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Fasciola hepatica, also known as the common liver fluke, is a trematod with a leaf-like and flattened body. The definitive hosts are herbivorous animals such as cattle, sheep, and goats, and it mostly causes disease in animals. Human is an incidental host. The metacercarial forms are transmitted by ingestion of aquatic plants (watercress) in contact with contaminated water. They reach the liver through the intestine, transform into adult form, and following their settlement on the bile ducts start to produce eggs. Serological methods facilitate diagnosis if eggs cannot be seen in feces. In endemic regions, fascioliasis is among the causes of fever of unknown origin (FUO). In this report, we present six adult cases who applied to the Infectious Diseases and Clinical Microbiology Outpatient Clinic with a clinical picture of FUO, and were serologically diagnosed as fascioliasis.

Pneumocystis jirovecii is a human-specific species and causes fatal infections like P.jirovecii pneumonia (PCP) in immunocompromised persons. Although direct microscopy is the gold standard in the diagnosis of the microorganism, molecular methods such as polymerase chain reaction (PCR) are needed in non-human immune deficiency virus (HIV) immunosuppresive patients with low P.jirovecii burden. In this study, we aimed to evaluate the value of real-time PCR (Rt-PCR) in the laboratory diagnosis of P.jirovecii. Bronchoalveolar lavage (BAL) specimens of 658 patients sent to Dokuz Eylul University Hospital Central Medical Parasitology Laboratory on suspicion of PCP were included in the study. BAL fluids were evaluated for identification of P.jirovecii mitochondrial gene coding ribosomal large subunit (mtLSUrRNA) using Rt-PCR. In addition, Giemsa and Gomori's methenamine silver (GMG) staining assays were applied to all samples and nested PCR (n-PCR) assay was applied to positive samples detected by real time PCR. Ninety-two (14.3%) of these samples were positive by Rt-PCR. Of these 92 patients, 85 (92.4%) were positive with n-PCR. Only seven of the specimens had P.jirovecii cysts and trophozoites with microscopic examination. The mean cycle threshold (CT ) value of Rt-PCR positive patients was 29.7 (18.17 ≤ CT ≤ 37.96). P.jirovecii load in these patients was calculated as 2.6 x 101-6.15 x 107 copies/ml. The difference between the mean CT values of n-PCR positive and negative results was statistically significant (p< 0.01). The CT values of Rt-PCR of the samples with positive microscopy were; 18.2, 20.9, 22.2, 24.3, 24.7, 26.5, 29.7. The difference between the CT means of the samples with positive and negative microscopy was statistically significant (p< 0.05). When positive patients were grouped according to their diagnosis; the lowest mean CT value (CTmean= 24.8) was found in HIV-positive patients. On the other hand, CT values were found to be significantly lower in the organ transplantation patients (CTmean= 26.15) and in the collagen-vascular-inflammatory patient group (CTmean= 27.8). This study demonstrated that Rt-PCR was the effective method in the diagnosis of P.jirovecii in the laboratory. Conventional n-PCR method was found to be more unsuccessful than Rt-PCR in the presence of very low density organism; direct microscopy is generally found to be positive in samples with a higher burden of P.jirovecii.

Pneumocystis jirovecii is a human-specific species and causes fatal infections like P.jirovecii pneumonia (PCP) in immunocompromised persons. Although direct microscopy is the gold standard in the diagnosis of the microorganism, molecular methods such as polymerase chain reaction (PCR) are needed in non-human immune deficiency virus (HIV) immunosuppresive patients with low P.jirovecii burden. In this study, we aimed to evaluate the value of real-time PCR (Rt-PCR) in the laboratory diagnosis of P.jirovecii. Bronchoalveolar lavage (BAL) specimens of 658 patients sent to Dokuz Eylul University Hospital Central Medical Parasitology Laboratory on suspicion of PCP were included in the study. BAL fluids were evaluated for identification of P.jirovecii mitochondrial gene coding ribosomal large subunit (mtLSUrRNA) using Rt-PCR. In addition, Giemsa and Gomori's methenamine silver (GMG) staining assays were applied to all samples and nested PCR (n-PCR) assay was applied to positive samples detected by real time PCR. Ninety-two (14.3%) of these samples were positive by Rt-PCR. Of these 92 patients, 85 (92.4%) were positive with n-PCR. Only seven of the specimens had P.jirovecii cysts and trophozoites with microscopic examination. The mean cycle threshold (CT ) value of Rt-PCR positive patients was 29.7 (18.17 ≤ CT ≤ 37.96). P.jirovecii load in these patients was calculated as 2.6 x 101-6.15 x 107 copies/ml. The difference between the mean CT values of n-PCR positive and negative results was statistically significant (p0.01). The CT values of Rt-PCR of the samples with positive microscopy were; 18.2, 20.9, 22.2, 24.3, 24.7, 26.5, 29.7. The difference between the CT means of the samples with positive and negative microscopy was statistically significant (p0.05). When positive patients were grouped according to their diagnosis; the lowest mean CT value (CTmean= 24.8) was found in HIV-positive patients. On the other hand, CT values were found to be significantly lower in the organ transplantation patients (CTmean= 26.15) and in the collagen-vascular-inflammatory patient group (CTmean= 27.8). This study demonstrated that Rt-PCR was the effective method in the diagnosis of P.jirovecii in the laboratory. Conventional n-PCR method was found to be more unsuccessful than Rt-PCR in the presence of very low density organism; direct microscopy is generally found to be positive in samples with a higher burden of P.jirovecii.

Amaç: Bağırsak parazitlerinin neden olduğu hastalıklar dünya genelinde olduğu gibi ülkemizde de önemli bir halk sağlığı problemidir. Bu çalışmada çeşitli gastrointestinal sistem yakınmaları ile Dokuz Eylül Üniversitesi Hastanesi’ne (DEÜH) başvuran 1hastalardaki bağırsak parazitleri araştırıldı.Yöntemler: Çalışmaya Ocak 2011-Aralık 2018 tarihleri arasında DEÜH Merkez Parazitoloji Laboratuvarı’na gönderilen 18460 hasta dahil edildi. Hastalara ait dışkı örnekleri Nativ-lugol yöntemiyle incelendikten sonra bu örneklere formol etil-asetatçöktürme yöntemi uygulandı. Gerekli görülen örneklere trikrom ve kinyoun asit-fast boyama yapıldı. Hastalara ait demografik verilere ise hastane ve laboratuvar bilgi işletim sistemi üzerinden ulaşıldı.Bulgular: İncelenen toplam 18460 hastanın %6’sında (1128) bir veya birden fazla parazit saptandı. Parazit saptanan olguların yaş ortalaması 39,7 (±23,1) yıl olmakla birlikte bunların %53,3’ü erkek, %47,6’sı kadındı. Pozitiflik oranının parazitlere göre dağılımı incelendiğinde ise; %4,8’i (879) Blastocystis hominis, %0,7’si (135) Entamoeba histolytica/dispar harici diğer amipler, %0,4’ü (70) Giardia intestinalis, %0,3’ü (49) Enterobius vermicularis, %0,1’i (21) Entamoeba histolytica/dispar ve %0,01’i (10) nadir görülen diğer parazitler şeklinde idi.Sonuç: Çalışmamız, bağırsak parazit enfeksiyonlarının bölgemizde halen önemli bir halk sağlığı sorunu olarak devam ettiğini göstermekle birlikte; görülme sıklıklarındaki düşüşü ortaya koyması açısından da önemlidir. Objective: Intestinal parasitic diseases are important public health problems in our country as well as in the world. In this study,intestinal parasites were investigated in patients admitted to Dokuz Eylül University Hospital (DEUH) with various gastrointestinal system complaints.Methods: Patients (n=18460) who were referred to the DEUH Central Parasitology Laboratory between January 2011 and December 2018, were included in the study. Fecal samples were examined with Nativ-lugol method and then formol ethylacetateprecipitation method was applied. Trichrome and kinyoun acid-fast stainings were performed on the necessary samples.Demographic data of the patients were obtained from the hospital’s and laboratory’s information operating system.Results: One or more parasites were detected in 6% (1128) of 18460 patients examined. The mean age of the patients with parasites was 39.7 (±23.1) years, of which 53.3% were male and 47.6% were female. The distribution of parasites detected were as follows; 4.8% (879) Blastocystis hominis, 0.7% (135) amoebas other than Entamoeba histolytica/dispar, 0.4% (70) Giardia intestinalis, 0.3% (49) Enterebius vermicularis, 0.1% (21) Entamoeba histolytica/dispar, and 0.01% (10) other rare parasites.Conclusion: Our study shows that intestinal parasitic infections are still an important public health problem in our region and that there is a decrease in their incidence

Dünyada yaygın olarak bulunan Acanthamoeba türleri, serbest yaşayan amipler olup, özellikle kontakt lens kullananlarda ve minör kornea travmalarında Acanthamoeba keratiti (AK) olarak bilinen ve körlüğe yol açabilen enfeksiyonlara neden olmaktadır. Günümüzde AK olgularının tedavisinde antifungaller ve antiseptiklerden yararlanılmakta, ancak tedavi süresinin uzun olması ve buna bağlı yan etkilerin ortaya çıkışı, kronik enfeksiyonlarda gözlenen kist formlarının ilaçlara dirençli oluşu gibi sorunların ortadan kaldırılması için alternatif ilaçlara ihtiyaç duyulmaktadır. Yapılan çalışmalar, bazı bitkisel ekstrelerin ve bitkisel kaynaklı uçucu yağların Acanthamoeba spp. üzerine etkili olabileceğini göstermektedir. Bu çalışmanın amacı, Lamiaceae ailesinde yer alan Mentha x piperita L. (nane), Melissa officinalis L. (oğulotu) ve Ocimum basilicum L. (fesleğen) bitkilerine ait uçucu yağların Acanthamoeba castellanii kist ve trofozoitleri üzerindeki etkilerinin in vitro olarak araştırılmasıdır. Çalışmada kullanılan A.castellanii T4 genotipi, çevreden en sık izole edilen, AK ve granülomatöz amibik ensefalite neden olabilen bir türdür. Amibisidal aktivitenin belirlenmesinde, Neo-Clevenger tipi distilasyon düzeneği ile elde edilen Mentha x priperita L., Melissa officinalis L. ve Ocimum basilicum L. uçucu yağları kullanılmıştır. İn vitro deneyler 96 çukurlu mikroplaklarda gerçekleştirilmiş; uçucu yağ dilüsyonlarının üzerine kist ve trofozoit solüsyonu eklenerek, kistler için 40, 20, 10, 5, 2.5 ve 1.25 µg/ml'lik, trofozoitler için ise 10, 5, 2.5, 1.25, 0.625 ve 0.313 µg/ml'lik son konsantrasyonlar elde edilmiştir. Plaklar, 30oC'de 1, 6, 24, 48 ve 72 saat boyunca inkübe edilmiş ve bu süreler sonunda amip formlarının canlılığı, tripan mavisi ile boyanarak ışık mikroskobu ile değerlendirilmiştir. Çalışmada, kontrol grubuyla karşılaştırıldığında, her bir uçucu yağın A.castellanii kist ve trofozoitleri üzerinde doza ve süreye bağımlı olarak artan amibisidal etki gösterdiği belirlenmiştir. Kullanılan uçucu yağların etkinliği değerlendirildiğinde, kist ve trofozoit formları için en yüksek letal etkinin Melissa officinalis ile oluştuğu, bunu Mentha x piperita ve Ocimum basilicum'un izlediği belirlenmiştir. Çalışmamızda, A.castellanii kistlerinin uçucu yağlara karşı duyarlılığı, beklendiği üzere trofozoitlerden daha düşük bulunmuştur. Melissa officinalis ve Mentha x piperita uçucu yağları için en yüksek konsantrasyonda (40 µg/ml) %100 öldürücü etkinin görüldüğü, buna karşın Ocimum basilicum uçucu yağının 72 saat sonunda ve en yüksek konsantrasyonda (40 µg/ml) bile kistlerin ancak %63.3'ünü öldürebildiği saptanmıştır. Sonuç olarak, Acanthamoeba spp. kist ve trofozoitlerine karşı Mentha x piperita, Melissa officinalis ve Ocimum basilicum bitkilerinden elde edilen uçucu yağ aktivitelerinin incelendiği bu ilk çalışmanın verileri, bu bitkilere ait uçucu yağların Acanthamoeba spp. enfeksiyonlarının tedavisinde geliştirilebilecek yeni ve alternatif doğal ürünler olabileceğini düşündürmektedir., Acanthamoeba species are free living amoeba found widely all over the world. They are responsible for Acanthamoeba keratitis (AK), an infection which is especially seen in contact lens users and after minor corneal traumas, that may lead blindness. At present, antifungals and antiseptics are used for the treatment of AK cases, however, some problems such as long treatment periods and the occurrence of side effects, resistance of cyst forms against drugs, emphasize the need for new drugs. There are some published studies that pointed out the effectiveness of plant extracts and essential oils on Acanthamoeba spp. The aim of this study was to investigate the in vitro effects of essential oils of Mentha x piperita L. (peppermint), Melissa officinalis L. (lemon balm) and Ocimum basilicum L. (basil) belonging to Lamiaceae family, on the cysts and trophozoites of Acanthamoeba castellanii. The strain used in our study, namely A. castellanii T4 genotype, is the most frequently isolated amoeba from environment and also the causative agent of AK and granulomatous amebic encephalitis. For the determination of amebicidal activity, essential oils obtained from Mentha x priperita L., Melissa officinalis L. and Ocimum basilicum L. by Neo-Clevenger type of distillation apparatus have been used. In vitro experiments were performed by using 96-well microplates. Cyst and trophozoite solutions were added on the essential oil dilutions to obtain the last concentrations of 40, 20, 10, 5, 2.5 and 1.25 µg/ml for the cysts, and 10, 5, 2.5, 1.25, 0.625 and 0.313 µg/ml for the trophozoites. After the incubation of microplates at 30oC for 1, 6, 24, 48 and 72 hours, the viability of parasitic forms were evaluated under the light microscope followed by staining trypan blue. It was found that, each essential oil showed amebicidal effect on A.castellani cysts and trophozoites dependent on dosage and time, when compared with the control group, The maximum lethal effect occured with Melissa officinalis followed by Mentha x piperita and Ocimum basilicum, respectively. In our study, susceptibility of A.castellanii trophozoites to essential oils were more than the cysts, as expected. The essential oils of Melissa officinalis and Mentha x piperita showed 100% lethal effect at their highest concentrations whereas the essential oil of Ocimum basilicum showed only 63.3% lethal effect on cysts after 72 hours at the highest concentration (40 µg/mL). The results of this first study investigating the activities of essential oils extracted from Mentha x piperita, Melissa officinalis and Ocimum basilicum against Acanthamoeba spp. cysts and trophozoites, have suggested that, these essential oils could be potential novel and alternative natural products for the treatment of Acanthamoeba spp. infections.

Detection of Pneumocystis jirovecii and its DNA in clinically asymptomatic people is defined as colonization. The aim of this study was to reveal the colonization prevalence of P. jirovecii and affecting factors in an immunocompetent population. The study included 200 cases undergoing forensic autopsy between February 2015 and April 2015. The cause of death was non-medical conditions (group 1) in 111 cases (55.5 %), medical conditions (group 2) in 73 cases (36.5 %) and undetermined (group 3) in 16 cases (group 3). Tissue specimens about 1 g in weight were taken from the right upper pulmonary lobe. After DNA extraction, nested PCR targeting mitochondrial large subunit rRNA was used to detect P. jirovecii. Of 200 cases, 37 (18.5 %) had P. jirovecii DNA. There was not a significant difference in place of living, gender, smoking status and medication use between the cases with P. jirovecii and those without P. jirovecii. A significantly high rate of P. jirovecii colonization was detected in group 2 (chi(2) = 7.674; P=0.022). P. jirovecii-colonized cases also had a chronic disease in 2 of 13 (group 1), 12 of 20 (group 2) and 1 of 4 (group 3) cases (chi(2) = 5.571; P=0.062). A significantly high rate of the cases aged 0-1 year had P. jirovecii (5/11; 45.5 %) (chi(2) = 5.639; P=0.018). The results of the study suggest that infants and patients with chronic diseases like cardiac or pulmonary diseases can be at risk for P. jirovecii colonization.

Objectives: To investigate Microsporidia spp. parasite , hepatitis A virus (HAV), and norovirus (NoV) contamination in mussels collected from 8 stations in the inner, middle, and outer regions of the Gulf of Izmir. Methods: In this cross-sectional study carried out between August 2009 and September 2010 in the Gulf of Izmir, Turkey, 15 mussels collected from each of the stations each season were pooled and homogenized to create a single representative sample. Thirty representative samples were available for analysis. Direct polymerase chain reaction (PCR), RT-nested PCR, and RT-booster PCR were used to investigate the pathogens. Results: The mussels were negative for Microsporidia spp., but 8 (26.7%) samples analyzed were positive for HAV and 9 (30%) were positive for NoV. Excluding Foca and Gediz, viral contamination was detected in all of the stations sampled. Conclusion: Our results suggest that viral contamination is present in mussels in the Gulf of Izmir and may pose a potential threat to human health in the region. Necessary measures should be taken to prevent future illness due to these pathogens. Saudi Med J 2016; Vol. 37 (6): 703-706 doi: 10.15537/smj.2016.6.15034

Pneumocystis pneumonia (PCP) caused by Pneumocystis jirovecii (P. jirovecii) is an opportunistic pulmonary infection that occurs in immunocompromised patients. Here, a 49-year-old female patient who was admitted to our hospital with respiratuary distress and whose bronchoalveolar lavage (BAL) fluid specimens had P. jirovecii and Aspegillus fumigatus was presented. She had been treated with corticosteroids because of interstisial lung disease and she was also diabetic. It is important to define the coinfection developed in the presence of immunosuppression.

Objective:Special Study Modules (SSM); improving independent learning, written and oralpresentation skills, learning and applying the basic principles of scientificmethodology in medicine or other scientific areas, are components of medicaleducation. A total of 39 special study modules have been fullfilled inParasitology Department of Dokuz Eylul University Faculty of Medicine. In this retrospective study, it was aimed to determine the contents andbenefits of the special study modules of Parasitology Department during theundergraduate study between 1998-2017 years.Material and Method: All information about the Special Study Modules wasobtained from the archives of the secretariat of the Special Study Module,affiliated to the Faculty of Medicine of Dokuz Eylul University.Results: In the Parasitology Department, the number of special studymodules were 6.5 per teaching staff and 0.34 per teaching staff in a year. 17(44%) of the studies were review articles, 9 (23%) were research projects and13 (%33) were social responsibility projects. Itwas observed that 25 of the modules were associated with parasitology topics,while the remaining 14 were associated with medical topics other thanparasitology.Conclusion: Parasitology education given in medical faculties is believedto be reinforced by special study modules. This education type also contributesto understand the importance of parasites in terms of public health., Amaç: Özel ÇalışmaModülleri (ÖÇM), tıp fakültesi öğrencilerinin tıbbi ya da tıp dışı diğerakademik alanlarda, bağımsız öğrenme becerilerini geliştirdikleri, bilimselyöntemlerin temel ilkelerini öğrendikleri ve uyguladıkları, yazılı ve sözlüsunma becerilerini geliştirdikleri eğitim etkinlikleridir. DEÜTF TıbbiParazitoloji Anabilim Dalında bugüne kadar öğrencilere toplam 39 ÖÇM yapıldı.Bu retrospektif çalışmada, Tıbbi Parazitoloji Anabilim Dalı tarafından1998-2017 yılları arasında lisans eğitimi kapsamında yaptırılan özel çalışmamodüllerinin içerikleri ve öğrencilere sağladıkları kazanımları belirlemekhedeflendi. Gereç ve Yöntem: Özel Çalışma Modülleri ile ilgili bilgiler, DEÜTFDekanlığı’na bağlı olarak çalışan ÖÇM sekreterliğine ait arşiv kayıtlarındanelde edildi.Bulgular: Tıbbi Parazitoloji Anabilim Dalı’nda öğretim üyesi başınadüşen ÖÇM sayısının, 6.5 olduğu, öğretim üyesi başına düşen yıllık modülsayısının ise 0.34/yıl olduğu saptandı. Toplam 39 ÖÇM’den 17 (%44)’sininderleme, 9 (%23)’unun araştırma ve 13 (%33)’ünün sosyal sorumluluk çalışmasıolduğu görüldü. Açılan tümÖÇM'lerin 25’inin parazitoloji konuları, kalan 14’ünün ise parazitolojidışı diğer tıbbi konular ile ilişkili olduğu gözlendi.Sonuç: Tıp fakültelerinde verilen Parazitoloji eğitiminin, ÖÇM’lerile pekiştiği ve parazitlerin toplumsal öneminin kavrandığı düşünülmektedir.

Acanthamoeba species are free living amoeba found widely all over the world. They are responsible for Acanthamoeba keratitis (AK), an infection which is especially seen in contact lens users and after minor corneal traumas, that may lead blindness. At present, antifungals and antiseptics are used for the treatment of AK cases, however, some problems such as long treatment periods and the occurrence of side effects, resistance of cyst forms against drugs, emphasize the need for new drugs. There are some published studies that pointed out the effectiveness of plant extracts and essential oils on Acanthamoeba spp. The aim of this study was to investigate the in vitro effects of essential oils of Mentha x piperita L. (peppermint), Melissa officinalis L. (lemon balm) and Ocimum basilicum L. (basil) belonging to Lamiaceae family, on the cysts and trophozoites of Acanthamoeba castellanii. The strain used in our study, namely A. castellanii T4 genotype, is the most frequently isolated amoeba from environment and also the causative agent of AK and granulomatous amebic encephalitis. For the determination of amebicidal activity, essential oils obtained from Mentha x priperita L., Melissa officinalis L. and Ocimum basilicum L. by Neo-Clevenger type of distillation apparatus have been used. In vitro experiments were performed by using 96-well microplates. Cyst and trophozoite solutions were added on the essential oil dilutions to obtain the last concentrations of 40, 20, 10, 5, 2.5 and 1.25 µg/ml for the cysts, and 10, 5, 2.5, 1.25, 0.625 and 0.313 µg/ml for the trophozoites. After the incubation of microplates at 30oC for 1, 6, 24, 48 and 72 hours, the viability of parasitic forms were evaluated under the light microscope followed by staining trypan blue. It was found that, each essential oil showed amebicidal effect on A.castellani cysts and trophozoites dependent on dosage and time, when compared with the control group, The maximum lethal effect occured with Melissa officinalis followed by Mentha x piperita and Ocimum basilicum, respectively. In our study, susceptibility of A.castellanii trophozoites to essential oils were more than the cysts, as expected. The essential oils of Melissa officinalis and Mentha x piperita showed 100% lethal effect at their highest concentrations whereas the essential oil of Ocimum basilicum showed only 63.3% lethal effect on cysts after 72 hours at the highest concentration (40 µg/mL). The results of this first study investigating the activities of essential oils extracted from Mentha x piperita, Melissa officinalis and Ocimum basilicum against Acanthamoeba spp. cysts and trophozoites, have suggested that, these essential oils could be potential novel and alternative natural products for the treatment of Acanthamoeba spp. infections.

Introduction Microsporidia spp. are ubiquitous and infect a wide variety of intervertebrates and vertebrates, including humans. Pulmonary microsporidiosis, characterized by nonspecific symptoms like fever, cough and dyspnea, is often overlooked in the differential diagnosis of pulmonary infections in immunsupressed patients. In this study, we aimed to determine the prevalence of pulmonary microsporidiosis in iatrogenically immunosuppressed patients and to evaluate the patient characteristics. Materials and methods Bronchoalveolar lavage (BAL) specimens from 63 iatrogenically immunosuppressed patients and 28 controls were examined with PCR. By using PMP1 and PMP2 common primers specifically designed for Enterocytozoon bieneusi, Encephalitozoon intestinalis, Encephalitozoon cuniculi and Encephalitozoon hellem small-subunit ribosomal DNA (SSU-rDNA) regions at 250-279 bp were amplified. In addition, PCR positive BAL specimens were examined with modified trichrome staining method for Microsporidia spores. Result Out of 63 immunosuppressed patients, nine (14.2%) had Microsporidia spp., but none of the control patients had Microsporidia spp. on PCR. This difference between two groups was statistically significant (χ² =4.439; p=0.035). On the other hand there was not a statistically significant relationship between PCR positivity and patient characteristics such as gender and age. Of nine patients with Microsporidia PCR positive, only one had spores of Microsporidia sp. Out of eight patients without spores, one had Mycobacterium tuberculosis, one patient had Klebsiella pneumoniae and five patients had Pneumocystis jirovecii DNA. Conclusion This is the first study to evaluate the pulmonary microsporidiosis in immunosupressed patients in Turkey. The results of the study indicated that Microsporidia spp. should be taken into account in the differential diagnosis of pulmonary infections in immunosupressed patients and it is important to use molecular methods such as PCR in the laboratory diagnosis of the causative agent.

Parasites are rarely associated with inflammation of the appendix. Generally, parasites cause acute abdominal pain via blocking the gut lumen. In this article, we presented a case of appendicitis where Enterobius vermicularis was detected in the surgical specimen and Taenia was detected in the stool. A 31 year old male patient was admitted to the emergency room with severe abdominal pain, which has begun two days ago. On physical examination, tenderness was positive on palpation of the right lower abdominal quadrant and the patient was operated on with the diagnosis of acute appendicitis. Histopathological examination of the patient's appendectomy material revealed numerous parts of parasites resembling Enterobius vermicularis and slight mucosal erosion. On parasitological examination of the patient's stool, Taenia eggs and adult forms were determined. Antiparasitic therapy was started with niclosamide for taeniasis and albendazole for enterobiasis. Parasitic infections can mimic acute appendicitis clinically. Radiological and laboratory findings do not help to distinguish the diagnosis of acute appendicitis. In the histopathological examination of the appendix, the findings of acute inflammation of the appendix wall may not be defined. For patients with normal histopathological examination, screening for parasites should be done, and anti-parasitic treatment should be started after appendectomy.

Resveratrol, a natural phytoalexin found mainly in grapes, possesses antibacterial, antifungal, and antiviral properties. However, there is no information about its effects on helminths such as Trichinella sp. In the present study, we investigated the effects of resveratrol on the viability of Trichinella spiralis life stages in vitro. Adult forms, newborn larvae (NBL), and muscle larvae (ML) were incubated with resveratrol at concentrations varying from 12.5 to 200 microg/ml. Resveratrol showed significant anthelmintic activity against NBL and adult forms of Trichinella, but not against ML. Our results suggest that resveratrol may be useful as a therapeutic agent to treat trichinellosis in early stages and warrant its further assessment in animal models of disease.

Pneumocystis pneumonia (PCP) is a potentially life-threatening infection for the immunocompromized patients. However, Pneumocystis jirovecii colonization can also be detected in healthy individuals and in patients with various underlying lung diseases. The aim of this study was to evaluate the immunocompetent and iatrogenically immunosuppressed patients in terms of PCP and P.jirovecii colonization. A total of 92 patients (66 male, 26 female; age range: 18-93 years, median: 58.5) who underwent bronchoscopy due to various pulmonary symptoms between January 2011-April 2014, were included in the study. Of these patients, 65 were under immunosuppressive therapy (38 were treated with anti-cancer drugs, 15 with anti-rejection/immunomodulatory drugs and 12 with corticosteroids), while 27 were immunocompetent. Bronchoalveolar lavage (BAL) fluids were evaluated for the presence of P.jirovecii mitochondrial gene coding ribosomal large subunit (mtLSUrRNA) with nested PCR (nPCR) method. All of the samples were also examined by Giemsa and Gomori's methenamine silver (GMG) staining methods. P.jirovecii DNA was detected in 31 (33.7%) out of 92 BAL samples by nPCR. Although six immunosuppressed patients were positive in the first round of amplification, 26 of 65 (40%) immunosuppressed and five of 27 (18.5%) immunocompetent patients were positive with nPCR. P.jirovecii cysts and trophozoites were detected in only five (16.1%) of the 31 nPCR positive samples. The probability of being immunosuppressive among nPCR positive cases was statistically higher than nPCR negative cases (χ²= 3.940; p= 0.047). This difference was more significant in organ transplant recipients and patients under anti-rejection/immunomodulatory treatment (χ²= 6.715, p= 0.01; χ²= 5.550, p= 0.018, respectively). When clinical, laboratory and radiological findings of nPCR positive patients were considered, five patients (2 kidney transplant, 1 bone marrow transplant, 1 interstitial lung disease and 1 lung cancer case) in immunosuppressed group were interpreted as "definite PCP" and eight patients (2 kidney transplant, 1 leukemia, 1 connective tissue disease, 1 Wegener's granulomatosus, 2 rheumatoid arthritis and 1 lung cancer case) were interpreted as "probable PCP". Other 18 (19.6%) nPCR positive patients, of them 13 were immunosuppressive and five were immunocompetent, were considered as "P.jirovecii colonization". The colonization rate was determined as 50% (13/26) in immunosuppressive patients, and was mostly detected in patients with hematological malignancies (4/13), followed by patients with solid tumors (3/13) and organ transplantations (3/13). On the other hand, all of the nPCR positive immunocompetent patients (5/5) were evaluated as colonization. In this study significant data was obtained about P.jirovecii epidemiology in our country. Our results also showed that iatrogenically immunosuppressed patients are under risk of PCP and nPCR method is more sensitive than conventional PCR and classical staining methods in the diagnosis of these patients.

Pneumocystis pneumonia (PCP) caused by Pneumocystis jirovecii (P. jirovecii) is an opportunistic pulmonary infection that occurs in immunocompromised patients. Here, a 49-year-old female patient who was admitted to our hospital with respiratuary distress and whose bronchoalveolar lavage (BAL) fluid specimens had P. jirovecii and Aspegillus fumigatus was presented. She had been treated with corticosteroids because of interstisial lung disease and she was also diabetic. It is important to define the coinfection developed in the presence of immunosuppression.

OBJECTIVE The detection of Pneumocystis jirovecii or its DNA in respiratory samples from individuals who do not have signs or symptoms of pneumonia has been defined as colonization. In this study, we aimed to investigate the prevalence of P. jirovecii colonization in patients with various lung diseases. METHODS Thirty patients who were followed-up and who had undergone bronchoscopy for diagnosis of different underlying diseases or pulmonary signs were included in the study. Bronchoalveolar lavage (BAL) fluids of these patients were analyzed with nPCR amplification of the mt-LSUrRNA gene of P. jirovecii. In addition to nPCR, giemsa, Gomori's methenamine silver (GMS), and indirect fluorescence antibody (IFA) staining assays were applied to all samples. RESULTS P. jirovecii DNA was detected in 21 of 30 (70%) BAL samples by nPCR. However, P. jirovecii cysts were found in 1 of 21 nPCR-positive samples by giemsa and GMS. IFA assay showed six samples to be positive, but only four of them were found to be positive by nPCR. CONCLUSION Result of our study showed that prevalence of P. jirovecii colonization is particularly high in patients with chronic pulmonary diseases, and nPCR was a good assay for evaluation of the colonization of P. jirovecii.

WOS: 000244162600009, PubMed ID: 17285854, Many serological tests ore widely used in the diagnosis of cystic echinococcosis CE), caused by the larval stages of Echinococcus granulosus. The present study was carried for differentiation between hepatic and pulmonary cystic echinococcosis by Western Blotting (WB). A total of 12 1 sera from patients with hepatic CE (37, pulmonary CE (3 1) and controls 5 3; consisting of six healthy, seven Hymenolepis nono infection, 20 hepatic and 20 pulmonary diseases other than CE) were examined. In all of the CE patients, E. granulosus infection was confirmed by surgical intervention. Sera were previously tested using IHA and ELISA to detect the E. granulosus specific antibodies. Sera from hepatic cases of CE reacted with 16 polypeptides of 6-116 kDa and sera from pulmonary cases of CE reacted with 14 polypeptides of 4-130 kDa by Western Blotting. The WB test enabled the detection of antibodies in the hepatic CF samples for proteins of 24, 32 34, 44-46 and 52-54 kDa in molecular weight in 78.4%, 75.7%, 78.4% and 89,2 % of the patients, respectively. In the pulmonary CF samples sera WB test enabled the detection of antibodies 24, 44-46, 100, 1 10, 1 16 and 120-124 kDo in molecular weight in 81.3 %, 75.0 %, 87.5 %, 71.9 %, 84.4 % and 65.6 % of the patients, respectively. We indicated that the antigenic components of high molecular weight con be good candidates for differentiation of hepatic CF from pulmonary CF.

Amaç: Bu çalışmanın amacı, Türkiye’de kutanöz leishmaniasisin en önemli etkeni L. tropica üzerinde HBO tedavisinin etkinliğini değerlendirmektir. Yöntem ve gereç: Leishmania tropica promastigot ve amastigot formları üzerinde hiperbarik oksijenin etkileri 2,5 atmosfer basıncı (ata) altında çalışıldı. HBO’nun promastigot formları üzerindeki sitotoksik etkileri, tripan mavisi testi ve MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) yöntemiyle incelendi. HBO tedavisinin L. tropica promastigot formları üzerinde etkilerini araştırmak amacıyla HBO uygulamasına maruz bırakılmış ve bırakılmamış hücre kültür plakları 26oC’de üç gün boyunca inkübe edildi. Diğer taraftan HBO’nun L. tropica amastigot formları üzerine olan etkileri akridin oranj boyama yöntemiyle tespit edildi. Bulgular: Her iki yöntem ile sitotoksik etkinin iki saat sonra başladığı ve altı saat sonra en üst seviyeye ulaştığı gözlemlendi. Canlı promastigotların sayısı tedaviden sonra 24 saat boyunca izlendi ve tedavinin ikinci saatinin sonunda promastigot sayılarında hafif bir artış olduğu, dört ve altı saat sonrasında ise promastigot sayılarının artışında önemli bir azalma olduğu tespit edildi (P < 0,001). Diğer taraft an HBO tedavisinin L. tropica amastigot formları üzerinde etkisinin 2, 4 ve 6. saatler için sırasıyla % 3,3, % 17,2 ve % 38,5 olduğu gözlemlendi. Sonuç: Bu çalışmada elde edilen sonuçlar, HBO tedavisinin L. tropica formlarına karşı kemoterapi ile birlikte destekleyici tedavi olarak kullanılabileceğini göstermektedir., Aim: To assess the efficiency of hyperbaric oxygen (HBO) therapy on L. tropica, which is the major causative agent of cutaneous leishmaniasis in Turkey. Materials and methods: the effects of HBO on Leishmania tropica promastigote and amastigote forms were studied at a pressure of 2.5 atmosphere absolute (ata). We examined the cytotoxic effect of HBO on promastigotes using the trypan blue exclusion test and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) dye-reduction assay. To investigate the effects of HBO treatment on the growth of the promastigotes, HBO-treated and non-HBO-treated cell culture flasks were incubated at 26 °C for 3 days, while the effects of HBO on L. tropica amastigotes were detected using the acridine orange staining method. Results: We observed that the cytotoxic eff ect emerged aft er 2 h and reached a maximum at 6 h with both methods. the number of live promastigotes was monitored for 24 h after treatment and there was a slight elevation at 2 h of treatment, but significant suppression was seen after 4 and 6 h of treatment (P < 0.001). We detected that the effect of HBO on L. tropica amastigote forms increased by 3.3%, 17.2%, and 38.5% at 2, 4, and 6 h, respectively. Conclusion: the results presented here indicate that HBO treatment could be used as supportive therapy in association with chemotherapeutic agents against L. tropica infection.

To evaluate the presence of Toxoplasma gondii and Cyclospora cayetanensis in edible shellfish, a total of 795 specimens of Mytilus galloprovincialis from 8 different sites on the west coast of Turkey (Bays of Izmir and Mersin) were examined. Fifty-three pooled samples were created and subjected to EvaGreen (R) RealTime PCR assay and HRM analysis for protozoans detection and oocyst quantification. Seven out of 8 sites were contaminated with at least one protozoan species. Twenty-one out of 53 (39.6%) samples tested positive for T. gondii, C cayetanensis or both pathogens: 26.4% samples positive for C cayetanensis; 9.4% for T. gondii, and 3.8% for both protozoans. The number of oocysts in positive samples ranged from 6 to 30 for T gondii and from 3 to 48 for C cayetanensis. This is the first report of T. gondii Type 1, and C. cayetanensis in M. galloprovincialis, the most consumed shellfish species in Turkey. (C) 2014 Elsevier Ltd. All rights reserved.

Amaç: Ocak 2005-Aralık 2009 yılları arasında, Dokuz Eylül Üniversitesi Hastanesi Merkez Laboratuvarı Parazitoloji Birimi’nin çeşitli gastrointestinal şikayetlerle başvuran 17756 olguda Blastocystis hominis (B. hominis) görülme sıklığının araştırılmasıdır. Yöntemler: Tüm olgulara ait dışkı örnekleri nativ-lugol inceleme yöntemi sonrası parakon dışkı konsantrasyon tüpü ile çöktürme yöntemi ile, şüpheli olgular trikrom ve Kinyoun acid-fast boyama yöntemleri ile incelenmiştir.Bulgular: Başvuran olguların 1510’unda (%8.50) bir veya birden fazla parazit saptanmıştır. Bu oranın bağırsak parazitlerine göre dağılımı şöyledir: B. hominis 778 (%4.38), apatojen amipler 343 (%1.93), Giardia intestinalis (G. intestinalis) 205 (%1.15), Enterobius vermicularis (E. vermicularis) 46 (%0.25), Entamoeba histolytica/Entamoeba dispar (E. histolytica/E. dispar) 34 (%0.19) ve nadir görülen diğer parazitler 104 (%0.58)’tür. Çalışmamızda gastrointestinal sistem yakınmaları olan hastalardan elde edilen dışkı örneği incelemelerinde en sık B. hominis’e rastlanmıştır. B. hominis saptanan toplam 778 hasta parazitin formlarına göre değerlendirildiğinde 525’inin (%67.49) vakuoler, 115’ini (%14.78) granüler, 138’inin (%17.73) hem vakuoler hem granüler formda olduğu belirlenmiştir.Sonuç: Semptomu olan bu olgularda B. hominis’in tek başına ve yüksek oranda saptanması nedeniyle parazitin patojen olduğu ve rutin dışkı incelemelerinde akıldan çıkarılmaması gerektiği düşünülmektedir. Objective: An investigation of Blastocystis hominis (B. hominis) prevalance in 17756 patients with gastrointestinal system complaints who presented at the parasitology laboratory of the Dokuz Eylul University Medical Faculty Hospital between January 2005 and December 2009 was carried out.Methods: Fecal samples of all patients were examined using the native-Lugol and trichrome and Kinyoun acid-fast staining method after sedimentation in fecal concentration tubes.Results: One or more parasites were detected in 1510 (8.50%) of the patients. The distribution of the intestinal parasites was as follows: B. hominis 778 (4.38%), nonpathogenic amoebas 343 (1.93%), Giardia intestinalis (G. intestinalis) 205 (1,15%), Enterobius vermicularis (E. vermicularis) 46 (0.25%), Entamoeba histolytica/Entamoeba dispar (E. histolytica/E. dispar) 34 (0.19%), and other rare parasites 104 (0.58%). The most frequently seen parasite was B. hominis in fecal samples of patients with gastrointestinal complaints in our study. Distribution of 778 patients with B. hominis due to parasite forms was determined as: vacuolar in 525 (67.49%), granular in 115 (14.78%), both vacuolar and granular in 138 (17.73%) cases.Conclusion: As B. hominis was the most frequently seen parasite in patients with gastrointestinal complaints, we suggest that the parasite should be considered as pathogenic and sufficient attention must be paid in routine stool examinations.

Pneumocystis pnömonisi (PCP) insanda Pneumocystis jirovecii’nin (P. jirovecii) neden olduğu fırsatçı bir akciğer enfeksiyonudur. Bu çalışmada böbrek transplantasyonu sonrasında pnömoni gelişen 23 yaşında bir erkek olgu sunulmaktadır. Hastanın bronkoalveoler lavaj (BAL) sıvısı örneklerinde Giemsa, metanamin-gümüş ve Toluidin-O boyaları ile P. jirovecii trofozoit ve kistleri saptanmıştır. PCP olarak değerlendirilen hasta 21 günlük trimetoprim-sülfamatoksazol (TMP-SMZ) tedavisine yanıt alınması üzerine taburcu edilmiştir. Transplantasyon sonrası profi laktik tedavi almasına rağmen PCP gelişen bu olgu, etkenin immunsupresyon gelişmiş hastalardaki önemini vurgulamak için sunulmuştur. Pneumocystis pneumonia (PCP) is an opportunistic infection caused by Pneumocystis jirovecii (P. jirovecii) in humans. We reported a 23 yearold male patient who developed pneumonia after renal transplantation. P. jirovecii cysts and trophozoites were detected in bronchoalveolar lavage (BAL) samples of the patient by Giemsa, methenamine-silver and Toluidine-O staining. The patient, who was diagnosed as PCP, was discharged as he recovered by 21 days trimethoprim-sulfamethoxazole (TMP-SMX) therapy. This case, who developed PCP even though he had received prophylaxis after transplantation, was reported to emphasize the importance of the agent in immunocompromised patients.

In this study, two free-living amoebae strains, Acanthamoeba genotype T4 and Paravahlkampfia sp., which were isolated from keratitis cases are presented. While the Acanthamoeba strain was isolated as a single agent, the Paravahlkampfia strain was found together with herpes simplex virus. Neither of the patients were contact lens wearers, but they did have a history of minor corneal trauma. Amoebae were detected on non-nutrient agar covered with Escherichia coli. Based on PCR-amplified 18S rRNA-gene analysis the first isolate was identified as Acanthamoeba genotype T4 and the second as Paravahlkampfia sp. In thermotolerance tests, the maximum temperature at which trophozoites continued to divide was determined as 37 °C for this Acanthamoeba strain and 35 °C for the Paravahlkampfia strain. To the best of our knowledge, the Acanthamoeba strain described herein is the second molecularly identified Acanthamoeba strain in an Acanthamoeba keratitis patient in Turkey. However, the Paravahlkampfia isolate is believed to be the first strain that has been isolated from a keratitis patient and has been molecularly differentiated from Vahlkampfia.