title: Epidemiological and diagnostic features of blastocystis infection in symptomatic patients in izmir province, Turkey.
abstract: BACKGROUND
  The aims of this study were to identify Blastocystis subtypes (STs) in a cohort of Turkish patients with various gastrointestinal symptoms using a novel Real Time PCR method developed recently for Blastocystis detection and assess the relationship between Blastocystis STs and patient symptoms.
  
  
  METHODS
  Totally, 617 stool samples of patients with gastrointestinal symptoms were examined with microscopy and inoculated in Jones medium. Blastocystis-positive samples were further assessed to identify coinfections with other possible pathogens, including bacteria and viruses. Diagnostic efficacies of microscopy, culture and Real-Time PCR were compared. PCR products were sequenced to identify the subtypes of Blastocystis isolates.
  
  
  RESULTS
  Totally 94 (15.24%) samples were positive for Blastocystis after all methods. Among these, 83 of 94 (88.3%) samples were identified with all methods, while 11 were positive only with Real Time PCR. Diarrhea and abdominal pain were the leading symptoms in the patients. The only pathogenic agent identified in 76 of 94 (80.9%) patients was Blastocystis. Subtype 3 was the leading Blastocystis subtype (44.6%), while subtypes 6 and 7 were firstly isolated from symptomatic patients in our region.
  
  
  CONCLUSIONS
  Comparison of three diagnostic methods indicated Real Time PCR as the most sensitive and specific method. Blastocystis was the only pathogenic agent among symptomatic patients, with subtype 3 being predominant. Patients with subtypes 6 and 7 need further assessments concerning the zoonotic potential of Blastocystis.
authors.affiliation: Dept. of Parasitology, School of Medicine, Ege University, Izmir, Turkey.
authors.forename: Hande
authors.initials: H
authors.lastname: Dagci
authors.affiliation: Dept. of Medical Microbiology, School of Medicine, Acibadem University, Istanbul, Turkey.
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Kurt
authors.affiliation: Ministry of Health's Moris Sinasi International Paediatric Hospital, Manisa, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Demirel
authors.affiliation: Dept. of Public Health, School of Medicine, Ege University, Izmir, Turkey.
authors.forename: Aliye
authors.initials: A
authors.lastname: Mandiracioglu
authors.affiliation: Dept. of Medical Microbiology, School of Medicine, Ege University, Izmir, Turkey.
authors.forename: Söhret
authors.initials: S
authors.lastname: Aydemir
authors.affiliation: Dept. of Paediatrics, School of Medicine, Ege University, Izmir, Turkey.
authors.forename: Ulas
authors.initials: U
authors.lastname: Saz
authors.affiliation: Dept. of Medical Microbiology, Section Parasitology, Amsterdam University, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Aldert
authors.initials: A
authors.lastname: Bart
authors.affiliation: Dept. of Medical Microbiology, Section Parasitology, Amsterdam University, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: VAN Gool
keywords: Blastocystis; Pathogenicity; Prevalence; Subtype; Turkey