Volume 17, Issue 3, 2009
Review
Crimean-Congo haemorrhagic fever: an enemy at the gates
Pittalis Silvia,
Meschi Silvia,
Castilletti Maria Concetta,
Di Caro Antonino,
Puro Vincenzo
Crimea-Congo haemorrhagic fever is a tick-borne viral zoonosis with the potential of human-to-human transmission. The disease occurs in extensive areas in Asia, South-eastern Europe and Africa. Haemorrhagic manifestations constitute a prominent symptom of the late disease stage, with case fatality rates from 9 to 50%. The recent increase in the number of cases in Eastern Europe and the potential for nosocomial outbreaks indicate the advisability of diagnosis in every patient hospitalized in Italy with haemorrhagic fever.
Original article
Combined Diagnostic Tool for joint prosthesis infections
Romanò Carlo Luca,
Romanò Delia,
Bonora Cristina,
Degrate Alessandro,
Mineo Giuseppe
While diagnosing infection of a joint prosthesis often requires a multi-modal approach, evaluation of combined multiple diagnostics is still a rather subjective process. Based on the known sensitivity and specificity of commonly performed tests for joint prosthesis infection, we developed the Combined Diagnostic Tool, a software program that automatically allows the Combined Tests Index (CTI) to be calculated. The CTI indicates, in a given subject, the relative probability of a combined series of positive tests being true compared to negative tests. CTI values above 1 indicate a progressively higher chance of a prosthesis being infected and vice versa. Double-blind, prospective evaluation of CTI, compared to intra-operative cultural and histological findings, was performed in a consecutive cohort of 36 patients. 21 patients had positive intra-operative findings for infection. All of them had a pre-operative CTI higher than 1 (range: 8.8 to 5552.6; mean: 711 +- 1298). 15 patients had negative intra-operative results. All had a CTI lower than 1 (range: 0.00013 – 0.297; mean 0.074 +- 0.099). The difference in CTI between the two groups was statistically significant (p = 0.04). Our results show that the Combined Tests Index may be a useful indicator for differential diagnosis of prosthetic infection.
Efficacy and safety of TA-sparing antiretroviral regimens in naїve HIV-positive patients
Gottardi Martina,
Lanzafame Massimiliano,
Lattuada Emanuela,
Soldani Fabio,
Boccafoglio Fabio,
Concia Ercole
To assess the potency, efficacy and toxicity of abacavir/lamivudine (ABC/3TC) versus tenfovir/emcitrabine (TDF/FTC) with efavirenz (EFV) in naive patients with HIV infection a prospective observational study was carried out to evaluate immunovirological parameters every three months and metabolic parameters every six months. In all, 21 patients were enrolled (10 on ABC/3TC and 11 on TDF/FTC). Fisher’s test revealed no statistically significant difference between the two arms in terms of immunological recovery and control of viral replication. For metabolic parameters at week 48 no statistically significant differences were noted between the two arms. The two ABC/3TC and TDF/FTC backbones showed the same potency; ABC had a more negative impact on metabolic parameters without statistical power.
Infective endocarditis: review of 36 cases
Lupis Francesco,
Giordano Salvatore,
Pampinella Diego,
Scarlata Francesco,
Romano Amelia
In a retrospective study of cases of infective endocarditis (IE) observed in adult patients, the data of patients hospitalized for “definite” IE in the Cardiosurgery Unit of ARNAS-Civico in Palermo (Italy) from March 2003 to September 2006 were analysed. All cases were classified according to the modified Duke criteria. In all, 36 immunocompetent patients with “definite” IE were included (20 males and 16 females with a median age of 54 years). The aortic valve (23/36, 64%) was the most commonly involved, followed by the mitral (19/36, 52.7%) and tricuspid valve (4/36, 11%). In 10 patients (27.7%), a double localization was observed. Blood culture yielded a positive result in 15 cases. Staphylococci and enterococci were the pathogens most commonly identified. Valvular diseases and previous cardiosurgical procedures were the risk factors most commonly noted. Four patients developed complications during the course of the disease, one of whom died. In patients with positive blood culture, antibiotics were prescribed on the basis of susceptibility test results. In patients with negative blood culture, empiric therapy was directed against Gram+ bacteria (glycopeptides, aminoglycosides and betalactams). Surgical therapy was necessary in 25 patients (69.4%). The patients were subsequently enrolled in a cardiological and infectivological follow-up. Our results showed that rapid diagnosis, correct antibiotic therapy and early surgical treatment improve the outcome in patients with infective endocarditis.
Epidemiology of ESBL-positive Enterobacteriaceae in Mantova hospital (Italy)
Gattuso Gianni,
Tomasoni Donatella,
Palvarini Loredana,
Chiarelli Cristina,
Nespeca Manuela,
Stradoni Raffaello,
Ceruti Rossella,
Ferri Ferdinando,
Scalzini Alfredo
In a retrospective study concerning the epidemiology of extended-spectrum beta-lactamase (ESBL) positive Enterobacteriaceae during 2007-2008 in the wards of the Carlo Poma hospital in Mantova, Mercurio surveillance software was used to detect alert microorganisms. Our objective was to link the epidemiological data with the type of patient and ward, and to assess the risk factors for such infections in particular nosocomial environments. The study enabled the change in the relative epidemiological data to be detected, and showed that such bacteria can be found almost throughout the hospital.
Case report
Cervical lymphoadenopathy due to Pseudomonas aeruginosa following mesotherapy
Shaladi Ali Muftah,
Crestani Francesco,
Bocchi Anna,
Saltari Maria Rita,
Piva Bruno,
Tartari Stefano
Mesotherapy is a treatment method devised for controlling several diseases by means of subcutaneous microinjections given at or around the affected areas at short time intervals. It is used to treat a variety of medical conditions, amongst which all orthopaedic diseases and rheumatic pain. Mesotherapy is especially indicated for neck pain. The mechanism of action is twofold: a pharmacological effect due to the drug administered, and a reflexogenic effect, the skin containing many nerve endings that are sensitive to the mechanical action of the needle. Although this therapy is safe, like any other medical intervention it cannot be considered free of complications that may occur, such as allergies, haematomas, bruising, wheals, granulomas and telangiectasias. Infective complications are also possible, due to pathogenic bacteria that are inoculated through contamination of products, of the materials used for the procedure or even from germs on the skin. We present the case of a patient who had cervical lymphadenopathy due to Pseudomonas aeruginosa after mesotherapy treatment for neck pain.
Use of PCR for TB bacteria on BAL in early diagnosis of tubercular lobitis
Franco Alfredo,
Aprea Lucia,
Conte Marco,
Manzillo Elio,
Marocco Alessandro,
Martucci Fiorella,
Parrella Roberto,
Pizzella Teresa,
Simioli Francesco,
Izzo Crescenzo Maria
In June 2008 a 23-year-old immunocompetent came to our observation, without fever and with an occasional cough for 2 months, who showed two chest X-rays and a CT, performed respectively 60, 40 and 20 days earlier, that pointed to a small lobitis at the right lung base. The patient had already undergone several antibiotic therapies that had not changed the X-graphic framework. On presentation, routine blood tests and cultural examinations of sputum were carried out to detect common germs, fungi and TB bacteria (microscopic observation, cultivation and PCR), and a new antibiotic therapy (piperacillin/tazobactam) was started. Since the radiological picture appeared unchanged after 10 days of therapy and the examinations (microscopic observation and PCR) were negative, bronchoscopy with bacteriological evaluation of BAL was performed, which was positive to Mycobacterium tuberculosis, and then tubercular lobitis was diagnosed. Therefore a specific therapy - rifampin (RMP), isoniazid (INH), etambutol (EMB), pyrazinamid (PZA) - was started and changed after 10 days due to the growth of mycobacteria resistant to INH and EMB on examination of sputum. Consequently, the early use of PCR on BAL allows, in skilled hands, small aspecific lobitis to be diagnosed more rapidly than using cultural examination of sputum.
Immunorecovery after prolonged HIV-related immunosuppression: opportunities of the new antiretroviral classes
Esposito Antonella,
Leti Wilma,
Fantauzzi Alessandra,
Pastori Daniele,
Isgrò Antonella,
Aiuti Fernando,
Mezzaroma Ivano
Treatment of multi-drug experienced patients is an important concern in the management of HIV-1 disease, partially solved by the availability of new drugs acting at different phases of viral replication. Immune recovery during cART is linked both to the activity of antiviral drugs, as well as to the regenerative capability of thymus and bone marrow. We report a patient with a 22-year-old HIV-1 disease and an AIDS diagnosis for 15 years, with extensive resistance to all antiretroviral drugs, who never had treatment interruption, except for short spells due to adverse effects. This decision was supported by both findings elsewhere that interruptions of cART in experienced patients with advanced disease are strongly associated with more rapid disease progression and by our evaluation of his bone marrow activity. The colony-forming cells assay performed in the patient showed residual clonogenic capability, increased in vitro by addition of protease inhibitors and IL-2. A new therapeutic scheme including darunavir and maraviroc allowed dramatic changes leading both to a quick reduction in plasmatic viral load with an impressive immune reconstitution and an improvement in clinical conditions.
Aeromonas hydrophila ecthyma gangrenosum without bacteraemia in a diabetic
man: the first case report in Italy
Avolio Manuela,
La Spisa Claudio,
Moscariello Francesco,
De Rosa Rita,
Camporese Alessandro
Ecthyma gangrenosum is a well recognized cutaneous manifestation of severe, invasive infection by Pseudomonas aeruginosa usually in immunocompromised and critically ill patients. This type of infection is usually fatal. Aeromonas infection is infrequently reported as the cause of ecthyma gangrenosum. Here we show the first case described in Italy of Aeromonas hydrophila ecthyma gangrenosum in the lower extremities in an immunocompetent diabetic without bacteraemia.
A 63-year-old obese diabetic male was admitted with an ulcer on his left leg, oedema, pain and fever. Throughout his hospitalization blood cultures remained sterile, but a culture of A. hydrophila was isolated following punctures from typical leg pseudomonal-ecthyma gangrenosum lesions developed after admission. The patient, questioned again, stated that a few days before he had worked in a well near his house without taking precautions.
We conclude that early diagnosis and suitable antibiotic therapy are important for the management of ecthyma gangrenosum. The typical presentation of soft tissue infection of A. hydrophila should mimic a Gram-positive infection, which may result in a delay in administration of appropriate antibiotics. Moreover, A. hydrophila should be considered a possible agent for non-pseudomonal ecthyma gangrenosum in a diabetic man with negative blood cultures, in presence of anamnestical risk factors.
The Infections in the History of Medicine
Malaria and memory in the Veneto region of Italy
Pegoraro Manuela,
Crotti Daniele
Malaria and emigration are two terms deeply embedded in Veneto history, related to images far back in the past, unknown to younger generations. Losing one’s own collective historical memory is a source of personal and cultural impoverishment and inevitably compromises one’s awareness of the present, possibly leading to superficial judgements and hastily formed opinions. Such a situation is all the more serious in a geographical area, north-eastern Italy, where immigration is so abundant. In this paper the authors seek to retrieve, at least in part, this memory, especially in terms of history (to what extent malaria afflicted residents in Veneto and migrants from the region) and biology (how much imprinting from malaria has remained in the native population’s genetic make-up).
