Volume 10, Issue 4, 2002
Review
The gut associated lymphoid tissue, the oral vaccines and the E. coli vaccines: a review
Aiuti Fernando,
Iebba Filippo
The aim of this work was a review of literature with regard to the mucosal immunity, the oral vaccines and the bacterial lysates. The Gut Associated Lymphoid Tissue (GALT) include effector and inductive sites and is constituted by organized and diffuse tissues. GALT defends the integrity of the gut, inhibits the development of allergy and autoimmunity and induce a mucosal and systemic immune response against enteric antigens. Bacterial lysates are innocuous and can reduce the frequency and the seriousness of diarrhoea, mucosal infections and diverticulitis; they induce the production and the biologic activity of secretory IgA and cytokines. The DNA vaccines are able to induce a strong immune response; the oral vaccines formulated with bacterial adhesins can inhibit the entry of pathogens and oral antigens across the gut. The use of adjuvants can amplify the activity of the oral vaccines; an objective of the research is the discovery of potent adjuvants without remarkable toxicity.
Antibiotic therapy in the elderly : features and problems
Russo Michele,
Iasimone Loredana,
Ambrosino Ersilia
Bacterial infections cause 30% of deaths in the elderly and are the most frequent cause of hospitalization in elderly patients. Diagnosis of infection can be difficult because aged patients
may have neither fever nor leucocytosis; most patients present unusual symptoms such as changes in mental status. The clinician must be cognisant of the frequent noncompliance with drug regimens because lack of elderly adherence to a prescribed antibiotic therapy has the potential to result in treatment failure and to foster the emergence of drug-resistant bacteria. Elderly frequently are taking other drugs such as antiarrhythmics and antihypertensives; ignorance of potential antibiotic-drug interaction can result in ineffective treatment or enhanced toxicity. Aging is associated with changes in physiological processes; the age-related decline in renal functon influences the excretion of some antibiotics (aminoglycosides, vancomycin, ofloxacin). The increased potential for toxicity of antimicrobial agents requires a careful drug selection as well as clinical and laboratory monitoring. The most frequent infections occurring in the elderly are pneumonia, urinary tract infection, intra-abdominal infection and soft tissue infection; prevalence and incidence of bacterial meningitis, bacterial endocarditis and bacteraemia are increasing with a mortality rate of 20 to 40%. These bacterial infections have different microbial causes and require different therapeutic approaches according to sites involved, elderly’s salient features and overall susceptibility of the bacteria in the ecosystem. Appropriate empirical antibiotic treatment reduces mortality also in bacteraemic old patients.
Original article
Pharyngotonsillitis caused by Streptococcus pyogenes: clinical and epidemiological aspects and resistance – fenotypes towards macrolides
Crotti Daniele,
D'Annibale Maria Letizia,
Ubaldi Manuela,
Fonzo Giovanna,
Medori Maria Chiara
During 2001 we analyzed 1730 pharyngeal swabs for S. pyogenes (SGA): 1142 children (0-10 years old), 132 adolescent subjects (11-17 years old), and 456 adults (18 or more years old). 994 subjects (664 children, 85 adolescent ones, 245 adults) had acute pharyngotonsillitis. In this last group we observed 321 positivities (32.3 %) for SGA: 40.4 % among children, 24.7 % among adolescent people, 13.1 % among adults. The pharyngotonsillitis prevailed during winter and spring. The resistances (R) towards erythromycin were 27.7 % (89 cases), and among children 30.6 % (82 cases), towards clyndamicin 15.3 % (49 cases, and 17.2 %, 46 cases, among children), towards rokytamicin 11.8 % (38 cases, and 13.1 %, 35 cases, among children). These were the fenotypes of R to erythromycin: 25.8 % M-fenotype, 19.1 % inducible (iMLS), 55.1 % constitutive (cMLS); among children respectively 25.6 %, 18.3 % and 53.7 %. Increased resistances towards 16-C macrolides, increased resistances of cMLS to erythromycin, and the persistance of R to 14-C macrolides around 30 % are discussed.
Have Ureaplasma urealyticum and Mycoplasma hominis infections any significant effect on women fertility?
Fenkci Veysel,
Yilmazer Mehmet,
Aktepe Orhan Cem
Ureaplasma urealyticum and Mycoplasma hominis are known as sexually transmitted agents. U. urealyticum and M. hominis jeopardize male fertility. However, it is unclear whether these infections significantly contribute to female infertility. In this controlled-study we aimed to establish whether M. hominis and U. urealyticum are risk factors for female fertility and prevalence of infection from these agents in patients attending our infertility clinic. Total 96 married women enrolled in this prospective study; the infertile (study) group consisted of 50 women and fertile (control) group comprised 46 women. The patients were searched about the presence of U. urealyticum and M. hominis by a micro-liquid culture method. The samples were collected from endocervical area with a dacron swab. 28 of 50 (56%) and 18 of 46 (39%) women were evaluated as positive for U. urealyticum culture in the study and control groups respectively. M. hominis was cultured from 4 of 50 (8%) women in the study group as no positive result in controls. There were no statistically significant differences between the groups for both agents (p>0.05), but the higher prevalence of U. urealyticum in infertile women gives emphasis to evaluate these agents in patients that have no any other etiological factor for infertility.
Infective Endocarditis in a series of 1527 autopsies: clinical-pathology correlations
Giuseppe Francesco,
Sharapova Galina A.,
Riccardo Flavia,
Esaulenko Elena V.
The study of 1527 autopsies showed that in 2% of cases the cause of death was Infective Endocarditis (IE) (acute in the absolute majority), mostly not diagnosed due to fulminant disease or to the short hospital stay and in some cases not correctly treated. Sepsis was correctly diagnosed in 12 patients (9 of whom were IV drug addicts) and was not identified in 14 patients (12 of whom had acute disease) who were diagnosed as suffering from CNS disease or pneumonia. Systematic autoptic study of patients with or without IE appears to be a very useful method to determine correctly IE mortality.
Outpatient Parenteral Antibiotic Therapy (OPAT) of diabetic foot infections with Piperacillin/tazobactam
Marvaso Alberto,
Esposito Silvano,
Noviello Silvana,
Ianniello Filomena,
Leone Sebastiano,
Maiello A.,
Petronella Pasquale
Treatment of diabetic foot infections (DFIs) represents an important challenge for surgeons, especially in light of the poor results achieved by traditional therapeutic approaches. In this study, the clinical and bacteriological efficacy of TZP for treatment of DFIs in 38 outpatients was evaluated. All patients (median age 63 yrs) were affected by DFIs to
different degrees of severity according to Wagner’s classification: degree 0, 7 pts; degree 1, 17 pts; degree 2, 10 pts; degree 3, 4 pts. Degree 0-1 infections underwent a 10-18 day course with TZP given i.m. (2.25 g bid); degree 2-3 infections were initially treated with TZP i.v. (4.5 g bid or tid). Some patients began treatment in hospital and after early discharge continued parenteral therapy at home; others were treated exclusively at home. Some pts, after a 5-7-day course of i.v. therapy switched to i.m. route. The average duration of antibiotic therapy was 28 days. At the end of treatment with TZP, some patients underwent a new treatment with oral coamoxi-clav for 10-15 days. A bacteriological examination was done for all patients: ulcus (degree 1) and deep tissue (degree 2-3) swabs at the first surgical toilette. Clinical controls, medications, surgical toilettes and microbiological cultures were performed according to the degree of severity, extension of the lesion and response to treatment. All cultures were positive for polymicrobial infections (Staphylococcus spp, Enterococcus spp, Enterobacteriaceae, Pseudomonas spp). In 30/38 pts (79%) a complete resolution was observed; in 4 pts (10%) an improvement. DFIs require long term parenteral treatment, with wide spectrum antibiotics including Gram +, Gram – and anaerobes. OPAT represents a valid alternative to hospitalisation when the general conditions of the patient are stable, the infection is not too severe and complications are not present. TZP proved to be a good choice for treatment of diabetic foot infections that, due to its high safety, can be successfully utilized also in OPAT programmes
Case report
Acute hepatitis-associated pure red cell aplasia: a case report
Della Loggia Paolo,
Cremonini Laura
After a holiday in Egypt, a 57-year-old caucasian woman developed acute hepatitis A. The illness seemed initially to have a benign course, with a decreasing trend of hepatic enzymes and an apparent recovery. Three weeks later a relapse occurred. Recurrence of symptoms and aminotransferase elevation were associated with severe anemia; a hyporegenerative anemia was diagnosed and all laboratory findings were consistent with pure red cell aplasia. The haematologic disorder was successfully treated with red cell transfusion and glucocorticoids.
World microbiological unification according to Woodrow Borah
Sabbatani Sergio
Now that developments in communication media are turning the world into a “global village” and there are risks of global epidemics due to infectious agents spread by possible terrorist attacks, this article aims to remind us of what happened in the “New World”, where in the space of a few decades the indigenous civilizations disappeared. When, following the geographical discoveries of the 15th, 16th and 17th centuries, millions of people met European sailors, soldiers and traders, the outbreak of pathocenosis was destructive – the intensity of this effect was directly related to the degree of isolation of the indigenous populations colonised by the Europeans. The author of this article recalls the Woodrow Borah thesis. Borah, a former History Professor at Berkeley University, elaborated a theory according to which the microbiological unification of the world is the prime cause of the genocide of the indigenous population in America and Oceania. The author emphasises that the events following the discovery of the American continent are very similar to the plague epidemic which started in 1348 in Europe.
