Volume 11, Issue 4, 2003
Review
Brain cysticercosis: review and case report
Sabbatani Sergio,
Fasulo Giovanni,
Chiodo Francesco
After thorough biological, epidemiological and clinical analysis as well as diagnosis and therapy of neurocysticercosis, the Authors describe a case they have encountered. Given the increase in the emigration rate from developing countries, the epidemiological nature of this case indicates that brain parasitosis due to helminths requires more attention. As seen in the last 20 years in the United States, these pathologies might increase significantly in Italy in the near future.
Original article
Non-tubercular vertebral osteomyelitis: diagnosis and therapy of 45 patients from a single Italian centre
Carrega Giuliana,
Arena Sergio,
Bartolacci Valentina,
Gavino Dario,
Mecca Domenico,
Sandrone Clemente,
Santoriello Luisa,
Tabasso Giuseppe,
Riccio Giovanni
Aim of the study: to evaluate the episodes of non-tubercular spondylodiskitis diagnosed between 1998 and 2002 at the Ospedale S. Corona, Pietra Ligure (SV). Methods: perspective evaluation of vertebral osteomyelitis classified as spontaneous or iatrogenic if associated with procedures on the spinal cord, with detection of associated risk factors, localization, aetiology and treatment.Results: 45 episodes, 71% spontaneous and 29% iatrogenic were observed. Associated risk factors were present in 47% of spontaneous spondylodiskitis. Lumbosacral localization was detected in 68% of spontaneous and 100% of iatrogenic episodes. Other localizations in spontaneous spondylodiskitis were dorsal (25%) or cervical (7%). Methicillin-sensitive staphylococci caused the majority of spontaneous spondylodiskitis, while methicillin-resistant strains were more frequently involved in iatrogenic episodes. Among spontaneous spondylodiskitis, 63% healed with antibiotics for 8 weeks, but surgery was often needed in dorsal localizations. In iatrogenic forms antibacterial therapy for 8 weeks-6 months was effective in cases not associated with foreign bodies but their presence always required surgery for healing. Conclusions: spondylodiskitis is more frequently localized at lumbosacral level. Beta-lactams are generally effective in spontaneous episodes, while iatrogenic ones often require associations of drugs. Surgery may be required in the case of dorsal localization or in the presence of foreign bodies.
Streptococcus bovis infectious endocarditis: clinical and epidemiological characteristics
Massaroni Katia,
Francavilla Rosa,
De Rosa Francesco Giuseppe
This paper shows our experience concerning the study of Streptococcus bovis infectious endocarditis (EI): 47 patients, with no prior history of IV drug abuse (NTD), who suffered EI caused by Streptococcus bovis were excerpted from a case record of 1053 cases with diagnosis of EI defined in accordance with Duke’s Hospital criteria. For each patient we considered age, sex, complications, echocardiographic findings, antibiotic therapy, eventual heart-surgery and final outcome of the disease. We then compared the parameters of our patients, with the ones of 216 NTD patients suffering non Streptococcus bovis EI, selected according to age correspondence and concomitant onset of the disease. The characteristics of Streptococcus bovis EI are analogous to the ones of EIs caused by other micro-organisms in NTD patients, except for a non statistically significant trend of higher frequency in old age and in males. Concerning possible predisposing conditions, we considered the association extensively described in the literature between Streptococcus bovis EI and gastroenteric pathology (above all colon neoplasms): this association was not frequently observed in our study because appropriate instrumental investigations of the digestive tract were carried out only in a minority of patients.
Resistance of Pseudomonas aeruginosa to ciprofloxacin and levofloxacin: 1998-2002
De Vecchi Elena,
Drago Lorenzo,
Nicola Lucia,
Colombo Alberto,
Guerra Anna,
Tocalli Loredana,
Medaglia Massimo,
Gismondo Maria Rita
The aim of this study was to evaluate resistance rates to ciprofloxacin and levofloxacin of Pseudomonas aeruginosa (n=1917 strains) isolated at Laboratory of Microbiology at L. Sacco Teaching Hospital in Milan, Italy in the period between January 1998 and October 2002.
Twenty-five percent of tested strains were isolated from sputum, 18% from bronchial lavage, 10% from urine, 9% from ear, 4.5% from blood and 26% from other materials. Ciprofloxacin-resistant strains were 121/ 411 (29%) in 1998, 158/ 526 (30%) in 1999, 136/ 400 (34%) in 2000, 129/ 390 (33%) in 2001 and 53/ 190 (28%) in 2002. Resistance rates for levofloxacin were 132/472 (28%) in 1999, 104/ 400 (26%) in 2000, 101/ 390 (26 %) in 2001 and 47/ 190 (25%) in 2002.
Our data highlight overall stability in resistance to ciprofloxacin and levofloxacin with minor variations for ciprofloxacin. Moreover, in contrast with international worldwide studies, resistance rates to ciprofloxacin remained higher than those related to levofloxacin throughout the period studied.
Helicobacter spp. and liver diseases
Coppola Nicola,
de Stefano Giorgio,
Marrocco Cecilia,
Scarano Ferdinando,
Scolastico Carlo,
Tarantino Luciano,
Rossi Giovanni,
Battaglia Martina,
Onofrio Mirella,
D’Aniello Flavia,
Pisapia Raffaella,
Sagnelli Caterina,
Sagnelli Evangelista,
Piccinino Felice,
Giorgio Antonio,
Filippini Pietro
To test whether Helicobacter species play a role in the enhancement of liver necro-inflammation and fibrosis and in the development of hepatocellular carcinoma (HCC), we sought DNA sequences of Helicobacter species in liver specimens from patients with viral-related chronic hepatitis, HCC or metastatic liver carcinoma. We enrolled 28 consecutive patients with ultrasound evidence of hepatic nodule(s) on their first liver biopsy: 21 had histological evidence of HCC (Group I) and 7 of metastatic liver carcinoma (Group II). In the same period we observed 27 consecutive patients with chronic hepatitis on their first liver biopsy (Group III). Helicobacter sequences were sought by PCR using primers for the 16S rDNA of Helicobacter spp, designed to amplify a 400 base-pair fragment, and detected by 2% agarose gel and hybridization with a specific biotinylated probe. We used, as positive controls for the DNA extraction from liver tissue, hepatic biopsy sections in which HBV infection was confirmed by HBcAg positivity and in which we amplified HBV-DNA by specific primers; positive controls for the amplification of Helicobacter spp were obtained from gastric biopsy sections in which Helicobacter pylori infection was confirmed by biochemical and histochemical tests. HBV-DNA was found in all five HBcAg positive liver biopsies. Helicobacter spp 16S rDNA was detected in all five biopsy specimens of gastric mucosa and in none of liver specimens from patients in any group.
Our data suggest that Helicobacter species were not involved in the pathogenesis of virus-related HCC, chronic hepatitis or liver carcinoma metastasis.
Efficacy of interferon treatment (IFN) in elderly patients with chronic hepatitis C
Alessi Nunziata,
Freni Maria Antonietta,
Spadaro Aldo,
Ajello Antonino,
Turiano Santi,
Migliorato Domenico,
Ferrau Oscar
The aim of this study was to evaluate the efficacy and tolerability of interferon treatment in aged patients with chronic hepatitis C. One hundred and fifty-four patients with chronic hepatitis C, consecutively treated with a-interferon (a-IFN), were retrospectively subdivided into two groups according to age ≥60 or <60 years. The two groups were compared in terms of biochemical and histological activity of the disease, HCV genotype, total dose of IFN received, incidence of side effects and rate of response to treatment. Statistical analysis was performed by Student’s t test, chi-square test and Fisher’s exact test. Aged patients had a higher prevalence of HCV genotype 1b and cirrhosis and received a lower dose of the drug. No differences were found in other epidemiological-clinical characteristics before treatment. The rate of sustained response and long–term response to therapy was similar in the two groups of patients (18% and 8% in the aged and 20% and 13% in the younger respectively). There was a trend of more frequent major side effects in aged patients (p=0.07). Treatment of chronic hepatitis C with a-IFN had the same efficacy in the two groups observed. In aged patients with chronic hepatitis C treatment with the more effective pegylated IFN should be taken into consideration, especially when association with ribavirin is at high risk of adverse events.
Drawbacks of antibiotic susceptibility of Streptococcus pneumoniae
Pasticci Maria Bruna,
Baldelli Franco,
Cardaccia Angela,
Moretti Amedeo,
Papili Rita,
Stagni Giuliano
During 10 years penicillin resistance among clinical isolates of S. pneumoniae was more or less stable. The cumulative proportion of penicillin non susceptible S. pneumoniae (PNSP) was 13.0%; 7.2% when isolates with MIC ≥ 2 mg/l were considered. Among PNSP only 2 strains were isolated from sterile body fluids, one having MIC >3.84 mg/l. Lack of susceptibility to cotrimoxazole was 38.4%. All isolates were susceptible to ceftriaxone, levofloxacin, moxifloxacin, and quinupristin-dalfopristin.
The Infections in the History of Medicine
Health service organization during the age of pestilence. II half
Sabbatani Sergio
The author presents the history of the places where patients with epidemic pathologies were isolated. Since the study of medicine began, such places have been known as asclepiei, xenodochi, hospices, lazarettos, sanitary cordons, and quarantine stations and they contributed to controlling epidemics in Europe. Important not only in the context in which they were created, these structures expressed the medical culture and point of view of that age. Although very far from discovering the cause of the pathology due to their lack of scientific knowledge, the medical class sometimes knew how to effectively organize the isolation of patients. The history of such structures interweaves with the long history of Christianity and with the emerging nations of Europe and the city-states of the Italian Renaissance. Previously, in classical Greece and Imperial Rome there had also been “homes for the sick” to isolate patients. Today the world is periodically hit by epidemics. In such moments the medical profession uses its research ability and organizational capabilities but also historical memory to reduce epidemic contagion.
