Volume 23, Issue 1, 2015
Original article
Health status of users of the Bologna local health authority drug addiction treatment services: a study of hospital admissions in the period 2004-201301
Pavarin Raimondo Maria,
Gambini Daniele
The aim of this study was to monitor the health status of the users of the services for drug addiction (SERT) in the metropolitan area of Bologna by analysing the hospital discharge records (SDO). For the period 2004-2013, among the residents of the metropolitan areas aged 15-64, we compared the trend in hospital admissions of SERT users with that of the general population. We calculated the standardised rates of hospitalisation and the likelihood of admission. Over the period in question the standardised hospitalisation rates decreased, with a larger drop among SERT users (330.17 males per 10,000 inhabitants in 2004, 215.91 in 2013; 547.60 females per 10,000 inhabitants in 2004, 283.20 in 2013) as compared with the general population (109.49 males in 2004, 82.16 in 2013; 161.40 females in 2004, 124.38 in 2013). Admission likelihood was always higher for SERT users, but was lower in 2013 than in 2004, especially for infectious diseases and psychic disorders. The results highlight the effectiveness of Bologna’s local system of services in taking care of aspects connected to addiction, as well as health-related disorders.
A survey on antibiotic therapy knowledge among physicians of a tertiary care and university hospital
Gentile Ivan,
Landolfo Danilo,
Riccardo Antonio,
Crispo Manuel,
Iula Vita Dora,
Minei Giuseppina,
Catania Maria Rosaria,
Borgia Guglielmo
Antibiotic therapy has resulted in major progress in the fight against infectious diseases and is associated with an improved quality of life and increased survival. However, the emergence of resistant bacterial strains represents an inevitable consequence of antibiotic treatment and yields a loss of beneficial effects. Due to the scarce availability of new molecules in the near future, physicians have to learn how to best use currently available molecules. The aim of the present study was to evaluate the criteria that physicians use in choosing targeted antibiotic therapy. To achieve this goal, we used a questionnaire comprising seven questions. The questionnaire was administered, with the guarantee of anonymity, to a pool of physicians at the Federico II University Hospital of Naples who could prescribe antibiotics. Of the physicians interviewed, 68% chose antibiotic therapy autonomously or in cooperation with other doctors of the same structure, whereas 30% of interviewees referred to the infectious diseases consultant (8% after the first bacterial isolation and 22% after antibiotic therapy failure). The definition and meaning of minimum inhibitory concentration (MIC) were known to the vast majority of physicians (82% and 83%, respectively). In contrast, few of the interviewees knew the definition or meaning of breakpoint (16% and 17%, respectively). The key question of the questionnaire focused on the main criterion for antibiotic choice: 68% of interviewees gave an incorrect answer, most interviewees considering only the lowest MIC value for the isolated bacterium as the fundamental parameter in antibiotic choice. Our study shows that antibiotic therapy in a teaching hospital is often chosen using inappropriate criteria. Due to the well-known effects of the wrong antibiotic choice on therapeutic failure rate and on healthcare cost, information and training programmes for physicians who prescribe antibiotics are urgently needed.
Evaluation of various staphylococcal cassette chromosome mec (SCCmec) types in Staphylococcus epidermidis invasive strains from hospitalised patients in Iran
Havaei Seyed Asghar,
Namvar Amirmorteza Ebrahimzadeh,
Moghim Sharareh,
Lari Abdolaziz Rastegar
Staphylococcus epidermidis is known to be a major cause of nosocomial infections particularly in catheter-associated bacteraemia, prosthetic valve endocarditis (PVE) and immunocompromised patients in different health care units. The emergence of multidrug-resistant strains, especially to beta-lactam antibiotics such as methicillin, has increased the mortality due to S. epidermidis. A kind of low affinity penicillin-binding protein (PBP2alfa), which is encoded by the mecA gene that is located in the staphylococcal cassette chromosome mec (SCCmec), mediates the resistance to methicillin. The aim of this study was to investigate the prevalence of SCCmec types and evaluate the antibiotic profile assay in invasive strains isolated from clinical samples. The study focused on invasive strains, determining the antimicrobial resistance profile, designing new primers for detection of the mecA gene and SCCmec typing with the multiplex PCR method. By using the PCR molecular test, 87.1% of all isolates were found to be positive for the mecA gene. In SCCmec typing, different types (I-V) were identified, in which SCCmec type I was detected in 3 isolates, SCCmec type II in 5 isolates, SCCmec type III in 22 isolates, SCCmec type IV in 27 isolates and SCCmec type V was distinguished in 4 isolates. Since coagulase-negative staphylococci are reported as a major cause of hospital infections, molecular typing methods like SCCmec typing would be a helpful method to control and prevent bacterial infections.
Determination of CTX-M beta-lactamase in Escherichia coli strains isolated from clinical samples
Yavuz Basak,
Ozer Burcin,
Inci Melek,
Duran Nizami
The aim of this study was to determine the ESBL with phenotypic tests and investigate the blaCTX-M genes with the PCR method in Escherichia coli strains. The presence of ESBL in E. coli strains was determined with the Vitek 2 automated system. ESBL-positive 100 and ESBL-negative 50 E. coli strains were included in the study. The ESBL disk diffusion screening test (DDST) and the combined disk confirmation tests (CDCT) were performed on these strains and the results of these tests were compared with each other. blaCTX-M genes were investigated with the PCR method. The results of CDCT-CAZ/CZC and CDCT-CTX/CTC were found to be consistent in 90% of strains. Those of the automated system, DDST and CDCT-CAZ/CZC were compatible with each other in 83.3% of strains. Also the results of the automated system and CDCT-CTX/CTC were found to be compatible in 83.3% of strains. Based on PCR, blaCTX-M genes were found in 67.3% of 150 strains. According to the order of frequency, 46%, 38.7%, 20%, 7.3% of strains were determined to carry groups I, IV, II and III, respectively.
Tenofovir disoproxil fumarate treatment in HbeAg-positive patients
Ayaz Celal,
Celen Mustafa Kemal,
Dal Tuba,
Deveci Ozcan,
Bayan Kadim,
Mert Duygu,
Oruc Ebru,
Ozcan Nida,
Kandemir Idris,
Dal Mehmet Sinal
Tenofovir disoproxil fumarate (Tenofovir DF) is a nucleotide analogue. This multicentre study reports retrospectively the long-term efficacy and safety data with tenofovir DF treatment in nucleosid(t)e-naive, hepatitis B e antigen (HBeAg)-positive chronic hepatitis B patients. Thirty-one patients (11 females, 20 males) received 245 mg tenofovir DF per diem. All patients’ initial serum hepatitis B virus (HBV) DNA levels were over 2,000 IU/ml. Serum alanine aminotransferase (ALT) levels, HBeAg, hepatitis B e antibodies (anti-HBe), hepatitis B surface antigen (HBsAg), hepatitis B surface antibodies (Anti-HBs), HBV DNA, creatinine and urea levels were evaluated at baseline, and at weeks 12, 24, 48 and 96 during therapy. Thirty-one patients completed 96 weeks of treatment. Mean age was 37.6 +/- 9.4 years. The initial mean value of ALT was 79 +/- 39.9 IU/L. At baseline, mean of fibrosis (Ishak) of liver biopsies was 2.3 +/- 0.7. Two of the patients (5.9%) achieved HBV DNA less than 300 copies at week 12 of treatment and 97.1 % at week 96. HBeAg loss was observed in 6.7% of patients. At week 96, HBsAg loss was not observed in any of the patients. Mean ALT at week 48 was 32.7 U/L, at week 96 32.6 U/L. Renal safety was good. Creatinine remained stable. Tenofovir DF was well tolerated and produced potent, continuous viral suppression with increasing HBeAg loss.
A prospective evaluation of maraviroc administration in patients with advanced HIV disease and multiple comorbidities: focus on efficacy and tolerability issues
Manfredi Roberto,
Calza Leonardo,
Marinacci Ginevra,
Cascavilla Alessandra,
Colangeli Vincenzo,
Salvadori Caterina,
Martelli Giulia,
Appolloni Lucia,
Puggioli Cristina,
Viale Pierluigi
In our HIV outpatient centre where over 1,200 patients are followed, maraviroc as an entry inhibitor was introduced in 2010. We aimed to assess the background, the therapeutic challenges and the prospective monitoring of all patients treated with a combination antiretroviral therapy (cART) including maraviroc. Sixty-six patients started a maraviroc-containing cART with a history of HIV infection lasting 13.9 +/- 10.7 years. This interim analysis presents patients who had at least 12 (mean 16.9 +/- 12.8) months of follow-up. One to 17 previous cART changes prompted the introduction of maraviroc in rescue regimens in the great majority of patients considered (53 of 66); in 13 cases, maraviroc was given to patients with advanced HIV disease and no immune recovery after 2-3 years of a virologically-effective cART. The most frequent companion antiretroviral agents were: darunavir/ritonavir (51 cases), raltegravir (49 subjects), and etravirine (36 cases). The most common underlying conditions were: AIDS (41 cases), liver cirrhosis (21), AIDS-related or other malignancies (20 cases), major cardiovascular events (18 cases), osteonecrosis and haemodialysis-treated kidney failure (3 cases each). A chronic HCV and HBV hepatitis were of concern in 25 and 13 patients. The addition of maraviroc added favourably to clinical-laboratory markers of HIV disease progression, and those of comorbid conditions. HIV viraemia became (or remained) undetectable in 55 patients of 66 (83.3%). An improvement in CD4+ count was observed in all 66 patients, based on a mean 24.9 +/- 19.2% increase versus baseline, paralleled by an improvement in mean absolute CD4+ count of 134.7 +/- 121.1 cells/mcL. A tendency towards an increased mean and peak CD4+ count was observed in the subgroup receiving a maraviroc-raltegravir-based cART. As no clinical-laboratory adverse events attributable to maraviroc occurred, nobody discontinued the study drug. Only mild-transient gastrointestinal disturbances, fatigue and anorexia, were reported during maraviroc administration, but their relationship with the study drug was difficult to assess because of the multiple comorbidities and polypharmacy. Our preliminary experience with maraviroc, even considering the limits of the proportionally reduced sample, the patients’ salvage stage of advanced disease and the related-unrelated morbidities, underlines its excellent efficacy and safety profile.
Case report
Aerosolized amphotericin B lipid complex and invasive pulmonary aspergillosis: a case report
Canetti Diana,
Cazzadori Angelo,
Adami Irene,
Lifrieri Francesca,
Cristino Stefania,
Concia Ercole
Invasive pulmonary aspergillosis (IPA) is an emerging life-threatening infection in immuno-compromised patients. The incidence of IPA following kidney transplantation is low (between 0.7 and 4%), yet mortality remains unacceptably high (75-80%). A first line therapy with voriconazole or lipid formulations of amphotericin B is often limited by co-morbidities, adverse effects and drug interactions. The case within this publication is the first described report of IPA in a renal transplant recipient responding to aerosolized amphotericin B lipid complex.
Performance of Alere Determine HIV-1/2 Ag/Ab Combo rapid test for acute HIV infection: a case report
Lanzafame Massimiliano,
Zorzi Antonella,
Rigo Fabio,
Adami Irene,
Del Bravo Paola,
Tonolli Elisabetta,
Concia Ercole,
Azzini Anna Maria
We describe a case of symptomatic acute HIV infection in a young man where a fourth-generation rapid screening test combining HIV-specific antibody and p24 antigen was negative. In highly suspicious cases of acute HIV infection, plasma HIV RNA assays together with conventional, non-rapid screening tests should be used.
Thalamo-mesencephalic aspergillus abscess in a heart transplant subject: a case report and literature review
Mazzaferri Fulvia,
Adami Irene,
Tocco Pierluigi,
Cazzadori Angelo,
Merighi Mara,
Forni Alberto,
Storato Silvia,
Ferrari Sergio,
Concia Ercole
Cerebral aspergillosis is a rare and highly fatal infection that mainly affects immunocompromised patients. We report on a case of a heart transplanted Caucasian man, who arrived at our hospital because of the onset of diplopy. We performed a broad diagnostic work-up: the brain MRI showed a single ring-enhancing thalamo-mesencephalic area suggestive of abscess lesion; cerebrospinal fluid (CSF) analysis disclosed galactomannan and β-D-glucan antigens. Thus the antifungal therapy was immediately started. We decided to discontinue the therapy 16 months later because of severe hepatic toxicity, given that the patient was persistently asymptomatic, brain imaging showed a progressive resolution of the abscess area and CSF antigen analysis was persistently negative. The follow-up at three months was unchanged.
An 81-year-old male with iliopsoas abscess by Streptococcus sanguis
dos Santos Vitorino Modesto,
Fachinelli Letícia Rita,
Farage Luciano,
Lima Gylseanne de Souza,
Machado de Carvalho Maíra Rocha,
Noguera de Andrade Igor Gabriel
Iliopsoas muscle abscess is an uncommon condition, which has been growing in incidence. We describe a primary iliopsoas abscess by Streptococcus sanguis affecting an 81-year-old man cured by antibiotic therapy and aspiration procedure. The objective is to enhance the suspicion index about the iliopsoas abscess that may be mistaken for other causes of acute abdomen. The important diagnostic role of abdominal imaging studies is also emphasised.
Histoplasmosis: the multiple sides of a an uncommon disease
Amadori Francesco,
Doria Roberta,
Gemignani Giulia,
Flammini Sarah,
Leonildi Alessandro,
Ciancia Eugenio Maria,
Sanguinetti Maurizio,
Menichetti Francesco
Disseminated histoplasmosis is an invasive fungal infection documented in patients with impaired cellular immunity coming from endemic areas (America, Asia, Africa). We report two cases of disseminated histoplasmosis in AIDS patients paradigmatic of the multifaceted nature of the disease, which may be an expression either of an advanced state of immunosuppression or the immune reconstitution inflammatory syndrome (IRIS).
Leg ulcer and osteomyelitis due to methicillin-susceptible Staphylococcus aureus infection after fracture repair treatment: a case highlighting the potential role of prostaglandin E1 vasodilator
Bentivegna Erminia,
Citarrella Emanuele,
Vivaldi Roberto,
De Luca Dario,
Maira Giovanna Grazia,
Casuccio Alessandra,
Di Carlo Paola
Prostaglandins appear to reduce biofilm formation and chronicization of infections, and stimulate a rapid and effective clearance of infecting micro-organisms. We report a case of recovery from methicillin-susceptible Staphylococcus aureus (MSSA) osteomyelitis after multidisciplinary management with antibiotics, anti-thrombotics and prostaglandin E1 (PGE1) vasodilator, in a patient with tibial plateau fracture repaired with internal fixation devices. A 47-year-old HIV-negative male with chronic ulcer on the proximal third of the left leg was admitted to the Orthopaedic Unit of the Orestano Clinic in Palermo, Italy, for suspected osteomyelitis. A biopsy of the skin ulcer and blood cultures were performed and resulted positive for MSSA. Labelled leukocyte scintigraphy confirmed osteomyelitis. No clinical improvement was observed after combined antibiotic treatment with rifampicin plus trimethoprim-sulfamethoxazole. The patient underwent a 4-day therapeutic cycle: PGE1 (alprostadil 60 mg/day IV) combined with nadroparin calcium plus gentamicin, followed by treatment with aminaftone plus sulodexide plus levofloxacin. At discharge, the patient's painful symptoms had completely resolved and the ulcer had cicatrized; recovery from osteomyelitis was confirmed by scintigraphy. This treatment protocol including PGE1 may result in a significant improvement in quality of life and functional status of patients with a reduction in direct and indirect costs and economic benefit for the National Health Service.
Macroscopic haemoglobinuria associated with Mycoplasma pneumoniae infection successfully treated by clarithromycin
Kazama Itsuro,
Tamada Tsutomu,
Nakajima Toshiyuki
A 25-year-old man developed macroscopic haemoglobinuria after a persistent dry cough. Although chest radiograph findings were normal, since the serum antibody for Mycoplasma pneumoniae was significantly elevated, a diagnosis infection with this organism was made. Despite the absence of apparent anaemia, a marked increase in serum haemolytic markers and positive result for urine haemoglobin indicated the haemolysis of red blood cells, which was likely to have occurred secondarily to M. pneumoniae infection. Shortly after the initiation of a macrolide antibiotic, clarithromycin, the patient’s haemoglobinuria completely disappeared together with a complete resolution of his respiratory symptoms. In this case, due to the lymphocyte-stimulatory nature of M. pneumoniae, an enhanced immune response, such as the production of cold agglutinins, was likely to be involved in the pathogenesis of erythrocyte haemolysis. The immunomodulatory property of clarithromycin was thought to repress the increased immunological reaction and thus enable the resolution of the urine abnormality.
The Infections in the History of Medicine
The first announcement about the 1918 "Spanish flu" pandemic in Greece through the writings of the pioneer newspaper “Thessalia" almost a century ago
Tsoucalas Gregory,
Karachaliou Fotini,
Kalogirou Vasiliki,
Gatos Giorgos,
Mavrogiannaki Eirini,
Antoniou Antonios,
Gatos Konstantinos
A local pioneer newspaper, "Thessalia", was the first to announce the arrival of "Spanish Flu" in Greece. It was July 19th 1918 when an epidemic outbreak occurred in the city of Patras. Until then, "Thessalia" had dealt in depth with the flu pandemic in the Greek district of Thessaly, informing the readers of the measures taken, as well as the social and economic aspects of the flu.
Mycobacterium infection in prehistoric humans: co-evolution in remote ages
Sabbatani Sandro,
Fiorino Sirio
The introduction of agriculture and animal husbandry at the end of the Mesolithic era, despite enabling a significant demographic growth through an increase in food storage and availability, caused new infectious noxae to enter the pathocoenosis. However in the Palaeolithic era, hunter-gatherers were already in contact with infectious diseases of animal origin, albeit episodically. Modern biomedical technologies allow us to estimate, with better approximation, how long mankind has been in contact with Mycobacterium tuberculosis. Archaeological finds, including human and animal remains (especially the aurochs), are particularly studied by palaeopathologists, as mycobacteria frequently cause bone involvement and this characteristic is of particular interest for palaeopathological (even macroscopic) studies; the interest is to detect the ancient DNA of MT, which is the cause of bone tuberculosis in skeletal remains as well as in mummies. According to our present knowledge, palaeopathological findings, confirmed by molecular techniques, suggest that tuberculosis in human skeletons goes back at most to 9000 years ago, while, in a veterinary environment, the most ancient DNA of MTBC to be detected in an American bison dates back about 17,000 years. The possibility of discovering archaeological finds making even more ancient human remains available leaves opens up the possibility of dating back to previous eras the transmission of MTBC infection to mankind. Phylogenetic works examining the available materials (DNAa) suggest that Mycobacterium tuberculosis, the cause of tuberculosis infection in humans and cattle (Aurochs), would have had a co-evolutionary process.
On the basis of recent phylogenetic studies, the MTBC genome would have had a wide span of time to reach a suitable adjustment, co-evolving in geographical environments both at high and low host density. It is likely that the strains that did not show this strong “flexibility” underwent extinction, in favour of more versatile, adaptable strains, that are able to infect susceptible hosts “always” and in any environmental condition.
