Toxoplasma gondii - obsessive -compulsive disorder relationship: is it different in children?

BACKGROUND AND AIM: Obsessive-compulsive disorder (OCD) is a common neuropsychiatric illness. Although the etiology of OCD is still unknown, recent investigations have associated development of OCD with infectious illness. Toxoplasma gondii (T. gondii) is a neurotropic protozoan parasite that causes infection of the central nervous system. In the last decade, a lot of researches have focused on the possible relationship between exposure to T. gondii and neuropsychiatric disorders such as schizophrenia. Therefore, in this study, it was aimed to investigate a possible association between Toxoplasma infection and OCD in children and adolescents. METHODS: We selected 55 patients with OCD (aged between 7 and 16 years) and 59 healthy children and adolescents (aged between 7 and 16 years), and investigated the seropositivity rate for anti-Toxoplasma IgG antibodies by enzyme-linked immunosorbent assay. RESULTS: The seropositivity rate for anti-T. gondii IgG antibodies among OCD patients (21.82%) was found to be higher than the rate in control group (15.25%). However, the difference between the OCD group and the control group was not statistically significant (p > .05). CONCLUSION: In contrast to studies in adult patients, the results of this study do not support the relationship between T. gondii and OCD children and adolescents.

Cutaneous myiasis in a malignant wound of the head and neck region.

Myiasis is a parasitic infestation of vital tissue of humans or other mammals by dipterous larvae. Human myiasis is a rare clinic condition but more frequently seen in tropical and subtropical areas, in patients who have poor hygiene, have bad housing conditions, are with mental retardation, or have advanced age. We report a case of myiasis in a malignant wound (squamous cell carcinoma) in the head and neck region because a few literature reports were seen in this localization. The patient's treatment was antisepsis, larval removal, and general care preventions, whereas standard treatment options or guidelines are not available.

[The rates of seropositivity and seroconversion of toxoplasma infection in pregnant women]. / Gebelerde Toksoplazma Enfeksiyonunun Seropozitiflik ve Serokonversiyon Oranlari

Infections caused by Toxoplasma gondii are frequently asymptomatic in healthy adults, however they may be serious in pregnant women and immunocompromised patients. The aims of this study were to investigate the rates of seropositivity and seroconversion in pregnant women and newborn cord blood samples, and to evaluate those data in the view of relation to lifestyle and nutrition. A total of 312 pregnant women (mean age: 28.1 ± 5.2 years) who were admitted to and followed by gynecology clinics of Inonu University Medical School Hospital, Malatya, Turkey were included in this observational and cross-sectional study. Anti-toxoplasma IgG and IgM antibodies in pregnants and newborn cord sera were screened by commercial ELISA and immunofluorescence antibody (BioTek; USA) methods. A total of 312 sera from pregnant women and 312 cord blood samples during delivery were collected. IgG seropositivity rate in pregnants was found as 37.5% (117/312), seroconversion was not determined in restrained pregnants and T.gondii IgM was found negative in all pregnants. Also in all newborns IgM was negative and IgG seropositivity was determined as 33.3% (104/312) in cord blood. There was a statistically significant relationship between IgG seropositivity and raw meat consumption (p< 0.001) and being engaged in agriculture (p< 0.005). It was concluded that toxoplasma antibodies should routinely be searched on the first visit of the pregnants and the seronegative cases should be trained about the preventive measures related to toxoplasmosis. The follow-up of toxoplasma seronegative cases during pregnancy can be achieved by only detecting the IgM class antibodies and this will also reduce the cost of screen test.

Is there any role of Toxoplasma gondii in the etiology of obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a common psychiatric illness. Although the aetiology of OCD is still unknown, the family-genetic data show that familial forms of OCD may be associated with a specific genetic susceptibility. Recent investigations have associated development of OCD with infectious illness. Toxoplasmic encephalitis (TE) is a common presentation of Toxoplasma gondii infection of the central nervous system (CNS). The most commonly affected CNS region in TE is the cerebral hemisphere, followed by the basal ganglia, cerebellum and brain stem. The basal ganglia has been implicated in the development of OCD. Therefore, in this study, it was aimed to investigate a possible association between Toxoplasma infection and OCD. We selected 42 patients with OCD and 100 healthy volunteers, and investigated the sero-positivity rate for anti-Toxoplasma IgG antibodies by Enzyme Linked Immunosorbent Assay (ELISA). The sero-positivity rate for anti-T. gondii IgG antibodies among OCD patients (47.62%) was found to be significantly higher than the rate in healthy volunteers (19%). This is the first report to examine a potential association between Toxoplasma infection and OCD. The main finding of the present study is an increased level of IgG antibodies to T. gondii in OCD patients when compared with the level in healthy controls. There might be a causal relationship between chronic toxoplasmosis and the aetiology of OCD.

Glutathione and malondialdehyde levels in patients with hydatid cyst.

OBJECTIVE: To investigate the levels of glutathione (GSH), and malondialdehide (MDA) in the sera of patients diagnosed with cyst hydatid. METHODS: Forty-six hydatid cyst patients who were indirect hemaglutination (IHA) and indirect fluorescence antibody (IFA) test positive constituted our study group in 2007. Patients diagnosed with hydatid cyst in the Inonu University School of Medicine, Department of Parasitology were re-called for the study. Forty healthy subjects who were negative for hydatid cyst by IHA and IFA methods, and who did not have any parasites on stool inspection formed the control group. The MDA level was analyzed in the sera by Uchiyama and Mihara method. The GSH activity was measured by the Ellman method. RESULTS: The GSH level was 11.31 -/+ 3.80 micromol/L and the MDA level was 67.94 -/+ 106.70 micromol/L in the study group, while they were 24.95 -/+ 6.55 micromol/L and 26.52 -/+ 19.42 micromol/L in the control group. CONCLUSION: An increase in MDA levels and a decrease in GSH activity in patients with hydatid cyst was observed.

Diagnosis of Trichomoniasis in Male Patients on Performing Nested Polymerase Chain Reaction.

OBJECTIVE: Trichomoniasis is a parasitic infection that occurs with the settlement of Trichomonas vaginalis in female and male urinary and reproductive tracts. This infection is generally asymptomatic in males, and males are thought to be a carrier for the transmission of infection. In this study, our aim was to detect trichomoniasis using nested polymerase chain reaction among males who were referred to a hospital with suspected urinary tract infection. METHODS: Urine samples were collected from 138 male patients between 18 and 50 years of age who were referred with suspected urinary system infection to the Urology Outpatient Clinic at Malatya University Medical Center Malatya between December 2013 and May 2014. Direct microscopy, two different culture methods, and nested Polymerase chain reaction (PCR) were performed for the investigation of T. vaginalis in urine samples. RESULTS: Urinary tract infection was diagnosed in 47 of the 138 patients according to white and red blood cell counts in the urine samples. T. vaginalis infection was detected in 6.5% (9/138) of the suspected patients by nested PCR, while none of the samples tested positive by direct microscopy and culture examinations. Statistical significance was found between infection of the urinary tract and nested PCR positivity for T. vaginalis. CONCLUSIONS: According to our results, nested PCR is the most sensitive method for the detection of trichomoniasis in male patients. We strongly recommend using nested PCR for the differential diagnosis of urinary infections in males.

Dust-mites: effect on lipid peroxidation.

BACKGROUND: Dust-mites are present in our homes, feed on dead exfoliated skin and other organic material. It is also known that oxidative stress may lead to cellular damage that can be confirmed by markers of cellular disruption. Oxidative stress in various infective processes has been documented. We investigated whether house dust-mites cause oxidative stress in patients. METHODS: Products of lipid peroxidation in erythrocytes and lymphocytes were assessed by measuring malondialdehyde concentration. RESULTS: Our results showed that patients who had a positive skin test for dust-mite antigens and had dust-mites present in their houses (dust-mite positive) had increased erythrocyte malondialdehyde levels (62.39 [18.56] nmol/g-Hb) compared with those who were skin test positive, dust-mite negative (45.45 [10.82]) or skin test negative, dust-mite negative (42.20 [5.68]). They also had significantly higher levels of lymphocyte malondialdehyde (4.22 [0.55] nmol/g-protein) compared with those who were skin test positive, dust-mite negative (3.46 [0.29]) or skin test negative, dust-mite negative (1.25 [0.31]; p <0.05). However, there was no statistically significant difference between the malondialdehyde levels of dust-mite negative/skin test positive and dust-mite negative/skin test negative patients. CONCLUSION: Increased malondialdehyde activity in lymphocytes and erythrocytes in the dust-mite positive/skin test positive group shows the presence of the oxidative stress in patients with dust-mite infestation.

Effectiveness of peptone-yeast extract (P-Y) medium in the cultivation and isolation of Entamoeba histolytica/Entamoeba dispar in Turkish patients.

Amebiasis is a common protozoan infection worldwide, causing serious health problems in both children and adults. Today, almost 10% of the world population is infected with Entamoeba histolytica/Entamoeba dispar. The aims of this study were both the comparison of the reproduction rates and densities of E. histolytica/E. dispar in Robinson, Dobell-Laidlaw and P-Y culture media and isolation of E. histolytica/E. dispar from stool samples in Peptone-Yeast (P-Y) medium. Trophozoites and cysts of E. histolytica/E. dispar, maintained in Robinson medium, and stool samples of patients with amebiasis were inoculated into P-Y, Robinson and Dobell-Laidlaw culture media. Reproduction rates reached their peak levels 48 h after the inoculation in all culture media. Reproduction rates in P-Y and Robinson media were found similar; however, they were higher than the reproduction rate in Dobell-Laidlaw medium (p < 0.01); there was no statistically significant difference between the reproduction rates of P-Y and Robinson media (p > 0.05). Twelve isolates from 12 patients were cultivated in P-Y medium and checked for reproduction everyday for 7 days. Twelve of the 12 (100%) isolates were cultivated in P-Y medium, indicating that the P-Y was an effective medium for the isolation of E. histolytica/E. dispar in stool samples. According to these results, P-Y medium could be preferred in immunologic, serologic and molecular studies and, thus the definitive diagnosis of amebiasis due to its low cost and simple formula.

Dysentery caused by Balantidium coli in a patient with non-Hodgkin's lymphoma from Turkey.

Balantidium coli is the only parasitic ciliate of man. It is a flattened oval organism covered with cilia, and a gullet at the anterior end. It is infrequently pathogenic for man, although epidemic buds in tropical zones have been described. The infection fundamentally affects the colon and causes variable clinic pictures, from asymptomatic to serious dysenteric forms. We present a case of parasitologically diagnosed as causes of diarrhea in a patient with non-Hodgkin's lymphoma from Turkey. In order to find out the causative etiologic agent of diarrhea, stool samples were examined by native, lugol and flotation methods and we detected moving trophozoites, which were approximately 60 microm long and 35 microm wide. These bodies were diagnosed as Balantidium coli. This case underlines that Balantidium coli should also be considered as a possible pathogen in immunocompromised patients with diarrhea.

[Evaluation of the intestinal parasitic infections in children patients with cancer]. / Kanser Hastasi Çocuklarda Bagirsak Paraziti Enfeksiyonlarinin Degerlendirilmesi.

OBJECTIVE: We aimed to determine the prevalence and type of the intestinal parasites in healthy, cancer and survivor children after cancer therapy, and to evaluate whether there are any differences in incidence and types of parasites during their neutropenic period. METHODS: Three different patient groups were formed. Group I and Group II were immune deficient patients with hematologic malignancy or solid tumors, and Group I were receiving intensive chemotherapy and had absolute neutrophil count less than 1000/mm³. Group II were receiving maintenance chemotherapy and had normal absolute neutrophil counts. One hundred and seventy two patients, who did not receive chronic immune suppressant treatment and who did not have immune deficiency were chosen among the patients admitted to pediatric hematology outpatient clinic. Parasitic evaluation of stools was performed on three consequtive days. RESULTS: Prevalence of parasite in Group I patients was significantly higher than other groups. The most commonly detected parasite in all groups was Giardia intestinalis. The presence of parasite in patients with absolute neutrophil counts below 1000/mm³ was found to be significantly higher than in patients with absolute neutrophil counts above 1000/mm³. CONCLUSION: Parasitic infections should not be ignored when these types of patients present with infection findings.

[The clinical, serological and morphological analysis of 91 patients with cystic echinococcosis following surgery]. / Kistik ekinokokkozis nedeniyle opere edilmis 91 olguda klinik, morfolojik ve serolojik irdelemeler.

Cystic echinococcocis (CE) is a zoonotic infection caused by metacestod form of Echinococcus granulosus. In this study, 91 patients with CE were revealed according to their gender, age, symptoms, cyst localization and size, and also to their preoperative serologic analysis results. These patients were recruited in Pathology Department of Inonu University, School of Medicine, Turgut Ozal Medical Center between January 2002 and December 2005. They had already undergone surgery following the preliminary diagnosis of CE and were diagnosed definitively after histopathological analysis. Thirty-seven of them were female (41%) and the rest were male (n=54, 59%). Mean age was 36.24 ± 20.35 (range: 4-80 years). Lung and liver were the most common localizations for CE cysts (n=67, 73.63%). Fifty patients' preoperative serological analysis (IHA) were already available (55%) and 46 of them (92%) were positive. Since histopathological definitive diagnosis was CE, false negative result rate was assessed as 8%. Intraabdominal CE cyst localization was found related with bigger cyst size and multiple organ involvement. Symptom duration was correlated with cyst size (p < 0.05; r < sup > 2 < /sup > =0.09). IHA results were failed to be found related with clinical features of the cysts.

Bilateral aural myiasis (Wohlfahrtia magnifica): a case with chronic suppurative otitis media.

Myiasis is a disease caused by fly larvae and aural myiasis is a rare clinic condition often occuring in children or mentally retarded people. We report the case of an unusual presentation of a bilateral aural myiasis in a mentally retarded patient with bilateral chronic otitis media caused by the third instar larvae of Wohlfahrtia magnifica. Two larvae were located on the other ear canal while two additional larvae were located in the middle ear cavity and were removed through perforation of the tympanic membrane. Treatment of aural myiasis is based on removal of the maggots and cleansing of the ear with ethanol, chloroform or physiological saline. Physiological saline is preferred in patients who have tympanic membrane perforation. Myiasis is related to personal hygiene. Therefore, in order to decrease the incidence of these infestations, care and hygiene standards should be carried out for those at risk.

The prevalence of Demodex folliculorum on the scrotum and male perineal skin.

Demodex folliculorum (D. folliculorum) is a human ectoparasite that resides in the pilosebasceous skin unit. Common sites of predilection are the skin of cheeks, forehead, nose, nasolabial fold and eyelids. Genital D. folliculorum inoculation case reports are extremely rare and depend on investigation of skin lesions. There is no study of genital skin without lesions, and, as far as we know, there is no literature on D. folliculorum prevalence in male genital skin. We examined D. folliculorum prevalence on the healthy scrotum and male perineum. One hundred males were examined for D. folliculorum on facial and genital skin. Samples were taken from cheek, forehead, scrotum and perineum by standard skin surface biopsy (SSSB) or hair epilation. The mean age was 53.5+/-13.0 (24-70) years. Eight percent of males had D. folliculorum on their facial skin. Mean Demodex density (Dd) of men with D. folliculorum positivity was 5.1+/- 2.9/ cm (2)(2-9/cm(2)). Diagnostic results of both sampling methods were similar. No D. folliculorum was demonstrated on genital skin.

What is the importance of Demodex folliculorum in Behçet's disease?

Demodex folliculorum is an obligate parasite and commonly detected in patients with immune system deprivation. This study is planned to document the Demodex folliculorum prevalence among patients with Behçet's disease (BD). The patients who referred to the ophthalmology clinic were included in the study. Fourty patients with BD and 131 patients with refractive errors without any ocular and systemic disease were included. For parasite detection, 3 eyelashes from each inferior eyelid were epilated. Standardized skin surface biopsy (SSSB) was performed for detection of parasite at cheeks of patients. Samples were prepared with Hoyer's solution and investigated under the light microscope. There were 15 female and 25 male in BD group and 61 female and 70 male patients ine control group. Mean ages were 37.62 and 38.38 for BD and control groups, respectively. Demodex folliculorum prevalence at eyelashes was 65% for BD and 10% for control group. SSSB of cheek revealed 7.5% positivity for BD and 10% for control group patients. Statistical analysis documented a significant difference for eyelashes (p < 0.05) which could not be detected for skin results. Investigation of Demodex folliculorum in BD may be useful, even in patients without any complaint, for the treatment of ocular and eyelid discomforts of these patients.

[The prevalence of Microsporidium among patients given a diagnosis of cancer]. / Kanser Tanisi Almis Hastalarda Microsporidium Görülme Sikligi.

The aim of this study was to determine the frequency of Microsporidium among patients given a diagnosis of cancer. For this purpose fecal samples from 320 patients aged 23.60+/-23.00 years were examined using native-Lugol and sedimentation methods and evaluated with modified trichrome, trichrome, and calcofluor dyes. Moreover a control group of 320 non-cancer patients was set up. While 10.9% of the patient group was found to have Microsporidium, only 5.6% of the control group did. Comparison between the control and patient groups in terms of presence of Microsporidium revealed a statistically significant difference. The analysis of a possible relation between intestinal parasites and the presence of Microsporidium revealed a statistically significant correlation between Microsporidium and Blastocystis hominis (P < 0.05). The frequencies of intestinal parasites in the control group and the patient group were found to be 17.8% and 18.1%, respectively. From the findings it was concluded that presence of intestinal parasites and Microsporidium in cancer patients can cause critical problems and adversely affect the therapy. Moreover it was suggested that cancer patients should be informed about regular feces examination and protection against parasites in order to improve their life standards and protect them against parasite infections during treatment.

[The prevalence of Microsporidium among adult patients admitted to the parasitology laboratory at the Inonu University Turgut Ozal Medical Center]. / Inönü Universitesi Turgut Ozal Tip Merkezi Parazitoloji Laboratuvarina Gelen Eriskin Hastalarda Microsporidium Görülme Sikligi.

Microsporidium can cause acute and self-restricted diarrhea cases among immunocompetent patients. The aim of this study was to investigate the presence of intestinal parasites and Microsporidium in patients presenting at the internal diseases polyclinic with some digestive system complaints but no immune suppressive problems, and to detect whether it has anything to do with the complaints. A total of 781 fecal samples were investigated for intestinal parasites and Microsporidium. Intestinal parasites were found in 16.11% and Microsporidium in 6.5%. A significant correlation was observed between the presence of intestinal parasites other than Microsporidium and dyspepsia, while in the case of Microsporidium, a significant frequency of dyspepsia and fatigue was observed. It was found that the presence of Microsporidium does not differ by age and gender. From the findings, it was concluded that patients with digestive system complaints should be examined for Microsporidium in addition to intestinal parasites, and the symptoms of dyspepsia and a lack of appetite should especially be given more careful attention.

[Determination of house dust mites in Eskisehir]. / Eskisehir'de Ev Tozu Akari Görülme Durumu.

House dust contains various organic and inorganic materials. The most important parts of the house dust are dust mites causing allergic diseases such as allergic rhinitis, asthma, atopic dermatitis and seasonal keratoconjunctivitis. In this study, a total of 72 random house dust samples collected from various regions of Eskisehir were examined. The dust samples were examined by the lactic acid precipitation method which was modified from the Spieksma-Boezaman's method. The mite positive house dust rate was 16.67% including Dermatophagoides pteronyssinus, Chortoglyphus arcuatus and Tyrophagus sp. It was concluded that investigation of a greater number of samples would lead to more precise rate of detection of mite positive dust and also that more mite species would be found.

A comparison of cytological and parasitological methods in the diagnosis of Trichomonas vaginalis.

Trichomonas vaginalis (T. vaginalis), which causes urogenital system infections in humans, develops symptomatically and asymptomatically. T. vaginalis in females is diagnosed using direct microscopy, Giemsa staining, and cultivation methods for examination of samples derived from the vaginal posterior fornix. Serologic methods can also be employed. In cytological diagnosis, the ectocervical smear is examined using the Papanicolaou (PAPS) stain. The aim of the present study was to compare the efficacy of the methods used in cytological and parasitological diagnosis. For this purpose, 506 female patients who visited the Obstetrics and Gynecology policlinic of the Academic Hospital of the Faculty of Medicine, Inönü University during a course of six years were involved in this study. The samples derived from the vaginal posterior fornix were examined in the parasitology laboratory, while the ectocervical samples were examined in the cytology laboratory. T. vaginalis was detected in 4.6% of the samples examined in parasitology laboratory, while parasites were found in only 0.9% of the samples taken to the cytology laboratory. The statistical analysis revealed a significant difference (P<0.05). It was concluded that parasitological methods are more sensitive than cytological methods in the diagnosis of T. vaginalis.

[A case of alveolar echinococcosis in Malatya province]. / Malatya'da Alveolar Echinococcosis Olgusu.

The disease resulting from being infected with the larval stage of Echinococcus multilocularis is called alveolar echinococcosis (AE). In our country AE is seen in eastern and southeastern regions of Anatolia. Previously no case of AE had been reported by any hospital in Malatya. In this one case, a 70 year-old woman who presented at the Inönü University Turgut Ozal Medical Center with a right upper quadrant abdominal pain was given a diagnosis of cystic echinococcosis (CE) by dynamic liver computed tomography. The pathological examination following the cystectomy revealed the presence of AE. This is a report of the first AE case detected in Malatya province.