The first case of Dirofilaria repens (D. repens) parasite in Turkey was detected by Unat in 1944, 1 and human infection with D. repens in the subconjunctiva was also first reported from Adana in 1993 by Soylu et al. 2 Since then, no other cases of human subconjunctival infection with D. repens have been reported in this region.D. repens is a mosquito-borne filaria, a parasite of the subcutaneous tissue of domestic and wild carnivores such as dogs, cats and foxes. 3 Dirofilaria species may be divided into two groups: subgenus Dirofilaria represented by Dirofilaria immitis, which is charecterized by a relatively smooth cuticle and normally found in the right heart and pulmonary vessels of dogs, the natural hosts; and subgenus Nochtiella, which parasitize the subcutaneous tissue. Species of this group have longitudinal ridges on the cuticle. Representative species are Dirofilaria (Nochtiella) repens found in dogs and cats, and Dirofilaria (Nochtiella) tenius found in racoons. 4 As there are no racoons in Turkey, this parasite is not found here. 2 The mature D. repens live in the tissues and organs of vertebrates, while their immature stages prefer the blood and lymph vessels. D. repens is a subdermal parasite in dogs. It has been proven that the parasite, called D. conjunctivae and normaly found in humans, is not a different species from D. repens. 5,6 The main cause of D. conjunctivae cases is D. tenius, which occurs mostly in America, and D. repens, which occurs mostly in Europe (especially in the southern and eastern parts), Russia and Sri Lanka. 5 İt is reported that D. conjunctivae is the immature type of D. repens, therefore, the main infection source of human dirofilariosis is dogs having Dirofilaria. 2,5 D. repens infection, rarely seen in humans, is a zoonotic illness. Humans get infected through blood-sucking arthropods such as mosquitoes, fleas and ticks. During blood sucking, these arthropods receive the immature stages of the parasite called microfilaria. After becoming mature in the arthropods' body, microfilaria is transferred into human or other vertebrates by the blood-sucking arthropods. For D. repens settling in the subconjunctiva, the human body is not an appropriate host, and therefore, no mature stages of the parasite are found in humans. 5 The correct diagnosis of the parasite is usually made with histological examination, based on the identification of the nematode, using the morphological characters of the species to differentiate it from the other Dirofilariae. 5 It is important to identify D. repens by microscopic evaluation of tissue cross section, as well as through its macroscopic characteristics. 7,8 The dyes used in examining the cross transverse sections are hematoxylin-eosin (HE)
Cutaneous leishmaniasis (CL) in Cukurova located in the southern part of Turkey is a public health problem. We assessed the efficiency of a PCR method in establishing the diagnosis of CL. We used two different targets, kinetoplast DNA (kDNA) for diagnosis and a mini-exon gene for species typing. 64 smear samples were taken from clinically CL suspected cases. The DNA was amplified kinetoplast DNA (kDNA) by using the polymerase chain reaction (PCR) with universal primers 13A-13B, specific for the Leishmania genus and DNA was amplified in the mini-exon region by PCR with Fme-Rme primers, specific for Leishmania species. We compared the sensitivity and specificity of conventional microscopy with kDNA and mini-exon PCR. kDNA PCR was found to have a specificty of 58.8% and a sensitivity of 100%, respectively. Furthermore, we performed a restriction fragment length polymorphism (RFLP) analysis on the PCR products of mini-exon for the genotyping of Leishmania species. Interestingly, the PCR-RFLP result showed that 31.5% of the isolates had Leishmania infantum (L.infantum) in CL cases without visceral leishmaniasis (VL) history.
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