Volume 7, Issue 4, 1999
Review
Salmonella non-typhoid infection: new epidemiological findings
Sagnelli Evangelista,
Coppola Nicola,
Scolastico Carlo
Food-borne infections are the most serious food safety problem in the world. In fact, they are responsible of millions of illnesses and thousand of deaths. Non-typhoid Salmonella infection is frequent world-wide and, although mild and self-limiting illness in normal subjects, it may cause a severe disease in patients with an immune-deficiency. Changes in the agents and in the vehicles of transmission and a higher number of patients with immune-depression have determined a world-spread of non-typhoid Salmonella infection in the last decades. The increased frequency of international travels and food commerce have been associated with outbreaks of unusual serotype of Salmonella. Moreover, drug-resistant Salmonella are emerged recently, as Ampicillin and Doxiciclin-resistant S. enteritidis or DT-104 multidrug-resistant S. typhimurium.
The outbreak of Salmonella disease is also linked to diffusion of HIV infection and of other immunodeficiencies. The lack of controls in food industry, the frequent contamination of mass-distributed food products and the decreased opportunities to transmit for instruction on food safety, both in school and inside the family, are the causes of large-scale outbreaks
Value of the test for serum HCV-RNA in clinical practice
Nardiello Salvatore,
Pizzella Teresa,
Galanti Bruno
The test to identify genomic RNA is the only tool currently available to directly evidence the presence of the hepatitis C virus (HCV) in infected subjects. In this review we examined the most commonly used qualitative and quantitative methods to detect HCV-RNA in serum or plasma, focusing particular attention on commercially available methods. Furthermore, we report the clinical conditions in which the viremia test is useful or even mandatory for the diagnosis of HCV infection, and comment on the usefulness of the test for monitoring patients in the course of antiviral therapy.
Original article
Central venous catheter-related sepsis: one year experience in a large university hospital
de Gaetano Donati Katleen,
Tacconelli Evelina,
Tumbarello Mario,
Bertagnolio Silvia,
Pittiruti Mauro,
Leone Fiammetta,
Cauda Roberto
Five hundred two central venous catheters (CVC) inserted in 366 patients were evaluated prospectively over a one-year period to determine the frequency and risk factors associated with CVC-related sepsis. A CVC-related infection was suspected in 190 cases (190/502, 38%). A catheter-related sepsis was established in 50 patients (10%). The infection rate was 0.8 cases of sepsis per 100 catheterdays. Staphylococcus epidermidis, Staphylococcus aureus, and Candida spp. were the most frequently isolated etiological agents of sepsis. On univariate analysis, six variables affecting the rate of catheter-related sepsis were identified: neutropenia > 8 days (p < 0.01); AIDS (p < 0.001); haematological malignancies (p < 0.001); total parenteral nutrition (p = 0.001); duration of site use (p = 0.04); high APACHE II score (p = 0.04). The logistic regression analysis revealed that AIDS and haematological malignancies were independent risk factors of catheter-related sepsis. In conclusion, although the incidence of established catheter infection is much lower than the incidence of suspected infection, in most cases it is wise to change the catheter with the guidewire technique and wait for culture of the tip, rather than to remove the catheter immediately.
Bacterial pneumonia in HIV-infected patients
Cocchi Laura,
Mongiovetti Massimo,
Giacchino Roberto,
Barasolo Gabriele,
Rizzi Laura,
Macerati Renato
Patients and methods: This is a retrospective study performed on HIV-positive patients discharged from our Institution from January 1993 through December 1998 with a diagnosis of bacterial pneumonia. Cases of TB or atypical micobacterial infection were excluded from this analysis. Causative organisms were identified, when possible, by taking into account positive cultures from diverse sources (blood, sputum, pleural fluid and others).
Results: In the 6-yr period we considered, 120 patients were identified. Among them, we were able to obtain clinical and imaging data on 98 cases. Focal infiltrates on chest X-ray studies were present in 87.7% of cases, 24.5% had a pleural effusion, 9.2% nodular lesions, 4.1% cavitary images and in 2 patients only hilar lymphadenopaties were noted. Causative agents resulted to be S. aureus (14 cases); P. aeruginosa (11); S. pneumoniae (6); R. equi (4); Enterobacter spp. and K. pneumoniae (3 cases each); E. coli, Peptostreptococcus spp and Enterococcus spp. (1 case each). No causative organism was isolated in 54 patients (55.1%) and the diagnosis was based on clinical and therapeutical grounds. Around half of cases (46.9%) responded well to therapy, while 11 (11.2%) died because of the lung infection. In 3 cases other opportunistic infections were the cause of death and 22 cases of relapse were recorded as well. Five patients resulted lost to follow-up.
Conclusions: This retrospective study demonstrated a high prevalence of S. aureus lung infections along with the presence of otherwise rare causative organisms such as R. equi. Radiologic appearance of lung lesions did not differ substantially from the one of HIV negative patients. A relatively good response to antibiotic therapy was also noted.
Sepsis: our series
Bellissima Pietro,
Amato Rosalba
Sepsis understood as persistent bacteremia with considerable clinical symptomatology that can develop into septic shock, retains its clinical, diagnostic and therapcutic meaning.
Its most recent definition as a systemic inflammatory secondary reaction to a verified infection may help us to understand the reactive events of the host against infections and prevent septic shock. We report clinical cases of sepsis with positive haemoculture observed in the Caltagirone (CT) Hospital in the last 15 years: 186 patients (117 males and 69 females), with particular focus on those over 61 years old and on patients admitted to the ICU. The clinical isolates and groups of the inpatients are listed. In particular, two cases of toxic shock syndrome and six cases of bacterial endocarditis are described. Mortality was about 30% for septic shock despite rational antibiotic therapy, support therapy and hospital admission to the intensive care unit.
Correlation between CD4 T-cell counts and HIV-1 RNA plasma levels in HIV-1 patients receiving highly active antiretroviral therapy (HAART)
Maggiolo Franco,
Bottura Patrizia,
Capra Riccardo,
Pravettoni Grazia,
Suter Fredy
The prognostic value of plasma HIV-1 RNA baseline levels in patients who are going to receive HAART has been recently questioned. In the present study the authors correlated the baseline counts of viremy and CD4 with the viral suppression induced by HAART in an ongoing cohort of HIV-1 positive patients. Data resulting from the study suggest that the HAART effect on CD4 T-cells depends both on the immunological status before starting therapy and on the degree of viral suppression. After briefly discussing about the possible causes of disconnection between CD4 T-cells count and plasma HIV-1 RNA levels, authors conclude that the viral suppression is the desired goal of antiretroviral treatment and that the maximum effect of HAART can be achieved by carefully clinically evaluating patients and individuating the best therapy.
Microbiological survey in an Intensive Care Unit
Cuniato Vincenzo,
Bellitti Filomena,
D’Isanto Rosa,
De Sio Antonio,
Marvaso Alberto,
Esposito Silvano
An epidemiological survey on 417 sample from ICU patients, was carried out from January ’97 to December 98 to verify the epidemiology of bacteria responsible for nosocomial infections and to monitor the susceptibility patterns to antimicrobial drugs during this period. Microbiological cultures were positive in 47.7% of the samples. P. aeruginosa was the most frequent pathogen, followed by Staphylococcus aureus, Candida spp, coagulase-negative staphylococci, E.coli, with a clear prevalence of Gram-negative over Gram-positive isolates. The evaluation of the antibiotic susceptibility profile of this bacterial pathogens suggests the importance of a costant epidemiological surveillance in ICU.
Case report
Eosinophilia and Strongyloides stercoralis infestation: case report
Tassara Rodolfo,
Parodi Lionello,
Brignone Marcello,
Di Pede Egidio,
Scogna Mauro,
Minetti Franca,
Bonanni Franco
Authors report about a case of Strongyloides stercoralis infestation. The patient, a 65-year old man, presented with a clinical history of eosinophilia but without symptomatology. Several stool specimen showed the presence of rhabditiform larvae of S. stercoralis and after therapy the patient had a normalization of the white blood ceIls count. The authors wish to point out the importance of the diagnosis because a change in immune status may convert a previously asymptomatic infection to hyperinfection.
A case of sepsis caused by BCG (Bacillus Calmette Guerin) after its bladder instillation in a 71-year-old patient affected by bladder carcinoma
Sica Salvatore,
Vargas Natasha,
Glielmi Gianfranco,
Avino Stefano,
Ciarallo Marianna
Sometimes the Calmette-Guerin bacillus can be used with success as local immunotherapy for superficial bladder carcinoma. BCG is a living attenuated strain of Mycobacterium bovis and therefore its biadder instillation may give rise, in some particular cases, to serious systemic effects, caused either by hypersensitivity reaction or by systemic dissemination in case with low efficiency of cellular immunity. We describe a case of sepsis in a 71-year-old patient after bladder instillation of BCG with a rare complication of granulomatous hepatitis. The etiological diagnosis of granulomatous hepatitis with PCR on liver biopsy is very important for the specific therapy before the patient can undergo a steroid regime.
The Infections in the History of Medicine
Plaut-Vincent’s angina
Pistacchio Eleonora
The clinical appearance of fuso-spirillar infection in patients with a serious impairment of the immunitary system was the starting-point for a historical study. At the end of nineteenth century two european researchers clarified the cause of many infections. Association of a spindle-shaped bacillus with a spirillar one was shown to cause several pathologies: necrotic ulcerous stomatitis, pseudomembranous angina, hepatic abscess, otitis, pneumonia, etc. The identification of such bacteria contributed to improving further differential diagnosis with diphteria.
