OBJECTIVE:Fresh vegetables are an important part of a healthy and nutrient-rich diet but the consumption of raw vegetables without proper washing is the main way for transmission of parasites. This study was aimed at determining the rate of parasitic contamination in prewashed fresh vegetables sold at randomly selected 10 retail markets which is the last step to reach the consumer in İzmir, Türkiye.METHODS:A total of 80 samples selected from eight types of vegetables including tomato, spinach, lettuce, rocket, mint, parsley, dill, and cucumber were examined for parasitic agents microscopically by sedimentation method after washing samples with normal saline. Statistical analysis was performed using SPSS software version 20.0.RESULTS:Protozoan cysts, helminth eggs, and larvae were detected in 21 (26.2%) of 80 samples from eight different vegetable species. Rhabditidiform larvae 18.7%, Blastocystis spp. 5%, Toxocara spp. 2.5%; Ascaris spp., Fasciola spp., Entamoeba histolytica/ Entamoeba dispar and hooked worms were found in 1.2%. Spinach and mint samples were contaminated with parasites significantly more than other fresh vegetable samples (p<0.008, odds ratio =80.0; p<0.017, odds ratio =46.6 respectively). Cruznema spp., a plant nematode, was found at the highest rate according to the results of culture, polymerase chain reaction and sequencing, respectively.CONCLUSION:In this study, the parasitic contamination was found in approximately one of the four vegetables sold in randomly selected markets in İzmir. These findings show that vegetables sold in local markets can cause parasitic infections if they are consumed without adequate washing and awareness should be raised on this issue. In addition, it was concluded that morphological examinations should be confirmed by molecular studies and sequencing as much as possible in order to avoid misdiagnosis of rhabditidiform larvae.

PURPOSE:Blastocystis sp. is one of the most prevalent intestinal protozoa found in humans and many other animals. The present study aimed to examine the distribution and genetic diversity of Blastocystis sp. in stool samples from patients with gastrointestinal complaints in İzmir, Turkey.METHODS:All stool samples of 439 patients with gastrointestinal complaints were examined by native-Lugol and trichrome staining. To investigate the presence of Blastocystis sp. in stool samples, DNA was isolated, and PCR was performed with the barcode region in the SSU rRNA gene. PCR positive samples were sequenced to identify subtypes and alleles of Blastocystis sp.RESULTS:The prevalence of Blastocystis sp. was found to be 16.6% (73/439) in patients with gastrointestinal complaints in İzmir, Turkey. Three different Blastocystis sp. subtypes were identified. ST3 (28/55; 51.0%) was the most common subtype followed by ST2 (19/55; 34.5%) and ST1 (8/55; 14.5%). Itching and diarrhea were the most prominent clinical symptoms in Blastocystis sp. positive patients. When clinical symptoms and subtypes were compared, diarrhea was found in 62.5%, 47.4%, and 46.4% of patients with ST1, ST2, and ST3 subtypes, respectively. In addition, itching was found in 37.5%, 32.1%, and 21.1% of patients with ST1, ST3, and ST2, respectively. Six distinct alleles were identified by allele analysis of Blastocystis 18S rRNA gene: allele 4 for ST1, alleles 9, 11, and 12 for ST2, and alleles 34 and 36 for ST3. In this study, Blastocystis sp. was detected in 16 of 21 districts, including the central and rural districts of İzmir. Although ST1 was detected in central districts, it was not found in rural districts.CONCLUSION:This study provides comprehensive data on the prevalence and molecular epidemiology of the genetic diversity at the level of subtypes and alleles of Blastocystis sp. in different districts of İzmir province in Turkey. To the best of our knowledge, this is the first study which evaluates the distribution of subtypes and alleles of Blastocystis sp. according to PCR and SSU rRNA gene sequencing in patients with gastrointestinal complaints in different districts of İzmir province in Turkey.

Purpose The primary aim of this study is to investigate Acanthamoeba in clinical samples of keratitis cases (n = 60), in contact lens (CL) and lens care solutions of asymptomatic CL users (n = 41), and to identify the genotypes in positive samples. The secondary aim is to assess the risk factors and clinical features of Acanthamoeba keratitis (AK) patients. Methods All samples from patients and asymptomatic CL users were examined by microscopy and inoculated in non-nutrient agar plates. PCR was performed using the DNA isolated from corneal scrapings, CL and lens care solution samples. Positive DNA samples were sequenced to determine the genotype of Acanthamoeba. Results In none of the samples, Acanthamoeba was identified by microscopy, while Acanthamoeba was detected in a patient with keratitis by culture method. However, Acanthamoeba was detected in 11.66% (7/60) of the keratitis patients by PCR. The genotypes of these isolates detected by sequencing were T4 (4), and T5 (3). Acanthamoeba was detected in none of the samples of asymptomatic CL users by any of the three methods. Conclusion To best of our knowledge, this is the first study to detect T5 genotype in AK patients from Turkey. In addition, the CL use was found to be an important risk factor for AK.

Dermatological cases caused by myiasis make up approximately 20% of travel diseases. Ocular involvement occurred in approximately 5% of these myiasis cases. The conjunctival involvement of Oestrus ovis (O. ovis) larvae, which is the active agent in most ocular infestation cases in humans, causes external ophthalmomyiasis. External ophthalmomyiasis was diagnosed because of O. ovis first-stage larvae that were removed from the conjunctiva of three patients who applied to the Şırnak State Hospital Eye Clinic with complaints of foreign body sensation, burning, stinging, watering, and redness in the eyes and swelling of the eyelids in July and October. All symptoms of the patients disappeared within a few days after the removal of the larvae. Ophthalmomyiasis due to O. ovis must be kept in mind in the differential diagnosis of patients presenting with similar eye complaints in areas where sheep and goat husbandry is performed intensely.

PURPOSE:This study was aimed to investigate the presence of pathogenic free-living amoebae (FLA) in suspected cases of meningoencephalitis with unknown causes of death in Turkey.METHOD:A total of 92 patients, who were diagnosed as meningoencephalitis, were enrolled. All cerebrospinal fluid (CSF) samples were directly microscopically examined and cultured. Acanthamoeba, N. fowleri and B. mandrillaris were further investigated using molecular diagnostic tools including real-time PCR, sequencing, and phylogenetic analyses.RESULTS:The examined CSF samples were not found positive for the presence of FLA by microscopic examination and culture method. However, two CSF samples were detected positive by real-time PCR assay. Of the positive CSF samples, one was identified as Acanthamoeba genotype T4 and the second positive sample was identified as N. fowleri belonging to genotype II. Furthermore, the pathogens diagnoses was verified through Sanger sequencing.CONCLUSION:This study was significant to report the presence of Acanthamoeba genotype T4 and N. fowleri genotype II in CSF samples by real-time PCR assay. The present study shows the significance of primary amoebic meningoencephalitis (PAM) and granulomatous amoebic encephalitis (GAE) as one of the differential diagnoses to be considered by clinicians during the evaluation of suspected meningoencephalitis or cases of unknown cause in Turkey. Using real-time PCR, this has made the rapid detection, in a short time-frame, of Acanthamoeba and N. fowleri in CSF samples from patients. The problems with qPCR is that it is not available in every laboratory, reagents are expensive, and it requires skilled and expert personnel to set up these assays.

Toxoplasma gondii is an obligate intracellular parasite that infects all animals, including humans, and causes toxoplasmosis. If toxoplasmosis occurs during pregnancy, it may affect the foetus owing to transplacental transmission. Such transmission may lead to foetal complications, some of which can be very serious, e.g. hydrocephaly and chorioretinitis; however, not all cases of acute toxoplasmosis during pregnancy result in foetal complications. The decision whether to continue or terminate the pregnancy is a difficult problem for families as well as healthcare professionals, thus making it important. Here we present a case of acute toxoplasmosis at 6 weeks of pregnancy. The patient was directly advised to terminate the pregnancy. However, with detailed laboratory analyses, close follow-up and treatment to prevent transplacental transmission, she successfully completed the pregnancy and eventually delivered a healthy baby. By presenting this case, we aimed to review acute toxoplasmosis during pregnancy.

Backround: The aim of this study was to reveal the prevalence of toxocariasis in patients with eosinophilia using Western blotting, and to show the importance of eosinophilia for toxocariasis. Materials and Methods: For this aim, 122 individuals, of whom 37 was without eosinophilia, were included to the study and in their serum sample, presence of IgG against Toxocara canis was investigated by Western blotting. Patients with eosinophilia were divided into two groups. In the first group (n=52), eosinophilic cells constitute 3% to 10% of total white cells (<10% ) whereas in the second group (n: 33) eosinophilic cells constitute greater than or equal to 10% of total white cells ( ≥ 10%) . In addition, the cut-off value of the control group (n=37) for eosinophilia was ≤3% of total white cells. Results: According to the results that obtained from the study, 62.3% (n=76/122) of all patients (including healthy people) were found seropositive. Also, 97% of (n=32/33) patient serum samples with ≥10 eosinophilia and 46.1% (n=24/52) of patient serum samples with <10% eosinophilia were found to be positive when patients were categorized depending on eosinophilia levels. Among control group serum samples with ≤3% eosinophilia (n=37), 54% of them were detected to be positive. Conclusion: Accordingly, the seropositivity rate detected in patients with at least 10% eosinophilia was statistically significant when compared with the other groups ( P<0.05 ). Seropositivity values detected in patients with eosinophilia are notable. Therefore, physicians should keep Toxocara spp. infection in mind in patients with eosinophilia.

BackgroundDientamoeba fragilis is a protozoan parasite of the human gastrointestinal tract and still controversial in association with gastrointestinal symptoms.PurposeWe present cross-sectional study of the prevalence of D. fragilis, and sociodemographic and clinical features in the patients with gastrointestinal symptoms.MethodsA total of 490 fecal specimens were collected from outpatients with gastrointestinal symptoms in the Department of Parasitology, Faculty of Medicine, Ege University and Celal Bayar University, Turkey. Fecal specimens were examined with microscopy and inoculated in Robinson medium. D. fragilis-positive samples were examined for the presence of other intestinal parasites using enzyme immunoassay. Real-time PCR analysis was performed on all samples.ResultsOf the 490 stool specimens examined by real-time PCR, 59 patients were positive for D. fragilis infection with prevalence rate of 12.04%. Forty-four of positive patients (74.5%) were found to be infected with only D. fragilis, while 23.7% were co-infected with Blastocystis and 1.7% were co-infected with Rotavirus. No statistically significant difference was found in all the examined patients in terms of D. fragilis positivity for all sociodemographic parameters. Loose stool consistency was associated with the presence of D. fragilis, with 18.3% (P=0.001). When the clinical symptoms of all the patients participating in this study were examined, diarrhea was statistically more significant in patients with the presence of D. fragilis (16.3%; P=0.001). The rate of diarrhea in D. fragilis-positive patients (84.09%; P=0.0005) was higher than that of D. fragilis-negative patients and it was statistically significant.ConclusionThis study is important for assessing the prevalence of D. fragilis and its association with other factors in symptomatic patients in a large sample group in Turkey, as well as investigating the relationship of identified symptoms with the D. fragilis pathogenicity. It is suggested that D. fragilis in this case is not a commensal parasite but a pathogenic parasite and that the most common clinical symptom is diarrhea.

Objective: We aimed to describe the clinical, laboratory, and radiological characteristics of visceral leishmaniasis (VL) in our region to find additional clues that can help diagnosis. Materials and Methods:All the patients with VL who admitted to our clinic between January 2010 and January 2018 were reviewed retrospectively.The patients with symptoms and signs suggestive of VL and a positive indirect fluorescent antibody test (IFA) or rapid diagnostic test, and/or direct parasitology consisting of the presence of amastigotes of Leishmania in bone marrow aspirate were included in the study.We collected the demographic and clinical features, laboratory, and radiological information from the hospital database. Results:We present ten (seven males and three females) cases of VL, with the mean age of 53 (range of 31-75).Serological tests such as IFA or rapid diagnostic tests were positive in all patients.Amastigotes of Leishmania were present in only three of eight patients who underwent bone marrow biopsy.Abdominal magnetic resonance imaging or computed tomography revealed that all patients (10/10) had splenomegaly, eight of 10 patients had hepatomegaly, and seven patients had intraabdominal lymphadenopathy.Seven patients had multiple hypodense nodular lesions in the spleen with homogeneous parenchyma.Two patients had nodular lesions in the liver.Two patients died because of multiorgan failure before completing their treatment.The remaining patients completed liposomal amphotericin B treatment and cured. Conclusion:VL should be suspected in the diagnosis of the patients, who had long-term fever, splenomegaly, pancytopenia associated with multiple nodular lesions in the spleen with/without liver involvement.

Brucellosis and fascioliasis are zoonoses which induce different type of cell-mediated immune responses and rarely cause hepatitis with together. Brucellosis induces T helper type 1 (Th1) immune response whereas Fasciola hepatica induces T helper type 2 (Th2) immune. It may be speculated that chronic fascioliasis can predispose to brucellosis by suppression of Th1 response against brucellosis. In this paper, we present a patient who was diagnosed with brucellosis as well as chronic fasciolasis on the basis of parasite that was seen incidentally during the abdomen ultrasonography. To our knowledge, this case is one of the few cases in the literature that showing the co-infection of the liver by both fascioliasis and brucellosis.

Toxocariasis caused by Toxocara canis or less frequently by T.catis is a common parasitic infection worldwide. Clinical spectrum in humans can vary from asymptomatic infection to serious organ disfunction depending on the load of parasite, migration target of the larva and the inflammatory response of the host. Transverse myelitis (TM) due to toxocariasis is an uncommon illness identified mainly as case reports in literature. In this report, a case of TM who was diagnosed as neurotoxocariasis by serological findings has been presented. A 44-year-old male patient complained with backache was diagnosed as TM in a medical center in which he has admitted two years ago, and treated with pregabalin and nonsteroidal drugs for six months. Because of the progression of the lesions he readmitted to another center and treated with high dose steroid therapy for three months. After six months of follow up, improvement has been achieved, however, since his symptoms reccurred in the following year he was admitted to our hospital. Magnetic resonance imaging (MRI) examination revealed a TM in a lower segment of spinal cord. He was suffering with weakness and numbness in the left lower extremity. There was no history of rural life or contact with cats or dogs in his anamnesis. Physical examination revealed normal cranial nerve functions, sensory and motor functions. There has been no pathological reflexes, and deep tendon reflexes were also normal. Laboratory findings yielded normal hemogram and biochemical tests, negative PPD and parasitological examination of stool were negative for cysts and ova. Viral hepatitis markers, anti-HIV, toxoplasma-IgM, CMV-IgM, rubella-IgM, EBV-VCA-IgM, VDRL, Brucella tube agglutination, echinococcus antibody, autoantibody tests and neuromyelitis optica test were negative. Examination of CSF showed 20 cells/mm3 (mononuclear cells), 45 mg/dl protein and normal levels of glucose and chlorine. In both serum and CSF samples of the patient Toxocara-IgG antibodies were detected by Western blot (WB) assay. Low molecular weight bands (30-40 kDa) were detected in both of the samples by repeated WB testing. CSF revealed more intense bands suggesting local antibody production. Therefore the patient was diagnosed as neurotoxocariasis, and treated with steroid and mebendazole for six weeks. Clinical improvement was detected in the case and thoracic MRI revealed significant improvement in myelitis signs two months after treatment. In conclusion, toxocariasis should be considered in the differential diagnosis of TM although the involvement of central nervous system is rare and serological testing should be performed properly in the serum and CSF samples for the diagnosis.

Objective: Visceral leishmaniasis (VL) is a systemic disease characterized with irregular fever, hepatosplenomegaly, and pancytopenia. Because VL is difficult to detect, misdiagnosis is common and treatment is often inappropriate and delayed. The aim of this article defines the reasons that cause a delay in diagnosis of the disease in Western Anatolia, where VL is endemic. We hope this article helps clinicians to improve their knowledge about the diagnosis of VL and to consider of the disease better.Material and Methods: The clinical and laboratory data records of 15 patients with VL who had been diagnosed and followed up in our hospital from August 2005 to December 2011 were retrospectively reviewed. The demographic, clinical, and laboratory features of the patients were recorded.Results: Thirteen patients were from Western Anatolia, which is the most endemic region of Turkey. The most common complaints were pallor and fever. All patients had hypoalbuminemia, hyperglobulinemia, and cytopenia. The symptoms of the patients had begun 5-180 days before admission.Conclusion: We concluded that VL should be considered in patients with prolonged fever, pallor, hepatosplenomegaly, and cytopenia and those who live in an endemic region. Education for general practitioners and pediatricians is necessary, and these educational efforts may reduce the delay in diagnosis.

Introduction: Toxoplasma gondii is a protozoon parasite that has a worldwide dissemination. It can cause serious clinical problems such as congenital toxoplasmosis, retinochoroiditis, and encephalitis. Currently, T. gondii genotypes are being associated with these clinical presentations which may help clinicians design their treatment strategy.Case reports: Two T. gondii strains named Ankara and Ege-1 were isolated from newborns with congenital toxoplasmosis in Central and Western Anatolia, respectively. Ankara and Ege-1 strains were isolated from the cerebrospinal fluid of newborns. According to microsatellite analysis, Ankara and Ege-1 strains were sorted as Africa 1 genotype.Conclusion: T. gondii strains isolated in Turkey were first time genotyped in this study. Africa 1 genotype has previously been isolated in immunosuppressed patients originating from sub-Saharan Africa. The reason of detecting a strain mainly detected in Africa can be associated with Turkey's specific geographical location. Turkey is like a bridge between Asia, Europe and Africa. Historically, Anatolia was on the Silk Road and other trading routes that ended in Europe. Thus, detecting Africa 1 strain in Anatolia can be anticipated. Consequently, strains detected mainly in Europe and Asia may also be detected in Anatolia and vice versa. Therefore, further studies are required to isolate more strains from Turkey. (c) 2013 Elsevier Ireland Ltd. All rights reserved.

Objective: Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. It is an important cause of morbidity in endemic areas and can be life threatening. In our country it can occur from childhood onwards and usually requires the prolonged use of medications.Material and Methods: Twelve paediatric cases admitted to the Ege University Children's Hospital with various symptoms and diagnosed with hydatid disease between 2009 and 2011 were included in the study.Results: During a 3-year period 12 patients (5 female, 7 male; mean age 11 +/- 2 years; range 6 to 14 years) were admitted to the hospital because of fatigue, nausea, fever and cough, abdominal pain, or back pain, or were diagnosed incidentally. Complete blood count tests revealed mild eosinophilia (mean=490 +/- 158/mm(3)); two cases admitted with fever (16%) had elevated C reactive protein levels and leucocytosis. All patients were treated with Albendazole (10 mg/kg/d), seven were treated surgically, four (33%) were treated with percutanous drainage (PAIR: puncture, aspiration, injection, re-aspiration) and two (16%) did not need invasive procedures and remain in follow up.Conclusion: This study presents the course of hydatid disease and emphasizes the diagnostic challenges in follow up.

Cyclospora cayetanensis and Cryptosporidium spp are the two emerging coccidian parasites causing human infections by inhabiting the intestinal tract and can either remain asymptomatically, or can cause endemic and epidemic diarrhea in both children and adults. In the present study, the prevalence of C. cayetanensis and Cryptosporidium spp were assessed in an epidemiological study in Izmir province, along with risk factors related to infection. A total of 873 individuals from both the city centre and counties were included in the study, and stool samples were examined with formalin ethyl acetate and Kinyoun acid-fast stained preparations. The prevalence of C. cayetanensis and Cryptosporidium spp were found to be 3.0% and 0.8%, respectively. Lower socio-economic conditions, lack of health insurance, consumption of tap water, eating in common places were all found to be associated with higher positivity for C. cayetanensis and Cryptosporidium spp. Abdominal pain was the prominent complaint of infected individuals. Despite relatively low prevalence rates, the presence of C. cayetanensis and Cryptosporidium spp in Izmir province requires further assessments of intestinal parasites. Public health measures that may prevent the local risk factors of infection should be improved and implemented.

Background: Lupoid leishmaniasis (LL) is an unusual chronic form of cutaneous leishmaniasis with clinical and histopathological features resembling lupus vulgaris. It is estimated that lupoid leishmaniasis represents approximately 0.5-6 % of all cutaneous leishmaniasis. In this report, a case of lupoid leishmaniasis that has been misdiagnosed as “lupus vulgaris” and then has been subsequently treated with anti-tuberculoid drugs for a substantial period is described.

The acid-fast staining method is widely used in the diagnosis of cryptosporidiosis, a disease causing diarrhea in humans. However in this technique, some of Cryptosporidium spp oocysts can not be stained and seen as formed "ghost-like bodies" and which can only be evaluated by experienced microscopists. In the recent years, PCR technique which is proven to be also highly sensitive in diagnosis and genotyping, is used as an alternative method. In our study we aimed to evaluate the efficacy of PCR in diagnosis of cryptosporodiosis. Thirty-three stool samples, belonging to 22 patients who applied to Ege University Hospital, Parasitology Clinic between August 2001 - August 2003 and microscopically diagnosed as cryptosporodiosis has been included in the study. Twenty-three of these 33 samples were processed immediately, while ten samples were stored in 10% formalin. As the control group, 11 stool samples including 8 specimens with different parasites and 3 negative samples were selected. Nested-PCR is applied to all samples. The sensitivity and specifity of the method for fresh and formalin preserved samples were found to be 100% and 50%, respectively. As a conclusion, PCR technique is found to be useful for diagnosis in cryptosporodiosis patients with especially those including few oocysts in their fresh feces.