Izazovi određivanja antimikrobnog učinka polifenola

As multidrug resistance gains momentum, the last two decades have seen an ever-growing interest in the antimicrobial properties of plant extracts and plant-derived compounds. Most of the focus is on polyphenols – a large and diverse group of phytochemicals with strong antibacterial activity. Testing methods provide reliable results as long as they follow standard procedures. However, methods and procedures used in antimicrobial susceptibility testing (AST) are often too diverse to allow comparison of results. The lack of uniformity and comparability is much owed to the absence of guidelines. The focus of this review is to give a critical overview of different methods used in the assessment of polyphenols antimicrobial efficacy and to highlight the importance of their standardisation.Istraživanje antimikrobnih učinaka biljnih ekstrakata i spojeva u proteklih nekoliko desetljeća zaokuplja interes brojnih znanstvenika zbog sve veće otpornosti bakterija na antibiotike. Najčešći i najviše proučavani sekundarni biljni metabolite su polifenoli – brojna i raznolika skupina fitokemikalija s dokazanim antibakterijskim djelovanjem. Međutim, istraživači koji proučavaju antimikrobni učinak prirodnih spojeva biljnoga podrijetla susreću se s brojnim preprekama, koje je potrebno prepoznati i izbjeći. Na rezultate ispitivanja antimikrobne osjetljivosti mogu utjecati brojni čimbenici, a izbor odgovarajuće metode ispitivanja od presudnog je značaja. Nepostojanje postupnika/smjernica za testiranje antimikrobnog učinka bioaktivnih prirodnih spojeva uvelike utječe na ujednačenost, analizu i usporedbu brojnih objavljenih rezultata. U načelu, samo primjena standardiziranih metoda osigurava dobivanje pouzdanih rezultata. Cilj je ovoga preglednog rada sustavno i kritički prikazati različite metode koje se koriste za ispitivanje antimikrobnog učinka polifenola te istaknuti potrebu za njihovom standardizacijom

Spontaneous splenic rupture in infectious mononucleosis: report of three cases

Prikazana su tri bolesnika sa spontanom rupturom slezene u infekcijskoj mononukleozi koji su uspješno izliječeni splenektomijom. Pojava boli u trbuhu, uz pad vrijednosti hemoglobina i hemodinamsku nestabilnost kod bolesnika s kliničkom slikom infekcijske mononukleoze, pobudila je sumnju na rupturu slezene, što je potvrđeno ultrazvučnim pregledom i/ili kompjutoriziranom tomografijom abdomena. Zbog hemodinamske nestabilnosti učinjena je splenektomija kao terapija izbora. U literaturi se opisuje sve više primjera uspješnog konzervativnog liječenja spontane rupture slezene u hemodinamski stabilnih bolesnika sa subkapsularnim hematomom, a bez rupture kapsule.We present three patients with spontaneous rupture of the spleen in infectious mononucleosis successfully treated with splenectomy. The occurrence of pain in the abdomen, together with a decline in the value of hemoglobin and hemodynamic instability in patients with clinical picture of infectious mononucleosis, aroused the suspicion of spleen rupture, which was confirmed by ultrasonography and/or computed tomography of the abdomen. Because of hemodynamic instability they underwent splenectomy as a treatment of choice. The literature describes many examples of successful conservative treatment of spontaneous splenic rupture in hemodynamically stable patients with subcapsular hematoma without capsule rupture

Bivalvular Staphylococcus aureus endocarditis in a young pregnant woman without known previous risk factors – a case report

Infektivni endokarditis značajan je uzrok pobola i smrtnosti. Posebno je težak klinički entitet u trudnica s obzirom na određeni stupanj imunosupresije u trudnoći, kao i zbog značajnih promjena kardiovaskularne funkcije u trudnica. Većina infektivnih endokarditisa, pa i u trudnoći, uzrokovana je bakterijama, a dominantno je zahvaćen jedan srčani zalistak, najučestalije mitralnog ušća. U ovom radu je prikazan slučaj liječenja i ishoda endokarditisa mitralnog i aortnog zaliska uzrokovanog bakterijom Staphylococcus aureus u prethodno zdrave trudnice.Infectious endocarditis is a significant cause of morbidity and mortality. It is a particularly difficult clinical entity in pregnant women due to a certain degree of immunosuppression in pregnancy, as well as due to significant changes in cardiovascular function in pregnant women. Most infectious endocarditis cases, even in pregnancy, are caused by bacteria, with one heart valve, most commonly the mitral orifice, predominantly affected. This paper presents treatment and outcome of mitral and aortic valve endocarditis caused by Staphylococcus aureus in a previously healthy pregnant woman

The Many Faces of Cat Scratch Disease – A Report of Four Cases

Bolest mačjeg ogreba (BMO) infekcija je uzrokovana Gram negativnom, fakultativno intracelularnom bakterijom Bartonella henselae. Glavni rezervoar infekcije je mačka i oko 75% bolesnika ima podatak o ogrebu ili ugrizu mačke u anamnezi. Rjeđe se infekcija javlja u kontaktu s psom, posredovano mačjom buhom ili neizravnim kontaktom oštećene kože ili sluznice s površinom kontaminiranom mačjom slinom. Infekcija može proći asimptomatski, ali se i prezentirati spektrom kliničkih manifestacija. U 85-90 % bolesnika radi se o klasičnoj BMO s kožnom lezijom i samoograničavajućim, regionalnim limfadenitisom dok ostale, rjeđe kliničke manifestacije, mogu zahvatiti gotovo svaki organ i organski sustav. Prikazujemo četiri bolesnika s BMO liječenih u Klinici za infektivne bolesti Kliničkog bolničkog centra Rijeka te raspravljamo o dijagnostičkim i terapijskim izazovima ove bolesti.Cat scratch disease (CSD) is an infection caused by the Gram negative, facultative intracellular bacteria Bartonella henselae. The main reservoir of the infection is cat and about 75% of the patients have a cat scratch or a bite in anamnesis. Rarely, infection results from exposure to dogs, cat fleas or from contact with cat saliva through broken skin or mucosal surfaces. Infection can be asymptomatic or present with a number of clinical manifestations. In wast majority (85-90%) of the patients CSD presents as a cutaneous lesion and self-limiting, regional lymphadenitis near the site of organism inoculation, other seldom manifestations, however, can include virtually every organ and organ system. We present four patients with CSD treated at the Clinical Hospital Center Rijeka and discuss diagnostic and therapeutic challenges of the CSD

Tick-Borne Encephalitis Due to Consumption of Raw Goat Milk, Gorski kotar, 2019: Clinical Case Reports

Virus krpeljnog meningoencefalitisa (KME) najčešći je uzročnik infekcija središnjeg živčanog sustava u endemskim područjima srednje Europe. Radi se o prirodno žarišnoj zoonozi, čiji rezervoar čine šumski glodavci, domaće i divlje životinje, a čovjek se zarazi prigodno, ubodom inficiranog krpelja. U posljednje je vrijeme sve više izvješća o epidemijama KME povezanih s konzumacijom svježeg mlijeka i mliječnih proizvoda. Cilj je rada prikazati kliničke značajke i tijek bolesti kod oboljelih od KME u tijeku grupiranja u Primorsko- goranskoj županiji (lipanj 2019. godine), povezanog s konzumacijom nepasteriziranog kozjeg mlijeka iz istog izvora. Tri su bolesnika hospitalizirana s kliničkom slikom meningitisa, a kod dvoje se infekcija prezentirala kao febrilna bolest s mijalgijama i općom slabošću. Kod svih je bolesnika infekcija potvrđena serološkom obradom. Niti jedan bolesnik nije bio cijepljen protiv KME niti je imao podatak o ugrizu krpelja. Ovim radom želimo ukazati na zdravstvene opasnosti prehrambenih navika konzumiranja sirovog mlijeka koje u današnje vrijeme postaje sve popularnije, osobito među zagovornicima „zdrave hrane“.Tick-borne encephalitis (TBE) is the most common central nervous system (CNS) infection in the endemic areas of Central Europe. TBE is a zoonosis whose reservoir are forest rodents, and other mammals and vectors are Ixodes ticks. Humans become infected through a tick bite, but recently many TBE outbreaks after consumption of unpasteurized milk and dairy products from infected livestock have been described. The aim of this study was to analyze clinical characteristics of five TBE cases who were infected after consumption of unpasteurized goat milk and dairy products from a small family farm in Primorje-Gorski Kotar County (June 2019). Tree patients developed CNS infection while two had febrile illness. None of the infected patients reported a history of a tick-bite or were vaccinated against TBE. The infection was confirmed by detection of TBE specific antibodies. Since "healthy" lifestyle that encourages consumption of raw milk and dairy products is increasingly fashionable, we would like to point out the importance of pasteurizing or boiling milk before the consumption

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

Izazovi određivanja antimikrobnog učinka polifenola

As multidrug resistance gains momentum, the last two decades have seen an ever-growing interest in the antimicrobial properties of plant extracts and plant-derived compounds. Most of the focus is on polyphenols – a large and diverse group of phytochemicals with strong antibacterial activity. Testing methods provide reliable results as long as they follow standard procedures. However, methods and procedures used in antimicrobial susceptibility testing (AST) are often too diverse to allow comparison of results. The lack of uniformity and comparability is much owed to the absence of guidelines. The focus of this review is to give a critical overview of different methods used in the assessment of polyphenols antimicrobial efficacy and to highlight the importance of their standardisation.Istraživanje antimikrobnih učinaka biljnih ekstrakata i spojeva u proteklih nekoliko desetljeća zaokuplja interes brojnih znanstvenika zbog sve veće otpornosti bakterija na antibiotike. Najčešći i najviše proučavani sekundarni biljni metabolite su polifenoli – brojna i raznolika skupina fitokemikalija s dokazanim antibakterijskim djelovanjem. Međutim, istraživači koji proučavaju antimikrobni učinak prirodnih spojeva biljnoga podrijetla susreću se s brojnim preprekama, koje je potrebno prepoznati i izbjeći. Na rezultate ispitivanja antimikrobne osjetljivosti mogu utjecati brojni čimbenici, a izbor odgovarajuće metode ispitivanja od presudnog je značaja. Nepostojanje postupnika/smjernica za testiranje antimikrobnog učinka bioaktivnih prirodnih spojeva uvelike utječe na ujednačenost, analizu i usporedbu brojnih objavljenih rezultata. U načelu, samo primjena standardiziranih metoda osigurava dobivanje pouzdanih rezultata. Cilj je ovoga preglednog rada sustavno i kritički prikazati različite metode koje se koriste za ispitivanje antimikrobnog učinka polifenola te istaknuti potrebu za njihovom standardizacijom

Izazovi određivanja antimikrobnog učinka polifenola

As multidrug resistance gains momentum, the last two decades have seen an ever-growing interest in the antimicrobial properties of plant extracts and plant-derived compounds. Most of the focus is on polyphenols – a large and diverse group of phytochemicals with strong antibacterial activity. Testing methods provide reliable results as long as they follow standard procedures. However, methods and procedures used in antimicrobial susceptibility testing (AST) are often too diverse to allow comparison of results. The lack of uniformity and comparability is much owed to the absence of guidelines. The focus of this review is to give a critical overview of different methods used in the assessment of polyphenols antimicrobial efficacy and to highlight the importance of their standardisation.Istraživanje antimikrobnih učinaka biljnih ekstrakata i spojeva u proteklih nekoliko desetljeća zaokuplja interes brojnih znanstvenika zbog sve veće otpornosti bakterija na antibiotike. Najčešći i najviše proučavani sekundarni biljni metabolite su polifenoli – brojna i raznolika skupina fitokemikalija s dokazanim antibakterijskim djelovanjem. Međutim, istraživači koji proučavaju antimikrobni učinak prirodnih spojeva biljnoga podrijetla susreću se s brojnim preprekama, koje je potrebno prepoznati i izbjeći. Na rezultate ispitivanja antimikrobne osjetljivosti mogu utjecati brojni čimbenici, a izbor odgovarajuće metode ispitivanja od presudnog je značaja. Nepostojanje postupnika/smjernica za testiranje antimikrobnog učinka bioaktivnih prirodnih spojeva uvelike utječe na ujednačenost, analizu i usporedbu brojnih objavljenih rezultata. U načelu, samo primjena standardiziranih metoda osigurava dobivanje pouzdanih rezultata. Cilj je ovoga preglednog rada sustavno i kritički prikazati različite metode koje se koriste za ispitivanje antimikrobnog učinka polifenola te istaknuti potrebu za njihovom standardizacijom

Acute Pericarditis in Co-Infection with Anaplasma phagocytophilum and Borrelia burgdorferi - a Case Report

Lajmska borelioza i krpeljni meningoencefalitis (KME) najčešće su bolesti prenosive krpeljima u Republici Hrvatskoj. Isti vektor, krpelj roda Ixodes ricinus, odgovoran je i za prijenos humane granulocitne anaplazmoze (HGA) koja se u našoj zemlji rijetko dokazuje, a prvi slučajevi su potvrđeni 1998. godine u Koprivničko-križevačkoj županiji. HGA se najčešće klinički prezentira vrućicom s leukopenijom, trombocitopenijom, povišenim aminotransferazama i CRP-om, a potvrđuje se serološki, pri čemu se povremeno dokaže koinfekcija s virusom KME i/ili bakterijom Borrelia burgdorferi. Prikazujemo slučaj 44-godišnje bolesnice koja je ambulantno liječena u Klinici za infektivne bolesti Kliničkog bolničkog centra Rijeka zbog vrućice s bicitopenijom (leukopenija, trombocitopenija) i akutnog perikarditisa. Serološkom je obradom dokazana akutna koinfekcija uzročnicima Anaplasma phagocytophilum i Borrelia burgdorferi. Liječenje je provedeno doksiciklinom i nesteroidnim antireumaticima, čime je postignut povoljan klinički odgovor.Lyme borreliosis and European tick-borne encephalitis are the most common tick-borne infections in Croatia. The common vector, Ixodes ricinus, is also responsible for the transmission of human granulocytic anaplasmosis (HGA), which, in our country is rarely detected, and the first cases were confirmed in the Koprivnica-Križevci County in 1998. HGA most commonly presents as fever with leukopenia, thrombocytopenia and altered aminotransferases and C reactive protein. The diagnosis is usually confirmed serologically and coinfection with European tick-borne encephalitis virus and Borrelia burgdorferi is rarely diagnosed. We present a 44-year-old, previously healthy patient, treated for fever with bicytopenia (leukopenia, thrombocytopenia) and acute pericarditis. Acute coinfection with Anaplasma phagocytophilum and B. burgdorferi was established serologically. The patient was treated with doxycycline and nonsteroidal noninflammatory drugs with favourable clinical outcome

An outbreak of ertapenem resistant, carbapenemase-negative and porin-deficient ESBL-producing Klebsiella pneumoniae complex

Introduction: Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen with dynamic molecular epidemiology. This study presents a retrospective analysis of the distribution and antibiotic resistance patterns of ertapenem-resistant ESBL-producing K. pneumoniae strains recovered during an outbreak from 2012 to 2014 in a Croatian University hospital. Methods We aimed to estimate genetic relatedness of clinical isolates and underlying mechanisms that conferred the ertapenem- resistant phenotype. Results: Expression analysis of genes involved in the antibiotic resistance showed reduced expression of major non-selective porin channel OmpK35. Reduced expression of OmpK36 porin channel in isolates resistant to at least one more carbapenem, apart from the ertapenem, was found to a lesser degree. Pulsed-field gel electrophoresis analysis of genomic DNA revealed that almost all isolates belonged to the same genetic clone. Conclusions: Caution regarding ertapenem- resistant, carbapenemase-negative porin- deficient mutants of K. pneumoniae is required as they are widespread, and under selective pressure this could result in a local clonal outbreak