Volume 21, Issue 2, 2013
Review
Clostridium difficile infection in the elderly
Di Bella Stefano,
Capone Alessandro,
Musso Maria,
Giannella Maddalena,
Tarasi Agapito,
Johnson Emma,
Taglietti Fabrizio,
Campoli Caterina,
Petrosillo Nicola
The incidence of C. difficile infections (CDI) in the elderly continues to rise and infection is associated with increased morbidity and mortality when compared to those affected in younger age-groups. Immunosenescence may be a contributory factor yet the exact immune responses that may protect against CDI are incompletely understood. Increased exposure to antibiotics, frequent and/or prolonged hospital admissions and residing in long-term care facilities provide multiple opportunities for host and pathogen to coincide. This review explores the epidemiology, diagnostic parameters and management of the spectrum of disease in the geriatric population. Deaths attributed to CDI are most common in the elderly population and are a major contributor to gastroenteritis-associated mortality in many countries. The elderly represent an “at-risk” population from this pathogen and efforts must be directed to preventing infection and optimising treatment in this group.
Original article
Correspondence between hospital admission and the pneumonia severity index (PSI), CURB-65 criteria and comparison of their predictive value in mortality and hospital stay
Varshochi Mojtaba,
Kianmehr Parisa,
Naghavi-Behzad Mohammad,
Bayat-Makoo Zhinous
Pneumonia severity assessment systems, such as the pneumonia severity index (PSI) and CURB-65, were designed to guide physicians to admit the patients involved to appropriate wards of hospitals. This study evaluated concordance rate of decisions leading to patients’ hospitalization in accordance with PSI and CURB-65 criteria and comparison of the two systems’ P-values in evaluating mortality and the hospitalization period of the patients in question.
A total of 134 hospitalized patients with community-acquired pneumonia (CAP) were evaluated. Patients were classified on the basis of risk factors implicated in the PSI and CURB-65 systems. Prognostic P-values and indication measures of hospitalization for the two systems were then compared. Eighty-seven males (64.9%) and 47 females (35.1%) with a mean age of 64.23±19.82 (15-103) years were enrolled in the study. Based on the results of both systems, hospitalization was indicated in 112 cases (83.6%) and there was total agreement between the two systems in 61 cases (45.5%). There was no significant association between hospitalization duration in the two systems. However, both systems significantly predicted mortality within the hospitalization period with rather equal accuracies. Patients expired more frequently in the group with indication of hospitalization based on the PSI classes. However, there was no significant difference in the mortality between the two groups with and without admission indication according to the CURB-65 system.
A considerable portion of our hospitalizations met the related criteria of the PSI/CURB-65. The two evaluation systems have near equal sensitivity and specificity for predicting mortality among hospitalized patients with CAP when the PSI class ≥IV and CURB-65 score ≥2.
Assessment of methicillin and clindamycin resistance patterns in Staphylococcus aureus isolated from a tertiary hospital in Turkey
Tekin Alicem,
Dal Tuba,
Deveci Ozcan,
Tekin Recep,
Atmaca Selahattin,
Dayan Saim
In order to detect the methicillin susceptibility and determine the prevalence of constitutive and inducible clindamycin resistance in Staphylococcus aureus strains, a total of 254 S. aureus isolates, including 139 (54.7%) methicillin-sensitive and 115 (45.3%) methicillin-resistant, were tested for clindamycin and erythromycin by Kirby-Bauer’s disk diffusion method. The disk diffusion induction test or D-test was performed on erythromycin-resistant and clindamycin-sensitive strains using the disk diffusion method. The erythromycin-resistant and clindamycin-sensitive strains with a D-shaped zone around the clindamycin disk were considered positive for inducible clindamycin resistance. If a strain was found to be both erythromycin-resistant and clindamycin-resistant, it was considered to have constitutive clindamycin resistance. Overall, ten (3.9%) strains, including two methicillin-resistant S. aureus and eight methicillin-sensitive S. aureus, were found to be erythromycin-resistant and clindamycin-sensitive according to the disk diffusion method and all of these strains showed inducible clindamycin resistance by the D-test method. Constitutive clindamycin resistance was detected in 100 of all MRSA strains.
In conclusion, the presence of inducible clindamycin-resistant strains may lead to clindamycin treatment failure in patients with S. aureus infection. The D-test method should be used for antimicrobial susceptibility testing of clindamycin.
In vitro activity of Eucalyptus smithii and Juniperus communis essential oils against bacterial biofilms and efficacy perspectives of complementary inhalation therapy in chronic and recurrent upper respiratory tract infections
Camporese Alessandro
Staphylococcus aureus and Pseudomonas aeruginosa have a high propensity to develop biofilms that are resistant to antimicrobial agents. Eucalyptus smithii and Juniperus communis essential oils are credited with a series of traditional therapeutical properties, including mucolytic effect. As S. aureus and P. aeruginosa biofilms are known to be important factors underlying their virulence and pathogenicity, the aim of this study was to investigate whether E. smithii and J. communis essential oils can interfere with biofilm formation as well as acting on mature biofilms. Tests of two S. aureus and P. aeruginosa clinical strains and two ATCC strains (S. aureus ATCC 25923 and P. aeruginosa ATCC 27853) showed that both E. smithii and J. communis essential oils interfere with the starting phases of biofilm production, as well as with mature biofilms. The results of this study reveal new relevant perspectives for a complementary inhalatory treatment of chronic and/or recurrent upper respiratory tract infections.
Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) among subjects working on bovine dairy farms
Antoci Eugenio,
Pinzone Marilia Rita,
Nunnari Giuseppe,
Stefani Stefania,
Cacopardo Bruno
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections worldwide and has recently been identified as an emerging pathogen in livestock and companion animals. Livestock-associated MRSA (LA-MRSA) may be responsible for increased rates of colonization and/or infection among people working on farms. We evaluated the prevalence and molecular characteristics of MRSA among dairy farmers in the province of Ragusa, South-Eastern Sicily, their animals and bulk tank milk samples. A surprisingly high number of samples tested positive for MRSA: 36% of human nasal swabs, 61% of bovine nasal swabs and 44% of bulk tank milk samples. MRSA carrier prevalence in humans significantly correlated with the percentage of positive cows on the farm, the number of livestock units and the presence of consensual positive bulk tank milk samples. Prospective studies are needed to investigate MRSA transmission between animals and humans and implement preventive strategies.
Case report
Cat-scratch disease presenting as a solitary splenic abscess in an immunocompetent adult: case report and literature review
Anyfantakis Dimitrios,
Kastanakis Miltiades,
Papadomichelakis Alexandros,
Petrakis Georgios,
Bobolakis Emmanouil
Cat-scratch disease is a common zoonotic infectious disease caused by Bartonella henselae. It is generally characterized by regional lymphadenopathy following exposure to an infected cat. Organ systemic manifestations occur rarely in atypical forms of the disease. Abscess of the spleen represents a rare, life-threatening clinical entity.
Here we report an unusual case of cat scratch disease presenting as an isolated splenic abscess in an immunocompetent adult. Comprehensive social history revealed retrospectively close contact with cats. Diagnosis of B. henselae infection was confirmed on the basis of positive serology, skin lesion and imaging findings. Initial efforts at spleen preserving management failed to improve clinical symptoms and classical splenectomy was finally performed. Splenic bartonellosis may become potentially fatal if not recognized. Since diagnosis is challenging, a high index of clinical suspicion is required.
Early diagnosis of cerebral aspergillosis with various methods: a case report
Sav Hafize,
Atalay Mustafa Altay,
Demir Gonca,
Akif Mehmet,
Nedret Ayse
The clinical and laboratory diagnosis of cerebral aspergillosis (CA) is problematic and mortality is quite high, even in cases receiving appropriate treatment. Therefore, an early and accurate diagnosis may prove to be life saving in patients with the diagnosis of CA. In this report, a case of CA which developed in a pediatric patient with acute lymphoblastic leukemia (ALL) is presented. Upon development of neutropenia and focal seizures in the left arm during implementation of the ALL treatment protocol, brain MRI was performed in the patient and nodular lesions compliant with brain abscess were detected in the frontal lobe, left cerebellum and the cingulate gyrus on the superior aspect of the left corpus callosum. Direct assessment of brain tissue revealed fungal elements, while consecutive serum galactomannan (GM) values were determined as 3.39 ng/ml and 0.72 ng/ml, and the consecutive serum (1→3)-beta-D-glucan (BG) values were 93 pg/ml and 356 pg/ml. Negative serum real-time polymerase chain reaction (RtPCR) and positive tissue RtPCR were determined, with growth of Aspergillus fumigatus in the culture. Treatment was initiated with amphotericin B and voriconazole; upon disappearance of symptoms and negative control serum BG and GM values, the patient was discharged with recommendations. In conclusion, this case is presented with the objective of indicating the significance of serological and molecular methods used in the early diagnosis of patients with CA.
A rare case of reactive pericardial effusion with cardiac tamponade subsequent to meningococcal meningitis
Berti Anna,
Bregani Enrico Rino,
Valcarenghi Caterina
We report a case of cardiac tamponade in a child with meningococcal disease. Although purulent meningococcal pericarditis is more frequent in children, we found a reactive pericardial effusion responsive to steroids and consistent with a rare immune-complex associated pericardial involvement.
Neonatal osteomyelitis of the talus due to methicillin-resistant Staphylococcus epidermidis
Pampinella Diego,
Serra Gregorio,
Giordano Salvatore,
Dones Piera,
Di Gangi Maria,
Failla Maria Concetta,
Corsello Giovanni
Acute osteomyelitis is a relatively rare disorder in the neonatal period, with considerable morbidity and mortality. Early diagnosis and prompt treatment are essential for a successful outcome. In this report we present a case of acute osteomyelitis of the talus due to methicillin-resistant Staphylococcus epidermidis, observed in a 30-day-old infant.
Pulmonary tuberculosis mimicking a severe community-acquired pneumonia with rhabdomyolysis
Tedesco Andrea,
Guglielmetti Lorenzo,
Conti Michela,
Cazzadori Angelo,
Concia Ercole
We relate the case of a 17-year-old girl with active pulmonary tuberculosis which mimicked a severe community-acquired pneumonia (CAP) associated to rhabdomyolysis. This report underlines the importance of excluding the diagnosis of pulmonary tuberculosis in any case of CAP which does not respond to standard antibiotic therapy, remembering that the empiric use of fluoroquinolones could delay the initiation of anti-tuberculosis treatment. This is, to our knowledge, the first description of a case of pulmonary tuberculosis complicated with rhabdomyolysis in a young girl without comorbidities.
The Infections in the History of Medicine
The Thasian epidemic of mumps during the 5th century BC
Tsoucalas Gregory,
Laios Kostantinos,
Karamanou Marianna,
Androutsos George
This article briefly reminds the readers of the huge importance of Hippocrates’s observation about the epidemic of mumps in Thasos during the 5th century BC. By putting great emphasis on the value of observation of the disease process, mainly from the practical point of view, the Corpus Hippocraticum gave us the first written detailed description of the disease.
The infectious diseases experiments conducted on human guinea pigs by Nazis in concentration camps
Sabbatani Sergio
The author systematically examined all available publications and web documents, with regard to scientifically documented experiments carried out by Nazi physicians in their concentration camps during World War II. This research focused on human experiments dealing with: malaria, tuberculosis, petechial typhus, viral hepatitis, and those regarding sulphonamides as antimicrobial agents. The concentration camps involved by experimental programmes on human guinea pigs were: Natzweiler-Struthof, Dachau, Mauthausen, Buchenwald, Neuengamme, Ravensbrück, Sachsenhausen and Auschwitz. Overall, around 7,200 deported prisoners went to their deaths during or because of these experiments (also considering human trials other than previously quoted ones). At the end of the war several physicians were charged with war crimes in two trials (Nuremberg and Dachau), and those found guilty were sentenced to death, or years of imprisonment. Some of them, including the notorious Josef Mengele, succeeded in escaping capture and being brought to justice. Thanks to these trials, partial light has been shed on these crimes, which not infrequently had children as designated victims, selected with excruciating cruelty in special segregation sections. The SS was the key structure which ensured maximum efficiency for these experimental programmes, from both logistic planning through to an operative control system carried out in concentration camps, and thanks to an autonomous, dedicated medical structure, which included a rigid hierarchy of physicians directly dependent on the head of SS forces (Reichsführer), i.e. Dr. Heinrich Himmler. Moreover, it is worth noting that also physicians who were not part of the SS corps collaborated in the above experiments on human guinea pigs: these included military personnel belonging to the Wehrmacht, academic physicians from German universities, and researchers who worked in some German pharmaceutical industries, such as IG Farben, Bayer and Boehring.
Letters to the editor
Long-term treatment of hepatocellular carcinoma with sorafenib
Abstract not available
Twenty years after … Blastocystis
Garavelli Pietro Luigi
Abstract not available
