Volume 8, Issue 4, 2000
Review
Central venous catheter - related infections
Marvaso Alberto
Central venous catheters are essential in complex medical and surgical interventions. It is estimated that 200,000 nosocomial bloodstream infections occur each year; 90% of these infections are related to the use of central venous catheters with increased morbidity and mortality, prolonged hospitalization and intensive unit stay, and greater hospital cost. The cause of the increased incidence of bacteremia and intravascular catheter infections is multifactorial and a source of ongoing debate. The skin, parenteral nutritional mixtures or hematogenous seeding accounted for 70% of the catheter-related bloodstream infections (CBI); the remaining 30% were traced to the hub. The three most common types of organisms causing CBI are coagulase negative staphylococci (usually S. epidermidis), S. aureus, and Candida spp. More rarely, gram-negative bacilli (Pseudomonas spp, Acinetobacter spp), enteric organisms and enterococci are implicated. Treatment includes catheter withdrawal and appropriate antibiotic coverage. For patients requiring only short-term access, the most effective approach is catheter removal, administration of parenteral antibiotics and replacement of the catheter at a different site. However, critically ill patients in hemodynamic monitoring or in TPN or chemotherapy require continuous central venous access, and the approach is to change the potentially infected line over guidewire, intravenous antibiotics and “catheter antibiotic lock” for 24 hours. If a patient’s clinical course fails to improve after 28-48 hours of antimicrobial therapy, the catheter should be removed and replaced at a new site.
Original article
Antibiotic resistance monitoring of nosocomial clinical isolates
Bellissima Pietro,
Amato Rosalba,
Bonfante Salvatore
The authors evaluate the epidemiological trend of in vitro resistance of 2,196 clinical isolates, chiefly Gram-negative, in Caltagirone hospital in 1998/99 to piperacillin-tazobactam, piperacillin, cefotaxime, ceftazidime, ceftriaxone, imipenem, ciprofloxacin and tobramicin.
The resistance percentage is reported for each year in order to study the phenomenon in time. The following results were obtained: resistance frequently increases or rarely stays constant in time for all antibiotics used; the resistance percentage is very high for some strains of bacteria; monitoring of resistance in a hospital can help in choosing the empirical therapy. Piperacillin-tazobactam, imipenem and ciprofloxacin were the most active drugs against clinical isolates.
Efficacy of alpha interferon treatment in patients with chronic hepatitis C associated to mixed cryoglobulinaemia
Scotto Gaetano,
Campanozzi Fausto,
D’Adduzio Antonio,
Fazio Vincenzina
Objective. Mixed cryoglobulinaemia is closely associated with hepatitis C virus (HCV) infection. The aim of this trial was to evaluate in a prospective open study the efficacy of -interferon in the treatment of chronic hepatitis C virus associated to mixed cryoglobulinaemia (MC).
Methods. Thirty-one consecutive patients were treated for the first time with -interferon at a dose of 6 MU three times a week for 12 months. All the patients presented cryoglobulins, which were responsible for clinical manifestations in 9.
Results.At the end of interferon treatment, 11 patients presented complete responses (biochemical and virological), including 7 subjects who presented MC-related clinical manifestations. Cryoglobulins had disappeared in 48.4% of the patients and a clinical improvement was observed in 7 out of 9 patients. Twelve months after interferon treatment was stopped, only 25.8% of patients still had undetectable cryoglobulins and 5 subjects who presented complete responses, all with MCrelated clinical manifestations had a relapse both of HCV-related biochemical and virological indexes and of MC clinical manifestations.
Conclusions. A 12-month course of -interferon is effective treatment for HCV-related cryoglobulinaemia, especially during therapy.
However we obtained scarce results in the follow-up above all in the patients with clinical manifestations of MC.
Humoral and cellular immunities to Brucella among population of North Campania Country
Galdiero Emilia,
Galdiero Roberta
Five hundred people coming from the country-side, where a large number of cattle is bredeed, and 500 people coming from the city, were examined for the presence of humoral and cellular immunity to brucellosis with the standard agglutination test (Sat), anti-human globulin test (AHGT), Elisa test (Enzyme-Linked Immunoadsorbent Test) and IFN-gamma release in vitro. We found that Elisa test showed a higher sensitivity respect to the Sat and the AHGT test. In fact, with the Elisa test the seroprevalence was 10% for IgG, 9,4% for IgM and 1% for IgA in the rural country compared with that of the urban country which was 8,2%, 8,3% and 0,4% respectively. The Sat test and AHGT test, instead, showed a percentage of 91% and 87% with a titre < 20 from the rural country and a percentage of 96% and 98% from the urban area. Morover we noticed that the test based on the production of IFN gamma which appears to be an important mediator of cell-mediated immune response, agreed with serological tests
Treatment of streptococcal tonsillo-pharyngitis in paediatric patients: short-course therapy with cefaclor
Esposito Silvano,
Noviello Silvana,
Ianniello Filomena,
D’Errico Gioacchino
Short-course treatments of streptococcal pharyngotonsillitis with oral cephalosporins and macrolides have resulted in a similar bacteriologic and clinical cure rate and in better compliance compared to the conventional 10-day course. Cefaclor has never been investigated for this purpose.
138 patients out of 420 recruited patients had a positive culture for S. pyogenes and were randomly assigned to receive cefaclor (25 mg/kg/bid) for a 5- (70 pts) or 10-day (68 pts) course. Patients were assessed clinically and bacteriologically 2-3 days after completing the course and followed up after 20-30 days. All 420 recruited patients belonged to a population of 2,800 children who had been previously screened for a streptococcal carrier state to exclude carriers from final evaluation.
Clinical cure and bacteriological eradication was recorded in 92.8% and 92.6% of patients in groups A and B respectively. Therefore, short-course therapy with cefaclor may offer an effective alternative treatment to conventional regimens, with potential for better compliance.
Case report
Chronic HPV correlated lymphedema of external genitals: a case report
Sapienza Mauro,
Curatolo Salvatore,
La Greca Stefano,
Castelli Giovanni,
Di Gregorio Pietro
The Authors describe an unusual case of association between skin lymphangiomas and HPV infection in external genitals. The encountered difficulties in diagnosis represented an excellent example of efficient integration among specialists of different medical branches.
Hepatitis C virus infection mimicking hemorrhagic fever: a case report
Morano Chiara Maria,
Perrone Antonio,
Deramo Maria Teresa,
Santarangelo Pasquale,
Schiraldi Oronzo
Acute C hepatitis, compared with hepatitis A or B, may sometimes be associated with extrahepatic manifestations of a haematologic nature. The first case of hepatitis associated with aplastic anemia was reported by Lorenz in 1955. We observed a patient who developed acute hepatitis, associated with febrile purpura: pancytopenia was present, but not aplasia.
This association is frequent in Flavivirus-related infections, like Dengue and Yellow Fever, and principally affects children and young people. HCV belongs to the Flavivirus family and so in this case clinical signs may have developed as a consequence of HCV infection.
Liposomal Amphotericin B for treatment of acute phase and secondary prophylaxis of visceral leishmaniasis in a HIV positive patient
Murdaca Giuseppe,
Setti Maurizio,
Campelli Antonio,
Ghio Massimo,
Puppo Francesco,
Indiveri Francesco
The authors describe a clinical case of an HIV+, HBV+ and HCV+ 46-year-old male patient, with a history of drug abuse of intravenous heroin, admitted to their attention for high remittent fever (39°C), weight loss and severe dysphonia. The increasing severity of dysphonia had required a fiberlaryngoscopic examination which allowed a diagnosis of hypertrophy of vocal chords. The Wright-Giemsa stain performed on vocal chord biopsy evidenced Leishmania infantum. The same protozoon was subsequently also revealed in bone marrow aspirate. The patient underwent a course of therapy with Amphotericin B deoxycolate (0.5 mg/kg) which had to be interrupted due to insurgence of diffuse petechiae and switched to Amphotericin in cholesterinic suspension (2.5 mg/kg every 21 days). After three months, insurgence of high fever related to the infusion induced the start of therapy with liposomal Amphotericin B (3 mg/kg every 28 days) which led in 4 weeks to a complete clinical remission. Prophylaxis with liposomal Amphotericin B is continuing and remission has persisted for 40 months.
This case report shows the importance of liposomal Amphotericin B therapy in order either to obtain clinical remission of visceral leishmaniasis or, in secondary prophylaxis, to reduce the risk of the disease’s recurrence.
The Infections in the History of Medicine
Dental caries: from verminous to infectious disease
Pistacchio Eleonora,
Disperati Simona
The purpose of our analysis is to study the evolution of knowledge about the etiology of caries. Since ancient times mankind has investigated the causes of a pathology which is at times most painful. Only in the second half of the nineteenth century, with the advent of microbiology, was the relationship between oral bacteria, food residues and tooth decay understood.
This important discovery was due to Willoughby Dayton Miller, one of Koch’s students. His “chemical-parasitical” theory was universally accepted in a few years. Even now, if we want to explain the causes of caries, we have to start from Miller’s study.
