Volume 15, Issue 1, 2007
Review
Early and timely therapy: when to interrupt antibiotic therapy in nosocomial acquired pneumonia?
Leone Sebastiano,
Fiore Marco,
Esposito Silvano,
Felaco Francesca Maria
Nosocomial pneumonia is the second most frequent nosocomial infection and represents the leading cause of death due to hospital acquired infections. In recent years, evidence has accumulated that initial inappropriate antibiotic treatment is an important and independent mortality risk factor for patients with nosocomial pneumonia. On this point, several authors have found that delaying the administration of appropriate antibacterial treatment is associated with an excess in hospital mortality. In this scenario, various strategies have been proposed, such as de-escalation therapy, that attempt to balance the need to provide appropriate initial treatment with limiting the emergence of antibacterial resistance. Another relevant point is the duration of antibiotic therapy: international guidelines suggest that it should be based upon the clinical response, with a standard duration of 14-21 days, but several authors have shown that a shorter course could lead to the same clinical results, and significantly reduce both antimicrobial consumption and the emergence of resistant pathogens. The present review deals with the clinical importance of early, shorter antibiotic therapy.
Propolis antimicrobial activity: what’s new?
De Vecchi Elena,
Drago Lorenzo
Propolis is a hive product that bees manufacture from balsamic resins actively secreted by plants on leaf buds and barks. Propolis composition is highly variable, depending on the plant species and on the season of collection. However, propolis essentially contains resins, balsams, essential oils, flavonoids, vitamins, minerals and pollen, albeit at different concentrations. Although more than 300 constituents have been identified in propolis samples, biological activity is mainly due to few substances, such as flavonoids, terpens, caffeic, ferulic and cumaric acids and esters.
Propolis is characterized by multifactorial activities, but only some of them have been substantiated by clinical and experimental evidence. It is widely acknowledged to exert antimicrobial activity against a wide range of microorganisms (bacteria, fungi and viruses), but also exerts antiinflammatory, anaesthetic, healing, vasoprotective, antioxidant, antitumoral, antiulcer and hepatoprotective activities. The wide spectrum of activities has led in recent years to the development of new technologies to improve propolis properties of the traditional hydroalcoholic extract.
This paper reviews the antimicrobial properties of propolis, focusing on respiratory pathogens. These characteristics make propolis a valid option for therapy of upper respiratory tract infections.
Original article
Clinical and microbiological features of Salmonella gastroenteritis in children
Saporito Laura,
Colomba Claudia,
Scarlata Francesco,
Li Vecchi Valentina,
Mammina Caterina,
Titone Lucina
The aim of our study was to evaluate the role of Salmonella spp in children hospitalised for acute gastroenteritis, and to study clinical and microbiological features of paediatric salmonellosis in our geographical area. In all, 540 patients admitted from March to September 2003 with symptoms of acute enteritis to the Infectious Diseases department of the “G. Di Cristina” hospital in Palermo were enrolled. Stool samples were collected within 48 hours of admission and tested for intestinal pathogens (bacterial, viral, parasites). Salmonella spp was detected in 18.5% of samples. The median age of infected children was 4.5 years. Salmonella enteritidis (49%) and Salmonella typhimurium (37%) were the most commonly identified genotypes. S. enteritidis infection was more frequently characterized by vomiting (65.3%) and dehydration (61.2%). Bloody diarrhoea was more common in S. typhimurium infection (40.5%). All strains were susceptible to ceftriaxone, while 40% of strains were resistant to tetracyclines and 37% to ampicillin.
Role of Dientamoeba fragilis in human bowel infections
Crotti Daniele,
D'Annibale Maria Letizia
During 2004, we identified 39 intestinal infections caused by Dientamoeba fragilis and 23 caused by Giardia duodenalis, on 1141 home subjects (3.4% and 2.0% respectively): D. fragilis was observed in 4.5% of O&P (29/644 subjects suffering from aspecific bowel disorders) and in 2.0% of diarrhoeas (10/497); G. duodenalis was observed in 3.1% (20/644) and in 0.6% (3/497) of cases respectively. No other pathogenic parasites were identified (only 1 case of enterobiasis in an asymptomatic child). Commensal protozoa were observed, among O&P, in 4.3% of cases (28/644). The non-pathogenic B. hominis, often associated with other protozoa, was observed in 4.1% of all 1141 cases.
D. fragilis is undoubtedly more frequent in adults (36/39 cases, 92.3%) than in children (3/39, 7.7%), and is prevalent among females (24/39, 61.5%) in respect of males (15/39, 38.5%). G. duodenalis is more prevalent among adults (16/23, 69.5%) than children (7/23, 30.5%), but is more frequent among males (13/23, 56.5%) than females (10/23, 43.5%).
Clinical correlations of dientamoebiasis and giardiasis are reported, seasonal and epidemiological features of these protozooses are outlined, and the authors emphasize the importance and need of Giemsa stain, among O&P and acute or prolonged diarrhoeas, on the basis of previous good direct microscopic observations of faecal specimens, for correct and complete diagnosis of intestinal infections.
Tuberculosis meningitis in adults: 5 cases
Capelli Anna,
Garlaschelli Anna Lisa,
Malfitano Antonello,
Filice Gaetano
La tubercolosi rappresenta tutt’oggi un problema di sanità pubblica di rilevanza mondiale.
In particolare, la forma meningea, pur se non frequente tra le localizzazioni extra-polmonari, è da sospettare in specifici contesti epidemiologici e di fronte a particolari quadri clinici.
La diagnosi di certezza si fonda sull’isolamento del Mycobacterium tuberculosis dal liquor, ma non sempre è ottenibile.
Presentiamo qui di seguito cinque casi di meningite tubercolare che sono stati ricoverati presso la nostra Divisione di Malattie Infettive e Tropicali negli ultimi sei anni, con lo scopo di evidenziare gli aspetti salienti che ci hanno guidato alla diagnosi e le difficoltà intercorse.
Rapid differential diagnosis of Orthopoxviruses and Herpesviruses based upon multiplex Real-time PCR
Sias Catia,
Carletti Fabrizio,
Capobianchi Maria R.,
Travaglini Damiano,
Chiappini Roberta,
Horejsh Douglas,
Di Caro Antonino
Objective: Variola virus, belonging to Orthopoxviridae family, is one of the most dangerous human pathogens that could be used as biological weapon. We have developed a new rapid assay, based upon Real-time PCR and melting temperatures analysis of amplicons, for the contemporary detection of Orthopoxvirus, VZV and HSV1-2, that are the most important infectious agents to be considered for differential diagnosis.
Methods: The target for detection of orthopoxvirus DNA has been a region of the crmB gene which is common to Variola virus and to other old world orthopoxviruses pathogenic for humans. The targets for VZV and HSV1-2 have been ORF 29 and DNA polymerase, respectively. Suitability of the amplified fragments to RFLP or sequencing analysis, to recognize the involved viral species, has been also tested.
Result: The selected primers have showed high sensitivity, specificity and compatibility with common amplification conditions. A mean melting temperature difference of 8.7°C was observed between the amplicons from the two virus types. Further identification of individual pathogens was made using RFLP analysis.
Conclusion: The PCR-based protocol set up in this study for presumptive differential diagnosis of variola and herpesviral infections is rapid and specific and it can be used also to detect other orthopoxviral infections, like monkeypox.
Case report
Successful treatment of Corynebacterium urealyticum encrusted cystitis: a case report and literature review
Perciaccante Antonio,
Pompeo Elena,
Fabi Flavia,
Venditti Mario
Encrusted cystitis is a very rare chronic inflammatory disease of the bladder characterized by precipitation and incrustation of phosphate and ammonium-magnesium salts on the vescical mucosa, caused by urinary infection due to urolithic microorganisms. Corynebacterium urealyticum or Corynebacterium group D2, a multiple antibiotic-resistant urea-splitting bacterium, is the most frequently incriminated aetiology.
We report a case of a 57-year-old man affected by systemic erythematosus lupus with a long history of dysuria and suprapubic pain who underwent percutaneous nephrostomy drainage with urethral stenting for lupoid obstructive uropathy. Before the diagnosis of encrusted cystitis by Corynebacterium urealyticum was established, the patient underwent five cystoscopies to remove the plaques and multiple unsuccessful antibiotic treatment courses. Eventually the infection was definitively cured after a two-week course with intramuscular teicoplanin.
Nephrotic syndrome and Gram-negative sepsis in a patient with strongyloidiasis: a case report
Rotolo Ugo,
Scarlata Francesco,
Giordano Salvatore,
Tortorici Calogera,
Bono Luisa,
Coglitore Mario,
Faraci Cesare,
Infurnari Laura,
Rubino Raffaella,
Romano Amelia
Strongyloidiasis is caused by a small intestinal nematode with a complex life cycle. In Italy the infection is endemic in rural areas of the Po Valley. The clinical syndrome of S. stercoralis encompasses a broad spectrum of symptoms and signs and, in the immunocompromised host, larvae can migrate to different organs and tissues. Also immune response seems to play a role in the pathogenesis of the disease. We report a case of strongyloidiasis complicated by Gram-negative sepsis and nephrotic syndrome in an immigrant from South America with a normal immune response. Whereas sepsis cleared up quickly, parasitic clearance was obtained only after treatment with ivermectin and nephritic syndrome was still present three months after the end of treatment.
Typhoid fever and acute pancreatitis: two cases
Rombolà Ferdinando,
Bertuccio Salvatore Nicola
Acute pancreatitis is a pancreatic inflammation that recognises Salmonella typhi among its aetiological agents. In this article the authors describe two cases of acute pancreatitis secondary to typhoid fever, evolving towards complete recovery. These two cases, besides confirming that Salmonella typhi can be responsible for acute pancreatitis, remind us that during typhoid fever, amylase enzyme test should be always assessed. Moreover, salmonella infection must also be considered in cases of non-alcoholic or non-lithiasic pancreatitis.
The Infections in the History of Medicine
Smallpox in Ferrara in the nineteenth century
Guidi Enrica,
Angelini Lauretta,
Cervato Katia,
Pizzo Francesco,
Rizzello Roberto,
Fortini Marco,
Contini Carlo
The aim of this work was to analyse the mortality for smallpox and the methods used during the nineteenth-century to control epidemics. Most of the historical material was found in the Historical Archives of the Ferrara City Council.
Over the whole period in question, there were 710 deaths in Ferrara (366 males and 344 females). The highest number was found in the years 1816, 1829, 1834, 1842, 1849, 1871 and 1891. Data analysis shows that most deaths occurred during the first half of the century. Subsequently, the phenomenon declined to almost zero. Males were more affected and nearly 70% of the deaths occurred under 5 years of age, 50%of which during the first year of life. At that time, the “guidelines” adopted were analogous to those currently followed when a new vaccination programme is started. The inspiring principles were the active and free supply of vaccine, universal vaccination, the informed consent of the population, the involvement of educators and also monetary rewards to the most industrious doctors in the practice of vaccination. In Ferrara vaccination began in 1801, but was only consistently implemented in 1812. By the end of the 19th century the number of persons vaccinated had increased from 3% to 7%. Vaccination initiatives assumed great importance among the population of Ferrara, in spite of initial resistance and suspicion of a practice which most people found incomprehensible.
