THE PREVALENCE OF VULVOVAGINAL CANDIDIASIS (VVC) AMONG WOMEN SUFFERING VAGINITIS ATTENDED A PRIVATE GYNECOLOGICAL CLINIC, ADEN-YEMEN

The study was carried out to determine the prevalence of vulvovaginal candidiasis among women suffering vaginitis. This prospective cross-sectional study was conducted among 120 women between the age of 15 to 45 years (mean age 39 years), attended a private gynecological clinic in Aden with symptoms of vaginitis between January and June 2019. A questionnaire was used to obtain information on the participants’ sociodemographic data and medical history. Direct microscopic examination (10% KOH), culture on SDA, germ tube test and gram staining were used to determine the prevalence of vulvovaginal candidiasis and to differentiate between C.albicans and non-albicans species. Out of 120 women, 25 (20.8%) were diagnosed with vulvovaginal candidiasis (VVC) and 95 (79.2%) with non-candidal vaginitis. C.albicans was the most prevalent with a prevalence rate of 17.5%. Although not statistically significant, vulvovaginal candidiasis tended to be more prevalent among women with 25-34 years. No statistically significant association between the prevalence of vulvovaginal candidiasis and educational level and marital status. Vulvovaginal candidiasis (VVC) was slightly high in Aden and Candida albicans was the most common causative agent of VVC. In the clinical diagnosis of VVC, both clinical criteria and microbiological tests must be used. Further study is needed to find out the prevalence of RVVC among women in the Aden governorate.

​Evaluation of Fungi Isolated in the Veterinary Microbiology Laboratory in Terms of Human Health

Background: The importance of zoonotic fungal infections is increasing today and continues to increase due to changing living conditions. Methods: Between 2012 and 2019 evaluated of fungi species isolated from 51 (20.07%) of 254 samples from 10 different animal species (dog, cat, horse, cow, goat, sheep, camel, penguin, bird, rabbit) with 10 different sample types Thus, the risk of those with zoonotic characteristics was assessed. Despite fungal hyphae and/or spores were seen in 63 (24.8%) of 254 samples in the direct microscopic examination, the isolation of fungi on Sabouraud dextrose agar occurred in only 51 of these samples (20.07%). Conclusion: Of all the 51 samples, 9 (17.64%) samples had more than one fungal agent. The predominant isolate was Aspergillus spp. with an isolation rate of 24 (47.05%), followed by Malassezia spp. 11 (21.56%), Alternaria spp. 6 (11.76%), Penicillium spp. and various yeasts 4 (7.84%), Microsporum spp. 3 (5.88%), Candida spp., Mucor spp., Geotrichum spp. 2 (3.92%) and Trichophyton spp. and Rhizopus spp. 1 (1.96%). Besides, samples were examined for the presence of bacteria and one or more of the bacteria were also isolated from 14 (27.4%) of 51 samples. This assessment in the veterinary microbiology laboratory has shown that the isolated fungi agents pose a significant risk of infection for people who take care of these animals or consume animal products and pet owners.

Genital Filariasis - A Recurred Case of Post Operated Hydrocele

Lymphatic filariasis, commonly termed as elephantiasis has been recorded since ancient Indian, Chinese, Egyptian and Persian writings.1 It is caused by a slender thread like nematode called Wuchereria bancrofti belonging to super family filaroidea.2 It exists in two morphological forms: Adult form and larvae. The adult form has a predilection for intrascrotal lymphatic vessels in hosts; thus hydrocele is one of the most common manifestations of bancroftian filariasis.3 Individuals having circulating microfilaria are outwardly healthy but have the ability to transmit infection to others through mosquito bites (Culex quinquefasciatus) 1 In developing countries like India, occurrence of genital filarial hydrocele is more common in people living in bancroftian endemic areas or in people who were previously operated for eversion of sac. We hereby report a case of hydrocele fluid with microfilaria- an incidental finding on microscopy. Wuchereria bancroti a filarial nematode inhabiting the lymphatics and transmitted through vector - culex mosquito. We hereby present a case of recurrence of genital filariasis. The patient presented with swelling of the left scrotal region with pain of dragging type. On evaluation, eosinophilia was not seen. He had a history of right hydrocele 28 years back. The aspirated hydrocele on direct microscopic examination showed presence of actively motile microfilaria which was confirmed on Giemsa staining. Recurrence is more common in bancroftian filarial endemic areas.

A STUDY OF CLINICALAND MYCOLOGICAL PROFILE OF TINEA INFECTIONS

INTRODUCTION: Dermatophytic infections, also known as ringworm, is one of the most common fungal infections of the skin around the world. The most common symptom seen with dermatophyte infection is pruritis. The varied presentation of tinea is often confusing with other skin diseases. It may be due to the irrational application of broad-spectrum steroid ointments and creams, leading to misdiagnosis and mismanagement. This study was begun to know the prevalence, clinical, and mycological prole of various dermatophytes OBJECTIVES OFTHE STUDY: 1.To study the prevalence of tinea infections. 2.To study the clinical presentation of patients with tinea infections. 3.To study the mycological prole of various tinea infections. METHODS: Clinical assessment was done, which include a detailed history, general physical examination, and examination of the lesion. After a complete review, the evaluation took place. Direct Microscopic Examination. Culture helps in the identication of species. CONCLUSION: To conclude, dermatophytosis is very common in India. It has been registered all over the world but with a different distribution, incidence, and epidemiology from location to location. Geographic location, climate, overcrowding, health care, immigration, personal and environmental hygiene, culture, and socioeconomic status have been attributed as major risk factors for these variations

Migration-associated malaria from Africa in southern Spain

Background The western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work. In recent years, there has been a significant increase in the number of cases of imported malaria associated with migrants from countries belonging to sub-Saharan Africa. The objective of our study is to describe the epidemiological, clinical and analytical characteristics of malaria patients treated in a specialized tropical unit, paying special attention to the differences between VFR and non-VFR migrants and also to the peculiarities of microscopic malaria cases compared to submicroscopic ones. Methods Retrospective observational study of migrants over 14 years of age with imported malaria treated from October 2004 to May 2019. Characteristics of VFR and non-VFR migrants were compared. Malaria cases were divided into microscopic malaria (MM) and submicroscopic malaria (SMM). SMM was defined as the presence of a positive malaria PCR test together with a negative direct microscopic examination and a negative rapid diagnostic test (RDT). Microscopic malaria was defined as the presence of a positive RDT and/or a positive smear examination. Results Three hundred thirty-six cases of malaria were diagnosed, 329 in sub-Saharan immigrants. Of these, 78.1% were VFR migrants, in whom MM predominated (85.2% of cases). In non-VFR migrants, SMM represented 72.2% of the cases. Overall, 239 (72.6%) patients presented MM and 90 (27.4%) SMM. Fever was the most frequent clinical manifestation (64.4%), mainly in the MM group (MM: 81.1% vs SMM: 20.0%; p < 0.01). The most frequent species was P. falciparum. Patients with SMM presented fewer cytopenias and a greater number of coinfections due to soil-transmitted helminths, filarial and intestinal protozoa compared to patients with MM. Conclusions Imported malaria in our area is closely related to sub-Saharan migration. VFR migrants are the main risk group, highlighting the need for actions aimed at improving disease prevention measures. On the other hand, almost a third of the cases are due to SMM. This fact could justify its systematic screening, at least for those travelers at greater risk. Graphic Abstract

Detection of Blastocystis in Stool Isolates Using Different Diagnostic Methods

Background: Blastocystis is a parasite that inhabits human intestinalis. It is commonly identified in asymptomatic individuals, while its pathogenic role is underestimated. In Syria, studies on this parasite are very few, and it is not documented in the laboratory reports. The present study aimed to evaluate the sensitivity of three different diagnostic methods in the detection of Blastocystis among patients with no specific or clear symptoms. Methods: Stool samples were collected from 70 patients suffering from various gastrointestinal symptoms. All samples were examined microscopically using iodine staining smears, and after in vitro cultivation at 37°C for 48- 72 h using Jones' medium. Molecular detection of Blastocystis was determined by fragment amplification of the SSU rRNA gene using PCR. Results: Blastocystis was identified in: 49 cases (70%) by direct microscopic examination, in 60 isolate (85.7%) by in vitro culture and in 64 (91.4%) of cases using molecular detection. Comparative analysis revealed that the sensitivity of microscopic detection for Blastocystis was 73.4% while it was 90.6% for in vitro culture and 95.9 - 96.7% using PCR detection method. Blastocystis was found alone in 32 (65.3%) of cases, while co-infection was detected in 17 (34.7%) samples. Conclusions: Our findings highlighted the importance of considering Blastocystis in laboratory diagnosis. Molecular methods are recommended for screening clinical specimens for Blastocystis infection especially among individuals with no common particular symptoms. If not applicable, two different diagnostic techniques are required for accurate diagnose of this parasite.

Accuracy of Interpretation of Fungi by Direct Microscopy using Chlorazol Black E versus Gold Standard Potassium Hydroxide

Background: Superficial fungal infections are skin diseases that affect people worldwide. To confirm the diagnosis of these diseases, mycological investigation by direct microscopic examination and culture are required. Chlorazol black E (CBE) is an acid-based dye of the trisazo group of dyes that has a high affinity for chitin. Data specific to the efficacy of CBE for detection of fungi by direct microscopy is limited. Objective: To investigate the accuracy of interpretation of fungi by direct microscopy using CBE versus potassium hydroxide (KOH). Materials and Methods: The present study was a retrospective study, conducted at the Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University in 2018. Slide interpretations by 33 microscopists were reviewed. The interpretation scores of all participants in each specimen were recorded and compared between CBE and KOH. Results: Thirty-three participants were included. The mean interpretation score of all participants was 17.2±4.9. The mean interpretation scores of overall specimens using CBE was significantly more than using KOH (p<0.001). For Candida spp. and dermatophytes, the accuracy of interpretation using CBE was statistically higher than KOH (p=0.020, p<0.001, respectively). Relative to negative findings, CBE yielded significantly more false-positive results than KOH (p=0.003). Conclusion: CBE for direct microscopic examination of fungi specimens is helpful for increasing the accuracy of interpretation. However, falsepositive results are more prevalent when using CBE. Keywords: Accuracy, Interpretation, Fungus, Direct microscopy, Chlorazol black E, Potassium hydroxide

Exfoliative dermatitis due to dermatophytosis

Exfoliative dermatitis (ED) or erythroderma is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface, which can be caused by variety of systemic and cutaneous diseases, such as infection, including dermatophytosis. Dermatophytosis is a superficial fungal infection of keratinized tissue caused by dermatophytes. There are only few case reports of ED due to dermatophytosis in literature. A 39-year-old male present with history of diffuse erythematous macules and scales almost on entire body due to dermatophytosis was reported. The diagnosis of dermatophytosis was confirmed by direct microscopic examination, fungal culture, and histopathological examination. Patient was treated with 2% ketoconazole shampoo and two pulses of 1-week of 200 mg itraconazole twice a day for each month. Clinical improvement was showed on the 7th day of observation characterized by decreasing of erythematous macules and scales. Mycological and clinical improvements were obtained on the 29th day of observation. The etiology of ED should be determined in order to give an appropiate treatment.

Diagnosis of Acanthamoeba keratitis in Mashhad, Northeastern Iran: A Gene-Based PCR Assay

Background: The genus Acanthamoeba is a free-living opportunistic protozoan parasite, which widely distributed in soil and fresh water. Acanthamoeba keratitis, which causes a sight-threating infection of the cornea, is going to rise in Iran and worldwide. The aim of this study was to compare direct microscopy, culture and PCR for detection of Acanthamoeba spp. in clinical samples and to determine the genotypes of Acanthamoeba spp. by sequencing 18SrRNA gene. Methods: Among patients clinically suspected to AK referred to a tertiary ophthalmology center at Mashhad, northeastern Iran. During 2017-18, twenty corneal scrapes specimens obtained. The samples were divided into three parts, subjected to direct microscopic examination, culture onto non-nutrient agar and PCR technique. Sensitivity, specificity, accuracy and likelihood ratio were evaluated. Results: Among 20 persons clinically suspected to amoebic keratitis, 13(69.2%) patients definitely diagnosed as Acanthamoeba keratitis. Wearing contact lens, eye trauma due to foreign particle and swimming in fresh water were the main predisposing factors. Most of patients suffered from pain and photophobia. Corneal ring infiltration and epithelial defect were common clinical sings. Direct examination had the lowest sensitivity and sensitivity of both Nelson-PCR and JDP-PCR methods were equal and highest. In addition, the results of sequencing identified that all strains belonged to T4 genotype. Conclusion: Amoebic keratitis is a sporadic parasitic keratitis, which is mainly seen in contact lens user in Mashhad. PCR based on 18S ribosomal DNA with JDP primers is a reliable and highly sensitive method for diagnosis of Acanthamoeba keratitis in clinically suspected cases.

Investigation of Cryptosporidium spp. and Giardia spp. in Lake Eğirdir (Isparta)

Objective: The aim of this study was to assess both the presence and seasonal variability of Cryptosporidium spp. and Giardia spp. in Eğirdir Lake within the borders of Isparta province, which is used for drinking, agricultural irrigation and recreational purposes. Method: The research was carried out between July 2016 and January 2017 and water samples were taken from five different stations in three different seasons in Lake Eğirdir. After direct microscopic examination of the samples (Native-Lugol method), they were stained with Modified Acid Fast (MAF), and examined under the light microscope for parasites. Results: Cryptosporidium spp and Giardia spp were detected in 15 water samples in summer months, with an average density of 99.2% and 93.3% respectively, in Lake Eğirdir. In addition, both parasites were also detected intensively in autumn and winter Conclusion: The use of Lake Eğirdir for daily needs of people, agriculture andrecreational purposes cause increase in protozoal density. Thus, it is necessary to conduct parasitological studies on Lake Eğirdir, especially during the periods of swimming tourism, to determine the protozoal epidemiology in humans and animals. In addition, it is important to carry out adequate disinfection processes and plan the necessary control programs in terms of public health in the regions where Lake Eğirdir is used as drinking water.