Volume 21, Issue 1, 2013
Review
The importance of being Dientamoeba fragilis
Lacasella Vita,
Brandonisio Olga,
Capolongo Carmen,
Marangi Marianna,
Giangaspero Annunziata
In recent years, interest in Dientamoeba fragilis on the part of biologists, clinicians and parasitologists has increased considerably due to the need to clarify the many unresolved issues related to the parasite and the associated infection. This paper aims to provide a summary of the state of knowledge of D. fragilis in its different aspects, and, through the analysis of the literature and the most recent data, the present review aims to record the reasons why this protozoan, although little known, should not be underestimated in the diagnosis of human parasitic infections also in Italy.
Original article
Trend of syphilis among patients at the Infectious Diseases Clinic of Perugia, Italy: a six-year observational retrospective study
Malincarne Lisa,
Angeli Giorgia,
Francisci Daniela,
Baldelli Franco,
Pasticci Maria Bruna
In order to describe the trend of syphilis at the Infectious Diseases Clinic of Perugia University, Italy, over a six-year period (2005-2010), 138 patients were identified and monitored. Syphilis diagnosis was as follows: latent 60%, secondary 21%, neurosyphilis 10%, primary 9%. The study population comprised 83% males, 59% Italians and 45% men who have sex with men (MSMs). Heterosexual females represented 28.5% cases among immigrants and 8.5% cases among Italians, while men with unknown sexual contacts were 28% and 14% respectively (p=0.0059). HIV co-infection was detected in 70% of patients, with a predominance of males (94%) and Italians (62%). Among HIV-positive patients, 63% were pre-existing HIV-infected: of these, 26% had primary or secondary syphilis. During the study period, the number of regional syphilis notifications at the Italian Health Department was lower with respect to the observed cases at the Infectious Diseases Clinic of Perugia (69 versus 138). Globally, the trend of syphilis infection remained stable over the six-year period. However, efforts to improve prevention and screening programs are required for persons at risk of both syphilis and HIV infection, as well as measures to strengthen syphilis notification procedures.
Infectious diseases and health in the migrant people: experience from Lampedusa 2011
Prestileo Tullio,
Cassarà Giuseppina,
Di Lorenzo Francesco,
Sanfilippo Adriana,
dalle Nogare Ernesto Renato,
Orlando Giuseppina,
Migration is one of the possible points of contact between the rich world and the poor world. This paper analyzes and quantifies the presence of infectious diseases in a cohort of about 25,000 immigrants from Africa who landed in Lampedusa in 2011.
The main clinical presentations of a cohort of migrants in Lampedusa were observed consecutively in 2011 during landing and then within the reception centers. In over 75% of the cases observed, the population was healthy. In 23% of cases diseases were observed in relation to the migration route, especially the precarious conditions of the crossing of the Channel of Sicily. Infectious diseases or female genital pathologies were observed in less than 2% of the population.
The experience of Lampedusa in 2011 confirmed the Healthy Migrant theory, a population predominantly represented by young people who are at risk of becoming ill during the difficult migration or in the host country due to poor living conditions. Taking care of such people is an act of civilization and ensures the health of this population and of the whole community.
Gram-negative urinary tract infections and increasing isolation of ESBL-producing or ceftazidime-resistant strains in children: results from a single-centre survey
Giardino Stefano,
Bandettini Roberto,
Perotti Maddalena,
Piaggio Giorgio,
Degl’Innocenti Ludovica,
Sacco Rosanna,
Ciucci Antonella,
Caviglia Ilaria,
Barabino Paola,
Ginocchio Francesca,
Losurdo Giuseppe,
Haupt Riccardo,
Castagnola Elio
Le infezioni delle vie urinarie (IVU) sono una importante causa di morbosità in pediatria, specialmente in presenza di malformazioni delle vie urinarie o disfunzioni neurologiche della vescica. Il Comitato Infezioni Ospedaliere dell’Istituto Giannina Gaslini – Genova – esegue una sorveglianza prospettica sulla epidemiologia delle IVU in bambini ricoverati presso l’Istituto, e i dati sono riportati come tasso di episodi/1000 giornate di ricovero. Nel periodo 2007-2011 si è osservato un aumento dell’incidenza delle IVU da batteri Gram-negativi, soprattutto nell’Unità Operativa di Nefrologia (da 11.63 a 27.48, coefficiente r 0.95; P< 0.05), associate ad un aumento del tasso di infezioni da ceppi ESBL-produttori (da 0.54 a 2.55, coefficiente r 0.89; P=0.05). Questo studio dimostra un aumento delle IVU da Gram-negativi, specie resistenti ai beta lattamici, in pediatria. Le cause possono essere multiple, ma è significativo che questa variazione epidemiologica si osservi soprattutto in un reparto dove viene routinariamente utilizzata profilassi antibatterica per tempi molto lunghi e a basso dosaggio. Questo fenomeno è preoccupante e necessita di monitoraggio attento al fine di ridurre il rischio di selezione di ceppi batterici con scarse o nulle opzioni terapeutiche.
Intestinal parasitosis: data analysis 2006-2011 in a teaching hospital of Ancona, Italy
Silvestri Carmela,
Greganti Gianfranco,
Arzeni Daniela,
Morciano Angela,
Castelli Pamela,
Barchiesi Francesco,
Cirioni Oscar,
Giacometti Andrea
Intestinal parasites are a serious problem in developing countries, but should not be underestimated in industrialised countries either. Between January 2006 and December 2011, stool specimens and the scotch tests of 5323 Italian and non-Italian patients (adults and children) attending the laboratory of our Infectious Diseases Clinic in a teaching Hospital at Ancona were analyzed specifically for intestinal parasites. The present study shows that, over a six-year period, of a total of 5323 patients 305 harboured at least one species of parasite (5.7%). Among the pathogenic protozoa Giardia lamblia was the most common, the overall prevalence of giardiasis being 1.8 % (99/5323). Helminths were found in 0.9% of the patients (48/5323). In particular, Hymenolepis nana, Strongyloides stercoralis and Trichuris trichiura were most commonly recovered in non-Italian children, suggesting that certain intestinal parasites are restricted to endemic areas in the tropics. Eighteen of the 305 infected patients had more than one parasite in their stools. Our study demonstrates that intestinal parasites must be considered even in industrialised areas and stool examination should be supported by epidemiological data and clinical features.
Case report
Development of sarcoidosis during treatment for chronic hepatitis C with pegylated interferon α-2a and ribavirin: case report and literature review
Cacopardo Bruno,
Pinzone Marilia Rita,
Nunnari Giuseppe
Sarcoidosis is a chronic inflammatory multisystem disease of unknown aetiology. IFN-α is an immunomodulatory cytokine, currently used with ribavirin in the treatment of chronic hepatitis C infection. Due to its effects on the immune system, IFN-α may lead to the induction or exacerbation of autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis and sarcoidosis. We report on a 37-year-old man, presenting with sarcoidosis during a six-month course of PEG-IFN α-2a and ribavirin for chronic hepatitis C virus genotype 3 infection.
High dose of trimethoprim-sulfamethoxazole and daptomycin as a therapeutic option for MRSA endocarditis with large vegetation complicated by embolic stroke: a case report and literature review
Di Carlo Paola,
D’Alessandro Natale,
Guadagnino Giuliana,
Bonura Celestino,
Mammina Caterina,
Lunetta Monica,
Novo Salvatore,
Giarratano Antonino
Large cardiac vegetation carries a poor prognosis and high mortality risk, especially if associated with methicillin-resistant Staphylococcus aureus (MRSA) infection. We share our experience of a rare and complicated large cardiac vegetation which had a favourable outcome with combination antibiotic treatment alone. A 35-year-old HIV-negative, HCV-positive male patient with a previous history of methicillin-susceptible S. aureus endocarditis showed MRSA mitral valve endocarditis with large vegetation, complicated by embolic stroke. The strain was soon identified by PCR but only after culture did the patient receive efficacious antibiotics. A combination of daptomycin plus trimethoprim/sulfamethoxazole (TMP/SMX) was administered for six weeks, followed by a high dosage of TMP/SMX for a further six weeks. Effectiveness of the treatment was demonstrated by the patient's clinical improvement and instrumental evidence of cardiac mitral vegetation clearance. Innovative antibiotic strategies in patient management are needed to fight Staphylococcus aureus endocarditis because strains show varying antimicrobial susceptibility patterns in different geographic areas. Timely initiation of targeted antimicrobial therapy remains a crucial step to reduce morbidity and mortality but culture is crucial for appropriate fine-tuning of antibiotic therapy.
Idiopathic thrombocytopenic purpura associated with splenic tuberculosis: case report
Dal Mehmet Sinan,
Dal Tuba,
Tekin Recep,
Bodakçi Erdal,
Düzköprü Yakup,
Ayyildiz Mehmet Orhan,
Tuberculosis is still one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. There are limited numbers of cases in which immune thrombocytopenia is associated with splenic tuberculosis. We report a case of immune thrombocytopenic purpura due to splenic tuberculosis. Our case was a 58-year-old female with headache, gum bleeding, redness in legs, and ecchymoses on the arms for 10 days. On admission to hospital, laboratory tests were as follows: platelet count 6.000/mm³ (150 000-450 000), haemoglobin: 12 g/dl, WBC: 8000/mm3, erythrocyte sedimentation rate: 58 mm/h and C-reactive protein was in normal ranges. After standard laboratory tests, the patient was diagnosed with idiopathic thrombocytopenic purpura. The patient presented abdominal lymphadenopathies and spleen in normal size in radiological examinations. Diagnostic laparotomy and splenectomy and lymph node excision was performed and splenic tuberculosis was detected in pathologic and microbiologic examination. The patient was successfully treated with apheresis platelets suspension, intravenous immunoglobulin and antituberculous therapy. In conclusion, splenic tuberculosis should be suspected in patients who have fever, abdominal lymphadenopathies and immune thrombocytopenic purpura. Histopathological examination is still an ideal method to confirm the diagnosis, suitably aided by microbiological examination.
A strange gingival swelling in an Italian child: a case of oral myiasis
Raffaldi Irene,
Scolfaro Carlo,
Pinon Michele,
Longo Stefano,
Savoia Dianella,
Tovo Pier-Angelo
Oral myiasis is a condition in which tissues of the oral cavity are invaded by the larvae of flies. It is a rare disease in humans, often associated with very poor dental and oral hygiene. In children the main predisposing factors are incompetent lips, thumb sucking habits and continuous mouth breathing. The condition has been reported mainly in Asia and South America and rarely in more developed countries. The cases recorded in Italy concern adults with ocular or cutaneous manifestations alone. We describe an unusual infestation of the oral cavity of a five-year-old Italian boy with a severe congenital heart defect. He presented a gingival swelling and, after a few hours, some larvae could be seen moving through his oral cavity. They were removed manually and an oral antibiotic was given to avoid a bacterial superinfection. Three days after, oral examination of the patient revealed a gradual decrease in gingival swelling; complete clinical resolution was achieved about two weeks later. This case is reported as a reminder to consider oral myiasis in the event of suspected gingival swelling in children, especially if they have predisposing factors or if they come from an endemic area.
The Infections in the History of Medicine
The history of the Greek Anti-Malaria League and the influence of the Italian School of Malariology
Tsiamis Costas,
Piperaki Evangelia-Theophano,
Tsakris Athanassios
In 1905, a group of eminent Greek physicians led by Professor of Hygiene and Microbiology Constantinos Savvas and the pediatrician Dr. Ioannis Kardamatis founded the Greek Anti-Malaria League. The League assumed a role that the State would not, and for the next 25 years organized the country’s anti-malaria campaign. During its first steps, the Greek Anti-Malaria League adopted the principles of Professor Angelo Celli’s Italian Anti-Malaria League. The League’s accomplishments include a decrease in malarial prevalence, due to mass treatment with quinine, new legislation ensuring the provision of quinine, State monopoly and the collection of epidemiologic data. However, defeat in the Greek-Turkish War (1922) and the massive influx of one million Greek refugees that ensued, led to a change in malarial epidemiology. In 1928, following a visit to Italy, the Greek League adopted the organization and knowledge of the Italian Malaria Schools in Rome and in Nettuno, and this experience served as the basis of their proposal to the State for the development of the anti-malaria services infrastructure. The State adopted many of Professor Savvas’ proposals and modified his plan according to Greek needs. The League’s experience, accumulated during its 25 years of struggle against malaria, was its legacy to the campaigns that eventually accomplished the eradication of malaria from Greece after World War II.
The death of Goffredo Mameli in 1849
Sabbatani Sergio
After the introduction of firearms, which became increasingly efficient over time, the number of seriously injured soldiers increased considerably during the nineteenth century. As a consequence, surgeons were called upon to broaden their activity, performing operations which had hitherto been considered too hazardous, since they were deemed to be too extensive, or were contraindicated by the risk of complications during surgery (haemorrhage, heart and circulatory failure). From 1846 onwards, the introduction of anaesthetic techniques carried out with ether had expanded surgical perspectives in anatomical districts like the abdomen, which were previously considered a sort of taboo, such that few surgeons ventured into the realm of this internal surgery. In the mid nineteenth century the possibility of suffering from severe infections, as an immediate complication after a firearm injury or after surgical intervention, was very high, ranging between 23% in London, up to 80% in Munich, according to the available records; in Zurich a 46% mortality is reported, and a similar 43% rate came from Edinburgh. The situation worsened during war time, since injured soldiers were recovered in extremely precarious conditions, ad hoc hospitals were located in dilapidated old buildings, and the physicians and health care providers were unaware of the minimum hygiene conditions required, and performed both operations and medications without taking sterility measures into consideration. The author reports and comments on the most significant parts on the documents written by Agostino Bertani, who described in full detail the clinical evolution of the wound suffered by Goffredo Mameli, the poet and patriot of the Italian Risorgimento who wrote the Italian national anthem. The clinical evolution of Mameli’s disease was unfavourable: he underwent amputation of the left lower limb after the firearm injury suffered during the defence of the Roman Republic, since a gangrenous complication had become apparent. The poet died of septicaemia on July 6, 1849, 17 days after the surgical operation.
Letters to the editor
The undefined role of Gram positive bacteria in chronic prostatitis development
Stamatiou Konstantinos
We recently completed a study on the association of the epidemiological features of patients with chronic prostatitis with the microbiological findings of their urine and prostatic secretion samples. It was noticed that the frequency rate of Gram + bacteria isolates observed in our study was relatively high. The most frequent Gram + bacteria were Coagulase-negative staphylococci (CoNS). However, unusual bacteria such as Streptococcus mitis and oralis (SMO) were also isolated in a few cases (5.7%). Almost all patients found with SMO in their urine and prostate secretion samples reported only oral intercourse. We therefore hypothesize that retrograde entry of SMO from the oral cavity to the prostate following insertive oral intercourse is not to be excluded.
Erratum
The role of marine hospices as therapeutic support for scrofula treatment in nineteenth-century Ferrara
Guidi Enrica,
Lupi Silvia,
Vicentini Chiara Beatrice,
Manfredini Stefano,
Altieri Lorenzo,
Scivales Sonia,
Contini Carlo
Erratum: the correct title of the paper reported on "Le Infezioni in Medicina", 2012, December; 20 (4), 300-312 is the following:
The role of marine hospices as therapeutic support for scrofula treatment in Ferrara in nineteenth-century
