Višnja Škerk

Urinary tract infections in HIV disease.

HIV-positive patients are liable to acquire opportunistic infections. Their liability to acquire other common infectious conditions is less frequently reported. In order to determine the frequency of urinary tract infections (UTI) in HIV-positive patients, we performed a retrospective analysis. The control group was formed from patients with community acquired pneumonia. We reviewed charts of 96 HIV-positive patients and of 314 patients in the control study group. The analysis has shown that patients with HIV had a UTI more frequently than the controls. Besides the difference in the frequency, we observed the difference in the etiology. Enterococci were the most frequent isolates in patients with HIV disease, whereas Escherichia coli was most frequently isolated in the controls. These facts should be taken into consideration when treatment of a UTI with suspected bacteremia in AIDS patients is initiated.

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).

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.

Serum levels of metalloproteinases and their inhibitors during infection with pathogens having integrin receptor-mediated cellular entry

Abstract Background: Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes with numerous roles in the normal immune response to infection. However, excess MMP activity following infection may lead to immunopathological processes that cause tissue damage. Their activity in normal tissues is subject to tight control, which is regulated by its specific endogenous tissue inhibitors (TIMPs). It is known that MMPs bind to cell surface proteins (e.g. integrins) and that such interactions can have modulatory effects on MMP functionality. The objective of this study was to determine whether there are differences in MMP and TIMP production during the acute phase of infection with different pathogens that use β-integrins as their receptors for cell entry. Methods: We measured the total amounts of soluble MMP-2, MMP-9, TIMP-1, and TIMP-2 in the sera from patients infected with Dobrava virus (DOBV), Coxiella burnetii, or uropathogenic Escherichia coli. Statistical analyses were used to correlate MMP/TIMP serum levels with different clinical laboratory parameters. Results: The results showed that both of the bacterial infections generally manifested the stronger effect on MMP production, while in contrast, viral infection introduced stronger changes to metalloproteinase inhibitors. MMPs and TIMPs were significantly correlated with some of the clinical laboratory parameters in both bacterial infections, but no correlations were found for DOBV infection. Conclusions: These findings suggest diverse mechanisms by which MMP activity could be implicated in the pathology of these 2 bacterial infections versus the viral DOBV infection, despite the type of their cellular entry receptors.

Metronidazole 1.5 gram dose for 7 or 14 days in the treatment of patients with chronic prostatitis caused by Trichomonas vaginalis : A randomized study

Corresponding author: Prof Višnja Škerk, MD, PhD, University Hospital for infectious Diseases „Dr. Fran Mihaljevich”, Mirogojska 8, 10 000 Zagreb, Croatia. Tel: ++385 1 2826 222; Fax: ++385 1 2826 471; e-mail: vskerk@bfm.hr clinical status including digitorectal prostatic examination, urethral swab specimens and selective samples of urine, VB1, VB2, VB3 and EPs, according to the 4-glass localization test (Meares and stamey’s localization technique). Urethral swab specimens, EPs and VB3 were examined for the presence of TV, Ureaplasma urealyticum, Mycoplasma hominis and Chlamydia trachomatis. Quantitative segmented cultures and bacterial identification as well as the presence of leukocytes in three voided bladder urine samples and EPs were performed at the Laboratory for Clinical Microbiology of the University Hospital for infectious Diseases “Dr. Fran Mihaljevich”, Zagreb, Croatia, using standard microbiological methods. Diagnosis of TV was confirmed by microscope examination and by culture on Diamond modified medium. C. trachomatis was proven by Hybrid Capture CT-iD DnA Test, version 2.0 (Digene, Gaithersburg, UsA). The diagnosis of urogenital mycoplasma was confirmed by semiquantitative culturing and antimicrobial susceptibility test Mycoplasma duo and s.i.R. Mycoplasma test (Bio Rad Laboratories). A total of 61 patients were included in the study. The mean age of patients was 31±7 years. Patients were randomized to receive metronidazole 3x500 mg orally for 7 days or 3x500 mg orally for 14 days. Female sexual partners were treated with a single dose of 2,0 g metronidazole. 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 according to patients’ responses to earlier and/or new clinical symptoms, clinical examination, including digitorectal prostatic examination and if necessary laboratory blood tests. Bacteriological efficacy of administered drug was evaluated 4-6 weeks after completion of therapy using microbiological methods identical to those used during study enrollment. Clinical response definitions: Cure: complete or incomplete resolution of urethral, prostatic or sexual symptoms, no need for additional therapy. Failure: no apparent response or progression of urethral, prostatic or sexual symptoms, or additional antibiotic therapy needed. Bacteriological response definitions: eradication: eradication of TV at the posttreatment visit. persistence: persistence of TV at the post-treatment visit. statistical significance of observed differences between the two treatment groups was assessed by Yates corrected chisquare test or Fisher’s exact test when appropriate. A total of 8 patients in each treatment group had nausea. Evaluation of clinical and bacteriological efficacy of administrated metronidazole is shown in table 1. in the group of patients with chronic prostatitis caused by TV, a significantly higher percentage of pathogen eradication (p=0.043) and a

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.

Detection of sexually transmitted pathogens in patients with chronic prostatitis/chronic pelvic pain: a prospective clinical study:

In <10% of patients with prostatitis syndrome, a causative uropathogenic organism can be detected. It has been shown that certain organisms that cause sexually transmitted infections can also cause chronic bacterial prostatitis, which can be hard to diagnose and treat appropriately because prostatic samples obtained by prostatic massage are not routinely tested to detect them. We conducted a clinical study to determine the prevalence of Chlamydia, mycoplasma, and trichomonas infection in 254 patients that were previously diagnosed and treated for chronic prostatitis/chronic pelvic pain syndrome due to negative urethral swab, urine, and prostate samples. Urethral swabs and standard Meares–Stamey four-glass tests were done. Detailed microbiological analysis was conducted to detect the above organisms. Thirty-five (13.8%) patients had positive expressed prostatic secretions/VB3 samples, of which 22 (10.1%) were sexually transmitted organisms that were not detected on previous tests.

Septic abortion caused by Campylobacter jejuni bacteraemia.

A 20-year-old female patient, 14 weeks pregnant, was admitted to hospital with anamnestic and clinical features of acute pyelonephritis. Clinical signs of septic abortion developed and after obstetric examination the therapy was changed to ampicillin, gentamicin and clindamycin. Campylobacter jejuni was isolated from blood cultures. Pathohistological findings confirmed diagnosis of purulent chorioamnionitis. After 2 weeks of ciprofloxacin administration the patient fully recovered. Campylobacter jejuni was not isolated from stool culture and no signs of acute enteritis were registered during the illness. Invasive forms of Campylobacter disease without enteritis are not unusual in immunocompromised hosts but they are restricted to C. fetus rather than C. jejuni isolates.