Volume 22, Issue 1, 2014
Review
Treating Clostridium difficile infection with faecal transplantation: donor microbiological testing
Russello Giuseppe,
Brovarone Flavia,
Bardaro Marcellino,
Carretto Edoardo
Clostridium difficile associated diseases (CDADs) or C. difficile infections (CDIs) are increasing in incidence, severity and mortality. Among patients with CDIs, those with recurrent disease are less responsive to traditional therapies with commonly used drugs, such as metronidazole and vancomycin. Faecal microbiota transplantation is an old therapeutic procedure that has been recently proposed as a safe and effective treatment for CDI patients non-responsive to antibiotic therapy. In this paper we discuss the microbiological procedures that should be performed on faecal microbiota donors.
Is it possible to predict HCV-related liver cirrhosis through routine laboratory parameters?
Gentile Ivan,
Buonomo Antonio Riccardo,
Zappulo Emanuela,
Borgia Guglielmo
It is estimated that hepatitis C virus (HCV) infects chronically about 160 million people worldwide. Between 15 and 56% of these chronic carriers will evolve towards liver cirrhosis during their lifetimes. In managing subjects with HCV chronic infection, it is crucial to perform accurate staging of the disease and specifically to ascertain whether or not they have liver cirrhosis for at least three reasons: i) the presence of cirrhosis has prognostic relevance as it entails a relatively high risk of developing decompensation (e.g., ascites, encephalopathy, jaundice, oesophageal variceal bleeding) or evolution toward hepatocellular carcinoma (HCC); ii) the presence of liver cirrhosis is the main indication for urgent treatment and paradoxically a factor predicting a poor response to currently available therapies. The timing of therapy is particular important considering that the new era of interferon-free antivirals will be a reality in a few years; iii) finally, in the presence of liver cirrhosis current guidelines recommend periodical screening for the presence of oesophageal varices and HCC.
With the exception of the most advanced stages, the diagnosis of liver cirrhosis is obtained by performing a percutaneous liver biopsy, which is an invasive technique and therefore is associated with a low but non-negligible rate of complications and even death. Finally, it has a non-null rate of false negative for the diagnosis of liver cirrhosis when compared with surgical biopsy. For these reasons several authors have devised non-invasive scores to predict cirrhosis using different means. The most useful are based on liver stiffness (fibroscan), on a panel of blood tests and a proprietary algorithm (fibrotest) or on routinely available parameters. This review focuses on the different scores based on routine parameters that differ in their ease of calculation, in their diagnostic power and in the information provided. Further studies are required to compare the diagnostic performance of different non-invasive scores with the histologic evaluation and other non-invasive methods (fibroscan or fibrotest) on independent cohorts of patients.
Original article
Integration among hospital pharmacists and infectious diseases physicians in the outpatient management of HIV infection
Appolloni Lucia,
Locchi Federica,
Girometti Nicolò,
Calza Leonardo,
Colangeli Vincenzo,
Manfredi Roberto,
Magistrelli Eleonora,
Piro Filomena,
Viale Pierluigi,
Puggioli Cristina
Permanent monitoring of adherence to combination antiretroviral therapy (cART), together with the assessment and management of related adverse events, plays a key role for optimised management of HIV infection. In our HIV outpatient clinic a dedicated pharmacist provides direct drug distribution and accountability, and gives information on administration mode, possible side effects and drug interactions. A survey card regarding cART adherence and adverse drug reactions (ADRs) is administered to all patients. All figures are recorded in an electronic database. In an ad interim analysis 659 consecutive patients’ data were evaluated, of whom 74% were fully adherent to cART. A lower adherence rate was found to be correlated with the presence of concurrent medications, and with the increasing number of daily cART tablets/capsules. A significant impact of cART adherence on a favourable course of the main laboratory surrogate markers of HIV disease progression (CD4+ T-lymphocyte count and HIV viral load) was also observed. Darunavir-containing cART was related to a lower incidence of early gastrointestinal and neuropsychiatric disturbances and also a reduced perception of morphological/physical changes. A multidisciplinary approach based on strict interaction between pharmacists and infectious diseases physicians may significantly improve cART adherence and the monitoring of adverse events, making a considerable contribution to the better management of HIV-infected patients.
A retrospective study on HIV and syphilis
Foggia Maria,
Gentile Ivan,
Bonadies Giovanni,
Buonomo Antonio Riccardo,
Minei Giuseppina,
Borrelli Francesco,
Squillace Lorenzo,
Maria Francesco,
Delfino Mario,
Borgia Guglielmo
In the early 1990s a reduction in the rate of sexually transmitted infections (STIs) occurred, although recent years have seen an increase. The aim of this study was to examine epidemiological and clinical features of syphilis cases in patients with HIV infection. We reviewed the charts of HIV-infected patients referring to our centre in the period 2002-2011. Fifty of the 402 consecutive HIV-positive patients (12.4%) received a diagnosis of syphilis. An increasing trend in the number of syphilis cases was observed within the period of the study. Most patients with syphilis (64%) presented a latent syphilis of unknown duration. About half of these received a concomitant diagnosis of HIV infection. Men who have sex with men (MSM) were the largest group. In the years 2002-2011, the incidence of syphilis in HIV-infected patients increased in our centre, notably among MSM. There is an urgent need for campaigns aiming to prevent STIs
High prevalence of parotideal abnormalities among HCV-infected patients
Cacopardo Bruno,
Pinzone Marilia Rita,
Gussio Maria,
Nunnari Giuseppe
Several salivary diseases, such as Sjogren’s syndrome (SS), chronic lymphocytic sialadenitis and parotid non-Hodgkin’s lymphoma, may occur in the setting of HCV infection. Our aim was to evaluate the prevalence of parotid abnormalities in a cohort of 310 patients with chronic hepatitis C (CHC) attending the Unit of Infectious Diseases of the Garibaldi Nesima Hospital of Catania. Our control group consisted of 188 patients with chronic HBV infection. We found that the prevalence of parotideal diseases was significantly higher among HCV-infected patients in comparison with HBV-infected (17% vs. 1%). Indeed, 53 CHC subjects had parotideal abnormalities: 24 patients (45.3%) had lymphoepithelial cysts of the salivary gland, six patients (11.3%) had a benign tumour, six patients (11.3%) had granulomatous lesions, 12 patients (22.7%) had Sjogren’s syndrome and four patients (7.5%) were diagnosed as having chronic lymphocytic sialadenitis. Finally, one patient (1.9%) had parotid non-Hodgkin’s lymphoma. In conclusion, parotideal abnormalities are common among HCV-infected individuals and targeted diagnostic protocols may help identify parotid involvement in this population of subjects.
Evaluation of the in vitro colistin susceptibility of Pseudomonas aeruginosa and Acinetobacter baumannii strains at a tertiary care centre in Western Turkey
Ece Gulfem,
Samlioglu Pinar,
Atalay Sabri,
Kose Sukran
Multidrug-resistant gram-negative bacteria are an important issue in intensive care units worldwide. Colistin, one of the earliest polymyxin antibiotics, was once widely used for the treatment of gram-negative bacterial infections. However, its use is now limited due to concerns over nephrotoxicity. The appearance of multidrug-resistant species, including A. baumannii and P. aeruginosa, has led to the re-emergence of this class of drugs. The aim of this study was to evaluate the susceptibility of A. baumannii and P. aeruginosa isolates to colistin and other antibiotics. The antimicrobial susceptibility of A. baumannii and P. aeruginosa isolates to colistin and other antibiotics was evaluated between January 2011 and October 2012 at Tepecik Education and Research Hospital in Izmir, Turkey. Clinical isolates were identified using an automatized Vitek 2.0 system. Colistin susceptibility was measured by E-test; the susceptibility profiles of other antibiotics were evaluated using the Kirby–Bauer disk-diffusion method. A total of 149 isolates were included in the study, consisting of 98 A. baumannii and 51 P. aeruginosa isolates. The MICs of colistin against A. baumannii were 0.125-2.0 µg/mL, and 0.25-2.0 µg/mL against P. aeruginosa; all multidrug-resistant strains examined in this study were susceptible to colistin. Recently, colistin has re-emerged as an effective treatment for infections due to multidrug-resistant A. baumannii, P. aeruginosa, and Klebsiella pneumoniae. All isolates examined in this study were susceptible to colistin, suggesting it could be a viable alternative for the treatment of infections with multidrug-resistant strains.
Case report
Dual infection of Mycoplasma pneumoniae and Chlamydophila pneumoniae in patients with atopic predispositions successfully treated by moxifloxacin
Kazama Itsuro,
Nakajima Toshiyuki
We report two cases of dual infection with Mycoplasma pneumoniae and Chlamydophila pneumoniae complicated by atopic dermatitis or allergic rhinitis. After exacerbations of atopic eczema or rhinitis, both patients presented a nocturnal fever with persistent cough for more than two weeks. Although the use of susceptible antibiotics, such as minocycline or azithromycin, failed to work, moxifloxacin completely resolved their prolonged symptoms shortly after the administration together with a dramatic improvement of the atopic symptoms. Since the patients in question were predisposed to atopic disorders and their lymphocytes were hypersensitive, an immunological response was thought to be easily triggered by the organisms. Additionally, due to the lymphocyte-stimulatory nature of M. pneumoniae and C. pneumoniae, enhanced immunity was likely to be involved in the pathogenesis. The immunomodulatory property of moxifloxacin was thought to repress the increased lymphocyte activity, and thus facilitated complete remission of the disease.
Mycoplasma pneumoniae infection with rhabdomyolysis in a child
Consilvio Nicola Pietro,
Rapino Daniele,
Scaparrotta Alessandra,
Attanasi Marina,
Di Pillo Sabrina,
Chiarelli Francesco,
Savini Vincenzo,
We report the history of a 7seven-year-old male boy with cough and fever, who developed rhabdomyolysis concomitant to with Mycoplasma pneumoniae infection. The association between this organism and the muscular injury is rarely described in paediatric patients. This case then thus emphasizes that even seemingly mild M. pneumoniae airway infections may be complicated by invalidating neuromuscular sequelae.
Extra-cerebral severe infections associated with haemorrhagic hereditary telangiectasia (Rendu-Osler-Weber Disease): five cases and a review of the literature
Musso Maria,
Capone Alessandro,
Chinello Pierangelo,
Di Bella Stefano,
Galati Vincenzo,
Noto Pasquale,
Taglietti Fabrizio,
Topino Simone,
Petrosillo Nicola
Hereditary haemorrhagic telangiectasia (HHT) is one of the most common autosomal dominant disorders and is characterized by genetically determined abnormalities of vascular structure. People affected by HHT are predisposed to severe infections such as cerebral abscesses, typical of patients with pulmonary arteriovenous malformations, and extra-cerebral infections such as bacteraemia, septic arthritis, osteomyelitis, hepatic abscesses, skin infections and infective endocarditis. We present a retrospective series of severe bacterial extra-cerebral infections in five patients affected by HHT, admitted to our Institute from January 2007 to June 2013. We also reviewed the literature of the last five years concerning infectious complications in people affected by HHT. Our study shows that HHT patients with infectious complications exclusively localized in extra-cerebral sites are usually fragile, old and affected by comorbidities. Moreover, we recognized a trend of Staphylococcus aureus (SA) severe infection recurrence in such patients, both in our series and in the literature. In our opinion these results suggest the need to evaluate the possible benefits of SA nasal colonization screening and decolonization in such patients.
Usefulness of (1→3)-β-D glucan in early diagnosing Pneumocystis jirovecii pneumonia: a case report
Atalay Mustafa Altay,
Koc Ayse Nedret,
Kaynar Leyla Gul,
Inci Melek,
Kasap Tekinsen Fatma Filiz,
Eser Bulent
Pneumocystis jirovecii pneumoniae (PJP) may be difficult to diagnose. Since pneumocystis cannot be cultured, the diagnosis of PJP requires microscopic examination to identify pneumocystis from induced sputum or bronchoalveolar lavage (BAL) fluid. In order to evaluate the usefulness of (1→3) ß-D-glucan (BDG) levels in the early diagnosis of PJP, we describe the case of PJP in a 25-year-old male with acute lymphoblastic leukaemia (ALL) admitted to hospital with progressive dyspnea and fever with chills. The patient was not infected with human immunodeficiency virus (HIV). Sputum, blood, and urine cultures were negative; smears for acid-fast bacilli and tests for viral antibodies were both negative. The microbiology study of the BAL with Giemsa and immunofluorescence staining, seven days after admission showed the existence of P. jiroveci in the lungs. Further, one day and five days after admission, (1→3) ß-D-glucan (BDG) levels were very high. The high serum level of BDG considerably decreased after treatment with trimethoprim-sulfamethoxazole (TMP-SMX) and the clinical condition of the patient increasingly improved.
The Infections in the History of Medicine
The figure of the doctor and the science of medicine through Boccaccio’s “Decameron”
Sgouridou Maria
In the person of Boccaccio the humanism of Florence found its major representative. In 1358 he completed his great work, The Decameron, begun some ten years earlier. Considered the prelude to the new spirit that was to be manifested by the Renaissance, it was written in the spirit of a human-centred era. In the tales of The Decameron, based on events occurring during the plague at Florence of 1348, Boccaccio provides a detailed outline of how medical events were viewed at a time of transition from the Middle Ages to the new age of change.
The Decameron opens with a description of the Bubonic Plague (Black Death). Boccaccio knows that it started in the East, and attributes it either to the influence of heavenly bodies or to God’s anger over the wicked deeds of men. But the symptoms of the plague are not like those in the East, where he has heard that a sudden gush of blood from the nose is a sure sign of impending death. Instead, there are swellings, the buboes, in the groin and under the armpit, growing to the size of a small apple or an egg, then large purple or black spots on other parts of the body, and death soon afterwards. This leads to the story of a group of seven young women and three young men who fled from plague-ridden Florence to a villa outside the city walls. To pass the time, they organized themselves so that each person at night has to amuse the others by telling a story. The stories, told over ten days, contain dramatic and or humorous, elements, and many refer in one way or another to the way illness was conceived and managed in those times.
The Venetian Lazarettos of Candia and the Great Plague (1592 - 1595)
Tsiamis Costas,
Thalassinou Eleni,
Poulakou-Rebelakou Effie,
Tsakris Athanasios,
Hatzakis Angelos,
The present study highlights the history of lazarettos in Candia (modern Heraklion, Crete, Greece), which was the most important Venetian possession in the Mediterranean at the time, while at the same time it recounts the terrible plague which went down in history as the Great Plague of Candia (1592-1595). The study will also attempt to give a satisfactory answer to the epidemiological questions raised by the worst epidemic that Crete had experienced since the era of the Black Death in the 14th century. The city was about to lose more than a half of its population (51.3%), although it was saved from complete annihilation by the composure, courage and inventiveness of its Venetian commander, Filippo Pasqualigo, whose report to the Venetian Senate makes an invaluable source of information regarding the events of this dramatic period. Candia would also witness the emergence of typical human reactions in cases of epidemics and mass deaths, such as running away along with the feeling of self-preservation, dissolute life and ephemeral pleasures, as well as lawlessness and criminality. The lazaretto proved inefficient in the face of a disaster of such scale, whereas the epidemic functioned as a “crash-test” for the Venetian health system. Eventually, in an era when the microbial nature of the disease was unknown, it seems that it was practically impossible to handle emergency situations of large-scale epidemics successfully, despite strict laws and well-organized precautionary health systems.
