Nebiye Yentür Doni

Limited polymorphism of the Plasmodium vivax merozoite surface protein 1 gene in isolates from Turkey.

The 200-kD merozoite surface protein of Plasmodium vivax (PvMSP-1) is one of the leading vaccine candidates against P. vivax malaria. However, the gene encoding PvMSP-1 (pvmsp1) is highly polymorphic and is a major obstacle to effective vaccine development. To further understand polymorphism in pvmsp1, we obtained 30 full-length pvmsp1 sequences from southeastern Turkey. Comparative analysis of sequences from Turkey and other areas showed substantially limited polymorphism. Substitutions were found at 280 and 162 amino acid sites in samples from other regions and those from Turkey, respectively. Eight substitutions were unique to Turkey. In one of them, D/E at position 1706 in the C-terminal 19-kD region, the K/E change at 1709 was the only polymorphism previously known. Limited diversity was also observed in microsatellites. Data suggest a recent population bottleneck in Turkey that may have obscured a signature for balancing selection in the C-terminal 42-kD region, which was otherwise detectable in other areas.

A Community-Based Survey on Syrian Refugee Women’s Health and Its Predictors in Şanliurfa, Turkey

ABSTRACT Reproductive characteristics, mental health symptoms, micronutrient deficiencies, and symptoms of sexually transmitted infections (STIs) were determined among married Syrian refugee women aged 15–49 years who were living outside of camps in 2015, using probability sampling. Of the 458 participants, 51.3 percent married before the age of 18 years. Early-age marriages and number of desired children increased after the war. In multivariable analyses, education (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.2–1.3) and length of stay in Şanlıurfa (aOR = 1.2; 95% CI = 1.1–1.2) were independently associated with early marriage. Approximately 16 percent of women were pregnant, and 26.7 percent of them had not received prenatal care; 47.7 percent had had a pregnancy loss; 50.8 percent reported symptoms of STIs. Of those who were sexually active, 37.8 percent were not using contraception. The prevalence of iron, B12, and folic acid deficiencies was 50 percent, 45.6 percent, and 10.5 percent, respectively. Early marriage (aOR = 2.2; 95% CI = 1.4–3.5) and number of desired children (aOR = 5.03; 95% CI = 3.2–7.9) were associated with not using contraception. Most (89.7 percent) women reported at least two mental health symptoms; lack of social support (aOR = 2.6; 95% CI = 1.3–5.3), language barrier (aOR = 2.3; 95% CI = 1.01–5.2), and B12 deficiency (aOR = 1.8; 95% CI = 1.01–3.4) were associated with such symptoms. The findings demonstrate the need for reproductive health and psychosocial services.

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.

Prevalence and associated risk factors of Toxoplasma gondii in female farmworkers of southeastern Turkey

INTRODUCTION There are a limited number of studies of the agricultural population about the prevalence of Toxoplasma gondii (T. gondii) infection throughout the world. The aim of this study was to determine the prevalence and risk factors of toxoplasmosis in female farmworkers in the southeastern region of Turkey. METHODOLOGY The optimum sample size was determined using the Epi Info Program, and blood samples were collected from 684 women of reproductive age. Serum samples were analyzed by qualitative and quantitative methods for anti-T. gondii IgG and IgM antibodies with a commercially available enzyme immunoassay. Questionnaires through which socio-demographic information was collected were applied during face-to-face interviews of subjects who gave their consent to participate in the study. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and Chi-square analyses and logistic regression were performed. RESULTS Of the 684 women, the prevalence of toxoplasmosis was determined to be 58.3% and 1% for IgG and IgM, respectively. Employment as a seasonal farmworker, increasing age, and having had three or more pregnancies were found to be the crucial associated risk factors that affect the prevalence of T. gondii infection (p < 0.05). In contrast to these, the provincial development level was found to be a confounding factor. There was no association between toxoplasmosis and household size, education attainment, and poverty in the bivariate analyses. CONCLUSIONS The findings show that control and serological screening programs should be implemented nationwide in Turkey for the reliable and fast detection of congenital Toxoplasma infections.

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.

Epidemiology of Hepatitis B in the Reproductive-Age Female Farmworkers of Southeastern Turkey

Background: There are limited data on the prevalence of the hepatitis B virus (HBV) infection in the agricultural population worldwide. Objectives: This study aimed to determine the prevalence of HBV infection and associated risk factors in the reproductive-age female farmworker. Materials and Methods: This cross-sectional study was conducted between January and April 2013 in southeastern region (SAR) of Turkey. A community-based representative agricultural sample (n = 705) from the agricultural areas of nine provinces of SAR was randomly determined by clustering method using Epi Info software. Questionnaires including demographic information and risk factors of HBV were administered to participants. The presence of HBsAg, anti-HBs, anti-HBc, and anti-HBe antibodies in blood samples were measured by ELISA. Results: The prevalence of the HBsAg, anti-HBs, anti-HBc, anti-HBe antibodies, and seropositivity were 5.7%, 25.9%, 28.9%, 16.4%, and 36.7%, respectively. There was no association between the HBsAg and the size of the household, age, education level, parity, and place of birth while the prevalence of HBsAg was higher in seasonal migratory farmworkers and people living in urban areas and the prevalence of anti-HBs antibody was significantly higher in women ≥ 35 years of age, those with a high parity, and those who gave birth without the assistance of health professionals (P < 0.05). The risk for HBV infection in the seasonal migratory group was 4.3 times higher in comparison to local workers (P = 0.00; OR = 4.3; 95% CI, 2.2-8.4), with a prevalence rate of 11%. Conclusions: The monitoring of at-risk groups like seasonal migratory farmworkers is necessary to strengthen the healthcare service provided to this population.

Comparison of direct microcopy and antigen casette tests for the detection of Giardia and Cryptosporidium

OBJECTIVE The aim of this study was to compare the direct microscopy used for detection of intestinal parasites with antigen casette tests used in diagnosis of giardiasis and crypyosporidiasis. METHODS Forty-six children who lived in the Şanlıurfa Orphanage were enrolled in this study. The stool specimens were taken in the morning and examined by using native-lugol, modified formalin-ethylacetate concentration methods and cellophane tape method on the same day at the Microbiology laboratory of Harran University. Also Kinyoun-acid fast stained preparations were used for the detection of Cryptosporidium. R-biopharm Cryptosporidium/Giardia casette antigen test was used for the determinaton of giardiasis and crytosporidiasis. RESULTS The mean age of the children enrolled in this study was 8.61±3.45 and the distribution of gender was 24 female (52.2%), 22 male (47.8%), respectively. According to stool examinations, 9 of 46 examples (19.60%) were determined as Giardia intestinalis, Cryptosporidium spp. had never been found. The result of the antigen screening casette test showed 9 of 46 samples (19.60%) were positive for G. intestinalis. Also Cryptosporidium spp. had never been found by the antigen casette test. CONCLUSION When we compared the results of the direct microscopy and antigen casette tests, we found no significant difference between them for test reliability (p > 0.05). Antigen tests have higher sensitivity (100%) and specifity (100%) than the modified acid-fast staining technique, therefore, it is a preferred reference method . However, an experienced staff working accurately might access the same conclusion. Considering the cost of antigen tests, direct microscopic examination is cheaper, andeasier when it used by an experienced person.

Determination of Imported Malaria Cases in Hatay by the Use of Molecular Methods

Malaria, being among the most important diseases throughout history, is still an important public health problem among parasitic diseases due to increasing population movements with various reasons such as migration, war and travel. According to WHO data each year 300-350 million people get exposed to malaria, each year 1.5-2.7 million people die from malaria and also 40% of the worlds population is still at risk for this disease. According to World Health Organisation (WHO) data, imported cases were not reported since 2013 in our country. However among imported cases Plasmodium falciparum malaria can be observed. The aim of this study wasto draw attention to the imported malaria cases increasing gradually and to the importance of the chemoprophylaxis in terms of malaria before travelling. In the study, male patients who have admitted to Hatay Province Malaria Center or Mustafa Kemal University Infectious Disease Department, ages between 25-60 years, were analyzed. All of the patients have worked abroad before. Patients were mostly from Sudan but there were also patients from endemic regions such as Africa, Nigeria, Pakistan, Mali island. The cases were evaluated according to age, gender and whether they had travel stories in Turkey or abroad. Blood samples taken from the patients were firstly prepared by thin and thick smear preparations and examined microscopically by staining with Giemsa stain method. Samples that were found positive by microscopic examination were impregnated on drying papers and genotyped using nested-PCR. Out of the 30 samples from patients who had traveled to endemic countries before, determined as positive by microscopical examination and genotyped by nested-PCR, 16 of them were identified as P.falciparum, six of them as P.vivax and eight of them as P.falciparum/P.vivax. The study suggested that malaria prophylaxis has to be applied before travelling to endemic countries, in return imported malaria has to be considered one of the first diseases in mind and people who will travel should be informed about this disease before travel.

Molecular identification of Leishmania spp. isolates causes cutaneous leishmaniasis (CL) in Sanliurfa Province, Turkey, where CL is highly endemic

Cutaneous leishmaniasis (CL) is an important public health problem in Turkey. CL has been most frequently seen in Sanliurfa. There is an expectation of increase in the population of leishmaniasis cases with the influence of Syrian refugees arriving in Turkey. In this study we aimed to diagnosis of CL and identifying of parasite from Leishmania isolates by using ITS 1 PCR RFLP. Samples were collected from 135 CL patients in Sanliurfa. After the specimens were inoculated in medium NNN, the ones which were cultures positive were cultivated in RPMI 1640 followed by PCR-RFLP. Genomic DNA was extracted phenol-chloroform procedure. Samples were examined by using ITS 1 PCR followed by RFLP analysis. Our results indicated that two species, L. tropica (132 samples) and L. major (3 samples), are responsible for cutaneous leishmaniasis in Sanlıurfa. Our study is the first scientific study in which it is reported molecular analyses of cutaneous leishmaniasis cases caused by L. major in Sanliurfa in Southestern Anatolia Region. Because CL cases caused by L.major are detected in our study, it is considered that genotyping is important for diagnosis of Leishmania and following change of epidemiology.

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.