Volume 7, Issue 3, 1999
Review
Bacterial colangitis: therapeutic features
Russo Michele,
Carmellino Salvatore,
Russo Gianluca
Cholangitis results from the combination of bactibilia and biliary tract obstruction. In recent years considerable progress has been made in the diagnosis and treatment of cholangitis; advances in endoscopic techniques and antibiotic therapy have ameliorated the prognosis of cholangitis. The choice of an antimicrobial regimen for cholangitis should take into account the antibiotic sensitivities of bacteria colonizing biliary tree, the antibiotic excretion into bile and whether biliary obstruction or bacteremia is present. Successful treatment depends on relieving biliary obstruction and administering antibiotics effective against bacteria implicated. The initial therapy should be active against E. coli and Klebsiella spp., while it is controversial whether the empirical antibiotic regimen should also include coverage against Enterococcus, Pseudomonas and anaerobes. The ureidopenicillins are the preferred initial treatment; the combination piperacillin-tazobactam may be active against the resistant species. Second generation cephalosporins like cefamandole and cefoxitin are still useful, cefoperazone gives excellent coverage against gram-negative bacteria, while cefepime may be suitable as treatment for acute cholangitis. In severe cholangitis an aminoglycoside can be added to the beta-lactamin; once-daily aminoglycoside administration is associated with a reduced incidence of nephrotoxicity also in patients with cholestasis. Whether the fluoroquinolones are effective in treatment for cholangitis has not been fully evaluated. In patients with suppurative cholangitis prompt endoscopic drainage is mandatory, since antibiotics alone will not sterilize the biliary tract in the face of obstruction. Antibiotic prophylaxis to prevent cholangitis after ERCP should be administered particularly to patients in whom biliary drainage is expected to be difficult; antimicrobial prophylaxis with piperacillin effectively prevents ERCP¬induced cholangitis. Antibiotic maintenance therapy can be highly successful in the treatment of recurrent cholangitis in patients with a compromised biliary tract.
New treatment perspectives for community acquired infections
Paradisi Franco,
Corti Gian Paolo
Respiratory and urinary tract infections, of great importance both for their high incidence and for their potential severity (particularly in the lower respiratory tract), represent one of the problems that doctors have to deal with in clinical practice. In outpatients the antibiotic prescription for such pathologies is most often empirical, and needs to consider the local epidemiology, including the incidence of antibiotic resistance, as well as the characteristics of drugs to be prescribed. From this point of view, the lack of drugs with a wide antibacterial spectrum, covering both classical and atypical bacteria, is now overcome by new fluoroquinolones, as levofloxacin. Its characteristics, such as the antibacterial activity extended to Gram positive (particularly S. pneumoniae), the pharmacokinetic profile allowing once daily administration and proper switch therapy, and safety, have been confirmed in wide international clinical studies and make levofloxacin an innovative drug with great potential.
Original article
Prevalence of Toxocara spp in public playgrounds in a town of Central Italy
Giacometti Andrea,
Cirioni Oscar,
Fortuna Moira,
Caselli Francesca,
Derrico Marcello Mario,
Drenaggi Davide,
Scalise Giorgio
In this study, the prevalence of Toxocara spp. was evaluated in the soil of 22 public playgrounds of Ancona (Italy). The public playgrounds were selected according to the different areal distribution (centre, low-lying areas centre, hilly areas suburbs) within the urban area of Ancona, central Italy. In six playgrounds there were signs restricting access for dogs; all of them were frequented by children. Parasites were found in the soil samples from 21 out of 22 playgrounds (95.5%). The most prevalent helminth found was Toxocara canis, the common roundworm of dogs. It was detected in the soil samples from 12 (54.5%) playgrounds. This study showed a low frequency of the other parasites. Our data highlight the need for improved knowledge of the relationship between humans and stray animals. Indeed several zooparasites have a role in the etiopathogenesis of common human diseases. The high environmental contamination frequency found underlines the necessity of prompt preventive public health measures, such as control of stray animals, treatment of infected pets and hygiene education of the population to increase awareness of potential zoonotic hazards.
Saquinavir + Zidovudine + Lamivudine in HIV positive naive or not naive patients
Izzo Crescenzo Maria,
Manzillo Elio,
Franco Alfredo,
Aprea Lucia,
Simioli Francesco,
Sbreglia Costanza,
Pagliano Pasquale
The aim of the study was to assess the virological/immunological outcome and safety of Saquinavir (SQV), Zidovudine (AZT) and Lamivudine (3TC) therapy in HIV patients. We retrospectively evaluated the charts of 36 HIV patients (male 87% median age 31 yrs, IVDA 72%) who underwent therapy with 5QV (1800 mg/die), AZT (500 mg/die) and 3TC (300 mg/die). 26 (72%) patients were previously on antiviral therapy for at least 16 weeks. No patient ranked in the CDC group. Patients were treated for at least 48 weeks. Hematological indices, changes in CD4+ cell count and plasma HIV-RNA levels were evaluated every 30, 60, and 90 days respectively. At baseline, CD4 cell count and viral load were 230/mcl and 4.55 log respectively for patients previously on therapy and 382/µl and 4.88 log respectively for naive patients. At week 48 the mean CD4+ cell count increase was 70/µl among previously treated and 98/mcl among untreated patients. In respect to the baseline, lower mean HIV-RNA levels were observed at week 12, 24 and 48. No patient showed AIDS-defining events. No patient discontinued therapy due to suspected toxicity. Patients showed a good immunological and virological response, regardless of their previous antiviral treatment. The terapy regimen was safe and well tolerated
Surveillance of antibiotic-resistant microorganisms for the rational use of antimicrobial drugs
Camporese Alessandro,
Santini Gianfranco
An epidemiological survey of 703 bacterial strains isolated in Pordenone was performed in the first eight months of 1998, to verify the predominant bacterial incidence, the susceptibility to antimicrobial drugs in this period, and variations in the resistance patterns. The study demonstrated some interesting variations in this period: for example, there is a considerable increase in antimicrobial resistance of Escherichia coli (especially to cotrimoxazole, ampicillin, piperacillin and ciprofloxacin) and Pseudomonas aeruginosa (to aztreonam and ciprofloxacin). The results suggest the importance of constant epidemiological surveillance in the hospital and community setting.
Case report
Necrotizing fasciitis: case reports and review of the literature
Di Gregorio Pietro,
Aliffi Antonia,
Bollo Mario,
Galvagna Salvatore
Necrotizing fasciitis is a rare, rapidly progressing infection affecting the superficial fascia and the subcutaneous tissue, accompanied by severe systemic toxicity and multiorgan failure. It is caused by aerobic and anaerobic bacteria, occasionally in a synergistic polymicrobial combination (Type I Necrotizing Fasciitis); in other cases group A ß-haemolitic Streptoccoccus is the organism responsible for the infection (Type II Necrotizing Fasciitis).
The infection often originates from small traumatic injuries or operative wounds and rapidly spreads especially in individuals with identifiable risk factors or immunocompromised patients. Sometimes necrotizing fasciitis occurs when no known portal of entry for bacteria is present. The increasing incidence of necrotizing fasciitis observed may reflect a resurgence of highly virulent mutant strains of group A beta-haemolitic Streptococcus. The pathogenesis, clinical features and treatment of the disease have been reviewed in the light of recent literature.
We also report clinical data for four patients with necrotizing fasciitis. They show the importance of early diagnosis and rapid, aggressive and radical surgical intervention. High-dose broad-spectrum antibiotic therapy and intensive medical support are also required to avoid a fatal outcome.
Streptococcus bovis as an opportunistic pathogen during advanced HIV disease
Manfredi Roberto,
Tadolini Marina,
Calza Leonardo,
Chiodo Francesco
Three rare case reports of HIV-related Streptococcus bovis bacteremia are described, and discussed on the basis of a literature review. The association with an advanced immunodeficiency, leukopenia-neutropenia, and liver cirrhosis is underlined as well as the possibility of multiple recurrences and the lack of apparent gastrointestinal lesions as risk factors.
Bacterial esophagitis in patients with HIV disease
Mastroianni Antonio,
Cancellieri Claudio,
Coronado Olga,
Manfredi Roberto,
Chiodo Francesco,
Pignatari Salvatore
The authors carried out a retrospective study by reviewing all patients with HIV disease presenting esophageal symptoms who were evaluated by upper endoscopy. Three cases of bacterial esophagitis are reported and discussed according to literature data.
The Infections in the History of Medicine
The use of antidiphterial serotherapy in Bologna in 1895. A pilot experience
Sabbatani Sergio,
Sandri Antonio
It was the year 1894 and the international scientific community was experiencing a historic moment. It was around this time that Pasteur, Kock, Löefler, Yersin and Behring discovered the microbiological causes of commonly occurring infectious diseases. In Bologna it was decided to eradicate the diphtheria epidemic which had claimed 152 victims, mainly children, the previous year by experimentally adopting specific serotherapy successfully applied in France shortly before. Supported by local government funding and with the aid of some enterprising local doctors, an efficacious serum was soon produced in Bologna. Good clinical results were obtained and production and sale costs were able to be considerably reduced. Little more than a century later, this is an example of applicative research where there is much still to be revealed.
