Environmental distribution of Cryptococcus neoformans and C. gattii around the Mediterranean basin.

In order to elucidate the distribution of Cryptococcus neoformans and C. gattii in the Mediterranean basin, an extensive environmental survey was carried out during 2012-2015. A total of 302 sites located in 12 countries were sampled, 6436 samples from 3765 trees were collected and 5% of trees were found to be colonized by cryptococcal yeasts. Cryptococcus neoformans was isolated from 177 trees and C. gattii from 13. Cryptococcus neoformans colonized 27% of Ceratonia, 10% of Olea, Platanus and Prunus trees and a lower percentage of other tree genera. The 13 C. gattii isolates were collected from five Eucalyptus, four Ceratonia, two Pinus and two Olea trees. Cryptococcus neoformans was distributed all around the Mediterranean basin, whereas C. gattii was isolated in Greece, Southern Italy and Spain, in agreement with previous findings from both clinical and environmental sources. Among C. neoformans isolates, VNI was the prevalent molecular type but VNII, VNIV and VNIII hybrid strains were also isolated. With the exception of a single VGIV isolate, all C. gattii isolates were VGI. The results confirmed the presence of both Cryptococcus species in the Mediterranean environment, and showed that both carob and olive trees represent an important niche for these yeasts.

Multilocus sequence typing analysis reveals that Cryptococcus neoformans var. neoformans is a recombinant population.

Cryptococcus neoformans var. neoformans (serotype D) represents about 30% of the clinical isolates in Europe and is present less frequently in the other continents. It is the prevalent etiological agent in primary cutaneous cryptococcosis as well as in cryptococcal skin lesions of disseminated cryptococcosis. Very little is known about the genotypic diversity of this Cryptococcus subtype. The aim of this study was to investigate the genotypic diversity among a set of clinical and environmental C. neoformans var. neoformans isolates and to evaluate the relationship between genotypes, geographical origin and clinical manifestations. A total of 83 globally collected C. neoformans var. neoformans isolates from Italy, Germany, France, Belgium, Denmark, Greece, Turkey, Thailand, Japan, Colombia, and the USA, recovered from different sources (primary and secondary cutaneous cryptococcosis, disseminated cryptococcosis, the environment, and animals), were included in the study. All isolates were confirmed to belong to genotype VNIV by molecular typing and they were further investigated by MLST analysis. Maximum likelihood phylogenetic as well as network analysis strongly suggested the existence of a recombinant rather than a clonal population structure. Geographical origin and source of isolation were not correlated with a specific MLST genotype. The comparison with a set of outgroup C. neoformans var. grubii isolates provided clear evidence that the two varieties have different population structures.

[Evaluation of Two Methods (Nativ-Lugol Preparation and Enzyme-Linked Immunosorbent Assay) for Detection of Entamoeba histolytica in Stool Samples]. / Entamoeba histolytica Tanisinda Iki Metodun (Enzyme Linked Immunosorbent Assay (ELISA) ve Nativ-Lugol) Degerlendirilmesi.

OBJECTIVE: This study aims to compare the performance of Native-Lugol examination and EIA Antigen Detection Test using stool samples obtained from patients diagnosed as clinical gastroenteritis and submitted to the Parasitology Laboratory in Uludag University between January 2010 and February 2011. METHODS: The stool samples taken from 116 patients and sent to the laboratory of parasitology from various clinics including outpatient services have been investigated using Native-Lugol examination and EIA Antigen Detection Kit (Wampole® E. histolytica II Techlab®, Inc., Blacksburg, Virginia) methods on all the samples. RESULTS: In one of 116 stool samples (%0,86), E. histolytica/E. dispar cysts and/or trophozoites were detected by using direct microscobic (nativ-lugol) method. E. histolytica specific antigen was detected in 34 (29.3%) out of the sample set, and the patients were given adequate treatment. The highest rate of E. histolytica specific antigen positivity were observed in 11-19 age group. CONCLUSION: On account of the fact that the sensitivity of direct microscopy is quite low, it is concluded that, from the viewpoint of preventing the amebiasis suspected patients from false diagnosis and hence from receiving inadequate treatment, the use of the ELISA method is more appropriate and advantageous, as it is cost effective and does not require highly qualified staff.

Effects of Malassezia yeasts on serum Th1 and Th2 cytokines in patients with guttate psoriasis.

BACKGROUND: Systemic and focal infections caused by microorganisms have been known to induce or exacerbate psoriasis. Although the role of yeast species of the genus Malassezia in the pathogenesis of psoriasis is not fully understood, it is thought that these lipophilic yeasts may represent a triggering factor in the exacerbation of psoriatic lesions. OBJECTIVES: This study investigated the effects of Malassezia yeasts on serum Th1 and Th2 cytokines in patients with guttate psoriasis (GP) in order to define their role in the pathogenesis of psoriasis. METHODS: Fifty patients with GP and 29 clinically healthy individuals were included in the study. All samples consisted of scales and scrapings taken from the scalps, trunks, and upper limbs of both psoriasis patients and healthy subjects. Psoriasis patients and healthy subjects were grouped according to their positivity or negativity for Malassezia yeasts as ascertained by direct microscopy and/or culture. An enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Th1 and Th2 cytokines in these groups. RESULTS: No significant differences in positivity for Malassezia yeasts were found between psoriatic skin and healthy skin in samples taken from different body sites. Serum interleukin-13 (IL-13) levels were significantly lower in the psoriasis group compared with the control group (P = 0.04). Levels of other cytokines did not differ significantly between the psoriasis and control groups. Mean levels of Th2 cytokines (IL-4, IL-10, IL-13), but not of Th1 cytokines (IL-2 and IFN-γ), were significantly lower in psoriasis patients positive for Malassezia yeasts compared with those negative for Malassezia yeasts and control subjects (P = 0.04, P < 0.001 and P = 0.01, respectively). CONCLUSIONS: The isolation of Malassezia yeasts from GP lesions does not necessarily mean that these species are pathogenic, but their downregulating effects on anti-inflammatory Th2 cytokines may contribute to the occurrence of GP.

[The distribution of intestinal parasites detected in the Uludag University Medical Faculty Hospital between 2009-2010]. / Uludag Üniversitesi Tip Fakültesi Hastanesinde 2009-2010 Yillarinda Saptanan Bagirsak Parazitlerinin Dagilimi

OBJECTIVE: Intestinal parasite infection is still an important public health problem. In this study, patients with various gastrointestinal system complaints presenting at various clinics of the Uludag University Medical Faculty, between 2009-2010 were investigated for intestinal parasites. METHODS: All fecal samples were examined with the formol ethyl acetate sedimentation method for helminth ova and protozoan cysts. For the diagnosis of coccidian protozoa, the modified Ehrlich-Ziehl-Neelsen was used. Trichrome staining was also performed in ambiguous cases. The cellophane tape method was used to detect Enterobius vermicularis egg. The prevalence of intestinal parasites was evaluated with respect to age, gender and the months in which cases were seen. RESULTS: One or more parasites were found in 195 of the 2686 stool samples. The overall prevalence of intestinal parasitic infection rate was 7.3%, and of these patients, 57.95% were female and 42.05% male. Predominant parasites were Giardia intestinalis 3.23%, followed by Entamoeba coli 2.34%, Entamoeba histolytica 0.59%, and Strongyloides stercoralis 0.44%. Enterobius vermicularis eggs were detected by the cellophane tape method in 80 (12.08%) out of 622 patients. The proportion of individuals infected with one parasite was 85.4%, two parasites 12.6%, and three parasites 2.0%. The age group 10-19 years had the highest prevalence of parasites and was predominantly infected with G. Intestinalis (p < 0.001). CONCLUSION: The results of this study emphasized that, even in the Bursa Province with a relatively high level of social hygiene, intestinal parasitic infections are still an important public health problem.

[The distribution of intestinal parasites detected in the Uludag University Medical School Hospital between 2005 and 2008]. / Uludag Üniversitesi Tip Fakültesi Hastanesine 2005-2008 yillari arasinda basvuran kisilerde saptanan bagirsak parazitlerinin dagilimi.

OBJECTIVE: Intestinal parasite infection is still an important public health problem. In this study, patients (outpatients and in-patients) with various gastrointestinal system complaints presenting at various clinics of the Uludag University Medical Faculty, from January 2009-December 2010 were investigated retrospectively for intestinal parasites. METHODS: Parasitological examinations were done with native-lugol, cellophane-tape methods and trichrome staining in ambiguous cases. Also modified Erlich-Ziehl-Nielsen staining was used to identify Cryptosporidium spp. RESULTS: In a total of 5,624 cases examined 10.25% were found infected with at least one or more parasite, without difference between genders. Enterobius vermicularis eggs (9.3%) was detected in 227 of 1,971 cellophane tape preparations. The distribution of identified parasites was as follows: Giardia intestinalis, 199 (34.48%); 29 Blastocystis hominis, 136 (23.57%); Entamoeba coli, 83 (14.38%); Enterobius vermicularis, 227 (9.3%). The prevalence of parasite infections in stool samples examined was highest among the age group of 10-29 years old (36.8%), followed by the age group 0-9 years, in which rate was 18.6%. Parasites such as helminth detected in 225 (32.09%) and protozoon in 476 (67.91%) of the patients were included in this study. CONCLUSION: This study re-emphasises the fact that intestinal parasitic infection is still an important public health problem.

A comparative study of dermatophyte infections in Bursa, Turkey.

A total of 555 specimens from 372 patients with symptoms compatible with superficial mycosis were included in this study. Those from patients clinically diagnosed as having dermatomycosis were thoroughly investigated by mycological examinations in the laboratory, including microscopic studies of KOH mounts and cultivation of the samples in culture. The results of this study and a previous study in our hospital conducted in 1980 were compared with respect to clinical presentation and etiological agents. Onychomycosis was the most common clinical form of dermatomycoses, and Trichophyton rubrum was the most common pathogen in this study.

[Investigation of the presence of HBV-DNA in isolated anti-HBc positive cases and their importance in blood banking]. / Izole anti-HBc pozitif olgularda HBV-DNA varliginin arastirilmasi ve bu olgularin kan bankaciligi açisindan önemi.

Despite the decrease in transfusion-transmitted hepatitis B virus (HBV), it is still one of the main problems in transfusion medicine. Recent studies have shown that HBV is transmissible to recipients from HBsAg negative donations. This study was aimed to detect anti-HBc, anti-HBs and HBV-DNA positivity in HBsAg negative cases and to determine whether a reconsideration is required for HBV screening policies in blood banking. In this study, anti-HBs and anti-HBc total was investigated in 9282 HBsAg negative donor samples by commercial ELISA (Orto-Clinical Diagnostics, Vitros, Brazil) system and HBV-DNA by real-time PCR method (QIAGEN, Artus 3000, Germany). In 9282 HBsAg negative samples, anti-HBc positivity rate was 18% (1679/9282). Anti-HBs negativity was detected in 15% (n=225) of these anti-HBc positive sera. Among the isolated anti-HBc positive (HBsAg negative, anti-HBc positive, anti-HBs negative) 225 serum samples 218 were investigated for HBV-DNA presence and one sample was found to be positive (0.45%). When the samples not tested due to insufficient serum amount were excluded, the total rate of isolated anti-HBc positivity in the study region was 2.5% (225/9107) and HBV-DNA positivity in the HBsAg negative group was 0.011% (1/9100). The annual number of blood donations in our center was about 21.000, thus the rate of HBV transmission from HBsAg negative donors could be estimated as 2.3 patients/year. Although the rate of HBV transmission due to HBV-DNA positivity among HBsAg negative blood donors is low, this risk should always be kept in mind in transfusion medicine.

[The investigation of malaria cases in Bursa between 2006-2008]. / Bursa Ilinde 2006-2008 Yillari Arasinda Saptanan Sitma Olgularinin Degerlendirilmesi.

Malaria caused by Plasmodium parasites is one of the most common infectious diseases and an enormous public health problem. In this study, malaria cases detected and reported by the Malaria Control Dispensary of the Infectious Disease Division of Bursa Health Directory from October 2006 through December 2008 have been reported. The cases were evaluated according to age, gender, occupation and localization of the cases (indigenous or imported cases). A total of 23.416 blood smears were examined during this 26-month period and malaria parasite was found in 9 cases (0.038%). Of the 9 positive cases, 8 (88.9%) were male and 1 (11.1%) was female. Of these, 4 (44.5%) were acquired in Azarbajcan; 1 (1.1%) in Pakistan; 1 (1.1%) in Ghana; 1 (1.1%) in Sudan; 1 (1.1%) in an unknown Africa country; and 1 (1.1%) in the southeastern of Turkey. Except for three cases of foreign origin infected with Plasmodium falciparum, all the other cases were caused by Plasmodium vivax. The 0.05% decrease in malaria cases during the last 26-month, compared with prior data of malaria prevalence in Bursa, resulted primarily from a decrease in the number of cases acquired in Turkey.

IL-10 and IL-6 gene polymorphisms as potential host susceptibility factors in Brucellosis.

Several genes encoding for different cytokines may play crucial roles in host susceptibility to Brucellosis, since the cytokine production capacity varies among individuals and depends on the cytokine gene polymorphism. The association of the cytokine gene polymorphisms with the development of Brucellosis was investigated in this study. DNA samples were obtained from a Turkish population of 40 patients with Brucellosis, and 50 healthy control subjects. All genotyping (IL-6, IL10, IFN-gamma, TGF-beta and TNF-alpha) experiments were performed using sequence-specific primers PCR (PCR-SSP). When compared to the healthy controls, the frequencies of high/intermediate producing genotypes of IL-10 and high producing genotype of IL-6 were significantly more common in the patient group. These results suggest that IL-10 and IL-6 gene polymorphisms may affect susceptibility to Brucellosis and increase risk of developing the disease. In order to confirm the biological significance of our results, further studies should be performed in larger population groups.

[Malaria in Bursa]. / Bursa'da sitma.

In this investigation, the records of malaria cases detected by the Malaria Control Unit of the Infectious Disease Division of Bursa Health Directory, from January 1, 2003-October 30, 2006, were retrospectively examined. During this period, a total of 64,529 blood samples were examined and 55 malaria cases (ranging from 01-71 years of age) were reported. Of these, 56.3% were found to be imported cases coming to Bursa from other countries for various reasons. According to the records, the total slide positivity determined during the malaria surveillance was 0.08%. With the exception of three cases of Plasmodium falciparum of foreign origin, the cases were caused by Plasmodium vivax. Of the 55 positive cases, 19 (34.5%) were female and 36 (65.5%), male and the highest rate of cases occurred during September. The aim of this study was to aid the work being done in the control of malaria in our region.

[The prevalence and distribution of intestinal parasites detected by the Uludag University Medical School]. / Uludag Universitesi Tip Fakültesindeki bagirsak parazit olgularinin prevalansi ve dagilimi.

In this study, patients (outpatients and in-patients) with various gastrointestinal system complaints presenting at various clinics of the Uludag University Medical Faculty, Bursa, from January 2001-December 2004 were investigated for intestinal parasites. The prevalence of intestinal parasites was evaluated according to age, gender and the months in which cases were seen. Saline and iodine preparations from 8,351 stool samples before and after formal-ethyl acetate concentration were examined under 100x and 400x magnification. Also, trichrome stained preparations in ambiguous cases and modified Erlich Ziehl Nielsen stained preparations for Cryptosporidium spp. were examined by oil-immersion lens (total magnification 1000x). One or more pathogenic parasites were found in 298 of the 8,381 stool samples. Enterobius vermicularis was detected in 227 of 3,758 cellophane tape preparations. The predominant parasite was E. vermicularis (prevalence of 1.56%), followed by Giardia intestinalis (1.03%) and Blastocystis hominis (0.96%). The overall prevalence of intestinal parasitic infection rate was 4.27%. Of these, 40.4% were female and 59.6%, male. The results indicated that 94.9% of the subjects had one parasite and 5.1%, co-infection with two parasites. The rate of intestinal parasites in the 0-9 age group was higher than that of other groups. The incidence of parasitic diseases was lower in this study as compared to results previously reported in our hospital. Although different infection rates were found in these studies, there were no statistically significant differences in our study.

[Short communication: retrospective analysis of 21 HIV/AIDS cases]. / KISA bildiri: HIV/AIDS'li 21 olgunun retrospektif analizi.

In this study, 21 HIV/AIDS cases (18 male, 3 female; age range 17-64 years), followed up in the Department of Infectious Diseases of Uludag University Medical Faculty between 1997-2003 have been analyzed retrospectively, by means of epidemiological, clinical and laboratory aspects. Nineteen (90%) of them were heterosexual, and in 9 cases the diagnosis was coincidental during the blood donations or routine testing. The non-compliance rate of patients to antiretroviral treatment was found as 76%, and the most important factor for non-compliance was the difficulty in providing antiretroviral drugs. The most frequently encountered opportunistic infections were oropharyngeal candidiasis (n:5), herpes zoster (n:4) and community acquired pneumonia (n:4).

[Evaluation of the distribution of intestinal parasites in the Uludag University Medical Faculty during a period of eight years.]. / Uludag Üniversitesi Tip Fakültesinde farkli yillarda bagirsak parazit dagilimlarinin degerlendirilmesi.

The purpose of the present study was to investigate retrospectively the distribution and prevalence of intestinal parasites in patients who presented at the routine parasitology laboratory of the Uludag University Medical Faculty, Bursa, during the 8 years from January 1993-December 2000. A total of 32,346 stool specimens were examined for intestinal parasites using native- Lugol and formol ethyl ether methods. Also, 10,897 cellophane- tape preparations were studied directly. Parasites were found in 8.14% of the samples. Of the patients, 46.32% were females and 53.68%, male. G. intestinalis (3.63%) and Enterobius vermicularis (3.41%) were the most prevalent parasites. The distribution of the parasites according the species was as follows: 115 (0.35%) Entamoeba histolytica and/or dispar, 73 (0.22%) Ascaris lumbricoides, 29 (0.089%) Taenia spp., 7 (%0.021) Dicrocoelium dentriticum, 6 (0.018%) Trichuris trichiura, 4 (0.012%) Hymenolepis nana, and 2 (0.006%) Strongyloides stercoralis. At least one parasite was seen in 96.47% of samples. Two parasites were found in 3.53% of the stool specimens,. The results of our study were similar to the rates of the Marmara Region. Our laboratory findings were found to be lower than previous laboratory findings.

[The epidemiology of malaria in Bursa.]. / Bursa'da sitma epidemiyolojisi.

Malaria is still one of the important public health problems in Anatolia. Since Bursa is a well-developed industrial and agricultural province in the Marmara region, migration rate to this region from eastern and southeastern regions of Turkey is quite high. In this retrospective study, malaria cases detected by the Malaria Control Unit Division of the Bursa Health Directorship from 1986-2002 have been evaluated. The total number of slide-positive cases was 700. Out of the 700 cases of malaria, 695 (99.3%) were found to have been caused by Plasmodium vivax and 5 (0.7%), by P. falciparum. Of these cases, 68.8% were male and of the males, 18.4% were soldiers. The majority of the cases (70.5%) had come from the southeastern region of Anatolia. Positivity rates were found to be highest in 1995 (21%) and 1996 (18.5%). In this study, we have reviewed the malaria cases according to age, gender and occupation as well as transmission characteristics, locality and source of infection.

Persistence of candiduria in ICU catheterized patients is not linked to adherence and proteolytic activities of Candida strains.

OBJECTIVE: In this study, the patients who developed asymptomatic candiduria in the intensive care unit were followed prospectively for the persistence of candiduria after the replacement of indwelling urethral catheter and the correlation between persistence and virulence factors (proteinase enzyme activity and epithelial adhesion) was assessed. DESIGN: Prospective study. SETTING: Intensive care unit and mycology laboratory at a university hospital. PATIENTS: Thirty-four patients with asymptomatic candiduria were included in the study. RESULTS: Candiduria persisted in 19 of 34 patients(56%; group 1) and cleared in 15 of 34 patients(44%; group 2) after urinary catheters were changed. When the virulence factors (epithelial adhesion and proteinase activity) and distribution of Candida spp. were compared between two groups, no statistically significant correlation was found. CONCLUSION: The host immune response might be more important than virulence factors of Candida spp. for persistence of candiduria.

Brucellar spondylitis: review of 25 cases.

OBJECTIVE: : Brucellar spondylitis is one of the most serious complications of brucellosis. It should be considered in patients who have back pain and neurologic disorders as well as systemic symptoms and findings in or from endemic areas such as Turkey. This report describes important features of the disease. METHODS: : Twenty-five patients with brucellar spondylitis were retrospectively evaluated in terms of their clinical, laboratory, and radiologic features and their response to different treatment regimens. RESULTS: : The most common symptoms of brucellar spondylitis were back pain, fever, and sweating. Rose Bengal tests were positive in all of these patients. Brucella species was isolated from blood cultures of 8 (32%) patients. Magnetic resonance imaging (MRI) showed that the lumbar segment was the most frequently involved region. Different combination regimens including 2 or 3 antibiotics were used. Combination of tetracycline (especially doxycycline) and streptomycin was the most widely used therapy regimen. Trimethoprim-sulfamethoxazole, ciprofloxacin, ofloxacin, and rifampin were also included in some combination therapies. In this series, the mean duration of antimicrobial therapy was 130 +/- 45.6 days (range, 77-281 days), and 92% of patients received therapy for >/= 90 days. There were no mortalities in this study. CONCLUSIONS: : Brucellar spondylitis should be considered in patients with back pain and neurologic disorders as well as systemic symptoms and findings in endemic areas. MR imaging is recommended in suspected cases. The patients can be treated effectively treated with appropriate antibiotic combinations. Follow up is important because relapses can occur.