Volume 6, Issue 4, 1998
Review
Clinical concern for antibiotic resistance
Esposito Silvano
Antibiotic resistance represents such a serious problem in the field of infectious diseases as to constitute as a threat for a post-antibiotic era. Currently, it contributes to increase treatment failures, morbidity and mortality rates, and health costs. Since 1993, the international scientific community has identified five different priorities in the struggle against antibiotic-resistance which are represented by the following bacterial species: Mycobacterium tuberculosis, Streptococcus pneumoniae, Staphylococcus spp, Enterococcus spp and Neisseria gonorrhoeae.
At present three different approaches have been identified to overcome this phenomenon: identification of mechanisms of bacterial resistance; epidemiological surveys; synthesis of new molecules active against multiresistant microrganisms.Besides the above mentioned strategies, preventive interventions should also be carried out mainly through the optimisation of antibiotic prophylaxis, optimisation of choice and duration of therapy, improvement of antibiotic prescriptions by means of educational and administrative programs, monitoring and feedback of bacterial resistance and finally by the definition and diffusion of guidelines for therapy.
Original article
Association between chronic hepatitis C virus infection and cryoglobulinemia
Scotto Gaetano,
Fazio Vincenzina
Hepatitis C virus infection (HCV) causes both acute and chronic liver disease and can be also associated with cryoglobulinemia (SC). SC is a systemic vasculitic disease, typically characterized by lower extremity purpure, arthralgias and fatigue and by circulating immune complexes which precipitate at low temperatures. We examined the prevalence of SC in a prospective study of 84 patients with chronic HCV hepatitis. Cryoglobulinemia was detected in 44 patients (53.4%) and was associated with the severity of liver damage and the duration of the disease. The analysis of HCV genotypes demonstrated a prevalence of 1 b. The amount of cryoglobulinemia was low in all the patients with SC and only 20% showed a clinical syndrome.
Glucagon test for Doppler sonography measurement of portal flow in chronic HCV infections
Iacomi Fabio,
Russo Vincenzo,
Toccaceli Fabrizio,
Sereno Silvia,
Uwechie Valentina,
Zardi Enrico,
Pasanisi Patrizia,
Laghi Vittorio
Purpose - To evaluate whether Doppler sonography measurement of portal flow velocity (PFV) after glucagon injection can be useful in assessing the severity of liver damage in chronic HCV infection. Methods - Forty-five patients (32 males and 13 females; mean age 54.1±14.8 years) with biochemical (raised serum ALT levels), virological (positive serum HCV RNA test) and histological (liver biopsy) evidence of chronic HCV infection were included in the study. According to hepatitis staging (degree of liver fibrosis), as assessed by Knodell histological activity index, patients were divided into three groups: group 1 (n.=17), with no or mild fibrosis (fibrosis score: 0-1); group 2 (n.=11), with severe fibrosis (score: 3); and group 3 (n.=17), with liver cirrhosis (score: 4). For sonographic measurements of PFV, a Doppler ultrasound multi-purpose equipment and a convex 3.5 MHz probe were used. All patients were examined after an 8-hour fast, in supine position, 10 min before (baseline), as well as 5 and 10 min after, intravenous administration of 1 mg of glucagon chloride (Novo Nordisk). Statistical analysis was performed by ANOVA test, Bonferroni t test and Spearman rank correlation test. Results - No significant differences were found in mean basal PFV of group 1 (19.4±2.4 cm/sec), group 2 (20.1±3.6 cm/sec) and group 3 (17.5±3.7 cm/sec) (p > 0.05). Five minutes after glucagon injection, all the three groups showed a significant increase in PFV (25.6±4.8,23.7±4.0 and 19.5±5.0 cm/sec, respectively; p < 0.05 vs baseline). The peak increase in PFV after glucagon injection was significantly higher in group 1 (7.9±3.7 cm/sec; 40.7% of basal value) than in group 2 (4.5±3.9 cm/sec; 22.4%) (p < 0.05) and in group 3 (2.7+2.3 cm/sec; 15.4%) (p < 0.05). A significant (p< 0.001) inverse correlation was also found between the patients fibrosis scores and peak increments of PFV induced by glucagon. Conclusions - In some patients with chronic HCV infection, Doppler sonography measurement of PFV after glucagon injection can be useful, in combination with other non invasive ultrasound investigations, both in staging of liver disease and in monitoring the progression of liver histological damage.
Case report
Attempted suicide during interferon therapy: a case report and literature review
Pardelli Riccardo,
Vivaldi Ilo,
Maccanti Osvalda,
Sani Spartaco,
Manicagli Veliero
Occasionally, in the medical literature, attempted or successful suicides during interferon therapy are reported.
We report a case of a 32-year-old man who developed a psychotic syndrome with attempted suicide at the third month of treatment. The cessation of interferon and an appropriate psychiatric therapy determined a complete remission of symptoms. A medical literature review, through several computerized searches, showed a lack of research into the subject. The main conclusion of our article emphasizes the importance of recognizing the early neuropsychiatric symptoms, that are reversible at the cessation of treatment.
Neurologic signs in bacterial endocarditis: an unusual case report
Tarquini Pierluigi,
Marani Toro Giuseppe
We describe the case of a 35-year-old woman, hospitalised due to a fever lasting two days, with signs and symptoms of cerebro-spinal meningitis. The subsequent occurrence of a thromboembolic event with stroke suggests that the neurological symptoms were secondary to a centre of infective endocarditis (instrumentally proved) in the absence of further outstanding symptoms of endocarditis. This event is very unusual during the course of endocardic disease.
CD30 (ki-1) antigen expression in acute infectious mononucleosis
Bellissima Pietro,
Tricoli Dario,
Platania Salvatore
The activation antigen CD30 (Ki-1) which is expressed by the lymphocytes T and B is related to the "nerve growth factor" (NFGR) like the receptor of the "tumor necrosis factor" (TNF) and is expressed in the group of large-cell anaplastic lymphoma (ACLC) and Hodgkin’s lymphoma and in non-Hodgkin’s lymphoma and within the T cells of infectious Mononucleosis. We describe a case of a 18 year-old who contracted Acute Infectious Mononucleosis showing lateral cervical lympho adenopathy. The histologic examination was suggestive for a large-cell anaplastic lymphoma with the antigen CD30, expressed by severa atypical immunoblasts. The remarkable immunoblastic proliferation with Reed-Sternberg-like cells, in milieu polymorphous inflammatory cells present in the course of Infectious Mononucleosis, can simulate large cell anaplastic lymphoma, as well as Hodgkins disease and non-Hodgkins lymphoma. The diagnosis for Infectious Mononucleosis is usually clinical and serological but in cases of cervical lymphnode biopsy a differential diagnosis must be done with positive lymphoma CD30. The criteria to differentiate histologically the Infectious Mononucleosis with large cell anaplastic lymphoma and non-HodgkinÕs lymphoma are discussed. Finally, the relationship between Infectious Mononucleosis and lymphoproliferative disease Epstein-Barr virus related is examined.
The Infections in the History of Medicine
The colera morbus in Bologna in 1886
Sabbatani Sergio,
Piro Franco
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