Emergence of a pandrug-resistant VIM-1-producing Providencia stuartii clonal strain causing an outbreak in a Greek intensive care unit.

Here we describe an outbreak caused by a pandrug-resistant Providencia stuartii strain involving 15 critically ill patients in a Greek intensive care unit (ICU) during September-November 2011. All isolates harboured the blaVIM-1 gene and a class 1 integron structure of 1913 bp as well as blaSHV-5 and blaTEM-1. Pulsed-field gel electrophoresis (PFGE) demonstrated that isolates from all 15 patients belonged to a single P. stuartii clonal type. As all of the infected patients were hospitalised during overlapping time periods, horizontal intra-ICU transmission was considered as the main route for the dissemination of the outbreak strain. The outbreak ended following reinforcement of infection control measures, including implementation of additional barrier precautions for infected patients.

Visceral leishmaniasis with endobronchial involvement in an immunocompetent adult.

Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement.

Syphilitic periostitis of the skull and ribs in a HIV positive patient.

We report the case of a HIV and syphilis co-infected patient who presented with headache and rash and was found to have syphilitic periostitis. Our case illustrates a rare manifestation of early syphilis and presents the diagnostic dilemmas that can arise in HIV and syphilis co-infected patients.

Activation and coagulation biomarkers are independent predictors of the development of opportunistic disease in patients with HIV infection.

BACKGROUND: Activation and coagulation biomarkers were measured within the Strategies for Management of Antiretroviral Therapy (SMART) trial. Their associations with opportunistic disease (OD) in human immunodeficiency virus (HIV)-positive patients were examined. METHODS: Inflammatory (high-sensitivity C-reactive protein [hsCRP], interleukin-6 [IL-6], amyloid-A, and amyloid-P) and coagulation (D-dimer and prothrombin-fragment 1+2) markers were determined. Conditional logistic regression analyses were used to assess associations between these biomarkers and risk of OD. RESULTS: The 91 patients who developed an OD were matched to 182 control subjects. Patients with an hsCRP level > or =5 microg/mL at baseline had a 3.5 higher odds of OD (95% confidence interval [CI], 1.5-8.1) than did those with an hsCRP level <1 microg/mL (P=.003, by test for trend) and patients with an IL-6 level > or =3 pg/mL at baseline had a 2.4 higher odds of OD (95% CI, 1.0-5.4) than did those with an IL-6 level <1.5 pg/mL (P=.02, by test for trend). No other baseline biomarkers predicted development of an OD. Latest follow-up hsCRP level for those with an hsCRP level > or =5 microg/mL (compared with a level <1 microg/mL; odds ratio [OR], 7.6; 95% CI, 2.0-28.5; [P=.002, by test for trend), latest amyloid-A level for those with an amyloid-A level > or =6 mg/L (compared with a level <2 mg/L; OR, 3.8; 95% CI, 1.1-13.4; P=.03, by test for trend), and latest IL-6 level for those with an IL-6 level > or =3 pg/mL (compared with a level <1.5 pg/mL; OR 2.4; 95% CI, 0.7-8.8; P=.04, by test for trend) were also associated with development of an OD. CONCLUSIONS: Higher IL-6 and hsCRP levels independently predicted development of OD. These biomarkers could provide additional prognostic information for predicting the risk of OD.

Red blood cell deformability in patients with sepsis: a marker for prognosis and monitoring of severity.

Sepsis in different states of severity (sepsis, severe sepsis, septic shock and adult respiratory distress syndrome (ARDS)) is associated with microcirculatory blood flow abnormalities leading to decreased red blood cell's (RBC's) deformability, impaired oxygen delivery to tissues and organs failure. The main goal of the present study, was to first determine the values of RBC's deformability, in the course of patients treated in an Intensive Care Unit (ICU) for basically sepsis and then deteriorated states and secondly to establish the prognostic efficiency of the test. For this purpose a filtration method and the hemorheometer, was used to determine experimentally the RBC's deformability, by measuring the RBC's Index of Rigidity (IR). Our results indicated that the IR was significantly increased in all patient groups and it was found to be approximately 51% higher in patients with sepsis, 229% in patients with severe sepsis, 1285% in patients with septic shock and 923% in patients with ARDS than in the healthy donors. The relationships between IR and Simplified Acute Physiology Score II (SAPS) and IR and Projected Mortality (PM) were found to be IR = 2.0237(SAPS) - 58.807 (r=0.731) and IR = 1.0671(PM) - 5.9829 (r=0.726) respectively. Our findings imply a significant impairment of the membrane's deformability possibly due to changes in its structure. It seems that the RBC's deformability is a useful mechanical parameter to estimate the prognosis and monitor patients suffering from different severity levels of sepsis.

Patterns of antibiotic use among adults and parents in the community: a questionnaire-based survey in a Greek urban population.

The purpose of this study was to look for factors that affect attitudes to antibiotic use in Greek urban settings. By using a questionnaire-based survey, we conducted 323 face-to-face interviews (173 adults, 150 carers of children). In the adult group, 74.6% admitted using non-prescribed antibiotics, while only 22.7% of parents had administered non-prescribed antibiotics to their children. Around 50% of adults discontinued therapy earlier, more than 10% did not follow the correct dosage instructions and about 55% admitted using leftover antibiotics. Of the parents, 18.7% discontinued therapy earlier and 7.3% admitted keeping leftover antibiotics. Our results showed that adults were likely to show unsatisfactory compliance and to use non-prescribed antibiotics, while parents were less likely to use non-prescribed antibiotics for their children and were more compliant.