Volume 14, Issue 2, 2006
Review
Clinical pharmacology of nucleoside and nucleotide reverse transcriptase inhibitors
Bonora Stefano,
Calcagno Andrea,
Gonzalez de Requena Daniel,
Bargiacchi Olivia,
Di Perri Giovanni
La farmacopea per i pazienti affetti da infezione da HIV è in continua espansione e nuovi farmaci vengono proposti per le associazioni terapeutiche. Gli inibitori nucleosidici e nucleotidici della transcrittasi inversa (Nt/NRTI) restano ad ogni buon conto il backbone di scelta della HAART. Benchè essi rappresentino in realtà la classe più vecchia di composti antiretrovirali, le loro caratteristiche farmacocinetiche e farmacodinamiche sono state meno studiate rispetto ai farmaci delle altri classi, quali gli inibitori della proteasi (PI) e gli inibitori non-nucleosidici della transcrittasi inversa (NNRTI). Lo scopo di questo articolo è di analizzare i principali aspetti di farmacologia clinica degli Nt/NRTI, con particolare riguardo agli elementi di maggior interesse per la gestione clinica del paziente. Pertanto verranno discusse le implicazione del metabolismo intracellulare degli Nt/NRTI sullo schema posologico, le potenzialità di interazione farmacologica e le caratteristiche farmacodinamiche.
Original article
Applications of LightCycler Staphylococcus MGRADE assay to detect Staphylococcus aureus and coagulase-negative staphylococci in clinical blood samples and in blood culture bottles
Carla Liberto Maria,
Puccio Rossana,
Matera Giovanni,
G. Lamberti Angelo,
Quirino Angela,
Barreca Giorgio,
Capicotto Renata,
Focà Alfredo
We evaluated the applicability of the LightCycler Staphylococcus MGRADE assay on artificially infected blood samples from healthy donors and on clinical specimens of 31 hospitalized patients. The sensitivity and specificity of the assay for detecting Staphylococcus aureus was 100% in blood samples, and 100% in blood culture bottles, when data from the BACTEC 9120 blood culture system were taken as gold standard. The same specificity and sensitivity was found during the search for CoNS (Coagulase Negative Staphylococci) in blood culture bottles, whereas a 93.33% sensitivity and 100% specificity was observed for detecting CoNS directly in blood clinical specimens.
Bacterial meningitis in adults: a retrospective multicentric study in Tuscany (Italy)
Ricciardi Liana,
Meini Micaela,
Luchi Sauro,
Scasso Antonio,
Corbisiero Raffaella,
Mencarelli Maria,
Cellesi Carla,
Aquilini Donatella,
Carbonai Simonetta,
Paladini Antonio,
Bresci Silvia,
Panunzi Isabella,
Leoncini Francesco,
Trezzi Michele,
Nencioni Carla,
Toti Mario,
Maccanti Osvalda,
Pardelli Riccardo,
Sani Spartaco,
Pippi Luigi,
Esperti Francesco,
Messeri Daniela,
Dionisio Daniele,
Pippi Francesco,
Blè Claudio,
Pienotti Piera,
Mazzotta Francesco
The Infectious Diseases Unit of Lucca Hospital conducted a multicentric retrospective study to evaluate the epidemiological and clinical features of adult patients affected by bacterial meningitis attending all the Infectious Diseases Units of Tuscany (Italy) from July 1999 to June 2004. A specific questionnaire was sent to all the units to collect information about each case of bacterial meningitis occurring in patients older than sixteen. Patients with meningitis by Mycobacterium tuberculosis were excluded from the analysis. Nine out of 12 Infectious Diseases Units of Tuscany took part in the study and 197 cases were identified. Most cases of meningitis occurred during 2002 with a slight reduction in cases in subsequent years. Streptococcus pneumoniae and Neisseria meningitidis were the most frequently isolated pathogens with an increase in diagnosis from 1999 to 2004; in 23.8% of patients no pathogens were isolated, with a reduction in meningitis from unknown aetiology from 1999 to 2004. Most patients were treated with a combination of two antibiotics, and corticosteroid drugs were added to the therapy; in the group of patients treated with corticosteroid drugs invalidating complications occurred in 23% of cases and 5% of patients died. In all, 27 out of 197 subjects (13.7%) developed invalidating complications and 20 out of 197 patients (10.2%) died.
Epidemiologic surveillance of multi-drug resistant Pseudomonas aeruginosa in Mantova Hospital (Italy)
Tomasoni Donatella,
Gattuso Gianni,
Chiarelli Cristina,
Palvarini Loredana,
Ceruti Rossella,
Berra Davide,
Stradoni Raffaello,
Scalzini Alfredo
For the period 2002-2005 we verified and compared the data of the prevalence and resistance of Pseudomonas aeruginosa (PA) isolated in Mantova Hospital (Italy) with the data from the international database. From the first six-month period of 2004 a significant increase was found (9% vs 28.8%) in the prevalence of multi-drug resistant PA (MDR-PA). The principal wards involved were the Intensive Care Unit and the Department of Respiratory Diseases. A significant increase in resistance rates was observed for all antimicrobials tested, in particular for aztreonam, ceftazidime, ciprofloxacin, gentamycin and imipenem. The lowest dual resistance rates were observed between amikacina with piperacillin/tazobactam, while the highest were for those that included ciprofloxacin and beta-lactams (aztreonam, cefepime). In this study we confirm the importance of continuous surveillance of laboratory data and tightening local control measures for nosocomial infections in order to prevent the spread and selection of MDR-PA.
Enterobiasis during 2002-2003 in Perugia province: beyond diagnostics
Crotti Daniele,
D'Annibale Maria Letizia
Between 2002 and 2003 we examined cellophane tapes of 119 children, both symptomatic and apparently asymptomatic. Eggs of Enterobius vermicularis were observed in 13.4% of children. This helminth is the most frequent in Italy, but it is as yet unrecognized, probably due to parasitological laboratories not being consulted, resulting in incomplete epidemiological data. We recall the biological aspects of this nematode and suggest the need for sound diagnosis to ensure proper surveillance of this exclusively human infection.
Case report
Nosocomial spondylodiskitis with epidural abscess and liquoral fistula cured with quinupristin/dalfopristin and linezolid
Marroni Massimo,
Tinca Manuela,
Belfiori Barbara,
Altobelli Gaia,
Malincarne Lisa,
Papili Rita,
Stagni Giuliano
Nosocomial infections after spinal surgery are relatively uncommon but potentially serious. The goal of diagnostic evaluation is to determine the extent of infection and identify the microorganism involved. Neuroimaging provides accurate information on correct topography, localization and propagation of the infection. Microbiological data are able to give aetiological causes.
In this patient with severe, chronic polymicrobial spine infection with epidural abscess and liquoral fistula due to multidrug-resistant organisms, the cure was achieved with long-term antimicrobial specific therapy with quinupristin-dalfopristin (50 days) and linezolid (100 days) with mild side effects. This positive result was due to combined medical and surgical treatment.
The Infections in the History of Medicine
Syphilis in sixteenth-century in Bologna. Health care and social assistance
(Part two)
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 degrada-tion, 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.
We also present the cure (guaiac and mercury) that they used at the time against syphilis. In such a difficult his-torical period beset with political and economic problems, the Bolognesi established two important institutions and showed that social solidarity is a value for the whole population.
