Volume 26, Issue 2, 2018
Original article
Microbiology and prognosis assessment of hospitalized patients with aspiration pneumonia: a single-center prospective cohort study
Papadopoulos Dimitrios,
Bader Iosif,
Gkioxari Efthalia,
Petta Vasiliki,
Tsaras Theodoros,
Galanopoulou Nikoletta,
Archontouli Maria-Anna,
Diamantea Filia,
Kastanakis Emmanouil,
Karagianidis Napoleon,
Filaditaki Vasiliki
Aspiration pneumonia has a high incidence in hospitalized patients with community-acquired pneumonia and results in high mortality rates. We aimed to evaluate microbiology and assess prognostic factors of aspiration pneumonia in the setting of a tertiary hospital pulmonology department. Community-acquired (CAAP) and healthcare-associated aspiration pneumonia (HCAAP) cases hospitalized over a period of a year were prospectively followed. Demographic, clinical, biological and radiological data were recorded at admission, while sputum, tracheal aspirates or bronchial washing samples were collected within 48 hours of admission. During hospital stay, therapeutic and supportive measures and resulting complications were recorded. Regression analysis was applied to find statistically significant prognostic factors. The sample consisted of 70 patients (67.1% men); 55.7% of them presented as HCAAP; 94.3% had positive culture of lower respiratory tract specimens with isolation of 115 pathogens, 47 of which were multidrug- or extensively drug-resistant. The most common pathogens were Pseudomonas aeruginosa (37.1%), Klebsiella pneumoniae (27.1%), Staphylococcus aureus (25.7%) and Acinetobacter baumannii (20%). Empiric antimicrobial therapy was combination therapy in 70% and included antipseudomonal and MRSA-targeted antibiotics in 61.4% and 11.4%, respectively. Patients in the HCAAP group had a higher rate of antibiotics usage in the previous trimester, more frequent isolation of resistant strains and were more likely to receive inadequate empiric treatment than those in the CAAP group. In-hospital mortality was 52.2%; no difference between groups was noted. Independent factors of increased mortality were older age (p=0.004), low serum albumin levels (p=0.039), increased radiological involvement (p=0.050) and ineffective initial therapy (p=0.001). We concluded that patients hospitalized for aspiration pneumonia have frequent contact with healthcare services and acquire multidrug-resistant Gram-negative bacteria. Empiric therapy should target these specific microorganisms as its success determines the prognosis.
Antibiotic prophylaxis in children undergoing abdominal surgery for neoplastic diseases
Pio Luca,
Avanzini Stefano,
Paraboschi Irene,
Wong Michela,
Naselli Aldo,
Garaventa Alberto,
Conte Massimo,
Rosati Ubaldo,
Losurdo Giuseppe,
Fratino Giuseppe,
Martucciello Giuseppe,
Mattioli Girolamo,
Castagnola Elio,
Little is known about the effectiveness of antibiotic prophylaxis for prevention of surgical site infections (SSIs) in paediatric abdominopelvic surgical oncology. A retrospective analysis was performed upon the incidence of SSIs in children receiving a 24-hour antibiotic prophylaxis with cefazolin for abdominopelvic oncological surgery. In all, 145 patients (57% females) with a median age of 4 years underwent surgical procedures for abdominopelvic tumours. No SSIs were detected, despite the various risk factors known to be associated with their occurrence (such as pre- and post- surgical chemotherapy, long hospitalization, intensive care unit admission and drain placement). Cefazolin prophylaxis seems to be safe and effective in preventing SSIs in children undergoing abdominopelvic surgery for oncological diseases.
Day-On, Day-Off emtricitabine, tenofovir disoproxil fumarate and efavirenz single tablet regimen (DODO) as maintenance therapy in HIV-infected patients
Costantini Andrea,
Tontini Chiara,
Rocchi Monia,
Martini Matteo,
Butini Luca
Reduced dose schedules may be feasible options to simplify antiretroviral therapy (ART) in selected HIV-1-infected individuals. Efficacy and safety of a Day-on, Day-off (DODO) schedule of tenofovir disoproxil fumarate, emtricitabine and efavirenz (FTC/TDF/EFV) single tablet regimen (STR) was assessed. Twenty-seven patients were prescribed the DODO schedule and were monitored for 48 weeks. Switching criteria were: no previous ART failure, no AIDS-defining illnesses, T CD4 cell nadir >200/mmc, and HIV-RNA below detection limit (40 copies/mL) for at least six months. Clinical and laboratory data, including plasma HIV-RNA levels, T CD4 and CD8 counts, liver and kidney function, lipid levels and ultrasensitive C-reactive protein (us-CRP) were assessed at baseline, week 4, 12, 24, and 48. Statistical analysis was performed by paired Student’s T-test for comparison between baseline and each time point and Chi square test for CD4/CD8 ratio comparison. In all, 26 out of 27 patients maintained plasma HIV-RNA levels below the detection limit through the entire follow-up. One patient experienced low level plasma HIV-RNA rebound at week 36 (47 copies/ml) and immediately reverted to the conventional dose schedule of FTC/TDF/EFV; plasma HIV-RNA was undetectable after four weeks. No major changes on liver and kidney function tests, lipid levels and us-CRP were observed. Although no profound modifications of T CD4 count were observed during follow-up, the CD4/CD8 ratio increased significantly at week 48 compared to the baseline (p<0.05). In conclusion, 48-week DODO administration of the fixed dose FTC/TDF/EFV STR combination was safe and effective in maintaining HIV viral replication below the detection limit in a selected group of HIV-1-infected individuals.
Risk factors for recurrences in patients with hepatitis C virus after achieving a sustained virological response: a multicentre study from Turkey
Arslan Ferhat,
Ceylan Bahadir,
Sahin Ahmet Riza,
Günal Özgür,
Kayaaslan Bircan,
Uğurlu Kenan,
Tanoğlu Alpaslan,
Iskender Gülsen,
Tosun Selma,
Atilla Aynur,
Sargın Fatma,
Batirel Ayse,
Karagöz Ergenekon,
Sonsuz Abdullah,
Mert Ali,
In this study, we aimed to determine the late relapse rate in hepatitis C patients with sustained virological response after interferon-based regimens, and evaluated the predictors of late relapse while comparing the real-life data of our country with that of others. A multicenter retrospective study was performed to investigate the data of patients infected with HCV who obtained sustained virological response after classical or pegylated interferon alpha (PegIFNα) and ribavirin (RBV) for 48 weeks. Sustained virological response was based on negative HCV RNA level by PCR at the end of six months after the therapy.
The information of patients enrolled in the study was retrieved from the hospital computer operating system and outpatient follow-up archives. We evaluated the age, gender, HCV RNA levels, HCV genotype, six-month and further follow-up of patients with sustained virologic response, presence of cirrhosis, steatosis and relapse. In all, 606 out of 629 chronic hepatitis C patients (mean age was 53±12 years; 57.6 % of them were female) with sustained virological response were evaluated. We excluded 23 patients who relapsed within six months after the end of treatment (EOT). The mean follow-up period of the patients was 71 months (range: 6-136) after therapy. Late relapse rate was 1.8% (n=11) in all patients. Univariate Cox proportional hazard regression models identified that cirrhosis and steatosis were associated with the late relapse [(p = 0.027; Hazard Ratio (HR) 2.328; 95% confidence interval (CI): 1.309-80.418), (p = 0.021; HR 1.446; 95% CI: 1.243-14.510, respectively]. In multivariable Cox regression analysis, steatosis was the only independent risk factor for late relapse (p = 0.03; HR 3.953; 95% CI: 1.146-13.635). Although the late relapse rate was approximately 2% in our study, clinicians should consider that pretreatment steatosis may be an important risk factor for late relapse.
HPV and Chlamydia trachomatis coinfection in women with Pap smear abnormality: baseline data of the HPV Pathogen ISS study
Mancini Fabiola,
Vescio Fenicia,
Mochi Stefania,
Accardi Luisa,
di Bonito Paola,
Ciervo Alessandra
Chlamydia trachomatis (Ct) and human papillomavirus (HPV) are the most common sexually transmitted pathogens. Whereas it is well known that infection with oncogenic HPV genotypes increases the risk of cervical cancer (CC), the implication of Ct in the pathogenesis of CC is still controversial. Hence, to investigate the possible implication of Ct infection alone, or with concomitant HPV infection, in the severity of cervical lesions, we conducted a study in 164 Caucasian HIV-negative women with abnormal Pap. Genomic HPV and Ct DNA were detected in 97 (59%) and 16 (10%) women respectively, and 15 (9%) of women were infected by both. Of the HPV positive samples, 89 (79%) were HR-HPV types or probable HR types and HPV16 was the most represented genotype. Interestingly, it was observed that co-infection was more frequent than HPV infection alone in women with high grade lesions.
In vitro culture of Toxoplasma gondii in HeLa, Vero, RBK and A549 cell lines
Jabari Sahar,
Keshavarz Hossien,
Salimi Mahboobeh,
Morovati Hassan,
Mohebali Mehdi,
Shojaee Saeedeh
Toxoplasma gondii is a protozoan parasite which can be grown in vivo and in vitro. Various cell lines are used for T. gondii culture in vitro. In this study, four cell lines of HeLa, Vero, RBK and A549 were compared with each other for T. gondii tachyzoites culture. The four cell lines were cultured and infected with 5 × 106 tachyzoites, respectively. The number of tachyzoites and viable host cells and pH of the media were assessed in each culture. The highest tachyzoite yield was seen in HeLa cell culture. The lowest number of viable host cells and the lowest pH were seen in HeLa cell line culture. The lowest tachyzoite yield, the highest viable cell and the highest pH were observed in Vero cell line culture. HeLa and Vero cell lines are thus appropriate for rapid and long-term propagations of T. gondii tachyzoites, respectively.
Species diversity and molecular analysis of Staphylococcus in confectioneries of a developing country, Iran
Hoveida Laleh,
Ataei Behrooz,
Amirmozafari Nour,
Noormohammadi Zahra
Confectionery is one of the potential sources of contamination and transmission of gastrointestinal infections to humans. Staphylococcus species, and particularly the coagulase-positive ones, have the remarkable capability to produce high amounts of enterotoxin in food. In the present study, the frequency and diversity of Staphylococcus in confectioneries in Iran were assessed by using a combination of conventional and molecular methods. A total of 55 confection samples were collected from 30 confectioneries of Isfahan. They were analyzed for the presence of Staphylococcus using standard protocols for isolation and characterization of the isolates. The conventional tests were used for primary identification and the sequence analysis of 16S rRNA was used for the species identification. A total of 47 out of 55 samples were gram-positive cocci (85.45%). They belonged to 39 Staphylococcus spp., 7 Macrococcus spp., and one Micrococcus spp. The most prevalent 11 various Staphylococcus species were S. aureus 30.8 %, S. warneri 20.5% and S. succinus 17.9. Identification and characterization of Staphylococcus species can be important for epidemiological investigations and assessment of virulence factors such as enterotoxin production and development of specific management practices to prevent staphylococcal food poisoning.
Case report
Three cases of non-Hodgkin's lymphoma in HIV-infected Bulgarian patients
Yancheva Nina,
Strashimirov Dimitar,
Hrischev Vasil,
Tchervenyakova Tatyana,
Nikolova Maria,
Aleksiev Ivaylo
HIV-associated lymphoma was first classified as an AIDS-defining disease by the American Center for Disease Control and Prevention (CDC) in 1985. Non-Hodgkin’s lymphomas (NHLs) are frequent malignancies in AIDS patients. The risk of NHL in the case of an underlying HIV infection is estimated to be 100 times greater than in the general population, and it increases with the progression of the retrovirus-related immunosuppression. Cases of HIV-related non-Hodgkin’s lymphoma are widely documented in the literature. In this article we present three cases of NHL and HIV hospitalized over a period of three years (2013-2016) at our specialized department for AIDS patients. Two of them were initially diagnosed with NHL and then with HIV infection. In one patient, NHL developed despite the patient’s taking background antiretroviral therapy. The first case was a 38-year-old male diagnosed previously with HIV, who developed a palpable mass in the left zygomatic bone. The second case was a 52-year-old male who was first diagnosed with a cutaneous lymphoma, and subsequently with HIV infection. The third patient was a 63-year-old male who presented with two palpable masses: one in the left part of the mandible, and the other in the right inguinal region, the latter subsequently diagnosed as lymphoma. Following the latter diagnosis, the patient tested positive for HIV. The histological findings of the three lymphomas were as follows: an NHL plasmoblastic lymphoma, a cutaneous large B-cell anaplastic lymphoma, and a diffuse large B-cell lymphoma. The first patient received antiretroviral therapy (ART) and EPOCH (etoposide, pharmarubicin, vincristin, endoxane, uromitexan) plus radiotherapy, while the second received ART and CHOEP (endoxan, epirubicin, vincristin, etoposide, prednisolone). The third patient died a few days after beginning antiretroviral therapy.
Antiviral activity of maraviroc plus mirtazapine in a low-risk HIV-negative patient with progressive multifocal leukoencephalopathy
Scabini Silvia,
Trunfio Mattia,
Pirriatore Veronica,
Imperiale Daniele,
Audagnotto Sabrina,
Bertucci Roberto,
Ghisetti Valeria,
Cinnirella Giacoma,
Cistaro Angelina,
Perna Mariaelena,
Calcagno Andrea,
Di Perri Giovanni
A case of progressive multifocal leukoencephalopathy (PML) is described in an HIV-negative patient with mixed connective-tissue disease (MCTD) on a minimally immunosuppressive treatment with hydroxychloroquine. The patient presented with right-sided weakness, episodes of disorientation and loss of short-term memory and of vision in her right eye. PML was diagnosed by JCV DNA on cerebrospinal fluid and radiological criteria. She was treated with off-label maraviroc and mirtazapine but died two months after hospital admission, despite a surprising decrease in the viral load of cerebrospinal fluid three weeks after starting therapy. Prompt diagnosis and antiviral treatment of PML even in low-risk patients are warranted. Future studies are required to define the therapeutic role of maraviroc (MVC) and mirtazapine in this setting.
A fatal case of cytomegalovirus disease in an immunocompetent young woman: a case report
Anyfantakis Dimitrios,
Damianaki Angeliki,
Krietsepi Vasiliki,
Panou Evdokia,
Kastanakis Serafim
Cytomegalovirus can cause severe disease with adverse outcome in immunocompromised patients. Severe cytomegalovirus infection in previously healthy individuals is rare. Here we present an unusual case of cytomegalovirus infection with neurological and pulmonary involvement in a previously healthy young woman with no history of immuno-suppression. Unfortunately, the disease followed a malignant course and despite the efforts of the medical staff the patient died. CMV infection should be considered in the diagnostic work-up of immunocompetent patients with fever and unexplained neurological or pulmonary manifestations. Although uncertainty exists regarding the optimal treatment of CMV in healthy individuals, early recognition and administration of ganciclovir may prevent a fatal outcome.
Madura foot: an imported case of a non-common diagnosis
Fasciana Teresa,
Colomba Claudia,
Cervo Adriana,
Di Carlo Paola,
Scarlata Francesco,
Mascarella Chiara,
Giammanco Anna,
Cascio Antonio
Mycetoma (or “madura foot”) is characterized by deformation, cutaneous lesions, infection of tissues extending from the cutaneous layer to the underlying fascia, and an indolent course. A number of fungal or bacterial agents that are introduced through traumatic inoculation can be responsible for the disease, but Actinomadura madurae is among the most common agents of mycetoma occurring worldwide. We report a case of madura foot caused by A. madurae in an immunocompetent young Somali man who was admitted with a diagnosis of skin and soft tissue infection of the left foot with osteomyelitis. The present report emphasizes the importance of the knowledge of this infection, which is sporadic but problematic to treat and, above all, difficult to diagnose. Moreover, a multidisciplinary approach with involvement of an infectious diseases specialist with experience in tropical diseases and a microbiology unit performing rapid molecular diagnostic tests is required for early diagnosis and an optimal antibiotic therapy.
Potential sexual transmission of Giardia in an endemic region: a case series
Fasciana Teresa,
Colomba Claudia,
Cervo Adriana,
Di Carlo Paola,
Scarlata Francesco,
Mascarella Chiara,
Giammanco Anna,
Cascio Antonio
We present four cases in which probable sexual transmission of Giardia lamblia was suspected. Diagnosing this mode of transmission in endemic areas is often difficult and should be considered only as possible, because exposure to poor sanitation and a potentially contaminated environment are always latent. However, as patients reported, there was no history of drinking tap water, exposure to recreational water, eating contaminated food, or other potential sources of infection but anilingus with an infected partner. We consider that in endemic countries, even when other more frequent modes of transmission could be playing the main role, the possibility of (re)infection due to sexual transmission should not be forgotten. Talking openly with patients, strengthening patient-specific preventive measures and counselling appear to be needed to reduce risks of Giardia infection transmission due to this often neglected route.
The Infections in the History of Medicine
Ancient treatment for lice: a source of suggestions for carriers of other infectious diseases?
Vicentini Chiara Beatrice,
Manfredini Stefano,
Contini Carlo
Louse infestation is one of the oldest contagious pestilential diseases of humankind, which has recently re-emerged in several developing countries as well as in homeless individuals and migrants. The present work provides the first phase of an historical excursus of louse remedies based on the classics of pharmaceutical literature, codes, pharmacopoeia and treatises. The second phase involves a literature search, based on the principal medical databases (SciFinder, Pubmed, Google Scholar, ISI-Web of Science and Scopus), to match ancient raw materials and active principles for the treatment of pediculosis and their possible applications, with other current infectious pathologies transmitted by different carriers. In this regard, Rhododendron tomentosum has revealed repellent insect activity, particularly against Aedes aegypti, responsible for Dengue fever, Chikungunya, Zika fever, Mayaro, yellow fever and other infectious diseases. Petroselinum crispum is an insecticide employed for resistant strains of A. aegypti. In the case of Delphinium staphisagria, the phytochemical profile was further investigated with the identification of further molecules in addition to delphinine. The latter shows interesting activities against Trypanosoma cruzi and Leishmania. Anthemis pyrethrum, now renamed as Anacyclus pyrethrum, although not containing pyrethrins present in several plants of the genus Chrysanthemum, revealed pediculicidal activity but did not produce satisfactory results in antiprotozoal activity.
Letters to the editor
Acute enterocolitis causing an appendicitis like symdrome
Kazama Itsuro,
Nakajima Toshiyuki
Not available
Mapping Zika in the 125 municipalities of Antioquia department of Colombia using Geographic Information System (GIS) during 2015-2016 outbreak
Thahir-Silva Shehana,
Liliana Mariet,
García-Loaiza Carlos Julián,
Villegas-Rojas Soraya,
Cardona-Ospina Jaime A. ,
Lagos-Grisales Guillermo J.,
Soto-Arbelaez Alicia,
Rodriguez-Morales Alfonso J.,
Nor available
