Aysen Gargili

The first clinical case due to AP92 like strain of Crimean-Congo Hemorrhagic Fever virus and a field survey

BackgroundCrimean-Congo Hemorrhagic Fever (CCHF) is a fatal infection, but no clinical case due to AP92 strain was reported. We described the first clinical case due to AP92 like CCHFV.MethodsA case infected by a AP92 like CCHFV was detected in Balkanian part of Turkey. Diagnosis was confirmed by RT-PCR and sequencing. A human serologic and tick survey studies were performed in the region, where the case detected.ResultsThirty eight individuals out of 741 were found to be anti CCHFV IgM positive. The attack rate for overall CCHFV was calculated as 5.2%. In univariate analyses, CCHFV IgM positivity was found to be associated with the age (p < 0.001), male gender (p = 0.001), agricultural activity (p = 0.036), and history of tick bite (p = 0.014). In multivariate analysis, older age (OR: 1.03, CI:1.01–1.05, p < 0.001), male gender were found to be the risk factors (OR: 2.5, CI:1.15–5.63, p = 0.020) for CCHFV infection.ConclusionThis is the first human case with AP92 like CCHFV infection. Furthermore, this is the first report of AP92 like strain in Turkey. In the region, elderly males carry the highest risk for CCHFV infection.

Ticks biting humans in the urban area of Istanbul

A passive surveillance for tick bites in humans was undertaken in the city of Istanbul (Turkey) in the summer and autumn of 2006. From 1,054 reported tick bites, most were females of Ixodes ricinus (27%) and nymphs of Hyalomma aegyptium (50%). A few adults of Hyalomma m. marginatum, Rhipicephalus sanguineus and Dermacentor marginatus were also recorded. We investigated potential risk factors for I. ricinus and H. aegyptium with spatial statistics. Climate features at 1-km resolution (monthly minimum temperatures in late summer and autumn and rainfall) and vegetation features at high resolution (density and heterogeneity of forest-type vegetation as well as distance of reporting site to these vegetation features) are useful variables explaining high reporting clusters for both Ixodes and Hyalomma. While Ixodes is highly reported in dense highly heterogeneous vegetation patches, Hyalomma is commonly found in areas far from forest-type features and in the small, relatively dry vegetation patches within the urban fabric.

The trend towards habitat fragmentation is the key factor driving the spread of Crimean-Congo haemorrhagic fever

We aimed to characterize an environmental niche driving the distribution of Crimean-Congo haemorrhagic fever (CCHF) in Turkey, using a geo-referenced collection of cases reported between 2003 and 2008 and a set of climate and vegetation features. We used mean monthly air temperatures and Normalized Derived Vegetation Index (NDVI) values, at a resolution of 0.1 degrees , as well as climate features at and below the surface. We computed significant differences in monthly variables between positive and negative sites, within the range of distribution of the tick vector. Seasonal climate (growth season and summer length, accumulated temperatures in winter) and vegetation components (anomalies in NDVI data) were analysed. Fragmentation of habitat was obtained from NDVI monthly data at a resolution of 1 km. Neither single climate or vegetation variables, nor any individual seasonal component, accounted in both space and time for the delineation of areas of disease although accumulated temperatures in winter consistently showed lower values in areas where the disease was reported. Coherent and significant differences between disease-containing and disease-free sites were found when habitat fragmentation and connectivity were examined. High fragmentation and connectivity were unambiguously associated with sites where disease is reported and accounted for the spatial spread of cases in 2003-2008. CCHF cases were always associated with areas of highly fragmented and well-connected patches within the range of the tick vector, while there were no reports from areas with low fragmentation. There was a linear relationship between degree of fragmentation and case incidence. The implications of these findings are discussed with reference to the concept of disease spread through networks of connected spots with high densities of infected vectors and social factors driving different human activities in sites of high fragmentation.

Imported Crimean-Congo hemorrhagic fever cases in Istanbul

We described a series of imported cases of Crimean-Congo Hemorrhagic Fever (CCHF) in Istanbul and investigated the genetic diversity of the virus. All the suspected cases of CCHF, who were applied to the health centers in Istanbul, were screened for CCHF virus (CCHFv) infection by using semi-nested Polymerase Chain Reaction (PCR) following RT-PCR. Simultaneous blood samples were also sent to the national reference laboratory in Ankara for serologic investigation. In 10 out of 91 patients, CCHFv was detected by PCR, and among 9 out of 10, anti-CCHFv IgM antibodies were also positive. Clinical features were characterized by fever, myalgia, and hemorrhage. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase were elevated, and bleeding markers were prolonged. All the cases were treated with ribavirin. There was no fatal case. All the strains clustered within the same group as other Europe/Turkey isolates.

Crimean-Congo hemorrhagic fever in European part of Turkey: genetic analysis of the virus strains from ticks and a seroepidemiological study in humans.

A survey of ticks from domestic ruminants, together with a serosurvey in humans was conducted in Thrace (northwestern Turkey) to evaluate the prevalence of Crimean-Congo hemorrhagic fever virus (CCHFV) in ticks and humans. More prevalent ticks were Hyalomma marginatum, Hyalomma aegyptium, Rhipicephalus bursa, and Rhipicephalus (Boophilus) annulatus, with low numbers of Dermacentor marginatus, Rhipicephalus sanguineus group, and Ixodes ricinus. No differences in the tick faunal composition were found among surveyed provinces. CCHFV was detected using specific primers for strains belonging to both Europe 1 and Europe 2 clades in a total of 15 pools of ticks collected in nine localities. The maximum likelihood estimate of infection rate was calculated as 0.72/100 ticks (95% CIu2009=u20090.42-1.16). Viral RNA was observed only in H. marginatum, R.(B.) annulatus, and R. bursa with overall maximum likelihood estimate infection rates being 0.93 (95% CIu2009=u20090.35-2.05), 0.74 (95% CIu2009=u20090.24-1.78), and 1.67 (95% CIu2009=u20090.69-3.46), respectively. The surveyed region is the only place where both viral strains are circulating together in nature in Turkey. Results from serosurvey on 193 samples from three localities in the region showed that immunoglobulin M and immunoglobulin G rates are compatible with an epidemiological situation in which the virus has been present for a long time and is not the result of a recent invasive event from the main epidemic center in Anatolia (north-central Turkey). Seropositivity rates cannot be compared against the tick faunal composition, because of the homogeneity in the results about tick surveys. The high rate of seropositivity, and the prevalence of CCHFV in both Europe 1 and 2 clades among the ticks, but few clinical cases suggest that the circulation of both viral strains may confer protection against the CCHFV infection.

Rickettsia Species in Ticks Removed from Humans in Istanbul, Turkey

A total of 167 ticks collected from humans in Istanbul (Turkey) in 2006 were screened for Rickettsia species, and nested PCRs targeting gltA and ompA rickettsial fragment genes were carried out. Rickettsia monacensis (51), R. aeschlimannii (8), R. conorii subsp. conorii (3), R. helvetica (2), R. raoultii (1), R. africae (1), R. felis (1), and other Rickettsia spp. (2), were detected. To our knowledge, these Rickettsia species (except R. conorii) had never been reported in ticks removed from humans in Turkey. The presence of R. africae also had not been previously described, either in Hyalomma ticks or in any European tick species. In addition, R. aeschlimannii and R. felis had not been found associated with Rhipicephalus bursa specimens. The presence of human pathogenic Rickettsia in ticks removed from humans provides information about the risk of tick-borne rickettsioses in Turkey.

A newly identified Crimean-Congo hemorrhagic fever virus strain in Turkey

Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral disease that occurs in approximately 30 countries. It has the most extensive geographic range among the tick-borne viruses that affect human health. Recently, a 6-year-old boy presented with complaints of fever, fatigue, and loss of appetite. He revealed a history of tick bite in rural Istanbul three days prior to presentation. A hyperemia was detected at the site of the tick bite. Laboratory tests showed that alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine phosphokinase levels were elevated and that the prothrombin time and activated partial thromboplastin time were prolonged. Anti-CCHF virus IgM ELISA and a reverse transcriptase-PCR assay for CCHF RNA were both positive. Phylogenetic studies revealed that the virus was a new AP92-like CCHF strain, which was named KMAG-Hu-07-01 (accession number EU057975). This patient could provide important information on the transmission dynamics of CCHF infection.

Cryptosporidiosis in Humans with Reference to the First Case of Cryptosporidium hominis Infection in Turkey

194 Copyright 2017 by The Medical Bulletin of University of Health Sciences Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayınevi. Telif Hakkı 2017 Sağlık Bilimleri Üniversitesi Haseki Eğitim ve Araştırma Hastanesi Haseki Tıp Bülteni, Galenos Yayınevi tarafından basılmıştır. AdxaddressxadforxadCorxadresxadponxaddenxadce/Yaxadz›flxadmaxadAdxadrexadsi:xadNadim Yılmazer Namık Kemal University, Faculty of Arts and Sciences, Department of Biology, Tekirdağ, Turkey Phone: +90 282 250 26 30 E-mail: nyilmazer@nku.edu.tr Received/GeliflxadTarihi:xad09 January 2017 Acxadcepxadted/KaxadbulxadTaxadrixadhi:xad03 February 2017 Türkiye’de İlk Cryptosporidium hominis Enfeksiyonu Olgusuna İlişkin Olarak İnsanlarda Cryptosporidiosis