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of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2010, Volume 16, book 1-B, Part B - INFECTIONS - CLINICAL
Subject Collection: Abstracts Medicine
Page: 31 - 58
Date of close: May 29, 2010
Antimicrobial resistance of germs isolated from
patients with bacterial respiratory infections
Popescu C.*, Gavriliu L., Popescu G.A., Dorobat O., Rafila A., Benea E,
Arama V, Streinu-Cercel A, Antonica D, Draganescu A., Gubavu C., Gliga
National Institute of Infectious Diseases “Matei Bals”, Bucharest,
Without local epidemiology of antimicrobial susceptibility data,
the first line syndromes therapy could be less adequate and could involve
a greater risk for bacteriological failure, with prolonged duration of
treatment and/or less favorable outcomes.
Goal: To define first line therapy for urinary tract infections. Methods:
Antimicrobial susceptibility analysis of urine culture isolated bacteria,
for a twelve months period: July 2008- June 2009 in a four infectious
diseases hospitals from Romania (MAR-T group). The surveillance time was
divided in two six month periods, to evaluate some susceptibility level
variations. Results: We analyzed the susceptibility profiles for 2164
bacterial isolates from urine cultures; the most frequent etiologies were
E coli - 1278 (59.07%) and Klebsiella pneumoniae isolates - 156 strains
(7.21%); Enterococcus faecalis was the most aminopenicillin with beta-lactam
inhibitors (oral), or cephalosporins (parenteral). For fluoroquinolones,
norfloxacin was non-inferior to ciprofloxacin: 71.62% versus 70.12% (p=0.57).
The only difference between the two study periods could be an increased
isolated gram-positive - 124 strains (5.73%). From tested antibiotics,
a good activity had:
- For ambulatory care (oral therapy): nitrofurantoin 78.63%, respectively
81.94%, and cefuroxime-axetil: 77.25%, respectively 78.69%
- For hospital care (parenteral administration): carbapenems: 95.09%,
respectively 96.79% and amikacin: 93.61%, respectively 89.51%
Statistical analysis indicates an almost significant superiority of nitrofurantoin
against fluoroquinolones, p=0.086.
Conclusion: The reappraisal of nitrofurantoin and norfloxacin (for lower
urinary tract infections), as of aminoglycosides for upper urinary tract
infections seem to be the best choice options in first line therapy. Carbapenems
need to be used as first-line treatment only in a few selected cases of
hospital-acquired upper urinary tract infections, when antimicrobial resistance
risk could be high (i.e. in-hospital urological intervention, multiple
recent antimicrobial treatment).
COMMUNITY ACQUIRED PNEUMONIA AND LOWER LOBE SYNDROME
CAUSED BY PASTEURELLA MULTOCIDA
Kontopoulou Konstantina, Stergiou Ioannis, Tsepanis Konstantinos, Tsiggene
Sabbato, Laudas Theodosios, Kriti Maria
General Hospital G. Gennimatas Thessaloniki
BACKGROUND: Pasteurella multocida is a small, gram-negative, nonmotile,
nonвЂ“spore-forming coccobacillus which often exists as a commensal in
the upper respiratory tracts of many livestock, poultry, and domestic
pet species, especially cats and dogs. The majority of the infections
are associated with an animal bite, scratch, or lick.
OBJECTIVE: Report of a community acquired pneumonia in a 15-year-old patient
caused by Pasteurella multocida.
CASE PRESENTATION: A 15-year-old female student with a history of bronchial
asthma was admitted in the emergency department of our hospital because
of a 16-hour history of fever (38,50C). She returned from a trip in Kastoria
where she visited the zoo and the local forest. In the morning she also
visited the local hospital there presenting intense cough and fever where
she was submitted in laboratory and radiological control. Because of lack
of remarkable clinical findings, a virus infection was considered as a
possible diagnosis. The rapid deterioration forced the patient to come
to our hospital for re-evaluation. The chest radiograph revealed thickening
of the right lower lobe. Computed tomography was performed, while blood
and sputum cultures were also received. CT scan revealed a large pleural
effusion on the right side combined with inflammation and atelectasis
of the upper sector of the right lower lobe. As far as sputum culture
is concerned, Pasteurella multocida was isolated in two consecutive probes.
The identification and the antibiotic susceptibility tests were performed
by the automated system VITEK II (BioMerieuxВ®, France). The strain was
sensitive in penicillin and second and third generation cephalosporins
and resistant to erythromycin, clindamycin and aminoglycosides. Piperacillin/tazobactam
was the antimicrobial agent administrated to the patient, who responded
well to the treatment. Particularly impressive was the complete dissolve
of the thickening in 48 hours.
COLONIZATION OF AN INTENSIVE CARE UNIT IN THE
BOUNDS OF INSPECTION OF HOSPITAL ACQUIRED INFECTIONS COMMITTEE
Kontopoulou Konstantina, Tsepanis Konstantinos, Tsiggene Savvato, Antoniadou
Eleni, Kriti Maria
General Hospital G. Gennimatas
OBJECTIVE: The study of the distribution frequency of the microorganisms
isolated from various places in ICU and their resistance phenotype.
MATERIAL AND METHOD: Our material consisted of 110 and 29 specimens collected
from different surfaces in ICU, before and after its pedantic disinfection,
respectively. The identification and the antibiotic susceptibility tests
were performed by the automated system VITEK II (BioMerieuxВ®, France)
and by the use of E-test for MIC determination.
RESULTS: Of the initial 110 specimens 47 (42.7%) were negative. In 23
we found staphylococcus epidermidis (15) and staphylococcus haemolyticus
(8). From the remaining 40 specimens there were isolated in order of frequency
the following: О‘cinetobacter baumanni (20), Ољlebsiella pneumoniae(14)
and Pseudomonas aeruginosa (6). All the strains of Acinetobacter baumanni
had the same resistance phenotype being sensitive only in colistin and
tigecycline. The strains of Pseudomonas were isolated from specimens collected
exclusively from taps and they were sensitive. All isolates of Ољlebsiella
pneumoniae revealed the same resistance phenotype being sensitive to gentamycin,
colistin and tigecycline and resistant to meropenem, imipenem and ertapenem,
a phenotype which is constant with the production of KPC type ОІ-lactamases.
These strains also harboured ESBL and by performing the imipenem-EDTA
double disk synergy test they were found negative for the production of
metallo-beta-lactamases. The production of KPC type ОІ-lactamases was
confirmed by the presence of blaKPC gene detected by real time PCR. Finally,
all the cultures of specimens received after the disinfection of ICU were
CONCLUSIONS: This study proves the important role of hospital acquired
infections committee in the dissemination restriction of multi-drug-resistant
isolates. In our hospital the proper collaboration between the laboratory,
the ICU and the hospital acquired infections committee contributed to
the avoidance of the dissemination of another dangerous resistance mechanism
according to recent reports in the journal “Antimicrobial Agents and Chemotherapy”
-Letter to the Editor(Vol.52 Feb 2008,p.796-797).
Antibiotic Susceptibility of Staphylococcus aureus
Isolates from Blood Cultures during the Period 2007-2009
Tosic T* Jovanovic M., Pavlovic M., Stosovic B., Milosevic B., Dulovic
O., Poluga J., Stevanovic G., Milosevic I., Pelemis M., Svabic-Vlahovic
Bacteriology Laboratory, Clinical Centre of Serbia, Belgrade
Objectives: Staphylococcus aureus is one of the most common causes
of bacteraemia and sepsis of hospital origin. Staphylococcus aureus bacteraemia
is an important clinical problem associated with a high mortality rate
and a significant burden on healthcare resources. Endocarditis is the
most common and important complication of Staphylococcus aureus bacteraemia.
We conducted a survey to establish antimicrobial susceptibility of Staphylococcus
aureus isolates from blood cultures during three years period.
Methods: Blood cultures have been processed on the Bactec 9240 automatic
system (Becton Dickinson), and positive samples have been streaked onto
solid media. The culture has been identified by standard methods of identification:
Gram stain, salt manitol agar, catalase test, plasma coagulase test. Antimicrobial
susceptibility was tested using Vitek 2 system and Vitek AST 580 card
(BioMerieux) and interpretation of the results was according to CLSI criteria.
Results: We examined a total of 159 isolates of Staphylococcus aureus:
42 (26.4%) in 2007, 69 (43.4%) in 2008 and 48 (30.2%) in 2009. The average
susceptibility in this period was: to penicillin 10%, methicillin 46%,
erythromycin 73%, clindamycin 76%, fusidic acid 82%, rifampicin 78%, tetracycline
62% and ciprofloxacin 61%. Susceptibility to: vancomycin, teicoplanin,
thrimethoprim-sulfametoxasole, linezolid and quinupristin/dalfopristin
was 100%. Only two isolates showed slightly elevated MIC for vancomycin
Conclusion: The frequency of methicillin resistant Staphylococcus aureus
(MRSA) isolates is similar to the frequency of MRSA in the surrounding
countries. Vancomycin is still the drug of choice for the treatment of
severe staphylococcal infections and the similar effect can be achieved
with the newer antibiotics such as linezolid and quinupristin/dalfopristin.
Antimicrobial resistance of urinary tract infection
germs and first-line antimicrobial treatment in Romania
Popescu G.A.*, Popescu C., Gavriliu L., Dorobat O., Rugina S., Miftode
E., Nicoara E., Dumitru I., Gubavu C. for MAR-T group
Nationale Infectious Diseases Institute “Matei Bals” Bucharest, Romania
Epidemiological, clinical and laboratory characteristics
and treatment of the patients with abdominal typhus in Clinic of Infectious
Diseases in University Clinical Center of Kosovo-Pristina from 2002-2009
H. Ramadani, S. Ahmeti, A. Zogaj-Berisha, A. Vishaj, A. Ponosheci, B.
Halili, A. Berisha
Clinic of Infestious Diseases - University Clinical Center of Kosovo
Background: Abdominal typhus is an acute enteric infective disease, bacteremic
and septicemic disease caused by Salmonella typhi. This disease appears
in sporadic form, but also in small and big epidemics, particularly in
regions without water supply and sanitation infrastructure.
Aim: Presentation of epidemiological, clinical, laboratory characteristics
and treatment of the patients with abdominal typhus in Clinic of Infectious
Diseases in University Clinical Center of Kosovo-Pristina from 2002-2009.
Material and Methods: We analyzed retrospectively 31 patients based on
epidemiological, clinical and laboratorial findings.
Results: The age of patients was from 1 to 67 years (1-15 y.o. 13 patiens
(M 6 - F 7); 16-49 y.o. 17 patients (M 10 - F 7); and one female patient
67 y.o.). 21 patients were from rural regions and 10 patients were from
urban regions. Diagnosis was based on clinical, laboratorial (biochemical,
serological and microbiological) and epidemiologic findings.
On 26 patients Widal Test was H1/160 and O1/160 and higher. High temperature
was present on 26 (83.8%) patients, fever, vomiting, diarrhea, abdominal
cramps, headache was present on 15 (48.4%) patients, and more rare were:
epistaxis 2 (6.45%) patients, back pain 3 (9.67%), sweating 2 (6.45%),
fatigue 4 (12.9%) patients.
From clinical findings, hepatomegaly was present on 15 (48.4%) patients
and splenomegaly on 9 (29%) patients. Moderate eritrocite sedimentation
rate was present on 6 (19.3%) cases, and high eritrocite sedimentation
rate was present on 12 (38.7%) cases. Moderate leucopenia 9 (29%) cases;
moderate anemia 15 (48.4%) cases, moderate leukocitosis 5 (16.1%) cases.
Higher incidence of hospitalization was recorded in 2002 with 21 (67.74%)
cases, in 2003 - 3 (9.67%) cases , 2004 - 2 (6.45%), 2005 вЂ“ 2 (6.45%),
2006 вЂ“ 1 (3.2%), and 2009 2 (6.45%) cases.
They were treated with Cotrimoxasole-Trimethoprim (6 cases), Ampicillin
(2 cases), Chloramphenicol (24 cases), Ceftriaxone (5 cases), Ciprofloxacin
Duration of treatment was from 5 to 21 days; In 41.3% of cases was 14
days. All patients were discharged from the clinic with improved clinical
Conclusion: Improvement of social conditions decreases frequency of the
disease and use of antibiotics enables successful treatment.
Keywords: Salmonella typhi, abdominal typhus, typhoid fever, chloramphenicol,
Cotrimoxasole-Trimethoprim, Ampicillin, ceftriaxone, ciprofloxacin, high
fever, infectious disease, Widal test.
Antimicrobial Susceptibility of Enterococci from
Blood Cultures during the Period 2002-2009
Stosovic Branka* Tosic T., Jovanovic M., Lavadinovic L., Poluga J., Milosevic
I., Stevanovic G., Milosevic B., Dulovic O., Pavlovic M., Dokic Lj., Pelemis
M., Svabic-Vlahovic M.
Microbiology department, Clinical Center of Serbia, Belgrade
Background. The aim of this survey is to perform the retrospective study
of the enterococcal strains isolated at the Bacteriology laboratory during
the period 2002-2009, before and after the occurence of first vancomycin
resistant enterococcus (VRE) in blood cultures.
Methods. A total of 79 enterococci were obtained from patient’s blood
cultures in the period of 8 years. Blood culutres have been processed
on Bactec 9240 system. The enterococcal strains were further identified
by the use of API Strep and Vitek 2 systems. Susceptibility testing was
performed by disk diffusion method, according to the CLSI guidelines,
and MICs were determined using Vitek 2 system.
Results. In the period of 2002-2005, 17 enterococci were collected and
in the period 2006-2009 that number was 62. The identified species were:
E. faecalis (41; 51,90%) , E. faecium (27; 34,18%) and E. durans (2; 2,53%),
while 9 (11,39%) Enterococci could not have been identified. The first
VRE from blood culture was isolated in 2006 and it was the only VRE (16.66%)
obtained from this kind of specimens in that year. In 2007 the VRE number
increased to 6 (50%). In 2008 the VRE number was 6 (28,57%) and in 2009
6 (26,09%). Comparing susceptibility of enterococci before and after the
occurrence of first VRE in blood cultures we found that the overall susceptibility
to ampicillin fall (88.20 to 41,94%), as well as susceptibility to ciprofloxacin
(29.40 to 20,69%) and vancomycin (100 to 69,35%). Susceptibility to tetracycline
has not been changed (35,29 to 35%). Susceptibility of E. faecalis remained
almost the same to ciprofloxacin while it decreased to ampicillin (100%
to 71,42%) and vancomycin (100% to 85,71%). E. faecium susceptibility
to ampicillin decreased (33.33% to 4,35%) as well as to vancomycin (100%
to 45,83%), and it remained 0% to ciprofloxacin. The both strains of E.
durans were susceptible to all antibiotics tested. The average susceptibility
to gentamicin high doses was 29,49%, to streptomycin high doses 27,27%
ad to linezilid 100%.
Conclusion. Our results imply that ampicillin is not efficiacious to Enterococcus
faecalis as good as it has been two years before. Vancomycin was efficacious
for the examined strains of E. durans, but other enterococci were less
susceptible to this antibiotic. For VRE linezolid is drug of choice for
treatment of severe infections caused by this organism.
Peg-Interferon induced Retinopathy in Patients
with Hepatitis C a side effect to keep in mind.
Mircea Chiotan, Daniela Munteanu, Carmen Chiotan, Victoria Arama, Raluca
Mihailescu, Mihaela Radulescu, Raluca Nastase, Ruxandra Moroti, Adriana
Hristea, Violeta Molagic
National Institute of Infectious Diseases “Prof. Dr. Matei Bals”,
Treatment of chronic hepatitis C with pegylatet
interferon and ribavirin- ouer exerience
Fabri M, Ruzic M, Pobor M, Preveden T, Ilic A, Dukic S i Klasnja B
Clinic for infectious diseases, Clinic Centar Vojvodina, Novi Sad,
Combined therapy with weekly injections of pegylated interferon alfa (Peg-IFN)
and daily ribavirin is currently the standard treatment for chronic hepatitis
C (CHC). The goal of this study was to show the predictors of response
Results: 280 patients with CHC were treated with combined therapy Peg-IFN
alfa 2a and ribavirin. 14.29% of patients have been previously treated
with standard IFN alfa + ribavirin ili/i PegIFN + ribavirin. After the
completion of therapy, patients were followed 6 months to 5 years. In
2.14% of patients the therapy was stopped due to serious side effects:
hiperbilirubinemia, depression, agranulocitosis, vasculitis, pneumonitis,
erithema exudativum multiforme and a pruritus resistant to therapy. 1.07%
of patients selfinitially stopped the treatment. 12.5% of patients didn’t
have an viral response (EVR - nondetectable RNA HCV after week 12, or
viral load declined by > 2 log). Transitory viral response (nondetectable
RNA HCV after week 12 but detectable at the end-of-treatment) was found
in 6.27%. Patients without EVR and with transitory viral response were
marked as NR (non responder), 19.19%. Relaps of the HCV infection (nondetectable
RNA HCV at the end of treatment, but detectable during the following 6
months) was noted in 11.07% of patients. Sustained viral response (SVR
- nondetectable RNA HCV 6 moths following the completion of therapy) was
found in 69.37% of patients.
By analising the predictors of the viral response, a statistically signifficant
difference was found (p<0.05) wth: age of patients <40 years SVR
84.93% v.s. >40 years 51.20%; duration of infection less than 20 years
SVR 71.60% v.s. 47.30% more than 20 years; virus genotipe 2 or 3 SVR 81.91%
v.s. 62.71% genotipe 1 and 4; without hepatic steatosis SVR 73.18% v.s.
52.94% with steatosis. Rates of SVR are also influenced by advanced hepatic
fibrosis: 78.89% v.s. 40.62%; and correction of dose of Peg-IFN 73.55%
v.s. 56.45%. No statistically signifficant difference was found between
the response to tretment and gender, ALT level, dose correction of ribavirin,
thyroid gland malfunction, presense of autoantibodies and viral load (p>0.05).
Conclusion: The treatment of CHC should be individualised and guided by
the number of viruses and host parameters.
Antibiotic Consumption in a Rehabilitation Unit
JJ. Lloveras* , M. Blisot, P. Grima
Centre de Reeducation Fonctionnelle, Bagneres de Luchon, France
The aim of this study is to present antibiotic consumption during a one-year
period in a rehabilitation unit and to compare these values with the results
of a similar regional retrospective study.
METHODS: We studied all the antibiotic treatments given in a 90- bed rehabilitation
department during the year 2008. Antibiotic consumption was defined by
the number of defined-daily-doses (DDD) and expressed as DDD per 1000
patient-days and DDD per 100 admissions. We calculated these indexes in
every class of antibiotics used during this period.We compared these results
with the values reported in a larger study performed in 121 similar institutions
in South-West France (7036 rehabilitation beds) during year 2007 (Politique
de bon usag et consommation des antibiotiques.Resistance bacterienne;
Donnees 2007 CCLIN Sud-Ouest; Groupe hospitalier Pellegrin 33076 BORDEAUX:
RESULTS: During the year 2008, 828 patients were admitted and 25611 bed-days
were notified. Total antibiotic consumption was 194 DDD/1000 bed-days
and 600 DDD/ 100 admissions; these values were similar with those found
in the larger study: 220 DDD/ 1000 bed-days and 551 DDD/100 admissions.Repartition
expressed in DDD/1000 bed-days was following: Penicillins: 64; Third generation
cephalosporins: 12; Macrolides and synergistins: 27; Quinolones: 43; Sulfamides:
11; Aminosides 3; Cyclines: 2; Glycopeptides: 5; Imidazoles: 2; Rifampicin:
19; Others: 6. These values were similar with those found in the larger
study: 220 DDD/ 1000 bed-days and 551 DDD/ 100 admissions, with a similar
CONCLUSION: In this study ,Penicillins were the most frequent prescribed
drugs followed by Quinolones, Macrolides and Cephalosporins. When compared
with the larger study, values were quite similar except a lower consommation
of Amoxicillin/clavulanate but a larger use of synergistins .
Antibiotic use has to be expressed in a standardized way in order to compare
the values found in different departments. The study of antibiotic use
appears important in order to minimize the cost of treatment and emergence
of resistants strains of microorganisms. This latter goal seems important
in rehabilitation units, where patients are often chronically infected.
In this setting, consumption looks usually close to 200 DDD/1000 bed-days.
An efficient way to decrease it could be to shorten durations of treatment
by one day in the situations where it is feasible ,following the well-admitted
Usefulness of Sputum Gram Stain and Culture for
Diagnosis of Pneumonia in a Geriatric Institution
JJ. Lloveras*, M.I. Shukr, C.Pinos, A. Lindoulsi, P. Grima
Centre de Reeducation Fonctionnelle, Bagneres de Luchon, France
the full publicaton of the article in JofIMAB 2010 16(3):20-22
The aim of this study is to evaluate sputum Gram stain and culture for
bacteriological diagnosis of lower respiratory tract infection in geriatric
METHODS: During a two-year period, from January 2007 to December 2008,
we retrospectively studied all the sputum samples send to the laboratory
in a geriatric 26-bed unit (mean age : 80,5 years,mean hospitalization
time :33 days)Isolated microorganisms were separated following Gram coloration
for bacteria and yeasts.Samples were shortly send (<24 hours) and all
submitted to examination before antibiotic therapy.
RESULTS: During the two-year period, 456 admissions and 16024 patient-days
were notified A total of 324 bacteriological isolates were send to the
laboratory and 42 sputum samples were studied (13%), corresponding to
9 samples/100 admissions and 3 samples / 1000 hospitalization days.Among
them,24 samples allowed a bacteriological diagnosis (57%) and 35 samples
showed prominent bacteria or yeast. Repartition (n=30) was following:
Gram +: 16 (53%), mainly staphylococcus (14)including 2 MRSA, a nd pneumococci(2);
Gram -: 14(47%)mainly Pseudomonas (6) and Haemophilus (4), Moraxella (1),
E Coli(1), Enterobacter(1), and Serratia(1).
CONCLUSION: Usefulness of sputum Gram stain and culture in Community-acquired
pneumonia is controversial.Most of the studies conclude to a limited impact
on treatment decision. However, in recent studies, this diagnostic test
seems to present a better value then previously appreciated, particularly
in pneumococcal pneumonia, allowing a bacteriological diagnosis in more
of 50% cases.In this study, performed in geriatric inpatients, we found
bacteriological diagnosis was guided in 57%cases.
Staphylococcus and pseudomonas were the proeminent microorganisms, as
it is reported in large-scale prevalence studies of nosocomial infections.
In geriatric units and in long-term care facilities,diagnostic tests for
management of lower respiratory tract infections are rarely performed
. Bacteriological diagnosis could be helped by Gram stain and culture,
allowing to adapt antibiotic therapy. Moreover, cost-efficacy of this
method could be evaluated and improved by adjustment for bed-occupancy.
A case of Parasitic Granulomatosis Infection
(Balantidiasis) Mimicking Lymphoma
Mohsen Meidani.*1- Mojtaba Rostami1.- Naser Kamalian2.
1.Department of Infectious and Tropical Disease, Isfahan University
of Medical Sciences, Isfahan, Iran 2.Department of Pathology, Tehran University
of Medical Sciences, Tehran, Iran
Sometimes infection disease presents with toxic appearance and mimicking
lymphoma. We report an 18-years-old boy who present with complaints of
high fever and diarrhea. In work-up he has aortic lymphadenopathy, elevated
ESR, anemia, pleural effusion and hepato-splenomegaly, so he candidates
for diagnostic laparotomy and biopsy and Pathologist reports parasitic
granulomatosis infection highly suggestive Balantidiasis.
An 18-years-old boy was admitted to our center (Alzahra University Hospital,
Isfahan, Iran) with complaints of high fever and diarrhea. Eight days
before admission, the patient began pain in the right upper quadrant of
abdomen and accompanied with frequent, painful and bloody stools. Temperature
peaked 40.3В°C with rising ESR (92mm/hr). His temperature in admission
was 39.5В°C, blood pressure was 90/60 mm Hg, heart rate was 110 / minute,
respiratory rate was 40 / minute. Erythema nodosum was seen on both legs.
Wright agglutination test, blood and stool cultures were negative, Serologic
tests for toxoplasma, human immunodeficiency virus (HIV) types 1 and 2,
hepatitis B surface antigen, and antibodies against hepatitis C virus
were negative, and PAS staining for fungal infection and Zeil-nelson for
TB were negative. PPD was negative. Spiral CT Scan of the abdomen and
pelvis confirmed hepatosplenomegaly and multiple small hypodense lesions
in both lobe of the liver and the spleen. Also there was bilateral pleural
effusion and large para-aortic lymph nodes. Skin biopsy showed an acanthosis
with spongiosis in epiderma and perivascular infiltration of neutrophils
was seen consistent with leukocytoclastic vasculitis. Because of progressive
course of disease extended antibiotic was started and diagnostic laparatomy
was done .Biopsies taken from spleen, liver and omentum revealed several
granuloma composed of central suppuration surrounded by macrophagic zone
and outer lymph mononuclear leukocytes and multinuclear gaint cells and
palisading granuloma. The bone-marrow was not consisted with lymphoma.
Pathologist recommended the diagnosis of parasitic granulomatosis infection,
more probably Balantidium coli with abscess formation, peritoneum, liver,
and spleen involvement. All antibiotics (no response to them) were discontinued
and doxycycline was administered and the patient had dramatic response
after 48 hours to doxycycline. Doxycycline continued for 2 weeks. Patient
was followed for 1 year. He is in good condition and control CT revealed
clearance of all the former lesions in spleen and liver. All the follow
up control laboratory is normal.
We report the case of a patient with fever, aortic lymphadenopathy, hepato-splenomegaly,
elevated ESR, anemia related to Balantidiasis. This diagnosis was supported
by positive results of tissue biopsy and progressive improvement after
treatment with doxycycline. Malignancy was suspected initially particularly
lymphoma, but extensive investigations failed to demonstrate any neoplasm.
Because of negative findings, a parasitic infection was considered. B.
coli is the largest and only ciliate protozoan that infects humans. Although
Balantidium coli infection of humans is rare, it is most likely to occur
in places where humans and pigs live in close contact. Infection has also
been observed in non-human primates, and rodents have been experimentally
infected. The infection is most frequently acquired by ingesting food
or water contaminated by pig faeces, and it may be asymptomatic or may
cause acute diarrhea. Common symptoms of Balantidiasis include chronic
diarrhea, occasional dysentery, nausea, foul breath, colitis, abdominal
pain, weight loss, deep intestinal ulcerations, and possibly perforation
of the intestine. The acute, bloody and mucoid form of infection may be
mild, severe or fulminating with numerous trophozoites in stools. The
chronic form presents as intermittent episodes of diarrhea. Left untreated,
fulminating acute Balantidiasis is reported to have a case fatality rate
of 30%. Parasite invasion can extend to the appendix and ileum, or it
may involve some extra digestive locations such as mesenteric lymph nodes,
peritoneum, liver or lung. The parasitological diagnosis can be established
by repeated microscopic examination of fresh stool samples and of tissue
scrapings obtained during endoscopy.
Balantidiasis is usually a benign and self-limited condition but fulminating
acute Balantidiasis is reported. Diagnosis of Balantidiasis is often difficult
in adults, requiring a high index of suspicion. Although there are few
reports about Balantidiasis presenting with systemic disease, so in patient
with complain of fever, lymphadenopathy, hepatosplenomegaly and weight
loss mimicking lymphoma, we should consider parasitic granulomatosis infection
(i.e. Balantidiasis) in differential diagnosis.
Key words: Balantidiasis, Lymphoma, Leukocytoclastic vasculitis
Antibiotic Resistance Rates in Pediatric Infections
Asimoula Koteli1,* Theodosios Lavdas1, Konstantinos Tsepanis1, Savvato
Tsingene1 , Kalliopi Chatzopoulou2, Paransem Lagoudaki2
1Microbiology Laboratory, 2Haematology Laboratory, “G. GENNIMATAS”
General Hospital of Thessaloniki, Greece
Enterococci are increacing in importance as nososomial pathogens. They
are the 3rd most frequent cause of infection in hospitals, responsible
for about 12% of hospital infections.
AIM: to determine the antimicrobial resistance patterns of enterococci
isolated from clinical specimens of pediatric patients treated at our
MATERIALS and METHODS:
86 clinical isolates of enterococci were collected for further analysis
during the period January 2006 through August 2009. Identification of
microorganisms and susceptibility test were performed by the Vitek 2 (BioMerieuxВ®,
France). The minimum inhibitory concentrations (MICs) of five antimicrobial
agents were determined by E-test method (SolnaВ®, Sweden) for each isolate.
Disk diffusion tests were also performed and the results were compared
with those reported by clinical laboratory. Because gentamycin susceptibility
tests showed inconsistent results in many isolates, MIC determinations
by the micro-broth dilution method were also performed for these isolates.
All isolates were tested for ОІ-lactamase production. Enterococcus faecalis
ATCC 29212 was used as a control.
43 strains out of 86 strains tested were E.faecalis, 37 E.faecium, 2 E.gallinarum,
2 E.avium, 1 E.durans and 1 E. hirae. Major sources of these isolates
included urine, tracheal secretions, traumas and only 5 E.faecalis from
blood. The resistance rates (%) for E.faecium and E.faecalis were: ampicillin74/28,
ciprofloxacin 69/10, erythromycin 89/69, gentamycin high level 59/34,
streptomycin high level 70/38, teicoplanin 6/0, tetracycline 26/69, trimethoprim/sulfa
97/90, vancomycin 6/0. 6 VRE strains (5 E. faecium from urine and 1 E.faecium
from blood) developed high resistance to vancomycin and teicoplanin, suggestive
that they belong to the phenotype VanA.
E.faecium showed higher resistance as E.faecalis. The high resistance
to aminoglycosides and the presence of VRE strains consist a serious problem
for the treatment of infections caused by them. Increased alertness should
be given to the occurrence of multi -resistant E.faecium and mechanisms
causing its abundance, such as selection via antibiotic pre-treatment
or ineffective empirical antibiotic treatment.
The Results of Fluoroquinolone Treatment in Infected
Allergic Bronchial Asthma.
Georgeta Sinitchi,* Costinela Georgescu, C. Vornicu, Doina Fedulov, Diana
Apollonia University Iasi, Romania; University of Medicine Galati
Bronchial infection favors, emphasizes and maintain respiratory allergic
manifestations, in particular allergic asthma. Hereditary and personal
allergic backgrounds, along with repeated treatments with antibiotics
are drug sensitizing risk factors, as well as microbial resistance. It
should be a therapeutic alternative, especially in primary and ambulatory
medicine, where an antibiogram often is not possible. Fluoroquinolones
are a therapeutic option in treating exacerbations of acute infections
of bronchitis and asthma, as well of sinusitis and community-acquired
METHOD: Our study included a total of 46 people with allergic asthma to
domestic and professional environmental factors, with infectious episodes.
On a number of 28 persons was possible bacteriological examination of
sputum and on a total of 18 persons the infectious germs found were: Streptococcus
pneumoniae, Haemophilus influenzae, Staphylococus aureus, Moraxela catarrhalis,
Escherichia coli, Pseudomonas aeruginosa.
RESULTS: Clinical manifestations were: fever, purulent sputum, exacerbation
of asthma. Administration of moxifloxacin was oral for 7-10 days, on female
and male patients, aged between 21 and 66 years. Contributing factors:
incorrect treatment of asthma, with failure to obey the therapeutic scheme,
environmental factors (cold, humidity, pollution) and related pathologies:
diabetes mellitus. The assessment was clinical, biological, paraclinical
(spirometry). The patients had drug allergic polisensitization, for which
were presented to the Cabinet of Allergology, with skin, respiratory and
cardiovascular manifestations. Moxifloxacin tolerance was good, as was
the change of the quality of life by 80%.
CONCLUSIONS: Fluoroquinolones (moxifloxacin) administered in acute bronchial
infections of allergic asthma with drug polisensitization had a beneficial
role, leading to clinical improvement and having a good tolerance.
Key words: allergic asthma, acute bronchial infections, drug sensitization,
HANTAVIRAL HAEMORHAGIC FEVER IN MONTENEGRO
Bogdanka Andric*, Marina Ratkovic, Dragica Terzic, Brankica Dupanovic,
Clinic Center of Montenegro, Podgorica, Montenegro
Objectives: Hanta viral hemorrhagic fever presents as acute infection
with hemorrhagic and renal complications. The causers of diseases are
Hantaviruses /buniaviridae/. Hantaviruses chronically infecting the rodents
in witch infection is going asymptomatically. In man it’s causing two
fundamental clinical syndromes -HFRS (hemorrhagic fever with renal syndromes)
and HPS hanta viral pulmonary distress syndromes.
Montenegro is endemic area for hanta viral hemorrhagic fever. The first
HFRS cases are registered from 1954. The disease presents difficult forms
Methods: In period 1998 - 2008 years, in Clinic Center of Montenegro,
145 cases with clinical diagnose of HFRS ware analyzed. Etiological confirmation
was done by Indirect Immune Fluorescence Methods /IIF/ to Virology Institute
- Torlak in Belgrade.
Results: Etiological diagnosis was confirmed in 85% cases. In 15% clinical
diagnosis was not confirmed. The examinations confirmed dominantly participation
of co infective forms of diseases, Beograd / Dobrava, Seoul and Hanta
serotype. In the past 3 - 5 years, number of clinical HFRS cases, without
etiological diagnosis is increasing. That fact obtains continuous research
of new hanta viral serotypes.
The cases ware mostly registered in north parts of Montenegro /Bijelo
Polje, Mojkovac, Kolasin/. Seasonal distribution of diseases, from March
to November, has increasing number of cases from June to September. Dominant
participation of ages from 16 - 50 years, and professional exposed categories,
is important epidemiological characteristic of infection. The clinical
manifestation of HFRS is consequence of immunity response, failures of
coagulation system and endocrinology disturbances. With usual therapeutically
treatment, in 91% cases we had success. Progressive course of renal insufficiency
/RI/ had 6 % of the patients. In examined group, we had 3% death cases.
Conclusion: In Europe, Pumala virus is primary causer of less complicated
forms of HFRS - endemic nephropathy/NE/. Beograd - Dobrava Hantavirus
is causer of difficult forms of diseases with hemorrhagic complications.
New examinations suggesting antigenic close relations between Beograd-Dobrava
and Saremaa viruses.
Simultaneous participation of two or moor serotypes of Hantaviruses /
coinfection/, are reflected in polymorphism, difficulties in clinical
presentation of disease, problems of the diagnosis, and bed course of
Electron Transfer in Therapeutic Alkaloids Triggers
Anastomosis in Traumatized Liver Blood Flow.
Pauli Virtanen, PhD.
PV-Ceuticals Ltd., Rusko, Finland
Bark was dried, milled and dissolved in methanol overnight and then filtered.
The residue was concentrated and proteins were precipitated with a small
amount of water. After the filtration, the solution was evaporated to
dryness. The bark from the deciduous tree Enantia chlorantha was used
as therapeutic alkaloid raw material. The method used was similar to that
used for flavonoid, quercetin in pharmacognosy. The yield consists of
five very similar bis-benzyl-isoquinoline alkaloids, maintaining functional
control in aqua solution, molecule palmatine being the most sensitive
to compensate for the others by hydrolytic change in the aqua solution.
This means that the proportions of alkaloids remain roughly constant when
isolated from natural sources. In this schematic structure, the electrons
associated with nitrogen, are orphan, and the easiest to transform.
The pivotal electron transfer is achieved in the alkaloid extract by evaporating
the alkaloids in dryness from the excess of water solution at 135oC. The
electron transfer was detected with a capillary zone electropherogram
scan. The UV-200 nm scan was used to monitor the changes in electrons.
A remarkable alteration was seen with nearly half of the specific, toxic
quaternary peaks having changed to the non-toxic side. One important peak
dominated the scan, this peak representing 40-45% of total scan intensity.
If it is less, the electron transfer must be repeated. Because of diminished
quaternary activities, the toxicities were diminished about 100-fold.
For verification, alkaloid extract was injected into laboratory rodents
as only a 1/100 diminished dose is sufficient for animal tests.
Three different lesions were selected for verification: D-GalN, ThAA and,
Allyl-Alcohol. The curative influence of electron-transfer-triggered anastomosis
on traumatized liver was detected. It was observed in all cases under
study, irrespective of injury origin. The cellular mess caused by foreign
material in tissue and dispersed cells began to be arranged so that alternative
paths for blood flow to portal veins were facilitated via opened sinusoids.
At the same time, the mitosis of hepatic cells was developed. The influence
of electron transfer in these alkaloids on dopamine subtypes in the brain
should be investigated in detail to solve this mystery. According to these
findings, the electron transfer provokes anastomosis: this seems to be
the key for a successful liver remedy irrespective of hepatic disease.
Latent Tuberculosis in Immigrants in Chania,
A. Damianaki, V. Krietsepi, S. Kaklamani, C. Papachristidi, S. Tsirakis,
M. Daoukakis, E. Daoukakis, S. Kastanakis*
General Hospital of Chania, Crete, Greece
Screening for latent tuberculosis (LTB) in immigrants in Chania of Crete,
using the mantoux test in a prospective study from 2005/11 to 2008/12.
Immigrants from high prevalence countries are at high risk for tuberculosis
reactivation. LTB is detected by a positive reaction to PPD skin test
(Mantoux) or high levels of interferon-gamma (IFN-Оі) release assays (IGRAs).
METHODS: In order to avoid false negative results individuals with malignancies
and immuno-compromised were excluded. After a brief questionnaire was
filled in, intradermal tuberculin (5U PPD) was administered and interpreted
48 to 72 hours later. Induration with diameter >10 mm was considered
positive for immigrants from developing countries and >15mm from developed
RESULTS: 2036 individuals were studied, 51% was male. The average age
was 30 В±10 years and the median time of residence in Greece 31 months.
A total of 34% of immigrants had LTB: 33,5% of immigrants from East Europe
, 24% of immigrants from Southeast Asia, 45% of immigrants from Africa
and 6,8% of immigrants from developed countries( USA, Australia, Western
Europe) The percentage of patients with LTB is affected by the country
of origin, observing lower percentage from developed countries (p<0.05)
and the highest in immigrants from Africa while 45% of all immigrants
have a negative mantoux.
CONCLUSION: The percentage of LTBI in immigrants in Chania is high. The
developing country of origin is a risk factor for LTB which could lead
to reactivation of the disease due to the conditions of migration and
Chemoprophylaxis Against Tuberculosis and Compliance
of Immigrants in Crete, Greece
A. Damianaki, V. Krietsepi, S. Kaklamani, V. Kasapaki, S. Tsirakis, M.Daoukakis,
E. Daoukakis, S. Kastanakis*
General Hospital of Chania, Crete, Greece.
OBJECTIVES: The study of compliance of immigrants with latent tubercoulosis
(LTB) in Chania of Crete by a prospective study from 2005/11 to 2008/12.
It is known that chemoprophylaxis for patients with LTBI reduces by far
the risk of reactivation of the disease and is an affective method for
METHODS: The immigrants were from Eastern Europe, Southeastern Asia, Africa
and fewer from developed countries and were examined at the pulmonary
department of the hospital for LTB using the mantoux technique in order
to obtain their health certificates necessary for their stay permit in
Greece, while there was telephone communication every month to check upon
RESULTS: 2036 immigrants were studied, 51% ‚. 691(34%) had LTB (positive
mantoux) and were tested with chest x-ray and sputum or gastric fluid
cultures for B Koch mycobacterium. One of them had active tuberculosis.19%(
2.7%) had radiographic findings on chest x-rays consistent with prior
TB. There was given a prescription for oral isoniazid for 9 months to
the immigrants with LTB and instructions for regular blood tests to prevent
any side effects. Only 20 (2.9%) complied with the treatment. 36(5, 2%)
didn’t complete it and 92% never received it.
CONCLUSION: The proportion of immigrants with LTB in Chania is high. But
the one that doesn’t receive chemoprophylaxis is provocatively high although
they-ve been directed otherwise and probably they-ll become the cause
of increase of incidence of tuberculosis in our town. Greek authorities
should take this under consideration and maybe receiving chemoprophylaxis
ought to be obligatory for acquiring a stay permit.
Tuberculous Pleural Effusion: Unusuall Clinical
A. Damianaki, V. Krietsepi, C. Petraki, E. Moirogiorgou, S. Tsirakis,
M. Daoukakis, E. Daoukakis, S. Kastanakis*
General Hospital of Chania, Crete, Greece
OBJECTIVES: The presentation of a case of tuberculous pleural effusion
(TPE) with rare clinical features. TPE is only 5% of the clinical features
of tuberculosis.it commonly starts as an acute respiratory disease with
fever, cough without sputum production, and pleuritic pain. Tuberculin
skin testing (using the Mantoux technique) may be negative initially,
while growing bacilli in pleural fluid cultures is rare.
METHODS: Physician female of 39 years-old, one of the writers, non smoker,
is examined by a pneumonologist because she feels and hears (without a
stethoscope) intense pleural rub throughout inspiration as well as expiration,
on the right hemithorax occasionally which was confirmed on auscultation.
Nevertheless the chest x-ray (face-profile), the ultra sound of the heart
and the blood tests were normal. The patient is put under observation
and she continues to hear the sound. For 25 days the chest x-rays remain
normal while a month later the patient suffers from fever, shivers, weakness,
fatigue, pleuritic pain. In auscultation of the lungs the breath sounds
were normal except a local reduction at the right bottom. Blood tests:
raised CRP and ESR and negative mantoux skin test. The chest x-ray revealed
limited pleural effusion on the right and the chest CT detected additional
pulmonary parenghymal lesions of the right lower lung lobe. A thoracentesis
for diagnostic purpose was done.
RESULTS: It was a lemphocytic exudative pleural effusion (85% lemphocytes)
with high rates of LDH (2003u/l). Afterwards antituberculus treatment
was administered to the patient (6INH-6PIF-2PZ-2ETH). She was clinically
improved and radiological findings were reduced in seven days. There was
complete radiological improvement and positive Mantoux test in two months.
The Ziehl Nielsen stain, the cytology test and several tests for detection
of either viral or bacterial infection or autoimmune diseases were negative.
ADA of the pleural fluid was 52u/l.The pleural fluid's culture for B Koch
was positive after 1.5 months.
CONCLUSION: Tuberculosis still amazes us. It should be highly suspected
and in certain cases appropriate treatment ought to be administered before
confirmation of the diagnosis.
An Intresting Case of Pulmonary Actinomycosis
A. Damianaki, V. Krietsepi, C. Papachristidi, S. Tsirakis, C. Petraki,
M. Daoukakis, E. Daoukakis, S. Kastanakis*
General Hospital of Chania, Crete, Greece.
OBJECTIVES: The presentation of an uncommon case of pulmonary actinomycosis
by A.Meyeri, its early diagnosis and effective treatment. Actinomyces
is gram-positive anaerobic bacterium.They are saprophytic organisms of
the oral cavity of patients with poor dental hygiene.It rarely causes
pulmonary actinomycosis, diagnosis is hard to confirm and requires longtime
treatment. The species most commonly found is actinomyces israelii while
A.meyeri is rare.
METHODS: A 40 year-old male smoker of 70 pack-years with no previous medical
history was admitted in the pulmonary department with low grade fever
up to 37,7 Celsius, cough and mucopurulent expectoration for two months
already and weight loss of 10 kg in that time. Physical examination found
severe periodontal disease and blood tests revealed raise of the WBC count
and CRP. Chest X-ray revealed an homogenous (shadow) opacity in the posterior
segmental bronchi of the right upper lobe of the lung. Piperacillin-Tazobactam
and Clindamycin were intravenously administered. Chest computed tomography
(CT) revealed a heterogeneous shadow with a central area of lower density.
There were no abnormal bronchoscopic findings while all sputum tests (cytology
and cultures for common bacterium and B-Koch) were negative. Next the
patient underwent CT guided fine needle aspiration of the lesion and the
aspirated material was foul smelling frank pus. A narrow chest tube (8F)
was inserted at the same time and there were drained 250ml of pus.
RESULTS: The patient is improved right after the drainage. Positive culture
results in the aspirated material for Actinomyces Meyeri came out 7 days
after patientвЂ™s administration date. The patient is since treated with
Penicillin though he had an allergic reaction to Penicillin and a gradual
desensitization was done. He's been administered Penicillin V 6000000IU/per
day for 2, 5 months now with minor radiological findings and he remains
CONCLUSION: The early diagnosis of pulmonary actinomycosis proves to be
life- saving for the patient.
Peripheral Neuropathy of Tuberculous Cause
A. Damianaki, V. Krietsepi, S. Tsirakis, V. Kasapaki, M. Daoukakis, E.
Daoukakis, S. Kastanakis*
General Hospital of Chania, Crete, Greece.
OBJECTIVES: The presentation of a case of tuberculous neuropathy in a
patient after ending the administration of isoniazid because of hepatic
METHODS: A female patient was admitted to our hospital because of periodic
intermittent afternoon fever up to 40В° C four months ago, non productive
cough and pleuritic pain on the right side for the past ten days. Physical
examination: reduction of intensity of the breath sounds at the bottom
of the right lung, diffuse wheezes. Chest x-ray: minor pleural effusion
on the right. ECG: normal. ESR: 94, CRP: 10,8, normochromic normocytic
anemia, BВ№ВІ, folic acid, ferittin and the rest blood tests were all
normal. The patient was considered to suffer from respiratory tract infection
and was treated with ampicillin/sulbactam and cinolon for ten days with
no significant improvement. Blood and urine cultures, Vidal, Wright, monotest,
hepatitis blood tests and antibodies for CMV, and thorough tests for autoimmune
disorders were negative. The pleural fluid was a lemphocytic exudative
effusion with low glucose rate and rates of adenosine adenodiaminidas
and lysozyme were indicative of tuberculous pleurisy. Cytology examination
and Ziehl Nielsen stain of the pleural fluid were negative. The pleural
effusion was considered to be of tuberculous cause and the patient was
treated with isoniazid, rifampicin, ethambutol, pyrazinamide and pyridoxine.
15 days later the patient was released from the hospital improved. She
was once more admitted 20 days later because of increased serum level
of aminotransferates. The anti-tuberculous regimens were discontinued.
7 days later the patient mentioned muscle weakness that was deteriorated
in the following days. An electromyogram (EMG) and a lumpar puncture were
RESULTS: Mycobacterium of tuberculosis was isolated in cultures of the
pleural fluid and tuberculous pleurisy was confirmed. The cerebrospinal
fluid from two LP in between 16 days was normal and Guillen Barre syndrome
was excluded. The EMG revealed an axonal sensory motor neuropathy. The
isoniazid peripheral neuropathy was also excluded because it's dose dependent
and it doesn't deteriorates after stopping its administration and furthermore
the patient was under prophylaxis with pyridoxine.
CONCLUSION: Tuberculous peripheral neuropathy is rarely described in international
references. So attention is required in differentiating from the one caused
by isoniazid which is a common treatment to those with tuberculosis.
Pulmonary and Soft Tissue Tuberculosis: an Interesting
A. Damianaki, V. Krietsepi, C. Papachristidi, S. Tsirakis, S. Chrisikos,
M. Daoukakis, E. Daoukakis, S. Kastanakis*
General Hospital of Chania, Crete, Greece.
OBJECTIVES: The indication of constant alertness of the physician for
detecting tuberculosis (TB), by presenting a rare clinical manifestation
of the disease.
METHODS: A male patient of 92 years of age was admitted in the pathology
clinic for investigating weakness, fatigue and feverish occurring three
days ago. The following are mentioned in his previous medical history:
moderate chronic renal insufficiency, osteoporosis, arterial hypertension,
rheumatoid arthritis (methylprednisolon for 5 years till then), asthma,
operation for duodenum diverticulosis. Physical examination: fine crackles
in the left middle lung area. Radiological tests: obscuration of the left
hilar by cellular infiltrates on the chest x-ray, areas with consolidation
and atelectasis with air bronchogram of the left lower lobe and pleural
thickening bilateral on the computed tomography. Blood tests: iron-deficiency
anemia, normal white blood cell count, moderate renal insufficiency, three
digit ERS. Negative sputum cultures for usual bacterium. The patient was
evaluated as being suffering from community acquired pneumonia and proper
antibiotics were administered. Anemia wasn't investigated any further
at that point and the patient was released with the recommendation to
be checked again soon which he neglected. 45 days afterwards he was admitted
in the surgery department because of fever and infection of soft tissue
on the right antibrachium: there was a localized painfull fluctuant swelling
in the size of an egg on the inner surface. The shadow on the chest x-ray
was enlarged. Blood tests were unchanged except a raise of the polymorphonuclear
cell count. The swelling was considered to be an abscess. Repeated punctures
produced a sterile macroscopically purulent fluid with plenty of neutrophils.
The abscess was drained.
RESULTS: Bacillus-Koch was observed on the direct microscopic examination
of the smear of the drained fluid and sputum. Isoniazid, rifambicin and
ethambutol were administered. The patient was released improved with the
diagnosis of pulmonary and soft tissue (cutaneous) tuberculosis.
CONCLUSION: Tuberculosis should worry the doctor especially in immunocompromised
elderly patients in order to avoid troublesome and deficiency in the differentiation
Tuberculosis During Pregnancy
A. Damianaki, V. Krietsepi, C. Papachristidi, S. Tsirakis, M. Daoukakis,
E. Daoukakis, S. Kastanakis*
General Hospital of Chania, Crete, Greece.
OBJECTIVES: The presentation of a tuberculous during pregnancy case that
wasn't early recognized as chest x-ray wasn't performed on time and its'
immediate diagnosis right after chest x-ray which guaranteed the health
both of the mother and the baby. It is known that if a tuberculous infection
is misdiagnosed during pregnancy it's dangerous for the mother as well
as the infant. It could result to neonatal or more rarely congenital tuberculosiw
which both present high mortality rates.
METHODS: Female of 24 years old and in the 30th week of pregnancy visited
the pulmonary department according to her gynecologist's order because
of cough and mucoid expectoration, since the beginning of her pregnancy.
She's been treated with expectorants and bronchodilators while a chest
x-ray wasn't done to protect the fetus from radiation. Physical examination
revealed crackles on auscultation of the upper part of the right hemi
thorax while blood tests revealed anemia and high rate of CRP and LDH.
Then a chest x-ray with lead cover round the pregnant woman’s abdomen
was done which demonstrated filtrates in the right upper and middle lobe
RESULTS: Sputum smear examination using the Ziehl-Nielsen stain was positive
for acid fast mycobacteriaceae in a few hours while its cultures identified
Koch Bacillus 1,5 months later. The pregnant woman was treated with isoniazid,
rifampicin and pyridoxine for 9 months and ethambutol for 2 months without
experiencing any side effects. Remission of the cough occurred after two
weeks and chest x-ray improved a month later. She gave birth to a healthy
girl of 3500 kg 8 weeks later, who had the BCG vaccine and isoniazid for
CONCLUSION: Pregnancy shouldn’t be an obstacle to a chest x-ray if symptoms
from the respiratory tract are present as long as the abdomen is properly
covered when necessary. Besides, TB should be highly suspected in such
a population group.
A Rare Case of Genital Infection Due to non Tuberculous
A. Damianaki, V. Krietsepi, S. Tsirakis, V. Kasapaki, S. Chrisikos, M.
Daoukakis, E. Daoukakis, S. Kastanakis*
General Hospital of Chania, Crete, Greece.
OBJECTIVES: The presentation of a rare case of epididymitis because
of non tuberculous (designated “atypical”) m. avium complex.
METHODS: A patient of 86 years old was admitted to our hospital because
of scrotal swelling on the right side with mild pain for two months and
no other accompanying symptoms. The physical examination revealed hydrocele,
enlargement and slight pain of the right orchid (testicle) and epididymis.
The rectal examination with a gloved finger was negative for prostate
induration .General blood tests were normal. Microscopy of urine specimens
was negative as well as the culture for routine bacterium, furthermore
7 urine cultures for acid-fast bacilli were negative, mantoux 12mm, chest
x-ray face was normal. An intravenous pyelogram detected no anatomic or
functional abnormalities along the urinary tract. The scrotal ultrasonography
demonstrated the right enlarged testicle containing a cavity of extreme
size with multiple septate bands and solid areas.
RESULTS: The swelling was suspicious for malignancy. The patient underwent
a right orchectomy. Histological examination demonstrated granuloma formation
with caseation at the top of the epididymis, indicative of tuberculosis.
The patient was treated with isoniazid, rifambicin, ethambutol for two
months till he gave up on his own and there was a recurrence. He then
received the same treatment from start leading to the symptoms recession
temporarily and reappearance of the hydrocele on the right. In the culture
of the fluid from the hydrocele m. avium complex was isolated resistant
to all first- line antituberculosis drugs. The patient was then treated
with isoniazid, rifambicin, ethambutol, clarithromycin and ciprofloxacin
while waiting for the drug susceptibility testing to the reserve antituberculosis
CONCLUSION: Tuberculous epididymo-orchitis although rare it should be
considered in differentiating diagnosis of scrotal swelling. A recurrence
in spite of the proper medical treatment should suggest that there is
a possibility of non tuberculous mycobacterium. M. avium complex is a
very scarce cause.
LIVER DYSFUNCTION IN MURINE TYPHUS: A STUDY OF
S. Doukakis, M. Papadakis, M. Daoukakis, A. Nikolidaki, D. Triantafillidou,
G. Polymili, K. Bambili, M. Junie, S. Kastanakis*
General Hospital Chania, Greece
The most frequent biochemical abnormality in murine typhus is a mild
elevation of AST but ALT and LDH are often elevated in parallel. A hundred
and sixty-one patients with compatible clinical status of murine typhus
and high serological titers of antibodies against Rickettsia typhi, were
studied from our team between January 1993 and December 2007. For the
study of their hepatic function three serum samples were obtained from
each patient. The first sample was obtained on admission, approximately
9 days after the onset of the disease. The second sample approximately
two weeks after the first. The third sample, taken from the one third
of the patients, was obtained one month after the second. On admission
(first sample) 139/160 patients (86.8%) presented an elevation of AST,
111/160 patients (69.4%) presented an elevation of ALT and 134/157 patients
(85.3%) presented an increase of LDH. The median value of AST, ALT and
LDH was 59.0 U/L, 52.0 U/L and 338.0 U/L respectively. Two weeks later
(second sample) 126/150 patients (84.0%) presented an increase of AST,
112/148 patients (75.7%) presented an increase of ALT and 117/145 patients
(78.0%) presented an elevation of LDH. The median value of AST, ALT and
LDH was 52.0 U/L, 53.5 U/L and 333.0 U/L respectively. One month later
(third sample) 14/42 patients (34.0%) presented an increase of AST, 12/42
patients (29.0%) presented an increase of ALT and 8/42 patients (19.0%)
presented an elevation of LDH. The median value of AST, ALT and LDH was
28.0 U/L, 24.0 U/L and 142 U/L respectively. Our study showed that the
time of normal restoration of liver function was about two months after
the onset of the disease.
BIOMEDICINE APPLICATION OF STAPHAGES (COCKTAIL)
FOR MRSA DIABETIC FOOT INFECTIONS, WOUNDS, BURNS AND ABSCESS CASES
Eman Kamel Al Digs, Nagwa Mohamed Amin Aref
King Abdul-Aziz University, College of Medicine, Saudi Arabia
Background:Since MRSA is one of the most resistant organisms for antibiotics,
and due to the lethality and specifications of Staphages for MRSA the
evaluation and the efficacy of Staphage therapy was performed in medical
cases of methecillin resistant Staphylococcus. aureus, MRSA, skin infection
in wounded patients (surgical and accidental), diabetic foot infections,
burn and abscess cases.
Methods:In our study, a mixture of ten phages, differed in their virulence
to MRSA isolates were used with all thirty patient isolates that were
lysed completely by spot-test. The problem of bacterial resistance to
methecillin which was 39.8% in our study, were solved by the well-chosen
mixture of staphages. Our used cocktail in therapy was identified based
on biological, molecular and electron microscopy characterizations. It
had two temperate phages, which had effect on the resistant bacteria.
Results:In the study group for 30 patients of MRSA in different local
skin infection cases at different hospitals/ Jeddah; showed that phage
therapy was highly effective in 90 % of the cases especially diabetic
foot infections. Phages were more effectively targeted to growing bacteria
in local infections and were administered in a limited number of small
doses over a short period. Phages eliminated pathogen more rapidly in
five days and effectively than standard antibiotics.
Conclusion: We recommend the application of such bacteriophage solution
of Bionanostructure virus particles (cocktail) on similar human or animal
skin infection cases. As well as a commercial pharmaceutical dressing
product by is suggested to be executed by any of the national or international
drug company that would embrace this staphage cocktail on a high level
of productivity, and we also are in need of further Cryo-EM, computation
simulation and modeling studies on Bionanostructure virus particles to
understand the conceptions of its effective mechanism at a molecular level.
Staphylococcus. aureus, MRSA, Staphage therapy, Bionanostructure virus
Brucellosis and Pulmonary diseases
Batool Sharifi-Mood *, Malihe Metanat *, Farshid Fayyaz-Jahani,* Adel
Fallah Ghajary *
Research Center for Infectious Diseases and Tropical Medicine, Boo-Ali
Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
Background/Aim: Symptoms of brucellosis are protean in nature, and none
is specific enough to support the diagnosis. Pulmonary symptoms including
cough and dyspnea develop in up to 19% of patients with brucellosis; however,
these symptoms are rarely associated with active pulmonary involvement.
Hereby, We studied the prevalence of brucellosis in patients who had a
chronic cough and sputum smear was negative for tuberculosis .
Material and Methods: During 12 months, from Dec 2008 to Dec 2009, we
evaluated all patients who referred to Infectious Clinics in Boo-Ali hospital
( located in Zahedan, Southeastern Iran) because of chronic cough. Patients
who were enrolled in our study had a chronic cough with duration more
than 3 weeks and three to six samples of sputum were negative for tuberculosis.
Blood samples tested for STA and 2ME. Titer more than 1/160 was positive
and the patient was treated by standard regimen. (Doxycycline and Streptomycin).
Results: Among 93 patients (54 male, 39female) with age range 15-69 years,
7 patients (6.5%)(5 male, 2 female) had a positive test for brucellosis.
But the Chest-X ray was normal in these patients.Only one patients had
a mild infiltration in lower lobe of right lung. All patients except whom
had a abnormal chest x-ray responded to therapeutic regimen. Therefore,
the last patient referred to Internist for bronchoscpic evaluation.
Conclusion: Localized complications of brucellosis are typically observed
in patients with acute disease or chronic untreated infection, but our
study showed even in endemic area, although, chronic cough and bronchitis
may develop in persons with brucellosis but, pneumonia due to brucellosis
is very rare.
Blood stream infections in ICU and non-ICU patients
in a tertiary care hospital: a three-year analysis
Eleni Prifti, 1 Louiza Barbitsa, 1 Anastasia Gatsiou, 1 Katerina Papanagiotou
1 Evagelos Kostis, 2 Konstantina Tzanetou.1
1Department of Microbiology, 2Department of Clinical Therapeutics,
Alexandra Hospital, Athens University, School of Medicine, Athens, Greece
To study retrospectively the bacterial and fungal pathogens of blood stream
infections (BSI) and their resistance rates to antimicrobial and antifungal
agents, for guiding appropriate empirical therapy in ICU and non-ICU patients.
All cases of BSI from January 2007 to October 2009 were reviewed. The
blood samples were inoculated in BacTec bottles and incubated in the automated
BACTEC 9240 system. Identification of the clinical isolates to the species
level was performed by standard laboratory tests and MicroScan system.
Antibiotic susceptibility testing was performed by the disk diffusion
technique, and the MICs were determined by MicroScan and the Etest strips.
Carbapenemase-producing K. pneumoniae (CPKP) was detected by Hodge test
and by EDTA and boronic acid (600 Ојg/disk) inhibition in a combined disk
method. The KPC and VIM-producing K. pneumoniae isolates were confirmed
Results. Culture-positive BSI occurred in 810 patients, 277 (34.2 %) in
ICU and 533 (65.8%) in non-ICU. In the ICU patients, Gram-negative and
Gram-positive bacteria, mixed pathogens, anaerobes and fungi were isolated
from 26.3%, 57.8%, 11.2%, 1.4%, and 3.2% respectively, while among the
non-ICU patients from 35.5%, 52.3%, 8%, 2%, and 2% respectively. The most
common Gram-negative pathogen isolated in both ICU and non-ICU patients
was E. coli, followed by K. pneumoniae (28.8%, 17.8%, and 48.2%, 10.3%
respectively). The most common Gram-positive blood isolates from ICU and
non-ICU patients were CoNS followed by S. aureus (73.5%, 12.2% and 65%,
12.2% respectively). E. coli blood isolates from both ICU and non-ICU
BSI showed a low resistance rate to extended spectrum ОІ-lactamases (15%
and 8% respectively), while K. pneumoniae showed a high resistance rate
(69%, and 30% respectively). Nine blood isolates of KPC-producing K. pneumoniae
were susceptible only to gentamicin and colistin (100%) and tigecyclin
(33%). Two blood isolates of VIM-producing K. pneumoniae were susceptible
only to gentamicin, colistin, aztreonam and tigecyclin (except for one,
which was resistant to aztreonam because of ESBL detection). The methicillin
resistance rate of CoNS and S. aureus was 75% and 32% in ICU and 72% and
30% in non-ICU isolates respectively.
Conclusions. The predominant pathogens isolated from both ICU and non-ICU
BSI are gram-positive. The emergence of multidrug resistant CPKP in ICU
patients and the high resistance rate of CoNS to methicillin should be
taken in to account, when empirical treatment is needed.
EPIDEMIOLOGICAL STUDY OF PREVALENCE OF EPSTEIN
BARR VIRUS (EBV) INFECTION AND SEROPOSITIVITY IN PATIENTS OF A GENERAL
Konstantinos Tsepanis*, Savvato Tsingene, Kalliopi Chatzopoulou, Georgios
Kalamaras, Asimoula Koteli, Paransem Lagoudaki
Haematology Laboratory, “G. Gennimatas” General Hospital of Thessaloniki,
Our objective was the detection of active infection, specific IgM and
IgG antibodies against EBV and the determination of seropositivity frequency
in outpatients and inpatients of our general hospital.
MATERIAL and METHOD:
Our sample consisted of 190 patients, 51.58% (n=98) male and 48.42% (n=92)
female, during the period January 2008-June 2009. Of them 84.21% (n=160)
were inpatients and 15.79% (n=30) outpatients. 43.16% (n=82) were children
and 56.84% (n=108) adults. Detection of VCA-IgM antibodies and a 4fold
increase in the IgG titer between the first and the second sample (3 weeks
later) confirmed an active EBV infection (primary or reactivated). The
seropositivity was confirmed by the presence of anti-EBNA (EBV nuclear
antigen) IgG. The detection of IgM and IgG antibodies was performed with
RESULTS: An active infection was confirmed in 22.1% of the patients (n=42).
Of them 45.23% (n=19) were children (12 boys and 7 girls) and 54.77% (n=23)
adults (2 men and 9 women). 82.6% (n=19) of the adults group were immunosuppressed
indicating a perhaps a reactivated infection. The overall prevalence of
EBV seropositivity amounted to 82.63% (n=157). The prevalence of EBV seropositivity
was 67.1% (n=55) and 94.4% (n=102) in children’s and adult’s population
CONCLUSIONS: EBV is an ubiquitous virus, while almost 95% of the adults
are seropositive. The majority of patients suffering from an acute infection
are children, teenagers, young adults and immunosuppressed patients. Serological
tests should be performed in immunosuppressed patients, because EBV along
with CMV cause life-threatening infections in patients suffering from
Comparison of Bacteriology of the External Auditory
Canal from Patients and Healthy Subjects
K. Kiakojori*, S. Mahdavi Omran, R. Rajabnia, AR. Majidian, E. Ferdosi
Babol University of Medical Sciences
Cerumen as known as ear wax, produce regularly by cerumen and lipid secretary
glands. Regarding affect of humid weather in Mazandaran Province (north
of Iran) on prevalence of pathogen microorganisms, this study was performed
to determine the bacterial flora of the ear in patients with acute otitis
externa and comparing it with healthy subjects.
Methods: In this case-control study, cerumens collected and cultured from
40 patients with clinically diagnosed Acute Otitis Externa and 80 healthy
subjects. After growth and diagnosis of their colonies, data collected
and enrolled in designed charts for comparing between two groups. The
obtained Data were analyzed using SPSS software.
Results: In case group, Staphylococcus (20.8%), Bacillus spp. (18.9%)
and Pseudomonas spp. (11.3%) and in control group Staphylococcus Epidermidis
(38.7%) and Diphtheroid (22.4%) were the commonest bacteria.
Conclusion: Normal bacterial flora of ear has inhibiting activity on growth
of pathogenic bacteria probably, and components (e.g. in oint like) with
normal and healthy cerumen (Cerumen Therapy) could be use in patients
with Acute Otitis Externa. This is especially recommended in cases such
as Recurrent Otitis Externa due to non-complete formation of cerumen.
Further studies are warranted to evaluate the therapeutic implication
of these findings.
Key words: Cerumen, Bacterial Flora, Acute Otitis Externa
Fungal Flora in Cerumen from Patients with Acute
Otitis Externa Comparison to Healthy Subjects (Babol 2009)
S. Mahdavi Omran*, K. Kiakojori, R. Rajabnia, AR. Majidian, SM. Aghajanpour
Babol University of Medical Sciences
Ear wax (Cerumen), produce regularly by cerumen and lipid secretary glands.
Regarding affect of humid weather in Mazandaran Province (north of Iran)
on prevalence of opportunistic microorganisms, this study was carried
out to determine the fungal flora of the ear canal in patients with acute
otitis externa and comparing to healthy subjects.
Methods: In this case-control study, cerumens collected and cultured from
40 patients with clinically diagnosed Acute Otitis Externa and 80 healthy
subjects. After growth and diagnosis of their colonies, data collected
and enrolled in designed charts for comparing between two groups. The
Data were analyzed using SPSS software.
Findings: In case group Aspergillus flavus (23.8%) and Candida spp. (16.6%)
were the most prevalent fungi; and in control group Mycelium Sterile (13.4%)
and Cladosporium (12.5%) were the commonest fungi.
Conclusion: Normal flora of ear has inhibiting activity on growth of pathogen
opportunistic fungi. These results may be benefit for use of some components
in healthy cerumen (Cerumen Therapy) for treatment of patients with Acute
Otitis Externa. This is especially recommended in cases such as Recurrent
Otitis Externa due to non-complete formation of cerumen.
Key words: Cerumen, Fungal Flora, Acute Otitis Externa
Compliance and Safety Study in Children with
Upper and Lower Respiratory Tract Infections (COMPAS)
G. Chroussos1, S. Mantagos2, G.A. Syrogiannopoulos3, A. Siamopoulou-Mavridou4,
N. Myriokefalitakis5, C. Karis6, E. Sereti7, F. Athanasiadou8, M. Athanassiou-Metaxa9,
E. Roilides10, A. Chantzimichael11, D. Kafetzis12, C. Tsoulas13, V. Grammelis13.
1 Univ Ped Clin, Ag.Sofia Hosp, Athens, Greece, 2 Univ Ped Clin, PAGN,
Patra, Greece, 3 Univ Ped, PAGN Larissa, Greece, 4 Univ Ped Clin, PAGN
Ioannina, Greece, 5 Univ. Ped, Gen Hosp Penteli, Athens, Greece, 6 Ped
Clin, Nikea Hospital Piraeus, Greece, 7 B\’ Univ. Ped, Gen Hosp Penteli,
Athens, Greece, 8 AHEPA Thessaloniki, Greece, 9 Univ Ped, Ippokrateio
Thessaloniki, Greece,10 Univ Ped, Ippokrateio Thessaloniki, Greece, 11
Univ Ped, PAGN Alexandroupoli, Greece, 12 Ped Clin, Aglaia Kyriakou, Greece,
13 Pfizer Hellas AE, Greece.
- Objectives: The objective of this study was to obtain data on the safety,
tolerability and compliance with azithromycin in children with bacterial
infections of the upper and lower respiratory tract. The primary objective
was to record any adverse events (AEs), either expected or unexpected,
following the use of azithromycin. The secondary objectives included parameters
for tolerability, compliance and efficacy.
- Methods: This prospective, non-interventional, post-marketing study
was conducted from April 2007 through January 2009, involving a network
of 12 Greek hospitals. 400 children and adolescents, 1-14 years old, with
respiratory tract infection that received azithromycin according to the
approved summary of product characteristics were recruited.
- Results: All subjects who received azithromycin (n=390) were evaluated
for AEs. There were no deaths or severe AEs reported. 4 (1.0%) subjects
discontinued due to AEs, all of which were considered related to study
medication and mild in severity, and all resolved within 3 days. 27 (6.9%)
subjects reported 32 treatment-emergent all causality AEs, most of them
being categorized as gastrointestinal disorders (20, 5.1%).including diarrhoea
(9 [2.3%]), abdominal pain (6 [1.5%]) and vomiting (6 [1.5%]). All AEs
were considered mild in severity. Compliance rate was high (94.7%) and
most parents/legal guardians assessed the pediatrician's instructions
as easy to follow (95.9%) and azithromycin as easier to administer compared
to other previous treatments (91.3%). Improvement in health status of
subjects at final visit was assessed in 355 patients (91%).
- Conclusion: The incidence of adverse events is low when azithromycin
is administered for the treatment of children with respiratory tract infection.
Compliance, tolerability and efficacy rates were estimated to be high.
This study was sponsored by Pfizer Hellas (ClinicalTrals.gov: NCT00939185)
A Rare Case of Bacteremia Due to Bacillus Pumilus
in an Immunocompetent Patient
Aik. Mantaka*, L. Kalogeraki, E. Sarri , K. Spiliopoulos , Th. Mylonaki
, E. Volanis, S. Kastanakis
General Hospital of Chania, Crete, Greece “Saint George”
Introduction: Bacillus Pumilus is a Gram-positive, aerobic, spore
forming microorganism that can cause bacteremia, usually transient, rarely
clinically significant. Bacillus species are isolated from 0,1-0,9% of
blood cultures, but only 5-10% of these are clinically significant infections.
Predisposing factors for Bacillus bacteremia are intravenous drug users,
those with prosthetic valvular devices,venous catheters or pacemakers
wires, hemodialysis and immuno-compromised hosts (malignant diseases,
neutropenia, treatment with corticosteroids, HIV), sickle cell anemia.
Aim: To present a rare case of bacteremia with Bacillus Pumilus.
Materials and methods: A 71 year old woman ( severe aortic valve stenosis,
mild mitral valve shortage, cardiac failure, mild renal failure, dyslipidaemia)
presented with weakness, fatigue and a feeling of breathlessness. Laboratory
findings revealed severe hypochromic, normocellular anaemia, Mayer test(+),so
she was transfused with 2 blood units and received iron iv. The day 4
and 5 of her hospitalization she presented fever up to 38,8C. From the
3 blood cultures taken, Bacillus Pumilus was isolated in bottle B and
C. The patient was immediately administered vancomycin in combination
with imipenem and rapidly became afebrile within the next 24h. A series
of paraclinical tests including transthoracic and transoesophageal echocardiography
(-) for vegetations , gastroscopy(-), colonoscopy(benign colon polyp),
chest computerized tomography(-), upper and lower abdomen computerized
tomography(-), and further laboratory findings, did not prove malignancy
or immunosupression as a cause of Bacillus Pumilus bacteremia.
Conclusion: Several cases of Bacillus Pumilus bacteremia have been reported
in the literature, but mainly in immunocompromised, psychiatric patients,
in patients with malignancies, venous catheters contamination or intravenous
drug users. Clinically significant infection by Bacillus species is rare.
A Case of Tetanus in a 76 year old Woman Presenting
L. Kalogeraki, Aik. Mantaka*, P. Kotsopoulos, Chr. Stavrelis, Lagoudaki
Ir. , E. Volanis, S. Kastanakis
General Hospital of Chania, Crete, Greece “Saint George”
Introduction: Tetanus is a medical condition caused by the Gram-positive,
obligate anaerobic bacterium Clostridium tetani. There are about one million
cases of tetanus reported worldwide annually, causing an estimated 300,000
to 500,000 deaths each year. In Greece tetanus is sporadic, mainly in
Aim: To present an elderly woman with tetanus who was admitted with symptoms
Material and Methods: A 76 year old woman (with pacemaker, chronic atrial
fibrillation) presented with a 48h difficulty in swallowing and eating.
The patient had a small injury at the left lower limb two days ago. She
had opisthotonos, stiffness of the neck, rigidity of pectoral and calf
muscles, trismus, but not any other cardiorespiratory dysfunction or loss
of consciousness. Passive immunization with 3000I.U. of human tetanus
immunoglobulin was administered i.m. and the patient begun treatment with
diazepam, ceftriaxone i.v. Staphylococcus CN was isolated from the wound
culture, so she was also administered ciprofloxacin i.v. After an 11-day
hospitalization the patient presented with apnea and generalized tetanic
seizures so, she was treated with phenobarbital and oxygen. The patient
stayed at the internal medicine department for 20 more days with gradual
improvement on the respiratory function and the painful spasms.
Conclusion: Tetanus should be included in the differential diagnosis of
dysphagia, especially concerning elderly people with a history of an injury.
In that case the direct treatment is crucial, as tetanus infection has
high mortality and morbidity rates even in nowadays.
Recurrent Bacteremias Caused by Streptococcus
Species in a Patient with Bio-prosthetic Aortic Valve
L. Kalogeraki, Aik. Mantaka*, Chr. Dolapsakis, D. Kolpondinos, Ch. Stavrelis,
Em. Volanis, S. Kastanakis
General Hospital of Chania, Crete-Greece “Saint George”
Introduction: Enterococcus Faecalis, a gram(+) cocci, can cause bacteremia,
surgical wound infection, rarely meningitis and it is the 3rd cause of
infective endocarditis and nosocomial bacteremia. Increased frequency
of nosocomial enterococcal bacteremia in recent years is a result of previous
exposure to broad-spectrum antibiotics in very ill debilitated patients,
malignant diseases and broad use of invasive procedures.
Aim: To present a case of recurrent bacteremias by streptococcus species
in a patient with bio-prosthetic aortic valve.
Material and methods: A 78 year old man (coronary artery disease, prosthetic
aortic valve, history of infective endocarditis by streptococcus 10 years
before, history of bacteremia by streptococcus gallolyticus 3 months before)
presented with 24h high fever 38C , arthralgia, myalgia and weakness.
Enterococcus Faecalis was isolated in bottle B and C from 3 blood cultures
taken. The patient was immediately administered Garamycin 80mg 1flx2 and
Begalin 2flx4. Paraclinical tests including transthoracic and transoesophageal
echocardiography did not prove the existence of vegetations on the prosthetic
aortic valve. Imaging tests did not detect any pathological findings,
dental test(-), ASLn(-), pharyngeal culture (-). The detection for bacteremia's
cause led finally to colonoscopy which proved sigmoid diverticulum and
a big rectum mass. Rectum's biopsy showed colon adenoma with partial transformation
into carcinoma. The patient was sent to specialists(surgeons-oncologists)
for further treatment.
Conclusion: What is really interesting in that case is the detection of
rectal carcinoma as portal of entry into the bloodstream of streptococcus
Chronic Prostatitis is associated with alexithymia,
obsessive compulsive symptoms and hypochondriasis
George-Michael Gourgoulis, Sotirios Tsiodras, Periklis Panagopoulos, George
Moussas, Kalliopi Tournikioti, Panagiota Korkoliakou, Styliani Nika, Styliani
Symbardi, Christos Christodoulou, Lefteris Lykouras, George Petrikkos.
1. 4th Dep. of Internal Medicine, 2. 2nd Dept of Psychiatry, “ATTIKON”
University Hospital, University of Athens Medical School, Athens
Background: Chronic prostatitis is considered by some a psychosomatic
illness. The psychological profile of patients suffering from chronic
prostatitis, has not been fully elucidated yet.
Methods: Consecutive patients diagnosed with chronic prostatitis at a
tertiary care ID clinic were evaluated for the presence of psychiatric
symptoms. More specifically the Toronto Alexithymia Scale, the Leyton
trait scale and the Whitley index were used for the evaluation of alexithymia,
obsessive compulsive symptoms and hypochondriasis respectively. The NIH
Consensus Classification System for Prostatitis Category was used for
prostatitis classification. The NIH Chronic prostatitis Symptom Index
(CPSI) was calculated for all patients.
Results: 64 patients (median age 39 yrs old; IQR 32.5-49.5 yrs) were evaluated.
According to the NIH Prostatitis Classification patients were categorized
as type II : 40%, IIIa: 9 %, IIIb: 42%, IV: 4%. Median CPSI score was
18 (IQR: 13-24). Median TAS score was 42.5 (IQR: 37.3-54), median Leyton
score was 13 (IQR: 10-15.8) and median Whitley score was 28 (IQR: 22-38).
A TAS score of >53 indicative of alexithymia was noted in 26.6% of
the population. An abnormal Leyton trait scale score indicative of obsessive-compulsive
disorder was noted in 57.8% and an abnormal Whitley score indicative of
hypochondria in 43.8% of patients. CPSI strongly correlated with TAS score
(r=0.57, p < 0.01).
Conclusion: Increased rates of alexithymia, obsessive compulsive symptoms
and hypochondriasis were discovered in this cohort of patients with chronic
prostatitis. Alexithymia was strongly associated with quality of life
measures such as the CPSI. These findings need further elucidation and
will help in establishing appropriate intervention strategies.
2009 H1N1 Influenza at Clinic for Infectious
Diseases in Podgorica
Nikcevic D.*, Nikcevic ЕЅ., Andric B., Dupanovic B., Terzic D., Obradovic
Clinic for Infectious Diseases in Podgorica, Health Center Cetinje,
In period from 21st June, 2009 to 29th January, 2010 at Clinic for
Infectious Diseases in Podgorica 274 patients with clinical diagnosis
of swine flu were hospitalized. We have analyzed their clinical and laboratory
Infection with pandemic AH1N1 influenza virus was laboratory confirmed
by RT-PCR in 180 cases, 15 in the “summer wave” and 165 in the "winter
wave" of epidemic. In 46 patients diagnosis is established on clinical
and epidemiological findings because RT-PCR test was not performed according
to the instructions from national Center for control of pandemic influenza.
Most of the patients were young people in the age 5-25 which made 53%,
36% were middle-aged (26-50) and 11% were older than 50 years.
Gastrointestinal disturbances were frequently registered among nonspecific
symptoms of illness (vomiting - 23%, diarrhea - 9% and abdominal pain
- 9%). RTG pneumonia was found in 62% and leukopenia (less than 4 G/L)
in 21% of patients. 34% of the patients were with co-morbidity or in status
of risk, especially with chronic cardiac diseases (15%) and chronic pulmonary
diseases (10%), including three pregnant women.
Not even one influenza H1N1 death was registered. Time of hospitalization
was 6,2 days in average.There were three cases of influenza H1N1 among
health workers on Clinic for infectious diseases in Podgorica
Dynamic Spread of Brucellosis in Humans in the
Area of Korca for the Years 1999-2009.
Klementina Puto, Stela Papa, Naxhije Hila
* Department of Biotechnology, Tirana University, Tirana, ALBANIA,
**Department of Biotechnology, Tirana University, Tirana, ALBANIA, Deparmtent
of Bio-Chemistry, ”Aleksander Xhuvani” University, Elbasan, ALBANIA.
Go to the
full publicaton of the article in JofIMAB 2010 16(3):11-16
Brucellosis disease is progressing rapidly, marking not only the
vast spread to cattle, but now seriously endangering human health. Brucellosis
is an infectious disease dekurs chronic, caused by bacteria of the genus
This bacterial zoonosis is transmitted as an infectious disease even in
people from infected animals, products and by-products produced from them.
In the brucellar infection map in all world Albania is also included,
among the endemic dissemination countries. In 1988 our country was declared
healthy from brucellosis. But political and economical changes that occurred
in our country after 1990, brought a significant increase of brucelar
infection in animals, as a result people were infected too. Therefore,
the object of our study is the dynamics of the spread of brucellosis in
humans at Korcaв’s region for the years 1999-2009.
For examining this disease two methods are used in our bacteriological
laboratory: evidence of Rosa-Bengal (RB) and Wright test (SAT). We have
studied different cases in these years and from our analysis the result
is positive for 1698 people.
The increased number of people infected with brucellosis shows that this
disease poses a serious problem with social risk to the health of population.
These data will serve as a microbiological archive to prevent and reduce
this disease, until it is eliminated by combining both veterinary services
and hygienic sanitation.
Respiratory tract infection and association with
an acute ischemic cardiac event.
S. Sympardi, S. Tsiodras, E. Giannitsioti, George-Michail Gourgoulis,
E. Iliodromitis, M. Rizos, A. Rigopoulos, J. Parisis, G. Filippatos, K.
Kanellakopoulou, M. Anastasiou-Nana, G. Petrikkos,
University of Athens Medical School, Athens, Greece.
Text: Background: We aimed to examine epidemiological associations
between the presence of an infection and admissions due to an acute ischemic
cardiac event in a tertiary care cardiology clinic.
Methods: Consecutive cases with an ischemic cardiac event admitted at
a tertiary care center cardiology clinic during a period of 6 months were
evaluated. Cases with an additional admission diagnosis of respiratory
tract infection (RI) within 72 hours of hospital admission were recorded.
The association with RTI and an ischemic cardiac event was studied using
univariate and multivariate analysis.
Results: 210 consecutive patients with an ischemic cardiac event leading
to an admission have been prospectively evaluated [75 % male, median age:
68 yrs (IQR 60-78), median APACHE III score: 74 (59-88)]. RTI was diagnosed
in 59.7% of cases. The presence of RTI was associated with the admission
diagnosis of an acute coronary event (OR: 3.1, 95% CI: 1.6-5.9, P=0.001).
An acute coronary event was also associated with increasing age (p<0.001),
male gender (p=0.07), history of hyperlipidemia (p<0.001), HTN (p<0.001),
chronic renal failure (CRF) (p<0.001), diabetes (DM) (p=0.01) and an
increased APACHE III score. Multivariate analysis revealed the following
variables to be associated with an ischemic cardiac event: increasing
age (OR: 1.05, 95% CI: 1.02-1.08, P=0.001), dyslipidemia (OR: 3.1, 95%
CI: 1.3-7.8, P=0.01) and the presence of RTI (OR: 2.3, 95% CI: 1.1-5,
P=0.03). No pathogen specific association was found.
Conclusion: In the presented cohort of patients the diagnosis of RTI was
associated with an acute coronary artery disease event. More studies should
investigate this association and potential prevention strategies.
Brucellar meningitis as the only manifestation
of human brucellosis: A case report of a rare presentation and review
of the literature
M. Souli*, D. Sinapidis , P. Koutoukas , K. Protopapas, G. Koukos , H.
4th Department of Internal Medicine, Athens University School of Medicine,
Text: Background: Central nervous system involvement is a rare and
perplexing complication of brucellosis, a worldwide prevalent zoonosis.
The reported incidence is 2-7% and the clinical presentation varies. Meningitis
is reported in 6-50% of cases in neurobrucellosis series. We report a
case of brucellar meningitis and discuss the diagnosis and management.
Case report: A 35-year old female farmer was admitted with high fever
and headache of 15-days duration. Physical examination revealed only subtle
nuchal rigidity. Routine laboratory tests were normal. Cerebrospinal fluid
(CSF) examination showed a white blood cell count of 330x106/L (lymphocytes
80%), a protein level of 102 mg/dL and a glycose level of 46 mg/dL (blood
glycose, 118 mg/dL). Blood and CSF cultures were negative. Extensive blood
and CSF work-up for viral, bacterial, mycobacterial, fungal, neoplastic,
primary neurologic or vasculitic causes of aseptic meningitis and a brain
MRI were unrevealing. The diagnosis of neurobrucellosis was confirmed
by a positive Rose Bengal Plate test, a standard tube agglutination test
(Wright) >1/2560, a high serum antibody level against Brucella (Elisa);
IgG, 79 NU and IgM 46.8 NU, a high CSF antibody level (Elisa); IgG, 11.4
NU and IgM 10.3 NU and a positive CSF PCR for B.melitensis. The patient
was treated with doxycycline, cotrimoxazole and rifampicin for 4 months
with a rapid clinical but a delayed CSF parameter improvement and remained
well at 7 months of follow-up.
Conclusions: Brucella spp. should always be considered as a cause of aseptic
meningitis in patients living in or returning from an endemic area. Prolonged
treatment with 3 adequate antimicrobials is recommended. Follow-up lumbar
punctures are needed because treatment duration depends on CSF parameters
returning to normal in order to avoid relapses.
PROBLEMS OF THERAPY DURING HEPATITIS B VIRAL
Svirtlih N1, Delic D1, Simonovic J1, Lazarevic I2
1Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia,
Belgrade, Serbia; 2Institute of Microbiology and Immunology, Medical Faculty
University of Belgrade, Serbia
Hepatitis B virus causes different spectrums of clinical diseases,
from acute to chronic hepatitis. Generally, the goal of antiviral treatment
is to suppress viral replication and prevent the possibility of the virus
to induce progression of liver disease. Two types of antiviral drugs are
currently approved that are mostly used in patients with chronic hepatitis
B: the alpha interferons and the nucleos(t)ide analogues. However, universal
opinion suggests that patients with chronic hepatitis B can not be вЂњcuredвЂќ
definitely and completely eliminate the virus. The persistence of covalently
closed circular HBV DNA in infected hepatocytes serves as a viral resevoir.
In spite of this fact, adequate treatment of these patients has shown
improvement in disease outcome and prolonged survival.
Many important questions are necessary to be resolved for effective treatment
depending on patients, antiviral drugs, and also, viral characteristics.
The most critical point is to select patients to treat or not, e.g., to
evaluate benefit of treatment vs. adverse effects that can cause severe
consequences (flare of the disease or various other organ damages).
Selection of patients depends on the stage and activity of the disease,
patient’s health status (undergoing hemodialysis or liver transplantation,
etc.), age, gender (possibility of pregnancy), co-infection with other
persistent viral infection (HCV, HIV), etc. Choice of antiviral therapy
depends on safety, efficiency and barrier to resistance (durability) of
antiviral dugs. Regarding treatment, regular monitoring is necessary (virologic
and biochemical) to notice eventual antiviral resistance (breakthrough
or rebound) that requires change of given therapy.
Properly confrontation with various problems in treating hepatitis B viral
infection will be effective to achieve long viral suppression and prolong
life of patients.
Extrapulmonary tuberculosis as an etiological
factor in fever of unknown origin
Stevanovic Goran, Pelemis Mijomir, Pavlovic Milorad, Lavadinovic Lidija,
Clinical Centar of Serbia, Clinic for infectious and tropical diseases
Objectives: The aims of this study were to determine prevalence of extrapulmonary
tuberculosis in patient with fever of unknown origin (FOU) who was HIV
negative, to show prevalence of, and types of extrapulmonary tuberculosis
(TB) and to determine trends of prevalence among patients with FOU.
Methods and results: During period 1994-2009, 2842 with FUO were evaluated
and treated in the Clinic for infectious and tropical diseases, Belgrade.
Extrapulmonary TB were diagnosed in 134 (4,7%) patients. Genitourinary
TB in 73 patients (renal - 60, orhiepididymitis - 4, salpingo-oophoritis
- 9); TB lymphadenitis in 13; meningitis in 15; TB pericarditis in 8,
spondylodiscitis in 6, liver TB in 4 and in one patient small intestine
TB. In 14 patients we did not confirm tuberculosis and after pulmonary
TB was excluded, they were treated empirically with antituberculous drags,
and had a good response. As a diagnostic methods we used: PPD skin test,
cerebrospinal fluid (CSF), sputum and urine cultivation, computed tomography,
echocardiography, intravenous pyelography, patohistological examination
of lymph nodes, intestine and liver, and gynecological laparoscopy. For
urine and CSF specimens PCR test was used after year 2001. The sensitivity
of conformation test were: CSF culture 100% (PCR 100%), urine culture
45% (PCR 68%), for histopathology lymph nodes 78%, small intestine 100%
(single patient) and liver 85%. As a diagnostic criteria, clinical course
of the illness, radiological examination, laparoscopy and other endoscopic
examinations and response to empiric therapy, were also used. Incidence
of extrapulmonary TB was in slight increasing after year 2001. Isoniazid,
rifampin, pyrazinamide, ethambutol and streptomycin were used for treatment.
Multi drug resistant TB were confirmed in 4 patients and in 7 patients
(drug sensitive TB) had relapses of the illness after treatment.
Conclusions: Extrapulmonary TB is increasing cause factor in patients
with FOU and should be always considered during evaluations of this patients.
Surveillance of Antimicrobial Resistance - a
Multicenter Study in Infectious Diseases Hospitals in Romania
L. C. Gavriliu *1, G. A. Popescu1, E. Nicoara2, E. Miftode3, S. Rugina4,
C. Popescu1, E. Benea1
1) ”Matei Bals” National Institute of Infectious Diseases , Bucharest,
Romania; 2) ”Victor Babes” Infectious Diseases Hospital, Timisoara, Romania;
3) ”St. Parascheva” Infectios Diseases Hospital, Iasi, Romania; 4) Infectious
Diseases Hospital from Constanta, Romania.
Antimicrobial resistance data could improve the quality of local
treatment guidelines in various infectious diseases. We started a surveillance
study to evaluate the level of resistance in four infectious diseases
hospitals in Romania.
Methods: A four-center retrospective study of bacterial antimicrobial
susceptibility (Infectious Diseases hospital fron Iasi, Constanta, Timisoara
and National Institute Matei Bals). We analysed a twelve months period
(December 2006-November 2007). Major problems of germs resistance and
difficulties in susceptibility testing were defined.
Results: We analysed 6011 bacterial isolates, duplicate and feces isolated
bacteria being excluded. More than half of tests were performed in Matei
Bals National Institute (54,28%) . The other centers tested 14,24-16,22
% isolated each. The Gram-positive-Gram negative proportions were similar
:48,20% to 51,80%. Quinolones and cephalosporins were less tested in some
centers,and ESBL tests weren’t regularly performed. 86,11% of results
were obtained with disk diffusion method. High level of resistance were
noted for Streptococcus pyogenes to macrolides 25,23%, Streptococcus pneumoniae
with diminished susceptibility for penicillin 51,34% and 46,15% resistance
to macrolides; methicillin-resistant Enterococcus spp 32,21%; Pseudomonas
spp. 40,46% fluorquinolones resistance and 27,20% carbapenems resistance
(imipenem and/or meropenem); Enterobacteriaceae 24,81% fluorquinolones
resistance and 23,11% third generation cephalosporins resistance.
Conclusions: The resistance levels are quite high, in accordance with
EARSS reported Romanian data, and for some situations even higher. The
misdiagnosed resistance due to technical problems could be an explanation,
as for other statistical results from our country. A more coherent activity
of susceptibility testing is mandatory .
Hemorragic fever caused by Hantaan virus
Georgia Kalpakou, Petros Stravopodis,Vasiliki Aggelopoulou(1),Irini Katsarou
General hospital of Zante,Greece ,(1)Health Center of Meligalas, Greece
To describe the clinical course, the laboratory findings, and the differential
diagnosis of the infection caused by Hantaan virus.
Material: A young male, 23 years old presented with high fever, headache
and severe malaise. His symptoms had begun two days earlier with weakness,
anorexia, and nausea. His medical history was unremarkable, he was single
and he was occupied with agricultural labours. The physical examination
revealed normal heart and lungs auscultation, enlargement of liver and
spleen, normal neurological findings. The laboratory findings at his admission
showed mild leucopoenia, thrombocytopenia, slight elevation of the liver
enzymes (double the normal value), normal renal function, and normal coagulation
tests. In the next two days the patient was still febrile, and the third
day of his hospitalization he presented clinical deterioration with hematouria,
oligouria and diffuse hemorrhagic rash and spontaneous conjuctiva haemorrhage.
At the same time, his laboratory findings revealed acute renal insufficiency,
and diffuse intravascular coagulation. The serological testing finally
revealed infection of Hantaan virus.
Conclusions: The clinical and the laboratory features of this patient
are common in a large variety of viral, parasitic or atypical bacterial
infections. When renal insufficiency and hemorrhagic lesions occurred,
it became more obvious that the virulent factor was affecting the kidneys
in a characteristic way. Such infections are leptospirosis and hemorrhagic
fever. Both the diseases have similar epidemiological subset and the same
host: small rodents. The clinical differential diagnosis between Hantaan
virus infection and leptospirosis is hard. In western Greece the frequency
of leptospirosis is high, thus the diagnosis of Hantaan is challenging
and the prevalence of the disease is probably underestimated. The outcome
for this patient was good with full recovery. The death rates for this
infection are reported to be between 5% and 10%.
Acute pericarditis due to alpha-interferon therapy-
Popescu C.*, Arama V., Paise A., Gliga S., Daha I., Mihailescu R., Radulescu
National Institute of Infectious Diseases \”Matei Bals\”, Bucharest,
We present the case of a female patient, 38 year old, known with
chronic HCV hepatitis, treated with peginterferon and ribavirin, (the
eighth month of antiviral treatment) which was admitted for chest pain,
dry cough, and fatigue, without fever. The antiviral therapy tolerability
was satisfactory, without hematological, endocrinological, ophthalmological
or autoimmune side effects, and treatment response was fast, with undetectable
viral load at 4 wk of therapy.
Physical examination showed distant heart sound, cough, pericardial friction
rub. The patient had thoracic pain. Chest x-ray, electrocardiogram and
laboratory data were normal. Echocardiogram showed Horowitz C1 pericardial
effusion with systolic and diastolic separation of epicardum and pericardium
(small effusion 18ml). The first suspicion was viral etiology and the
patient received NSAIDs (ibuprofen) and colchicines. The antiviral therapy
for HCV hepatitis was continued, under cardiology supervision. Clinical
outcome was to slow deterioration and echocardiogram showed an increase
of pericardial effusion, without risk of tamponade.
Although the literature doesnвЂ™t report other cases of acute pericarditis
secondary to interferon therapy, we stopped HCV antiviral therapy and
the outcome has been slow to improve both clinical and echocardiographic.
After 3 wk of stopping antiviral therapy, interferon was resumed. After
the first dose in the absence of ribavirin, the patient presented significant
chest pain, cough and thoracic pain. Echocardiogram performed at 48 hours
after interferon administration showed an increase of pericardial effusion.
We excluded other causes of perirditis. Linking acute pericarditis with
the administration of interferon has been determined for the presented
case by Naranjo ADR Probability Scale, which, with a value of 9 indicates
a certain association. We stopped the antiviral therapy, and all biological,
clinical and echocardiography data (5 months later) were normal. In terms
of HCV infection the patient achieved sustained virological response.
Conclusion: Interferon may be involved in the occurrence of pericarditis,
most likely immune mediated.
The usefulness of macrolides for community-acquired
Popescu C.*, Dorobat O., Popescu G. A., Arama V., Gavriliu L., Benea E.,
Rafila A., Hristea A., Popoiu M, Gliga S., Gubavu C
National Institute of Infectious Diseases “Matei Bals” Bucharest,
Because the macrolides are widely used in the treatment of community-acquired
infections due to gram-positive cocci, especially for respiratory tract
infections, ear-nose-throat (ENT) infections and skin infections, it is
important to macrolide resistance level of gram-positive cocci (GPC).
Methodology: We performed a surveillance study of patients with community-acquired
infections due to GPC during a twelve months period (July 2008 - June
2009) in order to establish the macrolide resistance level; we tested
the correlation between macrolide resistance and resistance to other antibiotics.
Results: We collected 597 strains of GPC: 60 of S pneumoniae, 301 of S
pyogenes, 218 of S aureus, 18 S epidermidis. 62 patients had community
acquired respiratory tract infections, 132 patients had skin infections
and 403 patients had ENT infections. The levels of resistance to macrolides
were: S pneumoniae - 42%, S aureus - 46%, S epidermidis вЂ“ 72%, S pyogenes
- 1.98%. The macrolide resistance levels are higher for the germs involved
in respiratory tract infections, 46.8% and in skin infections, 44.6% versus
germs from ENT infections, 12.90% (p<10-7 in both cases). The macrolide-resistant
isolates are more resistant to other antibiotics than macrolide-susceptible
isolates: S pneumoniae for penicillin: 16.7% vs 6.1% (p=0.19), for TMP/SMX:
66.7% vs 27.2% (p=0.012) and for tetracycline 58.3% vs 6.1% (p=0.0001);
S aureus for oxacillin: 56.1% vs 18.2% (p<10-7), for TMP/SMX: 4.1%
vs 0 (p<10-7), for fluoroquinolones: 15.9% vs 1.8% (P=0.0002), for
tetracycline: 78.2% vs 32.1% ( p<10-7).
Conclusions: The macrolide resistance level of GPC is high. In our area,
the macrolides remains useful as first-line regimen only in ENT infections.
Most of GPC macrolide-resistant isolates are also multidrug resistant
and the treatment of community acquired infections is more difficult,
involving newer fluoroquinolones or even second-line antimicrobials.
Tygacil in Pathogen-directed Therapy of Liver
Abscess: Efficacy and control of side effects
Popescu G.A.*, Gavriliu L., Benea E., Popescu C., Oancea I.
National Institute of Infectious Diseases \”Matei Bals\”, Bucharest,
We present the case of a patient with E coli ESBL-positive cholangitis
after cholecystectomy. The initial treatment with carbapenems was replaced
with tigecycline due to slow response and drugs-induced neutropenia. Tigecycline
controlled the both problems; a segmental hepatectomy removed abscess
area and a biliary duct stenosis.
Beta-Lactams and Pharmaceutical Interstitial
Nephritis (PINB) - Correlation between the Clinical Symptoms and the Laboratorial
Katsarou I, Christopoulos A, Ikonomopoulou E, Stavropoulou G, Kalpakou
G, Kapralos C
General Hospital - Renal Unit, Zakynthos, Greece.
A pharmaceutical interstitial nephritis by beta-lactams is an indirect
phenomenon, caused by immune reactions. As it can occur with a single
dose, it is therefore dose-independent. Our aim is to record the correlation
between the clinical symptoms of patients with PINB and their laboratorial
Material: Four patients, out of sixty-five: one woman and three men were
taken into consideration. Their ages were 31, 56, and 81 respectively.
An antibiotic therapy of beta-lactams was used (Penicillin, Azlocilline,
Tazocilline), against a respiratory pulmonary infection.
Conclusion: Frequency of PINB over the last years increases (on our research
was 6.15% while in bibliography data 4%). The most usual symptoms were
fever, eosinophilia; exanthema and arthritic pain were infrequent. The
most frequent symptom was fever and its appearance is characteristic after
a non-fever period. Eosinophilia varies from 500 to 5000/mm3.
Some bradicardia can be a useful finding, whenever it exists. A careful
monitoring of the renal function, with the recording of the tubular function
and that of the creatinine plasma, are considered to be necessary. In
most cases, ARF caused by beta-lactams is characterized as a non-oligouria.
Clinical presentation of hospitalized patients
with confirmed infection from A/H1N1 virus
Georgia Kalpakou, Petros Stravopodis,Olga Sidirokastriti, Maria Spinou,Irini
General hospital of Zante (Zakynthos), Greece
During the A /H1N1 pandemic, in the summer and fall of 2009 a large number
of patients with flu like symptoms presented to the general hospital of
Zakynthos. Very few of them needed hospitalization. We describe the clinical
and laboratory findings of these patients.
Material-Methods: From a total number of 823 patients who presented to
our hospital with flu like symptoms from June to December 2009 only 16
patients needed hospitalization. All of them had a positive PCR test for
A /H1N1 in pharyngeal sample. All of them had serious symptoms and especially
high fever and malaise. 8 of them had a serious medical history and they
were admitted to the hospital for safety reasons and closer observation.
4 of them were foreign tourists who could not have proper care and attention
outside the hospital. One of them was hospitalised because she acquired
streptococcal pneumonia a week after being diagnosed with the A /H1N1
infection. Only one of them presented viral pneumonia and ARDS and needed
hospitalization in critical care unit, with a good final outcome. The
laboratory findings were not characteristic in all of them. Radiological
findings existed in only 4 of them. All of the admitted patients received
oseltamivir from the onset of their disease.
Conclusions: Although we had a large number of patients, the need for
hospitalization was not as high as expected from the international data.
The fact that most of our cases were in the summer months was perhaps
contributing to a better outcome. We should also acknowledge that due
to the high level of information in Greece during the A /H1N1 pandemic,
the patients were seeking medical attention and care earlier in the course
of the disease.
Antimicrobial Sensitivity of Ureaplasma urealyticum
and Mycoplasma hominis in Cases with Vaginal Discharge in Kosovo
A. Kurti*, Gj. Mulliqi, L. Raka, Xh. Jakupi ,G. Lila, Rr. Bajrami, A.
Faculty of Medicine , University of Pristina; National Institute of
Public Health of Kosovo, Pristina , Kosovo
The objectives of study was to isolate Mycoplasma hominis (Mh) and Ureaplasma
urealyticum (Uu) and determine the antimicrobial resistance in cervico-vaginal
samples of women, who had complaints of vaginal discharge, using Mycoplasma
IST 2 (BioMerieux).
Methods: There were 471 patients included in the study. Vaginal samples
were taken from endocervical region after exocervical mucus had been swabbed
clean. Mycoplasma IST 2 used for investigation of Mh and Uu provided information
about the presence or absence of Mh and Uu and also their antimicrobial
susceptibility to Doxycycline, Josamycin, Ofloksacin, Erythromycin, Tetracycline,
Ciprofloxacin, Azythromycin, Clarythromycin and Pristinamycin.
Results: Uu has been isolated in 235 (49.90%) patients, while Mh has been
isolated in 42 (8.91%) of them. Uu and Mh have been both isolated in 36
(7.46%) of the patients.
Out of 235 Uu positive samples, in 211 cases (89.9%) the quantity was
higher then 10/4 CFU/ml. Out of 42 Mh positive samples, in 11 (26.2%)
the quantity was higher then 10/4 CFU/ml while in 31 (73.8%) of the positive
samples the quantity was lower then 10/4 CFU/ml.
Uu has shown resistance to Ciprofloxacin in 98 cases (41.7%), then to
Erythromycin in 43 (18.3%), Clarithromycin in 37 (15.7%), Azithromycin
in 25 (10.6%), Tetracycline and Ofloxacin in 22 (9.4%), to Doxycycline
in 5 (2.1%), Pristinamycin in 4 (1.7%) and to Josamycin in 2 (0.9%) cases.
Uu/Mh isolates have shown resistance to Erythromycin in 27 cases (75.0%),
followed by Clarithromycin in 25 (69.4 %), Ciprofloxacin in 24 (66.7%),
Azithromycin in 13 (36.1%), Tetracycline in 6 (16.7%), Ofloxacin and Pristinamycin
in 4 cases each (11.1 %), and to Doxycycline and Josamycin in 2 (5.6%)
The resistance of Uu/Mh isolates to Azithromycin, Ciprofloxacin, Clarithromycin
and Erythromycin is higher then in Uu isolates only. This difference is
higher in the case of Azithromycin ( range=1, X2-test = 14.75, p=0.0001
), Ciprofloxacin ( range=1, X2-test = 6.884, p=0.0087), Clarithromycin
(range =1, X2-test = 48.03, p<0.0001), Erythromycin (range =1, X2-test
= 49.47, p<0.0001).
Conclusions: A higher prevalence of Uu versus Mh is noted in the vaginal
swabs as well as higher resistance in the chinolone. In addition, Mh and
mixed isolates are more resistant in macrolides further explaining that
the macrolide resistence is attributed to Mh.
Pseudomonas Species Isolates And Their Antimicrobial
From Intensive Care Units Of The University Clinical Centre Of Kosovo
During The Year 2008
*G. Lila, Gj. Mulliqi, Rr. Bajrami, L. Raka, A. Kurti
University of Prishtina, Faculty of Medicine; Department of Microbiology,
Institute of Public Health of Kosovo, Prishtina, Kosovo.
The aim of the study was to isolate Pseudomonas sp. from various clinical
samples in the Intensive Care Unit of Kosovo and to determine the antimicrobial
Methods: A retrospective study has been conducted at the Microbiology
Department, National Institute of Public Health of Kosovo in Pristina.
Data from samples received and microbiologically examined during year
2008 has been used. In order to isolate and identify bacteria were used
the culture mediums as Agar-Blood, MacConkay-Agar, metabolic activity
(biochemical tests) and oxidase test. Antimicrobial susceptibility testing
was performed by Kirby Bauers disc diffusion method. Quality control was
performed using a local previously characterized Pseudomonas isolate.
Results: From total of 891 received samples during the study period 431
were gram negative rods. The majority of isolates were Pseudomonas spp.
154(37.29%), the largest number are isolated from tubus swabs 72(46.75%)
followed by tracheostoma 60(38.96%) and wounds 10(6.49%).
Pseudomonas isolates expressed highest susceptibility to Imipenem 120
samples (77.92% susceptible) and Amikacin 100(64.94% susceptible). The
resistance rate for Ampicilin 132 samples (85.71%), Cefotaxim 129(83.77%),
Trimethoprim-Sulfamethoxasole 127 (82.47%), Ceftazidime 124 (80.52%),
Ceftriaxone and Piperacilin each of them 123 (79.22%), Ciprofloxacin 84(54.5%),
Gentamycine and Tobramycine each of them 83 (53.90%).
Conclusion: The study shows high presence of Pseudomonas sp. among isolates
at the Intensive Care Units of the University Clinical Centre of Kosovo
accompanied with high resistance toward tested antimicrobials. This situation
reqests development and implementation of strict hygienic measures and
more prudent use of antimicrobials in these units
Differential expression of Interferon Gamma in
chronic Hepatitis C patients
Refat Sadeq, Salwa Badr el-Sabah, Heba Mohtady and Nesreen Al-Badawy
Departnet of Microbiology, Faculty of Medicine, Zagazig University,
Although IFN-alfa forms the foundation of therapy for chronic hepatitis
C, 30-50% of patients has a sustained response to IFN-alfa therapy. Type
I IFNs can promote IFN-gamma production by activating STAT4 .
We characterized the effects of pegylated IFN-alfa therapy for hepatitis
C on the capacity of patients’ PBMC to produce IFN-gamma ex vivo. Cells
from patients with a initial virological response to therapy had significantly
greater levels of IFN-alfa-driven IFN-gamma production after treatment
than those from non-responding patients.
Interferon stimulates the expression of a number of genes encoding enzymes
with antiviral activities, including myxovirus resistance-1 (MxA), 2-5-oligoadenylate
synthetase 1 (OAS-1) and double-stranded RNA-dependent protein kinase
This study was performed to elucidate whether a single nucleotide polymorphism
(SNP) (G/T at nt-88) in the promoter region of the MxA gene influences
the response to IFN therapy in patients with chronic hepatitis C virus
Polymorphisms of the MxA gene in 40 HCV patients were determined by polymerase
chain reaction-restriction fragment length polymorphism.
The frequency of SNP was compared between initial-responders (n = 21)
and nonresponders (n = 19), as determined by biochemical and virological
responses to IFN- alfa.
Multivariate analysis showed that among all patients HCV RNA level and
the SNP of the MxA gene were independent and significant determinants
of the outcome of IFN therapy [odds ratio (95% confidence interval), P
< ; ( ), P < 0.0001, respectively].
Key Words: single-nucleotide polymorphism (SNP), genetics,
disease association, immunomodulation , cytokine , memory T cell , IFN-
alfa, IFN- gamma
Staphylococcal Aureus Colonization and its Toxins
in Some Skin Diseases
Selim , A.G., Ghanem,A.H., Sadeq*, R.A. , Mohtady*, H.A., and Nashwan,
Dermatology&Venereology and Microbiology* Departments, Faculty
of Medicine, Zagazig University, Egypt
An important role of S. aureus colonization of the skin is its
potential to modify the course of dermatologic diseases. In particular,
S. aureus enterotoxins of types A through E and the TSST-1 have been
shown to trigger exacerbation of AD, psoriasis, CTCL and erythroderma.
The aim of the work is to assess the prevalence of S. aureus colonization
in AD, psoriasis, CTCL and erythroderma. Also to correlate the severity
of these diseases with the staphylococcal enterotoxins production.
Material and Methods: All patients included in this study underwent the
following protocol for evaluation: detailed history taking, clinical examination,
histopathological examination, Bacteriological study (Staphylococcus aureus
isolation and identification, test for enterotoxin production by S.
aureus and detection of staphylococcal enterotoxins A, B, C, and
D genes by the polymerase chain reaction).
Results: Bacterial toxins including SEs have been implicated in the pathogenesis
of CTCL. The prevalence of S. aureus in the lesional skin of
our patients with CTCL was higher than in non-lesional skin, there were
significant intergroups differences (p<0.05). As regard to toxins produced
by S. aureus, more toxin were found in the lesional than in non
Conclusion: S. aureus and its toxins have a significant role
in the pathogenesis of these dermatological diseases under study.
Date of close: May 29, 2010
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