Volume 17, Issue 2, 2009
Review
HIV Infection: treatment of naïve patients
Bonora Stefano,
Calcagno Andrea,
Di Perri Giovanni
Recently, the approach to initial therapy in naïve patients has profoundly changed. The trend in 2008 suggests that HAART be started earlier than previously held. HAART should also be considered in selected patients with a CD4(+) count falling in the range 350-400 cells/μL and in all subjects with a TCD4 (+) lower than 350 cells/μL. Initial HAART provides a sufficiently broad range of choices, undoubtedly destined to further improve in the near future. However, such a choice has to take into account the patient’s specific requirements and clinical picture, including comorbidity, risk factors for cardiovascular metabolic complications, simplicity and convenience of therapeutic regimen, and long-term tolerability.
Original article
Disappearance of Streptococcus pyogenes macrolides resistance in an area of northeastern Italy: a possible link with rational long-acting macrolide consumption
De Rosa Rita,
Avolio Manuela,
Stano Paola,
Luisa Maria,
Camporese Alessandro
Many studies have shown a correlation between higher consumption of long-acting macrolides and the development of resistance of S. pyogenes but, to our knowledge, no studies have reported the disappearance of S. pyogenes macrolide resistance. We evaluated the possible relationship between the rational use of long-acting macrolide consumption and the disappearance of S .pyogenes erythromycin resistance in an area of northeastern Italy, the district of Pordenone (approximately 300,000 inhabitants). The emerging use of new long-acting macrolides, especially since 1993, has caused a great increase in total macrolide consumption (expressed as defined daily doses per 1,000 inhabitants per day; DDDs), followed by a steady increase in the percentage of S. pyogenes resistant to erythromycin (from 4% in 1994 to 56.3% in 2000). Subsequently, from 2000 to 2007, the maintenance of steady-high DDDs of clarithromycin but low DDDs of azithromycin resulted in a sharp decrease in the percentage of S. pyogenes resistance to erythromycin (from 33.3% in 2001 to 0.2% in 2008). Disappearance of S. pyogenes erythromycin resistance in the last few years, compared with data of long-acting macrolide consumption from 2000 to 2007, suggests that S. pyogenes resistance to erythromycin is more likely associated with the specific type of compound used rather than with total consumption of long-acting macrolides.
Sexual exposure to HIV, sexual behaviour and use of pharmacological post-exposure prophylaxis (PEP)
Franco Alfredo,
Starace Fabrizio,
Aprea Lucia,
Faella Francesco Saverio,
Giordano Antonio,
Maiorino Cosimo,
Manzillo Elio,
Marocco Alessandro,
Martucci Fiorella,
Pizzella Teresa,
Simioli Francesco,
Izzo Crescenzo Maria
In this study we examined the characteristics of 60 subjects (49 M and 11 F, average age 32.3) out of 195 post-exposure pharmacological prophylaxis (PEP) to HIV, taken in our hospital from 2001 to 2008. The above-mentioned subjects are sexually exposed (or presumably exposed) to HIV. We considered both their sexual intercourse behaviour and protective measures, and sought to infer some trends in sexual behaviour in Italy. All the subjects were monitored until 180 days after exposure, as established by the national guidelines. Only one of the 60 people presented a seroconversion (he dropped out after a 15-day follow-up and after an inadequate 19-day prophylaxis). Another subject, a homosexual male, never previously tested, resulted positive at TIME 0 both for HIV-Ab and syphilis tests (due to previous risk-sexual exposure), which caused the suspension of the prophylaxis. No HBV, HCV or syphilis seroconversion occurred. Two other homosexual males showed a previously latent positivity to syphilis tests at TIME 0.
Diarrhoea in children: aetiology and clinical aspects
Palumbo Emilio,
Malorgio Cristiana,
Siani Alberto,
Bonora Gilberto
To determine the aetiology of diarrhoea in children <5 years hospitalised for acute enteritis and to evidence the chief clinical aspects in correlation with different aetiological agents, a total of 402 children with acute diarrhoea were examined between February 2003 and December 2006 in the Paediatric Department of Sondrio Hospital. Faecal samples were collected and processed by routine microbiological and biochemical tests. For all patients the clinical signs and symptoms on admission were evidenced. Most of the patients (310/402, 77.1%) were infected by rotavirus, while of the remaining 82 (22.9%) 40 were infected by salmonella species. In 42 patients, no bacterial agent was evidenced by microbiological tests. Clinical signs of mild dehydration were observed in 13 children during the hospital stay (all infected by rotavirus), while no case of metabolic acidosis, hypoglycaemia or hypovolaemic shock was documented. Elevated serum levels of uric acid were evidenced in 13/302 (4.3%) of patients with rotavirus infection, while only 1/82 (1.2%) rotavirus-negative children presented a minimal increase in serum uric acid level. Our retrospective study confirms the epidemiological and clinical importance of rotavirus as the main aetiological agent in hospitalised children <5 years affected by acute diarrhoea. There also emerged a possible correlation between rotavirus infection and hyperuricaemia, probably connected with dehydration.
Case report
Paucisymptomatic pneumonia due to Rothia mucilaginosa: case report and literature review
Fusconi Massimo,
Conti Cinzia,
De Virgilio Armando,
de Vincentiis Marco
Rothia mucilaginosa is a Gram-positive, coagulase-negative, encapsulated, non-spore-forming coccus considered part of the commensal flora of the oral cavity and the upper respiratory tract in humans. Its involvement has been reported in an increasing spectrum of infections, above all among immunocompromised patients. To date, only 11 cases of pneumonia due to Rothia mucilaginosa have been described in the literature. The authors report a case of pneumonia due to Rothia mucilaginosa in a 72-year-old man with laryngeal cancer and review the published cases of pneumonia due to this pathogen.
Salvage therapy with tenofovir followed by adefovir maintenance in a cirrhotic patient with a lamivudine resistant HBV flare
Stornaiuolo Gianfranca,
Brancaccio Giuseppina,
Precone Vincenza,
Sgrò Graziella,
Nardiello Salvatore,
Gaeta Giovanni Battista
A 36 year old man with chronic hepatitis B and cirrhosis was admitted in our Department for the onset of jaundice, ascites and ALT flare (x 35 u.n.v.) while under lamivudine treatment. Serum HBV-DNA was 1.48x106 IU/ml and lamivudine (LAM) resistance mutations were present. Tenofovir (TDF) 300 mg/day was added to LAM after its off-label use was authorised. HBV-DNA decreased in a biphasic manner and became undetectable by day 45. A parallel improvement in ALT and bilirubin values was detected. Tenofovir was substituted with adefovir dipivoxil 10 mg/day. Ten months after this switch HBV-DNA remained undetectable.
Tenofovir is an effective salvage therapy for critically ill patients with LAM-resistant HBV flares and can be switched to adefovir after HBV-DNA becomes undetectable. Local cost and reimbursement policies are important determinants in antiviral therapy.
Spontaneous and treatment-induced virological dynamic in the plasma, PBMC and tissue liver in a patient with chronic HBV and HCV coinfection.
Stanzione Maria,
Tonziello Gilda,
Iodice Valentina,
Macera Margherita,
Sagnelli Evangelista,
Piccinino Felice,
Coppola Nicola
Here it is reported the virological dynamic of HBV and HCV, identified in the plasma, peripheral blood mononuclear cells and tissue liver, in a patient with chronic HBV-HCV coinfection. A treatment with pegylated Interferon plus Ribavirin determined a sustained virological response for HCV in all the three studied compartments, but a reactivation of chronic HBV infection was observed. In fact, while at the first observation HBV-DNA was detectable only in the liver tissue, after antiviral therapy it was detectable in all the three compartments; moreover this HBV reactivation was associated with a hepatic flare. Then, the patient was treated with Entecavir, which has been determining the clearance of HBV from the peripheral compartments (plasma and PBMC) until today.
Dicrocoelium dendriticum: a true infection?
Magi Barbara,
Frati Elena,
Bernini Laura,
Sansoni Anna,
Zanelli Giacomo
Dicrocoelium dendriticum is a liver parasite of ruminants. Humans are occasionally infected by ingestion of intermediate hosts. We report a rare case of dicrocoeliasis in a 55-year-old woman who presented with eosinophilia and elevated bilirubin. Therapy with albendazole eradicated the parasite and normalized blood parameters.
The Infections in the History of Medicine
Syphilis in Ferrara in the nineteenth century
Angelini Lauretta,
Guidi Enrica,
Contini Carlo
In this article the authors highlight the behaviour of government authorities in the nineteenth century in Italy and especially in Ferrara to implement those measures deemed necessary to stem the spread of syphilis in epidemic form through the control of prostitution. Albeit discontinuously and until 1865, “corrupted” and infected women in Ferrara were assisted and treated by charitable institutions (Congregation of Charity, the Congregation of the Ladies of St. Vincent and the Sisters of Charity at the complex St. Mary of Consolation) since the Ferrara public hospital (Arcispedale S. Anna) could not accept or treat infected prostitutes for economic reasons and lack of beds. Subsequently, the hospital only treated prostitutes free of charge if they bore a certificate of poverty. The other infected prostitutes were sent to the “sifilicomio” in Modena. The authors also study mortality from syphilis in Ferrara from 1813 to 1899 in order to detect any significant differences according to age, sex and professional status and attempt to identify the stage of the disease (primary, secondary and tertiary), according to the terminology used by the doctors of that time.
