Retrospective Analysis of Cases with Imported Malaria in Hatay Province of Turkey: Seventy-Five Cases in Ten Years

Objective: Cases with imported malaria have increased complication and mortality rates because of delayed diagnosis and treatment in non-endemic countries. This study aimed to investigate the incidence and clinical features of imported malaria in our clinic during the past 10 years. Methods: This retrospective study included 75 cases diagnosed as having imported malaria in our clinic between January 2008 and December 2017. The epidemiological data, laboratory findings, treatment data and clinical course of the cases were obtained from system records. Results: Patients were predominantly male (%98.6) with a median age of 51 (23-64) years. All cases were infected with Plasmodium falciparum, had a recent travel history to Sub-Saharan African countries and none had received chemoprophylaxis before travel. The incidence of imported malaria showed a declining trend after 2015. The most common findings were fever (100%), thrombocytopenia (84%) and anemia (72%). Although 8% of patients had presented with severe malaria, none of them died. Conclusion: Despite increasing incidence of imported malaria in our country in recent years, there is a decrease in this number in our region. Since Turkey is one of the countries with the highest prevalence of imported malaria in the world, patients with fever and thrombocytopenia should be questioned whether or not they had a history of travel to malaria-endemic area.

Preventive effect of rolipram, a phosphodiesterase 4 enzyme inhibitor, on oxidative renal injury in acute ascending pyelonephritis model in rats.

OBJECTIVES: To evaluate the effects of rolipram, a phosphodiesterase 4 enzyme inhibitor, on Escherichia coli-induced renal oxidative damage in an acute pyelonephritis (PYN) rat model. METHODS: A total of 35 male Wistar albino rats were randomly divided into 7 groups (n = 5) as follows: control (uninfected), PYN 24 hours, PYN 48 hours, PYN 72 hours, PYN + rolipram 24 hours, PYN + rolipram 48 hours, and PYN + rolipram 72 hours. Ascending PYN was induced in the study groups by E. coli inoculation into the bladder, and the urethras were then occluded by collodium for 4 hours. Rolipram injections (1 mg/kg) were started before bacterial inoculation and repeated at 24-hour intervals in the PYN + rolipram groups until death. The rats were killed at the indicated times. Malondialdehyde and nitric oxide levels and superoxide dismutase and catalase activities were determined in kidney homogenates. Histopathologic examinations were also performed. RESULTS: Tissue malondialdehyde and nitric oxide levels and superoxide dismutase and catalase activities were significantly increased in the kidneys from the PYN groups. However, rolipram administration reduced renal malondialdehyde and nitric oxide levels and enhanced superoxide dismutase and catalase activities. The histopathologic examinations demonstrated that rolipram treatment reduced the inflammation grade in the kidney specimens. CONCLUSIONS: The results of our study have shown that rolipram has a protective effect on renal tissue from E. coli-induced oxidative injury. Therefore, phosphodiesterase 4 inhibitors might be a novel therapeutic option for the prevention and/or management of acute PYN.

The evaluation of immune responses to hepatitis B vaccination in diabetic and non-diabetic haemodialysis patients and the use of tetanus toxoid.

AIM: The aim of this study was to investigate whether haemodialysis (HD) patients suffering from diabetes mellitus could be considered at risk for the development of the protective antibodies to hepatitis B (HB) vaccination and, to evaluate the effectiveness of tetanus toxoid (TT) administrated 2 days before HB vaccination. METHODS: Forty-nine HD patients were divided into two groups: group A (19 diabetic patients) and group B (30 non-diabetic patients). A dose of 40 microg recombinant HB vaccine was injected intramuscularly to the patients at 0, 1, 2 and 6 months. RESULTS: After the completion of the course, the patients in group A were found to have a lower protective antibody rates than the patients in group B (57.8% vs 70%) (P > 0.05). After the administration of additional booster doses during 12 months, the protective antibody to hepatitis B surface antigen (HBsAb) levels were detected in 78.9% and 96.6% of the patients in group A and group B, respectively (P > 0.05). The patients not having protective HBsAb levels were administered TT and HB vaccines, and after course, all of them have produced protective HBsAb levels. CONCLUSION: The present study showed that diabetic patients on HD may carry a greater risk of not seroconverting than non-diabetic ones for antibody response to HB vaccination. The use of TT 2 days before HB vaccination may be a useful and effective method of enhancing the immune response to HB vaccination, especially in the patients with diabetes mellitus on HD.

Morganella morganii-associated arthritis in a diabetic patient.

This case report involves a 60-year-old diabetic man who developed septic arthritis as a result of the pathogen Morganella morganii. The patient had complaints of elevated body temperature, malaise, rigors and pain in the left knee, despite no history of trauma. On examination of the knee, erythema, warmth, tenderness and swelling was observed. Arthrocentesis performed on his left knee indicated the presence of straw-coloured, cloudy fluid without crystals. Bacterial identification based on biochemical and automated methods indicated the growth of M morganii. M morganii was also isolated sedimentafrom the exudate of a diabetic ulcer in the left foot, with antibiotic susceptibilities identical to those from the knee effusion. This case indicates that M morganii may be considered as a possible cause of septic arthritis in diabetic patients, especially those with diabetic foot infections.

Comparison of bacterial isolates cultured from hemodialysis patients and other patients with diabetic foot and their antimicrobial resistance.

The aim of this study was to compare microbial findings and their resistance to antibiotics between hemodialysis patients and patients without end-stage renal failure with diabetic foot infections. An 18-month-long descriptive study analyzed bacterial isolates obtained from 32 hemodialysis (HD) patients with diabetic foot infection in an Antakya hemodialysis center and 65 patients with diabetic foot infection admitted to the Education and Research Hospital of Mustafa Kemal University, Turkey. No significant difference in the mean number of pathogens per patient was found between the dialysis patients and other patients (2.3 vs. 2.1, respectively) (p > 0.05). While the occurrence of gram-positive bacteria in the HD patients was found to be 59.0%, this rate in the other patients was 53.1% (p > 0.05). While most frequent bacterial species isolated in the HD patients were S. aureus (22.9%), followed by coagulase-negative Staphylococcus spp. (CNS) (19.7%), the microorganisms in the other patients were found as CNS (20.7%), followed S. aureus (18.0%). The data recommend that antibiotic therapy in HD patients with diabetic foot infection should be more closely guided by culture findings and antimicrobial susceptibility results.

Distribution of Candida species in women with vulvovaginal symptoms and their association with different ages and contraceptive methods.

The aim of this study was to determine the frequency and distribution of Candida spp. within different age groups and different contraceptive methods users in women with vulvovaginal symptoms. The study included 569 female outpatients who had visited the Education and Research Hospital of Mustafa Kemal University, Turkey, between Jaunary 2004 and June 2005. Among 569 women with symptoms of vulvovaginitis, 240 (42.2%) were positive for Candida spp., of which 106 (44.2%) were C. albicans and 134 (55.8%) were non-albicans spp. The age group 26-30 y had the highest frequency of Candida spp. (23.7%). Candida spp. were isolated from 44.2% of contraceptive method users, and 37.9% of non-contraceptive users (p>0.05). The isolation rate of C. albicans was higher among oral-contraceptive users (57.5%) than IUCD users (38.5%), coitus interruptus (48.5%) and condom users (42.8%). These results indicate that factors associated with age and contraceptive method used may influence the occurrence and distribution of Candida spp. in women with vulvovaginal symptoms.

Protective effects of caffeic acid phenethyl ester, vitamin C, vitamin E and N-acetylcysteine on vancomycin-induced nephrotoxicity in rats.

The objective of this study was to compare the beneficial effects of caffeic acid phenethyl ester (CAPE), vitamin C, vitamin E and N-acetylcysteine on vancomycin-induced nephrotoxicity. Thirty rats were randomly devided into six groups: (i) control; (ii) vancomycin, 200 mg/kg administrated via intraperitoneal route; (iii) vancomycin plus CAPE-vancomycin with 10 micromol/kg CAPE; (iv) vancomycin plus vitamin C-vancomycin (intraperitoneally) with 200 mg/dl vitamin C in drinking water; (v) vancomycin plus vitamin E-vancomycin with 1000 mg/kg body weight vitamin E (intramuscularly); and (vi) vancomycin plus N-acetylcysteine-vancomycin with 10 mg/kg body weight (intraperitoneally) of N-acetylcysteine. Vancomycin treatments were started 1 day after the first administrations of these agents and continued for 7 days. At the end of the experiments, catalase activity was significantly decreased by vancomycin in kidney homogenates (P < 0.05). Vitamin E, vitamin C, N-acetylcysteine and CAPE administrations decreased the blood urea nitrogen levels increased by vancomycin, although significant differences were detected only in the vitamins E and C groups (P < 0.05). Increased renal malondialdehyde and nitric oxide levels by vancomycin were significantly suppressed by agents used in the study (P < 0.05). Histopathological examination demonstrated prominent damages in the vancomycin-treated group. Vitamin E was the most beneficial agent on vancomycin-induced tubular damage, followed by vitamin C, N-acetylcysteine and CAPE treatments, respectively. The data suggest that vitamin E, as well as vitamin C, N-acetylcysteine and CAPE, could be useful for reducing the detrimental effects on vancomycin-induced toxicity in kidneys.

Effects of intrauterine device and oral contraceptive on vaginal flora and epithelium.

OBJECTIVE: To investigate the microbial and cytopathological changes and genital symptoms in oral contraceptive pill (OCP) and intrauterine contraceptive device (IUCD) users. METHODS: Included in the study were 34 women using OCP and 34 women using IUCD for 24 to 36 months period and 34 women as control group. We conducted the study between March to September 2005 in Antakya Maternity Hospital, Turkey. Vaginal discharge was subjected to wet mount examination, gram staining, and culture. Cervical smears were examined and reported using the Bethesda system as reference. RESULTS: In the IUCD group, women with intermediate score was 20.6%, while those with bacterial vaginosis was 11.7%. In the OCP group however, women with intermediate score was 8.8%, while those with bacterial vaginosis was 5.9%. Compared to the control group, these rates were 2.9% for those with intermediate score and 2.9% for those with bacterial vaginosis. Escherichia coli vaginal colonization increased by 5-fold in the IUCD users (p<0.05). Cervical erosion was found in 14.7% of the women using IUCD as compared to the other groups (p<0.05). Actinomyces like organisms was detected in 11.7% of the IUCD users (p<0.05). CONCLUSION: The use of IUCD clearly alter the normal vaginal flora, although OCP appears to have minimal effects on the vaginal microbial flora. The data support the hypothesis that IUCD might change cervico vaginal environment, and suggests that women with IUCD may be at a higher risk for vulvovaginal infection.

Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in southern Turkey.

Primary infections caused by Toxoplasma gondii, rubella and cytomegalovirus (CMV) can lead to serious complications in pregnant women. The aim of this study was to determine the seroprevalence of Toxoplasma, rubella and CMV infections through antenatal screening. In this study, the consecutive records of 1652 pregnant women examined between the period March 2004 to January 2006 were included. The results of the antenatal screening for Toxoplasma, rubella and CMV during the first trimester of pregnancy were evaluated. Anti-Toxoplasma, anti-rubella and anti-CMV IgG and IgM antibodies were assayed using an enzyme linked immunosorbent assay method. Of the 1652 pregnant women tested, anti-Toxoplasma IgG antibody was found in 860 (52.1%) of the cases, while 9 (0.54%) of the subjects tested positive for anti-Toxoplasma IgM. Anti-rubella IgG and IgM antibodies were reactive in 1570 (95.0%), and in 9 (0.54%) of the tested women, respectively. Moreover, 1568 (94.9%) of them were found to be positive for anti-CMV IgG, while 7 (0.4%) tested positive for anti-CMV IgM. Consequently, because of the high seropositivity of T. gondii, rubella and CMV in the pregnant women, the country's health authorities should be alerted, and preventive measures should be taken.

Caffeic acid phenethyl ester suppresses oxidative stress in Escherichia coli-induced pyelonephritis in rats.

Although oxidative damage is known to be involved in inflammatory-mediated tissue destruction, modulation of oxygen free radical production represents a new approach to the treatment of inflammatory diseases. Caffeic acid phenethyl ester (CAPE), an active component of propolis from honeybee hives, has antioxidant, anti-inflammatory and antibacterial properties. For that reason, we aimed to investigate the efficiency of CAPE administration in preventing oxidative damage in pyelonephritis (PYN) caused by Escherichia coli. In this study, 35 Wistar rats were grouped as follows: control, PYN 24 h, PYN 48 h, PYN 72 h, CAPE 24 h, CAPE 48 h and CAPE 72 h. E. coli (1 x 10(9) c.f.u.) were inoculated into the rats in both PYN and CAPE groups via urethral catheterization. Ten microM/kg-body weight CAPE was injected to the rats in all CAPE groups 24 h before E. coli infection, and injections were repeated at 24-h intervals. Rats were sacrificed 24 h, 48 h and 72 h after infection in both PYN and CAPE groups. Malondialdehyde (MDA) and nitric oxide (NO) levels were significantly increased in kidneys of PYN groups. The activities of the antioxidant enzymes, catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and xanthine oxidase (XO) were also elevated by E. coli. However, CAPE administration reduced MDA and NO levels, as well as XO activity, although it increased SOD and GSH-Px activities. Histopathological examination showed that CAPE reduced the inflammation grade induced by E. coli. In conclusion, CAPE administrations decrease the oxidative damage occurring in PYN and therefore could be used for medical management of bacterial nephropathy.

[Falciparum malaria originating in foreign country: four cases]. / Yurtdisi kökenli Plasmodium falciparum sitmasi: dört olgu sunumu.

Malaria has been commonly determined in tropical and subtropical regions and the Plasmadium (P.) vivax generally occurs in our country, Turkey. However, in the people who have been travelling abroad from Turkey P. falciparum and P. malaria were also detected. The diagnosis was confirmed by microscopy of Giemsa stained thin and thick blood slides in four cases, at a magnification of 1000. The diagnosis of four cases was made by seeing the gametocytes of P.falciparum in thin blood films. The cases were found in Hatay region and the patients are those working abroad. The cases are presented in order to emphasize on the necessity of giving education on public health and taking the precautions for the prevention of the disease and in order to draw attention to malaria diseases caused by different species from abroad and to the fact that it can be seen in local cases as well.

Seroprevalence of hepatitis B and hepatitis C in patients with thalassemia and sickle cell anemia in a long-term follow-up.

BACKGROUND: Transfusion-dependent patients are more prone to acquiring various transfusion-transmitted infections such as hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV). The aim of the study was to investigate the prevalence of these infections in patients with thalassemia and with sickle cell anemia (SCA) receiving multiple blood transfusions. METHODS: The subjects of the present study were 399 multi-transfused patients with beta-thalassemia major or intermedia and SCA who have been registered at the two regional hemoglobinopathy centers in Turkey since 1996. Hepatitis B surface antigen (HBsAg), hepatitis C virus antibodies (anti-HCV) and human immunodeficiency virus antibodies (anti-HIV) tests were assayed by a second-generation enzyme-linked immunosorbent assay method. RESULTS: Of the 399 patients, 3 were HBsAg positive (0.75%), 18 were anti-HCV positive (4.5%), and none was anti-HIV positive. All patients with HBsAg and 14 (77.7 %) patients with HCV received initial blood transfusions before second-generation tests were performed. Patients who were anti-HCV positive had a significantly higher mean number of blood transfusions and peak serum alanine transaminase level than anti-HCV-negative patients. CONCLUSIONS: These results showed that after introduction of more sensitive screening tests and stringent donor selection procedures, incidence of HCV infection was significantly reduced, but there was still a serious risk for HCV infection, and there was a minor risk for HBV infection in patients with thalassemia and SCA.

Anti-Toxoplasma gondii antibodies in hemodialysis patients receiving long-term hemodialysis therapy in Turkey.

OBJECTIVE: Toxoplasma is a globally distributed pathogen for humans and animals. In situations of immunodeficiency, Toxoplasma gondii (T. gondii) emerges as a life-threatening infection. Toxoplasma gondii is transmitted parenterally, flourish in state immunosuppression and, most toxoplasma infections are asymptomatic. In the present study, we aimed to investigate the prevalence of anti-T. gondii antibodies in hemodialysis patients with chronic renal failure. We undertook a prospective study of our maintenance hemodialysis patients to determine whether these sources posed a risk for transmission of T. gondii. METHODS: This study was carried out on patients undergoing regular hemodialysis in the dialysis units (Hemodialysis Center of Antakya State Hospital, Emir Hemodialysis Center and Antakya Hemodialysis Center, Hatay, Turkey) between January 2004 and June 2004. Two hundred and fifty-five hemodialysis patients and 50 healthy controls were studied for the prevalence of anti-T. gondii antibodies by enzyme-linked immunosorbent assay. RESULTS: Anti-immunoglobulin G (IgG) and immunoglobulin M (IgM) T. gondii antibodies positivity were found to be 195 (76.5%) of the 255 hemodialysis patients and 24 (48%) of the 50 control subjects. The difference between them was statistically significant (p<0.05). In addition, an increase of the seropositivity rate was detected with increasing length of time on hemodialysis treatment, indicating a statistically significant difference between these 2 parameters (p<0.05). CONCLUSION: These findings confirm a high prevalence of toxoplasma infection in hemodialysis patients. These patients are a risk group for toxoplasma infection. Moreover, it is recommended that hemodialysis patients who are susceptible to toxoplasma infections should be identified by T. gondii IgG and IgM specific serological tests. Therefore, patients undergoing hemodialysis should be screened for toxoplasma before dialysis to prevent the dissemination of this infection through the hemodialysis procedure.