[Sexual exposure to HIV, sexual behaviour and use of pharmacological post-exposure prophylaxis (PEP)]. / Esposizione sessuale al virus HIV, comportamenti sessuali ed utilizzo della profilassi farmacologica post- esposizione (PEP).

In this study we examined the characteristics of 60 subjects (49 M and 11 F, average age 32.3) out of 195 post-exposure pharmacological prophylaxis (PEP) to HIV, taken in our hospital from 2001 to 2008. The above-mentioned subjects are sexually exposed (or presumably exposed) to HIV. We considered both their sexual intercourse behaviour and protective measures, and sought to infer some trends in sexual behaviour in Italy. All the subjects were monitored until 180 days after exposure, as established by the national guidelines. Only one of the 60 people presented a seroconversion (he dropped out after a 15-day follow-up and after an inadequate 19-day prophylaxis). Another subject, a homosexual male, never previously tested, resulted positive at time 0 both for HIV-Ab and syphilis tests (due to previous risk-sexual exposure), which caused the suspension of the prophylaxis. No HBV, HCV or syphilis seroconversion occurred. Two other homosexual males showed a previously latent positivity to syphilis tests at time 0.

Clinical case of seroconversion for syphilis following a needlestick injury: why not take a prophylaxis?

A 47-year-old woman was pricked accidentally with a needle previously used for a neurosyphilitic man. At day 0 she had no positive laboratory results for the infection, while the source, at day 1, had TPHA positive, but no post-exposure prophylaxis (PEP) against syphilis was prescribed. The subject missed the day 30 follow-up, and underwent our visit at day 90, when she showed no clinical signs, but she seroconverted (VDRL = positive 1/2; TPHA = positive 1/320; FTA-Abs IgG and IgM = present). She started antibiotic therapy, and currently her serological status is VDRL = positive 1/2, TPHA = positive 1/160, FTA-Abs IgM = negative.

Pneumococcal meningitis in childhood: a longitudinal prospective study.

After implementation of programmes for active immunization against Haemophilus influenzae b, Streptococcus pneumoniae and Neisseria meningitidis became the most common agents of bacterial meningitis in childhood. Over a 9-year period, children showing clinical and laboratory findings of meningitis on the basis of their positive cultures of blood or cerebro-spinal fluid (CSF) for S. pneumoniae were enrolled. Predisposing conditions, clinical and laboratory findings, and microbiological and imaging studies were considered. Meningitis-related death or neurological sequelae defined an unfavourable outcome. Sixty-four patients met the inclusion criteria. Thirty-one (48%) children had predisposing conditions to pneumococcal meningitis. Fever and neck stiffness were the main symptoms; 14 patients (22%) reported seizures before admission. Twenty-one patients required treatment in the intensive care unit (ICU). Streptococcus pneumoniae strains were penicillin susceptible in 54 cases (84%). Forty-eight children (75%) showed complete recovery. Two patients (3%) died, and 14 (22%) had sequelae. Patients with a low CSF cell count, low neutrophils, early admission to ICU or infection by penicillin-nonsusceptible strains of S. pneumoniae had an unfavourable outcome more frequently. Low blood neutrophils, low CSF cell count, early admission to ICU and infection by penicillin-nonsusceptible strains are the main factors predicting an unfavourable outcome in children with pneumococcal meningitis.

Four cases of meningitis by streptococci other than pneumoniae in adults: clinical and microbiological features.

Meningitis sustained by streptococci other than pneumoniae, infrequent in community medicine, is emerging as a hospital-acquired infection. We describe four cases of meningitis caused by streptococci other than pneumoniae in adults.

[Cases of Chikungunya fever in Italy in travellers returning from the Indian Ocean and risk of introduction of the disease to Italy]. / Casi di febbre Chikungunya in Italia in viaggiatori di ritorno dall'Oceano Indiano e rischio di introduzione nel territorio italiano.

Chikungunya fever is a viral disease characterized by fever, arthralgia and rash. A large outbreak of Chikungunya fever began in 2005 in La Reunion, and it is still ongoing on many islands and countries of the Indian Ocean. Several cases have been detected in Europe in travellers returning from the affected areas. The disease is transmitted by the bite of Aedes mosquitoes, which are also widespread in Italy. We describe 7 cases of Chikungunya fever imported into Italy by travellers returning from affected countries. The current outbreak is described, and the risk of establishment of a chain of transmission in Italy is discussed.

Toscana virus central nervous system infections in southern Italy.

Toscana virus was detected by reverse transcription-nested PCR in 5.6% of cerebrospinal fluid (CSF) samples from patients with meningitis and encephalitis during the summer in southern Italy. The central nervous system infections were associated with young adults and with a substantially benign clinical course. Presenting features and CSF findings are also discussed in the present report.

Visceral leishmaniasis in pregnancy: a case series and a systematic review of the literature.

OBJECTIVES: Visceral leishmaniasis (VL) is endemic in tropical and sub-tropical areas. Only anecdotal cases of VL in pregnancy are reported in the literature, although the disease is life-threatening for both mothers and infants. Here we report a small series of pregnant women with VL observed in the Neapolitan area over a 7 year period and carry out a systematic review of the literature on this topic. METHODS: Consecutive cases of VL in HIV-negative female patients between 1996 and 2002 were evaluated. Pregnant women who fulfilled criteria for VL diagnosis were included and diagnostic, clinical and therapeutic features were considered. The outcome for both the pregnant woman and the fetus was evaluated over a 24 month period of post-therapy follow-up. A systematic search of English language literature through the MEDLINE database and Cochrane Library with the search strings 'leishmaniasis AND pregnancy' and 'leishmaniasis AND visceral AND congenital' integrated with a manual search completed our study. RESULTS: Five consecutive pregnant women were diagnosed as having VL. Fever and hepatosplenomegaly were the main presenting symptoms. All received liposomal amphotericin B without any toxicity to either the mothers or newborns. No treatment failure or congenital VL case was observed. The systemic review of the literature revealed 17 cases of VL during pregnancy. Untreated VL resulted in consequences on the fetus or congenital VL. CONCLUSIONS: The efficacy and safety of amphotericin B formulations for mother and fetus are supported by the cumulative analysis of our data and literature data.

[Non post-operative spondylodiskitis. Our experience during the period 1990-2001]. / Spondilodisciti non chirurgiche. Casistica degli anni 1990-2001.

UNLABELLED: Aim of the study was to evaluate the prevalence and characteristics of non operative spondylodiskitis (SD) in our geographic area. METHODS: We evaluated retrospectively epidemiological, clinical, laboratory and radiological features of patients with non operative SD observed between 1990 and 2001 in our department of the "D. Cotugno" hospital - Naples. RESULTS: Eighteen patients with diagnosis of SD were evaluated. Etiologic agent was identified in 17 patients: M. tuberculosis in 5, brucella spp. in 4 and pyogenic bacteria in 8. Ten patients had underlying diseases or risk factors (4 diabetes mellitus, 3 arthrosis, 1 CRF, 1 IVDA and 2 previous back trauma). Symptoms preceded observation between 2 days and 12 months (median value 15 days). Seventeen patients presented fever, 13 back pain, 6 meningitis, 3 were comatous and 2 had severe sepsis. Ten patients showed high white blood cells count with granulocyte prevalence. Eritrosedimentation rate or C reactive protein were elevated in all patients. Diagnosis was confirmed in 8 patients only with radiographs of the spine, while 3 needed a CT and 11 a RMN imaging. Antimicrobial therapy was perfomed for at least 6 months in patients with brucellosis, 12 months in patients with tuberculosis and 2 months in patients with pyogenic SD. Persistent neurological deficit were observed in 2 patients. CONCLUSIONS: Neurological deficit may be avoid in patients affected by SD only with a carefull diagnosis and an accurate antibiotic therapy.