Case report: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) as a risk factor for central serous chorioretinopathy.

Purpose: To describe an atypical case of central serous chorioretinopathy (CSC) in a patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). Methods: A retrospective case report. Results: A 43-year-old white man with a genetic diagnosis of CADASIL was referred to our hospital because of reduced visual acuity in his right eye (20/30). In the previous 2 months, he developed CSC with subretinal fluid (SRF) and damage to the retinal pigmented epithelium without pachychoroid and pachyvessels or known risk factors for CSC. The patient was treated with transfoveal subthreshold micropulse yellow laser (577 nm) therapy. One month later, there were no signs of SRF, and visual acuity improved to 20/20. Conclusions: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is a genetic condition that primarily affects vascular smooth cells in small cerebral vessels and retinal arterioles. However, we hypothesize that CADASIL could also be responsible for an alteration of the vascular smooth cells in the choroidal arterioles, leading to choriocapillaris ischemia and CSC, even in the absence of a pachychoroid spectrum.

Genital and extra-genital Chlamydia trachomatis and Neisseria gonorrhoeae infections in young women attending a Sexually Transmitted Infections (STI) clinic.

Chlamydia trachomatis and Neisseria gonorrhoeae are the most common agents of bacterial sexually transmitted infections (STIs) worldwide. Here, we evaluated genital and extra-genital C. trachomatis and N. gonorrhoeae infection prevalence in a cohort of young women attending an STI Outpatients Clinic in Italy. From May 2019 to December 2019, 134 women aged 18-26 years were enrolled. A vaginal, a pharyngeal and a rectal swab for the molecular detection of C. trachomatis and N. gonorrhoeae were collected from each patient. Chlamydia-positive samples underwent a molecular genotyping based on pmpH gene. Total prevalence of C. trachomatis and N. gonorrhoeae infections was 17.9% and 11.2%, respectively. Chlamydial infections were prevalent in the urogenital (16.4%) and rectal (13.4%) sites, whereas N. gonorrhoeae predominated in the genital (7.4%) and pharyngeal (6%) mucosa. Overall, 5.2% of cases would have been missed if extra-genital sites had not been tested. Notably, 60% of women with a rectal infection did not report anal sex. A history of sexual contacts with a positive partner (P=0.03) and a history of ≥3 partners in the last 6 months (P=0.0075) were highly predictive of a bacterial STI. No cases of lymphogranuloma venereum were found. These data could help set up effective strategies to prevent the spread of STIs.

Pharyngeal microbiome alterations during Neisseria gonorrhoeae infection.

Pharyngeal gonorrhoea is a common sexually transmitted infection among 'men having sex with other men' (MSM). Neisseria gonorrhoeae (NG) pharyngeal infections are usually characterized by the absence of symptoms, acting as an important reservoir for their further spread. To the best of our knowledge, no information about the composition of the pharyngeal microbiome during an ongoing NG infection is currently available. Therefore, in this study, we characterized the pharyngeal bacterial community profiles associated with NG infection in a well-selected cohort of HIV-negative MSM reporting unsafe oral intercourse. A total of 70 pharyngeal swabs were considered, comparing non-infected subjects (n = 45) versus patients with pharyngeal gonorrhoea (n = 25) whose microbiota composition was analyzed from pharyngeal swabs through sequencing of hypervariable V3-V4 regions of the 16S rRNA gene. The pharyngeal microbiome of all subjects was dominated by Prevotellaceae, Veillonellaceae and Streptococcaceae families. Patients with pharyngeal gonorrhoea harboured a pharyngeal microbiome quite similar to negative subjects. Nevertheless, when looking to less-represented bacterial species (relative abundance approximately 1% or less), an imbalance between aerobe and anaerobe microorganisms was observed in NG-infected patients. In particular, the pharyngeal microbiome of NG-positive individuals was richer in several anaerobes (e.g. Treponema, Parvimonas, Peptococcus, Catonella, Filifactor) and poorer in various aerobe genera (i.e. Pseudomonas, Escherichia), compared to non-infected controls. No significant differences were noticed in the distribution of commensal Neisseria species of the oropharynx between NG-positive and negative subjects. Metabolic variations induced by changes in the microbiome abundance were assessed by a functional prediction of the bacterial metabolic pathways: a more abundant involvement of D-glutamine and D-glutamate metabolism, carbohydrate metabolism, as well as a greater activation of the energy metabolism was observed in patients with pharyngeal gonorrhoea compared to non-infected individuals. Information about the bacterial composition of the pharyngeal microbiome in case of gonorrhoea could shed light on the pathogenesis of the infection and open new perspectives for the prevention and control of this condition.