Volume 7, Issue 2, 1999
Review
Leptospirosis: epidemiology, diagnosis and clinical aspects
Russo Rosario,
Panarello Giovanna
Leptospires, world-wide distributed spirochetes, affect a great variety of mammalian hosts; several serovars belonging to the L. interrogans s.l. species can cause clinical manifestations in humans, becoming infected through the contact of skin cuts and mucous membranes with water and soil polluted by infected animals’ urine; rodents serve as the main reservoirs but the epidemiological importance of pets and cattle, as leptospire shedder is increasing. While the infection remains endemic in tropical regions, there is a new epidemiological trend in developed countries where, with the typical seasonal pattern, sporadic cases and/or outbreaks occur related more to recreational activities and poor sanitation than to occupational activities. The sudden onset presents a “flu-like” syndrome; the course is usually characterised by two clearly defined stages. All of the variable clinical manifestations, often independent of the responsible serovar, arise from the effects of a general vasculitis. The prognostic factors associated with severe forms (renal failure, jaundice, haemorrhagies) are not defined. Within the first days of illness, the leptospires can be isolated from blood and cerebrospinal fluid; serological diagnosis relies on microagglutination, IFA and ELISA; PCR early in the course, before the appearance of specific antibodies, allows etiological diagnosis. Prompt treatment has an enormous impact on outcome.
Plasma HIV-1 RNA viral load up to one year of follow-up in 64 patients treated with HAART
Di Nicuolo Giuseppe,
Gargiulo Miriam,
Starace Maria,
Punzi Rodolfo,
Tarro Giulio,
Esposito Ciro,
Loiacono Laura,
Liberti Alfonso
The aim of this study was to evaluate efficacy of highly active antiretroviral therapy (HAART) in 64 HIV-1 positive treatment-naive and previously treated patients, with different viral load at baseline. The HAART regimen consisted of one protease inhibitor and two reverse-transcriptase inhibitors. Plasma RNA viral load was measured by RT-PCR (Roche Amplicor Monitor kit) at enrolment and at months 3, 6, 9, and 12 of follow-up. The viral load fell below the threshold of 200 copies/ml in 46.9% of patients at month 6 and this result lasted up to month 12 of follow-up in 42.2% of patients. In these patients the CD4+ cell count increased from a baseline with a median of 194 cells/mmc at month 12. Treatment failure occurred in 35.9% of patients and the proportion was higher among previously treated patients. 7 patients stopped therapy because of poor compliance and 5 because of adverse drug effects. Also in our cases the HAART regimen showed more efficacy in treatment-naive patients, whereas baseline viral load >1x105 was the cause of less efficacy of therapy.
Original article
Virological and clinical aspects of multiple hepatitis virus infections: preliminary data of an italian multicentre study
Sagnelli Evangelista,
Coppola Nicola,
Scolastico Carlo,
Filippini Pietro,
Piccinino Felice
To evaluate the interference between HBV, HCV and HDV and the clinical impact of coinfection as compared with single HBV or HCV infection, we unrolled 618 HBsAg and/or anti-HCV positive subjects (337 with liver biopsy and 281 without liver biopsy) at their first observation at one of the seven Italian Liver Units from 1993 to 1997 (Padova, Rome, Sassari, Naples, Bari, Messina, Palermo). Serum HBV-DNA by dot-blot was found more frequently in patients with HBV infection alone (52% of 133 cases) than in those with HBV-HCV coinfection (28% of 64 cases, p<0.005) or in those with HBV-HDV-HCV coinfection (12% of 25 cases, p<0.0005) or with HBV-HDV coinfection (13% of 8 cases, p<0.05). We observed a higher prevalence of HCV-RNA positive cases in the patients with HCV infection alone (91.2% of 114 cases) than in those with HBV-HCV coinfection (64.5% of 62 cases, p<0.0001) or with HBV-HDV-HCV infection (19% of 21 cases, p<0.0001). These observations suggest a reciprocal inhibition of HBV and HCV genome in multiple hepatitis viral infection. A severe liver disease was more frequently observed in patients with HBV-HCV coinfection (66%) than in those with a single HBV infection (43%, p<0.05) or HCV infection (46%, p<0.05). Anti-HCV positive/anti-HBc positive patients, lacking both HBsAg and anti-HBs, compared with the anti-HCV positive/anti HBc negative ones, more frequently showed severe clinical presentation and less frequently had a sustained response to a-IFN treatment.
Incidence of fever of difficult diagnosis observed from January 1990 to August 1998
Sica Salvatore,
Avino Stefano,
Glielmi Gianfranco,
Rosario Sergio
Design: We evalueted incidence, period and etiology of the fever of difficult diagnosis (FDD) among 169 cases of fever of unknown origin (FUO) observed from 1-90 to 8-98. Materials and methods: we used the general and orientative diagnostic criteria useful for identifying some pathologies and also for distinguishing between infectious and non infectious fevers. Only as last attempt to solve the problem did we adopt ex-adiuvantibus treatments. Results: FDD incidence was 29.58%; we identified four main categories after detailed diagnostic work up:1) Fictitious fevers and abitual hyperthermia; 2) Systemic vasculitis with atypical clinical features; 3) Rheumatic polymyalgia; 4) Steroid-responder fevers. Conclusion: FDD is not a rare event, but of complicated resolution, some remaining unsolved. Our experience suggests that we consider only a few elements at first to distinguish organic from sine materia fevers: age, history of recent surgery, general clinical picture and aspecific indexes of inflammation.
Extraction and characterization of the lipopolysaccharide of Bartonella quintana
Matera Giovanni,
Liberto Maria Carla,
Pollio Antonio,
Diana Raffaele,
Martucci Maria,
Parlato Giuseppe,
Gulletta Elio,
Focà Alfredo
Bartonella quintana has been reported as the cause of trench fever, persistent endocarditis, bacteriaemia and has been isolated with an increasing incidence in clinical specimens from AIDS patients. One of the main pathogenic factors of gram-negative bacteria, including B. quintana, is the lipopolysaccharide (LPS). However, very little information is available on the features of Bartonella LPS. The aim of the present study was to extract, purify and characterise B. quintana LPS.
The effect of the LPS under scrutiny was also evaluated on TNFa release by means of the “in vitro” human whole blood model of sepsis. The Oklahoma strain of B. quintana was grown on sheep blood agar, at 37°C, in a moist atmosphere containing 5% carbon dioxide. Cells were harvested and washed in sterile and apyrogenic saline solution and LPS extracted following the procedure of Westphal e Jann (1965), modified by Minnick (1994). The LPS of B. quintana showed the migration pattern of a deep rough chemotype, and the chromogenic limulus amoebocyte lysate test (LAL test) revealed strong reactivity at low concentrations (6.2 pg/ml). Samples of human whole blood stimulated by 1000 ng/ml of B. quintana LPS released 1707±378 pg/ml of TNFa.
Bacterial pneumonia in HIV-infected patients
de Gaetano Donati Katleen,
Tacconelli Evelina,
Tumbarello Mario,
Bertagnolio Silvia,
Ardito Fausta,
Pirronti Tommaso,
Cauda Roberto
This case-control study assessed risk factors and prognostic indicators of 350 episodes of bacterial pneumonia in 285 HIV-infected patients. On univariate analysis, intravenous drug abuse (p<0.001), regular cigarette smoking (p<0.001), cirrhosis (p=0.04), and history of a previous episode of pneumonia (p=0.04), were risk factors for community-acquired episodes of bacterial pneumonia, whereas length of hospitalization (p=0.01) was a risk factor only for nosocomial bacterial pneumonia. The small amount of circulating T CD4+ cells, (<100/mmc) was a risk factor in both groups of pneumonia (p<0.05). Stepwise logistic regression analysis revealed that IVDA in community-acquired episodes and low levels of circulating T CD4+ cells, both in community-acquired and hospital-acquired episodes, were independent risk factors for the development of bacterial pneumonia. The case-fatality rate observed in our study was 27%. On stepwise logistic regression analysis, T CD4+ cell counts >100/mmc (p<0.02), neutropenia (p=0.04), PO2 arterial level <70 mmHg (p=0.01), and Karnofsky score <50 (p=0.04) were independent indicators of mortality. According to a personally developed prognostic score, 211 episodes of pneumonia (60%) were classified as mild, 63 (18%) as moderate, and 76 (22%) as severe. Clinicians must carefully evaluate those variables that can influence the prognosis of bacterial pneumonia to make early identification of affected patients and to promptly establish the most appropriate therapeutic strategy in each case.
Case report
Complicated purulent meningitis as first manifestation of a hidden HIV disease
Manfredi Roberto,
Chiodo Francesco
A case report of severe Streptococcus pneumoniae meningitis, prompting the diagnosis of a concurrent occult HIV infection, is presented. Despite a favorable in vitro susceptibility profile of the isolated microbial strain and timely antibiotic treatment, our patient suffered from permanent neurogical sequelae (severe bilateral central hypacusia). The role of penumococcal complications in the context of HIV disease and AIDS is rewieved in light of recent finding reported in the literature.
Nosocomial sepsis due to Ochrobactrum anthropi in HIV positive patients: two case reports
Manfredi Roberto,
Nanetti Anna,
Ferri Morena,
Chiodo Francesco
The first two case reports of nosocomial Ochrobactrum anthropi septicemia occurring in patients with HIV disease are presented, and discussed in light of recent evidence of non-fermenting gran-negative bacilli as emerging pathogens in hospitalized immunocompromised patients. Among patients with advanced HIV infection, O. anthropi septicemia may occur even when certain presumed risk factors (notably indwelling catheters and instrumentation) are lacking, while a low CD4+ lymphocyte count, neutropenia, and concurrent AIDS-related complications may act as predisposing conditions. Despite its low intrinsic pathogenicity, O. anthropi should be taken into consideration by both microbiologists and clinicians, due to its cumbersome identification procedures, its prevailing nosocomial occurrence, and its unpredictable antibiotic susceptibility pattern.
Bilobectomy in a brazilian infant suffering from extensive monolateral pulmonary TBC
Cigliano Bruno,
de Franciscis Alessandro,
Palazzo Giovanni,
Pisanti Antonio,
Rufolo Lucio,
di Martino Lucio
As there has recently been a significant increase in childhood tuberculosis, we considered an important contribution the clinical case of an infant from Brazil, who underwent right bilobectomy to treat a previously poorly cured enlarged pulmonary tubercular infiltrate.
The Infections in the History of Medicine
Flügge’s droplets
Pistacchio Eleonora
After a review of the main theories by various authors on the aetiology and transmission modes of tubercular infection, the paper deals with the discovery of the tubercular bacillus made by Koch and the experiments conducted by his co-worker, Cornet, who concluded that the tubercular bacillus was more concentrated around the subject suffering from open pulmonary TBC. However, it was Flugge who eventually clarified beyond any doubt, after many experiments, the real, direct transmission mode of tuberculosis through droplets of saliva emitted by the sick and which are still known today as Flugge’s droplets.
