Gut Microbiota Crosstalk with Resident Macrophages and Their Role in Invasive Amebic Colitis and Giardiasis-Review.

The innate immune response is highly dependent on the action of macrophages. They are abundant in the intestine subepithelial lamina propria of the mucosa, where they deploy multiple tasks and play a critical role. The balance between the gut microbiota and M2 macrophages is critical for gut health and homeostasis. Gut microbiota has the power to change macrophage phenotype and replenish the resident macrophage niche during and post infection. As far as the extracellular enteric parasitic infections invasive amebic colitis and giardiasis are concerned, a change of macrophages phenotype to a pro-inflammatory state is dependent on direct contact of the protozoan parasites with host cells. Macrophages induce strong pro-inflammatory response by inflammasome activation and secretion of interleukin IL-1ß. Inflammasomes play a key role in the response to cellular stress and microbe attacks. The balance between gut mucosal homeostasis and infection is dependent on the crosstalk between microbiota and resident macrophages. Parasitic infections involve NLRP1 and NLRP3 inflammasome activation. For Entamoeba histolytica and Giardia duodenalis infections, inflammasome NLRP3 activation is crucial to promote the host defenses. More studies are needed to further elucidate possible therapeutic and protective strategies against these protozoan enteric parasites' invasive infections in humans.

Cold-Water Immersion and Sports Massage Can Improve Pain Sensation but Not Functionality in Athletes with Delayed Onset Muscle Soreness.

This study aimed to investigate the effects of cold-water immersion (CWI) and sports massage on delayed-onset muscle soreness (DOMS) in amateur athletes. Sixty male amateur athletes were randomised into four equal groups (n = 15) receiving either CWI, sports massage, their combination, or served as controls after applying plyometric training to their lower extremities. The main outcomes measures were pain, exertion, rectus femoris perimeter, knee flexion range of motion, knee extensors isometric strength and serum creatine phosphokinase (CPK) levels examined before the plyometric training, immediately after the treatment, and 24, 48 and 72 h post exercise. We observed no significant differences between study groups in the most tested variables. CWI improved pain compared to the combined application of CWI and sports massage, and the control group both on the second and third day post exercise. Sports massage combined with CWI also led to a significant reduction in pain sensation compared to the control group. In conclusion the treatment interventions used were effective in reducing pain but were unable to affect other important adaptations of DOMS. Based on the above, sports scientists should reconsider the wide use of these interventions as a recovery strategy for athletes with DOMS.

Bacillus simplex as the Most Probable Culprit of Penetrating Trauma Infection: A Case Report.

Bacillus simplex is an environmental microorganism found in soil. Herein, we present the case of a 69-year-old Greek male patient who attended the Emergency Department at our hospital. The patient complained of lower right extremity swelling and pain, after suffering penetrating trauma whilst doing farm work in a rural area. Swab aerobic cultures revealed Bacillus simplex as identified by MALDI-TOF Mass Spectrometry. The strain was susceptible to vancomycin, imipenem, clindamycin, and ciprofloxacin. Our patient refused hospitalization; therefore, both ciprofloxacin and clindamycin were registered for a total of 19 days. No complications were experienced, and he recovered fully. In our case, the thorough cleaning of the ulcer bed prior to sample collection, the fact that it was the only microorganism isolated, and the wound's aggravating mechanism led the authors of the present study to the conclusion that B. simplex was the most probable culprit of the infection. To our knowledge, this is the second probable case of B. simplex infection described worldwide, and the first in Greece.

Adrenal gland injury after blunt abdominal trauma: Two case series and review of the literature.

INTRODUCTION: Adrenal gland injury (AGI) is a rare form of trauma that is often misdiagnosed, especially if isolated. PRESENTATION OF CASE: Herein we describe two rare cases of adrenal hematoma (AH) and adrenal contusion due to blunt abdominal trauma. A 33-year-old Caucasian male who was transported to the emergency department after a low-speed motorbike accident and a 69-year old Caucasian female who fell from 50 cm height. Both where complaining of intense pain in the right flank. Neither were under anti-coagulant or anti-platelet therapy. In both patients thoracoabdominal CE-CT revealed the injury. DISCUSSION: AGI is an uncommon finding in blunt trauma and isolated adrenal injuries usually result from low force accidents. Treatment is most commonly conservative, but depends on patient's status. In Greece, to our knowledge, these are the first such cases reported in adults. CONCLUSION: Diagnosis needs high level of clinical suspicion.

Post-traumatic rupture of the right ovary and liver after blunt abdominal trauma: A case report.

INTRODUCTION: Traumatic rupture of the ovary, due to blunt abdominal trauma, is rarely described in literature and is usually related to ovarian cyst or teratoma. PRESENTATION OF CASE: A 21-year-old Greek, female patient was transported to the Emergency Department complaining of abdominal pain as a result of a catapulting fall from a bicycle. It was determined that both right ovary and liver rupture had occurred. The patient was treated with rinsing of the peritoneal cavity, subhepatic packing and right ovary hemostasis. DISCUSSION: Traumatic rupture of the ovary, due to blunt abdominal trauma, is very rare and is usually connected to former ovarian cyst or teratoma. This is the first such ever documented case in Greece. CONCLUSION: Although rare, injury of the ovary following blunt abdominal trauma, should always be included in the differential diagnosis of acute abdomen in female patients.

Pyogenic Spondylodiscitis due to Streptococcus constellatus in an Immunocompromised Male Patient: A Case Report and Review of the Literature.

Pyogenic spondylodiscitis is a primary infection of the intervertebral disc and is a rare entity. Here, we describe the case of a 64-year-old male patient, a professional breeder, who attended the Emergency Department with sciatica and back pain that was worsening for a week. The patient had no history of surgery or trauma. The patient had poor oral hygiene. Magnetic resonance imaging (MRI) scan showed lumbar spondylodiscitis, and blood cultures revealed Streptococcus constellatus. The patient was initially treated with vancomycin but due to renal failure deterioration, the treatment was changed to daptomycin for 8 weeks. During hospitalization, he endured renal injury and nosocomial respiratory tract infection. The patient was discharged with no further complications. Follow-up revealed improvement of neurological signs. In our case, it seems that poor oral hygiene was the cause of bacteremia, which underlies the importance of a good oral health status in immunocompromised patients not only to prevent but also to successfully eliminate any dental source of infection. S. constellatus is an extremely rare pathogen and to our knowledge only two other cases of pyogenic spondylodiscitis are reported in the literature. Early diagnosis is very important for the prognosis of these patients.

A Case of Serratia marcescens Endocarditis in a Nonintravenous Drug-Using Male Patient and Review of Literature.

INTRODUCTION: Serratia marcescens is a rare cause of infective endocarditis and has almost exclusively been associated with intravenous drug use and hospital-acquired infections. Here, we present a case of infective endocarditis caused by Serratia marcescens in an otherwise healthy, nonintravenous drug-using male patient. CASE REPORT: A 41-year-old man presented with hypertension and hemoptysis. Blood cultures were obtained that showed bacteremia by Serratia marcescens. An echocardiogram was carried out that revealed severe mitral regurgitation accompanying ruptured mitral chordae tendineae. The patient received the appropriate antibiotic treatment, without further surgical intervention. DISCUSSION: Hospital-acquired infections by Serratia species are a common problem in medical practice and have been attributed to specialized interventional procedures. Taking into consideration the patient's immunocompetence and lack of intravenous drug use, it is possible that bacteremia could be attributed to a medical procedure. Moreover, in contrast to most cases described in the literature, no surgery was performed.

Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non-albicans in a 9-year period (2009-2017) in a university Greek hospital.

PURPOSE: The aim of the present study was to analyze candidaemia's epidemiology (incidence, species distribution, and susceptibility rates) and antifungal consumption during a 9-year period. METHODS: All candidaemias recorded at The University General Hospital of Patras, Greece, between 2009 and 2017 were included. Candida isolates were identified using the germ tube test, API 20C AUX System, and/or Vitek-2 YST card. Antifungal susceptibility was determined by the gradient method according to CLSI. RESULTS: During the study period, 505 episodes of candidaemia were observed with an overall incidence of 1.5 episodes per 1000 hospital admissions (1.1 episodes in 2009 to 1.9 in 2017: P 0.038, r 0.694). C. albicans was the leading cause (200 cases; 39.6%), followed by C. parapsilosis (185; 36.6%), C. glabrata (56; 11.1%), C. tropicalis (50; 9.9%), C. krusei (8; 0.2%), C. lusitaniae (5; < 0.1%), and C. guilliermondii (1; < 0.1%). Overall resistance to fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin (according to CLSI) were 11.6%, 4.1%, 2.0%, 6.0%, and 0.8%, respectively. The overall consumption of antifungal drugs was stable, with a significant reduction of fluconazole's use in favor of echinocandins. CONCLUSIONS: An increase in the incidence of candidaemia and a predominance of Candida non-albicans due to decreasing use of fluconazole in favor of more potent antifungals, such as echinocandins, are reported in this study.

Spontaneous cerebral abscess due to Bacillus subtilis in an immunocompetent male patient: A case report and review of literature.

BACKGROUND: Bacillus subtilis (B. subtilis) is considered a non-pathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have been reported, mainly in the form of pyogenic meningitis, usually in cases of direct inoculation by trauma or iatrogenically. CASE SUMMARY: A 51-year-old man, with a free previous medical history, presented to the Emergency Department of our hospital complaining of recurrent episodes of left upper limb weakness, during the last month, which had been worsened the last 48 h. During his presentation in Emergency Department he experienced a generalized tonic-clonic grand mal seizure. Brain magnetic resonance imaging (MRI) scan with intravenous Gadolinium revealed a 3.3 cm × 2.7 cm lesion at the right parietal lobe surrounded by mild vasogenic edema, which included the posterior central gyrus. The core of the lesion showed relatively homogenous restricted diffusion. Post Gadolinium T1W1 image, revealed a ring-shaped enhancement. Due to the imaging findings, brain abscess was our primary consideration. Detailed examination for clinical signs of infectious foci revealed only poor oral hygiene with severe tooth decay and periodontal disease, but without detection of dental abscess. The patient underwent surgical treatment with right parietal craniotomy and total excision of the lesion. Pus and capsule tissue grew B. subtilis and according to antibiogram intravenous ceftriaxone 2 g bids was administered for 4 wk. The patient remained asymptomatic and follow-up MRI scan two months after operation showed complete removal of the abscess. CONCLUSION: This case highlights the ultimate importance of appropriate oral hygiene and dental care to avoid potentially serious infectious complications and second, B. subtilis should not be considered merely as laboratory contaminant especially when cultivated by appropriate central nervous system specimen.

Pleural empyema due to Salmonella enterica serovar Enteritidis in an immunocompetent elderly patient: a case report.

INTRODUCTION: Pleural empyema as a focal infection due to Salmonella enterica serovar Enteritidis is rare and most commonly described among immunosuppressed patients or patients who suffer from sickle cell anaemia and lung malignancies. CASE PRESENTATION: Here, we present an 81-year-old immunocompetent Greek woman with bacteraemia and pleural empyema due to Salmonella Enteritidis without any gastrointestinal symptoms. CONCLUSION: In our case, we suggest that patient's pleural effusion secondary to heart failure was complicated by empyema and that focal intravascular infection was the cause of bacteraemia.

Synergistic regulation of Pseudomonas aeruginosa-induced cytokine production in human monocytes by mannose receptor and TLR2.

The immune response to pathogen is regulated by a combination of specific PRR, which are involved in pathogen recognition. Pseudomonas aeruginosa, a bacterium that causes life-threatening disease in immuno-compromised host, is recognized by distinct members of the TLR family. We have previously shown that viable P. aeruginosa bacteria are recognized by human monocytes mainly through TLR2. Using ligand-specific blocking antibodies, we herein show that the mannose receptor (MR), a phagocytic receptor for unopsonized P. aeruginosa bacteria, contributes equally to TLR2 in proinflammatory cytokine production by human monocytes in response to P. aeruginosa infection. Synergy of both receptors totally controls the immune response. Viable P. aeruginosa bacteria activate NF-kappaB and MAPK pathways and enhance TLR2-mediated signaling in MR-transfected human embryonic kidney 293 cells. Moreover, MR follows the same kinetics and colocalizes with TLR2 in the endosome during in vivo infection of human macrophages with P. aeruginosa. The studies provide the first demonstration of a significant role for MR, synergistic with TLR2, in activating a proinflammatory response to P. aeruginosa infection.