[Cystic Echinococcosis in Humans in Turkey]. / Türkiye'de Insanlarda Kistik Ekinokokkoz.

Although cystic echinococcosis (CE) is quite prevalent in Turkey, it is extremely neglected due to being usually asymptomatic for years and frequently not to be reported although it is obligatory. Most of the data on the prevalence of CE in humans in Turkey are based on hospital records, reported cases and the studies based on serological methods and they do not reflect the truth. The fact that detecting no cysts in most of the seropositive cases limits the value of researches based on serological tests. The most valuable epidemiologic data on CE are obtained by mass screening surveys with the use of portable ultrasonography (US) and it took the place of serological tests, especially in the last 20 years. Two of 190 cases older than 20 years were found to be positive for CE in a village of Konya city at the first study that US was performed in Turkey. At the first research performed on preliminary school children in Manisa Province; of the 630 students examined by US, serology and chest X-ray, 2 (0.3%) were diagnosed as CE by US. Only US was used at the second study, and hydatid cysts were observed in 3 (0.5%) of the 575 students in two villages; these data suggested that the use of US alone was more easy, fast and beneficial in the field studies. In the third research, 6093 students from 37 different schools of Manisa Province were selected as a representative sample, and 9 (0.2%) children (two previously operated) were found to be positive for CE by US. The only response to the invitation to use this model in different regions of Turkey was from Elazig Province and of the 2500 students selected, six cases (one previously operated) were detected, and the prevalence was found to be 0.2% in Elazig Province. During the same years, of the 102 cases sharing the same living space with 40 patients operated due to CE, 13 (12.7%) were radiologically diagnosed as CE in Van, while CE was diagnosed in 1 (0.5%) of the 209 cases in an area dealing with animal husbandry in Aydin. At the fourth research in Manisa, 4275 students from university were examined by US, while 2034 of these were also serologically tested by ELISA and Western Blot (WB). The efficacy of WB as a screening test in CE was investigated for the first time in the world; six new and three operated cases were detected, and the prevalence was 0.2%. During the research in the rural areas of Bulgaria, Romania and Turkey, of the 8618 cases living in six cities (Ankara, Aksaray, Balikesir, Bitlis, Edirne, Sanliurfa) of Turkey, 53 (0.6%) abdominal CE cases were detected by US and one of every 163 cases in Turkey was found to be infected with CE. This ratio shows that CE is one of the most important public health problems in Turkey. Control of CE is possible with "One Health" concept. An effective control program and changes in valid laws are needed in Turkey. In this review, the value of different diagnostic procedures have also been discussed.

[A native mixed Plasmodium falciparum and Plasmodium vivax malaria case molecularly proven after 22 years in Manisa, Turkey]. / Manisa'da 22 yil sonra moleküler olarak kanitlanmis yerli Plasmodium falciparum ve Plasmodium vivax karma enfeksiyonu.

Plasmodium falciparum malaria causes about 450.000 deaths every year, mostly in children around the world. The infection is seen in cases coming from abroad and may lead to deaths in Turkey. Many native P.falciparum malaria cases and deaths due to this infection were observed in Turkey during mid 1900's when malaria was epidemic. But only two native cases were reported in the last 50 years, both from Manisa. First case was a one-year old baby who has come to Manisa from Urfa with his family and has never been abroad. He has diagnosed with Plasmodium vivax malaria and treated with chloroquine and primaquine. A previously obtained thin blood film was examined and characteristic P.falciparum rings in red blood cells were observed and the case was published together with photographs as probable P.falciparum and P.vivax mixed infection. After this case, microscopists working in Malaria Control Unit of Manisa were informed about the differentiation of malaria species in thin blood samples. Soon afterward, another case who have never been abroad before were also diagnosed with P.falciparum and P.vivax mixed infection and this case was also published with photographs taken from thin blood samples. As molecular diagnostic methods were not improved and widespread in those years, it could not be applied in both cases. A Giemsa stained thin blood sample of the baby case was incidentally found 22 years afterwards and with the aim of molecular diagnosis, the blood sample on the slide previously processed for DNA isolation, then analysed with "FTD Malaria Differentiation (Fast Track Diagnostics, Luxembourg)" multiplex kit with real-time polymerase chain reaction by using probes special for P.falciparum, P.ovale, P.malariae, P.vivax species. DNA's belonging to P.falciparum and P.vivax were found to be positive, the case is molecularly proved to have P.falciparum and P.vivax mixed infection. This case indicated that Turkey is convenient for the expansion of P.falciparum malaria in terms of the climate and vectors and suggested that the potential danger may increase with the effects of global warming, wars and migrations and may jump to Europe over Turkey. The case which molecularly proved the existence of native P.falciparum malaria in the near future in Turkey, was presented to draw attention to the danger of this infection for Turkey and Europe.

A mass screening survey of cystic echinococcosis by ultrasonography, Western blotting, and ELISA among university students in Manisa, Turkey.

Cystic echinococcosis (CE) is one of the most important zoonotic diseases in a wide geographic area, including Turkey. In the present project, a total of 4275 students from Celal Bayar University, Manisa, Turkey, were screened by ultrasonography (US) and specific antibodies for CE were examined by Western blotting (WB) and ELISA in finger prick blood samples of 2034 of 4275 volunteered students. We aimed to report the apparent prevalence of CE based on different diagnostic procedures and to compare WB and ELISA with US in diagnosis of CE in a mass screening setting. Six new cases were diagnosed as CE by US during the survey. In addition to these cases, three students were also detected to have been previously operated and pathologically confirmed for hepatic CE. US revealed parenchymal changes in these cases in concordance with their operation history; so, the prevalence of CE by US was calculated as 0.21% (9/4275) (95%CI, 0.11-0.39%) among university students in Manisa. Bands were detected at 8, 28, 32, 38, 42, 47, 70 and 90kDa by WB and the cases were considered to be positive for CE when at least three of the bands were seen together. Apparent prevalence of CE by ELISA and WB were found to be 2.11% (43/2034) (95%CI, 1.57-2.83%) and 0.25% (5/2034) (95%CI, 0.10-0.57%), respectively. Of the six US positive cases, WB was positive in only one case with two cysts in the liver. All of four cases with liver involvement were positive by ELISA. The high prevalence of CE among university students in Manisa indicated that CE is a major health problem in this area of Turkey. Our results supported that WB is rather difficult and not feasible as a mass screening test and may not be effective for confirmation especially in asymptomatic cases. As a result, we recommend US to be used initially in mass screening surveys for CE followed by confirmation by ELISA for suspected cases. Further examination primarily by chest X-ray followed by computed tomography and/or magnetic resonance imaging, if needed, should be recommended for US negative, ELISA and WB positive individuals who may have non-abdominal cysts.

Fasciola hepatica infection in echinococcosis suspected cases.

OBJECTIVE: Fasciola hepatica, a liver fluke of sheep and cattle, may accidentally infect humans. The main signs and symptoms of the fasciolosis are eosinophilia, abdominal pain and hepatomegaly and may also be attributed to Cystic Echinococcosis (CE) caused by Echinococcus granulosus, which is a prevalent infection in Turkey. METHODS: Sera samples of 226 CE suspected cases were tested for anti-F. hepatica antibodies by an excretory secretory ELISA (ES-ELISA) and for anti-E. granulosus antibodies by ELISA and indirect hemagglutination (IHA) tests. Cases which were seropositive for fasciolosis were further evaluated radiologically and examined for F. hepatica eggs. RESULTS: Five (2.2%) and 96 (42.4%) of the 226 CE suspected cases were found seropositive for fasciolosis and CE, respectively. Although the radiological findings strongly suggested that there was fasciolosis in three cases, F. hepatica eggs were detected in two patients only. CONCLUSION: These data suggest that human fasciolosis is not as rare as previously reported in Turkey. F. hepatica infection should be suspected especially in the presence of eosinophilia, abdominal pain and liver lesions.