Volume 22, Issue 3, 2014
Review
Vector transmitted diseases and climate changes in Europe
Rossati Antonella,
Bargiacchi Olivia,
Kroumova Vesselina,
Luigi Pietro
The increase in temperatures recorded since the mid-nineteenth century is unprecedented in the history of mankind. The consequences of climate changes are numerous and can affect human health through direct (extreme events, natural disasters) or indirect (alteration of the ecosystem) mechanisms. Climate changes have repercussions on ecosystems, agriculture, social conditions, migration, conflicts and the transmission mode of infectious diseases.
Vector-borne diseases are infections transmitted by the bite of infected arthropods such as mosquitoes, ticks, triatomines, sand flies and flies. Epidemiological cornerstones of vector-borne diseases are: the ecology and behaviour of the host, the ecology and behaviour of the vector, and the population’s degree of immunity. Mosquito vectors related to human diseases mainly belong to the genus Culex, Aedes and Mansonia. Climate changes in Europe have increased the spread of new vectors, such as Aedes albopictus, and in some situations have made it possible to sustain the autochthonous transmission of some diseases (outbreak of Chukungunya virus in northern Italy in 2007, cases of dengue in the South of France and in Croatia). Despite the eradication of malaria from Europe, anopheline carriers are still present, and they may allow the transmission of the disease if the climatic conditions favour the development of the vectors and their contacts with plasmodium carriers.
The tick Ixodes ricinus is a vector whose expansion has been documented both in latitude and in altitude in relation to the temperature increase; at the same time the related main viral and bacterial infections have increased. In northern Italy and Germany, the appearance of Leishmaniasis has been associated to climatic conditions that favour the development of the vector Phlebotomus papatasi and the maturation of the parasite within the vector, although the increase of cases of visceral leishmaniasis is also related to host immune factors, particularly immunodepression caused by the human immunodeficiency virus (HIV).
Despite the importance of global warming in facilitating the transmission of certain infectious diseases, due consideration must be taken of the role played by other variables, such as the increase in international travel, migration and trade, with the risk of importing parasites and vectors with the goods. In addition, the control of certain infections was possible in the past through improvements in socio-economic conditions of affected populations. However, the reduction in resources allocated to health care has recently led to the re-emergence of diseases that were considered eradicated.
Original article
Beyond depression: assessing personality disorders, alexithymia and socio-emotional alienation in patients with HIV infection
Masiello Addolorata,
De Guglielmo Carmen,
Giglio Sergio,
Acone Nicola
HIV infection is commonly associated with emotional and cognitive disorders that recognize both causes of an organic nature (related to the virus itself) and non-organic factors (emotional stress resulting from HIV diagnosis, social stigma and continued risk behaviour such as alcohol or drug abuse). Most of the literature has focused attention on depressive disorder, the most common mental disorder in the HIV population. In our analysis we evaluated the presence of personality disorders and alexithymia in a group of patients seropositive for HIV through appropriate psychological tests. Our data revealed a close relationship between socio-emotional alienation, distorted body perception and the difficulty in relating with each other, which is perceived as threatening and judgmental; this concept takes us back to the social stigma that modifies the emotional communication of HIV patients. The illness is experienced as an outsider that modifies the body, imprisons the emotionalism and cannot be controlled. Such personality alterations stop the emotional communication, thereby developing alexithymia.
Distribution of liver disease in a cohort of immigrants in Sicily: analysis of day-hospital admissions in a migration medicine unit
Affronti Marco,
Affronti Andrea,
Soresi Maurizio,
Giannitrapani Lydia,
Campagna Elisa,
Tramuto Fabio,
Brunori Giuseppe,
Montalto Giuseppe,
The objective of this study was to evaluate the frequency of liver disease and its aetiology in a cohort of immigrants. We retrospectively examined the hospital discharge charts of all the immigrant patients presenting at our day hospital from July 2009 to June 2013, and after evaluating the anamnestic, clinical and laboratory data on these charts we identified subjects with liver disease and its various aetiologies. The total sample population consisted of 1218 patients, of whom 112 (9.2%) had a diagnosis of liver disease. More than two-thirds of the latter (67.8%) came from Africa, while 15.2% were from Asia and 17.0% from Eastern Europe. In most patients the disease was related to HBV (44.6%), followed by alcohol (25%) and then HCV or cryptogenic disease (both 15.2%). Forty-six patients had undergone liver biopsy, which showed eight cases of varying degrees of liver steatosis, 29 cases with a variable severity of chronic liver disease, eight cases with a definite picture of liver cirrhosis and one case of alcoholic hepatitis. These data show that a significant proportion of our immigrant population has liver disease and that the most frequent cause is hepatitis B infection.
Prevalence and titre of antibodies against Hepatitis A virus in HIV-infected men having sex with men in Greece
Kourkounti Sofia,
Paparizos Vassilios,
Leuow Kirsten,
Kyriakis Kyriakos,
Antoniou Christina
Hepatitis A remains a serious vaccine-preventable disease for HIV patients. We tested 897 HIV-infected men having sex with men (MSM) for antibodies against hepatitis A virus (anti-HAV) and measured the geometric mean antibody titres (GMTs) in a group of patients who received a hepatitis A vaccine and in patients with immunity to HAV due to infection in childhood. In all, 320 patients (35%) had positive anti-HAV antibodies. Multivariate analysis showed that only age (p<0.001) and ethnic origin (OR 20.029, p<0.001) had a statistically significant effect on the presence of antibodies. In addition, age was a fairly sensitive (68.4%) and specific (64.2%) marker, patients being separated by the 36.5 years cut-off point. The response rate of patients who get vaccinated (n=383), one month following the administration of the second dose of the vaccine, was 76%. The GMT of the vaccinated patients was 305 mIU/ml versus 7105 mIU/ml of patients with past infection. The vast majority of HIV-infected MSM patients in Greece is susceptible to HAV. Immunity to HAV in newly vaccinated patients, unlike patients with natural immunity, is low and probably requires monitoring.
Congenital and perinatal infections in the Marche region (Italy): an epidemiological study and differences between ethnic groups
Ruffini Ermanno,
Compagnoni Luigina,
Tubaldi Lucia,
Infriccioli Giovanna,
Vianelli Patrizia,
Genga Roberto,
Bonifazi Vitaliana,
Dieni Alessandra,
Guerrini Domenico,
Basili Gabriella,
Salvatori Patrizia,
DeColli Rosa,
Leone Luciano,
Gesuita Rosaria
The purpose of this study was to evaluate the epidemiological data regarding congenital and perinatal infections in the Marche region to verify the existence of differences in relation to maternal country of origin. This prospective study was conducted from May 2001 to April 2012, and it involved all the maternity units of the Marche region. A total of 10232 pregnant women were included, 25.1% of whom were of foreign nationality while the number of births totalled 10371. Estimated uptake of antenatal screening was 80.5% for CMV infection, 98.6% for HBV infection, 97.5% for HCV infection, 97.4% for HIV infection, 93.1% for syphilis and 98.5% for toxoplasmosis. For group B streptococcus vaginal and perianal swabs were performed in 81.2% of all women (78.4% in immigrant and 90.4% in Italian women; the difference was statistically significant [p <0.001]) and 13.6% were positive. The overall prevalence for CMV infection was 72.3% (91.9% in immigrant women) while for toxoplasmosis it was 27.5% (28.8% in immigrant women). The rate of seroconversion in pregnant women investigated for CMV infection was 0.28%, while that for toxoplasmosis was 0.09%. The overall prevalence for HBV infection was 0.79% (4.3% in immigrant and 0.4% in Italian pregnant women; the difference was statistically significant [p <0.001]), 0.4% for HCV infection (1% in immigrant and 0.48% in Italian pregnant women; the difference was not statistically significant [p = 0.413]), 0.22% for syphilis (0.8% in immigrant and 0.08% in Italian pregnant women; the difference was not statistically significant [p = 0.062]), 0.09% for HIV infection, and 0.03% for tuberculosis. The prevalence of congenital CMV infection was 0.04% and that of congenital toxoplasmosis 0.01%. The prevalence of early-onset infection from Group B streptococcus was 0.029%. No cases were observed of congenital syphilis, congenital tuberculosis or maternal and neonatal HSV infections. The study proves that in the Marche region there is a high percentage of women who undergo prenatal screening, including screening for infections, not offered by the National Health Service, such as CMV and HCV. The data also demonstrate that some infections, such as tuberculosis, HIV and HBV, almost exclusively affect immigrant women. Regarding neonatal infections, the data presented are in line with those in the literature, with the exception of congenital CMV infection, in which the low prevalence observed could be linked to the recent and massive migration of already immunized women.
A measles outbreak in Catania, Sicily: the importance of high vaccination coverage and early notification of cases for health and economic reasons
Maurizio Benedetto,
Fontana Rossella,
Pinzone Marilia Rita,
Cuccia Mario,
Bellissimo Francesco,
Rapisarda Liliana,
Rinnone Sebastiano,
Rapisarda Venerando,
Pavone Piero,
Cacopardo Bruno,
Nunnari Giuseppe
Measles is a paediatric exanthematous disease. Even though vaccination has dramatically reduced measles morbidity and mortality, outbreaks still occur due to insufficient vaccination coverage and importation of the virus from endemic regions. Although child vaccination coverage in Italy has been broadened (from 74% in 2000 to 90.1% in 2011), outbreaks are still observed at a regional level. We describe epidemiological and clinical characteristics of cases reported from January 2009 to May 2010 to the Epidemiology Service of the Provincial Health Authority of Catania. We obtained demographic data and vaccination status from the database of the Epidemiology Service and clinical features and laboratory data from medical records.
In all, 522 cases were notified: 286 males (54%), median age 12 years (interquartile range(IQR) 4-18); 401 cases (77%) were notified by the hospital, and 121 (23%) by general practitioners. Only one patient had been previously vaccinated. 52 cases were hospitalized, median age 18 years (IQR 17-23). We observed hypertransaminasaemia in 20 patients (38%), thrombocytopenia in 22 patients (42%) and a creatine phosphokinase increase in 16 (30%). Complications (pneumonia, haemorrhagic cystitis, acute hepatitis) occurred in 10 patients (19%), all older than 18. Recent outbreaks show that immunization practices are still insufficient. Most cases were recorded in adolescents and young adults; even if the vaccine has limited virus circulation in childhood, it did not prevent the infection of other age groups. The number of notifications also suggests that the phenomenon is underestimated. In order to monitor the disease we need early notification of cases and increased vaccination coverage.
Case report
A case of Crimean-Congo haemorrhagic fever with normal laboratory findings
Sari Tugba,
Hatipoglu Cigdem Ataman
Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease caused by Nairovirus, of the family Bunyaviridae. This is the first case report of a confirmed CCHF case without laboratory abnormality. A 36-year-old woman was admitted to our clinic with the complaints of fever, chills, myalgia and vomiting. She was living in a CCHF-endemic region and had received a tick bite ten days previously. Her complaints had started five days after the tick bite, and bleeding of the nose and vagen followed. Under laboratory analysis, serum white blood cell (WBC) was 7300/mm3, haemoglobin (Hb)11.9 gr/dL, platelet (Plt) count 293000/mm³, aspartate transaminase (AST) was 23 U/L, alanine transaminase (ALT) 14 U/L, lactate dehydrogenase (LDH) 139 U/L, creatinine phosphokinase (CPK) 39 U/L, INR 0.8 and APTT 26.2 seconds. Based on these clinical and epidemiological findings, a diagnosis of CCHF infection was suspected, and the diagnosis of CCHF was confirmed with a blood sample tested by TaqMan-based one-step RT-PCR positivity and IgM antibody positivity. We suggest that patients from an endemic region who have typical epidemiological and clinical findings should be evaluated as a possible case for CCHF even if the laboratory findings are not compatible.
Visceral leishmaniasis in a psoriatic arthritis patient treated with methotrexate
Hadjipetrou Athanasios,
Anyfantakis Dimitrios,
Gkogkou Argyro,
Palla Katerina,
Lagoudaki Eirini,
Milonaki Theoharoula,
Kastanakis Serafim
Visceral leishmaniasis, in Greece, represents a relatively rare, potentially fatal clinical entity. Here we describe a case of visceral leishmaniasis infection in a 65-year old Greek male with psoriatic arthritis treated with methotrexate, who presented with high grade fever, chills, splenomegaly, pancytopenia and polyclonal hypergammaglobulinaemia. A diagnosis of visceral leishmaniasis was finally established. Visceral leishmaniasis should be included in the differential diagnosis for infections in patients receiving methotrexate for rheumatic diseases, especially in endemic areas.
Anicteric leptospirosis with pneumonitis, pericarditis and acalculous cholecystitis
dos Santos Vitorino Modesto,
dos Santos Uliana Medeiros,
Gebrom Daniela Gomes,
Oliveira Santos Alessandra Maria Rodriguez,
Vieira Cancado Ana Carolina
We report the case of a 19-year-old male patient admitted to hospital with fever, asthenia, vomiting, abdominal and chest pains, cough with yellowish sputum, and hypotension. Laboratory tests showed leukocytosis and high creatine phosphokinase levels, without hyperbilirubinaemia or renal failure. The tomographic images of the chest and abdomen showed a right basal pneumonia and acalculous cholecystitis. The electrocardiograms revealed significant characteristics of acute pericarditis. Specific serology for leptospirosis done in the second and third weeks of disease showed positive results. The use of ceftriaxone 1g intravenously, twice a day for 7 days, resulted in an overall clinic improvement. The role of the suspicion index for diagnosis of leptospirosis is emphasized in anicteric patients, as well as the unsuspected possibility of pulmonary, pericardial and gallbladder involvement.
Streptococcus dysgalactiae subspecies equisimilis bacteraemia in an HIV-1 patient with HBV/HCV co-infections: case report and literature review
Milito Cinzia,
Carello Rossella,
Fantauzzi Alessandra,
Vullo Vincenzo,
Mezzaroma Ivano
Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a common pathogen in animals and generally considered a rare cause of infection in humans. Recently, epidemiological studies demonstrated an increasing number of severe infections, including bacteraemia and endocarditis, caused by SDSE, mainly in predisposed hosts, immunocompromised by underlying conditions. Even though the immune status seems to play an important role in the appearance of SDSE infections, this microorganism has been rarely described as a pathogen in HIV-1 infected subjects. An extensive review of the literature on this pathogen is reported, with a description of a case of SDSE bacteraemia associated to septic arthritis with soft tissue infection in a patient with HIV-1 disease and chronic hepatitis due to HCV and HBV co-infections.
Irreversible acute renal failure and cholestatic hepatitis following therapy with indomethacin in an HIV-naïve patient with pericarditis: a case report
Colomba Claudia,
Siracusa Lucia,
Madonia Simona,
Bonura Silvia,
Rubino Raffaella
The most frequent clinical manifestation of cardiovascular diseases in patients with AIDS is pericarditis. Indomethacin is a well tolerated non-steroidal inflammatory drug (NSAID) widely used in the treatment of pericarditis but it can provoke acute renal failure. Tenofovir has also been associated with chronic renal dysfunction. Liver damage can occur during treatment with NSAIDs. We describe the first case of acute renal failure and cholestatic hepatitis occurring in an HIV-naïve patient with pericarditis starting HAART (highly active antiretroviral therapy) and assuming indomethacin and antibiotic therapy for opportunistic infections (OIs) at the same time. Based on our case we suggest that attention be paid to drug-drug interactions in such patients.
Petechial rash associated with Parvovirus B19 in children: case report and literature review
Tuccio Alessandra,
Zanelli Giacomo,
Rodriguez Dhyana Chiara,
Tataranno Maria Luisa,
Vascotto Marina,
Balestri Paolo
Human Parvovirus B19 (B19V) infection usually causes erythema infectiosum (EI). In recent decades, several uncommon exanthems have been described in association with B19V. Recently, haemorrhagic manifestations such as purpuric-petechial rash have been reported. We describe an unusual paediatric case of B19V associated with generalized petechial eruption, and a review of the recent literature.
The Infections in the History of Medicine
The experiments conducted by Japanese on human guinea pigs, and the use of biological weapons during the Sino-Japanese war (1937-1945)
Sabbatani Sergio
Starting from the end of the nineteenth century, and during the first four decades of the past century, Japan showed considerable military expansion, on the back of a pan-Asiatic and imperialistic ideology, comparable only to those expressed by Wilhelmian and Nazi Germany. This growth led to Japan playing an extremely important role in the Asia-Pacific continent, which unavoidably brought the country onto a collision course with the British Empire and the United States of America. The Japanese general Shiro Ishii, who had undoubted organisational abilities but also a propensity for crimes against mankind, starting from the end of the 1920s and during the subsequent decade, under the suggestion of a military physician, developed a research programme to obtain biological weapons, since he was aware of the lack of raw materials, technology and scientific background in nuclear weapons. This project was taken forward despite Japan’s ratification of the Geneva protocol, undersigned by 70 nations, which posed strict limits to the use of both biological and chemical weapons. In actual fact, the protocol allowed these weapons for defensive purposes, and permitted their experimental development. The research programme, developed with the support of the high command of the Japanese army and certainly known by the Emperor (Tenno) Hirohito, had its operative basis from the year 1932 in the satellite state of Manchukuo, but later and paralleling the increased, aggressive behaviour towards China and the English and American colonies during World War II, spread towards other Asian provinces occupied by the Japanese armies, with other operative units. In these dedicated bases, which were true concentration camps, numerous experiments were carried out on human guinea pigs, frequently concluding with vivisection. Among others, experiments of freezing, thirst, hunger, loss of blood, wounding with firearms, and bone fractures, were performed, as well as the inoculation of microorganisms (including Yersinia pestis, Vibrio cholerae, Richettsia typhi, and Salmonella typhi), and spores of Bacillus anthracis. With regard to infectious diseases, the objective was to establish the most effective models for the use of biological weapons, taking into consideration the features of territories and populations to be placed under attack. It has been estimated that over 100,000 people suffered in such experiments, and according to the authors who studied these facts on the basis of original documentation, approximately 540,000 subjects lost their lives in China and Korea due to epidemics caused by the Japanese between 1937 and 1945.
Breast milk, an antigenic factor against infections in Ancient Greece
Laios Konstantinos,
Tsoucalas Gregory,
Karamanou Marianna,
Tsoucalas Ioannis,
Androutsos George
No summary
