Factors leading to dissemination of cutaneous anthrax: an international ID-IRI study

Background: Although anthrax is a rare zoonotic infection, it still causes significant mortality and morbidity. In this multicenter study, which is the largest anthrax case series ever reported, we aimed to describe the factors leading to dissemination of cutaneous anthrax. Methods: Adult patients with cutaneous anthrax from 16 referral centers were pooled. The study had a retrospective design, and included patients treated between January 1, 1990 and December 1, 2019. Probable, and confirmed cases based upon CDC anthrax 2018 case definition were included in the study. A descriptive statistical analysis was performed for all variables. Results: A total of 141 cutaneous anthrax patients were included. Of these, 105 (74%) patients had probable and 36 (26%) had confirmed diagnosis. Anthrax meningitis and bacteremia occurred in three and six patients, respectively. Sequelae were observed in three patients: cicatricial ectropion followed by ocular anthrax (n = 2) and movement restriction on the left hand after surgical intervention (n = 1). One patient had gastrointestinal anthrax. The parameters related to poor outcome (p < 0.05) were fever, anorexia, hypoxia, malaise/fatigue, cellulitis, fasciitis, lymphadenopathy, leukocytosis, high CRP and creatinine levels, longer duration of antimicrobial therapy, and combined therapy. The last two were seemingly the consequences of dissemination rather than being the reasons. The fatality rate was 1.4%. Conclusions: Rapid identification of anthrax is crucial for prompt and effective treatment. Systemic symptoms, disseminated local infection, and high inflammatory markers should alert the treating physicians for the dissemination of the disease. © 2022 The Author

Ability to cause erythema migrans differs between Borrelia burgdorferi sensu lato isolates

Background: Lyme borreliosis is a tick-borne disease caused by Borrelia burgdorferi sensu lato. The variety of characteristic and non-specific clinical manifestations is partially explained by its genetic diversity. We investigated the ability of B. burgdorferi sl isolates to cause erythema migrans. Methods. The genetic constellation of isolates from ticks was compared to isolates found in erythema migrans. PCR and sequence analysis was performed on the plasmid-encoded ospC and the chromosomal 5S-23S rDNA spacer region (IGS). Results: Seven different B. burgdorferi sl genospecies were identified in 152 borrelia isolates from ticks and erythema migrans biopsies. B afzelii (51%) and B. garinii (27%) were the most common in ticks. From the 44 sequences obtained from erythema migrans samples 42 were B. afzelii, one B. garinii and one B. bavariensis. Significant associations with erythema migrans formation were found for four IGS and two ospC types. Five from 45 ospC types were associated with more than one genospecies. Conclusions: B. burgdorferi sl isolates differ in their propensity to cause erythema migrans. These differences were also found within genospecies. In other words, although B. afzelii was mostly associated with erythema migrans, some B. afzelii isolates had a low ability to cause erythema migrans. Our data further support the occurrence of plasmid exchange between borrelia genospecies under natural conditions

Characteristics and empiric antimicrobial therapy of urinary tract infections in patients treated at the Departement of Infectious Diseases, General Hospital »Dr. Josip Benčević« in Slavonski Brod

Infekcije mokraćnog sustava (IMS) jedan su od najčešćih razloga traženja liječničke pomoći, pa stoga i među najčešćim razlozima propisivanja antibiotika. Istaknuta je analiza najčešćih uzročnika IMS u našoj sredini, uočavanje stupnja rezistencije na pojedine antibiotike, te ocjena uspješnosti ordinirane empirijske antimikrobne terapije. Retrospektivno su obrađeni podaci o bolesnicima liječenim na Odjelu za zarazne bolesti Opće bolnice »Dr. Josip Benčević« u Slavonskom Brodu, zbog akutnih infekcija mokraćnog sustava, tijekom 2004. godine. Najčešći je uzročnik IMS bila Escherichia coli, premda je u muškaraca s kompliciranim IMS bio najčešći uzročnik Pseudomonas aeruginosa. Obzirom da je 45 % izoliranih bakterija Escherichia coli bilo rezistentno na amoksicilin, a 35 % na kotrimoksazol, ovi antibiotici se u našoj sredini ne mogu upotrebljavati u empirijskoj antimikrobnoj terapiji IMS. Čak 65 % izoliranih bakterija Pseudomonas aeruginosa nije bilo osjetljivo na gentamicin, a 45 % na ciprofloksacin. Najčešći neuspjeh empirijske antimikrobne terapije zabilježen je u muškaraca s kompliciranim IMS, pa bi nam bio najbolji izbor empirijskog antimikrobnog liječenja ovih bolesnika kombinacija piperacilina s tazobaktamom, karbapenemi ili cefepim.Urinarv tract infections (UTI) are one of the most common reasons for seeking medical consultation and therefore are among the most frequent reasons for antibiotic prescription. The purpose of this paper is the analvsis of the most common etiologic agents of UTI in our environment, registration of the degree of bacterial resistance, and evaluation of empiric antibiotic therapv success. Retrospectively data of patients, hospitalized during year 2004, at the Departement of Infectious Diseases, General Hospital »Dr. Josip Benčević« in Slavonski Brod, due to acute urinarv tract infections, were analysed. The most common cause of UTI was Escherichia coli, although in male patients with complicated UTI, the most common cause was Pseudomonas aeruginosa. Since 45% of Escherichia coli were amoxicillin resistant, and 35% trimethoprim-sulfamethoxazole resistant, these antimicrobials can\u27t be used as empiric therapy drugs in our environment. As much as 65% of Pseudomonas aeruginosa were gentamicin and 45% ciprofloxacin resistant. The most frequent empiric antibiotic therapy failure was observed in male patients with complicated UTI, so the best empiric drug choice for these patients, in our situation, would be piperacillin/tazobactam, carbapenems or cefepime

International multicentre study of candida auris infections

Background: Candida auris has emerged globally as a multi-drug resistant yeast and is commonly associated with nosocomial outbreaks in ICUs. Methods: We conducted a retrospective observational multicentre study to determine the epidemiology of C. auris infections, its management strategies, patient outcomes, and infection prevention and control practices across 10 centres from five countries. Results: Significant risk factors for C. auris infection include the age group of 61–70 years (39%), recent history of ICU admission (63%), diabetes (63%), renal failure (52%), presence of CVC (91%) and previous history of antibiotic treatment (96%). C. auris was commonly isolated from blood (76%). Echinocandins were the most sensitive drugs. Most common antifungals used for treatment were caspofungin (40%), anidulafungin (28%) and micafungin (15%). The median duration of treatment was 20 days. Source removal was conductedin 74% patients. All-cause crude mortality rate after 30 days was 37%. Antifungal therapy was associated with a reduction in mortality (OR:0.27) and so was source removal (OR:0.74). Contact isolation precautions were followed in 87% patients. Conclusions: C. auris infection carries a high risk for associated mortality. The organism is mainly resistant to most azoles and even amphotericin-B. Targeted antifungal therapy, mainly an echinocandin, and source control are the prominent therapeutic approaches

REV-ERBα Participates in Circadian SREBP Signaling and Bile Acid Homeostasis

The nuclear receptor REV-ERBα shapes the daily activity profile of Sterol Response Element Binding Protein (SREBP) and thereby participates in the circadian control of cholesterol and bile acid synthesis in the liver

Microbial functional change is linked with clinical outcomes after capsular fecal transplant in cirrhosis

BACKGROUND. Hepatic encephalopathy (HE) is associated with poor outcomes. A prior randomized, pilot trial demonstrated safety after oral capsular fecal microbial transplant (FMT) in HE, with favorable changes in microbial composition and cognition. However, microbial functional changes are unclear. The aim of this study was to determine the effect of FMT on the gut-brain axis compared with placebo, using microbial function based on bile acids (BAs), inflammation (serum IL-6, LPS-binding protein [LBP]), and their association with EncephalApp. METHODS. Twenty cirrhotic patients were randomized 1:1 into groups that received 1-time FMT capsules from a donor enriched in Lachnospiraceae and Ruminococcaceae or placebo capsules, with 5-month follow-up for safety outcomes. Stool microbiota and BA; serum IL-6, BA, and LBP; and EncephalApp were analyzed at baseline and 4 weeks after FMT/placebo. Correlation networks among microbiota, BAs, EncephalApp, IL-6, and LBP were performed before/after FMT. RESULTS. FMT-assigned participants had 1 HE recurrence and 2 unrelated infections. Six placebo-assigned participants developed negative outcomes. FMT, but not placebo, was associated with reduced serum IL-6 and LBP and improved EncephalApp. FMT-assigned participants demonstrated higher deconjugation and secondary BA formation in feces and serum compared with baseline. No change was seen in placebo. Correlation networks showed greater complexity after FMT compared with baseline. Beneficial taxa, such as Ruminococcaceae, Verrucomicrobiaceae, and Lachnospiraceae, were correlated with cognitive improvement and decrease in inflammation after FMT. Fecal/serum secondary/primary ratios and PiCRUST secondary BA pathways did not increase in participants who developed poor outcomes. CONCLUSION. Gut microbial function in cirrhosis is beneficially affected by capsular FMT, with improved inflammation and cognition. Lower secondary BAs in FMT recipients could select for participants who develop negative outcomes. TRIAL REGISTRATION. Clinicaltrials.gov NCT03152188. FUNDING. National Center for Advancing Translational Sciences NIH grant R21TR002024, VA Merit Review grant 2I0CX001076, the United Kingdom National Institute for Health Research Biomedical Facility at Imperial College London, the British Heart Foundation, Wellcome Trust, and King’s College London

First case of imported chikungunya infection in Croatia, 2016

Boris Luksic,1,2 Nenad Pandak,2,3 Edita Drazic-Maras,1 Svjetlana Karabuva,1 Mislav Radic,2,4 Andrea Babic-Erceg,5 Ljubo Barbic,6 Vladimir Stevanovic,6 Tatjana Vilibic-Cavlek5,7,8 1Clinical Department of Infectious Diseases, University Hospital Centre Split, Split, Croatia; 2School of Medicine, University of Split, Split, Croatia; 3Department of Infectious Diseases, General Hospital &ldquo;Dr Josip Bencevic&rdquo;, Slavonski Brod, Croatia; 4Department of Rheumatology and Clinical Immunology, University Hospital Centre Split, Split, Croatia; 5Croatian National Institute of Public Health, Zagreb, Croatia; 6Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia; 7Reference Centre for Diagnosis and Surveillance of Viral Zoonoses of the Ministry of Health of the Republic of Croatia, Zagreb, Croatia; 8School of Medicine, University of Zagreb, Zagreb, Croatia Abstract: In recent years, several European countries reported cases of imported chikungunya infection. We present the first imported clinically manifested chikungunya fever in Croatia. A 27-year-old woman returned to Croatia on 21 March 2016, after she stayed in Costa Rica for two months where she had noticed a mosquito bite on her left forearm. Five days after the mosquito bite she developed severe arthralgias, fever and erythematous papular rash. In next few days symptoms gradually subsided. After ten days she felt better, but arthralgias re-appeared accompanied with morning stiffness. Two weeks after the onset of the disease she visited the infectious diseases outpatient department. The physical examination revealed rash on the trunk, extremities, palms and soles. Laboratory findings showed slightly elevated liver transaminases. Serological tests performed on day 20 after disease onset showed a high titer of chikungunya virus (CHIKV) IgM and IgG antibodies which indicated CHIKV infection. CHIKV-RNA was not detected. Serology to dengue and Zika virus was negative. The patient was treated with nonsteroid anti-inflammatory drugs and paracetamol. Her symptoms ameliorated, however, three months later she still complaint of arthralgias. The presented case highlights the need for inclusion of CHIKV in the differential diagnosis of arthralgia in all travelers returning from countries with documented CHIKV transmission. Keywords: chikungunya, imported, Croati