Volume 15, Issue 2, 2007
Review
Cholera: recent acquisitions
Nardiello Salvatore,
Ilario Adelaide,
M. Fusco Francesco,
Cuomo Gianluca
Cholera is still a medical problem in several countries, leading to the death of a large number of affected individuals. Recent acquisitions on the epidemiology of Vibrio cholerae suggest that there is a risk of global spreading of the disease and of the development of new pathogenic strains. We have reviewed the most recent hypothesis on the ecology of cholera, in particular on the origin of epidemics. Recent developments in the fields of therapy and prophylaxis of cholera are also reported.
Original article
Acute hepatitis C infection: epidemiological and clinical aspects, and efficacy of interferon therapy
Luchi Sauro,
Ricciardi Liana,
Meini Micaela,
Fiorini Italbo,
de Gennaro Michele,
Moneta Sara,
Bosco Giovanni,
Scasso Antonio
Acute hepatitis C virus infection becomes chronic in 50-80% of patients; in recent years a number of studies on acute hepatitis C have shown that interferon treatment can solve more than 80% of cases. In this study we evaluated all cases of acute hepatitis C referred to our unit from 1998 to 2005 to study the epidemiological and clinical features and the efficacy of interferon therapy during the course of the disease. Forty-three patients (28 males, 15 females) were monitored: 22 were drug-addicts, 6 patients referred from recent surgery, in 3 cases a percutaneous exposure was described, 2 patients had had a colonscopy, 4 were partners of subjects with chronic hepatitis C and in the remaining cases the transmission route was uncertain. All subjects were symptomatic, jaundice was evident in 20 out of 43 patients and in all cases hepatic protein synthesis was unaltered.
Of the 21 patients who consented to interferon therapy, in 19 cases a sustained virological response was achieved while in 2 cases the follow-up period was too short for evaluation. Four of the 22 non-treated patients had a spontaneous resolution of the infection, in 13 cases the infection became chronic, and in 4 cases the follow-up was too short for an analysis.
In our study all patients were young, in 58% of subjects a parenteral exposure was described and most patients were drug-addicts. All the treated patients obtained a sustained response, while in the majority of non-treated cases the infection became chronic.
Perioperative antibiotic prophylaxis and cost in a Turkish University Hospital
Yalcin Arzu Didem,
Yalcin Ata Nevzed,
Atalay Habip,
Oner Ozlem,
Erbay Riza Hakan,
Serin Simay
Although surgical site infections have decreased with the use of prophylactic antibiotics, inappropriate surgical antibiotic prophylaxis is still a world-wide problem. In this retrospective study, perioperative antibiotic prophylaxis was evaluated in a university hospital. All surgical procedures (n=2038) performed in the year 2002 were included. The study setting was the Anesthesiology and Reanimation unit in Pamukkale University Medicine Faculty Hospital.
A total of 1902 patients received antibiotic prophylaxis. Ninety-two percent of all procedures were elective, 8% emergencies. Approximately 85.7% were clean surgery, 8.5% clean-contaminated, 5.3% contaminated, and 0.5% dirty. Approximately 93.3% of patients received antibiotic prophylaxis. Although timing of prophylaxis was appropriate in all procedures, duration was optimal in only 29.0% of all cases. Sulbactam/ampicillin (33.2%), cefepime (23.4%), ceftriaxone (15.1%), ciprofloxacin (12.6%) and cefazolin (11%) were the most commonly used antibiotics. Instead of an estimated optimal cost of perioperative antibiotic prophylaxis ranging between US$2.6 and 7.8 according to guidelines, the average cost was US$62 per patient.
We believe that compliance regarding the optimal choice, frequency and duration of perioperative antibiotic prophylaxis is inadequate, thereby making additional efforts necessary
Abnormal liver function in Mediterranean Spotted Fever
Micalizzi Anna,
La Spada Emanuele,
Corsale Sveva,
Arculeo Angela,
La Spada Monica,
Quartararo Pasquale,
Giannitrapani Lydia,
Soresi Maurizio,
Affronti Mario,
Montalto Giuseppe
Il coinvolgimento della funzione epatica in corso di Febbre Bottonosa del Mediterraneo (FBM) non è largamente studiato, e solitamente di minore rilievo rispetto alla condizione clinica generale. In questo studio abbiamo retrospettivamente analizzato la prevalenza della compromissione epatica in tutti i pazienti affetti da FBM, ricoveratisi consecutivamente presso il nostro dipartimento di Medicina negli ultimi 4 anni, monitorando i principali parametri della funzione epatica. Sono stati inclusi nello studio 49 soggetti mentre sono stati esclusi quei pazienti con FBM ma conosciuti precedentemente come portatori di una malattia cronica di fegato. Al momento dell’ospedalizzazione i valori medi di transaminasi erano al di sopra della norma; 27 pazienti (55,1% ) e 25 (51 %) avevano la TGO e la TGP sopra i valori della norma. Alla dimissione i valori sono pressocchè rientrati in tutti i casi tranne che in 2 soggetti per la TGO e 4 per la TGP. I valori di fosfatasi alcalina erano nei limiti della norma all’ingresso, ma 22 pazienti avevano valori sopra i limiti della norma che sono rientrati in tutti i casi alla fine del trattamento. Diciotto pazienti (36,7%) avevano un aumento contemporaneo di TGO, TGP e fosfatasi alcalina. Non sono state evidenziate variazioni importanti per quanto riguarda i valori di albuminemia, di gamma globulinemia e per i valori di bilirubinemia. I valori delle piastrine invece, presentavano mediamente una riduzione significativa all’ingresso, ma si sono normalizzate dopo la fine del trattamento. All’ecografia quasi metà dei pazienti ha presentato epatomegalia con i caratteri dell’infiammazione e nel 39% dei casi è stata rilevata una splenomegalia. In conclusione, come precedentemente riportato in letteratura, la frequenza dell’impegno epatico in corso di FBM è elevata ma usualmente non serio. In alcuni casi però l’aumento delle transaminasi può essere importante e protrarsi oltre il periodo di convalescenza della malattia infettiva, non acquisendo comunque i caratteri della progressione.
Case report
Human meningitis caused by Streptococcus suis: the first case report from north-eastern Italy
Camporese Alessandro,
Tizianel Gianni,
Bruschetta Graziano,
Cruciatti Barbara,
Pomes Angelo
We describe the first case of Streptococcus suis meningitis in the north-east of Italy. We would like to stress that Streptococcus suis should be seriously considered in the differential diagnosis of human meningitis especially in adults with a recent history of close contact with pigs or unprocessed pork meat.
HPV oral infection. Case report of an HIV-positive Nigerian sex worker
Martini Salvatore,
Colella Giuseppe,
Masiello Addolorata,
Lanza Alessandro,
Pisapia Raffaella,
Cascone Angela,
Di Martino Filomena,
Filippini Alberico,
Filippini Pietro
HPV infections have become a major problem in immunocompromised patients, particularly in HIV-positive subjects. HPV lesions are observed more frequently in the ano-genital area and rarely in different body areas, such as the skin and oral cavity. However, in HIV-positive subjects there is an increased risk of oral condylomas.
We describe the case of an HIV-positive Nigerian young woman, who came to our notice due to the appearance of small labial and mouth mucous membrane lesions, related to HPV infection, as shown by a biopsy. These lesions were not evident in the genital area. After two years in which the patient no longer received therapy, there was a progressive reduction in CD4 count, associated with the development of the oral condylomas. Hence the patient began a new HAART combination, but after seven months, although a slight improvement emerged in the CD4 count with the disappearance of HIV-RNA, there has been no regression of oral condylomas.
HPV infections have become a major problem in immunocompromised patients, particularly in HIV-positive subjects. HPV lesions are observed more frequently in the ano-genital area and rarely in different body areas, such as the skin and oral cavity. However, in HIV-positive subjects there is an increased risk of oral condylomas.
We describe the case of an HIV-positive Nigerian young woman, who came to our notice due to the appearance of small labial and mouth mucous membrane lesions, related to HPV infection, as shown by a biopsy. These lesions were not evident in the genital area. After two years in which the patient no longer received therapy, there was a progressive reduction in CD4 count, associated with the development of the oral condylomas. Hence the patient began a new HAART combination, but after seven months, although a slight improvement emerged in the CD4 count with the disappearance of HIV-RNA, there has been no regression of oral condylomas.
Tuberculous sacro-ileitis: two cases and radiological findings
Sirmatel Ocal,
Yazgan Pelin,
Gursoy Bensu,
Sirmatel Fatma,
Zyerek Fadile Yildiz,
Ozturk Adil
Infective sacro-ileitis is due to common bacteria, 25% being tuberculosis and 10% brucellosis. Slow progression characterizes joint tuberculosis, an uncommon variant of this disease. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. We report two cases with tuberculous sacro-ileitis which initially mimicked brucellosis infiltration. Diagnosis of tuberculosis of the sacroiliac joint was established by fine-needle aspiration of joint and radiological imaging methods such as computerized tomography, magnetic resonance and three-phase bone scan. The current diagnosis and treatment of this condition is discussed based on these cases and a literature review.
Aortic-right atrium fistula complicating Austrian Syndrome: a case report and literature review
Luzzati Roberto,
Pinamonti Bruno,
Giacomazzi Donatella,
Sinagra Gianfranco,
Zingone Bartolo
La triade polmonite, meningite ed endocardite da Streptococcus pneumoniae è conosciuta come sindrome di Austrian. Si descrive un caso con fistola tra aorta ed atrio destro in una donna sottoposta a splenectomia per linfoma di Hodgkin. La revisione della letteratura dimostra che negli anni recenti la prevalenza della sindrome di Austrian si stà riducendo dal 19% al 3% tra i pazienti con endocardite pneumococcica. Questo caso clinico sottolinea che la diagnosi di endocardite deve essere considerata precocemente in tutti i pazienti con meningite o batteriemia pneumococcica, soprattutto nei soggetti immunocompromessi.
The Infections in the History of Medicine
Yellow fever
Sabbatani Sergio,
Fiorino Sirio
After the discovery of the New World, yellow fever proved to be an important risk factor of morbidity and mortality for Caribbean populations. In the following centuries epidemic risk, expanded by sea trade and travel, progressively reached the settlements in North America and Brazil as well as the Atlantic seaboard of tropical and equatorial Africa. In the eighteenth century and the first half of the nineteenth century epidemics of yellow fever were reported in some coastal towns in the Iberian peninsula, French coast, Great Britain and Italy, where, in 1804 at Leghorn, only one epidemic was documented.
Prevention and control programs against yellow fever, developed at the beginning of the twentieth century in Cuba and in Panama, were a major breakthrough in understanding definitively its aetiology and pathogenesis. Subsequently, further advances in knowledge of yellow fever epidemiology were obtained when French scientists, working in West and Central Africa, showed that monkeys were major hosts of the yellow fever virus (the wild yellow fever virus), besides man. In addition, advances in research, contributing to the development of vaccines against the yellow fever virus in the first half of the nineteenth century, are reported in this paper.
