Volume 26, Issue 1, 2018
Review
New insights into classification, epidemiology and microbiology of SSTIs, including diabetic foot infections
Esposito Silvano,
Noviello Silvana,
De Caro Francesco,
Boccia Giovanni
Skin and soft tissue infections (SSTIs) involve a heterogeneous group of entities with different clinical presentations classified according to several specific criteria. Because of their great variability, their incidence and prevalence is difficult to accurately determine. Yet it is generally thought that the rate of SSTIs is globally increasing due to an aging population, strictly associated with the increase in the number of critical and immunocompromised patients. The aetiology of SSTIs is also extremely variable, reflecting the noteworthy heterogeneity of their clinical presentations and their epidemiology. Gram-positive are far more prevalently than Gram-negative cocci responsible for STTIs globally considered including both aerobe and anaerobe microorganisms. The emergence of multidrug-resistance bacteria represents a serious public health threat which is making antimicrobial therapy less efficacious and more challenging by the day.
Original article
Zero surgical site infection in primary knee arthroplasty with multidisciplinary intervention: is it possible?
Karakoç Zehra Çağla,
Haklar Uğur
Surgical site infections (SSI) are among the most important complications in knee arthroplasty. In this article we aim to retrospectively evaluate effects of preoperative multidisciplinary assessment and treatment of focal infections in primary knee arthroplasty patients operated by a single surgeon in a single center. A total of 93 patients undergoing 120 primary knee arthroplasty operations were included in the study. In the preoperative assessment all patients were consulted by infectious diseases, otorhinolaryngology (ENT) and dentistry departments, and female patients additionally by gynecology departments to evaluate and treat possible focal infections. Decolonization protocols were implemented for the bacterial growths detected in nasal and urine cultures. Patients received one of four surgical interventions, namely unilateral total knee arthroplasty (TKA), unilateral robotic-assisted unicompartmental knee arthroplasty (RUKA), bilateral RUKA or unilateral TKA and unilateral RUKA. No patients received bilateral TKA in a single session. Out of 93 patients 70 (75.3%) were female, mean age was 67.7 ± 9.9 years, and American Society of Anesthesiologists (ASA) scores were < 3 for 93.5% of the study group. Fifty-two (55.9%) of the patients received RUKA. Mean value for the duration of operations was 150.7 ± 67 minutes, for hospitalization it was 5.9 ± 2.8 days, and postoperative follow-up was 25.7 ± 8.8 months. None of the patients developed SSI in the follow-up period. Many factors are associated with SSI after knee arthroplasty. Total absence of SSI in our study group may be attributable to meticulous patient selection, multidisciplinary preoperative assessment, and the performance of RUKA by a single surgeon in a single center.
Prevalence of diabetes mellitus (DM) in tuberculosis (TB) patients: clinical and radiologic features in the TB-DM association based on a five-year hospital study
Pavlović Jovana M.,
Pavlovic Aleksandar D.,
Bulajić Milica V.,
Pešut Dragica O.
A previously known association of tuberculosis (TB), now a global emergency, with diabetes mellitus (DM), a chronic disease of increasing prevalence worldwide, has resurfaced. DM is a recognised TB risk factor and M. tuberculosis infection usually disturbs glycoregulation. We aimed to estimate DM prevalence among TB patients and to analyse clinical and radiologic manifestations of TB in this group. The cross-sectional study included 1017 patients discharged with a TB diagnosis from a tertiary level facility in a five-year period. After exclusion of 128 patients with TB sequelae, we selected 889 patients with confirmed active TB, and the final selection led to 88 subjects with both active TB and DM. DM was found in 9.89% of active TB patients. Testing hypotheses for single-sample proportions showed that the prevalence was significantly higher than the prevalence in the general population (p<0.01). The average patient age was 60.47±14.88 years (range: 20-88), while the male/female ratio was 2.26. We found pulmonary TB in 96.3% of the 88 subjects, and extrapulmonary in 3.4%, the latter more frequently in women (p=0.08). Cavities were more frequently found in tobacco smokers compared to non-smokers (p=0.002) and in patients living in rural settings (p=0.002); haemoptysis was detected more frequently in men compared to women (p=0.044). Half of the patients had no fever at all, and only 14.8% had tachycardia. Auscultatory findings were positive in 57 (64.8%) patients. Radiographic changes were atypical in 17/88 (19.3%) patients and included pulmonary bases in seven patients, upper lobe anterior segment, and disseminated miliary pattern in two patients. DM prevalence is significantly higher among TB patients compared to the general population. The mean age of TB patients with DM is significantly higher than expected in TB patients alone. Knowledge of TB clinical and radiologic variations in this group of patients may reduce the delay in TB diagnosis with its clinical and epidemiologic consequences.
Research trends in Carrion’s disease in the last 60 years. A bibliometric assessment of Latin American scientific production
Culquichicón Carlos,
Ramos-Cedano Emanuel,
Helguero-Santin Luis M.,
Niño-Garcia Roberto,
Rodriguez-Morales Alfonso J.
Carrion’s disease is a major re-emerging and occupational health disease. This bibliometric study aimed to evaluate scientific production on this disease both globally and in Latin America. SCI-E, MEDLINE/GoPubMed, SCOPUS, ScIELO, and LILACS databases were searched for Carrion’s disease-related articles. They were classified according to publication year, type, city and institution of origin, international cooperation, scientific journal, impact factor, publication language, author(s), and H-index. There were 170 articles in SCI-E. The USA was the largest contributor (42.9%), followed by Peru (24.1%) and Spain (12.4%). Latin American publications were cited 811 times (regional H-index=18). There were 335 articles in SCOPUS: 25.9%, 11.6%, and 8.3% were published by the USA, Peru, and Spain, respectively. Latin American publications were cited 613 times (H-index=12): Peru, Colombia, and Brazil received the most citations (n=395, H-index=10; n=61, H-index=1; and n=54, H-index=4, respectively). The most scientifically productive American institution was the University of Montana (2.9% of American production). In Peru, it was the Institute of Tropical Medicine Alexander von Humboldt of Peruvian University Cayetano Heredia (6.5% of Peruvian scientific production). There were 3,802 articles in Medline (1.2% were Peruvian), 35 in SciELO (94.3% were from Peru), and 168 in LILACS (11% were published in 2010–2014; only one article was published in 2015). Scientific production worldwide is led by the USA, and, in Latin America, by Peru and Brazil. However, Latin American scientific production in bibliographic databases is much lower than in other regions, despite being an endemic area for Carrion’s disease.
Epidemiological profile of malaria among various socio-demographic groups in a western district of Odisha, India
Pradhan Nitika,
Pradhan Prakash,
Pati Sanghamitra,
Hazra Rupenangshu K.
A retrospective analysis of malaria incidence, patterns and trends in Bargarh, a western district of Odisha, India, over five consecutive years (2012 to 2016) among various socio-demographic components was established from the National Vector Borne Disease Control Programme (NVBDCP), Bargarh, as well as from district survey reports. The increasing trend in malariometric indices such as the Annual Blood Examination Rate (ABER), the Annual Parasite index (API) as well as the Total Positive Rate (TPR) reveals a better surveillance activity but an alarming situation for malaria. The trend for P. falciparum and P. vivax infection is found to be zigzagging or fluctuating for the five years in question, with the preponderance of P. falciparum infection. Malaria in Bargarh district is age-specific where there is a strong positive correlation between the age factor and malaria morbidity, but it is gender-blind. The incidence of malaria is increasing among deprived communities as well as pregnant women in the district. The community perception study reveals the knowledge level regarding cause, prevention and treatment for malaria, which is lower among deprived communities than more progressive communities. The overall epidemiological study highlights the dynamics of disease transmission among various demographic members in Bargarh district, whilst evaluating awareness of current malaria endemicity.
Hepatitis A outbreak in men who have sex with men (MSM) in Brescia (Northern Italy), July 2016-July 2017
Comelli Agnese,
Izzo Ilaria,
Casari Salvatore,
Spinetti Angiola,
Bergamasco Alberto,
Castelli Francesco
Since June 2016, an outbreak of hepatitis A has been reported in Europe. Here we report the HAV outbreak in Brescia (Northern Italy) from July 2016 to July 2017. We actively recorded all HAV cases defined by detection of HAV IgM antibodies in serum. Data on sexual behaviour, travel attitudes, concomitant sexually transmitted diseases (STDs), clinical presentation and laboratory results were collected. Forty-two confirmed cases were recorded: 25 (60%) were MSM and reported sexual contact at risk of STDs. Compared to 2015 and the first half of 2016, when only three hepatitis A cases were recorded, in the 12 months in question the number of cases rose 14-fold. Among 25 MSM, 14 were HIV-infected. Hepatitis A is usually a self-limiting disease, but it could be more serious in the case of HIV co-infection, immunosuppression and chronic hepatitis. HAV infection has a high outbreak potential in MSM because of more common oro-anal practices compared to HS, a high interconnectedness global network, chemsex practices and a new tendency to travel abroad to attend group sex events. In our experience, most cases occurred in MSM and 56% of them were HIV-infected, suggesting the need to promote active screening, immunization and education in this population.
Beta-tubulin gene in the differentiation of Fusarium species by PCR-RFLP analysis
Nosratabadi Mohsen,
Kachuei Reza,
Rezaie Sassan,
Beigi Harchegani Asghar
Fusarium species belong to one of the most important fungal groups in the medical, agricultural, and veterinary fields. This study aimed to evaluate the efficiency of PCR-RFLP analysis of the beta (β)-tubulin region for differentiating Fusarium species. A total of 107 strains of Fusarium spp. were studied, including isolates from environmental, clinical, and reference sources. The β-tubulin genes of all isolates were successfully amplified with primer pairs (T1 and T22). A PCR product of approximately 1400 base pairs was generated for each Fusarium sp. After evaluation of various enzymes, three restriction enzymes, namely Ban II, BsaWI, and HincII, were selected. Based on the selected enzymes, the isolated Fusarium spp. were categorized into 24 groups. In this study we were able to identify F. graminearum, F. culmorum, and F. cerealis through the proposed analyses as well as other pathogenically important species such as F. oxysporum and F. solani. Unlike all other similar previous studies, this study was able to differentiate among F. graminearum, F. culmorum, and F. cerealis. However, we were unable to differentiate F. armeniacum and F. acuminatum or F. sportrichioides from F. langsethiae. Hence, it is recommended that other genes must be evaluated to overcome the limitations of the β-tubulin gene in differentiating the above species.
Determination of antibiotic resistance pattern and prevalence of OXA-type carbapenemases among Acinetobacter baumannii clinical isolates from inpatients in Isfahan, central Iran
Rezaei Aliakbar,
Fazeli Hossein,
Moghadampour Mehdi,
Halaji Mehrdad,
Faghri Jamshid
Acinetobacter baumannii is one of the most important bacterial species with the ability to produce OXA-type carbapenemases. We aimed to evaluate the prevalence of OXA-type carbapenemases among clinical isolates of A. baumannii in three major hospitals of Isfahan. In this cross-sectional descriptive study, 153 non-repeated strains of A. baumannii were isolated from various clinical samples of hospitalized patients in Al-Zahra, Imam Mousa Kazem, and Shariati hospitals from October 2015 to October 2016. Antimicrobial susceptibility testing for imipenem, meropenem, ertapenem, cefepime, ceftazidime, ceftriaxone, piperacillin-tazobactam, gentamicin, amikacin, ciprofloxacin, and tetracycline was performed using the disk diffusion method. In order to identify blaOXA genes, a multiplex polymerase chain reaction was used. The resistance rates in A. baumannii isolates to beta-lactam antibiotics including imipenem, ertapenem, meropenem, cefepime, ceftazidime, ceftriaxone, and piperacillin/tazobactam were 100%, 100%, 99.3%, 97.4%, 96.7%, 97.4%, and 98.6%, respectively. PCR assay showed the presence of blaOXA genes in all isolates. The blaOXA-51 gene was recognized in all (100%) isolates, 90.8% and 62.1% of isolates possessed the blaOXA-23 and blaOXA-24 genes, respectively, while the blaOXA-58 gene was not detected in any of the isolates. Also, 56.2% of isolates had both the blaOXA-23 and blaOXA-24 genes simultaneously. We found that the prevalence of OXA-type carbapenemases among carbapenem-resistant A. baumannii isolates is high in Isfahan, with OXA-23 being the major carbapenemase mechanism responsible for the resistance phenotype.
Molecular characteristics of multiple and extensive drug-resistant Acinetobacter baumannii isolates obtained from hospitalized patients in Southwestern Iran
Soltani Behnaz,
Heidari Hamid,
Sedigh Hadi,
Hadi Nahal,
Mardaneh Jalal,
Motamedifar Mohammad
The emergence of multiple drug-resistant (MDR) Acinetobacter baumannii strains has become a global problem. This study aimed to evaluate the occurrence of antibiotic resistance and to investigate the presence of antibiotic resistance determinants among A. baumannii isolates obtained from hospitalized patients in Iran. This cross-sectional study was performed on 92 A. baumannii isolates in the years 2015-2016. Antimicrobial susceptibility testing was carried out by the disk diffusion method. The presence of antibiotic resistance determinants was detected by the PCR method. All the A. baumannii isolates were resistant to tested carbapenems, fluoroquinolones and sulfonamide agents, and susceptible to polymixins. Of the isolates 92.4% were extensive drug-resistant (XDR) and 7.6% were MDR. PCR screening for the presence of integron genes revealed that class 1 integron presented in 46.7% of isolates and class 2 in 18.5% isolates. Of the investigated antibiotic resistance genes, bla VIM, bla IMP, bla SPM, sul1 and sul2 were positive in 75%, 12%, 12%, 47.8%, and 67.4% of isolates, respectively. The high prevalence of metallo-beta-lactamase (MBL) and sul genes in our results may indicate the importance of these genes in the dissemination of carbapenem- and sulfonamide-resistant A. baumannii isolates. Rational and restricted prescription of carbapenems may be an effective way to minimize the emergence and spread of MBL-harboring strains.
Case report
Trombiculiasis: an underreported ectoparasitosis in Sicily
Caputo Valentina,
Santi Fiorella,
Cascio Antonio,
Trizzino Marcello,
Colomba Claudia
Trombiculiasis is a common but underreported ectoparasitosis characterized by an infestation of the skin by the larval stage of various species of mites belonging to the phylum Arthropoda, class Arachnida, subclass Acarina. Clinical manifestations consist of pruritic erythematous and urticarial macules and papules located on covered thin and glabrous skin. In recent studies Neotrombicula autumnalis larvae have been described as the possible vectors of pathogens such as Borrelia burgdorferi and Anaplasma phagocytophilum. Few reports of trombiculosis have been collected in the medical literature to date. We report a typical case of trombiculosis induced by trombiculid larvae of N. autumnalis, which are habitual parasites of various endo- and ectothermic vertebrates.
Respiratory syncytial virus bronchiolitis and hypertransaminasemia
Giordano Salvatore,
Di Gangi Maria,
Concetta Maria,
Bruno Lucrezia,
Falcone Veronica,
Dones Piera
Bronchiolitis is the most common disease of the lower respiratory tract occurring in children during their first year of life, becoming the most frequent cause of hospitalization. Although the disease can also be caused by other viruses, more than 70% of bronchiolitis cases are caused by respiratory syncytial virus (RSV). RSV bronchiolitis clinically presents rhinitis, coughing, increased breathing and eating difficulties; the symptoms are usually mild, but in some cases may be so severe as to require hospitalization. Diagnosis is mainly clinical and is based on a thorough medical history and a physical examination. Therapy is substantially of support, and has the aim of ensuring alimentation/hydration and optimal oxygenation. It has been recently noted that RSV infections may cause extra-pulmonary manifestations, including liver problems, as rarely described in the literature. The aim of this paper is to present three cases of RSV bronchiolitis in children with elevated transitory transaminase levels.
Report on three cases of pertussis in the Urbino area (Italy)
Brindicci Gaetano,
Carboni Danilo,
Genga Roberto,
Moschini Eleonora,
Montorzi Giulia,
Viscogliosi Felicetta,
Muratori Giovanni,
Ripanti Gabriele
Pertussis is a contagious, infectious disease that affects mainly children and is caused by Bordetella pertussis. The pertussis vaccine has changed the epidemiology of the disease up to the point when it almost vanished, with a minimum number of cases recorded in Italy (2008) when vaccination coverage was 97%. For the same reason the natural history of the disease was also modified. Indeed, in high-income countries the lack of immunity acquired with the vaccine causes adolescents and adults to become an important source of infection for unvaccinated subjects, the newborn and children who have not completed their primary education. The reduction in the vaccinated pediatric population and the loss of acquired immunity could be the cause of the re-emergence of a disease which, in developing countries, has a 4% mortality rate among children under one year of age. In this work we describe three cases of pertussis that are apparently unrelated. They occurred in the area of Urbino in a period of slightly under a month. Italy is going through a historical moment of great suspicion regarding pediatric vaccination, despite scientific evidence that should allay such suspicion. To increase people’s awareness of vaccinations with a view to comments made regarding older children and adults it is our view that more effective intervention methods are needed.
Giardiasis and subsequent diagnosis of HIV infection in a patient with persistent diarrhoea: a case report
Saifi Erkin Saeed,
Gavazzi Alice,
Spandrio Sara
Although its prevalence in resource-rich countries is not precisely estimated, persistent diarrhoea is not a common event if extreme ages are excluded. Enteric pathogens, of various underlying aetiologies, often cause major diarrhoeal syndromes, especially in immunocompromised adults. While there is a rich medical literature regarding HIV-related infections, information about the diagnosis of HIV-infection from diarrhoea as a presenting complaint is scarce. Our case report focuses on a 29-year-old Italian male with persistent diarrhoea who was diagnosed with Giardiasis and subsequently tested for HIV infection, resulting positive. In approaching young adults with persistent diarrhoea, lowering the threshold of suspicion for HIV infection proves useful.
Congenital Chagas disease in a Bolivian newborn in Bergamo (Italy)
Bargiggia Graziano,
Ruggeri Maurizio,
Ortalli Gaia,
Gabrielli Simona,
Rodari Paola,
D’Antiga Lorenzo,
Farina Claudio
Chagas disease (CD) is an uncommon disease in Europe. Its epidemiology has changed because of mass migration from Latin America to Europe. Herein we describe a congenital case of CD in a Bolivian newborn in Bergamo, the main city of residence for the Bolivian community in Italy. At delivery, serological analyses evidenced IgG antibodies against Trypanosoma cruzi both in the child and mother, as expected. Hemoscopic analyses on peripheral blood were repeatedly negative during the first months of life. Eventually, thanks to T. cruzi Real Time polymerase chain reaction (RT-PCR) positivity on peripheral blood and development of progressive anemia in the following weeks, congenital Chagas disease was diagnosed and benznidazole-based therapy started. A progressive antibodies’ index decrease was observed till negativity (306 days apart). RT-PCR was negative at the end of treatment. Our case is instructive and management of congenital CD is discussed from the perspective of a non-endemic country
The Infections in the History of Medicine
Spanish flu in Italy: new data, new questions
Fornasin Alessio,
Breschi Marco,
Manfredini Matteo
This paper proposes a new estimate for the number of victims of Spanish flu in Italy and highlights some aspects of mortality closely linked to the First World War. The sources used are official death statistics and the Albo d’oro, a roll of honor of the Italians fallen in the First World War. The new estimate of deaths from the flu is 410,000 for 1918, which should be raised to 466,000 when the numbers are taken up to 1920. Deaths from Spanish flu among the military were about 70,000. The time sequence of deaths recognizes two distinct peaks, one in October and one in November 1918. Between these two peaks, the lowest number of deaths falls in the week of the armistice between Italy and Austria-Hungary (signed 4 November 1918). This suggests links between Spanish flu and WWI that cannot be merely explained in terms of movement of people and contagion.
The treatment of latent TB infection in HIV-positive people: the Verona experience
Cordioli Maddalena,
Mazzaferri Fulvia,
Fasani Giada,
Del Bravo Paola,
Lattuada Emanuele,
Vento Sandro,
Concia Ercole,
Lanzafame Massimiliano
Not available
