Mustafa Aksoy

Pediatric Cutaneous Leishmaniasis in an Endemic Region in Turkey: A Retrospective Analysis of 8786 Cases during 1998-2014.

Background Cutaneous leishmaniasis (CL) is a major public health concern in Turkey and Sanliurfa represents the most endemic city in Turkey. Although children are most commonly affected by CL, detailed studies of pediatric CL in Turkey are lacking. Methodology/Principal Findings In this report we retrospectively evaluated clinical and epidemiological data of 8786 pediatric CL cases, and how children respond to antimonial therapy. CL was observed most frequently in children between 6–10 years old. Interestingly this group showed shorter duration of disease and smaller lesions compared to 0–5 year and 11–15 year old groups. Females were more affected in all groups. Lesion localization and types varied among groups, with 0–5 year old presenting head/neck and mucosal lesions, and more often suffered from recidivans type, this could be associated to the longest duration of the disease in this group. Eleven-15 year old group showed fewer lesions in the head/neck but more generalized lesions. Evaluation of treatment response revealed that intra-lesional treatment was preferred over intramuscular treatment. However, 0–5 year old received intramuscular treatment more often than the other groups. Furthermore, the majority of 0–5 year old group which received intra-lesional treatment did not received subsequent intra-lesional cycles, as did children in the range of 6–15 years old. Conclusions/Significance We report an increase in pediatric CL patients within the last four years. Analysis of pediatric CL patients by age revealed significant differences in CL progression. The data suggest that children between 0–5 years old responded better than other groups to intralesional treatment, since they received more often a single cycle of IL treatment, although follow up observation is required since they were more prone to develop recidivans. Eleven-15 year old patients comprise the largest percentage of patients receiving two or three cycles of intralesional treatment, suggesting that this group did not respond efficiently to intralesional treatment and highlighting the need for more effective therapeutic strategies against CL.

Meglumine antimoniate is more effective than sodium stibogluconate in the treatment of cutaneous leishmaniasis

Abstract Sodium stibogluconate (SSG, Pentostam) and meglumine antimoniate (MA, Glucantime) are two antimonials that are widely used to treat cutaneous leishmaniasis (CL), but the relative efficacies of these treatments are not clear. The aim of this study is to compare the efficacy of intralesional SSG with intralesional MA therapy in the treatment of CL. One month after completion of the therapy, 1431 of 1728 patients (82%) who received intralesional MA showed complete clinical cure compared to 1157 of 1728 patients (67%) in the SSG group. Patients who did not respond to the first round of therapy were re-administered the same treatment but with twice weekly injections. Following completion of the second course of therapy, 237 of 297 patients (80%) in the MA group and 407 of 561 patients (72%) in the SSG group healed their lesions by 1-month post-treatment. At both times, the differences in cure rates between MA and SSG groups were statistically significant (p < 0.05). Cure rates in the MA group were always significantly higher than SSG groups irrespective of other parameters including age, gender, lesion site and type of lesion. Intralesional MA is more effective than intralesional SSG in the treatment of CL.

Lip leishmaniasis: Clinical characteristics of 621 patients.

© 2015 International Journal of Critical Illness and Injury Science | Published by Wolters Kluwer Medknow Dear Editor, Old world leishmaniasis is seen in a wide geographical area including Turkey, as well. The causative agent is generally Leishmaniasis tropica, and the agent is rarely identified to be leishmaniasis major in such patients.[1] Depending on the leishmaniasis type and the person’s immune system, it may be in one of the cutaneous, mucocutaneous leishmaniasis (ML), or visceral leishmaniasis (VL) forms.[2] Mucosal involvement is rarely seen with old world leishmaniasis.[3] ML disease is an important endemic disease and public health problem in undeveloped countries, since it has a significant rate of morbidity and mortality.[4]

[Successful treatment of cutaneous leishmaniasis with amphotericin B; a case of unresponsive to pentavalent antimony therapy].

Cutaneous Leishmaniasis (CL) is a skin infection caused by various species of Leishmania parasites, which is transmitted by infected Phlebotomus sandfly bites. Pentavalent antimonials (meglumine antimoniate and sodium stibogluconate) are used for the treatment of adult CL patients as an effective and safe method. Liposomal amphotericin B is an alternative for the treatment of choice in cutaneous leishmaniasis cases which pentavalan antimony contraindicated or unresponsive to pentavalent antimony therapy. In this study, successful treatment with systemic liposomal amphotericin B of a cutaneous leishmaniasis case developing local side effects related both systemic and intralesional meglumine antimonate treatment was presented.

A Comparison of Demographic and Clinical Characteristics of Syrian and Turkish Patients with Cutaneous Leishmaniasis

Cutaneous leishmaniasis (CL) is a significant public health problem with increasing incidence, especially in extreme circumstances. In this study, we compared the sociodemographic and clinical characteristics of 685 Syrian CL patients afflicted by the Syrian conflict and 685 Turkish CL patients in 2012. Patient age, gender, duration of disease, lesion size, type, and localization were evaluated. The duration of CL disease in Syrian CL patients (4.5 ± 4.3 weeks) was shorter than that of Turkish CL patients (11.9 ± 9.7 weeks). The number of lesions was greater in Syrian patients (2.46 ± 2.43) than in Turkish patients (1.93 ± 1.47). Lesion sizes were comparable between both groups (Syrian, 11.2 ± 8.7 mm; Turkish, 10.7 ± 7.7 mm). In Syrian CL patients, nodular type lesions were the most common (325 patients, 49.1%), whereas, in Turkish CL patients, ulcer type lesions were the most common (352 patients, 51.5%). Our results indicate variations in the clinicoepidemiological features of CL between Turkish and Syrian patients within Sanliurfa province. This highlights the impact of social unrest and environmental conditions on the epidemiology of CL within this region. Approaches to prevention, control, and treatment of CL in these areas should take into consideration the emerging changes in clinicoepidemiological parameters of the disease.

Clinical practice guidelines for the diagnosis and treatment of cutaneous leishmaniasis in Turkey

Cutaneous leishmaniasis (CL) is a vector‐born parasitic disease characterized by various skin lesions that cause disfiguration if healed spontaneously. Although CL has been endemic for many years in the southern regions of Turkey, an increasing incidence in nonendemic regions is being observed due to returning travelers and, more recently, due to Syrian refugees. Thus far, a limited number of national guidelines have been proposed, but no common Turkish consensus has emerged.

Community-Based Assessment to Determine the Seroprevalence of HBsAg, Anti-HBs, Anti-HCV, HIV, and Syphilis for Reproductive-Aged Female Syrian Refugees Living in Sanliurfa, Turkey

Background: Sanliurfa, a city of southeast Turkey hosted to approximately 401,050 Syrian refugees. There are no data about the sexually transmitted infections (STI) of Syrian refugees in literature. Hence, it was aimed to determine the seroprevalence of hepatitis B surface antigens (HBsAg), hepatitis B surface antibodies (anti-HBs), hepatitis C virus antibodies (anti-HCV), human immunodeficiency virus (HIV), and syphilis. Methods: A multi-purpose cross sectional study was conducted between April and May 2015 in different districts of Sanliurfa. This study was supported by United Nations Population Fund with the project titled “Determination of General Health Status and Reproductive Health Problems in Syrian Immigrants”. The sample size was calculated as 460 houses by the probability cluster sampling method. A married Syrian woman was chosen in each house, thus study was successfully carried out in 458 houses. Data included socio-demographic variables; the symptoms of vaginal purulent discharge, bleeding, abdominal pain, and dysuria were collected from each participant. Eight mL of venous blood samples were collected from participants. Sera were analyzed for HBsAg, anti-HBs, anti-HCV, HIV, syphilis. Results: The mean age of the total participants was 30.0 ± 8.9 years. The households of the family ranged from 2 27; the mean household size was 9.9 ± 4.9 persons. The seroprevalence rates of the HB sAg, anti-HBs, anti-HCV seropositivity were 4.1%, 17.7%, 0.4%, respectively. No one had neither HIV nor syphilis antibodies. Conclusions: Screening should be provided for STI for female refugees and they should be educated about the increasing awareness, transmission, control, prevention of STIs, blood-borne diseases.

Lumbosacral region herpes zoster case in healthy child

Herpes zoster (HZ), su çiçeği veya primer varisella infeksiyonu sonrasında varisella zoster virüs (VZV)’ün latent kaldığı dorsal ganglionun inerve ettiği dermatom alanında görülen eritemli alanda veziküler lezyonlarla seyreden, çoğunlukla ağrı ve kaşıntının eşlik ettiği akut bir cilt infeksiyondur (1). HZ’li hastalarda postherpetik nevralji, miyelit, kranial sinir felci ve vaskülopati gibi çeşitli nörolojik komplikasyonlar gelişebilir (2). Ağrı, kaşıntı ve komplikasyonlar yaşam kalitesinde ve hatta fonksiyonel yetersizliğe bile neden olabilir. Çocukluk çağında klinik olarak daha iyi seyirli olan HZ’de nadiren komplikasyon gelişmektedir. Erişkin yaşlarda daha çok görülen HZ, 10 yaşından küçük sağlıklı çocuklarda ise daha seyrek görülmektedir (3). Otoimmün hastalıklar, astım, diyabet, biyolojik tedaviler veya immünsupresifler, kanser veya bağışıklık yetmezlik virüsü enfeksiyonu gibi altta yatan bozukluklardan ve tedavilerden birine sahip olan hastalarda HZ gelişme riski yüksektir (4). Bu çalışmamızda 4 yaşında risk faktörü olmayan, sağlıklı erkek hasta sunulmuştur.

Quality of life in patients with melasma in Turkish women

The aim of this study was to determine the impact of melasma on quality of life (QoL) using the dermatology life quality index (DLQI) questionnaire in a group of outpatients. This study is questionnairebased. A total of 101 Turkish women suffering from melasma, who themselves were able to understand and complete the Turkish version of the DLQI questionnaire, were enrolled. This questionnaire included 10 questions; each of each was scored on a scale of 0-3, with a maximum score of 30. The data were analyzed after the results had been collated and the higher the DLQI score, the poorer the QoL. The participants’ mean age was 29.53±6.87 years, and mean DLQI score was 6.02±4.94. When we divided the participants into two subgroups according to age, the DLQI scores for younger and older individuals were 7.44±4.99 and 4.33±4.36, respectively (P=0.001). When the melasma area and severity index (MASI) score was used, participants with mild and moderate disease had mean DLQI scores of 5.80±4.72 and 7.11±5.90, respectively. No patient had severe disease. Melasma might affect the participants’ QoL, especially that of the younger individuals, in our study population.

A Case Of Bilateral Acquired Localized Lipoatrophy.

Lipoatrophy is characterized by inflammation and tissue loss in fatty tissue. This disease may be congenital or acquired, primary or secondary. Secondary lipoatrophy develops with infections, collagen tissue diseases, tumors and drug injections. In this report, we present the case of a 14-year-old female patient who developed lipoatrophy following intramuscular steroid injection to both buttocks.