Volume 22, Issue 4, 2014
Original article
Municipal waste collectors and hepatitis B and C virus infection: a cross-sectional study
Tsovili Eva,
Rachiotis George,
Symvoulakis Emmanouil K.,
Thanasias Efthimios,
Giannisopoulou Olganthi,
Papagiannis Dimitrios,
Eleftheriou Andreas,
Hadjichristodoulou Christos
There is some evidence that municipal waste collectors are at risk of Hepatitis B virus infection (HBV). Published information on risk of Hepatitis C Virus (HCV) infection among waste collectors is scant. We aimed to investigate the prevalence and possible risk factors of HBV and HCV infections among waste collectors in a municipality of the broader region of Attica, Greece. A cross-sectional sero-prevalence study was conducted in a municipality of the broader region of Attica, Greece. Fifty waste collectors participated in the study (response rate: 95%). The group of municipal waste collectors was compared to a convenient sample of white collar employees not exposed to waste (n=83). Waste collectors recorded a significantly higher prevalence of hepatitis B virus infection (anti-HBc positivity) in comparison to the reference group (15% vs. 2.5%, respectively; p .001). Waste collectors who reported frequent exposure to needle-stick injuries had higher risk of HBV infection (RR=8.28; 95% CI=1.076-63.79; p=0.033). Only one municipal waste collector was anti-HCV positive. Our study corroborates previous results of an increased prevalence of Hepatitis B infection among municipal waste collectors. In addition we found that needle stick injuries were associated with the risk of HBV infection. By contrast, HCV infection does not seem to represent a significant occupational hazard among waste collectors. Vaccination against HBV among municipal solid waste collectors and promotion and use of safer methods for the collection of non-hospital medical waste could represent potential measures for the prevention of Hepatitis B Virus infection among municipal waste collectors.
A nightmare for haematology clinics: extensively drug-resistant (XDR) Acinetobacter baumannnii
Metan Gökhan,
Pala Çiğdem,
Kaynar Leylagül,
Cevahir Fatma,
Alp Emine
The purpose of our study was to share experience on demographic characteristics and clinical outcome of the patients infected with extensively drug-resistant Acinetobacter baumannii (XDRAB) in haematology clinics, focusing on the period with a sudden increase in the number of XDRAB cases. A regular patient-based infection control programme was set up in haematology clinics and haematopoietic stem cell transplant centre starting from 2008. An infection control nurse visited all patients daily. A form including demographic data and laboratory results were recorded for all patients. The source of infections was identified according to the criteria proposed by the Centers for Disease Control and Prevention. While haematology ward-acquired XRDAB was rare before 2012, between January 2012 and July 2013, 29 A. baumannii infection episodes were detected in 28 patients. All but one isolate were MDR and 72.4% (21 out of 29) were XDR. Blood cultures revealed A. baumannii in 26 out of 29 episodes. While the haematological malignancy was relapsing or not under remission in 15 patients, four patients were under remission, and 10 patients were newly diagnosed. The mortality rate was 81.2%. All patients with a poor outcome died in the first week after the index blood culture was performed. In 16 out of 29 episodes, the patients died before the culture results became available. Colistin was initiated for the treatment in 11 out of 29 episodes. Three patients received colistin combined with sulbactam or sulbactam containing beta-lactams; the remaining eight patients who received colistin monotherapy were already under carbapenems. In conclusion, XDRAB infections can easily become nightmares for haematology clinics without any reliable treatment option.
Circulating Apo 2L levels decreased in genotype II hepatitis C with pegylated interferon-2 alpha treatment
Yalcin Arzu Didem,
Celik Betul,
Kose Sukran,
Seyman Derya,
Gumuslu Saadet,
Yalcin Ata Nevzat
Pro-inflammatory factors regulated by TRAIL in vivo may lead to the development of novel therapeutic strategies for diseases as diverse as infection, autoimmunity and allergy. In this study we aimed to investigate the relationship between IFN treatment response, HCV viral load and sApo 2L levels. Eleven HCV-treatment naïve HCV-infected patients were treated with pegIFN alfa-2a. Intensive serum circulating Apo 2L levels were monitored at study visits on day 0 (pretreatment), and in weeks 4, 6 and 12. HCV-RNA and sApo 2L levels decreased gradually with PegIF-α 2 treatment and the differences were significant between day 0 and week 4 (p=0.001, p 0.005 and p=0.01, p 0.005 respectively); between day 0 and week 12 (p=0.001, p 0.005 and p=0.001, p 0.000 respectively); between weeks 6 and 12 (p=0.01, p 0.05 and p=0.01, p 0.05 respectively). We suggest that decreased levels of circulating Apo 2L may reflect its increased binding to its ligand expressed on hepatocytes or lymphocytes under the influence of PegIFN treatment.
Raltegravir use prospectively assessed in a major HIV outpatient clinic in Italy: sample population, virological-immunological activity, and tolerability profile
Manfredi Roberto,
Calza Leonardo,
Marinacci Ginevra,
Cascavilla Alessandra,
Colangeli Vincenzo,
Salvadori Caterina,
Martelli Giulia,
Appolloni Lucia,
Puggioli Cristina,
Viale Pierluigi
Raltegravir, as the first HIV integrase inhibitor, has been used and prospectively monitored since 2010 in our HIV outpatient centre, where over 1,200 patients are monitored. The aim of our report is to perform an interim assessment of the background, the safety profile and the clinical-laboratory monitoring of all patients treated with a combination antiretroviral therapy (cART) including raltegravir, for at least 12 months. In all, 109 pretreated patients started a raltegravir-containing cART when aged 44.8±19.2 years, with a history of HIV infection lasting 13.4±9.7 years. All subjects were monitored for at least 12 months (mean 17.2±10.3 months). In the vast majority of cases (93 of 109: 85.3%), multiple (3-16) prior cART changes prompted raltegravir introduction in advanced-salvage lines: 72 of 109 (66.1%) patients had even developed a concurrent triple-class resistance to anti-HIV compounds. The most frequent companion antiretroviral agents were: darunavir/ritonavir (75 cases), maraviroc (47 subjects), and etravirine (38 cases). The most common underlying conditions were: AIDS (46 patients), liver cirrhosis (31 cases), AIDS-related or other malignancies (23 cases), and major cardio-cerebro-vascular events (18 cases). A chronic HCV and HBV hepatitis were of concern in 48 and 23 patients, respectively. The adjunct of raltegravir favourably affected all clinical-laboratory markers of HIV disease progression, and those of the broad spectrum of comorbidities, except for two patients who failed the raltegravir-containing cART due to insufficient adherence. Despite the already compromised clinical situation, a minority of subjects experienced mild-transient clinical-laboratory untoward events possibly attributable to raltegravir, such that no patients discontinued raltegravir during the observation period. Only three AIDS-defining conditions became apparent during raltegravir-based cART; chemotherapy and/or radiotherapy cycles were performed as scheduled in patients suffering from cancer; chronic hepatitis B and C progressed to liver cirrhosis and/or hepatocarcinoma in only 2 and 6 patients. Otherwise, treatment with pegylated interferon-ribavirin became feasible in 25 patients of 48 with chronic HCV. During raltegravir-containing cART, neither autoimmune disorders nor novel malignancies were diagnosed. Only mild-transient gastrointestinal disorders, fatigue, dizziness, insomnia and cutaneous rash were reported, although their relationship with the study drug was difficult to assess due to multiple comorbidities and polypharmacy. Abnormal liver function testings were observed in 57 patients (52.3%), all suffering from concurrent hepato-biliary disorders. Significant increases in serum lipids and/or lipase levels versus baseline values were never registered: serum lipid levels significantly improved after raltegravir introduction.
Our experience with raltegravir underlines its excellent efficacy and safety profile, which exploits a novel mechanism of action, and displays no cross-resistance with any other antiretroviral. A progressively extended prescription in naïve patients and early cART lines will allow the therapeutic potential of raltegravir to be exploited.
Comparison of serum IL-1beta and C-reactive protein levels in early diagnosis and management of neonatal sepsis
Ayazi Parviz,
Mahyar Abolfazl,
Daneshi Mohammad Mahdi,
Jahanihashemi Hassan,
Esmailzadehha Neda,
Mosaferirad Negin
Clinical signs and symptoms of non-infectious diseases are similar to those of infectious diseases during infancy. Therefore, rapid new methods for diagnosis of infections in infants are urgently needed. To examine the utility of measuring serum IL-1β for immediate diagnosis of sepsis in infants, in this cross-sectional epidemiological study blood samples were taken from 83 infants (41 female and 42 male) in whom infection was suspected and who were admitted to hospital. To perform serum interleukin (IL)-1β and quantitative C-reactive protein (CRP) tests, blood samples were placed in ice containers and delivered to the laboratory. The serum was removed from the samples at 4°C and stored in refrigerators at −30°C until the time of testing. The results were analysed by t tests. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of serum IL-1β were 27%, 71%, 25%, and 73%, respectively. Sensitivity, specificity, PPV and NPV of serum quantitative CRP were 76%, 60%, 40% and 88%, respectively. Hence quantitative serum CRP measurement for the diagnosis of infections is more efficient than measuring serum IL-1β levels. In general, quantitative serum CRP measurement as an alternative to other tests such as serum IL-1β assays might be an ideal test for diagnosing infections in infants.
2009 H1N1 flu pandemic among professional basketball players: data from 18 countries
Kousoulis Antonis A.,
Sergentanis Theodoros N.,
Tsiodras Sotirios
Although influenza may be propagated in innumerable occasions and daily situations involving exposure, basketball may create many chances for close contact in which influenza could spread. This study aims to quantify and assess the impact of the 2009 H1N1 influenza pandemic among professional basketball players. A multi-step strategy was followed to gather the relevant data during the 2009-10 basketball season. Possible risk factors were recorded; logistic regression was performed to assess the impact of the former. Where data were only available in the press, cases were also verified by subsequent communication with the national basketball federations. Relevant data were available for 18 countries (218 teams, 3,024 players). In all, 52 H1N1 cases in 19 teams were reported. A larger number of players presented as a risk factor for the emergence of H1N1 cases to a borderline extent (Odds Ratio, OR=1.19, 95% CI: 1.00-1.41, p=0.056). A borderline association also implicated the population of the city-basis (OR=1.01, 95% CI: 1.00-1.02, p=0.094). On the other hand, no significant association with risk of H1N1 emergence was demonstrated regarding latitude and longitude of the city-basis.
Even in environments where the best possible preventive and other medical care is provided influenza continues to be a threat. The microenvironment (crowding index, players per team) seemed to represent the most meaningful predictor regarding H1N1 emergence in a basketball team.
Case report
Unsuspected tuberculosis in COPD and use of levofloxacin: diagnostic challenges
dos Santos Vitorino Modesto,
Martin Rosane Rodriguez,
Fachinelli Letícia Rita,
Montes Araujo Monique Chivatto,
dos Santos Uliana Medeiros,
de Carvalho Ribeiro Kayursula Dantas
A 92-year-old female ex-smoker with chronic obstructive pulmonary disease (COPD) GOLD III, was admitted because of communitarian pneumonia in November 2013. She had been using inhaled corticosteroids and bronchodilators and presented five exacerbations of COPD due to pneumonia in the sameyear, with hospitalizations in March and September. The patient underwent the routine protocol for exacerbated COPD, and bacilloscopy for tuberculosis (TB) was negative. On admission, she had intense dyspnea and a productive cough that improved by administration of levofloxacin. Tests with Ziehl-Neelsen staining in bronchopulmonary secretions resulted negative. Notwithstanding, during actual admission, the culture in Lowenstein-Jensen medium seeded in September was found positive for M. tuberculosis susceptible to isoniazid, rifampin, streptomycin, and ethambutol. Therefore, the patient underwent the standard regimen for tuberculosis. Except in September, when she used piperacillin-tazobactam, all previous exacerbations of COPD were treated with levofloxacin. This effective drug against M. tuberculosis can hinder its growth in culture. The use of levofloxacin in unsuspected TB may constitute an additional diagnostic challenge, and risk of late diagnosis is increased in patients with COPD in use of inhaled corticosteroids. Case studies may contribute to increase the suspicion index about TB associated with COPD.
An incidental case of biliary fascioliasis mimicking cholangiocellular carcinoma
Şenateş Ebubekir,
Doğan Abdullah,
Şenateş Banu Erkalma,
Bodakçi Erdal,
Bekçibaşi Muhammet
Fascioliasis is a zoonotic infestation caused by Fasciola hepatica that usually attacks mammals, such as goats, sheep and cattle. The parasites can infect humans via freshwater plants contaminated with encysted metacercariae. In the acute phase, which involves hepatic invasion, the disease may present with abdominal pain, mild fever and hepatomegaly. In the chronic phase, the parasites settle into the biliary tracts, and then cause cholangitis and cholestasis. Sometimes, the disease may mimic malignancies, creating a mass appearance. Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and treatment method because it allows simultaneous diagnosis and treatment. Here, we present a 44-year-old female patient who presented to our hospital with complaints of abdominal pain, nausea, vomiting, anorexia and weight loss. After diagnostic investigations with laboratory and imaging methods, she was initially hospitalized with a preliminary diagnosis of cholangiocellular carcinoma (CCC). However, after a full work-up, the patient was diagnosed with Fasciola hepatica via ERCP and parasites were extracted with ERCP at the same time and then treated with a single dose of triclabendazole 10 mg/kg. Two months later, the clinical status of the patient had improved markedly, with resolution of all symptoms and all laboratory and imaging tests returning to within normal limits.
What is hiding behind bubbles of air? An unusual Streptococcus pyogenes meningitis
Gritti Paolo,
Lanterna Andrea Luigi,
Sarnecki Tatyana,
Brembilla Carlo,
Agostinis Cristina,
Rizzi Marco,
Lorini Ferdinando Luca
Streptococcus pyogenes is a rare but aggressive cause of meningitis, which often evolves in a poor outcome with fatal consequences. Although lumbar puncture and CT scan of the brain are the gold standard of diagnosis of cerebral infections, they can have some limitations. We report and describe the clinical history and neuroimaging of a 36-year-old woman admitted to the emergency department of our hospital three days after the onset of earache and otorrhoea. When the patient developed an emergent refractory status epilepticus, the CT scan of the brain showed an unusual pneumocephalus. However, the MRI study of the brain revealed a pachymeningitis with partial thrombosis of the right transverse sinus and subdural empyema due to a S. pyogenes otitis media. Prompt diagnosis and the specific findings of the MRI allowed rapid correct treatment and thus led to a good outcome for the patient.
Focal epithelial hyperplasia in a Turkish family
Gökahmetoğlu Selma,
Ferahbaş Ayten,
Canöz Özlem
Focal epithelial hyperplasia (FEH) is a benign proliferative condition that is more frequently found in children of certain ethnic groups. Human papillomavirus (HPV) 13 and 32 genotypes has been consistently detected in these lesions. In this study a daughter, mother and father had FEH, and HPV 13 was shown by sequence analysis in the lesions of these patients. Cryotherapy was applied to the lesions and the lesions improved, but did not recover properly. In conclusion, HPV genotyping should be performed in FEH cases.
Acute brucellosis associated with leukocytoclastic vasculitis and splenic infarct
Uçmak Feyzullah,
Uçmak Derya,
Beştaş Remzi,
Anli Ruken Azizoğlu,
Adanir Haydar
Brucellosis is globally the most prevalent multisystem infection of zoonotic origin, while it is still one of the most important public health problems in Turkey as non-pasteurised milk and dairy products are consumed. Early diagnosis is vital to prevent the possibly lethal complications caused by the disease. However, diagnosis might be delayed as the disease does not have a single and typical manifestation and presents with various symptoms of different systems. Brucellosis and associated splenic infarct have rarely been studied, there being few cases in the literature. One of the rare involvements in this disease is dermatological involvement, which has been found in less than 10% of brucellosis cases. In this study, we discuss a 17-year-old male patient who was admitted to our hospital due to fever, abdominal pain, arthralgia and rash on legs, diagnosed with brucellosis through brucellosis tube agglutination test and found to have splenic infarct upon examination and leukocytoclastic vasculitis according to the skin biopsies in the light of the present literature.
Epstein Barr virus infection reactivation as a possible trigger of primary biliary cirrhosis-like syndrome in a patient with multiple sclerosis in the course of fingolimod treatment
Marrone Aldo,
Signoriello Elisabetta,
Alfieri Gennaro,
Dalla Mora Liliana,
Rinaldi Luca,
Rainone Ilaria,
Adinolfi Luigi Elio,
Lus Giacomo
Primary biliary cirrhosis (PBC) and multiple sclerosis (MS) are considered autoimmune diseases with a multifactorial aetiology which is thought to be due to a combination of genetic predisposition and environmental triggers. An association of both diseases has been previously described in sporadic case reports. Fingolimod, an antagonist of the sphingosine-1-phosphate receptor family (S1P1/3/4/5), is a promising and effective drug in the treatment of MS. Here we describe a case of PBC-like syndrome that was unmasked, concomitantly or consequently to Epstein Barr virus (EBV)-infection reactivation, in a 34-year-old male patient with relapsing-remitting multiple sclerosis who was receiving fingolimod treatment.
Recombinant Human Erythropoietin (RHuEpo) and Granular Colony Stimulating Factor (G-CSF) in hepatitis C virus (HCV) related to mixed cryoglobulinaemia associated to membranoproliferative glomerulonephritis type I: a case report description
Mauro Endri,
Gattei Valter,
Mazzaro Cesare
HCV infection is related to hepatic disease and mixed cryoglobulinaemia (MC). Renal involvement is reported in one third of cryoglobulinaemic patients. The combination of HCV-related MC with renal involvement has been associated with poor survival and identified as “Hepatitis C Virus Risk Syndrome (HCV-RS)”. Here we describe antiviral treatment and management of side effects (anaemia and neutropenia) with RHuEpo and G-CSF in a rare case of HCV-RS.
The Infections in the History of Medicine
Demystifying the epidemic among Achaeans during the Trojan War
Tsoucalas Gregory,
Laios Konstantinos,
Karamanou Marianna,
Androutsos George
Although some modern scholars believe that Homer had at least a basic medical education, given that a plethora of medical terms may be found in his poems, in the case of the pestilence that killed the Achaeans (one of the Hellenic peoples believed to have inhabited the Peloponnese) at Troy, his reference was simply informative. No symptoms were mentioned and the only thing known was that mules and dogs were the first to die. While Delphic Apollo was usually on the side of Peloponnesians, during the Trojan War Apollo Smintheus (the Mouse God) sided with the Trojans. Apollo was invoked as Smintheus by his priest Chryses two times and on both occasions a pestilence ensued. In our paper we try to clarify whether this pestilence, as we believe, was caused by a member of the Alphavirus genus, which can inflict a serious epidemic both on human and animal species, especially in equines.
