Volume 20, Issue 2, 2012
Review
Endocarditis caused by nutritionally variant streptococci: a case report and literature review
Giuliano Simone,
Caccese Roberta,
Carfagna Paolo,
Vena Antonio,
Falcone Marco,
Venditti Mario
Infective endocarditis (IE) due to Abiotrophia and Granulicatella species, previously referred to as nutritionally variant streptococci (NVS), occurs rarely and is often associated with negative blood cultures. Rates of treatment failure, infection relapse and mortality are higher than those of endocarditis caused by other viridans streptococci.
We report a case of endocarditis caused by Granulicatella adiacens in a young man with no risk factors, who was successfully treated with surgery and combination antimicrobial chemotherapy, and provide a literature review of endocarditis attributable to these rare species of fastidious gram-positive cocci which have proven exceedingly difficult to treat, with high rates of relapse and therapeutic failure despite in vitro effective antibiotic treatment regimens.
Analysis of literature revealed a high prevalence (61%) of valvular heart predisposing conditions associated with endocarditis caused by NVS, such as congenital valvular heart disease or heart valve prosthesis. On the other hand, 39% of cases showed no evidence of risk factors. Combination antimicrobial chemotherapy with penicillin and gentamicin represents the antimicrobial treatment of choice in the management of patients with IE attributable to NVS. Heart valve replacement surgery should be considered in cases of hemodynamic derangement due to significant valve destruction.
Myopericarditis during a primary Epstein-Barr virus infection in an otherwise young adult. An unusual and insidious complication. Case report and a 60-year literature review
Sabbatani Sergio,
Manfredi Roberto,
Ortolani Paolo,
Trapani Fabio Filippo,
Viale Pierluigi
An otherwise healthy young man had infectious mononucleosis detected after an atypical clinical onset, including myocarditis and pericarditis. Our patient slowly but completely recovered from his cardiac complications after the course of his primary Epstein-Barr infection, as shown by periodical electrocardiographic and ultrasonographic studies, and a simple treatment with aspirin alone. Our case report is briefly reported, and discussed with regard to the existing literature, which has recorded such complications since the mid 1940s.
Original article
Prevalence and antimicrobial susceptibility of Ureaplasma urealyticum and Mycoplasma hominis in a population of Italian and immigrant outpatients
Leli Christian,
Mencacci Antonella,
Concetta Jessica,
D’Alò Francesco,
Farinelli Senia,
Vitali Mariolina,
Montagna Paolo,
Bietolini Cristiana,
Meucci Marta,
Perito Stefano,
Bistoni Francesco
Ureaplasma urealyticum and Mycoplasma hominis are associated with non-gonococcal urethritis, increased risk of recurrent miscarriage, infertility and pelvic inflammatory disease. Migration flows from other countries change the local epidemiological profile of infectious diseases of patients treated by general practitioners and hospital doctors. Few studies have evaluated this ever-changing issue in the Italian population. The aim of this study was to assess possible differences in prevalence and antimicrobial susceptibility of U. urealyticum and M. hominis in a population of 433 Italian and immigrant outpatients by means of the commercially available MYCOFAST Screening EvolutioN 3 Kit. Prevalence of positive samples was 44.5% in Italian patients and 53.4% in immigrants. Samples positive for U. urealyticum and total isolates were more frequent in African patients: U. urealyticum, 51.5% vs 33.3%; Yates-corrected chi-square=3.98; p=0.046; total isolates, 54.5% vs 34.3%; Yates-corrected chi-square=4.45; p=0.035. Among samples positive for U. urealyticum, 66.4% were resistant to ciprofloxacin, whereas 27.6% to ofloxacin. In M. hominis isolates, 66.7% were resistant to both azythromycin and roxythromycin. Our study showed how prevalence of genital mycoplasmas and antibiotic resistance profiles change in relation to the country of origin. Therefore, surveillance is critical for the early cure and prevention of the occurrence of resistant strains.
Evaluation of a home-made method to determine viral genotype and characterize mutations conferring drug resistance in chronic hepatitis B patients
Pagani Elisabetta,
Pasquetto Valentina,
Cemin Chiara,
Rossi Patrizia,
Crovatto Marina,
Gava Graziella,
Felder Martina,
Huemer Hartwig P.,
Larcher Clara
We compared a home-made sequencing system to analyze plasma samples from patients with chronic HBV infection with the commercial TRUGENE HBV Genotyping Assay. A PCR and sequencing protocol based on published primers was applied to detect the viral genotypes as well as the major patterns of point mutations leading to resistance to lamivudine, adefovir and entecavir. For the determination of HBV genotypes the obtained sequences were aligned with a database created within the RIDOM TraceEdit program and publicly available reference sequences. Our results showed perfect correlation with the commercial system, with types D (72%) and A (22%) being the most frequent genotypes. The resistance loci were also reliably detected with mostly combined L180M and M204V/I mutations as the local patterns. M204I mutations were more frequent in genotype D, M204V in genotype A isolates. G173L mutations were not found. The only genotype C isolate tested revealed a different pattern (E263D and I269L). These data speak for the usability of this rapid amplification and sequencing approach for routine genotyping of HBV isolates and simultaneous determination of the drug resistance profile of the dominant viral species.
Enterobacteria producers of extended-spectrum beta-lactamase in a hospital from Venezuela
Tedesco-Maiullari Rosa Maria,
Guevara Armando
The emergence of antimicrobial resistance due to extended-spectrum beta-lactamase (ESBL) has significant clinical impact and is a public health problem. The aim of the present study was to determine the frequency of infections by ESBL-producing enterobacteria in patients hospitalized in the Ruiz y Paez Hospital (CHRP) from Cuidad Bolivar, Venezuela, from January to July 2011. We determined the ESBL production from all isolates of E. coli, K. pneumoniae, K. oxytoca and P. mirabilis, using a double disk synergy test and combined disk method. Of the Enterobacteriaceae isolated, 20.3% (53) were ESBL producers, the main ones being K. pneumoniae and E. coli with 56.6% and 43.3% respectively: 15.7% of all E. coli and 47.6% of all K. pneumoniae were ESBL producers, and were more frequent in the purulent samples (43.3%) and blood (30.1%). The service with the greatest number of isolated ESBL-producing enterobacteria was medicine (26.4%) followed by perinatology (24.5%). We concluded that the CHRP has a high rate of ESBL-producing enterobacteria, mainly K. pneumoniae.
Rotavirus and adenovirus prevalence at Tepecik education and research hospital
Ece Gulfem,
Samlioglu Pinar,
Ulker Temel,
Kose Sukran,
Ersan Gursel
Diarrhoea affects many people globally. Rotaviruses and enteric adenovirus types 40 and 41 are the most common viruses causing childhood gastroenteritis. The aim of this study was to determine the prevalence of rotavirus and adenovirus from the faecal samples obtained at the Infectious Diseases and Clinical Microbiology Laboratory of Tepecik Education and Research Hospital. The faecal samples were screened for rotavirus, and adenovirus by commercially available immunochromatographic EIA kit (Rotavirus/Adenovirus Combo Rapid Test Device) (San Diego,CA, USA). A total of 1112 stool samples were collected from May 23rd 2008 to May 25th 2010. Of these faecal samples, 201(18.07%) were positive for rotavirus and 14 (1.2 %) for adenovirus antigen. In our study the most common agent detected was rotavirus. Viral antigen analysis in stool specimens is important for diagnosis. Detection of the viral aetiology in gastroenteritis cases will prevent unnecessary antibiotic consumption.
Case detection rates of impetigo by gender and age
Kiriakis Kyriakos P.,
Tadros Aline,
Dimou Anastasia,
Karamanou Marianna,
Banaka Fotini,
Alexoudi Iliana
A cross sectional study was carried out (impetigo cases n=265, relative prevalence 5.3‰, among 50,237 outpatients). Males predominated in childhood, adulthood and overall (OR 2.0) and exhibited a more protracted susceptibility. Impetigo was more prevalent in summer months. Lesions were located on the head and neck (65.4%), followed by 19.6% on an upper extremity and by 7.5% each on the trunk and a lower extremity.
Mycobacterium tuberculosis and human immunodeficiency virus coinfection in a tertiary care hospital in Midwestern Brazil
Lins Tatiana Bacelar Acioli,
Soares Eldom de Medeiros ,
dos Santos Felipe Macedo,
Pimenta Mandacaru Polyana Maria,
Pina Tatiana,
de Araujo-Filho Joao Alves
Infection with human immunodeficiency virus (HIV) increases the risk of tuberculosis (TB), and HIV TB coinfection is associated with higher mortality. This study aimed to characterize patients coinfected with Mycobacterium tuberculosis and HIV in a reference centre for cases involving complications or drug resistance in TB. This retrospective cohort study was conducted at a Hospital for Tropical Diseases in the state of Goiás, Midwestern Brazil. Patients’ medical records were reviewed between January 2008 and December 2009. Sixty-one cases of TB/HIV coinfection were evaluated, and 54 HIV-seronegative TB cases were selected as controls. The prevalence of TB HIV-coinfected patients in 2008/2009 was 23%. Coinfection was more prevalent in men (75.4%), with a mean age of 37.1 years. Pulmonary disease (50.8%) was the most frequent clinical form of TB in coinfected patients, followed by disseminated disease (32.8%). Anaemia, malnutrition and low levels of CD4 T lymphocytes were found in about 80% of coinfected patients. Bilateral pulmonary infiltrates were the most common radiographic finding in coinfected patients (51.8%), and pulmonary cavitation was the rarest event (5.4%). The mortality rate was 2.8 times higher in the TB HIV-coinfected group (39.3%) than in TB patients without HIV (18.5%). Actions targeting the TB HIV-coinfected population, based on national and international recommendations, are necessary to improve prognosis and outcomes in TB and HIV infection in the institution.
Case report
Reversible sudden hearing loss in a chronic hepatitis C patient who achieved a sustained response to antiviral re-treatment
Zampino Rosa,
Costa Giuseppe,
Barillari Mariarosaria,
Adinolfi Luigi Elio,
Marrone Aldo
We describe the case of a patient with chronic hepatitis C treated with standard and pegylated-interferon (PEG-IFN) alpha and ribavirin. He developed a reversible hearing loss during the first course of PEG-IFN + ribavirin, but achieved sustained viral clearance and biochemical normalization after PEG-IFN + ribavirin re-treatment.
Abdominal tuberculosis in a young immigrant patient: a clinical case
Masiello Addolorata,
Pacifico Piera,
Giglio Sergio,
Maio Patrizia,
dell’Aquila Giuseppina,
Magliocca Mario,
Acone Nicola
In developing countries, tuberculosis (TBC) is commonly associated with inadequate socio-economic and sanitary conditions. Currently, in Western countries, TBC is often linked with HIV infection, an ageing population or trans-global migration. Approximately two out of ten TB cases worldwide are extra-pulmonary, of which abdominal tuberculosis accounts for 11%-16%. The Mycobacterium tuberculosis complex involves the abdomen as primary or secondary localization (hematogenous spread or from pulmonary foci or infected neighbouring organs). Abdominal TBC can infect the gastrointestinal tract, peritoneum, mesentery, abdominal lymph nodes, liver, spleen, and pancreas. Diagnosis of abdominal tuberculosis is difficult because of vague and non-specific clinical features and due to the differential diagnosis with other granulomatous diseases such as Crohn’s Disease. It is of great importance for clinicians to pay great attention to tubercular aetiology as a possible cause of gastrointestinal symptoms. Here we describe the clinical case of a young immigrant patient with intestinal TB for whom the wrong initial diagnosis led to a delay in the correct diagnosis and a worsening of the already serious general conditions.
The Infections in the History of Medicine
The Justinian plague
Sabbatan Sergio,
Manfredi Roberto,
Fiorino Sirio
In their medical-historical review, the authors assess the evolution of bubonic plague epidemics: after breaking out in the Egyptian port of Pelusium in October 541 AD, the epidemics hit several regions in the Mediterranean basin in a succession of waves. The so-called Justinian plague took its name from the Byzantine emperor of the period, and seriously conditioned the expansionary aims of the Eastern Roman empire towards Italy (which was occupied by Goths), and Northern Africa (where the Vandals had settled), during the first decades of its spread. In the Eastern Empire the plague played a considerable role in reducing the tensions between Persians and Byzantines, especially on the Syrian and Anatolian fronts. It had a major demographic impact, reducing the possibility of recruitment to the Roman legions and leading to a significant drop in tax revenues, which were essential to sustain the state and its military machine. Finally, the plague also took its toll on economic resources (especially agriculture), indirectly leading to a vicious inflationary circle. In the space of over two centuries, plague epidemics paralyzed most trade and commercial exchanges. Furthermore, the Justinian plague, halting the consolidation of the influence of the Eastern Roman empire over some Western regions (including Italy and Northern Africa, which were ruled by Barbarians), supported the development and rise of a number of Roman-Barbarian kingdoms. It may therefore be suggested that the Justinian plague occurred at a very critical historical moment, which represents the real watershed between the Ancient World and the upcoming Middle Ages.
