[Evaluation of the Methods Used for the Detection of Entamoeba histolytica in Stool Samples of Patients with Diarrhea]

Amoebic dysentery (amebiasis) is a parasitic infection caused by Entamoeba histolytica. The diagnosis of invasive amebiasis has traditionally been based on direct and stained microscopic examination of stool samples. Stool microscopy exhibits low sensitivity and it is difficult to distinguish E.histolytica cysts and trophozoites from cells such as leukocytes, macrophages and non-pathogenic Entamoeba species in the stool by microscopy. Therefore more sensitive and specific diagnostic methods such as enzyme linked immunosorbent assay (ELISA) tests which investigate the presence of E.histolytica-specific antigen in stool, and polymerase chain reaction (PCR) are being widely used. In this study it was aimed to study stool samples of the patients who applied with the clinical signs of amebiasis by using direct and permanent stained microscopy, E.histolytica adhesin antigen ELISA test and real-time PCR-based BD Max Enteric Parasite Panel (BD Max EPP) test and to evaluate the diagnostic values of these tests. A total of 546 faecal samples with blood and/or mucus were analyzed in the study. In these samples, the presence of E.histolytica was investigated by direct and permanent stained microscopy, E.histolytica adhesin antigen ELISA and BD Max EPP PCR. Of the samples 36.3% were suspected to contain E.histolytica/dispar/moshkovskii cyst and/or trophozoite by direct microscopic examination. Trichrome staining was performed on these samples and 49 samples were found suspicious for the presence of E.histolytica/dispar/moshkovskii cysts and/or trophozoites. The presence of E.histolytica and other Entamoeba species was not confirmed in 75.2% of the samples. BD Max EPP PCR and E.histolytica adhesin antigen ELISA tests were studied in 49 faecal samples that were suspected by trichrome staining. None of these samples were positive by ELISA. Forty-four samples were negative by PCR and invalid test results were obtained in five samples. In this study, E.histolytica was not detected in the patient population. The results of this study showed that microscopic examination alone is not sufficient for the detection of E.histolytica. It is concluded that it is necessary to use a more sensitive and specific also rapid diagnostic test such as E.histolytica-specific antigen detection test or PCR in the diagnosis of amebiasis to avoid misdiagnosis and unnecessary treatment of patients.

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

Cystoisospora belli 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.

Visceral Leishmaniasis in A Patient Presenting with Fever of Unknown Origin: A Case Report From a Low-endemic Region of Turkey

Leishmaniasis is a neglected disease that is prevalent in tropical and subtropical regions of the world. Even though cutaneous leishmaniasis is the most common form, visceral leishmaniasis is associated with high mortality. The case presented herein is a 39 year-old bed-ridden female who presented with fever of unknown origin, tachypnea and pancytopenia. She was initially misdiagnosed as having autoimmune pancytopenia elsewhere and treated with corticosteroids and intravenous immunoglobulin. She had also received wide-spectrum antibiotics for febrile neutropenia. We performed a leishmania rK39 dipstick test which turned out to be positive along with visualisation of amastigote forms of leishmania on bone marrow biopsy. Thus, we made a diagnosis of visceral leishmaniasis and treated her with liposomal amphotericin B. Her clinical course was complicated by respiratory failure necessitating invasive mechanical ventilation. She responded well to treatment and was later extubated, shortly before being discharged. At 6 months of follow-up, no sign of recurrence was observed.

[The Importance of Awareness for Malaria Regarding Prophylaxis and Early Diagnosis: Two Imported Malaria Cases in Turkey]

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 Plasmodium falciparum and P.vivax 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 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.