Ebola virus infection: epidemiology, clinical features and laboratory diagnosis

Rengina Vorou1, Emmanouil Papadogiannakis2
1.Hellenic Center for Diseases Control and Prevention, Athens, Greece
2.Department of Veterinary Public Health, National School of Public Health, Athens, Greece

Οn August 8, 2014, World Health Organization declared the Ebola epidemic in Western Africa as public health emergency of international concern, as a result of its unprecedented expansion from West Africa to other regions. During this epidemic, 28.500 cases and 11.315 deaths have been reported. Our review covers the period 1976-2016 and summarizes available literature on
previous and current Ebola outbreaks, clinical findings, laboratory diagnosis, mode of transmission, and the local or regional epizootic. In 1976, the first two cases of simultaneous Ebola outbreaks were identified in Sudan and Zaire. According to the known data the virus is fatal among non-human primates. The animal reservoir, the amplification host and other intermediate hosts are not yet clear. The virus has been detected in the dogs and the fruit bats in central Africa. It has been also experimentally inoculated in fruit and free tailed bats. The longer lasting dry seasons
in the deforested areas of Western Africa along with the behavioral patterns of wild animals, facilitate the dissemination of the virus from wild life to humans. The ways in which the Ebola
virus is transmitted among human populations are the direct contact with infected bats or primates, the contact with human blood or body fluids (mainly during the ritual burials), the contaminated
objects of the patients or syringes contaminated by the fluids of the patients (hospitaldissemination). In the case of outbreaks among humans, the main difficulty of the local health authorities or the international medical expeditions into the field, was the wasting of time until the diagnosis is laboratory confirmed. The laboratory investigation focuses on reverse transcriptase PCR, keeping the ELISA for cross checking and cross-sectional prevalence studies. At the moment, there is no treatment or an approved vaccine, while the results from plasma transfusion of convalescent patients are still controversial.

Major Histocompatibility Complex – Immunopeptidome current data

Asimoula Kavvada, Maria Chatzidimitriou, Stella Mitka
Alexander Technological Educational Institute of Thessaloniki (ATEITH), Thessaloniki, Greece

Major Histocompatibility Complex (MHC) is a highly polymorphic and polygenic system that is responsible
for the encoding of HLA antigens. The genes of MHC are organized in three clusters:
class I and class II regions, which encode HLA antigens, and class III region. They are inherited according
to Mendel’s laws as a whole. HLA antigens are consisted of two heavy and two light chains.
Also, they have a binding groove, which binds the peptide of foreign antigens. Class I HLA molecules
are located to the membrane of all nucleated cells. In contrast, class II HLA molecules are located
to some antigen presenting cells (APCs). The binding groove of HLA class I molecules binds
endogenous antigens and presents them to CD8 cells, while HLA class II molecules present exogenous
antigens to CD4 cells. This phenomenon is called MHC restriction. The major biological
role of this system is the control of the immune response. MHC function is applied to many medical
fields, such as transplantations, immune resistance to some diseases and mate choice.
Nowadays, a new area, which is called MHC-immunopeptidomic, is being researched. MHC-immunopeptidomic
studies the countless peptides presented to the cell surface by MHC molecules,which consist the immunopeptidome.
The immunopeptides are derived to two clusters: class I peptides and class II peptides. These peptides are
products of protein degradation. Class I peptides are the most interesting, since they derive from
endogenous proteins. Endogenous proteins of great importance are the rapidly degraded polypeptides (RDPs).
RDPs are derived to Short Lived Proteins (SLiPs) and Defective Ribosomal Products (DRiPs). Although the
structure of DRiPs is not entirely defined, it is supported that DRiPs are responsible for the rapid
recognition of the viral antigens and they are connected to tumor immunosurveillance. MHC-immunopeptidome
could offer new aspects to cancer immunotherapy, vaccines and autoimmunity. A newborn mass spectrometry
method, which is called SWATH-MS, consists a new tool for studying MHC-immunopeptidome.

ORIGINAL ARTICLE Genetic variations in Ureaplasma parvummacrolide resistance associated genes

Tzimoula Kotrotsiou, Maria Exindari, Eudoxia Diza, Georgia Gioula, Angeliki Melidou, Nicolaos Malisiovas
Microbiology Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

Macrolides are widely used for the treatment of ureaplasma infections. The aim of this study was
to investigate possible genetic resistance determinants in Ureaplasma parvum isolates with erythromycin
elevated MICs. Nine U. parvumisolates (four isolates with MIC ? 8 μg/ml and five isolates
with MIC ? 8 μg/ml) from urogenital specimens were studied for genetic mechanisms of macrolide
resistance. 23S rRNA operons, L4 and L22 ribosomal protein genes were amplified and sequenced.
The obtained sequences were compared with the respective genotype specific-reference strains.
In total 15 point mutations were revealed. Isolates with elevated erythromycin MICs presented
point mutations at more than one genes of Operon 1 23S-rRNΑ, of Operon 2 23S-rRNΑ, L4 and L22
protein genes. The point mutation A196G at the L22 protein gene was reported for the first time
and corresponded to a change (N66D) into the amino acid sequence of the deriving protein.
In conclusion, both previously recognized and novel point mutations were detected in strains with
altered susceptibility to macrolides, revealing a possible correlation with resistance to macrolides.

ORIGINAL ARTICLE A comparative study of the impact of the immunosupression with or without mammalian target of rapamycin inhibitors on the hematology parameters, infections’ profile and cytomegalovirus viremia in kidney allograft recipients

Evangelia Myserli1, Magdalini Pagana1, Evangelia Dafa1, Gregorios Myserlis2, Angeliki Karyoti1,
Anna Diamantopoulou1, Aikaterini Karantani1, Eleni Vagdatli1, Vasileios Papanikolaou2,
Dionysopoulou Sofia3, Eleni Sidiropoulou3
1.Biopathology Laboratory, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
2.Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital
of Thessaloniki, Thessaloniki, Greece
3.Biopathology Laboratory, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece

In solid organ transplantation immunosuppression is associated with hematology parameters
disorders, increased incidence of infections and malignasies. The purpose of this study was to
record and compare hematological parameters and infections’ profile among kidney allograft
recipients receiving either mammalian target of rapamycin inhibitors (mTOR inhibitors) or derivatives
of mycophenolic acid (MPAs) in combination with calcineurin inhibitors (CNIs) and corticosteroids
(M). We studied 25 kidney transplant recipients (19 men, 6 women) during one year.
The patients were divided into 2 groups depending on whether they were receiving mTOR inhibitors
or not. The two groups did not differ in CMV seropositivity between donor and recipient.
We recorded and compared during the course of a year and every two months White Blood Cell
count (WBC), hematocrit, number of platelets and fibrinogen levels between the two groups.
During the same period of time we recorded and compared the number and the type of infections[urinary tract infections, respiratory infections, gastrointestinal, CMV infections and / or
viremia (CMV Real Time PCR), HSV infections, wound infections] during one year with stable immunosuppressive
regimen. Statistical analysis was performed by the method of Student T-test
and the X2 (Chi-square) with the statistical program SPSS.20 for Windows. There was not any statistically
significant difference of WBC count, hematocrit, number of platelets and fibrinogen levels
between the two groups. A statistically significant lower proportion of patients who were
receiving mTOR inhibitors showed CMV infection and / or viremia and respiratory infections.
There was not any statistically significant difference of the incidence of other types of infections
between the two groups.
In conclusion, Immunosuppression with mTOR inhibitors in patients with renal transplantation
is associated with reduced incidence of CMV infection or viremia and respiratory infections compared
with immunosuppression including mycophenolic acid derivatives.

ORIGINAL ARTICLE The evolution of infectious diseases and Microbiology in Greece during 20th century through the lectures of Athens Medical Society (1900-1935)

Constantinos Tsiamis1, Georgia Vrioni1, Evangelos Vogiatzakis2, Athanassios Tsakris1
1.Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
2.Department of Microbiology, General Chest Hospital “Sotiria”, Athens, Greece

The aim of this study is to present the nosological spectrum of Greece during the Interwar. The
source of information for the study have been the lectures of the Athens Medical Society during
the period 1900-1935, which include microbiology-related issues that cut across various medical
topics. The lectures of Athens Medical Society contain data of the epidemic outbreaks, the morphology
of microorganisms, diagnosis and treatment. The analysis of these communications reveals
that Greece was affected by malaria, typhus and tuberculosis. Also, this period is
characterized by the great epidemic of dengue fever in Greece (1927). Other diseases, such as
plague, smallpox, and cholera, often appear as epidemic outbreaks with minimal mortality. Also,
it seems that the lectures of Athens Medical Society follows the scientific timeliness and the serious
infectious diseases of the country. Only exceptions are the lack of lectures concerning the Spanish flu
pandemic (1918), syphilis and the infectious diseases of the Greek refugees from Asia Minor (1923-24).