Correlazione clinico-laboratoristica nelle cheratiti da Acanthamoeba: esperienza dell'AOU Careggi di Firenze.

La cheratite da Acanthamoeba (AK) rappresenta una sfida interessante tanto per il clinico quanto per il microbiologo. Si tratta di un’entità clinica grave, con partenza localizzata all’epitelio corneale e successiva formazione di ulcere con danno stromale ingravescente. La difficoltà clinica sta nel sospettare la patologia e nel riuscire a coglierne gli aspetti caratterizzanti. Ciò non è sempre facile, dato che nelle fasi iniziali la AK ha una clinica sovrapponibile a quella di altri tipi di cheratite. La difficoltà per il microbiologo risiede nella gestione del campione, e nell’allestimento dei test diagnostici. Il tempo è fattore cruciale. Il microbiologo deve trovare strategie atte a velocizzare il processo diagnostico e a ottenere risultati clinicamente validi, data la gravità della AK e dato che, spesso, il quesito diagnostico viene posto in fasi già avanzate di malattia. Lo scopo di questo lavoro è quello di illustrare il percorso della diagnostica delle AK nella SOD microbiologia e virologia dell’Azienda Ospedaliera Universitaria Careggi, con un modello di integrazione clinico-laboratoristica. E’ nata l’esigenza di creare un “filo diretto” tra microbiologo e oculista al fine di indirizzare l’iter diagnostico correttamente, evitando analisi ridondanti e sprechi di materiale. L’obiettivo è l’allestimento di un percorso per la gestione delle AK e la diagnostica rapida e sostenibile da un punto di vista economico. Su tutti i pazienti sui quali sussiste un sospetto di AK vengono eseguite la PCR home made e l’esame colturale parassitologico; sui campioni positivi, a posteriori, viene eseguita genotipizzazione molecolare a fini epidemiologici. Secondo i dati riportati in letteratura i casi di AK sono sottostimati, a causa delle difficoltà diagnostiche loro correlate. Dal momento in cui è iniziata questa stretta collaborazione tra microbiologia e oculistica, è emerso come anche nella nostra area l’AK nei pazienti portatori di lenti a contatto non rappresenta una patologia rara, bensì un’entità clinica da considerare, sospettare, diagnosticare e trattare precocemente

Hypochlorous acid hygiene solution in patients affected by blepharitis: a prospective randomised study

Background/aims To investigate the clinical outcomes and antimicrobial activity of an hypochlorous acid hygiene solution compared with hyaluronic acid wipes for blepharitis treatment in patients with dry eye disease (DED).Methods This study involved 48 eyes of 48 patients affected by blepharitis with mild to moderate DED. 24 patients were treated with a hypochlorous acid hygiene solution (HOCL group) and 24 patients were treated with hyaluronic acid wipes (HYAL group) for a period of 4 weeks. The following clinical outcomes were assessed before (V0) and after the treatment period (V1): non-invasive keratograph break up time (NIK-BUT), tear film BUT (TF-BUT) tear meniscus height (TMH), Keratograph meibography, Meibomian Gland Yield Secretion Score (MGYSS), Corneal Staining Score (CSS), Schirmer test I, Keratograph conjunctival redness score and Ocular Surface Disease Index (OSDI). Moreover, microbiological analysis of upper and lower eyelid margins was performed at V0 both before and 5 min after treatment.Results After 1-month NIK-BUT and TF-BUT significantly increased in HOCL group, while they did not show a statistically significant difference in HYAL group compared with baseline. OSDI, TMH and MGYSS showed a significant difference in both groups, while Schirmer test, meibography, CSS and conjunctival redness score did not significantly change in both groups. Bacterial load showed a significant reduction in both groups, more pronounced in HOCL group compared with HYAL group.Conclusions Hypochlorous acid hygiene solution can be securely employed in blepharitis treatment considering the satisfying clinical outcomes and antimicrobial activity compared with hyaluronic acid wipes

Breakthrough Lactobacillus rhamnosus GG bacteremia associated with probiotic use in an adult patient with severe active ulcerative colitis: case report and review of the literature

Probiotics are widely investigated in the treatment of various bowel diseases. However, they may also have a pathogenic potential, and the role of Lactobacillus spp. as opportunistic pathogens, mostly following disruption of the intestinal mucosa, is emerging. We report on a case of bacteremia caused by L. rhamnosus GG in an adult patient affected by severe active ulcerative colitis under treatment with corticosteroids and mesalazine. Lactobacillus bacteremia was associated with candidemia and occurred while the patient was receiving a probiotic formulation containing the same strain (as determined by PFGE typing), and was being concomitantly treated with i.v. vancomycin, to which the Lactobacillus strain was resistant. L. rhamnosus GG bacteremia, therefore, was apparently related with translocation of bacteria from the intestinal lumen to the blood. Pending conclusive evidence, use of probiotics should be considered with caution in case of active severe inflammatory bowel diseases with mucosal disruption

Privileged incorporation of selenium as selenocysteine in Lactobacillus reuteri proteins demonstrated by selenium-specific imaging and proteomics

International audienceAn analytical approach was developed to study the incorporation of selenium (Se), an important trace element involved in the protection of cells from oxidative stress, into the well-known probiotic Lactobacillus reuteri Lb2 BM-DSM 16143. The analyses revealed that about half of the internalized Se was covalently incorporated into soluble proteins. Se-enriched proteins were detected in 2D gels by laser ablation inductively coupled plasma mass spectrometry imaging (LA-ICP MSI) and identified by capillary HPLC with the parallel ICP MS (78Se) and electrospray Orbitrap MS/MS detection. On the basis of the identification of 10 richest in selenium proteins, it was demonstrated that selenium was incorporated by the strain exclusively as selenocysteine. Also, the exact location of selenocysteine within the primary sequence was determined. This finding is in a striking contrast to another common nutraceutical, Se-enriched yeast, which incorporates Se principally as selenomethionine. © 2013 by The American Society for Biochemistry and Molecular Biology, Inc

Extraction of high level visual features for the automatic recognition of UTIs

Urinary Tract Infections (UTIs) are a severe public health problem, accounting for more than eight million visits to health care providers each year. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections. Normally, UTIs are diagnosed by traditional methods, based on cultivation of bacteria on Petri dishes, followed by a visual evaluation by human experts. The need of achieving faster and more accurate results, in order to set a targeted and sudden therapy, motivates the design of an automatic solution in place of the standard procedure. In this paper, we propose an algorithm that combines a “bag–of–words” approach with machine learning techniques to recognize infected plates and provide the automatic classification of the bacterial species. Preliminary experimental results are promising and motivate the introduction of a visual word dictionary with respect to using low level visual features