A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child.

Brain abscess due to Entamoeba histolytica (E. histolytica) may pose a diagnostic problem or a therapeutic challenge, as evidenced by the paucity of papers reporting complete recovery after treatment. An 11-year-old girl presented with progressive drowsiness, diminished movements of the left upper limb, and swallowing problems. Cranial MRI showed multiple, contrast-dense masses with fluid content. She was started on meropenem. Surgical drainage was performed. No bacterial or fungal growth was observed in drainage samples. Entamoeba histolytica trophozoites were detected in the tissue sample. Intravenous metronidazole was started and continued for 6 weeks, at the end of which abscesses were found and to have shrunk considerably. Intravenous therapy was switched to oral metronidazole, which was continued for 2 weeks. She regained all her preexisting abilities. Multiple brain abscesses due to E. histolytica is a very rare occurrence, and histopathologic evaluation is important in diagnosis.

Investigation of intestinal parasites in dialysis patients.

OBJECTIVE: To search for the opportunistic and other pathogenic intestinal parasites in dialysis patients, and to compare the methods used for diagnosis. METHODS: This is a randomized study, which recruited participants from the dialysis patients. The study was carried out in the Department of Microbiology, Research Hospital, School of Medicine in Kocaeli University, Kocaeli, Turkey between June 2012 and March 2013. One hundred and forty-two patients were diagnosed with an end-stage renal failure, which underwent dialysis, and 150 healthy volunteers were enrolled in the study. Native-lugol, formol ethyl acetate sedimentation method, trichrome, modified trichrome, acid fast, and Calcofluor staining methods were applied to the stool samples. For the diagnosis of Cryptosporidium spp., Giardia intestinalis (G. intestinalis), and Entamoeba histolytica (E. histolytica), commercially available ELISA kits were used, which detect antigen in the stool. RESULTS: Parasites were found in 62 of the dialysis patients (43.7%) and 19 of the control group (12.7%). The most encountered parasitic agents in the dialysis patients were Blastocystis spp. (23.9%), G. intestinalis (8.5%), E. histolytica (2.1%), Microsporidia spp. (2.1%), and Cryptosporidium spp. (2.1%). The parasite detection rate of the formol ethyl acetate sedimentation method was found to be higher than native-lugol (p<0.05). CONCLUSION: To protect the dialysis patients with diarrhea from parasitic infections, it is important to carry out interval stool examinations with trichrome, modified trichrome, acid fast, and Calcofluor staining methods, and the ELISA method, which detects antigen in the stool.

The relationship between adiponectin, NT-pro-BNP and left ventricular ejection fraction in non-cachectic patients with systolic heart failure: an observational study.

OBJECTIVE: NT-pro-brain natriuretic peptide (NT-proBNP) has been shown to be an accurate diagnostic marker in patients with heart failure (HF). Adiponectin (Adp) levels are increased in HF but its diagnostic value is still uncertain in these patients. The study was designed to investigate the possible association of these markers in non-cachectic patients with newly diagnosed systolic heart failure. METHODS: Fifty-seven systolic HF patients and 20 matched controls were enrolled in an observational cross-sectional study. Physical and echocardiographic examinations were performed and serum Adp, NT-proBNP, tumor necrosis factor-alpha (TNF-α) levels were measured. Study variables were compared between the groups. Correlation analyses were done and the diagnostic validity of the markers was compared with ROC analysis. RESULTS: Adp and NT-proBNP levels were significantly higher in HF group (20.19±12.9 vs. 7.65±4.6 µg/mL; p<0.001 and 1051.74±606.2 vs. 222.53±65.6 pg/mL; p=0.002; respectively). TNF-α levels were similar between the groups (2.83±1.8 vs. 2.08±1.2 pg/mL; p=0.582). Correlation analysis showed significant association among Adp and NT-proBNP levels, (r=0.448; p<0.001), and left ventricular ejection fraction (LVEF) values (r=-0.466; p<0.001). The Adp and NT-proBNP showed comparable diagnostic performances with mean [95% confidence interval] areas under the curves of 0.857 (0.771-0.944) and 0.888 (0.815-0.960), respectively. CONCLUSION: There were significant correlation between Adp levels with NT-proBNP levels and LVEF values but no any association between Adp levels with body mass index values and TNF-α levels in patients with newly diagnosed systolic heart failure. The result may arouse suspicion about the hypothesis, which proposes that Adp levels simply reflects disease severity or cardiac cachexia in patients with HF.

The investigation of congenital toxoplasmosis in a tertiary care hospital in Turkey.

OBJECTIVE: To elucidate the prevalence of congenital toxoplasmosis in Turkey. METHODS: This study was conducted in the Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey during the period of 2006 and 2007. Venous blood before delivery and cord blood during delivery were collected from 138 women, and we observed the presence of immunoglobulin (Ig)G and IgM antibodies by Enzyme Linked Immunosorbant Assay (ELISA), western blotting, and other serologic tests. RESULTS: The combination of ELISA and western blotting have the greatest sensitivity among the serological techniques used. The results of the cord and venous sera were comparable with no significant difference, except for one sample. CONCLUSION: Data obtained showed that early characterization of IgG antibodies synthesized by congenitally infected newborn is important. This preliminary study sets an example to the studies that would help both in determining the incidence of congenital toxoplasmosis by screening larger populations and in preventing sequels by early diagnosis.

Helicobacter pylori seropositivity in patients with acute coronary syndromes.

The aim of this study was to investigate the seroprevalence of Helicobacter pylori (HP) in patients with coronary atherosclerosis and acute coronary syndromes. We enrolled 152 patients (group I, 73 patients with acute coronary syndrome; group II, 79 patients with chronic stable angina) and 22 control subjects. An enzyme-linked immunosorbent assay for immunoglobulin (Ig) G test for HP diagnosis was used on all enrolled subjects. C-reactive protein (CRP) was also measured in all patients as an inflammatory marker. Seropositivity rates for HP were significantly higher in patients with coronary artery disease than in controls (80.2% versus 54.5%; P < 0.05). Although CRP level was significantly higher in group I than in group II (1.72 +/- 2.89 mg/dl versus 0.53 +/- 0.63 mg/dl, P < 0.0001), HP infection rates were similar between groups (86.3% versus 74.6%, P > 0.05). Infection with HP may influence atherogenesis through low-grade, persistent inflammatory stimulation. However, our data show evidence of increased systemic inflammation in patients with acute coronary syndrome, which was unrelated to an increased HP seropositivity.

The prevalence of cryptosporidiosis in Turkish children, and genotyping of isolates by nested polymerase chain reaction-restriction fragment length polymorphism.

OBJECTIVE: To verify the incidence of cryptosporidiosis among Turkish elementary school students. METHODS: This study was conducted in the Department of Parasitology, Faculty of Medicine, Ege University, Turkey during a 3-month period in 2006. We assessed the fecal samples of 707 children using modified acid-fast and phenol-auramine staining followed by modified Ritchie concentration method. All Cryptosporidium species isolates were analyzed by nested polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) to differentiate the genotypes of the isolates. After the coprological examination, 4 samples were found to be positive for Cryptosporidium species oocysts. RESULTS: In the present study, all 4 oocysts were of zoonotic origin and belonged to Cryptosporidium parvum genotype 2 indicating that in Turkey the potential sources of human cryptosporidiosis is from animals. CONCLUSION: The application of genotyping to clinical isolates of Cryptosporidium has significantly increased our knowledge and understanding of the distribution and epidemiology of this parasite. The PCR and RFLP techniques represent a more rapid and simple method of genotyping to support epidemiological and clinical investigations than conventional analytical DNA techniques.

Acanthamoeba keratitis in a 5-year-old boy without a history of contact lens usage.

PURPOSE: This study was designed to report a case of acanthamoeba keratitis in a 5-year-old child without a history of trauma or contact lens usage. METHODS: The history, clinical presentation, diagnostic, and therapeutic approaches were reviewed. RESULTS: A 5-year-old child without any history of trauma or contact lens use was referred to our university clinic with an initial diagnosis of disciform herpetic keratitis. After 2 weeks of antibacterial and antiviral therapy, a corneal biopsy was performed for diagnostic purposes. The biopsy revealed acanthamoeba. Subsequently intensive therapy with chlorhexidine diacetate 0.02%, ketoconazole tb, hexamidine di-isethionate 0.1% was initiated. At the end of the first month, topical prednisolone acetate 1% was added to reduce inflammation, Chlorhexidine diacetate 0.02% and oral ketoconazole were discontinued, and hexamidine di-isethionate 0.1% was lowered to 4 x 1 and was administered for an additional 4 months. At the end of 5 months, all medications were withdrawn and amblyopia treatment was started. CONCLUSION: When dealing with keratitis in children, acanthamoeba should be considered even without history of contact lens usage or trauma.