Sema Ertug

Intestinal parasites prevalence and related factors in school children, a western city sample-Turkey

BackgroundIntestinal parasitic infections are amongst the most common infections worldwide. Epidemiological research carried out in different countries has shown that the social and economical situation of the individuals is an important cause in the prevalence of intestinal parasites. Previous studies in Turkey revealed a high prevalence of intestinal parasitic infection. The objectives of the current study were to determine the prevalence of intestinal parasitic infections in Aydin among 7–14 years old school children and to identify associated socio-demographic and environmental factors, behavioral habits and also related complaints.MethodsMultistage sampling was used in the selection of the study sample. A questionnaire, cellulose adhesive and a stool specimen examination were done.ResultsA total of 456 stool specimens were collected. 145 students (31.8%) were infected with one or more intestinal parasites. 29 (6.4%) of the students were infected more than one parasite, 26 (5.7%) with two parasites and 3 (0.7%) with three parasites. The three most common were E. vermicularis, G. intestinalis and E. coli. Intestinal parasite prevalence was higher in rural area, in children with less than primary school educated mother, in children who use hands for washing anal area after defecation, and in children who use toilet paper sometimes or never. The relation between child health and mother education is well known. Children were traditionally taught to wash anal area by hand. Toiler paper usage was not common and might be due to low income or just a behavioral habit also. Most of the complaints of the study population were not significantly related with the intestinal parasitic infection.ConclusionsIntestinal parasitic infection is an important public health problem in Aydin, Turkey. Rural residence, mother education less than primary school, sometimes or never usage of toilet paper, and washing anal area by hands after defecation were the significant associations. Interventions including health education on personal hygiene to the students and to the parents, especially to mothers are required. The ratio of uneducated women should be declined with specific programs. A multisectoral approach is needed.

Seroprevalence and risk factors for toxoplasma infection among pregnant women in Aydin province, Turkey.

BackgroundThe aims of the present study were to determine the prevalence of toxoplasmosis in pregnant women at first trimester of their pregnancy and to follow up the seroconversion for next two trimesters, and to identify the risk factors and possible contamination routes in Aydin province, Turkey.MethodThe sample size was calculated as 423 on a prevalence of 50%, d=0.05 at a confidence level of 95% with 10% addition. It was a cross-sectional study with multistage sampling. After a questionnaire applied to the pregnant women, anti-Toxoplasma IgG antibodies were studied with ELISA and IFA, values in conflict with DA test, where IgM antibodies were studied with ELISA and for borderline or positive values of IgM avidity test was used.ResultsThe mean age of 389 (92.9%) of pregnant women in the study was 24.28+/-4.56 years, the seroprevalence of anti-Toxoplasma IgG antibodies for toxoplasmosis was 30.1%. Seroprevalence was increased with age (p=0.001) and with drinking water consumption other than bottled water (p=0.042). No significant relations were observed between anti-Toxoplasma IgG antibodies and education level, being native or migrant, abortion history, consumption of meat, vegetable and milk/milk products, personal or kitchen hygiene habits, cat owning at home of the pregnant women. No IgM antibody was detected.ConclusionOne of every three pregnant women in Aydin was at risk of toxoplasmosis at the first trimester of their pregnancy. Increased seroprevalance with age was a predictable result because of increasing time of exposure. Increased seroprevalence with consumption of municipal and uncontrolled water (well/spring water) supplies was similar with latest epidemiological findings.

Epilepsy and seropositivity rates of Toxocara canis and Toxoplasma gondii

PURPOSE Increased seropositivity for Toxoplasma gondii and Toxocara canis have been observed in epileptic patients. Our aim is to determine whether there is any relationship between these agents and epilepsy in our cryptogenic epilepsy group. MATERIAL AND METHODS We studied specific IgG antibodies against T. gondii and T. canis in 100 cryptogenic epileptic patients and 50 healthy volunteers that had no history of epilepsy in their first degree relatives. We studied T. gondii and T. canis-specific IgG antibody serum levels and compared the values of these two groups. RESULT We found similar T. gondii and T. canis serum IgG antibodies in patients with cryptogenic epilepsy and in the control group, even though the control group included more animal owners. CONCLUSION We did not show any relationships between epilepsy and positive T. gondii and T. canis serology in our epileptic patients.

Acanthamoeba keratitis due to Acanthamoeba genotype T4 in a non-contact-lens wearer in Turkey

An otherwise healthy 22-year-old man presented with Acanthamoeba keratitis (AK) in the right eye. He was not a contact lens wearer and had no history of corneal trauma. The Acanthamoeba strain isolated from a corneal scraping was identified as morphological group II and genotype T4. Three more Acanthamoeba strains isolated from sites of possible human contact with acanthamoebae in the same geographical region, including a lens storage case, tap water and soil, were subjected to morphological and molecular biological identification. Whereas the strain from tap water also exhibited genotype T4, the two other isolates were identified as morphological group I and genotype T9. To the best of our knowledge, this is the first study identifying an AK-causing Acanthamoeba strain in Turkey and the first isolation of genotype T9 in this country.

Prevalence of Demodex folliculorum in young adults: relation with sociodemographic/hygienic factors and acne vulgaris.

474 JEADV 2006, 20, 461–488

Is Blastocystis hominis a new etiologic factor or a coincidence in iron deficiency anemia

Iron deficiency anemia (IDA) is a frequent health problem. Gut parasites such as N. americanus and A. duodenale are known to cause blood loss, but the role of Blastocystis hominis is uncertain. In this study, 212 patients (193 female, 19 male, mean age 41 SD 15 yrs) with IDA were enrolled and 90 persons without IDA (78 female, 12 male, mean age 45 SD 17 yrs). Microscopic examination of stools for B. hominis using the native lugol method was done three times on each subject. If any specimen contained five or more cysts per ×400 field, the person was considered positive. B. hominis was found in 48 out of 212 subjects with IDA (22.6%) and in five of 90 (5.6%) subjects without IDA. This difference is highly statistically significant (P < 0.001). Few subjects had other gut parasites and there was no statistical difference in the ir frequencies between IDA and non‐IDA subjects. Blastocystis hominis may play a role in the development of IDA either on its own or in conjunction with some other agent.

Evaluation of serum cystatin-C in dogs with visceral leishmaniasis

Serum Cystatin C (sCys-C) is one of the most important serum markers of renal function assessment in dogs. The purpose of this study was to determine the sCys-C concentration in dogs with visceral leishmaniasis (VL). In the study, 16 dogs with VL and 10 clinical healty dogs (control) were used. Mean sCys-C concentration of the infected dogs was significantly higher than that of the control group (p < 0.05). Mean serum creatinine concentration was lower and mean blood urea nitrogen, albumin and globulin concentrations were higher in dogs with VL; however, these changes were not statistically significant. Mean total protein and phosphorus concentrations were found to be higher in dogs with VL than healthy dogs (p < 0.05). No significant correlation had been determined between sCys-C and other variables. Visceral leishmaniasis in dogs has increased sCys-C concentration indicating a possible renal impairment; however, further studies are needed to be performed together with renal biopsies in the investigation sCys-C in dogs with VL.

Blastocystis in ulcerative colitis patients: Genetic diversity and analysis of laboratory findings.

OBJECTIVE To determine Blastocystis frequency and subtypes (ST) in ulcerative colitis (UC) patients and analyse some laboratory findings between Blastocystis positive and negative cases. METHODS Faecal samples from 150 UC patients in Adnan Menderes University, Training and Research Hospital were examined by direct microscopy and cultivated in Jones medium. Blastocystis positive cultures were subjected to DNA isolation and subtypes were identified by sequencing of barcode region. A retrospective analysis was conducted on C reactive protein (CRP), leucocyte counts (WBC), neutrophil counts, and sedimentation rates. RESULTS The overall positive rate of Blastocystis was 8% (12 patients) and the most abundant subtype was ST3 (eight isolates, 66.7%), followed by ST1, ST2 and ST7. Laboratory findings between Blastocystis infected and non-infected UC patients were not significantly different. Blastocystis frequency was 3.8% among the patients in active stage, while it was 11.8% among the patients in remission stage. CONCLUSIONS The present study confirms previous findings that have indicated the predominance of Blastocystis ST3 in humans and contributes additional evidence that suggests the low colonisation of Blastocystis infection in ulcerative colitis patients during active stage.

[Research to investigate human cystic echinococcosis with ultrasound and serologic methods and educational studies in different provinces of Aydın/Turkey].

OBJECTIVE Cystic echinococcosis (CE) is particularly prevalent in rural areas where domestic animal breeding is common. We planned to investigate the CE among the 7-88 years old inhabitants of (n=209) four villages in the Aydın district, by a portable ultrasound scanner (US) and with serologic methods. METHODS Participants were assessed by ultrasound and sera samples were tested for anti-E. granulosus antibodies by serological tests (ELISA and IHA). A questionnaire was given to the participants in order to assess their knowledge about the disease. RESULTS Hepatic CE was detected in one case (0.47%) by US, while 24 (11.48%) and 28 (13.39%) cases were found to be seropositive for CE by ELISA and IHA, respectively. With both tests, in 9 participants (4.3%), parasite-specific antibodies were detected. According to questionnaire results, 84.22% of the participants were found to have no knowledge about the disease. Only 15.21% of the dog owners were giving anti-parasite drugs to their dogs. CONCLUSION This study is one of the small number of community-based studies about CE performed in Turkey, in which US was applied. Our results suggest that we need national control programs including a multi-sectorial collaboration to eradicate hydatidosis and effective actions to control cystic echinococcosis.

A new focus for cutaneous leishmaniasis in the West Coast of Turkey.

Cutaneous leishmaniasis (CL) is a massive public health problem in numerous regions of the world and in the recent years the number of cases increased significantly. CL is widespread in most countries in the Mediterranean zone, including Turkey. Most of the CL cases are seen in the south-east and south regions of Turkey. New native CL cases have recently been detected, with increasing number in the more socio-economically developed west part of the Turkey. The study was carried out from January 1996, when the first CL was diagnosed in Aydin, to January 2004. CL is among the diseases to be reported to the Ministry of Health and all patients diagnosed as CL in clinics in Aydin were included in this study. Patients were diagnosed clinically, and the diagnosis was confirmed by laboratory study. Aspirates from the lesions of CL were stained by Giemsa and cultured on the Novy–NicolleMacNeal (NNN) medium. The cultures were incubated at 241C and observed every week for one month. A total of 159 patients were diagnosed as CL: 101 (63.5%) were women and 58 (36.5%) were men. The age ranged between eight months and 81 years. The highest percentage of CL cases (40.9%) occurred in the 1–20-year age group. Ninety-three (58.4%) of the patients were from urban areas of the city. The socio-economic survey revealed that the majority of the patients lived under precarious conditions. There was no educational infrastructure and the level of education was low, with some of the adult patients being illiterate. The first CL case was diagnosed in 1996 and afterwards there was an increase in CL cases attaining maximum in the years 2000–2001 (Figure 1). CL is endemic in many countries, with an at-risk population of millions of people worldwide. CL is also seen in the countries surrounding the Mediterranean Sea, including Turkey. CL is endemic especially in the Southeastern and South Regions of Turkey. Leishmania tropica is the protozoan causing CL in Turkey and Phlebotomus sergenti is the main suspected vector. CL cases have been reported from different cities in Turkey such as Sanliurfa, Adana, Hatay, Antalya, Kayseri, Icel, Kahramanmaras and Nigde, which are located in the middle, east and southern parts of Turkey. Some sporadic cases were reported from the west part of Turkey, but all of the reported cases were visitors from the endemic parts of Turkey. Aydin city is located in the west coast of the Turkey. It is an attractive tourist city with famous beaches and historical background. Every year millions of people visit this city from Turkey and other countries. In comparison with the east part of Turkey, this region is the socio-economically more developed part of Turkey. Thousands of people have immigrated from the east part of Turkey to this region in the last decade. As a result, leishmaniasis may have transported with the immigrants to this region of the country and the first cases started to be seen with increasing numbers after 1996. The most striking thing about most of our patients was that there was no history of any kind of contact with the endemic areas in Turkey. Most of the patients had not left the province of Aydin and they had no visitors from the southeastern and eastern parts of the country, which are known to be endemic areas. Consequently, this region is the first place in west Turkey with its native CL cases. With a suitable climate, Aydin seems to be a new focus for CL in Turkey. As CL has become endemic in this region, this disease should be included in differential diagnosis in returning traveller with symptoms suggesting Leishmaniasis.