Volume 18, Issue 2, 2010
Review
Severe bacterial infections in haemodialysis patients
Leone Sebastiano,
Suter Fredy
Infections are today by far the most common complication affecting patients with chronic kidney disease and particularly those undergoing chronic haemodialysis. Numerous antimicrobial-resistant pathogens have emerged among patients with chronic kidney disease. These patients are hospitalized with greater frequency than the general population and the number of hospitalizations has been shown to correlate with higher infection rates. This review will briefly discuss the most common infections in patients undergoing chronic haemodialysis, the clinical relevance of antimicrobial resistance in these patients, and their therapeutic options.
The return of anthrax. From bioterrorism to the zoonotic cluster of Sciacca district
Scarlata Francesco,
Colletti Pietro,
Bonura Silvia,
Trizzino Marcello,
Giordano Salvatore,
Titone Lucina
Anthrax is a disease caused by Bacillus anthracis which affects herbivorous animals. Humans acquire the disease incidentally by exposure to infected animals, animal products or spores on soil. The infection is still endemic in many regions in developing countries. In Italy animal clusters are very rare and human cases are exceptional. Bacillus anthrax is also a potential source for acts of bioterrorism. In the natural human infection, cutaneous anthrax is the most widespread, while the other two, pulmonary and gastrointestinal anthrax, are very rare forms. We describe the first case of human anthrax occurring in western Sicily in the last twenty years. The cutaneous lesion healed without significant scarring after antibiotic treatment with tigecycline, rifampin and ciprofloxacin. Following our diagnosis, a cluster of bovine anthrax was detected in the district of Sciacca, causing the death of 13 animals. A larger outbreak was avoided by the vaccination of over 5000 herbivores.
Original article
Economic evaluation of posaconazole in prophylaxis of invasive fungal infections in Italian neutropenic patients with acute myeloid leukaemia or myelodysplastic syndrome
Lazzaro Carlo
The objective of this study was to assess the costs and effectiveness (avoided invasive fungal infections - IFIs; overall mortality) of prophylaxis with posaconazole 200 mg per os TID and standard azoles (fluconazole 400 mg per os OD; itraconazole 200 mg per os BID) in neutropenic patients with acute myelogenous leukaemia or myelodysplastic syndromes. A 100-day cost-effectiveness model was developed following the Italian hospital perspective. The probability of IFIs, death from IFIs, and death from other causes was obtained from the literature. Health care sector resources (type; volume; unit cost) are given in Euros and refer to 2009. The robustness of the cost-effectiveness model was tested via one-way and probabilistic sensitivity analyses. Total costs for posaconazole (standard azoles) was estimated at Euros 3365.26 (Euros 2339.96). Posaconazole is consistently more effective than standard azoles. The incremental cost-effectiveness ratio for avoided IFI (avoided overall mortality) with posaconazole is Euros 15,850.51 (Euros 18,038.43). Sensitivity analyses confirmed the robustness of such findings. In conclusion, posaconazole as a prophylaxis in neutropenic patients with AML or MDS who are at risk of IFI is “good value for money” for Italian hospitals.
Epidemiologic and clinical parameters in hospitalized patients with novel Influenza A (H1N1) in Taranto province, Italy
Buccoliero Giovanni,
Romanelli Chiara,
Lonero Gaetano,
Loperfido Pietro,
Chimienti Angelo,
Resta Francesco
The global spread of novel influenza A (H1N1) led the World Health Organization to declare a pandemic on June 11, 2009. Our study aimed to describe the epidemiologic and clinical parameters of hospitalized patients during the pandemic. Fifty-one persons with suspected influenza A H1N1 were hospitalized. Thirty-two of them (14 male and 18 female) were positive for novel influenza A (H1N1) viral RNA by real time PCR in nasopharyngeal specimens. Of those who tested positive, 46.8% (15 patients) were aged between 25-49 years and only 9.3% (3) were over 65 years old. Nineteen of the 32 presented a co-morbidity. The mean duration of hospitalization was 6.5 days (range 3-19). An influenza complication was presented by 68.7% of patients (all of them <65 years old), which in most cases was pulmonary disease (18 bronchopneumonia, 2 interstitial pneumonia). Four patients required mechanical ventilation in Intensive Therapy Care. One patient died of a concomitant myo-pericarditis. Of the patients with influenza complications, 60% presented co-morbidity conditions. Neurologic complication (encephalitis) occurred in two young women; prognosis was good and without neurologic sequelae. In conclusion, our data do not show a correlation between gender and risk of hospitalization or influenza complication. The presence of co-morbidity does not increase the risk of pulmonary complication, which is more frequent among young adults.
IIn vitro activity of daptomycin and comparator agents against Staphylococcus aureus isolates from intravenous drug users with right endocarditis
Sanchez-Porto Antonio,
Casanova-Roman Manuel,
Casas-Ciria Javier,
Santaella Maria Jose,
Sanchez-Morenilla Immaculada,
Eiros-Bouza Jose Maria
There is an increasing need for alternative agents in endocarditis, especially with the increasing incidence of vancomycin-intermediate Staphylococcus aureus (VISA). We evaluated the in vitro activity of daptomycin and several comparator agents against 33 non-duplicate clinical Staphylococcus aureus isolates from intravenous drug users with right endocarditis. Wider microdilution panels were used for all the comparator agents and daptomycin. Daptomycin was also tested using E-test strips. E-test strips were used to confirm the vancomycin MICs. Methicillin-resistant Staphylococcus aureus (MRSA isolates with vancomycin MICs ≥2 μg/mL were screened using the E-test GRD. In all, 30 isolates were methicillin-susceptible (MSSA) and 3 MRSA. The three MRSA isolates exhibited a false vancomycin MIC >2 μg/mL determined by Wider microdilution panels. They were screened using the E-test GRD and they were GRD negative. Their final MIC was 2 μg/mL. Three MSSA and three MRSA isolates had a vancomycin MIC of 2 μg/mL. Four MSSA isolates had a vancomycin MIC of 1.5 μg/mL, daptomycin MIC90 0.25 μg/mL, linezolid MIC90 2 μg/mL. As regards daptomycin, wider microdilution panels and E-test strips yielded the same results. Our findings suggest that daptomycin and linezolid are a viable alternative for treating right endocarditis and bacteraemia caused by MSSA, MRSA and hVISA.
Hepatitis A in men having sex with men (MSMs) in northern Italy
Pini Alessandro,
Tomasoni Lina Rachele,
Cristini Graziella,
Puoti Massimo,
Matteelli Alberto,
Carosi Giampiero,
Castelli Francesco
During 2009 there was an increased incidence of acute hepatitis A virus (HAV) infection among homosexual males which, in our institute, outnumbered the number of cases in travellers, thus becoming the prime HAV risk factor. Some of our HAV cases occurred in HIV-infected subjects. This observation underlines the action of HAV as a sexually transmitted infection and urges preventive measures, such as routine HAV vaccination in the HIV-infected population.
Bismuth-based quadruple Helicobacter pylori eradication regimen alters the composition of gut microbiota
Süzük Serap,
Yalinay Meltem,
Karakan Tarkan
Microbiota is a dynamic system showing individual differences in both the number and species of microorganisms. Dietary habits, lifestyle, age, genetic predisposition of the host and use of antibiotics are effective on microbiota. The aim of our research was to carry out a quantitative comparison of Bifidobacterium spp, Bacteroides fragilis, Lactobacillus spp, Akkermansia mucinophilia and Faecalibacterium prausnitzii, important bacterial microbiota species, before and after antibiotic therapy treated with tetracycline and metronidazole in patients who are diagnosed as positive for Helicobacter pylori (HP), and to determine the effects of antibiotic use on the microbiota. Eighteen HP-positive patients were enrolled in this study. A special extraction kit (QIAmp DNA Stool Mini Kit, QIAgen, GERMANY) was used for the DNA isolation procedure. Primers specific to the 16S rRNA region of the bacteria included in the study were used for the amplification of the target region. All the bacteria were subjected to real-time quantification procedure with PCR method on RotorGene® 20 device (Qiagen, Germany). According to quantification before and after antibiotic use in patients receiving HP treatment, statistically significant decreases were observed in Bifidobacterium spp (p=0.001), B. fragilis (p=0.001), Lactobacillus spp (p=0.001), A. mucinophilia (p=0.001) and F. prausnitzii (p=0.001). We were unable to identify B. fragilis in the microbiota of five patients after treatment. Based on the data obtained, it can be concluded that antibiotics used to treat HP can prepare the ground that could result in dysbiosis in microbiota.
Case report
Nocardiosis dissemination following transthoracic needle biopsy: two case reports
Forner Gabriella,
Mengoli Carlo,
Fuser Rodolfo,
Scotton Pier Giorgio
Pulmonary nocardiosis is a rare respiratory infection whose diagnosis can easily be missed because there are no suggestive symptoms. Nocardiosis is typically regarded as an opportunistic infection, but one-third of infected patients are immunocompetent. We present two situations of pulmonary lesions in immunocompetent people. A CT-guided percutaneous transthoracic needle biopsy was performed in both cases but was not informative. Suppurative inflammation had developed as a complication of the procedure in the biopsy site after 1-2 weeks. Pus was aspirated and culture showed Nocardia spp. Therefore we hypothesize that the pulmonary lesion was caused initially by Nocardia which had subsequently disseminated to the chest wall after the biopsy. Treatment with trimethoprim/sulfamethoxazole was undertaken. Resolution of the disease was evaluated according to the clinical symptoms and radiological resolution after 6 months therapy.
Pneumocystis jiroveci and Cytomegalovirus pneumonia in patients with alcoholic hepatic cirrhosis
Dodi Ferdinando,
Centanaro Monica,
Campolucci Andrea,
Valente Umberto,
Pagano Gabriella
We have described a fatal case of interstitial pneumonia with pleuritis in woman, 54 years old, suffered from end stage liver disease caused by ethanolic hepatic cirrhosis. Broncholavage microbiological culture was negative but biomolecular assays with polymerase chain reaction demonstred Pneumocystis jiroveci and Cytomegalovirus. She died despite aetiological therapy with cotrimoxazole and gancyclovir. Immunodeficiency of the delayed immune response, related to the severe liver disease and ethanol use, explains the occurrence of these opportunistic infections in ethanolic cirrhotic patients too.
Rhodotorula glutinis sepsis. A case report
Pulvirenti Fabrizio,
Pasqua Paolo,
Falzone Elio,
Maffeo Federico,
Gugliara Carmelo,
Guarneri Luigi
Fungal sepsis is an important cause of fever resistant to antibiotic therapy that is very often taken into marginal account. It should instead be particularly considered in patients with a long history of immune depression such as diabetes or chronic and debilitating diseases. Blood cultures are essential for diagnostic purposes, preferably performed in antibiotic wash-out, since they may allow identification of pathogenic (or opportunistic) fungi responsible for episodes of fungal sepsis. The case described illustrates an episode of systemic infection by Rhodotorula glutinis correlated with the presence of CVC.
Icteric hepatitis in a patient with non-Hodgkin’s lymphoma treated by rituximab-based chemotherapy
Coppola Nicola,
Masiello Addolorata,
Tonziello Gilda,
Macera Margherita,
Iodice Valentina,
Caprio Nunzio,
Pasquale Giuseppe
We report the case of a patient with non-Hodgkin’s lymphoma who, during chemotherapy according to the r-CHOP schedule (rituximab-cyclophosphamide-doxorubicin-vincristine and prednisone), showed a hepatic flare with jaundice. Given the patient’s state of asymptomatic carrier of HBsAg, we began a treatment of telbivudine (600mg/die), resulting in a regression of hepatitis flare and negativization of HBV viraemia.
The Infections in the History of Medicine
Augusto Murri. Analysis of medical systems, and the basis of modern clinical methodology
Manfredi Roberto
Based on some selected documents of the renowned Italian clinician Augusto Murri, the principal milestones and limitations of current clinical methodology are narrated and discussed.
