Biological therapy of inflammatory bowel disease (IBD) carries an increased risk for the development of opportunistic infections due to immunomodulation. The aim of this study was to determine the ...prevalence and types of oral infections in IBD patients treated with biological (anti-TNF-α and anti-integrin-α4β7) and conventional medication protocols. The study included 20 IBD patients receiving anti-TNF-α therapy, 20 IBD patients receiving anti-integrin-α4β7 therapy and 20 IBD patients without immunomodulatory therapy. Participants completed questionnaires on medical information, oral lesions and symptoms. For each patient, clinical examination and a salivary flow rate test were performed, followed by a swab of the oral mucosa. The swab samples were cultured to identify Candida spp. and oral bacteria. No bacterial opportunistic infections were detected. Candidiasis was detected in four participants, with no significant difference between groups (p = 0.765). Hyposalivation was most common in the anti-TNF-α group, with a significant difference between groups (p = 0.036). There were no significant differences between groups in self-reported oral mucosal lesions and symptoms (p > 0.05), or in the distribution of oral mucosal lesions (p > 0.05). This study suggests that IBD patients receiving biological therapy are at no greater risk of developing oral opportunistic infections than IBD patients not receiving immunomodulatory therapy.
The introductory part has summarized the role of malaria in the course of history and various attempts of its eradication in Croatia before the World War I. Furthemore, there is a list of activities ...and results accomplished between 1922 and 1927 on the island of Krk by Dr. Otmar Trausmiller. After a systematic sanitation of all anopheles habitats, primarily natural and artificial bodies of still water, and introduction of imported gambusia to those bodies of water, anopheles was virtually eradicated on the island. What followed was an evident decrease of new malaria incidents, and in the campaign against malaria there was still major concern in the form of chronic patients and intensive quinine therapy. Today, about eighty years after it was introduced to Krk, gambusia still abides in ponds across the island and it represents one of the main factors in the protection against potential revival of indigenous malaria.
Cilj : Cilj rada je prikazati prvi slučaj oftalmomijaze uzrokovane larvama Oestrus ovis u Primorsko-goranskoj županiji te osvijestiti zdravstvene djelatnike o infestaciji larvama kao mogućem ...uzročniku konjunktivitisa. Prikaz slučaja : U hitnu oftalmološku ambulantu upućena je pacijentica zbog osjećaja stranog tijela u oku. Oftalmološkim pregledom lijevo je utvrđena kemoza bulbarne spojnice uz prisutnost triju larvi. Nakon aplikacije lokalnog anestetika larve su uklonjene i poslane na mikrobiološku analizu. Mikroskopskim pregledom uočene su larve koje su prema morfologiji odgovarale larvama ovčjeg štrka stadija L1. Pacijentici su preporučene kortikosteroidne i antibiotske kapi i mast za oko te je na kontrolnom pregledu za tri dana došlo do potpune regresije simptoma. Zaključci : U Hrvatskoj su do sada u literaturi zabilježena samo dva slučaja humane estroze. Rana dijagnoza i liječenje važni su zbog sprječavanja mogućih komplikacija. Za ovo stanje ne postoji sistemska terapija, nego se provodi mehaničko odstranjivanje uzročnika uz lokalni antibiotik za sprječavanje bakterijske infekcije.
Aim : The objective of this case report is to present the first case of ophthalmomyiasis caused by Oestrus ovis larvae in the Primorje Goranska County, Croatia, and to raise awareness of healthcare professionals about larval infestation as a possible cause of conjunctivitis. Case report : A female patient was examined at the emergency ophthalmology clinic because of a foreign body sensation in her eye. Ophthalmological examination revealed chemosis of the left bulbar junction with the presence of three larvae. After the application of a local anesthetic, the larvae were removed and sent for microbiological analysis. In light microscopy, the morphology corresponded to the L1 stage larvae of sheep botfly. Corticosteroid, antibiotic drops and eye ointment were recommended to the patient, and at the follow-up examination three days later there was a complete regression of the symptoms. Conclusions : So far, only two cases of ophthalmomyiasis from Croatia have been reported. Early diagnosis and treatment are important to prevent complications. There is no systemic therapy for this condition, but mechanical removal of the causative agent is carried out with a local antibiotic to prevent bacterial infection.
Background
We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non‐alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, ...we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non‐significant or no liver fibrosis.
Methods
NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum.
Results
Patients with non‐alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07‐37.37), 2.50 (1.16‐5.37) and 27.6 (6.41‐119), respectively). The most commonly isolated were gram‐negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae.
Conclusion
In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well‐investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.
Tuberculosis is an airborne disease caused by Mycobacterium tuberculosis. In 15–20% cases of active disease extrapulmonary tuberculosis may occur, most commonly in the head and neck region. ...Tuberculous otitis media accounts for 0,1% of the total number of tuberculosis patients. This paper provides insight into current state of literature of tuberculous otitis media. It also includes the case of a 53-year-old patient with tuberculous otitis media. The patient had a liver transplantation and she showed an atypical manifestation of the disease including acute otitis media and coinfection with Achromobacter xylosoxidans. The paper describes in detail the methods of diagnosis and the infection treatment. Considering the polymorphic clinical presentation of tuberculous otitis media in cases with long lasting otorrhoea differential diagnosis should include an infection with Mycobacerium tuberculosis.
The Francisella tularensis-containing phagosome (FCP) matures to a late-endosome-like phagosome prior to bacterial escape into the cytosols of macrophages, where bacterial proliferation occurs. Our ...data show that within the first 15 min after infection of primary human monocyte-derived macrophages (hMDMs), ~90% of the FCPs acquire the proton vacuolar ATPase (vATPase) pump and the lysomotropic dye LysoTracker, which concentrates in acidic compartments, similar to phagosomes harboring the Listeria monocytogenes control. The acquired proton vATPase pump and lysomotropic dye are gradually lost by 30 to 60 min postinfection, which coincides with bacterial escape into the cytosols of hMDMs. Colocalization of phagosomes harboring the iglD mutant with the vATPase pump and the LysoTracker dye was also transient, and the loss of colocalization was faster than that observed for the wild-type strain, which is consistent with the faster escape of the iglD mutant into the macrophage cytosol. In contrast, colocalization of both makers with phagosomes harboring the iglC mutant was persistent, which is consistent with fusion to the lysosomes and failure of the iglC mutant to escape into the macrophage cytosol. We have utilized a fluorescence microscopy-based phagosome integrity assay for differential labeling of vacuolar versus cytosolic bacteria, using antibacterial antibodies loaded into the cytosols of live hMDMs. We show that specific inhibition of the proton vATPase pump by bafilomycin A1 (BFA) blocks rapid bacterial escape into the cytosols of hMDMs, but 30% to 50% of the bacteria escape into the cytosol by 6 to 12 h after BFA treatment. The effect of BFA on the blocking of bacterial escape into the cytosol is completely reversible, as the bacteria escape after removal of BFA. We also show that the limited fusion of the FCP to lysosomes is not due to failure to recruit the late-endosomal fusion regulator Rab7. Therefore, within few minutes of its biogenesis, the FCP transiently acquires the proton vATPase pump to acidify the phagosome, and this transient acidification is essential for subsequent bacterial escape into the macrophage cytosol.
Transplantirani i ostali urološki pacijenti imaju češće potrebu za uvođenjem ureteralnog stenta, odnosno urinarnih katetera, te su izloženi povećanom riziku za stjecanje infekcija mokraćnog sustava ...(IMS). To je najčešća infektivna komplikacija u primatelja alogeničnog grafta, glavni izvor pijelonefritisa, bakterijemije i sepse. Također, IMS su najzastupljenije infekcije povezane sa zdravstvenom skrbi, a glavni rizični čimbenik za njihov nastanak je upravo prisustvo katetera. Vodeći uzročnici ovih infekcija su E. coli, E. faecalis, vrste iz roda Klebsiella, Proteus i Pseudomonas koje često karakterizira i višestruka antimikrobna rezistencija, što dodatno ugrožava klinički ishod. Radi praćenja IMS-a povezanih s uporabom katetera svake se godine provodi jednodnevno presječno istraživanje kojim su obuhvaćeni svi pacijenti hospitalizirani taj dan. Rezultati pridonose sagledavanju problema, unaprjeđenju mjera prevencije, planiranju empirijske antimikrobne terapije, odnosno sigurnosti hospitaliziranih uroloških pacijenata.
Transplanted and other urological patients are more likely to need a ureteral stent, or urinary catheters, and are at increased risk of acquiring urinary tract infections (UTI). It is the most common infectious complication in the recipient of allogeneic graft, the main source of pyelonephritis, bacteremia and sepsis. Also, UTIs are the most common healthcare associated infections, and the main risk factor for their occurence is the use of urinary catheters. The leading agents of these infections are E. coli, E. faecalis, species of the genus Klebsiella, Proteus and Pseudomonas, often characterized by multiple antimicrobial resistance, further compromising clinical outcome. To monitor the catheter associated UTI, a one-day point-prevalence study is conducted every year, covering all patients hospitalized that day. The results contribute to the understanding of the problem, improvement of prevention measures, planning of empirical antimicrobial therapy, that is, the safety of hospitalized urological patients.
Biological therapy of inflammatory bowel disease (IBD) carries an increased risk for the development of opportunistic infections due to immunomodulation. The aim of this study was to determine the ...prevalence and types of oral infections in IBD patients treated with biological (anti-TNF-α and anti-integrin-α4β7) and conventional medication protocols. The study included 20 IBD patients receiving anti-TNF-α therapy, 20 IBD patients receiving anti-integrin-α4β7 therapy and 20 IBD patients without immunomodulatory therapy. Participants completed questionnaires on medical information, oral lesions and symptoms. For each patient, clinical examination and a salivary flow rate test were performed, followed by a swab of the oral mucosa. The swab samples were cultured to identify Candida spp. and oral bacteria. No bacterial opportunistic infections were detected. Candidiasis was detected in four participants, with no significant difference between groups (p = 0.765). Hyposalivation was most common in the anti-TNF-α group, with a significant difference between groups (p = 0.036). There were no significant differences between groups in self-reported oral mucosal lesions and symptoms (p > 0.05), or in the distribution of oral mucosal lesions (p > 0.05). This study suggests that IBD patients receiving biological therapy are at no greater risk of developing oral opportunistic infections than IBD patients not receiving immunomodulatory therapy.
Rezistencija na antimikrobne lijekove ugrožava kvalitetu medicinske skrbi u zajednici i bolničkom okruženju. Bakterijska rezistencija prisutna je od samog početka antibiotskog doba, ali je u ...proteklih dvadesetak godina poprimila zabrinjavajući trend porasta. Prirođena rezistencija je stalna, genetski zadana osobina nekog mikroorganizma. Stečena rezistencija nastaje neočekivano, u prethodno osjetljivoj bakteriji, mutacijom ili češće horizontalnim prijenosom gena putem plazmida. Rezistencija često nije u potpunosti genetski određena, već može biti heterogena unutar populacije, ovisna o okolišu, strukturi bakterijske populacije ili o fiziološkom stanju bakterijske stanice. Selekcijski pritisak antibiotika važan je čimbenik u odabiru i širenju rezistentnih bakterija. Pojava višestrukorezistentnih bakterija kao uzročnika bolesti posebno je alarmantna. Takvi mikroorganizmi se uobičajeno nazivaju „superbakterije“, ali ne zato što su virulentnije, nego zato jer zbog suženog izbora antibiotika konačni ishod liječenja takvih infekcija može biti neizvjestan i često nepovoljan. Stoga je cilj ovog preglednog članka prikazati saznanja o rezistenciji, mehanizmima bakterijske otpornosti prema antibioticima i onim višestrukorezistentnim bakterijama koje danas predstavljaju najveću prijetnju globalno i lokalno, a udružene su pod akronimom ESKAPE.
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