Volume 15, Issue 3, 2007
Review
Therapeutic options in chronic HBV infection
Felaco Francesca Maria,
Leone Sebastiano,
Stanzione Maria
A durable suppression of viral replication in chronic HBV infection decreases the risk of liver disease progression. Treatment is recommended for patients in the immune-active phases of chronic HBV infection (HBeAg positive or HBeAg negative patients with serum HBV-DNA and elevated ALT). Licensed HBV therapies include interferon (sIFN, pegylated-IFN alfa-2a) and nucleoside/nucleotide analogues (lamivudine, adefovir, entecavir) allowing for two different treatment strategies: a finite treatment course of IFN that provides sustained off-treatment response in about one third of patients, or an indefinite treatment with nucleoside/nucleotide analogues that provides a therapy maintained response. IFN has the advantage of a defined treatment duration and of lacking resistance selection; disadvantages are the subcutaneous route of administration and poor tolerability. Nucleoside/nucleotide analogues are orally administered and well tolerated; their drawback is the risk of developing antiviral resistance which increases with duration of treatment. A finite course of IFN should be tried as first-line therapy; a long-term treatment with nucleoside/nucleotide analogues should be used for patients not responding or intolerant to interferon.
Use of fluoroquinolones in Intensive Care Units in a multi-drug-resistance era
Esposito Silvano,
Fiore Marco
Despite the high level of antibiotic resistance in ICUs, fluoroquinolones remain the most frequent utilized antibiotic in these settings.
Since the discovery of this class of antibiotics several mechanisms have been identified as responsible for resistance to fluoroquinolones and more recently a new one have been studied which is responsible for transferable resistance, which acts by means of an enzymatic inactivaction affecting only some members of the fluoroquinolones class.
In fact, the cr variant of the gene aac(6)-Ib translates an aminoglycosides acetiltrasferases which confers a reduced susceptibility to those fluoroquinolones carrying this substrate, as ciprofloxacin and norfloxacin, but not to others such as levofloxacin. It is therefore interesting to speculate that the use of levofloxacin could avoid the development of resistance in those bacteria presenting this enzyme but not in those carrying a Qnr gene.
The application of these new aspects of molecular biology in the clinical practice together with the knowledge of the risk factors could in the future contribute to reduce the development of antibiotic resistance.
The ID consultation, the use of practical and reliable guidelines, the use of antibiotic association based on local epidemiology would represent further strategies to minimize the antibiotic resistance development optimizing the therapeutic choice
Original article
Activity of ulifloxacin against clinical hospital isolates
Gemignani Giulia,
Tascini Carlo,
Leonildi Alessandro,
Piaggesi Alberto,
Menichetti Francesco
We evaluated the activity of ulifloxacin in comparison with ciprofloxacin, levofloxacin and moxifloxacin against clinical isolates from a large teaching hospital in Italy. The isolates derived from patients admitted to surgical and medical wards and intensive care units. Multi-drug resistant S. aureus, P. aeruginosa, enterococci and Enterobacteriaceae spp. strains were included in the study. Ulifloxacin was slightly more active than ciprofloxacin and levofloxacin against gram negative isolates. Against gram positive strains ulifloxacin was as active as moxifloxacin.
Pandemic influenza: impact on Health Care Facilities in Lazio, Italy, and the role of hospitals in pandemic management
Fusco Francesco Maria,
Pittalis Silvia,
Puro Vincenzo,
Lauria Francesco Nicola,
Ippolito Giuseppe
Highly Pathogenic Avian Influenza Virus H5N1 has so far caused more than 250 human cases. This virus is not transmitted efficaciously from person to person, but the capacity of human-to-human transmission could be acquired in the future. Consequently, the epidemiological and virological evolution of H5N1 is strictly monitored, insofar as the virus is a potential agent of an influenza pandemic. During such a pandemic, health care facilities would have to cope with many cases of severe respiratory illnesses, often requiring intensive care and mechanical pulmonary ventilation. In this article, the impact of the pandemic on health care facilities in Lazio, Italy, is evaluated using a statistical model, Flu-Surge. Moreover, some aspects of hospital preparedness for a pandemic, in particular in emergency departments, are discussed.
Preliminary survey of human intestinal parasitosis in a Peruvian Andean zone
Crotti Daniele,
D'Annibale Maria Letizia,
Basileo Michela,
La Torre Gaudencio
We studied 91 faecal specimens of 38 children and 53 adults in a five-day epidemiological survey between the end of February and the beginning of March, 2006. The subjects were in- or out-patients of Chacas Hospital, Ancash. The O&P were performed with macroscopic evaluation, microscopic (direct and after formalin-ether concentration, FEA) observations and Giemsa permanent stain of all faecal samples. 61 subjects (67.0%) were infected with parasites (25 children, 65.5%, and 36 adults, 67.9%). D. fragilis was prevalent in 30.8% of subjects (28.9% of children, 32.1% of adults); G. duodenalis was observed in 12.1% of cases (21.1% of children and 5.7% of adults); A. lumbricoides was observed in 15.4% of cases (18.4% and 19.9% respectively); other helminths were identified in 7.7% of cases (10.1% and 5.7% respectively); non-pathogenic protozoa alone were observed in 23.1% of cases (28.9% among children and 19.9% among adults). D. fragilis was more frequent among females (44.7% vs. 20.8%), while G. duodenalis and A. lumbricoides among males (13.2% vs. 10.5% and 17.0% vs. 13.2% respectively). We emphasize the usefulness of both FEA and Giemsa permanent stain for a good O&P.
Case report
Clinical case of seroconversion for syphilis following a needlestick injury: why not take a prophylaxis?
Franco Alfredo,
Aprea Lucia,
Dell’Isola Chiara,
Saverio Francesco,
Felaco Francesca Maria,
Manzillo Elio,
Martucci Fiorella,
Pizzella Teresa,
Sansone Matilde,
Simioli Francesco,
Simioli Stefania,
Izzo Crescenzo Maria
E’ descritto un caso di sieroconversione per lue successiva ad una puntura accidentale con ago infetto. Nel caso clinico illustrato, una donna di 47 anni si punge accidentalmente con un ago precedentemente usato da un soggetto affetto da neurolue. Al tempo 0 il soggetto esposto aveva sierologia negativa per lue, mentre il soggetto fonte risultava TPHA positivo. Non viene prescritta (in quanto non prevista) profilassi post-esposizione per la sifilide. La paziente non si presenta al follow-up in 30^ giornata, ma torna alla nostra osservazione dopo 3 mesi. Non si evidenzia alcun segno clinico di malattia sifilitica, ma è presente sieroconversione per lue in atto (VDRL = positiva 1/2, TPHA positiva 1/320, FTA-Abs IgG ed IgM presenti), per la quale si prescrive terapia antibiotica specifica. Allo stato attuale, la paziente presenta VDRL positiva 1/2, TPHA positiva 1/160, FTA-Abs IgM negativa.
Two cases of actinomycosis
Romano Amelia,
Scarlata Francesco,
Giordano Salvatore,
Infurnari Laura,
Li Vecchi Valentina,
Librizzi Damiano,
D’Angelo Mario,
Lipani Giuseppe,
Marasà Lorenzo
Actinomycosis is a bacterial infection due to Gram-positive bacteria of the Actinomyces genus. The authors describe two cases: one of them occurred in a woman with a clinical presentation of a right submandibular indurative mass. After surgery, histological examination showed a granulomatous tissue with many actinomycetes. The second case was observed in a man admitted to hospital with a diagnosis of pulmonary heteroplastic lesion. Also in this case, histological examination showed many actinomycotic colonies. Actinomycosis is an uncommon disease. Establishment of definite diagnosis requires a high index of suspicion in all cases of relapsing cervical lesions. Pulmonary actinomycosis is a rare diagnosis; respiratory physicians should be aware of this important differential when investigating patients for persistent pulmonary shadowing.
EBV reactivation in a patient undergoing chemotherapy for invasive thymoma
Giordano Salvatore,
Pampinella Diego,
Alù Massimiliano,
Agostara Biagio,
Romano Amelia
Over the last few years evidence has emerged to indicate the involvement of herpes viruses in several infectious complications observed in patients undergoing antiblastic chemotherapy. We present a case of bilateral parotiditis due to EBV reactivation in a patient who had received chemotherapy because of an invasive thymoma.
In October 2006, a 53-year-old man with pulmonary and pleural metastases owing to an invasive thymoma, was started on chemotherapy with cisplatin, adriamycin and cyclophosphamide. In January 2007, after consultation with an infectious disease specialist, the patient was admitted to the oncology department because of bilateral swelling of the parotid glands which was most likely of infectious or mycotic origin and attributed to immunosuppression by chemotherapy (the last cycle was completed on 28th December 2006). During his hospital stay, the patient underwent routine blood tests, serological tests (EBV-VCA IgM/IgG: positive/positive, EBV-EBNA IgG: positive), cultural and instrumental tests. Due to the serological results, we decided to search for EBV in blood by using PCR (23,000 copies/100,000 cells). We hypothesize that EBV infection could have caused both thymoma and bilateral parotiditis. Accordingly, a multidisciplinary approach, including consultation with an oncologist, infectious disease and microbiology specialists, is the best way to manage infectious complications in patients with a deficit of cells-mediated immunity.
The Infections in the History of Medicine
Lazzaro Spallanzani and his refutation of the Theory of Spontaneous Generation
Mancini Renata,
Nigro Maria,
Ippolito Giuseppe
The development and refinement of microscopy in the 17th century revealed to science a whole new world of microorganisms, until then unknown, that appeared to arise spontaneously, and fuelled a controversy that had seemed definitively resolved by Francesco Redi’s experiments, the question of the spontaneous generation and origin of life.
At the half of the 18th century a young Italian abbot, Lazzaro Spallanzani, Professor of Physics and Mathematics at the University of Reggio Emilia, started repeating the experiments of John Turberville Needham. The English Catholic priest claimed to have demonstrated the validity of the theory of spontaneous generation after observing the growth of small organisms in some chicken broth placed in sealed flasks and heated for 30 minutes. Spallanzani found significant errors in the experiments conducted by Needham and, after trying several variations on them, disproved the theory of spontaneous generation.
