Volume 18, Issue 3, 2010
Original article
Community-acquired pneumonia: a budget impact model
Giusti Massimo,
Bamfi Francesco,
Perrone Francesco,
Pitrelli Andrea,
Pippo Lara,
Giuliani Luigi
Community-acquired pneumonia (CAP) is an infectious disease with high morbidity and mortality and a major social and economic impact. A budget impact model was developed to estimate the impact on hospital direct costs of different antibiotic therapies suggested by international and national (FADOI) guidelines on treatment of patients hospitalized with CAP. The model includes the costs of drugs, staffing, consumables and in-patient stays in two different scenarios: intravenous therapy only and switch therapy; it compares levofloxacin (monotherapy) versus other combination therapies as suggested by the guidelines and includes the cost of failure of first-line treatment. Budget impact analysis shows that the cost of CAP-hospitalized patients in Italy consists mainly in the cost of treatment failure while that of antibiotics is just a small component of total direct costs incurred by hospitals.
Prevalence of intestinal parasitosis in Reggio Emilia (Italy) during 2009
Guidetti Carlotta,
Ricci Lidia,
Vecchia Luigi
The purpose of this survey is to assess the prevalence of intestinal parasites in Reggio Emilia during 2009. We analyzed 1961 samples from 1503 subjects: a copro-parasitological standard examination was performed in 1416 of the subjects and the scotch-test in the remaining 87. Of the 1503 subjects examined, 111 (7.4%) were positive for one or more parasites. Pathogenic parasites were found in 44 subjects (39.6% of all positive subjects) and non-pathogenic protozoa were found in 67 subjects (60.4% of all positive subjects). The most commonly found species were, of the protozoa, Blastocystis hominis, Dientamoeba fragilis and Giardia intestinalis and, of the helminths, Enterobius vermicularis and Taenia Spp. This epidemiological survey shows the need to pay more attention to immigrants and travellers to endemic areas as potential carriers of major parasitic infections in the community.
Study on in-vitro susceptibility of ESBL-positive Escherichia coli isolated from urine specimens
Grandesso Stefano,
Sapino Barbara,
Mazzucato Sandra,
Alessandrini Roberta,
Solinas Maria,
Gion Massimo
Treatment of infections by ß-lactamase-producing microorganisms is very difficult. Our aim was to determine the in vitro susceptibility of 430 ESBL-positive Escherichia coli strains isolated from urinary tract infections. All the microorganisms were isolated in the Microbiology Unit at the Ospedale dell’Angelo in Mestre (Venice) between May 2008 and September 2009 and were confirmed by the double-disk test. All microorganisms were sensitive to imipenem and meropenem, 98.4% to tigecycline, 95.1% to amikacin, 89.3% to nitrofurantoin, 67.5% to gentamycin and 63.2% to piperacillin/tazobactam. Only 22.6% were sensitive to cotrimoxazole, while fluoroquinolone (norfloxacin and levofloxacin) activity was found to be very low (6%).
Clinical, virological and epidemiological aspects of acute B hepatitis in the Catania area (Italy)
Scalia Guido,
Russo Raffaela,
Palermo Ilenia,
Gussio Maria,
Bellissimo Francesco,
Fatuzzo Filippo,
Montineri Arturo,
Patamia Ildebrando,
Costanzo Maria,
Zappalà Daniela,
Russo Rosario,
Cacopardo Bruno
Starting from January 1997 we prospectively evaluated all cases of acute hepatitis B admitted to two of the main Infectious Diseases Units in Catania (eastern Sicily). The survey was extended throughout a 10-year period up to December 2007. Between 1997 and 1999 we observed 21 cases of acute hepatitis B; between 2000 and 2002 18 cases; between 2003 and 2005 22 cases and, finally, 37 cases were reported in the period 2006-2007. We found an increase in acute hepatitis B cases among people aged 26 to 44 years (from 38% in 1997-99 to 70% in 2006-07). A progressive decrease in intravenous drug abuse as a risk factor for acute hepatitis B was also observed (from 61% to 14%) together with a parallel increase in cases due to sexual transmission (from 19% to 56%) and outpatient cosmetic surgical procedures. Mean time to serum HBsAg negativization was longer in the last period (2006-07), with 6 cases out of 37 showing HBsAg persistence beyond 12 months from the clinical onset. Furthermore, in 2006-07 there were 12 cases (42%) of acute hepatitis due to HBV genotypes A and F. In our area, a progressive drop of hepatitis B cases due to intravenous drug abuse occurred, whereas heterosexual and iatrogenic cases increased. Cases due to HBV non-D genotypes may well be related to migration from endemic areas towards Sicily.
Hepatitis C and immigration: a multicentre study
Scotto Gaetano,
Armignacco Orlando,
Starnini Giulio,
Francavilla Ruggiero,
Foti Giuseppe,
Portelli Vincenzo,
Mazzeo Maurizio,
Minerva Nicola,
Carretta Vito,
Lo Muzio Lorenzo,
Fazio Vincenzina
This retrospective multicentre study aims to evaluate the clinical and epidemiological features of HCV infection in a cohort of immigrants in Italy. Tests were carried out on 194 HCV positive subjects, who represented 5.7% of the participants at baseline screening: the virological (viral load, genotype) and biochemical appearance of their infection was determined, and the disease was staged by histological examination in the patients who had indicated their willingness. Standard therapy (peg-interferon + ribavirin) was implemented in patients who agreed to undergo treatment. The majority of immigrants were of East-European origin (48.4%), females were globally slightly predominant and the average age was 41.4 years. Of the 194 patients, 119 (63.1%) proved to be viraemic: genotype 1 was the most frequent, followed by genotype 4, the latter mainly in African patients. The histological staging of liver disease conducted in 25 patients showed mild hepatitis in 13 subjects, moderate/severe hepatitis in eight subjects and cirrhosis in four. Although 45 out of 119 patients (37.8%) with determinable HCV RNA agreed to undergo treatment, 11 of them independently stopped taking medication before the course of therapy was completed, without any significant side effects. At the sixth month of follow-up, the overall sustained virological response (SVR) was shown by 22/45 patients (48.8%). In our study, migrant populations had higher rates of HCV-related chronic hepatitis than the indigenous population; in some cases the infections were contracted in the country of origin, but in others the infection took place in Italy. The most commonly represented genotype, besides 1, was 4, especially among Africans. The therapeutic management of immigrants proved to be very difficult, mostly but not exclusively because of social factors.
Case report
Aural myiasis in an infant
Casanova-Román Manuel,
Sánchez-Legaza Elena,
Sánchez-Porto Antonio,
Murga Carlos
Aural myiasis is a rare clinical state that usually occurs in developing countries
and in patients who mentally retarded or have poor personal hygiene. However, the prevalence has decreased over the years, and now it is very rare. The authors describe a case of aural myiasis caused by Wohlfartia magnifica in a five-month-old infant. The treatment used was a combination of suctioning and microsurgical forceps under an operative microscope. Additionally, topical and oral antibiotics were given to avoid secondary infection.
Coexistent cervical spine fusion and thoracic disc herniations with acute myelitis
dos Santos Vitorino Modesto,
Rocha de Sá Diana Aristótelis,
Nascimento Cavalcanti de Oliveira Érika Renata,
dos Santos Barcelos Maria,
Silva Paz Bruno César,
Andrade Loana Márquez
Thoracic disc herniations are commonly found in asymptomatic individuals, sometimes with genetic predisposition. Congenital fusions of cervical vertebrae occur in Klippel-Feil syndrome, which may be asymptomatic or cause compressive myelitis due to cervical instability or associated herniated discs. We report the case of a 72-year-old man with monophasic acute transverse myelitis probably caused by herpes simplex virus, coexistent with fused cervical vertebrae (C4-C5) and thoracic herniated discs. Establishment of the aetiology in cases of transverse acute myelitis can constitute a challenge in patients with cervical spine anomaly and disc herniations.
Intrathecal colistin for treatment of multidrug resistant (MDR) Pseudomonas aeruginosa after neurosurgical ventriculitis
Baiocchi Marco,
Catena Vincenzo,
Zago Stefano,
Badolati Luigi,
Baccarin Monica
Cerebrospinal fluid (CSF) shunts significantly improve the quality of life in patients with acute hydrocephalus. However, infections associated with a CSF shunt constitute a severe complication with high morbidity and mortality. We describe a case of CFS shunt infection cured with intrathecal colistin.
Neurological impairment and arthritis in an immunocompetent child with human parvovirus B19 chronic infection
Bozzola Elena,
Krzysztofiak Andrzej,
Cortis Eisabetta
Human parvovirus B19 (HPV-B19) is usually a self-limiting infection in immunocompetent children. In this case report, instead, we describe an immunocompotent child with evidence of persistent HPV-B19 infection, arthritis and neurological impairment. He was first admitted to hospital for HPV-B19 infection and sent home in good clinical condition after anti-inflammatory therapy. Eight months later he was re-admitted to hospital for episodes of arthritis and weakness, myalgia, tremors in his legs and hands, and was unable to walk unaided. In both plasma and serum, HPV-B19 DNA, detected by polymerase chain reaction, was still present. For neurological symptoms, he underwent magnetic resonance, which showed increased signal intensity at the spinal roots in the lumbar region, compatible with polyradiculoneuritis. After immunoglobulin therapy he had an excellent response in clinical and radiological terms, suggesting an association between neurological impairment and HPV-B19 infection. Eleven months after the second admission, the patient was still in good clinical condition.
The Infections in the History of Medicine
The plague of the Philistines and other pestilences in the Ancient World: exploring relations between the religious-literary tradition, artistic evidence and scientific proof
Sabbatani Sergio,
Fiorino Sirio
In ancient times the term pestilence referred not only to infectious disease caused by Yersinia pestis, but also to several different epidemics. We explore the relations between references in the Bible and recent scientific evidence concerning some infectious diseases, especially the so-called Plague of the Philistines and leprosy. In addition, some considerations regarding possible connections among likely infectious epidemic diseases and the Ten Plagues of Egypt are reported. Evidence suggesting the presence of the rat in the Nile Valley in the II millennium BC is shown; a possible role of the rat in the plague spreading already in this historical period should be confirmed by these data.
While the biblical tale in the Book of Samuel may well report an epidemic event resembling the plague, as to date this infectious disease remains unknown, it is not conceivable to confirm the presence of leprosy in the same age, because the little palaeopathologic evidence of the latter disease, in the geographic area corresponding to Egypt and Palestine, is late, dating back only to the II century AD.
Letters to the editor
Necrotizing soft-tissue infections in a general hospital
Sanchez-Porto Antonio,
Martin-Gomez Manuel,
Casanova-Roman Manuel,
Casas-Ciria Javier,
Nacle Belen
Summary not available
Chloramphenicol and rifampin may be the only options against Stenotrophomonas maltophilia. A tale of a colonized bladder device in a patient with myelofibrosis
Savini Vincenzo,
Catavitello Chiara,
D’Aloisio Marianna,
Balbinot Andrea,
Astolfi Daniela,
Masciarelli Gioviana,
Pompilio Arianna,
Di Bonaventura Giovanni,
D’Antonio Domenico
Summary not available
Whipple’s disease in an AIDS patient with Kaposi’s sarcoma. Report of a case
Bargiacchi Olivia,
Salerno Anna Maria,
Brondolo Roberta,
Rizzo Giovanni,
Brustia Diego,
Garavalli Pietro Luigi
Summary not available
