Vedrana Škerk

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).

Electrocardiographic changes in hospitalized patients with leptospirosis over a 10-year period.

Summary Background The aim of this study was to investigate the incidence and type of ECG changes in patients with leptospirosis regardless of clinical evidence of cardiac involvement. Material/Methods A total of 97 patients with serologically confirmed leptospirosis treated at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević‟ in Zagreb, Croatia, were included in this retrospective study. A 12-lead resting ECG was routinely performed in the first 2 days after hospital admission. Thorough past and current medical history was obtained, and careful physical examination and laboratory tests were performed. Results Abnormal ECG findings were found in 56 of 97 (58%) patients. Patients with abnormal ECG had significantly elevated values of bilirubin and alanine aminotransferase, lower values of potassium and lower number of platelets, as well as more frequently recorded abnormal chest x-ray. Non-specific ventricular repolarization disturbances were the most common abnormal ECG finding. Other recorded ECG abnormalities were sinus tachycardia, right branch conduction disturbances, low voltage of the QRS complex in standard limb leads, supraventricular and ventricular extrasystoles, intraventricular conduction disturbances, atrioventricular block first-degree and atrial fibrillation. Myopericarditis was identified in 4 patients. Regardless of ECG changes, the most commonly detected infection was with Leptospira interrogans serovar Australis, Leptospira interrogans serovar Saxkoebing and Leptospira kirschneri serovar Grippotyphosa. Conclusions The ECG abnormalities are common at the beginning of disease and are possibly caused by the direct effect of leptospires or are the non-specific result of a febrile infection and metabolic and electrolyte abnormalities. New studies are required for better understanding of the mechanism of ECG alterations in leptospirosis.

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.

Ureaplasma urealyticum and Mycoplasma hominis susceptibility to antimicrobial agents.

Ureaplasma urealyticum and Mycoplasma hominis are causally linked to urethritis, prostatitis, epididymitis, urethral syndrome, cervicitis, urolithiasis, complications in pregnancy, infertility, reactive arthritis and serious infections in newborns and immunocompromised host. Susceptibility testing of U. urealyticum and M. hominis is necessary, because it enables adequate antimicrobial treatment. The aim of this study was to determine the susceptibility of U. urealyticum and M. hominis to erythromycin, doxycycline, tetracycline, ofloxacin and clindamycin.

The clinical significance of Ureaplasma urealyticum in chronic prostatitis.

The role of Ureaplasma urealyticum in bacterial prostatitis has not been completely clarified and there are no widely accepted criteria for defining prostatitis caused by these or other infrequently isolated pathogens. However, Ureaplasma urealyticum and other unusual pathogens found in expressed prostatic secretion (EPS)/urine voided immediately after prostatic massage (VB3) of some patients cannot be ignored. Also, Ureaplasma urealyticum found in EPS and VB3 has also been brought into connection to genesis of urolithiasis, infertility and Reiters syndrome. The aim of this prospective study was to investigate the role of Ureaplasma urealyticum in chronic prostatitis.

Diagnosis and treatment of chronic prostatitis caused by Chlamydia trachomatis.

Chlamydia trachomatis is the most common bacterial pathogen of sexually transmitted disease causing acute and chronic, recurrent and persistent urogenital infections, as well as acute and chronic bacterial prostatitis 1,2. The aim of this prospective study was: to compare two diagnostic methods: McCoy culture including immunofluorescent typing with monoclonal antibodies and DNA/RNA Digene hybridization method to prove C. trachomatis in expressed prostatic secretion (EPS) or voided bladder urine collected immediately after prostatic massage (VB3); to compare clinical and bacteriological efficacy as well as tolerability of administered drug 4-6 weeks and 6 months after completion of therapy. This study was conducted at the Outpatient Department for Urogenital Infections and Sexually Transmitted Diseases, University Hospital for Infectious Diseases “Dr Fran Mihaljevic h” Zagreb, Croatia between January 1, 2004 and June 30, 2004. In that period we prospectively investigated a total of 291 patients over 18 years of age with chronic prostate infection caused by C. trachomatis. The Ethics Committee of the University Hospital for Infectious Diseases “Dr Fran Mihaljevic h” Zagreb approved the study. The following data were obtained for each of a total of 291 patients: medical history, clinical status including digitorectal prostatic examination, urethral swab specimens, VB1 (first voided urine), VB2 (midstream urine), EPS (expressed prostatic secretion) and VB3 (voided bladder urine collected immediately Journal of Chemotherapy Vol. 17 n. 5 (570-571) 2005

Comparison of Clinical Symptoms Scored According to the National Institutes of Health Chronic Prostatitis Symptoms Index and Assessment of Antimicrobial Treatment in Patients with Chronic Prostatitis Syndrome

Abstract We examined a total of 194 patients over 18 years of age with chronic prostatitis syndrome and no evidence of structural or functional lower genitourinary tract abnor-malities. the following data were obtained for each patient: clinical history - the severity of chronic prostatitis symptoms scored by a Croatian translation of the NIH CPSI questionnaire, clinical status including digitorectal examination, urethral swab specimens, and selective samples of urine and expressed prostatic secretion, according to the 4-glass localization test (meares and Stamey localization technique). Patients were treated orally with antimicrobial agents in doses and duration according to clinical practice in Croatia. An infectious etiology was determined in 169 (87%) patients. Chlamydia trachomatis was the causative pathogen in 38 (20%) Tri-chomonas vaginalis in 35 (18%) Enterococcusin 36 (19%) and Escherichia coli in 35 (18%) patients. in the remaining 25 patients the following causative pathogens were found: Ureaplasma urealyticum, Proteus mirabilis, Klebsiella pneumoniae, Streptococcus agalactiae and Pseudomonas aeruginosa. Comparison of symptoms scores and effect on quality of life has shown that the most severe clinical presentation of disease was recorded in patients with chronic bacterial prostatitis caused by E. coli and Enterococcus(p<0.001). Clinical success was paralleled by bacteriological eradication in chronic bacterial prostatitis caused by C. trachomatis, Enterococcus and E. coli (kappa >0.2<0.5), but not in inflammatory chronic pelvic pain syndrome caused by T. vaginalis.

The significance of Chlamydia trachomatis in prostatitis syndrome

Abstract Research and publication expenses were supported in part by the Croatian Science Foundation and PLIVA Croatia Ltd. (project no. 04/30 ‘Research on the aetiology, epidemiology, diagnostics, and treatment of patients with prostatitis syndrome’).

The association of ventricular tachycardia and endothelial dysfunction in the setting of acute myocardial infarction with ST elevation

Background Ventricular tachycardia (VT) is frequently seen in ischemic settings like acute myocardial infarction with ST segment elevation (STEMI). Endothelial dysfunction (ED) represents inflammation and the loss of all protective features of the endothelium. We aimed to examine the association between VT and ED in patients with STEMI. Material/Methods The study included 90 subjects (30 with VT and acute STEMI, 30 with STEMI without VT, and 30 controls). Sera of all subjects were tested on ED markers by enzyme immunoassay: sICAM-1 (intracellular adhesive molecule-1), sVCAM-1 (vascular adhesive molecule-1), P- and E-selectins, and VEGF (vascular endothelial growth factor). In addition, CRP (C-reactive protein) was detected. Results Significantly increased values of low-density lipoprotein, triglycerides, leukocytes, creatinine, and the number of cigarettes smoked were observed among patients with VT+STEMI in comparison to controls. The levels of E-selectin were significantly lower in the VT+STEMI group than in the other groups, while the levels of VCAM-1 were significantly higher in the groups with STEMI and VT+STEMI compared to the controls. Lower levels of VEGF were recorded in STEMI and VT+STEMI groups compared to the control group. A significant correlation between CRP and VCAM-1 in patients with VT +STEMI was demonstrated. Conclusions We showed that ED may have a role in the immunopathogenesis of VT in patients with STEMI. The role of sE-selectin and correlation of sVCAM-1 with CRP as possible ED predictive markers in patients with VT+STEMI should be further investigated in a large cohort of patients.