Leishmania donovani Transmission Cycle Associated with Human Infection, Phlebotomus alexandri Sand Flies, and Hare Blood Meals, Israel1.

Cutaneous leishmaniasis caused by Leishmania major or L. tropica and visceral leishmaniasis caused by L. infantum have been reported in Israel. We collected Phlebotomus spp. sand flies in the Negev desert of southern Israel to identify circulating Leishmania spp. Of 22,636 trapped sand flies, 80% were P. alexandri. We sequenced Leishmania-specific internal transcribed spacer 1 fragments and K26 genes. Of 5,019 Phlebotomus female sand flies, 2.5% were Leishmania DNA-positive; 92% of infections were L. donovani. Phylogenetic analyses showed separate clustering of L. donovani and L. infantum. P. alexandri flies positive for L. donovani harbored blood meals from European hares. Leishmania DNA isolated from a patient with cutaneous leishmaniasis who lived in the survey area was identical to L. donovani from P. alexandri flies. We report circulation of L. donovani, a cause of visceral leishmaniasis, in southern Israel. Prompt diagnosis and Leishmania spp. identification are critical to prevent leishmaniasis progression.

Anti-Leishmania major Properties of Nuphar lutea (Yellow Water Lily) Leaf Extracts and Purified 6,6' Dihydroxythiobinupharidine (DTBN).

Cutaneous leishmaniasis (CL) is a zoonotic disease, manifested as chronic ulcers, potentially leaving unattractive scars. There is no preventive vaccination or optimal medication against leishmaniasis. Chemotherapy generally depends upon a small group of compounds, each with its own efficacy, toxicity, and rate of drug resistance. To date, no standardized, simple, safe, and highly effective regimen for treating CL exists. Therefore, there is an urgent need to develop new optimal medication for this disease. Sesquiterpen thio-alkaloids constitute a group of plant secondary metabolites that bear great potential for medicinal uses. The nupharidines found in Nuphar lutea belong to this group of compounds. We have previously published that Nuphar lutea semi-purified extract containing major components of nupharidines has strong anti-leishmanial activity in vitro. Here, we present in vivo data on the therapeutic benefit of the extract against Leishmania major (L. major) in infected mice. We also expanded these observations by establishing the therapeutic effect of the extract-purified nupharidine 6,6'-dihydroxythiobinupharidine (DTBN) in vitro against promastigotes and intracellular amastigotes as well as in vivo in L. major-infected mice. The results suggest that this novel anti-parasitic small molecule has the potential to be further developed against Leishmania.

[Prevalence of sexually transmitted diseases (STD) in HIV positive women in southern Israel].

BACKGROUND: Co-infection of HIV and other sexualLy transmitted diseases (STDs) is common. The Centers for Disease Control and Prevention (CDC) recommends routine yearly screening for STDs in HIV carriers. There is only scarce data on the prevalence of STD in HIV positive individuals in Israel and no current recommendations on this issue are available. OBJECTIVES: To evaluate the prevalence of STDs, in HIV positive females attending the HIV Clinic at the Soroka University Medical Center in Beer Sheva and to compare prevalence and risk factors for STDs between HIV female carriers of Ethiopian and non-Ethiopian origin. METHODS: Eighty five HIV-positive women were enrolled in the study. Demographic data and sexual behavior were obtained and medical records were reviewed. Cervical swabs for Neisseria gonorrhoeae, Herpes simplex 1 and 2, Ureaplasma urealyticum and Mycoplasma hominis and serum samples for hepatitis B, C and syphilis were obtained. RESULTS: Thirty two of the study participants (37.6%) had at least one STD and in eleven cases (12.9%) two or more STDs were found. Ureaplasma urealyticum was the most frequent pathogen (29.4%). Prevalence for Mycoplasma hominis, HSV1 and 2, Neisseria gonorrhoeae, syphilis and HBV was low. Despite significant differences in sexual behavior between women of Ethiopian and non-Ethiopian origin there were no differences in the prevalence of STDs in the two groups. HCV was significantly more prevalent in women of non-Ethiopian origin, due to high use of intravenous drugs in this group. There was no correlation between CD4 levels and the prevalence of STDs in both groups. DISCUSSION AND CONCLUSION: A relatively low prevalence of STDs among female HIV carriers was found, despite low condom use. The exclusion of males in this study may have contributed to this. The most frequent pathogen found in this study was asymptomatic Ureaplasma urealyticum (29.4%). As this pathogen may cause premature delivery and fetal death it seems important to routinely screen HIV-positive fertile women for its presence. A nationwide multicenter study of HIV-positive females and males is needed in order to establish the prevalence of STDs in this population in Israel and to recommend a screening policy.

Challenging diagnosis of Mycolicibacterium cosmeticum/canariasense infection: A case report and literature review.

We present the case of an immunocompromised child with Mycolicibacterium cosmeticum/ canariasense infection. Our case highlights the difficulty in adequate speciation. Most isolates described in the literature were identified using 16 s-rRNA PCR, which if performed on our sample would at best be inconclusive. Misidentifications could have a real impact on the body of evidence collected on these isolates thus far.

Comorbidities and Risk Factors of Patients Diagnosed with CRC after Positive Fecal Test in Real Life.

(1) Background: Fecal occult blood test (FOBT) is the modality of choice in most countries for colorectal cancer (CRC) screening. We aimed to investigate the risk factors for CRC among patients with a positive FOBT in real life. (2) Methods: This was a retrospective study that included patients who tested positive for FOBT. Data regarding the comorbidities and laboratories were collected and compared between CRC and non-CRC groups. (3) Results: Positive FOBT was found among 45,500 (5.36%) subjects and CRC was found in 1502 (3.3%). CRC patients were older, age 62.7 ± 7.15 years compared with 59.33 ± 7.3 years (p < 0.001), and had significantly higher rates of hypertension (48.4% vs. 44.7%, p = 0.002), iron-deficiency anemia (20.6% vs. 16.4, p < 0.001), family history of CRC (7.3% vs. 5.1%, p < 0.001), and previous CRC (6.5% vs. 0.3%, p < 0.001). Lower levels of hemoglobin, iron, and ferritin were found in the CRC group. Age, family history of CRC, and previous CRC were found to be significant risk factors for diagnosis of CRC after positive FOBT with OR of 1.057, 1.4, and 15.9, respectively. (4) Conclusions: Iron-deficiency anemia, family history of CRC, previous colorectal cancer, and low hemoglobin, iron, and ferritin levels should direct physicians to give high priority to colonoscopy scheduling.

Genomic Characterization of Antimicrobial Resistance, Virulence, and Phylogeny of the Genus Ochrobactrum.

Ochrobactrum is a ubiquitous Gram-negative microorganism, mostly found in the environment, which can cause opportunistic infections in humans. It is almost uniformly resistant to penicillins and cephalosporins through an AmpC-like ß-lactamase enzyme class (OCH). We studied 130 assembled genomes, of which 5 were animal-derived isolates recovered in Israel, and 125 publicly available genomes. Our analysis focused on antimicrobial resistance (AMR) genes, virulence genes, and whole-genome phylogeny. We found that 76% of Ochrobactrum genomes harbored a blaOCH ß-lactamase gene variant, while 7% harbored another AmpC-like gene. No virulence genes other than lipopolysaccharide-associated genes were found. Core genome multilocus sequence typing clustered most samples to known species, but neither geographical clustering nor isolation source clustering were evident. When analyzing the distribution of different blaOCH variants as well as of the blaOCH-deficient samples, a clear phylogenomic clustering was apparent for specific species. The current analysis of the largest collection to date of Ochrobactrum genomes sheds light on the resistome, virulome, phylogeny, and species classification of this increasingly reported human pathogen. Our findings also suggest that Ochrobactrum deserves further characterization to underpin its evolution, taxonomy, and antimicrobial resistance.