Volume 11, Issue 2, 2003
Review
Bacterial granulomatous hepatitis
Pasquale Giuseppe,
Scarano Ferdinando,
Sagnelli Caterina
The liver may react to different infectious and non- infectious agents, developing granulomatous lesions which characterize granulomatous hepatitis. Granulomas of the liver are circumscribed inflammatory lesions (size from 50 to 300 mm) composed of epithelioid cells, varied numbers of mononuclear cells and eosinophils and multinucleated giant cells. They represent a specialized cell-mediated immune response to a wide variety of etiological factors. A broad spectrum of microorganisms may trigger hepatic granulomas. M. tuberculosis is the more frequent agent (~ 44%). Granulomatous hepatitis is characterized by a febrile illness with systemic signs and symptoms such as fatigue, sweating, shivering, hepatomegaly and/or splenomegaly, abnormalities in serum liver tests (aminotransferase, alkaline phosphatase). Liver biopsy provides diagnostic information in approximately 15-30% of cases, identifying directly the microbial agent with special microbial stains and polymerase chain reaction or finding distinctive microscopic features, suggestive of specific microorganisms. In such cases appropriate therapy is possible. Unfortunately in one third of cases is impossible to reach aetiological diagnosis on histological criteria alone. In these cases a therapeutic attempt with steroids, effective in the idiopathic granulomatous hepatitis, may be useful.
Original article
Mediastinal tubercular lymphadenitis and adenobronchial fistulas (TABF) in paediatric age. 1980-2001 case record
Lancella Laura,
Nicolosi Luciana,
Bottero Sergio,
Carnevale Enza,
Krzysztofiak Andrzej,
Ticca Fausto
The aim of this study is to assess the frequency and clinical importance of mediastinal tubercular lymphadenitis and adenobronchial fistulas (TABF) and to evaluate the role of fiberbronchoscopy and surgical bronchoscopy associated with antimicrobical chemotherapy.
136 cases of primary pulmonary TBC, admitted to the Unit of Infectious Diseases, Bambino Gesu Children Hospital in Rome, between 1980 and 2001, were enrolled in the study. We considered 56 patients with clinical and radiological evidence of mediastinal tubercular lymphadenitis and 28 patients with adenobronchial fistulas (TABF). The incidence of TABF was 20,58% of primary pulmonary TBC. All patients were treated by medical therapy combined with local endobronchial surgery. TABF emerges as a complication of pediatric primary pulmonary TBC. We suggest a clinical and radiological survey to decide the utility of a diagnostic and therapeutic surgical bronchoscopy.
Factors associated to times of clinical diagnosis of infectious endocarditis. Analysis of a multicentre case-record
Cicalini Stefania,
De Rosa Francesco Giuseppe,
Francavilla Rosa,
Arnaudo Isabella
The authors demonstrate that time necessary for diagnosis in 902 patients with validated infectious endocarditis was significantly shorter in 249 drug addicts confronted with 653 non-addicted patients.
With regard to the latter category we noticed a significant tendency in diagnostic time reduction in the last five years of observation and this is probably due to the improved knowledge on infectivologists regarding the clinical presentation of infectious endocarditis rather than the application of validating protocols.
Tuberculosis infection and disease in immigrant children
Giacchino Raffaella,
di Martino Lucio,
Losurdo Giuseppe,
Pisanti Antonello
From the second half of the eighties, the cases of tuberculosis (TBC) in Italy have been constantly increasing. The increase in TBC cases in developed countries is related to different factors, including HIV epidemic and increased number of immigrants from countries with high TBC incidence and important socio-economic problems. Compared with adults few children with TBC were homeless or coinfected with HIV, nonetheless the children lived frequently in low socioeconomic status and consequently high risk of being uninsured and with adults at risk for tuberculosis (immediate relative, household members, or recently immigrated).
An epidemiologic study was carried out, in order to evaluate the impact of TBC infection in immigrant children. From January 2001 to December 2002, Mantoux test (5 IU) was performed in immigrant children hospitalized or followed in two children hospitals. They included 228 children: mean age 4 years (range 1 month to 15 years). The patients came from: South America (44%) (especially from Ecuador), from Africa (20%), from Eastern Europe (19%), (especially from Middle East and North Africa), from Far East (17%). In 30 cases (13,2%) Mantoux test was positive. Among these latter, 21 presented latent infection, whereas another 9 had tuberculous disease with pulmonary localization and one of them associated with cervical adenopathy. In the study period, among all children (4426) admitted the two Units, the prevalence of tuberculous disease was 2,5% in immigrant children compared 0.2% in native children.
Accurate epidemiologic monitoring, further clinical studies aimed at highlighting TBC peculiar aspects in children, and adequate therapy can lead to TBC control in the immigrant children.
Case report
Visceral leishmaniasis and HIV co-infection: a rare case of pulmonary and oral localization
Nigro Luciano,
Montineri A.,
Larosa R.,
Zuccarello M.,
Iacobello C.,
no surname no name
Visceral leishmaniasis (VL) has increased as a complicating infection in subjects with human immunodeficiency virus (HIV) in countries bordering the Mediterranean sea. The clinical course as well as organ involvement of VL are often atypical in HIV positive subjects. In this study a case of VL with pulmonary and oral mucose localisation in a patient with acquired immune deficiency syndrome (AIDS), is reported.
These findings, together with the presence of the parasite in the peripheral blood smear, confirm that in HIV positive patients the impaired immune system allows the spreading and the atypical localisation of the Leishmania amastigotes more easily than in immuno-competent individuals. In endemic areas and in HIV positive subjects a systemic and careful parasitological follow-up is necessary to ensure that any clinical form of leishmaniasis is not overlooked.
Mycobacterium flavescens vertebral osteomyelitis in an immunocompetent host
Mastroianni Antonio
The aim of this paper is to describe a rare case of vertebral osteomyelitis caused by Mycobacterium flavescens in an immunocompetent patient. Mycobacterium flavescens is a rapidly growing, pigmented, non-tuberculous mycobacterium, usually described as non-pathogenic for humans but occasionally reported as the cause of serious infectious complications recognized in clinical practice. This study stressed the importance of recent reports that describe the occurrence of vertebral osteomyelitis due to non-tuberculous mycobacteria that have also been recognized with an increasing incidence among immunocompetent hosts. A brief review of the current literature on human disease caused by Mycobacterium flavescens is also reported.
Acute mediastinitis: a severe complication of transdermal therapy in a patient with ischaemic heart disease. A case report
Faggian Federica,
Lattuada Emanuela,
Lanzafame Massimiliano,
Trevenzoli Marco,
Cattelan Anna Maria,
Concia Ercole
Acute mediastinitis is an uncommon and potentially devastating infection.
Generally, mediastinitis occurs as a postoperative infection following median sternotomy. We describe a case of acute mediastinitis in a patient with ischaemic heart disease, secondary to the spread of cutaneous infection of the chest wall in the application site of transdermal nitroglycerine patches.
Sternoclavicular joint infection in an adult without predisposing risk factors
Zanelli Giacomo,
Sansoni Anna,
Migliorini Lucia,
Donati Elisa,
no surname no name
Septic arthritis of the sternoclavicular joint (SCJ) is an uncommon condition and it has been associated with numerous predisposing factors. We describe a rare case of SCJ infection due to Staphylococcus aureus in an adult without known underlying predisposing conditions and in which recovery was achieved with medical therapy alone.
The Infections in the History of Medicine
Anthrax and Carbuncle: two sides of the same coin
Mancini Renata,
Ippolito Giuseppe
The disease caused by Bacillus anthracis is one of the most critical concerns to the general public and public health authorities due both to the anthrax cases caused by the intentional release of the germ in the USA at the close of 2001 when letters and packages were contaminated with anthrax spores, and the current threat of biological warfare.
After a brief excursus on the history of the terms Anthrax and Carbuncle, we survey the main evidence of anthrax found in the ancient literature, and deal with the identification of the pathogenic agent responsible for the disease and the subsequent discovery of the first anthrax vaccine and its use in order to control the spread of the disease in the cattle. Finally, we examine some of the most important episodes of occupational exposure to the Bacillus anthracis that occurred in the past two centuries and the preventive measures applied both to employees and the workplace.
