Volume 19, Issue 1, 2011
Review
West Nile disease: review of clinical features and risk factors associated with severe disease
Salcuni Pasquale,
Rizzo Caterina
West Nile Disease (WND) is an acute viral disease that is transmitted by a mosquito vector. Birds are the virus reservoirs and the natural amplifying hosts for the life cycle of the virus. Mammals, such as horses and humans, are secondary accidental hosts. In human cases the disease can be asymptomatic or show mild systemic symptoms, such as fever, headache, myalgia, fatigue, anorexia and lymphoadenopathy, and a non-pruritic maculo-papular rash can occur. In the elderly and immunocompromised severe clinical manifestations include the West Nile Neuro-invasive Disease (WNND): encephalitises, meningitises, meningo-encephalitises, Guillain-Barré-like syndromes, polyradiculoneuritis and acute flaccid paralyses. In the last 10 years many European countries have experienced outbreaks in animals and in humans (Romania, the Czech Republic, France, Italy). The increasing number of human cases indicates the public health threat of WND and the importance of achieving a better case definition of this disease at international level. The aim of this article is to scrutinise the available literature for the most frequently occurring clinical features of WNND and detect any associations with pre-existing risk factors.
Original article
Measles outbreak in adults in Italy
Bassetti Matteo,
Schenone Eva,
Calzi Anna,
Camera Marco,
Valle Laura,
Ansaldi Filippo,
Pagano Gabriella,
Viscoli Claudio
Several outbreaks of measles have been reported since 2007 both in Italy and elsewhere in Europe. The objective of this study was to analyze the characteristics of the cases of measles that were hospitalized at San Martino Hospital from January 2008 to April 2009. All suspected cases of measles from January 2008 to April 2009 were analyzed. Laboratory confirmation was attained by determination of measles-specific IgM antibodies with enzyme immunoassay and/or detection of the measles virus genome in throat swab or urine by nested polymerase chain reaction (PCR). In all, 114 patients with clinically suspected measles were observed and laboratory confirmation was obtained in 83 cases: 34 (34/83; 41%) by specific genome PCR; five (5/83; 6%) only by IgM antibodies and 44 (44/83; 53%) by both methods. The median age was 25 years (range 15-66). The vaccination status was known for 80/83 patients, amongst whom the proportion of unvaccinated was 90% (72/80). No severe complications were observed. The most common complications were nausea/vomiting in 28/83 (34%) and radiologically documented interstitial pneumonia in 22/83 (26%) cases. The median length of hospitalization was five days (range 1-9 days). Almost 90% of patients were aged 20 years and older and hence measles cannot be regarded solely as a childhood disease. Thus widespread high vaccination coverage would be required to prevent new outbreaks and hospitalizations in the adult population.
Pulmonary complications from pandemic AH1N1 influenza: clinical-radiological features
Bellissima Pietro,
Bellissima Giuseppe
We describe the epidemiology, clinical features, radiological findings, therapy and course for 15 patients hospitalized at the Infectious Diseases UOC of Gravina Hospital Caltagirone for a serious respiratory condition with verified infection A(H1N1) from 9 November to 22 December 2009. We retrospectively reviewed medical records, laboratory and instrumental tests performed on hospitalized patients. All patients had significant respiratory impairment: nine had co-morbidities and risk factors such as obesity, pregnancy, immunosuppressant conditions and muscular dystrophy. Symptoms were similar to those of seasonal influenza; radiological investigation of the chest (RX and CT) presents lung involvement in 80% of patients and changes in the bio-humoral indices. Development into acute respiratory distress syndrome (ARDS) was observed in six patients: three were ventilated with a Venturi mask, three were treated in intensive care and two patients used extracorporeal membrane oxygenation (ECMO). Two died. All patients received antiviral and symptomatic therapy for 5-21 days. A(H1N1) virus infection led to a mild to moderate flu syndrome, which was often cured by symptomatic treatment; some patients required hospitalization for viral pneumonia, mixed pneumonia or ARDS. In previous flu epidemics there was no development into ARDS (40% in our series).
Intestinal parasitosis prevalence in outpatients and inpatients of Cà Granda IRCCS Foundation - Ospedale Maggiore Policlinico of Milan: data comparison between 1984-1985 and 2007-2009
Grande Romualdo,
Ranzi Maria Luisa,
Restelli Antonella,
Maraschini Anna,
Perego Luisa,
Torresani Erminio
This paper evaluates the prevalence of intestinal parasitosis in a specific population over three years (2007-2009). The results were compared with published data collected from the same population in 1984-1985. During a survey from January 1st 2007 to December 31st 2009 a total of 2962 inpatients and outpatients were evaluated in our facility (IRCCS Foundation - Ospedale Maggiore Policlinico) for ova and protozoa stool examination (OPE) over three specimens collected alternatively for three days. 614 inpatients and outpatients were evaluated for the Graham Test (GT) over three slides collected for three days (day by day). Sixty inpatients and outpatients were also sampled for agar culture for detecting Strongyloides larvae in faeces. OPE revealed 13.26% of the patients positive for parasites; TG revealed 8.14% were positive. Overall, 16.66% of the patients were positive for Strongyloides larvae agar culture. Of the OPE trial group, only 4.2% were positive for real pathogen parasites. 1.78% of the total was affected by several parasites. Apart from the prevalence of Entamoeba histolytica/dispar and Taenia spp, which was unchanged, all other levels fell compared with the 1984 - 1985 results. New pathogens, namely Hymenolepis nana and Schistosoma mansoni, were detected during 2007-2009 period. Strongyloides stercoralis was the most frequently diagnosed helminth in 2007-2009 as in the previous time period.
Case report
Cystic hydatidosis: a rare case of spine localization
Scarlata Francesco,
Giordano Salvatore,
Saporito Laura,
Marasà Lorenzo,
Li Pani Giuseppe,
Odierna Antonio,
Scaglione Vincenzo,
Di Carlo Paola,
Romano Amelia
Cystic hydatidosis is a zoonosis endemic both to Sicily and other Mediterranean areas. Generally, Echinococcus granulosus tapeworms develop in the liver, lung and less frequently in the peritoneum, spleen or kidney. We present a rare case of spinal hydatid disease. The patient was a 38-year-old housewife with a vertebral echinococcosis revealed by acute paraplegia of the legs. Medical treatment with albendazole and surgical intervention improved the clinical symptoms. This case is emblematic both for the unusual localization and for the need of a multidisciplinary approach for diagnosing and monitoring suspected hydatid lesions. Patients with suspected abdominal or lung echinococcosis should also be investigated for other localizations such as the brain, spine and heart. Furthermore, in endemic areas hydatidosis must be suspected in the presence of lesions occupying space in these districts.
Linezolid and clindamycin improve the outcome of severe, necrotizing pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)
Soavi Laura,
Signorini Liana,
Stellini Roberto,
Acquarolo Annamaria,
Fiorese Bertilla,
Magri Silvia,
Pantosti Annalisa,
Suter Fredy,
Carosi Giampiero
The last decade has been characterized by the emergence of CA-MRSA strains associated with the production of Panton-Valentine leukocidin. We report a case of necrotizing pneumonia and septic shock caused by CA-MRSA, in which early recognition of the syndrome and appropriate treatment with two toxin-suppressing antibiotics improved the patient’s outcome.
An unusual case of meningitis
Gritti Paolo,
Lanterna Luigi A.,
Chinaglia Daniela,
Manara Ornella,
Soavi Laura,
Zilio Anna,
Suter Fredy
We report on a patient who presented at our hospital with fever, headache, neck pain, partial nuchal rigidity and decreased vision of the left eye. The clinical history, biochemical and instrumental exams performed suggested meningitis but the final hypothesis achieved was an unusual case of Neuro-Behçet-Disease (NBD) without orogenital ulcerations at presentation and with normal MRI findings, whose course was complicated by fatal cerebral venous sinus thrombosis and intracranial haemorrhage. The post-mortem results confirmed the diagnosis. This is a rare case confirmed by anatomo-pathological findings where NBD can present itself as an acute meningeal syndrome that mimics central nervous system infections, making diagnosis difficult and delaying treatment.
Progressive disseminated histoplasmosis among human immunodeficiency virus-infected patients from West-Africa: report of four imported cases in Italy
Inojosa Walter,
Rossi Maria Cristina,
Laurino Licia,
Giobbia Mario,
Fuser Rodolfo,
Carniato Antonella,
Farina Francesca,
De Pieri Marika,
Baldasso Francesco,
Forner Gabriella,
Scotton PierGiorgio
We report four imported cases of progressive disseminated histoplasmosis (PDH) due to Histoplasma capsulatum variety capsulatum in Human Immunodeficiency Virus-infected patients from West Africa. This report highlights the need to consider diagnosis of PDH among patients with acquired immunodeficiency syndrome who originate from West Africa and present with a prolonged febrile illness and very low CD4 count.
The Infections in the History of Medicine
Globalization and infectious diseases: the past and future
Scotto Gaetano
Globalization is a widely-used term that can be defined in a number of different ways. When used in an economic context, it refers to the reduction and removal of barriers between national borders in order to facilitate the flow of goods, capital, services and labour. Globalization is not a new phenomenon. Today the concept of globalization can be extended to include global exposure to infectious diseases, which is becoming more apparent. The aim of this article is to examine the influence of globalization on the outbreak and spread of infections in the world.
