Therapy with two NRTIs/NtRTI represents the current basis of highly active antiretroviral therapy (HAART) and is almost always associated either with a NNRTI or a protease inhibitor. Thymidine analogues zidovudine and stavudine were largely used in the past and the use of backbones not including one of them was uncommon. However, the use of thymidine analogues today has several drawbacks, such as fragile pharmacokinetics, the need of two daily doses, unsatisfactory safety and toxicity profiles, a large number of pills and important cross-resistance phenomena. The possibility of using backbones not including thymidine analogues is thus becoming increasingly popular, provided that efficacy is not affected. Moreover, as some of the problems related to thymidine analogue toxicity are only partly reversible, the strategy supporting the use of a thymidine analogue sparing regimen appears to be the only way to prevent damage that otherwise could be potentially irreversible. However, the quality and benefit of this approach have long been acknowledged in the DHHS guidelines, positioning the association of tenofovir and emtricitabine among the choices recommended for naïve patients, for a modern approach to HIV infection therapy.

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Our aim was to evaluate the prevalence of HIV infection in immigrants hospitalised in infectious disease settings in Italy during 2002. Each participating centre filled in a CRF which regarded the number of immigrants hospitalised in ordinary regime or in day-hospital during 2002 and, for HIV-positive patients only, some demographic (age, sex, origin) and clinical features (only HIV positivity or AIDS, new diagnosis or not, diagnosis of opportunistic infections). A total of 46 Infectious Diseases Units participated in the study and a total number of 2255 patients were tested for anti-HIV, irrespective of the cause of hospitalization, with 378 (16%) cases of positivity. Women accounted for 47.9%; the mean age of the population was 34.5 years. African patients showed a higher prevalence of HIV infections than subjects from other geographical areas (61.9% of all cases). Most HIV-infected patients were unaware of their positivity. In conclusion, HIV infection represents one of the main health problems among immigrants, particularly of African origin.

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In this study a total of 219 patients who developed nosocomial infections and were treated in Sisli Etfal Training and Research Hospital between January 2001 and March 2003 were evaluated retrospectively. In all, 337 bacterial strains were isolated in these patients. The aim of our study was to assess the causative agents of catheter-related nosocomial infections, the distribution rate of causative agents due to hospital units, infection sites and catheter types, and determine the risk factors which facilitate such nosocomial infections. The most frequently isolated causative agents in catheter infections were Pseudomonas spp. (17%), Klebsiella spp. (16%), E. coli (13%), Acinetobacter spp. (12%), Coagulase Negative Staphylococci (CNS) (11%) and Methicillin-Resistant S. aureus (MRSA) (9%). In 136 (59%) patients infections were due to urinary catheterization and in 52 patients (23%) due to tracheal aspiration catheters. Of the 229 catheters applied, the polymicrobial infection rate was found to be 24% (55 patients). Multiple drug resistant strains were more frequently isolated in Intensive Care Units (ICU). It was emphasized that as ICUs are important risk factors for the development of catheter infections, the resistance patterns of the isolated microorganisms from the unit should be taken into consideration for the selection of appropriate antibiotics. We also conclude that it is important to avoid unnecessary catheterization and that preventive measures should be properly applied.

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Ocular toxoplasmosis can be a progressive and recurring disease that can threaten visual function. Retinochoroiditis develops gradually weeks to years after subclinical congenital toxoplasmosis; this is the preponderant form, which is frequently bilateral; with healing, white or dark-pigmented scars may result. Toxoplasmosis acquired in older children and adults rarely progresses to retinochoroiditis; it is generally unilateral. We report the results of a clinical study concerning 16 patients with ocular toxoplasmosis observed for the first time in the period from 1992 to 2004 and followed up until today. The patients came to the Department of Infectious Diseases of the Second University of Naples. We studied 16 patients, 10 of whom were females; 11 cases presented ocular signs of congenital toxoplasmosis, while in 5 cases ocular impairment was related to an acquired toxoplasmosis. Only one case of congenital toxoplasma chorioretinitis was symptomatic at birth: it was complicated by microphthalmia and strabismus, calcifications in the brain and epilepsy; 10 congenital cases were asymptomatic at birth and were recognized after several years because of a reactivation of infection. In 5 patients congenital chorioretinitis was bilateral, with presence of scars in the contralateral eye. The 5 cases of acquired toxoplasma retinitis were ascertained by anamnestic, serologic and ophthalmologic examinations; in 4 of them the lesion was typical and unilateral; the 5th case was a 6-year-old boy with acquired toxoplasma bilateral neuroretinitis. 13/16 cases of ocular toxoplasmosis were treated with the combination of pyrimethamine, sulfadiazine; they were followed up and re-treated if necessary. The therapy was resolutive in each case. Our experience confirms that late-onset retinal lesions and relapse can occur many years after birth but that the overall ocular prognosis is satisfactory when congenital damage is recognized early and treated appropriately. Prevention of congenital and acquired toxoplasmosis is very important in controlling ocular toxoplasmosis.

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Administration of antimicrobial agents is the most frequent and significant cause of modifications to gastrointestinal bacterial microflora. The aim of the present study was to evaluate the impact on Gram-negative aerobic bacterial intestinal flora, the possible colonization by Candida spp. and the possible emergence of resistant bacterial strains in a ten mice group receiving levofloxacin at the dosage of 10mg/kg once a day for 5 consecutive days. Our results are in agreement with those of other studies and reveal that Gram-negative aerobic bacteria are strongly suppressed during levofloxacin treatment. Neither colonization by Candida spp. nor emergence of resistant micro-organisms to levofloxacin and/or ciprofloxacin were observed. After 7 days from completing treatment, bacterial intestinal flora was restored in 8 out of 9 mice. Levofloxacin does not significantly affect intestinal microflora. Therefore, it may be suitable for selective decontamination of the gastrointestinal tract in immunocompromised patients, for prophylaxis of urinary tract infections and for treatment of intestinal bacterial infections.

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We report here the results of a retrospective study carried out on 200 tuberculosis cases admitted to the Hospital of Siena during the period 1994-2003. For each case, epidemiological, clinical and microbiological data were collected in order to analyze the trend of tuberculosis over the years and to compare our experience with similar studies. Indigenous patients were significantly older than immigrants (60.1 vs 34.2 yrs; p<0.01) more frequently affected by underlying chronic diseases. Overcrowding and HIV infection were predisposing conditions in 30 subjects (15% of cases) recently arrived from high endemicity countries. Pulmonary tuberculosis (TB) was diagnosed in 71% of cases, irrespective of origin. The death rate was 5%. Microbiological investigation was positive in 74.4% of examined subjects; 9.8% of isolates were resistant to one or more antituberculous drugs. The number of cases admitted to the Hospital seems to have slowly decreased in the last few years; factors that may influence this trend are discussed. Our results confirm a distinct epidemiological pattern of the disease between indigenous patients and immigrants, which is typical of low-endemicity countries. The delay in the diagnosis and management of the disease observed in this case-series report underlines the need to improve information on TB and skill in treatment, and to maintain specialized centres.

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Hypereosinophilic syndrome has been reported to be associated with hepatic dysfunction; liver histology is mainly characterized by a diffuse eosinophilic inflammatory infiltrate. A 28-yr-old women, affected by idiopathic hypereosinophilic syndrome with bone marrow and pulmonary eosinophilic infiltrates associated with peripheral eosinophilia, developed features of chronic hepatitis without a significant eosinophil component. She responded favourably to systemic glucocorticoid therapy with normalization of liver function tests within a few weeks. This observation could support the hypothesis that liver damage in idiopathic hypereosinophilic syndrome may be due to circulating substances produced by eosinophils rather than direct infiltration of liver by these inflammatory cells.

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Geotrichum capitatum, now known as Blastoschizomyces capitatus, can be responsible for several opportunistic infections (systemic infection or localized at lungs, liver, kidney, encephalitis or meningitis) in an immunocompromised host, especially in those patients affected by leukaemia or under immunosuppressive therapies. A 66-year-old woman with polimyosite under steroid and immunosuppressant therapy was hospitalized in ICU for an acute respiratory distress with moderate hypoxaemia and normocapnia. Pulmonary X-ray revealed a bilateral pneumonia. Hypoxaemia became severe 48 hours later and the patient underwent mechanical ventilation and empirical antibiotic therapy. Blood cultures, urine cultures and serological tests were negative, while yeast was identified by Gram’s stain of bronchoaspirate. Before identifying the yeasts Fluconazole was added to therapy. At day 5 the clinical conditions remained severe and Candida spp were excluded: so Fluconazole was switched to lyposomial B Amphotericine. At day 8 B. capitatus was identified. At day 26 the patient died of refractory respiratory insufficiency. B. capitatus infection is infrequent and its prognosis is severe, with a high mortality rate (>50%). Microbiological diagnosis requires time to characterize the yeast. At present no standard therapy is available although some authors report a good susceptibility to Amphotericine B and Voriconazole (100%), according to NCCLS guidelines.

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Herpes simplex viruses (HSV), and especially HSV-1, are the most common cause of acute, sporadic viral encephalitis. HSV-2 is an uncommon cause of encephalitis. We report a rare case of HSV-2 encephalitis that was free of genital lesions. In terms of the patient’s case history, she had a Cesarean section four months before, herpes labialis 30 days before, varicella zoster 20 days before. We discuss the possibility that postpartum stress may be one of the factors in this case.

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The loss of low-lying farmland to marshes and swamps was a striking phenomenon in Italy and other regions of Europe after the fall of the Roman Empire. Throughout the Middle Ages extensive fertile agricultural lands were abandoned due to increased marshiness and the risk of the spread of malaria diffusion. In economic and social terms, this was a further source of decline. In this scenario of progressive abandonment which supported the spread of disease, Benedictine and Cistercian monks performed extensive land reclamation (relying on channels, dams and embankments), leading to a progressive control of seasonal flooding by rivers and basins. Inside the abbeys monastic medicine flourished, which in some regions often represented the main reference point for health care for all residents (whether the common people, nobles or clergy), in the “Dark Ages”. Many monks paid with their own lives: malaria and malnutrition were the most frequent causes of morbidity and mortality. Benedictine and Cistercian monks, who had embraced the Benedictine rule, today deserve high consideration, as the major supporters of Europe’s recovery, which took place on the continent from the 13th century onward. Their mottos, “Pray and work” (Ora et labora) and “That God may be glorified in all things” (Ut in omnibus glorificatur Deus) supported their daily life and action. For centuries inside abbeys and fortified farmsteads known as grancie monks added prayers to work, in their attempt to reclaim land. Nature often treated them badly, ut despite such difficulties, the monks never shrank from danger.

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