Cryptosporidiosis in immunocompromised patients in a Turkish University Hospital

The prevalence of Cryptosporidiosis in 18 immunosuppressed diarrheic patients was evaluated by examination of fecal samples by direct staining (Modified Kinyoun and Giemsa), direct and indirect immunofluoriscence methods. Forty patients (10 nondiarrheic immunosuppressed, 10 nondiarrheic immunocompetent, and 20 diarrheic immunocompetent) were included in the study as the control group. 11 of 18 samples were positive for cryptosporidial oocysts by at least one of the methods. Oocysts were detected in all (n=7) of the AIDS patients. This high frequency was attributed to a probable nosocomial infection. None of the samples from control subjects were found positive for Cryptosporidium. Our results indicate that Cryptosporidial oocysts should be detected particularly in immunosuppressed patients with diarrhea. Modified Kinyoun staining method is practical and reliable for this purpose. Immunofluorescence staining methods can be applied for confirmation of the results

Comparison of Laboratory Methods for Detection of Pneumocystis carinii

Detection of P. carinii is increased by the use of polymerase chain reaction (PCR), particularly on sputum samples. In this study, sputum samples obtained from 30 immunosuppressed patients with respiratory symptoms (12 HIV infected) were tested by standard cytochemical staining (Giemsa and methenamine silver), immunofluorescense (IF) staining and PCR for detection of P. carinii and the results were compared. P. carinii were detected in 4, 8, and 13 sputum samples by cytological staining, IF test and PCR, respectively. Specific amplification bands were obtained in all sputum samples which were positive by both other tests. All tests gave negative results in sputum samples obtained from 5 HIV infected asymptomatic patients. Our observations suggest that PCR results were found to be well correlated with P. carinii pneumonia (PCP) especially in non-HIV infected patients. However, PCR positivity obtained on HIV infected patients could be misleading in the diagnosis of PCP without careful clinical evaluation. Positive results obtained by Giemsa staining or IF test confirm diagnosis of PCP with high degree correlation. As a result, we suggest testing sputum samples by both PCR and IF techniques for detection of P. carinii

Cystoisospora belli infection in a renal transplant recipient: a case report and review of literature

Cystoisospora belli&nbsp;is a coccidian parasite that causes prolonged watery diarrhea especially among immunocompromised patients. Herein, we report a renal transplant patient who complaints of alternating diarrhea and review of literature related to cystoisosporiasis amongst the transplant recipients.</p

Sıtmada Profilaksi ve Erken Tanı İçin Farkındalığın Önemi: Türkiye’de Yurt Dışı Kaynaklı İki Sıtma Olgusu

Türkiye’de en sık görülen sıtma etkeni Plasmodium vivax olmakla beraber, son yıllarda yurt dışı kaynaklı sıtma olguları bildirilmektedir. Bu çalışmada, Sahra-altı Afrika kaynaklı iki sıtma olgusu sunulmuş, sıtmanın önlenmesinde profilaksinin öneminin vurgulanması ile tanı ve tedavi yaklaşımlarının tartışılması amaçlanmıştır. İlk olgu Gana Cumhuriyeti’nde çalışan 45 yaşında erkek hasta olup Türkiye’ye döndükten sonra ateş, terleme, titreme şikayetleriyle Hacettepe Üniversitesi Hastaneleri Erişkin Acil Servisine başvurmuştur. Genel durumu iyi olan ve fizik muayenesinde patolojik bulguya rastlanmayan hastanın hastanedeki ilk ateş epizodu sonrası tam kan sayımında anemi ve trombositopeni, biyokimyasal testlerinde ise hiponatremi ve alkalen fosfataz yüksekliği saptanmıştır. İkinci olgu, Fildişi Sahili’nden yaklaşık iki hafta önce dönen 39 yaşında erkek hasta olup ateş, terleme, titreme ve halsizlik şikayetleriyle hastanemiz acil servisine başvurmuştur. Hastanın yapılan fizik muayenesinde solunum seslerinde azalma ve splenomegali saptanmış, tam kan sayımında pansitopeni ve biyokimyasal testlerinde karaciğer enzimlerinde yükseklik tespit edilmiştir. Laboratuvarımızda hastalara ait kalın damla preparatının mikroskobik incelemesi sonucu taşlı yüzük hücreleri görülmesi, ince yayma preparatında ise aynı eritrosit içinde birden çok taşlı yüzük hücreli şeklin görülmesi ve olgun trofozoit veya şizont formlarının görülmemesi ile&nbsp;Plasmodium falciparum’a bağlı gelişen sıtma tanısı konulmuştur. Hızlı antijen testi (Digamed, Belçika) ikinci hastada&nbsp;P.falciparum&nbsp;ve&nbsp;P.vivax&nbsp;için pozitif sonuç vermiş ve hasta şiddetli sıtma kliniğine bağlı olarak yoğun bakım ünitesinde takip edilmiştir. Her iki hasta da endemik bölgelere (Gana Cumhuriyeti ve Fildişi Sahili) sık ve uzun süren seyahatleri nedeniyle sıtma profilaksisi kullanmadıklarını belirtmişlerdir. Klorokin direnci yüksek bölgeye seyahat öyküleri olması nedeniyle, hastalara Dünya Sağlık Örgütü güncel önerilerine uygun doz ve sürede artemeter/lumefantrin tedavisi başlanmıştır. İkinci olguya olası&nbsp;P.vivax&nbsp;enfeksiyonuna yönelik primakin tedavisi eklenmiştir. Tedavi ile hastaların kliniği düzelmiş ve laboratuvar bulguları normale dönmüştür. Sonuç olarak, endemik bölgeye seyahat eden bireyler profilaksinin önemi hakkında bilgilendirilmeli, bireylere uygun profilaksi başlanmalı ve seyahat sonrası ateş ile kliniğe başvuran hastaların ayırıcı tanısında sıtma akılda bulundurulmalıdır.In spite of the fact that Plasmodium vivax is the leading causative agent of malaria in our country, imported malaria cases have been reported, recently. In this report, two malaria cases originated from sub-Saharan Africa, and their diagnostic and therapeutic approaches were aimed to be presented. First case, 45-year-old male, who has been working in Republic of Ghana, was admitted to Hacettepe University Hospitals Emergency Service with complaints of fever, sweating and shivering, after returning to Turkey. On admission, his general condition was fine and his physical examination revealed no pathological finding. After his admission, a fever episode occured and his blood tests revealed anemia, trombocytopenia and increased alkaline phosphatase level. Second case, 39-year-old-male admitted to the emergency service with the complaints of fever, shivering and myalgia. His physical examination revealed decreased breath sounds and splenomegaly, his laboratory tests resulted in pansitopenia and elevated liver enzymes. In the thick blood smears of the patients ring formed young trophozoites are detected and in the thin films multiple ring forms demonstrated in one erythrocyte with the absence of mature trophozoites and schizont forms, which were compatible with falciparum malaria. The rapid antigen test (Digamed, Belgium) of the second case found to be positive for both&nbsp;Plasmodium falciparum&nbsp;and&nbsp;P.vivax&nbsp;and this patient followed-up in intensive care unit due to his deterioration of general condition, respiratory distress, hematuria and change of consciousness. Neither cases were commenced on malaria prophylaxis. Both patients have been in countries which chloroquine resistance is commonly seen, they were treated with artemether/lumefantrine as current World Health Organization recommended. Targeting hypnozoites of&nbsp;P.vivax, primaquine was added to the therapy of the second patient. Both patients resulted in cure. In conclusion, while travelling to endemic countries, people should be informed about the importance of malaria prophylaxis and prophylaxis should be commenced immediately and continued appropriately. Additionally, malaria should always be considered in the differential diagnosis of high fever for the patients who admitted to the hospital with a travelling history to these countries.</p