Volume 20, Issue 4, 2012
Review
Impact of recent advances in molecular techniques on diagnosing lower respiratory tract infections (LRTIs)
Camporese Alessandro
At present there is still a great deficit in the routine aetiological diagnosis of lower respiratory tract infections (LRTIs): in most studies more than 50% of cases have no aetiological diagnosis, resulting in prescribing unnecessary or inappropriate antibiotics. A wide variety of diagnostic procedures and techniques are applied to detect the aetiological pathogens of LRTIs. Traditional diagnostic culture methods lack sensitivity, are not feasible in many contexts, and focus only on a few of the large number of aetiological agents. Molecular methods are revolutionizing the diagnostic procedures for managing patients with LRTIs, resulting from a combination of improved sensitivity and specificity, a potential for automatisation and the production of very rapid results.
The pharmacoeconomics of antiretroviral drugs and the role of adherence
Bargiacchi Olivia,
Brondolo Roberta,
Rizzo Giovanni,
Garavelli Pietro Luigi
In the past decade health care expenses have increased by 50% in Italy, a country whose population mostly consists of people aged over 50 years old, the main users of health care services. Pharmaceutical expenditure is the main issue: monoclonal antibodies, biological immunosuppressants, antitumorals and antiretrovirals are the most expensive drugs. The cost of HIV/AIDS has remained constant during the last four years. Despite the increase in pharmaceutical costs, which made the infection chronic, hospitalization costs have been reduced. With sustainable economic development as a chiefly long-term target, a clinical governance system is nonetheless needed which also takes account of the adherence to antiretroviral therapy: thus poor adherence leads to a reduction in efficacy and at the same time an increase in welfare and community costs. Recently in SSvD “Prevention and cure of HIV infection and related syndromes” of “Maggiore della Carità” University Hospital, Novara, adherence to antiretroviral therapy in 100 consecutive patients was evaluated. The results show that patients with high adherence to the treatment prescribed have a less expensive drug combination. Moreover, with better infection control and a higher immune recovery, they have less impact on social and health care costs.
Original article
Comparison of cefuroxime and co-amoxiclav in the treatment of acute sinusitis in a sample of the Iranian population
Lari Abdolaziz Rastegar,
Alinejad Faranak,
Alaghehbandan Reza,
Mostafavi Hamid,
Asghari Babak,
Gholami Abbas
Objectives: Acute sinusitis is a common upper respiratory tract infection worldwide, which can be severely complicated if inappropriate treatment is applied. The aim of this study was to assess and compare efficacy of cefuroxime and co-amoxiclav in the treatment of acute sinusitis in an Iranian sample population.
Methods: A randomized clinical trial, comparing the efficacy of two oral antibiotics, cefuroxime and co-amoxiclav in the treatment of acute sinusitis, was conducted in 2007. A total of 99 patients were enrolled in the study. The clinical diagnosis of acute sinusitis was based on association of suborbital pain, purulent rhinorrhea and purulent discharge on the middle nasal meatus. All patients were also radiographically examined and their diagnoses were confirmed. Patients were randomly assigned to either receive 10 days of treatment with cefuroxime 250 mg twice daily (n=57) or receive co-amoxiclav 500/125 mg three times daily (n=42). Patients’ responses to treatment were assessed during and at the end of the treatment.
Results: A satisfactory clinical outcome (cure or improvement of symptoms) was found in 86% (49/57) and 71.4% (30/42) of the clinically evaluable patients treated with cefuroxime or co-amoxiclav, respectively (p >0.05).
Conclusions: The findings of this study suggest that cefuroxime (twice daily) is comparably effective as co-amoxiclav (three times a day) in the treatment of patients with acute sinusitis.
Molecular epidemiology of methicillin-resistant Staphylococcus aureus from bacteraemia in northern Italy
Aschbacher Richard,
Pichon Bruno,
Wootton Mandy,
Davies Leanne,
Binazzi Raffaella,
Pike Rachel,
Ganner Mark,
Hill Robert,
Pagani Elisabetta,
Agreiter Iris,
Mian Peter,
Larcher Clara,
Kearns Angela
Background: Vancomycin is frequently used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia; reduced susceptibility to vancomycin is therefore disturbing.
Methods: molecular epidemiological analysis of 81 MRSA bacteraemia isolates collected during 2002-10 in the province of Bolzano, northern Italy was performed. MICs of a range of antimicrobials were determined by agar microdilution, screening for hGISA was by Macro-Etest and Etest GRD and confirmed by PAP-AUC with vancomycin and teicoplanin. All isolates were characterised by toxin gene profiling, agr, spa, and SCCmec-typing; MLST and PFGE were carried out on representative strains.
Results: The dominant clones identified were ST8-MRSA-IVc (55%) and ST228- and ST111-MRSA-I (25%); most of the latter two lineages (19/20; 95%) were GISA or PAP-AUC confirmed hGISA. One ST8-MRSA-IVc isolate harboured ccrA2B2 together with ccrA4B4. The remainder were diverse genotypically and belonged to MLST clonal complexes 1, 22, 45 and 398.
Conclusions: Diverse lineages of MRSA were identified as causing bacteraemia in a province in northern Italy. The association of a specific genotype with the hGISA and GISA phenotypes among representatives of the second most common lineage identified is of clinical concern.
Prospective multicentre survey on clinical features and management approach to community-acquired pneumonia in emergency departments in Italy: focus on hospital admitted cases
Viale Pierluigi,
Tedeschi Sara,
Tumietto Fabio,
Ferrari Rodolfo,
Azzari Chiara,
Scudeller Luigia
Background: The correct management of community-acquired pneumonia (CAP) in emergency departments (EDs) is pivotal for the proper use of hospital resources and to ensure optimal management for each patient. Despite a significant body of relevant literature, several doubts remain, namely related to the optimal definition of clinical severity, the most useful criteria for sound patient allocation, the value of immediate microbiological diagnosis, and the criteria for treatment choice.
Methods: prospective, multicentric cohort study, enrolling for a period of 24 months all the CAP cases referred to 9 EDs in Italian hospitals. For every enrolled patient demographics and clinical data were collected and clinical severity was defined using and comparing three different predictive rules.
Results: Of 1214 patients who enrolled, 844 were admitted to hospital. Of these, the mean age was 64±20 and only 56.9% were over 65 years. Nearly 50% of patients admitted had low scores of severity but over 70% had one or more comorbidities. Overall mortality was 8.5%. Streptococcus pneumoniae was the most represented aetiological agent, but globally the yield of microbiological work up was scant (16%).
Comment: in a real-life study condition, predictive rules, very attractive for prognosis, are not useful for clinicians to decide on admission of a patient with CAP, mainly when compared with assessment of comorbidities.
Case report
Molecular diagnosis of Staphylococcus aureus prosthetic aortic graft infection: a case report
Avolio Manuela,
Bonea Massimo,
Camporese Alessandro
Introduzione: il capitolo delle infezioni post impianto di endoprotesi aortica è un capitolo dibattuto ampiamente in letteratura. Rappresentano circa l’1% delle complicanze post-chirurgiche e sono associate ad un tasso elevato di mortalità. Nella maggior parte dei casi tali infezioni vengono affrontate empiricamente perché tali pazienti sono già in copertura antibiotica così da non consentire l‘isolamento del patogeno. Al riguardo, la letteratura è molto attenta alle nuove possibilità diagnostiche molecolari, e specialmente all’inquadramento di tali complicanze in un preciso algoritmo diagnostico e gestionale del paziente.
Caso clinico: paziente di 62 anni sottoposto nel 2004 a chirurgia protesica endovascolare EVAR in seguito ad insorto aneurisma dell’aorta addominale sottorenale. Nel 2009, in seguito a un normale controllo, viene rilevato un endoleak tipo II, la più frequente complicanza a lungo termine per questo genere di interventi. Si decide di intervenire procedendo all’embolizzazione dell’aneurisma con puntura diretta TAC guidata, ma dopo 9 giorni il paziente viene ricoverato per iperpiressia.
Discussione: il caso clinico presentato dimostra che in contesti nei quali la diagnostica colturale standard non consente di avere delle risposte a specifici quesiti eziologici, i test molecolari permettono invece di ottenere risultati in grado di modificare efficacemente l’intervento terapeutico con un decisivo impatto sull’outcome clinico del paziente.
Multiple abscesses of the left brain hemisphere due to Listeria monocytogenes in an immunocompromised patient: a case report
Matera Giovanni,
Puccio Rossana,
Giancotti Aida,
Quirino Angela,
Guadagnino Vincenzo,
Pardatscher Kurt,
Caroleo Santo,
De Rose Marisa,
Amorosi Andrea,
Liberto Maria Carla,
Focà Alfredo
We describe a case of brain abscesses in a cirrhotic and diabetic 57-year-old woman showing fever, aphasia, right hemiparesis and seizures. Neuroradiological investigation revealed unilateral cerebritis evolving in multiple abscesses. From blood and surgical drainage samples Listeria monocytogenes grew in pure culture. Despite decompressive craniotomy, the patient died two months after hospital admission.
Male breast cancer in an HIV-infected patient: a case report
Calabresi Alessandra,
Castelnuovo Filippo,
Ferraresi Alice,
Quiros-Roldan Eugenia
Male breast cancer is rare and few cases of breast cancer in human immunodeficiency virus (HIV)-infected patients are reported. We describe the case of breast cancer in a 65-year-old HIV-positive man who presented a nodule near the nipple of his left breast. He did not report risk factors for breast cancer, but he had liver cirrhosis. Biopsy of the lesion revealed a ductal carcinoma and he was submitted to mastectomy and axillary dissection. Staging resulted in pT1c/pN1a/M0; it was positive for the presence of oestrogen/progesterone receptors, negative for the human epidermal growth factor receptor-2. He was also treated with local radiotherapy and tamoxifen. At cancer diagnosis, he received highly active antiretroviral therapy (HAART) with undetectable HIV viral load, and his CD4+ T-cell count was 445 cells/mm3.
Patients with HIV infection have a higher cancer risk due to immunosuppression: it concerns not only malignancies related to human acquired immunodeficiency syndrome (AIDS), but also other cancers. A heightened awareness of male breast cancer by HIV specialists is needed, especially for particular risk categories, such as trans-sexuals who take oestrogen therapies, and for the presence of breast conditions, such as gynecomastia, usually considered as part of the lipodystrophy syndrome.
Resolution of migratory pulmonary infiltrates by moxifloxacin in a patient with dual infection of Mycoplasma pneumoniae and Bordetella pertussis
Kazama Itsuro,
Tamada Tsutomu,
Nakajima Toshiyuki
A 37-year-old Japanese woman, who was not vaccinated against Bordetella pertussis, developed a nocturnal fever with persistent dry cough for more than 2 weeks. A chest radiograph showed poorly-defined nodular opacities in the left lung. Due to the significant rise in serum antibodies for both Mycoplasma pneumoniae and B. pertussis, a diagnosis of dual infection with the organisms was made. Despite the use of susceptible antibiotics, the patient’s symptoms did not improve and her chest radiograph showed migratory pulmonary infiltrates. However, a quinolone derivative, moxifloxacin, dramatically improved her symptoms and resolved the pulmonary infiltrates shortly after administration. In this case, due to the lymphocyte-stimulatory nature of M. pneumoniae and B. pertussis, an increased immunological response was likely to be involved in the pathogenesis of pneumonia. The immunomodulatory property of moxifloxacin was thought to repress the increased lymphocyte activity, and thus facilitated complete remission of the disease.
The Infections in the History of Medicine
The role of marine hospices as therapeutic support for scrofula treatment in nineteenth-century Ferrara
Guidi Enrica,
Lupi Silvia,
Vicentini Chiara Beatrice,
Manfredini Stefano,
Altieri Lorenzo,
Scivales Sonia,
Contini Carlo
The authors carried out an observational study for the years 1867-1874 on the morbidity of children from Ferrara suffering from scrofula, sent to marine hospices for sea bathing treatment. A total of 490 cases (250 F, 240 M) were studied in relation to the following variables: age, sex, forms of scrofula, years and outcome. In particular, the present work describes the preliminary organizational steps planned to allow the seaside stay, the clinical features and the outcomes. Dissemination of information to the public and to benefactors had the specific aim to strengthen these benefits for those children affected by the sad and serious consequences of scrofula.
Aretaeus of Cappodocia. Views on diphtheria
Tsoucalas Gregory,
Marineli Filio,
Karamanou Marianna,
Laios Konstantinos,
Androutsos George
Aretaeus of Cappadocia composed a vivid description of diphtheria, noting the symptoms, complications, as well as the remedies to cure it. He was the medical author who used the terms "eschara" and "diphtheres" which are still in use by modern physicians, and the first who recognized the croup. His alum remedy has stood the test of time and is nowadays still under study.
Letters to the editor
Pharmacokinetic exposure and virological efficacy of a reduced atazanavir dose
Lanzafame Massimiliano,
Lattuada Emanuela,
Corsini Fabiana,
Concia Ercole,
Vento Sandro
Not available
Rapid spread of multiresistant Acinetobacter baumannii isolates in intensive care units (ICUs) and in vitro activity of colistin and tigecycline
Buccoliero Giovanni,
Morelli Elisabetta,
Lonero Gaetano,
Romanelli Chiara,
Resta Francesco,
Pisconti Salvatore
Not available
Leprosy-like cutaneous presentation in histoplasmosis
Wiwanitkit Viroj
Not available
Erratum
Streptococcus anginosus group disseminated infection: case report and review of literature
G. Simone,
G. Rubini,
A. Conti,
P. Goldoni,
M. Falcone,
A. Vena,
M. Venditti,
S. Morelli
Erratum
This corrects the list of authors at page 145 of the article published on
Infez Med. 2012 Sep; 20(3): 145-54, that should be read as follows:
Giuliano S., Rubini G., Conte A., Goldoni P., Falcone M.,
Vena A., Venditti M., Morelli S.
