S Ozensoy

Leishmaniasis in Turkey

Leishmaniases are widespread in most countries in the Mediterranean basin, including Turkey. Two forms are observed in Turkey; Leishmania infantum is responsible from visceral leishmaniasis (VL), and L. tropica causes cutaneous leishmaniasis (CL). Phlebotomus sergenti, P. papatasi, P. major and P. syriacus are considered to be the probable vectors, and dogs are the main reservoir of L. infantum, while P. sergenti is the main suspected vector of L. tropica.VL is sporadically seen mainly in the Aegean, Mediterranean, and Central Anatolia Regions, but CL is endemic, especially in the Southeastern and Mediterranean Regions. Major touristic sites are free of both infections, and no infection is reported in any tourist. Mean number of annual VL and CL cases reported to Ministry of Health are 40 and 1,204, respectively, in the last four years. These data suggest that both VL and CL represent a public health problem in Turkey, but a decline is observed in the number of cases with both infections in recent years.

Detection of species-specific antibody response of humans and mice bitten by sand flies.

Sand fly saliva plays an important role in Leishmania transmission. We characterized the host antibody response to saliva from 3 sand fly species. Specific IgG was observed in sera from experimentally bitten mice as well as in sera from individuals living in the endemic area of Leishmania tropica in Sanliurfa, Turkey. Sera of Sanliurfa inhabitants showed high IgG levels against saliva of Phlebotomus sergenti and P. papatasi, the 2 most abundant sand fly species in this area, but did not react with saliva of the New World sand fly, Lutzomyia longipalpis. Patients with active Le. tropica lesions possessed significantly higher anti-P. sergenti IgG levels than the healthy individuals from the same place while anti-P. papatasi IgG levels were equal in both groups. Major protein bands in P. papatasi and P. sergenti saliva reacted with both, human and mice sera; in P. papatasi, however, mouse IgG recognized preferentially the 42 kDa protein band while the human IgG reacted strongly with the 30 kDa band. Our data suggest that the antibody response to sand fly saliva could be used for monitoring the exposure of humans and other hosts to sand flies and might be used as a marker of risks for Leishmania transmission in endemic areas.

Epidemiology, diagnosis and control of leishmaniasis in the Mediterranean region.

The leishmaniases are a widespread and medically important group of parasitic diseases, some of which pose a serious health threat in communities throughout the Mediterranean basin. In 1993, a joint, collaborative study of the Mediterranean leishmaniases was initiated by scientists from Israel, Turkey, Portugal and the Netherlands. The aim of this project was the development of a multi-component approach to the successful control of all forms of leishmaniasis, with special emphasis on the more severe, visceral leishmaniasis (VL). The need for highly sensitive and accurate new tools to facilitate diagnosis and epidemiological surveys of endemic areas and for studies on the immunology of VL in laboratory models (dogs and mice) was soon recognized. It is anticipated that the development of these tools and the associated technology will provide a better understanding of the disease and improve its control.

Development of a fast agglutination screening test (FAST) for the detection of anti-Leishmania antibodies in dogs

A fast agglutination screening test (FAST) for the detection of anti-Leishmania antibodies in serum samples from dogs with visceral leishmaniosis was developed. The test is based on the direct agglutination test (DAT), but combines a higher parasite concentration with a smaller test volume. In contrast to the DAT, the FAST makes use of only one serum dilution and the results can be read within 3 h as opposed to 18-20 h for the DAT. The FAST was evaluated using serum samples of confirmed cases of the disease and healthy controls collected in the most important endemic regions of canine visceral leishmaniosis, import cases of canine leishmaniosis in a non-endemic country, from non-endemic healthy controls and from dogs with other diseases. The performance of the FAST was compared with standard DAT. In the present study, the FAST had a sensitivity of 93.6% and a specificity of 89.0%. The DAT had a sensitivity of 88.6% and a specificity of 96.7%. Furthermore, using a large panel of serum samples of previously examined DAT positive or negative dogs it was shown that degree of agreement between the two tests was high (95.7%; kappa value = 0.91). The FAST offers the advantages of the DAT based on freeze-dried antigen with respect to stability of the antigen, sensitivity and specificity. Moreover, the FAST allows the rapid screening of a large number of samples, which makes the test very useful for epidemiological screening of large populations of dogs.

A survey on canine leishmaniasis in western Turkey by parasite, DNA and antibody detection assays.

Human visceral leishmaniasis (VL) caused by Leishmania infantum is found throughout the Mediterranean Region, including Turkey, where dogs are considered to be the main reservoir host for this parasite. In the district of Manisa, western Turkey, 37 human VL cases were reported from June 1993-August 1997. Twenty-four villages in this district were chosen for a survey of disease prevalence in dogs. The dogs, 490 in total, were examined using either the indirect immunofluoresence assay (IFAT) or direct agglutination test (DAT). Anti-Leishmania antibodies were found by at least one test in 5.3% (26/490) of the dogs. Infections were confirmed by parasitological examination of or polymerase chain reaction (PCR) on lymph node aspirates in 65% (13/20) and 76.4% (13/17) of the seropositive dogs tested, respectively. The confirmation rate was 85% by combining the results of PCR and microscopy. Our results demonstrate that canine VL is wide spread in western Turkey where human VL is endemic, and that serodiagnosis is a valuable tool for monitoring the infection.

Serum and hair levels of zinc and other elements in dogs with visceral leishmaniasis

The aim of this study was to determine the zinc, iron, copper, calcium, phosphorus, and magnesium levels in blood serum and zinc and copper levels in hair of dogs with canine visceral leishmaniasis. The serum zinc and iron levels were found to be significantly lower in diseased dogs than those of healthy controls. Serum copper levels were significantly higher, whereas no significant differences were observed for calcium, phosphorus, and magnesium. There were no significant differences in the zinc and copper levels in hair. Our results show that the serum zinc, iron, and copper levels are altered in canine leishmaniasis.

Seroprevalence of Canine Leishmaniasis in Northern Cyprus

OBJECTIVE Canine leishmaniasis (CanL) is an important public and veterinary health problem in Mediterranean Basin countries. In this study, we aimed to determine the seroprevalence of CanL in several provinces of Northern Cyprus. METHODS The seroprevalence of CanL was determined by the indirect fluorescent antibody (IFA) test in dog sera. In total, 281 dogs were randomly selected from Nicosia (n=80), Trikomo (n=58), Famagusta (n=60), Morphou (n=30), and Kyrenia (n=53), consistent with a statistically representative number of the regional dog population. RESULTS Ten (3.55%) out of 281 dogs were found to be seropositive by the IFA test. CanL seropositivity differed between cities as follows: 1.72% (1/58) in Trikomo, 13.20% (7/53) in Kyrenia, 1.67% (1/60) in Famagusta, and 3.33% (1/30) in Morphou. No seropositive dog was found in Nicosia. The symptoms in 37 out of 281 dogs were generalized lymphadenopathy, weight loss, alopecia, exfoliative dermatitis, and epistaxis. Four out of 10 seropositive dogs showed at least one clinical symptom that could be related with CanL. CONCLUSION CanL seroprevalence was found to be 3.55% (10/281) in Northern Cyprus. Seropositive dogs, in particular, had lived in areas that exhibited rural as well as urban characteristics.