Phlebovirus infection in Greece: a case report.

BACKGROUND: Sandfly-transmitted phleboviruses cause to humans an asymptomatic or mild infection to severe meningitis or encephalitis. Phleovirus infections are common in the Mediterranean countries during the summertime when sandflies are active. It is estimated that several cases remain undiagnosed. DESCRIPTION OF CASE: In July 2013, a 45-year-old Greek male, was admitted to the General Hospital of Florina in northwestern Greece with two-day history of fever, myalgia, arthralgia, mild headache, and hemorrhagic exanthema. A serum sample obtained from the patient on the 6(th) day of illness was tested negative for West Nile virus infection. Instead, high titers of IgM and IgG antibodies against Toscana virus (TOSV) were detected, with low titers against sandfly fever Naples virus and no reactivity against sandfly fever Sicilian and Cyprus viruses, suggesting that the causative agent was TOSV or other phlebovirus with antigenic similarity to TOSV. CONCLUSION: Phleboviruses have to be included in the differential diagnosis of acute summer febrile cases, accompanied or not by neurological symptoms. Effort has to be paid to test clinical samples during the first days of the disease when the virus is detectable by molecular or isolation methods, in order to elucidate the complex epidemiology of phleboviruses in the Mediterranean area. Hippokratia 2015; 19 (2):189-191.

Acanthamoeba keratitis and contact lens disinfecting solutions.

OBJECTIVES: To report cases of culture-proved Acanthamoeba keratitis in Greece over a 10-year period and to evaluate the effectiveness of the commonly used commercial contact lens disinfecting systems in clinical cases of Acanthamoeba keratitis. MATERIAL AND METHODS: During the years 1994-2004, 45 contact lens wearers and 3 non-contact lens wearers presenting with symptoms and signs of keratitis underwent corneal sampling. The scrapings obtained were inoculated directly onto appropriate culture media for bacteria, fungi and Acanthamoeba. All proved positive for Acanthamoeba. The contact lenses and contact lens disinfecting solutions (16 one-step 3% hydrogen peroxide and 3 multipurpose solutions) of 19/45 patients with culture-proven Acanthamoeba keratitis were cultured for bacteria, fungi and Acanthamoeba. RESULTS: Acanthamoeba was isolated from contact lenses and contact lens disinfecting solutions in all 19 cases of Acanthamoeba keratitis studied. CONCLUSIONS: The main risk factor for corneal infection in contact lens wearers is the use of contact lens disinfecting systems ineffective at killing Acanthamoeba cysts and trophozoites, as well as bacteria and fungi. Improvement or development of new contact lens disinfecting systems by manufacturers is needed to prevent Acanthamoeba keratitis.

Colistin for Klebsiella pneumoniae-associated sepsis.

Klebsiella pneumoniae that was resistant to all available antibiotics (minimum inhibitory concentration of imipenem, 32 microg/mL), including carbapenems, was isolated from blood samples obtained from a 48-year-old patient in the intensive care unit. The patient developed septic shock, which was successfully treated with colistin, the only antibiotic with activity against this multidrug-resistant strain.

Fleroxacin in single dose oral therapy of uncomplicated lower urinary tract infection.

A randomized comparative study was performed in twenty women with acute uncomplicated lower urinary tract infection (UTI). They received a single oral dose of either fleroxacin 600 mg or amoxycillin 3 g. Pathogens were Escherichia coli (17), Proteus mirabilis (2) and Staphylococcus aureus (1). A complete clinical and microbiological cure was observed in all patients of both groups. One patient in the fleroxacin group had gastric irritation. A single oral dose of fleroxacin may be suitable for the treatment of lower UTI even when it is due to organisms resistant to amoxycillin and other traditional oral antimicrobials.

Staphylococcal infections in hospital: the Greek experience.

Resistance rates of various species to many antimicrobials are very high in Greece. Mean resistance rates of Staphylococcus aureus isolated in 12 Athens hospitals in the second half of 1986 were 80% for penicillin, 32% for methicillin, 22% for gentamicin, 27% for erythromycin, 17% for lincomycin and 16% for co-trimoxazole. In a prospective study in the General Hospital of Athens from May to July 1987, 40 coagulase-positive staphylococcal strains were isolated from various materials from inpatients. Of these 78% were resistant to penicillin, 50% to methicillin at 37 degrees C, 62% to methicillin at 30 degrees C, 38% to erythromycin, 32% to tobramycin, 15% to clindamycin, 15% to fusidic acid, 9% to amikacin, 5% to netilmicin and 0% to vancomycin. Ten of these strains (seven methicillin-resistant) were responsible for severe infections and three of the affected patients died (two nosocomial pneumonias, one infected burn, all due to methicillin-resistant strains). Another 11 strains (eight methicillin-resistant) were responsible for mild infections. From 41 coagulase-negative staphylococci isolated from inpatients, seven (five methicillin-resistant) were held responsible for mild infections. Of the 20 patients with infections due to methicillin-resistant strains, nine had previously received a beta- lactam antibiotic. Staphylococci are not responsible, however, for a large proportion of infections in our hospital at the moment. High resistance rates in Greece are due to overuse of antibiotics, a phenomenon attributed to a consumer's society behaviour of doctors and patients.

Brucellosis in two thalassaemic patients infected by blood transfusions from the same donor.

Brucellosis was diagnosed in two polytransfused, thalassaemic patients who had received blood containing brucella agglutinins from an asymptomatic donor. In one of the patients the onset of the disease simulated infectious mononucleosis. Despite the fact that both cases were splenetomized, the course of illness was not life threatening. However, a tendency for recurrence of the infection and persistence of high brucella agglutinin titres were noted.