Dokaz bakterije Mycoplasma genitalium u muškaraca sa sindromom kroničnog prostatitisa: prevalencija, dijagnostički kriteriji te rutinski probir [Detection of Mycoplasma genitalium in men with chronic prostatitis syndrome: prevalence, diagnostic criteria and population-based screening]

In the study, there were 91 patients with chronic prostatitis symptoms and 26 asymptomatic men enrolled, all treated at the Outpatient department for urogenital infections and sexually transmitted diseases of the University hospital for infectious diseases “Dr. Fran Mihaljević” in the period February 1 to August 1, 2010. After initial patient history, every patient filled out the Croatian translation of the NIH chronic prostatitis symptom index (NIH-CPSI), followed by a clinical examination. Urethral swabs were performed and selective collection of urine and expressed prostatic secretion (EPS) samples by the Meares-Stamey 4-glass test followed. Finally, an ultrasound examination of the pelvis was performed. The number of leukocytes, gram-positive and gram-negative bacteria in urine and EPS was determined in 1 ml samples, and a finding of ≥10 leukocytes in EPS or VB 3 signified an inflammatory nature of the disease. Urethral swabs were analyzed for M. genitalium, C. trachomatis, M. hominis, and U. urealyticum. EPS and VB 3 were analyzed for the presence of M. genitalium, C. trachomatis, M. hominis, U. urealyticum, and T. vaginalis; while all three urine and EPS samples were cultured to identify gram-positive and gram-negative bacteria. An infectious etiology of the chronic prostatitis syndrome was confirmed in 16 patients (17%), while only in one (1%) was there a confirmed inflammatory nature of the disease, ie. an inflammatory case of the chronic pelvic pain syndrome by T. vaginalis was determined. M. genitalium was not proven in any of the urethral, EPS or VB 3 samples of the patients with symptoms or signs of chronic prostatitis syndrome, by any of the three modern diagnostic methods (a standardized PCR method with a MgPa target gene of the main adhesion protein; a PCR method for 16S rRNA; and a real-time PCR also for 16S rRNA). Also, there were no positive findings in the control group. As M. genitalium, in this study, was not proven in any of the subjects, we conclude that routine sampling for M. genitalium within the chronic prostatitis syndrome, at this time, is not warranted, but the problem should be further investigated in a larger number of patients

Autochthonous hepatitis E in a patient from Zagreb: a case report

Hepatits E virus (HEV) je globalni patogen koji uzrokuje epidemijske i sporadične slučajeve akutnog hepatitisa u Aziji i Africi. Sporadični slučajevi bilježe se i u Europi, većinom u putnika iz endemskih zemalja. U studenom 2012. godine zaprimljen je bolesnik u dobi 62 godine zbog sumnje na bakterijsku pneumoniju. Bolest je započela dva tjedna pred prijam febrilitetom i respiratornim simptomima koji su regredirali tijekom ambulantnog liječenja cefuroksim-aksetilom. Šesti dan liječenja zbog pojave osipa bolesnik je hospitaliziran. Bolesnik je kod prijma bio ikteričan, s eritematoznim makuloznim osipom. Laboratorijskom obradom nađene su umjereno povišene vrijednosti upalnih parametara uz hiperbilirubinemiju i povišene vrijednosti transaminaza. Na sumacijskoj snimci torakalnih organa viđen je opsežan intersticijski infiltrat u desnom gornjem režnju pluća. Serološkim i molekularnim testovima dokazana je akutna infekcija HEV-om. Serološka dijagnostika za uzročnike atipične pneumonije ukazivala je na moguću istovremenu infekciju s C. pneumoniae. Simptomatskim liječenjem postignuto je izlječenje uz normalizaciju svih laboratorijskih nalaza nakon tri mjeseca praćenja, bez razvoja komplikacija. Ovim radom prikazali smo bolesnika iz Zagreba s ikteričnim oblikom akutnog hepatitisa E koji nije boravio izvan Hrvatske što je prema dostupnoj literaturi prvi opisani slučaj autohtonog hepatitisa E u Hrvatskoj. Bolesnik je tijekom bolesti razvio osip i pneumonični infiltrat koji se etiološki nisu mogli jasno definirati. Bolesnike s kliničkom slikom akutnog virusnog hepatitisa koji nije uzrokovan virusima hepatitis A, B ili C te EBV-om i CMV-om trebalo bi testirati i na HEV.Hepatitis E virus (HEV) is a global pathogen that causes epidemic and sporadic cases of acute hepatitis in Asia and Africa. However, recently, sporadic cases have been recorded in European countries as well. In November 2012, a 62-year-old patient was admitted with suspicion of bacterial pneumonia. The disease started two weeks prior to admission with fever and respiratory symptoms. The regression of symptoms was noted during outpatient treatment with cefuroxime-axetil. On the sixth day of treatment a rash appeared and the patient was admitted to our hospital. On admission, he was icteric, with an erythematous macular rash on the trunk. Laboratory tests found moderately elevated inflammatory parameters with hyperbilirubinemia and elevated liver enzymes. On chest X-ray extensive interstitial pulmonary infiltration was recorded. Serological and molecular diagnostics confirmed acute HEV-infection. Serological diagnostics on microorganisms of atypical pneumonia suggested possible simultaneous C. pneumoniae infection. Symptomatic treatment achieved a complete cure with normalization of laboratory tests after three months follow-up, without any complications. In this paper, we presented a case of an icteric form of acute hepatitis E in a patient from Zagreb who didn\u27 travel abroad, therefore according to avaliable literature, this is the first described case of autochthotonous hepatitis E in Croatia. During the course of the disease the patient developed a rash and pneumonic infiltration the etiology of which could not be clearly defined. In patients with clinical feature of acute viral hepatitis after exclusion of hepatitis A, B, C and EBV and CMV infections, diagnostic on HEV should be conducted

GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

Pneumonija iz opće populacije, odnosno stečena izvan bolnice vrlo je česta bolest uzrokovana brojnim mikro­organizmima s različitom kliničkom pojavnošću, težinom i prognozom te ima važan udio u pobolu i smrtnosti pučanstva s rastućim troškovima liječenja u cijelom svijetu. Izjednačavanje i poboljšanje liječenja odraslih bolesnika propisuju smjernice mnogih institucija i profesionalnih udruženja. Sve moderne smjernice za liječenje pneumonija iz opće populacije ­temelje se na kliničkoj dijagnozi pneumonije potvrđene rendgenskom slikom pluća i empirijskom izboru antibiotika. Poput ostalih najpoznatijih (američke, europske, britanske), naše smjernice s racionalnim pristupom baziraju se na procjeni težine bolesti, dobi bolesnika, popratnim kroničnim bolestima, rizičnim čimbenicima i epidemiološkim podatcima. Na osnovi težine bolesti propisuju dijagnostičke i terapijske postupke prema mjestu zbrinjavanja pneumonija: ambulantno, na bolničkom odjelu, odnosno u jedinicama za intenzivno liječenje. Liječenje pneumonija antibiotikom treba započeti odmah, odnosno u roku od četiri sata nakon postavljanja kliničke dijagnoze. Parenteralna primjena antibiotika može se zamijeniti peroralnom najčešće 48 – 96 sati od početka liječenja, čak i u bolesnika s težim oblikom bolesti ako su zadovoljeni krite­riji. Cijepljenje protiv influence i pneumokokne bolesti preporučuje se svim osobama s povišenim rizikom. U izradi smjernica sudjelovali su ekspertni predstavnici pet relevantnih društava HLZ-a i Hrvatskoga torakalnog društva te Referentnog centra za dijagnostiku i liječenje infektivnih bolesti Ministarstva zdravstva Republike Hrvatske. Namijenjene su liječnicima obiteljske medicine i specijalistima različitih struka koji liječe bolesnike s pneumonijom ambulantno ili u bolnici.Community-acquired pneumonia (CAP), or pneumonia acquired outside the hospital, is a very common disease caused by numerous microorganisms with various clinical presentations, disease severity and outcome. CAP is associated with significant morbidity and mortality in affected population and rising costs of medical treatment worldwide. Uniform and improved clinical approach and treatment of adult patients with CAP is advocated in many guidelines developed by various institutions and professional associations. All current guidelines for the treatment of CAP are based on clinical ­diagnosis of pneumonia confirmed by chest radiography and empirical choice of antibiotics. As other well-known guidelines (American, European, British), the Croatian guidelines are trying to rationalize clinical approach based on the assessment of disease severity, patient age, comorbidities, risk factors and epidemiological data. Depending on disease severity, diagnostic and therapeutic procedures are prescribed according to the site of care for CAP patients: outpatient setting, hospital wards or the intensive care unit. Antibiotic treatment of pneumonia should be initiated immediately, or within four hours after establishing the clinical diagnosis. Parenteral administration of antibiotics can be switched to oral usually 48 to 96 hours from the start of treatment, even in patients with severe clinical presentation of disease if all criteria are met. Vaccination against influenza and pneumococcal disease is recommended for all high-risk persons. Expert representatives of five professional societies of the Croatian Medical Association and Croatian Thoracic Society and the Reference Center for Diagnosis and Treatment of Infectious Diseases of the Croatian Ministry of Health participated in the preparation of these guidelines. They are designed for general practitioners and specialists from different medical disciplines who treat patients with pneumonia in outpatient or hospital setting

2015/16 seasonal vaccine effectiveness against hospitalisation with influenza a(H1N1)pdm09 and B among elderly people in Europe: Results from the I-MOVE+ project

We conducted a multicentre test-negative caseâ\u80\u93control study in 27 hospitals of 11 European countries to measure 2015/16 influenza vaccine effectiveness (IVE) against hospitalised influenza A(H1N1)pdm09 and B among people aged â\u89¥ 65 years. Patients swabbed within 7 days after onset of symptoms compatible with severe acute respiratory infection were included. Information on demographics, vaccination and underlying conditions was collected. Using logistic regression, we measured IVE adjusted for potential confounders. We included 355 influenza A(H1N1)pdm09 cases, 110 influenza B cases, and 1,274 controls. Adjusted IVE against influenza A(H1N1)pdm09 was 42% (95% confidence interval (CI): 22 to 57). It was 59% (95% CI: 23 to 78), 48% (95% CI: 5 to 71), 43% (95% CI: 8 to 65) and 39% (95% CI: 7 to 60) in patients with diabetes mellitus, cancer, lung and heart disease, respectively. Adjusted IVE against influenza B was 52% (95% CI: 24 to 70). It was 62% (95% CI: 5 to 85), 60% (95% CI: 18 to 80) and 36% (95% CI: -23 to 67) in patients with diabetes mellitus, lung and heart disease, respectively. 2015/16 IVE estimates against hospitalised influenza in elderly people was moderate against influenza A(H1N1)pdm09 and B, including among those with diabetes mellitus, cancer, lung or heart diseases

Detection of Mycoplasma genitalium in men with chronic prostatitis syndrome: prevalence, diagnostic criteria and population-based screening

Cilj ovog presječnog istraživanja bio je istražiti prevalenciju M. genitalium u muškaraca sa sindromom kroničnog prostatitisa. Nadalje, specifični ciljevi bili su utvrditi potrebu osnovnog probira populacije te procijeniti pouzdanost dijagnostičkih metoda. Svrha doktorskog rada bila je dopuna dosadašnjeg znanja o moguće novom uzročniku u etiologiji sindroma kroničnog prostatitisa uvođenjem suvremenih dijagnostičkih metoda, a u cilju uspješnijeg liječenja. U istraživanje je uključen 91 bolesnik sa simptomima kroničnog prostatitisa i 26 asimptomatskih muškaraca, koji su obrađeni u Ambulanti za urogenitalne infekcije i spolno prenosive bolesti Klinike za infektivne bolesti „Dr. Fran Mihaljević“ u razdoblju od 01. veljače do 01. kolovoza 2010. g. Nakon uzimanja anamneze, svaki ispitanik je ispunio hrvatski prijevod upitnika o simptomima kroničnog prostatitisa, a zatim je obavljen klinički pregled. Slijedilo je uzimanje obrisaka uretre te selektivnih uzoraka urina i eksprimata prostate metodom „četiri čaše“. Završno je učinjen ultrazvučni pregled zdjelice. Broj leukocita te gram-pozitivnih i gram-negativnih bakterija u mokraći i eksprimatu prostate određivan je u uzorcima od 1 ml, a nalaz od ≥10 leukocita u EPS ili VB 3 upućivao je na upalnu prirodu bolesti. Obrisak uretre se analizirao na M. genitalium, C. trachomatis, M. hominis i U. urealyticum. U EPS i VB 3 tražila se M. genitalium, C. trachomatis, M. hominis, U. urealyticum i T. vaginalis, dok su u sva tri uzorka mokraće i EPS kulturom identificirane gram-negativne i gram-pozitivne bakterije. Infektivna etiologija sindroma kroničnog prostatitisa potvrđena je u 16 (17%) bolesnika, međutim samo je u jednoga (1%) dokazana upalna priroda bolesti tj. utvrđen je upalni oblik sindroma kronične zdjelične boli uzrokovan T. vaginalis. M. genitalium nije dokazana niti u jednom uzorku uretre, EPS ili VB 3 ispitanika sa simptomima ili znakovima sindroma kroničnog prostatitisa, korištenjem bilo koje od tri suvremene dijagnostičke metode (standardizirana PCR metoda čiji je ciljni gen MgPa gen glavnog athezijskog proteina, PCR metoda usmjerena na 16S rRNA i real-time PCR također usmjeren 16S rRNA). Također nije bilo pozitivnog nalaza među pripadnicima kontrolne skupine. S obzirom da u ovom istraživanju M. genitalium nije dokazana niti u jednog ispitanika, zaključujemo da je rutinski probir na M. genitalium u sklopu sindroma kroničnog prostatitisa za sada nepotreban, međutim potrebno je proširiti istraživanje na veći broj ispitanika.In the study, there were 91 patients with chronic prostatitis symptoms and 26 asymptomatic men enrolled, all treated at the Outpatient department for urogenital infections and sexually transmitted diseases of the University hospital for infectious diseases “Dr. Fran Mihaljević” in the period February 1 to August 1, 2010. After initial patient history, every patient filled out the Croatian translation of the NIH chronic prostatitis symptom index (NIH-CPSI), followed by a clinical examination. Urethral swabs were performed and selective collection of urine and expressed prostatic secretion (EPS) samples by the Meares-Stamey 4-glass test followed. Finally, an ultrasound examination of the pelvis was performed. The number of leukocytes, gram-positive and gram-negative bacteria in urine and EPS was determined in 1 ml samples, and a finding of ≥10 leukocytes in EPS or VB 3 signified an inflammatory nature of the disease. Urethral swabs were analyzed for M. genitalium, C. trachomatis, M. hominis, and U. urealyticum. EPS and VB 3 were analyzed for the presence of M. genitalium, C. trachomatis, M. hominis, U. urealyticum, and T. vaginalis; while all three urine and EPS samples were cultured to identify gram-positive and gram-negative bacteria. An infectious etiology of the chronic prostatitis syndrome was confirmed in 16 patients (17%), while only in one (1%) was there a confirmed inflammatory nature of the disease, ie. an inflammatory case of the chronic pelvic pain syndrome by T. vaginalis was determined. M. genitalium was not proven in any of the urethral, EPS or VB 3 samples of the patients with symptoms or signs of chronic prostatitis syndrome, by any of the three modern diagnostic methods (a standardized PCR method with a MgPa target gene of the main adhesion protein; a PCR method for 16S rRNA; and a real-time PCR also for 16S rRNA). Also, there were no positive findings in the control group. As M. genitalium, in this study, was not proven in any of the subjects, we conclude that routine sampling for M. genitalium within the chronic prostatitis syndrome, at this time, is not warranted, but the problem should be further investigated in a larger number of patients

Detection of Mycoplasma genitalium in men with chronic prostatitis syndrome: prevalence, diagnostic criteria and population-based screening

Cilj ovog presječnog istraživanja bio je istražiti prevalenciju M. genitalium u muškaraca sa sindromom kroničnog prostatitisa. Nadalje, specifični ciljevi bili su utvrditi potrebu osnovnog probira populacije te procijeniti pouzdanost dijagnostičkih metoda. Svrha doktorskog rada bila je dopuna dosadašnjeg znanja o moguće novom uzročniku u etiologiji sindroma kroničnog prostatitisa uvođenjem suvremenih dijagnostičkih metoda, a u cilju uspješnijeg liječenja. U istraživanje je uključen 91 bolesnik sa simptomima kroničnog prostatitisa i 26 asimptomatskih muškaraca, koji su obrađeni u Ambulanti za urogenitalne infekcije i spolno prenosive bolesti Klinike za infektivne bolesti „Dr. Fran Mihaljević“ u razdoblju od 01. veljače do 01. kolovoza 2010. g. Nakon uzimanja anamneze, svaki ispitanik je ispunio hrvatski prijevod upitnika o simptomima kroničnog prostatitisa, a zatim je obavljen klinički pregled. Slijedilo je uzimanje obrisaka uretre te selektivnih uzoraka urina i eksprimata prostate metodom „četiri čaše“. Završno je učinjen ultrazvučni pregled zdjelice. Broj leukocita te gram-pozitivnih i gram-negativnih bakterija u mokraći i eksprimatu prostate određivan je u uzorcima od 1 ml, a nalaz od ≥10 leukocita u EPS ili VB 3 upućivao je na upalnu prirodu bolesti. Obrisak uretre se analizirao na M. genitalium, C. trachomatis, M. hominis i U. urealyticum. U EPS i VB 3 tražila se M. genitalium, C. trachomatis, M. hominis, U. urealyticum i T. vaginalis, dok su u sva tri uzorka mokraće i EPS kulturom identificirane gram-negativne i gram-pozitivne bakterije. Infektivna etiologija sindroma kroničnog prostatitisa potvrđena je u 16 (17%) bolesnika, međutim samo je u jednoga (1%) dokazana upalna priroda bolesti tj. utvrđen je upalni oblik sindroma kronične zdjelične boli uzrokovan T. vaginalis. M. genitalium nije dokazana niti u jednom uzorku uretre, EPS ili VB 3 ispitanika sa simptomima ili znakovima sindroma kroničnog prostatitisa, korištenjem bilo koje od tri suvremene dijagnostičke metode (standardizirana PCR metoda čiji je ciljni gen MgPa gen glavnog athezijskog proteina, PCR metoda usmjerena na 16S rRNA i real-time PCR također usmjeren 16S rRNA). Također nije bilo pozitivnog nalaza među pripadnicima kontrolne skupine. S obzirom da u ovom istraživanju M. genitalium nije dokazana niti u jednog ispitanika, zaključujemo da je rutinski probir na M. genitalium u sklopu sindroma kroničnog prostatitisa za sada nepotreban, međutim potrebno je proširiti istraživanje na veći broj ispitanika.In the study, there were 91 patients with chronic prostatitis symptoms and 26 asymptomatic men enrolled, all treated at the Outpatient department for urogenital infections and sexually transmitted diseases of the University hospital for infectious diseases “Dr. Fran Mihaljević” in the period February 1 to August 1, 2010. After initial patient history, every patient filled out the Croatian translation of the NIH chronic prostatitis symptom index (NIH-CPSI), followed by a clinical examination. Urethral swabs were performed and selective collection of urine and expressed prostatic secretion (EPS) samples by the Meares-Stamey 4-glass test followed. Finally, an ultrasound examination of the pelvis was performed. The number of leukocytes, gram-positive and gram-negative bacteria in urine and EPS was determined in 1 ml samples, and a finding of ≥10 leukocytes in EPS or VB 3 signified an inflammatory nature of the disease. Urethral swabs were analyzed for M. genitalium, C. trachomatis, M. hominis, and U. urealyticum. EPS and VB 3 were analyzed for the presence of M. genitalium, C. trachomatis, M. hominis, U. urealyticum, and T. vaginalis; while all three urine and EPS samples were cultured to identify gram-positive and gram-negative bacteria. An infectious etiology of the chronic prostatitis syndrome was confirmed in 16 patients (17%), while only in one (1%) was there a confirmed inflammatory nature of the disease, ie. an inflammatory case of the chronic pelvic pain syndrome by T. vaginalis was determined. M. genitalium was not proven in any of the urethral, EPS or VB 3 samples of the patients with symptoms or signs of chronic prostatitis syndrome, by any of the three modern diagnostic methods (a standardized PCR method with a MgPa target gene of the main adhesion protein; a PCR method for 16S rRNA; and a real-time PCR also for 16S rRNA). Also, there were no positive findings in the control group. As M. genitalium, in this study, was not proven in any of the subjects, we conclude that routine sampling for M. genitalium within the chronic prostatitis syndrome, at this time, is not warranted, but the problem should be further investigated in a larger number of patients

Detection of Mycoplasma genitalium in men with chronic prostatitis syndrome: prevalence, diagnostic criteria and population-based screening

Cilj ovog presječnog istraživanja bio je istražiti prevalenciju M. genitalium u muškaraca sa sindromom kroničnog prostatitisa. Nadalje, specifični ciljevi bili su utvrditi potrebu osnovnog probira populacije te procijeniti pouzdanost dijagnostičkih metoda. Svrha doktorskog rada bila je dopuna dosadašnjeg znanja o moguće novom uzročniku u etiologiji sindroma kroničnog prostatitisa uvođenjem suvremenih dijagnostičkih metoda, a u cilju uspješnijeg liječenja. U istraživanje je uključen 91 bolesnik sa simptomima kroničnog prostatitisa i 26 asimptomatskih muškaraca, koji su obrađeni u Ambulanti za urogenitalne infekcije i spolno prenosive bolesti Klinike za infektivne bolesti „Dr. Fran Mihaljević“ u razdoblju od 01. veljače do 01. kolovoza 2010. g. Nakon uzimanja anamneze, svaki ispitanik je ispunio hrvatski prijevod upitnika o simptomima kroničnog prostatitisa, a zatim je obavljen klinički pregled. Slijedilo je uzimanje obrisaka uretre te selektivnih uzoraka urina i eksprimata prostate metodom „četiri čaše“. Završno je učinjen ultrazvučni pregled zdjelice. Broj leukocita te gram-pozitivnih i gram-negativnih bakterija u mokraći i eksprimatu prostate određivan je u uzorcima od 1 ml, a nalaz od ≥10 leukocita u EPS ili VB 3 upućivao je na upalnu prirodu bolesti. Obrisak uretre se analizirao na M. genitalium, C. trachomatis, M. hominis i U. urealyticum. U EPS i VB 3 tražila se M. genitalium, C. trachomatis, M. hominis, U. urealyticum i T. vaginalis, dok su u sva tri uzorka mokraće i EPS kulturom identificirane gram-negativne i gram-pozitivne bakterije. Infektivna etiologija sindroma kroničnog prostatitisa potvrđena je u 16 (17%) bolesnika, međutim samo je u jednoga (1%) dokazana upalna priroda bolesti tj. utvrđen je upalni oblik sindroma kronične zdjelične boli uzrokovan T. vaginalis. M. genitalium nije dokazana niti u jednom uzorku uretre, EPS ili VB 3 ispitanika sa simptomima ili znakovima sindroma kroničnog prostatitisa, korištenjem bilo koje od tri suvremene dijagnostičke metode (standardizirana PCR metoda čiji je ciljni gen MgPa gen glavnog athezijskog proteina, PCR metoda usmjerena na 16S rRNA i real-time PCR također usmjeren 16S rRNA). Također nije bilo pozitivnog nalaza među pripadnicima kontrolne skupine. S obzirom da u ovom istraživanju M. genitalium nije dokazana niti u jednog ispitanika, zaključujemo da je rutinski probir na M. genitalium u sklopu sindroma kroničnog prostatitisa za sada nepotreban, međutim potrebno je proširiti istraživanje na veći broj ispitanika.In the study, there were 91 patients with chronic prostatitis symptoms and 26 asymptomatic men enrolled, all treated at the Outpatient department for urogenital infections and sexually transmitted diseases of the University hospital for infectious diseases “Dr. Fran Mihaljević” in the period February 1 to August 1, 2010. After initial patient history, every patient filled out the Croatian translation of the NIH chronic prostatitis symptom index (NIH-CPSI), followed by a clinical examination. Urethral swabs were performed and selective collection of urine and expressed prostatic secretion (EPS) samples by the Meares-Stamey 4-glass test followed. Finally, an ultrasound examination of the pelvis was performed. The number of leukocytes, gram-positive and gram-negative bacteria in urine and EPS was determined in 1 ml samples, and a finding of ≥10 leukocytes in EPS or VB 3 signified an inflammatory nature of the disease. Urethral swabs were analyzed for M. genitalium, C. trachomatis, M. hominis, and U. urealyticum. EPS and VB 3 were analyzed for the presence of M. genitalium, C. trachomatis, M. hominis, U. urealyticum, and T. vaginalis; while all three urine and EPS samples were cultured to identify gram-positive and gram-negative bacteria. An infectious etiology of the chronic prostatitis syndrome was confirmed in 16 patients (17%), while only in one (1%) was there a confirmed inflammatory nature of the disease, ie. an inflammatory case of the chronic pelvic pain syndrome by T. vaginalis was determined. M. genitalium was not proven in any of the urethral, EPS or VB 3 samples of the patients with symptoms or signs of chronic prostatitis syndrome, by any of the three modern diagnostic methods (a standardized PCR method with a MgPa target gene of the main adhesion protein; a PCR method for 16S rRNA; and a real-time PCR also for 16S rRNA). Also, there were no positive findings in the control group. As M. genitalium, in this study, was not proven in any of the subjects, we conclude that routine sampling for M. genitalium within the chronic prostatitis syndrome, at this time, is not warranted, but the problem should be further investigated in a larger number of patients

Smjernice za liječenje pneumonija iz opće populacije u odraslih [Guidelines for the management of community-acquired pneumonia in adults]

Community-acquired pneumonia (CAP), or pneumonia acquired outside the hospital, is a very common disease caused by numerous microorganisms with various clinical presentations, disease severity and outcome. CAP is associated with significant morbidity and mortality in affected population and rising costs of medical treatment worldwide. Uniform and improved clinical approach and treatment of adult patients with CAP is advocated in many guidelines developed by various institutions and professional associations. All current guidelines for the treatment of CAP are based on clinical ­diagnosis of pneumonia confirmed by chest radiography and empirical choice of antibiotics. As other well-known guidelines (American, European, British), the Croatian guidelines are trying to rationalize clinical approach based on the assessment of disease severity, patient age, comorbidities, risk factors and epidemiological data. Depending on disease severity, diagnostic and therapeutic procedures are prescribed according to the site of care for CAP patients: outpatient setting, hospital wards or the intensive care unit. Antibiotic treatment of pneumonia should be initiated immediately, or within four hours after establishing the clinical diagnosis. Parenteral administration of antibiotics can be switched to oral usually 48 to 96 hours from the start of treatment, even in patients with severe clinical presentation of disease if all criteria are met. Vaccination against influenza and pneumococcal disease is recommended for all high-risk persons. Expert representatives of five professional societies of the Croatian Medical Association and Croatian Thoracic Society and the Reference Center for Diagnosis and Treatment of Infectious Diseases of the Croatian Ministry of Health participated in the preparation of these guidelines. They are designed for general practitioners and specialists from different medical disciplines who treat patients with pneumonia in outpatient or hospital setting