The incidence rate of hepatocellular carcinoma (HCC) has been increasing over the last 20 years. HCC is a worldwide, but the incidence is very high in countries of South East Asia, China, sub-Saharan Africa and southern Europe. Liver cirrhosis is the most important risk factor for the development of HCC, through necrotic-proliferative and dysplatic activity. HBV is indicated as a carcinogen agent, while it is unknown the real role of HCV in hepatocarcinogenesis. The role played by aflatoxins, ethanol, hemochromatosis, familiarity and sex hormones is still undefined. The clinical presentation of HCC is similar to that of chronic hepatitis and cirrhosis indicating the need of a periodic screening (even 4-6 mounths) with alpha-fetoprotein determination and addominal ultrasound scan. Hepatic resection, liver transplation and percoutaneos ethanol iniection are the options more frequently chosen for treating patients with HCC.

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Patients with liver cirrhosis have an impaired function of reticuloendothelial system; moreover they exhibit several defects of cellular and humoral immunity. These deficiencies enhance their susceptibility to bacterial infections. The prognosis is better if the infection is detected as early as possible and treated adequately. Except in cases of septicemia, empirical monotherapy is effective. Broad-spectrum ß-lactam antibiotics have proved efficient for the treatment of severe infections; a limitation of third-generation cephalosporins is their ineffectiveness against Enterococci; the acylureidopenicillins may be a good choice since they are active against Enterococci and most enteric, pulmonary and urinary pathogens, including Escherichia coli and Streptococcus pneumoniae which are the pathogens most frequently isolated from cirrhotic patients with severe infection. Similarly, the combination of a ß-lactamase inhibitor with a penicillin may offer an adequate antibacterial spectrum. Piperacillin, like other ß-lactam antibiotics, can induce leukopenia in patients with cirrhosis; the more severe the hepatic dysfunction, the greater the risk; a reduction in dosages is necessary. Meropenem monotherapy is effective and safe for the initial therapeutic regimen of bacterial infection. The fluorquinolones may be useful for the treatment of infections in liver cirrhosis; however, the marginal activity against S. pneumoniae is a drawback. Oral long-term fluoroquinolone administration is utilized for the prevention of spontaneous bacterial peritonitis recurrence; selective intestinal decontamination with fluoroquinolones is useful in preventing bacterial infections in cirrhosis with gastrointestinal hemorrhage. Given the high risk of nephrotoxicity due to aminoglycosides in liver cirrhosis, these antibiotics should be used only in cases of severe infection with septicemia, in which b-lactam-aminoglycoside combination is indicated for rapid bactericidal effect and enhanced killing afforded by sinergism. Perhaps a short course (no more than 3 days) and a once-daily schedule of administration would minimize the risk of aminoglycoside-induced nephrotoxicity.

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A retrospective study on 357 children admitted to four Pediatric Infectious Disease Centers in Rome, affected by acute meningitis, during 10 years period, between January, 1, 1985 and December, 31, 1994 was carried out. Haemophilis influenzae type b was detected in 110 patients; all children aged between 1 month and 5 years; the maximum incidence (74,5%) was observed in patients under two years. The following diagnostic criteria were utilized: - Gram stain of CSF - Latex test on CSF, blood, urine - CSF and blood cultures. The in vitro sensitivity of 65 isolates was tested by using the Kirby-Bauer method. We detected 15,3% of strains resistant to Ampicillin and 1,5% resistant to CAF. We also observed a high number of Hib strains resistant to Erythromycin and Cotrimoxazole. Only one strain Ceftriaxone resistant was isolated, confirming the high in vitro sensibility Hib to III generation cephalosporins that still remain the first choise drugs in Hib meningitis.

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A correct and consistent condom use can minimize the risk of acquiring HIV infection through sexual intercourses. The aim of this study has been to assess knowledge and attitudes towards condom use among adolescents and young adults living in southern Italy. 620 randomly selected subjects have been interviewed by means of a 16-item standardized questionnaire: 87,3% consider condom an useful tool in the prevention of sexually transmitted diseases; however, 53,5% think that condom may reduce sexual pleasure and 26,8% state that its cost is too high to allow regular use. These results emphasize the need of carefully planned programs aimed to overcome objective and subjective barriers in the use of condom to prevent HIV infection spreading.

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To detect the presence of anti-HIV IgA in HIV infected subjects and in seronegative subjects at risk of infection, we assessed a Western Blot using nitrocellulose strips with HIV separated proteins. We tested at least 2 different serum samples from 9 anti-HIV positive subjects (Group A), 9 anti-HIV negative subjects at risk of infection (Group B) and 9 controls (Group C). One subject in Group B became anti-HIV positive during the observation. Anti-HIV IgA were detected in all patients of Group A, in 66.6% of patients of Group B and in no patient of Group C. The subject who seroconverted during the observation showed positivity for IgA anti-HIV in both serum samples, while anti-HIV IgG became detectable only on the second serum sample. A newborn from a seropositive mother showed maternal anti-HIV IgG on the first 2 out of 3 serum samples while showed anti-HIV IgA positivity on the third sample only. This child is still anti-HIV negative.

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To detect HlV proviral DNA in lymphocytes from subjects at risk of acquiring HIV infection, we assessed a Polymerase Chain Reaction Assay using the SK38 and SK39 primers for the amplification and the SK19 probe for the hybridization. The detection of amplified HIV-DNA was obtained by a new colorimetric method, the DNA enzyme immunoassay (DEIA). The PCR we performed allowed to detect HIV-pDNA in lymphocytes of 13 out of 64 subjects at risk of acquiring HIV infection. Seven of these 13 became anti-HIV positive during a follow up of 8 months.

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Non tuberculous Micobacterial (NTM) Infections mainly affect immunocompromised patients, appearing as disseminated or pulmonary disease. In immunocompetent children the most common form of infection with NTM is cervical adenitis. Ear infection seems to be a rare disease. We present a case of otomastoiditis caused by Mycobacterium avium in a 15 months old child, immunologically normal. Patient was referred for persistent right otitis unresponsive to routine medical therapy. TC scan of the ear and temporal bones revealed: soft tissue in external auditory canal, Eustachian canal, and middle ear overlying ossicles with erosion of tegmen timpani. Tuberculin skin test was positive with 5 units PPD and culture yielded M. avium. The patient undergo timpanomastoidectomy and medical therapy with antituberculous drugs and Steroids, subsequently he was given Clarithromycin and Rifabutin. M. avium is an ubiquituos low grade pathogen found in soil, water, dust and food. There is no evidence of direct transmission. Only a few cases of otomastoiditis due to M. avium have previously been reported. The case presented underlines the importance of microbiological investigations. When a NTM infection is suspected surgeons and infectious diseases specialists should cooperate to find an optimal treatment regimen of this unusual disease.

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Listeriosis is an emerging opportunistic infection in the immunocompromised host. A case of sepsis due to Listeria monocytogenes in a patient with advanced HIV infection and severe neutropenia, treated for an underlying non-Hodgkin's limphoma, is described. Therapy with cotrimoxazole associated with rHuG-CSF (filgrastim) let to a rapidly favourable clinical and microbiological outcome, and to the correction of concurrent neutropenia. The case report is discussed according to a literature review of all cases of listeriosis reported until now in the setting of HIV infection and AIDS. In particular, the role of both cotrimoxazole and rHuG-CSF adjunct in the treatment of listeriosis in the immunocompromised patient is focused.

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Our paper describes an unusual case of herpetic whitlow due to HSV-2 in an HIV-1 and HIV-2 infected patient. This patient was a 33-year-old cook, HIV-1Ab and HIV-2Ab positive for 4 years. The CD4+ cell count was below 50 cells/µL and no previous AIDS-defining illness happened. After having had a jagged tearing wound by a carving-knife on index finger of his right hand, he showed a rapid advancing erosion, which completely encircled his forefinger, due to HSV-2. Twenty days later he also showed two small adiacent lesions on penile shaft which rapidly extended with multiple subpreputial lesions. These lesions were caused by HSV-2 infection too. Both, finger and penile lesions, completely healed after a 3-week treatment with intravenous and oral acyclovir.

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