The life expectancy of HIV-infected patients treated with highly active antiretroviral therapy (HAART) has increased and now approaches that of the general population, while also the definition of AIDS has lost most of its epidemiological and clinical significance, due to the immune recovery obtained by large-scale administration of potent antiretroviral combinations. The prolonged survival of subjects with HIV infection, and the late recognition of patients with occult disease, contribute to a progressive increase of the disease incidence in patients aged 50-60 years or more, in the next future. Unfortunately, the large majority of therapeutic trials addressed to assess and compare novel antiretroviral molecules and associations, as well as studies regarding antimicrobial chemotherapy of prophylaxis of AIDS-related opportunistic infections, have just advanced age and/or underlying chronic disorders (i.e. liver or kidney failure) among main exclusion criteria, or do not allow to extrapolate data regarding older subjects, compared with younger ones. The limited data available until now show that antiretroviral therapy has a similar virological efficacy in the elderly compared with younger patients, but the immune reconstitution is often slower and blunted according to age progression, although some neat studies have shown that the thymic function (which controls most of quantitative and functional immune recovery) can be preserved in adults and even in advanced age. When facing older subjects, the Infectious Disease specialist has to take careful attention to eventual chronic end-organ disorders, all possible pharmacological interactions, and overwhelming toxicity due to underlying drug therapies: all these issues may significantly interfere with HAART efficacy, patients’ adherence to prescribed treatments, and frequency and severity of untoward events. The guidelines of antiretroviral therapy and those of treatment and prophylaxis of AIDS-associated illnesses should be appropriately updated, on the ground of novel features due to the emerging increase of mean age of HIV-infected patient population.

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Objective: To describe infectious diseases mortality in Italy between 1969 and 1999, with particular emphasis on sex, age, and geographic differences. Methods: Using mortality data provided by the Italian Central Institute for Statistics (ISTAT), we evaluated all codes of the ICD8 and ICD9 classifications to identify each cause of death attributable to infectious agents. Deaths for HIV/AIDS were excluded. Results: Infectious diseases were responsible of 1.7% of the overall mortality between 1969-1999, and our approach identified 57.5% of all deaths for infections not included in the ICD8 and ICD9 infectious disease codes. Up to 1994, the mortality for all infectious diseases showed a very strong downward trend, with a 6-fold decline. Such downward trend tended to level off in 1995-1999, mainly because of increasing deaths for septicaemias, heart infections and hepatitis. An increasing proportions of deaths due to infectious diseases occurred in the elderly, from 48.1% in 1969-1979 to 77.3% in 1990-1999. Mortality rates were consistently higher in men than in women and showed a substantial geographic heterogeneity. In newborns, mortality rates declined 10-fold and an inverse north-south geographic gradient persisted during the study period. Conclusions: This exhaustive methodological approach to identify infectious causes of deaths allowed to better define the burden of infections on mortality and to register downward trends similar to those registered in other industrialized countries.

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In a survey of 25 Divisions of Internal Medicine and Pneumology, distributed over the Italian territory, our study was aimed to verify the diagnostic and therapeutic pathway, the gravity in accordance to Fine’s score (PSI), the median hospital length of stay and mortality rate among patients consecutively hospitalized for community-acquired pneumonia (CAP), from January 1 to March 31, 2002. Overal 407 patients have been evaluated, with a mean age of 69 years; with a Fine’s score respectively: 28% <70, 21.4% between 71 and 90, 31.25 between 91 and 130, 19.4%>130. A single chest radiography was done in 27.2% of the patients, two chest radiographs were done in 55.2% of the patients, more than two chest radiographs in 13.2% of the patients. A CT scanning of the thorax was performed in 20.1% of the patients; the measurement of arterial blood gas tensions was done in 73.4% of the patients. Antibiotics were used as follows: beta-lactams in 46.5% of the patients, fluoroquinolones in 30% of the patients, macrolides in 13.2% of the patients, glycopeptides in 2.2% of the patients, others in 2.9% of the patients. The mean of length of hospital stay was 11 days; the 30-day in-hospital mortality was 9.6%. This study showed that a large number of patients with low- risk CAP have been unnecessarily hospitalized.

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Background: Geographical position, increasing flow of immigrants and refugee coming from regions where malaria is endemic might further increase those cases of malaria imported to Calabria due to travel for military mission, visiting relatives, business and leisure. However, only few reports were published regarding imported malaria in Calabria, a region of Southern Italy. Patients and Methods: Based on data from our laboratory, on official reports received from Italian Ministry of Health and Regional Health Offices, an epidemiological analysis of malaria cases registered in Calabria from 1988 through 2001 is reported. The epidemiological and clinical features concerning the cases are discussed. Results: A total of 34 slide-confirmed malaria cases were observed in Calabria during the period of the present study, January 1988 – December 2001. Infections were mostly acquired in Africa (84.8%), while the remaining ones were coming from Asia (9.1%) and from South America and Europe (6.0%). Length of stay in endemic area did not increase the infection risk. Etiological diagnosis indicated Plasmodium falciparum as the most often species involved (60.6%), followed by Plasmodium vivax (36.3%) and by P. vivax/Plasmodium malariae mixed infection (3.0%). Mortality rate was about 3.0%. The number of cases during the second seven-year period of this study became almost the double in comparison with the first seven-year period. Correct chemoprophylaxis was done by only 27.3% of our studied subjects. Delay of malaria diagnosis ranged between 4 days and 1 month. Conclusions: Increasing of malaria cases, mostly due to P. falciparum, delay of diagnosis and reporting to Health Regional Office, as well as enhancing arrival of refugees from endemic areas are epidemiological concerns in Calabria as the southernmost region of continental Italy and in Europe.

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Human hydatid disease due to Echinococcus granulosus is frequently observed in Italy, especially in the central and southern areas and in the isles. In the last twenty years some important advances concerning the epidemiology as the diagnostic and therapeutical approach changed our knowledge of this disease. In Italy the liver, kidney and peritoneum localizations account about 95% of the cases. The authors describe four paediatric cases with unusual localization (kidney and muscle) emphasising the difficulties in the diagnosis.

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In this article the authors describe a cerebral coenurosis case, a rare infection caused from the larval stage of the tapeworm Taenia multiceps, which they encountered in the professional practice. The specific epidemiological elements, linked to the parasitic lifecycle in dogs, will also be covered. The authors consider the diagnostic, pathologic and clinical elements that allowed the differential diagnosis with respect to the neurocysticercosis, a parasitic infection caused by the larval form of other Cestoda and discuss the possible medical therapeutic approaches (albendazole or praziquantel) and the neurosurgery intervention. They emphasize the need to obtain a correct hystopathological diagnosis in order to achieve a differential diagnosis versus the other larval parasitosis. According to the current Public Health Regulations this diagnosis must be reported to the Health Official to allow planning the necessary epidemiological interventions.

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In recent years, several reports have emphasized the increasing importance of visceral leishmaniasis as an opportunistic infection among HIV-positive patients in areas where both infections are endemic. Major challenges in the treatment of leishmaniasis include widespread resistance to pentavalent antimonial compounds, absence of safe chemotherapeutic agents, and treatment failure and relapses in HIV-leishmania coinfected patients. Despite the associated adverse reactions and the need for prolonged parenteral treatment, for several decades pentavalent antimony has remained the traditional, first-line therapy for kala-azar throughout the world. However conventional antimony treatment for visceral leishmaniasis has several main drawbacks, including the toxicity of pentavalent antimonials, the prolonged therapy required to achieve cure, and the risk of relapse even after initial good response. In recent years, the search for alternative treatment has led to the recognition of lipid associated amphotericin B formulations as powerful antileishmanial agents. Several observations have also suggested that GM-CSF can be used as an antileishmanial treatment. Indeed, GM-CSF induces potentially beneficial effects in visceral leishmaniasis, such as blood monocyte mobilization, macrophage activation, and amelioration of granulocytopenia. In this report, we describe the safety and efficacy of combination treatment with liposomal amphotericin B and rHuGM-CSF immunotherapy used for the therapy of visceral leishmaniasis in a patient with AIDS.

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