Volume 21, Issue 3, 2013
Review
Hepatitis E
Scotto Gaetano,
Bulla Fabio,
Campanale Francesca,
Tartaglia Alessandra,
Fazio Vincenzina
Hepatitis E virus (HEV) represents the main aetiological agent of enteric non-A hepatitis and is the only member of a new virus, Hepevirus, belonging to the family of Hepeviridae. HEV is the single most important cause of acute clinical hepatitis among adults in many areas of the developing world, specifically the Indian subcontinent and Southeast Asia, the Middle East and North Africa, where it is a common cause of sporadic and epidemic waterborne outbreaks and results in a high rate of morbidity and death, especially in pregnant women. Once thought of as an infection confined to developing countries, it is now recognized as a geographically widely distributed disease. In low-endemic regions (Western countries), sporadic cases of locally-acquired HEV infection are reported, acquired possibly through zoonotic transmission from pigs, wild boars or deer. In persons with pre-existing chronic liver disease, HEV superinfection can present as acute-on-chronic liver disease. In European countries, chronic infection, which may progress to liver cirrhosis, has been reported among immunosuppressed persons. Two testing vaccines proved to be highly effective in preventing the disease; these vaccines should be of particular use in groups that are at high risk of HEV infection.
Original article
Adherence to antiretroviral therapy among HIV-infected prisoners
Paparizos Vassilios,
Kourkounti Sofia,
Leuow Kirsten,
Georgoulas Stergios,
Kyriakis Kyriakos,
Antoniou Christina
Αdherence, the act of following a course of medication in exactly the manner prescribed, is critical for the success of therapy. Adherence is influenced by many behavioural and social factors and incarceration might be one such factor. This study determined the level of adherence and reasons for non-adherence to antiretroviral therapy among 93 HIV-infected prisoners. Up to 56% of these patients had poor adherence. A similar rate of adherence was detected in prisoners after release. Problems with antiretroviral adherence among prisoners appear to be mostly linked to their deviant behaviour. Inmates with poor adherence had higher HIV-related morbidity and mortality. Age and country of origin were also associated to adherence.
Seroepidemiology of toxoplasmosis in childbearing women of Northwest Iran
Rajaii Mehrangiz,
Pourhassan Aboulfazl,
Asle-Rahnamaie-Akbari Najibeh,
Aghebati Leili,
Xie Juliana Ling,
Goldust Mohammad,
Naghavi-Bezhzad Mohammad
Toxoplasma gondii causes the most common parasitic infection in the world. Congenital transmission, prenatal mortality and abortion are major problems of T. gondii. Prevalence of toxoplasmosis is high in Iran, especially in Azerbaijan. The current literature reviewed in this paper reveal results pertaining to various regions of Iran. The present cross-sectional e-study was designed to evaluate the seroprevalence of toxoplasmosis in childbearing women in Northwest Iran. We evaluated 1659 women in childbearing age from several cities in Northwestern Iran (Tabriz, Maragheh, Ahar, Marand, Sarab, Miane) from July 2009 to August 2010. Women aged between 20 and 40 years and seeking prenatal care were enrolled in the study. The subjects’ sera were probed with indirect fluorescent antibody (IFA).
A total of 1659 subjects were examined. Titres ranged from 1:100 to 1:800. In all, 899 subjects (54.13%) were seropositive. The highest frequency of seropositivity was shown in 1:200 dilution (36.08%) and in subjects from Maragheh (84% of 211 subjects). There was a direct linear relationship between seropositivity and age (p 0.001). Also, seroprevalence of toxoplasmosis was higher in subjects with primary school/lower educational level (p 0.001) and subjects living in rural regions (p 0.001). Overall, more than 50% of women in childbearing age were seropositive for toxoplasmosis in northwestern Iran. Increasing seroprevalence of toxoplasmosis with age was a predictable result due to longer exposure to the parasite. The relationship between increasing seroprevalence and lower educational level as well as living in rural areas is in line with the latest epidemiological findings, which also show such relationships due to lower socioeconomic status.
Microbial and vaginal determinants influencing Mycoplasma hominis and Ureaplasma urealyticum genital colonization in a population of female patients
Leli Christian,
Meucci Marta,
Vento Simona,
D’Alò Francesco,
Farinelli Senia,
Perito Stefano,
Bistoni Francesco,
Mencacci Antonella
Mycoplasma hominis and Ureaplasma urealyticum are associated with chorioamnionitis, preterm delivery and pelvic inflammatory disease. The aim of this study was to evaluate the possible risk factors of co-colonization by M. hominis in patients already colonized by U. urealyticum and compare demographic parameters, vaginal pH and microbiota of women colonized by U. urealyticum or M. hominis. A total of 452 patients positive for U. urealyticum or M. hominis were analysed, 421 (93.1%) of whom were positive for U. urealyticum and 31 (6.9%) for M. hominis. Patients positive for M. hominis compared to patients positive for U. urealyticum were more frequently colonized by Gardnerella vaginalis (71% vs 18.5%; p 0.0001), less frequently by lactobacilli (16.1% vs 61.5%; p 0.0001), and more frequently had a pH value higher than 4.5 (96.8% vs 57%; p 0.0001), all conditions associated to bacterial vaginosis (BV). Logistic regression analysis showed that only G. vaginalis colonization and pH higher than 4.5 were independently related to M. hominis colonization (respectively p 0.0001 and p 0.016). Thus, in women colonized by U. urealyticum, BV is an independent risk factor for M. hominis co-colonization.
Liver function test abnormalities in murine typhus in Greece: a retrospective study of 165 cases
Anyfantakis Dimitrios,
Doukakis Stephanos,
Papadakis Michael,
Triantafyllidou Domniki,
Bambili Konstantina,
Polimili Georgia,
Kastanakis Serafim
The aim of this study was to analyse data relating to the liver function profile during acute infection from murine typhus in the city of Chania in the island of Crete (Greece). A retrospective study of the files of all the cases with a diagnosis of murine typhus admitted to the Saint George General Hospital of Chania over a 15-year period (1993-2008) was performed. Variations in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) levels were recorded from three consecutive examined serum samples. A total of 165 patients were diagnosed with murine typhus during the above time period. Serum aminotransferase and lactate dehydrogenase were abnormal in most of the first examined samples. Remarkably on admission, serum levels of AST, ALT, and LDH recorded an increase above the cut-off point in 142 (86%), 114 (69%) and 136 (82.4%) patients respectively. More than two out of every ten patients presented hepatomegaly. In conclusion, liver dysfunction occurs frequently in patients with murine typhus. A high level of physicians’ awareness is required for the liver biochemical abnormalities caused by this worldwide zoonotic disease, especially in endemic areas such as Greece.
Carbapenem resistance in Acinetobacter baumannii: where is it heading?
Deveci Ozcam,
Dal Tuba,
Tekin Recep,
Bozkurt Fatma,
Tekin Alicem,
Dayan Saim
In the context of the substantial increase in antibiotic resistance rates of Acinetobacter baumannii, we aimed to evaluate the susceptibility rate changes of A. baumannii strains for carbapenems. A. baumannii strains isolated from patients diagnosed with healthcare-associated infections between 2007-2010 were included. A total of 127 A. baumannii strains [53 (42%) from the intensive care unit and 74 (58%) from the non-intensive care unit] were isolated. Conventional methods and an automated microbiology system were used for identification. Susceptibility testing was studied by Kirby-Bauer disk diffusion method. In 2007, five of 26 strains, in 2008, 18 of 31, in 2009, 10 of 35, in 2010, and 20 of 35 were obtained from intensive care unit patients. The susceptibility rate for imipenem was 50% in 2007 but 20% in 2010, while for meropenem it was 55% in 2007 but 12% in 2010.
Prevention and control of antibiotic resistance among Acinetobacter species needs antibiotic usage restrictions and infection control precautions.
Case report
In vivo antiviral activity of telbivudine against HIV-1: a case report
Gentile Ivan,
Bonadies Giovanni,
Carleo Maria Aurora,
Buonomo Antonio Riccardo,
Borrelli Francesco,
Portella Giuseppe,
Borgia Guglielmo
The treatment of HBV infection in patients with HIV co-infection presents several peculiar features: some drugs active against HBV are also active against HIV. This precludes their use in monotherapy in HIV-HBV co-infected patients due to the potential risk of selecting HIV-resistant strains. Telbivudine seemed to be a candidate for exclusive anti-HBV therapy because it exerts no significant in vitro activity against HIV. In this context, we describe the case of a HIV-HBV co-infected patient who presented indication for treatment only for HBV infection. After a short course of interferon treatment withdrawn due to adverse events, adefovir monotherapy was started. Since no significant viral drop was achieved during adefovir treatment, telbivudine was added. This treatment was associated with a complete virological response on HBV. It is noteworthy that after two months of this treatment even the HIV viral load presented a significant reduction. Our findings pose concerns of possible antiviral activity of telbivudine against HIV and therefore of selecting resistant mutations.
Paediatric tubercular spinal abscess involving the dorsal, lumbar and sacral regions and causing spinal cord compression
Bozzola Elena,
Bozzola Mauro,
Magistrelli Andrea,
Calcaterra Valeria,
Larizza Daniela,
Lancella Laura,
Villani Alberto
Tubercular spinal localization is very rare (5%) in paediatric age. We report the unusual case of a child with a history of bacillus Calmette-Guérin vaccination who presented with lymphadenitis in the absence of pulmonary involvement. Despite appropriate anti-tubercular therapy, the patient developed spinal tuberculosis with cord compression. Urgent surgical decompression was performed: laminectomy was done at D3-D5 levels and the higher abscess was then flushed using a catheter, decompressing the cauda equina. Our findings suggest that diagnosis of tuberculosis should be considered even in light of anamnestic vaccination at birth, and that surgical treatment should be rapidly provided in the event of spinal cord compression to avoid devastating sequelae.
Human herpes virus associated with Hashimoto's thyroiditis
Di Crescenzo Vincenzo,
D’Antonio Antonio,
Tonacchera Massimo,
Carlomagno Chiara,
Vitale Mario
Hashimoto’s thyroiditis is the most frequent autoimmune disease with genetic and environmental aetiologies. Viral infections have been postulated as one of the factors that may trigger autoimmune diseases. Many studies suggest that Herpes simplex virus infections are involved in a variety of autoimmune diseases. We report the case of three patients presenting for the first time herpes labialis a few months before the onset of hashitoxicosis. Serological and clinical exams support the possible role of human herpes viruses in the aetiology of Hashimoto’s thyroiditis.
The Infections in the History of Medicine
Cholera epidemic in Brescia in 1836
Vaglia Alberto
Cholera first made its appearance in Italy in 1836. According to reports of the time the consequences were catastrophic: both the number of the people falling ill and the incidence of mortality were high. On the basis of extensive documentation from various archives, the disease appears to have been known in its clinical aspect but its aetiology remained obscure. Hence physicians were powerless to combat such a scourge. The sense of unease and confusion that accompanied the evolution of these sad events drove the population to the use of religious practices of various kinds. It is still possible to find signs of such devotion in churches, votive chapels and ex voto offerings.
Treatment and remedies against smallpox outbreaks in Ferrara in the late nineteenth century
Vicentini Chiara Beatrice,
Manfredini Stefano,
Altieri Lorenzo,
Lupi Silvia,
Guidi Enrica,
Contini Carlo
Health interventions against smallpox during the two epidemics in the second half of the 19th century are outlined. The 1871 hospital health report and the medical report on smallpox patients treated at the hospital and poorhouse of Ferrara between January 1891 and January 1892, drawn up by Alessandro Bennati, provide both interesting data and insights into the treatments and remedies of the time. The treatment of this illness was – and indeed could be – nothing other than symptomatic, there being no real means to halt the spread of the disease. Rather, other remedies were found by alleviating pain and regaining energy during the various stages of the disease. A close relationship between vaccination and the incidence and gravity of the illness is underlined. When the practice of vaccination started to be widely employed at the end of the century, there were almost no cases of death due to smallpox. The pharmacopoeias of the time, Antonio Campana's Farmacopea ferrarese in particular, proved an essential guide in the analysis of each document
