Volume 19, Issue 3, 2011
Review
HBV and pregnancy
Nardiello Salvatore,
Orsini Annarita,
Gentile Ivan,
Gaeta Giovanni Battista
The clinical course of HBV infection in pregnant women does not usually differ from the course in non-pregnant women. Hepatitis flare rarely occurs during pregnancy, but it is frequent after delivery. HBV carrier status is associated with a higher incidence of gestational diabetes mellitus, pre-term labour and miscarriage. In the case of HBV-infected women wishing to become pregnant, the therapy could be delayed after delivery if the liver disease is mild, while if the woman has a moderate/severe liver disease, or becomes pregnant while on treatment, the potential risks of the antivirals have to be compared with the risks of hepatitis flares with progression to hepatic decompensation without treatment. The availability of highly effective passive-active immunoprophylaxis of the neonate using hepatitis B immune globulin and hepatitis B vaccine has considerably reduced the incidence of the vertical transmission of HBV infection, but a residual risk exists in cases of high maternal HBV-DNA levels: in such cases, the administration of anti-viral therapy during the third trimester of pregnancy may further reduce the risk of neonatal infection.
Loa loa filariasis in Italy: review of the literature with a clinical report
Sgrelli Alessio,
De Socio Giuseppe Vittorio Luigi,
Papili Rita,
D Annibale Maria Letizia,
Baldelli Franco
We present the case of an asymptomatic Loa loa disease in a 28-year-old Nigerian man living in Italy for 5 years. The man was admitted to our clinic for an occasional identification of hypereosinophilia (white blood cell count 5440/mmc, eosinophil 42%) and the presence of microfilaria at an hemoscopic evaluation. The diagnosis was made by testing the diurnal peripheral blood that showed a parasitaemia of 7000 microfilia/mL. The patient was treated with ivermectin 12 mg on the first day followed by albendazole 400 mg every 12 hours for 21 days with a reduction but no negativization of the parasitaemia and no collateral effect. Filariasis should be considered in all patients who come from or have stayed in endemic areas or who present alterations in the leukocyte formula, including hypereosinophilia, or some unexplainable allergic disorders. The lab diagnosis can be conducted through a hemoscopic test or directly with the identification of the adult worm, whereas the parasitaemia can be evaluated only through a hemoscopic test. The therapy can be non-conclusive or carried out with difficulty as finding diethylcarbamazine may be a hard task or potentially fatal anaphylactic reactions may occur.
Original article
Which screening for Leishmania infantum in asymptomatic blood donors?
Tordini Giacinta,
Puttini Camilla,
Rossetti Barbara,
Sammarro Gabriella,
Fanetti Alessandra,
Cianchino Sergio,
Valoriani Beatrice,
Fossombroni Vittorio,
Campoccia Giuseppe,
Cavion Maria Antonietta,
Zanelli Giacomo
Leishmaniasis is a protozoan infection endemic in Italy with a greatly underestimated prevalence. The recent documentation of parasitaemia in blood donors is a cause of concern for blood safety. Because there is no screening against leishmania, we performed a study to assess the presence of protozoa in blood donors of Siena district (Tuscany) during the seasonal activity of the vector. From June to October 2007, 162 patients were screened for Leishmania infantum by indirect immunofluorescence serology (IFAT) and PCR for kinetoplast (kDNA). No subject was positive for antibodies, while 11 samples (6.8%) were positive for kDNA. A second PCR (nested-PCR) was negative for all kDNA positive individuals and other subjects for a total of 55 samples (33% of total subjects). The sequence analysis of three samples positive for kDNA was compatible with mitochondrial DNA. Through the techniques used, we were unable to confirm the presence of leishmania in the blood of the subjects studied. The choice of the diagnostic protocol in blood donors remains an open issue as molecular analysis (kDNA) seems to suggest, in our experience, limits of specificity.
Aetiology of intestinal parasites in a sample of students from Mozambique
Guidetti Carlotta,
Ricci Lidia,
Vecchia Luigi
The purpose of this survey is to assess the prevalence of intestinal parasites in a population of Mozambican students. Ninety five faecal samples were collected at the three schools in Marrere, Mozambique, for a period of about one week. Observations of fresh and Giemsa-stained samples were performed at the laboratory of the Geral de Marrere Hospital; observation after concentration (FEA) was performed later at the Microbiology Laboratory of the S. Maria Nuova Hospital (Reggio Emilia, Italy). The results show a high rate of intestinal parasites among the subjects examined, supported mainly by helminths (Strongyloides stercoralis and Ancylostoma/Necator americanus), and protozoa (Dientamoeba fragilis and Giardia intestinalis). Analysis of data shows that the search for pathogenic parasites with the formalin-ethyl acetate (FEA) stool concentration technique shows higher sensitivity than the observation of fresh samples (60% vs 30%) and in some cases allows the presence of a second or third parasite to be detected. The high rate of parasitosis in endemic areas underlines the importance of lending greater attention to immigrant patients in Italy, due also to the fact that parasitosis is often found in asymptomatic forms.
Socio-economic modelling of rotavirus vaccination in Castilla y León, Spain
Pérez-Rubio Alberto,
Luquero Francisco Javier,
Eiros Bouza Jose María,
Castrodeza Sanz Jose Javier,
Bachiller Luque Maria del Rosario ,
Ortiz de Lejarazu Raúl,
Sánchez Porto Antonio
Rotavirus is one of the main causes of acute gastroenteritis in infants and young children. Furthermore, rotavirus is the leading cause of hospitalization and death from acute gastroenteritis among infants and young children worldwide. Although death due to rotavirus is rare in industrialized regions such as Spain, the rotavirus disease burden and its economic impact is severe. This study aims to assess systematic vaccination against rotavirus economically and socially in a Spanish region.
Economic cost-effectiveness and cost-benefit assessment through a choice tree was designed. We estimated health provider costs, economic costs and quality-adjusted life years (QALYs) lost due to rotavirus infections. The study includes a fictitious cohort of 100,000 children from Castilla y León who were also administered the rotavirus vaccine together with diphtheria and tetanus toxoids and pertussis (DTP) . The study adopted a society and health care system perspective. A sensitivity analysis was developed to assess the uncertainty of some variables. According to the estimated incidence rate for children in Castilla y León, rotavirus immunization is projected to prevent 45% of cases with RotaTeq® and 57% with Rotarix®. The respective cost per QALY is about €75,000 and 50,000 from the perspective of the health care system. Routine infant vaccination in Castilla y León using either rotavirus vaccine is not profitable from the payer’s perspective and is not cost-effective under basic case assumptions unless the vaccine is available at a lower cost.
HPV-related diseases and screening program in male partners
Scaglione Giuseppe,
Li Destri Natalia,
Scibetta Nunzia,
Alio Walter,
Prestileo Tullio
HPV is a sexually transmitted virus. The main risk factor for infection of the female population is the heterosexual transmission with partners who are infected with human papilloma virus (HPV). HPV infection is very common in sexually active males, and it is the most common STDs. In our experience the prevalence of infection is just under 50%. There are careful and well-established procedures that are applied to women with HPV; on the contrary, with regard to male population, there is, often, less focus and less sensitivity during both diagnostic and therapeutic strategies.
The objectives of this study respond to two specific questions:
1. Is it useful to control male partner?
2. What tests are advisable and necessary for a proper definition of the problem?
In this study 160 male patients, partners of patients with HPV infection, were examined by peniscopia, the search for HPV-DNA and biopsy of the penis.
The study results show that the percentage of HPV infection of the male partners of women with HPV infection is quite high, ranging from 47 to 49% in relation to the methods used. The prevalence of patients with "high-risk" virus which stands at over 60%. Moreover, from 17.5% to 40.5%, we observed an infection with multiple genotypes of which is known as a hazard factor of aggravation and persistence of HPV infection.
In conclusion, HPV-related diseases is a clinical infection of the couple and it is obvious that to the couple should be given great attention. For an important and effective prevention of transmission of HPV from the male "subject to viruses" to woman, and for the prevention "ping - pong" effect, it is essential to submit all the male partners of women infected with HPV peniscopia, HPV tests, and possibly a biopsy of the penis.
Case report
Pneumocystis jiroveci pneumonia (PCP) misdiagnosed as pandemic influenza H1N1 in a renal transplant patient
Metan Gokhan,
Bozkurt Ilkay,
Koc Ayşe Nedret
Respiratory infections are of particular concern in transplant patients. However, there is a significant overlap in the symptoms caused by different pathogens. Here, we report a case of Pneumocystis jiroveci pneumonia (PCP) in a renal transplant patient which was initially misdiagnosed as pandemic influenza H1N1. The patient did not improve under oseltamivir treatment and bronchoscopy was performed five days later after hospitalization. PCP was diagnosed by microscoping evaluation of bronchoalveolar lavage (BAL) fluid. Besides, BAL and serum of the patient yielded a large amount of 1,3-beta-D-glucan, a cellwall compotent of medically important mycoses including P. jiroveci. The patient was successfully treated with intravenous trimethoprim-sulfamethoxazole. Due to the lack of sensitivity of influenza case definitions, the attending physicians should be careful about alternative diagnoses particularly in transplant patients with severe respiratory infections.
Unsuspected giant hydatid cyst of the liver in an 87-year-old woman
dos Santos Vitorino Modesto,
Andrade de Almeida Ana Carla ,
de Carlalho Santos Suelma,
Machado Lima Regina Lucas,
Abel Fastudo Custodio
Hydatid cystic disease from Echinococcus granulosus is described in some Brazilian as well as Italian areas. Liver hydatidosis is the most common presentation, which may evolve without symptoms. The authors describe an 87-year-old woman with an unsuspected giant hydatid cyst of the liver and emphasize the diagnostic challenges, mainly involving patients from non-endemic regions.
Streptococcus gordonii extensive multiple subcutanoeus abscesses
Esposito Silvano,
Avallone Lucio,
Massari Angelo,
Lo Pardo Dante,
Pezzuti Gabriela,
Smaldone Pasquale,
Anzalone Silvana,
Ardimento Pasquale
We describe extensive multiple subcutaneous abscesses involving the peri-scapular region, the right posterior and lateral peri-trochanteric area and ipsilateral thigh occurring in a 66-years-old woman. Streptococcus gorgonii was identified as the unique pathogen. Despite this microorganism is generally considered not pathogenic, it has been previously described as responsible for two cases of peritonitis and one case of endocarditis.
The patient has been treated with immediate surgical incision and drainage and was cured after two months of antibiotic therapy, medications and hyperbaric oxygen therapy.
The Infections in the History of Medicine
Epidemic waves of the Black Death in the Byzantine Empire (1347-1453 AD)
Tsiamis Costas,
Poulakou-Rebelakou Effie,
Tsakris Athanassios,
Petridou Eleni
The lack of valid demographic data and the literary ambiguities of the Byzantine chroniclers raise questions about the actual size and mortality rate of the Black Death in the Byzantine Empire. This study presents for the first time a quantitative overview of the Black Death in Byzantium for the period 1347-1453. Our data were obtained from descriptions of the plague, by prominent Byzantine historians and scholars, grouped by time of appearance and geographical spread. During the period 1347-1453, a total of 61 plague reports were noted, which can be distinguished in nine major epidemic waves, 11 local outbreaks and 16 disease-free periods. The capital Constantinople and the Venetian colonies of the Ionian and Aegean Sea were the areas most affected by the plague. The epidemic waves of the Black Death in Byzantium had a total average duration of 3.2 years. Scientific ignorance of the nature of the disease, a turbulent period of warfare and an organized maritime network seem to have contributed to the spread of the disease. Employing quantitative analysis, our multidisciplinary study sheds light from various standpoints on the evolution and dynamic of the plague in the South-eastern Mediterranean during the 14th and 15th centuries, despite the lack of sound morbidity and mortality data.
