External Ophtalmomyasis Caused by Oestrus Ovis Larvae: The First Case in the Primorje Goranska County, Croatia – a Case Report

Cilj: Cilj rada je prikazati prvi slučaj oftalmomijaze uzrokovane larvama Oestrus ovis u Primorsko-goranskoj županiji te osvijestiti zdravstvene djelatnike o infestaciji larvama kao mogućem uzročniku konjunktivitisa. Prikaz slučaja: U hitnu oftalmološku ambulantu upućena je pacijentica zbog osjećaja stranog tijela u oku. Oftalmološkim pregledom lijevo je utvrđena kemoza bulbarne spojnice uz prisutnost triju larvi. Nakon aplikacije lokalnog anestetika larve su uklonjene i poslane na mikrobiološku analizu. Mikroskopskim pregledom uočene su larve koje su prema morfologiji odgovarale larvama ovčjeg štrka stadija L1. Pacijentici su preporučene kortikosteroidne i antibiotske kapi i mast za oko te je na kontrolnom pregledu za tri dana došlo do potpune regresije simptoma. Zaključci: U Hrvatskoj su do sada u literaturi zabilježena samo dva slučaja humane estroze. Rana dijagnoza i liječenje važni su zbog sprječavanja mogućih komplikacija. Za ovo stanje ne postoji sistemska terapija, nego se provodi mehaničko odstranjivanje uzročnika uz lokalni antibiotik za sprječavanje bakterijske infekcije.Aim: The objective of this case report is to present the first case of ophthalmomyiasis caused by Oestrus ovis larvae in the Primorje Goranska County, Croatia, and to raise awareness of healthcare professionals about larval infestation as a possible cause of conjunctivitis. Case report: A female patient was examined at the emergency ophthalmology clinic because of a foreign body sensation in her eye. Ophthalmological examination revealed chemosis of the left bulbar junction with the presence of three larvae. After the application of a local anesthetic, the larvae were removed and sent for microbiological analysis. In light microscopy, the morphology corresponded to the L1 stage larvae of sheep botfly. Corticosteroid, antibiotic drops and eye ointment were recommended to the patient, and at the follow-up examination three days later there was a complete regression of the symptoms. Conclusions: So far, only two cases of ophthalmomyiasis from Croatia have been reported. Early diagnosis and treatment are important to prevent complications. There is no systemic therapy for this condition, but mechanical removal of the causative agent is carried out with a local antibiotic to prevent bacterial infection

ESKAPE – bacteria that alert the world

Rezistencija na antimikrobne lijekove ugrožava kvalitetu medicinske skrbi u zajednici i bolničkom okruženju. Bakterijska rezistencija prisutna je od samog početka antibiotskog doba, ali je u proteklih dvadesetak godina poprimila zabrinjavajući trend porasta. Prirođena rezistencija je stalna, genetski zadana osobina nekog mikroorganizma. Stečena rezistencija nastaje neočekivano, u prethodno osjetljivoj bakteriji, mutacijom ili češće horizontalnim prijenosom gena putem plazmida. Rezistencija često nije u potpunosti genetski određena, već može biti heterogena unutar populacije, ovisna o okolišu, strukturi bakterijske populacije ili o fiziološkom stanju bakterijske stanice. Selekcijski pritisak antibiotika važan je čimbenik u odabiru i širenju rezistentnih bakterija. Pojava višestrukorezistentnih bakterija kao uzročnika bolesti posebno je alarmantna. Takvi mikroorganizmi se uobičajeno nazivaju „superbakterije“, ali ne zato što su virulentnije, nego zato jer zbog suženog izbora antibiotika konačni ishod liječenja takvih infekcija može biti neizvjestan i često nepovoljan. Stoga je cilj ovog preglednog članka prikazati saznanja o rezistenciji, mehanizmima bakterijske otpornosti prema antibioticima i onim višestrukorezistentnim bakterijama koje danas predstavljaju najveću prijetnju globalno i lokalno, a udružene su pod akronimom ESKAPE.Resistance to antimicrobial drugs jeopardizes the quality of medical care in the community and in the hospital environment. Bacterial resistance has been present since the beginning of the antibiotic period, but over the last twenty years it has a worrying increasing trend. Innate resistance is a permanent, genetic predetermined feature of some microorganism. Acquired resistance occurs unexpectedly, in a previously sensitive bacterium, by mutation, or more often by horizontal genes transmission by plasmids. Resistance does not always have to be completely genetically defined, but can be heterogeneous within the population, depending on the environment, bacterial population structure and physiological state of bacterial cell. Antibiotic selection pressure is an important factor in the selection and spread of resistant bacteria. Appearance of multiple resistant bacteria as a cause of the disease is particularly alarming. Such microorganisms, are commonly referred to as "super-bacteria", not because they are more virulent, but due to the narrowed choice of susceptible antibiotics. The final outcomes of infections caused by these microorganisms are uncertain and often disadvantageous. Therefore, the aim of this review article is to provide insights into bacterial resistance, resistance mechanisms to antibiotics and multi-resistant bacteria that present the greatest threat globally and locally, and are associated under the acronym ESKAPE

Bacterial contamination of used surgical masks among high-risk ward staff

Uvod: Zaštitne maske kontaminiraju se uporabom, mikrobiotom nosne i usne šupljine te kože lica. Izvješća o kontaminaciji i potencijalu za prijenos uzročnika bolničkih infekcija nedostaju ili su rijetka. Istraženo je može li maska postati izvor mikroorganizama i predstavljati rizik za prijenos infekcija povezanih sa zdravstvenom skrbi. Cilj rada bio je usporediti mikrobno opterećenje maski, vestibuluma nosa i ruku djelatnika kako bismo identificirali potencijalne rizike. Metode: Provedena je studija prevalencije u jednom danu u studenom 2022. godine na hematološkom odjelu tercijarne bolnice. Kriterij uključivanja bila je činjenica da se djelatnik tog jutra nalazi u neposrednom radu sa stacionarnim bolesnicima. Uzeti su brisevi nosa, ruku i maski. Sudionici su podijeljeni u dvije skupine: oni koji su masku nosili do 30 minuta i oni koji su je nosili više od 1 sata. Brisevi su obrađeni standardnim mikrobiološkim postupcima. Rezultati: Od 10 ispitanika, njih je 5 masku nosilo 30-ak minuta, a preostalih 5 više od 1 sata. U prvoj skupini nije bilo pozitivnih mikrobioloških nalaza. U skupini djelatnika koji su masku nosili dulje od 1 sata izolirani su koagulaza negativni stafilokoki, Staphylococcus hominis i Staphylococcus warneri u tri od pet ispitanika. Iz briseva vestibuluma nosa u jednom slučaju identificiran je meticilin osjetljiv Staphylococcus aureus. U dva slučaja identificirane su iste vrste, S. hominis i S. warneri, kao i na njihovim maskama. Brisevi ruku kod devetero djelatnika ostali su sterilni, dok su u jednom slučaju izolirani antrakoidi iz roda Bacillus. Rasprava sa zaključkom: Unutar jednog sata na zaštitnim maskama mogu se naći bakterije koje se nalaze u nosu ili koži lica djelatnika. Produljenom uporabom može se očekivati povećanje broja, ali i kontaminacija raznolikim vrstama mikroorganizama što može predstavljati značajan rizik biološke sigurnosti. Osnaživanje prakse higijene ruku minimizira rizik od infekcija i povećava sigurnost pacijenata i osoblja.Introduction: Protective masks become contaminated through use, with the microbiota of the nasal and oral cavities as well as facial skin. We have investigated whether masks could become a source of microorganisms and pose a risk for the transmission of healthcare-associated infections. This study aimed to compare the microbial burden on masks, vestibulum nasi, and hands of healthcare workers to identify potential risks. Methods: A one-day prevalence study was conducted in November 2022 in the hematology department of a tertiary hospital. The inclusion criterion was the fact that the worker was directly involved in caring for inpatients that morning. Swabs were taken from the nose, hands, and masks. Participants were divided into two groups: those who wore the mask for up to 30 minutes and those who wore it for over 1 hour. Swabs were processed using standard microbiological methods. Results: Out of 10 participants, 5 wore the mask for around 30 minutes, and the remaining 5 wore it for over 1 hour. The first group showed no positive microbiological findings. In the second group, coagulase-negative staphylococci, Staphylococcus hominis, and Staphylococcus warneri were isolated in three out of five participants. The nasal colonization by methicillin-sensitive Staphylococcus aureus was detected in one case. In two cases, the same species, S. hominis and S. warneri, as on their masks were identified. Hand swabs remained sterile in nine workers, while in one case, Bacillus species were isolated. Discussion with Conclusion: Within one hour of use, protective masks can harbor bacteria found in nose or facial skin of healthcare workers. Prolonged use may lead to an increase in bacterial counts and contamination with various types of microorganisms, representing a significant risk to biological safety. Strengthening hand hygiene practices minimizes the risk of infections and enhances patient and staff safety

Temporal Bone Actinomycosis Accompanied by Actinomycotic Meningitis and Cervical Lymphadenitis – a Case Report

Aktinomikoza predstavlja rijetku kroničnu infekciju uzrokovanu anaerobnom, Gram pozitivnom bakterijom koja pripada rodu Actinomyces. U ovom smo radu prikazali slučaj aktinomikoze temporalne kosti i meningitisa uzrokovanog Aktinomicetama te limfadenitisa vrata kod imunokompetentne bolesnice s anamnezom kroničnog supurativnog otitisa nakon traumatske perforacije bubnjića starijeg datuma. Liječenje je uspješno provedeno kombiniranom kirurškom i dugotrajnom antimikrobnom terapijom. Ovim prikazom želimo skrenuti pozornost na meningitis kojeg uzrokuje Actinomyces spp. te kojeg je, iako je rijedak, potrebno uključiti u diferencijalnu dijagnozu kroničnog meningitisa, osobito kod pacijenata s kroničnom upalom srednjeg uha i paranazalnih sinusa. Jednako tako, želimo skrenuti pozornost i na ostale manifestacije ove rijetke bolesti.Actinomycosis represents rare chronic infection caused by anaerobic, Gram positive bacteria belonging to Actinomyces genus. Here we present a case of temporal bone actinomycosis accompanied by meningitis and cervical lymphadenitis in imunocompetent patient with case history of chronic suppurative otitis media as a tympanic membrane perforation sequelae. The patient was successfully treated with both surgical and prolonged antimicrobial therapy. This case, although rare, implies cosideration of Actinomyces spp. in diferential diagnosis of chronic meningitis, especially in patients with case history of chronic otitis media or chronic sinusitis

MALARIA IN CROATIA IN THE PERIOD BETWEEN 1987 TO 2006

Retrospektivna studija o incidenciji malarije u Hrvatskoj od 1987. do 2006. temeljena je na službenim podacima Hrvatskog zavoda za javno zdravstvo. U tom razdoblju u Hrvatskoj je registriran 201 slučaj malarije. Najvi{e (79,6%) slučajeva bilo je importirano iz Afrike, znatno manje iz Azije (17%) te po nekoliko slučajeva iz Južne Amerike ili nepoznatih lokaliteta. Jedan slučaj zavr{io je smrtnim ishodom. Od uzročnika utvr|eni su Plasmodium falciparum (64,7%), Plasmodium vivax (19,9%), Plasmodium malariae (2,0%), Plasmodium ovale (0,5%), i miješane infekcije (6,0%), a u 6,9% slu- čajeva uzročnik nije odre|en. U oboljelih je kemoprofilaksa primijenjena redovito i ispravno u 23,3% slučajeva, neredovito u 8,0%, neispravno u 9,5%, za 9,5% nije poznato, a preostalih 48,7% nije ju provodilo. Oko 70% oboljelih su pomorci, a preostali dio čine radnici na privremenom radu u tropskim zemljama i turisti. U zaključku se zagovaraju mjere prevencije u osoba koje borave u malaričnim područjima svim oblicima informiranja o bolesti, provođenje trajne kemoprofilakse te rigorozne kontrole i praćenje svih prispjelih iz rizičnih sredina. Zbog potencijalne opasnosti od razvoja endemije i širenja importiranih uzročnika pozornost valja usmjeriti ponajprije na održavanje svijesti u zdravstvu o potrebi prepoznavanja unesenih slučajeva i što brže adekvatne terapijeA 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

国府、今後の進路 : 和平の鍵―日支具体事項折衝 : 中央集権、対外策に主力 : 南京本社特電五日 村上特派員発

The introductory part has summarized the role of malaria in the course of history and various attempts of its eradication in Croatiabefore the World War I. Furthemore, there is a list of activities andresults accomplished between 1922 and 1927 on the island of Krk by Dr. Otmar Trausmiller. After a systematic sanitation of all anopheleshabitats, 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 followedwas an evident decrease of new malaria incidents, and in the campaignagainst 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 theprotection against potential revival of indigenous malaria

Catheter associated urinary tract infections – targeting zero infections

Transplantirani i ostali urološki pacijenti imaju češće potrebu za uvođenjem ureteralnog stenta, odnosno urinarnih katetera, te su izloženi povećanom riziku za stjecanje infekcija mokraćnog sustava (IMS). To je najčešća infektivna komplikacija u primatelja alogeničnog grafta, glavni izvor pijelonefritisa, bakterijemije i sepse. Također, IMS su najzastupljenije infekcije povezane sa zdravstvenom skrbi, a glavni rizični čimbenik za njihov nastanak je upravo prisustvo katetera. Vodeći uzročnici ovih infekcija su E. coli, E. faecalis, vrste iz roda Klebsiella, Proteus i Pseudomonas koje često karakterizira i višestruka antimikrobna rezistencija, što dodatno ugrožava klinički ishod. Radi praćenja IMS-a povezanih s uporabom katetera svake se godine provodi jednodnevno presječno istraživanje kojim su obuhvaćeni svi pacijenti hospitalizirani taj dan. Rezultati pridonose sagledavanju problema, unaprjeđenju mjera prevencije, planiranju empirijske antimikrobne terapije, odnosno sigurnosti hospitaliziranih uroloških pacijenata.Transplanted and other urological patients are more likely to need a ureteral stent, or urinary catheters, and are at increased risk of acquiring urinary tract infections (UTI). It is the most common infectious complication in the recipient of allogeneic graft, the main source of pyelonephritis, bacteremia and sepsis. Also, UTIs are the most common healthcare associated infections, and the main risk factor for their occurence is the use of urinary catheters. The leading agents of these infections are E. coli, E. faecalis, species of the genus Klebsiella, Proteus and Pseudomonas, often characterized by multiple antimicrobial resistance, further compromising clinical outcome. To monitor the catheter associated UTI, a one-day point-prevalence study is conducted every year, covering all patients hospitalized that day. The results contribute to the understanding of the problem, improvement of prevention measures, planning of empirical antimicrobial therapy, that is, the safety of hospitalized urological patients

Middle ear 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

External Ophtalmomyasis Caused by Oestrus Ovis Larvae: The First Case in the Primorje Goranska County, Croatia – a Case Report

Cilj: Cilj rada je prikazati prvi slučaj oftalmomijaze uzrokovane larvama Oestrus ovis u Primorsko-goranskoj županiji te osvijestiti zdravstvene djelatnike o infestaciji larvama kao mogućem uzročniku konjunktivitisa. Prikaz slučaja: U hitnu oftalmološku ambulantu upućena je pacijentica zbog osjećaja stranog tijela u oku. Oftalmološkim pregledom lijevo je utvrđena kemoza bulbarne spojnice uz prisutnost triju larvi. Nakon aplikacije lokalnog anestetika larve su uklonjene i poslane na mikrobiološku analizu. Mikroskopskim pregledom uočene su larve koje su prema morfologiji odgovarale larvama ovčjeg štrka stadija L1. Pacijentici su preporučene kortikosteroidne i antibiotske kapi i mast za oko te je na kontrolnom pregledu za tri dana došlo do potpune regresije simptoma. Zaključci: U Hrvatskoj su do sada u literaturi zabilježena samo dva slučaja humane estroze. Rana dijagnoza i liječenje važni su zbog sprječavanja mogućih komplikacija. Za ovo stanje ne postoji sistemska terapija, nego se provodi mehaničko odstranjivanje uzročnika uz lokalni antibiotik za sprječavanje bakterijske infekcije.Aim: The objective of this case report is to present the first case of ophthalmomyiasis caused by Oestrus ovis larvae in the Primorje Goranska County, Croatia, and to raise awareness of healthcare professionals about larval infestation as a possible cause of conjunctivitis. Case report: A female patient was examined at the emergency ophthalmology clinic because of a foreign body sensation in her eye. Ophthalmological examination revealed chemosis of the left bulbar junction with the presence of three larvae. After the application of a local anesthetic, the larvae were removed and sent for microbiological analysis. In light microscopy, the morphology corresponded to the L1 stage larvae of sheep botfly. Corticosteroid, antibiotic drops and eye ointment were recommended to the patient, and at the follow-up examination three days later there was a complete regression of the symptoms. Conclusions: So far, only two cases of ophthalmomyiasis from Croatia have been reported. Early diagnosis and treatment are important to prevent complications. There is no systemic therapy for this condition, but mechanical removal of the causative agent is carried out with a local antibiotic to prevent bacterial infection