Laboratorijska dijagnostika trihineloze

Postavljanje točne i pouzdane dijagnoze infekcije nematodom roda Trichinella često je nemoguće na osnovi epidemioloških podataka.(1) Brojna su klinička stanja koja pokazuju sličnu simptomatologiju.(2-4) Stoga je etiološka, mikrobiološka-parazitološka dijagnostika infekcije jedina specifična i pouzdana.(2)Mikrobiološka dijagnostika trihineloze može biti direktna i/ili indirektna. Direktnom dijagnostikom izravno se dokazuje uzročnik, dok je indirektna dijagnostika pokazatelj kontakta bolesnika s uzročnikom.(3) Pravilnim odabirom metoda moguće je postaviti ili odbaciti dijagnozu trihineloze

Laboratorijska dijagnostika trihineloze

Postavljanje točne i pouzdane dijagnoze infekcije nematodom roda Trichinella često je nemoguće na osnovi epidemioloških podataka.(1) Brojna su klinička stanja koja pokazuju sličnu simptomatologiju.(2-4) Stoga je etiološka, mikrobiološka-parazitološka dijagnostika infekcije jedina specifična i pouzdana.(2)Mikrobiološka dijagnostika trihineloze može biti direktna i/ili indirektna. Direktnom dijagnostikom izravno se dokazuje uzročnik, dok je indirektna dijagnostika pokazatelj kontakta bolesnika s uzročnikom.(3) Pravilnim odabirom metoda moguće je postaviti ili odbaciti dijagnozu trihineloze

The role of IgG avidity in diagnosis of cytomegalovirus infection in newborns and infants [Uloga IgG aviditeta u dijagnostici infekcije citomegalovirusom u novorođenčadi i dojenčadi]

To evaluate the value of IgG avidity in diagnosis of congenital cytomegalovirus (CMV) infection in newborns and infants we collected serum samples from 40 infants under 12 months of age with suspected congenital CMV infection. Sera were tested for IgM, IgG and IgG avidity. For 25 of them, virus isolation and/or polymerase chain reaction (PCR) on urine specimens were performed. Thirteen (32.5%) patients showed the presence of CMV IgM antibodies, 3 (7.5%) had equivocal IgM result, and 24 (60.0%) patients had IgG antibodies only. Using IgG avidity, CMV infection (low avidity index-AI) was documented in 61.5% IgM positive and 54.2% IgM negative patients. Eight of nine (88.8%) IgM positive patients were positive either on virus isolation or PCR. In IgM negative patients, 46.6% urine cultures were positive for CMV and 66.6% were PCR positive. According to age, IgG avidity demonstrated acute/recent primary CMV infection in 58.8% patients younger than three months compared with 91.7% and 81.8% in 3-6 and 6-12 months old babies, respectively. In conclusion, IgG avidity is useful in diagnosis of CMV infection either in IgM positive or IgM negative children older than 3 months of age. In infants less than 3 months, transplacentally derived maternal IgG antibodies of high avidity influence on the IgG avidity result. In these children, CMV infection should be confirmed by direct virologic methods such as virus isolation or PCR

Sociodemographic, sexual behaviour and microbiological profiles of men attending public health laboratory for testing for sexually transmitted diseases

In order to identify the groups at risk of sexually transmitted diseases (STDs), we assessed the sociodemographic profiles of men testing for STD, their sexual habits, and the results of microbiological analysis. During a three-year period, a total of 700 men older than 18 years of age completed the questionnaire regarding sociodemographic and sexual behavior. Urethral swabs were taken for microbiological analysis. Thirty-three percent of respondents reported not using condoms. Those that do not use condoms were predominantly less educated, unmarried but in steady relationships, employed, with children, and smokers. Alcohol or drug usage before sexual intercourse was disclosed by 21.4% of respondents, and 10.3% respondents reported sexual intercourses with commercial sex workers. Finally, 24.0% respondents reported sexual relations abroad. In 28.1% of subjects, one or more pathogens were observed in urethral swabs. The most commonly diagnosed microorganism was Ureaplasma urealyticum, followed by Chlamydia trachomatis, Mycoplasma hominis, Trichomonas vaginalis, and Neisseria gonorrhoeae. This study identified several factors that may contribute to the general risk of STD transmission, which will serve to better understand the transmission dynamics and implementation of adequate prevention programs. </p

Painless Acanthamoeba Keratitis in a Soft Contact Lens Wearer – Case Report

Aim of our paper is to present a case of painless Acanthamoeba keratitis in a soft contact lens wearer. A 17-year-old male, highly myopic, prolonged soft contact lens wearer, presented to us with painless red watery right eye having remarkably diminished vision. Last six weeks he was treated elsewhere for the microbial keratitis with no improvement. No pain was reported and on the direct questionnaire about it he denied it. There was marked mixed conjunctival and ciliary injection. A central stromal opacity with a pronounced surrounding corneal ring of inflammatory infiltration and epithelial defect was seen on biomicroscopy of the right eye. Circular pannus was already formed reaching epithelial defect overlying corneal ring infiltrate. Acanthamoeba spp in the corneal sample was confirmed. Prolonged therapy with 0.02% chlorhexidine digluconate solution combined with 0.1% hexamidine solution resulted in corneal healing left with a large central dense stromal opacity with circular pannus reaching peripheral third of the cornea but with very thin blood vessels and the best corrected visual acuity of 0.1 tested on Snellen chart. In conclusion, even in a lack of typical symptom for Acanthamoeba keratitis such as pain, this amoeba should be ruled out especially in a soft contact lens wearer

Trichophyton Spp. Fungal Keratitis in 22 Years Old Female Contact Lenses Wearer

Fungal keratitis represents one of the most difficult forms of microbial keratitis to diagnose and treat successfully. It is difficult to obtain correct diagnosis and topical antifungal preparations. Fungi can cause severe stromal necrosis and enter the anterior chamber by penetrating an intact Descemet membrane. The most common pathogens are filamentous fungi (Aspergillus and Fusarium spp.) and Candida albicans. The incidence of Trichophyton spp. keratitis is 5%. A 22 years old female contact lenses wearer after keratitis developed corneal melting syndrome, spontaneous perforation of the cornea and complicated cataract of the left eye. Conjunctival swab was sterile as well as first sample of corneal tissue and sample from the anterior chamber. Urgent therapeutic perforating keratoplasty (PK), was performed together with extracapsular cataract extraction and the implantation of the intraocular lens in the posterior chamber. The patient was treated with ciprofloxacin and diflucan (systemic therapy); with dexamethason and atropin (subconjunctivaly) and chlorhexidine, brolene, levofloxacin, polimyxin B, and dexamethason/neomycin (topically). Microbiology evaluation was performed once again following excisional biopsy of the intracameral portion of the lesion. The presence of Trichophyton spp. was finally confirmed. Itraconazole and garamycin were included in the systemic therapy. Corneal graft was clear for 17 days but decompesated 28 days after the PK. After two weeks microorganisms invaded the vitreous and caused endophthalmitis. Despite urgent pars plana vitrectomy patient developed endophthalmitis, lost light sensation and developed phthysis. Evisceration and the implantation of silicon prosthesis was done. Perforating keratoplasty is a method of choice in treating severe infectious keratitis unresponsive to conservative tretment but without the eradication of microorganisms it cannot restore the vision or save the eye. Trichophyton spp. may cause a severe disease of the anterior and posterior part of the eye which may finish with the lost of vision/eye. Prompt diagnosis and treatment of Trichophyton spp. keratitis are essential for a good visual outcome

Dirofilaria Repens as a Cause of Subconjunctival Infection in a 77-Years Old Female Patient from Croatia – A Case Report

The zoonotic parasites of the genus Dirofilaria are on the increase as an accidental finding or as a cause of disease in humans worldwide. Human dirofilariasis usually manifests as either subcutaneous infiltrates or lung parenchymal dis- ease, in many cases asymptomatically. We report the case of a 77-year old female patient presenting with irritation and pain in her left eye. Ophthalmologic examination of the temporal part of her left eye revealed motile and threadlike or- ganism, which was surgically extracted and morphologically identified as Dirofilaria. Further molecular diagnostics with polymerase chain reaction (PCR) confirmed that the isolated organism is Dirofilaria repens. Due to already recog- nized autochthonous occurrence of human dirofilariasis in Croatia, human dirofilariasis must be included in the differ- ential diagnosis of patients presenting with subcutaneous nodules, eye affection and other potential manifestations of this disease

INFECTIONS CAUSED BY FREE LIVING AMOEBAS - ETIOLOGY, CLINICAL SYMPTOMS, DIAGNOSTIC, THERAPY AND PREVENTION

SAŽETAK Slobodnoživuće amebe iz rodova Naegleria, Acanthamoeba, Balamuthia i Sappinia, široj su medicinskoj struci nepoznate, ili slabo poznate. Te amebe mogu biti uzročnici životno ugrožavajućih bolesti koje nepravodobno prepoznate i neodgovarajuće liječene, gotovo redovito završavaju ili s teškim posljedicama, ili smrću. U radu je u kratkim crtama prikazana morfologija i epidemiologija slobodnoživućih ameba, kliničke osobitosti, te mogućnosti dijagnostike, liječenja i prevencije infekcija uzrokovanih tim amebama.SUMMARY Free-living amoebas, members of the genera Naegleria, Acanthamoea, Balamuthia and Sappinia are generally unknown or little known in the medical profession. They can cause life-treathening diseases. If not recognized early enough or inapropriately treated they can cause death or serious consequences. In this paper we presented morphology, epidemiology, clinical characteristics, diagnosis, therapy and prevention of these infections

Painless Acanthamoeba Keratitis in a Soft Contact Lens Wearer – Case Report

Aim of our paper is to present a case of painless Acanthamoeba keratitis in a soft contact lens wearer. A 17-year-old male, highly myopic, prolonged soft contact lens wearer, presented to us with painless red watery right eye having remarkably diminished vision. Last six weeks he was treated elsewhere for the microbial keratitis with no improvement. No pain was reported and on the direct questionnaire about it he denied it. There was marked mixed conjunctival and ciliary injection. A central stromal opacity with a pronounced surrounding corneal ring of inflammatory infiltration and epithelial defect was seen on biomicroscopy of the right eye. Circular pannus was already formed reaching epithelial defect overlying corneal ring infiltrate. Acanthamoeba spp in the corneal sample was confirmed. Prolonged therapy with 0.02% chlorhexidine digluconate solution combined with 0.1% hexamidine solution resulted in corneal healing left with a large central dense stromal opacity with circular pannus reaching peripheral third of the cornea but with very thin blood vessels and the best corrected visual acuity of 0.1 tested on Snellen chart. In conclusion, even in a lack of typical symptom for Acanthamoeba keratitis such as pain, this amoeba should be ruled out especially in a soft contact lens wearer