Browsing by Author "Özbel Y."

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    Leishmaniasis in Turkey
    (2002) Ok Ü.Z.; Balcioǧlu I.C.; Taylan Özkan A.; Özensoy S.; Özbel Y.
    Leishmaniases are widespread in most countries in the Mediterranean basin, including Turkey. Two forms are observed in Turkey; Leishmania infantum is responsible from visceral leishmaniasis (VL), and L. tropica causes cutaneous leishmaniasis (CL). Phlebotomus sergenti, P. papatasi, P. major and P. syriacus are considered to be the probable vectors, and dogs are the main reservoir of L. infantum, while P. sergenti is the main suspected vector of L. tropica. VL is sporadically seen mainly in the Aegean, Mediterranean, and Central Anatolia Regions, but CL is endemic, especially in the Southeastern and Mediterranean Regions. Major touristic sites are free of both infections, and no infection is reported in any tourist. Mean number of annual VL and CL cases reported to Ministry of Health are 40 and 1,204, respectively, in the last four years. These data suggest that both VL and CL represent a public health problem in Turkey, but a decline is observed in the number of cases with both infections in recent years. © 2002 Elsevier Science B.V. All rights reserved.
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    Seroprevalence of canine visceral leishmaniasis in Kuşadasi, Turkey
    (TUBITAK, 2005) Özensoy Töz S.; Ertabaklar H.; Özbel Y.; Cüneyt Balcioǧlu I.; Yildizli N.; Alkan M.Z.
    Human and canine visceral leishmaniasis cases have been reported from Kuşadasi, a town in western Turkey, since 1993. In orcer to better understand the epidemiology of canine visceral leishmaniasis (CanVL) in the region, we aimed: (i) to determine the prevalence of CanVL in Kuşadasi using a randomly selected dog population and (ii) to measure the effect of case control on the prevalence of the disease. In this study, all 109 dogs kept at the dog shelter of Kuşadasi Municipality (reflecting random selectivity) were screened serologically using IFAT and rK39 ELISA in 1999. Ten dogs (9.1%) were seropositive or borderline in 1 of the 2 tests. Seropositive dogs (8) died spontaneously or were euthanized, while borderline dogs (2) underwent monthly serological examinations. One year later, in a second sampling, a total of 85 dogs were examined (27 previously tested and 58 new). Four dogs 4.7%) showed seropositivity. Seropositive dogs (2) were euthanized while borderline dogs (2) underwent monthly serological examinations. The reduction in the prevalence of the disease (from 9.1% to 4.7%) appears to be the result of culling CanVL positive dogs from the general population. © TÜBİTAK.
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    In vitro and in vivo activities of Haplophyllum myrtifolium against Leishmania tropica
    (2007) Östan I.; Saǧlam H.; Limoncu M.E.; Ertabaklar H.; Toz S.Ö.; Özbel Y.; Özbilgin A.
    This study aimed to evaluate the in vitro and in vivo leishmanicidal activity of an endemic Turkish plant and compare its efficacy with a reference drug. In addition to the in vitro activities of the ethanol, acidified and alkaloid extracts and furoquinoline alkaloids skimmianine and γ-fagarine, in vivo antileishmanial activitiy of the acidified extract of HaplophyUum myrtifolium Boiss. (Rutaceae) were investigated against Leishmania tropica (L. tropica), a causative agent of cutaneous leishmaniasis. All the extracts and pure compounds showed in vitro inhibitory activity against the promastigotes of. L tropica. The in vitro 50% inhibitory concentrations of γ-fagarine, acidified extract, ethanol extract, skimmianine and alkaloid extract against promastigotes were determined as 8.7,9.4,10.9,25.7 and 25.8 μ/ml respectively. In vivo results of HaplophyUum myrtifolium acidified extract showed that this plant has a limited effect on decreasing the lesion size of experimental mice infected with Leishmania tropica. To the best of our knowledge, this is the first time both the in vitro and in vivo antileishmanial activity of HaplophyUum mrytifolium have been reported in the same research.
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    Subungual myiasis in a woman with psychiatric disturbance
    (2008) Balcioǧlu I.C.; Ecemiş T.; Ayer A.; Özbel Y.
    Myiasis is caused by the invasion of tissues or organs of men and animals by dipterous larvae. The disease is infrequent in Turkey. A case of a 65-year-old woman having been initially diagnosed with chronic psychosis, and found to have a left big toe nail invaded by the larvae of Calliphora spp., is presented. A total of 17 maggots were removed from the left big toe of the patient, which were then determined as Calliphora spp. The patient has undergone surgical withdrawal of both nails of her big toes, followed by the administration of oral prophylactic antimicrobial treatment. This is the second recorded case of subungual myiasis by Calliphora spp. in Turkey. Myiasis should be considered in patients with lower personal hygiene, especially with chronic psychiatric disturbances. © 2008 Elsevier Ireland Ltd. All rights reserved.
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    Treatment of head lice with dimeticone 4% lotion: Comparison of two formulations in a randomised controlled trial in rural Turkey
    (2009) Kurt Ö.; Balcioǧlu I.C.; Burgess I.F.; Limoncu M.E.; Girginkardeşler N.; Tabak T.; Muslu H.; Ermiş Z.; Sahin M.T.; Bilac C.; Kavur H.; Özbel Y.
    Background. Dimeticone 4% lotion was shown to be an effective treatment for head louse infestation in two randomised controlled trials in England. It is not affected by insecticide resistance but efficacy obtained (70-75%) was lower than expected. This study was designed to evaluate efficacy of dimeticone 4% lotion in a geographically, socially, and culturally different setting, in rural Turkey and, in order to achieve blinding, it was compared with a potential alternative formulation. Methods. Children from two village schools were screened for head lice by detection combing. All infested students and family members could participate, giving access to treatment for the whole community. Two investigator applied treatments were given 7 days apart. Outcome was assessed by detection combing three times between treatments and twice the week following second treatment. Results. In the intention to treat group 35/36 treated using dimeticone 4% had no lice after the second treatment but there were two protocol violators giving 91.7% treatment success. The alternative product gave 30/36 (83.3%) treatment success, a difference of 8.4% (95% CI -9.8% to 26.2%). The cure rates per-protocol were 33/34 (97.1%) and 30/35 (85.7%) respectively. We were unable to find any newly emerged louse nymphs on 77.8% of dimeticone 4% treated participants or on 66.7% of those treated with the alternative formulation. No adverse events were identified. Conclusion. Our results confirm the efficacy of dimeticone 4% lotion against lice and eggs and we found no detectable difference between this product and dimeticone 4% lotion with nerolidol 2% added. We believe that the high cure rate was related to the lower intensity of infestation in Turkey, together with the level of community engagement, compared with previous studies in the UK. Trial Registration. Current Controlled Trials ISRCTN10431107.
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    Spatial distribution of phlebotomine sand flies in the Aydin Mountains and surroundings: The main focus of cutaneous leishmaniasis in western Turkey
    (2011) Özbel Y.; Balcioǧlu I.C.; Ölgen M.K.; Şimsek F.M.; Töz S.O.; Ertabaklar H.; Demir S.; Alkan M.Z.
    An entomological survey was conducted to determine the spatial distribution of phlebotomine fauna and understand the effect of environmental factors. The entomological survey was carried out during 2006-2007 in a study area in the rural area of Aydin province, near the Kusadasi town where VL, CL, and canine leishmaniasis (CanL) are endemic. In 2006 and 2007, 132 locations were sampled using sticky traps mainly on embankments. Detailed environmental and meteorological information was also collected for each location. The results of entomological studies indicated that the probable vectors are Phlebotomus tobbi and P. neglectus for VL and CanL, and P. similis for CL in this western leishmaniasis focus. The data revealed a correlation between their presence and spatial variables such as altitude, sampling site location, and humidity. The distribution areas of probable vector species in this study area allowed the identification of risk levels, which may provide useful information to guide the leishmaniasis research in endemic regions. © 2011 The Society for Vector Ecology.
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    The in vitro effects of azithromycin and Clarithromycin on promastigotes and amastigotes of Leishmania tropica; [Leishmania tropica promastigotları ve amastigotları üzerine azitromisin ve klaritromisinin in vitro etkisi]
    (Veteriner Fakultesi Dergisi, 2012) Balcioğlu İ.C.; Ok Ü.Z.; Özbel Y.; Girginkardeşler N.; Özbilgin A.
    Leishmania (L.) tropica is one of the most common species responsible for cutaneous leishmaniasis (CL) in the Old World including Turkey. The pentavalent antimonials are widely used as intralesional and/or intramuscular in the treatment of CL, but increase in resistance to these agents led to investigations on alternative drugs. In vitro antileishmanial activities of two macrolides, azithromycin and clarithromycin were evaluated on promastigotes in RPMI 1640 medium and amastigotes in macrophage series of L. tropica. ED50 values of azithromycin and clarithromycin were found to be 5 µg/ml and <5 µg/ml on promastigotes, and 50-75 µg/ml and <3 µg/ ml on amastigotes, respectively, while ED90 values of the same drugs were 75 µg/ml and 25 µg/ml on promastigotes and 100 µg/ml and 10 µg/ml on amastigotes, respectively. Our data suggested that clarithromycin and azithromycin were effective on both L. tropica promastigotes and amastigotes in vitro. Clarithromycin was found to be more effective than azithromycin at lower concentrations on promastigotes and amastigotes. In vivo studies should be planned to detect intracellular concentrations of these drugs for the effective route and dosage. © 2012, Veteriner Fakultesi Dergisi. All rights reserved.
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    Are regular controls conducted in schools adequate in lowering the incidence of head lice (Pediculus capitis) infestation?; [Okullarda düzenli aralıklarla gerçekleştirilen kontroller saç biti (Pediculus capitis) insidansını düşürmekte yeterli olabilir mi?]
    (Veteriner Fakultesi Dergisi, 2012) Balcioğlu İ.C.; Kurt Ö.; Limoncu M.E.; Ermiş V.Ö.; Tabak T.; Oyur T.; Muslu H.; Kavur H.; Görgün S.; Girginkardeşler N.; Yereli K.; Bilaç C.; Özbel Y.
    In the present study, school children of similar age-groups from two villages of Manisa province, namely Osmancalı and Maldan, were examined in regular time periods to monitorize the changes in the incidence of head lice (Pediculus capitis). A total of 2091 children (1565 in Osmancalı and 526 in Maldan) were combed with a newly-designed lice comb (PDC®, KSL Consulting, Helsinge, Denmark) four times in May and November in 2008 and 2009. The assessment of the results was conducted with SPSS® v.15 program using CHAID and logistic regression analysis. The results of the periodic examinations of the children showed that the infestation rate of girls were found to be higher significantly compared to boys (P<0.001), and the incidence of head lice infestation in boys from Osmancalı was found three times higher than the incidence in boys in Maldan (P=0.002). In addition, regular dry combing and treatment lowered the infestation rates among girls significantly (P=0.001). According to the results of the study, regular dry combing of school children with specially-designed lice combs may be essential for the control of this common infestation, especially in rural areas. © 2012, Veteriner Fakultesi Dergisi. All rights reserved.
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    A new approach for determining the spatial risk levels for visceral and cutaneous leishmaniasis related with the distribution of vector species in western part of turkey using geographical information systems and remote sensing; [Coğrafi bilgi sistemleri ve uzaktan algılama kullanılarak türkiye’nin batısında visseral ve kutanöz leishmaniasisde vektör türlerin dağılımı ile ilişkili mekansal risk düzeylerinin saptanması için yeni bir yaklaşım]
    (Veteriner Fakultesi Dergisi, 2012) Ölgen M.K.; Özbel Y.; Balcioğlu I.C.; Demir S.; Şimşek F.; Özensoy Töz S.; Ertabaklar H.; Alkan M.Z.
    Leishmaniases are present in two clinical forms, as visceral and cutaneous, in Turkey showing a tendency of spreading throughout the country. The aim of the present study was to produce a new model for determining the spatial risk levels using the data in a selected study site in the western part of Turkey. The results of entomological studies in this leishmaniasis focus indicated the presence of suspected vector species Phlebotomus (Larroussius) tobbi and P. (Larroussius) neglectus for the visceral, P. (Paraphlebotomus) similis for cutaneous forms of the disease. The new risk model was developed based on univariate and multivariate binary logistic regression analyses of geographical variables as altitude, aspect, Normalized Difference Vegetation Index (NDVI), Enhanced Vegetation Index (EVI) and Land Surface Temperature (LST) values related to the distribution of these three species. The results of the new model were used to produce the risk maps and the potential distribution areas of the incriminated vector species with the use of geographical technologies which allowed the identification of the leishmaniasis risk levels that may provide useful information to guide the control program interventions. © 2012, Veteriner Fakultesi Dergisi. All rights reserved.
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    Leishmaniasis in Turkey: Determination of Leishmania species by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS)
    (Tehran University of Medical Sciences (TUMS), 2014) Culha G.; Akyar I.; Yildiz Zeyrek F.; Kurt Ö.; Gündüz C.; Özensoy Töz S.; Östan I.; Cavus I.; Gülkan B.; Kocagöz T.; Özbel Y.; Özbilgin A.
    Background: Cutaneous leishmaniasis (CL) is endemic in Southeastern Anatolia, mainly in Sanliurfa and Hatay provinces, and the causative agents are mostly Leishmania tropica and less frequently L. infantum. Here, we report the first MALDI-TOF analyses of Leishmania promastigotes obtained from the cultures of two CL cases from Osmaniye and Hatay provinces who were initially diagnosed by microscopy, culture and identified as L. infantum with Real-Time PCR (RT-PCR). Methods: Samples obtained from the skin lesions of patients were initially stained with Giemsa and cultivated in NNN medium. Examination of the smears and cultures revealed Leishmania amastigotes and promastigotes, respectively. The promastigotes (MHOM/TR/2012/CBU15 and MHOM/TR/2012/MK05) obtained from the cultures of both patients were used for RT-PCR targeting the ITS-1 region in the SSU of rRNA. The reference strains of four Leishmania species (L. infantum, L. donovani, L. tropica and L. major) were initially assessed with MALDI-TOF and their data were added to MALDI-TOF Biotyper Library. Results: Both RT-PCR and MALDI-TOF analyses indicated that the causative agent in both patient samples was L. infantum. Conclusion: Despite disadvantages such as requirement of culture fluid with nothing but promastigotes and high cost, MALDI-TOF analysis may be a fast, sensitive and specific diagnostic tool in especially large-scale research studies, where the cost declines, relatively.
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    Treatment of head lice (Pediculus humanus capitis) infestation: Is regular combing alone with a special detection comb effective at all levels?
    (Springer Verlag, 2015) Kurt Ö.; Balcıoğlu I.C.; Limoncu M.E.; Girginkardeşler N.; Arserim S.K.; Görgün S.; Oyur T.; Karakuş M.; Düzyol D.; Gökmen A.A.; Kitapçıoğlu G.; Özbel Y.
    Head lice infestation (HLI) caused by Pediculus humanus capitis has been a public health problem worldwide. Specially designed combs are used to identify head lice, while anti-lice products are applied on the scalp for treatment. In the present study, we aimed to test whether combing only by precision detection comb (PDC) or metal pin comb (MPC) could be effective alternatives to the use of anti-lice products in children. A total of 560 children from two rural schools in Turkey were screened. In the PDC trial, children were combed every second day for 14 days, while in the MPC trial, combing was performed once in every four days for 15 days. Children were divided into two groups (dry combing and wet combing) for both trials and results were compared. The results showed no significant differences between dry and wet combing strategies for both combs for the removal of head lice (p > 0.05). The number of adult head lice declined significantly on each subsequent combing day in both approaches, except on day 15 in the MPC trial. In the end, no louse was found in 54.1 and 48.9 % of children in the PDC and MPC trials, respectively. Since family members of infested children were not available, they were not checked for HLI. Four times combing within 2 weeks with MPC combs was found effective for both treatment of low HLI and prevention of heavy HLI. In conclusion, regular combing by special combs decreases HLI level in children and is safely applicable as long-term treatment. © 2015, Springer-Verlag Berlin Heidelberg.
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    Evaluation of conjunctival swab sampling in the diagnosis of canine leishmaniasis: A two-year follow-up study in Çukurova Plain, Turkey
    (Elsevier B.V., 2015) Karakuş M.; Töz S.; Ertabaklar H.; Paşa S.; Atasoy A.; Arserim S.K.; Ölgen M.K.; Ziya Alkan M.; Durrant C.; Özbel Y.
    The diagnosis of canine leishmaniasis (CanL) in symptomatic and asymptomatic dogs is a very important and problematic public health issue in Turkey. A longitudinal study was carried out on dogs in selected villages in the Çukurova Plain in Turkey, from July 2011 to June 2013, where cutaneous (CL) and visceral (VL) leishmaniasis is endemic. The study aimed to determine the prevalence of CanL and to evaluate the early diagnostic performance of the non-invasive conjunctival swab nested PCR (CS n-PCR) test in comparison with the Indirect Fluorescent Antibody Test (IFAT). The consecutive blood and CS samples from a representative number of dogs (80-100 dogs/each survey) were collected in a cohort of 6 villages located in the area. Clinical symptoms, demographic and physical features about each dog were noted and lymph node aspiration samples were obtained from selected dogs with lymphadenopathy. In four surveys during the period, a total of 338 sets (blood and CS) of samples from 206 dogs were obtained, such that 83 dogs were sampled more than once. In the cross-sectional analysis, the CanL prevalence was found to be 27.18% (between 7.14% and 39.13%) by IFAT and 41.74% (between 29.03% and 46.66%) by CS n-PCR. The isolated strains were identified as Leishmania infantum MON-1 (n = 9) and MON-98 (n = 2) by MLEE analysis. Genetic studies targeting the Hsp70 and ITS1 regions performed on 11 dog isolates also showed two clear separate groups. According to IFAT results, 24 of the 83 dogs sampled more than once showed seroconversion (n = 19) or a four-fold increase in Ab titers (n = 5), while 17 were positive in the initial screening. Forty-two dogs stayed negative during the whole period. The natural Leishmania exposure rate was detected as 31.14% in the study area. CS n-PCR only detected Leishmania infection earlier than IFAT in 8 dogs. No statistical difference was found after the analysis of demographical and physical data. The results indicated that (i) circulation of the dog population is very common in settlements in the Çukurova Plain, but the disease prevalence is high and stable, (ii) the performance of CS n-PCR for detecting Leishmania-dog contact is higher than IFAT, (iii) and some of the parasites isolated from dogs have different zymodemes and/or genotypes from previous human and sand fly isolates; suggesting the probability of two different cycles of leishmaniasis in this particular area. This hypothesis should be supported by future studies targeting vectors and reservoirs. © 2015 Elsevier B.V.
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    Comparing the Efficacy of Commercially Available Insecticide and Dimeticone based Solutions on Head Lice, Pediculus capitis: in vitro Trials
    (2015) Balcıoğlu I.C.; Karakuş M.; Arserim S.K.; Limoncu M.E.; Töz S.; Baştemur S.; Öncel K.; Özbel Y.
    OBJECTIVE: Head lice infestation is a public health and social problem for almost all countries worldwide. For its treatment, insecticide and dimeticone-based solutions are currently available in the markets in many countries. We aimed to compare the efficacy of commercially available anti-head lice shampoos containing insecticide and physically effective products with different percentages of dimeticone using an in vitro technique.; METHODS: Head lice specimens were collected from primary school children using special plastic and metal combs. Anti-head lice products were commercially purchased and used directly. The specimens were placed one by one in 5-cm Petri dishes containing a slightly wet filter paper and were kept in a plastic cage at 28±2°C and 50%±20% relative humidity. A standardized protocol was used for testing all the products, and mortality data were obtained after 24 h. Two control tests were performed with each batch of trials. For each product and control, 10-20 head lice specimens were used, and the results were statistically analyzed.; RESULTS: Our study demonstrated that among all the tested products, two products containing mineral oils [5.5% dimeticone & silicone (patented product) and dimeticone (no percentage mentioned in the prospectus) & cyclopentasiloxane] were found to be more effective for killing head lice in vitro.; CONCLUSION: Physically effective products can be repetitively used because they are non-toxic and resistance to them is not expected. To control the infestation at a public level, the use of these products needs to be encouraged with respect to their cost price.
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    Detection of Leishmania major and Leishmania tropica in domestic cats in the Ege Region of Turkey
    (Elsevier B.V., 2015) Paşa S.; Tetik Vardarli A.; Erol N.; Karakuş M.; Töz S.; Atasoy A.; Balcioğlu T.C.; Emek Tuna G.; Ermiş T.V.; Ertabaklar H.; Özbel Y.
    Leishmaniosis is a group of diseases caused by different species of Leishmania parasites in mammalian species. The aim of the present study was to investigate the presence of Leishmania spp. DNA in cats using real time polymerase chain reaction (RT-PCR) assays targeting internal transcribed spacer (ITS1) and heat-shock protein 70 gene (Hsp70) regions with Leishmania species-specific primers and probes. Blood samples were collected from 147 cats (73 female; 74 male) in the endemic regions for zoonotic visceral leishmaniasis in the western provinces of Turkey and analyzed using two RT-PCR assays. Additionally, Hsp70 RT-PCR products were sequenced. ELISA assays for feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) were also carried out for 145 of the 147 samples.Overall, 13/147 (8.84%) cats were positive for Leishmania by RT-PCR (4 L. major and 9 L. tropica). FIV and FeLV antibody and/or antigen was detected in 4 and 5 cats among Leishmania DNA positives, respectively. To the best of our knowledge, this study is the first to investigate and report the presence of L. major and L. tropica infections in a large group of domestic cats in Turkey. The results obtained indicate that species identification of Leishmania is essential for epidemiological understanding and that clinical signs alone are not indicative for leishmaniosis in cats, as it is in dogs. This study suggests that extensive research should be carried out in cat populations in order to fully understand the role of cats in the epidemiology of the disease. © 2015 Elsevier B.V.
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    sandflyDST: a dynamic web-based decision support tool for the morphological identification of sandflies present in Anatolia and mainland Europe, and user study
    (Blackwell Publishing Ltd, 2016) Karakülah G.; Karakuş M.; Suner A.; Demir S.; Arserim S.K.; Töz S.; Özbel Y.
    Species identification of sandflies is mainly performed according to morphological characters using classical written identification keys. This study introduces a new web-based decision support tool (sandflyDST) for guiding the morphological identification of sandfly species present in Anatolia and mainland Europe and classified in the Phlebotomus and Sergentomyia genera (both: Diptera: Psychodidae). The current version of the tool consists of 111 questions and 36 drawings obtained from classical written keys, and 107 photographs for the quick and easy identification of 26 species of the genus Phlebotomus and four species of the genus Sergentomyia. The tool guides users through a decision tree using yes/no questions about the morphological characters of the specimen. The tool was applied by 30 individuals, who then completed study questionnaires. The results of subsequent analyses indicated that the usability (x‾SUSScore=75.4) and users' level of appreciation (86.6%) of the tool were quite high; almost all of the participants considered recommending the tool to others. The tool may also be useful in training new entomologists and maintaining their level of expertise. This is a dynamic tool and can be improved or upgraded according to feedback. The tool is now available online at http://parasitology.ege.edu.tr/sandflyDST/index.php. © 2016 The Royal Entomological Society.
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    Leishmaniasis in Turkey: First clinical isolation of Leishmania major from 18 autochthonous cases of cutaneous leishmaniasis in four geographical regions
    (Blackwell Publishing Ltd, 2016) Özbilgin A.; Çulha G.; Uzun S.; Harman M.; Topal S.G.; Okudan F.; Zeyrek F.; Gündüz C.; Östan I.; Karakuş M.; Töz S.; Kurt Ö.; Akyar I.; Erat A.; Güngör D.; Kayabaşi Ç.; Çavuş I.; Bastien P.; Pratlong F.; Kocagöz T.; Özbel Y.
    Objective: To report isolation of Leishmania major strains obtained from 18 Turkish autochthonous cutaneous leishmaniasis (CL) patients infected with L. major between 2011 and 2014. Methods: Initial diagnosis relied on microscopy and culture in enriched medium, prepared by adding specific amounts of liver extract, protein and lipid sources to NNN medium. Promastigotes were then transferred to RPMI medium including 10% of foetal calf serum for mass culture. Species-specific real-time PCR targeting ITS1 region of Leishmania spp. was performed using both lesion aspiration samples and cultured promastigotes. Two of 18 isolates were identified by isoenzyme analysis in the Leishmaniasis Reference Center in Montpellier, France. Each isolate was inoculated into the footpads of six mice to observe the pathogenicity of L. major. Developing lesions were observed, and the thickening of footpads was measured weekly. Results: Melting curve analyses of 18 isolates showed a peak concordant with L. major, and two of them were confirmed by isoenzyme analyses as L. major zymodeme MON103. In the mouse model, acute lesions seen on day 21 were accepted as an indication of heavy infection. Severe impairments were observed on all mouse footpads over 3 weeks, which even progressed to extremity amputation. Conclusion: Cutaneous leishmaniasis-causing L. major was recently identified in Adana province in southern Turkey, with PCR. Our study shows that such CL cases are not limited to Adana but currently present from western to Southeastern Anatolia, and along the Mediterranean coast. The role of small mammals, the main reservoirs of L. major in Anatolia, needs to be elucidated, as do the underlying factors that cause severe clinical manifestations in L. major infections in Turkey, contrary to the infections in neighbouring countries. © 2016 John Wiley & Sons Ltd.
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    Molecular detection and identification of Leishmania spp. in naturally infected Phlebotomus tobbi and Sergentomyia dentata in a focus of human and canine leishmaniasis in western Turkey
    (Elsevier B.V., 2016) Özbel Y.; Karakuş M.; Arserim S.K.; Kalkan Ş.O.; Töz S.
    Human visceral leishmaniasis (VL) is reported from 38 provinces of Turkey and dogs are accepted as main reservoir hosts. Kuşadasi town, belonging to Aydin province and located in western part of Turkey, is endemic for human and canine visceral leishmaniasis caused by Leishmania infantum MON1 and MON98.In this study, phlebotomine survey was conducted to determine the vector sand fly species and to identify sand fly blood meal sources. In August and September 2012, 1027 sand fly specimens were caught using CDC light traps. Eight Phlebotomus and two Sergentomyia species with the dominancy of Phlebotomus tobbi (61.34%) were detected. A total of 622 female sand flies (571 Phlebotomus; 51 Sergentomyia) were checked for Leishmania infection by direct dissection of the midgut. The half of the midgut content was inoculated into NNN culture for isolation of the parasite. Leishmania species-specific ITS1 real time PCR, conventional PCR assays of ITS1 and hsp70 genes and subsequent sequencing were performed from extracted DNAs. A region of cytochrome b (cyt-b) gene of vertebrates based PCR was used to determine the source of blood meal of sand flies.In microscopical examinations, two female specimens (0.32%) were found naturally infected with high number and different stages of promastigotes. No growth was observed in NNN culture but Leishmania DNA was obtained from both specimens. First positive specimen was identified as P. tobbi and L. infantum DNA was detected. Second specimen was Sergentomyia dentata, but Leishmania DNA could not be identified on species level. A total of 16 blood-fed female P. tobbi specimens were used for blood meal analysis and eight, three and one specimens were positive for human, dog and mouse, respectively.This is the first detection of Leishmania promastigotes using microscopical examination in P. tobbi and S. dentata in human and canine visceral leishmaniasis endemic area in western part of Turkey. Our results indicate that, (i) P. tobbi is the principal vector species and (ii) human and dogs are main blood sources. The detection of Leishmania sp. in Sergentomyia species may be an evidence for natural cycle of Sauro-leishmania agents in the area. © 2016 Elsevier B.V.
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    Epidemiological analysis of Leishmania tropica strains and giemsa-stained smears from Syrian and Turkish leishmaniasis patients using multilocus microsatellite typing (MLMT)
    (Public Library of Science, 2017) Karakuş M.; Nasereddin A.; Onay H.; Karaca E.; Özkeklikçi A.; Jaffe C.L.; Kuhls K.; Özbilgin A.; Ertabaklar H.; Demir S.; Özbel Y.; Töz S.
    Turkey is located in an important geographical location, in terms of the epidemiology of vector-borne diseases, linking Asia and Europe. Cutaneous leishmaniasis (CL) is one of the endemic diseases in a Turkey and according to the Ministry Health of Turkey, 45% of CL patients originate from Şanlıurfa province located in southeastern Turkey. Herein, the epidemiological status of CL, caused by L. tropica, in Turkey was examined using multilocus microsatellite typing (MLMT) of strains obtained from Turkish and Syrian patients. A total of 38 cryopreserved strains and 20 Giemsa-stained smears were included in the present study. MLMT was performed using 12 highly specific microsatellite markers. Delta K (ΔK) calculation and Bayesian statistics were used to determine the population structure. Three main populations (POP A, B and C) were identified and further examination revealed the presence of three subpopulations for POP B and C. Combined analysis was performed using the data of previously typed L. tropica strains and Mediterranean and Şanlıurfa populations were identified. This finding suggests that the epidemiological status of L. tropica is more complicated than expected when compared to previous studies. A new population, comprised of Syrian L. tropica samples, was reported for the first time in Turkey, and the data presented here will provide new epidemiological information for further studies. © 2017 Karakuş et al.
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    Leishmaniasis in Turkey: Visceral and cutaneous leishmaniasis caused by Leishmania donovani in Turkey
    (Elsevier B.V., 2017) Özbilgin A.; Harman M.; Karakuş M.; Bart A.; Töz S.; Kurt Ö.; Çavuş İ.; Polat E.; Gündüz C.; Van Gool T.; Özbel Y.
    In Turkey, the main causative agents are Leishmania tropica (L. tropica) and Leishmania infantum (L. infantum) for cutaneous leishmaniasis (CL) and L. infantum for visceral leishmaniasis (VL). In this study, we investigated leishmaniasis cases caused by L. donovani and established animal models for understanding its tropism in in vivo conditions. Clinical samples (lesion aspirations and bone marrow) obtained from CL/VL patients were investigated using parasitological (smear/NNN) and DNA-based techniques. For species identification, a real time ITS1-PCR was performed using isolates and results were confirmed by hsp70 PCR-N/sequencing and cpb gene PCR/sequencing in order to reveal Leishmania donovani and Leishmania infantum discrimination. Clinical materials from CL and VL patients were also inoculated into two experimental groups (Group CL and Group VL) of Balb/C mice intraperitoneally for creating clinical picture of Turkish L. donovani strains. After 45 days, the samples from visible sores of the skin were taken, and spleens and livers were removed. Measurements of the internal organs were done and touch preparations were prepared for checking the presence of amastigotes. The strains were isolated from all patients and amastigotes were seen in all smears of the patients, and then isolates were immediately stored in liquid nitrogen. In real time ITS1-PCR, the melting temperatures of all samples were out of range of L. infantum, L. tropica and L. major. Sequencing of hsp70 PCR-N showed that all isolates highly identical to previously submitted L. donovani sequences in GenBank, and cpb gene sequencing showed five isolates had longer cpbF allele, whereas one isolate contained a mixed sequence of both cpbF and cpbE. All mice in both experimental groups became infected. Compared to controls, the length and width of both liver and spleen were significantly elevated (p < 0.001) in both groups of mice. However, the weight of the liver increased significantly in all mice whereas the weight of spleen increased only in VL group. Amastigotes were also seen in all touch preparations prepared from skin sores, spleen and liver. L. donovani strain was isolated from autocutaneous a VL patient first time in Turkey. Animal models using clinical samples were successfully established and important clinical differences of the isolated strains were observed. © 2017 Elsevier B.V.
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    Vector and reservoir surveillance study in a canine and human leishmaniasis endemic area in most western part of Turkey, Karaburun
    (Elsevier B.V., 2019) Karakuş M.; Arserim S.K.; Erişöz Kasap Ö.; Pekağırbaş M.; Aküzüm D.; Alten B.; Töz S.; Özbel Y.
    Leishmaniasis is an arthropod borne disease that is endemic in 102 countries and one and half million new cases are reported each year. Sand flies are the one and only proven vectors of the disease and dogs are the main reservoirs in urban areas. Karaburun peninsula is located in most western part of Turkey and is reported to be an endemic area for human and canine leishmaniasis. The most recent study was undertaken more than 15 years ago in The peninsula and no clear data available for vectors or reservoirs. Thus, we aimed to update the information regarding sand fly diversity, infection status of reservoirs and vectors in the study area. Sand flies were collected using CDC light traps at 13 different sites of Karaburun and species identification was made using previously published keys. Monospecific pools were generated using midguts with blood retention and were screened for the presence of Leishmania spp. DNA by molecular techniques. A non-invasive conjunctival swab sampling was performed to identify the infection status among reservoirs and species typing of the causative agent was also undertaken using ITS1 PCR. Three out of 30 pools were found positive for Leishmania infantum that were generated using guts of Phlebotomus tobbi (n:36). Among all sampled dogs (44) and cats (19), 11 and one of them were found positive for L. infantum, respectively. There was a decrease in the number of P. papatasi during the study period, while increase was observed in the number of P. tobbi. The presence of proven vectors and reservoirs as well as Leishmania DNA in cats was shown in the present study. Sand fly fauna is updated and Leishmania DNA presence in cats was reported in the study area for the first time. © 2018 Elsevier B.V.