Volume 14, Issue 1, 2006
Review
Effect of anti-retroviral therapy on body composition changes: a literature review
Dell’Isola Chiara,
Aprea Lucia,
Pizzella Teresa,
Izzo Crescenzo Maria
Protein-energetic malnutrition, characterized by both lean mass and fat depletion, was common in the pre-HAART era, and was associated with shortened survival and diminished quality of life. The pathogenesis of protein-energy malnutrition was multifactorial, and nutritional treatments were largely ineffective in the absence of disease stabilization. The introduction of HAART brought markedly improved outcomes, including a decrease in the incidence of malnutrition. However, other nutritional and metabolic alterations were noticed, and included changes in body shape, both lipoatrophy and lipohypertrophy, as well as changes in metabolism, notably hyperlipidemia and insulin resistance. These conditions, though sometimes occurring together, may occur independently, suggesting a complex, multifactorial cause. Several mechanisms have been hypothesized, including impairment to adipocyte differentiation and adipokine regulation, production of proinflammatory cytokines and mitochondrial toxicity. The role of the single drug class is still unclear, because both PI and NRTI have been associated with the syndrome, and the therapeutic protocols include both groups. Most of the medical therapies proposed for lipodystrophy are ineffective, and even if surgery remains an alternative, it is not associated with long lasting outcomes.
Original article
Health care and infective aspects in patients affected by Common Variable Immunodeficiency assisted in the Lazio Regional Authority Reference Centre for Primary Immunodeficiencies
De Santis Wladimiro,
Esposito Antonella,
Conti Valentina,
Fantauzzi Alessandra,
Guerra Andrea,
Mezzaroma Ivano,
Aiuti Fernando
Common variable immunodeficiency (CVID) is a chronic condition characterised by a predominant defect of humoral immunity. In most cases the diagnosis of CVID is made during adulthood; the main clinical features of CVID are chronic and relapsing infections (mainly of respiratory and gastroenteric tracts). CVID patients may also develop neoplastic and autoimmune diseases. In our centre (the Regional Centre for Primary Immunodeficiencies of the Lazio Regional Authority) we administered a 23-item questionnaire to 60 patients with CVID undergoing substitutive therapy with intravenous immunoglobulins (IVIG) about their demographic characteristics, time of clinical onset, time of diagnosis of CVID, clinical features, IVIG doses and administration intervals, and self-assessment of health status. In addition, the clinical history of all patients was reviewed, and the levels of serum IgG, IgA and IgM were evaluated and compared with the pre-therapy serum concentration. Moreover, an analysis of the treatment costs was performed. At onset, 67.2% of patients presented recurrent respiratory infections, and 50% had infections of the lower respiratory tract; 39.6% of the patients had gastroenteric infections. Most patients (57%) had recurrent infections of at least 2 of the respiratory, gastroenteric and/or urogenital tracts. In 37.9% of the group the diagnosis of CVID was made in less than 2 years after the beginning of symptoms, but in many cases (22.4%) the diagnosis took more than 10 years. 93% of patients are treated with a dose of IVIG between 6 and 15 g per administration, with intervals between 2 and 3 weeks. The review of patients’clinical history showed that 43% of patients have had respiratory infections during the follow-up in our Centre, 43% have splenomegaly (3% were also subjected to splenectomy) and 18.3% have autoimmune diseases. The mean concentration of IgG before the beginning of IVIG therapy was 235±187 mg/dl, while during the follow-up it was 664±145 mg/dl. Given the long time often required for diagnosis, general physicians and specialists should be better informed in order to make diagnosis swifter. The substitutive therapy with IVIG is effective in preventing recurrent infections and complications. A thorough follow-up is important for diagnosing neoplastic and autoimmune complications; in addition, immunologic analysis of peripheral blood and bone marrow are useful in identifying subgroups of patients with more severe clinical features. Finally, in selected patients, treatment costs may be controlled by modifying the dosage of IVIG or the intervals between administrations.
Comparative in vitro activity of prulifloxacin, levofloxacin and ciprofloxacin against urinary pathogens
Noviello Silvana,
Ianniello Filomena,
Leone Sebastiano,
Esposito Silvano
The present investigation aimed to compare the in vitro antimicrobial activity of prulifloxacin to that of levofloxacin and ciprofloxacin against recently isolated urinary pathogens. From our large bacterial collection, 978 non-duplicated clinical isolates, derived from patients’ urinary infections, maintained with minimal sub-culture deep-frozen at –70°C in a matrix of Brain Heart Infusion broth + 20% glycerol, were tested to determine MICs of prulifloxacin, levofloxacin and ciprofloxacin by means of the broth microdilution technique.
For Gram negative bacteria no significant difference was observed between all three antibiotics. Enterobacteria showed a resistance rate ranging between 6% (Enterobacter spp) and ~20% (Escherichia coli). Antibiotic resistance of Pseudomonas spp was higher (30.3%). For Gram positive, all methicillin-susceptible Staphylococcus aureus strains were sensitive whereas 30% of methicillin-resistant and enterococci were resistant to all three antibiotics.
Prulifloxacin exerts its antibacterial activity at lower concentrations than ciprofloxacin and levofloxacin. The in vitro activity of prulifloxacin against urinary pathogens and its high and prolonged urinary concentration following a single oral dose, suggest that prulifloxacin is an alternative to other fluoroquinolones for treatment of urinary tract infections.
Cardiac manifestations during viral acute hepatitis
Rombolà Ferdinando,
Spinoso Antonio,
Bertuccio Salvatore Nicola
The authors describe a retrospective study conducted on 46 patients with acute viral hepatitis, searching for cardiac disorders. These disorders appeared in about 43% of cases, only with benign evolution. The most frequent alterations are electrocardiographic disorders, followed by conduction blocks, axis deviations and arrhythmias. Acute pericarditis was also described, associated with HCV infection. The viral agents most frequently involved are HBV and HCV, followed by cytomegalovirus, and Epstein-Barr virus. In conclusion, the incidence of cardiac manifestations during viral acute hepatitis is rather high, but with benign evolution.
Hyperlactacidemia during antiretroviral therapy: frequency and clinical-therapeutic correlations
Manfredi Roberto,
Calza Leonardo,
Chiodo Francesco
While asymptomatic hyperlactacidemia is quite a frequent phenomenon among HIV-infected patients treated with highly active antiretroviral therapy (HAART), lactic acidosis is a rare, but potentially life-threatening occurrence. Epidemiology, clinical and laboratory presentation, evolution, and outcome of this phenomenon are currently under intensive investigation, and the most likely pathogenetic pathways seem to involve mitochondrial toxicity prompted by the administration of nucleoside reverse transcriptase inhibitors. Our case-control study on an extensive, single centre population treated for HIV infection provides novel insights on these emerging issues, reported and discussed on the basis of the most recently published findings.
Case report
Fatal Haemolytic Uraemic Syndrome in an AIDS Patient with Disseminated Adenovirus and Cytomegalovirus Co-infection
Francisci Daniela,
Marroni Massimo,
Morosi Sabrina,
Canovari Benedetta,
Belfiori Barbara,
Stagni Giuliano,
Baldelli Franco
Descriviamo un caso fatale di sindrome uremico emolitica occorso in una giovane donna affetta da AIDS, in cui è stata riscontrata una duplice infezione virale disseminata: da adenovirus (ADV) e da cytomegalovirus (CMV). Gli autori ipotizzano che tale co-infezione da ADV/CMV abbia avuto un ruolo nel quadro clinico complessivo.
Clinical efficacy of intravenous colistin therapy in combination with ceftazidime in severe MDR P. aeruginosa systemic infections in two haematological patients.
Tascini Carlo,
Menichetti Francesco,
Stefanelli Alessandro,
Loni Carlo,
Lambelet Paola
Nosocomial infections due to MDR P. aeruginosa are an increasing problem. Therapeutical options are few. We describe two haematological patients with severe neutropenia and systemic infection due to MDR P. aeruginosa treated successfully with colistin plus ceftazidime. Severe adverse events were not described.
The Infections in the History of Medicine
Syphilis in sixteenth-century in Bologna. Health care and social assistance
(Part One)
Sabbatani Sergio
Syphilis arrived in Bologna in the summer of 1495, after Fornovo’s battle on the Taro where Charles VIII’s army, following the invasion of Naples, fought against the anti-French league who faced up to the invaders as they withdrew. It was the battle-weary Bolognesi, prisoners, deserters and probably some prostitutes following the French and mercenary army who introduced the infection into the city.
At the beginning of the syphilis epidemic, the disease was very aggressive with particularly visible symptoms and many resulting deaths. Subsequently, contemporaries mention an abatement of this aggressivity in time spans that varied, but in no cases exceeded 60 years. In 1507 Bologna lost its political autonomy, becoming dependent on Rome. This was symptomatic of the upheavals throughout Italy in the sixteenth century. In this situation of economic and institutional crisis the Bolognesi were able to react with decision to the epidemic, re-converting the municipal hospital dedicated to S. Maria dei Guarini during the sixteenth century. This hospital, specializing in treating syphilis, was called “Ospedale di San Giobbe”. It was closed in 1798, after the entry of the French army into Bologna.
In 1560 the Bolognesi, realising that the most important causes of the spread of syphilis were social degradation, prostitution and poverty, founded another institution for the poor and for the prevention of prostitution. This institution was developed by the Opera dei Mendicanti and provided hospitality during the 1590 famine, in a city of 55,000 inhabitants, for as many as 1400 poor and sick.
