Otitis represents the second most common infection of the upper respiratory tract, its treatment being the most common cause for prescribing antibiotics in the United States. A large number of antimicrobials, especially beta-lactams and macrolides, are generally used for treating acute otitis media (AOM) in paediatric patients, owing to their antibacterial spectrum including the main aetiological pathogens. Efficacy, safety and compliance of cefaclor were compared with those of other antibiotics in the treatment of paediatric AOM in a meta-analysis of randomized controlled trials published between 1981 and 2004. Overall, evaluations were performed on 24 studies (Medline/PubMed, keywords “cefaclor and otitis”) which proved eligible (Jadad score ≥1); sixteen out of the 24 studies were multicentre, seven were double-blind. Mostly, the comparator agent was a beta-lactam, in four and three cases it was a macrolide or the association trimethoprim-sulfamethoxazole, respectively. Efficacy and safety were end-points of all studies whereas only 9 studies evaluated compliance. For the majority of studies (16/24) cefaclor was administered for a 10-day course. The analysis was based on a 2x2 contingency table with classification by treatment and number of improvements/cures, side-effects, and compliance of the individual studies. The global estimate of the effective treatments was obtained with the weighted mean of the log OR (Odd Ratio) according to Mantel-Haenszel and associated confidence intervals (CI) at 95%. All the calculations were performed using SAS v.8. Chi-square test was performed. Clinical efficacy evaluation, number of improvements/cures, did not evidence a statistically significant difference among cefaclor and comparators (86.8% vs 88.7%; Odds Ratio 0.77, IC 0.61/0.94). In the cefaclor-treated patients, adverse events were observed in a statistically significant lower percentage compared to other antibiotics: 13.3% vs 19,4% (P <0.0001), diarrhoea and gastro-intestinal disturbances being the most frequently observed. Compliance was observed in a similar proportion in the two patient groups, cefaclor and comparators (cefaclor 88.1%; comparators 91.1%) and the slight difference was not statistically significant (Odds Ratio 0.77, IC 0.39 – 1.15). The present meta-analysis proves that in the treatment of paediatric AOM cefaclor exhibits a clinical efficacy equal to other antibiotics usually employed in this setting, similar compliance but superior safety.

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The clinical management of perinatal toxoplasmosis involves a gynaecologist during pregnancy and a neonatologist after delivery. Then, in the absence of a uniform approach, early evaluation of infected infants requires a thorough long-term follow-up also in asymptomatic children, who have to be observed for at least one year due to unpredictable sequelae in later life. We retrospectively analyzed pregnancy management of 54 women with certain infection from Toxoplasma gondii (TG) and prospectively enrolled their infants to compare prenatal management with postnatal clinical outcome. All mothers with sieroconversion for TG infection were from the Palermo area and were retrospectively analyzed, whereas their newborns referred to G. Di Cristina Children Clinical Hospital between 1999-2004 were prospectively enrolled in a 48-month follow-up. Timing of infection was dated for 24 women (45%) to the first trimester, 18 (33%) to the second and 12 (22%) the third. The maternal-fetal transmission rate was 17.2%. Prenatal diagnosis from amniotic fluid was performed in 25/54 pregnant subjects and showed positive results in 6. Despite diagnosis of TG infection, 9 women were untreated and only 2 with positive amniocentesis received combined therapy. 10/55 enrolled infants were infected and half of them were preterm and/or SGA at birth. None showed peculiar signs of TG at birth but 4 had abnormalities during the follow-up. 9/10 infected children were born to mothers who had undergone neither amniocentesis nor combined therapy. Conclusions: Our work confirms the difficulty of applying standardized therapeutic protocol for TG infection during pregnancy. The asymptomatic course of TG infection at birth confirms the importance of an instrumental long-term follow-up to identify typical TG lesion to prevent sequelae.

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Background: Human herpes virus 8 (HHV-8) is the putative infectious agent of multifactorial diseases, such as Kaposi’s sarcoma (KS), primary effusion lymphoma and multicentric Castleman’s disease. However, its exact mode of action as well as its transmission is still under investigation. Besides, little is known about its seroprevalence in the population. HHV-8 epidemiology has been widely studied all over the world, demonstrating significant differences in distribution among various geographical areas and various population communities. Very few studies of HHV-8 seroprevalence have been conducted in Italy, particularly in Sicily which, along with other Mediterranean areas, is known to have high rates of KS incidence. Between January 2001 and April 2002, 424 patients were consecutively recruited from three treatment facilities. An Infectious Diseases Clinic provided 196 anti-HIV positive patients, both affected by AIDS and not. A further 122 anti-HIV negative intravenous drug users were recruited from drug treatment clinics, while as a control group from the Blood Bank 126 blood donors were recruited. Base-line serum samples were assayed for antibodies to HHV-8 latency-associated nuclear antigen (anti-LANA) by IFA (Viramed Biotech AG, Planneg/Steinkirken - Germany). Anti-HHV-8 antibodies were found in 98 individuals (23.1%). HHV-8 reactivity was more common among anti-HIV positive patients (89/196, 45.4%, 95 C.I. 38.4-52.4) than in IDUs (6/102, 5.9%, 95 C.I. 1.2-16.2) and the control group (3/126, 2.4%, 95 C.I. 0.7-10.1). Overall, anti-HHV-8 antibodies were found in all three groups with large differences between groups.

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HBV-DNA quantitation, the HBe antigen status and the appearance of mutations in the core promoter, precore and polymerase regions are important elements in the management of chronic HBV infection. We performed a technical evaluation of 3 new kits, affigene® HBV VL, affigene® HBV mutant VL and affigene® HBV DE/3TC assays (Sangtec Molecular Diagnostics) in comparison with the Amplicor HBV Monitor™ assay (Manual Test, Roche), direct sequencing and direct sequencing/Inno-LIPA HBV DR (Innogenetics), respectively. We evaluated the clinical application of these tests in the management of patients with chronic (HBeAg positive) hepatitis B. Serial sera of 11 chronic HBeAg positive patients were studied before, during and after lamivudine/interferon treatment. HBV-DNA quantitation detected with affigene® HBV VL showed a high correlation with the Amplicor HBV Monitor™ test (r=0.85). affigene® HBV mutant VL (positions G1764A, G1896A) and affigene® HBV DE/3TC (positions rtL180M, rtM204V/I) were able to detect a low presence of mutants in a mixed population (wild type and mutant) compared to direct sequencing and Inno-LIPA HBV DR, which identified only the dominant population. These three sensitive assays, performed with the same DNA extraction, give clinicians useful information for the management of chronic hepatitis B and for timing treatment.

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Fosfomycin is a molecule that inhibits the early stage of peptidoglycan synthesis and shows a broad-spectrum bactericidal activity against Gram-positive and Gram-negative bacteria. Using the Killing-curve method, we tested the in vitro bactericidal activity of fosfomycin alone or in combination with vancomycin or teicoplanin at a concentration of 8 µg/mL, that is easily achievable in serum at standard dosing regimens, against seven methicillin-resistant Staphylococcus aureus strains, isolated from patients with well documented device-associated infections unresponsive to or relapsing after glycopeptide therapy. MICs of vancomycin ranged from 1 to 4 µg/mL, MICs of teicoplanin from 2 to 8 µg/mL; MICs of fosfomycin were 8 µg/mL for two strains and >128 µg/mL for the remaining strains. The seven strains proved tolerant when tested for vancomycin and teicoplanin used alone at 2xMIC concentration. Fosfomycin was bactericidal (reduction of 2 log of the inoculum) only against the two susceptible strains. In all cases both vancomycin and teicoplanin in combination with fosfomycin developed bactericidal synergism already at a concentration of 1x MIC. If these results are confirmed by in vivo experiments, the combination of fosfomycin with glycopeptides might be useful for treating device-associated infections, and in preventing the phenomenon of increasing MICs for glycopeptides.

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Bacterial infections occur frequently in patients with cirrhosis and may worsen the disease outcome. We investigated the prevalence of bacteriuria in 500 consecutive patients with cirrhosis, in different Child-Pugh stages (41.4% A; 40.8% B; 17% C) and analysed the associated risk factors. Most of the cirrhosis cases were virus related; alcohol abuse was recorded in 6.2% of the patients. Bacteriuria was detected in 139 (27.8%) cases: 32.4% were >106 cfu/ml; 7.9% >105  <106 cfu/ml and the remaining cases <105 cfu/ml. Escherichia coli was the most frequent isolated agent (84.5%); Proteus spp. strains were detected only in bacteriuria <105 cfu/ml. At univariate analysis, female gender, age and presence of diabetes were significantly associated to bacteriuria, while Child-Pugh stage and the presence of hepatocellular carcinoma were not. In a multivariate model, only female gender and diabetes were significantly associated to bacteriuria. These results indicate that advanced cirrhosis was not a risk for bacteriuria, that was associated rather to gender and diabetes, which are common risk factors for bacteriuria in non-cirrhotic patients.

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The progressive emergence of antimicrobial-resistant Gram-positive cocci especially in the setting of surgery and intensive care, recommends particular attention in making sound therapeutic choices to overcome both microbial resistances and haemato-encephalic barriers to effective local drug penetration. As in other Western countries, the occurrence of methicillin-resistant Staphylococcus aureus is particularly high also in Italy, especially when high-risk patients and/or settings are involved. In treating post-neurosurgical central nervous system infections (cerebral abscess and meningitis), a key issue is represented by the low cerebrospinal fluid concentration of the two available glycopeptide antibiotics (vancomycin and teicoplanin), usually recommended as first-line therapy of resistant Gram-positive cocci. Recent findings have focused on the possible role of linezolid, an oxazolidinone antibiotic, as a suitable candidate for the treatment of severe brain infection (abscesses) and post-neurosurgical infection, where treatment options and efficacy are significantly limited by the low glycopeptide transfer and the spread of glycopeptide-resistant bacterial strains. Three representative case reports (two brain abscesses and one post-surgical meningitis) are presented and discussed in light of the current literature: in all these cases, salvage linezolid treatment proved resolutory.

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The authors describe a human case of ophthalmomyiasis caused by the “sheep fly” Oestrus ovis larva. They emphasize the importance of collaboration between practitioner or specialist and parasitologist for a sound, definitive aetiological diagnosis of such uncommon pathologies.

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Myiasis is the infestation of human or animal tissues by fly larvae. The disease is widespread especially in tropical countries. Here we report a case of myiasis due to Cordylobia anthropophaga that occurred in a traveller returning from Senegal. This case has some peculiar characteristics, regarding the site of the lesion and the clinical presentation.

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The author presents the developments in society and public health that paved the way, thanks to the birth of social and scientific associations and later to state intervention, for the establishment of hospitals for tuberculosis in Italy at the beginning of the 20th century. From 1890 onwards many fruitful meetings, conferences and debates ultimately led to the passing of a specific law on public health care; in 1927 this law covered about half the population. The First World War was undoubtedly the prime cause that stopped the downward trend in mortality and morbidity from the tuberculosis epidemic in the early 20th century. Early on, Bologna, together with other cities in Tuscany and Lombardy, developed plans for therapy (i.e. hospitals for tuberculosis) and prevention (i.e. holiday camps). However, in Italy in the 1930s tuberculosis continued to be a major problem despite such improvements in public health. In Europe, Germany was the nation that pioneered the fight against tuberculosis by social, scientific and legislative means. Since 1883 there had been a specific law for insurance against illnesses and a network of sanatoria had been established.

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