Leo Markovinović

Adenovirus respiratory infections in hospitalized children: clinical findings in relation to species and serotypes.

Background: There are >50 adenovirus (ADV) serotypes that are divided into 7 species (A–G). The aim of this study was to characterize ADV serotypes and species in hospitalized infants and children in the City of Zagreb and Zagreb County and to describe clinical features and laboratory findings of ADV infections according to the causative ADV serotype. Methods: During the 3-year period from January 2006 to November 2008, 135 children (<10 years of age) with ADV respiratory infection, based on virus isolation, were treated at 2 hospitals in Zagreb. Demographics, clinical presentations and laboratory findings were evaluated. Results: Of the 135 ADV isolates, 77 (57.0%) were type 2, followed by 26 (19.3%) of type 1, 15 (11.1%) isolates of type 3, 2 (1.5%) of type 6 and only 1 (0.7%) was type 7. Male-to-female ratio was 3.2:1 (103 boys and 32 girls). The mean age was 22.9 months. The most common symptoms were fever (98%), rhinorrhea (89%) and cough (71%). The mean peak body temperature was 39.8°C. Tonsillitis was present in 79 (59%) and acute otitis media in 37 (28%) patients. Leukocytosis (>15.0 × 109/L) was noted in 103 (77%) patients. Serum C-reactive protein was >40 mg/L in 74 patients (56%). The erythrocyte sedimentation rate was ≥30 mm/h in 91 (71%) of the 127 patients tested. Conclusions: In this study, the most common isolated serotype was ADV type 2. Most affected children were younger than 3 years. ADV infections in young children can present with prolonged fever, leukocytosis and significantly elevated C-reactive protein and erythrocyte sedimentation rate, mimicking bacterial infections.

Comparative Randomized Pilot Study of Azithromycin and Doxycycline Efficacy and Tolerability in the Treatment of Prostate Infection Caused by Ureaplasma urealyticum

A total of 1,442 patients with symptoms of chronic prostatitis were examined over a 4-year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia. The inclusion criteria for chronic prostatitis caused by Ureaplasma urealyticum were the presence of clinical symptoms, presence of U. urealyticum in expressed prostatic secretion (EPS) or voided urine collected immediately after prostatic massage (VB3), absence of U. urealyticum in urethral swabs and absence of other possible pathogens of chronic prostatitis in EPS or VB3. A total of 63 patients with prostate infection caused by U. urealyticum were available for this pilot study. The patients were randomized according to a computer randomization list to receive a total dose of 4.5 g of azithromycin given as a 3-day therapy of 1 × 500 mg weekly for 3 weeks or doxycyline 100 mg b.i.d. for 21 days. Patients’ sexual partners were treated at the same time. Clinical efficacy and tolerability of the administered drug as well as possible adverse events were evaluated during, at the end and 4–6 weeks after completion of therapy. Bacteriological efficacy was evaluated 4–6 weeks after completion of therapy. Treatment groups did not differ regarding age, distribution of urethral, prostatic, sexual and other symptoms, or digitorectal prostatic examination. Five patients treated with doxycycline had nausea. In the group of patients with prostate infection caused by U. urealyticum, the eradication rate was not significantly different with regard to the administered azithromycin (25/32) or doxycycline (23/31). Clinical cure did not significantly differ with regard to the administered azithromycin (22/32) or doxycycline (21/31).

Azithromycin in the treatment of chronic prostatitis caused by Chlamydia trachomatis.

Chlamydia trachomatis is the most common bacterial pathogen of sexually transmitted diseases. It causes 30-50% of nongonococcal urethritis and is the most frequent pathogen of epididymitis in males up to 35 years of age 1. However, how often C. trachomatis causes chronic prostatitis and what the best therapeutic regimen is for the treatment of prostatitis chlamydial infections are still open to debate 2. We determined the frequency of chlamydial prostatitis and investigated the efficacy of azithromycin in the treatment of prostatitis chlamydial infections between March 1, 1999 and February 28, 2001, at the Outpatient Department for Urogenital Infections of the University Hospital for Infectious Diseases “Dr Fran Mihaljevic” Zagreb, Croatia. We examined a total of 388 patients with symptoms of chronic prostatitis and inflammatory material in expressed prostatic secretion or in urine sample collected immediately after prostatic massage. In all patients, the presence of leukocytes, bacteria, vaginal trichomonas and urogenital mycoplasma was analyzed in urethral swab Journal of Chemotherapy Vol. 13 n. 5 (664-665) 2001

The significance of Chlamydia trachomatis in urethritis and prostatitis - differences in therapeutic approach - Croatian experience.

Abstract We examined a total of 1014 patients over 18 years of age; 252 with urethritis and 762 with chronic prostatitis syndrome. The mean age of patients with urethritis was 32.7 and with prostatitis syndrome 37.6 years. Clinical symptoms of urethritis were present from a few days to several months. In patients with chronic prostatitis syndrome, symptoms were present for at least 3 months. Chlamydia trachomatis alone was confirmed in 26 (10%) and in combination with Ureaplasma urealyticum in 6 (2%) patients with urethritis. in 171 (68%) patients with urethritis neither C. trachomatis nor U. urealyticum or Mycoplasma hominis were found. C. trachomatis alone was confirmed in 70 (9%), and in combination with other microorganisms in 7 (1%) patients with chronic prostatitis syndrome. In Croatia, the frequency of chronic chlamydial prostatitis has not significantly changed in the last 10 years, while the frequency of infections among adolescents decreased. the recommended regimen for acute chlamydial urethritis in Croatia is azithromycin 1.0 g as a single dose, and a total dose of 4-4.5 g azithromycin for chronic chlamydial prostatitis.

The role of chlamydia trachomatis in the etiology of chronic prostatitis

INTRODUCTION & OBJECTIVES: Basic factors for the classification of prostatitis syndrome are clinical symptoms and signs and the presence of bacteria and leukocytes in selectively collected urine samples and in EPS by Meares and Stamey localisation technique. The aim of this study was to investigate the etiology of chronic bacterial prostatitis and inflammatory chronic pelvis pain syndrome i.e. nonbacterial prostatitis. MATERIALS & METHODS: We examined a total of 388 patients, older than 18 years of age, with symptoms of chronic prostatitis. The inclusion criteria for chronic bacterial prostatitis was as follows: - a bacterial count of 103 cfu/ml or more (if only Gram-positive cocci are found in EPS, a bacterial count of 10 x 104 cfu/ml or more is required), and 10 or more WBCs/hpf (including macrophages) in EPS or VB3 -finding of 10 or many times greater number of bacteria in EPS and urine bladder sample collected immediately after prostatic massage, than in first voided urine or midstream urine. The inclusion criteria for Chlamydia trachomatis prostatitis was the presence of 10 or more WBCs/hpf in EPS or VB3, the presence of Chlamydia trachomatis in EPS or VB3, absence of Chlamydia trachomatis in urethral swabs and other possible pathogens of chronic prostatitis in VB1, VB2, EPS or VB3. The inclusion criteria for nonbacterial prostatitis or inflammatory chronic pelvis pain syndrome was the isolation of Ureaplasma urealyticum, Mycoplasma hominis or Trichomonas vaginalis and 10 or more WBCs/hpf in EPS of VB3. RESULTS: Disease etiology was determined in 276 (71, 13%) patients. Chlamydia trachomatis was proved to be causative in 109 patients, Trichomonas vaginalis in 52, Escherichia coli in 26, Enterococcus in 25, Proteus mirabilis in 14, Klebsiella pneumoniae in 6, Streptococcus agalactiae in 8, Ureaplasma urealyticum in 7patients with chronic prostatitis. Other patients with had mixed infection. CONCLUSION: Chlamydia trachomatis was proved to be the causative pathogen in one third of patients with chronic prostatitis. Since Chlamydia trachomatis is a bacterium, chlamydial prostatic infection should be defined as chronic bacterial prostatitis.