First case of human Gongylonema pulchrum infection in Slovenia.

Nematodes of the genus Gongylonema infect a wide range of mammals worldwide but are only sporadically reported in humans. We describe a case of human infection with Gongylonema pulchrum in a 41-year-old man. The patient extracted the nematode from the submucosa under his tongue and correctly self-diagnosed the infection with the help of the Google search engine. In the laboratory, the collected nematode was confirmed as G. pulchrum microscopically by morphological analysis and genetically by amplifying and sequencing the parasite's rDNA. This is the first report of human G. pulchrum infection in Slovenia.

Successful control of the first OXA-48 and/or NDM carbapenemase-producing Klebsiella pneumoniae outbreak in Slovenia 2014-2016.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) occur only sporadically in Slovenia. AIM: To describe the first Slovenian carbapenemase-producing (CP) Klebsiella pneumoniae and Escherichia coli outbreak which occurred at the tertiary teaching hospital University Medical Centre Ljubljana from October 2014 to April 2015. METHODS: A CPE-positive case was defined as any patient infected or colonized with CPE. A strict definition of a contact patient was adopted. Measures to prevent cross-transmission included cohorting of all CPE carriers with strict contact precautions and assignment of dedicated healthcare workers, cohorting of all contact patients until obtaining the result of screening cultures, systematic rectal screening of contact patients, and tagging of all CPE-positive cases and their contacts. Educational campaigns on CPEs were implemented. Clinical specimens were processed using standard procedures. Pulsed-field gel electrophoresis (PFGE) was used to determine relatedness. Multi-locus sequence typing was performed on CP K. pneumoniae isolates that belonged to different pulsotypes. FINDINGS: Before the outbreak was brought under control, 40 patients were colonized or infected with OXA-48 and/or New Delhi metallo-ß-lactamase (NDM)-producing CPE; in 38 patients OXA-48 and/or NDM-producing K. pneumoniae was detected, in seven OXA-48 and/or NDM-producing E. coli was found together with K. pneumoniae, and in two patients only CP E. coli was isolated. The outbreak was oligoclonal with two major CP K. pneumoniae clusters belonging to ST437 and ST147 in epidemiologically linked patients. CONCLUSION: Initial standard control measures failed to prevent the outbreak. Once the problem had been recognized, strict infection control measures and the education of healthcare workers contributed to the successful control of the outbreak.

Hydroxyapatite/gold/arginine: designing the structure to create antibacterial activity.

Antimicrobial peptides, selective antimicrobials able to "recognize" and "target" bacterial cells, are significant advancement in comparison to non-selective antimicrobials widely used in practice. The major problem of this class of macromolecules is, however, a short half-life. Starting from the key physicochemical properties of antibacterial peptides, our intention was to develop their stable analogue. We designed hydroxyapatite/gold/arginine (HAp/Au/arginine) nanocomposite that contains: (i) hydrophobic gold (Au) nanoparticles, (b) positively charged, hydrophilic arginine molecules that functionalize the surface of the Au and (c) hydroxyapatite (HAp) bioactive carrier of the functionalized Au nanoparticles. None of the components used for the formation of the nanocomposite have any influence on bacterial growth; however, its structure with specific chemistry of the surface, which is analogous to that of antibacterial peptides, provides this property. The developed nanocomposite possesses all the beneficial properties of antibacterial peptides and is one step ahead of them as far as stability is concerned. The material follows contact-based mechanism significantly improved in comparison to metabolism-involved mechanism of antibacterial peptides. In comparison to the non-selective HAp/Ag reference, newly-developed material possesses stronger antibacterial action, is more compatible to human cells and can be suggested as safer and more effective replacement of Ag-based antibacterial components in biomaterials.

Two cases of complications of the thrombolysis of right heart free-floating thrombi with pulmonary embolism: important role of echocardiographically based management.

We present two cases where successful thrombolysis of right heart thrombi and pulmonary embolism was accompanied by serious adverse events. In patient 1 with massive pulmonary thromboembolism, transesophageal ultrasound revealed large right atrial thrombus entrapped in a patent foramen ovale. Initial treatment with heparin was substituted with thrombolysis, which resulted in clinical improvement and dissolution of right heart thrombus but was followed by fatal intracerebral haemorrhage. In patient 2, thrombolysis caused mobilisation of thrombotic mass as evidenced by disappearance of thrombus on ultrasound. Massive pulmonary thromboembolism resulted in circulatory collapse. Short cardiopulmonary resuscitation restored spontaneous circulation and the patient recovered completely.

Comparison of erythema migrans caused by Borrelia afzelii and Borrelia garinii.

BACKGROUND: We compared epidemiological and clinical characteristics of patients with erythema migrans (EM) caused by Borrelia afzelii and Borrelia garinii. PATIENTS AND METHODS: 200 consecutive adult patients with B. afzelii isolated from the skin lesion and 53 consecutive adult patients with EM caused by B. garinii qualified for the present study. RESULTS: Comparison of the two groups revealed several distinctions. Patients with EM caused by B. garinii were older, had their skin lesions more often located on the trunk but less often on extremities, had shorter incubation and faster evolution of EM, more often reported associated local and certain systemic symptoms, had abnormal liver function test results more often and were more frequently seropositive. CONCLUSION: Early localized Lyme borreliosis caused by B. afzelii and B. garinii has distinct epidemiological and clinical characteristics. Clinical features of EM depend upon the genospecies of Borrelia burgdorferi sensu lato causing the illness.

Mercury and methylmercury in the Gulf of Trieste (northern Adriatic Sea).

The distribution, sources and fate of mercury (Hg) in the water column of the Gulf of Trieste (northern Adriatic Sea), affected by the Hg polluted river Soca/Isonzo for centuries draining the cinnabar-rich deposits of the Idrija mining district (NW Slovenia), were studied in terms of total and dissolved Hg, reactive Hg, total and dissolved methylmercury (MeHg), mesozooplankton Hg and MeHg, and sedimentation rates of particulate Hg. Higher total Hg concentrations in the surface layer were restricted to the area of the Gulf in front of the river plume expanding in a westerly direction. Higher concentrations in bottom water layers were the consequence of sediment resuspension. Dissolved Hg exhibited higher concentrations in the surface layer in the area in front of the river plume. Higher bottom concentrations of dissolved Hg observed at some stations were probably due to remobilization from sediments, including resuspension and benthic recycling. The relationship between dissolved Hg in the surface layer and salinity showed nonconservative mixing in June 1995 during higher riverine inflow and nearly conservative mixing in September 1995 during lower riverine inflow. Both mixing curves confirm the river Soca/Isonzo to be the most important source of total and dissolved Hg, which are significantly correlated, in the Gulf. Reactive Hg is significantly correlated with dissolved Hg, indicating that the majority of dissolved Hg is reactive and potentially involved in biogeochemical transformations. The higher total MeHg in the bottom layer is the result of remobilization of MeHg from sediments including benthic fluxes. Strong seasonal variation of sedimentation rates of particulate Hg was found during a 2-year study in the central part of the Gulf. These variations followed those of total sedimented matter, indicating that sedimented Hg is mostly associated with inorganic matter. About a 2.5-fold higher fluxes of particulate Hg were observed at the depth of 20 m relative to 10 m which is attributed to bottom sediment resuspension. Temporal variability of mesozooplankton Hg and MeHg is the consequence of biomass and species variations, and grazing behaviour. From the preliminary Hg mass balance it appears that the Gulf is an efficient trap for total Hg and a net source of MeHg.

Certification of the methylmercury content in SRM 2977 mussel tissue (organic contaminants and trace elements) and SRM 1566b oyster tissue.

The methylmercury content in two new marine bivalve mollusk tissue Standard Reference Materials (SRMs) has been certified using results of analyses from the National Institute of Standards and Technology (NIST) and two other laboratories. The certified concentrations of methylmercury were established based on the results from four and six different (independent) analytical methods, respectively, for SRM 1566b Oyster Tissue (13.2 +/- 0.7 microg/kg) and SRM 2977 Mussel Tissue (organic contaminants and trace elements) (36.2 +/- 1.7 microg/kg). The certified concentration of methylmercury in SRM 1566b is among the lowest in any certified reference material (CRM).

Influence of the Sostanj coal-fired thermal power plant on mercury and methyl mercury concentrations in Lake Velenje, Slovenia

Lake Velenje is located in one of the most polluted regions in Slovenia, the Salek Valley. The major source of pollution in the valley is the coal-fired thermal power plant in Sostanj (STPP, capacity 775 MW). It has five separate units. All units have electrostatic precipitators for fly ash removal. Unit 4 also has installed a wet flue gas desulfurisation system (FGD system). Total mercury (THg) concentrations were measured in lignite, slag and ash samples from the STPP. In flue gas, different mercury species (THg, MeHg, Hg2+, Hg0) were determined separately for unit 4 and unit 5 which use different flue gas cleaning technology. Mercury and methyl mercury (MeHg) concentrations were also measured in lake water at different depths, in inflow water, outflow water, rain, snow and lake sediments in order to establish the influence of the power plant on the lake. Most mercury emitted from the power plant is in the elemental form. The ratio between oxidised and elemental Hg depends on the flue gas cleaning technology. Mass balance calculations have been performed for the STPP. The results show that the major sources of mercury in Lake Velenje are wet deposition and lake inflows. Total and MeHg concentrations in the water column are very low and can be compared to other non-contaminated freshwater lakes in the world.

Comparison of the epidemiological and clinical features of tick-borne encephalitis in children and adults.

The aim of this prospective study was to compare epidemiological data and clinical features in children and adults with tick-borne encephalitis (TBE). Patients with aseptic meningitis diagnosed at the University Medical Centre, Department of Infectious Diseases, Ljubljana, Slovenia, from June to August 1997, in whom the diagnosis of TBE was ascertained by the presence of serum IgM antibodies against TBE virus, who were serologically negative for Borrelia burgdorferi sensu lato and had a negative PCR CSF result on enteroviral infection, were included in the study. Out of 213 patients with aseptic meningitis, 80 (37.56%) fulfilled inclusion criteria. There were 20 children and 60 adults. In both groups males predominated. Virtually all patients had headache and fever, and more than 50% suffered from vomiting. The majority of patients in both groups recalled a tick bite, had a biphasic course of the illness, and was found to have obviously expressed meningeal signs. In both groups the median CSF leukocyte count was somewhat lower than 100 x 10(6)/l with a predominance of lymphocytes. Children were more often given antibiotics during the initial phase of TBE than adults (p = 0.0095). Several other statistically significant distinctions (p < 0.05) were found including the frequency of fatigue, malaise, vertigo, photophobia, myalgias, arthralgias, as well as elevated CSF albumin and protein concentration, elevated albumin quotient and IgG quotient; all these findings were more often present in adults. In addition a longer duration of fever, more frequent need for anti-edematous treatment and longer hospitalization were found in adults. Direct comparison of clinical and epidemiological characteristics of TBE in children and adults revealed differences in several clinical and laboratory features and corroborates the previous conclusion that TBE in childhood is a milder illness than TBE in adults.

A methodological study of mercury speciation using dogfish liver CRM (DOLT-2).

The purpose of the study was to optimise analytical methods for determination of the chemical speciation of mercury in studies of protective mechanisms of selenium. Optimisation of the methods was performed using CRM DOLT-2 (Dogfish liver), both in its original form and after separation of various fractions. The sample was homogenised with 10 mM Tris-HCl buffer (pH 7.6) and ultracentrifuged. The soluble phase obtained was applied to a size exclusion chromatography column (Sephadex G-75 column) for separation of various protein fractions. Total mercury (total Hg), monomethyl mercury (MeHg) and selenium (Se) were determined in whole dogfish liver tissue and its soluble and insoluble phases (pellet). Different approaches for determination of total Hg and MeHg were compared. Simultaneous determination of MeHg and inorganic mercury (Hg2+) was based on alkaline dissolution and/or acid leaching, followed by ethylation, room temperature precollection, isothermal gas chromatography (GC), pyrolysis and detection with cold vapour atomic fluorescence spectrometry (CVAFS). The sum of MeHg and Hg2+ was compared to total Hg results obtained by acid digestion and CVAAS detection. The accuracy of MeHg determination was checked by its determination using acid leaching at room temperature, solvent extraction, back extraction into Milli-Q water, ethylation, GC and CVAFS detection. For the insoluble phase it is recommended to use solvent extraction for MeHg and acid digestion CVAAS for total Hg. For determination of MeHg and Hg2+ in the lyophilised sample and water soluble fractions containing low concentrations of mercury species, the simultaneous measurement of MeHg and Hg2+ after alkaline dissolution is the most appropriate method.

Microbial aetiology of community-acquired pneumonia in hospitalised patients.

Adult patients hospitalised with community-acquired pneumonia were studied prospectively to determine the microbial aetiology of pneumonia. Between April 1996 and March 1997, blood and sputum samples were collected for culture. Throat swabs were obtained for isolation of viruses and for detection of antigens of Chlamydia pneumoniae, influenza viruses A and B, respiratory syncytial virus and parainfluenza virus. Antibodies against Legionella spp., Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, Coxiella burnetii, influenza viruses A and B, respiratory syncytial virus, adenovirus and parainfluenza virus were tested in serum samples. Two hundred eleven patients were included in the study; paired sera were available from 152 patients. Blood culture was positive in 23 (10.9%) patients, Streptococcus pneumoniae being the bacterium isolated most frequently. A fourfold or greater rise or fall in the Chlamydia pneumoniae IgG and/or IgM antibody titre was found in 20 (9.5%) patients and a high antibody titre (> or = 1:512) in the first and/or the second serum sample in 18 (18.5%) patients. Antibodies confirming acute Mycoplasma pneumoniae infection were found in 12 (5.7%) patients, Legionella spp. in six (2.8%), Chlamydia psittaci in two and Coxiella burnetii in one. Three patients had pulmonary tuberculosis. Only two patients had a virus present in the throat swab (adenovirus in one patient and echovirus in the other), and in nine patients, viral antigen was detected. Acute viral infection was confirmed in 51 (24.1%) patients. Bacterial pneumonia was diagnosed in 84 (39.8%) patients, 23 of whom had concurrent viral infection. Acute viral pneumonia without any other identified pathogen was diagnosed in 28 patients. Streptococcus pneumoniae and Chlamydia pneumoniae were the most frequently identified microorganisms.

Mercury in contaminated coastal environments; a case study: the Gulf of Trieste.

Some general facts, uncertainties and gaps in current knowledge of Hg cycling in coastal and oceanic environments are given. As a case study the Gulf of Trieste is chosen. The Gulf is subject to substantial Hg pollution, originating from the Soca river, that drains the cinnabar deposits of the world's second largest Hg mining area, Idrija, Slovenia. The Gulf belongs to one of the most polluted areas in the Mediterranean. Apart from Hg problems, the Gulf is also a subject to industrial and sewage pollution. Due to deteriorating water quality in the Gulf there is a great concern that Hg can be remobilized from sediments to the water column as well as enhance methylation rates which may consequently increase already elevated Hg levels in aquatic organisms. The paper presents data from a recent study which aims to assess the extent of contamination of the Gulf of Trieste after the closure of the Hg mine. Mercury and methylmercury were measured in various environmental compartments (estuarine and marine waters, sediments, and organisms) during the period 1995-1997. Data obtained show that even 10 years after closure of the Hg mine, Hg concentrations in river sediments and water are still very high and did not show the expected decrease of Hg in the Gulf of Trieste. A provisional annual mercury mass balance was established for the Gulf of Trieste showing that the major source of inorganic mercury is still the River Soca (Isonzo) while the major source of methylmercury is the bottom sediment of the Gulf.

Has the presence or absence of Borrelia burgdorferi sensu lato as detected by skin culture any influence on the course of erythema migrans?

The aim of this prospective study was to compare epidemiological and clinical data in patients with a positive Borrelia burgdorferi sensu lato culture and culture-negative erythema migrans skin lesions. Of the 546 adult patients with erythema migrans seen at our institution in 1997 in whom a skin biopsy was performed and the specimen cultured for the presence of B. burgdorferi sensu lato, 235 (43%) had a positive and 311 (57%) a negative skin culture. More women than men were present in both groups and women were also significantly older than men. Tick bites resulting in culture-positive erythema migrans predominated in May (p = 0.012), while in August and September tick bites with subsequent culture-negative skin lesions were more common (p = 0.018 and 0.011, respectively). Similarly, erythema migrans lesions noticed by our patients in May were significantly more often Borrelia culture positive than negative (p = 0.004), while lesions appearing in October were significantly more often culture negative (p = 0.004). In addition to these seasonal differences, the comparison of the large number of Borrelia skin culture-positive and -negative patients with erythema migrans also revealed differences in several clinical parameters including a larger diameter of skin lesions in the culture-positive group (p = 0.007 at presentation, and p = 0.039 at registration, respectively), a lesser number of multiple skin lesions (7/235 versus 27/311, p = 0.006), and a lower frequency of signs/symptoms (p = 0.039) associated with erythema migrans lesions in culture-positive than in culture-negative patients. We have no plausible explanation for the majority of these rather unexpected findings. Of the 59 patients who, prior to biopsy, had received brief courses of antibiotics known to be effective in the treatment of erythema migrans, 12 (20.3%) were culture positive. As anticipated, the ratio of culture positivity in pretreated patients was significantly lower (p < 0.001) than in those without antecedent antibiotic therapy.

Lyme borreliosis and peripheral facial palsy.

From 1994 to 1996, 114 consecutive patients older than 15 years who presented at the Department of Infectious Diseases, University Medical Centre, Ljubljana, fulfilled the criteria for inclusion into this study on the borrelial aetiology of peripheral facial palsy (PFP). The study was restricted to patients without a conceivable explanation for their PFP, erythema migrans or history of erythema migrans, clinical signs/symptoms of frank meningitis or any other neurological manifestation in addition to PFP. In 22 (19.3%) of these 114 patients borrelial infection was confirmed by one of the following: in 3 (13.6%) by the isolation of Borrelia burgdorferi sensu lato from cerebrospinal fluid (CSF), in 11 (50%) by the presence of intrathecal antibody production, and in 8 (36.4%) by seroconversion to borrelial antigens. Additional 20 (17.5%) patients interpreted as having had a probable borrelial infection, had positive (> or = 1:256) IFA IgM and/or IgG borrelial serum antibody titres, and in 9 (7.9%) patients borderline borrelial antibody titres (1:128) were found (interpreted as a possible infection). In 63 (55.3%) patients the serological tests remained negative. Lymphocytic pleocytosis was found at the first visit in 12/22 (54.5%) patients with confirmed borrelial infection, in 3/20 (15%) with probable infection, in 1/9 (11.1%) with possible infection, and in 10/63 (15.9%) patients with symptoms of unknown aetiology. Patients with confirmed borrelial infection had abnormal CSF findings significantly more often than did patients with symptoms of unknown aetiology (p = 0.0139 for lymphocytic pleocytosis and/or elevated CSF protein levels, and p = 0.0010 for lymphocytic pleocytosis). Local and systemic signs/-symptoms were also more common in patients with confirmed borrelial infection than in those with an symptoms of unknown aetiology (p = 0.0258). In Slovenia which is a highly endemic region for Lyme borreliosis, borrelial infection is a frequent cause of PFP in adult patients. PFP may occur early in the course of LB, prior to measurable antibody response, indicating the need for serologic follow-up. Abnormal CSF results and the presence of additional local and/or systemic symptoms are factors indicating a higher possibility of borrelial aetiology of PFP and should alert physicians to suspect LB.

An unusual lawn mower injury.

The authors report a case of foot trauma produced by a piece of the lawn mower blade, which was fired projectile-wise from the machine while it was in operation. At hit the calcaneous and remained trapped in the bone. The wound healed after removal of the foreign body, wound debridement and systemic and local antibiotic prophylaxis. In the professional literature available, no report has been found on a missile injury produced by a piece of rotating lawn mower knife.