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    The infection risk of visceral leishmaniasis among household members of active patients
    (Elsevier Ireland Ltd, 2006) Sakru, Nermin; Toz, Seray Ozensoy; Korkmaz, Metin; Kavakli, Tulay; Alkan, M. Ziya; Ozbel, Yusuf
    Human visceral leishmaniasis (HVL), caused by Leishmania infantum is mainly observed as sporadic cases in Turkey and dogs are considered as the main reservoir of the disease. The incidence of visceral leishmaniasis among members of households where a HVL infection has already been diagnosed was studied in clusters around the diagnosed cases in different regions in Turkey. A total of 47 serum samples collected from the households of 11 proven visceral leishmaniasis patients were screened for anti-Leishmania antibodies by indirect immunofluorescent antibody test (IFAT). Three and one such household members belonging to the different families were found to be seropositive and borderline, respectively. Diagnosis was confirmed with the presence of amastigotes in bone marrow aspiration samples in all seropositives while the borderline case with slight and indefinitive symptoms of VL was followed only serologically at 3-month intervals and improved spontaneously in I year. Household members of individuals with previously confirmed visceral leishmaniasis were found to have higher frequency of the disease suggesting the household members should be included in the risk group for visceral leishmaniasis and serological screening should be performed for the detection of possible infection. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
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    Investigation of asymptomatic visceral leishmaniasis cases using western blot in an endemic area in Turkey
    (Edizioni Internazionali Srl, 2007) Sakru, Nermin; Korkmaz, Metin; Ozbel, Yusuf; Ertabaklar, Hatice; Sengul, Mustafa; Toz, Seray Ozensoy
    In Turkey, Leishmania infantum is responsible for human visceral leishmaniasis (VL), which is seen mainly in the Aegean, Mediterranean, and Central Anatolia Regions. This study aimed to determine asymptomatic infections in an endemic area of VL in Turkey using the western blot technique. A total of 82 persons including children and adults were chosen randomly in Denizli province which is one of the endemic sites for VL. Serum samples were collected and screened using indirect immunofluorescent test (IFAT), enzyme-linked immunosorbent assay (ELISA) and western blot (WB). One year later, 35 of the 82 persons were sampled and screened serologically for the second time. Seven out of 82 samples were found to be positive by western blot analysis with the presence of 14 and/or 18 kDa bands. Two of these seven sera were also positive by IFAT, but only one of these two was positive by ELISA. Only one person showing seropositivity with all three tests had clinical symptoms and was diagnosed as VL with the presence of amastigotes in bone marrow aspirate. Because six people, including the one found to be seropositive in all two tests, had no clinical symptoms, they were accepted as asymptomatic carriers. The ratio of asymptomatic infection was calculated as 7.41% (6/81) in the region. In the second sampling, the western blot revealed antibodies against the same antigens in all seven subjects. Our findings showed that the presence of antibodies against 14 and 18 kDa antigens are important for the diagnosis of symptomatic and asymptomatic infections. Western blot eras found to be effective in the detection of asymptomatic persons in the epidemiological studies in endemic areas.
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    Serological and entomological survey of zoonotic visceral leishmaniasis in Denizli Province, Aegean Region, Turkey
    (Edizioni Int Srl, 2009) Toez, Seray Oezensoy; Sakru, Nermin; Ertabaklar, Hatice; Demir, Samiye; Sengul, Mustafa; Ozbel, Yusuf
    A cross-sectional seroepidemiological survey of leishmaniasis was carried out among children and adults from four villages and one district of Denizli province located in the Southern Aegean Region of Turkey where 14 human visceral leishmaniasis (HVL) cases including 4 adults Were reported between 1993 and 2000. Blood samples were taken from 329 children, 217 adults and 140 dogs and a physical examination was also done. Indirect fluorescent antibody test and enzyme linked immunosorbent assay were performed for all sera. All 329 sera collected from children were found to be negative while 2 (0.09%) out of 217 adult sera were found to be seropositive. One seropositive adult patient was confirmed parasitologically as HVL after bone marrow aspiration and treated with AmBisome (R) while the other was followed only serologically because of the absence of symptoms. The overall canine leishmaniasis seroprevalence was found to be 20.7%. Sand flies were collected using CDC light traps in three out of five study sites and midguts; of females were checked for promastigotes after dissection/identification. Eight Phlebotomus species were found in the region. Phlebotomus neglectus and R papatasi were determined as dominant species with the ratio of 43.52% and 37.35%, respectively. No promastigotes were found in the midgut specimens. In addition, the results showed the presence of vector sand fly Species, as well as a high seroprevalence of anti-Leishmania antibodies among dogs from rural and a suburban area of Denizli province with a large proportion of asymptomatic seropositive dogs.