Volume 13, Issue 4, 2005
Review
HCV reinfection after liver transplantation for HCV cirrhosis
Pasquale Giuseppe,
Iannicelli Paolo,
Martini Salvatore,
Mogavero Anna Rita,
Caprio Nunzio,
no surname no name
no surname no name
Cirrhosis due to hepatitis C virus (HCV) infection is now the most frequent indication for orthotopic liver transplantation (OLT). Recurrence of hepatitis C infection is the major cause of late mortality in patients undergoing OLT for hepatitis C cirrhosis. Recurrent HCV infection develops in 100% of patients HCV + in pre-transplantation time. Histological recurrence occurs in 75-80% of patients after OLT:1/3 of them progress to allograft cirrhosis within 5-7 years. Cholestatic hepatitis C develops in a sub-group of patients who progresses rapidly to graft failure. As a result of this accelerated course of HCV infection, long-term graft and patient survival are significantly reduced in patients undergoing OLT for HCV-related cirrhosis compared with other groups. Moreover, several recurrence’s risk factors have been described as predictors of disease severity including those related to the virus, the host, the donor. There are numerous therapeutic strategies to prevent and to treat HCV disease recurrence after OLT. The most common strategy to treat HCV infection post-OLT is based on interferons and ribavirine. Even if clinical trials have shown that the combina-tion of ribavirine with Peg-interferons is more effective than its association with standard inter-ferons, the use of Peg-interferons in transplanted patients is limited by the side-effects of the drug. About treatment of hepatitis C virus infection in the allograft dark and not still cleared points are a lot: the timing and the target of therapy, the dose and duration of pharmacological treatment.
Original article
Varicella and its complications as cause of hospitalization.
Losurdo Giuseppe,
Bertoluzzo Luisella,
Canale Francesco,
Timitilli Anna,
Bondi Elisabetta,
Castagnola Elio,
Giacchino Raffaella
Varicella is an acute contagious disease that most commonly occurs in childhood. Although normally benign, varicella can occasionally develop into a more serious illness. Moreover, the infection can lead to serious complications, such as Staphylococcus aureus infections, otitis media, endocarditis, pneumonia, and rare central nervous system (CNS) events like cerebellar ataxia and encephalitis.
This study was conducted to analyze the hospitalization rate due to varicella or its complications in a tertiary care hospital in Italy, where varicella vaccination has not yet been implemented.
The review was carried out on cases of children with varicella identified by ICD9 and ICD9-CM diagnostic codes and admitted to the Giannina Gaslini Children’s Research Hospital of Genoa, Italy, from January 1st, 1995 to December 31st, 2004. For each case reporting complications, the clinical report form was extracted and the events recorded.
Varicella was recorded in 346 (0,16%) out of 212,647 total hospital discharges. Chickenpox with detailed complications and cerebrovascular diseases accounted for 56 discharges (12.14%), for a total of 728 days. Fifteen patients needed more than one hospitalization because of severe sequelae as result of CNS involvement. We reported three particular cases of invasive infections and four children affected with cerebrovascular diseases following varicella.
Our retrospective data regarding a single tertiary care pediatric hospital shows that hospitalization due to varicella or its sequelae may present an important medical and indirect economic problem.
Human leptospirosis in the Vicenza area (Italy) from 1990 to 2003: an epidemiological and clinical study
Conti Emma,
Lazzarini Luca,
Reatto Patrizia,
Tositti Giulia,
de Lalla Fausto
All cases of human leptospirosis observed at the S. Bortolo Hospital, Vicenza, Italy, in the period from September 1990 to December 2003 were retrospectively reviewed. The aim of the study was to define the epidemiological, clinical, diagnostic, and therapeutic aspects of this infection and to compare these with an earlier local study (1979-1990) in order to assess if any changes have occurred over time. The screening test was made using macroscopic agglutination and the diagnosis was definitively confirmed using the microscopic agglutination test (MAT). The etiological serotype was identified in 13 patients (68%) and Leptospira poi was the most frequent serovar. Hepatic and renal involvements were present in a high percentage of patients (71% and 74%, respectively), cardiac involvement in 39%, and hypertriglyceridemia and hepatic steatosis were observed in 68% and 43% of cases, respectively. One patient died because of acute renal and respiratory failure. Intravenous penicillin was the treatment of choice. A consistent reduction in the prevalence was observed during the time period of this study (n = 38) compared with the previous period (n = 86); males were more affected than females in both time periods. In industrialized countries the prevalence of leptospirosis is decreasing; nevertheless, this infection is no longer limited to specific occupational groups and remains a potential fatal disease that should be included in the differential diagnosis of all the patients with unexplained fever.
Treatment of acute bacterial tonsillopharyngitis in paediatrics: a meta-analysis
Esposito Silvano,
Novelli Andrea,
Noviello Silvana,
D’Errico Gioacchino
Pharyngotonsillitis represents the most common infection of the upper respiratory tract, its treatment being the most common cause for prescribing antibiotics.
Efficacy, safety and compliance of cefaclor were compared with those of other antibiotics in the treatment of paediatric acute bacterial tonsillopharyngitis in a meta-analysis of randomized controlled trials published between 1979 and 2003. Overall, evaluations were performed on 16 studies (Medline/PubMed, keywords “cefaclor and tonsillopharyngitis”) which proved eligible (Jadad score ≥1); twelve out of 16 studies were multicentre ones, only one was a double-blind study. Mostly, the comparator agent was a beta-lactam, in four cases it was a macrolide. Efficacy and safety were end-points of all studies whereas only 13 and 9 studies evaluated adverse events and compliance, respectively. 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%. Chi-square test was performed. All the calculations were performed using SAS v.8.
Clinical efficacy evaluation, number of improvements/cures, did not evidence a statistically significant difference among cefaclor and comparators (93.8% vs 92.3%; Odds Ratio 1.21, IC 0.95/1.48). In the cefaclor-treated patients, adverse events were observed in a statistically significant lower percentage compared to other antibiotics: 8.5% vs 15.5% (Odds Ratio 0.49, IC 0.22/0.76; P <0.0001). Compliance was observed in a similar proportion in both the two groups, cefaclor and comparators (cefaclor, mean 100%; comparators, mean 98.3%).
The present meta-analysis proves that in the treatment of paediatric acute bacterial tonsillopharyngitis cefaclor exhibits a clinical efficacy equal to other antibiotics usually employed in this setting, similar compliance but superior safety.
Comparison of incidence of sepsis in cancer patients that underwent systemic or loco-regional chemotherapy
Della Seta Roberta,
Pacetti Paola,
Mambrini Andrea,
Santorsa Teresa,
Flora Roberto,
Orlandi Massimo,
Cantore Maurizio
In this retrospective non controlled trial we evaluated the incidence of sepsis in cancer patients in two different periods (January-June 2003 versus January-June 2004). The main difference in these two periods was that in our oncology department we changed from systemic chemotherapy to loco-regional chemotherapy using less myelosuppressive drugs and developed the domiciliary assistance. The aim of the study was to assess the incidence of sepsis in order to demonstrate a reduction of the infection related to the change of chemotherapy. In addition, this study may be able to describe the epidemiology of sepsis in cancer patients afferent to our oncology department. The incidence of sepsis was reduced in the second period from 24.3% to 6.2%. The pathogens more frequently isolated in this study were coagulase-negative staphylococci (CNS) followed by Escherichia coli and Staphylococcus aureus. Less invasive therapy may reduce infective complication of chemotherapy. The epidemiology of sepsis may be very helpful to design empiric therapeutic protocol for febrile patients that have received chemotherapy.
Case report
Brucellosis with erythema nodosum-like manifestations diagnosed by isolated positivity of the
ELISA test for anti-Brucella IgM.
Nardiello Salvatore,
Fusco Francesco Maria,
Ilario Adelaide,
Ambrosino Ersilia,
Nuzzo Immacolata,
Rossiello Luigi,
Bentivoglio Concetta,
Rossiello Raffaele,
Galanti Bruno
Brucellosis is endemic in the Mediterranean area. In spite of the false negative results, the standard
agglutination test remains the routine test for the diagnosis of brucellosis in southern Italy. We
present a case of a patient with undulant fever and erythema nodosum-like skin lesions, with
negative serum agglutination test, but isolated positivity of the ELISA test for anti-Brucella IgM. A diagnosis of brucellosis for this patient was supported by the anamnestic and clinical data, and by the response to therapy. This case and a review of the literature urge us to consider the ELISA test indispensable for the serological diagnosis of brucellosis.
Urinary schistosomiasis: remarks on a case
Scarlata Francesco,
Giordano Salvatore,
Romano Amelia,
Marasà Lorenzo,
Lipani Giuseppe,
Infurnari Laura,
Titone Lucina
La schistosomiasi urinaria è una malattia parassitaria causata da Schistosoma haematobium caratterizzata da quadri clinici correlati a lesioni granulomatose della mucosa e della sottomucosa vescicale. Tale patologia colpisce circa 80 milioni di persone in Africa, Medio-Oriente ed India, mentre in Italia è raramente osservata in immigrati e in viaggiatori provenienti da aree endemiche.
Gli autori descrivono un caso osservato in un 26enne recentemente immigrato dal Ghana con sintomi di cistite emorragica. Cistoscopia ed esame bioptico hanno evidenziato lesioni granulomatose della parete vescicale contenenti uova calcificate. L’esame parassitologico delle urine è risultato positivo per uova di S. haematobium. Buona la risposta al Praziquantel (40 mg/Kg una tantum). Gli autori sottolineano il rischio dell’introduzione della schistosomiasi in quelle regioni italiane in cui sono presenti l’ospite intermedio ed idonee condizioni climatiche.
The Infections in the History of Medicine
A history of Malaria from and for a popular point of view
Crotti Daniele
The author outlines parasitological features of human plasmodia and Anopheles, lingering over public health and human aspects of this protozoan infection. Starting from the etymology of “mal’aria” word, the author marks out a brief but proved history of this social disease, reminding not only clinical, medical or scientific aspects. In other words, the author dwells upon literary, custom and habits as well as historic-cultural aspects, with attention to significance regarding popular importance of this question in Italy.
