Determination of antibiotic resistance and high-performance liquid chromatography profiles for Mycobacterium species.

BACKGROUND: Incidence of mycobacterial infections has been increasing. However, diagnosis and treatment of mycobacterial infections can be difficult. The aim of this study was to investigate high-performance liquid chromatography (HPLC) analysis of the mycolic acids for rapid identification and dendrogram cluster analysis of mycobacterium species. METHODS: Clinical specimens received for mycobacterial culture and antimicrobial susceptibility test were processed by standard laboratory protocols. Positive cultures were analyzed with HPLC method. Mycolic acid analysis with HPLC was used for diagnosis of tuberculosis and other mycobacterial infections. These reports were compared with Sherlock Library mycobacterial species, and the similarity index was analyzed. This value was formed by a software in multidimensional space that was the calculation of the average distance between the nearest library profile and unknown profile. RESULTS: The ninety-two samples were identified as M. tuberculosis. (similarity index between 0.593 and 0.994). One of the other strains was identified as M. avium intracellulare (strain No. 82) (SI = 0.906); one of them was identified as M. interjectum (strain no. 89) (SI = 0.644). Total 94 samples were identified, and dendrogram was applied to these samples. Profile A (10.6%), profile B (59.6%), profile C (11.7%), profile D (3.2%), and other profiles as single different profiles were identified. Rates for each as 1% (89, 94, 1, 82, 26, 42, 32, 41, 100, 43, 47, 44, 40, 35). CONCLUSION: High-performance liquid chromatography is a useful, rapid, reliable, and practical method for diagnosis of mycobacterium species.

Investigation of Strongyloides stercoralis Seroprevalence in Individuals Who Grow Vegetables and Gather Mushroom in Mugla Province in Turkey.

OBJECTIVE: This study aimed to determine the incidence of Strongyloides stercoralis in individuals who live in rural areas in the towns near Mugla and have contact with humid soil and gather saffron milk cap mushroom in autumn, and to obtain epidemiological data in our region. METHODS: A total of 281 volunteers were included; 192 of them were the individuals who only gather mushroom, only work in the garden, or gather mushroom as well as work in the garden, while 89 had no contact with the soil. Totally, 281 sera were tested for the presence of S. stercoralis-IgG antibodies by ELISA technique, using a commercial kit (DRG® Diagnostics Strongyloides IgG ELISA EIA-4208; Germany). RESULTS: One of 281 volunteers (0.3 %) was found positive for S. stercoralis-IgG antibodies, while the other 280 volunteers (99.7 %) were found negative. Thirty-seven, 33, and 43 of 192 volunteers reported wearing only boots, only gloves, and both boots and gloves, respectively. Seventy-nine of 192 volunteers reported wearing neither boots nor gloves. CONCLUSION: This preliminary study is the first study that involves the individuals with soil contact in our country, and it was concluded that this study will offer an insight into the other studies on S. stercoralis.

Antifungal susceptibilities of Candida species isolated from urine culture.

Candida spp. are the most common opportunistic mycosis worldwide. Although Candida albicans is the most common cause of urinary tract infections, the frequency of non-albicans Candida species is increasing with common use of antifungal in the prophylaxis and treatment. This may lead to difficulties in treatment. Antifungal tests should be applied with identification of species for effective treatment. In this study, identification of Candida species isolated from urine culture and investigation of susceptibility of these strains to amphotericin B, flucytosine, fluconazole, voriconazole was aimed. In this study, 58 Candida strains isolated from urine cultures at Osmaniye State Hospital between January 2012 and April 2013 were included. Urine culture and antifungal susceptibility tests were applied. Incidence rate of Candida spp. was determined as C. albicans (56.9%), Candida glabrata (20.6%), Candida tropicalis (10.3%), Candida parapsilosis (7%), Candida krusei (3.4%), Candida kefyr (1.8%). Most of the isolates were susceptible to amphotericin B, flucytosine, fluconazole, voriconazole. Twenty three (39.7%) Candida strains were isolated from internal medical branches and Intensive Care Unit and 12 (20.6%) from the Surgical Medical Branches. C. albicans and C. glabrata species were isolated most frequently as a candiduria factor in this hospital between January 2012 and April 2013. The analysis of antifungal susceptibility profile shows no significant resistance to antifungals.

The Presence of Demodex Folliculorum in Various Obese Groups According to BMI Levels.

BACKGROUND: This study aimed to detect the presence of the parasite Demodex folliculorum (DF) in various obese groups according to BMI Levels. MATERIALS AND METHODS: A total of 182 patients (40.8 ± 14.8 years, min-max age 19 - 73 years) were enrolled in the study, of those 65 (35.7%) were female and 117 (64.3%) were male. They had previously applied to Mustafa Kemal University (Faculty of Medicine, Endocrine Outpatient Clinic) during 2012. A standardized skin surface biopsy method was used to research the existence of DF. Patients were classified into four main groups, including: obese (n = 89), overweight (n = 31), normal (n = 32), and underweight (n = 30). RESULTS: There was no significant difference between groups in terms of age and sex. The total DF positivity was 19 (21.3%) in obese patients. Among those with positive DF, the mean BMI was 35.7 ± 12.1 kg/m(2), while those with negative DF had a mean BMI of 29.2 ± 9.2 kg/m(2). There was a significant difference between two groups (P = 0.002). Also, the underweight group has significantly higher DF positivity in comparison to the normal weight group. CONCLUSION: The DF positivity was significantly higher in obese patients in accordance with the physiopathologic nature of the disease.

[An alternative biphasic nutrient medium for the diagnosis of cutaneous leishmaniasis]. / Kutanöz leysmanyazis tanisinda alternatif bifazik nutrient besiyeri.

Cutaneous leishmaniasis (CL) caused by the Leishmania spp. parasites, is a disease characterized by nodulo-ulcerative lesions in the skin. CL is transmitted to humans by infected sandflies during blood sucking, and is endemic in about 98 countries over the world. The demonstration of amastigotes via microscopic examination, and the growth of promastigotes in NNN (Novy-MacNeal-Nicolle) medium are gold standard methods for laboratory diagnosis. The aim of this study was to compare the biphasic NNN medium that is frequently used in routine laboratories with the biphasic nutrient medium that can be prepared easily in microbiology laboratories, for the growth of promastigotes. In the study, the aspiration fluid sample was used as clinical sample which was obtained from the skin lesion of a 47-year-old female patient admitted to Izmir Katip Celebi Ataturk Education and Research Hospital dermatology outpatient clinic and pre-diagnosed as CL. The aspirate sample taken from the lesion was evaluated with microscopy, cultivation in two different media and real-time polymerase chain reaction (Rt-PCR) methods. In microscopic examination Leishmania amastigotes were observed in Giemsa-stained smears prepared from the aspiration fluid. In Rt-PCR performed by using specific primers and probes targeting ITS1 region of Leishmania parasite, a melting-curve compatible with L.tropica was detected. For cultivation, triple inoculations of the aspirate sample into NNN (NNN + RPMI 1640 + 10% fetal calf serum) and nutrient media (nutrient agar + nutrient broth + 10% fetal calf serum) were used. The cultures were incubated at 27°C for 10 days, and the number of propagated promastigotes were counted on the third, seventh and tenth days. The growth of Leishmania promastigotes was detected in both media on the third day. The number of promastigotes grown in NNN medium on the third, seventh and tenth days were 105/ml, 106/ml and 108/ml, respectively. Those values in nutrient medium were 106/ml, 107/ml and 108/ml on the third, seventh and tenth days, respectively. Although the number of promastigotes on the third and seventh days were higher in nutrient medium than NNN medium, the number of cultivated promastigotes were equal on the tenth day. As a result, nutrient medium is considered to have an impact in the diagnosis of CL, by providing an alternative to the routine medium used and can readily be available in microbiology and parasitology laboratories with long shelf-life. It was concluded that biphasic nutrient medium could be used as a supplementary medium for diagnosis in laboratories in the absence of NNN medium or can not be provided.

Higher frequency of methicillin resistant bacteria in children with familial mediterranean fever.

OBJECTIVE: To investigate resistant microorganisms in nasal mucosa of children with Familial Mediterranean Fever. METHODS: The study was conducted from March to May 2013 at Mustafa Kemal University, Turkey, and comprised children with Familial Mediterranean Fever and healthy controls. All subjects had no history of antibiotic or local and/or systemic steroid use within the preceding 2 weeks. Nasal swab samples were obtained from all the subjects. Strain identification was done by using standard methods. SPSS 13 was used for statistical analysis. RESULTS: Of the 151 subjects in the study, 73 (48.34%) were cases and 78 (51.65%) were controls. Among the cases, there were 26(35.6%) girls, while among the controls, there were 40(51.3%) girls (p=0.052). The mean age of the cases was 7.78 ± 3.34 years (range: 3-15 years), while it was 8.15 ± 2.71 years (range: 3-16) among the controls (p = 0.208). Methicillin-resistant coagulase-negative staphylococcus and methicillin-resistant staphylococcus aureus were isolated in both the groups. The growth rate of resistant bacteria was 63% (n = 46) in the cases, in the controls (p = 0.003; odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.4-5.2). Among the controls, history of hospitalisation increased the risk for the presence of resistant bacteria by 7.7 fold (OR: 7.7; 95% CI: 1.4-40.4). CONCLUSION: Higher rates of resistant bacteria showed that they were at risk of comorbidities related to antibiotic resistance.

[Macrolide-lincosamide-streptogramin B (MLSB) resistance phenotypes in clinical Staphylococcus isolates and investigation of telithromycin activity]. / Klinik stafilokok izolatlarinda makrolid-linkozamid-streptogramin B (MLSB) direnç fenotipleri ve telitromisin etkinliginin arastirilmasi

Staphylococci are one of the most common pathogens isolated from nosocomial and community acquired infections. Antibiotics such as clindamycin and erythromycin have been useful options for treating skin and soft-tissue infections caused by staphylococci. However, expression of macrolide-lincosamide-streptogramin B resistance (MLSB) can limit the effectiveness of these drugs. The aims of this study were to investigate the prevalence and phenotypes of MLSB resistance in staphylococcus strains isolated from clinical samples and to determine the telithromycin activity against these isolates. A total of 218 strains [92 Staphylococcus aureus and 126 coagulase-negative staphylococci (CNS)] isolated from different clinical samples (wound, abscess, blood, sterile body fluids, catheter, upper respiratory tract samples) between February 2011 to December 2012 were included in the study. The isolates were identified by using conventional methods and automated bacterial identification system (BD Phoenix 100™ System, Becton Dickinson, USA). Methicillin resistance of the isolates was determined with the use of cefoxitin (30 µg) disk and telithromycin (15 µg) activity was detected by Kirby-Bauer disk diffusion method. MLSB resistance phenotypes were investigated by the D-test method using erythromycin (15 µg) and clindamycin (2 µg) disks. Of 92 S.aureus isolates, 23 were methicillin-resistant (MRSA) and 69 were methicillin-susceptible (MSSA), whereas 78 of 126 CNS isolates were methicillin-resistant (MRCNS) and 48 were methicillin-susceptible (MSCNS). Hundred and seventy-two (79%) isolates were found as erythromycin-resistant, and the rates of erythromycin resistance in MRSA, MSSA, MRCNS and MSCNS strains were 83%, 71%, 95% and 63%, respectively. Inducible type of MLSB resistance (iMLSB type) was observed in 26%, 6%, 51% and 33%; chromosomal resistance (cMLSB type) in 32%, 27%, 27% and 17% and efflux pump connected resistance (MSB type) in 42%, 67%, 22% and 50% of the MRSA, MSSA, MRCNS and MSCNS, respectively. Forty-four (20%) strains were found susceptible to both clindamycin and erythromycin (S type resistance). Resistance due to enzymatic inactivation (L type) was observed only in two of the CNS strains (0.9%), one was methicillin-resistant and the other was susceptible. Total telithromycin resistance was detected as 26.6% (n= 58), while the resistance rates in MRSA, MSSA, MRCNS and MSKNS isolates were 35%, 35%, 28% and 8%, respectively. Telithromycin resistance rate was 34% (58/172) in erythromycin-resistant isolates. However, all erythromycin-susceptible isolates (n= 46) were also susceptible to telithromycin. Telithromycin-resistant isolates frequently exhibited cMLSB phenotype (39/44; 67.2%), followed by MSB (16/72; 27.6%) and iMLSB (3/56; 5.2%). In conclusion, clindamycin is still an effective antibiotic for the treatment of staphylococcal infections in our hospital, however, 34% resistance rate against telithromycin may limit the use of this agent which is an alternative for the treatment of infections caused by clindamycin and erythromycin-resistant strains.

Evaluation of mean platelet volume in patients with type 2 diabetes mellitus and blood glucose regulation: a marker for atherosclerosis?

OBJECTIVE: Platelets have an important role in atherosclerosis and arterial thrombosis. Cardiovascular complication prevalence of type 2 diabetes mellitus (type 2 DM) may be associated with glycosylated hemoglobin (HbA1c) and mean platelet volume (MPV). The aim of the study was to investigate if platelets were activated in diabetes and its associated vascular complications by measuring the MPV in the diabetics compared to the non-diabetics, and to determine the correlation of MPV with fasting serum glucose (FSG), HbA1c and duration of diabetes in the diabetic patients, respectively. MATERIALS AND METHODS: The study carried out in 65 patients with type 2 DM and 40 non-diabetic subjects. In addition to non-diabetic patients, all diabetic patients were divided into two groups according to their HbA1c levels: group A consisted of patients with HbA1c levels ≤7% and group B consisted of patients with HbA1c levels >7%. RESULTS: MPV was significantly higher in Group B as compared to both non-diabetics and Group A. MPV had a high positive correlation with HbA1c and FSG, as with diabetes duration. It is found that MPV was increased in type 2 DM. CONCLUSION: Our findings suggested an association between MPV and HbA1c. Therefore, MPV would be a beneficial prognostic marker of cardio-vascular complications in patients with type 2 DM.

Antimicrobial effects of several calcium silicate-based root-end filling materials.

The purpose of this study was to evaluate, in vitro, the antimicrobial effect of iRoot BP, iRoot BP Plus, and mineral trioxide aggregate (MTA) against Entercoccus faecalis and Candida albicans by using direct contact test. The materials were tested immediately after application to the microtiter wells and after setting for 1-day and for 7-days. Ten microliters of microbial suspension was added to each well for direct contact with each material for 1 h at 37°C and 100% humidity. Then fresh media was added and, survival of bacteria and fungi was determined by using 10-fold serial dilution and inoculated onto agar plates. In fresh and 1-day samples all of tested materials showed statistically significant antimicrobial effects compared to control groups (p<0.05). In 7-day samples, there were no significantly differences compared to control groups. MTA, iRoot BP and iRoot BP Plus had similar antimicrobial efficacy against E. faecalis and C. albicans.

Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus.

OBJECTIVE: Leukocytosis is thought to be directly associated with the pathogenesis of atherosclerosis and metabolic syndrome. Increased white blood cell (WBC) count is related to cardiovascular disease in patients with type 2 diabetes mellitus; raised neutrophil lymphocyte ratio (NLR) is associated with metabolic syndrome. There is little information, however, concerning a correlation between glycosylated haemoglobin (HbA1c) and NLR. The aim of the present study was to investigate the relationship between NLR and blood glucose regulation. METHODS: This retrospective study was conducted in patients with type 2 diabetes mellitus, divided into two groups according to HbA1c levels: group 1, HbA1c levels ≤ 7%; group 2, HbA1c levels > 7%. Venous WBC, neutrophil and lymphocyte counts were determined. RESULTS: Of 71 patients included, fasting serum glucose, neutrophil and WBC counts were significantly higher in group 2 compared with group 1. NLR had a positive correlation with HbA1c. CONCLUSION: There may be a significant relationship between NLR and blood glucose regulation. The authors propose that increased NLR may be associated with elevated HbA1c in patients with type 2 diabetes mellitus.

Identification of nasal bacterial flora profile and carriage rates of methicillin-resistant Staphylococcus aureus in patients with allergic rhinitis.

The aim of the present study was to evaluate the effect of allergic rhinitis (AR) on the nasal flora and colonization rates of resistant microorganisms in comparison to healthy individuals. This colonization may be important in terms of AR-related disorders, the resistant microorganisms' carriage, and its complications and co-morbidities. The study was performed with two groups. The study group was composed of 54 adult patients with AR. The control group was composed of 50 healthy individuals. None of the individuals in both groups have used any antibiotics, local or systemic steroid within the last month. Composition of bacterial nasal flora and carriage rates of methicillin-resistant Staphylococcus aureus (MRSA) were evaluated with conventional methods by taking nasal smears with a swab. In the study group, methicillin-sensitive coagulase-negative staphylococci (MRCNS) were detected in 30%; whereas diphtheroids in 25%, methicillin-resistant coagulase-negative staphylococci in 13%, methicillin-sensitive S. aureus in 9%, methicillin-resistant S. aureus in 3.7%, and extended-spectrum beta lactamases-positive gram-negative bacilli (GR-ESBL+) in 3.7% were detected. In the control group, methicillin-sensitive coagulase-negative staphylococci were detected in 54%; whereas diphtheroids in 21%, methicillin-resistant coagulase-negative staphylococci in 1.5%, methicillin-sensitive S. aureus in 16%, methicillin-resistant S. aureus in 1.5%, Gr-ESBL(-) in 4%, and viridians streptococci in 3% were detected. It is found that the MRSA and MRCNS colonization is higher in patients with AR. This colonization may be important in terms of AR-related disorders, the resistant microorganisms' carriage, and its complications and co-morbidities in comparison to healthy subjects.

Antifungal activity of several root canal sealers against Candida albicans.

OBJECTIVE: The purpose of this in vitro study was to evaluate the antifungal activity of several root canal sealers (iRoot SP, MTA Fillapex and GuttaFlow) against Candida albicans and compare them to that of AH Plus Jet. MATERIALS AND METHODS: A 10 µL fungi in suspension was allowed to directly contact the sealers, which were freshly mixed or allowed to set for 1 or 7 days. Fresh media was then added and survival of fungi was determined by using 10-fold serial dilution and inoculated onto agar plates. After incubation for 48 h, colony-forming units (CFU) were calculated and their log10 values converted. The data were analyzed using ANOVA and Tukey tests (α = 0.05). RESULTS: Freshly mixed AH Plus Jet totally inhibited the growth of fungi and showed the highest antifungal activity. GuttaFlow did not show any significant antifungal activity at all times. Freshly mixed iRoot SP and MTA Fillapex were found to be antifungal. Statistical differences were found between freshly mixed and set samples (p < 0.05) in favor of the former, except GuttaFlow. No statistically significant differences were found among the tested sealers at the 1 and 7-day samples (p > 0.05). CONCLUSIONS: Fresh AH Plus Jet had very potent antifungal activity. All sealers, except GuttaFlow, exhibited antifungal activity when freshly mixed.

The effect of blood glucose regulation on the presence of opportunistic Demodex folliculorum mites in patients with type 2 diabetes mellitus.

OBJECTIVES: To measure the rate of Demodex folliculorum mite infestation in patients with type 2 diabetes mellitus and to investigate if it was related to blood glucose control. METHODS: Patients with type 2 diabetes were classified according to their glycosylated haemoglobin (HbA(1c)) level into two groups: a well controlled blood glucose group (HbA(1c) ≤ 7%) and a poorly controlled blood glucose group (HbA(1c) > 7%). A standardized skin surface biopsy method was used to determine if the patients had D. folliculorum infestation (>5 mites/cm² of skin). RESULTS: A total of 69 patients (38 female) were enrolled in the study. Seventeen (24.6%) patients had D. folliculorum infestation. There were no significant differences in age, sex or body mass index between patients with and without D. folliculorum infestations. A significantly higher proportion of patients with poor blood glucose control had D. folliculorum infestation compared with patients with well controlled blood glucose. CONCLUSIONS: These current findings suggest that poor blood glucose regulation increases the susceptibility to D. folliculorum mite infestation in patients with type 2 diabetes.

Detection of primary clarithromycin resistance of Helicobacter pylori and association between cagA (+) status and clinical outcome.

Helicobacter pylori was examined in 110 patients (82 (74.5) with gastritis, 18 (16.4) with duodenitis, six (5.5) with duodenal ulcer and gastroesophageal reflux, and four (3.6 %) with normal) with gastrointestinal problems living in rural area, no history of macrolide use, and detected by culture (71.8) or direct detection from gastric biopsies by PCR (82.7 %). Also, cagA gene was identified using PCR and was found positive in 68/91 (74.7 %) strains. The prevalence of clarithromycin-resistant H. pylori was investigated by two methods including PCR-RFLP (7.7 (A2142G 1.1 and A2143G 6.6 %)) and twofold agar dilution (8.9 %) to detect phenotypic and genotypic status simultaneously. Among all the H. pylori positive patients, eight (8.8 %) isolates were found to be resistant to clarithromycin by at least one of the AD and/or PCR-RFLP methods. H. pylori positive rates were significantly correlated with patients' sex, age, and endoscopic findings (p = 0.040, <0.001 and <0.001, respectively). There were no differences in gender or endoscopic findings related to cagA (+) and cagA (-) patients. The gene of cagA was not significantly helpful in predicting the clinical outcome of H. pylori infection alone. In conclusion, we revealed that there was a low prevalence of primer clarithromycin resistance in patients living in rural area with no history of macrolide use. The prevalence of mutant strains among the macrolide-resistant H. pylori varies even geographically between close provinces.

[Investigating Demodex folliculorum in patients with urological cancer]. / Ürolojik Kanserli Hastalarda Demodex folliculorum Arastirilmasi

OBJECTIVE: In this study, it was aimed to determine frequency of Demodex folliculorum infestation in patients with urological cancers. METHODS: This study evaluated 49 patients with urological cancers; 31 sex-matched healthy individuals as a control group were included in the study between March 2011 and April 2012 at the Hospital of Mustafa Kemal University, School of Medicine, Urology Clinic. The demographic characteristics of the patients were recorded. Samples from the perineal region of the subjects were taken by standard method of superficial skin biopsy and evaluated by microscopy. Presence of five or more Demodex sp. in a cm < sup > 2 < /sup > was considered as positive. RESULTS: Mean age was found to be 60.2±18.6 years. D. folliculorum was found to be positive in 11 (22.4%) of the patients with cancer and in 1 (3.2%) of the subjects in the control group. It was found that D. folliculorum frequency was significantly higher in the cancer group compared to the control group. No significant difference was found among the cancer groups in terms of D. folliculorum detection. In the cancer group, mean age was significantly higher in D. folliculorum positive patients than negative ones. CONCLUSION: It should be kept in mind that D. folliculorum incidence may increase in immunosuppressive states, such as cancer.

Prevalence and genotypes of Helicobacter pylori in gastric biopsy specimens from patients with gastroduodenal pathologies in the Cukurova Region of Turkey.

The effects of Helicobacter pylori genotypes on clinical prognosis in the Cukurova region of Turkey were investigated by PCR. The prevalence of type I strains carrying the s1c allele, unlike in neighboring regions and countries, was found to be significantly higher in patients with gastritis and/or gastric ulcers (P = 0.001), and that of type I strains carrying the s1a allele was found to be significantly higher in patients with duodenal ulcers (P < 0.001). The cagA gene was strongly associated with the more virulent vacA genotypes (P < 0.001).

Asymptomatic dermatophyte scalp carriage in school children in Adana, Turkey.

The aim of this study was to determine the prevalence of asymptomatic dermatophyte scalp carriage and symptomatic tinea capitis in Adana Province, Cukurova region, Turkey. For this purpose, a screening study was performed in five schools, between January 2004 and May 2005, covering a total of 5143 children with 2740 (53.3%) boys and 2403 (46.7%) girls, aged 7-14 years (9.6 +/- 2.0). The diagnosis was made using the cotton swab method with inoculation onto Sabouraud glucose agar amended with cycloheximide, chloramphenicol and gentamicin. Among 10 (0.2%) cases, six asymptomatic carriers (mean age 10.7 +/- 2.3) and four symptomatic cases (mean age 8.3 +/- 0.5) were detected, all of whom were boys and had immigrated from the south-eastern and eastern region of Anatolia, Turkey. The mean age differences were found to be statistically significant (Mann-Whitney U=3.000, P=0.046). Boys were found to be more prone to asymptomatic carriage (P=0.033), but not tinea capitis (P>0.05). Zoophilic dermatophytes, namely Microsporum canis (40%) and Trichophyton mentagrophytes var. mentagrophytes (40%) were the most commonly isolated species, followed by anthropophilic Trichophyton tonsurans (10%), while no causative agent was detected in a case (10%) with tinea capitis superficialis. Scalp cultures were found to be dermatophyte-negative after 3- to 8-month follow-up in cases with asymptomatic carriage. As a conclusion, the prevalence of asymptomatic carrier state was similar with the prevalence of symptomatic cases, and we found a predominance of zoophilic species.