BIMONTHLY JOURNAL OF THE HELLENIC MICROBIOLOGY SOCIETY

55 6, - 2010
VOL. 55 ISSUE 6, November - December 2010

Official Publication of the Hellenic Microbiology Society

ISSN 0438-9573


BIMONTHLY JOURNAL OF THE HELLENIC MICROBIOLOGY SOCIETY
/ Editors
. , . / C. Tzanetou, G. Vrioni

ISSN 0438-9573

/ Scientific Advisory Board

2009-2011

/ President
. / A. Tsakris

/ Vice President
. / E. Kouskouni

/ Secretary General
. - / E. Trikka-Graphakos

/ Secretary
. / K. Tzanetou

/ Treasurer
. / G. Vrioni

/ Members
. / G. Katsanis
. / D. Petropoulou

. / E. Anastasiou
. - / M. Arvanitidou-Vagiona
. / G. Arsenis
N. - / N. Vavatsi-Christaki
. / N. Vakalis
. - / M. Varla-Lefterioti
. / A. Vatopoulos
. / E. Vogiatzakis
. / A. Vogiatzi
. / M. Georgiakaki
E. - / E. Diza-Mataftsi
. / G. Driva
. / E. Zervou
. - / K. Themeli-Digalaki
. / Th. Theodoridis
. / A. Iniotaki
. / C. Kalergi
. / A. Kansouzidou
. / P. Karaboyia
. / S. Kartali
. / G. Katsanis
. / V. Kapsimali
. / G. Kouppari
. / E. Kouskouni
. / C. Koutsia
. / T. Kremastinou
. - / A. Kostoula-Tsiara
. - / S. Levidiotou-Stefanou
. / E. Lebessi

. - / E. Malamou-Lada
. / N. Malissiovas
. / G. Margariti
. / G. Maropoulos
. / A. Mavridis
. / A. Mentis
. - / A. Mitroussia-Ziouva
. / C. Nikolaou
. / . Dalamaga
. / A. Pagali
. / A. Papa
. / C. Papadopoulou
. / J. Papaparaskevas
. / C. Papasteriadi
. / E. Paraskaki
. / P. Paraskevopoulou
. / D. Petropoulou
. / E. Piperaki
. / S. Pournaras
. / N. Spanakis
I. / I. Spiliopoulou
. / F. Paliogianni
. / E. Papadogeorgaki
. - / E. Trikka-Graphakos
. / A. Tsakris
. - / A. Tseleni-Kotsovili
. / E. Fakiri
. / A. Flemetakis
. / H. Choremi

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OBITUARY

447

Antigoni Emmanouilidou-Arseni
G. Vrioni

EDITORIAL
Ifakara-Tanzania;

2nd

449

Seminar on Tropical and Travel Medicine,

summer 2009
M. Drogari-Apiranthitou

REVIEW

453

The neglected tropical diseases: old acquaintances - new data

M. Drogari-Apiranthitou

REVIEW

461

Contents

Nontuberculous (atypical) mycobacterial keratitis following refractive

surgery with laser in situ keratosmileusis
(LASIK)

444

I. Chatziralli, G. Vrioni

REVIEW

469

Human Bocavirus; a newly identified respiratory virus

A. Kourti, E. T. Piperaki, N. Spanakis

REVIEW

477

Progress and challenges in the laboratory diagnosis of Toxoplasma

gondii infection
A. Kansouzidou-Kanakoudi

CASE REPORT

489

Isolation of an oxygen resistant Clostridium tertium in peritoneal fluid in a patient with gangrenous cholocystitis: a case report
I. Petraki, V. Souniadis, I. Daniil, N. Rekliti, V. Karabas, M. Kimouli, G. Vrioni,
S. Pinis, D. Petropoulou

CASE REPORT

495

Ultrasound guided Fine Needle Aspiration (FNA-C) of liver's echinococcal cyst

in a patient with negative anti-echinococcus antibody test results:
case report
M. Fotou, M. Economou, D. Drouveli, C. Tsiamis, M. Pirounaki, A. Moulakakis,
M. Toutouza-Yiotsa

HISTORY OF MICROBIOLOGY

501

The microbiologic control of water supply network of Athens

during the Inter-War period
C. Tsiamis, G. Vrioni

THANKSGIVINGS

512

LITERATURE REVIEW

513

CONGRESSES

523

447

-
.

- .

449

,
2009
. -

453

: -
. -

461

. , .

469

BOCA-:
. , .. , .

477

. -

489

Clostridium tertium
:

445

. , . , . , . , . , . , . ,
. , .

495

(FNA-C)

:
. , . , . , . , . , . ,
. -

Contents

()
laser
in situ keratosmileusis (LASIK)

501

. , .

512

513

523

. ,1 P. G. Koehler,2 R. Connelly3
1Department

of Entomology, University of Florida, Bldg. 970, Natural Area Drive, Gainesville,

FL, 32611-0620, USA
2Florida Medical Entomology Laboratory, 200 9th Street SE, Vero Beach, FL, 32962, USA

, & , , ,
Philip G. Koehler, & , ,
,
Roxanne Connelly, & ,
(Florida Medical Entomology Laboratory - FMEL), ,

.
.
,
() , () .
Y

I ,
, .

Alexandra Chaskopoulou
Department of Entomology,
University of Florida, Bldg. 970,
Natural Area Drive, Gainesville,
FL, 32611-0620, USA
. 001- 352-3288717
e-mail: andahask@ufl.edu

55 4, - 2010

291
291

. , P. G. KOEHLER, R. CONNELLY

292

(: Flaviviridae), ,

, 2010 , 1936

. , ,
, ,
, , .
1/150
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(.. , , ,
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Culex
(>15.000 Culex !)
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, 2010). 2 Culex
Anopheles
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.

1. Culex
"".

VOL. 55 ISSUE 4, July - August 2010

1996-97 , .
K >500 .
= 10% .
1999 - Queens, .
K 61 .
= 7 .



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??????
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????????????
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Blastocystis
sp.

2.
( 2010).

Centers of Disease Control and

Prevention (CDC)
1.256
239 . ,
2010 30.000 1.179 .
2004 - .
K 779 .
= 28 .
2005 - .
K 880 .
= 19 .

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55 4, - 2010

293

. , P. G. KOEHLER, R. CONNELLY

, ,
.

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, ,
.

Summary
West Nile Fever / Encephalitis: how to interrupt the disease by
effectively controlling the vector
294

A. Chaskopoulou,1 P. G. Koehler,1 R. Connelly2

1Department

of Entomology, University of Florida, Bldg. 970, Natural Area Drive, Gainesville,

FL, 32611-0620, USA
2Florida Medical Entomology Laboratory, 200 9th Street SE, Vero Beach, FL, 32962, USA

West Nile Virus (WNV) is transmitted to humans through the bite of an infected mosquito and can
cause serious clinical conditions. Integrated Mosquito Management programs are the optimum
way to protect the people from the pestiferous, disease-carrying insects. Research has shown that
in the case of a disease epidemic the most effective emergency response to suppress WNV infected mosquitoes and interrupt the disease transmission is aerial adulticiding.
Key words

West Nile virus, control measures, adulticide.

1. Carney RM, Husted S, Jean C, Glaser C, Kramer V. Efficacy of aerial spraying

of mosquito adulticide in reducing incidence of West Nile Virus, California,
2005. Emerg Infect Dis 2008; 14:747-754.
2. Lothrop HD, Lothrop BB, Gomsi DE, Reisen WK. Intensive early season adulticide applications decrease arbovirus transmission throughout the Coachella Valley, Riverside County, California. Vector Borne Zoonotic Dis 2008; 8:475-489.

VOL. 55 ISSUE 4, July - August 2010


Ureaplasma urealyticum:
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. , .
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Ureaplasma urealyticum , . ,
" ". U. urealyticum , .
, . , .
Y

Ureaplasma urealyticum, ,
, .

,
' ,
...
54124,
: 2310 999031,
fax: 2130 999140
e-mail: mexidari@med.auth.gr

. ,
-

55 4, - 2010

295

. , .

,
, .

Ureaplasma urealyticum ,
.
,
1954 M. C. Shepard1 U. urealyticum,

, ,
.

6 : U. diversum, U. gallorale, U. felinum, U.

cati, U. parvum, U. urealyticum.4 14 . 1 (U.
parvum) 4 , 1, 3, 6
14
2 (U.
urealyticum), 10 ,
2, 4, 5, 7, 8, 9, 10, 11, 12 13.5
U. urealyticum, 5'-
multiple banded antigen (MB), 4 1 10
2
( 1). 1 3 14, 1 6, 2 2, 5, 8 9, 4, 10, 12
13, 7 11.5

Mollicutes,
: Mycoplasmatales,
Entomoplasmatales, Acholeplasmatales Anaeroplasmatales.2 , Mycoplasma Ureaplasma
, Mycoplasmatales, Mycoplasmataceae.3
Ureaplasma -

0.1-0.8 m, .
Gram-
. -

296

1. 14 Ureaplasma urealyticum 5'

(multiple banded antigen, MBA).5

VOL. 55 ISSUE 4, July - August 2010

UREALYTICUM:
E
?????? ?????? ???????? ????UREAPLASMA
??????? ????????????
???O
Blastocystis
sp.

.2,6-7 .

.
,
, .
U.
urealyticum

" ".4
,
0.3 m.

.
,
""

.1
Gram U. urealyticum. Dienes II
Giemsa.8

Dienes,
.

U. urealyticum , ,
DNA RNA,
70S.8
4.1-4.8 x 108 daltons
- (C+G) 25.5%.1,9 To , M. genitalium, 3 U. urealyticum

751.719 , 613
39 RNA .9
H U. urealyticum
,
L- ,
,
(15-30% 2.5% ).
, ,
-

. ,
,
, , .1
Ureaplasma , , :
,
IgA, IgA
C,
MBA,
.

C- . .
(hlyA)9
(UU375)
MBA UU376
"
U. urealyticum".10
U. urealyticum, , (heat shock proteins) GroEL GroES, ,
FtsZ
.9

U. urealyticum

Mycoplasmataceae .
. , , , 1-6 . , .
.1
:
pH 6.00.5 515% CO2. U. urealyticum pH, pH
(7.8-8.0).1
: .

55 4, - 2010

297

. , .

298

36-37oC 60C 10-30

min. , 4C 16 -20
-60oC 6 .1
:
, -, 1020% . , L-
,
. L-
pH. U. urealyticum
, . hominis,

. .1
:
.1
: , , ,
.1,4

, 5--2'-.1
:


. 95%
U. urealyticum : , F0F1-ATP /.

Ni2+, F0F1-ATP
F0
F1.9
U. urealyticum . , .9
U. urealyticum Fe3+
.
.9
, U. urealyticum
HeLa
.1
VOL. 55 ISSUE 4, July - August 2010

U. urealyticum ,
45-75%.

.
, ,
status.4
-
, . 1
,
2
1.11 1986



(40%)
(5%).4

.

.
45-66%
U. urealyticum
. ,
, .
,
.3

U.
urealyticum.
()
-.
,
37C.7 ,

.12
,

UREALYTICUM:
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??????? ????????????
???O
Blastocystis
sp.

: ,
- .7
, , .4
, U. urealyticum . TNF-a
, , IL-1
.13,14
2008, U. urealyticum ,
IL-8
,
in vitro.15

U. urealyticum .14

U. urealyticum , ,

.
, ,
.

. , , ,
, .4 , .4

47.44% 16 52.9% 17 U. urealyticum. , o ,
U. urealyticum.
, ,

. 1978

.18

HPV U. urealyticum
, ,
Papilloma (HPV)
.
HPV U. urealyticum (>10.000 CCU/ml, CCU: Color Changing Units). ,
,
, .19 HPV-,
(H-SIL) ( ASC-US, L-SIL).20

U. urealyticum
,
,
. , ,


,
.21
U. urealyticum
.

-

U. urealyticum
,22
.23
, .
, .3

U. urealyticum ,

55 4, - 2010

299

. , .

, , , , , , , .3

( 0.5%
200U/ml,
Hank's),4 .
, U.
urealyticum .

,
, U9 broth,
Ford's broth pH 6.0 Shepard's M10 pH
6.0. .24
:

,

,
, U. urealyticum,
pH.

300

36C ,
pH .

. . -

.24
7
U. urealyticum.
, 0.015% , , , L-,
0.1% , pH 6.0.25
, 48 36 C 10%
CO2.
10x 2-4 .
, , " " " ".1



. U. urealyticum
,
, ( 2). ,

U. urealyticum.
U. urealyticum .
7


.25

CFU (Colony Forming Units).

2. Mycoplasma hominis
Ureaplasma urealyticum
7.
U.
urealyticum

,
M. hominis .25

VOL. 55 ISSUE 4, July - August 2010

UREALYTICUM:
E
?????? ?????? ???????? ????UREAPLASMA
??????? ????????????
???O
Blastocystis
sp.

, .26-31 U. urealyticum
( Kirby-Bauer), .

.4,32
,
,
. pH , , U. urealyticum,
.4


(test). ,
, pH,
.33

(PCR), .
,
. U. urealyticum (ureA, ureB,
ureC) . 34
, , 429 .34 , PCR
U. urealyticum 16S rRNA, 16S23S rRNA 5'-
MBA,34 DNA
.

.4

-
U. urealyticum,
. , (
, , , ),
(', ', ', ' ), , . ( )
().35
U. urealyticum (, ),
.
26 ,27
.
V
23S-rRNA C2243N (T C).26
U. urealyticum
tetM,

. ,

.28,29
( IV DNA ) (ParC ParE
IV GyrA GyrB
DNA ).30,31
,
U. urealyticum
.
Kechagia .,16
: 04.5%, 6.3-33.3% 18-77.5%.

U. urealyticum

55 4, - 2010

301

. , .

U. urealyticum ,
, .
U. urealyticum

.
, ,
,
, .

Summary
Ureaplasma urealyticum: so common but so disregarded
microorganism
Tz. Kotrotsiou, M. Exindari
B Laboratory of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

302

Ureaplasma urealyticum belongs to Mycoplasmas, the smallest among free-living cellular microorganisms. Its unique characteristics are the lack of cellular wall, the hydrolysis of urea by the enzyme urease and the "urchin-like" colonies on solid nutrients. U. urealyticum often colonizes the urogenital system of healthy subjects but also it has the potential to cause a variety of infections. In
the present paper the unique characteristics of the microorganism, its pathogenicity in relation to
the laboratory diagnosis and the therapeutic regimes are reviewed. The globally observed resistance, to currently used antibiotics, makes the study of U. urealyticum particularly interesting and
important to the medical community.

Key words

Ureaplasma urealyticum, urease,

urogenital, resistance.

1. Shepard MC, Lunceford CD, Ford DK, Purcell RH, Taylor-Robinson D, Razin S, Black FT. Ureaplasma urealyticum gen. nov., sp.
nov.: Proposed nomenclature for the human T (T-Strain) mycoplasmas. Inter J Sys Bacter 1974; 24:160-171.
2. Prescott LM, Harley JP, Klein DA. Bacteria: The low G+ C Gram
positives. Microbiology 6th ed Mc Graw Hill, New York 2005:504-507.

VOL. 55 ISSUE 4, July - August 2010

3. , . Ureaplasma urealyiticum:
. 2008; 70:46-52.
4. .
. 2, 4 , , 1994:722-740.
5. Fanrong K, James G, Zhenfang M, Gordon S, Wang B, Gilbert G.
Phylogenetic analysis of Ureaplasma urealyticum - support for the

UREALYTICUM:
E
?????? ?????? ???????? ????UREAPLASMA
??????? ????????????
???O
Blastocystis
sp.
establishment of a new species, Ureaplasma parvum. Intern J System Bacter 1999; 49:1879-1889.
6. Waites KB, Taylor-Robinson D. Mycoplasma and Ureaplasma. In:
Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA.
Medical microbiology 9th ed. ASM Press, 2007:1004-1020.
7. Mycoplasmas (Mollicutes) & Cell Wall-Defective Bacteria.
Jawetz, Melwick, Adelberg's Medical Microbiology 21st ed. Appleton and Lange USA 1998:299-302.
8. , - . . 2 , University Studio Press, 2004:177-180.
9. Glass J, Lefkowitz E, Glass J, Heiner C, Chen E, Cassell G. The
complete sequence of the mucosal pathogen Ureaplasma urealyticum. Nature 2000; 407:757-762.
10. Zimmerman CU, Stiedl T, Rosengarten R, Spergser J. Alternate
phase variation in expression of two major surface membrane proteins (MBA and UU376) of Ureaplasma parvum serovar 3. FEMS
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11. Yi R, Xuejin Z. Investigation on biovars and genotypes of Ureaplasma urealyticum in the cervix in a Chinese gynecologic check-up
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12. Saada A.B, Terespolski Y, Adoni A, Kahane I. Adherence of Ureaplasma urealyticum to human erytrocytes. Infect Immun 1991;
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13. Jacobsson B, Aaltonen R, Rantakokko-Jalava K, Morken NH, Alanen A. Quantification of Ureaplasma urealyticum DNA in the amniotic fluid from patients in PTL and Pprom and its relation to inflammatory cytokine levels. Acta Obstet Gynecol Scand 2009; 88:63-70.
14. Doh K, Barton P, Korneeva I, Perni S, Bongiovanni A.M, Tuttle S,
Skupski D, Witkin S. Differential vaginal expression of interleukin-1 system cytokines in the presence of Mycoplasma hominis
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15. Harada K, Tanaka H. Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory
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16. Kechagia N, Bersimis S, Chatzipanagiotou S. Incidence and antimicrobial susceptibilities of genital mycoplasmas in outpatient women with clinical vaginitis in Athens, Greece. J Antimicrob Chemother 2008; 62:122-125.
17. Baka S, Kouskouni E, Antonopoulou S, Sioutis D, Papakonstantinou M, Hassiakos D, Logothetis E, Liapis A. Prevalence of Ureaplasma urealyticum and Mycoplasma hominis in women with chronic urinary symptoms. Urology 2009; 74:62-66.
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Lancet 1978; 2:917-920.
19. Verteramo R, Pierangeli A, Mancini E, Calzolari E, Bucci M, Osborn J, et al. Human Papillomaviruses and genital co-infections in
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20. Lukic A, Canzio C, Patella A, Giovagnoli MR, Cipriani P, Frega
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21. Fenkci V, Yilmazer M, Aktepe O. Have Ureaplasma urealyticum
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22. Bayraktar M, Ozerol I, Gucluer N, Celik O. Prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in pregnant women. Int J Inf Dis 2010; 14:90-95.
23. Liang XD, Gu TT, Wang JL, Cui H, Wei LH. Relationship between Ureaplasma urealyticum infection and ectopic pregnancy.
Zhonghua Fu Clian Ke Za Zhi 2007; 42:370-373.
24. Kundsin R, Parreno A, Poulin S. Significance of appropriate techniques and media for isolation and identification of Ureaplasma
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25. Shepard M, Lunceford C. Differential agar medium (A7) for identification of Ureaplasma urealyticum (Human T Mycoplasmas) in
primary cultures of clinical material. J Clin Microbiol 1976; 3:613625.
26. Dongya M, Wencheng X, Xiaobo M, Lu W. Transition mutations
in 23S r RNA account for acquired resistance to macrolides in
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27. Palu G, Valisena S, Barile MF, Meloni GA. Mechanisms of macrolide resistance in Ureaplasma urealyticum: a study on collection
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28. Roberts M.C, Kenny G. Dissemination of the tetM Tetracycline
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29. Blanchard A, Crabb DM, Dybvig K, Duffy LB, Cassel GH. Rapid
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30. Zhang W, Wu Y, Yin W, Yu M. Study of isolation of fluoroquinolone-resistant Ureaplasma urealyticum and identification of mutant sites. Chin Med J 2002; 115:1573-1575.
31. Xie X, Zhang J. Trends in the rates of resistance of Ureaplasma
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C, Bianchini H. In vitro Susceptibility of Ureaplasma urealyticum
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55 4, - 2010

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PANDAS: -


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PANDAS (
-Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection) / ,
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11
166 73,
.: 6937232072
e-mail: kontokostaskimon@yahoo.gr

55 4, - 2010

305

. , .

306

"PANDAS syndrome"

(Pediatric Autoimmune Neuropsychiatric Disorders
Associated with Streptococcal Infection). , ,

ICD (International Classification of Diseases) DSM (Diagnostic and Statistical manual
of Mental Diseases),
(

-) tic (
Tourette) ,
.1-2
( 3%)

18 ( )

.3


,

.
, ,
,

.4
Sydenham ( Jones).
65 100%
Sydenham 2 4
,

.
,5-6

VOL. 55 ISSUE 4, July - August 2010

(
).7-8

tic ()
(
) () ( ). 9-11
.12
CD4+ - Th1
Th2. Th1 ,
IL2 IFN-, T . Th2 IL4, IL5,
IL6 IL10 ,
,
.13
Husby .,




.14

( ) PANDAS ( ).

21 Sydenham 15
PANDAS 35

PANDAS:

?????? ?????? ???????? ???? ??????? ????????????

???
Blastocystis
sp.

.15


' ' ,
, Sydenham PANDAS
. 16
,

D8/17

.17-19 Kawikova
.
, IgA .20 IgA
(MBP) IgA ,
.

5 : )
tic, ) 3 12
(
98% ,21 )
, )
)
. 5 .22-23
, CYBOCS (Children's Yale-Brown Obsessive-Compulsive Scale).24

(

5%)
.
, .25

PANDAS
,
.
, ,
.

1.
.


,
.
Asbahr .26 4
50
30 Sydenham. , 2 , 70%
(21 ) ,
, ,
.27-29
Hounie .,30



.

.

-
PANDAS.31 H
12 ,
,

, .32-33
,

55 4, - 2010

307

. , .

308

.


.34-35 ,

.


,
.36-37 MRI

( )
.
, .

Yaddanapudi .38


(
C4
-2- ), , ,
PANDAS .

IgG (
IgG1)
,

.

2.

, ( Cengel-Kultur
.39 Schrag .40)
,
.
PANDAS ,

VOL. 55 ISSUE 4, July - August 2010

(ELISA) . , - PANDAS
,
,
.41 ,
,

, , , .42-43 24
Singer . anti-GM1, GlcNac .44

Morris .45
. , anti-GFAP ( ) anti-MAP2 ( ),
PANDAS
.
, .
, PANDAS

,


.
. ,
(
) -

PANDAS:

?????? ?????? ???????? ???? ??????? ????????????

???
Blastocystis
sp.

,
, .

,

.

Summary
PANDAS syndrome: relation between group A -h
hemolytic
streptococci and obsessive-ccompulsive disorder
K. Kontokostas, G. Vrioni
Department of Microbiology, Medical School, University of Athens, Athens, Greece

PANDAS is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with

Streptococcal Infection. This syndrome is characterized by recurrent, acute fulminant tics and/or
obsessive-compulsive behaviors that are temporally associated with a streptococcal infection such
as scarlet fever or strep throat. The existence of this disorder has generated great scientific interest, as well as considerable dispute. PANDAS syndrome, pathophysiologically, is proposed to be
a post-streptococcal autoimmune disorder similar to Sydenham's chorea. More precisely, it is hypothesized that tics and obsessive-compulsive symptoms result from group A -hemolytic streptococci activation of the adaptive immune system, either by the production of auto-antibodies which
cross-react against neuronal tissue (theory of molecular mimicry) or by the production of inflammatory-mediated proteins such as cytokines and chemokines. It is also believed that pathophysiology
of PANDAS involves genetic susceptibility and the D8/17 autoantibody has been proposed as a
possible genetic marker. The role of the immune system in the etiology of OCD (Obsessive-Compulsive Disorder) and tic disorders is unclear; clinical observations suggest that symptoms result
from a combination of local, regional and systemic abnormalities. Moreover the effectiveness of
immunomodulatory therapies suggests that there is systemic involvement. In contrast, use of penicillin prophylaxis for the prevention of neuropsychiatric symptom exacerbations has failed; in addition recent studies demonstrate a lack of specificity of antineuronal antibodies, which raise serious
questions about the role of autoimmunity in PANDAS. Investigations of the PANDAS subgroup
should continue in order to provide new insights into the nature of this disorder.
Key words

PANDAS, obsessive-compulsive disorder, -hemolytic

streptococcus group A, molecular mimicry.

1. Snider LA, Swendo SE. Post-streptococcal autoimmune disorders

of the central nervous system. Curr Opin Neurol 2003; 16:359-365.
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3. Geller DA, Biederman JS, Jones J, Shapiro S, Schwartz S, Park K.

Obsessive-compulsive disorder in children and adolescents: a review. Harv Rev Psychiatry 1998; 5:260-273.
4. Kurlan R, Kaplan EL. The pediatric autoimmune neuropsychiatric
disorders associated with streptococcal infection etiology for tics

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310

and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician. 2004; 113:883-886.
5. McKee DH, Sussman JD. Case report: severe acute parkinsonism
associated with streptococcal infection and anti-basal ganglia antibodies. Ann Neurol 2001; 50:588-595.
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7. Peterson BS, Leckman JF, Tucker D, Scahill L, Staib L, Zhang H
et al. Preliminary findings of antistreptococcal antibody titers and
basal ganglia volumes in tic, Obsessive-compulsive and AttentionDeficit hyperactivity Disorders. Arch Gen Psychiatry 2000; 57:364372.
8. Castelanos FX, Giedd JN, Marsh WL, Hamburger SD, Vaituzis
AC, Dickstein DP et al. Quantitative brain magnetic resonance
imaging in attention-deficit hyperactivity disorder. Arch Gen
Psychiatry 1996; 53:607-616.
9. Pavone P, Parano E, Rizzo R, Trifiletti RR. Autoimmune neuropsychiatric disorders associated with streptococcal infection: Sydenham chorea, PANDAS, PANDAS variants. J Child Neurol
2006; 21:727-736.
10. Church AJ, Dale RC, Giovannoni G. Anti basal ganglia antibodies: a possible diafnostic utility in idiopathic movement disorders.
Arch Dis Child 2004; 89:611-614.
11. Church AJ, Dale RC, Lees AJ, Giovannoni G, Robertson MM.
Tourette's syndrome, a cross sectional study to examine the
PANDAS hypothesis. J Neurol Neurosurg Psychiatry 2003; 74:602607.
12. Kurlan R. The PANDAS hypothesis: losing its bite? Mov Disord
2004; 19: 371-374.
13. Lacroix-Desmazes S, Kaveri SV, Mouthon L. Self reactive antibodies in healthy individuals. J Immunol Methods 1998; 216:117-137.
14. Husby G, van de Rijn I, Zabriskie JB, Abdin ZH, Williams RC.
Antibodies reacting with cytoplasm of subthalamic and caudate
nuclei neurons in chorea and acute rheumatic fever. J Exp Med.
1976; 144:1094-1110.
15. Swendo SE, Leonard HL, Mittleman B, Allen AJ, Rapoport JL,
Dow SP et al. Identification of children with PANDAS by a marker associated with rheumatic fever. Am J Psychiatry 1997; 154:110112.
16. Khanna AK, Buskirk DR, Williams RC, Gibofsky A, Crow MK,
Menon A et al. Presence of a non HLA B cell antigen in rheumatic
fever patients and their families as defined by a monoclonal antibody. J Clin Invest 1989; 83:1710-1716.
17. Gibofsky A. The genetics of rheumatic fever: relationship to streptococcal infection and autoimmune disease. J Reumatol Suppl
1991; 30:1-5.
18. Murphy TK, Goodman WK, Fudge MW, Williams RC, Ayoub
EM, Dalal M et al. Lymphocyte antigen D8/17: a peripheral marker for childhood-onset OCD and TS. Am J Psychiatry 1997; 154:
402-407.
19. Chapman F, Visvanathan K, Carrano-Manjarrez R, Zabriskie J. A
flow cytometric assay for D8/17 cell marker in patients with TS
and OCD. J Immunol Methods 1998; 219:181-186.
20. Kawikowa I, Grady BP, Tobiasova Z, Zhang Y, Vojdani A, Katsovich L et al. Children with TS may suffer immunoglobulin A dysgammaglobulinemia: preliminary report. Biol Psychiatry 2010; 67:
679-683.
21. Shulman ST. Streptococcal pharyngitis: clinical and epidemiologic
factors. Pediatr Infect Dis J 1989; 8:816-819.

VOL. 55 ISSUE 4, July - August 2010

22. Arnold PD, Richter MA. Is obsessive-compulsive disorder an autoimmune disease? CMAJ 2001; 165:1353-1358.
23. Swendo SE. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Mol Psychiatry 2002; 7:S24-S25.
24. Scahill L, Riddle M, McSwiggin-Hardin M. Children's Yale-Brown
Obsessive-Compulsive scale: reliability and validity. J Am Acad
Child Adolesc Psychiatry 1997; 36:844-852.
25. Singer HS, Hong JH, Yoon DY, Williams PN. Serum antibodies
do not differentiate PANDAS and TS from control. Neurology
2005; 65:1701-1707.
26. Asbahr FR, Negrao AB, Gentil V, Zanetta DMT, da Paz JA, Marques-Dias, Kiss MH. Obsessive-Compulsive and related symptoms
in children and Adolescents with Rheumatic Fever with and without chorea: a prospective 6-month study. Am J Psychiatry 1998;
155:1122-1124.
27. Singer HS, Giuliano JD, Zimmermann AM, Walkup JT. Infection:
a stimulus for tic disorders. Pediatr Neurol 2000; 22:380-383.
28. Mercadante M, Busatto G, Lombroso P, Prado L, Rosario-Campos M, do Valle R et al. The psychiatric symptoms of rheumatic
fever. Am J Psychiatry 2000; 157:2036-2038.
29. Swendo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S et al. PANDAS: clinical description of the first 50 cases.
Am J Psychiatry 1998; 155: 264-271.
30. de Alvarenga PG, Floresi AC, Torres AR, Hounie AG, Fossaluza
V, Gentil AF, Pereira CAB, Miguel EC. Higher prevalence of
obsessive-compulsive spectrum disorders in rheumatic fever. Gen
Hosp Psychiatry 2009; 31:178-180.
31. Muller M, Riedel M, Erfurth A, Moller HJ. Immunoglobulin treatment in Gilles de la Tourette syndrome. Der Nervenarzt 1997;
68:914-916.
32. Matarazzo EB. TS treated with ACTH and prednisone: report of 2
cases. J Child Adolesc Psycopharm 1992; 2: 215-226.
33. Snider LA, Lougee L, Slattery M. Antibiotic prophylaxis with
azithromycin and penicillin for childhood-onset neuropsychiatric
disorders. Biol Psychiatry 2005; 57:788-792.
34. Budman C, Coffey B, Dure L. Regarding antibiotic prophylaxis
with azithromycin and penicillin for childhood-onset neuropsychiatric disorders. Biol Psychiatry 2005; 58: 917-919.
35. Kaplan EL, Kurlan R, Van Gheem A, Johnson DR. Two year persistence of group A streptococci in the throat accompanied by falling streptococcal antibody titers: the upper respiratory tract carrier state confirmed and microbiologically and immunologically examined. Pediatric Academic Societies Meeting 2006; San Francisco:
abstract 3526.166
36. Trail Z, Pike M, Byrne J. Sydenham chorea: a case showing striatal
abnormalities on CT and MRI. Dev Med Child Neurol 1995; 37:
270-273.
37. Kienzle GD, Breger RK, Chun RW, Zupanc ML, Sackett JF. Sydenham chorea: MR manifestation in 2 cases. AJNR Am J Neuroradiol 1991; 12:73-76.
38. Yaddanapudi K, Horning M, Serge R, de Miranda J, Baghban A,
Villar G et al. Passive transfer of streptococcus-induced antibodies
reproduces behavioral disturbances in a mouse model of PANDAS. Mol Psychiatry 2010; 15:712-726.
39. Cengel-Kultur SE, Cop E, Kara A, Cengiz AB, Uludag AK, Unal
F. The relationship between group A beta hemolytic streptococcal
infection and psychiatric symptoms: a pilot study. Turk J Pediatr
2009; 51:317-324.
40. Schrag A, Gilbert R, Giovannoni G, Robertson MM, Metcalfe C,
Ben-Shlomo Y. Streptococcal infection, TS and OCD: is there a
connection? Neurology 2009; 73:1256-1263.

PANDAS:

?????? ?????? ???????? ???? ??????? ????????????

???
Blastocystis
sp.
41. Singer HS, Hong JJ, Yoon DY, Williams PN. Serum autoantibodies do not differentiate PANDAS and Tourette syndrome from controls. Neurology 2005; 65:1701-1707.
42. Dale RC, Candler PM, Church AJ, Wait R, Pocock JM, Giovannoni G. Glycolytic enzymes on neuronal membranes are candidate
auto antigens in post streptococcal neuropsychiatric disorders.
Mov Disord 2004; 19:S33.
43. Dale RC, Heyman I, Giovanonnoni G, Church AJ. Incidence of

anti-brain antibodies in children with OCD. British J Psychiatry

2005; 187:314-319.
44. Singer HS, Gause C, Morris C, Lopez P. Serial immune markers
do not correlate with clinical exacerbations in PANDAS. Pediatrics
2008; 121:1198-1205.
45. Morris CM, Pardo-Villamizar C, Gause CD, Singer HS. Serum autoantibodies measured by immunofluorescence confirm a failure to differentiate PANDAS and TS from controls. J Neurol Sci 2009; 276:45-48.

311

55 4, - 2010


Rhizomucor
. -
, , ' ,
"", ,

- Rhizomucor, R. variabilis, Mucor hiemalis f. luteus R.

variabilis var. regularior,
, (). , . , . , 7
, . RNA (RpB2), , internal transcribed spacer (ITS), .
. ,
RpB2. .

ITS, RpB2 .
.
Y

Rhizomucor, R. variabilis, Mucor hiemalis f. luteus, R. variabilis var. regularior, , , .

-,


. 75, 11527, ,
.: 210 7462127
Fax: 210 7462210
e-mail: mdrogari@hotmail.com
mdrogari@med.uoa.gr

55 4, - 2010

313

. -

314

Mucorales, Rhizopus, Mucor, Lichtheimia (

Absidia, Mycocladus) Rhizomucor,

.

, , .1-2
Rhizomucor, R. variabilis, ,
, ( 1).
,
,3-4
/ .
R. variabilis var. regularior
.5

.
Rhizomucor, o R. variabilis ,
. ,
:

Mucor hiemalis f. luteus,
. ,
.
2 internal transcribed spacer (ITS)
DNA.6

R. variabilis var. regularior

.7 Mucor circinelloides Mucor griseoroseus
.
.

. ,
.

, . ,

(ITS, SSU, , ),


ITS.8 , ,

.
RNA (RpB2)
-mRNA
ITS.9
.
, -

,
. Rhizomucor, , .

1. Rhizopus variabilis: A. K , . B. K ,
( ) . 3 .
( Lu XL ., 2009).4

VOL. 55 ISSUE 4, July - August 2010

?????? ?????? ???????? ???? ??????? ????????????

??? Blastocystis
sp.

3 4 (Centraal Bureau voor Schimmelcultures, CBS, Utrecht, the Netherlands). (

CBS) 1.

SMA (Hesseltine's modified
synthetic Mucor agar) : 20 g , 2 g , 0.5 g KH2PO4, 0.25 g MgSO4.7H2O, 0.5 mg 20 g
1000 ml , pH7.7 26-28oC 9 .
(slide cultures), 2 3 .
.

PDA
pH7. 24, 33,
37, 40 43C.
: MEA (3-4
25C) PDA ,

. 8 1, 2 3
, . 8
.
/ (mm/h).

DNA Mo ller .10

ITS : V9G - LR3 1300 bp. 1 2 II
RNA,
VH6F (5') G2R (3') RpBI 5F2
(5') 7cR RpBII ( 1250 bp) ( 2).2

MEGA4 Neighbor-Joining.11-12 Maximum Composite Likelihood
.13
.

: , ,
. ,
3-4 33C.
, R. variabilis R. variabilis var.
regularior.
103. 93 R. variabilis, 654.78 Mucor variisporus aff., 609.78 Mucor hiemalis f. hiemalis,
977.68 Mucor hiemalis f. hiemalis, 700.71 Mucor hiemalis f. luteus 100.164 Mucor hiemalis f. luteus . ,
,
.
(2-3 ) , ,

, ,
(Centraal Bureau voor Schimmelcultures, CBS, Utrecht, the Netherlands).

CBS

103. 93
654.78
609.78
977.68
700.71
100.164
384.95

R. variabilis ( )
Mucor variisporus aff.
Mucor hiemalis f. hiemalis
Mucor hiemalis f. hiemalis
Mucor hiemalis f. luteus
Mucor hiemalis f. luteus
R. variabilis var. regularior

, ()
,
,
,
,
, ( )
, ()

55 4, - 2010

315

. -

2. RpB2 ( RNA ).
.

, ,
.
' ,
.

.
. . ,
. -

: 4 m 2.3m,
2-7 m 1.1-4 m, .
(columellae) .
, (collarette) ( 3 4).
384.95 R. variabilis var. regularior
: ( Mucor circinelloides)

316

3. 103. 93 Rhizopus variabilis ( ): .

, . , .
, . .

VOL. 55 ISSUE 4, July - August 2010

?????? ?????? ???????? ???? ??????? ????????????

??? Blastocystis
sp.

4.
100.164 Mucor
hiemalis f. Luteus: . , .
, .
()
. .

,
, .
: 6.3 m 4.7 m, 4-9 m 3.5-6.6 m,
( 5).

, ( 6). 24, 33 37C,
33C. 40 43C
.

ITS
PCR .
,
.
RpBI , -

RpBII (
7).
.

, , ( ) . ,
consensus, .

( 8), 103. 93 R.
variabilis, 654.78 Mucor variisporus aff., 609.78 Mucor
hiemalis f. hiemalis, 977.68 Mucor hiemalis f. hiemalis,
700.71 Mucor hiemalis f. luteus 384.95 R. variabilis
var. regularior , 100.164
Mucor hiemalis f. luteus .

, , 103. 93 R. variabilis, 654.78 Mucor variisporus aff., 609.78 Mucor hiemalis f. hiemalis,
977.68 Mucor hiemalis f. hiemalis, 700.71 Mucor
hiemalis f. luteus, 100.164 Mucor hie-

55 4, - 2010

317

. -

5. 384.95 R. variabilis var. regularior:

. , .

, . , . ().

malis f. luteus, ( " variabilis"). To

384.95 R. variabilis var. regularior -

,
,
.

318

6. . ( mm/) .

VOL. 55 ISSUE 4, July - August 2010

?????? ?????? ???????? ???? ??????? ????????????

??? Blastocystis
sp.

7. PCR 1% .

,
RpB2. ,
100.164 Mucor hiemalis f. luteus
" variabilis".
384.95 .

RpB2 .2
, ,
, -

8. 7 Rhizomucor. MEGA4 Neighbor-Joining.11-12 Maximum Composite Likelihood .13 . 650 .

55 4, - 2010

319

. -

.
.14
variabilis,
, (forward) . .
. ,
,
.15-16

, .
,
, , / . (mating experiments) ,
.
.17 ,

,
- CBS, .
,

,

(Atlas of Clinical Fungi, de Hoog, Guarro, Gene & Figueras, CBS/Univ. Rovira i
Virgili).

,
(Centraal Bureau voor
Schimmelcultures, CBS, Utrecht, the Netherlands),
,
2009,
().
. . , . .
. S.
de Hoog

.

320

Summary
Re-cclassification of species of the Rhizomucor genus
M. Drogari-Apiranthitou
Microbiology Laboratory, Medical School, University of Athens, Athens, Greece and 4th Department
of Propaedeutic Medicine, University General Hospital "Attiko", Medical School, University of Athens,
Athens, Greece

Non-thermophile species of the genus Rhizomucor, such as R. variabilis, Mucor hiemalis f. luteus
and R. variabilis var. regularior, are rare opportunistic fungi, which in contrast to other zygomycetes
(fungi of the mucorales order) can cause extended andslowly progressing skin infections in immune-competent individuals. During the recent years these fungal species have caused particular
medical interest because of their increasing incidence, mainly in farmers from China. Because of
the particular intraspecific variability of their genome and their infrequence, there is some confusion concerning their proper taxonomy. Aiming at a more accurate laboratory diagnosis, in the pre-

VOL. 55 ISSUE 4, July - August 2010

?????? ?????? ???????? ???? ??????? ????????????

??? Blastocystis
sp.

sent study, the reclassification of 7 clinical and environmental strains of this fungal group was attempted, using morphological, thermokinetic and molecular criteria. Seeking a suitable gene for
the classification of zygomycetes as an alternative to the widely used internal transcribed spacer
(ITS), the nuclear gene encoding the second largest subunit of RNA polymerase II (RpB2) was
used for the molecular analysis. All strains showed similar macroscopic and thermokinetic characterstics. Microscopical differences however, were not fully confirmed by RpB2 analysis. This study
is the first to use RpB2 for the phylogenetic analysis of mucorales. Given the small number of strains collected by the reference centers and the difficulty in sequencing genes other than the ITS,
the usefulness of RpB2 for the intraspecies taxonomy of mucorales needs further investigation.
Furthermore, the deposal of such strains in the collection of a reference centre and recording of
the resulting infections can help greatly to the correct classification of the rare mucorales species.
Key words

Rhizomucor, R. variabilis, Mucor hiemalis f.

luteus, R. variabilis var. regularior, zygomycetes,
mucorales, taxonomy.

1. Malani AN, Kauffman CA. Changing epidemiology of rare mould

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9. Liu YJ, Whelen S, Hall BD. Phylogenetic Relationships among

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reconstructing phylogenetic trees. Mol Biol Evol 1987; 4:406-425.
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phylogenies by using the neighbor-joining method. Proc Natl Acad
Sci U S A 2004; 101:11030-11035.
14. Alastruey-Izquierdo A, Hoffmann K, de Hoog GS, RodriguezTudela JL, Voigt K, Bibashi E, Walther G. Species recognition
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Absidia pro parte, Mycocladus). J Clin Microbiol 2010;48:21542170.
15. Wiens J. Missing data and the design of phylogenetic analyses. J
Biomed Inform 2006; 39:34-42.
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phylogenetic error. Syst Biol 2002; 51:588-598.
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55 4, - 2010

321



Staphylococcus aureus : 2006-2
2008
. ,1 . ,1 . ,1 .. ,2 . ,1 . ,1 . ,1
. ,1 . ,1 . 2
1
2

, " "
,

methicillin-resistant Staphylococcus aureus (MRSA). , MRSA . MRSA

. ( 2006 2008) ( , ).
. BacT/Alert 3D (bioMerieux, Marcy l'
Etoile, France), MICs Vitek 2
API Staph (bioMerieux, Marcy l' Etoile, France) . MRSA , CLSI, (E-test, AB Biodisk, Solna, Sweden). MRSA
/100 /1000 -. 23.107 , 44 MRSA. MRSA
2006-2008 ( 0.60 /100
2006, 1.15 2007 1.22 2008 0.57 /1000 - 2006 0.93 2007 1.13
2008, p<0.001 2 MRSA ).
MRSA (0.15 /100 2006, 0.16 2007 0.21 2008, p=N.S), ,
( 0.04 /100 2006 0.13 2007

55 4, - 2010

323

. , . , . .

0.17 2008, p=N.S). , MRSA

( 0.79 /100 2006 1.44 2007 1.60 2008, 0.89 /1000 - 2006 1.34
2007 1.71 2008, p=N.S).
, MRSA
. ' Gram-
, MRSA ,
.
Y

,
, , MRSA.

324

methicillin-resistant
Staphylococcus aureus (MRSA) ,
,
.1 H methicillin mecA.2 MRSA,
, ,
,
, ,
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MRSA
19614
(Hospital-Acquired Healthcare-Associated MRSA, HA-MRSA).5 HA-MRSA

,
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48-72
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MRSA (Community-Acquired MRSA CA-MRSA) 48-72 -

VOL. 55 ISSUE 4, July - August 2010

,

.... " ",
. 3,
18454,
: 213-2077162
e-mail: idaniil@med.uoa.gr

, ,
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Center for Disease Control (CDC),

.7 ,

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.

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" ".

.
(), .
3 , 2006
2008.
23.107

, 12 (919 ),
, 114 (15.355 ) ,
64 (6.833 ) .
S. aureus, . MRSA
.
BacT/Alert 3D system (bioMerieux, Marcy l'
Etoile, France).

MICs
Vitek 2 Compact
(bioMerieux) API
Staph (bioMerieux).
S. aureus

(E-test, AB Biodisk, Solna, Sweden),
CLSI.11

MRSA
/100
/1000 - .

MRSA 44 S. aureus
(MSSA) 53 ( 1).
2006 MSSA
20 MRSA 11, 2007 18 14,
2008 15 19 .
MRSA
(x2 test, p<0.001), 1 ( 0.60 /100
2006 1.15 2007
1.22 2008 0.57 /1.000 - 2006 0.93 -

325

1. MSSA MRSA 2006-2008.

55 4, - 2010

. , . , . .

326

MRSA
,

2006-2008.
2006

2007

2008

/ 100
/ 1000 -

0.60
0.57

1.15
0.93

1.22
1.13

/ 100
/ 1000 -

0.15
0.26

0.16
0.20

0.21
0.32

/ 100
/ 1000 -

0.04
20.06

0.13
0.21

0.17
0.26

/ 100
/ 1000 -

0.79
0.89

1.44
1.34

1.60
1.71

2007 1.13
2008).
MRSA

(0.15 /100 2006, 0.16 2007 0.21 2008, x2
test, p=N.S), ( 1).
, ,
, , MRSA

( 0.04 /100 2006
0.13 2007 0.17 2008, x2
test, p=N.S), ( 1).
,
MRSA ,
( 0.79 /100 2006 1.44 2007
1.60 2008, 0.89 /1.000 - 2006 1.34 2007 1.71 2008, x2
test, p=N.S).

S. aureus
.

.12
,13 ,

VOL. 55 ISSUE 4, July - August 2010

.1
MRSA
,14 , .5
HA-MRSA

, ,
, ,
.15
,
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S. aureus, MRSA .

.
S. aureus

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,
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,
,

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(43-58%) (2%).15 MR-

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Staphylococcus aureus.12

Methicillin-sensitive Staphylococcus aureus (MSSA)

Methicillin-resistant Staphylococcus aureus (MRSA)

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mupirocin
MRSA
MRSA ,
,

SA , MRSA. ,
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1986, 1997 41%.10 MRSA,
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.

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.

55 4, - 2010

327

. , . , . .

Summary
Trends in the incidence of methicillin-rresistant Staphylococcus
aureus nosocomial bloodstream infections in a tertiary care hospital
in Greece: a three-yyear study (2006-2
2008)
M, Kimouli,1 P. Karle,1 I. Daniil,1 E. T. Piperaki,2 I. Petraki,1 A. Tsiabouris,1 M. Karakatsanis,1
N. Rekliti,1 D. Petropoulou,1 A. Tsakris2
1Department
2Department

328

of Microbiology, Saint Panteleimon General Hospital, Nicea, Greece,

of Microbiology, Medical School, University of Athens, Athens, Greece

Greece is one of the European countries that experiences high rates of methicillin-resistant Staphylococcus aureus (MRSA). However, data regarding the incidence of MRSA infections are limited.
We describe the trends in the incidence of MRSA nosocomial bloodstream infections (BSI) in a large tertiary care hospital in the greater area of Piraeus, Greece. Data from January 2006 to December 2008 were analyzed. We focused in hospital departments of high risk for nosocomial infections
(ICU, medical and surgical departments). Only the first BSI of each patient was included in the incidence calculation. Staphylococcal bacteremia was detected by BacT/Alert 3D system (bioMerieux,
Marcy l' Etoile, France); identification and MICs were performed using Vitek 2 and API Staph (bioMerieux, Marcy l' Etoile, France) systems. Disc diffusion and agar-gradient diffusion (Etest, AB Biodisk, Solna, Sweden) methods were used to confirm MRSA detection according to CLSI guidelines. The incidence rate of nosocomial BSI due to MRSA was calculated as the number of cases/100 admissions and the number of cases/1,000 patient-days. Data from 23,107 patients were
evaluated. MRSA caused BSI in a total of 44 patients. The incidence rate increased significantly in
ICU (from 0.60 cases/100 ICU admissions in 2006 to 1.15 cases in 2007 and to 1.22 cases in 2008
and from 0.57 cases/1,000 patient-days in 2006 to 0.93 in 2007 and to 1.13 cases in 2008; x2 test
for trend; p<0.001 for both calculations of the incidence rate). In medical departments the incidence rate was not considerably changed (0.15 cases/100 admissions in 2006, 0.16 in 2007 and 0.21
in 2008 p=N.S), whereas in surgical departments a significant, not statistically, increase was detected (from 0.04 cases/100 admissions in 2006 to 0.13 in 2007 and to 0.17 in 2008, p=N.S). Overall, the total incidence of MRSA increased (from 0.79 cases/100 admissions in 2006 to 1.44 cases
in 2007 and to 1.60 cases in 2008 and from 0.89 cases/1,000 patient-days in 2006 to 1.34 in 2007
and to 1.71 in 2008, p=N.S). In hospital departments with high risk of BSIs, MRSA is a serious
concern causing difficulties in treatment and infection control measures. The incidence of nosocomial BSI due to MRSA should be an indicator of the performance of a hospital's infection control
strategies. These preliminary findings suggest that although gram-negative BSIs prevail in Greece,
there is also a raise in the incidence of MRSA bacteremia. Further analyses are needed to confirm
this trend.
Key words

Staphylococcus, bloodstream infection,

nosocomial infections, MRSA.

VOL. 55 ISSUE 4, July - August 2010

X STAPHYLOCOCCUS
AUREUS
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???????? ????
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1. Chambers HF, Deleo FR. Waves of resistance: Staphylococcus aureus in the antibiotic era. Nat Rev Microbiol 2009; 7:629-641.
2. Broekema NM, Van TT, Monson TA, Marshall SA, Warshauer
DM. Comparison of cefoxitin and oxacillin disk diffusion methods
for detection of mecA-mediated resistance in Staphylococcus aureus in a large-scale study. J Clin Microbiol 2009; 47:217-219.
3. File TM Jr. Impact of community-acquired methicillin-resistant
Staphylococcus aureus in the hospital setting. Cleve Clin J Med
2007; 74(Suppl 4):S6-S11.
4. Jevons MP. Celbenin-resistant staphylococci. BMJ 1961; i:125125.
5. Gosbell IB. Epidemiology, clinical features and management of infections due to community methicillin-resistant Staphylococcus aureus (cMRSA). Int Med J 2005; 35:S120-S135.
6. Deurenberg RH, Vink C, Kalenic S, Friedrich AW, Bruggeman
CA, Stobberingh EE. The molecular evolution of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2007; 13:222-235.
7. MRSA in Healthcare Settings, CDC Infection Control in Healthcare. At: http://www.cdc.gov/ncidod/dhqp/ar_MRSA_spotlight
_2006.html. Accessed June 21, 2007.
8. Moalla M, Baratin D, Giard M, Vanhems P. Incidence of methicillin-resistant Staphylococcus aureus nosocomial infections in intensive care units in Lyon University hospitals, France, 2003-2006. Infect Control Hosp Epidemiol 2008; 29:454-456.
9. Circulaire n DHOS/ED/DGS/SD5C/2006/163 du 7 avril 2006 relative au tableau de bord des infections nosocomiales, et portant
sur les modalites de calcul de l'indicateur sur le taux de Staphylococcus aureus resistant a la meticilline par les etablissements de sa-

nte. Available at: http://www.sante.gouv.fr/htm/dossiers/nosoco/

tab_bord/sarm/doc_pdf/circulaire_070406_163t0.pdf. Accessed
June 21, 2007.
10. Aires de Sousa M, Bartzavali C, Spiliopoulou I, Sanches IS, Crisostomo MI, de Lencastre H. Two international methicillin-resistant
Staphylococcus aureus clones endemic in a university hospital in
Patras, Greece. J Clin Microbiol 2003; 41:2027-2032.
11. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; Twentieth informational supplement. CLSI document M100-S20. Clinical and Laboratory Standards Institute, Wayne, Pa.
12. Plata K, Rosato AE, Wegrzyn G. Staphylococcus aureus as an infectious agent: overview of biochemistry and molecular genetics of
its pathogenicity. Acta Biochim Pol 2009; 56:597-612.
13. Grossley KB, Archer GL. The staphylococci in human disease.
Churchill Livingstone, New York, USA, 1997.
14. Fluit AC, Schmitz FJ. MRSA Current perspectives. Cromwell
Press Wiltshire, UK, 2003.
15. Stefani S, Varaldo PE. Epidemiology of methicillin-resistant
staphylococci in Europe. Clin Microbiol Infect 2003; 9:1179-1186.
16. Doebbeling BN, Breneman DL, Neu HC, Aly R, Yangco BG, Holley HP, et al. Elimination of Staphylococcus aureus nasal carriage
in health care workers: analysis of six clinical trials with calcium
mupirocin ointment. Clin Infect Dis 1993; 17:466-474.
17. Boyce JM, Jackson MM, Pugliese G, Batt MD, Fleming D, Garner
JS, et al. Methicillin-resistant Staphylococcus aureus (MRSA): a
briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994; 15:105-115.

329

55 4, - 2010

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Fax: 210-7462210
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VOL. 55 ISSUE 4, July - August 2010

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VOL. 55 ISSUE 4, July - August 2010

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Summary
Dysentery in Greece during Interwar: Analysis of data based on the
book of the first Greek female microbiologist, Aggeliki Panagiotatou,
entitle "Tropical Countries' Dysenteries and Enteritis"
C. Tsiamis,1 A. Tsakris2

336

1Laboratory

of Cytology, Hippokration General Hospital, Athens, Greece

of Microbiology, Medical School, University of Athens, Athens, Greece

2Department

The present study reports dysentery in Greece during the Interwar period. The disease was endemic
during the first decades of 20th century and was a very serious public health threat with social consequences. This study is based on the book of Aggeliki Panagiotatou "Tropical Countries' Dysenteries and Enteritis" (Alexandria, 1932) and the review of "Public Health in Greece" about dysentery for
the period 1924-1932. Aggeliki Panagiotatou was the first Greek female clinical microbiologist and
first adjunct professor of Hygiene and Tropical Medicine in the Medical School of Athens University.
Her book, dedicated to the physicians and the Greek children, contains the scientific data of that era
concerning dysentery together with data from her personal studies in Egypt. Panagiotatou accepts
the existence of two different kinds of dysentery (bacterial and parasitic) and describes the symptoms, the diagnostic methods and the therapeutic regimes of the various dysenteric syndromes
covering the whole microbiological field. Her detailed descriptions about dysentery and enteritis have
helped the Greek physicians to differentiate the diagnosis of the dysenteric syndrome correctly.
Key words

Panagiotatou, dysentery, enteritis,

Greece, Interwar period.

VOL. 55 ISSUE 4, July - August 2010


?????? ?????? ???????? ???? ??????? ????????????
??? Blastocystis
sp.

1. . (1878-1954):
Acta Microbiologica Hellenica 1995; 40:434-439.
2. . . : . 8. , 1988: 116.
3. . " ". . , 1932: 5-16, 27-29, 33-37, 6069.

4. Cook G. Influence of diarrhoeal disease on military and naval campaigns. Journal of Royal Society of Medicine 2001; 94:95-97.
5. . .
., 1933: 87-90, 317-318.
6. Bequignon Y. Grece, coll. Le Guide Bleus. Ed. Hachette, Paris 1932.
7. . . 1951.
8. . . . . ,
2004.

337

55 4, - 2010