Volume 11, Issue 1, 2003
Review
Childhood Mediterranean visceral leishmaniasis
Cascio Antonio,
Colomba Claudia
Visceral leishmaniasis (VL) is endemic in areas bordering the Mediterranean Sea (Spain, Italy, France, Greece, Morocco, Tunisia) where it is caused by Leishmania infantum and it is transmitted by the bite of hematophagous sandfly belonging to Phlebotomus spp.; dog constitutes the main reservoir of the infection. In comparison with the past, when VL was typically observed more frequently in children, the current ratio of childhood to adult cases is approximately 1:1. The onset of the disease is characterized by a non-specific initial symptomatology; fever, pallor and splenomegaly are always present. Pancytopenia is present very often; the laboratory diagnosis is established by serological tests (indirect fluorescent-antibody assay, immunoassay test, indirect hemagglutination assay) and by demonstration of Leishmania parasites by microscopy, culture or polymerase chain reaction (PCR) in the bone marrow aspirates. The use of PCR performed on peripheral blood has been reported to be highly sensitive for the diagnosis and the follow up of children with VL. Pentavalent antimonial drugs have been used for many decades as standard treatment for VL; in Italy liposomal amphotericin B (AmBisome) is nowadays considered the first-line treatment for VL.
Original article
Uselessness of liver biopsy in patients with hepatitis C virus chronic infection
and persistently normal aminotransferase levels
Pasquale Giuseppe,
Sagnelli Evangelista,
Coppola Nicola,
Scarano Ferdinando,
Scolastico Carlo,
Sagnelli Caterina,
Bellomo Patrizia,
Lettieri Annamaria,
Filippini Pietro,
Piccinino Felice
This case-control study evaluated the real need for liver biopsy in subjects with persistently normal aminotransferase values over a long period by comparing the histological features of these subjects with those of patients with abnormal aminotransferase values. We considered as “Cases” all 32 consecutive anti-HCV/HCV-RNA positive subjects with at least eight normal serum ALT values during the last twelve months; for each “Case”, we selected as a “Control” one anti-HCV/HCV-RNA positive patient with at least two abnormal serum ALT values during the last twelve months. The Cases and Controls were matched for age (± 5 years) and sex.
In the Case group, 1 subject showed normal liver tissue, 18 minimal chronic hepatitis (CH) and 13 mild CH. In the Control group, 7 subjects showed minimal CH, 19 mild CH, 3 moderate CH, 1 severe CH and 2 cirrhosis. The subjects in the Control group showed a significantly higher HAI score (5.39+2.81) than those in the Case group (2.96+1.62, p < 0.001). The subjects in the Control group more frequently showed a fibrosis score greater than 1 (28.1%) compared to the Case group (9.4%; p<0.05). Finally, steatosis was more frequent and more severe in the Control group than in the Case group (respectively, 78.1% vs 50%, p < 0.05; and 1.47+1.16 vs 0.6+0.71, p < 0.001). The HAI and fibrosis scores did not correlate with the ALT value, HCV genotype or HCV viral load in either the Case or Control group.
Our findings showed that the subjects with a persistently normal serum ALT value had minimal or mild chronic hepatitis, thus demonstrating that a liver biopsy is not indicated for these subjects.
First evaluations of LPV/RTV(Kaletra) efficacy on HIV-positive patients treated with multiple drugs
Sabbatani Sergio,
Legnani Giorgio,
Fulgaro Ciro
At the current epidemic stage, characterized by the rise of antiretroviral drug resistance, it is necessary to administer to HIV-positive patients increasingly effective treatments. This is possible only by means of powerful drugs.
In a retrospective study, the authors evaluate 78 patients: 76 pre-treated with multiple drugs and 2 naïves. The 78 patients received LPV/RTV, starting from the fourth 3-month period of 2000 until the first 3-month period of 2002.
The average treatment duration was 6.5 (± 5.5) months; the median value 6 months. The efficacy of the LPV/RTV therapeutic regimen was evaluated by a cytofluorimetric count of CD4+ and determination of the HIV viral load. There were 14 drop-out patients (17.9%): 5 because of auto-suspension, 1 due to absence of clinical and virological efficacy, 5 due to side effects (3 hepatopathy, 1 allergy and 1 nausea); three patients were lost on follow-up. There were 64 (82.1%) patients on treatment. Forty patients responded (51.3%) and 13 (16.7%) had uncontrolled viraemia (over than 200 copies/ml). However, the treatment with LPV/RTV was not interrupted for these patients, because in the follow-up they showed an increase in CD4+ values.
The authors conclude that the LPV/RTV combination confirms previous findings: it is a drug with a relatively low incidence of side effects, capable of powerful results even in the treatment of patients receiving multiple drugs and thus subjected to the risk of developing antiretroviral drug resistance.
Treatment of bacterial conjuntivitis with topical ciprofloxacin and norfloxacin: a comparative study
Chisari Giuseppe,
Sanfilippo Marisa,
Reibaldi Michele
The authors studied the epidemiology of external ocular infections and the therapeutic efficacy of topical ciprofloxacin and norfloxacin in the treatment of conjunctivitis and blepharitis. Signs and symptoms in two study-group (ciprofloxacin group A = 95 patients and norfloxacin group B = 95 patients) as well as the microbiological data obtained from the conjunctival swab before and after treatment were considered. The clinical and bacteriological success rate in the two study-groups was respectively 91% (group A) and 83% (group B). The results of the present study confirm the therapeutic efficacy of topical fluoroquinolones in the treatment of bacterial conjunctivitis and blepharitis.
HHV8 infection and acute lymphoblastic leukaemia in children
Di Gangi Maria,
Romano Amelia,
Gabriella Maria,
Vitale Francesco,
Perna Anna Maria,
Tramuto Francesca,
Mazzola Angela,
Scarlata Francesco
HHV8 has been consistently linked to both classical and endemic Kaposi’s Sarcoma (KS), primary effusion lymphoma and multicentric Castleman’s disease. HHV8 has also been associated to other oncologic diseases although such reports have not been confirmed. Little is known about the transmission routes of HHV8. The main transmission route may differ between developed and developing countries. We carried out a serologic study by Immunofluorescence of antiHHV8 antibodies on 40 children with Acute Lymphoblastic Leukaemia (ALL) and their relatives. 5 children with ALL were positive (12.5%). Seroprevalence was not significantly higher than the western Sicily pediatric population. The variation in seroprevalence between the relatives of HHV8 seropositive and seronegative patients was not significant. Therefore HHV8 does not appear to be correlated with ALL and the main transmission route in our cases could occurr outside the family.
Case report
Subphrenic abscess during the course of acute brucellosis: diagnosis and treatment with percutaneous sonographically-guided drainage
Giorgio Antonio,
de Stefano Giorgio,
Tarantino Luciano,
Liorre Giulia,
Scala Vincenzo,
De Sena Raffaele
Abscess formation during the course of acute brucellosis is a rare event. A case of subphrenic abscess, the first to our knowledge, is described. A 49 years-old male patient with fever and a mild increase in ALT and gamma-GT was referred to our Institution. Routine blood exams tested negative and antibodies against Brucella spp. Were also negative. CT examination of abdomen was normal.
After 8 days, US examination showed a liquid area under the right diaphragma and US-guided puncture revealed an abscess; pus culture showed the presence of Brucella melitensis. Seven days later theWright reaction became positive. After percutaneous catheter drainage of the abscess, fever disappeared and US follow-up showed reconstitution of subphrenic space.
Our study confirm that sonography is a valid method to demonstrate abdominal abscess and that US-guided percutaneous puncture and drainage are useful tools in diagnosis and treatment of fluid abdominal collections.
Enanthema as the first clinical manifestation of abacavir hypersensitivity reaction: a case report
Lanzafame Massimiliano,
Trevenzoli Marco,
Lattuada Emanuela,
Faggian Federica,
Vento Sandro,
Concia Ercole
Abacavir is a nucleoside analogue reverse transcriptase inhibitor used in combination with other antiretroviral drugs for the treatment of HIV 1-infection. Approximately 3% of patients who receive abacavir develop an idiosyncratic hypersensitivity reaction. The most common symptoms are fever, skin rash and gastrointestinal disorders.
Respiratory symptoms occurred in approximately 20% of patients who have hypersensitivity reaction. We describe the first case, to our knowledge, of hypesensitivity reaction characterized by enanthema and fever without skin rash promptly resolved after discontinuation of abacavir.
Cutaneous cryptococcosis in an immunocompetent host
Coppola Carmine,
Ferraioli Giovanna,
Scarano Ferdinando
An immunocompetent 62-year-old woman presented with cutaneous lesions over her right arm and the hypogastrium. The diagnosis of cutaneous cryptococcosis was made on the basis of the demonstration and isolation of Cryptococcus neoformans from the aspirated pus. The patient responded to fluconazole treatment.
The Infections in the History of Medicine
Observations on the 1348 pest epidemic. Measures taken to combat its tragic effects and avoid epidemic recrudescence
Sabbatani Sergio
When the “Black Death” swept through Europe from southern France in 1348, in the short space of two years the Europeans were hit by one of the most serious epidemics ever recorded in human history. Yersinia pestis reached Europe by sea, its contamination propagated by the Genoese ships coming from the Crimean port of Jaffa. For the first time the world experienced microbiological unification: East and West were equally involved in the tragedy that spread, and no town remained unscathed during the various epidemic waves which succeeded one another in the following three centuries.
The authors of this article describe how and why the epidemic spread, as well as the factors that led to the swift, and often fatal, involment of millions of Europeans. The second part of the article deals with the measures taken by the healthcare authorities of European towns and countries in order to halt the proliferation of the disease.
According to the data and observations by authoritative authors, selected among the many who studied the disease that from the 14th century spread like a scourge throughout the known world at the time, the epidemic could have been even more serious, in terms of mortality and morbidity, without the disciplinary and provisional health measures taken. The experience gained in Italy and all over Europe at the time proved useful not only to better manage the epidemics which cyclically broke out, but also to efficiently combat the cholera epidemics of the 19th century.
With the 14th century plague epidemic, the Europeans and their political and administrative representatives may well have realized for the very first time that contamination could be combatted by adopting a set of rational, scientific norms - although in practice such rules were mostly inspired by misguided scientific theories.
Humankind was no longer alone. A new society was emerging, one that was not going to passively accept the more or less mysterious ways of a superior being of fate.
The Italian and German city-states, the emerging nations (France, England, Austria, Spain, Holland) developed and adopted procedures to control the epidemic - at the first on an ad hoc basis, then permanently. Sometimes success was achieved but always at a high price on the part of the individual and the local community. The path to an epidemic-free existence for humankind was still a long one.