Absence of Oral Opportunistic Infections in Patients with Inflammatory Bowel Disease Receiving Anti-TNF-α and Anti-Integrin-α4ß7 Therapy.

Biological therapy of inflammatory bowel disease (IBD) carries an increased risk for the development of opportunistic infections due to immunomodulation. The aim of this study was to determine the prevalence and types of oral infections in IBD patients treated with biological (anti-TNF-α and anti-integrin-α4ß7) and conventional medication protocols. The study included 20 IBD patients receiving anti-TNF-α therapy, 20 IBD patients receiving anti-integrin-α4ß7 therapy and 20 IBD patients without immunomodulatory therapy. Participants completed questionnaires on medical information, oral lesions and symptoms. For each patient, clinical examination and a salivary flow rate test were performed, followed by a swab of the oral mucosa. The swab samples were cultured to identify Candida spp. and oral bacteria. No bacterial opportunistic infections were detected. Candidiasis was detected in four participants, with no significant difference between groups (p = 0.765). Hyposalivation was most common in the anti-TNF-α group, with a significant difference between groups (p = 0.036). There were no significant differences between groups in self-reported oral mucosal lesions and symptoms (p > 0.05), or in the distribution of oral mucosal lesions (p > 0.05). This study suggests that IBD patients receiving biological therapy are at no greater risk of developing oral opportunistic infections than IBD patients not receiving immunomodulatory therapy.

Small intestinal bacterial overgrowth and non-alcoholic fatty liver disease diagnosed by transient elastography and liver biopsy.

BACKGROUND: We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in non-alcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared with patients with non-significant or no liver fibrosis. METHODS: NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum. RESULTS: Patients with non-alcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (P < .05). According to histological characteristics, there was a higher proportion of patients in the SIBO group with higher steatosis and fibrosis grade, lobular and portal inflammation, and ballooning grade (P < .001). In multivariate analysis, significant predictors associated with SF and NASH were type 2 diabetes mellitus (T2DM) and SIBO. Moreover, in multivariate analysis, significant predictors that were independently associated with SIBO were T2DM, fibrosis stage and ballooning grade (OR 8.80 (2.07-37.37), 2.50 (1.16-5.37) and 27.6 (6.41-119), respectively). The most commonly isolated were gram-negative bacteria, predominantly Escherichia coli and Klebsiella pneumoniae. CONCLUSION: In this relatively large population of patients, we used a gold standard for both SIBO (quantitative culture of duodenum's descending part aspirate) and NAFLD (LB), and we demonstrated that NASH patients and those with SF had a higher incidence of SIBO. Moreover, significant predictors independently associated with SIBO were T2DM, fibrosis stage and ballooning grade. Although TE is a well-investigated method for steatosis and fibrosis detection, in our study, independent predictors of SIBO were histological characteristics of NAFLD, while elastographic parameters did not reach statistical significance.

Middle east tuberculosis in an immunocompromised patient: Case report and review of the literature.

Tuberculosis is an airborne disease caused by Mycobacterium tuberculosis. In 15-20% cases of active disease extrapulmonary tuberculosis may occur, most commonly in the head and neck region. Tuberculous otitis media accounts for 0,1% of the total number of tuberculosis patients. This paper provides insight into current state of literature of tuberculous otitis media. It also includes the case of a 53-year-old patient with tuberculous otitis media. The patient had a liver transplantation and she showed an atypical manifestation of the disease including acute otitis media and coinfection with Achromobacter xylosoxidans. The paper describes in detail the methods of diagnosis and the infection treatment. Considering the polymorphic clinical presentation of tuberculous otitis media in cases with long lasting otorrhoea differential diagnosis should include an infection with Mycobacerium tuberculosis.

Mechanisms of Carbapenem Resistance in Multidrug-Resistant Clinical Isolates of Pseudomonas aeruginosa from a Croatian Hospital.

Pseudomonas aeruginosa is an opportunistic pathogen, one of the leading causes of nosocomial infections such as pneumonia, urinary tract infections, and bacteraemia. The bacterial resistance to structurally unrelated antibiotics and its spread within hospitals limits the efficient antimicrobial options and patients' outcome. Carbapenems are important agents for the therapy of infections due to multidrug-resistant (MDR) P. aeruginosa; hence, the development of carbapenem resistance severely hampers effective therapeutic options. The aim of this investigation was to examine mechanisms of carbapenem resistance and genomic diversity in carbapenem-resistant MDR strains of P. aeruginosa, which caused an outbreak among patients in Clinical Hospital Rijeka. Most of the isolates showed decreased expression of porin that is important for the entry of carbapenems (oprD). Overexpression of MexAB-OprM, MexCD-OprJ, and MexEF-OprN efflux systems was observed in many of the isolates. Production of metallo-ß-lactamases was not detected. Typing by pulsed-field gel electrophoresis discriminated the isolates into five clusters. The clonal distribution of the strains was related to the location of hospital departments where the isolates were collected, which implies that most of the infections were caused by spread of the epidemic strains within the hospital.

Beginnings and success in preventing anophelism by means of gambusia fish on the island of Krk in Croatia from 1922 to 1927.

The introductory part has summarized the role of malaria in the course of history and various attempts of its eradication in Croatia before the World War I. Furthemore, there is a list of activities and results accomplished between 1922 and 1927 on the island of Krk by Dr. Otmar Trausmiller. After a systematic sanitation of all anopheles habitats, primarily natural and artificial bodies of still water, and introduction of imported gambusia to those bodies of water, anopheles was virtually eradicated on the island. What followed was an evident decrease of new malaria incidents, and in the campaign against malaria there was still major concern in the form of chronic patients and intensive quinine therapy. Today, about eighty years after it was introduced to Krk, gambusia still abides in ponds across the island and it represents one of the main factors in the protection against potential revival of indigenous malaria.

[Malaria in Croatia in the period between 1987 to 2006]. / Malarija u Hrvatskoj u razdoblju od 1987. do 2006.

A retrospective study about the incidence of malaria in Croatia in the period from 1987 to 2006 based on the official data of the Croatian National Institute of Public Health. In this period there were 201 cases of malaria registered in Croatia. The majority (79.6%) were imported from Africa, a significantly lower number from Asia (17%), and several cases from South America or from unknown locations. One case ended in death. The causative agents determined are Plasmodium falciparum (64.7%), Plasmodium vivax (19.9%), Plasmodium malariae (2.0%), Plasmodium ovale (0.5%), and mixed infections (6.0%). The causative agent was not discovered in 6.9% of the cases. Chemoprophylaxis was given to patients in regular intervals and correctly in 23.3% of the cases, in irregular intervals in 8.0% of the cases, incorrectly in 9.5% of the cases, in 9.5% the manner of application is unknown, and the remaining 48.7% did not use chemoprophylaxis. Approximately 70% of the patients are seamen, and the remaning are workers temporarily working in tropical countries and tourists. In conclusion, authors argue in favour of prevention measures in persons who stay in malarious areas, by providing them with information about the disease, applying permanent prophylaxis and rigorous control, as well as monitoring all persons arriving from risky areas. On account of the danger of the possible reintroduction of malaria and spreading imported causative agents, we should focus our attention primarily on the early detection and appropriate therapy of infected cases from abroad.

Acquisition of the vacuolar ATPase proton pump and phagosome acidification are essential for escape of Francisella tularensis into the macrophage cytosol.

The Francisella tularensis-containing phagosome (FCP) matures to a late-endosome-like phagosome prior to bacterial escape into the cytosols of macrophages, where bacterial proliferation occurs. Our data show that within the first 15 min after infection of primary human monocyte-derived macrophages (hMDMs), approximately 90% of the FCPs acquire the proton vacuolar ATPase (vATPase) pump and the lysomotropic dye LysoTracker, which concentrates in acidic compartments, similar to phagosomes harboring the Listeria monocytogenes control. The acquired proton vATPase pump and lysomotropic dye are gradually lost by 30 to 60 min postinfection, which coincides with bacterial escape into the cytosols of hMDMs. Colocalization of phagosomes harboring the iglD mutant with the vATPase pump and the LysoTracker dye was also transient, and the loss of colocalization was faster than that observed for the wild-type strain, which is consistent with the faster escape of the iglD mutant into the macrophage cytosol. In contrast, colocalization of both makers with phagosomes harboring the iglC mutant was persistent, which is consistent with fusion to the lysosomes and failure of the iglC mutant to escape into the macrophage cytosol. We have utilized a fluorescence microscopy-based phagosome integrity assay for differential labeling of vacuolar versus cytosolic bacteria, using antibacterial antibodies loaded into the cytosols of live hMDMs. We show that specific inhibition of the proton vATPase pump by bafilomycin A1 (BFA) blocks rapid bacterial escape into the cytosols of hMDMs, but 30% to 50% of the bacteria escape into the cytosol by 6 to 12 h after BFA treatment. The effect of BFA on the blocking of bacterial escape into the cytosol is completely reversible, as the bacteria escape after removal of BFA. We also show that the limited fusion of the FCP to lysosomes is not due to failure to recruit the late-endosomal fusion regulator Rab7. Therefore, within few minutes of its biogenesis, the FCP transiently acquires the proton vATPase pump to acidify the phagosome, and this transient acidification is essential for subsequent bacterial escape into the macrophage cytosol.