Hakan Kavur

Treatment of head lice with dimeticone 4% lotion: comparison of two formulations in a randomised controlled trial in rural Turkey

BackgroundDimeticone 4% lotion was shown to be an effective treatment for head louse infestation in two randomised controlled trials in England. It is not affected by insecticide resistance but efficacy obtained (70-75%) was lower than expected. This study was designed to evaluate efficacy of dimeticone 4% lotion in a geographically, socially, and culturally different setting, in rural Turkey and, in order to achieve blinding, it was compared with a potential alternative formulation.MethodsChildren from two village schools were screened for head lice by detection combing. All infested students and family members could participate, giving access to treatment for the whole community. Two investigator applied treatments were given 7 days apart. Outcome was assessed by detection combing three times between treatments and twice the week following second treatment.ResultsIn the intention to treat group 35/36 treated using dimeticone 4% had no lice after the second treatment but there were two protocol violators giving 91.7% treatment success. The alternative product gave 30/36 (83.3%) treatment success, a difference of 8.4% (95% CI -9.8% to 26.2%). The cure rates per-protocol were 33/34 (97.1%) and 30/35 (85.7%) respectively. We were unable to find any newly emerged louse nymphs on 77.8% of dimeticone 4% treated participants or on 66.7% of those treated with the alternative formulation. No adverse events were identified.ConclusionOur results confirm the efficacy of dimeticone 4% lotion against lice and eggs and we found no detectable difference between this product and dimeticone 4% lotion with nerolidol 2% added. We believe that the high cure rate was related to the lower intensity of infestation in Turkey, together with the level of community engagement, compared with previous studies in the UK.Trial RegistrationCurrent Controlled Trials ISRCTN10431107

Entomological Survey for Sand Fly Fauna in Imamoglu Province (Cutaneous Leishmaniasis Endemic Region) of Adana, Turkey

ABSTRACT Leishmaniasis, presenting in two clinical forms, cutaneous and visceral in Turkey, is widespread in most of the countries in the Mediterranean Basin. An average of 10 to 13% of cases are reported from Adana every year. This paper presents the results of an entomological survey in an endemic focus of cutaneous leishmaniasis in Imamoglu province of Adana in Turkey. We collected 654 sand fly specimen using 100 light traps in 20 nights in August 2013 and July 2014. Several keys and previous drawings were used in the identification of the species. In total, six Phlebotomus species were identified; Phlebotomus tobbi (50.3%), Phlebotomus papatasi (34%), Phlebotomus perfiliewi (2.9%), Phlebotomus sergenti (0.4%), Phlebotomus neglectus/syriacus (0.8%), and Sergentomyia spp. (11.5%). In addition, the female/male rate was found to be 0.84. Collected sand flies (44 pools of 1–10 individuals) were analyzed microscopically, and no promastigotes were found in the midgut specimens. Using a genus specific real time-polymerase chain reaction (PCR) assay for simultaneous detection of Old Word Leishmania. We detected only 3 of the 44 pools with Leishmania by genus-specific real-time PCR assay. P. tobbi was found to be dominant species in spite of the differences in sand fly fauna composition. To the best of our knowledge, this is the first study for sand fly fauna including 15 villages where endemic focus of cutaneous leishmaniasis in Imamoglu, Adana Province, Turkey.

Prediction of Cutaneous Leishmaniasis Epidemiology in Mersin Using Ecological Niche Modeling

OBJECTIVE In our study, we aimed to develop an ecological niche model showing current distribution of cutaneous leishmaniasis (CL) by using location information on 630 cases of CL reported in the Mersin province between 2005 and 2015 and bioclimatic and environmental variables. METHODS The ecological niche model was based on interpretation of patient locations and climatic data entered in geographical information systems and maximum entropy databases. RESULTS In the model produced for the Mersin province, the area under the curve was calculated as 0.918. Also, the mean temperature of the driest quarter (BIO9), mean temperature of the warmest quarter (BIO10), and maximum temperature of the warmest month (BIO5) were determined as climatic factors that are most effective for CL distribution. CONCLUSION There is a relationship between distribution of CL and climatic factors in the Mersin province. The developed model will contribute to better understanding of epidemiology and control of vector-borne diseases by authorities in the ministry of health.

Phlebotomus halepensis (Diptera: Psychodidae) Vectorial Capacity in Afyon and Nigde Province, Turkey

Abstract Leishmaniasis is a one of the vector-borne diseases and has two clinical forms in Turkey: cutaneous and visceral. The aim of this study was to determine the sand fly fauna in Afyon and Nigde provinces where endemic foci of cutaneous leishmaniasis (CL) in Turkey. In Afyon, 2,259 sand flies were collected in 73 locations in August 2009 and August 2010, using CDC light traps. In total, eight Phlebotomus species were identified; Phlebotomus halepensis (47.41%), Phlebotomus papatasi (31.42%), Phlebotomus neglectus/syriacus (9.38%), Phlebotomus balcanicus (7.48%), Phlebotomus simici (2.12%), Phlebotomus perfiliewi (1.90%), Phlebotomus sergenti (0.08%), Phlebotomus similis (0.13%), and Sergentomyia dentata (0.04%). A total of 418 sand fly specimens were caught by CDC light traps in 40 stations in Nigde in September 2009 and September 2010. In total, seven Phlebotomus species were identified; P. halepensis (74.16%), P. simici (13.87%), P. papatasi (3.82%), P. neglectus/syriacus (2.87%), P. balcanicus (2.63%), P. sergenti (2.39%), and Phlebotomus tobbi (0.23%). Collected sand flies were examined by microscope, and no promastigotes were found in their midguts. We categorized and pooled female specimens (1,031 females, 73 pools of 2–33 individuals). Leishmania species-specific ITS1 real-time PCR assay was performed for detection and identification of parasites. We detected 6 of the 73 pools with Leishmania tropica (Ross, 1903), (Trypanosomatidae). In conclusion, P. halepensis was found to be dominant species in both areas. We are in opinion that our findings support P. halepensis vectorial role for L. tropica in nature and it could be responsible for the transmission of L. tropica in these endemic areas.

Investigation of the spatial distribution of sandfly species and cutaneous leishmaniasis risk factors by using geographical information system technologies in Karaisali district of Adana province, Turkey

Background & objectives: Cutaneous leishmaniasis displays two epidemiological routes of transmission, zoonotic cutaneous leishmaniasis (ZCL) which includes animal reservoir hosts in the transmission cycle and anthroponotic cutaneous leishmaniasis (ACL), where human is the sole source of infection for the vector sandflies. About 10–13% of CL cases are reported each year from Adana province in Turkey. The aim of this study was to develop a predictive model for determining the spatial risk level of cutaneous leishmaniasis in the Adana province, southern part of Turkey, in relation to environmental factors. Methods: Entomological survey was carried out between June 2015 and September 2016. Sandflies were collected from Karaisali district of the Adana province using light-traps and sticky papers. Sandfly fauna results were compared with environmental data obtained from field-survey, and examined with univariate and binary logistic regression in PASW statistical software. The ArcMap application of ArcGIS10.0. software was used for geographical adjustments to create maps and establish a risk model. Results: In total five sandfly species were identified in the study area, and three of them (Phlebotomus tobbi, P. neglectus/syriacus and P. perfiliewi) were detected as potential vectors of cutaneous leishmaniasis. The results showed that enhanced vegetation index (EVI) and emissivity band 31 (EMIS31) values are related to the distribution of these three species. Interpretation & conclusion: The created risk maps may provide useful information to guide the control programme interventions and prevent the economic loses in the future insecticide applications. They could be used to better understand the distribution of vectors, and determine the epidemiology and risk level of the CL.

Geographical Information Systems in Determination of Cutaneous Leishmaniasis Spatial Risk Level Based on Distribution of Vector Species in Imamoglu Province, Adana

Abstract The Imamoglu district located in the southeast of Adana province in Turkey is an endemic focus of cutaneous leishmaniasis (CL) owing to dominancy of Phlebotomus tobbi, which is a probable vector of Leishmania infantum. About 11.26% of CL cases reported each year are from Imamoglu, Adana, and between 2008 and 2015, 223 cases of CL were reported. Leishmania infantum, which may be transmitted by P. tobbi, Phlebotomus neglectus/syriacus, and Phlebotomus perfiliewi, is referred as leishmaniasis factor in Adana. Thus, the aim of this study was to map the risk areas for each sand fly species using remote sensing images based on environmental factors and geographical characteristics. Two field works in two consecutive years (2013 and 2014) were conducted and six sand fly species were caught, four of which were identified as probable vector species. Field work results were compared with environmental data obtained from satellite images by univariate and binary logistic regression in PASW. ARCMAP 10.2 software was used for geographical adjustments, creating a database and estimating a risk model by using previous risk value formulas. The results showed that the distribution of three probable leishmaniasis vectors (P. tobbi, P. neglectus/syriacus, and P. perfiliewi) was associated with normalized difference vegetation index (NDVI), digital elevation model (DEM), night-time land surface temperature (LSTNIGHT), and emissivity (EMIS31) values, which were related to the local authorities, who take these findings into account when deciding on high risk areas for CL.

[The effects of chitin synthesis inhibitor, diflubenzuron on the larvae of Culex pipiens (L.) and Culiseta longiareolata (Macquart) (Diptera: Culicidae)].

OBJECTIVE The aim of the present study was to detect effects of diflubenzuron on Culex pipiens and Culiseta longiareolata larvae, and determine the weekly mortality rate and most effective dose of diflubenzuron during the study. METHODS The lower and higher doses (0.016, 0.032, and 0.064 mg(ai)/cm(2)) than 0.05 mg(ai)/cm(2) which are brecommended for granular formulation of diflubenzuron by WHO (World Health Organization) was applied against 1st, 2nd, 3rd and 4th instars under laboratory conditions and mortality was recorded. RESULTS According to our data, diflubenzuron was more effective against early instars, and it was found most effective in the 4th and 3(th) week post-treatment in the application for Culex pipiens and Culiseta longiareolata larvae respectively. In addition, the most effective dose of diflubenzuron was obtained as 0.064 mg(ai)/cm(2) (LC50 > 4640 ppm, LC90 = 0.0034 ppm). Furthermore Culiseta longiareolata was more sensitive than Culex pipiens larvae. CONCLUSION Knowing the specific mortality rate of diflubenzuron in different mosquitoe species and larvae stages, plays an important role in determining the resistance against diflubenzuron.