Volume 12, Issue 1, 2004
Review
Guidelines for the management of HCV infection in HIV-infected persons
Antonucci Giorgio,
Antinori Andrea,
Boumis Evangelo,
Delongis Patrizio,
Gentile Marco,
Girardi Enrico,
Lauria Francesco,
Narciso Pasquale,
Noto Pasquale,
Palmieri Fabrizio,
Oliva Alessandra,
Petrosillo Nicola,
Rosati Silvia,
Urso Rocco,
Tocci Guido,
Tozzi Valerio,
Visco Ubaldo,
Ippolito Giuseppe
It is crucial to ensure an optimal clinical management of HCV infection in HIV-co-infected persons. The reasons for the development of guidelines on HCV-infection treatment in HIV-infected persons arise from the need for a standardised management of HIV/HCV coinfection in our Institute. The aim of these guidelines are: to clarify principles of clinical management of HCV infection in HIV-infected patients to care-providers; to improve the awareness of HIV-infected patients cared for our Institute on current management of HCV infection; to improve the quality of care on this topic.
These guidelines, based on Evidence based Medicine principles, have been developed by a panel of experts, who conducted a systematic review of the literature, mainly taking into account current international recommendations. In the present document, the most frequent clinical presentation occurring in the management of HIV/HCV co-infected patients at our Institution are discussed.
The adherence to present guidelines and their effectiveness at our Institution, outcome indicators will be evaluated.
The present guidelines cannot entirely substitute the judgement of an expert clinician. However, adherence to these guidelines will contribute to the improvement of the standard of care of HIV/HCV-co-infected persons.
The role of linezolid in the therapy of infections caused by multiresistant Gram-positive cocci
Paradisi Franco,
Corti Gianpaolo
Gram-positive cocci are becoming more and more common agents of nosocomial infections, primarily enterococci and staphylococci in the field of surgical site and bloodstream infection. At the same time, the frequency of multiresistant enterococci
and methicillin-resistant staphylococci has increased, whereas glycopeptide-resistant enterococcal strains and, recently, staphylococci with reduced susceptibility to lycopeptides have appeared, so making the use of glycopeptides as the
“last-chance drugs” ineffective. Under those circumstances, the synthesis of new potent antibiotics, antibiotics, such as oxazolidinones, is both desirable and welcome. Linezolid possesses a high activity against all multiresistant gram-positive cocci, favourable pharmacokinetics, a good safety profile, a complete bioavailability after oral administration permitting switch therapy, a low capacity of inducing resistance, and both clinical and microbiologic efficacy as demonstrated by a number of clinical trials conducted on thousands of patients. So, linezolid is an important therapeutic option in the treatment of infections caused by multiresistant enterococcal and staphylococcal strains.
Original article
Diagnosis of disseminated mycobacterial infection in AIDS patients by us-guided fine needle aspiration biopsy of lymphnodes and spleen
Tarantino Luciano,
Giorgio Antonio,
de Stefano Giorgio,
Scala Vincenzo,
Liorre Giulia,
Di Sarno Antonella,
Esposito Francesco
Aim: to evaluate the efficacy of abdominal US and Fine Needle Aspiration Biopsy (FNAB) in the diagnosis of disseminated mycobacteriosis (DM) in patients with Acquired Immunodeficiency Syndrome (AIDS).
Methods: We reviewed the US and clinical records of 18 AIDS patients (12 males; 22 – 43 years) with DM studied with abdominal US. 18 patients underwent fine needle aspiration biopsy (FNAB) of enlarged abdominal lymphnodes and 11 underwent FNAB of the spleen. All aspirates were studied with acid-fast stain for fast examination and cultures for isolation of mycobacteria.
Results: Abdominal US showed: enlarged abdominal lymphnodes (diameter range: 5 – 35 mm; mean 17 mm) splenomegaly (spleen diameter range: 14 – 22 cm; mean: 16.2 mm) and hepatomegaly (right hepatic lobe thickness range: 14.5 – 18.5 cm) in all patients; multiple splenic abscesses (diameter range: 3 – 20 mm) in 11 patients; small intestines’ wall thickening in 5 patients (maximum bowel wall thickness range: 7-15 mm); mild to moderate ascites in 8 patients; pleural effusion in 4 patients; hyperechogenicity of kydneys’ cortex in 5 patients; peritoneal abscesses in one and retroperitoneal abscess in one patient .
Fast-acid-stain of spleen and/or lymphnodes’ FNAB specimens allowed an early diagnosis of mycobacteriosis in 18/18 cases (100 %). Cultures of lymphnode’s aspirates grew mycobacteria in 10/18 patients (56%). Spleen aspirates grew mycobacteria in 11/11 patients (100%). Blood cultures were positive in 6/18 patients (33 %). Diagnosis of species was: M. tuberculosis in 9 and M. avium in 6 patients. In 3/18 patients (17%) all cultures were negative .
Conclusions: Abdominal US features can suggest DM in AIDS patients. Spleen and/or lymphnode’s FNAB allows a specific diagnosis in 100% of the patients.
The community acquired pneumonia: appropriateness of the admissions, risk factors and therapy
Libanore Marco,
Bicocchi Roberto,
Pantaleoni Mario,
Bicocchi Maria Paola,
Napoli Nicola,
Ghinelli Florio
In a clinical and epidemiological study used Fine’s Pneumonia Severity Index to determine the appropriateness of the hospitalisation of patients with community acquired pneumonia in the Internal Medicine Department of a hospital in Northern Italy. Risk factors and antibiotic treatment were checked against recent international guidelines. The study shows that 20% of the admissions were to be not appropriate. The principal risk factors were old age and such the co-morbidities heart failure, chronic cerebral diseases and COPD. In the home setting macrolides are less used than the new fluoroquinolones respirators. In the hospitals arrangements, –lactams are still highly used, perhaps because of the high percentage of elderly patients. The data currently available suggest that some new fluoroquinolones such as levofloxacin are quite effective, presenting a broad spectrum of action, high bioavailability and good tolerability. Sequential therapy with this antibiotic leads to shorter hospitalisation times.
Efficacy of Telithromycin in the Treatment of Experimental Bacteroides fragilis Intraabdominal Abscess in the Senescent Mice.
Thadepalli Haragopal,
Chuah See Hean,
Vidad Aleli,
Gollapudi Sastry
The efficacy of telithromycin (HMR 3647), a new ketolide, in the treatment of experimental Bacteroides fragilis intraabdominal abscess in young and senescent mice was evaluated. Two different age groups of mice, young (2-3 months) and senescent (18-24 months) were used in this study. Telithromycin (50mg/kg/bid) was compared with clindamycin and metronidazole, both administered in 100 mg/kg/bid doses. Telithromycin cured the infection in 74% of the young and 67% of the old mice but this difference was not significant. Telithromycin efficacy was comparable to that of clindamycin which cured 82% of the young and 75% of the old, but was superior to the efficacy of metronidazole, which cured 61% of the young and 50% of the senescent mice. Young animals that were not cured by any of the three antibiotics showed decrease in the viable bacterial cell counts by two logs while the senescent mice had a one log difference. Serum, pus and tissue concentrations of telithromycin were five-fold higher in the old mice than in the young. Age by itself had no adverse effect on therapeutic outcome of any of the three antibiotics used.
Another emerging event occurring during HIV infection treated with whatsoever antiretroviral therapy: frequency and role of gynecomastia
Manfredi Roberto,
Calza Leonardo,
Chiodo Francesco
To identify HIV-associated episodes of gynecomastia occurred during antiretroviral therapy in a cohort of around 1,000 patients, and to investigate potential correlations with demographic and epidemiological variables, clinical-laboratory markers of HIV disease, metabolic disturbances, and antiretroviral treatment, a cross-sectional survey of 1.007 patients treated for at least 12 months (669 males: 66.4%), identified all subjects with true (ultrasonography-confirmed) gynecomastia, after exclusion of all other predisposing conditions. Special attention was paid to eventual metabolic alterations, including lipodystrophy syndrome, dyslipidemia, and hyperglycemia, and administered antiretrovirals. Fifteen of the 516 evaluable male subjects (2.9%), developed gynecomastia when aged 12-58 years. A concurrent lipodystrophy was present in all cases, while hypertriglyceridemia, hypercholesterolemia, and hyperglycemia were found in 11, 6, and 3 patients, respectively. Duration of seropositivity and time from start of antiretroviral therapy varied significantly, and no correlation was found with HIV disease progression, but 5 patients never received protease inhibitors, while an efavirenz-based treatment apparently prompted gynecomastia in 4 protease inhibitor-naïve patients, and worsened this sign in other 4 patients switching from a protease inhibitor-based HAART. One patient developed gynecomastia while on isolated nucleoside analogue therapy. In the whole patient group, stavudine proved the nucleoside analogue administered more frequently and for a more prolonged time. During the follow-up, no significant ameliorament of gynecomastia was observed despite eventual therapeutic changes. Gynecomastia, as an emerging untoward event of treated HIV infection, deserves further investigation, from an epidemiological, clinical, and especially pathogenetic point of view. The frequent association with metabolic abnormalities suggests some common ethiologic pathway with other HAART-related disturbances.
Epidemiology of salmonellosis in Caltagirone area (Sicily)
Bellissima Pietro,
Amato Rosalba,
Aurnia Giovanna,
Cannizzo Rosario,
Bonfante Salvatore
The authors report the results of an epidemiological-clinical study concerning episodes of salmonellosis observed in Caltagirone (CT) from 1999 to 2002 and reported to the National Centre for Control of pathogen enterobacteria (enter-net Italy). Overall, two hundred and forty strains of salmonella were isolated, typed and in vitro tested for susceptibility to eleven different antibiotics. Cases were evaluated according to patients’ age, risk factors and clinical findings. Salmonella enteritidis (39%) was the most prevalent serovar followed by S. typhimurium (16%), S. newport (6%), S. salamae (5%) and others.
The highest rate of antibiotic resistance was observed in S. typhimurium.
Case report
Pneumococcal bacterial peritonitis in aids patient following esophageal endoscopic variceal sclerotherapy. Case report and recommendations for antibiotic prophylaxis.
Ferretto Roberto,
Carlotto Antonio,
Nicolini Giangiacomo,
Marranconi Franco
Chronic viral hepatitis is a common co-morbidity in Italian HIV-infected patients. It represents an important emergent associated risk of mortality in patients with HIV infection whose survival has increasingly improved by highly active antiretroviral therapy. In such patients further infectious predisposing factors, related to hepatic failure and esophageal haemorrage, worsen the immunodeficiency due to HIV infection. Bacterial peritonitis has been reported in 3% of patients after esophageal endoscopic injection sclerotherapy emergency and in 0,5% of elective procedure. Combined antibiotic prophylaxis with aminopenicillins beta-lactamase inhibitor and fluoroquinolone should be regularly given to AIDS patients with decompensated liver cirrhosis who have esophageal variceal bleeding. A case of a pneumococcal bacterial peritonitis following emergency esophageal endoscopic sclerotherapy for variceal bleeding in patient with AIDS and liver cirrhosis with ascites is reported.
Microbiological investigations on a nosocomial case of Legionella pneumophila pneumonia associated with water birth and review of neonatal cases.
Franzin Laura,
Cabodi Daniela,
Scolfaro Carlo,
Gioannini Paolo
A case of Legionella pneumophila 1 pneumonia, confirmed by positive serology and urinary antigen, occurred in a 7-day old neonate after water birth in hospital. As respiratory samples were not available for culture, further microbiological investigations were performed in neonate and environment, in order to recognize the source of infection. The hospital water supply was contaminated by L. pneumophila 1 strains (300-2000 cfu/L) of two monoclonal subtypes of Pontiac subgroup. L. spiritensis (10-225 cfu/L) was isolated from cold tap water of the patient’s home. PCR from tap and humidifiers water of the patient’s home was positive for Legionella spp, but not for L. pneumophila. Because L. pneumophila 1, responsible of child infection, was only isolated from the hospital pool water for waterbirthing, we conclude that the infant acquired the nosocomial legionellosis by prolonged delivery in contaminated water, perhaps by aspiration. Infection control measures for waterbirthing are highly recommended. A review of neonatal case of legionellosis is also presented. As this rare infection may have a high fatality rate if unrecognized, pediatricians shoud be aware of the possibility of the legionellosis in newborns.
The Infections in the History of Medicine
First attempt at smallpox engrafting (variolatio) in the 18th century
Sabbatani Sergio
In Bologna halfway through the XVIII century some brilliant Doctors carried out smallpox grafts, first in Italy, obtaining interesting results.The Academicians and the Scientific Institution censured the activities of these testers so that one of them had to continue his workin Padova, where he went to teach continuing in that town the smallpox grafts.
The Bologna’s Curia, on the contrary, expressed a positive theological judgement about these experimentations.
Forty years after these researches, in 1801, the Bologna’s Senate called Luigi Sacco to organize campaigns to vaccinate and prevent by this way smallpox. Bologna had been flogged by a new epidemic in that year.
What happened in Bologna during XVIII century about scientific researches reflected the decadent demografic, economic and politic situation the town was living.
This tendency would have come to an end only with Italian Risorgimento.
