Volume 18, Issue 4, 2010
Review
Malaria: an update
Scotto Gaetano
More than 100 years have passed since the discovery of its aetiological agent, but malaria is still the first cause of morbidity and mortality in the world. After the initial illusory successes of the fight against the infection, malarial infection is currently in a phase of expansion due to the sum of several contributory factors: the rise of anophelism related to the failure of eradication campaigns in endemic areas, due to environmental, structural and economic causes; the spread of stocks of chloroquine-resistant Plasmodium falciparum in such areas; the increase in travel for work and tourism, and the flows of populations due to wars, political issues, or just survival. In this paper we inspected all the aspects of the infection, from historical aspects - in which there was sometimes a mingling of history and legend – to those more properly defined as scientific. We seek to point out less well-known details, both about the vector and the clinical-epidemiological aspects concerning the populations in endemic areas, semi-immune subjects and foreigners. We also underline the importance both of prophylaxis and treatment of infection in travellers in high-risk areas, in the light of pharmacological resistance developed by the parasite and of the new usable molecules.
Original article
Hospital consumption of antibiotics at the Policlinico Hospital of the Second University of Naples: results of retrospective data collection
Rafaniello Concetta,
Ianniello Benedetta,
Sullo Nikol,
De Rosa Stefania,
Sportiello Liberata,
Rossi Francesco,
D’Agostino Bruno,
Capuano Annalisa
In the therapeutic field, analysis of antibiotics consumption and use is of great importance: it is considered a necessary prerequisite for initiating measures to rationalize the use of antibiotics, but also to limit bacterial resistance. In this light, we conducted an observational study on antibiotics consumption at the Policlinico University Hospital in Naples to evaluate the prescription of antibiotics in the hospital’s four main divisions. We used the Defined Daily Dose (DDD) as a measure of antibiotics consumption, and collected data retrospectively from 2006 to 2007. Our findings clearly show a 23.3% increase in antibiotics consumption in 2007 vs 2006. The classes of antibiotics experiencing the greatest percentage increases were penicillins and other β-lactams, quinolones and glycopeptides. In particular, among other β-lactams (J01D) in 2007 was the consumption of third-generation cephalosporins and carbapenems. The surgical division showed the largest increase in use of antibiotics, while in intensive care we found a reduction. Our data suggest consumption data should be compared with information on prescriptions and costs so as to monitor more closely the consumption of antibiotics and thus rationalize their use with a view to reducing the phenomenon of bacterial resistance. Finally, it would be useful to launch a training program for the proper use of antibiotics in our University Hospital.
In vitro synergism of ulifloxacin plus piperacillin/tazobactam against clinical isolates of Enterobacteriaceae producing extended-spectrum or AmpC-Type -lactamases
Tascini Carlo,
Mantengoli Elisabetta,
Gemignani Giulia,
Leonildi Alessandro,
Di Maggio Tiziana,
Fondelli Serena,
Rossolini Gian Maria,
Tagliaferri Enrico,
Menichetti Francesco
Extended spectrum beta-lactamase (ESBL) and ampicillinase C (AmpC) producing Enterobacteriaceae are nowadays frequently isolated in clinical practice. Carbapenems are generally the drugs of choice in such a case and resistance to these molecules is on the rise. Rationalizing their use is to be considered essential, possibly identifying alternative regimens. We thus examined 10 strains of Enterobacteriaceae isolated from patients previously unsuccessfully treated with a beta-lactam or a quinolone; eight strains were either ESBL or AmpC producers. Ulifloxacin showed minimum inhibitory concentrations (MICs) lower than ciprofloxacin and levofloxacin. Tested with the checkerboard method, the association of ulifloxacin and piperacillin/tazobactam proved fully synergistic on five strains and partially synergistic on three. The above association was fully synergistic towards three strains resistant to piperacillin/tazobactam and one strain resistant to ulifloxacin, with MICs in association easily obtainable at standard doses. Our in vitro study demonstrates a synergistic activity of ulifloxacin and piperacillin/tazobactam in association towards ESBL and AmpC-producing Enterobacteriaceae. Clinical studies are needed to confirm in vivo the effectiveness of this regimen.
Cost analysis of ventilator-associated pneumonia in Turkish medical-surgical intensive care units
Karaoglan Hicran,
Nevzat Ata,
Cengiz Melike,
Ramazanoglu Atilla,
Ogunc Dilara,
Hakan Riza,
Yilmaz Murat,
Mamikoglu Latife
A study was carried out to assess treatment success and the overall costs of patients with ventilator-associated pneumonia (VAP). In a prospective case control study, data were collected from 25 intensive care unit (ICU) beds. A total of 162 ICU patients who required mechanical ventilation were assessed. Of these, 81 patients were diagnosed with VAP and the other 81 were controls (without VAP). Risk of mortality was analyzed and total cost of care was recorded. Age, sex and underlying disease were similar between the groups. The mean length of stay (LOS) in the ICUs in the VAP cases (15.7±9.1 days) exceeded that of the controls (4.9±4.9 days) (p<0.0001), and the additional LOS attributable to VAP was estimated at 10.8 days. In the VAP group, 25 patients had early-onset VAP, and the other 56 patients had late-onset VAP. Mortality rates were higher in VAP patients (32%) than controls (19.7%) p<0.05). Total costs were USD 8602.7±5045.5 in the VAP group and USD 2621.9±2053.3 in controls. The additional cost for VAP was found to be USD 5980 per patient. These data suggest that morbidity, mortality, ICU length of stay and costs increase with VAP. The additional costs for VAP are especially based on the use of novel and expensive antibiotics, other drugs, and medical material.
Case report
Ileocaecal intussusception associated with adenovirus infection: a case report
Pampinella Diego,
Scarlata Francesco,
Nasta Roberto,
Iacono Maurizio,
Concetta Maria,
Di Gangi Maria,
Giordano Salvatore,
Dones Piera
Intestinal intussusception is the invagination of an intestinal segment into another. Childhood intussusception is usually idiopathic, whereas adult intussusception is usually due to a definable intraluminal lesion or to a systemic disease. Although the aetiology of idiopathic forms often remains unclear, there is appreciable evidence to support an indirect role played by certain infectious agents. In this report we present a case of childhood intussusception probably due to adenovirus infection.
Respiratory and uro-genital infection with bacillus of Calmette-Guérin following administration as a local adjuvant therapy of bladder carcinoma
Dentale Nicola,
Manfredi Roberto
An exemplary case report of dual-site, respiratory and genito-urinary granulomatous infection caused by bacillus of Calmette-Guérin (BCG) in a patient with prior pulmonary tuberculosis and with chronic obstructive pulmonary disease (COPD), treated for several weeks with local, intravesical adjuvant BCG therapy for a relapsing transitional bladder carcinoma, is presented and discussed in the context of the cumbersome diagnostic and differential diagnostic process, as well as recent findings in the literature. Only four cases of respiratory BCG-itis (tuberculosis-like forms) have been reported until now to the best of our knowledge (two of them following bladder instillation of BCG), but our case is the only one which showed a dual, concurrent granulomatous localization of BCG-itis, also involving the genito-urinary tract.
Retinopathy in chronic hepatitis C patients during interferon treatment: a case report
Rossi Cristina,
Scotton Pier Giorgio,
Farina Francesca,
Vaglia Alberto
Ocular involvement, mainly as optic neuropathy or retinopathy, in the course of interferon therapy is clinically rare, while the subclinical retinal toxicity is quite frequent. We present a case of retinal toxicity during treatment with PEG-INF alpha 2b and ribavirin for HCV hepatitis. We suggest that all patients receive an ophthalmological examination at base-line and repeated ophthalmological examination only if clinically advisable.
Pulmonary embolism and acute cytomegalovirus infection in an immunocompetent patient
Citton Rita,
Soscia Fabrizio,
Notarianni Ermanno,
Tieghi Tiziana,
Mastroianni Claudio Maria,
Del Borgo Cosmo,
Gianfreda Romina,
Belvisi Valeria
A case of an immunocompetent man with acute CMV infection associated with a pulmonary embolism is described. Acute CMV infection could be a risk factor for developing thromboembolism. Pulmonary embolism should be included in differential diagnosis in patients with acute CMV infections and pulmonary opacities.
The Infections in the History of Medicine
Garibaldi's wounds
Sabbatani Sergio
On the 150th anniversary of the Unification of Italy in 1860, this paper relates the events linked to Giuseppe Garibaldi’s wounding by fire-arms as well as the difficulties encountered while the famous patient was being treated. The class of physicians, widely represented among the ranks of Garibaldi’s volunteers, enthusiastically joined the Italian Risorgimento. Its contribution was essential to the immediate treatment of the wounded on battlefields. Garibaldi himself, during his military career, was struck by fire-arms on at least three occasions. In particular, this issue covers the diagnostic and therapeutic problems to be tackled following his wounding by a Bersagliere on Aspromonte in 1862 as well as in the course of fighting against Austrian soldiers on Mount Suello (1866) during the Third War of Independence.
Letters to the editor
Prolonged novel Influenza A (H1N1) in neutropenic patients receiving chemotherapy
Bargiacchi Olivia,
Salerno Anna Maria,
Rosa Felicita,
Rizzo Giovanni,
Brustia Diego,
Garavelli Pietro Luigi
Abstract not available
