Volume 5, Issue 3, 1997
Review
Bacterial infections in intensive care units: etiology and pathogenesis
Esposito Silvano,
Noviello Silvana
Bacterial infections represent the main cause of morbidity and mortality in Intensive Care Units (ICU). The infections developed in ICU correspond to 24% of the overall nosocomial infections. Endogenous bacterial flora sustains 85% of infectious episodes. In fact in ICU cutaneous, oro-pharyngeal and gastro-intestinal flora are substantially modified being replaced by nosocomial microrganisms which will become responsible for sepsis and infections localized at respiratory and urinary tracts. The Authors review these main diseases acquired in ICU analyzing the epidemiologic features, pathogenesis, ways of transmission and diagnostic criteria. Finally it is underlined the importance of microbiology in any surveillance program of ICU acquired infections. It is desirable that each unit carries out an epidemiological evaluation by means of own microbiological data in order to establish, together with clinical epidemiologists and infectious diseases specialists, accurate programs of prevention.
Original article
Bacterial meningitis and CSF cytokines
Ticca Fausto,
Lancella Laura,
Mastroianni Claudio Maria,
Comparcola Donatella,
Graziani Maria Cecilia,
Nicolosi Luciana,
Rivosecchi Maria Rosa,
Catania Salvatore,
Vullo Vincenzo
Aim of study is the determination of concentrations of two important cytokines: TNF alfa and IL-8 in children with bacterial meningitis to establish a correlation between infection, CSF concentration of cytokines and neurological sequelae. TNF alfa and IL-8 concentrations in CSF have been measured by quantitative immunometric enzyme assay during the course of the disease. In the purulent meningitis we observed that CSF concentrations of these cytokines decreased to undectable values 24 to 48 hours after beginning of the antibiotic therapy. Conversely, in the 3 patients with mycobacterial meningitis (TBM) the concentrations of IL-8 were higher for a longer period, being detectable in the CSF between 4 and 8 weeks after the beginning of the specific treatment. We found no significant differences of the values of IL-8 in children with neurological sequelae compared with children without sequelae.
Anti-HAV screening patients with chronic hepatitis
Sagnelli Evangelista,
Liorre Giulia,
Mogavero Anna Rita,
Russello Luisa,
Rossi Giovanni,
Filippini Pietro,
Felaco Francesca Maria,
Piccinino Felice
Following the decrease in HAV endemicity levels in the last decades, nowadays in Italy most people aged less than 30 years are susceptible to the infection. We have tested for serum anti HAV IgG 194 chronic hepatitis patients from Naples to evaluate the level of protection against HAV in a category of patients in whom an acute necrosis due to HAV might induce liver failure. The study shows that 90.7% of neapolitan chronic hepatitis patients has serologic evidence of prior HAV infection. Specifically, 98.1% of the patients over 40 years of age, but only 54.6% of those under 40 tested positive for anti- HAV IgG. 102 patients had cirrhosis and only one tested negative.
The data suggest that HAV vaccination in susceptible chronic hepatitis patients should be judged by the physicians in care on the basis of the severity of disease, patient's age, real risk of exposure to the infection, and level of education.
The ursodeoxycholic acid for the treatment of HCV infections
Scotto Gaetano
Hepatitis C is a very serious disease. If it is not treated, it leads to chronic hepatitis and cirrhosis in 50% and 20% of cases, respectively. Furthermore, patients with cirrhosis might develop hepatocarcinoma. Interferon seems to be the therapy of choice in the treatment of the disease. However, since the molecule cannot always be used (non-compliant patient; severe side effects; liver-associated pathologies; patient age) alternative therapies have been investigated. Ursodeoxycholic acid (UDCA) stands out among recommended non-antiviral molecules.
74 patients affected by HCV chronic infections were enrolled in this single-blind study. One group (A: 37 patients) was treated with UDCA (600 mg/day for 12 months) and compared with a control group (B: 37 patients) in order to assess the therapy efficacy in reducing cytolysis index and to estimate viremia and histologic score variation. Results: 13 patients did not complete the study (8 belonging to group A; 5 to group B). 65,5% of the patients treated with UDCA showed ALT reduction; 42,1% of them with complete response. The situation remained unchanged in 15 patients all the treatment along. In group B, only 12,5% showed a significant ALT reduction. During the follow-up, in 69,4% of group-A responders ALT was found to return to pretreatment values. No variation was observed in the viremia and histologic score of patients who had accepted a control biopsy. Conclusions: UDCA is undoubtedly suitable for reducing cytolysis index in patients with HCV chronic infections. It is well tolerated but it does not modify the disease natural course.
Spontaneous bacterial peritonitis in patients with liver cirrhosis. Differential aspects with portal thrombosis
Pasquale Giuseppe,
Galante Domenico,
Gaeta Giovanni Battista,
Russo Grazia,
Giolitto Giancarlo,
Stanzione Maria,
Felaco Francesca Maria
In a series of 155 patients with decompensated liver cirrhosis spontaneous bacterial peritonitis (SBP) was diagnosed in 15 cases (9.7%) and portal thrombosis (PT) in 8 (5.1%) by mean of standard criteria. The main clinical and laboratory characteristics were similar in the two groups of patients; fever was more frequently recorded in the SBP patients. Cytological examination of the ascites showed an increase in total cell count and in neutrophils count higher in SBP group than in PT. The diagnosis of PT was confirmed by ultrasonography. The data suggest that a cytological examination of the ascites should be performed in all patients with decompensated cirrhosis and may contribute to the differential diagnosis of SBP or PT.
HIV Antigens as complement fixing circulating immune complexes
Filippini Pietro,
Guarino Marina,
Lapenta Caterina,
Marrocco Cecilia,
Scolastico Carlo,
Panico Leonarda,
Messina Vincenzo,
Piccinino Felice,
Sagnelli Evangelista
To detect HIV antigens in circulating complement fixing immune complexes (ICs) we assessed an ELISA using wells of microtitre plates coated with F(ab)2 anti-C3b and monoclonal antibodies anti-HIV gp120 and anti-HIV p24. We tested 24 anti-HIV positive subjects (Group A), 10 anti-HIV negative subjects at risk of acquiring HIV infection (Group B), 20 normal controls (Group C) and 2 seroconversion panels. We found HIV antigens in ICs in all sera from seroconversion panels, in 25.5% of sera from subjects in Group A, in 28.6% of sera from subjects in Group B and in no serum from subjects in Group C. A subject in Group B acquired HIV infection during the observation. HIV antigens in ICs by our assay were detected 8 months before Anti-HIV and Ag by commercial ELISA.
Case report
Neurological disorder associated to EBV: three case reports
Luchi Sauro,
Del Bono Laura,
Vincenti Antonella,
Messina Francesco,
Scasso Antonio
Epstein-Barr virus (EBV) is associated with a wide range of clinical manifestations. Neurological involvement (NI) during Infectious Mononucleosis occurs in 1-5% of the cases, the only NI is more rare. From January 1995 to December 1996 three patients with NI and EBV infection have been observed in our department. The diagnosis were: meningoradiculitis (1 case), meningoencephalitis (1 case), aseptic meningitis (1 case). The diagnosis was based on the results of the lumbar puncture and on the serology: IgM VCA positive at the onset of the symptoms and a significant increase of the IgG VCA after three weeks. No other etiology was apparent. All the patients have been treated with dexamethasone, glycerol and acyclovir obtaining a complete remission of the disease. In these cases the NI has been the only clinical manifestation of the EBV infection. Therefore the authors believe that it is important recognize that EBV can cause a myriad of neurological illness with or without the stigmata of infectious mononucleosis and recommend the need to suspect this infection in any acute neurologic disorder.
Intestinal amoebiasis with hepatic abscess: a case report
Bellissima Pietro,
Bonfante Salvatore,
Failla Umberto
The Authors report an imported case of intestinal amoebiasis with hepatic abscess in a Sicilian young man, living in Venezuela. The clinical aspects (anamnesis about residence in endemic area, abdomen disorders, pain in right hipocondrium, fever, hepatomegaly, slimming), the diagnostic aspects (faeces parasitologic test, bio-humoral and serological tests, ultrasonography, scintigraphy and T.C. of the liver) and therapy (medical and surgical treatment, drainage of abscess cavity) are described. Medical therapy (metronidazole + chloroquine + paronomycine) cleared up intestinal infection and reduced hepatic abscess.
The Infections in the History of Medicine
Cholera in Bologna in XIX century. A brief report on the scientific knowledge of the period
Sabbatani Sergio,
Giusberti Fabio,
Piro Franco
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