Fatal human anaplasmosis associated with macrophage activation syndrome in Greece and the Public Health response.

Human granulocytic anaplasmosis (HGA) is a tick-borne disease caused by Anaplasma phagocytophilum that has the potential to spread in new geographical areas. The first fatal case of HGA in Greece is presented. Fever of unknown origin, renal and respiratory insufficiency and development of macrophage activation syndrome characterized the clinical presentation. Amplification and sequencing of a fragment of the groEL gene revealed the presence of A. phagocytophilum. The epidemiological and clinical features were collected during an epidemiological investigation. Public health measures were instituted by the Hellenic Centre for Disease Control and Prevention. The Public Health intervention required the collaboration of epidemiologists, veterinarians and microbiologists. Emphasis was given to communication activities and misconceptions concerning canines and their role in the disease. The emergence of human anaplasmosis in a new geographical area highlights the importance of disease awareness and of the need for continued support for tick and tick-borne disease surveillance networks.

Migrant screening: Lessons learned from the migrant holding level at the Greek-Turkish borders.

In March 2011, a migrant health project became operational that aimed to provide medical and psychosocial support to migrants at the Greek-Turkish border. The aim of this study is to describe common syndromes, the communicable disease profile and vaccination patterns in newly arrived migrants through a surveillance system that was based on medical records data as well as screening procedures. Data were collected prospectively using one standardized form per patient including demographic information, civil status, and medical and vaccination history. A tuberculin screening test (TST) and serological testing for HIV, hepatitis B and hepatitis C were performed after obtaining informed consent. A total of 6899 migrants were screened, the majority of whom were male (91%) and 18-31 years old (85%), with a mean age of 25.3 years. Of all patients, 2.5% received secondary care. Common complaints and diagnoses included respiratory infections (23%) and myalgia (18%). The tuberculin screening test (TST) was positive in 7.8% out of 1132 patients tested. Out of 632 migrants, 0.3%, 3.2% and 0.8% tested positive for HIV, hepatitis B and hepatitis C, respectively. Overall, 22.3% of adults were vaccinated against poliomyelitis. Irregular migrants that enter Greek borders are generally in good health. Nevertheless, the risk of spreading communicable diseases is an important issue to consider among migrants at the holding level due to severe overcrowding conditions. Therefore, there is a need to strengthen surveillance and implement harmonized screening procedures with the aim of providing sustainable and good quality services that are focused on prevention and early treatment.

MLST typing of antimicrobial-resistant Propionibacterium acnes isolates from patients with moderate to severe acne vulgaris.

Molecular typing data on antimicrobial-resistant Propionibacterium strains are limited in the literature. We examined antimicrobial resistance profiles and the underlying resistance mechanisms in Propionibacterium spp. isolates recovered from patients with moderate to severe acne vulgaris in Greece. The clonallity of the resistant Propionibacterium acnes isolates was also investigated. Propionibacterium spp. isolates were detected using Tryptone-Yeast Extract-Glucose (TYG) agar plates supplemented with 4% furazolidone. Erythromycin, clindamycin, vancomycin, penicillin, co-trimoxazole, doxycycline, minocycline and ciprofloxacin MICs were determined using the gradient strip method. Erythromycin, clindamycin and tetracycline mechanisms of resistance were determined using PCR and sequencing of the domain V of 23S rRNA and 16S rRNA, as well as the presence of the ermX gene. Typing was performed using the multi locus sequence typing (MLST) methodology. Seventy nine isolates from 76 patients were collected. Twenty-three isolates (29.1%) exhibited resistance to erythromycin and clindamycin, while two additional isolates (2.5%) were resistant only to erythromycin. Resistance to tetracycline was not detected. The underlying molecular mechanisms were point mutations A2059G and A2058G. MLST typing of the P. acnes resistant isolates revealed that lineage type IA1 (ST-1, 3 and 52) prevailed (12/18; 66.7%), whilst lineage type IA2 (ST-2 and 22) accounted for five more isolates (27.8%). Susceptible isolates were more evenly distributed between ST types. Propionibacterium spp. from moderate to severe acne vulgaris in Greece are frequently resistant to erythromycin/clindamycin but not to tetracyclines, mainly due to the point mutations A2059G and A2058G. P. acnes resistant isolates were more clonally related than susceptible ones and belonged to a limited number of MLST types.

Coexistence of a colon carcinoma with two distinct renal cell carcinomas: a case report.

INTRODUCTION: We present the case of a patient with two tumors in his left kidney and a synchronous colon cancer. While coexisting tumors have been previously described in the same kidney or the kidney and other organs, or the colon and other organs, to the best of our knowledge no such concurrency of three primary tumors has been reported in the literature to date. CASE PRESENTATION: A 72-year-old man of Greek nationality presenting with pain in the right hypochondrium underwent a series of examinations that revealed gallstones, a tumor in the hepatic flexure of the colon and an additional tumor in the upper pole of the left kidney. He was subjected to a right hemicolectomy, left nephrectomy and cholecystectomy, and his postoperative course was uneventful. Histopathology examinations showed a mucinous colon adenocarcinoma, plus two tumors in the left kidney, a papillary renal cell carcinoma and a chromophobe renal cell carcinoma. CONCLUSION: This case underlines the need to routinely scan patients pre-operatively in order to exclude coexisting tumors, especially asymptomatic renal tumors in patients with colorectal cancer, and additionally to screen concurrent tumors genetically in order to detect putative common genetic alterations.