Volume 6, Issue 1, 1998
Review
Infectious diarrhoeas
Sagnelli Evangelista,
Coppola Nicola,
Liorre Giulia
The infective diarrhoea show a high morbility in infants of all countries and a high mortality in infants and children of developing countries. In developed countries there is a high frequency of “traveler’s diarrhoea”. The different pathogenesis of infectious diarrhoeas (intestinal invasion, intestinal adherence, citonecrotic or citotonic toxins) influences the clinical presentation (watery diarrhoea or diarrhoea with blood and mucos, presence or assence of fever). The key factor in the management of acute watery diarrhoea is the restoration of water and electrolyte balance; but frequently an antimicrobial treatment is needed.
Original article
Treatment of Community Acquired Pneumonia (CAP) in adults with amoxicillin/clavulanic acid switch therapy: a multicenter italian study
Legnani Delfino,
Paizis Giorgio,
Beghi Gianfranco
Patients with community acquired pneumonia (CAP) previously treated with other oral antibiotics (Cephalosporins 35,3%, Macrolides 26,9%, Tetracyclines 14,1%, Quinolones 12,8%, other 10,9%) for at least 72 hours at home were considered for this national multicentre study. 43 hospitalized patients (17 males and 26 females) ranging between the ages of 19 and 79 were treated with Amoxicillin/Clavulanic acid (AMC) 1,2 g e.v., T.l.D. for at least 3 days. I.V. Treatments were switched to AMC p.o. after apyrexial status. Average treatment duration was 10,8 + 3.6. Sputum/B.A.L. samples were obtained from all patients submitted for microbiological exams in order to determine microbiological aetiology of CAP in patients who have failed on previous antibiotics. At the end of treatment, 30 patients (96,8%) were considered cured, while treatment failed in 1 patient (3,2%). 12 patients were considered not evaluable because serology was positive for M. pneumoniae (5 pts); for C.pneumoniae (3 pts.); 1 patients was positive for Mycobacterium tuberculosis; 1 patient was positive for HIV and Mycobacterium spp.; 2 patients were non-evaluable for lung or bronchial tumor. Not reported adverse events.
Neurobrucellosis: clinical and therapeutic features
Bellissima Pietro,
Turturici Maria Ausilia
Brucellosis is a common zoonosis endemic in many parts of the world. Neurologic involvement is a rare but serious complication and it occurs in 2 - 5% of cases. Neurologic signs can appear during the active phase of disease or later. Six cases of neurobrucellosis are described: meningoencephalitis in 2 cases, meningitis with brain abscess in 1 case, encephalomielitis in 3 cases. Diagnosis was made on the basis of history of the exposure to brucella, of serum and cerebrospinal fluid positive serology, of quantitative change in cerebrospinal fluid, on EEG, CT and MNR and favorable response to specific treatment (rifampin, rolitetracycline tirmethoprim-sulfamethoxazole).
Neurobrucellosis should be suspected in case of neurological deficit in brucellosis endemic areas. Treatment of neurobrucellosis remains controversial: we recommend a regimen with rifampin 600 mg x 2 i.v. + tirmethoprim-sulfamethoxazole 2 ff x 2 i.v. for a period of 6-8 weeks.
Assuring quality of AIDS care: organizational and functional aspects
Starace Fabrizio,
Minaci Sambiase Federica,
Lorenzo Elvira
The implementation of a method to assess the quality of care provided to HIV-infected subjects and AIDS patients is outlined. Two sets of factors have been considered: one pertaining the structural aspects of the health care setting (“D. Cotugno” Hospital, the largest infectious diseases hospital in Southern Italy); the other concerning the operational and qualitative aspects of care, including staff and patients’ satisfaction. Structural factor have been assessed by analyzing data provided by hospital administration; operational aspects have been investigated by means of medical record review and the administration of a semi-structured interview to health care workers. Results helped to prioritize evidence-based interventions aimed to improve the quality of AIDS care.
Case report
Multiple osteo-articular involvement due to methicillin-resistant Staphylococcus aureus septicaemia: clinical and therapeutic evaluation
Cosentino Stefano,
Cacopardo Bruno,
Maurizio Benedetto,
Vinciguerra Giuseppina,
Zagami Aldo,
Vinci Giovanni,
Boscia Vincenzo,
Ricifari Luciano,
Bonaccorsi Sabrina,
Nunnari Antonino
Here we report a rare case of septic spondilodiskitis by methicillin-resistant Staphylococcus aureus, complicated by the atypical involvement of two articular sites such as manubrio-clavicular joints and right wrist. The source of the septic process was identified in hand’s eczematous lesions and paronychia.
A first therapeutical attempt performed by combining teicoplanin with netilmicin or rifampicin was useless. A new course with vancomycin instead of teicoplanin favoured the prompt remission of symptoms. Following 10 weeks of continuous treatment, we observed the complete disappearance of all radiological signs of vertebral damage. Though rarely, polyarthritis may complicate a Staphylococcus aureus bacteraemia. An adequate chemio-antibiotic course may lead to definitive recovery and avoid surgery.
Rhodococcus equi pneumonia in AIDS: a case report
Gargiulo Miriam,
Montesarchio Vincenzo,
Sangiovanni Vincenzo,
Fabiano Bice Annamarina,
Conte Marco,
Chirianni Antonio
We describe the first case, in Campania, of Rhodococcus equi pneumonia in an HIV positive subject. The clinical symptoms resolved after antibiotic therapy. The pulmonary lesion at 10 months of radiological follow up results just partially reduced in its diameters.
Type I necrotising fasciitis of heel in a diabetic patient
Gokalan Inci,
Yalcin Nevzat,
Sermez Yurdaer,
Yilmaz Mustafa
Necrotising fasciitis is a potentially fatal clinical disease caused by infection with various bacteria. Diabetes mellitus, one of the predisposing factors for necrotising fasciitis is also an important factor in the progression of the illness by increasing its morbidity and mortality rate. In this case report, a 54 year old diabetic woman with type-I necrotising fasciitis of the heel was treated with extensive debridments, broad spectrum antimicrobial therapy and intensive regulation of blood glucose levels. The resulting new positive data pertaining to the morbidity and mortality of this severe disease suggest that the old management of this disease should be re-examined.
The struggle against the variolous poison (Part 1)
Vannozzi Francesca
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