Volume 18, Issue 1, 2010
Review
Prosthetic joint infections by multi-drug resistant bacteria
Bulla Fabio,
Filippini Pietro
Prosthetic joint infections by multi-drug resistant bacteria are today one of the most important and complex problems in orthopedics and traumatology.
Most important and frequent resistant bacteria involved in infection of total joint replacements include: methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, vancomycin-resistant enterococci, multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii.
There are several laboratory tests available, but none has been shown to achieve 100% of sensitivity and specificity.
Treatment of a patient with infection by a resistant organism, requires costly and prolonged hospital stay, weeks or months of antibiotic therapy, and often multiple surgical procedures.
Only a strictly cooperation between orthopedic surgeon and infectious disease specialist, before, during and after prosthetic joint procedure, could improve patient management.
Original article
Prevalence of Plasmodium spp. in asymptomatic African migrants assessed by nucleic acid sequence based amplification
Marangi Marianna,
Di Tullio Rocco,
Martinelli Domenico,
Fazio Vincenzina,
Prato Rosy,
Angarano Gioacchino,
Giangaspero Annunziata,
Scotto Gaetano
Malaria is one of the most important infectious diseases in the world. Although most cases occur in the tropical regions of Africa, Asia, Central and South America, there is in Europe a significant increase in the number of imported cases in non-endemic countries, in particular due to the higher mobility in today’s society. The prevalence of a possible asymptomatic infection with Plasmodium species was assessed using Nucleic Acid Sequence Based Amplification (NASBA) assays on clinical samples collected from 195 study cases with no clinical signs related to malaria and coming from sub-Saharan Africa. In addition, base-line demographic, clinical and socio-economic information was collected from study participants who also underwent a full clinical examination. Sixty-two study subjects (31.8%) were found positive for Plasmodium using a pan Plasmodium specific NASBA based on the small subunit 18S rRNA gene (18S NASBA). Twenty-four samples (38%) of the 62 positive study cases were found positive with a Pfs25 mRNA NASBA, which specifically detects gametocytes of Plasmodium falciparum. This study showed that a substantial proportion of people originating from malaria endemic countries harbour malaria parasites in their blood. If transmission conditions are available, they could be a reservoir.
Durability and tolerability of long-term nevirapine-based HAART
Giacometti Andrea,
Butini Luca,
Cirioni Oscar,
Costantini Andrea,
Montroni Maria,
Scalise Giorgio
Efficacy and tolerability of nevirapine-based HAART regimens were retrospectively evaluated. HIV-1-infected patients were included if they had been receiving a NVP-containing HAART regimen for at least 60 months, regardless of the reason for its initiation. A total of 82 patients were included in this study. The median follow-up time period was 96 months (range 64-120). At the time of starting NVP-based therapy, 31.7% (26 patients) were antiretroviral-naïve, while 68.3% (56 patients) switched to an NVP-based strategy because of intolerance to the prior regimen, failure of a previous regimen or for simplification purposes. Coinfection with hepatitis B or C viruses was present in 26.8% of the patients (n=22). The most frequent nucleoside analogue backbone was zidovudine/lamivudine (52.4%) followed by stavudine/lamivudine (15.8%). A protease inhibitor was concomitantly administered in 2.4% of cases. To investigate the tolerability, we report the results separately on the basis of the presence/absence of HBV and/or HCV coinfection. Coinfected patients displayed significantly higher baseline liver enzymes than non-coinfected patients. Nevertheless, ALT levels showed a constant decrease over time in coinfected patients. Overall, median triglycerides, HDL and total cholesterol values tended to be lower in coinfected patients than in the remaining subjects. In particular, there was a significant decrease in triglyceride values in both groups and, concomitantly, a slight increase in total cholesterol. On the other hand, HDL cholesterol demonstrated a progressive increase. Finally, no change was found in glucose plasma levels, which always remained within normal ranges. In conclusion, no long-term toxicities associated with the use of nevirapine beyond five years were documented in our cohort of patients, even in coinfected patients. Long-term exposure to nevirapine was associated with optimal HIV suppression and favourable lipidic and glucidic profiles.
Tigecycline in the treatment of Ventilator-Associated Pneumonia: experience from the Latin American Tigecycline Use Registry
Curcio Daniel,
Castagnino Jorge,
Vazquez Walter,
Vergara Gabriel,
Curiale Ariel
Objective: The aim of this study was to evaluate the clinical success rate of the patients with ventilator-associated pneumonia (VAP) treated with tigecycline. Methods: Data from patients with established criteria of VAP were collected using a web-based reporting system from 16 February, 2006 to June 23, 2009. One hundred and seventeen patients coming from 10 ICUs from Argentina were studied. Results: Overall, attending physician reported clinical success in 74 patients (63%; 95%CI= 54.08-72.41%). Global mortality proportion was 33% (39/117 patients). Patients with APACHE II score at admission 15 showed a clinical success rate significantly lower and a mortality rate significantly higher than those with APACHE II score at admission <15 (52.6% [30/57] vs 73.3% [44/60]; p=0.0332, and 45.6% [26/57]vs 21.7% [13/60]; p=0.0108). The etiology of VAP was established in 60 patients (51%). Acinetobacter spp. (59%; in 84% of cases carbapenems-resistant), and methicillin-resistant Staphylococcus aureus (22%) were the most common microorganisms isolated. Eleven patients (1.5%) had VAP with bacteremia (respiratory sample and blood cultures positive for the same pathogens). Conclusions: As initial evidence, our results suggest that tigecycline may be an acceptable alternative for therapy in patients with VAP. Nevertheless, only controlled clinical trials will provide the evidence to support approval for new indications.
Case report
Pulmonary hydatid disease in childhood: a case report
Giordano Salvatore,
Scarlata Francesco,
Nasta Roberto,
Calì Mario,
Accomando Salvatore,
Losi Giuseppe,
Maggio Cristina,
Venezia Silvia,
Cardella Francesca,
Liotta Andrea
Echinococcosis/hydatidosis is a parasitic zoonosis caused in humans by the larval stage of the Echinococcus granulosus cestode. Although notification of infestation is required, there are no reliable data on the prevalence of this parasitosis among humans in Italy. This zoonosis was first reported in ancient times (Hippocrates, fourth century BC) and since then many cases of echinococcosis/hydatidosis have been described. Currently, it is considered one of the main parasitoses affecting animals bred for income and one of the most important parasitic zoonoses. We present the clinical case of a three-year-old child, living in Palermo with a dog in his house, who came to our observation for dyspnea occurring after physical exercise. Diagnosis of echinococcosis was performed on the operating table and by histological examination. The case presented is special in its manifestation from a clinical point of view, because the young patient experienced multiple injuries only to lungs, without involvement of other organs and, although the left lung cysts appeared fissured on the operating table, our patient never presented immunoallergic disorders.
Differential diagnosis of lung nodules: breast cancer metastases and lung tuberculosis
Endri Mauro,
Cartei Giuseppe,
Zustovich Fable,
Serino Francesco Saverio,
Fassina Ambrogio
In a follow-up a 74-year-old woman with breast cancer (clinical stage T4N1M0 at onset, treatment by surgical resection and tamoxifen) presented a combination of two distinct diseases in the lung: breast cancer metastasis and tuberculosis. A CT scan showed multiple pulmonary nodular lesions and in only one lesion fine needle aspiration cytology (FNAC) diagnosed tuberculosis. After specific antibiotic therapy, isoniazide and rifampin, a CT scan highlighted disappearance of tubercular lesion. Because occurrence of tuberculosis during chemo or hormone therapy for metastatic breast cancer is rare, the present case is noteworthy. Indeed, it is worth pointing out the differential diagnosis of pulmonary nodular lesions in patients with cancer and the possible reactivation of tuberculosis even in patients without specific symptoms, without typical tubercular radiological features.
Fatal reactivation of HBV and HDV during a long-lasting interruption of HAART in a patient co-infected with HIV, HCV, HBV and HDV
Polilli Ennio,
Sozio Federica,
Mazzotta Elena,
Pieri Alessandro,
Alterio Luciana,
Placido Elena,
Agostinone Adriana,
Di Masi Francesco,
Tontodonati Monica,
Consorte Augusta,
Cosentino Luana,
Parruti Giustino
Coinfection by the Human Immunodeficiency Virus (HIV) and hepatitis viruses is a frequent condition in drug addicts. In the present study we report on the case of a patient with a history of drug and alcohol abuse who was sequentially infected with HIV, HCV, HBV and HDV. He died of an overwhelming reactivation of HBV and HDV in spite of a recent interferon treatment. HBV and HDV resumed their active replication after over 20 years of complete latency, that is after long-lasting viral undetectability, when the patient deliberately discontinued his last HAART regimen. HBV and HDV reactivated in spite of a relatively preserved immune system and a recent immune stimulatory treatment with pegylated interferon.
Acute pericarditis and myocarditis by Toxoplasma gondii in an immunocompetent young man: a case report
Pergola Gaetano,
Cascone Angelina,
Russo Michele
Infection due to protozoan parasite Toxoplasma gondii is highly prevalent among humans throughout the world. Acquired primary infection is seldom severe in immunocompetent people while it can be life-threatening in immunodeficient ones. We report a case of acquired toxoplasmosis in an immunocompetent healty 32-year-old man, presenting as acute pericarditis and myocarditis. The patient complained of intense chest pain, asthenia, arthralgia, low-grade fever, neck lymphadenopathy. Increased seric cardiac enzymes, electrocardiografic anomalies of repolarization and the presence of pericardic effusion on echocardiogram needed anti-inflammatory and anti-arrhythmic drugs and a close monitoring. The aetiological diagnosis, supported by serological tests positive for toxoplasmosis, recommended an antibiotic therapy as additional treatment (spiramycin 9MU/day for one month). Full symptoms remission and normalization of serological values suggested, however, that no more effective anti-protozoan treatment was needed. Thus, the infection by Toxoplasma gondii should be taken into account in the aetiology of either acute pericarditis or myocarditis, because a specific treatment is available, which can improve on the prognosis of the disease.
The Infections in the History of Medicine
Malaria infection and human evolution
Sabbatani Sergio,
Manfredi Roberto,
Fiorino Sirio
During the evolution of the genus Homo, with regard to the species habilis, erectus and sapiens, malaria has played a key biological role in influencing human development. The plasmodia causing malaria have evolved in two ways, in biological and phylogenetic terms: Plasmodium vivax, Plasmodium malariae and Plasmodium ovale appear to have either coevolved with human mankind, or encountered human species during the most ancient phases of Homo evolution; on the other hand, Plasmodium falciparum has been transmitted to humans by monkeys in a more recent period, probably between the end of the Mesolithic and the beginning of the Neolithic age. The authors show both direct and indirect biomolecular evidence of malarial infection, detected in buried subjects, dating to ancient times and brought to light in the course of archaeological excavations in major Mediterranean sites.
In this review of the literature the authors present scientific evidence confirming the role of malaria in affecting the evolution of populations in Mediterranean countries. The people living in several different Mediterranean regions, the cradle of western civilization, have been progressively influenced by malaria in the course of the spread of this endemic disease in recent millennia. In addition, populations affected by endemic malaria progressively developed cultural, dietary and behavioural adaptation mechanisms, which contributed to diminish the risk of disease. These habits were probably not fully conscious. Nevertheless it may be thought that both these customs and biological modifications, caused by malarial plasmodia, favoured the emergence of groups of people with greater resistance to malaria. All these factors have diminished the unfavourable demographic impact of the disease, also positively influencing the general development and growth of civilization.
Letters to the editor
Discrepancy between Vitek 2 and the agar disk method in detecting the amoxicillin-clavulanate resistance in a Klebsiella pneumoniae isolate
Savini Vincenzo,
Catavitello Chiara,
Balbinot Andrea,
Bianco Azaira,
Masciarelli Gioviana,
Astolfi Daniela,
D’Antonio Domenico
Abstract not available
Concerning the article “An infant botulism case occurred in Italy”
Fenicia Lucia,
Arnon Stephen S.
Not available
