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Hepatitis C virus (HCV) is one of the major causes of chronic hepatitis. It is important to know the genotypes of HCV in the decision of the HCV related chronic hepatitis therapy. The aim of this study was to evaluate the HCV genotypes determined at the Microbiology Laboratory of Akdeniz University Hospital, and to evaluate the changes in the distribution of the genotypes within the last five years. A total of 422 blood samples from HCV-RNA positive chronic hepatitis C patients (219 male, 203 female; age range: 8-79 yrs, mean age 46.3 ± 15.5 yrs) which were sent to our laboratory for genotyping between 2009-2013 period, were analyzed retrospectively. HCV-RNA extractions were performed in an automated system (EZ1 Virus Mini Kit v2.0, Qiagen, Germany), and a commercial reverse hybridization line probe-based assay (LIPA; GEN-C RT-PCR, Italy) was carried out for genotyping, For viral load determinations, a real-time PCR method (Cobas TaqMan HCV, Roche Diagnostics, Germany) was used. Demographic data of the patients were obtained from the hospital information systems and electronic patients' files. Out of the 422 patients, genotype 1b was detected in 63.3% (n= 267), genotype 1a in 14.7% (n= 62), genotype 3a in 11.1% (n= 47), genotype 2b in 0.9% (n= 4), genotype 4e in 0.2% (n= 1). The subtypes couldn't be determined for 5.4% (n= 23), 2.6% (n= 11) and 1.4% (n= 6) of the patients infected with genotype 1, 2 and 4, respectively. One (0.2%) patient, was coinfected with genotype 1 and 4. Of the patients, 40 were foreign-born (16 cases from Russia; 4 of each from Ukraine and Georgia; 3 of each from Turkmenistan, Kyrgyzstan, and Germany; one of each from Tajikistan, Azerbaijan, Uzbekistan, Chechnya, Moldova, Switzerland and Romania) and among these patients genotype 3a (19/40; 47.5%) was the most common genotype followed by genotype 1b (17/40; 42.5%). Median values of HCV viral load were 668.500 IU/ml (range: 2.000-9.630.000) in the whole group; while it was 732.000 IU/ml (range: 2.000-9.630.000) in patients infected with genotype 1 and 444.000 IU/ml (range: 2.650- 8.330.000) in patients infected with the other genotypes (p> 0.05). Patients infected with genotype 1 were found to be older than those infected with other genotypes (47 ± 15.7 and 39.5 ± 12.2, respectively; p< 0.001). Among patients infected with different genotypes, there was no statistically significant difference in terms of genders (p> 0.05). In conclusion, the determination of HCV genotypes is of crucial importance for treatment decision-making of chronic HCV infection. Besides, it also allows monitoring the changes in the epidemiology of HCV. In this study, although genotype 1b was determined as the most common HCV genotype, the detection of other genotypes was remarkable. This finding was attributed to the presence of many foreign national people in Antalya region which was a high capacity tourism area in Turkey.

Cyclospora cayetanensis which is a recently described pathogen, is associated with prolonged diarrheae and history of travelling to tropical regions and intake of suspicious food and water. Cryptosporidium parvum is another pathogen that causes severe diarrhea defined initially in especially AIDS patients since 1980's. Cases of cyclosporiasis are frequently missed, since it is difficult to detect the parasite in human fecal samples, despite an increasing amount of data regarding this parasite. To identify both of these coccidian protozoa, faeces should be examined by modified acid-fast stain. Co-incidence of C. cayetanensis and C. parvum is seen rarely in Turkey. In this case report, C. cayetanensis and C. parvum found in a 28 years old pregnant women living in continental climate and without a history of travel, were presented. The patient had prolonged diarrhea and investigation of the feces by modified acid-fast and carbol fuchsin stains revealed C. cayetanensis and C. parvum. The immunoglobulin and lymphocyte subgroup testing done for the evaluation of the immune status of the patient, were all within normal limits. Following treatment with trimethoprim-sulfamethoxazole for 15 days, the oocyst number in feces has decreased. However, hepatic vein thrombosis and liver failure have developed in the postnatal period and she was diagnosed as Budd-Chiari syndrome. It was concluded that when the effect of pregnancy on immunity was taken into account, C. cayetonensis and C. parvum should be considered in cases of prolonged diarrhoeae in pregnant women.