Volume 19, Issue 4, 2011
Review
Management of cardiac implantable electronic device infections: recommendations from a study panel
Durante-Mangoni Emanuele,
Carbonara Sergio,
Iacobello Carmelo,
Tripodi Marie-Françoise,
Carretta Anna,
Caprioli Vincenzo,
Pellegrino Pierluigi,
Di Biase Matteo,
Favale Stefano,
Santantonio Teresa Antonia,
Esposito Silvano,
Nappi Gianantonio,
Angarano Gioacchino,
Utili Riccardo,
Cardiac Implantable Electronic Device (CIED) infections are an emerging clinical issue. There are no national recommendations on the management of these infections, also due to the limited number of dedicated and high quality clinical studies. Therefore, researchers from southern Italian centres have decided to share the clinical experience gathered so far in this field and report practical recommendations for the diagnosis and treatment of adult patients with CIED infection or endocarditis. Here we review the risk factors, diagnostic issues (microbiological and echocardiographic) and aetiology, and describe extensively the best therapeutic approach. We also address the management of complications, follow-up after discharge and the prevention of CIED infections. In this regard, a multidisciplinary approach is fundamental to appropriately manage the initial diagnostic process and the comorbidities, to plan proper antimicrobial treatment and complete percutaneous hardware removal, with the key support of microbiology and echocardiography.
NDM-1: the superbug?
Pittalis Silvia,
Ferraro Federica,
Puro Vincenzo
A novel type of carbapenemase, New Delhi metallo β-lactamase-1 (NDM-1), was first identified in 2008 in two Enterobacteriacea isolates, both recovered from a Swedish patient transferred from India. The emergence of NDM-1 is now reported from all continents, often in patients with a history of travel or hospitalization in the Indian subcontinent. The NDM-1 producing Gram-negative bacteria are mainly Enterobacteriaceae, which can cause colonization or fatal infections, with worrying antimicrobial susceptibility profiles: some isolates have developed resistance to practically all available antibiotics. Is the NDM-1 the super-bug? Are we in the post-antibiotic era? This review is a summary of currently available knowledge of NDM-1 that draws attention to future antimicrobial resistance scenarios.
Original article
Utility of brain natriuretic peptide as prognostic marker in community-acquired pneumonia and chronic obstructive pulmonary disease exacerbation patients presenting to the emergency department
Leli Christian
Brain natriuretic peptide (BNP) is a strong prognostic predictor in congestive heart failure patients. Community-acquired pneumonia (CAP) is frequently associated with systemic inflammatory response syndrome (SIRS), evolving into septic shock, with high mortality. The aim of this study was to compare BNP mean values in CAP, chronic obstructive pulmonary disease (COPD) exacerbation, and acute bronchitis patients, and to evaluate the correlation of BNP values with length of hospital stay. In all, we analysed 56 patients (28 males and 28 females) admitted to our Emergency Department from May 2010 to April 2011 because of dyspnea. The CAP patients had significantly higher mean BNP values in comparison to acute bronchitis patients (127.2±80.6 Vs 45.9±38.3 pg/mL; p=0.003), and a significantly positive correlation was found between their BNP values and length of hospital stay (r=0.404; p=0.05). A stepwise multivariate linear regression analysis model showed white blood cell count as the only independent predictor of length of hospital stay (β=0.67, p=0.05). The results suggest that CAP patients with SIRS have increased mean BNP levels compared to acute bronchitis patients, but this parameter failed to predict the length of hospital stay.
Risk factors for toxoplasmosis in pregnant women in central Italy
Thaller Raffaella,
Tammaro Federica,
Pentimalli Henny
Between 2005 and 2007 we examined 2356 pregnant women. We interviewed the patients concerning their dietary behaviour and lifestyles during pregnancy in correlation with the possibility of contracting toxoplasmosis. Our purpose was to ascertain the importance of different risk factors in a group of Italian patients and assess the level of knowledge on this matter. The survey questions were related to: 1) eating rare/raw meat; 2) eating commercial or homemade ham or other pork derivatives such as dry sausage and salami; 3) owning a garden or a plot for fruit and vegetables; 4) owning pets, especially cats; 5) living in town or in the country; 6) eating fresh uncooked vegetables.
On the basis of serological tests (Toxo IgG, IgM, IgA, avidity test) we identified three groups of women: those with primary infection, seronegative women (control), and those with inactive infections. Comparison of the first two groups showed that each risk factor significantly increases the likelihood of acquiring toxoplasmosis. Higher odds ratios were observed for those living in the country and for those consuming homemade cured meat.
Mediterranean Spotted Fever in paediatric and adult patients: two clinical aspects of the same disease
Colomba Claudia,
Saporito Laura,
Siracusa Lucia,
Giammanco Giovanni,
Bonura Silvia,
Titone Lucina
Mediterranean Spotted Fever is an acute febrile disease caused by Rickettsia conorii and transmitted to humans by the brown dog tick Rhipicephalus sanguineus. Nearly 400 cases are reported every year in Sicily, mainly from June to September. The aim of this study is to compare the clinical and laboratory features of two different groups of patients , one of adults and one of children. The analysis included all adult patients with MSF diagnosed at the Institute of Infectious Diseases, “Paolo Giaccone” University Polyclinic in Palermo, during the period January 2007- August 2010 and all the children diagnosed with MSF at the “G. Di Cristina” Children’s Hospital in Palermo during the period January 1997- December 2004. On admission, a complete physical and laboratory examination was carried out on every patient. An indirect immunofluorescence assay for Rickettsia conorii was performed in every case, a PCR assay was performed with blood samples from some adult patients.
Analysis of the results confirms that MSF is a benign, and self-limiting disease in children, while severe complications can often arise in adults.
Case report
Renal abscess in childhood: a case report
Pampinella Diego,
Giordano Salvatore,
Failla Maria Concetta,
Di Gangi Maria,
Matina Federico,
Nasta Roberto,
Dones Piera
We describe the case of a previously healthy six-year-old boy with a right renal abscess due to a methicillin-resistant Staphylococcus aureus, which necessitated a radical nephrectomy. Although renal ultrasonography is often the initial tool to identify fluid collection, in our case the diagnosis was obtained only after performing an abdominal CT with intravenous contrast. It is therefore necessary to combine these different imaging techniques in all children with fever and abdominal/lumbar pain without any apparent cause in order to obtain an early diagnosis and minimise organ damage.
Chronic osteomyelitis due to Pseudomonas aeruginosa: treatment with elastomeric infusor in an outpatient setting
Carrega Giuliana,
Bartolacci Valentina,
Burastero Giorgio,
Casalino-Finocchio Giorgetta,
Izzo Manuela,
Ronca Agostina,
Santoriello Luisa,
Tigano Stefania,
Riccio Giovanni
Chronic bacterial osteomyelitis requires long-term antibiotic treatment (at least 6-8 weeks). After in-hospital management, patients are usually discharged and treated in outpatient settings. However, when the aetiology is represented by Gram-negative microorganisms, outpatient treatment could be difficult. Beta-lactam administration by means of an elastomeric infusor may represent an attractive approach. We report two cases of osteomyelitis due to Pseudomonas aeruginosa successfully treated with continuous ceftazidime administration via an elastomeric infusor in outpatient settings. In both cases the patients were free from clinical and laboratory signs of osteomyelitis at the end of treatment and after 12 months’ follow-up.
Streptococcus bovis meningitis associated with colonic diverticulosis and hearing impairment: a case report
Neves da Silva Claúdia Neto Gonçalves,
Carneiro de Araújo Rosane Silva,
de Araújo-Filho João Alves
Tropical Diseases Hospital, Goiânia, Goiás; Department of Tropical Medicine and Dermatology, Tropical Medicine and Public Health Institute, Federal University of Goiás, Goiânia, Brazil
The Infections in the History of Medicine
Epidemiological, social and public health aspects of tuberculosis in Ferrara in the 19th century
Guidi Enrica,
Angelini Lauretta,
Lupi Silvia,
Vicentini Chiara Beatrice,
Mares Donatella,
Manfredini Stefano,
Contini Carlo
Our first study of tuberculosis in Ferrara during the nineteenth century, whose results have been recently published, focused on disease treatment. Here we present the descriptive analysis of mortality, with the following results being attained: two behavioural patterns are detected with regard to the onset of disease, before and after 1850; TB is a specific disease that affects all parts of the body in all age groups: childhood, and active and passive populations; there are no significant differences with regard to gender; as regards the occupations performed by the deceased, those related to industry and agriculture and to various other activities and services are those with the highest mortality; tuberculosis has a seasonal pattern; summer and autumn are the periods of greatest prevalence (hot weather and humidity are factors that affect the respiratory system); among the forms of tuberculosis it can be observed that up to the year 1850 people died in Ferrara either of pulmonary tuberculosis or TB localised in other areas; from 1851 onward there appears to have been a dramatic change, with a decrease in unspecific diagnosis but the appearance of disease manifestations in its various clinical forms.
