Volume 23, Issue 3, 2015
Review
Predisposing factors endorsing Candida infections
Singh Shweta,
Fatima Zeeshan,
Hameed Saif
Candida albicans is an opportunistic human fungal pathogen which is involved in infections ranging from superficial, mucosal to systemic candidiasis. It is the fourth most leading cause of death in nosocomial infections. Candidal infections are increasing at an alarming rate due to poor clinical management in hospital settings, more use of antibiotics, increased drug resistance, immunosuppression and host-pathogen related factors. There are various predisposing factors which can be immunologic or non-immunologic in origin that make a person susceptible to such infections. This review article establishes the need to understand the various predisposing factors leading to Candidal infections and discusses them on a common platform.
Nasopharyngeal carcinoma: review of the literature with a focus on therapeutical implications
Strazzulla Alessio,
Settimo Giorgio,
Giancotti Aida,
Pisani Vincenzo,
Costa Chiara,
Zicca Emilia,
La Boria Alessandro,
Roveda Laura,
Liberto Maria Carla,
Tucci Luigi,
Donato Giuseppe,
Focà Alfredo,
Torti Carlo
Nasopharyngeal carcinoma (NPC) is a rare neoplasm which is associated with Epstein-Barr virus (EBV). First of all, we reviewed the literature on NPC treatment. Radio/chemotherapy is currently the gold standard but unfortunately it is affected by rates of failure ranging from 7% up to 58%. Because NPC development is promoted by the EBV latent life cycle, EBV-targeted treatments were investigated. Firstly, forcing cytolytic virus activation through administration of gemcitabine and/or valproic acid before administration of a nucleoside analogue showed anti-tumoral activity in vitro as well as in murine model and it was also well tolerated in humans. Secondly, the association of autologous EBV-specific cytotoxic T lymphocytes with chemotherapy correlated with an improved median survival and was safe but not effective versus metastatic lesions. Thirdly, suppression of late membrane protein-1 in the clinic proved controversial because it gave resistance to chemotherapy and, on the other hand, increased radiosensitivity. Finally, we suggest future perspectives for clinical research which should include both prospective and observational cohort studies to assess the role of different risk factors in the development of NPC and the effectiveness of new investigational treatments.
Original article
Procalcitonin, C-reactive protein and serum lactate dehydrogenase in the diagnosis of bacterial sepsis, SIRS and systemic candidiasis
Miglietta Fabio,
Faneschi Maria Letizia,
Lobreglio Giambattista,
Palumbo Claudio,
Rizzo Adriana,
Cucurachi Marco,
Portaccio Gerolamo,
Guerra Francesco,
Pizzolante Maria
The aim of this study was to evaluate procalcitonin (PCT), C-reactive protein (CRP), platelet count (PLT) and serum lactate dehydrogenase (LDH) as early markers for diagnosis of SIRS, bacterial sepsis and systemic candidiasis in intensive care unit (ICU) patients. Based on blood culture results, the patients were divided into a sepsis group (70 patients), a SIRS group (42 patients) and a systemic candidiasis group (33 patients). PCT, CRP, LDH and PLT levels were measured on day 0 and on day 2 from the sepsis symptom onset. PCT levels were higher in Gram negative sepsis than those in Gram positive sepsis, although the P-value between the two subgroups is not significant (P=0.095). Bacterial sepsis group had higher PCT and CRP levels compared with the systemic candidiasis group, whereas PLT and LDH levels showed similar levels in these two subgroups. The AUC for PCT (AUC: 0.892, P <0.001) was larger than for CRP (AUC: 0.738, P <0.001). The best cut-off values for PCT and CRP were 0.99 ng/mL and 76.2 mg/L, respectively. Diagnostic sensitivity and specificity for PCT were 84.3% and 81.8% whereas CRP showed a sensitivity of 77.2% and a specificity of 63.6%. However, PCT was unable to discriminate between SIRS and systemic candidiasis groups (P=0.093 N.S.). In conclusion, PCT can be used as a preliminary marker in the event of clinical suspicion of systemic candidiasis; however, low PCT levels (<0.99 ng/mL) necessarily require the use of other specific markers of candidaemia to confirm the diagnosis, due to great uniformity of PCT levels in systemic candidiasis and SIRS groups.
The role of zinc in acute pyelonephritis
Mahyar Abolfazl,
Ayazi Parviz,
Farzadmanesh Shahin,
Sahmani Mehdi,
Oveisi Sonia,
Chegini Victoria,
Esmaeily Shiva
This study was conducted to determine the serum concentration of zinc in children with acute pyelonephritis. Serum zinc levels of 60 children with acute pyelonephritis and 60 healthy children were compared. Acute pyelonephritis was diagnosed using Tc-99m dimercaptosuccinic acid (DMSA) renal scan. Serum zinc levels were measured by the atomic absorption flame spectrophotometry. The levels in question in the case and control groups were 70.73 ± 14.15 and 87.61 ± 12.68 µg/dL, respectively (P=0.001). There was no correlation between serum zinc level with inflammatory markers, severity of acute pyelonephritis and duration of the disease. This study showed that there is a correlation between serum zinc level and acute pyelonephritis. Zinc would therefore appear to play a certain role in the pathogenesis of acute pyelonephritis.
Catheter-associated urinary tract infection (CA-UTI) incidence in an Internal Medicine Ward of a Northern Italian Hospital
Izzo Ilaria,
Lania Donatella,
Bella Daniele,
Formaini-Marioni Cesare,
Coccaglio Romana,
Colombini Paolo
Catheter-associated urinary tract infections (CA-UTI) are estimated to be the most frequent nosocomial infections (40%). A catheter is introduced to 10-25% of inpatients, and is often left on site for a long period of time. We carried out a prospective study on inpatients of our Internal Medicine ward to assess the incidence of CA-UTI under the implementation of corrective action. All inpatients who underwent introduction of a urinary catheter upon or after admission to our ward were included in the study. Patients with bacteriuria or positive urine culture before catheterization, others with less than 24 hours catheterism, or bearing a catheter on admission were all excluded from the study. CA-UTI diagnosis was assessed on the basis of CDC 2009 guidelines. The investigation was held between June 2010 and March 2013 in five steps or phases. In the first phase open circuit drainage catheterism was used, in the second phase close circuit drainage catheterism was introduced, while in the third phase disposable lubrification was added to closed circuit drainage catheterism. In the next step (phase 4) we introduced number of days of catheterism control and nurse training; in the last phase (5) emptying urine collection bags on a container was added. In phase 1 we estimated six UTIs out of 18 patients (incidence 33%), in phase 2 we had four infections out of 10 patients (40%). Given the results, we had to reflect on the quality of the procedures of catheter positioning and management . Where feasible, we improved technical practices and during follow-up there was evidence of CA-UTI in 10 patients over 25 (phase 3, 40%), and eight infections over 25 (phase 4, 32%). Once all these steps had been implemented, in phase 5 we determined a sharp reduction in CA-UTI (2 patients over 27, or 7.5%, p=0.025). This improvement was particularly evident in the rate of infection per days of catheter, which was reduced from 43.4/1000 to 13.6/1000. Although the statistical power of the present study has its limitations, we attained a significant reduction in catheter-associated UTIs through the implementation of close circuit catheterism and improvements in care practices.
Comparison of manual and automated nucleic acid isolation methods for HBV-DNA and HCV-RNA assays
Yagmur Gulhan,
Uludag Altun Hatice,
Gökahmetoglu Selma,
Basok Ela
In the diagnosis and monitoring of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, it is important to use methods that can provide rapid and reliable results. The present study aimed to compare the automated and manual extraction methods during the nucleic acid isolation phase for HBV-DNA and HCV-RNA assays. The study included 93 serum samples, 49 of which were for the HBV-DNA assay and 44 for the HCV-RNA assay. DNA and RNA isolation from the samples was performed manually with a “QIAmpMin Elute Kit” (Qiagen, Germany) and the automated isolation system, NucliSens easyMAG (BioMérieux, France). All the extraction products were amplified using the iCycler device (Bio-Rad, USA). With both methods, compliance was found in 21 (42.8%) samples in the HBV-DNA assay; nine (18.3%) samples had a higher amount of viral nucleic acid with the manual method, whereas 19 samples (38.7%) were found to have a higher amount of nucleic acid with the automated system. For the HCV-RNA assay, total compliance was found in 31 (70.4%) samples; 12 (27.2%) samples had a higher amount of viral nucleic acid with the manual method whereas one sample (2.2%) was found to have a higher amount of nucleic acid with the automated system. It was concluded that the NucliSens easyMAG automated isolation system can be used with confidence for nucleic acid extraction due to its higher sensitivity, providing results in a shorter time, and assured standardization.
Seroprevalence of hepatitis E virus (HEV) infection in blood donors and renal transplant recipients: a retrospective study from central Italy
Puttini Camilla,
Riccio Maria Letizia,
Redi David,
Tordini Giacinta,
Cenerini Melissa,
Romanello Fulvia,
De Luca Andrea,
Carmellini Mario,
Fossombroni Vittorio,
Cusi Maria Grazia,
Zanelli Giacomo
Autochthonous hepatitis E virus (HEV) is an emerging health issue in developed countries and is thought to be a porcine zoonosis; its spread is underestimated and there is concern about the possibility of chronic infection in immunosuppressed patients; HEV transmission through blood has also been demonstrated. We conducted a retrospective study (2007-2013) on HEV seroprevalence using stored serum samples from 132 blood donors and 118 renal transplant recipients living mainly in central Italy. Anti-HEV IgG was positive in 12/132 (9.1%) of the blood donors and 12/118 (10.2%) of the transplant recipients. All subjects but one were autochthonous and none showed signs of liver disease at the time of sampling. A significant association was documented between mean age of patients and the serology against HEV especially in the group of blood donors. Our study, albeit limited and retrospective, confirms the circulation of autochthonous HEV in central Italy; the presence of antibodies against HEV in particular categories of persons such as blood donors and transplant patients, who are not screened for the infection, raises questions in terms of transfusion safety and health protection of immunocompromised patients.
Case report
Brucellosis as a primary cause of tenosynovitis of the extensor muscle of the arm
Tekin Recep,
Cevik Figen Ceylan,
Tekin Rojbin Ceylan,
Cevik Remzi
Osteoarticular involvement is the most frequently observed complication of brucellosis. Brucellosis tenosynovitis of the extensor tendon sheath is an extremely rare manifestation of musculoskeletal brucellosis. A 36-year-old male patient presented with described pain in his right wrist that had started six days earlier. There was also a diffuse swelling in the 1st finger of his right hand. The patient described fever, night sweats, widespread muscle pain and fatigue that had been going on for the last six days. Standard tube agglutination for Brucella was positive at a titre of 1/320. At diagnosis, the patient showed radiographic abnormalities. Doxycycline 200 mg/d and rifampicin 600 mg/d were given for six weeks. Complete resolution was achieved with medical treatment.
Disseminated Mycobacterium avium complex disease in a patient with left ventricular assist device (Heart Mate II)
Cordioli Maddalena,
Del Bravo Paola,
Rigo Fabio,
Azzini Anna Maria,
Merighi Mara,
Forni Alberto,
Concia Ercole
Although disseminated Mycobacterium avium complex disease occurs mainly in immunocompromised hosts, especially HIV-infected patients in the last stage of the disease (AIDS), this condition is still rare in immunocompetent subjects. We report the case of a Caucasian man who received a left ventricular assist device two years before as a bridge to heart transplantation, that began to present signs and symptoms of mycobacterial infection. The diagnostic work-up we performed showed the presence of Mycobacterium intracellulare in lungs and both peripherical and bone marrow blood. Although evaluated, we found no abnormalities in the patient’s immune system that can be related to mycobacterial infection. The beginning of a specific therapy made the patient slowly improve and further nuclear medicine assay (PET-TC) showed a good reduction in radio-labelled drug captation.
Severe invasive pulmonary zygomycosis by Rhizomucor pusillus and concomitant severe bacterial endocarditis in acute promyelocytic leukaemia
Rocconi Roberta,
Mazzucato Sandra,
Farina Claudio,
Grandesso Stefano
We describe a severe pulmonary invasive zygomycosis sustained by Rhizomucor pusillus and concomitant bacterial endocarditis in a woman diagnosed with acute promyelocytic leukaemia.
Geotrichum capitatum respiratory tract infection in a patient with polytrauma
Radic Marina,
Goic-Barisic Ivana,
Kuscevic Dorjan,
Novak Anita,
Tonkic Marija,
Rubic Zana
Geotrichum capitatum is a rare pathogen that causes opportunistic fungal infections in immunocompromised patients, particulary in patients with hematological malignancies. We report the case of a 72-year patient with polytrauma whose outcome was fatal. During his stay in the intensive care unit (ICU), he received a broad-spectrum antimicrobial therapy and underwent different invasive procedures. After becoming febrile on the 7th day of admission, two consecutive bronchoalveolar lavage (BAL) specimens were taken for microbiological analysis. The isolated species came as G. capitatum, that was identified using VITEK 2. Unfortunately, patient died before fungal identification, so the antifungal therapy wasn't administered. This case presentation emphasizes the importance of Geotrichum capitatum as an emerging fungal pathogen, as well as the significance of the predisponing factors that contributed to development of infection.
Endocarditis and meningitis associated to nape piercing in a young female: a case report
Mariano Andrea,
Pisapia Raffaella,
Abdeddaim Amina,
Taibi Chiara,
Rianda Alessia,
Vincenzi Laura,
D Offizi Gianpiero
Body piercing is a social phenomenon on the rise especially among young people. This procedure may be complicated by serious bacterial and viral infections. We report a case of Staphylococcus aureus infective endocarditis and meningitis arising from the site of a nape piercing, after its removal. A 21-year-old Italian female was admitted to hospital with neurological impairment and sepsis. A diagnosis of endocarditis associated with meningitis by S. aureus, complicated by septic emboli in the brain, retina, skin and kidney, was formulated on the basis of modified Duke’s criteria. The likely port-of-entry was the site of a nape piercing, removed two months before. In view of the widespread practice of body piercing, provision of correct and timely information concerning the associated serious risks is now imperative. Such information should emphasise the option for antibiotic prophylaxis, and the importance of careful local hygiene, even after piercing removal.
Wound botulism after traumatic open fracture in Italy
De Rosa Francesco Giuseppe,
Stella Maria Laura,
Astegiano Sara,
Corcione Silvia,
Motta Ilaria,
Decastelli Lucia,
Di Perri Giovanni
Seventeen days after a traumatic open fracture, a Clostridium botulinum wound infection was diagnosed, with self-limiting symptoms. This is the first report of wound botulism in Italy and the authors discuss the possible role of aerosolized contamination of the wound prior to hospital admission.
The Infections in the History of Medicine
Lord Byron’s death: a case of late malarial relapse?
Tsiamis Costas,
Piperaki Evangelia-Theophano,
Kalantzis George,
Poulakou-Rebelakou Effie,
Tompros Nikolaos,
Thalassinou Eleni,
Spiliopoulou Chara,
Tsakris Athanassios
The study examines the pathological circumstances related to Byron’s death, the primary issue being malaria. Lord Byron died during the Greek War of Independence against the Ottoman Empire, in Messolonghi on 19 April 1824. Byron’s medical profile consists of recurrent onsets of fever, which gave rise to the suspicion of malaria relapses. According to Byron’s letters he reported crises of fever in Greece (1810), Malta (1811), Italy (1817-1819) and England. Evidence from Byron's autopsy, specifically the absence of hepatosplenomegaly, does not support a hypothetical diagnosis of malaria. Nonetheless, the relapsing fevers cannot be ignored and the same applies to the possibility of malaria relapse or re-infection in line with the endemic nature of the Messolonghi area. Our research on the chronologies of Byron’s reported fevers found that new attacks occurred at intervals of 540 days on average. Moreover, the most outstanding feature of Plasmodium vivax and Plasmodium ovale is their ability to form dormant forms of hypnozoites in the liver which, when reactivated (110-777 days), cause true relapses of clinical disease. Of course, an ex post facto diagnosis is under debate, because the malaria diagnosis is not clinical but microscopic. Byron’s example raises alarm over a current medical problem, i.e. the diagnosis of unexplained fevers, and the need for a detailed travel or immigration history, which will include malaria in the differential diagnosis.
Letters to the editor
Atypical exanthems associated with parvovirus B19 infection: similarities and differences between adults and children
Drago Francesco,
Ciccarese Giulia,
Javor Sanja,
Cozzani Emanuele,
Parodi Aurora
Not available
Risk factors for carotid atherosclerosis in chronic hepatitis C: no role of the APOC3 variant
Zampino Rosa,
Florio Anna,
Grandone Anna,
Capoluongo Nicolina,
Marrone Aldo,
Minichini Carmine,
Adinolfi Luigi Elio,
del Giudice Emanuele Miraglia,
Coppola Nicola
Not available
