Volume 12, Issue 4, 2004
Original article
Immigrazione, infezione da HIV, e terapia antiretrovirale in Italia. Uno studio epidemiologico e clinico
Manfredi Roberto,
Calza Leonardo,
Chiodo Francesco
Epidemiological, clinical, and therapeutic features of 77 consecutive HIV-infected non-European Union immigrants were compared according to gender. Immigrants (from Sub-Saharan Africa in around 60% of cases) represented 7.9% of our patient cohort at the end of 2002. Compared with male patients, females were more numerous, significantly younger (p<.0001), and experienced sexual exposure versus drug addiction (p<.02), while no difference was observed according to place of origin. A negative HIV serology preceding immigration was available for five women and four males only, while HIV disease was known before migration in 14 men versus 7 women (p<.04). The tendency towards a shorter known history of HIV infection (p<.05) of females versus males may be responsible for a lower incidence of AIDS among women (p<.02). The use of antiretroviral treatment was matched by time and selected regimens, but compliance proved significantly greater in females versus males (p<.0001), and women had less need of a regimen switch due to poor tolerability or refusal (73.2% versus 61.1%); the latter could be responsible for a greater mean CD4+ count (p<.02), and lower mean plasma viremia (p<.0001), although no difference was found when considering viral suppression rate (70.7% among women, 52.8% among men). Surveillance studies and prospective therapeutic trials are strongly warranted, in order to have a reliable assessment of HIV-infected immigrated people, to check the efficacy of preventive measures, obtain validated data about the clinical, virologic, and immunological evolution and outcome of HIV infection undergoing HAART, and to evaluate the frequency and role of eventual untoward effects of pharmacologic treatment.
Stenotrophomonas maltophilia lipopolysaccharide (LPS) and antibiotics: “in vitro” effects on inflammatory mediators
Matera Giovanni,
Barreca Giorgio Settimo,
Puccio Rossana,
Quirino Angela,
Liberto Maria Carla,
De Rosa Marta,
Focà Alfredo
Stenotrophomonas maltophilia is an emerging pathogen implicated in an increasing number of severe pulmonary infections and nosocomial sepsis. We evaluated the influence of four different antibiotics on the bacterial count and LPS activity found in broth cultures of S. maltophilia. After 4 h ceftazidime (CTZ) decreased live bacteria but increased endotoxin activity, whilst isepamicin (ISE), tobramycin (TB), and polymyxin B (PB) reduced both of them. We also investigated the influence of the above mentioned antibiotics on the ability of S. maltophilia culture filtrates and S. maltophilia LPS, extracted in our laboratory, to stimulate sepsis mediators such as tumor necrosis factor TNF-, interleukin 8 (IL-8), interleukin 10 (IL-10), Nitric Oxide (NO) and as bactericidal/permeability-increasing protein (BPI) in human whole blood. Our results demonstrated that both single polycationic antibiotics and the combination of two molecules are able to kill bacteria and neutralize released S. maltophilia LPS. Combination between ß-lactams and aminoglycosides is often able to reduce the pro-inflammatory effects of S. maltophilia culture filtrates.
Campylobacter enteritis in Western Sicily. Remarks on 35 cases
Scarlata Francesco,
Titone Lucina,
Li Vecchi Valentina,
Arena Rosanna,
Bruno Alessandra,
Merlino Francesca,
Di Bernardo Francesca
Campylobacter spp is the main cause of bacterial gastroenteritis in the developed countries, resulting mainly from the contamination of poultry and animal products. Pathogenesis remains unclear. Various clinical features ranging from watery diarrhoea in apyrexia to dysentery in hyperpyrexia may be the result of differences between strains in the expression of different pathogenetic factors. There are many difficulties in isolating the bacteria in question.
Methods We processed 540 faecal specimens of children with gastroenteritis. We detected enteropathogen bacteria including Campylobacter spp as well as Rotavirus, Adenovirus and protozoans. For the isolation of Campylobacter we employed the filter membrane technique. The filtrate was plated onto non-selective agar (blood-agar) in microaerophilic atmosphere.
The rank order of isolation frequency was: Rotavirus (30.0%), Salmonella (18.5%), Adenovirus (12.6%), Campylobacter (6.5%), Shigella (1.1%), Giardia (0.6%). The Campylobacter strains belonged to C.jejuni in 31 cases and C. coli in 4 cases. The clinical features were: fever (80%), vomitus (31,4%) and diarrhoea in all cases (watery diarrhoea (25.7%), stools more compact with mucus and blood (57.1%) or with mucus alone (17.1%)).
Conclusions In Western Sicily Campylobacter spp is the second most common agent of bacterial enteritis. We believe that some procedural errors, such as the employment of excessively selective media, could be the cause of the past failure to isolate Campylobacter.
Epidemiology of tuberculosis in immigrant patients hospitalised in Infectious Disease Units in Italy: multicentric study
Scotto Gaetano,
Saracino Annalisa,
El-Hamed Issa,
Iannece Maria Donata,
Geraci Salvatore,
Palumbo Emilio,
Cibelli Donatella Concetta,
Angarano Gioacchino
In order to retrospectively evaluate the prevalence of immigrant patients affected by active tuberculosis, we analysed the clinical data of 2255 immigrant patients hospitalised during 2002 in ordinary admission or in Day Hospital in 48 Clinics of Infectious Diseases. In all, 303 patients were affected by active tuberculosis (13.4% of the total immigrant hospitalised patients); 30 patients (9.9%) were also HIV-positive. There was a considerable male gender bias (62.5%); the mean age was 29.7 years; 144 patients were from Africa (47.5%), 72 (23.7%) from Asia, 47 (15.5%) from eastern Europe and 40 (13.2%) from South America. The clinical variants were: pulmonary (57.7%), lymph node (15.8%), meningitis (13.8%), intestinal (4.2%), bone (3.3%), pleurical (2.3%), peritoneal (2.3%) and renal (0.6%). We conclude that tuberculosis is a very frequent disease among immigrants, especially of African origin. The high percentage is due to several factors, such as no vaccine prophylaxis and poor, overcrowded living conditions. It is fundamental to focus on the need to provide better health support for all subjects by setting up screening plans to estimate the real incidence of this pathology and ensure medical treatment to prevent the spread of this infection among immigrants and the local host population.
Streptococcus pneumoniae meningitis in children. Case records 1985 – 2003.
Nicolosi Luciana,
Lancella Laura,
Krzysztofiak Andrzej,
Ticca Fausto
Acute bacterial meningitis and sepsis are the most severe among invasive diseases due to Streptococcus pneumoniae, particularly in pediatric age, and present a high risk of mortality and neurologic sequelae. S. pneumoniae is a major worldwide pathogen in children. The widespread emergence of penicillin-resistant pneumococci, a new pneumococcal conjugate vaccine, and the epidemiological prevalence of some serotypes, have recently focused attention on S. pneumoniae disease.
We reviewed the data on incidence, epidemiology, diagnosis, therapy in children hospitalized with acute bacterial meningitis in the Division of Infectious Diseases of the Bambino Gesù Children’s Hospital, Rome, between 1985- 2003. S. pneumoniae was isolated in 16.3% of the children, progressively emerging as the prevalent pathogen. The highest incidence was found in children younger than 2 yrs. The disease still presents a high rate of long-term sequelae, especially hearing loss and neurological handicap.
Penicillin and ampicillin resistant isolates were found in 2.3% of positive cultures; no strain was resistant to cephalosporins and vancomycin. Our data support the recommendations to consider administration of the 7-valent pneumococcal conjugate vaccine for children older than 2 months of age, with special consideration for selected groups. We recommend monitoring all invasive pneumococcal infections in children, the emergence of antibiotic-resistance and changes in prevalence of pathogen serotypes.
Clinical efficacy and tolerability of short course therapy with cefaclor compared with long-term therapy for treatment of acute otitis media in children
Catania Salvatore,
Gallo Andrea
Clinical efficacy and tolerability of two different regimens of cefaclor were studied in 410 paediatric patients affected by non-recurrent acute otitis media (AOM). 204 patients were randomly treated with cefaclor given at the dosage of 50mg/kg/die in two doses for 5 days; 206 patients with 40mg/kg/die in two doses for 10 days. Diagnosis of acute otitis media was based on the following signs and symptoms: otalgia, fever, possible otorrhea, alterations of tympanic membrane under otoscopic examination.
At the end of the treatment 95.5% of patients were cured after short-term therapy and 94.8% after long-term therapy. At the follow-up (two months after the interruption of treatment) 19 and 17 patients respectively had a recurrence. Side effects were observed in 6.9% and 8.7% of patients respectively (not statistically significant); they were mild, never requiring interruption of the treatment. Cefaclor therapy is very effective for treating children aged 2-6 years affected by acute otitis media, with no significant difference related to treatment duration. Short-course treatments appear better in terms of compliance and tolerability.
Case report
A case of diphyllobothriasis: description and diagnosis
Cavalcanti P.,
Filia M. A.,
Crotti Daniele
We describe a case of asymptomatic infection caused by Diphyllobothrium latum, probably following a meal of “sushi” in a Japanese restaurant in Rome one year before. The diagnosis was obtained observing morphology and seizures of proglottids and ova. We recall the life cycle of this cestode and report criteria for a differential diagnosis with other species of the Diphyllobothrium genus, usually rare in humans, and caused by the ingestion of marine fish and not freshwater fish.
Nosocomial Aspergillus flavus wound infections following cardiac surgery
Fiorio Maurizio,
Marroni Massimo,
Morosi Sabrina,
Stagni Giuliano
In this report we describe three cases of Aspergillus flavus sternal wound infection following cardiac surgery. All three cases occurred in a 3-month period coinciding with hospital renovation activities. The patients were successfully treated with combined surgical and medical therapy.
Hepatitis-associated aplastic anemia: description of a new case
Andreana Augusto,
Cesaro Giuseppe,
Giordano Maria Grazia,
Ricciotti Raffaella,
Andreana Lorenzo
Hepatitis-associated aplastic anemia is an only recently recognised syndrome. We present a case whereby a month after an episode of fever, a 17-year-old boy was recovered with liver enzyme elevation and circulating platelet reduction. All the acute viral hepatitis markers were negative. After bone marrow aspiration a severe aplastic anemia was diagnosed and all the findings were consistent with hepatitis-associated aplastic anemia. The disorder was initially treated with glucocorticoids and platelet transfusion, obtaining the normalization of the liver enzymes but worsening of the aplastic anemia. An HLA-identical related marrow donor was not found. The patient responded to immunosuppressive treatment but died of multi-organ failure due to severe sepsis.
Paranasal sinus mucormycosis in an immunocompetent host: efficacy and safety of combination therapy with Liposomal Amphotericin B and adjuvant rHuGM-CSF
Mastroianni Antonio
Invasive mucormycosis is a well-documented disease in the immunocompromised patient, but in recent years it has been reported increasingly in immunocompetent patients. We report a case of maxillary paranasal sinus mucormycosis in an immunologically competent host that was successfully treated with surgery and combined liposomal amphotericin B and rHuGM-CSF. We discuss the emerging incidence of invasive zygomycosis in immunocompetent patients and the potential clinical application of immunotherapy as adjunctive therapy for invasive mucormycosis in association with liposomal amphotericin B and surgical debridement.
The Infections in the History of Medicine
Historical insights into tuberculosis
Sabbatani Sergio
The author presents the ideas of Girolamo Fracastoro, an Italian scientist from Verona, who postulated in 1546 that tuberculosis was caused by “seminaria contagionum”, which were invisible but somehow living and transmissible, that harboured a fondness for those who were constitutionally receptive. This was followed by a major discussion, but the official scientific world did not understand the real importance of the revolutionary idea. Nevertheless, during the 17th and 18th centuries in Italy, but also in France and Spain, the first measures to reduce the spread of tubercular disease were adopted. These public health measures were extended with some difficulty, but were mostly abandoned at the end of 18th century, before the beginning and the development of microbiology as a science. The author presents the more successful guidelines against tuberculosis proposed at that time.
