Katinka Pónyai

Eosinophilic fasciitis associated with Mycoplasma arginini infection

ABSTRACT Eosinophilic fasciitis (EF) with generalized sclerodermiform skin lesions developed over a 19-month period in a previously healthy 23-year-old man. Although we confirmed EF by skin histology and laboratory tests, the recurrent fevers and the clinical observation of sclerotic prepuce with urethritis indicated further bacteriological analysis by conventional microbiological and DNA-based tests. Urethra cultures were positive for an arginine-hydrolyzing mycoplasma and Ureaplasma urealyticum. The patient also had serum IgM antibodies to Mycoplasma pneumoniae using enzyme-linked immunosorbent assay (ELISA)-based qualitative detection. Mycoplasma arginini was isolated from two independent venous blood serum samples and was identified by conventional microbiological tests and sequencing of the 16S rRNA and rpoB genes (GenBank sequence accession numbers HM179555 and HM179556, respectively). M. arginini genomic DNA also was detected by species-specific PCR in the skin lesion biopsy sample. Treatment with corticosteroids and long-term courses of selected antibiotics led to remission of skin symptoms and normalization of laboratory values. This report provides the first evidence of EF associated with mycoplasma infection and the second report of human infection with M. arginini and therefore suggests that this mycoplasma infection might have contributed to the pathogenesis of the disease.

Dirofilaria repens infection case in Hungary: a case report

A 51‐year‐old female developed urticarial lesions of her right forearm which progressed into transient edema and subcutaneous swelling. Later a small infiltrated subcutaneous nodule also appeared and was removed in toto. Histopathological examination revealed the presence of Dirofilaria repens.This worm is the cause of an endemic zoonosis in the Mediterranean area. In the past decade many cases have been reported worldwide, but the condition appears rare in Hungary and skin findings have not been described.

Frequency and antibiotic resistance of Ureaplasma urealyticum and Mycoplasma hominis in genital samples of sexually active individuals

UNLABELLED Ureaplasma urealyticum and Mycoplasma hominis have important role among the causative agents of sexually transmitted diseases. AIM The aim of the study was to determine the frequency and antibiotic resistance of Ureaplasma urealyticum and Mycoplasma hominis in genital samples obtained from patients examined in the Sexually Transmitted Diseases Centre of the Department of Dermatology, Venerology and Dermatooncology, Semmelweis University, Budapest between May 1, 2008 and July 31, 2010. PATIENTS AND METHODS Samples were taken from the urethra in men and from the cervix and urethra in women by universal swab (Biolab®) into Urea-Myco DUO kit (Bio-Rad®) and were incubated for 48 hours at 37 C°. Antibiotic sensitivity of positive samples was determined in U9 bouillon using SIR Mycoplasma kit (Bio-Rad®). RESULTS Samples for 4154 patients aged 16-60 years were examined. In 247/4154 samples (6%) U. urealyticum and in 26/4154 samples (0.63%) M. hominis was isolated from the genital tract. Most U. urealyticum and M. hominis strains (75% and 77%, respectively) were cultured from cervix, while the remaining 25%, and 23% from the male and female urethra, respectively. U. urealyticum and M. hominis were most commonly detected in patients aged between 21 and 40 years. The majority of U. urealyticum strains were sensitive to tetracycline (94%), doxycycline (95%), azithromycin (88%) and josamycin (90%), but were resistant to ofloxacin (21%), erythromycin (85%) and clindamycin (79%). Seventy-seven percent of the U. urealyticum strains were simultaneously resistant to erythromycin and clindamycin, suggesting that ex iuvantibus therapies may select cross-resistant strains to both antibiotics. The resistance of M. hominis to clindamycin, doxycycline, ofloxacin and tetracycline varied between 4% and 12 %. CONCLUSIONS Because none of the strains was sensitive to all examined antibiotics, the antibiotic sensitivity of U. urealyticum and M. hominis strains should be determined. The high rate of ofloxacin, erythromycin and clindamycin resistance should be considered in the therapy of U. urealyticum infections in Hungary. This is the first such a clinical microbiological study in this topic in Hungary.

Primary Syphilis on the Finger

demonstrating Treponema pallidum . Syphilis serology was positive, particularly the rapid plasma reagin (1: 128), confirmed by TPHA ( Treponema pallidum hemagglutination test), as well as the Treponema PCR, taken from the primary ulcer. The patient received HIV counseling; the test was negative. Our diagnosis was secondary syphilis with primary chancre still present. The patient received intramuscular injections of 2.4 million units of benzathine penicillin, weekly for 3 weeks. After the first injection, the patient presented a Herxheimer reaction with fever and shivering. At follow-up visits, 2 weeks ( fig. 1 b) and 4 weeks after starting the treatment, marked recovery of skin symptoms was observed, except for the moth-eaten alopecia. The ulcer healed uneventfully and the growth of nail was undisturbed. A repeated RPR test, 6 months after the treatment, was negative. Tracing for contacts revealed one further undiagnosed case and the source. The male with latent syphilis was treated as well.

Syphilis and HIV coinfection — Hungarian Sexually Transmitted Infection Centre Experience between 2005 and 2013

BACKGROUND STIs like HIV and syphilis are acquired as comorbidities by high risk populations and may influence their original course and prognosis. METHODS Between January of 2005 and 2013 data of syphilis and HIV patients were collected at the Department of Dermatology of Semmelweis University, Budapest. Diagnostic procedures included clinical analysis and screening of serum samples for Treponema pallidum and HIV antibodies. RESULTS A total of 1,401 new syphilitic and 338 new HIV infections were diagnosed. In syphilis patients 86.58% had monoinfection,7.92% already had an HIV infection and 5.5% had acquired syphilis and HIV infection simultaneously, so 22.78% of the new HIV patients acquired the infection with syphilis together. Male gender, MSM (men who had sex with men) orientation and positive past venerological history were dominant in all groups. Most patients were diagnosed in a latent infectious stage based on the result of a serological check-up. Secondary stage and neurosyphilis were more common in coinfections. CONCLUSION (i) male gender, MSM orientation, and positive venerological history are risk factors for acquiring new STIs, (ii) clinical course were different in HIV infected patients, (iii) but their timely and regular check-ups resulted in earlier diagnosis of syphilis, suggesting the necessity for frequent screening.

Sexually transmitted coinfections. HIV coinfections

Coinfections of sexually transmitted infections are frequent due to the same transmission routes which may facilitate the transmission of other sexually transmitted infections. Sexually transmitted coinfections are associated with atypical and generally more severe clinical features, more complications, resistency to treatment, unfavourable outcome, and worse prognosis. Sexually transmitted infections may increase the likelihood of acquiring and transmission of HIV infection. The authors summarize the most important characteristics of sexually transmitted infections (such as HIV and hepatitis B virus, HIV and hepatitis C virus, HIV and syphilis, HIV and gonorrhoeae, HIV and chlamydia coinfections). These infections are more frequent in HIV infected patients than in the normal population. The shared transmission routes, impairment of the immune response, elevated cytokine levels and the associated inflammatory milieu produce local tissue damage, breaches in mucosal epithelium, which increases the risk of human immunodeficiency virus infection. Regular screening for sexually transmitted infections, use of more sensitive diagnostic methods, improved reporting and avoidance of unsafe sexual behaviour among certain subpopulations as well as education are essential in the prevention of sexually transmitted coinfections.

Ureaplasmas: From commensal flora to serious infections

The two existing human pathogen Ureaplasma species containing 14 serovars are associated with a variety of maladies. Colonizing the human urogenital tract, ureaplasmas cause infections mainly in these organs. However, in the special population of immunosuppressed patients or preterm and very low birth weight newborns such serious Ureaplasma infections such as meningitis or pericarditis have been described. Because they lack a cell wall, ureaplasmas are very susceptible to drying and other adverse environmental conditions; therefore, careful attention has to be given to specimen collection and transportation. Commercially available culture based tests made the laboratory diagnosis of Ureaplasma species much easier. PCR methods provide further facilities to get faster diagnosis, simultaneously with serovar identification, quantitation of Ureaplasma or detection of other sexually transmitted infectious pathogens. Although fluoroquinolone, macrolide, and tetracycline resistant strains are known, antibiotic treatment of Ureaplasma infections is not problematic for now. The mechanism of antibiotic resistance has not been entirely understood till now. Biofilm-forming ability of Ureaplasmas can be important in chronic infections and antibiotic resistance. The basic microbiology of Ureaplasma species, such as clinical manifestations, the diagnostic opportunities, and the therapeutic options are reviewed in the current article.

[Analysis of syphilis and gonorrhoea cases, based on data from the National STD Centre, Department of Dermatology and Venerology, Semmelweis University (2005-2008)].

The STD Department of Semmelweis University Budapest is the National Centre of Hungary, which is responsible for screening and care of sexually transmitted diseases (STD), including syphilis and gonorrhoea. 42,114 patients attended the STD Department and 25,362 anonymous screening (HIV: 12,337, syphilis: 13,025) were done between January 2005 and December 2008. During this period 600 syphilitic and 339 gonorrhoea infections were diagnosed. The obligatory HIV screening of patients with sexually transmitted infections (STI) resulted positive result in 47 cases, and 63 patients infected with HIV acquired new syphilitic or gonorrhoea infection. Contact tracing was successful in around 400 syphilis cases, and 150-200 gonorrhoea cases per year. We present our statistical data in order to call attention to the resurgence of syphilis and gonorrhoea and the importance of STD co-infections.

The importance of IgM positivity in laboratory diagnosis of gestational and congenital syphilis

From January 1, 2009 through December 31, 2011, from 33,753 blood samples for syphilis screening, Treponema pallidum infections were confirmed in 241 pregnant women at the Department of Dermatology, Venerology, and Dermatooncology of Semmelweis University Budapest. In this period, four children born to inadequately or untreated women were confirmed to have connatal syphilis. The height of rapid plasma reagin (RPR) titer was measured to determine the stage of the infection and to examine the success of the antilues therapy. The diagnosis of maternal syphilis infection was confirmed with enzyme linked immunosorbent assay (ELISA), T. pallidum particle agglutination (TPPA), and IgG and IgM immunoblots. Maternal IgM immunoblot results identify mothers at risk of delivering babies with connatal syphilis better than the height of maternal RPR titer. The standard serological tests are less useful in newborns because of IgG transfer across the placenta. IgM test which depends on the infants response has more specificity in diagnosing connatal syphilis.

Patients with Syphilis and Gonorrhoea: Analysis of Cases Based on Data (2005-2008) of the National Sexually Transmitted Disease Centre, Department of Dermatology, Venereology and Dermatologic Oncology, Semmelweis University

Abstract In the STD Centre of Hungary at our department, we have been providing care for patients with syphilis, gonorrhoea and other STD infections since 2004. Our STD centre includes a screening station where we perform anonymous screening for HIV and syphilis. Between the 1st of January 2005 and the 31st of December 2008, there were a total of 42,114 patient-doctor encounters. We performed 25,362 screening examinations for HIV and syphilis, in association with a medical visit (HIV: 12,337; syphilis: 13,025). Voluntary screening examinations were performed in 18,883 cases (HIV: 16,614; syphilis: 2,269). During the 4 years, we diagnosed 600 and 339 new cases of syphilis and gonorrhoea, respectively. The obligatory HIV screening of STI patients resulted in a total of 47 new HIV infections, and we diagnosed 63 new infections of syphilis or gonorrhoea among the known HIV-seropositive patients under care. By including the network of care providers in the whole country, we performed successful contact tracing...