Volume 20, Issue 3, 2012
Review
Streptococcus anginosus group disseminated infection: case report and review of literature
Simone Giuliano,
Rubini Giorgia,
Conti Andrea,
Goldoni Paola,
Falcone Marco,
Vena Antonio,
Venditti Mario,
Morelli Sergio,
Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infections. There are very few reports of disseminated infections sustained by members of this streptococcal group. We report a case of a highly disseminated infection and analyse previous literature reports. Disseminated pyogenic infection has been defined as an infection affecting two or more of the following organs/systems: central nervous system, lung, liver and spleen. We performed a PubMed search using the terms: “S. milleri”, “S. anginosus”, “brain abscess”, “pulmonary abscess”, “hepatic abscess”, “spleen abscess”. We reviewed 12 case reports including the one presented in this paper.
Underlying conditions such as dental infections, malignancy, gastrointestinal and respiratory tract disease accounted for 42% of cases. No definite endocarditis was encountered, even though positive blood cultures were found in 67% of patients. Concomitant brain-liver, brain-lung and brain-spleen involvement occurred in 50%, 42% and 8% of cases respectively. Ninety-one percent (91%) of patients were treated with β-lactams, and surgical procedures were performed in 67% of patients.
Infections caused by S. anginosus group members are satisfactorily treated with penicillin G and cephalosporins. It is very important to associate surgery to antimicrobial chemotherapy in order to achieve a full or nearly full clinical recovery.
Update on diabetic foot infections
Pascale Renato,
Vitale Mario,
Esposito Silvano
Diabetes is one of the most common non-transmitted disease and currently 346 million people are affected in the world. According to the World Health Organization about 15% of diabetic patients develop a foot ulcer in need of medical care. Infection is a serious complication and in the western world it is the major responsible cause of lower limb amputation. In the 84% of cases amputation is the final step in the treatment of a non-healing foot ulcer. So, it's clear that, in order to reduce amputation rate, it's important to prevent foot ulcer formation and improve the treatment of lesion.
In this review we report the most recent international literature as regards epidemiology, etiology, classification, diagnosis, microbiology and treatment of infected diabetic foot ulcers. The purpose of our work is to remark the multifactorial features of this pathology and the role of infectious disease specialist in a multidisciplinary team for the treatment of infected diabetic foot ulcers. The knowledge of microbiology on one hand, and the need of a complex and long term antibiotic therapy on the other, point out the importance of infectious disease specialist to facilitate, if possible, the healing of a infected diabetic foot ulcers.
Original article
Respiratory Syncytial Virus infection: a decade of contributions
Blanco del Val Alfredo,
Eiros Bouza José Maria,
Mayo Iscar Agustín,
Bachiller Luque M. Rosario,
Blanco del Val Beatriz,
Sánchez Porto Antonio,
Ortiz de Lejarzu Raúl
Respiratory Syncytial Virus (RSV) is the main cause of acute lower respiratory tract infections in children under 2 years, its distribution is worldwide and even in very different climatic conditions, it appears to have similar features, certainly knowing it will produce a significant amount of infections each year.
We present the results of a retrospective review of positive cases for RSV detected in the Microbiology Laboratory of the Hospital Clínico Universitario of Valladolid in the period between 1990 and 2000, dealing with its presentation at the given time with the weather variables of temperature and humidity.
Every year, we have observed as the clustering of cases was associated with two outbreaks, one at the beginning and the other at the end of the year, coinciding with the coldest and wettest months. This pattern has been repeated every revised year, according to an annual rate, with the onset of the first insulation between the months of October and February, and of the last ending between March and June, showing the highest peaks of isolation during the month of February. Therefore, every year we observe a break or seasonal slip matching the months with higher temperatures and lower humidity.
Community-acquired bloodstream infections among paediatric patients admitted to an Italian tertiary specialistic Centre: a prospective survey
Calitri Carmelina,
Viran Silvia,
Scolfaro Carlo,
Raffaldi Irene,
De Intinis Gianfranco,
Gregori Gabriella,
Bianciotto Manuela,
Tovo Pier Angelo
Introduction. Invasive bacterial diseases continue to represent a significant burden in paediatric age, and the emergence of previously secondary bacteria and antibiotic-resistant strains requires a continuous surveillance.
Materials and methods. A one-year prospective survey on laboratory confirmed community-acquired bloodstream infections (CA-LBSIs) cases admitted to an Italian tertiary specialistic paediatric Hospital.
Results. Twelve cases were documented, with an incidence rate of 0.39/1,000 admissions to the Emergency Department, and of 2.9/1,000 hospitalizations to general and specialized wards. Mean age at diagnosis was 5.2 ± 5.9 years, with 58.3% of episodes regarding children < 2 years. Six episodes were caused by Gram positive and six by Gram negative bacteria, with potential vaccine-preventable pathogens responsible of 50% of CA-LBSIs. Empiric antibiotic therapy prescribed at admission was found appropriate to microbiological results in the totality of cases and administered for a mean time of 17.7 ± 10.1 days. No resistant strains were found. All patients had a good outcome.
Conclusions. Prompt collection of samples for microbiological tests together with the rapid institution of empiric antibiotic therapy are essential for the correct management of CA-LBSIs in paediatric patients. Implementation of vaccinations against the major responsible pathogens remains the most important prevention strategy.
ESBL and MBL Mediated Resistance in Acinetobacter baumannii: a global threat to burnt patients
Owlia Parviz,
Azimi Leila,
Gholami Abbas,
Asghari Babak,
Rastegar Lari Abdolaziz
Acinetobacter baumannii è un microrganismo patogeno responsabile di gravi infezioni, soprattutto nei pazienti ustionati. Questo studio è stato condotto al fine di determinare la prevalenza della produzione di beta-lattamasi a spettro esteso (ESBL) e metallo-beta-lattamasi (MBL) in ceppi di A. baumannii isolati da pazienti ustionati. Complessivamente, sono stati analizzati 126 isolati provenienti da pazienti di ambo i sessi ricoverati presso l’Unità per ustionati del Motahari Hospital di Tehran. I test di sensibilità e la produzione di ESBL e MBL sono stati condotti in accordo alle linee guida del CLSI. La produzione di ESBL è stata rilevata nel 21% degli isolati resistenti a ceftazidime; la produzione di MBL è stata rilevata nel 39% degli isolati resistenti a imipenem. La degenza prolungata cui sono sottoposti i pazienti ustionati ha costituito un fattore che ha contribuito notevolmente all’elevata incidenza di isolamento di batteri resistenti. Si conferma la necessità di una attenta sorveglianza degli isolati di A. baumannii produttori di ESBL e MBL nei pazienti ustionati al fine di istituire la migliore terapia antibiotica.
Experimental evaluation of the Sysmex UF-1000i for ruling out nongonococcal urethritis
Grosso Shamanta,
Bruschetta Graziano,
Camporese Alessandro
Acute nongonococcal urethritis (NGU) is one of the commonest sexually transmitted infections affecting men and women. The diagnosis of NGU has traditionally required microscopic evidence of urethritis. However, a significant proportion of patients with urethral symptoms do not have microscopic evidence of urethritis. The purpose of the present study was to evaluate the analytical performance of the UF1000i, a recently introduced fluorescence flow cytometer intended for urinalysis purposes which provides new analytical features that seem particularly suitable for microbiological diagnostics, for ruling out NGU or predicting the presence of infection.
The Sysmex UF1000i is a flow cytometry analyzer capable of quantifying a lot of particles, including bacteria (BACT) and white blood cells (WBCs). To evaluate the analytical performance of the UF1000i as a method for ruling out NGU, we examined 200 urethral smear samples, collected in a new liquid transport medium (Copan), and compared the UF1000i results with standard culture/molecular and microscopic Gram stain results.
With instrument cut-off values of 200 BACT x10E6/L and 500 WBCs x10E6/L, we obtained a sensitivity of 84%, a specificity of 82%, and a high negative predictive value (96%).
Culture/molecular detection of pathogens remains the gold standard technique for the diagnosis of NGU. However, the Sysmex UF1000i is capable of improving the efficiency of NGU presumptive diagnosis, providing results in a few minutes, with a high negative predictive value and high values of sensitivity.
Tuberculous peritonitis: experience in Treviso from 2000 to 2010
Carniato Antonella,
Fuser Rodolfo,
Giobbia Mario,
Rossi Cristina,
Farina Francesca,
Inojosa Walter,
Pintaldi Salvatore,
Scotton Pier Giorgio
Peritonitis is an uncommon localization of tuberculosis in Italy; diagnosis and treatment are often difficult and delayed. Fifteen cases, followed by Infectious Diseases Department in Treviso from 2000 to 2010, are described. Mortality and long term complications were absent, in contrast with medical literature. The usefulness of steroid therapy is still uncertain.
Other sites of infection were present in 60 percent of patients (pulmonary TB in 47%), urging the clinician to examine the case promptly to determine infectiousness status.
Case report
Disseminated nocardiosis in a patient with haemophilia: a problem of differential diagnosis
Gattuso Gianni,
Tomasoni Donatella,
Scalzini Alfredo,
Costa Paolo
Nocardia is found worldwide in soils and dust. In immunocompromised patients the lungs appear to be the most common initial site of infection due to the inhalation of free living organisms. Nocardia asteroides is the most commonly isolated pathogenic Nocardia species. Pulmonary nocardiosis may mimic tuberculosis, staphylococcal or mycotic infections. Disseminated disease mainly occurs in immunocompromised patients with underlying illnesses such as chronic granulomatous disease, human immunodeficiency virus (HIV) infection, in patients undergoing cytotoxic chemotherapy, organ transplantation or prolonged glucocorticoid treatment. Subcutaneous infection occurs from trauma related inoculation of the organism. The Authors describe a clinical case regarding a patient with acquired haemophilia A, admitted to the hospital because of disseminated nocardiosis mimicking a neoplastic disease. He recovered completely after the antibiotic treatment.
Necrotizing pneumonia caused by Panton-Valentine leukocidin-producing methicillin-susceptible Staphylococcus aureus (MSSA)
Catena Vincenzo,
Baiocchi Marco,
Lentini Paolo,
Badolati Luigi,
Baccarin Monica,
Del Monte Daniele D.,
Rubini Alessandro
Staphylococcus aureus harboured by Panton-Valentine leukocidin (PVL) is emerging as a serious problem worldwide.
There has been an increase in the incidence of necrotizing lung infections in otherwise healthy young people with very high mortality rate associated with these strains.
This report documents a confirmed case of necrotizing pneumonia due to methicillin-susceptible S. aureus (MSSA) harbouring Panton-Valentine leukocidin genes.
An apparently healthy 49-year old man was admitted to our hospital for dyspnea and he quickly developed acute respiratory distress syndrome. MSSA harbouring Panton-Valentine leukocidin genes were cultured from the abscess fluid and from multiple blood specimens.
Aggressive antibiotic therapy was started and intensive supportive care led finally to a complete recovery.
Rapid identification of Panton-Valentine leukocidin in MSSA samples should be supposed when a young, immunocompetent patient, develops a necrotizing pneumonia.
Bactericidal antistaphylococcal antibiotics are recommended for the treatment as soon as possible to avoid the potentially devastating consequences of this kind of S. aureus.
Leprosy-like cutaneous presentation of Histoplasma capsulatum infection in an African HIV+ patient
Scarlata Francesco,
Imburgia Claudia,
Trizzino Marcello,
Titone Lucina
Histoplasma capsulatum is an opportunistic dimorphic fungus responsible for most often self-limiting or flu-like infections but potentially lethal in immunocompromised hosts. Histoplasmosis is rare in Europe. We reported a case of disseminated histoplasmosis in an African HIV patient with a leprosy-like primary cutaneous presentation and involvement of lungs, brain, limphnodes and eye. The therapy with liposomial B amphotericin and itraconazole led to a prompt resolution of the symptoms.
The Infections in the History of Medicine
Specific immunoglobulin against hepatitis C virus. Why not?
Piazza Marcello
Not available
The Justinian plague (part two). The influence of the epidemic on the Islamic Empire evolution
Sabbatani Sergio,
Manfredi Roberto,
Fiorino Sirio
The Islamic Empire started its tumultuous and rapid expansion from the year 622 A.D. (the year of Mohammed’s Egira). This rapid growth coincided with the epidemic spread of the bubonic plague in the Middle East. Although a first epidemic event had been documented in the year 570 A.D. (pre-Islamic phase), in the Arabic peninsula, classically according to M.W. Dols five severe episodes of plague sub-epidemics are considered in the middle-eastern geographic area: the first occurred in 627 and 628 A.D., the fifth in 716 A.D.. Anyway, we may state that at the onset of Islam the geographic region including Egypt, Palestine, Syria, Iraq, and Iran was involved by endemic plague. In their work, on the ground of a literature review, the Authors describe the characteristics of the epidemic phenomenon, and analyze the how the plague affected the interpretation of Prophet’s Koran and Hadits. The passive attitude demonstrated by many Muslims during early Islam was not shared by all believers, since others moved towards a more “soft” approach, which included the behaviour of the so called “moving aside”, when the contagion was of concern. The epidemic plague significantly contributed to the weakening of the Eastern Roman Empire, and the rapid decline of the Persian Empire, while during the early expansion phases of Islam, it indirectly favoured the nomadic Arab tribes which, moving on desert or semi-desert territories, succeeded in escaping the contagion more easily. Subsequently, when the Arab population became sedentary, after occupying the conquered cities, this initial advantage was significantly reduced.
