Because the symptoms and signs of Brucellosis are nonspecific the diagnosis is made with certainty by isolation of brucella or of its nucleic acids, or by evidence of a specific immunologic response. The rate of isolation from blood varies from 50 to 80% during the acute phase; bone marrow cultures may have a higher rate than blood in chronic disease. Recently, the isolation time for brucellae may be reduced by automated culture systems (e.g. the lysis-concentration technique or BACTEC) from weeks to days. Although a number of techniques have been developed to measure brucella antibodies (immunoenzymatic, immunofluorescent assays), the serum agglutination test is the simplest and most widely used. Recently, the Polymerase Chain Reaction has been used to evidence nucleic acids of brucella; although it shows high specificity and sensitivity, in the acute and chronic disease, and allows rapid diagnosis, standardization and further evaluation are needed.

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The authors intend to evaluate the results obtained from a pharmaco-economic project included in the 1999 and 2000 budgets. The objectives of the study are: 1) to establish whether there has been a saving in expences for antibiotic therapy (T.A.) during the first half-year of 1999 and during the first half-year of 2000 and to ascertain the reasons for any positive result; 2) to evaluate the average hospital stay in the first half-year of 2000 and to observe how many times patients were been discharged early with shift therapy. Of the 286 patients (1999) and 309 (2000) considered, we focused attention on 187 (1999) and 190 patients (2000) who were treated with antibiotic therapy. A substantial cost saving was found in antibiotic use (-31%) in the first half-year of 2000 due to the early discharge and the continuation of home therapy for a fair number of patients and due to increased attention in the choice of medicine for less serious diseases. The second objective was not achieved with the reduction of average hospital stay even if the average length of antibiotic therapies (D.M.T.) fell from 13.1 days at 1st September to 9.8 days in the first half-year of 2000 (P:NS). These results suggest that projects designed to achieve financial savings and improvements require more cooperation between clinical U.O. and services that enable hospital stay to be shortened.

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In order to assess the relationship betwecn a diagnosis of sexually-transmitted disease (STD), sexual behaviour, condom use, and other social, demographic, and epidemiological variables in a cohort of young adults who referrred to a STD centre during a 9-year period, all patients aged 13-20 years were prospectively evaluated, with special attention paid to sexual behaviour, and use of condom or other contraceptive techniques. The 284 assessed young adults represented 6.1% of all patients with a diagnosis of STD: an increasing temporal trend was noticed (from 3.ó% in 1991, up to 10.4% nel 1999: p<.0001). On the whole, 70.1% of subjects aged 20 years or less never used a condom during the 6 months preceding the diagnosis of STD: only 21.8% of patients reported regular condom use, and 4.9% more subjects referred occasional use, while in the remaining 3.2% of cases other contraceptive methods were employed. Among under age patients (10.6% of study population), the rate of condom use was 3.3% only, while male homoseuals always denied the use of barrier methods. Although a progressive increase in condom use was observed through the study time (from 0% encountered in 1991-1994, to 57.6% of 1999: p<.0001), this phenomenon proved linked only to the massive increase of immigrant sex workers, which occurred since 1997. When excluding from analysis any probable female prostitutes, lack of condom use tested related to the male gender (p<.05), and a low education (p<.04). Over 50% of patients reported 0-1 partners during the last 6 months, even thongh an increase in sexual promiscuity was observed dunng the last three years, compared with 1991-1996 (p<.02). Among the 297 different STD episodes (mostly nongonococcal cervicitis-vaginitis and urethritis, and HPV infection), an increasing incidence of nongonococcal STD and syphilis was found, but no correlation was observed betwecn the spectrum of diagnosed STD, sexual behaviour, and condom use. In particular, in 69.9% of the 103 episodes nongonococcal disease occurred despite regular (65 cases), or occasional (7 episodes) condom use. Moreover, no signifìcant relationship was disclosed between STD occurrence, condom use, and other analyzed social, demographic, epidemiological, and clinical variables. According to our survey, an increased risk of STD seems to involve young adults, and to be related to the variation of multiple demographic, epidemiological, and behavioral features. While immigration and prostitution had the major impact during the last three years, sexual promiscuity and infrequent condom use represent persistent; risk factors in this age population. Besides their diagnostic and therapeutic role, STD centres are able to carry out permanent monitoring of STD, as a starting point to plan adequate information campaigns and specific prevention strategies.

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To determine the prevalence of intestinal parasitic infections in western Sicily from 1993 to 2000, fecal samples from 3024 patients (subdivided into native Sicilian children, migrants from developing countries and HIV+ patients,) were collected and observed on direct examination or by the formalin-ether sedimentation technique of Ritchie. Lugol, Kinyoun and Gomori's trichromic stain techniques were employed. Trophozoites or mainly protozoan cists and helminthic eggs were detected in 195 patients (6.4%). The positivity rate was 18.7% in HIV+ patients, 10.3% in migrants and 5.0% in native Sicilian children. Tape test for Enterobius eggs was employed on 1449 patients with a positivity rate of 11%. The importance of parasitology also in new millennium is emphasized.

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Mediterranean spotted fever is an infectious disease due to Rickettsia conori transmitted to man by the dog tick Rhipicephalus sanguineus. The review of a consecutive series of 525 cases, admitted to Caltagirone hospital in the last 20 years, permits the classic clinical picture to be identified by fever, maculopapular eruption and tache noire, and any complications to be visualized. Usually the course of the disease is good, but 12.7% of our cases reported complications such as renal failure, myocarditis, pneumonia, encephalitis, anicteric hepatitis, gastrointestinal bleeding, anaemia and impaired glucose tolerance. The development of a systemic vasculite is the main pathogenetic factor in the origin of systemic complications. Early diagnosis and specific antibiotic treatment may reduce the risk of complications.

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Objective: To evaluate the efficacy of a program to control nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA). Methods: Analysis of the incidence of infection and contamination due to MRSA in patients admitted to the hospital of Cremona 6 months before and 3 years after the introduction of the guidelines (July 1997). Results: During the 42 months of the study period, on 80705 admissions, 511 cases of MRSA contamination/infection were identified, the incidence being 0.57 cases per 100 admissions. The infection rate dropped from 0.34 (IC95%: 0.25–0.45) in the first 6 months of the study, before the introduction of guidelines, to 0.17 (IC95%: 0.14–0.20) in the following 3 years (p=0.01). Severe infection decreased from 0.18 to 0.1 per 100 admissions, with a 44% decrease (p=0.058), while mild infections dimineshed from 0.16 to 0.07 per 100 admissions (p=0.045). Methicillin resistance among nosocomial isolates of Staphylococcus aureus was reduced from 53 % to 35 % (p<0.0001). Conclusions: The introduction of a program to control the nosocomial spread of MRSA proved effective in reducing both the incidence of infection and the methicillin-resistance of Staphylococcus aureus isolates. The cost effectiveness of the program seems very favourable.

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In the present study we show our experience as one of the Centers (center 006) of the Italian Index of Protease Inhibitors (PI). In this multicentric, observational study we studied HIV-positive naive patients for antiretroviral therapy with protease inhibitors. From 8/1/97 to 31/1/98 in our department 64 patients were enrolled and followed up trough an electronic medical sheet in order to evaluate efficacy, tolerability, toxicity and compliance of treatment with PI. Our results show a reduction in AIDS-related mortality and a decrease in AIDS defining diseases: in particular data show an increase in CNS pathologies in comparison with other opportunistic events. Moreover, in patients non complaints to therapy, the progression of the disease was more frequent. The side effects more frequently observed during PI treatment were hypertrigliceridaemia and lipodystrophy; gynaecomastia and hyperprolactinaemia were even present, perhaps as expression of direct metabolic action of HAART therapy.

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The authors describe a case of severe CMV retinitis in a young adult AIDS patient who recovered following first a course of ganciclovir and then HAART. Six months after the initial episode while still under successful HAART, the patient developed an acute episode of retinitis despite a persistent significant improvement in the immunological picture and a very low level of CMV reactivation. The acute episode can be related to an enhanced individual reactivity to minor CMV replication.

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