Volume 16, Issue 2, 2008
Review
Skin and soft tissue infections: current therapeutic options
Esposito Silvano,
Noviello Silvana,
Leone Sebastiano
In the present review, the authors focus on skin and soft tissue infections (SSTIs), a set of commonly observed pathologies which can present different features in terms of site and localization, clinical characteristics, and the aetiological agent responsible; their severity is related to the depth of the affected sites. After a brief introduction to the diverse classification criteria which are currently adopted by various authors, we discuss the aetiology and role of the most frequently occurring pathogen, Staphylococcus aureus, often methicillin-resistant, as well as the possible therapeutic options.
We first present the internationally recommended guidelines, and stress that SSTI management has to conform to different criteria, in accordance with the different clinical settings: mild infections require simple and cost-saving treatments while severe infections make timely and aggressive treatments mandatory. The review then reports the recent data concerning the efficacy of new antimicrobials for treating SSTIs. In particular, results observed with linezolid, tigecycline, and daptomycin are discussed.
Original article
Status of influenza vaccination in patients presenting to two neighborhood primary health care clinics in Antalya
Oncel Selma,
Turhan Ozge,
Hasan Polat,
Nevzat Ata
The objective of our study was to determine the status of influenza vaccination in patients presenting to two neighborhood primary health care clinics at the provincial centre of Antalya. This type of descriptive research was conducted between March 15 and April 15, 2006, at Primary Health Care Clinics Number 9 and 16 in Antalya. A prepared questionnaire was completed by Akdeniz University Medical Faculty intern physicians during face-to-face interviews with 1494 patients. Information about infants and children were obtained from their parents. Data that were obtained were evaluated using the SPSS program.
It was determined that 7.4% (111 individuals) of the research group had been vaccinated against influenza. Although there were no infants between 6 - 23 months who had been vaccinated, the percentage of individuals in the 60+ age group who had been vaccinated was 27.9%. The vaccination status was significantly higher in the 60+ age group (p<0.001), in university graduates (p<0.001), in civil servants, in those with health insurance (p<0.025) and in those who had any kind of risk (p<0.001). It was determined that 24.6% of the research group had had influenza in the last month. In those at risk of catching influenza the vaccination rate was 14.9%. In the research group 27.3% of the chronic obstructive pulmonary disease (COPD) patients, 21.3% of the chronic cardiopulmonary disease patients, 18.0% of those with asthma, and 13.4% of the individuals with diabetes mellitus had received the influenza vaccination. It is recommended that all health care personnel working in primary health care clinics must educate the public about this issue.
Association between raised IL-8 serum levels and resistance to combined peg-interferon + ribavirin therapy in HCV+ active chronic hepatitis
Cacopardo Bruno,
Nigro Luciano,
Nunnari Giuseppe,
La Medica Giuseppe,
Cappellani Alessandro,
Palermo Filippo,
Cappello Elisa,
Russo Rosario
IL-8 serum levels were measured in a group of 44 patients affected with Chronic Active Hepatitis (CAH) HCV+ at the beginning and end of Peg-Interferon + Ribavirin combined therapy. IL-8 levels were compared with those measured in a group of healthy controls. The patients were treated for 12 months, and then followed up for 6 months after the end of the therapy. IL-8 serum levels were detected by ELISA at the beginning and end of the therapy, and then at the end of the follow-up. IL-8 serum levels were significantly more elevated (p<0.01) in CAH HCV+ patients than in the healthy controls. Furthermore, IL-8 serum levels in those patients who subsequently showed a sustained virological response to the therapy, declined on treatment and maintained lower levels than in those who did not respond to therapy. Serum IL-8 can be considered and proposed as a non-invasive and predictive marker of response to combined PEG IFNα2b + Ribavirin in CAH HCV+.
Low bone mineral density in institutionalized patients with HIV and psychiatric co-morbidity
De Socio Giuseppe,
Fabbriciani Gianluigi,
Fanelli Luca,
Leli Christian,
Callarelli Laura,
Scarponi Anna Maria
Osteoporosis occurs in HIV-infected patients as well as in common psychiatric conditions and causes significant morbidity. There are no published studies assessing bone mineral density (BMD) in institutionalized HIV patients with associated psychiatric disorders. We analyzed 51 subjects in a case control study: 17 HIV patients (males or pre-menopausal females) with psychiatric co-morbidity and a long-term antipsychotic and antiretroviral therapy; and 34 control healthy subjects, not infected with HIV, matched with patients by age and sex. The results show that the HIV group had significantly higher rates of pathological T-scores, as compared with the controls (71% vs. 9% p<0.001). Chronic mental illness may represent a possible important co-factor influencing BMD in HIV patients. We suggest that fracture risk should be carefully evaluated for institutionalized HIV patients with psychiatric co-morbidity.
Case report
Inguinal lymphadenopathy due to Bartonella henselae
Mancino Paola,
Ucciferri Claudio,
Falasca Katia,
Racciatti Delia,
Di Girolamo Arturo,
Vecchiet Jacopo,
Pizzigallo. Eligio
The bacterium Bartonella henselae causes cat scratch disease, a self-limited zoonotic disease which is common among children and adolescents. The most typical clinical presentation is a regional lymphadenopathy that commonly involves only a single node of cervical and axillary lymph nodes. Inguinal localization is rarely described. We report a case of a 35-year-old Caucasian male complaining of a painless right inguinal mass and slight fever. A diagnosis of Bartonella henselae infection was made according to the histopathological exam of the excised mass, that showed an inflammatory state likely due to Bartonella, and to the titre of antibodies for this agent. Cat scratch disease can occur at any age and may also involve inguinal lymph nodes. Therefore it should always be included in the differential diagnosis of lymphadenopathy for adults. It is important that a meticulous personal history is obtained and that a specific serological test and pathological examination of the lesions are carried out. Often antibiotic treatment is not required because it is a benign disease and often resolves spontaneously.
Linezolid therapy for the treatment of nocardial infection: report of a case and review of the literature
Falcone Marco,
Pompeo Maria Elena,
Fabi Flavia,
Venditti Mario
Treatment of Nocardia infections continues to be difficult, especially for central nervous system infections or disseminated diseases and when sustained by highly drug-resistant species such as Nocardia farcinica. Linezolid, the first oxazolidinone approved for clinical use, shows an excellent in vitro activity against all species of Nocardia, and achieves good central nervous system and lung concentrations. We describe the case of a patient with pulmonary nocardiosis and intolerance to trimethoprim/sulfamethoxazole successfully treated with linezolid, and review all the published cases of systemic nocardiosis treated with this agent. On the basis of the available evidence, linezolid appears an effective option for the treatment of nocardiosis.
Immune thrombocytopenic purpura as a complication of Bartonella henselae infection
Palumbo Emilio,
Sodini Federica,
Boscarelli Giuseppe,
Nasca Giuseppina,
Branchi Maurizio,
Pellegrini Guido
Immune thrombocytopenic purpura is an infrequent yet well-recognized complication of viral infections, such as mumps, rubella, varicella, cytomegalovirus, parvovirus and infectious monunucleosis by Epstein-Barr virus. Some recent studies have described a possible association between Henoch-Schonlein purpura, a non-thrombocytopenic purpura, and seropositivity for Bartonella henselae, but in the literature only sporadic case reports have described a severe immune thrombocytopenic purpura as a complication of Bartonella henselae infection. We report a case of an immunocompetent child with clinical and serological evidence of Bartonella henselae infection presenting with purpura and cervical lymphoadenopathy and treated with intravenous immunoglobulin. The patient obtained a rapid and persistent increase in platelet count and a complete regression of purpura.
Reports on nine cases of spondylodiscitis
Romano Amelia,
Giordano Salvatore,
Abbagnato Luisa,
Scarlata Francesco,
Miceli Silvana,
Scaglione Vincenzo,
Odierna Antonio,
Politi Francesca,
Pepe Alessio,
Agostara Biagio
Spondylodiscitis is an infection of the intervertebral disk and the adjacent vertebrae, with or without associated epidural or psoas abscesses. It is a serious disease both due to its long-term course and the possible outcomes. It is frequently caused by S. aureus and, in endemic areas, by Mycobacterium tuberculosis and Brucella spp. We describe 9 cases, from October 2004 to August 2005, all spontaneous diseases occurring in adults (mean age 64 years). The site of infection was lumbar in 7, lumbar-sacral in 1 and dorsal in 1. None were associated to sepsis. The causative bacteria were known in 6 cases (1 BK, 1 S. aureus, 4 Brucella) and unknown in 3 cases. In all cases therapy was only medical. Significant circulation in Sicily of both Mycobacterium tuberculosis and Brucella spp. make those microorganisms the most frequent agents of spondylodiscitis.
The Infections in the History of Medicine
Physicians and philosophers tackling Cupid’s disease: combating syphilis in the 18th century
Sabbatani Sergio
After the great fear caused by the rapid spread of syphilis in the 16th century (and the progressive contraction in the following century), the European political authorities had to tackle a disease that had become endemic. There was no solution in terms of treatment since the cause was unknown: the only precaution seemed to be the repression of such behaviour as prostitution, which seemed connected to the spread of Cupid’s disease, as syphilis was called euphemistically in cultured circles. Medicine was powerless, and thinkers and philosophers helped the rulers with their ideas to develop laws to repress and reduce the incidence of the disease.
In the 18th century, philosophers such as Ludovico Antonio Muratori and Peter Frank (founder of the Health Police), the priest Maria Gennaro Sarnelli, the libertine Bernard De Mandeville, the Neapolitan thinker Gaetano Filangeri, the founder of Congregazione della Carità Don Giulio Canali and the Abbot Antonio Genovesi contributed with their studies and sometimes works to focus attention on health problems in relation to syphilis prevention, even if repression remained the most widely adopted solution.
