Volume 17, Issue 1, 2009
Review
Chagas disease: an emerging public health problem in Italy?
Guerri-Guttenberg Roberto A.,
Ciannameo Anna,
Di Girolamo Chiara,
Milei J. José
Chagas’ disease is an endemic parasitic illness in the American continent, affecting around 16 to 18 million people. Given that 9.5% of immigrants to Italy are from Latin America and that the infection can be transmitted in non-endemic countries congenitally by organ donations and blood transfusions, Chagas disease should be regarded as an emerging public health problem in Italy. Clinical guidelines as well as health protocols are needed to deal with this rarely recognized disease.
Enterococcus raffinosus endocarditis. First case and literature review
Mastroianni Antonio
Enterococcus raffinosus, a non-faecalis and non-faecium enterococcus, rarely causes infections in humans. We describe the first reported case of primary bacterial endocarditis caused by E. raffinosus, with a review of the literature.
Original article
Lenograstim in the treatment of severe neutropenia in patients treated with Peg-IFN and ribavirin: the experience of a single hepatology unit
Tarantino Luciano,
De Rosa Annunziata,
Tambaro Orsola,
Ripa Carmine,
Celiento Marta,
Schiano Antonio
Lenograstim is a G-CSF that allows therapy with Peg-IFNα to be continued in cases of haematotoxicity. This study evaluates the efficacy of lenograstim administration in a group of eight patients with chronic HCV-related hepatitis who developed neutropenia during antiviral treatment. Patients with absolute neutrophil counts < 900 cells/mmc and early viral response received lenograstim at the dosage of 263 μg 24 hours prior to administration of Peg-IFNα 2b. All patients receiving lenograstim completed the antiviral treatment (48 weeks) with standard doses of PEG-IFNα, with six of the eight patients (75%) showing a sustained virological response.
In vitro activity of voriconazole and other antifungal agents against clinical isolates of 138 Candida spp.
Ricciardi Anna Maria,
Ricciardi Rosanna,
Danzi Martina,
Mungiguerra Maria,
Pisano Luigi,
Marino Angela
Voriconazole is used for treating invasive Aspergillosis, Fusarium and Scedosporium infections as well as resistant candidiasis. It is referred to as a second generation triazole. The purpose of this study was to evaluate the concordance of the results of antifungal voriconazole susceptibility tests for yeast isolates, comparing the Sensititre YeastOne® method, ATBTM FUNGUS 3 and Etest. In all, 138 yeast isolates (42 C. tropicalis, 36 C. glabrata, 14 C. albicans, 8 C. famata, 6 C. parapsilosis, 4 C. dubliniensis, 3 C. krusei, 3 C. lusitaniae, 2 C. zeylanoides, 20 Candida spp.) were tested for susceptibility to amphotericin B, flucytosine, fluconazole, itraconazole and voriconazole with ATBTM FUNGUS 3 method. The concordance between the Sensititre YeastOne® method, ATBTM FUNGUS 3 and Etest for voriconazole was high (90%).
Measles outbreak in the city of Bologna, December 2007 to May 2008
Calza Leonardo,
Rosseti Nirmala,
Piergentili Benedetta,
Cascavilla Alessandra,
Trapani Filippo,
Pocaterra Daria,
Verucchi Gabriella,
Manfredi Roberto,
Chiodo Francesco
Several outbreaks of measles were reported after the year 2006 in various Italian regions, including Piemonte, Lombardy, Tuscany, Veneto and Emilia Romagna. Most reported cases occurred in the Piemonte region where a major outbreak began in September 2007 among a group of unvaccinated adolescents. This report is a preliminary description of the main epidemiological, clinical and laboratory features of 26 confirmed cases of measles diagnosed at the Institute of Infectious Diseases of the S. Orsola Hospital in Bologna in the northern Italian region of Emilia Romagna between December 2007 and May 2008.
Case report
P. falciparum malaria recrudescence in a cancer patient
Focà Emanuele,
Zulli Roberto,
Buelli Fabio,
De Vecchi Massimiliano,
Regazzoli Antonio,
Castelli Francesco
Persons living for long periods of time in malaria hyper-endemic areas may suffer from hyper-reactive malarial splenomegaly (HMS), a frequent cause of splenomegaly in such areas. Splenomegaly and sub-microscopic P. falciparum parasitaemia are hallmarks of HMS. Spleen has been suggested to play a protective antimalarial role and splenectomy may trigger symptomatic malaria attacks. Other causes of immune suppression may possibly reactivate latent malaria parasites. We report the case of an Italian 60-year-old male, who had spent 33 years in sub-Saharan Africa, who experienced a P. falciparum malaria attack 12 months after his return to Italy, concomitantly with a diagnosis of lung carcinoma possibly impairing his immune system.
Mirtazapine in an HIV-1 infected patient with progressive multifocal leukoencephalopathy
Lanzafame Massimiliano,
Ferrari Sergio,
Lattuada Emanuela,
Corsini Fabiana,
Deganello Roberto,
Vento Sandro,
Concia Ercole
We describe the clinical course of an HIV-infected patient with progressive multifocal leukoencephalopathy who took mirtazapine for his depression. After six months of therapy the clinical symptoms had not worsened and the neuroradiological image of the brain was unchanged. Further studies are necessary to determine the effect of serotonin receptor antagonist in treating PML associated to HIV.
Acute urinary retention due to HSV-1: a case report
Mancino Paola,
Dalessandro Margherita,
Falasca Katia,
Ucciferri Claudio,
Pizzigallo Eligio,
Vecchiet Jacopo
Complications in urinary tract nervous routes due to herpes viruses as VZV and HSV-2 are well known. Acute urinary retention and chronic neuropathic pain are not rare when sacral dermatomes are involved by these viruses. However, an analogous condition has not yet been clearly ascribed to HSV-1 infection. We present a 32-year-old immunocompetent patient with fever, lumbar pain and acute urinary retention who had never had herpetic clinical manifestations. Urodynamic studies diagnosed a neurologic bladder with an absent filling sensation. Cystoscopic assessment revealed the presence of reddened and isolated small mucosal areas in the bladder walls. The search for herpes viruses in plasma and CSF by PCR assay were positive for HSV-1. After treatment with antiviral therapy the disease resolved. Intermittent catheterization was necessary and voiding dysfunction resolved after three weeks by its appearance. Neurological damage to the central nervous system (CNS) and/or PNS due to HSV-1 seems to be the most likely reason. The course of disease was benign and self-remitting.
Cryptococcus neoformans meningoencephalitis among apparently immunocompetent patients: description of two cases
Carniato Antonella,
Scotton Pier Giorgi,
Miotti Antonio Marco,
Mengoli Carlo
Cryptococcus neoformans is a ubiquitous fungal pathogen which causes human disease ranging from asymptomatic colonization of the lungs, to severe pneumonia, mediastinitis, meningitis or generalized infection. Although cryptococcal infection shows notably opportunistic features, it is sometimes also found among apparently immunocompetent individuals, with an extremely adverse outcome in the case of SNC involvement. Therefore, when faced with a presumed healthy person with anamnestic, clinical, CSF and instrumental findings consistent with chronic meningitis/meningoencephalitis, we must also consider cryptococcosis as a possible cause of disease. This may be rapidly achieved by resorting to quite a simple serological test, namely cryptococcal antigen detection.
We describe two cases of cryptococcal meningoencephalitis occurring among apparently immunocompetent subjects (both HIV-negative, not under corticosteroid or immunosuppressive regimen, nor undergoing chemotherapy or radiotherapy. Laboratory diagnostics revealed the existence of reasonable immunological deficit for both subjects. Unfortunately, we were unable to establish whether the alterations in question were preexisting or concomitant with fungal infection. Our patients’ course was somewhat problematic, according to findings observed in broader-based studies: this could mostly be explained by the considerable diagnostic delay which often marks cryptococcal infections of immunocompetent individuals. Nevertheless, neither of these two cases were complicated by intracranial pressure increase, leading us to speculate whether this disease may occur less frequently under conditions of substantial immunological integrity.
The Infections in the History of Medicine
Contribution of palaeopathology to defining the pathocoenosis of infectious diseases (Part two)
Sabbatani Sergio,
Fiorino Sirio
In the second part of their review the authors focus on palaeopathological studies, performed in mummified tissues, with reference to infectious diseases. The analysis of samples obtained from both natural and artificial mummies may provide, in some favourable events, a more complete knowledge of these findings in comparison to information obtained from only comprehensive examination of the skeleton. The acquired data enable us to understand not only the diseases which afflicted mankind, but also dietary and hygiene conditions of ancient populations. We report knowledge acquired regarding some palaeopathological conditions, including schistosomiasis, smallpox, cisticercosis, trichinosis, ascaridiasis, echinococcosis, filariasis, hepatitis E virus, condylomatosis, pulmonary tubercolosis, pediculosis, visceral leishmaniasis as well as Diphyllobotrium sp., Dicrocoelium dendriticum and Fasciola hepatica infestations. In addition some interesting findings concerning the relationship between dietary and food intake colonized by streptomyces are described.
This review reports the discovery of human remains from different geographic areas: while most of these studies describe findings in two Mediterranean countries (Italy and Egypt), some refer to Britain and German-speaking countries (Austria and Germany) as well as the area in Africa known as Nubia, along the Nile. Both histological and biomolecular diagnosis are useful not only to identify a specific disease in a subject from the remote past, but also to achieve information concerning its frequency and evolution. Such knowledge may thus allow us to understand the intensity of cultural exchanges and links among different populations and the role of these relationships in transmitting and spreading infectious diseases in a certain geographic area.
