Volume 31, Issue 3, 2023
Review
Update on Mpox : a brief narrative review
Antinori Spinello,
Casalini Giacomo,
Giacomelli Andrea,
Rodriguez-Morales Alfonso J
Mpox (formerly Monkeypox), a neglected tropical disease once confined to Central and West Africa, emerged as a global epidemic outbreak in May, 2022 with 87,529 cases reported as of May, 23, 2023. It predominantly affected men (96.2%) who have sex with men (84-100%), although other transmission routes have been reported, including occupational exposure and vertical transmission. Concomitant HIV infection has been recorded in 21-46.9% and pre-exposure prophylaxis against HIV infection has been reported in 11-57% of published cases. The current outbreak clinical presentation differs from endemic cases with prodromal symptoms that could be absent: the number of lesions is generally low, with skin lesions predominantly localised in the ano-genital areas and frequent lesions present in different stages of progression (i.e., asynchronous). Asymptomatic Mpox infection can occur in 1.8-6.5% of at-risk subjects. People living with HIV with severe immunodeficiency (less than 100 CD4+ lymphocytes per microliter) are at risk of more severe clinical manifestations and death. According to a systematic review and meta-analysis, the hospitalisation rate is around 6% and the observed case-fatality rate is less than 0.1%. Tecovirimat is the drug of choice for treating severe cases although there is no evidence of efficacy from randomised controlled trials. Immunization with a live non-replicating vaccine (JYNNEOS) effectively reduces the disease’s incidence.
Therapy Initiation and Rapid Start with Bictegravir/Emtricitabine/Tenofovir Alafenamide in PLWH
Antinori Andrea
Advanced HIV naive represents an unfavorable prognostic condition due to a persistent high risk of death, increased probability of virological failure, immunologic impairment, clinical progression, and immune reconstitution inflammatory syndrome (IRIS), cumulative adverse drug events, drug-drug interactions and increased healthcare costs.
Currently, all international guidelines recommend the rapid initiation of ART, especially in late-stage naive patients.
Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), due to its efficacy high genetic barrier, good safety profile, and low DDI potential, is one of the regimens recommended for overall rapid initiation by international guidelines.
B/F/TAF has been tested in observational or uncontrolled pilot studies (OPERA, RAINBOW), while a large randomized controlled trial is currently ongoing (LAPTOP).
In conclusion, B/F/TAF is an ideal combination for the initiation of antiretroviral therapy, particularly in the HIV late presenter or advanced HIV disease patient, even in the context of rapid start or same-day treatment regimens, where the initiation of treatment usually occurs in
the absence of information on viral load, CD4 count, biochemical profile and HIV transmitted resistance.
Clinical Pharmacology of the SingleTablet Regimen (STR) Bictegravir/Emtricitabine/Tenofovir Alafenamide (BIC/FTC/TAF)
DiPerri Giovanni
In Italy a proportion of HIV patients exceeding 50% are diagnosed at advanced stages of disease.
A sizeable proportion of patients under chronic HIV treatment has a story of poor adherence with archived resistance associated mutations, a condition implying some risks in case of treatment with dual regimens.
Conventional three-drug regimens will remain necessary in the short-mid term, in order to avoid treatment failure and selection of drug resistance. Efficacy, tolerability, safety, genetic barrier, forgiveness and a good compatibility with concurrent medications are all features that describe the overall quality of BIC/FTC/TAF, a combination whose robustness will remain a point of reference for the next years.
Leptospirosis in India: a systematic review and meta-analysis of clinical profile, treatment and outcomes
Gupta Nitin,
Wilson William,
Ravindra Prithvishree
Introduction: Leptospirosis is a zoonotic bacterial infection with significant mortality and morbidity, especially in resource-limited settings. This systematic review aimed to study the clinical profile and outcome of patients with leptospirosis in India.
Methodology: All articles up to 02.08.2022 were searched using the two databases, PubMed and Scopus. A total of 542 articles were found using the search terms related to 'leptospirosis' and 'India'. After two rounds of screening, 55 articles were included. The data were collected on epidemiology, clinical features, laboratory features and treatment of patients with leptospirosis.
Results: Most cases of leptospirosis were reported from the coastal belt. A large percentage of patients were identified as farmers, and exposure to rainfall was identified as an important risk factor. Fever was present in 97%, and conjunctival suffusion was present in 35% of cases. Haemoptysis, gastrointestinal bleeding, and haematuria were present in 5%, 5% and 12% of patients, respectively. Liver and kidney were involved in 34% and 35% of the patients, respectively. The average haemoglobin, leucocyte count and platelet count across various studies ranged from 9.6-12.5 grams/dl, 8.8-11.3 thousand/µl and 20-130 thousand/µl, respectively. Treatment details were sparsely available in some studies, with penicillin, ceftriaxone, and doxycycline used commonly. The pooled mortality across various studies was calculated as 11% [95% CI-8-15%, I2=93%, P<0.001].
Conclusions: Leptospirosis is associated with significant mortality in Indian settings. There is a need for studies focussing on treatment modalities.
The sources of antimicrobial peptides against Gram-positives and Gram-negatives: our research experience
Rizzetto Giulio,
Gambini Daisy,
Maurizi Andrea,
Molinelli Elisa,
De Simoni Edoardo,
Pallotta Francesco,
Brescini Lucia,
Cirioni Oscar,
Offidani Annamaria,
Simonetti Oriana,
Giacometti Andrea
Antibiotic resistance of Gram-positive and Gram-negative bacteria is becoming increasingly prevalent. For this reason, the search for new molecules that can overcome current resistance and also recover antibiotics that are no longer effective is becoming increasingly urgent. Our research group at the 'Polytechnic University of Marche' managed to study the effectiveness of certain antimicrobial peptides (AMPs). We decided to review our experience with AMPs by classifying them according to their origin and evaluating their effect on Gram-negative and Gram-positive bacteria. AMPs can derive from mammals, amphibians, microorganisms, and insects. In conclusion, our research experience shows that the richest source of AMPs are amphibians. However, the studies done are mainly in vitro or in animal models, requiring further human studies to assess the efficacy and safety of these molecules. AMPs may be a new therapeutic option for infections sustained by multi-resistant micro-organisms and for overcoming the mechanisms of resistance to antibiotics currently used.
In particular, combining AMPs with antibiotics, including those with limited antimicrobial activity due to antimicrobial resistance, has often shown a synergistic effect, increasing or restoring their efficacy. The possibility of using manageable and relatively safe antibiotics again is crucial, considering the widespread increase in bacterial resistance in hospitals and the community. Despite a plethora of research on AMPs and their application as potential treatment on infectious diseases, this area needs further exploration. There is evidence that the characteristics of AMPs can seriously improve through structural chemical modifications and different delivery systems to become alternatives drugs to conventional antibiotics. The aim is to provide an overview of the possible sources from which AMPs are extracted, evaluating their action exclusively on Gram-positive and negative bacteria. This is to determine, based on our experience, which might be the most promising sources of AMPs for future research as well.
Candida auris: the new fungal threat
Pallotta Francesco,
Viale Pierluigi,
Barchiesi. Francesco
Candida auris is an emergent fungal pathogen of particular concern. Since its first identification in Japan in 2009, it rapidly spread all over the world, including Italy. The main concern related to the diffusion of this fungus is its antifungal resistance. It is speculated that about 90% of isolates are resistant to fluconazole, 30% to amphotericin B and 5% to echinocandins; furthermore, some cases of pan-antifungal resistance have been described. Critically ill patients are particularly at risk of being colonized by this yeast and person-to-person transmission may generate hospital outbreaks. In fact, C. auris can survive on inanimate surfaces for a long time and commonly used disinfectants are not effective. Additionally, devices such as central venous catheters (CVCs) or urinary catheters are particularly at risk of being colonized, representing a possible source for the development of bloodstream infections caused by C. auris, which carries a high mortality rate. Given its capability to spread in the hospital setting and the limited therapeutic options it is of outmost importance to promptly identify C. auris. However, commonly used biochemical tests frequently misidentify C. auris as other Candida species; currently the best identification techniques are MALDI-TOF and molecular methods, such as PCR of the ITS and D1/D2 regions of the 28s ribosomal DNA. Whole genome sequencing remains the gold standard for the phylogenetic investigation of outbreaks. The majority of cases of colonization by C. albicans will not cause bloodstream infections and contact precautions and surveillance of contacts will be sufficient. When invasive fungal infections occur, echinocandins still represent the first therapeutic choice. A combination therapy or the use of novel antifungals (such as ibrexafungerp or fosmanogepix) would be required for echinocandin resistant strains. In conclusion, C. auris represents a growing threat because of its antifungal resistance characteristics, its difficult identification and its easy spread from person to person. The aim of this mini-review is to summarize the main aspects concerning this pathogen.
Prevalence of Toxocara eggs in Latin American parks: a systematic review and meta-analysis
Bonilla-Aldana D. Katterine,
Morales-Garcia Laura Valentina,
Ulloque-Badaracco Juan R.,
Mosquera-Rojas Melany D.,
Alarcón-Braga Esteban A.,
Hernandez-Bustamante Enrique A.,
Al-kassab-Córdova Ali,
Benites-Zapata Vicente A.,
Rodriguez-Morales Alfonso J.,
Delgado Olinda
Introduction: Toxocariasis is an infection caused in canines, felines, humans, and other vertebrates by species of the genus Toxocara, such as T. canis and T. cati. The embryonated eggs of these parasites are the main form of acquisition of the infection both for definitive hosts, such as the dog and the cat, respectively and for paratenic hosts, such as humans and other vertebrates. Toxocariasis infection in humans causes visceral larva migrans syndrome. When deposited on park soils, environmental contamination becomes a risk for environmental, human, and animal health.
Objective: To systemically estimate the prevalence of Toxocara spp. eggs in park soils in Latin America.
Methods: A systematic review and meta-analysis were performed to evaluate the prevalence of Toxocara eggs in park soils in Latin America, defined by copro-parasitological, molecular and immunological techniques. We searched PubMed, Scopus, Web of Sciences, Embase, LILACS and SciELO for studies published from 1900 through 28 January 2023. A meta-analysis was performed using a random-effects model to calculate the pooled prevalence and 95% confidence intervals (95% CI). Heterogeneity was measured through I2 statistics.
Results: Forty-nine studies (2,508 parks and 12,833 samples) were included, of whom 44 had a low risk of bias. The pooled prevalence of Toxocara eggs in parks in Latin America was 50.0% (95% CI: 40.0%-60.0%). Argentina had the highest prevalence of Toxocara eggs in parks (100%), followed by Brazil (66%) and Venezuela (63%). The pooled prevalence of Toxocara eggs in soil samples was 20.0% (95% CI: 14.0%-26.0%); in faecal samples, it was 13.0% (95% CI: 6.0%-23.0%).
Conclusion: The presence of Toxocara canis eggs in public parks in Latin America is a zoonotic and public health threat for the people who go to these places, especially if children play on the ground with dirt or contaminated objects; since many pet owners and general public are not adequately informed about the mode of transmission of this parasite.
Evolution of Plasmodium vivax and resistance patterns for infection based on Duffy genotype and phenotype
Picón-Jaimes Yelson Alejandro,
Lozada-Martinez Ivan David,
Forero Buelvas María Camila,
Ardila Sarmiento Andrés Felipe,
Serrano Baez Gustavo Adolfo,
Nazareno Erazo Deilly Yohana,
Cuastumal Martínez José Daniel,
Ruiz-Gutierrez Franklin Kevin,
Carreño Barrera Victor Daniel
The Duffy protein, a transmembrane molecule, acts as a receptor for various chemokines and facilitates binding between reticulocytes and the Plasmodium Duffy antigen binding protein. Duffy expression is associated with the Duffy chemokine receptor antigen genotype on chromosome 1 and exhibits variation across different geographic regions. Traditionally, the Duffy negative genotype and phenotype have been described to confer a certain level of protection against infection and symptom development. However, recent data suggest a shift in this behavior, with significantly higher prevalence observed in individuals with Duffy negative genotype or phenotype. Given that malaria is an endemic vector-borne disease in regions of Asia, Africa, and Latin America, posing a substantial global burden of disease and prioritizing public and global health, identifying evolutionary changes in infection and resistance patterns holds great importance for the design of strategies and reevaluation of conventional interventions. Hence, the aim of this review was to analyze the evolution of Plasmodium vivax and infection resistance patterns based on Duffy genotype and phenotype. The distribution of genotypes, phenotypes, and polymorphisms of P. vivax ligands and erythrocyte receptors varies geographically, notably resistance patterns of this microorganism in individuals with Duffy negative genotype and phenotype have significantly changed compared to studies conducted 30 years ago. The prevalence of vivax malaria in individuals with a Duffy negative status can reach up to 100%. Consequently, prioritizing research on this topic is essential for public health.
Original article
Response to BNT162b2 mRNA COVID-19 vaccine of ART-experienced people living with HIV: a prospective analysis from a single-center study in Rome, Italy
Lombardi Francesca,
Belmonti Simone,
Di Giambendetto Simona
Objectives. We aimed to assess the immunologic response to BNT162b2 mRNA COVID-19 vaccine in ART-experienced people living with HIV (PLWH).
Methods: In this pilot prospective study, we enrolled 20 PLWH (all on effective ART, 80% with CD4 cells count >500) and 52 immunocompetent health-care workers, as control. All subjects received two doses of vaccine 21 days apart. Serum samples were collected at different time points, immediately before first administration (BL) and 21 days after each dose (T1 and T2) and 45-50 days after second dose (T3). We evaluated the immune response in terms of frequency of responders and antibody titers against SARS-CoV-2 at each timepoint. The viro-immunological parameters of PLWH were also monitored.
Results: We found that the participants displayed an immune response after the first dose that increased markedly at T2. At T3 a significantly descending trend of IgG levels was observed in both groups. No difference in humoral immune response assessed in terms of percentage of responders after first and second dose and in terms of IgG titers over time and at each time point was found between groups. Any significant variation in terms of viremia and immunological parameters was observed in PLWH.
Conclusions: BNT162b2 mRNA COVID-19 vaccine appears immunogenic in this setting of PLWH eliciting an immune response comparable to that of healthy donors.
Antibiotic prophylaxis compliance differences in surgery and gynecology/obstetrics services in Huánuco, Peru.
Panduro-Correa Vicky,
Gomez-Gonzales Walter,
Rabaan Ali A.,
Valencia-Martínez Juan Carlos,
Gutiérrez-Acuña Yeni,
Chihuantito-Abal Luis,
Zavaleta-Oliver Jenny,
Barboza Joshuan J.,
Rodriguez-Morales Alfonso J.,
Arteaga-Livias Kovy
Introduction. Surgical site infections (SSIs) can increase mortality and morbidity in patients after surgery. Antibiotic prophylaxis is an effective measure to prevent SSIs, but inappropriate prescription is frequent. The objective of the study was to determine compliance with the clinical practice guideline for antibiotic prophylaxis in the general surgery and gynecology and obstetrics wards in the city of Huánuco, Peru.
Methods. An analytical cross-sectional study was carried out on all surgical interventions in the general surgery and gynecology and obstetrics services during the year 2019. Compliance was determined based on the chosen antibiotic, dose, time of administration, and duration of prophylaxis. Related factors considered were age, presence of co-morbidities, surgery performed, duration of surgery, types of procedure, anesthesia, as well as years as a surgeon and anesthesiologist.
Results. A total of 557 medical records of patients with a median age of 33 years undergoing surgery were collected,. Antibiotic prophylaxis was correctly followed in all aspects in 14.6% of cases in the general surgery service and only in 5.6% of cases in the gynecology and obstetrics service. The correct duration of prophylaxis was 11.6% and 19.7% in general surgery and gynecology and obstetrics, respectively.
Conclusion. Low compliance with institutional clinical practice guidelines for antibiotic prophylaxis was identified in both services. However, surgical interventions in the general surgery service presented better compliance with antibiotic prophylaxis compared to gynecology and obstetrics procedures.
Comparative outcomes of direct-acting antiviral treatment in patients with HIV-Hepatitis C co-infection: insights from a single center experience in Colombia.
Vergara-Samur Hernán,
Martínez-Vernaza Samuel,
De la Hoz Alejandro,
Barahona-Correa Julián,
Ortiz Juan Pablo,
Gualtero-Trujillo Sandra,
Rumbo-Romero José,
Salazar Luis Miguel,
Suárez Quintero Yanette,
Valderrama-Beltrán Sandra
Background: Direct-acting antivirals (DAA) were introduced to Latin America with the aim of eliminating hepatitis c (HCV) in the region. There are scarce data on the outcomes of people living with HIV and HCV treated with these medications in Colombia. This study compares the outcomes of patients with HIV-HCV co-infection and HCV mono-infection treated with DAAs.
Methods: Retrospective observational study including patients ≥18 years old with HCV infection treated with DAAs from August 2017 to December 2019 in a comprehensive center in Colombia. The main outcome was sustained virologic response (SVR). Secondary outcomes included reinfection, relapse and adverse events.
Results: We included 223 individuals with HCV treated with DAAs; 142 (63.6%) individuals were mono-infected and 81 (36.3%) co-infected. Genotypes 1b (49.7%) and 4 (33.9%) were the most common. Overall SVR after DAA treatment was 96.8%. Relapse rate was 2.24%, reinfection rate was 6.28% and adverse events occurred in 27.8% of cases. SVR was comparable in patients with co- and mono-infection (95% vs 97.8%, p=0.245).
Conclusion: DAA were effective in mono-infected (HCV) and co-infected (HCV/HIV) patients and reinfection was high in this last group.
Case report
Multifaceted realities of scrub typhus: a case series from southern India
Ravikumar Diviya Bharathi,
Sivasubramanian Barath Prashanth,
Shanmugam Sruthi Nandhaa,
Krishnaswamy Vanitha,
Rabaan Ali,
Al-Tawfig Jaffar A.,
Tirupathi Raghavendra
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, a Gram-negative bacillus, commonly occurring in the Asia-Pacific region. It is transmitted to humans by the bite of an infected Leptotrombidium mite and the bacterium causes endothelial dysfunction resulting in widespread vasculitis and the possible development of thrombocytopenia, meningitis, acute respiratory distress syndrome, and infrequently, myocarditis. Early diagnosis and prompt treatment are crucial in managing scrub typhus. Here, we present four cases of scrub typhus with a comprehensive literature review. This study highlights the significance of considering scrub typhus as a possible diagnosis in patients of all ages from endemic regions who exhibit symptoms such as fever, thrombocytopenia, or transaminitis, even in the absence of typical clinical features. Two cases exhibited the characteristic lesion of eschar at the site of mite feeding. One case involved a middle-aged woman who was diagnosed with typhus-induced myocarditis with left ventricular dysfunction. Another case involved a 23-day-old neonate with poor feeding and seizures, who was diagnosed with late-onset sepsis with meningitis. Scrub typhus was confirmed in all cases using a positive qualitative IgM ELISA. However, it is preferred to use paired (ELISA before and after antibiotic therapy) or quantitative titers for confirmation. Healthcare providers must consider the patient's exposure history and clinical presentation to diagnose and treat scrub typhus promptly.
Vertebral osteomyelitis due to Lactobacillus paracasei in a diabetic patient. A case report and literature review
Carrega Giuliana,
Ricciardi Barbara,
Bartolacci Valentina,
Brenci Sabrina,
Izzo Manuela,
Morelli Patrizia,
Tigano Stefania,
Riccio Giovanni
Staphylococci are the most frequent cause of vertebral osteomyelitis, but infections due to unusual pathogens are also reported. We describe a rare case of spondylodiscitis due to Lactobacillus paracasei. A 74-year-old diabetic male was evaluated for fever and back pain. Blood cultures and vertebral biopsy were positive for Lactobacillus paracasei. He often took laxatives and probiotics for chronic constipation. After target treatment the patient improved but he died for a heart attack two months after the end of the treatment. Although Lactobacillus paracasei is usually not pathogenic, sepsis is described in immunocompromised patients while vertebral osteomyelitis is rare.
Streptococcus pseudoporcinus bacteremia in a patient with skin and soft tissue infection. A case report and literature review
Papapanagiotou Michalis,
Ioannou Petros,
Alexakis Konstantinos,
Maraki Sofia,
Papadokostaki Eleni,
Kofteridis Diamantis P.
Streptococcus pseudoporcinus is a beta-hemolytic Streptococcus species arranged in short chains, which was first described in 2006. In the last years, there have been several reports of human infections by this bacterium, with five skin and soft tissue infections identified. Herein, a case of S. pseudoporcinus skin and soft tissue infection in a patient who also developed bacteremia and was successfully treated with intravenous antibiotics, is reported. Α 67-year-old man with a history of diffuse large B-cell lymphoma presented to the emergency department because of fever, redness, swelling, and pain in the left lower limb. He was admitted to the medical ward, diagnosed with severe non-purulent skin and soft tissue infection, and treated empirically with intravenous piperacillin/tazobactam at 4.5gr thrice daily and daptomycin at 10mg/kg once daily. Blood cultures were obtained before the initiation of the antibiotics and grew S. pseudoporcinus. Treatment was de-escalated to ceftriaxone at a dose of 2gr once daily. He completed two weeks of intravenous antimicrobial treatment. S. pseudoporcinus is an emerging pathogen associated with skin and soft tissue infections, bacteremia, and other invasive, potentially life-threatening infections. Further investigation is warranted to clarify this microorganism's pathogenesis and biological significance.
Toxoplasmosis mimicking CMV chorioretinitis in newly diagnosed PLWH: a case report
Lamanna Francesco,
Passerotto Rosa Anna,
Carbone Andrea,
Jo Steiner Rebecca,
Iannone Valentina,
Salvo Pierluigi Francesco,
Ciccullo Arturo,
Baldin Gianmaria,
Borghetti Alberto,
Dusina Alex
Background: cytomegalovirus (CMV) retinitis, cerebral and ocular toxoplasmosis are common infections in patients with acquired immunodeficiency syndrome (AIDS). Material and methods: this is a case of a 46-year-old female with previous Kaposi's sarcoma, diagnosed with an HIV infection two weeks prior to hospitalization. Blood test at diagnosis showed a CD4+ count of 77 cell/μL and HIV-RNA 3.758.745 copies/mL. Therapy with bictegravir/emtricitabine/tenofovir alafenamide fumarate was started and clinical, viroimmunological and microbiological investigations were performed. Results: the patient went to our hospital for the onset of left occipito-parietal headache and blurred vision. Brain CT and MRI were performed which did not show focal lesions or vascular alterations. Syphilis serology was negative, Toxoplasma gondii serology showed positive IgG and negative IgM, serum CMV-DNA was 31.184 IU/mL. Eye fundus evidenced intraretinal hemorrhages, fluorescein angiography and computed optical tomography documented cottony exudates, retinal hemorrhages and vitreous involvement. Therapy with valganciclovir was initiated for suspicion of CMV retinitis. About a month later, the patient reported blurred vision for which she was re-admitted. Ocular fundus showed a cottony lesion near the macula. Molecular test on vitreous body was positive for Toxoplasma gondii, while on cerebrospinal fluid it was negative; in addition, an MRI of the brain with contrast medium was performed which showed an area of altered hyperintense signal compatible with a diagnosis of Toxoplasma gondii uveitis and neurotoxoplasmosis. Therapy with pyrimethamine and clindamycin (allergy for sulfonamide reported by the patient) was started. Allergy counseling was performed with the execution of allergy tests (patch test) with negative result; therefore the administration of clindamycin was replaced with sulfadiazine. A month following the start of anti-toxoplasma therapy, there was a clinical and radiological improvement. Conclusions: despite progressive developments in the management of PLWH, in this case two different kind of opportunistic infection are found in a late-presenter patient. In particular, two aspects can be highlighted. The first one is that, in the setting of an highly impaired immune system, clinical presentation can be deceptive and more than one opportunistic infection can be observed together in the same patient. The second aspect is that after starting antiretroviral therapy, a rapid improvement of viro-immunologic parameters has been documented, probably leading to an immune reconstitution inflammatory syndrome (IRIS).
A case of histological diagnosis of Toxoplasma gondii myositis in a person living with HIV
De Benedetto Ilaria,
Biagini Francesco,
Urbano Guido,
Mongini Tiziana Enrica,
Cassetta Ilaria,
Scaglione Luca,
Curtoni Antonio,
Calleri Guido,
Calcagno Andrea,
De Rosa Francesco Giuseppe,
Corcione Silvia
We report the case of a 58-year-old male with a recent diagnosis of HIV infection admitted for progressive muscular weakness and psychomotor impairment. Cerebrospinal examination documented a mild hyperproteinorrachia, with normal cells count and reduced glycorrhachia. Brain gadolinium-enhanced MRI showed bilateral T2 and FLAIR hyperintensities in the nucleo-capsular region and irregular contrast-enhancement of the globi pallidi and the right putamen. The histologic analysis of a quadriceps biopsy showed several foci of inflammatory infiltrates with concomitant muscular fiber atrophy and degeneration. Scattered intracytoplasmic inclusions were observed in muscle fibers, representing the main pathological feature. A positive PCR for Toxoplasma gondii and a Toxoplasma gondii specific monoclonal antibody immunohistochemical staining confirmed the diagnosis.
The Infections in the History of Medicine
The 1889-90 flu pandemic in Greece: a social, cultural and economic history with lessons for the 21st century
Kousoulis Antonis A.
The 1889-1892 influenza pandemic is the first flu outbreak that can be demonstrated to have been truly worldwide in scope. Its initial spread, along with the successive waves, coincided with an uneasy period of economic and political instability in Greece. Greek historians have largely ignored this outbreak in a national setting and have exclusively focused on the economic crisis and social unrest of that era. As in other countries, it seems that in Greece, too, the case fatality ratio was low, but morbidity and public health issues gained importance. Culturally, it triggered the creation of a new terminology around disease and proved an inspiration for satirical magazines. The economic distress of large parts of the population contributed to the design of health measures of only limited impact, with the press being the main source for dissemination of new health information. Despite being separated by 130 years, the 1889 influenza pandemic and the COVID-19 pandemic share some striking similarities. They both spread across transport lines and were followed by spotty and multifocal subsequent waves, disproportionately affected the poorest and most vulnerable, and led to neologisms, strong public health debates, and shifts in employment habits and measures. As we move forward into the 21st century, it is essential that we are able to reflect on such shared trends over decades, which are true because of common and interactive co-determinants of infectious disease outbreak emergence and spread and our responses to them.
Letters to the editor
Chagas disease in Italy: an update of epidemiological studies
Antinori Spinello,
Giacomelli Andrea,
Sabaini Federico,
Casalini Giacomo,
Ridolfo Anna Lisa
Not available
