys. In the present study, Giardia intestinalis (12.6%), Blastocystis hominis (12.6%), Entamoeba coli (7.3%), Cyclospora cayetanensis (5.3%), and Cryptosporidium spp. (2%) were detected. CONCLUSION: Statistical analysis was evaluated with the frequency of parasitism and revenue level, educational level of families, settlement area, whether there is a sewage network or not, whether animal husbandry is done or not, and source of water in home is from tap or well. The differences were not significantly. The possible reasons for the high rate of parasitosis, especially with G. intestinalis, E. coli, and B. hominis, are inadequate education, living in small houses with large numbers of people, sewage system, and lack of clean and safe drinking water.

Comparison of microscopy, ELISA, and real-time PCR for detection of Giardia intestinalis in human stool specimens

Background/aim: This study included patients who had digestive system complaints between August 2015 and October 2015. The research was designed to compare conventional microscopy with an antigen detection ELISA kit and the TaqMan-based real-time PCR (RT-PCR) technique for detection of Giardia intestinalis in human stool specimens. Materials and methods: Samples were concentrated by formalin-ether sedimentation technique and microscopic examinations were carried out on wet mount slides. A commercially available ELISA kit (Giardia CELISA, Cellabs, Brookvale, Australia) was used for immunoassay. DNA was extracted from fecal samples of about 200 mg using the QIAamp Fast DNA Stool Mini Kit (QIAGEN, Hilden, Germany) and the LightCycler Nano system (Roche Diagnostics, Mannheim, Germany) was used for the TaqMan-based RT-PCR assay. Results: A total of 94 stool samples, 38 of them diagnosed positive (40.4%) and 56 of them diagnosed negative by microscopy, were selected for evaluation by antigen detection and molecular assays. The prevalence of G. intestinalis infection was found as 46.8% (n: 44) and 79.8% (n: 75) by ELISA and RT-PCR, respectively. RT-PCR revealed by far the highest positivity rate compared to the other two methods. The difference between these methods was found to be statistically significant (P < 0.05). In comparison to PCR, the sensitivity and specificity of microscopy and ELISA were 50.7% and 100% and 53.3% and 79%, respectively. Conclusion: RT-PCR seems to be much more sensitive and beneficial for rapid and accurate diagnosis of G. intestinalis in human stools.

Cyclospora cayetanensis, Opportunistic Protozoan Parasite, in Van Province, Turkey: A Report of Seven Cases.

The aim of this study is to report seven Cyclospora cayetanensis (C.cayetanensis) cases determined in Yuzuncu Yil University Medical Faculty Parasitology Laboratory, Van province, Turkey. In the study native-Lugol, formalin-ethyl acetate and modified acid-fast staining methods were performed to stool samples of the patients sent from outpatient clinics of the hospital. All of the patients infected with C. cayetanensis were older than 15 years. In our cases there were not a history of international travel. Only one of our seven cases was immunosuppressed. Trimethoprim-sulfamethoxazole (160/800 mg) was administered for the treatment of the patient. In conclusion, it was understood that the physicians should consider cyclosporiosis in the patients with diarrhea and abdominal pain.

A pediatric case of Fascioliasis with eosinophilic pneumonia.

Fasciolia spp. are common trematode infestations worldwide. Fasciolia spp. may lead to hepatic diseases in the acute phase and may cause biliary diseases in the chronic phase. In addition, Fasciolia spp. may rarely cause extrahepatic signs and symptoms. The clinical manifestations of fascioliasis are divided into three groups: typical, atypical, and ectopic. Eosinophilic pneumonia is an atypical presentation of acute fascioliasis and it has been reported very rarely. Herein, we report a boy with marked blood eosinophilia and eosinophilic pneumonia who was diagnosed with fascioliasis by serologic tests and abdominal USG. The patient recovered completely following triclabendazole treatment.

Prevalence of Entamoeba spp. in Stool Samples of Patients with Amebiasis Suspect by Native-Lugol and ELISA.

OBJECTIVE: This study aimed to determine the prevalence of Entamoeba spp. in suspected stool samples submitted to our laboratory. METHODS: In this retrospective study, stool samples of 998 patients with suspected amebiasis were sent from various clinics and services to our laboratory and were investigated by native-Lugol and enzyme-linked immunosorbent assay (ELISA) [for Entamoeba spp. antigen (Ridascreen® Entamoeba)] between January 2010 and December 2014. RESULTS: By the end of the study, it was shown that 8.5% (85) of 997 patients, 7.45% (39) of males and 9.8% (46) of females whom amoeba antigen inspected in their stool samples, were positive. No parasite was identified by the saline-Lugol method. The highest antigen positivity was detected in the 25-44-year-old group with 11% positivity, and a high positivity of 23.2% was seen in March. CONCLUSION: These results demonstrate that amebiasis is still a major health concern for our region. Although no parasite was detected during microscopic examinations, the detection of antigen positivity by ELISA reveals that microscopic examinations require experience and utilizing only microscopic examinations may lead to overlooks. To obtain more reliable results in diagnosis, ELISA analyses that use E. histolytica-specific monoclonal antibodies should be applied in addition to microscopic methods.

Cystoisospora sp. Infection Determined in Immunosuppressed and Immunocompetent Children: Three Cases Report.

The aim of this study was to present three cystoisosporiasis cases diagnosed in pediatric patients of the Yuzuncu Yil University Medical Faculty. In the study, stool samples of the patients were evaluated by native-Lugol and modified acid-fast staining methods in the Parasitology Laboratory. The first case was a 4-year-old male child diagnosed with acute lymphoblastic leukemia (ALL). It was reported that the patient had abdominal pain, and permanent bloody and mucous diarrhea (8-10 times a day) was present for almost 1 week after the beginning of ALL treatment. The second case was a 10-year-old boy diagnosed with depression. The patient was brought to our hospital by his parents with complaints of abdominal pain, diarrhea, lack of appetite, weight loss, and fatigue persisting since 1 month in addition to headache, fear, sleeplessness, and waking up with cry. The third case was a 13-year-old boy who complained of abdominal pain, diarrhea (rare occasions), lack of appetite, and headache for 2 months. These patients had not traveled abroad. The cases were treated successfully with co-trimoxazole. Our results suggest that all patient groups with diarrhea and abdominal pain should also be considered in cystoisosporiasis.