ABSTRACT
Since 2003, a rising incidence of Clostridium difficile infection (CDI) in North America and Europe has coincided with outbreaks of C. difficile PCR ribotype 027. This ribotype was not observed in Poland until 2008. In the period 2008-2010, outbreaks of antibiotic-associated diarrhoea occurred in three different hospitals in Poland. Of 30 C. difficile isolates available for microbiological characterisation, 17 (56%) were positive for binary toxin genes and belonged to PCR ribotype 027 (n = 7) and its closely related PCR ribotype 176 (n = 10). All 17 binary toxin-positive C. difficile strains demonstrated high-level resistance to fluoroquinolones (minimum inhibitory concentration (MIC) ≥ 32 mg/L), including ciprofloxacin, gatifloxacin, and moxifloxacin, as well as erythromycin and clindamycin (MIC ≥ 256 mg/L for both). Of 14 patients from whom clinical information was available, 50% had a severe form of CDI, defined by fever (>38.5 °C), decreased kidney function, and high leucocyte count. We conclude that outbreaks of CDI associated with hypervirulent strains belonging to PCR ribotypes 027 and 176 occurred in hospitals in Poland. Further studies evaluating the clinical impact of type 176 are urgently needed.
Subject(s)
Clostridioides difficile/classification , Clostridium Infections/epidemiology , Cross Infection/epidemiology , Diarrhea/epidemiology , Disease Outbreaks , Polymerase Chain Reaction , Ribotyping , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Bacterial Toxins/genetics , Clostridioides difficile/genetics , Clostridioides difficile/isolation & purification , Clostridium Infections/microbiology , Cross Infection/microbiology , Diarrhea/microbiology , Drug Resistance, Bacterial , Female , Hospitals , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Molecular Epidemiology , Poland/epidemiologyABSTRACT
Elevated levels of cardiac troponins are an established method of diagnosis of heart muscle necrosis. A case of a long distance amateur-marathon runner, who showed significant elevation of plasma troponin I after extreme physical effort is reported. The diagnostic examinations did not reveal atherosclerosis burden, but myocardial bridging of coronary artery. The authors describe the significance of the pathology in the view of extreme sport effort performed by the described patient.
Subject(s)
Myocardial Bridging/diagnosis , Myocardial Bridging/physiopathology , Running/physiology , Troponin I/blood , Adult , Exercise Test , Humans , Male , Myocardial Bridging/blood , Troponin/bloodABSTRACT
The study presents the case of a 78-year-old woman with recurrent pulmonary embolism, treated with 2 courses of thrombolysis. In this patient, due to heparin-induced thrombocytopenia, fondaparinux therapy was used.
