Volume 23, Issue 4, 2015
Review
Role of prulifloxacin in the treatment of acute rhinosinusitis
Passali Desiderio,
Crisanti Anna,
Bellussi Luisa Maria
Acute rhinosinusitis (ARS) is a very common disease faced more often by general practitioners than ear, nose and throat specialists, pneumologists or allergologists. In an outpatients’ setting, upper respiratory tract infection is the third most common cause of a primary care consultation, one third of which is attributable to ARS, diagnosed upon clinical presentation. In some cases however, signs and symptoms do not allow clear differentiation from viral, post-viral or bacterial infection. This compels GPs and family doctors to make a careful choice and first use the best antimicrobial treatment to avoid recurrences or complications and the rise of antibiotic resistance. Amoxicillin, thanks to its narrow spectrum against likely respiratory pathogens, is recommended as first-line therapy to treat acute bacterial rhinosinusitis by several international guidelines, being safe at the same time. Other antibiotics (beta-lactams, macrolides and newer drugs, such as fluoroquinolones) have been evaluated in double-blind studies versus placebo or comparative studies in terms of efficacy, safety and costs. Prulifloxacin, the active metabolite of ulifloxacin, is an oral fluoroquinolone with a broad in vitro activity spectrum against Gram-positive and negative bacteria and among fluoroquinolones has the lowest power of inducing resistance. In vitro and in vivo studies have shown its clinical efficacy and pathogen eradication. Ulifloxacin T1/2 and plasma and tissue concentrations including the nose-paranasal sinuses mucosa allow once daily administration at the dosage of 600 mg.
Prulifloxacin shows a high safety profile: it is the fluoroquinolone with the lowest risk of cardiac arrhythmias for prolongation of the QT interval; the CNS penetration is negligible; in women prulifloxacin does not affect the lactobacillary component of the vaginal microbiota, lowering the risk of genito-urinary tract infections. The pharmacokinetic characteristics and safety profile of prulifloxacin make it the antibiotic option with the best potential to achieve clinical cures and bacteriological eradication, well tolerated and safe without specific restriction or posologic changes in the elderly and in patients with co-morbidities in multiple treatment, hence resolving ARS reliably and being simple and easy to administer.
Eosinophils and eosinophilia
Scarlata Francesco
Eosinophils were previously considered granulocytes involved in host protection against helminth infections and in inflammation related to atopic diseases. Instead, as supported by recent studies, eosinophils are today considered multifunctional cells involved also in homeostasis of the gastrointestinal tract and other organs, conferring innate and adaptive immunity to certain bacteria and viruses, and perhaps in the control of oncogenicity. Unexplained eosinophilia could be an expression of paraneoplastic syndrome or constitutional factors. Irrespective of the underlying conditions and aetiology of eosinophilia, eosinophil-derived substances may induce potentially irreversible organ damage. A diagnostic algorithm is discussed.
Dalbavancin for the treatment of acute bacterial skin and skin structure infections
Esposito Silvano,
Noviello Silvana,
Leone Sebastiano
Dalbavancin is a novel parenteral lipoglycopeptide antibiotic approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) in adults. Dalbavancin is highly active against common Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA). Dalbavancin has a prolonged half-life that allows for once weekly dosing. Phase III trials have demonstrated non-inferiority compared with vancomycin/linezolid in the treatment of ABSSSIs, including those sustained by MRSA.
Original article
Evaluation of CHROMagar Candida, VITEK2 YST and VITEK® MS for identification of Candida strains isolated from blood cultures
Sariguzel Fatma Mutlu,
Berk Elife,
Koc Ayse Nedret,
Sav Hafize,
Aydemir Gonca
The aim of this study is to compare conventional methods, CHROMagar Candida, VITEK2 YST card and VITEK®MS system for the identification of Candida strains isolated from blood cultures. Fifty-four strains were identified according to conventional methods, CHROMagar Candida, VITEK2 YST card and VITEK®MS. Sequencing was used as the reference method. The 54 strains included 32 Candida parapsilosis, 19 Candida albicans, 1 Candida glabrata and 2 Candida tropicalis according to the reference method. One C. albicans and one C. glabrata isolate were misidentified as C. parapsilosis by CHROMagar Candida. Two C. parapsilosis and three C. albicans isolates were misidentified by VITEK2 YST card. CHROMagar Candida, VITEK2 YST card and VITEK®MS identified correctly 96.2%, 90.7% and 100% of all strains, respectively. We found that the CHROMagar Candida, VITEK2 YST card and VITEK®MS system are easy, rapid and accurate alternative methods for the identification of yeast species in the clinical microbiology laboratory.
Comparison of renal ultrasonography and dimercaptosuccinic acid renal scintigraphy in febrile urinary tract infection
Ayazi Parviz,
Mahyar Abolfazl,
Noroozian Elham,
Esmailzadehha Neda,
Barikani Ameneh
Accurate and early diagnosis and appropriate treatment of patient with urinary tract infection (UTI) are essential for the prevention or restriction of permanent damage to the kidneys in children. The aim of this study was to compare renal ultrasonography (US) and dimercaptosuccinic acid (DMSA) renal scan in the diagnosis of patients with febrile urinary tract infection. This study involved the medical records of children with febrile urinary tract infection who were admitted to the children’s hospital in Qazvin, Iran. Pyelonephritis was diagnosed on the basis of clinical symptoms, laboratory tests and abnormal DMSA renal scans. The criteria for abnormality of renal US were an increase or a decrease in diffuse or focal parenchymal echogenicity, loss of corticomedullary differentiation, kidney position irregularities, parenchymal reduction and increased kidney size.
Of the 100 study patients, 23% had an abnormal US and 46% had an abnormal DMSA renal scan. Of the latter patients, 15 had concurrent abnormal US (P value ≤ 0.03, concordance rate: 18%). Renal US had a sensitivity of 32%, specificity of 85%, positive predictive value of 65% and negative predictive value of 60%. Of the 77 patients with normal US, 31 (40.2%) had an abnormal DMSA renal scan. Despite the benefits and accessibility of renal US, its value in the diagnosis of pyelonephritis is limited.
Antiretroviral therapy management and rationalisation of available resources
Cirioni Oscar,
Castelletti Sefora,
Ucciferri Claudio,
Falasca Katia,
Orsetti Elena,
Mazzocato Susanna,
Valeriani Chiara,
Di Campli Francesco Maria,
Barchiesi Francesco,
Vecchiet Jacopo,
Giacometti Andrea
The treatment of HIV disease has led to a new division of management costs by shifting most of the necessary resources from inpatient treatment to outpatient management. Among the initiatives aimed at rationalising the resources available, we compared efficacy, tolerability and pharmacoeconomic impact of different regimes of antiretroviral therapy (ART). The survey covered the first 50 patients, clinically stable and with good viro-immunological response, who switched in June 2012 from an ART based on the triple combination of tenofovir (TDF), emtricitabine (FTC) and a protease inhibitor boosted with ritonavir (PI/r) or a non-nucleoside reverse transcriptase inhibitor (NNRTI), to a treatment based on abacavir (ABC), lamivudine (3TC) and a PI/r or NNRTI. Of the 50 patients who operated the switch, 39 replaced a PI with nevirapine (NVP), for which the largest group of patients was treated with ABC + 3TC + NVP. On 31 May 2015, all patients completed the observation period of 96 weeks, with a mean observation period of 132 weeks and clinical-laboratory checks every four months. Laboratory analysis revealed an optimal maintenance of viral suppression and absolute and relative number of CD4 + lymphocytes and improving trend of creatinine, proteinuria, serum phosphate and bone alkaline phosphatase. There was a variable effect on lipids, with a drop in triglycerides associated with a modest increase in total cholesterol. Much of the HIV-positive population reporting to our hospitals (>50%) comprises individuals who have for years been in stable viraemic suppression, making a satisfactory immune recovery while in good overall clinical condition. This type of patient was the target of the present survey. At the end of 96 weeks of observation the new regimes were well tolerated and did not lead to viro-immunological or clinical deterioration. Pharmacoeconomic analysis showed better containment of the overall costs. No patient needed to be hospitalised during the observation period.
Risk of urinary tract infection in patients with positive urine culture and antibiotic therapy undergoing cystoscopy in a third-level hospital
Escandón-Vargas Kevin,
García-Perdomo Herney Andrés,
Echeverría Fernando,
Osorio José Daniel
The aim of the study was to determine the risk of urinary tract infection (UTI) following rigid cystoscopy in outpatients with positive urine culture and antibiotic treatment compared to outpatients with negative urine culture and without antibiotic prophylaxis. A prospective pilot study in two groups of patients was conducted in a third-level hospital in Cali, Colombia. Group 1 comprised asymptomatic patients with positive urine culture and group 2 were asymptomatic patients with sterile urine. UTI and urosepsis were assessed after seven and 30 days. Eighty-nine patients, 13 from group 1 and 76 from group 2, were followed up in this pilot study. General incidence of UTI at the seventh or 30th day was 4.5% (4/89). There were no statistically significant differences in risk of UTI or urosepsis at the seventh or 30th day between the two groups. The risk of UTI following rigid cystoscopy in outpatients with positive urine culture and antibiotic treatment did not differ significantly from the risk in outpatients with negative urine culture without antibiotic prophylaxis at day 7 and 30.
A local experience of treatment response in chronic hepatitis C infection
Bijani Behzad,
Ghanei Laleh,
Kazemifar Amir Mohammad
Hepatitis C virus infection is the major cause of liver cirrhosis. Antiviral treatment can achieve persistent viral clearance to prevent long-term complications of the disease. Despite the introduction of direct acting antivirals (DAAs) as effective therapy in recent years, the standard regimen consisting of interferon and ribavirin which are more accessible and inexpensive is still widely prescribed for the majority of worldwide hepatitis C patients in developing countries. The present study was conducted to demonstrate a local experience of treatment response (with combination therapy; interferon and ribavirin) and outcome in patients with chronic hepatitis C infection. In all, 107 patients from a referral centre for infectious diseases participated in the study from 2007 to 2012. They were evaluated for demographic characteristics, the disease, the presence of metabolic syndrome and its sub-scores, and lab characteristics. The resulting data were analysed with paired T-test, chi-square test, Fisher exact test and logistic regression, according to relevance.
The virus eradication rate was 72.9% and 72% at the end of treatment and 6 months later, respectively. Of the patients with HCV chronic hepatitis, 27.96% had concomitant metabolic syndrome. There were statistically significant relationships between response to the treatment and the patient's age and gender, the genotype of the virus, presence of metabolic syndrome, waist circumference, BMI, viral load prior to the treatment and blood pressure (systolic and diastolic). Presence of metabolic syndrome (OR: 20.69, CI: 2.83 – 151.34, P=0.003) and the genotype of the virus (OR: 6.64, CI: (1.48 – 29.72), P=0.013) were independent risk factors of failure to achieve sustained virologic response in treatment of chronic hepatitis C with interferon and ribavirin in multivariate logistic regression analysis. According to the current study, HCV infection should be considered a metabolic disease, further to a viral infection. Metabolic factors may impact outcome of the antiviral therapy. Patients should be evaluated for metabolic factors prior to and during antiviral treatment.
Case report
Association between acute motor axonal neuropathy and septic shock due to Acinetobacter baumannii
Toscani Lucia,
Guarducci Diletta,
Matà Sabrina,
Furlan Tiziana,
Ballo Piercarlo
In this report, we describe a case of acute motoral axonal neuropathy (AMAN) following septic shock due to Acinetobacter baumannii. The aetiology of AMAN is still not fully clarified. An association with a potential infection by Campylobacter jejuni, resulting in stimulation of autoimmune response against gangliosides mediated by a phenomenon of molecular mimicry, is believed to play a major role. Since the lipopolysaccharide of A. baumannii has a structure that is similar to that of C. jejuni, we hypothesise that the infection by A. baumannii in our patient may have had a pathogenic role in the development of the neurological picture via a mechanism of molecular mimicry.
Linezolid therapy in a perinatal late-onset Staphylococcus aureus sepsis complicated by spondylodiscitis and endophthalmitis
Krzysztofiak Andrzej,
Bozzola Elena,
Lancella Laura,
Boccuzzi Elena,
Vittucci Anna Chiara,
Marchesi Alessandra,
Villani Alberto
We report the case of a two-month-old immunocompetent girl affected by Staphylococcus aureus sepsis complicated with pneumonia and pleural effusion, spondylodiscitis and endophthalmitis treated with linezolid. She developed a S. aureus sepsis in the neonatal period antibiotically treated with clinical resolution. Ten days after therapy discontinuation, the infant experienced a new S. aureus sepsis complicated by pneumonia with pleural effusion. Due to the presence of dorsal swelling, a pulmonary computer tomography was performed that showed a dorsal D5-D6 spondylodiscitis. Since the sepsis was scarcely responsive to several appropriate antibiotics, we finally decided to treat the patient with linezolid. A few weeks after changing antibiotics, the child underwent an ophthalmologic visit. Due to the finding of ocular lesions, imaging examinations were performed. The diagnosis was compatible with retinoblastoma, such that the eye was enucleated. Nevertheless, histological and microbiological investigations did not confirm the tumour hypothesis, but revealed a S. aureus abscess with retinal detachment. The child completed antibiotic therapy with linezolid and was visited periodically at the Infectious Disease Unit for a follow-up. She underwent progressive resolution of discitis and did not present any further flare of sepsis. Nevertheless, she still has a replacement device in her right eye and a D5-D6 severe kyphosis with spinal fusion.
Paravertebral abscess by Escherichia coli and melanoma metastasis in an older woman
dos Santos Vitorino Modesto,
Passini Flores Viviane Vieira,
Gebrim Daniela Gomes,
Flores Leandro Pretto,
Silva Renata Faria,
da Cruz Silva Samuel Abner
Paravertebral abscesses are usually caused by Staphylococcus aureus, and often affect older people with diabetes mellitus or immunosuppression. We report a huge lumbar abscess caused by Escherichia coli in an 81-year-old woman with diabetes and melanoma metastasis. Lumbar vertebra and surrounding soft tissues were involved by the Gram-negative infection, and imaging features were indicative of malignant condition. Diagnosis was established by images of magnetic resonance, histopathology, and bacterial culture from abscess fluid. This condition poses diagnosis challenges and seems to be increasing in frequency. Reports of case studies might enhance the suspicion index of primary care physicians about this entity.
Delayed fatal diagnosis in atypical rickettsial infectious disease
Nisi Fulvio,
Marturano Federico,
Galzerano Antonio,
Peduto Vito Aldo
We report the case of an 84-year-old man admitted to ICU with symptoms/signs occurring after upper respiratory airways disease. The upper respiratory condition consisting in an uvula oedema required an empiric anti-inflammatory and antibiotic therapy which masked the clinical features usually seen in the case of rickettsial infections, especially cutaneous rash. Although the patient subsequently presented unexplained cardiac and neurological involvement, the starting treatment interfered with the diagnostic process, resulting in a delayed diagnosis. Rickettsia and other conditions related with a possible tick bite have to be considered in the list of differential diagnosis especially in the case of severe systemic or localised disease, particularly when the only suspicious sign is a clinical history indicative of a patient living in poor conditions of hygiene.
A probable drug-to-drug interaction between voriconazole and haloperidol in a slow metabolizer of CYP2C19
Motta Ilaria,
Calcagno Andrea,
Baietto Lorena,
D’Avolio Antonio,
De Rosa Francesco Giuseppe,
Bonora Stefano
We present a case of Aspergillus fumigatus renal abscess treated with voriconazole of a HIV-positive 43-year-old male patient. Following haloperidol treatment we observed an unexpected increase in voriconazole through concentrations and liver function tests. CYP2C19*2 loss of function allele was stated, an interaction probably explained by the introduction of haloperidol, a weak CYP3A4 inhibitor. Therapeutic drug monitoring and CYP2C19 genotyping may be suggested when administering voriconazole to complex patients.
Cutaneous anthrax in an unusual location: case report
Sari Tugba,
Koruk Suda Tekin
Cutaneous anthrax is well known, unlike anthrax of the lumbar region, which is not reported elsewhere. We present a case of anthrax of the lumbar region in a 50-year-old man. The infection was characterised by a wide, black eschar and oedema on an erythematous ground. After isolation of the Gram-positive bacilli from the skin lesions, prompt antibiotic treatment (intravenous sulbactam-ampicillin 1.5 g every six hours) was initiated. Following eradication of the bacilli after 14 days of antibiotic treatment, a split-thickness skin graft was applied. A diagnosis of anthrax depends on clinical suspicion. Early diagnosis, antibiotic and surgical treatment can facilitate the treatment and prevent development of complications.
The Infections in the History of Medicine
The nineteenth-century epidemic waves of influenza
Vicentini Chiara Beatrice,
Guidi Enrica,
Lupi Silvia,
Maritati Martina,
Manfedini Stefano,
Contini Carlo
The retrospective analysis undertaken by our working group in the sphere of infectious diseases, with particular emphasis on nineteenth-century epidemics, regards influenza, which according to the scholar W.I. Beveridge, was defined as "one of the greatest enemies of man". The work is divided into three parts: influenza, its historical names and the characteristics of the recurrent epidemics from the sixteenth to the nineteenth century among the world's population. This part is followed by treatment and remedial action in the nineteenth century. The third, deals with death attributed to influenza and its complications observed in the city of Ferrara in the years when outbreaks occurred, affecting the majority of the populations: 1830-1833, 1836-1837, 1847-1848, 1857-1858, 1873-1875, 1889-1892, the latter known as the great pandemic.
