Volume 14, Issue 4, 2006
Review
Daptomycin, the first cydal antibiotic of a new class active against Gram positive pathogens
Stefani Stefania,
Esposito Silvano
Antibiotic resistance among Gram-positive bacteria has increased in recent years, thereby compromising the use of traditional therapies. Reducing the spread of antimicrobial resistance is mandatory and requires worldwide cooperation. Complementary to such measures in the management of infectious diseases is the development of novel therapeutic agents. Daptomycin is the first in a new class of antibiotics, the cyclic lipopeptide with a potent and bactericidal activity against Gram-positive pathogens and, due to its in vitro and in vivo characteristics, demonstrates to be an exciting option for the treatment of Gram-positive infections.
It has very good pharmacokinetics properties with a long half-life which allows a single intravenous daily dose and is currently approved for treatment of complicated skin and soft tissue infections at the dosage of 4 mg/kg/die and for treatment of bacteremia and endocarditis at the dosage of 6 mg/kg/die.
Its favourable clinical profile together with its bactericidal activity and low potential for development of resistance makes daptomycin a good alternative to currently used agents for treatment of Gram positive infections.
Interactions and false positive results of galactomannan antigen detection for diagnosis of invasive aspergillosis
Machetti Marco,
Viscoli Claudio
Invasive aspergillosis (IA) is a leading cause of morbidity and mortality in immunocompromised hosts, with a survival rate lower than 50%. Although proven diagnosis of IA requires histopathological evidence of deep-tissue invasion, eventually supported by microbiological cultures, critical conditions of patients often hamper invasive diagnostic procedures, and many IA cases are not diagnosed during life.
Detection of circulating galactomannan antigens is a non-invasive method widely used to support the diagnosis of IA. However, results of test performance have been variable and, in particular, the method shows specificity problems due to cross reactions and false positive results caused by other microorganisms, foods, antibiotics, graft versus host disease and particular physiological conditions of premature infants. It appears therefore mandatory to know exactly all these possible interactions, in order to properly evaluate GM test results and correctly apply them to the diagnosis of IA and to clinical practice.
Original article
Seroepidemiology of Fascioliasis in the Antalya Region and uselessness of eosinophil count as a surrogate marker and portable ultrasonography for epidemiological surveillance
Ozge Turhan,
Korkmaz Metin,
Saba Rabin,
Kabaalioglu Adnan,
Inan Dilara,
Mamikoglu Latife
Background: Fascioliasis is a great tropical disease all over the world so we tried to investigate the incidence of fascioliasis in the Antalya region of Turkey and also to find an answer to the question if initial ultrasonographic examination (US) and eosinophil count is a predictive sign in diagnosis of fascioliasis.
Material and methods: In this study, 597 adult persons were included. All cases were examined for eosinophilia and antibodies against Fasciola hepatica by enzyme linked immunosorbent assay (ELISA). 344 of them were examined by portable US.
Results: ELISA was positive in 18 (3%) of 597 persons. This rate is appropriate for the definition of mesoendemic region for human fascioliasis. Among seropositive people only 2 (11.11%) cases had eosinophilia (p=0.3). US findings were not related to fascioliasis.
Conclusions: Future epidemiologic studies are required in order to find the real situation of fascioliasis in Turkey as in the world and initial US and eosinophil count is not useful predictive method for fascioliasis prevalence.
Prevalence and clinical significance of Ureaplasma urealyticum and Mycoplasma hominis in the lower genital tract of HIV-1-infected women
Lanzafame Massimiliano,
Delama Andrea,
Lattuada Emanuela,
Faggian Federica
Mycoplasma hominis and Ureaplasma urealyticum are frequently isolated from the cervical and vaginal tracts of HIV-negative asymptomatic women. Published data lack indisputable conclusions and doubts still exist as to whether these mycoplasmas are pathogens or mere co-factors associated with genital infections. We therefore conducted a surveillance study to investigate the prevalence of genital mycoplasmas in HIV-1 positive women (110 patients), attending the outpatient Infectious Diseases Clinic of our tertiary referral Hospital, by speculum examination, PAP test, endocervical and vaginal swabs obtained by gynaecologists.
Ureaplasma urealyticum was isolated from the cervix of 45 women (41%). Mycoplasma hominis was recovered from 12 women (11%), in four of whom it was isolated at the same time from the vagina. PAP test results ruled out subclinical cervicitis in all women. Bacterial vaginosis, assessed by Amsel criteria and the Nugent score, was absent in all women. Our data show that the mycoplasmas in question are found in the lower genital tract of asymptomatic HIV-1-positive women at a frequency similar to that reported in the HIV-negative female population, and make a role for these microorganisms unlikely in the aetiology of cervico-vaginal infections also in this particular patient population.
Evaluation of Vitek 2 performance for identifying extended spectrum beta-lactamases in Enterobacteriaceae “other than Escherichia coli, Proteus mirabilis and Klebsiella spp”
Diamante Paola,
Camporese Alessandro
Production of beta-lactamases is the main resistance mechanism of gram-negative bacteria against beta-lactam antibiotics. Extended spectrum beta-lactamases (ESBLs) have the ability to hydrolyze a broader spectrum of beta-lactam drugs. Hence rapid, accurate detection of this resistance mechanism is extremely important to guide proper patient antimicrobial therapy.
These enzymes are most commonly produced by Klebsiella spp. and Escherichia coli, but may also occur widely in other gram-negative bacteria, including Enterobacter spp., Proteus spp., Morganella morganii, Providencia stuartii, Serratia marcescens and others that also produce other chromosomal and plasmid-mediated enzymes, like AmpC beta-lactamases. The main problem is that no CLSI (Clinical and Laboratory Standards Institute) recommendations exist for ESBL detection for Enterobacteriaceae “other than E. coli, Proteus mirabilis and Klebsiella spp.” and for detecting plasmid-mediated AmpC beta-lactamases.
We carried out an evaluation of Vitek 2 Advanced Expert System (AES) performance for identifying ESBL in Enterobacteriaceae, also “other than E. coli, Proteus mirabilis and Klebsiella spp.”, comparing results obtained with Etest and double disk data. Seventy isolates of Enterobacteriaceae were tested for the production of extended-spectrum beta-lactamases (ESBLs) by using Vitek 2, Etest and the double disk method. The use of Etest was performed as a gold standard method by comparing interpretation results of Vitek 2 Advanced Expert System (AES).
In comparison with the Etest method, AES produced 19 ESBL warnings, of which only 5 were classified as “major misunderstandings”, especially for Enterobacteriaceae “other than E. coli, Proteus mirabilis and Klebsiella spp.” which produced plasmid-mediated AmpC beta-lactamases. The Etest, together with the cefoxitin sensibility test, was found to be the best method to confirm ESBLs and distinguish AmpC from ESBLs.
Case report
Pott’s disease in a patient affected with epilepsy and behavioural abnormalities
Sapienza Mauro,
Occhipinti Maria Lidia,
Spadaro Paolo,
Rossetto Giuseppe
The authors report on a case of Pott’s disease in a patient attending a long-term psychiatric hospital for about 34 years. Difficulties regarding case management concern either diagnosis, due to the numerous and misleading comorbidities, or pharmacological treatment, due to both the interference between neurotropic and antitubercular drugs and the capacity of some antimycobacterial drugs to reduce significantly the epileptogenic threshold, thus enhancing epileptic crises.
Four cases of meningitis by streptococci other than pneumoniae in adults: clinical and microbiological features
Attanasio Vittorio,
Pagliano Pasquale,
Fusco Ugo,
Zampino Rosa,
Faella Francesco Saverio
Meningitis sustained by streptococci other than pneumoniae, infrequent in community medicine, is emerging as a hospital-acquired infection. We describe four cases of meningitis caused by streptococci other than pneumoniae in adults.
Nosocomial Brevundimonas vesicularis meningitis
Mondello Placido,
Ferrari Lucio,
Carnevale Giuseppe
Brevundimonas vesicularis infrequently causes human infections. We describe a case of meningitis due to Brevundimonas vesicularis, resistant to piperacillin, gentamicin and amikacin as well as to cephalosporins, aztreonam, imipenem and meropenem. The meningitis was acquired in hospital by a patient operated for astrocytoma and represents a classical hospital infection.
Cases of Chikungunya fever in Italy in travellers returning from the Indian Ocean and risk of introduction of the disease to Italy
Fusco Francesco Maria,
Puro Vincenzo,
Di Caro Antonino,
Nicastri Emanuele,
Carannante Novella,
Faella Francesco Saverio,
Barzon Luisa,
Di Cesare Simona,
Palù Giorgio,
Capobianchi Maria Rosaria,
Ippolito Giuseppe
Chikungunya fever is a viral disease characterized by fever, arthralgia and rash. A large outbreak of Chikungunya fever began in 2005 in La Reunion, and it is still ongoing on many islands and countries of the Indian Ocean. Several cases have been detected in Europe in travellers returning from the affected areas. The disease is transmitted by the bite of Aedes mosquitoes, which are also widespread in Italy. We describe 7 cases of Chikungunya fever imported into Italy by travellers returning from affected countries. The current outbreak is described, and the risk of establishment of a chain of transmission in Italy is discussed.
Which antibiotic prophylaxis to use for urologic procedures in patients at risk for infective endocarditis: a report on two cases.
Scotton Pier Giorgio,
Vaglia Alberto,
Rizzi Marco,
Ravasio Veronica,
Mengoli Carlo
In urologic surgery, antibiotic prophylaxis is generally recommended for transrectal prostate biopsies and transurethral prostate resection. While a fluoroquinolone (such as ciprofloxacin or levofloxacin) may be appropriate in most instances, patients at risk for infectious endocarditis (IE) may require a different regimen, effective also against Enterococcus species. We describe and comment on the cases of two patients who, following urologic procedures and antibiotic prophylaxis, developed Enterococcus faecalis endocarditis. We also propose an antibiotic prophylactic regimen for urologic procedures suitable for patients at risk for infectious endocarditis (IE).
The Infections in the History of Medicine
Petechial typhus in Napoleonic Italy. Scientific debate and the role of Giovanni Rasori
Sabbatani Sergio
During the Napoleonic wars, an epidemic recrudescence of petechial typhus was observed throughout Europe. In Italy, the epidemic first broke out in Genoa, in 1799, coming from southern France, during the sieges of the Austro-Hungarian army. Giovanni Rasori, a young Republican physician and man of the sciences, supported the besieged and contributed to defend the city. From the beginning, Rasori identified the cause of the epidemic in petechial typhus, being able to evaluate its clinical presentation, and developed a pathogenetic theory, known as contrastimulus. At that time, this theory obtained some success, though opposed by the academic establishment in Lombardy.
In this article, we present the medical and philosophical ideas which, in the period between the 18th and 19th century, pervaded medical Italian culture. Furthermore, a biographic profile of Giovanni Rasori is described, a courageous scientist who did not disdain to take part in political and cultural Italian life during a historical period that was to become important for the future fortunes of Italy.
