Volume 27, Issue 1, 2019
Review
Co-infection HBV and malaria: a striking association
Scotto Gaetano,
Fazio Vincenzina,
Lo Muzio Lorenzo
Background: Many geographical areas are highly endemic for infectious tropical diseases, although in disproportional fashion. Various infections often overlap in terms of presentation of various epidemiological and clinical manifestations that are linked to the mutual influence of pathogens. The epidemiological and clinical aspects of hepatitis B virus and malaria co-infection remain little known because there have not been many studies until recently.
Methods: We performed a systematic search of the epidemiology of HBV/malaria co-infection, in particular, their overlapping clinical and histological features and their reciprocal conditioning. We examined published data regarding HBV and malaria.
Results: The data we obtained varied substantially. The interaction between malarial parasites and HBV viruses, both in chronic HBV hepatitis patients and in carriers, did not vary or change the clinical evolution of either infection. The diversity of epidemiological and clinical results depended both on the geographical areas in which the studies were carried out and on the various stages of the infections at the time of the study.
Conclusion: Strategies to improve currently available diagnostic techniques, and studies dealing with vector control procedures and other operational tools and approaches are needed for better understanding of this health problem.
Original article
Triple combination therapy with high-dose ampicillin/sulbactam, high-dose tigecycline and colistin in the treatment of ventilator-associated pneumonia caused by pan-drug resistant Acinetobacter baumannii: a case series study
Assimakopoulos Stelios F.,
Karamouzos Vassilis,
Lefkaditi Aikaterini,
Sklavou Christina,
Kolonitsiou Fevronia,
Christofidou Mirto,
Fligou Fotini,
Gogos Charalambos,
Marangos Markos
Acinetobacter baumannii has evolved in recent decades as a major problem in carbapenem-resistant gram-negative nosocomial infections, associated with high mortality rates especially in intensive care units (ICUs). Recent reports highlight the increasing prevalence of resistance to colistin, a last resort therapeutic option for carbapenem-resistant A. baumannii. We retrospectively evaluated the potential efficacy, in terms of clinical and microbiological cure and mortality, of a combination of intravenous colistin and high-dose ampicillin/sulbactam and high-dose tigecycline, concurrently administered with inhaled colistin, in 10 ICU patients with ventilator-associated pneumonia (VAP) caused by carbapenem- and colistin-resistant A. baumannii strains, with high tigecycline MICs > 2μg/mL. Nine patients (90%) exhibited a successful clinical outcome, accompanied by microbiological eradication in seven of them. All clinically cured patients survived at 14 and 28 days. Acute kidney injury (AKI) was observed in one patient. In view of the increasing prevalence of pan-drug resistant A. baumannii infections in ICUs, its associated high rates of mortality and the lack of effective treatment options, we feel that there is an emerging need for our results to be further validated in larger prospective studies.
Trends in Klebsiella pneumoniae strains isolated from the bloodstream in a teaching hospital in southern Italy
Del Prete Raffaele,
Ronga Luigi,
Addati Grazia,
Magrone Raffaella,
Abbasciano Angela,
Decimo Marilù,
Mosca Adriana,
Miragliotta Giuseppe
Klebsiella pneumoniae is a common nosocomial pathogen involved in many infectious diseases such as bacteraemia, urinary and respiratory tract infections. It is responsible for the rise in morbidity and mortality rates since most clinical isolates exhibit resistance to several antibiotics. Moreover, the epidemiology of these nosocomial infections is variable across countries and regions. From January 2015 to December 2017 we retrospectively analysed the bloodstream infections caused by K. pneumoniae strains in hospitalised patients with the aim of studying the temporal trends of wild type (WT), multi-drug resistant (MDR), extended drug resistant (XDR), pan-drug resistant (PDR) and carbapenem-resistant (CR) strains. In all, 439 K. pneumoniae isolates from 356 patients were collected from all units of the Policlinico of Bari. The majority of clinical isolates were collected from the intensive care unit (125, 28.47%), haematology (34, 7.74%), rehabilitation (27, 6.15%) and cardiac surgery wards (25, 5.69%). Moreover, the majority of the isolates were classified as CR (325, 74.03%, 95%CI: 69.61-78.19) and XDR (255, 58.09%, 95%CI: 53.31-62.72). Annual prevalence rates and monthly counts were analysed using the Chi Squared test for trends and the Poisson regression with multiple p-value correction according to Benjamini and Hochberg’s procedure. The annual relative frequencies of the XDR and CR K. pneumoniae isolates decreased significantly from 63.37% to 48.44% and from 78.48% to 63.28% respectively, while WT K. pneumoniae significantly increased from 13.95% to 23.44%. Poisson regression analysis confirmed the presence of a decreasing monthly trend for the XDR and CR K. pneumoniae count series. In order to control the spread of antibiotic resistance, more inclusive surveillance data will be needed to either confirm these results or improve antibiotic stewardship measures.
Molecular characterization of multidrug and extensive drug-resistant Mycobacterium tuberculosis isolates from Iran
Kazemian Hossien,
Kardan-Yamchi Jalil,
Mosavari Nader,
Mehdi Feizabadi Mohammad
Tuberculosis (TB) is one of the main causes of death among curable infectious diseases and one of the top 10 causes of death worldwide. Hence, molecular typing of MTB strains is necessary for epidemiological studies and helps to identify risk factors for TB transmission. Therefore, the present study was conducted to determine molecular typing of drug-resistant M. tuberculosis strains isolated from Iran using the RFLP-PGRS method. Thirty-two MDR strains and one XDR strain were isolated from TB patients in four major cities of Iran. MTB isolates were subjected to drug susceptibility testing. Whole genomic DNA from mycobacterial colonies were extracted and hybridized with PGRS probe in RFLP analysis. All fingerprinted MDR and XDR isolates were grouped into 13 clusters. The largest cluster (cluster 3) contained 48.4% (n = 16) of all isolates. Clusters 1, 4, and 6 included 2, 4, and 2 isolates, respectively. Two isolates were in cluster 7, one was H37Rv standard strain, which was used as a control strain in this study, and eight isolates were placed in single clusters. This study provides information about molecular epidemiology of MDR-TB in Iran. The alarming increase in the incidence of MDR isolates, especially Beijing strains, raises concerns for TB control programs in Iran.
Hepatitis C screening in the Emergency Department of a large hospital in southern Italy: results of a pilot study
Gentile Ivan,
Pinchera Biagio,
Viceconte Giulio,
Crispo Manuel,
Simeone Davide,
Scotto Riccardo,
Zappulo Emanuela,
Maraolo Alberto Enrico,
Paladino Fiorella,
Tortora Raffaella,
Di Costanzo Giovanni Giuseppe,
Buonomo Antonio Riccardo,
Borgia Guglielmo
Around 71 million people worldwide are chronically infected with hepatitis C. HCV prevalence among individuals born in the United States between 1945 and 1965 is estimated to be about 3%. In Italy, about 2% of the population is chronically infected with HCV. Since chronic HCV infection is often asymptomatic, many patients require access to medical care only in an advanced phase of the disease. The best strategy for bringing out hidden chronic HCV infection remains uncertain. The aim of the study was to evaluate the feasibility of an FDA-approved rapid salivary, point-of-care (POC) assay for anti-HCV, performed in patients aged between 45 and 80 years old who were referred to the emergency department of a large hospital in southern Italy and were all unaware of their HCV serostatus. In all, 966 patients were interviewed during the study period. Among them, 220 patients were enrolled. Notably, 25/588 (4%) reported to be anti-HCV positive. Of these, 19 were already being treated with direct-acting antivirals (DAA). Among the enrolled patients, two (0.9%) tested anti-HCV positive and 218 (99.1%) were negative at screening. Both patients with a positive test were male, below the age of 54, with a previous history of intravenous drug abuse, a low level of education, and who had had at least one experience of unprotected sex. We scheduled a visit for treatment evaluation for every positive patient who was not on treatment. Neither of the two de novo patients and 3/6 (50%) patients who were aware of their anti-HCV positivity came to the follow-up visit. Our study shows that a screening strategy for HCV infection in ED is feasible and that about 1% of patients attending the ED and who are unaware of their conditions are anti-HCV positive. Moreover, a non-negligible proportion of subjects, though aware of their condition, was not linked to any hepatologic center.
Risk of professional accidental exposure to biological agents in health care workers: a retrospective analysis carried out in a southern Italian tertiary hospital
Bianco Vincenzo,
Spera Anna Maria,
Maraolo Alberto Enrico,
Parente Serena,
Donno Davide,
Schiano Moriello Nicola,
Tosone Grazia
Worldwide the needlestick injuries of health care workers (HCWs) still represent a major health problem. The authors aimed to evaluate the risk of HCW needlestick injuries in a tertiary university hospital in southern Italy in relation to some HCW characteristics (age, sex, professional profile, work department) and the source of infection. All HCWs of the University Hospital “Federico II” in Naples, Italy, attending the Infectious Diseases Unit after potential accidental contact to blood-borne viruses through needlestick injuries were enrolled during a 22-year period. HCWs underwent clinical analysis and were administered a specific questionnaire to collect (in anonymous fashion) data about age, sex, professional profile and work department. From 1995 to 2016 1,477 needlestick injuries in the same number of people (one accident per person) were recorded by our service. The HCWs were predominately males (n = 806, 55%) and the mean age was 39.4 years (±10 SD). The job categories most involved were: physicians (41%), followed by nurses (33%) and healthcare assistants (HCAs, 10%). The incidence proportion was calculated for these highest-risk categories in three defined time points (at the beginning, in the middle and at the end of the study period): 104/2149 (4.86%) in 1995, 41/2498 (1.64%) in 2005 and 25/2057 (1.22%) in 2015. Most injuries occurred in General Surgery (14.21%), Gynecology and Obstetrics (9%) and Pediatrics (6.49%). In about 34% the HCWs had been exposed to HCV infected fluids. Over time, a significant decrease in accidental exposure was recorded for physicians (p= 0.019), nurses (p< 0.0001) and HCAs (p< 0.0001). Our results confirm that some profiles, namely physicians, nurses and healthcare assistants, are still at risk of needlestick injuries, especially in surgical areas, including obstetric wards. Further primary and secondary prevention strategies are needed to decrease the incidence of new cases of needlestick injuries.
Alexithymia in HIV, HCV and coinfections
Cappabianca Andrea,
Vitale Margherita,
Madonia Simona,
Spera Annamaria,
Boffa Nicola,
Masullo Alfonso,
Santoro Renato
Recent studies show that alexithymia, an impairment of emotional processing, plays a role in HIV and HCV infections, although little is known about about alexithymia in HIV/HCV coinfection. This study aimed to assess alexithymia in patients suffering from HIV, HCV or HIV/HCV coinfection and observe major differences. We selected 153 subjects, excluding those with psychiatric diagnosis, cognitive impairment or opportunistic diseases, of whom 70 (46%) had HIV infection, 57 (37%) HCV infection and 26 (17%) HIV/HCV coinfection. For the evaluation of alexithymia, we used the Toronto Alexithymia Scale (TAS-20), a self-report questionnaire which allows the results to be assessed both on a dimensional level and on defined cutoff scores. Data analysis showed significant differences between monoinfected and coinfected subjects. The coinfected group had a mean score of 54.00 ±13.43, higher than HIV (48.11 ± 12.38) and HCV (48.28 ± 10.71) (p <0.05). Furthermore, we found clinically relevant scores (≥51) in 65.38% of coinfected subjects, in 42.85% of HIV and in 40.35% of HCV (p <0.05). Given the medical and behavioral correlates of alexithymia highlighted in the literature, we suggest that further investigations are needed to clarify the relationship between alexithymia and HIV/HCV coinfection.
Prevalence and predictors of malignancies in HIV patients: results of a retrospective multicentric Italian cohort
Mazzotta Elena,
Riccardi Niccolò,
Tontodonati Monica,
Gabrielli Chiara,
Mazzocato Susanna,
Mazzetti Marcello,
Falasca Katia,
Vecchiet Jacopo,
Barchiesi Francesco,
Francisi Daniela,
Siri Giacomo,
Cenderello Giovanni,
Parruti Giustino
We report the sharp reduction in the incidence of AIDS defining cancers in a multicentric, retrospective study carried out since 1991 and involving six Infectious Diseases Units spread across Italy. However, due to the parallel increase in non-AIDS defining cancers, cancer incidence was not reduced. Focusing on predictors of death in HIV-positive patients with neoplastic disease, multivariate models revealed that males as well as drug abusers were independently associated with a poor clinical outcome.
Efficacy of 5-nitroimidazole compounds for giardiasis in Cuban children: systematic review and meta-analysis
Escobedo Angel A.,
Almirall Pedro,
González-Fraile Eduardo,
Ballesteros Javier
Five-nitroimidazole (5-NI) compounds are among the most commonly used medications in the treatment of giardiasis. However, after more than five decades of their initial indication for such treatment, there are some concerns about the efficacy of 5-NIs in giardiasis. This study sought to compare the efficacy of any 5-NI with any other antigiardial drug for the treatment of Cuban children with giardiasis. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched CUMED, EBSCOhost and PubMed databases. Two reviewers independently assessed trial eligibility, trial quality and extracted appropriate data. The primary outcome was the parasitological cure. The effect estimate was the pooled relative risk (RR) with 95% confidence intervals (CI). We included seven RCTs in the systematic review, involving a total of 1046 children. When the effect of 5-NIs was compared with that of benzimidazole compounds, the pooled effect was significant and favored 5-NIs [the relative risk (RR) is 1.35, 95% CI =1.05 to 1.75], with high heterogeneity (4 studies, I2=79%). Compared with chloroquine, the pooled effects of the 5-NIs were not significant [RR is 0.96, 95% CI=0.79 to 1.18, (2 studies, I2=68%)]. Our results support the use of 5-NIs (mainly tinidazole) as first-line therapy for Cuban pediatric patients infected with Giardia and may continue being used as reference drugs in future RCTs of giardiasis. These data could help inform policy decisions in Cuba. Caution is needed in extrapolating such data in other settings.
Human fascioliasis in nomads: A population-based serosurvey in southwest Iran
Zoghi Sina,
Emami Mehdi,
Shahriarirad Sepehr,
Vahedi Razieh,
Cheraghi Mohammad Reza,
Zamiri Bardia,
Arefkhah Nasir,
Ghorbani Fariba,
Sarkari Bahador
Fascioliasis is a human and veterinary concern in Iran. This cross-sectional population-based study was conducted to determine the seroprevalence of human fascioliasis among nomadic people in Kohgiluyeh and Boyer-Ahmad province located in the southwest of Iran. Venous blood samples were collected from 933 nomads in the area. A predesigned questionnaire containing basic epidemiological information was filled out for each subject during the sampling. Sera were evaluated for anti-Fasciola antibodies, using excretory-secretory (ES) antigen of Fasciola hepatica in an ELISA system. Of 933 recruited subjects, 726 (77.8%) were females and 206 (22.1%) were males. The mean age of the participants was 43.1 (±16.7) years old. Most of the subjects (24.6%) were in the age group of 21-30 years old. Anti-Fasciola antibodies were detected in 24 (2.6%) out of 933 cases. Of 24 seropositive cases, 3 (12.5%) were male and 21 (87.5%) were female. The differences between the seropositivity and sex, age, level of education and residence area were not statistically significant (p >0.05). Findings of the current study demonstrated that the seroprevalence of fascioliasis in the studied nomadic population was significant, and that preventive and control measures should be taken to prevent the disease from spreading and causing even greater health and economic problems in this area.
Case report
Pseudomonas aeruginosa severe skin infection in a toddler with X-linked agammaglobulinemia due to a novel BTK mutation
Riccardi Niccolò,
Rotulo Gioacchino Andrea,
Favilli Federica,
Loy Anna,
Moratto Daniele,
Giliani Silvia,
Mesini Alessio,
Romanini Maria Victoria,
Volpi Stefano,
Moscatelli Andrea,
Castagnola Elio
Agammaglobulinemia is a congenital deficit of humoral immunity characterized by a decreased level or complete absence of immunoglobulins and profound reduction of B-lymphocytes associated with an increased risk of life-threatening bacterial infection. We report a case of invasive Pseudomonas aeruginosa severe skin and soft tissue infection treated with vacuum-assisted closure and antibiotics in a toddler with a previously unreported mutation of the Bruton tyrosin kinase gene
Primary non-typhoidal Salmonella infection presenting as a splenic abscess in a healthy adolescent male
Manzar Nabeel,
Almuqamam Mohamed,
Kaushik Kunal,
Dahabra Loai,
Falcone Mariana,
Rimareva Natalia,
Pierre Louisdon,
Adeyinka Adebayo
Isolated splenic abscess in a previously healthy patient is a rare clinical condition and remains a diagnostic dilemma. Clinical presentation is often non-specific and leads to a delay in diagnosis. Imaging studies help to elucidate the condition. Despite advances in medical diagnostics and therapeutics, splenic abscesses can cause significant morbidity and can be fatal. Although splenectomy was considered the treatment of choice in the past, recent trends have seen a shift towards more conservative management. We present the clinical case of a patient who presented to our emergency room with a chief complaint of left shoulder and left upper quadrant abdominal pain. Abdominal imaging showed an intrasplenic collection suspicious for a hemorrhage or an abscess. Percutaneous drainage was successfully performed, followed by conservative management with intravenous antibiotics. The culture of the fluid drained from the spleen was positive for Salmonella Saintpaul. The patient improved and was discharged. A high degree of clinical suspicion is necessary for early identification of a splenic abscess. Splenectomy can be avoided with the use of interventional radiological drainage.
Rothia mucilaginosa bacteremia in end-stage renal disease and solid organ transplant: the need for raised awareness
Bejjanki Harini,
Koratala Abhilash
Rothia mucilaginosa, previously known as Stomatococcus mucilaginosus, is a Gram-positive coccus that is a part of the oropharyngeal and upper respiratory tract microbiota. Although this organism is believed to be of low virulence, it is increasingly being recognized as an opportunistic pathogen mostly affecting immunocompromised hosts. In this article, we describe a case of Rothia mucilaginosa bacteremia in an immunocompromised heart transplant recipient with end-stage renal disease, who was getting maintenance hemodialysis via a tunneled catheter. To the best of our knowledge, no cases of Rothia mucilaginosa bacteremia have been reported previously in heart transplant patients.
Primary gastrointestinal aspergillosis: a case report and literature review
Ceylan Bahadır,
Yılmaz Mesut,
Beköz Hüseyin Saffet,
Ramadan Saime,
Akan Gülhan Ertan,
Mert Ali
Invasive aspergillosis is a severe infection that generally involves the lungs. Primary gastrointestinal aspergillosis is the least common form of invasive aspergillosis. A patient aged 65 years developed a febrile neutropenic episode following an autologous stem cell transplant for plasmacytoid variant diffuse large B-cell gastric non-Hodgkin’s lymphoma. He had abdominal pain on the second day of the febrile neutropenic episode and ileus occurred on the sixth day. His general condition deteriorated despite broad spectrum antibiotics and caspofungin treatment, and intestinal perforation occurred on the nineteenth day of the febrile neutropenic episode. Pathological examination of the resected jejunum and ileum revealed mould hyphae compatible with aspergillus. The patient died due to massive gastrointestinal bleeding on the fifth post-operative day. Although a rare condition, primary gastrointestinal aspergillosis should be kept in mind while treating neutropenic patients with gastrointestinal symptoms.
A case of Trichosporon asahii urinary tract infection in a frail elderly patient
Acampora Nicola,
Frizza Alessandro,
Brau Fabrizio,
Torelli Riccardo,
Vella Antonietta,
De Carolis Elena,
Fantoni Massimo
Trichosporon urinary tract infection (UTI) is an unusual emerging infection, caused mostly by Trichosporon asahii, described especially in hospitalized patients. To date the interpretation and management of Trichosporon positive urinary culture remains a diagnostic and therapeutic dilemma for which there are no precise indications, and the challenge can be even more complicated in comorbid frail elderly patients. Triazoles are known to be the most effective antifungal drugs but can raise concerns about pharmacological interaction. We report a case of Trichosporon asahii nosocomial UTI in an elderly patient.
HHV6-related mild encephalopathy with reversible splenial lesion (MERS) presenting with urinary and fecal retention in an Italian adolescent
Cursi Laura,
Boccuzzi Elena,
Lancella Laura,
Longo Daniela,
Figà Talamanca Lorenzo,
Bozzola Elena,
Villani Alberto
Mild encephalopathy with a reversible splenial lesion (MERS) is an uncommon clinico-radiological entity characterized by magnetic resonance imaging (MRI) findings of a reversible lesion in the splenium of corpus callosum associated with a significant neurological manifestation of encephalopathy. The majority of reported cases involve the Asiatic population and are closely associated with infection. We report the case of an adolescent with an HHV6-related MERS presenting with hyponatremia and urinary and fecal retention. To our knowledge, urinary retention is not a constant aspect of the disease and has rarely been described, while fecal retention has never been reported before. Despite the self-limiting nature of the disease, it is mandatory to suspect it for a faster diagnosis and it might be useful to know its rare occurrences in order to better understand its etiopathogenetic mechanisms.
Switch to rilpivirine improves diabetes in an elderly HIV-positive patient
Ucciferri Claudio,
Di Rosa Zaira,
Vignale Francesca,
Vecchiet Jacopo,
Falasca Katia
Glucose intolerance and diabetes are becoming increasingly common in HIV-infected patients in the cART era. Many factors are associated with the development of diabetes in HIV-infected individuals who receive cART, one of which is the assumption of specific antiretroviral classes or agents. We describe a case in a 72-year-old Caucasian man with long-term HIV infection. We observed the development of unbalanced diabetes treated with insulin and metformin which improved when we replaced zidovudine with rilpivirine. This switch improved diabetes to such an extent that insulin suspension was required. In several countries zidovudine has long been used due to its low cost, although several side effects have been observed, especially in the long term. In this case, the switch to rilpivirine was shown to be able to improve the toxicity of zidovudine on glucose metabolism, representing a good option to be used
The Infections in the History of Medicine
Piero Sepulcri (1899-1980) and malaria eradication in Veneto
Lazzarini Luca,
Giordani Maria Teresa,
Manfrin Vinicio
Piero Sepulcri may be considered the antimalaria pioneer in the Italian region of Veneto during the 20th century. Through his activity with the Regional Antimalarial Institute he made a major contribution to one of the most important successes of medicine in the 20th century: malaria eradication in Italy. His writings on the activity of the Antimalarial Institute display the phases of eradication. In the first period antimalarial drugs were used to cure infected patients and as prophylaxis against infection. In the second period, eradication of vectors permitted the lack of transmission and consequent eradication of malarial disease. The history of malaria eradication in Italy is of the utmost importance because it established a series of steps to be taken against any transmittable disease that could return and spread once again in Italy or elsewhere.
Letters to the editor
Visceral leishmaniasis in a patient with systemic lupus erythematosus from Colombia, Latin America
Villamil-Gómez Wilmer E.,
Calderón-Gomezcaseres Álvaro,
Rodriguez-Morales Alfonso J.
Not available
Emergence of a highly resistant typhoid strain: a new global health challenge
Fatima Khunsha,
Shabbir Osama,
Ochani Rohan Kumar
Not available
