The prion diseases or transmissible spongiform encephalopathies (TSE) constitute a group of ereditary or acquired neurodegenerative disorders. The Authors evaluate the etiopathogenetic background, the clinical features and the current concerns with special attention to bovine spongiform encephalopathy and new variant Creutzfeldt Jacob disease.

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Four hundred Staphylococci strains, isolated from different in intensive care unit hospitalized patients, were analyzed. 53% of all strains were resistant to methicillin. Against methicillin-resistant S. aureus (MRSA), teicoplanin and vancomycin (100% of susceptibility), rifampin (76.3%) and co-trimoxazole (73%) emerged as the most potent drugs tested; the 15% of the strains were susceptible to ciprofloxacin, erythromycin, clindamycin and gentamicin. Only one MRSA strain (0.8%) resulted hetero-resistant to vancomycin. Among 100 strains exposed to serial concentration of vancomycin (0.25-32 mg/L for 30 days), 57 were selected with intermediate-level of resistance to the glycopeptides; the MRSA strains have shown to acquire resistance in vitro more easily than methicillin-susceptible. These results indicate that in the clones of Staphylococci circulating in our region, the evolution of glycopeptides-resistance is not a rapid process and the loss of effectiveness of these antibiotics cannot be predicted to short term. In particular, the restriction profile analysis of chromosomal DNA from MRSA strains, selected in vitro with intermediate -level of vancomycin resistance, demonstrated that at the moment in the hospital departments studied, the diffusion of a clone able to acquire resistance more easily than others is not present.

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Fluoroquinolones resistance in Staphylococci is associated to point mutations in grlA (80,84 and 116) grlB, gyrA (84,88) and gyrB genes. Almost all MRSA strains are ciprofloxacin and levofloxacin resistant while, in a lesser degree, MRCoN staphylococci show to be resistant to levofloxacin. This observation made possible to predict a different correlation between methicillin-resistance and the resistance to FQs in this two different species. In this study, we compare genomic analysis of S. aureus and S. epidermidis with the resistance to FQs. Our results show that strains of MRSA are distributed in 4 different PFGE-types while 12 MRSE strains are distributed in 9. MRSA resistant to FQs showed a unique PFGE pattern; on the contrary of FQs susceptible MRSA and MSSA. Furthermore mecA and gyrA genes are located in the same SmaI fragment in MRSA and in different in MRSE. MSSE and MRSE show more ClaI/mecA polymorphisms than MRSA. All this data confirm the clonal origin of MRSA and show that FQs resistance is linked to the presence of mec locus and both clonally spread. On the contrary in MRSE FQs-resistance is independent from MR and arise with the normal frequence of antibiotic induction.

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The occurrence of P fimbriae in a total of 222 uropathogenic Escherichia coli (UPEC) strains was investigated. Out of the total, 31 (14%) were P fimbriated. Of 24 pyelonephritogenic E. coli strains, three (13%) with P fimbriae occurred in children with clinical pyelonephritis, and of 198 E. coli strains 29 (15%) occurred in children with cystitis. Prevalence of P fimbriae of E. coli strains was found to be quite similar in patients with cystitis and pyelonephritis.

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In order to assess the epidemiological, microbiological, and clinical features of cellulitis and soft tissue infection occurring during the course of HIV disease, clinical and laboratory data of 2221 hospitalizations carried out since 1991 were retrospectively examined, and 67 bacteriologically-proven episodes of cellulitis-soft tissue infection were identified (3.02% of overall admissions). Among the 92 cultured pathogens, Staphylococcus aureus was the most frequent (46 cases), followed by Pseudomonas spp., Escherichia coli, and Streptococcus pyogenes; 38.1% of patients had a polymicrobial infection. I.v. drug use (p<.02) and the male gender (p<.05), were significantly associated with the occurrence of these complications, while a great variation in the severity of underlying immunodeficiency was shown. An elevated rate (83.6%) of episodes of cellulitis or soft tissue infection were community-acquired in origin; the comprehensive frequency of these episodes significantly dropped during the highly active antiretroviral therapy (HAART) era (p<.01). Limbs were involved in over 80% of episodes, and an hematogenous dissemination of bacterial infection (which occurred in 25.4% of cases), proved significantly related to a CD4+ lymphocyte count <100 cells/L (p<.03), and an absolute neutrophil count <1000 cells/L (p<.05). S. aureus strains showed an elevated in vitro resistance rate to penicillin, ampicillin, and rifampin, and a 21.7% rate of methicillin-resistance, while among the 29 gram-negative microorganisms, resistance to ampicillin and first-generation cephalosporins, and that to amoxycillinclavulanate and second-generation cephalosporin, occurred in over 90% and 60% of tested strains, respectively. All episodes of HIV-associated cellulitis and soft tissue infection were favorably treated in 5-16 days, in over 60% of cases with associated -lactam and aminoglycoside antibiotics; a recurrence of staphylococcal cellulitis occurred in 4 patients only, 6-17 months after the initial episode. Cellulitis and soft tissue infection are underestimated complications of HIV disease, but they have a broad etiological and clinical spectrum, are predominantly community-acquired, and are responsible for an appreciable morbidity, due to the supporting role of i.v. drug addiction, and the frequent hematogenous dissemination (which proved to be significantly related to the progression of immunodeficiency and underlying disease). The frequent polymicrobial etiology requires a combination antimicrobial therapy (to be guided by in vitro susceptibility studies), which may avoid a complicated and recurrent disease course in the great majority of cases.

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The authors evaluated the efficacy and safety of an OPAT program in a small group of patients affected by infective endocarditis. Three patients were considered eligible for the treatment; i.e. they had a stable hemodynamic balance and no embolic events. Streptococcus spp. grew in blood cultures of two patients, while blood cultures were negative in the third patient. Long-acting antibiotics were used and all patients recovered from the infection without adverse events. The treatment was efficacious and safe. This preliminary experience suggests that OPAT programs can be promoted in infective endocarditis with advantage. Strictness and caution are necessary in screening and monitoring patients.

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We describe a case of TBC spinal column infection complicated by vertebral abscesses in an immigrant teenager. We underline the importance of always suspecting a tubercular illness when fever has unknown origins, and when patients come from countries where TBC is still endemic. We reaffirm, for early and accurate diagnosis, the importance of abdominal ecography and spinal tomography.

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Smallpox vaccination encountered several obstacles to its widespread adoption in the years following its discovery by Jenner in 1798 due to practical problems (vaccine availability) and weak support from health authorities. In the present paper the author describes the problems related to smallpox vaccination in the Siena area and how such problems were overcome. Vaccination was first practised in this region at the beginning of the 19th century thanks to Elisa Bonaparte’s efforts and support, who set a fine example by vaccinating her own children personally.

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